China is now confronting the intertwined challenges of air pollution and climate change. Given the high synergies between air pollution abatement and climate change mitigation, the Chinese government is actively promoting synergetic control of these two issues. The Synergetic Roadmap project was launched in 2021 to track and analyze the progress of synergetic control in China by developing and monitoring key indicators. The Synergetic Roadmap 2022 report is the first annual update, featuring 20 indicators across five aspects: synergetic governance system and practices, progress in structural transition, air pollution and associated weather-climate interactions, sources, sinks, and mitigation pathway of atmospheric composition, and health impacts and benefits of coordinated control. Compared to the comprehensive review presented in the 2021 report, the Synergetic Roadmap 2022 report places particular emphasis on progress in 2021 with highlights on actions in key sectors and the relevant milestones. These milestones include the proportion of non-fossil power generation capacity surpassing coal-fired capacity for the first time, a decline in the production of crude steel and cement after years of growth, and the surging penetration of electric vehicles. Additionally, in 2022, China issued the first national policy that synergizes abatements of pollution and carbon emissions, marking a new era for China’s pollution-carbon co-control. These changes highlight China’s efforts to reshape its energy, economic, and transportation structures to meet the demand for synergetic control and sustainable development. Consequently, the country has witnessed a slowdown in carbon emission growth, improved air quality, and increased health benefits in recent years.
Background: Climate change is a global challenge that is resulting in an increased occurrence of extreme weather events. Extreme weather events have been shown to negatively impact various health conditions, leading to an overall increase in morbidity and mortality. Ear, nose, and throat (ENT) emergencies are among the most common reasons for emergency department visits (EV). Acute otitis externa (AOE), an inflammatory external auditory canal skin infection, is the second most common condition for ENT-related emergency admissions. Previously, AOE has been associated with higher temperatures during summer; However, no data exists on extreme weather events’ immediate and delayed effects on AOE-related EVs. Identifying these relationships could help predict EVs, optimize health resources, and relieve its significant burden on healthcare systems. Objective: This study aimed to associate the effects of extreme weather events with the immediate and delayed risk of AOE-related EVs.Methods: A total of 1522 AOE-related EVs from the ENT outpatient clinic of the Vienna General Hospital between 2015 and 2018 were analyzed. Meteorological data for the same study period was obtained from the Austrian Central Institution for Meteorology and Geodynamics for Vienna and a distributed lag non-linear model used to associate extreme weather events with the total number of AOE-related EVs. Relative risk (RR) and cumulative RR were analyzed over a period of 14 days.Results: AOE-related EVs showed a pronounced seasonality, with the highest occurrence in summer. The RR for AOE-related EVs was significantly increased one day after high-temperature events for seven days, to a maximum of 1.95 [1.04-3.65]. Low and high relative humidity significantly reduced the same-day occurrence of AOE-related EVs to 0.65 [0.46-0.92] and 0.74 [0.58-0.95]. Increased precipitation and wind speed significantly decreased the RR of AOE-related EVs four and seven days after occurrence. After one day, low atmospheric pressure events showed an increased RR of 1.42 [1.02-1.98] in AOE-related EVs.Conclusions: Extreme weather events significantly impact AOE-related EVs. While high mean temperatures were positively correlated with AOE-related EVs, low humidity was found to have a negative same-day effect, sup-porting the idea of multiple factors being involved in increasing the susceptibility for AOE. Knowledge of the pattern of events could allow the implementation of time-optimized prevention strategies to reduce the incidence of AOE, the frequency of EVs, and the burden on health care systems.
Diseases of the kidney and urinary tract impose a significant portion of the total disease burden, and linkages to high temperature exposure suggest that this burden may increase in the near future. We examined the association between climate and daily emergency department (ED) visits for kidney and urinary disease at the University of Virginia main hospital in Charlottesville, Virginia from 2005 to 2020. Generalized additive models and distributed lag nonlinear models were used to examine these associations over a 21-day lag period. After testing a variety of weather variables from observations taken at the Charlottesville, Albemarle County Airport weather station, 1 p.m. temperature was found to have the strongest association with ED visits for renal and urinary visits while controlling for seasonal and trend factors, air quality, day of the week, and wintry weather. The relative risk of ED visits exhibited a stronger association with high temperatures compared to low temperatures. The heat response was pronounced at short lags (0-1 days) with the relative risk (RR) increasing when 1 p.m. temperatures exceeded 20°C and peaking at 29°C (RR = 1.28). By comparison, low temperatures (≤0°C) exhibited a negative association (RR = 0.80 at -10°C) at short lags (0-1 day), with evidence of a weak RR increase at lags of 2-3 and 9-14 days. These results for ED visitation are consistent with other studies linking high temperatures to acute kidney injury, chronic kidney disease, the development of kidney stones, and other associated illnesses. A better understanding of the impact of temperature extremes in generating or exacerbating existing conditions could assist medical health professionals in the prevention and management of these diseases during extreme weather events.
Recent studies have shown that heat-mortality risk differs by level of greenspace and impervious surface. However, these studies do not consider both green spaces and impervious surfaces simultaneously, and further did not fully consider community- and individual-level characteristics. In this study we explored the effect modification of greenspace and impervious surface on the association between heat and mortality and how it differs by race/ethnicity dissimilarity index levels in North Carolina, USA. We aggregated datasets for greenspace, impervious surface estimates, temperature, and mortality for 1275 census tracts for North Carolina, USA, for 2000 to 2016 for 5 warm months (May to September). We used distributed lag non-linear models to estimate the heat-mortality relationship in each census tract. Heat-mortality relative risk (RR) was higher for census tracts with low greenspace than high greenspace (RR comparing risk at 99th temperature and minimum mortality temperature: 1.08 (1.02, 1.15) for low greenspace and 0.97 (0.87, 1.08) for high greenspace). Heat-mortality RR was higher for tracts with high impervious surface than low impervious surface (1.04 (1.00, 1.09) for high impervious surface and 0.94 (0.84, 1.05) for low impervious surface). Census tracts with high dissimilarity value and low greenspace had the highest heat-mortality risk compared to the tracts with high dissimilarity value with and high greenspace (1.13 (1.02, 1.24) for high dissimilarity index and 0.97 (0.86, 1.09) for low dissimilarity index). Communities with low greenspace or high impervious surfaces had higher heat-mortality associations, and this effect modification was higher for high race/ethnicity dissimilarity regions.
PURPOSE: Older adults exhibit a wide range of capabilities and vulnerabilities that affect their capacity to respond to heat. This study analysed the associations between hot temperatures and Accident & Emergency (A&E) attendance taking into account older adult-focused social vulnerability. METHODS: Daily A&E attendance data of Young-old (65-74) and Old-old (75+) was obtained for Hong Kong 2010-2019 hot seasons and stratified into three Social Vulnerability Index (SVI) groups (Low, Moderate, High). Mean temperature (lag 0-2) was analysed on A&E attendance at each SVI using Generalized Additive Models and Distributed Lag Non-linear Models. RESULTS: High temperatures were associated with increased same-day (lag 0) relative risk (RR) of A&E attendance for Young-old and Old-old in High SVI districts, with RR being 1.024 (95 % CI: 1.011, 1.037) and 1.036 (95 % CI: 1.018, 1.053), respectively. The Old-old living in Moderate and Low SVI districts also demonstrated increased RR of 1.037 (95 % CI: 1.028, 1.047) and 1.022 (95 % CI: 1.009, 1.036), respectively. Fewer emergency visits were found on the subsequent day (lag 1) of hot temperatures. CONCLUSIONS: Older adults, both young-old and old-old, living in districts with higher social vulnerability tended to have increased risk of A&E attendance associated with same-day high temperature. With climate change and rapidly aging population, cities should prepare to meet needs of more vulnerable older adults in extreme heat.
BACKGROUND: Evidence suggests that maternal exposure to heat might increase the risk of preterm birth (PTB), but no study has investigated the effect from urban heat island (UHI) at individual level. AIMS: Our study aimed to investigate the association between individual UHI exposure and PTB. METHODS: We utilized data from the ongoing China Birth Cohort Study (CBCS), encompassing 103,040 birth records up to December 2020. UHI exposure was estimated for each participant using a novel individual assessment method based on temperature data and satellite-derived land cover data. We used generalized linear mixed-effects models to estimate the association between UHI exposure and PTB, adjusting for potential confounders including maternal characteristics and environmental factors. RESULTS: Consistent and statistically significant associations between UHI exposure and PTB were observed up to 21 days before birth. A 5 °C increment in UHI exposure was associated with 27 % higher risk (OR = 1.27, 95 % confident interval: 1.20, 1.34) of preterm birth in lagged day 1. Stratified analysis indicated that the associations were more pronounced in participants who were older, had higher pre-pregnancy body mass index level, of higher socioeconomic status and living in greener areas. CONCLUSION: Maternal exposure to UHI was associated with increased risk of PTB. These findings have implications for developing targeted interventions for susceptible subgroups of pregnant women. More research is needed to validate our findings of increased risk of preterm birth due to UHI exposure among pregnant women.
Current efforts to adapt to climate change are not sufficient to reduce projected impacts. Vulnerability assessments are essential to allocate resources where they are needed most. However, current assessments that use principal component analysis suffer from multiple shortcomings and are hard to translate into concrete actions. To address these issues, this article proposes a novel data-driven vulnerability assessment within a risk framework. The framework is based on the definitions from the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, but some definitions, such as sensitivity and adaptive capacity, are clarified. Heat waves that occurred between 2001 and 2018 in Quebec (Canada) are used to validate the framework. The studied impact is the daily mortality rates per cooling degree-days (CDD) region. A vulnerability map is produced to identify the distributions of summer mortality rates in aggregate dissemination areas within each CDD region. Socioeconomic and environmental variables are used to calculate impact and vulnerability. We compared abilities of AutoGluon (an AutoML framework), Gaussian process, and deep Gaussian process to model the impact and vulnerability. We offer advice on how to avoid common pitfalls with artificial intelligence and machine-learning algorithms. Gaussian process is a promising approach for supporting the proposed framework. SHAP values provide an explanation for the model results and are consistent with current knowledge of vulnerability. Recommendations are made to implement the proposed framework quantitatively or qualitatively.
A case-crossover study among 511,767 cardiovascular disease (CVD) deaths in Jiangsu province, China, during 2015-2021 was conducted to assess the association of exposure to ambient ozone (O(3)) and heat wave with CVD mortality and explore their possible interactions. Heat wave was defined as extreme high temperature for at least two consecutive days. Grid-level heat waves were defined by multiple combinations of apparent temperature thresholds and durations. Residential O(3) and heat wave exposures were assessed using grid data sets (spatial resolution: 1 km × 1 km for O(3); 0.0625° × 0.0625° for heat wave). Conditional logistic regression models were applied for exposure-response analyses and evaluation of additive interactions. Under different heat wave definitions, the odds ratios (ORs) of CVD mortality associated with medium-level and high-level O(3) exposures ranged from 1.029 to 1.107 compared with low-level O(3), while the ORs for heat wave exposure ranged from 1.14 to 1.65. Significant synergistic effects on CVD mortality were observed for the O(3) and heat wave exposures, which were generally greater with higher levels of the O(3) exposure, higher temperature thresholds, and longer durations of heat wave exposure. Up to 5.8% of the CVD deaths were attributable to O(3) and heat wave. Women and older adults were more vulnerable to the exposure to O(3) and heat wave exposure. Exposure to both O(3) and heat wave was significantly associated with an increased odds of CVD mortality, and O(3) and heat wave can interact synergistically to trigger CVD deaths.
In the modern world, climate change and global warming are serious problems. The thermal management of the human body under these conditions, especially during physical activity and work, is crucial. Hot weather conditions with intense metabolic activity lead to a critical health and safety situation. Reducing heat stress in workers who work outdoors or in hot environments has always been a challenge for occupational health and safety experts. The pivotal solution is to use personal cooling garments (PCGs) to build confidence in the safety and health of workers. This review study summarizes the mechanisms of 12 types of PCGs and discusses PCM garments as the most widely used PCGs. The importance of enhancing the effectiveness of PCMs with nanoparticles and biomass-derived porous carbon materials has been noticed. Furthermore, performance indicators and equations, the methods of evaluating the performance of cooling garments and the advantages or disadvantages of using these methods, factors affecting the cooling efficiency of PCM garments, and the application of PCM in textiles have been discussed. Afterward, the challenges and future trends in the design of PCM garments are introduced. The result of this review research can be helpful in the thermal management of the human body, especially for workers, by designing cooling garments with better efficiency and ultimately reducing energy consumption to cool the entire work environment.
Older adults are at greater risk of heat-related morbidity and mortality during heat waves, which is commonly linked to impaired thermoregulation. However, little is known about the influence of increasing age on the relation between thermal strain and perceptual responses during daylong heat exposure. We evaluated thermal and perceptual responses in 20 young (19-31 yr) and 39 older adults (20 with hypertension and/or type 2 diabetes; 61-78 yr) resting in the heat for 9 h (heat index: 37°C). Body core and mean skin temperature areas under the curve (AUC, hours 0-9) were assessed as indicators of cumulative thermal strain. Self-reported symptoms (68-item environmental symptoms questionnaire) and mood disturbance (40-item profile of mood states questionnaire) were assessed at end-heating (adjusted for prescores). Body core temperature AUC was 2.4°C·h [1.0, 3.7] higher in older relative to young adults (P < 0.001), whereas mean skin temperature AUC was not different (-0.5°C·h [-4.1, 3.2] P = 0.799). At end-heating, self-reported symptoms were not different between age groups (0.99-fold [0.80, 1.23], P = 0.923), with or without adjustment for body core or mean skin temperature AUC (both P ≥ 0.824). Mood disturbance was 0.93-fold [0.88, 0.99] lower in older, relative to young adults (P = 0.031). Older adults with and without chronic health conditions experienced similar thermal strain, yet those with these conditions reported lower symptom scores and mood disturbance compared with young adults and their age-matched counterparts (all P ≤ 0.026). Although older adults experienced heightened thermal strain during the 9-h heat exposure, they did not experience greater self-reported symptoms or mood disturbance relative to young adults.NEW & NOTEWORTHY Despite experiencing greater cumulative thermal strain during 9 h of passive heat exposure, older adults reported similar heat-related symptoms and lower mood disturbance than young adults. Furthermore, self-reported symptoms and mood disturbance were lower in older adults with common age-associated health conditions than young adults and healthy age-matched counterparts. Perceptual responses to heat in older adults can underestimate their level of thermal strain compared with young adults, which may contribute to their increased heat vulnerability.
The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients’ health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.
Climate change is the greatest threat to human health, with one of its direct effects being global warming and its impact on health. Currently, the world is experiencing an increase in the mean global temperature, but this increase affects different populations to different degrees. This is due to the fact that individual, demographic, geographical and social factors influence vulnerability and the capacity to adapt. Adaptation is the process of adjusting to the current or envisaged climate and its effects, with the aim of mitigating harm and taking advantage of the beneficial opportunities. There are different ways of measuring the effectiveness of adaptation, and the most representative indicator is via the time trend in the temperature-mortality relationship. Despite the rise in the number of studies that have examined the temperature-mortality relationship in recent years, there are very few that have analysed whether a particular population has or has not adapted to heat. We conducted a scoping review that met the following criteria, namely: including all persons; considering the heat adaptation concept; and covering the context of the impact of global warming on health and mortality. A total of 23 studies were selected. This review found very few studies targeting adaptation to heat in the human population and a limited number of countries carrying out research in this field, something that highlights the lack of research in this area. It is therefore crucial for political decision-makers to support studies that serve to enhance our comprehension of long-term adaptation to heat and its impact on the health of the human population.
Urban Heat Island (UHI) research has acquired popularity in recent decades because of increasing recognition of heat stress impacts on human health, environments, and urban resilience under the compounding pressures of urbanization and climate change. The development of remote sensing technology has dramatically facilitated UHI research to better understand its spatiotemporal characteristics. However, there remain many knowledge gaps, confusions, and issues in surface UHI (SUHI) studies, such as different definitions of urban and rural areas, methodologies dealing with cloud cover, and other common pitfalls that can increase uncertainties and confuse researchers and practitioners in choosing appropriate assessment methods. We showcase these issues along with future research directions to overcome them. This review also evaluates SUHI studies over the past decade and systematically highlights the control factors, quantitative proxies, impacts, and mitigation interventions. This review provides a valuable reference and opens up new avenues for future research to better understand the dynamics of local climate change under the complex interplay between urbanization and global climate change.
Many oil and gas extraction (OGE) activities occur in high-heat environments, resulting in a significant risk of heat-related illness among outdoor workers in this industry. This report highlights cases of occupational heat-related illness that resulted in death and identifies common risk factors for heat-related fatalities and hospitalizations among OGE workers. Two databases maintained by the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) were reviewed to identify heat-related fatalities, hospitalizations, and associated risk factors among OGE workers. Nine fatalities and associated risk factors were identified during 2014-2019 from NIOSH’s Fatalities in Oil and Gas Extraction (FOG) Database. Risk factors identified included those commonly associated with heat-related fatalities: new workers not acclimatized to heat, inadequate heat stress training, and underlying hypertension or cardiovascular disease. Of particular note, substance use was identified as a significant risk factor as more than half of the fatalities included a positive postmortem test for amphetamines or methamphetamines. Fifty heat-related hospitalizations were identified from OSHA’s Severe Injury Report Database during January 2015-May 2021. Heat stress has been and will continue to be an important cause of fatality and adverse health effects in OGE as hot outdoor working conditions become more common and extreme. More emphasis on heat stress training, acclimatization regimens, medical screening, and implementation of workplace-supportive recovery programs may reduce heat-related fatalities and injuries in this industry.
BACKGROUND: The impact of global warming on health due to climate change is increasingly studied, but the global burden of self-harm and interpersonal violence attributable to high temperature is still limited. This study aimed to systematically assess the burden of self-harm and interpersonal violence attributable to high temperature globally or by region and climate zone from 1990 to 2019. METHODS: We obtained the global, regional, and national deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life year rates (ASDR) of self-harm and interpersonal violence due to high temperature from 1990 to 2019 through the Global Burden of Disease Study (GBD) 2019. The burden of self-harm and interpersonal violence due to high temperature was estimated by age, sex, climate zone, the socio-demographic index (SDI), and the healthcare access and quality index (HAQ). Average annual percentage changes (AAPCs) in ASMR and ASDR were calculated for 1990-2019 using the Joinpoint model. RESULTS: From 1990 to 2019, the global deaths and DALYs related to self-harm and interpersonal violence due to high temperature increased from 20,002 (95% UI, 9243 to 41,928) and 1,107,216 (95% UI, 512,062 to 2,319,477) to 26,459 (95% UI, 13,574 to 47,265) and 1,382,487 (95% UI, 722,060 to 2,474,441), respectively. However, the ASMR and ASDR showed varying degrees of decreasing trends, with decreases of 13.36% and 12.66%, respectively. The ASMR was high and declining in low and low-middle SDI regions, particularly in tropical and subtropical regions. In addition, SDI and HAQ index were negatively correlated with ASMR in 204 countries and regions. CONCLUSIONS: The global burden of self-harm and interpersonal violence attributed to high temperature has decreased over the past 30 years, but the number of deaths and DALYs continues to rise. Climate change continues to make heat stress a significant risk factor for self-harm and interpersonal violence worldwide.
Heat stress issues in healthcare workers (HCWs) have been widely recognized but no published guidelines have clearly specified healthy shift work hours and the time to experience heatstroke while performing healthcare tasks in outdoor settings. Using a rational biophysical model and hourly meteorological data collected during sixty hot summer months (June-August 2002-2021) in 34 major Chinese cities, this study determined healthy shift work hours and heatstroke risks in HCWs with three levels of body mass index (BMI = 18.0, 23.0, and 27.0 kg/m(2)) while performing healthcare tasks. Our simulation results found that HCWs should switch shifts every 2 h. HCWs with a higher BMI could see their shifts extended by 10-28 min. HCWs with 18.0 kg/m(2) BMI should finish shifts 10-23 min earlier than their counterparts. Heatstroke can strike HCWs in 143 min. HCWs should not wear impermeable PPE suits outdoors for >2 h in cities other than Guiyang, Qingdao, Kunming, Xining, and Lhasa for safety reasons. To ensure 8 h of healthy labor, HCWs are advised to wear personal cooling systems with a cooling power of >= 194.8 W/m(2) or to work in testing booths, where HVAC setpoint temperature for PPE-clad HCWs is 25.0 degrees C, with RH = 50-65 % and a fanning speed of 2.5 m/s.
AIMS: Previous studies have related heat waves to morbidity and mortality of cardiovascular diseases; however, potential mechanisms remained limited. Our aims were to investigate the short-term effects of heat waves on a series of clinical/subclinical indicators associated with cardiovascular health. METHODS: Our study used 80,574 health examination records from the Health Management Center of Nanjing Zhongda Hospital during the warm seasons of 2019-2021, including 62,128 participants. A total of 11 recognized indicators of cardiovascular risk or injury were assessed. Air pollution and meteorological data were obtained from the Nanjing Ecological Environment Bureau and the China Meteorological Data Network, respectively. Heat waves were defined as a daily average temperature over the 95th percentile for three or more consecutive days from May to September. We used a combination of linear mixed effects models and distributed lag nonlinear models to assess the lagged effects of heat waves on clinical and subclinical cardiovascular indicators. Stratified analyses based on individuals’ characteristics, including gender, age, body mass index (BMI), diabetes, and hypertension, were also performed. RESULTS: Heat waves were related to significant changes in most indicators, with the magnitude of effects generally peaking at a lag of 0 to 3 days. Moreover, the cumulative percentage changes over lag 0-7 days were -0.82 % to -2.55 % in blood pressure, 1.32 % in heart rate, 0.20 % to 2.66 % in systemic inflammation markers, 0.36 % in a blood viscosity parameter, 9.36 % in homocysteine, and 1.35 % to 3.25 % in injuring myocardial enzymes. Interestingly, females and males showed distinct susceptibilities in different indicators. Stronger effects were also found in participants aged 50 years or over, individuals with abnormal BMI status, and patients with diabetes. CONCLUSION: Short-term exposure to heat waves could significantly alter clinical/subclinical cardiovascular indicator profiles, including blood pressure changes, increased heart rate, acute systemic inflammation, elevated blood viscosity, and myocardial injury.
Extreme temperatures are occurring more frequently and intensely, leading to more significant impacts on a variety of populations in the world as climate change continues. Little research to date, however, has investigated the temporal, spatial, and social patterns in which human mobility responds to extreme temperatures from the perspective of regional heterogeneity. This study, taking the Greater Houston area in the United States as a testbed, conducted statistical and geospatial analyses to measure the unequal impacts of extreme temperatures on human mobility in cities. In particular, the changes in daily human mobility across dimensions (i.e., temperatures, spatial gradients, and social relationships) when experiencing extreme temperatures are examined. The results show that extreme heat inhibits people’s willingness to make short trips, while cold weather promotes more frequent short trips. Besides, extreme temperatures impede the mobility of people near the city center while promoting movement to the suburbs. Furthermore, the areas with large numbers of disadvantaged social groups were more likely to be affected by extreme temperatures. The socio-demographic inequalities in the impacts of extreme temperatures quantified in this study could promote more scientific, targeted, and practical policy planning and implementation by local governments.
Heat is identified as a key climate risk in Europe. Vulnerability to heat can be aggravated by enhanced exposure (e.g., urban heat island), individual susceptibility (e.g., age, income), and adaptive capacity (e.g., home ownership, presence of vegetation). We investigated the spatial and temporal patterns of the environmental and social drivers of vulnerability to heat in the Paris region, France, over the 2000-2020 period, and their association with mortality (restricted to 2000-2017). Daily temperatures were modeled for the 5265 IRIS of the Paris region for 2000-2020. Annual land use and socioeconomic data were collected for each IRIS. They were used to identify a priori five classes of heatvulnerable areas based on a cluster analysis. The temperature-mortality relationship was investigated using a time-series approach stratified by clusters of vulnerability. The Paris region exhibited a strong urban heat island effect, with a marked shift in temperature distributions after 2015. The clustering suggested that the most heat-vulnerable IRIS in the Paris region have a high or very high exposure to temperature in a highly urbanized environment with little vegetation, but are not systematically associated with social deprivation. A similar J-shape temperature-mortality relationship was observed in the five clusters. Between 2000 and 2017, around 8000 deaths were attributable to heat, 5600 of which were observed in the most vulnerable clusters. Vulnerability assessments based on geographical indicators are key tools for urban planners and decision -makers. They complement the knowledge about individual risk factors but should be further evaluated through interdisciplinary collaborations.
While impact of heat exposure on human health is well-documented, limited research exists on its effect on kidney disease hospital admissions especially in Texas, a state with diverse demographics and a high heat-related death rate. We aimed to explore the link between high temperatures and emergency kidney disease hospital admissions across 12 Texas Metropolitan Statistical Areas (MSAs) from 2004 to 2013, considering causes, age groups, and ethnic populations. To investigate the correlation between high temperatures and emergency hospital admissions, we utilized MSA-level hospital admission and weather data. We employed a Generalized Additive Model to calculate the association specific to each MSA, and then performed a random effects meta-analysis to estimate the overall correlation. Analyses were stratified by age groups, admission causes, and racial/ethnic disparities. Sensitivity analysis involved lag modifications and ozone inclusion in the model. Our analysis found that each 1 °C increase in temperature was associated with a 1.73 % (95 % CI [1.43, 2.03]) increase in hospital admissions related to all types of kidney diseases. Besides, the effect estimates varied across different age groups and specific types of kidney diseases. We observed statistically significant associations between high temperatures and emergency hospital admissions for Acute Kidney Injury (AKI) (3.34 % (95 % CI [2.86, 3.82])), Kidney Stone (1.76 % (95 % CI [0.94, 2.60])), and Urinary Tract Infections (UTI) (1.06 % (95 % CI [0.61, 1.51])). Our research findings indicate disparities in certain Metropolitan Statistical Areas (MSAs). In Austin, Houston, San Antonio, and Dallas metropolitan areas, the estimated effects are more pronounced for African Americans when compared to the White population. Additionally, in Dallas, Houston, El Paso, and San Antonio, the estimated effects are greater for the Hispanic group compared to the Non-Hispanic group. This study finds a strong link between higher temperatures and kidney disease-related hospital admissions in Texas, especially for AKI. Public health actions are necessary to address these temperature-related health risks, including targeted kidney health initiatives. More research is needed to understand the mechanisms and address health disparities among racial/ethnic groups.
OBJECTIVES: Climate change has increased attention to the health effects of high ambient temperatures and heatwaves worldwide. Both cause-specific mortality and hospital admissions are studied widely, mainly concentrating on warmer climates, but studies focusing on more subtle health effects and cold climates lack. This study investigated the effect of summertime daily ambient temperatures and heatwaves on sick leaves in the employed population in Helsinki, Finland, a Nordic country with a relatively cold climate. METHODS: We obtained from the City of Helsinki personnel register data on sick leaves for the summer months (June-August) of 2002-2017. We estimated the overall cumulative association of all and short (maximum 3-day) sick leaves with daily mean temperature over a 21-day lag period using a negative binomial regression model coupled with a penalized distributed lag non-linear model (penalized DLNM). The association of sick leaves with heatwaves (cut-off temperature 20.8 °C), and prolonged heatwaves, was estimated using a negative binomial regression model coupled with DLNM. We adjusted the time series model for potential confounders, such as air pollution, relative humidity, time trends, and holidays. RESULTS: Increasing daily temperature tended to be associated with decreased overall cumulative risk of sick leaves and short sick leaves over a 21-day lag period. In addition, heatwaves and prolonged heatwaves were associated with decreased overall cumulative risk of sick leaves compared to all other summer days: RR 0.87 (95 % CI 0.78 to 0.97) and RR 0.83 (95 % CI 0.70 to 0.98), respectively. CONCLUSIONS: This research suggests that summertime daily temperatures that are high for this northern location have protective effects on the health of the working population.
Heat exposure presents a significant weather-related health risk in England and Wales, and is associated with acute impacts on mortality and adverse effects on a range of clinical conditions, as well as increased healthcare costs. Most heat-related health outcomes are preventable with health protection measures such as behavioural changes, individual cooling actions, and strategies implemented at the landscape level or related to improved urban infrastructure. We review current limitations in reporting systems and propose ten indicators to monitor changes in heat exposures, vulnerabilities, heat-health outcomes, and progress on adaptation actions. These indicators can primarily inform local area decision-making in managing risks across multiple sectors such as public health, adult and social care, housing, urban planning, and education. The indicators can be used alongside information on other vulnerabilities relevant for heat and health such as underlying morbidity or housing characteristics, to prioritise the most effective adaptation actions for those who need it the most.
Climate extremes, notably compound extremes, pose significant risks to human society and environmental systems. These extremes, heightened by urbanization-a hallmark of modern socioeconomic progression-inflict persistent, intense thermal conditions. The comprehension of urbanization’s impact on compound temperature extremes, particularly in Central-South China, a region with rapid urbanization and a subtropical climate, remains limited. In addition, most existing studies relied on static urban-rural division, and few used dynamic division, with no research yet juxtaposing findings from both methods. Against this backdrop, this study provided an unprecedented assessment of urbanization’s impact on both individual and compound temperature extremes in Central South China, focusing on Hunan Province during long-time period of 1960-2022 under both static and dynamic urban-rural divisions. In both urban and rural stations, a pronounced warming trend was evident across individual and compound temperature extremes. Besides, a tendency of independent day/night extremes shifting towards extremes spanning both was observed. Notably, the escalation of heat compound extreme temperature indices (ETIs) outpaces that of cold ones, with a larger urban-rural discrepancy under dynamic classifications. Urbanization intensifies temperature extremes, particularly affecting the reduction of independent cold days (30.97 %-33.94 %) and the increase in compound hot events (23.91 %-24.87 %). Interestingly, urbanization’s impact is more substantial on independent daytime extremes than on independent nighttime ones. Urbanization’s influence on ETIs was consistently observed under both static and dynamic classifications, with the latter revealing a more pronounced contribution (1 %-3 %), and the contribution to compound ETIs is 6 %-8 % higher than to individual ETIs. These findings emphasize the importance of considering urbanization’s multifaceted impacts on climate strategies and underscore the need for adaptive infrastructure and sustainable practices to mitigate escalating climate risks.
As an effective measure to mitigate the negative effects of heat-related risks on human health, improving the urban environment requires space and financial resources. It is necessary to identify the key areas to mitigate heat-related risk to balance mitigation efficiency and planning feasibility. This study proposes a framework to identify key areas from a network perspective based on heat exposure risk identification and green infrastructure construction. Two networks, a heat exposure spreading network and a green infrastructure network, were constructed using morphological spatial pattern analysis and circuit theory based on population density and remote sensing image data. Beijing, as a highly urbanized city, was chosen as the case study. For key areas, we proposed environmental improvement measures, and the effectiveness of these measures was confirmed by ENVI-met simulations. The results show that there are 294 key areas that could split high heat exposure patches, block high heat exposure patch connections, and control the spread of high heat exposure patches. Increasing greenery coverage by increasing street tree greening, parking lot greening, urban forest construction, and urban park construction can reduce regional temperatures by 0.18-5.34 degrees C. This study provides an approach to mitigate heat-related risk in highly urbanized cities.
Across countries, extreme heat events are projected to increase in frequency and intensity because of climate change. Exposure to extreme heat events can have a substantial negative impact on human health, and extant research suggests that individuals with mental illness are particularly vulnerable. To date, there has been no review of evidence regarding this vulnerability to inform response strategies and future research. A systematic review was undertaken to investigate mental illness as an effect modifier of the relationship between heat exposure and morbidity or mortality. Six databases (Medline, Embase, Global Health, PsychInfo, CINAHL and Scopus) were searched for studies published between the years 2000 to 2022. Twenty-two observational studies that met the inclusion criteria were investigated through narrative synthesis. The RoBANS tool, ROBIS and GRADE were used to assess the certainty of evidence including the risk of bias. Individuals with mental illness experience worse morbidity and mortality outcomes compared to their counterparts without mental illness in all studies investigating high temperature over a single day. This did not hold for studies examining heatwaves, which reported mixed findings. People with diagnosed mental illness should be targeted for policy and service attention during high temperature days. Further research should investigate specific mental illness and adjust for a wider range of confounding factors.
Climate change is increasingly affecting human well-being and will inevitably impact on occupational sectors in terms of costs, productivity, workers’ health and injuries. Among the cooling garment developed to reduce heat strain, the ventilation jacket could be considered for possible use in workplaces, as it is wearable without limiting the user’s mobility and autonomy. In this study, simulations with a sweating manikin are carried out to investigate the effects of a short-sleeved ventilation jacket on human thermophysiological responses in a warm-dry scenario. Simulations were performed in a climatic chamber (air temperature = 30.1 °C; air velocity = 0.29 m/s; relative humidity = 30.0 %), considering two constant levels of metabolic rate M (M(1) = 2.4 MET; M(2) = 3.2 MET), a sequence of these two (Work), and three levels of fan velocities (l(f) = 0; l(f)=2; l(f)=4). The results revealed a more evident impact on the mean skin temperature (T(sk)) compared to the rectal temperature (T(re)), with significant decreases (compared to fan-off) at all M levels, for T(sk) from the beginning and for T(re) from the 61(st) minute. Skin temperatures of the torso zones decreased significantly (compared to fan-off) at all M levels, and a greater drop was registered for the Back. The fans at the highest level (l(f)=4) were significantly effective in improving whole-body and local thermal sensations when compared to fan-off, at all M levels. At the intermediate level (l(f)=2), the statistical significance varied with thermal zone, M and time interval considered. The results of the simulations also showed that the Lower Torso needs to be monitored at M(2) level, as the drop in skin temperature could lead to local overcooling and thermal discomfort. Simulations showed the potential effectiveness of the ventilation jacket, but human trials are needed to verify its cooling power in real working conditions.
Ixodes scapularis (the blacklegged tick) is widely distributed in forested areas across the eastern United States. The public health impact of I. scapularis is greatest in the north, where nymphal stage ticks commonly bite humans and serve as primary vectors for multiple human pathogens. There were dramatic increases in the tick’s distribution and abundance over the last half-century in the northern part of the eastern US, and climate warming is commonly mentioned as a primary driver for these changes. In this review, we summarize the evidence for the observed spread and proliferation of I. scapularis being driven by climate warming. Although laboratory and small-scale field studies have provided insights into how temperature and humidity impact survival and reproduction of I. scapularis, using these associations to predict broad-scale distribution and abundance patterns is more challenging. Numerous efforts have been undertaken to model the distribution and abundance of I. scapularis at state, regional, and global scales based on climate and landscape variables, but outcomes have been ambiguous. Across the models, the functional relationships between seasonal or annual measures of heat, cold, precipitation, or humidity and tick presence or abundance were inconsistent. The contribution of climate relative to landscape variables was poorly defined. Over the last half-century, climate warming occurred in parallel with spread and population increase of the white-tailed deer, the most important reproductive host for I. scapularis adults, in the northern part of the eastern US. There is strong evidence for white-tailed deer playing a key role to facilitate spread and proliferation of I. scapularis in the US over the last century. However, due to a lack of spatially and temporally congruent data, climate, landscape, and host variables are rarely included in the same models, thus limiting the ability to evaluate their relative contributions or interactions in defining the geographic range and abundance patterns of ticks. We conclude that the role of climate change as a key driver for geographic expansion and population increase of I. scapularis in the northern part of the eastern US over the last half-century remains uncertain.
India is at a high risk of heat stress-induced health impacts and economic losses owing to its tropical climate, high population density, and inadequate adaptive planning. The health impacts of heat stress across climate zones in India have not been adequately explored. Here, we examine and report the vulnerability to heat stress in India using 42 years (1979-2020) of meteorological data from ERA-5 and developed climate-zone-specific percentile-based human comfort class thresholds. We found that the heat stress is usually 1-4 °C higher on heatwave (HW) days than on nonheatwave (NHW) days. However, the stress on NHW days remains considerable and cannot be neglected. We then showed the association of a newly formulated India heat index (IHI) with daily all-cause mortality in three cities – Delhi (semiarid), Varanasi (humid subtropical), and Chennai (tropical wet and dry), using a semiparametric quasi-Poisson regression model, adjusted for nonlinear confounding effects of time and PM(2.5). The all-cause mortality risk was enhanced by 8.1% (95% confidence interval, CI: 6.0-10.3), 5.9% (4.6-7.2), and 8.0% (1.7-14.2) during “sweltering” days in Varanasi, Delhi, and Chennai, respectively, relative to “comfortable” days. Across four age groups, the impact was more severe in Varanasi (ranging from a 3.2 to 7.5% increase in mortality risk for a unit rise in IHI) than in Delhi (2.6-4.2% higher risk) and Chennai (0.9-5.7% higher risk). We observed a 3-6 days lag effect of heat stress on mortality in these cities. Our results reveal heterogeneity in heat stress impact across diverse climate zones in India and call for developing an early warning system keeping in mind these regional variations.
Schistosomiasis, a neglected tropical disease caused by parasitic worms, poses a major public health challenge in economically disadvantaged regions, especially in Sub-Saharan Africa. Climate factors, such as temperature and rainfall patterns, play a crucial role in the transmission dynamics of the disease. This study presents a deterministic model that aims to evaluate the temporal and seasonal transmission dynamics of schistosomiasis by examining the influence of temperature and rainfall over time. Equilibrium states are examined to ascertain their existence and stability employing the center manifold theory, while the basic reproduction number is calculated using the next-generation technique. To validate the model’s applicability, demographic and climatological data from Uganda, Kenya, and Tanzania, which are endemic East African countries situated in the tropical region, are utilized as a case study region. The findings of this study provide evidence that the transmission of schistosomiasis in human populations is significantly influenced by seasonal and monthly variations, with incidence rates varying across countries depending on the frequency of temperature and rainfall. Consequently, the region is marked by both schistosomiasis emergencies and re-emergences. Specifically, it is observed that monthly mean temperatures within the range of 22-27 °C create favorable conditions for the development of schistosomiasis and have a positive impact on the reproduction numbers. On the other hand, monthly maximum temperatures ranging from 27 to 33 °C have an adverse effect on transmission. Furthermore, through sensitivity analysis, it is projected that by the year 2050, factors such as the recruitment rate of snails, the presence of parasite egg-containing stools, and the rate of miracidia shedding per parasite egg will contribute significantly to the occurrence and control of schistosomiasis infections. This study highlights the significant influence of seasonal and monthly variations, driven by temperature and rainfall patterns, on the transmission dynamics of schistosomiasis. These findings underscore the importance of considering climate factors in the control and prevention strategies of schistosomiasis. Additionally, the projected impact of various factors on schistosomiasis infections by 2050 emphasizes the need for proactive measures to mitigate the disease’s impact on vulnerable populations. Overall, this research provides valuable insights to anticipate future challenges and devise adaptive measures to address schistosomiasis transmission patterns.
Exposure to heat is associated with a substantial burden of disease and is an emerging issue in the context of climate change. Heat is of particular concern in India, which is one of the world’s hottest countries and also most populous, where relatively little is known about personal heat exposure, particularly in rural areas. Here, we leverage data collected as part of a randomized controlled trial to describe personal temperature exposures of adult women (40-79 years of age) in rural Tamil Nadu. We also characterize measurement error in heat exposure assessment by comparing personal exposure measurements to the nearest ambient monitoring stations and to commonly used modeled temperature data products. We find that temperatures differ across individuals in the same area on the same day, sometimes by more than 5 °C within the same hour, and that some individuals experience sharp increases in heat exposure in the early morning or evening, potentially a result of cooking with solid fuels. We find somewhat stronger correlations between the personal exposure measurements and the modeled products than with ambient monitors. We did not find evidence of systematic biases, which indicates that adjusting for discrepancies between different exposure measurement methods is not straightforward.
Urban heat waves pose a significant risk to the health and safety of city dwellers, with urbanization potentially amplifying the health impact of extreme heat. Accurate assessments of population heat exposure hinge on the interplay between temperature, population spatial dynamics, and the epidemiological effects of temperature on health. Yet, many past studies have over-simplified the matter by assuming static populations, leading to substantial inaccuracies in heat exposure assessments. To address these issues, this study integrates dynamic population data, fluctuating temperature, and the exposure-response relationship between temperature and health to construct an advanced heat exposure assessment framework predicated on a population dynamic model. We analyzed urban heat island characteristics, population dynamics, and heat exposure during heat wave conditions in Beijing, a major city in China. Our findings highlight significant intra-day population movement between urban and suburban areas during heat wave conditions, with spatial population flow patterns showing clear scale-dependent characteristics. These population flow dynamics intensify heat exposure levels, and the disparity between dynamic population-weighted temperature and average temperature is most pronounced at night. Our research provides a more comprehensive understanding of real urban population heat exposure levels and can furnish city administrators with more scientifically rigorous evidence.
BACKGROUND: High temperatures and heatwaves are occurring more frequently and lasting longer because of climate change. A synthesis of existing evidence of heat-related health impacts in the Western Pacific Region (WPR) is lacking. This review addresses this gap. METHODS: The Scopus and PubMed databases were searched for reviews about heat impacts on mortality, cardiovascular morbidity, respiratory morbidity, dehydration and heat stroke, adverse birth outcomes, and sleep disturbance. The last search was conducted in February 2023 and only publications written in English were included. Primary studies and reviews that did not include specific WPR data were excluded. Data were extracted from 29 reviews. FINDINGS: There is strong evidence of heat-related mortality in the WPR, with the evidence concentrating on high-income countries and China. Associations between heat and cardiovascular or respiratory morbidity are not robust. There is evidence of heat-related dehydration and stroke, and preterm and still births in high-income countries in the WPR. Some evidence of sleep disturbance from heat is found for Australia, Japan and China. INTERPRETATION: Mortality is by far the most studied and robust health outcome of heat. Future research should focus on morbidity, and lower income countries in continental Asia and Pacific Island States, where there is little review-level evidence. FUNDING: Funded by the World Health Organization WPR Office.
BACKGROUND: Numerous studies have investigated the association between heat wave exposure increased heat-related hospitalizations in the general population. However, little is known about heat-related morbidity in young children who are more vulnerable than the general population. Therefore, we aimed to evaluate the association between hospitalization for heat-related illness in children and heat wave exposure in South Korea. METHODS: We used the National Health Insurance Service (NHIS) database, which provides medical records from 2015 to 2019 in South Korea. We defined daily hospitalizations for heat-related illness of children younger than five years during the summer period (June to August). We considered the definition of heat waves considering the absolute temperature and percentile. A total of 12 different heat waves were used. A time-series analysis was used to investigate the association between heat wave exposure and heat-related hospitalization among children younger than five years. We used a two-stage design involving a meta-analysis after modeling by each region. RESULTS: We included 16,879 daily heat-related hospitalizations among children younger than five years. Overall, heat wave exposure within two days was most related for heat-related hospitalizations in young children. The relative risk (RR) due to heat wave exposure within two days (lag2) (12 definitions: 70th to 90th percentile of maximum temperature) ranged from 1.038 (95% confidence interval (CI): 0.971, 1.110) to 1.083 (95% CI: 1.036, 1.133). We found that boys were more vulnerable to heat exposure than girls. In addition, we found that urban areas were more vulnerable to heat exposure than rural areas. CONCLUSIONS: In our study, heat wave exposure during summer was found to be associated with an increased risk of hospitalization for heat-related illness among children younger than five years. Our findings suggest the need for summer heat wave management and prevention for children.
PURPOSE OF REVIEW: This review discusses the urgency of addressing human-caused climate change and its impacts on health and the environment. RECENT FINDINGS: The latest evidence shows that current climate changes are primarily attributable to greenhouse gas emissions from human industrial activity. Exceeding 1.5°C of warming above preindustrial levels is projected to increase extreme weather events, increase rates of heat-related morbidity and mortality and vector-borne disease, exacerbate food and water insecurity, harm biodiversity and agriculture, displace communities, and disproportionately impact disadvantaged groups. SUMMARY: Urgent action is required to curb emissions, enact adaptation strategies, and promote climate justice. The healthcare sector must reduce its ecological footprint and prepare systems and workers to address climate change’s health effects. Further research should support climate solutions while promoting health equity and environmental justice.
BACKGROUND: Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC’s 2021 heat dome. METHODS: We conducted a review of consecutive adults presenting to 7 hospitals in BC’s Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality. RESULTS: Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3). INTERPRETATION: Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.
Few studies have delved into the effects of heatwaves on sleep duration loss among older adults. Our study examined correlations between heatwave exposure and sleep duration reductions in this demographic. Utilizing data of 7,240 older adults drawn from the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2018, we assessed sleep duration differences between the baseline year (2015) and follow-up year (2018). Absolute reductions in sleep duration were defined as differences of ≥ 1, 1.5, or 2 h. Changes in sleep duration were categorized based on cut-offs of 5 and 8 h, including excessive decrease, moderate to short and persistent short sleep duration types. 12 heatwave definitions combining four thresholds (90th, 92.5th, 95th, and 97.5th percentiles of daily minimum temperature) and three durations (≥2, ≥3 and ≥ 4 days) were used. Heatwave exposure was determined by the difference in the number of 12 preceding months’ heatwave days or events in 2015 and the number of 12 preceding months’ heatwave days or events in 2018. The results showed that increased heatwave events (defined as ≥ P90th percentile & lasting three days) were associated with a higher likelihood of ≥ 1-hour sleep reduction and persistent short sleep duration. An increase in heatwave event (defined as ≥ P95th percentile & lasting three days) was linked to shifts from moderate to short sleep duration. For the association between an absolute reduction in sleep duration and heatwave exposure, while higher thresholds signified greater sleep reduction risks, the effect estimates of longer durations were not uniformly consistent. We observed that air pollution and green space modified the relationship between heatwaves and sleep duration. Females, urban residents, and individuals with chronic diseases were identified as vulnerable populations. This study found that increased heatwave exposure was associated with a higher risk of sleep duration loss in older adults.
CONTEXT: During the summer of 2021, western Canada experienced a deadly heat event. From the first heat alert to postevent reporting, thousands of media articles were published that reference the heat event. However, a gap remains in understanding how this communication chain-from the release of a public heat alert to information shared through media outlets to the public-currently operates to disseminate heat-related messaging across Canada. OBJECTIVE: To understand the role of digital media in delivering heat-health messaging during an extreme heat event in Canada. DESIGN: A qualitative content analysis was conducted using Canadian news articles published on the 2021 Heat Dome between June 2021 and February 2022 (n = 2909). The coding frame was designed to align with the basic framework for information gathering used in journalism (who, what, where, when, and how) and included both concept-driven and data-driven codes. RESULTS: Overall, 2909 unique media articles discussing the 2021 Heat Dome were identified, with the majority (74%) published by online news agencies (how). The highest article count was on June 29, 2021 (n = 159), representing 5% of the total data set (n = 2909) spanning 260 days (when); 57% of the identified locations were in British Columbia (where). Although we found that the top voices providing media-based heat-health messages are government officials (who), only 23% of articles included heat-health messaging that aligns with the government health alert bulletins released during extreme heat. In addition, heat-health messaging frequently included contradictory content, inconsistent language, or incorrect advice (what). CONCLUSION: The findings demonstrate clear opportunities to improve health communication related to extreme heat, perhaps most importantly, including updates to mass media messaging educating the public on heat-protective behaviors.
Exposure to heatwaves may result in adverse human health impacts. Heat alerts in South Africa are currently based on defined temperature-fixed threshold values for large towns and cities. However, heat-health warning systems (HHWS) should incorporate metrics that have been shown to be effective predictors of negative heat-related health outcomes. This study contributes to the development of a HHWS for South Africa that can potentially minimize heat-related mortality. Distributed lag nonlinear models (DLNM) were used to assess the association between maximum and minimum temperature and diurnal temperature range (DTR) and population-adjusted mortality during summer months, and the effects were presented as incidence rate ratios (IRR). District-level thresholds for the best predictor from these three metrics were estimated with threshold regression. The mortality dataset contained records of daily registered deaths (n = 8,476,532) from 1997 to 2013 and data for the temperature indices were for the same period. Maximum temperature appeared to be the most statistically significant predictor of all-cause mortality with strong associations observed in 40 out of 52 districts. Maximum temperature was associated with increased risk of mortality in all but three of the districts. Our results also found that heat-related mortality was influenced by regional climate because the spatial distribution of the thresholds varied according to the climate zones across the country. On average, districts located in the hot, arid interior provinces of the Northern Cape and North West experienced some of the highest thresholds compared to districts located in temperate interior or coastal provinces. As the effects of climate change become more significant, population exposure to heat is increasing. Therefore, evidence-based HHWS are required to reduce heat-related mortality and morbidity. The exceedance of the maximum temperature thresholds provided in this study could be used to issue heat alerts as part of effective heat health action plans.
Extreme heatwaves in tropical cities represent a significant short-term weather challenge, directly impacting urban heat, exacerbating human discomfort, and increasing energy demands. To alleviate this, meteorological adjustments utilizing reflective roofing technologies, such as cool roofs, can effectively mitigate heatwaveinduced excess heat and enhance thermal comfort. This study assessed the effectiveness of cool roofs in cooling urban areas following heatwaves in Kolkata, India, using comprehensive city-scale simulations. The study presumed that the existing roofing materials, with a reflectivity of 0.15 and emissivity of 0.85, indicated the unmitigated condition. These materials were replaced with third-generation cool roof materials featuring a reflectivity of 0.80 and emissivity of 0.85, leading to a substantial improvement in urban meteorology and thermal comfort compared to the unmitigated state. Notably, during heatwave episodes, the most significant computed reductions in energy flux were 181.3 Wm-2, 16.6 Wm-2, 56.3 Wm-2, and 251.9 Wm-2 for sensible heat, latent heat, ground storage, and net inflow radiation, respectively. Consequently, this led to decreases of 2.3 degrees C, 6.1 degrees C, 21.8 degrees C, and 1.9 degrees C in urban thermal parameters during peak hours (14:00 LT) for ambient temperature, surface temperature, roof surface temperature, and urban canopy temperature, respectively. The maximum drops in the planetary boundary layer (PBL) were 130.6 m, 1978.5 m, and 1010.3 m for 6:00 LT, 14:00 LT, and 18:00 LT, with an average of 870.3 m. Cool roofs demonstrated their potential to minimize thermal stress during heatwave periods, showcasing a maximum drop in the heat stress index (HSI) of up to 1.5 degrees C in the morning. Furthermore, outdoor thermal comfort could be significantly enhanced by lowering the universal thermal comfort index (UTCI) at the near surface, resulting in reductions of up to 1.8 degrees C during peak hours. On average, there was a reduction in UTCI between day and night of approximately 1.2 degrees C and 0.7 degrees C in densely populated urban areas. Additionally, the study evaluated 32 case studies that focused on cool roof strategies, revealing remarkably consistent findings that suggest a plausible justification. These findings provide a valuable framework for urban planners and policymakers considering the integration of cool roofs-based heat reduction technology at the city scale.
BACKGROUND: Climate change is a global environmental phenomenon that affects human health. It has a negative impact on the health and well-being of older adults. Therefore, educating older adults about coping with climate change and providing psychological interventions could promote successful aging. AIM: To determine the effectiveness of psycho-educational program on climate change distress and risk perception among older adults. METHODS: A quasi-experimental research design, “pre-test and post-test was followed. The study used the Climate Change Distress, the Impairment Scale, and the Risk Perception Scale. Data were collected from 80 older adults aged 60 years and above at three elderly clubs in Damanhour City, El-Behaira Governorate, Egypt. RESULTS: The difference in mean severity of climate change distress, impairment, and risk perception scores between the study and control groups after the psycho-educational program was statistically significant. CONCLUSION: Psycho-educational interventions can reduce climate change distress and impairment among older adults and increase their risk perception.
PURPOSE: As climate change accelerates, healthcare workers (HCW) are expected to be more frequently exposed to heat at work. Heat stress can be exacerbated by physical activity and unfavorable working requirements, such as wearing personal protective equipment (PPE). Thus, understanding its potential negative effects on HCW´s health and working performance is becoming crucial. Using wearable sensors, this study investigated the physiological effects of heat stress due to HCW-related activities. METHODS: Eighteen participants performed four experimental sessions in a controlled climatic environment following a standardized protocol. The conditions were (a) 22 °C, (b) 22 °C and PPE, (c) 27 °C and (d) 27 °C and PPE. An ear sensor (body temperature, heart rate) and a skin sensor (skin temperature) were used to record the participants´ physiological parameters. RESULTS: Heat and PPE had a significant effect on the measured physiological parameters. When wearing PPE, the median participants’ body temperature was 0.1 °C higher compared to not wearing PPE. At 27 °C, the median body temperature was 0.5 °C higher than at 22 °C. For median skin temperature, wearing PPE resulted in a 0.4 °C increase and higher temperatures in a 1.0 °C increase. An increase in median heart rate was also observed for PPE (+ 2/min) and heat (+ 3/min). CONCLUSION: Long-term health and productivity risks can be further aggravated by the predicted temperature rise due to climate change. Further physiological studies with a well-designed intervention are needed to strengthen the evidence for developing comprehensive policies to protect workers in the healthcare sector.
Background: Extreme heat events are a leading weather-related killer in the United States and are predicted to increase in frequency, duration, and intensity. Emergency managers lead short-term response to heat events as well as other natural and man-made hazards with discretion to develop criteria to activate heat responses, such as opening cooling centers and increasing surveillance activities. We aim to describe and summarize emergency management plans for short-term response to extreme heat events across the U.S.Methods: Information on hazard mitigation plans (HMP) and heat response plans (HRP) in the 25 most populated cities in the US were collected from the National Science Foundation’s Natural Hazards Engineering Research Infrastructure DesignSafe Data Depot; interviews with emergency managers; and Freedom of Information Act requests. Obtained responses and pol-icy documents were analyzed to answer the following questions developed in consultation with the National Weather Service (NWS), Weather Program Office: 1. How many locations have developed an HRP? 2. What are the emergency management heat response activation thresholds and metrics for emergency response? 3. Do thresholds change with cascading hazards? 4. Are heat vulnerability indexes (HVI) and/or social vulnerability indexes (SVI) included, and 5. Are health outcomes considered in the development of thresholds? Results: 1. There is no statistical difference in the prevalence of HRPs across geographic regions in the U.S. 2. Initial response thresholds vary greatly across locations from an ambient temperature of 80-85F (26-29 C) to a Heat Index of 108F (42 C). Eighty-eight (22 of 25) percent of locations are using the NWS Heat Index and twelve percent (3 of 25) are using the experimental HeatRisk Product. 3. Sixty-Eight (17 of 25) percent of cities consider cascading hazards, such as a power grid outage, in their HMP or HRP. None of the cities, however, lower response thresholds, as explicitly written in the plans, during these events. 4. Forty percent (10 of 25) of municipalities have an HVI or SVI included or addressed in their plans, & 5. Three of the cities (New York, Phoenix, & Boston) have adapted response thresholds based on local epidemiological studies Discussion: There is little consistency in the advisory, warning, and watch criteria thresholds across cities which may be a source of confusion to the public. If such criteria are to be tailored to each geographic location, local epidemiological studies and vulnerabilities should help inform the criteria.
With global warming, the issue of urban surface overheating has emerged as one of the most urgent concerns for modern cities worldwide. However, the simulation of thermal comfort with high spatiotemporal resolution remains a challenge. In this study, an approach is presented to integrate several global meteorological raster data for the production of high spatial and temporal resolution thermal comfort raster datasets. Our approach produced a dataset in the GuangdongHong Kong-Macao Greater Bay Area (GBA) covering 98.30% of diurnal moments in 5 years, and the spatial coverage of the region exceeded 87%. The assessment results showed that from 2002 to 2020, mean universal thermal climate index (UTCI) slightly increases from 16.0 to 20.6 degrees C to 17.3-26.2 degrees C, dominated by no heat stress (9.0 degrees C-26.0 degrees C). The low-value center of UTCI locates in the north GBA, around Zhaoqing and northern Guangzhou, while the high-value center moved westward from Huizhou to Foshan, Dongguan, and the south of Guangzhou. Over the past 18 years, the heat stress has become larger in the spatial extent and more prolonged. The heat island effect has intensified over the past 18 years, resulting in a coexistence of the positive heat island intensity and the negative heat island intensity. The result investigates urban thermal comfort conditions for urban thermal environment management and provides a spatial reference for human-centered urban planning.
With increasing urbanisation and climate change, more people will be exposed to extreme heat. While health impacts of heat are well known, far less is known about how heat and responses to heat affect daily life. Such information is needed if appropriate advice is to be provided on heat adaptation. This study describes heat-related symptoms that can impact wellbeing but do not necessarily require medical treatment, and how heat changes people’s behaviour, including their strategies for relieving heat and seeking heat health advice. Data were collected through an Australia-wide online survey with 1665 responses. We found that heat leads to maladaptive behaviours that could affect long-term health, such as reducing outside activities (67% of respondents) and increasing the consumption of soft drinks (27% of respondents) and alcohol (11% of respondents). Two-thirds of respondents used more air-conditioning to relieve heat stress and many reported poor sleep quality. Behaviour change was strongly correlated with respondents’ age, degree of physical activity and the extent to which people sought advice on heat and health (37% of respondents). The results can help identify individuals least likely to cope well with heat and who may benefit most from heat relief advice.
This study assessed the energy-saving and climate-adaptive potential of cool skin and ventilated cavity skin facade technologies in Seoul’s high-rise apartment buildings. We created weather scenarios for historical, midterm future, and long-term future conditions using Coordinated Regional Downscaling EXperiment (CORDEX) method. Building energy simulations were conducted on a South Korean high-rise apartment model to evaluate their performance under different weather conditions. The results indicate that cool skin and ventilated cavity skin technologies can save cooling energy during summers but lead to heating energy penalties in winters. Ventilated cavity skin outperforms cool skin, offering better cooling energy savings and reduced heating penalties. Combining both technologies yields the highest overall energy savings, with 7 %, 9 %, and 10 % cooling energy savings for cool skin, ventilated cavity skin, and the combined package, respectively. However, cool skin increases heating energy consumption by 5 %, while ventilated cavity skin has minimal impact on heating energy. These envelope technologies also reduce peak electricity demand by at least 5 %, 8 %, and 9 %, respectively. They contribute to heat stress reduction, enhance resilience, and decrease extreme heat risks for occupants during power outages by at least 18 % under various weather conditions. Considering the prevalence of aging high-rise apartments in South Korea, adopting these envelope renovation strategies can effectively reduce cooling loads, enhance thermal comfort, and boost resilience under future climates, while avoiding costly reconstruction.
PURPOSE OF REVIEW: Kidney stones affect an increasing proportion of the population. We suggest that these trends are in part influenced by exposure to higher temperatures as a result of climate change and urbanization. The changing epidemiology of kidney stones is a topic worthy of discussion due to the economic and healthcare burden the condition poses as well as the quality-of-life disruption faced by individuals with kidney stones. RECENT FINDINGS: The relationship between heat and kidney stones is well supported. Exposure to high temperatures has been shown to increase risk for stone development within a short time frame. Effects are modified by factors such as sex, comorbid conditions, and population vulnerability and adaptability. Urban heat islands (UHIs) likely exaggerate the effect of increasing global surface temperature. The concentration of UHIs often coincides with historic redlining practices in the United States, potentially contributing to observed disparities in kidney health among minoritized populations. As global surface temperature increases and urbanization trends continue, a greater proportion of the world’s population is exposed to significant temperature extremes each year, leading to the expectation that kidney stone prevalence will continue to increase. SUMMARY: This work describes the effect of increasing global surface temperature as a result of climate change on kidney stone disease and kidney health. These effects may result in further perpetuation of significant kidney stone related social disparities. We suggest strategies to mitigate the effects of heat exposure on stone formation.
Climate change is a significant public health crisis that is both rooted in pre-existing inequitable socioeconomic and racial systems and will further worsen these social injustices. In the face of acute and slow-moving natural disasters, women, and particularly women of color, will be more susceptible to gender-based violence, displacement, and other socioeconomic stressors, all of which have adverse mental health outcomes. Among the social consequences of climate change, eco-anxiety resulting from these negative impacts is also increasingly a significant factor in family planning and reproductive justice, as well as disruptions of the feminine connection to nature that numerous cultures historically and currently honor. This narrative review will discuss these sociologic factors and also touch on ways that practitioners can become involved in climate-related advocacy for the physical and mental well-being of their patients.
Exposure to high heat and humidity in the workplace is a critical health and safety issue. In Australia, where heat waves are occurring with more frequency and intensity the risks posed by occupational heat exposure have been acknowledged by employer groups, trade unions, and statutory government agencies. In this study we investigate the employment context in which heat stress is experienced, and whether the mode of employment affects the capacity to manage it. We examine the experience of workplace heat exposure for two groups of affected outdoor workers: contracted pieceworkers in bicycle delivery and permanently employed municipal workers in parks and road maintenance. Data was collected in Sydney during the summer of 2019 via surveys and in-person interviews with the two sets of workers. Research findings reflect the well-established nexus between outside temperature, humidity and work effort in producing heat stress. The comparative findings reveal that more secure forms of employment enable social organisation and workflow to manage heat stress and that, conversely, more contingent forms of employment such as contractual piece work can exacerbate exposure. The research dem-onstrates that the mode of employment has a direct bearing on the capacity to address workplace heat stress: growth in contract or ‘gig’ work may exacerbate impacts; this issue is likely to become more important with advancing climate change.
Extreme heat events directly impact worker health and cause additional cascading and transitional workplace impacts. However, current investigations on these impacts often rely on specific datasets (e.g., compensation claims, hospitalizations). Thus, to continue to work towards preventing and mitigating the occupational risks posed by extreme heat events, this study aimed to explore the occupational impacts of the 2021 Heat Dome in Canada using a qualitative content analysis method on a news-based dataset. A systematized review of news articles published before, during, and after the 2021 Heat Dome was conducted on academic (n = 8) and news (n = 5) databases, along with targeted grey literature. Two researchers qualitatively coded the articles in NVivo for occupational impacts or references mentioned within the articles. Overall, 52 different occupations were identified as being impacted by the 2021 Heat Dome. Impacts were diverse and ranged from work cancellations or delays to work modifications and reports of heat-related illnesses. The 2021 Heat Dome impacted the health and safety of many occupational groups and provided new insights into the expanding impacts that extreme heat events can have on the Canadian workforce. With climate projections showing a growing trend of more hot days and intense heat waves in Canada, addressing these concerns should be a critical priority.
Climate change may lead to more frequent and severe weather events, resulting in significant financial and human health impacts. This paper develops a risk metric using building performance simulation by associating thermal and incidental risks in buildings during power outages while considering multiple cold and hot events. Conditional Value at Risk (CVaR) is calculated using variations in outage events. According to the results, employing an integrated building design and a microgrid with photovoltaic panels that can be disconnected from the grid halves vulnerability related to ice storms and completely mitigates it for historical heatwave events. The variability study has revealed that a code-minimum design has eight times the CVaR of the as-built design. This novel methodology has the potential to inform future environmental, social, and corporate governance strategies and assist infrastructure operators in managing their risk exposure to future climate change events, considering various types of risks and multiple hazards.
Constraining an increase in global mean temperature below 2 degrees C compared to pre-industrial levels is critical to limiting dangerous and cascading impacts of anthropogenic climate change. Understanding future climatic changes and their spatial heterogeneity at 2 degrees C warming is thus important for policy makers to prepare actionable adaptation and mitigation plans by identifying where and to what extent lives and livelihoods will be impacted. This study uses the recently released NASA Earth eXchange Global Daily Downscaled Projections (NEX-GDDP) CMIP6 data to provide a broad overview of projected changes in six key climate variables and two climate impact indicators at a time when warming exceeds 2 degrees C. Analysis of global mean temperature changes indicates the 2040s as the decade when most CMIP6 models reach 2 degrees C warming with respect to a pre-industrial period (1850-1900). During the 2040s, we find that global mean temperature, precipitation, relative humidity, downwelling shortwave and longwave radiation, and wind speed over land under the high emission scenario are projected to change by +2.8 degrees C, +22.4 mm/year, -0.73%, -2.23 , +15.9 W/m(2), and -0.04 m/s, respectively. Many of the future changes are expected to exacerbate climate impacts including heat stress and fire danger. Our analysis shows geographic patterns of policy-relevant climatic changes, as parts of the globe will experience significant climate impacts even if the goal to keep warming below 2 degrees C goal is achieved. Our results highlight the urgent need for further studies focused on identifying key hotspots and advancing region-specific actionable adaptation and mitigation plans.
Excessive summer heat is becoming people’s daily reality creating an urgency to understand heatwaves and their consequences better. This article suggests an interdisciplinary analytical framework of heat(waves) as multiple objects. It brings together data and perspectives from social anthropology, sociology, climate science, epidemiology, and meteorology to map the gaps in knowledge about heat(waves) and their impacts on one of the most vulnerable groups: older adults. Based on research in Poland and Spain, we look at heat(waves) as simultaneously individual experiences, biophysical changes, and socio-political phenomena. Climatologists and meteorologists define heat(waves) as prolonged episodes of abnormally high temperatures. Epidemiologists perceive heat(waves) through raising morbidity and mortality rates. For policymakers, they are an emergency defined by duration and temperature thresholds. Older adults living in Warsaw and Madrid recognize a heat(wave) when they feel it in their bodies, when they cannot sleep, or when they need to change their daily routines. Such differently situated scientific definitions and embodied knowledge stem not only from varied epistemological perspectives but demonstrate that heat(waves) are ontologically different. By looking at convergences and divergences between these perspectives, we see that the length of heat(waves) varies and that older adults often experience longer periods of excessive heat than climate measurements or policy alerts indicate; that the impact of nighttime temperatures is more important than daily temperatures; and that there is a discrepancy between heat(waves) as anomalies and as increasingly common events. The article addresses an important gap between biophysical definitions of heatwaves and the experiences of the most vulnerable groups.
The Wet Bulb Globe Temperature (WBGT) is an international standard heat index used by the health, industrial, sports, and climate sectors to assess thermal comfort during heat extremes. Observations of its components, the globe and the wet bulb temperature (WBT), are however sparse. Therefore WBGT is difficult to derive, making it common to rely on approximations, such as the ones developed by Liljegren et al. (2008, https://doi.org/10.1080/15459620802310770, WBGTLiljegren ) and by the American College of Sports Medicine ( WBGTACSM87 ). In this study, a global data set is created by implementing an updated WBGT method using ECMWF ERA5 gridded meteorological variables and is evaluated against existing WBGT methods. The new method, WBGTBrimicombe , uses globe temperature calculated using mean radiant temperature and is found to be accurate in comparison to WBGTLiljegren across three heatwave case studies. In addition, it is found that WBGTACSM87 is not an adequate approximation of WBGT. Our new method is a candidate for a global forecasting early warning system.
Rising temperatures will impact urban communities, which are growing as a proportion of the global population. However, the effects of increasing temperature may not be felt equally, with less wealthy neighbourhoods experiencing hotter thermal environments in some urban areas because of geographic location and tree cover. While relationships have been drawn between wealth inequality and temperature in urban areas, these rarely project into the future or combine humidity and air temperatures into ‘wet-bulb temperature’ at fine spatial resolution, which is more directly relevant to the human experienced environment. Here I present an analysis of present and future wet-bulb temperatures in Hong Kong, an economically developed subtropical city in South-East Asia. I couple census data with recently available 30 x 30 m resolution climate models to examine how the income of districts and their physical characteristics are correlated with human-experienced local temperatures. I uncover evidence of thermal inequity, with wealthier districts exhibiting cooler conditions than less wealthy districts. Projecting into the future using three different climate change scenarios I demonstrate that wet-bulb temperatures considered dangerous to human survival may be commonly experienced in Hong Kong by the end of the century. However, the wealthiest districts of Hong Kong are likely to have a thermal safety margin of at least 25-30 years more than the least wealthy districts before these dangerous temperatures are reached. Due to the high population density and economic importance of the region, these findings have significant implications for public health and urban planning as global temperatures continue to rise.
In the context of global warming, frequent heat wave disasters have seriously threatened the safety of human life and property. The urban agglomeration, as the main region with a high concentration of population and economy, is susceptible to heat weaves due to the existing urban heat island effect. In this study, we investigated the temporal and spatial characteristics of heat waves (heat index, HI) in China from 2000 to 2020 and assess the vulnerability of 19 urban agglomerations to heat waves from the perspective of exposure, sensitivity and adaptability. The results show that: (1) In the past 20 years, the frequency and intensity of HI (greater than 26.67 °C) both showed an upward trend. (2) Shandong Peninsula, Central Henan, Yangtze River Delta, Middle Reaches of Yangtze River, and Mid-southern Liaoning urban agglomerations always maintain a high vulnerability. (3) From 2000 to 2020, the vulnerability of Beijing-Tianjin-Hebei, Yangtze River Delta, Chengdu-Chongqing, Middle reaches of Yangtze River, Guangdong-Fujian-Zhejiang, Harbin-Changchun and Mid-southern Liaoning urban agglomerations were always dominated by exposure. The vulnerability of Shandong Peninsula, Beibu Gulf and Central Henan urban agglomeration has always been dominated by sensitivity. The vulnerability of North Tianshan Mountain, Lanzhou-Xining, Guanzhong and Hu-Bao-E-Yu urban agglomeration has always been dominated by inadequate adaptability. (4) Recently, the factors that contributed most to exposure, sensitivity and adaptability were population density, the proportion of outdoor workers and water supply, with contribution rates of 38%, 55% and 26%, respectively. This study can provide a scientific basis for the rational allocation of resources among urban agglomerations, effectively formulating policies and guiding population migration from high temperature disasters.
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
OBJECTIVES: To perform geographic contour analysis of sea and land ambulance rescue times in an archipelago subject to super typhoons; to design point-of-care testing strategies for medical emergencies and weather disasters made more intense by global warming and rising oceans; and to assess needs for prehospital testing on spatial care paths that accelerate decision making, increase efficiency, improve outcomes, and enhance standards of care in island nations. METHODS: We performed needs assessments, inspected healthcare facilities, and collected ambulance rescue times from professionals in the Bantayan Archipelago, Philippines. We mapped sea/land ambulance rescue routes and time contours. To reveal gaps, we statistically compared the fastest and slowest patient rescue times from islands/islets and barangays to the District Hospital on Bantayan Island. We developed spatial care paths (the fastest routes to care) for acute myocardial infarction, community care, and infectious diseases. We generated a compendium of prehospital diagnostic testing and integrated outcomes evidence, diagnostic needs, and public health goals to recommend point-of-care strategies that build geographic health resilience. RESULTS: We observed limited access to COVID-19 assays, absence of blood gas/pH testing for critical care support, and spatial gaps in land and airborne rescues that worsened during inclement weather and sea swells. Mean paired differences (slowest-fastest) in ambulance rescue times to the District Hospital for both islands and barangays were significant (P < 0.0001). Spatial care path analysis showed where point-of-care cardiac troponin testing should be implemented for expedited care of acute myocardial infarction. Geospatial strengths comprised distributed primary care that can be facilitated by point-of-care testing, logical interisland transfers for which decision making and triage could be accelerated with onboard diagnostics, and healthcare networks amenable to medical advances in prehospital testing that accelerate treatment. CONCLUSIONS: Point-of-care testing should be positioned upstream close to homes and island populations that have prolonged rescue time contours. Geospatially optimized point-of-need diagnostics and distributed prehospital testing have high potential to improve outcomes. These improvements will potentially decrease disparities in mortality among archipelago versus urban dwellers, help improve island public health, and enhance resilience for increasingly adverse and frequent climate change weather disasters that impact vulnerable coastal areas. [350 words].
Heatwaves are increasingly recognized as a severe natural hazard that pose substantial threats to human wellbeing and sustainability with physical, mental, and economic impacts. Heatwave Early Warning Systems (HEWSs) have emerged as a promising solution to mitigate these adverse impacts. This study aims to valuate a Short Message Service (SMS)-based early warning system specifically targeting heat-vulnerable populations and their determinants in central Vietnam, an area prone to heat-related illnesses. By employing the contingent valuation method, individuals’ willingness to pay (WTP) for the warning system and the determinants of the WTP were assessed. The findings showed an average WTP of VND 283,110 (similar to USD 11) per person per year, according to the parametric estimate. The total WTP for the affected population in central Vietnam reached VND 857,283,678,000 or USD 37,273,203 per year, assuming that 50% of the heat-vulnerable population contributes to HEWSs financially. Significant determinants of WTP were identified, including bid levels, cost of heat-related illnesses, background diseases, and exposure to heat. Policymakers and health authorities can utilize these findings to develop effective adaptation strategies for preventing and mitigating heat-related illnesses, while also promoting sustainable development in central Vietnam.
This study analyzes the weather-related health damage of present and future extreme temperatures in Argentina. Focusing on mortality, short-term impacts of temperature are obtained by regressing monthly mortality rates on inter-annual monthly weather variability. For this purpose, a countrywide panel dataset at the municipal level was constructed from the universe of deaths between 2010 and 2019, and daily meteorological records from the ERA5 weather dataset. Then, NASA Earth Exchange Global Daily Downscaled Projections (NEX-GDDP) are used to project future mortality by 2085 under two climate scenarios. Finally, present and future mortality-related economic damages are assessed using the Value of a Statistical Life. The results show that one additional day of extreme temperatures increase all-cause mortality rates relative to mild weather and that the impact of hotter-than-average temperatures is greater in magnitude than that of colder ones. Substantial heterogeneity exists between causes of death and age groups, with older people facing greater risks, while the results for gender are inconclusive. All days of extreme cold in a year generate damage equivalent to 0.64% of GDP, while heat damage is 0.11% of GDP. The total damage by extreme temperatures adds up to 0.75% of the 2019 GDP. When future temperatures are valued, the total damage increases by an additional 1.45% under scenario RCP8.5 because the lower mortality occurring on cold days only partially offsets the increase in the number of hot days. On the contrary, if temperature changes were to be mild (i.e., under scenario RCP4.5), overall mortality would be lower at the national level and the corresponding damages would decrease by 0.02%.
Climate change is creating an increase in temperatures, which is harming the quality of life of people all over the world, particularly those with minimal financial resources. While 30% of the world’s population is now vulnerable to extreme heat, estimates show that ratio will rise to 74% in the next 20 years, according to forecasts. Using the UrbClim climate model, this study examines the space-time variability of the heat stress index (HI) in different local climate zones (LCZs), as well as how heat wave conditions might affect this index based on land use and land cover. To that end, Seville, in Southern Spain, was investigated during the summer of 2017, when it had four heat waves. The following indices were considered for each urban sub-area: Normalized Difference Vegetation, Proportion Vegetation, Normalized Difference Built, and Urban Index. The goal is to conduct a statistical analysis of the link between the aforementioned elements and the heat stress index in order to recommend mitigation and resilience techniques. Our findings showed that compact and industrial LCZs (2, 3, and 10) are less resistant to HI than open and rural regions (5, 6, B, D, and G), which are more resistant to HI due to higher vegetation rates. The heat wave condition exacerbates the HI in all LCZs. As a result, initiatives such as enhancing open space, increasing green space, or using green roofs and façades might alleviate heat stress and improve people’s quality of life.
Vector-borne diseases are among the greatest causes of human suffering globally. Several studies have linked climate change and increasing temperature with rises in vector abundance, and in the incidence and geographical distribution of diseases. The microbiome of vectors can have profound effects on how efficiently a vector sustains pathogen development and transmission. Growing evidence indicates that the composition of vectors’ gut microbiome might change with shifts in temperature. Nonetheless, due to a lack of studies on vector microbiome turnover under a changing climate, the consequences for vector-borne disease incidence are still unknown. Here, we argue that climate change effects on vector competence are still poorly understood and the expected increase in vector-borne disease transmission might not follow a relationship as simple and straightforward as past research has suggested. Furthermore, we pose questions that are yet to be answered to enhance our current understanding of the effect of climate change on vector microbiomes, competence, and, ultimately, vector-borne diseases transmission.
This article approaches how the urban climate has become a risk factor for the homeless population.Methods: The empirical investigation draws on Rio de Janeiro, Brazil, considering the impacts of cold, heat, and rainfall events on these individuals. Precipitation and surface temperature analyses were performed to identify the urban climate processes to which the homeless are exposed.Results: Results indicate that these individuals tend to prioritize commercial areas for settling down, overlooking their susceptibility to extreme weather events.Conclusion: Downtown Rio de Janeiro concentrates the highest temperature and precipitation thresholds, increasing homeless exposure to urban climate effects as the group is also concentrated in the area. Their exposure intensifies morbidities and comorbidities and will likely be aggravated by increased extreme events due to climate change.
Extreme heat represents a growing threat to public health, especially across the densely populated, developed landscape of cities. Climate adaptation strategies that aim to manage urban microclimates through purposeful design can reduce the heat exposure of urban populations, however, it is unclear how the temperature impacts of urban green space and albedo vary across cities and background climate. This study quantifies the sensitivity of surface temperature to landcover characteristics tied to two widely used climate adaptation strategies, urban greening and albedo manipulation (e.g. white roofs), by combining long-term remote sensing observations of land surface temperature, albedo, and moisture with high-resolution landcover datasets in a spatial regression analysis at the census block scale across seven United States cities. We find tree cover to have an average cooling impact of -0.089 K per % cover, which is approximately four times stronger than the average grass cover cooling impact of -0.021 K per % cover. Variability in the magnitude of grass cover cooling impacts was primarily a function of vegetation moisture content, with the Land Surface Water Index (LSWI) explaining 89 % of the variability in grass cover cooling impacts across cities. Variability in tree cover cooling impacts was primarily a function of sunlight and vegetation moisture content, with solar irradiance and LSWI explaining 97 % of the cooling variability across cities. Albedo cooling impacts were consistent across cities with an average cooling impact of -0.187 K per increase of 0.01. While these interventions are broadly effective across cities, there are critical regional trade-offs between vegetation cooling efficiency, irrigation requirements, and the temporal duration and evolution of the cooling benefits. In warm, arid cities, high albedo surfaces offer multifaceted benefits such as cooling and water conservation, whereas temperate, mesic cities likely benefit from a combination of strategies, with greening efforts targeting highly paved neighborhoods.
The urban climate affects more than half the world’s population, and urban green spaces are considered a nature based solution to alleviate the urban heat island effect and adapt cities to climate change. Knowledge on urban green spaces cooling draws mostly on data from temperate climates, and similar research in humid tropical climates often focuses on the dry season. This study presents year-round temperature and humidity data for sixteen stationary sensors in Paramaribo, the capital of Suriname, and remotely sensed land surface temperatures for these locations. Analysis was done of diurnal and seasonal dynamics, the extent of urban green space cooling and the relation between locational characteristics and the micro-climate. Results show cooling up to 2.5 degrees C with distinct seasonal patterns, and that locations exhibiting stronger cooling during the day have smaller temperature ranges of about 4 degrees C at night compared to ranges of 5-7 degrees C at other locations. Locations with more trees and complex vegetation structure have temperatures that are 1-5 degrees C lower than other locations, but this cooling decreases when the ratio with impervious surfaces increases. Land surface temperature differences between more vegetated and built-up areas reach up to 2.5 degrees C. High correlations found among micro-climate indicators imply easier comparison between studies when using any of these indicators, even if not the same ones. The longer term data collected in our study enables investigating urban green space cooling taking into account seasonality typical to the humid-tropics and finds that this cooling can help cities in the Caribbean region adapt to temperature extremes, despite high humidity. Our study further provides an example for overcoming data scarcity and contributes to developing strategies for mitigating increasing heat-related health risks in the humid tropics.
With the increasing intensity, frequency and duration of heat waves, adaptation measures are becoming increasingly relevant and are moving up the agenda of decision-makers. In particular, urban areas require effective solutions due to the urban heat island effect and the increasing number of urban dwellers, including highly vulnerable social groups, such as people with low income or who lack access to public areas. However, despite there being strong agreement about the relevance of urban greening as an adaptation measure, there is still a limited understanding of where such measures should be implemented and for whom they are potentially accessible and beneficial. Through a systematic scoping review of the academic literature, this paper shows critical regional and methodological research gaps in mainstream adaptation research, including a bias towards Asian and European cities, and a lack of assessments of the socio-economic context and the accessibility of urban greening structures. Addressing the spatial issues of urban greening is of great importance for achieving the Sustainable Development Goals, given the ongoing urbanisation trends and projected increase in heat risk.
Heat is an increasing climate risk for cities due to climate change and the urban heat island effect. Extreme heat has inequitable impacts across social, economic, and urban environmental systems. Despite increasing awareness of heat risk, the planning and governance structures for mitigating and managing heat are less understood than those for other climate risks. We studied five large, climatically-diverse U.S. cities to better understand urban heat governance with a focus on the field of urban planning. We first conducted a plan evaluation of these cities’ comprehensive, climate action, and hazard mitigation plans (n = 14) and then interviewed urban planners, resilience professionals, hazard mitigation planners, emergency managers, and public health professionals (n = 22). We found that aspects of heat planning occur across a variety of municipal plans but only a small number of strategies were explicitly framed in terms of heat, suggesting an opportunity to better connect heat with other policy goals. Urban planners tended to play a backseat role relative to other professions, despite the field’s importance for reducing heat-related inequity. Better understanding the role of urban planning within broader governance structures can help policymakers to best engage in heat mitigation and management.
The urban heat island (UHI) effect exacerbates the adverse impact of heat on human health. However, while the UHI effect is further intensified during extreme heat events, prior studies have rarely mapped the UHI effect during extreme heat events to assess its direct temperature impact on mortality. This study examined the UHI effect during extreme heat and non-extreme heat scenarios and compared their temperature-mortality associations in Hong Kong from 2010 to 2019. Four urban heat island degree hour (UHIdh) scenarios were mapped onto Hong Kong’s tertiary planning units and classified into three levels (Low, Moderate, and High). We assessed the association between temperature and non-external mortality of populations living in each UHIdh level for the extreme heat/non-extreme heat scenarios during the 2010-2019 hot seasons. Our results showed substantial differences between the temperature-mortality associations in the three levels under the UHIdh extreme heat scenario (UHIdh_EH). While there was no evidence of increased mortality in Low UHIdh_EH areas, the mortality risk in Moderate and High UHIdh_EH areas were significantly increased during periods of hot temperature, with the High UHIdh_EH areas displaying almost double the risk (RR: 1.08, 95%CI: 1.03, 1.14 vs. RR: 1.05, 95 % CI: 1.01, 1.09). However, other non-extreme heat UHI scenarios did not demonstrate as prominent of a difference. When stratified by age, the heat effects were found in Moderate and High UHIdh_EH among the elderly aged 75 and above. Our study found a difference in the temperature-mortality associations based on UHI intensity and potential heat vulnerability of populations during extreme heat events. Preventive measures should be taken to mitigate heat especially in urban areas with high UHI intensity during extreme heat events, with particular attention and support for those prone to heat vulnerability, such as the elderly and poorer populations.
Many United States (US) cities are experiencing urban heat islands (UHIs) and climate change-driven temperature increases. Extreme heat increases cardiovascular disease (CVD) risk, yet little is known about how this association varies with UHI intensity (UHII) within and between cities. We aimed to identify the urban populations most at-risk of and burdened by heat-related CVD morbidity in UHI-affected areas compared to unaffected areas. ZIP code-level daily counts of CVD hospitalizations among Medicare enrollees, aged 65-114, were obtained for 120 US metropolitan statistical areas (MSAs) between 2000 and 2017. Mean ambient temperature exposure was estimated by interpolating daily weather station observations. ZIP codes were classified as low and high UHII using the first and fourth quartiles of an existing surface UHII metric, weighted to each have 25% of all CVD hospitalizations. MSA-specific associations between ambient temperature and CVD hospitalization were estimated using quasi-Poisson regression with distributed lag non-linear models and pooled via multivariate meta-analyses. Across the US, extreme heat (MSA-specific 99th percentile, on average 28.6 °C) increased the risk of CVD hospitalization by 1.5% (95% CI: 0.4%, 2.6%), with considerable variation among MSAs. Extreme heat-related CVD hospitalization risk in high UHII areas (2.4% [95% CI: 0.4%, 4.3%]) exceeded that in low UHII areas (1.0% [95% CI: -0.8%, 2.8%]), with upwards of a 10% difference in some MSAs. During the 18-year study period, there were an estimated 37,028 (95% CI: 35,741, 37,988) heat-attributable CVD admissions. High UHII areas accounted for 35% of the total heat-related CVD burden, while low UHII areas accounted for 4%. High UHII disproportionately impacted already heat-vulnerable populations; females, individuals aged 75-114, and those with chronic conditions living in high UHII areas experienced the largest heat-related CVD impacts. Overall, extreme heat increased cardiovascular morbidity risk and burden in older urban populations, with UHIs exacerbating these impacts among those with existing vulnerabilities.
The energy balance differences between urban and rural areas give rise to a representative phenomenon of urban climate change called the urban heat island (UHI). The UHI phenomenon, which is exacerbated by global warming effects and urban expansion, exposes urban areas and populations to thermal stress and overheating. Therefore, measuring the intensity of UHI vulnerability is needed to mitigate its effects on health, comfort, energy consumption and infrastructure. Additionally, urban decision makers are looking for methodologies to identify the most vulnerable areas in urban planning. This research aims to investigate areas prone to urban overheating in Montpellier Mediterranean metropolitan area as a representative case study of the French urban planning context. The objective is to develop a methodology for assessing UHI vulnerability based on the interaction of exposure and sensitivity to urban planning policies. Accordingly, a set of fifteen indicators is developed to visualize urban planning policies, exposure and sensitivity to urban overheating. A statistical-based method is applied to determine the individual weights based on the indicators’ variance, which is calculated using principal component analysis (PCA). The spatial and urban planning distribution of vulnerability is then analyzed. The results indicate that the areas with the highest urban planning challenges are most vulnerable to UHI. In fact, the results reveal that these areas have urban planning characteristics likely to aggravate urban overheating. Therefore, this research proposes a methodology for integrating mitigation solutions into urban planning: increase in permeable and green areas; improvement of urban ventilation and heat exchange and decrease in anthropogenic heat generation. It demonstrates that combining urban planning policies with exposure and sensitivity is a new perspective for vulnerability studies. The findings of this study can be utilized by decision makers to better visualize areas susceptible to UHI and plan appropriate mitigation strategies.
In recent decades, urbanization and the dramatic increase in urban populations have exacerbated the urban heat island effect. At present, much attention has been paid to the causes and patterns of the urban heat island effect. However, there are few quantitative studies on the impact of the urban heat island effect. By extracting post world climate data, DEM data, and land use data for 20 years between 2001 and 2020, this paper first studies the variation pattern and spatial distribution characteristics of urban heat islands in New York State, summarizes the seasonal distribution characteristics of temperature, and then uses Giles formula to calculate Tom’s discomfort index and evaluate human thermal comfort, and evaluates the effect of heat island effect on human sensory thermal comfort. The results show that on the time scale, the surface temperature in the study area generally showed a slow upward trend over the past 20 years. For example, in July, the maximum and minimum temperatures increased by 3.2 degrees C and 4.1 degrees C, respectively. At the spatial scale, most of the heat island areas in the study area were distributed in the New York City agglomeration, especially from May to October, when the heat island effect was particularly obvious. The temperature map showed obvious high temperatures. Compared with 2001, the human discomfort index (DI) increased between June and August 2020. The land use map shows that as the city expands, people’s DI index also increases, and the proportion of people who feel uncomfortable with heat increases to 50%. Except for the New York City cluster, other areas were mostly athermicfree. This result shows that excessive urban development concentration seriously affects residents’ quality of life. We should pay attention to the superimposed impact of climate change and urban heat islands on the human discomfort index, and adjust the local high temperature and thermal field area through reasonable planning, strengthening greening, and using building technology to make cities more livable.
Climate change and its corollaries suggest that urban planning tools and strategies need to integrate adaptation and resilience approaches into urban development. This study aims to inform decision makers and the scientific community of the importance of appropriating data on urban adaptation and resilience strategies in the city of N’Djamena. After sampling 519 city dwellers, oriented questionnaires and focus groups were used to collect socio-demographic parameters, major climate risks, their impacts on urban issues and the urban resilience strategies employed. The various exposure and impact indices were used to identify and prioritize climate risks and urban exposure issues with the populations concerned. The study highlighted three major climatic hazards, namely, flooding, heat waves and strong winds, and their impact on social and community facilities, the living environment and human health. Ten vulnerability factors have been identified, of which the intrinsically geophysical factors are most familiar to the city’s population. The principal component analysis (PCA) illustrates ten (10) strategies for adaptation and resilience to urban climate risks. To meet the climatic challenges in urban areas, this study makes several short-, medium- and long-term recommendations to decision makers.
Diabetics are sensitive to high ambient temperature due to impaired thermoregulation. However, available evidence on the impact of prolonged high temperature (i.e., heatwave) on diabetes deaths is limited and whether urban and rural areas differ in heatwave vulnerability remains unknown so far. A time-stratified case-crossover analysis was employed to estimate the association between heatwaves and diabetes deaths in 1486 districts (509 urban and 977 rural areas) of eastern China (Jiangsu Province), 2016-2019. For each decedent, residential heatwave exposure was measured by matching daily mean temperatures to the geocoded residential address. We adopted nine-tiered heatwave definitions incorporating intensity and duration. Stratified analyses by decedents’ characteristics (gender, age, and education) were also conducted. During the study period, there were 18,685 deaths from diabetes (urban proportion: 36.95 %, p-value for urban-rural difference < 0.05). Heatwaves were associated with an increased risk of diabetes deaths, with greater and longer-lasting effects in rural areas than urban areas [e.g., rural odds ratio (OR): 1.19 (95 % confidence interval (CI): 1.14, 1.25) vs. urban OR: 1.09 (95 % CI: 1.05, 1.12)]. Risk of diabetes deaths increased with the intensity of heatwaves in rural areas (p-value for trend <0.01), but not in urban areas. Stratified analyses in rural areas suggested that females and less-educated people were more vulnerable to heatwave-related diabetes deaths. Our findings revealed the urban-rural disparity in the risk of diabetes deaths associated with heatwaves. Rural diabetics should be made aware of the increased death risk posed by heatwaves in the context of warming climate.
As rapid urbanization becomes a key topic within urban studies and planning particularly in the Global South, it needs to be considered what radical implications to urban environment mean. Reviewing literature on urbanization and its implications on urban environment from within the Global South and on sustainable development research and environmental studies, this article discusses eight implications of urbanization-environmental conundrum: pollution, water resource degradation, urban heat island effect, sea level rise and urban flooding, urban sprawl and slum growth, urban agriculture decline, public health deterioration, and urban wetland destruction that question the ontology of urbanization in Global South cities. Drawing on cases from Saudi Arabian cities, findings indicate that sustainable development agenda is skewed towards socio-economic development with limited focus on environmental issues. This situation is threatening the sustainability of rapidly urbanizing cities. The paper proposes a rhizomatic understanding of environmental importance as a roadmap for sustainable and transformative urbanization in Global South. This ontology changes understandings of what sustainable urbanization should be in rapidly growing Global South cities.
OBJECTIVES: (i) To analyze trends and gaps in evidence of health effects on pollutants and extreme temperatures by evidence mapping; (ii) to conduct a cross-sectional survey on the use of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in systematic reviews or meta-analyses (SR/MAs) of health effects on pollutants and extreme temperatures. STUDY DESIGN AND SETTING: PubMed, Embase, the Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched until July 7, 2022. SR/MAs investigated health effects of pollutants and extreme temperatures were included. RESULTS: Out of 22,658 studies, 312 SR/MAs were included in evidence mapping, and the effects of pollutants on cancer and congenital malformations were new research hotspots. Among 16 SR/MAs involving 108 outcomes that were rated using GRADE, the certainty of evidence was mostly downgraded for inconsistency (50, 42.7%), imprecision (33, 28.2%), and risk of bias (24, 20.5%). In contrast, concentration-response gradient (26, 65.0%) was the main upgrade factor. CONCLUSION: GRADE is not widely used in SR/MAs of health effects on pollutants and extreme temperatures. The certainty of evidence is generally low, mainly because of the serious inconsistency or imprecision. Use of the GRADE in SR/MAs of health effects on pollutants and extreme temperatures should strengthen.
The urban heat island (UHI) phenomenon and climate change have become the major concern for city sustainability in wake of global warming and rapid growth in urbanization. This has resulted in increased intensity of heat stress and worsened outdoor thermal environmental conditions in urban microclimates. Water bodies are among the most effective means to alleviate the UHI and improve the thermal environment of urban microclimates. The thermal comfort conditions are observed at the pedestrian’s level in a horizontal direction and at different vertical levels by assessing the reduction in three variables: ambient air temperature, surface temperatures, and alteration of flow velocity. The water body model used in this simulation is first validated using the sub-configuration method by replicating a previous experimental study. Two different scenarios (one with a realistic setting and the other with a representative water body) were studied and the results show that, for isolated streets, the water bodies can effectively improve thermal comfort conditions by reducing ambient air temperature (i.e. a reduction of 0.9 ?) and surface temperature by 3.5 ?, thereby reducing energy consumption. Moreover, a significant increase in the wind velocity was also observed reaching its maximum value at peak times of thermal stress.
Temperature records are being broken across the world, leading to incalculable suffering. The poorest and most disadvantaged people, who contributed the least to global warming, are the ones bearing the most severe consequences of extreme heat because of their limited adaptive capacity. Understanding the needs of the most disadvantaged is imperative to develop fair and adequate strategies to adapt to extreme heat and keep cool. This Perspective discusses how to understand systemic cooling poverty with the aim of informing policy and practice to support vulnerable people. Heatwaves are more frequent and lead to considerable suffering, especially among the poorest and most disadvantaged people. This Perspective discusses the concept of systemic cooling poverty with the aim of informing policy and practice to support vulnerable groups.
Extreme heat causes more deaths than tornadoes and floods combined in the United States. While vulnerable populations are at higher risk of heat-health impacts, anyone can be at risk from extreme heat without appropriate actions. Therefore, heat risk communication efforts, especially those on a wide scale, should engage not only the vulnerable subgroups but also the entire population with the goal of encouraging everyone to take appropriate protective actions during extreme heat events. As one step to achieve this goal, this study examined how to effectively depict people’s susceptibility in heat risk messages. Using a survey experiment (N = 1386), this study compared the effectiveness of four statements that varied how they depicted which types of people were susceptible to heat-health impacts. Relative to traditional messaging that lists specific vulnerable subgroups, a statement that “anyone can be at risk” and a statement without susceptibility information were respectively more effective in making messages personally relevant. Mentioning the “anyone can be at risk” statement and the “certain subgroups are at more risk” statement together reduced belief in the hazard happening compared to mentioning the latter statement individually. Implications for risk communication in broader domains are discussed.
Environmental stressors including high temperature and air pollution cause health problems. However, understanding how the combined exposure to heat and air pollution affects both physical and mental health remains insufficient due to the complexity of such effects mingling with human society, urban and natural environments. Our study roots in the Social Ecological Theory and employs a tri-environmental conceptual framework (i.e., across social, built and natural environment) to examine how the combined exposure to heat and air pollution affect self-reported physical and mental health via, for the first time, the fine-grained nationwide investigation in Australia and highlight how such effects vary across inter- and intra-urban areas. We conducted an ecological study to explore the importance of heat and air quality to physical and mental health by considering 48 tri-environmental confounders through the global and local random forest regression models, as advanced machine learning methods with the advantage of revealing the spatial heterogeneity of variables. Our key findings are threefold. First, the social and built environmental factors are important to physical and mental health in both urban and rural areas, and even more important than exposure to heat and air pollution. Second, the relationship between temperature and air quality and health follows a V-shape, reflecting people’s different adaptation and tolerance to temperature and air quality. Third, the important roles that heat and air pollution play in physical and mental health are most obvious in the inner-city and near inner-city areas of the major capital cities, as well as in the industrial zones in peri-urban regions and in Darwin city with a low-latitude. We draw several policy implications to minimise the inter- and intra-urban differences in healthcare access and service distribution to populations with different sensitivity to heat and air quality across urban and rural areas. Our conceptual framework can also be applied to examine the relationship between other environmental problems and health outcomes in the era of a warming climate.
An extraordinary and unprecedented heatwave swept across western North America (i.e., the Pacific Northwest) in late June of 2021, resulting in hundreds of deaths, a massive die-off of sea creatures off the coast, and horrific wildfires. Here, we use observational data to find the atmospheric circulation variabilities of the North Pacific and Arctic-Pacific-Canada patterns that co-occurred with the development and mature phases of the heatwave, as well as the North America pattern, which coincided with the decaying and eastward movement of the heatwave. Climate models from the Coupled Model Intercomparison Project (Phase 6) are not designed to simulate a particular heatwave event like this one. Still, models show that greenhouse gases are the main reason for the long-term increase of average daily maximum temperature in western North America in the past and future.
The unprecedented 2021 June-July heatwave in Western North America resulted in record-breaking human-perceived heat stress across the region, measured by the humidex considering both air temperature and humidity. During extended summer (June-September), both 95th percentiles of daily maximum humidex (HX95) and air temperature (TX95) have increased over the 1940-2022 period, with even faster intensification in the last two decades (2001-2022). HX95 has increased more than TX95 because of the positive monotonic nonlinear relationship between humidex and air temperature at a given level of relative humidity. The Canadian Earth System Model version 5 (CanESM5) projects a larger increase in human-perceived heat stress than air temperature across the region under low to high emission scenarios (HX95 increases 4.40-7.04 degrees C and TX95 increases 2.92-4.65 degrees C between 1981-2010 and 2041-2060). Moreover, CanESM5 projects significant increases in the frequency of HX and TX conditions that exceed the levels reached in 2021 under intermediate and high emission scenarios. Using humidex, a measure that combines air temperature and humidity, we assessed the human-perceived heat stress during the record-breaking 2021 summer heatwave in Western North America. The 2021 heatwave broke records for both air temperature and humidex, and these two measures have been increasing in the past decades. The heatwave was drier than usual due to high pressure in the atmosphere, clear skies, and more heat warming up the air instead of evaporating water. Humidex will rise more than air temperature under various emission scenarios, making people feel even hotter in the region. The climate model used suggests that humidex values and temperatures that exceed the levels observed in 2021 will happen much more often and be much more intense across the region in the future, with estimates of three to ten times for humidex and two to seven times for air temperature more frequent under intermediate to high emission scenarios by the end of the century. However, the likelihood of extreme humidex in dry conditions, as observed in 2021, will remain low, like historical levels. Unprecedented 2021 heatwave in Western North America resulted in record-breaking human-perceived heat stress, considering both air temperature and humidityExtreme human-perceived heat stress increased at a faster rate than extreme air temperature, both showing rapid increases in recent decadesFor events exceeding 2021 level, a larger future increase in extreme human-perceived heat stress is projected compared to air temperature
The warming of the global climate system is expected to result in significant socio-economic stress, primarily through the occurrence of extreme weather and climate events, with the potential for severe impacts on societies. This was evidenced by the vulnerability of European nations during the 2003 summer heatwave, which resulted in the death of tens of thousands of individuals due to heat-related complications. In this analysis, we examine the summer of 2022 in Spain, a Mediterranean country that is among the most impacted by the effects of climate change. A distinct pattern of the subtropical ridge in the 500 hPa geopotential height, which is typically linked to the occurrence of heatwaves in the Iberian Peninsula (IP), and the atmospheric blocking in the North Atlantic region facilitated the southerly flow of exceptionally warm air masses from Africa towards the IP, contributing to the sustained high temperatures throughout the summer season. Our results show that Spain experienced record -breaking temperatures in nearly half of the country that favored more frequent, intense, and longer-lasting heatwaves compared to previous historical records available from 1893. In general, despite normal rainfall conditions, the extremely high temperatures led to intense drought conditions in most areas. Finally, the pa-leoclimatic records suggest that the average summer temperature of 2022 was unprecedented within the last 700 years, and the driest within the last 279 in NE Spain. These findings highlight the need for measures to mitigate the effects of heat on at-risk populations, and to increase resilience and adaptation to climate change in the future.
Some impacts of climate change that are expected to affect the American workforce are rising temperatures, greater prevalence of wildland fires, increase in Lyme disease, and exposure to insecticides. The purpose of this study was to assess how fatal and non-fatal occupational injuries due to environmental heat, forest/brush fires, Lyme disease, and exposure to insecticides have changed over time in the United States and if there were any significant relationships between national occupational injury/illness data and national temperature trends. METHODS: Linear regression models assessed fatal and non-fatal injuries/illnesses since 1992 by both the frequency of incidents and the proportion of total incidents and the effects of national average temperatures. RESULTS: There were significant increases in occupational fatalities and illnesses due to exposure to environmental heat and national average annual temperatures were predictive of heat exposure fatalities and illnesses. CONCLUSION: Heat exposure is an occupational hazard that must be managed carefully in the coming years. Organizations will need to take more aggressive heat exposure control measures as temperatures continue to rise and remain hotter for longer periods during the year. While not currently showing increasing trends on a national scale, the prevalence of occupational incidents due to forest/brush fires, Lyme disease, and insecticides should be monitored as the United States experiences more of the projected impacts of climate change.
Warmer global climate and urban heat islands (UHIs) interact, by exacerbating heatwaves and increasing the extreme heat days in cities. The implications of added heat stress in urban environments due to intensifying surface UHIs (SUHIs) is of utmost concern. Seasonal, annual and decadal nighttime SUHI intensities (SUHIIs), from 2001 to 2020, for nine major populated cities of India are analyzed. This includes five megacities- Delhi, Mumbai, Kolkata, Bangalore, and Chennai, and four incipient megacities- Hyderabad, Ahmedabad, Surat, and Pune. The key role of increasing urbanization (pre- and post-2010) in expansion and intensification of nighttime SUHIs in India is highlighted. For all cities either pre-monsoon (MAM) or winter (December-February; DJF) seasons show the strongest SUHII development. During the 2001-2010, and the 2011-2020 decade, a nighttime SUHII maxima of respectively (i) 2.1 degrees C and 2.5 degrees C for Delhi, (ii) 1.3 degrees C and 1.5 degrees C for Mumbai, (iii) 1.3 degrees C and 1.5 degrees C for Kolkata, (iv) 0.6 degrees C and 1.0 degrees C Bangalore, (v) 1.7 degrees C and 1.9 degrees C for Chennai, (vi) 1.8 degrees C and 2.3 degrees C for Hyderabad, (vii) 2.8 degrees C and 3.1 degrees C for Ahmedabad, (viii) 1.9 degrees C and 2.4 degrees C for Surat, and (ix) 0.8 degrees C and 1.3 degrees C for Pune is noted. Further, all incipient megacities showed a mean annual growth rate of nighttime SUHII of over 0.007 degrees C/year, substantially greater than in the megacities. High SUHII magnitudes, greater growth rates of SUHII, and huge populations, severely compounds the vulnerability of Indian cities to excessive heat exposure risk, especially during MAM heatwaves. Lastly, the implications of nighttime SUHII findings from the present study, on the increase in heat stress, the loss of labor productivity and the rise in heat-related mortality rate is emphasized. The study recommends implementation of city-specific action plans to mitigate the heat stressed urban environment. Targeted use of cooling strategies in localized hotspots within the urban areas where high intensity SUHIs are likely to form is also suggested.
Droughts reduce hydropower production and heatwaves increase electricity demand, forcing power system operators to rely more on fossil fuel power plants. However, less is known about how droughts and heat waves impact the county level distribution of health damages from power plant emissions. Using California as a case study, we simulate emissions from power plants under a 500-year synthetic weather ensemble. We find that human health damages are highest in hot, dry years. Counties with a majority of people of color and counties with high pollution burden (which are somewhat overlapping) are disproportionately impacted by increased emissions from power plants during droughts and heat waves. Taxing power plant operations based on each plant’s contribution to health damages significantly reduces average exposure. However, emissions taxes do not reduce air pollution damages on the worst polluting days, because supply scarcity (caused by severe heat waves) forces system operators to use every power plant available to avoid causing a blackout.
When co-occurring with elevated levels of ambient relative humidity (RH), hot extremes are more perceivable and consequently more health-damaging. Quantifying changes in humid-heat extremes has therefore gained considerable scientific and societal attention, but a fundamental yet critical aspect to the estimation-data reliability-has been largely downplayed in previous analysis. By comparing similar to 10 observational and reanalysis datasets to fully-homogenized observations across China, we report ubiquitous inhomogeneity in RH series in these popularly-used datasets [including HadISD(H) and ERA5], which accordingly produce unrealistically strong drying trends 2-3 times the homogenized dataset-based estimate during 1979-2013 in warm-moist southeast China. Locally, an inhomogeneity-caused exaggeration of drying by a magnitude of 1% decade(-1) translates into a significant underestimation of increasing rates for frequency and intensity of humid-heat extremes by more than 1.2 days decade(-1) and .07% decade(-1) respectively. From a regional perspective, these inhomogeneous records have underestimated the frequency increase of extremes by up to 2 days decade(-1) and their intensification by up to .4 degrees C decade(-1) in southeast China. Extremes identified via homogenized and non-homogenized datasets also differ in the bivariate joint distribution structure, with former cases featuring similarly hot temperatures yet discernably lower humidity.
Prolonged exposure to extreme heat and direct sunlight can result in illness and death. In urban areas of dense concentrations of pavement, buildings, and other surfaces that absorb and retain heat, harmful environmental exposures to extreme heat and direct sunlight for residents can occur on a daily basis during certain parts of the year. Tree canopies provide shade and help to cool the environment, making mature trees with large canopies a simple and effective way to reduce urban heat and avoid direct sunlight. We develop a demographically representative agent-based model to understand the extent to which different demographics of residents in Norfolk, VA are (in)equitably shaded from direct sunlight and extreme heat conditions during a walk on a clear summer day. In the model each agent represents a different resident of Norfolk, VA. We use the model to assess the extent to which the city’s tree planting plan will be effective in remediating any existing inequities. Our results show that inequitable conditions exist for residents at (1) different education levels, (2) different income levels, and (3) living in different census tracts. Norfolk’s Tree Planting Program effectively reduces the distance residents of all demographics walk in extreme heat and are exposed to direct sunlight. However, residents of the city at lower income levels still experience statistically significantly more extreme heat and direct sunlight exposure due to a lack of tree canopies in summer months than those at higher income levels.
Exposure to extreme temperatures in workplaces implies serious physical hazards to workers. In addition, a poorly acclimatized worker can have reduced performance and alertness. It may therefore be more vulnerable to the risk of accidents and injuries. Due to the incompatibility of standards and regulations with some work en-vironments and a lack of thermal exchange in many personal protective equipment, heat stress remains among the most common physical risks in many industrial sectors. Furthermore, conventional methods of measuring physiological parameters in order to calculate personal thermophysiological constraints are not practical to use during work tasks. However, the emergence of wearable technologies can contribute to real-time measurement of body temperature and the biometric signals needed to assess thermophysiological constraints while actively working. Thus, the present study was carried out in order to scrutinize the current knowledge of these types of technologies by analyzing the available systems and the advances made in previous studies, as well as to discuss the efforts required to develop devices for the prevention of the occurrence of heat stress in real time.
The unsustainable expansion of cities is generating urban heat islands (UHIs) by exchanging (trading) vegetation cover (green) for built impervious surfaces which is associated with heat-related health risks, globally. This phenomenon is exacerbated by climate change and anthropogenic activities like urban population growth, particularly in African cities. This study explores the spatio-temporal trends of land surface temperature (LST), land use land cover (LULC) and their economic and health risks in the Greater Accra Metropolitan Area (GAMA) of Ghana, from 1991 to 2021. We extracted LST/LULC information from Landsat datasets to perform change analysis, alongside an online survey across 56 communities on how LST relates to economic and human health risks perceptions of residents. The results show urbanization of GAMA is trading greens for heated surfaces, impacting communities’ health risks. While the built environment grew (8.6%), the vegetation cover declined (2.5%) and the mean LST rose (0.8 degrees C) in 25 years. A 30 degrees C LST corresponds to the point of inflexion of exchanging green vegetative cover for heated built surfaces. The forest community of Kisseman, the populous community of Dansoman and the harbour city of Tema corresponded to the first, fourth and fifth LST quintiles, changing at -0.05 degrees C, 0.06 degrees C and 0.164 degrees C per year. The common health risks include discomfort from heavy sweating, headaches, dehydration, thirst and skin rashes. These results call for climate action and green spatial planning through urban forestry and environmentalism in GAMA. For urban resilience and sustainable cities, we advocate green-cooling multi-purpose housing, roads, and industrial infrastructure.
Concerns about the health and safety of working populations as well as preventive actions to reduce heat-related illnesses and fatalities have intensified as global warming and heatwaves continue to rise as a result of climate change. This study aimed to translate and culturally-adapted the translated Malay version of the Heat Strain Score Index (HSSI) questionnaire so that it can be utilized as a screening tool for heat stress among the Malay-speaking outdoor workers. The original English version of HSSI underwent forward-backward translation and was cross-culturally adapted into the Malay language by bilingual translators based on established guidelines. The content validation was reviewed by a six-member expert committee including the representative of outdoor workers. Face validation was carried out among 10 outdoor workers involved with various work tasks. Psychometric analysis was conducted based on a cross-sectional study among 188 workers who were eligible. Exploratory Factor Analysis (EFA) was used for construct validity while internal consistency reliability was performed using Cronbach’s alpha. The interclass correlation coefficient (ICC) was used to calculate the test-retest reliability. Both content and face validity were acceptable with the overall content validity index being 1.00, while the universal face validity index was 0.83. The factor analysis using varimax rotation extracted four factors which explained 56.32% of the cumulative percentage of variance and factor loading ranging from 0.415 to 0.804. The internal consistency reliability was acceptable with Cronbach’s alpha ranging from 0.705 to 0.758 for all the factors. The overall ICC value was 0.792 (95% CI; 0.764-0.801) which signifies good reliability. The findings from this study indicate that the Malay version of HSSI is a reliable and culturally-adapted instrument. Further validation is needed so that it can be used extensively assess the heat stress among susceptible Malay-speaking outdoor workers in Malaysia who are exposed to hot humid environments.
Rising temperatures that occur in cities resulted in the urban heat island (UHI) which could also amplify the thermal heat stress, leading to climate-related human mortality. Our study investigated the UHI effect and thermal heat stress of heat index (HI) in the U.S. cities of arid, continental, temperate, and tropical climate zones. A long-term simulation of the UHI and HI was conducted using Community Land Model version 5.0 from 1990 to 2014. The relationship between UHI and HI with climate and energy flux variables are analyzed with divided study periods (1990-2000 and 2001-2014) for the urban impact assessment. Higher sensible heat was reported, particularly in the arid and tropical cities. Further, temperate climate showed increasing annual trends for UHI and Delta HI (urban-rural difference of HIs). The later period (2001-2014) demonstrated greater UHI and Delta HI trends, implying a notable change in climate and urban expansion. The UHI, ranging from 0.73 degrees C to 2.07 degrees C, was more intense compared with Delta HI, at 0.14 degrees C to 1.23 degrees C. The UHI was positively correlated with temperatures in hot cities, while precipitation is the main driver in the continental city. For Delta HI, the relationship with temperatures were dominant in all climate zones.
With increasing urbanisation and climate change, citizens are more frequently exposed to heat stress. In the current pragmatists’ discourse, efforts to adapt cities to deteriorating climate conditions should reflect not only the objective (physical) effects of the proposed measures, but also citizens’ preferences, which influence the perception schemata and mental image of a place. This study employs the innovative approach of mental mapping, using an online survey to identify mental hotspots and coolspots in two Central European cities of Plzen and Olomouc (Czechia). Map points and polygons, indicating locations thermally (un)comfortable to individual respondents, are combined into aggregate mental maps. Personal behavioural adaptation measures and citizens’ preferences for measures ameliorating thermal discomfort in thermally uncomfortable areas are analysed. The results show that the most preferred measures for improving thermal comfort are trees and parks, and a combination of greenery with blue elements. Other measures, such as temporary greenery, green roofs and facades, exterior shading elements, water spraying and misting, and street sprinkling, are substantially less frequently proposed. However, there are spatial differences between the preferred measures. The character of mental coolspots confirms citizens’ preferences for trees and parks and its synergy with blue elements and provides inspiration for positive change in (mental) hotspots. Moreover, the uneven spatial distribution of mental coolspots in the studied cities revealed neighbourhoods with few or no cooling opportunities in public areas.
Epidemiological evidence suggests that outdoor climate strongly influences human health. However, since people spend 90% of their time indoors, the indoor environment may be a better indicator of epidemiological diseases and infections. Despite previous studies exploring the relationship between indoor and outdoor thermal environments, little is known about this relationship in China’s subtropical countryside. This study aims to investigate the indoor-outdoor relationship of air temperature and relative humidity, examine the spatial and temporal variation characteristics of the indoor thermal environment, and estimate indoor thermal comfort. We monitored outdoor and indoor air temperature and relative humidity for two years using wireless IoT temperature/humidity button sensors in fourteen residential buildings. Our results show that the average vertical spatial variance range of air temperature was largest in summer (2.11 degrees C) and smallest in fall (1.23 degrees C), while horizontal spatial variation was negligible. The average daily temporal variation range was largest on the third floor (2.3 degrees C) and smallest on the first floor (1.5 degrees C). Indoor air temperatures were highly correlated with outdoor air temperatures, with a linear correlation coefficient greater than 0.9. The relationship between indoor and outdoor relative humidity was moderate, with an average correlation coefficient of 0.54. Furthermore, we found that almost all uncomfortable indoor air temperature points were lower than the lower temperature limit of the adaptive comfort band in all seasons, and almost no indoor temperatures in summer and winter were within the PMV comfort band.
Often described as a silent killer or invisible threat, heat contributes to more fatalities than other types of climate change-exacerbated extreme weather, and the impacts are especially pronounced in racialised and segregated urban communities. In an era of climate urbanism, efforts to scientifically categorise heat and link heat to health impacts are helping to support early warning systems and urban investments in heat mitigation infrastructure, bolstering climate urbanism branding strategies. Meanwhile, relatively little research has examined lived experiences with heat-related dangers, and cold rarely features in climate health discourse even though it contributes to many more fatalities than heat. Here, I present household interviews on thermal lived experiences that inform a notion of thermal (in)security, asserting that heat and cold-related threats are forms of structural violence intertwined with housing, energy and related social determinants of health. Juxtaposing city-level climate refuge narratives with lived experiences on the ground, I find that residents’ thermal insecurities are linked to the interpersonal, contractual and bureaucratically-structured relationships that constrain adaptations to heat and cold. This research contributes to an emerging critical heat studies agenda, which aims to shift thermal discourse from its current meteorological orientation to instead centre people’s everyday adaptive thermal practices and struggles.
It has been observed that high temperature exposure is associated with a reduction in lung function and some possible biological mechanisms have been suggested. However, it is unclear if thermal perception plays a role in the association. From September 3rd to 15th, 2018, in Guangzhou, China, we repeatedly measured daily thermal perception and lung function among 126 participants with outdoor military training. We performed a linear mixed model and stratified analyses by the origin of students, gender, and the training period to evaluate the effects of thermal perception on lung function. A total of 399 measurements were collected. Per vote increase in thermal sensation vote towards the “hot” direction was associated with a - 0.04 L (95% CI: - 0.08 to - 0.01) decrease in forced vital capacity (FVC), and - 0.04 L (95% CI: - 0.08 to - 0.01) decrease in forced expiratory volume in 1 s (FEV(1)). Per grade increase towards the “very uncomfortable” direction for thermal comfort vote was associated with an increased percentage of forced expiratory volume in 1 s (FEV(1)%) by 1.52% (95% CI: 0.18 to 2.86). For thermal preference, with preferred cooler vote increased by one level, FVC and FEV(1) decreased by - 0.05 L/s (95% CI: - 0.08 to - 0.02) and - 0.05L/s (95% CI: - 0.08 to - 0.02), respectively. The effects of thermal perception on lung function were stronger among non-local and in the first week of training. Our study suggests that in the same high-temperature environment, thermal perception is associated with lung function, even in healthy adults.
In the modern world with climate changes and increasing pollution, different types of stress are becoming an increasing challenge. Hence, the identification of reliable biomarkers of stress and accessible sensors to measure such biomarkers are attracting increasing attention. In the current study, we demonstrate that the activity, but not the expression, of the ubiquitous enzyme topoisomerase 1 (TOP1), as measured in crude cell extracts by the REEAD sensor system, is markedly reduced in response to thermal stress in both fruit flies (Drosophila melanogaster) and cultivated human cells. This effect was observed in response to both mild-to-moderate long-term heat stress and more severe short-term heat stress in D. melanogaster. In cultivated HeLa cells a reduced TOP1 activity was observed in response to both cold and heat stress. The reduced TOP1 activity appeared dependent on one or more cellular pathways since the activity of purified TOP1 was unaffected by the utilized stress temperatures. We demonstrate successful quantitative measurement of TOP1 activity using an easily accessible chemiluminescence readout for REEAD pointing towards a sensor system suitable for point-of-care assessment of stress responses based on TOP1 as a biomarker.
Heat and tropospheric ozone have acute impacts on rates of premature death. Warm temperatures affect the photochemical processes in ozone formation, suggesting ozone as a mediator of the acute health effect of heat on mortality. We assembled a summertime daily time-series data set of 15 French urban areas during 2000-2015 to decompose the acute total effect of heat waves on mortality into natural direct and indirect effects using a regression-based product method under the potential outcomes framework. For each area, we estimated the effect of heat waves on mortality using a quasi-Poisson model with adjustment for covariates such as lagged nitrogen dioxide concentration, and we modeled ozone with a linear regression of heat waves and the same set of covariates. We pooled estimates across areas using random-effects models. We also provide R software code (R Foundation for Statistical Computing, Vienna, Austria) with which to reproduce or replicate our analysis. Most areas demonstrated evidence of mediation by ozone, with the pooled relative risks for natural indirect effects being 1.03 (95% confidence interval (CI): 1.02, 1.05), 1.03 (95% CI: 1.01, 1.04), and 1.04 (95% CI: 1.00, 1.07) for nonaccidental, cardiovascular, and respiratory mortality, respectively. We found evidence of a mediation effect by ozone in the association between heat waves and mortality in France which varied by geographic location and cause of mortality.
With growing global concerns about climate change, the significance of urban greenery in architecture and urban planning is becoming increasingly apparent. Urban vegetation naturally cools cities, provides comfort and clean air, and has positive social, health, and economic effects. It is essential to ensure passive thermal comfort and safeguard biodiversity. It is widely recognized that urban greenery not only withstands severe outdoor climatic events, but also symbiotically interacts with buildings and citizens. Several studies demonstrated the potential of vegetation to provide outdoor thermal comfort, air purification, noise reduction, and various other ecosystem services. To emphasize the potential of urban green spaces to interact with the local urban morphology in terms of microclimatic aspects, the research examines the dynamic connection between various urban textures and urban green spaces. This study emphasizes how urban green spaces, such as parks, green spaces, and urban greenery, respond to temperature variations in both the present scenario and the projected future. Central to this contribution is the examination of the relationship between urban vegetation and its potential to reduce and counteract urban overheating in both current and projected future scenarios. The aim is to evaluate the effectiveness of urban vegetation compared to dense urban textures. The interaction between urban block morphology, building types, vegetation, and microclimates is presented here for comparative assessment, highlighting the different thermal behaviour and outdoor comfort responses in various urban areas in current and projected scenarios. Using a microclimatic simulation tool, the research will delve deeper into the potential and constraints associated with the role of urban greens in addressing the increasing temperatures in climate change. This paper presents a comparative microclimatic evaluation of two selected green areas in Parma, Italy, within different urban contexts. The evaluation compares the current situation with a projected future scenario (2050) to determine the most effective factors for mitigating overheating phenomena in existing cities.
Global climate change has contributed to the intensity, frequency, and duration of heatwave events. The association between heatwaves and elderly mortality is highly researched in developed countries. In contrast, heatwave impact on hospital admissions has been insufficiently studied worldwide due to data availability and sensitivity. In our opinion, the relationship between heatwaves and hospital admissions is worthwhile to explore as it could have a profound impact on healthcare systems. Therefore, we aimed to investigate the associations between heatwaves and hospitalisations for the elderly by age group in Selangor, Malaysia, from 2010 to 2020. We further explored the impact of heatwaves on the risks of cause-specific hospital admissions across age groups within the elderly. This study applied generalized additive models (GAMs) with the Poisson family and distributed lag models (DLMs) to estimate the effect of heatwaves on hospitalisations. According to the findings, there was no significant increase in hospitalisations for those aged 60 and older during heatwaves; however, a rise in mean apparent temperature (ATmean) by 1 °C significantly increased the risk of hospital admission by 12.9%. Heatwaves had no immediate effects on hospital admissions among elderly patients, but significant delay effects were identified for ATmean with a lag of 0-3 days. The hospital admission rates of the elderly groups started declining after a 5-day average following the heatwave event. Females were found to be relatively more vulnerable than males during heatwave periods. Consequently, these results can provide a reference to improve public health strategies to target elderly people who are at the greatest risk of hospitalisations due to heatwaves. Development of early heatwave and health warning systems for the elderly would assist with preventing and reducing health risks while also minimising the burden on the whole hospital system in Selangor, Malaysia.
BACKGROUND: Pregnancy loss, a major health issue that affects human sustainability, has been linked to short-term exposure to ground-surface ozone (O(3)). However, the association is inconsistent, possibly because of the co-occurrence of O(3) and heat episodes, as increased temperature is a risk factor for pregnancy loss. To explain this inconsistency, the effect of O(3) on pregnancy loss needs to be examined jointly with that of high temperature. METHODS: A total of 247,305 pregnancy losses during the warm season were extracted from fetal death certificates from the 386 counties in contiguous United States from 1989 to 2005. We assessed environmental exposure based on the daily maximum 8 h average of O(3) from Air Quality System monitors and the 24 h average temperature from the North American Regional Reanalysis product. We conducted a bidirectional, time-stratified case-crossover study of the association between pregnancy loss and exposures to O(3) and temperature and their multiplicative interaction. The main time window for the exposure assessment was the day of case occurrence and the preceding 3 days. To estimate the association, we used conditional logistic regression with adjustment for relative humidity, height of the planetary boundary layer, and holidays. Sensitivity analyses were performed on the lagged structure, nonlinearity, and between-subpopulation heterogeneity of the estimated joint effect. RESULTS: The joint effect was first estimated by the regression against categorical exposure by tertile. Compared to the low-low exposure group (O(3) ≤ 78 μg/m(3) and temperature ≤ 18 °C), the odds of pregnancy loss was significantly higher by 6.0 % (95 % confidence interval [CI] 2.4-9.7 %), 9.8 % (6.1-13.8 %), and 7.5 % (4.7-10.3 %) in the high-low (>104 μg/m(3) and ≤18 °C), low-high (≤78 μg/m(3) and >23 °C), and high-high (>104 μg/m(3) and >23 °C) groups. The model of linear exposure and the multiplicative interaction yielded similar results. Each increment of 10 μg/m(3) in O(3) and 1 °C in temperature was associated with a 3.0 % (2.0 %-4.0 %) and 3.9 % (3.5 %-4.3 %), respectively, increase in the odds of pregnancy loss. A decrease in odds of 0.2 % (0.1 %-0.2 %) was associated with the temperature × O(3) interaction. The finding of an antagonistic interaction between temperature and O(3) was confirmed by models parametrizing the joint exposure as alternative nonlinear terms (i.e., a two-dimensional spline term or a varying-coefficient term) and was robust to a variety of exposure lags and stratifications. Therefore, the marginal effect of O(3) was estimated to vary by climate zone. A significant association between O(3) and pregnancy loss was observed in the northern, but not southern, United States. CONCLUSION: Joint exposure to O(3) and high temperature can increase the risk for pregnancy loss. The adverse effect of O(3) is potentially modified by ambient temperature. In high-latitude cities, controlling for O(3) pollution could protect maternal health.
The rise in air temperature in urban areas has been attracting the attention of urban climate researchers for years now, focusing on the intensity of the so-called Urban Heat Island (UHI) phenomenon. Recently, though, it has been rightly questioned whether the concept of UHI intensity is helpful in assessing mitigation of urban heat stress, especially since the concept does not reflect the spatial and temporal microscale climatic differences between adjacent intra-urban locations and the much lower magnitude of the UHI effect during daytime. Moreover, while UHI research is focused on near-surface air temperature levels, the existing evidence makes it clear that air temperature does not fully describe the intensity of street-level daytime heat stress during the hot season. This study attempted to evaluate the correlation between exposure to shortwave radiation and significant increases in heat stress under summer conditions through extensive monitoring. Using a mobile measurement setup we monitored summer daytime outdoor conditions in 148 unique locations in Tel Aviv-Yafo, a coastal city with a hot-summer Mediterranean climate. Analysis of the resulting dataset showed the decisive effect of solar exposure on significantly increased heat stress according to three common thermal comfort indices. A much weaker correlation was observed between comfort levels and air temperature, relative humidity, and wind speed levels. These findings support the conclusion that under summer daytime conditions in similarly hot climates the provision of shade has a far stronger positive effect on reducing heat stress than, for example, feasible reductions in air temperatures or increases in wind speed.
INTRODUCTION: Urban ozone pollution in China is becoming increasingly serious. Climate warming, high temperatures, and ozone pollution all have significant impacts on human health. However, the synergistic effects of high temperatures and ozone pollution in summer on human health are rarely studied. China is at a critical stage of environmental pollution control. Assessing the health impact of high temperatures and ozone exposure on the number of deaths from circulatory diseases is of great significance for formulating ozone-related prevention and control policies. METHODS: This study uses daily data on deaths from circulatory system diseases in Shijiazhuang from June to August during the summer of 2013-2016, as well as concurrent meteorological data and concentration of O(3) and PM(2.5) pollution data. The generalized additive model (GAM) with Poisson distribution, smooth curve threshold effect, and saturation effect method is used to control for confounding effects. RESULTS: The study evaluates the impact of short-term exposure to temperature and ozone on deaths from circulatory system diseases and the synergistic effect after controlling for confounding factors. The results show that the impact of temperature and ozone on deaths from circulatory system diseases in Shijiazhuang is nonlinear, with a temperature threshold of 27.5°C and an ozone concentration threshold of 100 μg/m(3). With an increase of temperature by 1°C, the risk of deaths for total population, men and women are 6.8%, 4.6% and 9.3%, respectively. The increase in temperature and ozone concentration has a greater impact on women; in men, the increase has a lag effect of 2 to 3 days, but the lag did not affect women. DISCUSSION: In conclusion, high temperatures and high ozone concentration have synergistic enhancement effects on circulatory system diseases. Prevention and scientific management strategies of circulatory system diseases in high temperatures and high ozone environments should be strengthened.
The risk of high-temperature-related diseases is increasing owing to global warming. This study aimed to assess the trend of disease burden caused by high temperatures in Mainland China from 1990 to 2019 and to predict the trend of disease burden over the next 10 years. The latest data were downloaded from the Global Burden of Disease Database (GBD) for analysis, and the disease burden related to high temperature was described by mortality and disability-adjusted life-years (DALYs) and stratified by etiology, sex, and age. Statistical analyses were performed using the R software. In 2019, there were 13,907 deaths attributed to high temperatures in Mainland China, and this was 29.55% higher than the 10,735 deaths in 1990. Overall, the age-standardized mortality and DALYs attributed to high temperatures showed a downward trend from 1990 to 2019. We observed an etiological shift in high-temperature-related diseases. The age-standardized DALYs contribution attributed to high temperatures in 1990 was mainly from communicable, maternal, neonatal, and nutritional diseases (CMNND) (21.81/100,000), followed by injury (18.30/100,000) and non-communicable diseases (10.40/100,000). In 2019, the largest contribution shifted to non-communicable diseases (10.07/100,000), followed by injuries (5.21/100,000), and CMNND (2.30/100,000). The disease burden attributed to high temperatures was higher in males than in females and increased with age. In 2030, the mortality rate and DALYs due to high temperatures are predicted to decrease further, and the largest contribution will come from chronic non-communicable diseases, the occurrence of which will remain at a high level over the next 10 years. The burden of disease due to high temperatures in Mainland China is still heavy, mainly due to population aging and an increase in non-communicable diseases.
The 2021 unprecedented Pacific Northwest heatwave broke temperature records by extraordinary amounts. Impacts included hundreds of deaths, mass-mortalities of marine life, increased wildfires, reduced crop and fruit yields, and river flooding. In late June 2021 a heatwave of unprecedented magnitude impacted the Pacific Northwest region of Canada and the United States. Many locations broke all-time maximum temperature records by more than 5 & DEG;C, and the Canadian national temperature record was broken by 4.6 & DEG;C, with a new record temperature of 49.6 & DEG;C. Here, we provide a comprehensive summary of this event and its impacts. Upstream diabatic heating played a key role in the magnitude of this anomaly. Weather forecasts provided advanced notice of the event, while sub-seasonal forecasts showed an increased likelihood of a heat extreme with lead times of 10-20 days. The impacts of this event were catastrophic, including hundreds of attributable deaths across the Pacific Northwest, mass-mortalities of marine life, reduced crop and fruit yields, river flooding from rapid snow and glacier melt, and a substantial increase in wildfires-the latter contributing to landslides in the months following. These impacts provide examples we can learn from and a vivid depiction of how climate change can be so devastating.
Compound dry-hot extreme (CDHE) events pose greater risks to the environment, society, and human health than their univariate counterparts. Here, we project decadal-length changes in the frequency and duration of CDHE events for major U.S. cities during the 21st century. Using the Weather Research and Forecasting (WRF) model coupled to an urban canopy parameterization, we find a considerable increase in the frequency and duration of future CDHE events across all U.S. major cities under the compound effect of high-intensity GHG- and urban development-induced warming. Our results indicate that while GHG-induced warming is the primary driver of the increased frequency and duration of CDHE events, urban development amplifies this effect and should not be neglected. Furthermore, We show that the highest frequency amplification of major CDHE events is expected for U.S. cities across the Great Plains South, Southwest, and the southern part of the Northwest National Climate Assessment regions.
Climate change is increasing heat-associated mortality particularly in hotter parts of the world. The Northern Territory is a large and sparsely populated peri-equatorial state in Australia. The Northern Territory has the highest proportion of Aboriginal and Torres Strait Islander people in Australia (31%), most of whom live in remote communities of over 65 Aboriginal Nations defined by ancient social, cultural, and linguistic heritage. The remainder non-Indigenous population lives mostly within the two urban centres (Darwin in the Top End region and Alice Springs in the Centre region of the Northern Territory). Here we aim to compare non-Indigenous (eg, high income) and Indigenous societies in a tropical environment and explore the relative importance of physiological, sociocultural, and technological and infrastructural adaptations to heat. METHODS: In this case time series, we matched temperature at the time of death using a modified distributed lag non-linear model for all deaths in the Northern Territory, Australia, from Jan 1, 1980, to Dec 31, 2019. Data on deaths came from the national registry of Births, Deaths and Marriages. Cases were excluded if location or date of death were not recorded or if the person was a non-resident. Daily maximum and minimum temperature were measured and recorded by the Bureau of Meteorology. Hot weather was defined as mean temperature greater than 35°C over a 3-day lag. Socioeconomic status as indicated by Index of Relative Socioeconomic Disadvantage was mapped from location at death. FINDINGS: During the study period, 34 782 deaths were recorded; after exclusions 31 800 deaths were included in statistical analysis (15 801 Aboriginal and 15 999 non-Indigenous). There was no apparent reduction in heat susceptibility despite infrastructural and technological improvements for the majority non-Indigenous population over the study period with no heat-associated mortality in the first two decades (1980-99; relative risk 1·00 [95% CI 0·87-1·15]) compared with the second two decades (2000-19; 1·14 [1·01-1·29]). Despite marked socioeconomic inequity, Aboriginal people are not more susceptible to heat mortality (1·05, [0·95-1·18]) than non-Indigenous people (1·18 [1·06-1·29]). INTERPRETATION: It is widely believed that technological and infrastructural adaptations are crucial in preparing for hotter climates; however, this study suggests that social and cultural adaptations to increasing hot weather are potentially powerful mechanisms for protecting human health. Although cool shelters are essential during extreme heat, research is required to determine whether excessive exposure to air-conditioned spaces might impair physiological acclimatisation to the prevailing environment. Understanding sociocultural practices from past and ancient societies provides insight into non-technological adaptation opportunities that are protective of health. FUNDING: None.
Significant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM. METHODS: We conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM(2.5) and NO(2)), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined. RESULTS: In total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9-14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM(2.5) during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts. CONCLUSION: Using a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.
The evidence of non-optimum ambient temperature and humidity-related mortality is widely reported. However, the joint effects of high humidity and extreme temperatures on mortality remain to understand. We collected mortality data and meteorological variables for 91 counties in central China, from 2017 to 2020. A traditional time-series model with a distributed lag non-linear model was first employed to estimate the location-specific associations between extreme temperatures or high humidity and extreme temperatures and mortality. Then, we conducted a meta-analysis to pool the county-specific estimated effect values. A total of 1,196,916 non-accidental deaths occurred during the study period. Extreme heat increased non-accidental mortality with a relative risk (RR) of 1.071 ((95% confidence interval (CI):1.022, 1.121), while extreme cold worsened the risk of stroke mortality by 2.817 (95 CI%: 1.084, 7.321). For the effect of extreme cold, high humidity increased the RR of 3.908 (95 CI%: 2.721, 5.612) in non-accidental mortality and the effect was strongest in stroke with 5.320 (95 CI%: 3.395 vs 8.338). Under the joint effect of extreme cold and high humidity, there is a lagged association with the mortality risks peaked at 12d for non-accidental mortality. High humidity significantly enhances the risk of extreme cold-related non-accidental mortality, especially regarding stroke. Our findings will assist in the development of preparedness and prevention strategies in Hunan Province and even throughout China to reduce the immediate weather-related impacts.
In the present era of global warming and dramatically increased environmental pollution posing a threat to animal life, the understanding and manipulation of organisms’ resources of stress tolerance is apparently a question of survival. Heat stress and other forms of stressful factors induce a highly organized response of organisms at the cellular level where heat shock proteins (Hsps) and in particular Hsp70 family of chaperones are among the major players in the protection from the environmental challenge. The present review article summarizes the peculiarities of the Hsp70 family of proteins protective functions being a result of many millions of years of adaptive evolution. It discusses the molecular structure and specific details of hsp70 gene regulation in various organisms, living in diverse climatic zones, with a special emphasis on the protective role of Hsp70 in adverse conditions of the environment. The review discusses the molecular mechanisms underlying Hsp70-specific properties that emerged in the course of adaptation to harsh environmental conditions. This review also includes the data on the anti-inflammatory role of Hsp70 and the involvement of endogenous and recombinant Hsp70 (recHsp70) in proteostatic machinery in various pathologies including neurodegenerative ones such as Alzheimer’s and Parkinson’s diseases in rodent model organisms and humans in vivo and in vitro. Specifically, the role of Hsp70 as an indicator of disease type and severity and the use of recHsp70 in several pathologies are discussed. The review discusses different roles exhibited by Hsp70 in various diseases including the dual and sometimes antagonistic role of this chaperone in various forms of cancer and viral infection including the SARS-Cov-2 case. Since Hsp70 apparently plays an important role in many diseases and pathologies and has significant therapeutic potential there is a dire need to develop cheap recombinant Hsp70 production and further investigate the interaction of externally supplied and endogenous Hsp70 in chaperonotherapy.
Myocardial infarction (MI) is a leading cause of morbidity and mortality in the United States and its risk increases with extreme temperatures. Climate change causes variability in weather patterns, including extreme temperature events that disproportionately affect socioeconomically disadvantaged communities. Many studies on the health effects of extreme temperatures have considered community-level socioeconomic disadvantage. OBJECTIVES: To evaluate effect modification of the relationship between short-term ambient temperature and MI, by individual-level insurance status (insured vs. uninsured). METHODS: We identified MI hospitalizations and insurance status across New York State (NYS) hospitals from 1995 to 2015 in the New York Department of Health Statewide Planning and Research Cooperative System database, using International Classification of Diseases codes. We linked short-term ambient temperature (averaging the 6 hours preceding the event [MI hospitalization]) or nonevent control period in patient residential zip codes. We employed a time-stratified case-crossover study design for both insured and uninsured strata, and then compared the group-specific rate ratios. RESULTS: Over the study period, there were 1,095,051 primary MI admissions, 966,475 (88%) among insured patients. During extremely cold temperatures (<5.8 °C) insured patients experienced reduced rates of MI; this was not observed among the uninsured counterparts. At warmer temperatures starting at the 65th percentile (15.7 °C), uninsured patients had higher rates than insured patients (e.g., for a 6-hour pre-event average temperature increase from the median to the 75th percentile, the rate of MI increased was 2.0% [0.0%-4.0%] higher in uninsured group). CONCLUSIONS: Uninsured individuals may face disproportionate rates of MI hospitalization during extreme temperatures.
Over the last two decades, vector-borne pathogens (VBPs) have changed their distribution across the globe as a consequence of a variety of environmental, socioeconomic and geopolitical factors. Dirofilaria immitis and Dirofilaria repens are perfect exemplars of European VBPs of One Health concern that have undergone profound changes in their distribution, with new hotspots of infection appearing in previously non-endemic countries. Some areas, such as the United Kingdom, are still considered non-endemic. However, a combination of climate change and the potential spread of invasive mosquito species may change this scenario, exposing the country to the risk of outbreaks of filarial infections. Only a limited number of non-autochthonous cases have been recorded in the United Kingdom to date. These infections remain a diagnostic challenge for clinicians unfamiliar with these “exotic” parasites, which in turn complicates the approach to treatment and management. Therefore, this review aims to (i) describe the first case of D. repens infection in a dog currently resident in Scotland, (ii) summarise the available literature on Dirofilaria spp. infections in both humans and animals in the United Kingdom and (iii) assess the suitability of the United Kingdom for the establishment of these new VBPs.
Increases in ambient temperatures and the frequency of extreme heat events constitute important burdens on global public health. However, evidence on their effects on public health is limited and inconclusive in China. In this study, data on daily deaths recorded in 33 Chinese cities from 2007 to 2013 was used to evaluate the effect of heat on mortality in China. In addition to the definition of a heatwave established by the China Meteorological Administration, we combined four city-specific relative thresholds (90th, 92.5th, 95th, and 97.5th percentiles) of the daily mean temperature during the study period and three durations of ? 2, ? 3, and ? 4 days, from which 13 heatwave definitions were developed. Then, we estimated the main and added effects of heat at the city level using a quasi-Poisson generalized additive model combined with a distributed lag nonlinear model. Next, the estimates for the effects were pooled at the national level using a multivariable meta-analysis. Subgroup analysis was performed according to sex, age, educational attainment, and spatially stratified heterogeneity. The results showed that the mortality risk increased from 22.3% to 37.1% due to the effects of the different heatwave definitions. The added effects were much lower, with the highest increase of 3.9% (95% CI: 1.7%-6.1%) in mortality risk. Females, the elderly, populations with low educational levels, and populations living inland in China were found to be the most vulnerable to the detrimental effects of heat. These findings have important implications for the improvement of early warning systems for heatwaves.
Climate services for health can facilitate health resilience and adaptation to climate change, particularly if they are well-calibrated to promote wellness and save lives. In this study, the status of climate services for health in South Africa’s Agincourt sub-district, Mpumalanga province, was assessed. A qualitative case study methodology encompassing multiple methods of data collection was used. The results show that climate services for health in the Agincourt sub-district, albeit essential, are fragmented and underdeveloped. Scientifically informed heathealth services are non-existent. Notwithsatnding this gap, healthcare and allied professionals are aware of the importance of climate services for health. The main barrier to climate services delivery is the paucity of interagency coordination; for example, coordination to plan and respond to climate-health information between the South African Weather Services and the Departments of Health and Education is lacking. Inclusive climate services for health are essential for positive prevention and treatment outcomes. Future studies must provide an investment case for climate services for health, demonstrating the benefits of acting and the costs of inaction.
Heatwaves are becoming more frequent under climate change and can lead to thousands of excess deaths. Adaptation to extreme weather events often occurs in response to an event, with communities learning fast following unexpectedly impactful events. Using extreme value statistics, here we show where regional temperature records are statistically likely to be exceeded, and therefore communities might be more at-risk. In 31% of regions examined, the observed daily maximum temperature record is exceptional. Climate models suggest that similar behaviour can occur in any region. In some regions, such as Afghanistan and parts of Central America, this is a particular problem – not only have they the potential for far more extreme heatwaves than experienced, but their population is growing and increasingly exposed because of limited healthcare and energy resources. We urge policy makers in vulnerable regions to consider if heat action plans are sufficient for what might come. The global risk of record-breaking heatwaves is assessed, with the most at-risk regions identified. It is shown that record-smashing events that currently appear implausible could happen anywhere as a result of climate change.
We aim to explore the link between maternal weekly temperature exposure and CHD in offspring and identify the relative contributions from heat and cold and from moderate and extreme atmospheric temperature. From January 2019 to December 2020, newborns who were diagnosed with CHD by echocardiography in the Network Platform for Congenital Heart Disease (NPCHD) from 11 cities in eastern China were enrolled in the present study. We appraised the exposure lag response relationship between temperature and CHDs in the distributed lag nonlinear model and further probed the pooled estimates by multivariate meta-analysis. We further performed the exposure-response curves in extreme temperature (5(th) percentile for cold and 95(th) for hot events). We also delve into the cumulative risk ratios (CRRs) of temperature on CHDs in general and subgroups. In this study, 5904 of 983, 523 infants were diagnosed with CHDs. The temperature-CHD combination performed positive significance in two exposure windows, gestational weeks 10-16 and 26-31, and reached the maximum effect in the 28th week. Compared with extreme cold (5(th), 6.14℃), these effects were higher in extreme heat (95(th), 29.26℃). The cumulative exposure-response curve showed a steep nonlinear rise in the hot tail but showed non-significance at low temperatures. In this range, the CRRs of temperature showed an increment to a ceiling of 3.781 (95% CI: 1.460-10.723). The temperature- CHD curves for both sex groups showed a general growth trend. No statistical significance was observed between these two groups (P = 0.106). The cumulative effect of the temperature related CHD was significant in regions with lower education levels (maximum CRR was 9.282 (3.019-28.535)). A degree centigrade increase in temperature exposure was associated with the increment of CHD risk in the first and second trimesters, especially in extreme heat. Neonates born in lower education regions were more vulnerable to temperature-related CHDs.
Household air conditioning is one of the most effective approaches for reducing the health impacts of heat exposure; however, few studies have measured the prevalence of household air conditioning in Canada. DATA AND METHODS: Data were obtained from the 2017 Canadian Community Health Survey and the 2017 Households and the Environment Survey. Statistics Canada linked the survey respondents and created survey weights. Four heat-vulnerable populations were defined: older adults, older adults living alone, older adults with at least one health condition associated with reduced thermoregulation and older adults living alone and with a health condition associated with reduced thermoregulation. Weighted ratios and logistic regression models were used to analyze person-level air conditioning rates for national, regional and heat-vulnerable populations. RESULTS: Approximately 61% of the national population had household air conditioning. Regional rates ranged between 32% in British Columbia and 85% in Ontario. People living alone and people who did not own a home were significantly less likely to have air conditioning in Canada and in most regions. One heat vulnerable group, older adults living alone, had significantly lower air conditioning rates compared with the national and Ontario averages, at 56% and 81%, respectively. INTERPRETATION: This study is the first to quantify air conditioning prevalence in Canada at the person-level. The results of this study may inform heat-health policies and climate change adaptation strategies that aim to identify populations with high risks of heat-related mortality or morbidity and low access to household air conditioning.
Studies have shown that exposure to extreme ambient temperature can contribute to adverse pregnancy outcomes, however, results across studies have been inconsistent. We aimed to evaluate the relationships between trimester-specific extreme temperature exposures and fetal growth restriction indicated by small for gestational age (SGA) in term pregnancies, and to assess whether and to what extent this relationship varies between different geographic regions. We linked 1,436,480 singleton term newborns (2014-2016) in Hubei Province, China, with a sub-district-level temperature exposures estimated by a generalized additive spatio-temporal model. Mixed-effects logistic regression models were employed to estimate the effects of extreme cold (temperature ≤5th percentile) and heat exposures (temperature >95th percentile) on term SGA in three different geographic regions, while adjusting for the effects of maternal age, infant sex, the frequency of health checks, parity, educational level, season of birth, area-level income, and PM(2.5) exposure. We also stratified our analyses by infant sex, maternal age, urban‒rural type, income categories and PM(2.5) exposure for robustness analyses. We found that both cold (OR:1.32, 95% CI: 1.25-1.39) and heat (OR:1.17, 95% CI: 1.13-1.22) exposures during the third trimester significantly increased the risk of SGA in the East region. Only extreme heat exposure (OR:1.29, 95% CI: 1.21-1.37) during the third trimester was significantly related to SGA in the Middle region. Our findings suggest that extreme ambient temperature exposure during pregnancy can lead to fetal growth restriction. Governments and public health institutions should pay more attention to environmental stresses during gestation, especially in the late stage of the pregnancy.
Global warming contributes to the widespread spread of some of the main vectors of natural-focal infections. Ixodid ticks can inhabit large numbers both in woodlands and in meadow and pasture areas. Recent decades have seen a shift in the habitats of many parasites to the northern regions, which contributes to the survival and reproduction of not only the vectors themselves but also to the completion of the development cycle of ticks. The growth of the population size and duration of the spring-autumn period of tick activity increases the period of the epidemic season. The epidemiological situation is complicated by the persistence and almost constant activity of natural foci of arthropod-borne infections. Weather conditions, precipitation, humidity (relative humidity of at least 85%), and air temperature affect the life cycle and range of ixodid ticks. These factors make a certain contribution to geographical expansion due to changes in the habitats of vegetation and carriers in the wild (animals, birds, and rodents), which carry ticks to new territories. The northern border of the area of ixodid infections – viral tick-borne encephalitis and ixodid borreliosis – lies now beyond the borders of the Arctic. However, there is evidence of a possible movement of these boundaries to the north, so the southern part of the Arctic region may fall into the zone of potential risk of transmission of these infections.
Extreme ambient temperatures are well-known for their adverse impact on public health, in the form of increased mortality and morbidity due to respiratory and cardio-vascular diseases. However, to capture the total impact of weather on cause-specific mortality/morbidity, the synoptic atmospheric conditions over the region under study need to be taken into account. The objective of this work is to identify weather types over Thessaloniki, Greece, statistically associated with mortality from circulatory and respiratory diseases, in an attempt to holistically determine the impact of weather on cause-specific mortality in the region. For this purpose, we employed datasets from the NCEP/NCAR Reanalysis comprising intrinsic daily data, gridded at a resolution of 2.5°×2.5° and covering a 41-year period (1980-2020). The first set used contains data of 500 hPa and 1,000 hPa geopotential heights for the main geographical domain of the Mediterranean region (30°N-45°N, 10°Ε-35°E). The second set comprises meteorological variables (2 m temperature, specific humidity, 2 m zonal and 2 m meridional wind and total cloud cover) for a geographical domain of north Greece (40.95°Ν, 22.50°Ε-26.25°E). We applied a combination of principal components analysis (PCA) as a dimensionality reduction tool and k-means cluster analysis (CA) in order to group days with homogeneous synoptic meteorological parameters. The derived weather types were statistically correlated with respiratory and mortality data for the time-period 1999-2018. It was concluded that the most fatal conditions for public health in Thessaloniki were associated with weather types bringing low/extremely low ambient temperature over north Greece.
Under the background of global warming, interaction between heat waves (HWs) and urban heat island (UHI) has led to trends of increase in the intensity, frequency, and duration of extreme heat events in urban areas, seriously threatening the health of urban populations. Taking Guangzhou (a tropical megacity in China) as an example, this study used automatic weather station data and ERA5 reanalysis data to explore the interaction between HWs and UHI, and to elucidate the effects of wind speed and local climate zones (LCZs) on such interaction. Results revealed obvious HWs-UHI interaction in Guangzhou, whereby HWs induces an amplification effect on UHI intensity (UHII) that was most significant at night. In the main urban area, UHII and HWs both weakened with increasing wind speed, indicating that low wind speeds contribute to increased occurrence of HWs and enhancement of UHII. Differently, in some areas peripheral to the main urban area, the UHII at medium wind speeds was stronger than that at low wind speeds, which reflect the impact of heat advection from the urban center. For different LCZs in the main urban area, the strongest UHII, highest risk of HW occurrence, and most significant HWs-UHI interaction were found in the compact mid-rise buildings and compact low-rise buildings (LCZ2 and LCZ3, respectively), followed by the compact high-rise buildings (LCZ1), which was mainly affected by the shading effect of high-rise buildings. The weakest UHII and lowest risk of HW occurrence were found in open high-rise buildings and open mid-rise buildings (LCZ4 and LCZ5, respectively), which generally have good ventilation conditions. Our findings will help to understand urban warming and its association with UHI and HW events in tropical urban regions, which has implications for rational improvement of the urban thermal environment in other tropical urban regions globally.
Exposure to extreme temperatures or fine particles is associated with adverse health outcomes but their interactive effects remain unclear. We aimed to explore the interactions of extreme temperatures and PM(2.5) pollution on mortalities. Based on the daily mortality data collected during 2015-2019 in Jiangsu Province, China, we conducted generalized linear models with distributed lag non-linear model to estimate the regional-level effects of cold/hot extremes and PM(2.5) pollution. The relative excess risk due to interaction (RERI) was evaluated to represent the interaction. The relative risks (RRs) and cumulative relative risks (CRRs) of total and cause-specific mortalities associated with hot extremes were significantly stronger (p < 0.05) than those related to cold extremes across Jiangsu. We identified significantly higher interactions between hot extremes and PM(2.5) pollution, with the RERI range of 0.00-1.15. The interactions peaked on ischaemic heart disease (RERI = 1.13 [95%CI: 0.85, 1.41]) in middle Jiangsu. For respiratory mortality, RERIs were higher in females and the less educated. The interaction pattern remained consistent when defining the extremes/pollution with different thresholds. This study provides a comprehensive picture of the interactions between extreme temperatures and PM(2.5) pollution on total and cause-specific mortalities. The projected interactions call for public health actions to face the twin challenges, especially the co-appearance of hot extremes and PM pollution.
This paper explores the relationship between human health and energy technologies, with a focus on how energy technology needs to adapt to new health challenges. The authors examine how a clean, affordable, and reliable energy infrastructure is critical for mitigating the impact of future pandemics. They also look at how increasing the proportion of solar and wind energy can create a near-zero emission energy system that is independent of fuel supply and its associated environmental problems. However, to ensure system resilience, significant investments in energy storage and smart control systems are necessary. For instance, the pandemic led to around 5% increase in US residential sector electricity consumption share in 2020 compared to 2019 due to stay-at-home orders, which could impact grid reliability and resiliency. This work also highlights the importance of designing energy -efficient and low-cost cooling and heating technologies for residential buildings to protect vulnerable populations from the health consequences of rising temperatures due to climate change. Additionally, the growing number of refugees worldwide and the need for efficient portable power sources in refugee camps are also addressed. The authors demonstrate how pandemics like COVID-19 can have far-reaching effects on energy technologies, from household energy use to large energy companies, and result in energy insecurity and decreased quality of life for many. (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
During the 2021 Heat Dome, 619 people in British Columbia died due to the heat. This public health disaster was made worse by the ongoing COVID-19 pandemic. Few studies have explored the intersection of heat with COVID-19, and none in Canada. Considering that climate change is expected to increase the frequency of extreme heat events, it is important to improve our understanding of intersecting public health crises. Thus, this study aimed to explore media-based public health communication in Canada during the COVID-19 pandemic and the 2021 Heat Dome. A qualitative content analysis was conducted on a subset of media articles (n = 520) related to the COVID-19 pandemic which were identified through a previous media analysis on the 2021 Heat Dome (n = 2909). Many of the articles provided conflicting health messages that may have confused the public about which health protective actions to take. The articles also showed how the COVID-19 pandemic may have exacerbated the health impacts of the 2021 Heat Dome, as pandemic-related public health measures may have deterred people away from protecting themselves from heat. This study, which provides novel insight into the prioritization of public health messaging when an extreme heat event occurs concurrently with a pandemic, supports the need for consistent heat health guidance.
BACKGROUND: Although many studies have reported the mortality effect of temperature, there were few studies on the mortality risk of humidity, let alone the joint effect of temperature and humidity. This study aimed to investigate the joint and interaction effect of high temperature and relative humidity on mortality in China, which will deepen understanding the health risk of mixture climate exposure. METHODS: The mortality and meteorological data were collected from 353 locations in China (2013-2017 in Jilin, Hunan, Guangdong and Yunnan provinces, 2009-2017 in Zhejiang province, and 2006-2011 in other Provinces). We defined location-specific daily mean temperature ≥ 75th percentile of distribution as high temperature, while minimum mortality relative humidity as the threshold of high relative humidity. A time-series model with a distributed lag non-linear model was first employed to estimate the location-specific associations between humid-hot events and mortality, then we conducted meta-analysis to pool the mortality effect of humid-hot events. Finally, an additive interaction model was used to examine the interactive effect between high temperature and relative humidity. RESULTS: The excess rate (ER) of non-accidental mortality attributed to dry-hot events was 10.18% (95% confidence interval (CI): 8.93%, 11.45%), which was higher than that of wet-hot events (ER = 3.21%, 95% CI: 0.59%, 5.89%). The attributable fraction (AF) of mortality attributed to dry-hot events was 10.00% (95% CI: 9.50%, 10.72%) with higher burden for females, older people, central China, cardiovascular diseases and urban city. While for wet-hot events, AF was much lower (3.31%, 95% CI: 2.60%, 4.30%). We also found that high temperature and low relative humidity had synergistic additive interaction on mortality risk. CONCLUSION: Dry-hot events may have a higher risk of mortality than wet-hot events, and the joint effect of high temperature and low relative humidity may be greater than the sum of their individual effects.
Climate change increases the frequency of extreme climate events and impacts the economy and the society in a negative way. As typical climate events, temperature anomalies affect individual health and working conditions, particularly for industries that depend heavily on temperatures. Using a research setting of Chinese temperature-sensitive enterprises, we analyze the impact of temperature on labor productivity. The findings indicate an inverse U-shaped relationship between temperature and labor productivity, with labor productivity peaking at 24.90 & DEG;C on average. Further analysis shows that labor productivity peaks in the eastern regions at a higher level (26.25 & DEG;C) than in the central and western regions (20 & DEG;C). Moreover, we note that technological innovation is crucial for enterprises to manage climate risks and maintain effective labor productivity. This study provides empirical evidence on the relationship between environmental risk and corporate operations, shedding light on the significance of corporate sustainable development against accelerating global climate change.
Climate change is a global threat to public health and causes or worsens various diseases including atopic dermatitis (AD), allergic, infectious, cardiovascular diseases, physical injuries, and mental disorders. The incidence of allergy, such as AD, has increased over the past several decades, and environmental factors such as climate change have been implicated as a potential mechanism. A substantial amount of literature has been published on the impact of climate factors, including cold and hot temperatures, on the skin barrier and AD. Studies in several countries have found a greater incidence of AD in children born in the colder seasons of fall and winter. The effect of cold and warm temperatures on itch, skin flares, increased outpatient visits, skin barrier dysfunction, development of AD, and asthma exacerbations have been reported. Understanding mechanisms by which changes in temperature influence allergies is critical to the development of measures for the prevention and treatment of allergic disorders, such as AD and asthma. Low and high temperatures induce the production of proinflammatory cytokines and lipid mediators such as interleukin-1β, thymic stromal lymphopoietin, and prostaglandin E2, and cause itch and flares by activation of TRPVs such as TRPV1, TRPV3, and TRPV4. TRPV antagonists may attenuate temperature-mediated itch, skin barrier dysfunction, and exacerbation of AD.
BACKGROUND: The impacts of heatwaves are a rapidly growing area of study; however, much of the existing research focusses on national data analysis. This article aims to add a local perspective using data from only one county, East Sussex, and comparing these with the pre-existing national data. METHODS: Population data were obtained from publicly available sources such as the Office of National Statistics, in addition to anonymized data from patients. Statistical analysis calculated excess mortality and emergency hospital admissions associated with both winter and heatwaves. Further analyses into factors associated with worse health outcomes in pre-existing data, such as the extremes of age (under 1 s and over 75 s), dementia and respiratory conditions, were conducted and their effect on excess mortality and emergency admissions was compared with national data. RESULTS: Excess winter mortality within East Sussex averaged 22.5%. Excess heatwave mortality averaged 17%, measuring higher than national data. The relative significance of these data is expected to increase over the next 30 years in line with the UK Health Security Agency projection of heat-related mortality tripling by 2050 in the context of global warming and increasing temperatures. CONCLUSIONS: Although the number of residents dying or requiring emergency admission due to cold weather is larger than that of heatwaves, trends show a worsening impact of heatwaves. The results of this report are significant findings which show more action is required to mitigate the effects of extreme heat.
Ticks are obligatory hematophagous parasites that serve as vectors for a large amount of important human and livestock pathogens around the world, and their distribution and incidence of tick-associated diseases are currently increasing because of environmental biomass being modified by both climate change and other human activities. Hyalomma species are of major concern for public health, due to their important role as vectors of several diseases such as the Crimea-Congo hemorrhagic fever (CCHF) virus in humans or theileriosis in cattle. Characterizing the Hyalomma-associated microbiota and delving into the complex interactions between ticks and their bacterial endosymbionts for host survival, development, and pathogen transmission are fundamental, as it may provide new insights and spawn new paradigms to control tick-borne diseases. Francisella-like endosymbionts (FLEs) have recently gained importance, not only as a consequence of the public health concerns of the highly transmissible Francisella tularensis, but for the essential role of FLEs in tick homeostasis. In this comprehensive review, we discuss the growing importance of ticks associated with the genus Hyalomma, their associated tick-borne human and animal diseases in the era of climate change, as well as the role of the microbiome and the FLE in their ecology. We compile current evidence from around the world on FLEs in Hyalomma species and examine the impact of new molecular techniques in the study of tick microbiomes (both in research and in clinical practice). Lastly, we also discuss different endosymbiont-directed strategies for the control of tick populations and tick-borne diseases, providing insights into new evidence-based opportunities for the future.
We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people and those living in the hot regions in Southern Vietnam. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios.
The relationship between heat exposure and perinatal morbidity and mortality is of increasing concern as global temperatures rise and extreme heat events become more frequent and intense. Heat exposure can lead to a multitude of harmful outcomes for pregnant individuals and neonates, including hospitalization and death. This state of the science review explored the evidence on the associations between heat exposure and negative health outcomes during pregnancy and the neonatal period. Findings suggest that improving health care provider and patient awareness of heat-related risks and implementing specific interventions could mitigate adverse outcomes. Furthermore, public health and other policy interventions are needed to increase thermal comfort and reduce societal exposure to extreme heat and related risks. Early warning systems, medical alerts, provider and patient education, and increased access to health care and thermal comfort may improve pregnancy and early life health outcomes.
The U.S. Global Change Research Program reports that the frequency and intensity of extreme heat are increasing globally. Studies of the impact of climate change on child health often exclude sleep, despite its importance for healthy growth and development. To address this gap in the literature, we studied the impact of unusually high temperatures in the summer of 2022 on infants’ sleep. Sleep was assessed objectively using Nanit camera monitors in infants’ homes. Generally, sleep was not impacted when temperatures stayed below 88° but was negatively impacted when temperatures reached over 100°. Compared to non-heatwave nights, infants had less total sleep, less efficient sleep, took longer to fall asleep, had more fragmented sleep, and parents’ visits were more frequent during the night. Following peaks in temperature, sleep metrics rebounded to better than average compared to non-peak nights, suggesting that infants compensated for disrupted sleep by sleeping more and with fewer interruptions once the temperature dropped below 85°. Increased instances of disrupted sleep in infancy have important implications for psychological health and development. Climate disruptions such as heat waves that create occasional or ongoing sleep disruptions can leave infants vulnerable and unprepared for learning.
INTRODUCTION: The psychosocial impacts of extreme weather events are contributing to the burden of mental illness, exacerbated by pre-existing vulnerabilities. Despite an emerging global interest in this association, Africa remains poorly represented in the literature. METHODS: A scoping review of peer-reviewed studies was conducted to determine the adverse mental health outcomes associated with extreme weather events in Africa (2008-2021). The review was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS: A total of 12,204 peer-reviewed articles were identified of which 12 were retained for analysis. These studies were all conducted in 8 countries in Sub-Saharan Africa. Adverse mental health outcomes were identified resulting from flood (n = 4), drought (n = 4), extreme heat (n = 1), bushfire (n = 1), and multiple events (n = 2). Findings included pathological outcomes with predictable symptomatology including mood disorders; trauma- and stressor-related disorders; and suicide. Additionally, conditions indicating psychological distress which were below the pathological threshold including emotion regulation difficulties, disturbed sleep, alcohol use, stress, and anxiety. The quantitative evidence for the association between extreme weather events and mental health was limited primarily by a lack of longitudinal data, exposure gradient, and comparison to an unaffected group, as well as a failure to provide an objective exposure measure. The qualitative evidence for this association was complimentary but without sufficient clinical measurement these outcomes cannot be verified as psychological morbidities. In addition, this review provided insight into the mental health of vulnerable communities affected by extreme weather events including those living in poverty, farmers, pastoralists, women, and children. CONCLUSION: This review provided some preliminary evidence for the association between extreme weather events and adverse mental health outcomes for populations in Africa. The review also provides insight to vulnerable populations affected by extreme weather events. Future research with stronger designs and methodologies are recommended.
In Indonesia, 12% or 3 million married couples suffer from infertility, with 36% of cases caused by male factors. Heat exposure, obesity, and lack of physical activity can decrease sperm quality by inducing oxidative stress and inflammation and altering the hypothalamic-pituitary-gonadal axis mechanisms. This study investigated the impact of heat exposure, obesity, and physical activity on sperm quality. This study employed an analytical observational design with a cross-sectional approach, conducted at the Sekar Fertility Clinic, Dr. Moewardi General Hospital. Sixty samples were analyzed using bivariate, multivariate, and chi 2 tests or Fisher exact test with a 95% confidence interval and p<0.05. Exposure to heat was found to increase the risk of low-sperm concentration by 74.09 times (p=0.001), obesity increased the risk of low-sperm concentration by 16.74 times (p=0.013), and low-sperm motility by 6.12 times (p=0.014), and lack of physical activity increased the risk of low-sperm concentration by 27.23 times (p=0.033). Heat exposure, obesity, and physical inactivity are associated with low-sperm concentration, and obesity is also associated with low-sperm motility.
Climate change affects human health and has been linked to several infectious diseases in recent year. However, there is limited assessment on the impact of heat waves and cold spells on pneumonia risk. This study aims to examine the association of heat waves and cold spells with daily pneumonia hospitalizations in 168 cities in China. Data on pneumonia hospitalizations between 2014 and 2017 were extracted from a national claim database of 280 million beneficiaries. We consider combining temperature intensity and duration to define heat waves and cold spells.This association was quantified using a quasi-Poisson generalized linear model combined with a distributed lag nonlinear model. Exposure-response curves and potential effect modifiers were also estimated. We found that the peak relative risk (RR) of cold spells on daily hospitalizations for pneumonia was observed in relatively mild cold spells with a threshold below the 3 days at the 2nd percentile (RR = 1.69, 95% CI: 1.46-1.92). The risk of heat waves increased with the thresholds, and the greatest risk was found for extremely heatwave period of 4 days at the 98th percentile (RR = 1.69, 95% CI: 1.46-1.92). Heat waves and cold spells are more likely to adversely affect women. In conclusion, our study provided novel and strong evidence that exposure to heat waves and cold spells was associate with increased hospital visits for pneumonia, especially in females. This is the first national study in China to comprehensively evaluate the influence of heat waves and cold spells on pneumonia risk, and the findings may offer valuable insights into the impact of climate change on public health.
BACKGROUND: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. OBJECTIVE: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. METHODS: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. RESULTS: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. CONCLUSIONS: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. TRIAL REGISTRATION: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44702.
Many studies had shown that with global warming, heat waves may increase the mortality risk of Chinese populations. However, these findings are not consistent. Therefore, we elucidated the associations by meta-analysis and quantified the magnitude of these risks, as well as the underlying factors. METHODS: We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, EMBASE, and Web of Science for literature screening up to Nov 10, 2022, to analyze the effect of heat waves on mortality in the Chinese population. Literature screening and data extraction were performed independently by two researchers and the data were merged by meta-analysis. In addition, we conducted subgroup analysis by sex, age, years of education, region, and number of events to explore the source of heterogeneity. RESULTS: Fifteen related studies on the impact on heat waves of the death of Chinese people were included in this study. The results of the meta-analysis showed that heat waves were significantly associated with increased mortality from non-accidental deaths, cardiovascular diseases, stroke, respiratory diseases, and circulatory diseases in the Chinese population: non-accidental mortality (RR = 1.19, 95% CI: 1.13-1.27, P < .01), cardiovascular diseases (RR = 1.25, 95% CI: 1.14-1.38), stroke (RR = 1.11, 95% CI: 1.03-1.20), respiratory diseases (RR = 1.18, 95% CI: 1.09-1.28), and circulatory diseases (RR = 1.11, 95% CI: 1.06-1.17). Subgroup analyses showed that heat waves had a higher risk of non-accidental death for those with <6 years of education than for those with ≥6 years of education. Meta-regression analysis showed that the contribution of the study year to the inter studied heterogeneity was 50.57%. The sensitivity analysis showed that the exclusion of any single study did not materially alter the overall combined effect. The meta-analysis method indicated no obvious evidence of publication bias. CONCLUSIONS: The results of the review indicated that heat waves were associated with increased mortality in the Chinese population, that attention should be paid to high-risk groups, and that public health policies and strategies should be implemented to more effectively respond to and adapt to climate change.
Climate change increases the likelihood of heatwave events, causing human thermal discomfort and even mortality. However, it is not clear to what extent humans with long-term and short-term experience of hot summer exposure can adapt to thermal comfort in urban public open spaces when both experience their heat wave periods. Therefore, this study aims to investigate outdoor perceived thermal comfort in urban public open spaces during heatwave periods between two groups of people who have long-term and short-term experience of hot-summer exposure. Field surveys were conducted in public squares and parks during the heatwaves in Chongqing, China and Reading, the UK. Chongqing is known as a ‘furnace city’ and people have been living in a hot summer for a long time, while in Reading the summer is warm and people unusually experience the heat wave. The main results show that Chongqing respondents living in a hot climate for a longer period can endure more heat than Reading respondents during the heatwaves, indicating that Chongqing respondents have more thermal resilience. Besides, different behavioural adaptation measures show that people are active participants to choose their thermal preferences, rather than passive recipients of the thermal environments. The research implication contributes that protective measures against heatwaves need to be taken for pedestrians, including more shaded places with efficient ventilation design for sheltering and handy facilities such as drinking fountains and water spray. The research has novelty in deepening the dynamic theory of human thermal comfort and providing empirical evidence of thermal adaptation in extreme-high temperature events.
Out-of-hospital cardiac arrest (OHCA) is a time-critical and fatal medical emergency that has been linked to non-optimal temperatures. However, the future burden of OHCA due to non-optimal temperatures, heatwaves, and cold spells under climate change has not been well evaluated. METHODS: We conducted a time-stratified case-crossover study in 15 Northern Chinese cities throughout 2020 to estimate the exposure-response relationships of non-optimal temperatures, heatwaves, and cold spells with hourly OHCA onset in hot and cold seasons. We obtained future daily average temperatures by using 20 general circulation models under two greenhouse gas emission scenarios: one with certain emission control and the other with relaxed control. Lastly, we projected the change of OHCA burden under these two climate scenarios. FINDINGS: We analyzed a total of 29,671 OHCA patients and found that high temperatures and heatwaves as well as low temperatures and cold spells were all significantly associated with an increased risk of OHCA onset. Under the scenario of uncontrolled emissions, the attributable fraction (AF) of OHCA due to high temperatures and heatwaves would increase by 4.94% and 6.99% from the 2010s to 2090s, respectively. The AF due to low temperatures would decrease by 1.27% by the 2090s and the effects of cold spells were projected to be marginal after the 2050s. Under a medium emission control scenario, the upward trend of heat-related OHCA burden would become flat, and the decline in cold-related OHCA burden would also slow down. INTERPRETATION: Our study provides evidence of significant morbidity risk and burden of OHCA associated with global warming across Northern China. Our findings indicate that the increase in OHCA burden attributable to heat could not be offset by the decrements attributable to cold, emphasizing the importance of mitigation policies for limiting global warming and reducing the associated risks of OHCA onset. FUNDING: National Science & Technology Fundamental Resources Investigation Project (2018FY100600, 2018FY100602), National Key R&D Program of China (2020YFC1512700, 2020YFC1512705, 2020YFC1512703), Key R&D Program of Shandong Province (2021ZLGX02, 2021SFGC0503), Natural Science Foundation of Shandong Province (ZR2021MH231), Taishan Pandeng Scholar Program of Shandong Province (tspd20181220), the Interdisciplinary Young Researcher Groups Program of Shandong University (2020QNQT004), ECCM Program of Clinical Research Center of Shandong University (2021SDUCRCA001, 2021SDUCRCA002), foundation from Clinical Research Center of Shandong University (2020SDUCRCB003), National Natural Science Foundation of China (82272240).
The present study contributes to the issue of the urban heat island (UHI) effect with its possibly associated thermal stress for city dwellers and its potential mitigation during heat waves and dry spells in Central Europe. It is based on meteorological measurements along an urban transect in the city of Wurzburg, Germany. Due to its topographic and structural situation, Wurzburg is prone to an intense urban heat island (UHI). The measurements have started in 2018 and, hence, cover a period that was characterized by record high temperatures and long dry spells in Central Europe. Particularly on days with a maximum air temperature of more than 25 degrees C, an intense UHI was observed with the highest amplitude in the afternoon and, even more, during the evening hours. The highest measured difference between the densely built inner city and the outskirts was 8.2 degrees C. The UHI during summer is noticeably more pronounced, especially during the evening hours, when the regional background climate is anomalously warm and dry. This can be ascribed to anticyclonic weather types that prevailed over Central Europe during summertime between 2018 and 2020. The cooling effect of urban trees, in this case Tilia cordata, on near-surface air temperature amounts to partly more than 2 degrees C and, hence, mitigates the UHI locally, especially at noon and in the early afternoon. However, the cooling rate is only half as much when the trees suffer from water stress. Thus, an appropriate management of city’s green infrastructure represents a useful strategy to mitigate the strength of the UHI and the heat stress in Central Europe.
Human-induced climate change is leading to an increase in the intensity and frequency of extreme weather events, which are severely affecting the health of the population. The exceptional heat during the summer of 2022 in Europe is an example, with record-breaking temperatures only below the infamous 2003 summer. High ambient temperatures are associated with many health outcomes, including premature mortality. However, there is limited quantitative evidence on the contribution of anthropogenic activities to the substantial heat-related mortality observed in recent times. Here we combined methods in climate epidemiology and attribution to quantify the heat-related mortality burden attributed to human-induced climate change in Switzerland during the summer of 2022. We first estimated heat-mortality association in each canton and age/sex population between 1990 and 2017 in a two-stage time-series analysis. We then calculated the mortality attributed to heat in the summer of 2022 using observed mortality, and compared it with the hypothetical heat-related burden that would have occurred in absence of human-induced climate change. This counterfactual scenario was derived by regressing the Swiss average temperature against global mean temperature in both observations and CMIP6 models. We estimate 623 deaths [95% empirical confidence interval (95% eCI): 151-1068] due to heat between June and August 2022, corresponding to 3.5% of all-cause mortality. More importantly, we find that 60% of this burden (370 deaths [95% eCI: 133-644]) could have been avoided in absence of human-induced climate change. Older women were affected the most, as well as populations in western and southern Switzerland and more urbanized areas. Our findings demonstrate that human-induced climate change was a relevant driver of the exceptional excess health burden observed in the 2022 summer in Switzerland.
Extreme weather events lead to significant adverse societal costs. Extreme Event Attribution (EEA), a methodology that examines how anthropogenic greenhouse gas emissions had changed the occurrence of specific extreme weather events, allows us to quantify the climate change-induced component of these costs. We collect data from all available EEA studies, combine these with data on the socio-economic costs of these events and extrapolate for missing data to arrive at an estimate of the global costs of extreme weather attributable to climate change in the last twenty years. We find that US[Formula: see text] 143 billion per year of the costs of extreme events is attributable to climatic change. The majority (63%), of this is due to human loss of life. Our results suggest that the frequently cited estimates of the economic costs of climate change arrived at by using Integrated Assessment Models may be substantially underestimated.
Global warming and rapid population growth are two of the most pressing issues in today’s world. There is growing evidence of rising temperatures. The urban heat island effect is a significant environmental issue facing cities today. Although this issue has gained much attention from developed countries, countries in Africa are yet to grapple with it on a significant scale. This paper examined the rising research dimensions and major methodological techniques in studying urban heat effects. The paper adopted a systematic review method where peer-reviewed articles formed the trajectory of debate on Urban Heat Island (UHI) in African cities. The paper finds remote sensing the most common method in analysing UHI effect than ground use technology (weather station), which is limited in spatial spread in most African countries. Urbanization and other human-induced factors majorly contribute to UHI and this has an impact on many elements of life, including morbidity, mortality, birth weight decrease, and social strife. The paper recommends research priority on UHI effect in African cities due to the rising population.
INTRODUCTION: The associations between non-optimal ambient temperature, air pollution and SARS-CoV-2 infection and post COVID-19 condition (PCC) remain constrained in current understanding. We conducted a retrospective analysis to explore how ambient temperature affected SARS-CoV-2 infection in individuals who later developed PCC compared to those who did not. We investigated if these associations were modified by air pollution. METHODS: We conducted a bidirectional time-stratified case-crossover study among individuals who tested positive for SARS-CoV-2 between May 2021 and June 2022. We included 6302 infections, with 2850 PCC cases. We used conditional logistic regression and distributed lag non-linear models to obtain odds ratios (OR) and 95% confidence intervals (CI) for non-optimal temperatures relative to the period median temperature (10.6 °C) on lags 0 to 5. For effect modification, daily average PM(2.5) concentrations were categorized using the period median concentration (8.8 μg/m(3)). Z-tests were used to compare the results by PCC status and PM(2.5). RESULTS: Non-optimal cold temperatures increased the cumulative odds of infection (OR = 1.93; 95%CI:1.67-2.23, OR = 3.53; 95%CI:2.72-4.58, for moderate and extreme cold, respectively), with the strongest associations observed for non-PCC cases. Non-optimal heat temperatures decreased the odds of infection except for moderate heat among PCC cases (OR = 1.32; 95%CI:0.89-1.96). When PM(2.5) was >8.8 μg/m(3), the associations with cold were stronger, and moderate heat doubled the odds of infection with later development of PCC (OR = 2.18; 95%CI:1.01-4.69). When PM(2.5) was ≤8.8 μg/m(3), exposure to non-optimal temperatures reduced the odds of infection. CONCLUSION: Exposure to cold increases SARS-CoV2 risk, especially on days with moderate to high air pollution. Heated temperatures and moderate to high air pollution during infection may cause PCC. These findings stress the need for mitigation and adaptation strategies for climate change to reduce increasing trends in the frequency of weather extremes that have consequences on air pollution concentrations.
Objective: There is substantial literature detailing the interaction between climate change and diabetes incidence, prevalence, and development. However, there is limited understanding on the impact of climate change on People Living with Diabetes (PWD). This scoping review describes the impact of climate change on morbidity and mortality for PWD. Materials and methods: The scoping review was conducted between November 2022 and February 2023, using articles published in PubMed Central and Google Scholar databases. Articles published from 1970 to 2022 with the following key terms “diabetes”, “type 1 warming”, and “natural disaster” were reviewed. Results: A total of 13,838 articles were identified and reviewed. After applying the review criteria, 42 applicable articles were included in the scoping review. PWD are impacted directly by climate change-induced events including extreme temperatures, air pollution, and natural disasters. Difficulty in storing insulin, maintaining special diets, and accessing diabetes supplies are indirect results of the climate crisis on people with diabetes leading to adverse outcomes such as increased risk of hospitalizations, morbidity, and mortality. Conclusions: Environmental hazards due to climate change increase morbidity and mortality for PWD. Policies that address the interconnection between the two phenomena would improve global diabetes population health. Future research should explore potential solutions to addressing this crisis across multiple populations and settings. (Clin Diabetol 2023; 12; 3: 186-200)
An asphalt-concrete parking lot was converted to a small urban forest with 72 trees and permeable pavement as an urban heat island countermeasure. Microclimate monitoring was performed pre- and post-renovation using fixed and mobile measurements. We propose a protocol to estimate robust statistical effects over 24 h constructed with several days of observation, and to compare the spatial distribution of heat stress pre- and post-conversion regardless of differences in weather conditions. Detailed effects on solar and infrared radiation, microclimate and pedestrian heat stress are assessed and tested for statistical significance. Great improvements of pedestrian heat stress are reported, especially in daytime, following the creation of shade which significantly reduces the radiative load of the area. UTCI-equivalent temperature is reduced up to 6.2 & DEG;C (3.1 & DEG;C on a 24h-average). Mobile measurements were used to characterize the spatial disparity of heat stress. Strong thermal discomfort is exhibited under direct insolation. At night, positive effects on pedestrian heat stress are slightly counterbalanced by an increase in infrared trapping due to the reduction of the sky view factor beneath the trees while wind speed is slowed. Recommendations are formulated for urban planners.
Farmers in tropical countries have been impacted by slow-onset heat stress. By comparing the nature of farming activities performed by conventional farmworkers and agroecological farmers, this study examined the changes in physiological health in responses to heat exposure through a six-month longitudinal study. Throughout the six-month follow-up period, the heat stress index (HSI), physiological strain indices (PSI), and physiological health parameters (BMI, blood glucose level, blood cholesterol level, uric acid level) were measured and repeated every two-month. Physiological parameters were recorded twice daily, before and during their first lunch break. This study found that slow-onset heat stress affects farmers differently. The health of agroecological farmers is more resistant to slow-onset extreme temperatures. Pre-existing metabolic health effects from pesticide exposure make conventional farmers more susceptible to extreme temperatures, delaying their bodies’ adaptation to rising temperatures.
The association between heatwaves and cognitive impairment in older adults, especially the joint effect of air pollution and green space on this association, remains unknown. The present cohort study used data from waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Heatwaves were defined as having daily maximum temperature ≥ 92.5th, 95th and 97.5th percentile that continued at least two, three and four days, measured as the one-year heatwave days prior to the participants’ incident cognitive impairment. Data on the annual average air pollutant concentrations of fine particulate matter (PM(2.5)) and ozone (O(3)) as well as green space exposure (according to the Normalized Difference Vegetation Index (NDVI)) were collected. Time-varying Cox proportional hazards models were constructed to examine the independent effect of heatwaves on cognitive impairment and the combined effect of heatwaves, air pollution, and green space on cognitive impairment. Potential multiplicative interactions were examined by adding a product term of air pollutants and NDVI with heatwaves in the models. The relative excess risk due to interaction (RERI) was calculated to reflect additive interactions. We found that heatwave exposure was associated with higher risks of cognitive impairment, with hazard ratios (HRs) and 95 % confidence intervals (CIs) ranging from 1.035 (95 % CI: 1.016-1.055) to 1.058 (95 % CI: 1.040-1.075). We observed a positive interaction of PM(2.5) concentrations, O(3) concentrations, lack of green space, and heatwave exposure on a multiplicative scale (HRs for product terms >1). Furthermore, we found a synergistic interaction of PM(2.5) concentrations, O(3), lack of green space, and heatwave exposure on an additive scale, with RERIs >0. These results suggest that extreme heat exposure may be a potential risk factor for cognitive impairment in older adults. Additionally, coexposure to air pollution and lack of green space exacerbated the adverse effects of heatwaves on cognitive function.
Studies show that heat waves (HWs) are among the most important atmospheric phenomena that negatively affect human health. This study aims to determine the effects of HWs on hospital admissions (HA) in the Edirne province of Turkey. Polyclinic admission and atmospheric data, including daily maximum temperatures, were used. HW is defined as temperature at the % 90 threshold of daily maximum temperatures that persists for at least 3 consecutive days or more. With this definition, a 6-day HW was detected, and a lag of 3 days was added to this HW. Logarithmic Z test was used for the analysis. As a result of the study, The Risk Ratio (RR) showing the relationship between 9-day HW and HAs was calculated as 1.19 (95% confident interval [CI]: 1.17-1.21, P < .05), and it was determined that there were 2557 extra HAs in total. When HAs were analyzed according to sex, it was observed that female admissions were higher than male admissions. To analyze admissions by age, the data were divided into 3 groups: children (<15 years), adult (15-64 years), and elderly (≥65 years). As a result of the analysis, the highest increase was observed in patients < 15 years of age, and the RR was 1.33 (95% CI: 1.24-1.42 P < .05). When the patient density in polyclinics was analyzed, the Cardiology polyclinic had the highest number of patient admissions with an RR, 1.36 (95% CI: 1.30-1.43 P < .05). The results of this study will guide measures to be taken against HWs.
Shading effectively alleviates heat stress caused by heatwaves and urban heat islands. Artificial shading is a viable alternative to urban greenery when tree planting is impracticable. While tree shade has been studied extensively, the effects of shading devices on the microclimate and illuminance are not well understood. To examine the influence of shading devices on outdoor thermal and visual comfort, we conducted on-site mete-orological observations and surveys (n = 1272) on a university campus in Guangzhou during the summer of 2018. In ENVI-met simulations, various shading device properties were compared, including materials, trans-parency, and size. Simulation results indicate that shading devices reduced mean radiant temperature, Physio-logical Equivalent Temperature (PET), and Universal Thermal Climate Index (UTCI) up to 24.8 degrees C, 12.0 degrees C and 5.9 degrees C, respectively. However, there was a negligible reduction in air temperature and wind speed. Opaque materials and glass covers with 10% transparency decreased illuminance by 73%-83% and 65%-75%, respec-tively. Moreover, the size threshold for optimal cooling effects differs in locations with different sky view factors and tree shade. Our survey reveals that reducing the illuminance by > 90,000 lux and sun sensation vote from +2.5 to +1 can lower the thermal sensation vote by up to one vote. As shading devices decrease illuminance and thermal indices, the cross-modal effect between visual and thermal comfort would need to be considered in optimizing the design of shading devices. Further observation and numerical simulation of outdoor microclimate and illuminance are necessary to validate this cross-modal effect in other climatic regions.
In the context of recent climate change, temperature-attributable mortality has become an important public health threat worldwide. A large number of studies in Europe have identified a relationship between temperature and mortality, while only a limited number of scholars provided evidence for Serbia. In order to provide more evidence for better management of health resources at the regional and local level, this study aims to assess the impact of summer temperature on the population in Serbia, using daily average temperature (T(a)) and mortality (CDR (crude death rate) per 100,000). The analysis was done for five areas (Belgrade, Novi Sad, Niš, Loznica, and Vranje), covering the summer (June-August) period of 2001-2015. In order to quantify the T(a)-related CDR, a generalized additive model (GAM) assuming a quasi-Poisson distribution with log as the link function was used. Five regression models were constructed, for each area, revealing a statistically significant positive relationship between T(a) and CDR in four areas. The effect of T(a) on CDR was defined as the relative risk (RR), which was obtained as the exponential regression coefficient of the models. RR indicates that a 1 °C increase in T(a) at lag0 was associated with an increase in CDR of 1.7% for Belgrade, Novi Sad, and Niš and 2% for Loznica. The model for Vranje did not quantify a statistically significant increase in CDR due to T(a) (RR=1.006, 95% CI 0.991-1.020). Similar results were confirmed for gender, with a slightly higher risk for women. Analysis across lag structure showed different exposure, but the highest effect of T(a) mainly occurs over the short term and persists for 3 days.
Various types of damage, including health risks, caused by abnormal climate conditions have gradually increased in recent years, particularly in cities with a high degree of complexity. In particular, it is important to address heatwave damage risk from both technical and policy perspectives because it poses risks to older adults and/or disadvantaged individuals. This study was performed to assess the quantitative effects of two heatwave mitigation measures, cool roofs and cool pavements, in the Jangyumugye district of Gimhae, Republic of Korea. Thermal imaging cameras were used to measure surface temperatures after the installation of these measures; after the installation of cool roofs, indoor temperatures were also measured using temperature measurement data loggers. Then, a survey was conducted to obtain feedback from users of the associated facilities. From August to October 2019, surface temperatures were significantly reduced following the installation of cool roofs and cool pavements. Cool roofs constructed using slabs and panels provided average temperature reductions of 15.5 degrees C and 11.6 degrees C, respectively. Cool pavements showed a temperature reduction of >= 4 degrees C in both parking lot and alley sites. More than 30% of users noticed a reduction in temperature as a result of heatwave measure installation. These results may be used by the city to make informed policy decisions regarding the implementation of heatwave mitigation measures.
Greece was affected by a prolonged and extreme heat wave (HW) event (July 28-August 05) during the abnormally hot summer of 2021, with the maximum temperature in Athens, the capital of the country, reaching up to 43.9 °C in the city center. This observation corresponds to the second highest maximum temperature recorded since 1900, based on the historical temperature time series of the National Observatory of Athens weather station at Thissio. In the present study, a multi-scale numerical modeling system is used to analyze the urban climate and thermal bioclimate in the Athens urban area (AUA) in the course of the HW event, as well as during 3 days prior to the heat wave and 3 days after the episode. The system consists of the Weather Research and Forecasting model, the advanced urban scheme BEP/BEM (Building Energy Parameterization/Building Energy Model) and the human-biometeorological model RayMan Pro, and incorporates the local climate zone (LCZ) classification scheme. The system’s validation results demonstrated a robust modeling set-up, characterized by high capability in capturing the observed magnitude and diurnal variation of the urban meteorological and heat stress conditions. The analysis of two- and three-dimensional fields of near-surface air temperature, humidity and wind unraveled the interplay of geographical factors (surface relief and proximity to the sea), background atmospheric circulations (Etesians and sea breeze) and HW-related synoptic forcing with the AUA’s urban form. These interactions had a significant impact on the LCZs heat stress responsiveness, expressed using the modified physiologically equivalent temperature (mPET), between different regions of the study area, as well as at inter- and intra-LCZ level (statistically significant differences at 95 % confidence interval), providing thus, urban design and health-related implications that can be exploited in human thermal discomfort mitigation strategies in AUA.
The allocation of resources towards the development and enhancement of urban parks offers an effective strategy for promoting and improving the health and well-being of urban populations. Investments in urban parks can result in a multitude of health benefits. The increased usage of greenspace by park users has been linked to positive physical and mental health outcomes. Additionally, the expansion of greenspace in urban areas can mitigate harmful impacts from air pollutants, heat, noise, and climate-related health risks. While the health benefits attributed to urban parks and greenspaces are well documented, few studies have measured the economic value of these benefits. This study applied a novel ecohealth economic valuation framework to quantify and estimate the potential economic value of health benefits attributed to the development of a proposed park in the downtown core of Peterborough, Canada. The results indicated that development of the small urban park will result in annual benefits of CAD 133,000 per year, including CAD 109,877 in the avoided economic burden of physical inactivity, CAD 23,084 in health savings associated with improved mental health, and CAD 127 in health savings attributed to better air quality. When including the economic value of higher life satisfaction, the economic benefit is more than CAD 4 million per year. The study demonstrates the value of developing and enhancing urban parks as a strategy to improve population health and well-being, and as a means of cost savings to the medical system.
OBJECTIVE: Ambient extreme temperatures have been associated with mental and behavior disorders (MBDs). However, few studies have assesed whether vulnerability factors such as ambient air pollution, pre-existing mental health conditions and residential environmental factors increase susceptibility. This study aims to evaluate the associations between short-term variations in outdoor ambient extreme temperatures and MBD-related emergency department (ED) visits and how these associations are modified by vulnerability factors. METHODS: We conducted a case-crossover study of 9,958,759 MBD ED visits in Alberta and Ontario, Canada made between March 1st, 2004 and December 31st, 2020. Daily average temperature was assigned to individual cases with ED visits for MBD using gridded data at a 1 km × 1 km spatial resolution. Conditional logistic regression was used to estimate associations between extreme temperatures (i.e., risk of ED visit at the 2.5th percentile temperature for cold and 97.5th percentile temperature for heat for each health region compared to the minimal temperature risk) and MBD ED visits. Age, sex, pre-existing mental health conditions, ambient air pollution (i.e. PM(2.5), NO(2) and O(3)) and residential environmental factors (neighborhood deprivation, residential green space exposure and urbanization) were evaluated as potential effect modifiers. RESULTS: Cumulative exposure to extreme heat over 0-5 days (odds ratio [OR] = 1.145; 95% CI: 1.121-1.171) was associated with ED visits for any MBD. However, cumulative exposure to extreme cold was associated with lower risk of ED visits for any MBD (OR = 0.981; 95% CI: 0.976-0.987). We also found heat to be associated with ED visits for specific MBDs such as substance use disorders, dementia, neurotic disorders, schizophrenia and personality behavior disorder. Individuals with pre-existing mental health conditions, those exposed to higher daily concentrations of NO(2) and O(3) and those residing in neighborhoods with greater material and social deprivation were at higher risk of heat-related MBD ED visits. Increasing tree canopy coverage appeared to mitigate risks of the effect of heat on MBD ED visits. CONCLUSIONS: Findings provide evidence that the impacts of heat on MBD ED visits may vary across different vulnerability factors.
The effect of ambient temperature on relative risk (RR) of cardiovascular disease (CVD) is different in China than in other countries due to the different geographical environment, climate the different inter- and intra-individual characteristics of the population within China. It is therefore important to integrate information to evaluate the impact of temperature on RR of CVD in China. We performed a meta-analysis to evaluate the effect of temperature on RR of CVD. The Web of Science, Google Scholar, and China National Knowledge Infrastructure databases were searched back to 2022 and nine studies were included in the study. The Cochran Q test and I(2) statistics were used to assess heterogeneity, while Egger’s test was used to assess publication bias. The pooled estimated size of the relationship between ambient temperature and CVD hospitalization in the random effect model was 1.2044 (95%CI: 1.0610-1.3671) for the cold effect and 1.1982 (95%CI: 1.0166-1.4122) for the heat effect. The Egger’s test showed a potential publication bias for the cold effect, whereas there was no apparent publication bias for the heat effect. There is a significant effect of ambient temperature on RR of CVD for both the cold effect and heat effect. The effect of socioeconomic factors should be considered more thoroughly in future studies.
This study traces the causal effects of extreme weather events on nutritional and health outcomes among rural children in Uganda using four waves of individual child survey data (2009-2014). A simultaneous regression model was applied for causal inference while also accounting for households’ adaptive responses. The study finds the evidence of a significant negative relationship between extreme weather events and availability of calories and nutrients for children. In particular, droughts reduced calorie, protein and zinc supply, and overall diet diversity by 67%, 37%, 28% and 30%, respectively. We further traced the effects of this reduced calorie and nutrient availability on child health indicators. A 10% decrease in zinc supply decreased height-for-age z-scores (HAZ) by around 0.139 – 0.164 standard deviations (SD), and increased probability of stunting ranging from 3.1 to 3.5 percentage points. Both boys and girls HAZ and stunting rates were sensitive to nutrient inadequacies. Different coping and adaptation strategies significantly influenced rural households’ ability to safeguard children’s nutrition and health against the effects of extreme weather. The findings of this study provide specific insights for building ex-ante resilience against extreme weather events, particularly when compared to ex-post, unsustainable, and often costlier relief actions.
Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso. METHODS: In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area. FINDINGS: Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]). INTERPRETATION: Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. FUNDING: Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation.
OBJECTIVES: Farmworkers disproportionately experience preventable adverse health effects from heat exposure. We sought to evaluate the effect of participatory heat education on farmworker knowledge. METHODS: We conducted a parallel, comparison group intervention study to investigate the effectiveness of a Spanish/English participatory, culturally-tailored, heat education-based intervention on farmworker heat knowledge in the Summer 2019. We used convenience sampling to recruit adult outdoor farmworkers from Central/Eastern Washington State, USA. Crews were randomized to receive the intervention (n = 40 participants) versus not receive the intervention (n = 43 participants). We assessed changes in heat knowledge, scored on a scale from 0 to 11, between baseline, immediate post-intervention, and post-season, which was approximately three months after baseline, using the Wilcoxon signed-rank test. We compared differences in knowledge scores from baseline to post-season between groups using analysis of variance. RESULTS: Average knowledge scores improved from 4.6 (standard deviation [sd] 1.5) to 6.3 (sd 2.0) pre to post season in the intervention group (p < 0.001). There was a greater improvement in pre-post knowledge scores in the intervention (average difference 1.6, sd 2.0) versus the comparison group (average difference 0.41, sd 1.7) (p = 0.04). CONCLUSIONS: Participatory heat training was effective in improving farmworker heat knowledge over the course of a summer season. Results of this study will be used to guide heat prevention efforts for farmworkers. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT04234802.
Walking promotes human health and well-being. However, increasing temperatures due to global climate change and urban heat islands challenge urban walkability. While people navigate urban settings, they encounter asymmetrical environmental conditions not captured by most thermal comfort models. Critically, these models predominantly factor in the Mean Radiant Temperature (MRT) but tend to neglect the effects of non-uniform solar radiation on human comfort. This study delves into the thermal impacts of solar radiation on walking individuals, utilizing a controlled environment with solar simulators. 28 subjects walked on a treadmill, simulating the walking state of pedestrians, under asymmetrical radiation conditions with the source being overhead, in front, behind, and to the side. Participants responded to queries concerning their overall thermal comfort, thermal sensation, and thermal acceptability. In addition, they provided feedback on directional and segmental thermal sensations across various body parts. Our findings revealed that the thermal sensation varied depending on the direction of radiation, and their responses regarding their forearms were most closely related to their whole body. These results provide information that can be valuable in the design of outdoor environments that will be thermally comfortable and will encourage people to walk during hot weather.
Regarding the predisposition of individuals to change when confronted with future climate scenarios, it is necessary to understand the perception of the groups under analysis and how to engage with society to collectively act toward climate change mitigation. A question remains to be answered: how to ensure that people engage, participate, and gain awareness of the undergoing problem that urban climate change poses for the future of cities’ management? This research intends to contribute to solving this question by raising another question: “How willing are residents of the Alvalade neighborhood (Lisbon) to change their behavior and way of life when faced with climate change scenarios?” We present a methodology using microclimatic modeling with ENVI-met and questionnaires for the resident community. The present and future local climate scenarios (representing a present hot day versus the extreme IPCC RCP 8.5 scenario) were presented to a set of residents. These figures show the projected UTCI (Universal Thermal Climate Index) in a dramatic but accurate aggravated way. The inquiries allowed us to conclude that people are more aware of local climate change and health risks from extremely hot summer weather, but they continue to resist adopting behavior change for adaptation, although most of them declared this could be important to tackle climate change. The second conclusion is that people think that local authorities should be more active than themselves and will have greater responsibility for climate change adaptation and interventions. In times of climate crisis, the participation of the resident community can be an important help in decision making and finding measures to mitigate adverse climate effects in urban environments.
Climate change is disrupting the fundamental conditions of human life and exacerbating existing inequity by placing further burdens on communities that are already vulnerable. Risk exposure varies by where people live and work. In this article, we examine the spatial overlap of the compound risks of COVID-19 and extreme heat in New York City. We assess the relationship between socio-demographic and natural, built and social environmental characteristics, and the spatial correspondence of COVID-19 daily case rates across three pandemic waves. We use these data to create a compound risk index combining heat, COVID-19, density and social vulnerability. Our findings demonstrate that the compound risk of COVID-19 and heat are public health and equity challenges. Heat and COVID-19 exposure are influenced by natural, built, and social environmental factors, including access to mitigation infrastructure. Socio-demographic characteristics are significant indicators of COVID-19 and heat exposure and of where compound vulnerability exists. Using GIS mapping, we illustrate how COVID-19 risk geographies change across the three waves of the pandemic and the particular impact of vaccinations before the onset of the third wave. We, then, use our compound risk index to assess heat interventions undertaken by the City, identify neighborhoods of both adequate and inadequate coverage and provide recommendations for future interventions.
Anthropogenic climate change will have a detrimental impact on global health, including the direct impact of higher ambient temperatures. Existing projections of heat-related health outcomes in a changing climate often consider increasing ambient temperatures alone. Population growth and structure has been identified as a key source of uncertainty in future projections. Age acts as a modifier of heat risk, with heat-risk generally increasing in older age-groups. In many countries the population is ageing as lower birth rates and increasing life expectancy alter the population structure. Preparing for an older population, in particular in the context of a warmer climate should therefore be a priority in public health research and policy. We assess the level of inclusion of population growth and demographic changes in research projecting exposure to heat and heat-related health outcomes. To assess the level of inclusion of population changes in the literature, keyword searches of two databases were implemented, followed by reference and citation scans to identify any missed papers. Relevant papers, those including a projection of the heat health burden under climate change, were then checked for inclusion of population scenarios. Where sensitivity to population change was studied the impact of this on projections was extracted. Our analysis suggests that projecting the heat health burden is a growing area of research, however, some areas remain understudied including Africa and the Middle East and morbidity is rarely explored with most studies focusing on mortality. Of the studies pairing projections of population and climate, specifically SSPs and RCPs, many used pairing considered to be unfeasible. We find that not including any projected changes in population or demographics leads to underestimation of health burdens of on average 64 %. Inclusion of population changes increased the heat health burden across all but two studies.
Recent studies and reports suggest an increased mortality rate of undocumented border crossers (UBCs) in Arizona is the result of heat extremes and climatic change. Conversely, others have shown that deaths have occurred in cooler environments than in previous years. We hypothesized that human locomotion plays a greater role in heat-related mortality and that such events are not simply the result of exposure. To test our hypothesis, we used a postmortem geographic application of the human heat balance equation for 2,746 UBC deaths between 1990 and 2022 and performed regression and cluster analyses to assess the impacts of ambient temperature and exertion. Results demonstrate exertion having greater explaining power, suggesting that heat-related mortality among UBCs is not simply a function of extreme temperatures, but more so a result of the required physical exertion. Additionally, the power of these variables is not static but changes with place, time, and policy.
Extreme heat is increasingly being acknowledged as a serious hazard to human health, through a combination of physiological responses to heat, expressed as dry and wet bulb temperatures, and personal factors. Here we present an analysis of the diurnal variability of dry and wet bulb temperatures using station data in South Asia during both regular and heatwave days. We find that diurnal cycles differ, with the daily maximum wet bulb temperature occurring several hours after the daily maximum dry bulb temperature. Using radiosonde profiles, we show that the timing and amplitude of the diurnal variability of wet bulb temperature can be explained by changes in boundary layer depths and water content. Physiological thresholds for uncompensable heat stress were exceeded even in the evenings, many hours after dry bulb temperature peaks. Cumulative exceedances occurred in 105 instances, corresponding to at least 300 hours of exposure to uncompensable heat stress in South Asia between 1995 and 2020. We conclude that physiologically relevant thresholds provide a more robust way to estimate health impacts, and that wet bulb temperature alone is insufficient as an indicator of hazardous heat. Human physiological thresholds for uncompensable heat stress were exceeded for more than 300 hours in South Asia between 1995 and 2020, including in the evenings, according to an analysis of the diurnal variability of wet and dry bulb temperatures in station data.
BACKGROUND: Heat is a significant cause of mortality, but impact patterns are heterogenous. Previous studies assessing such heterogeneity focused exclusively on risk rather than heat-attributable mortality burdens and assume predictors are independent. OBJECTIVES: We assessed how four interrelated regional-level sociodemographic predictors-education, life expectancy, the ratio of older to younger people (aging index), and relative income-influence heterogeneity in heat-attributable mortality burdens in Europe and then derived insights into adaptation strategies. METHODS: We extracted four outcomes from a temperature-mortality study covering 16 European countries: the rate of increase in mortality risk at moderate and extreme temperatures (moderate and extreme slope, respectively), the minimum mortality temperature percentile (MMTP), and the underlying mortality rate. We used structural equation modeling with country-level random effects to quantify the direct and indirect influences of the predictors on the outcomes. RESULTS: Higher levels of education were directly associated with lower heat-related mortality at moderate and extreme temperatures via lower slopes and higher MMTPs. A one standard deviation increase in education was associated with a – 0.46 ± 0.14, – 0.41 ± 0.12, and 0.41 ± 0.12 standard deviation (±standard error) change in the moderate slope, extreme slope, and MMTP, respectively. However, education had mixed indirect influences via associations with life expectancy, the aging index, and relative income. Higher life expectancy had mixed relations with heat-related mortality, being associated with higher risk at moderate temperatures (0.33 ± 0.11 for the moderate slope; – 0.19 ± 0.097 for the MMTP) but lower underlying mortality rates ( – 0.72 ± 0.097). A higher aging index was associated with higher burdens through higher risk at extreme temperatures (0.13 ± 0.072 for the extreme slope) and higher underlying mortality rates (0.93 ± 0.055). Relative income had relatively small, mixed influences. DISCUSSION: Our novel approach provided insights into actions for reducing the health impacts of heat. First, the results show the interrelations between possible vulnerability-generating mechanisms and suggest future research directions. Second, the findings point to the need for a dual approach to adaptation, with actions that explicitly target heat exposure reduction and actions focused explicitly on the root causes of vulnerability. For the latter, the climate crisis may be leveraged to accelerate ongoing general public health programs. https://doi.org/10.1289/EHP11766.
Temperature may be an important environmental factor affecting psoriasis. This study aimed to determine the potential association between apparent temperature (AT) and outpatient visits for psoriasis in Hefei, China. Daily psoriasis clinic visits in Hefei were collected from January 1, 2016 to December 31, 2020. A Poisson generalized linear regression model (PGLM) combined with a distributional lagged nonlinear model (DLNM) was used to analyze the impact of AT on psoriasis outpatient visits; the model was adjusted for relative humidity, wind speed, precipitation, PM2.5, NO2, SO2, time trends, Sundays, and holidays. The analyses were stratified by age and sex. A total of 24,351 patients with psoriasis were included in this study. Only a low AT showed a delayed and strong risk effect. Referring to the median AT (16.8 degrees C), the effect of low AT started at lag 2 days and showed an increasing and then decreasing trend for approximately 5 days; the effect of extreme cold (1st percentile) and cold (5th percentile) peaked at lag 4 days with a relative risk (RR) of 1.117 (95% CI:1.065 to 1.171) and 1.081 (95% CI:1.044 to 1.119), respectively. The effect of mild cold (25th percentile) reached a maximum RR of 1.033 (95% CI:1.017 to 1.048) at lag 6 days. Subgroup analysis showed that low AT risk was more pronounced and longer-lasting in men and individuals aged <45 years. Our study provides evidence that a low AT increases the risk of psoriasis. Men and young people are vulnerable to potential adverse effects. There is a need for enhanced health interventions, medical care, and early warnings for patients.
PURPOSE OF REVIEW: The Mediterranean basin is highly vulnerable to climate change. This study is aimed at quantifying the risk of mortality associated with exposure to high ambient temperature in the Mediterranean basin in the general population and in vulnerable sub-populations. RECENT FINDINGS: We retrieved effect estimates from studies linking temperature and mortality in the Mediterranean basin, between 2000 and 2021. In a meta-analysis of 16 studies, we found an increased risk of all-cause mortality due to ambient heat/high temperature exposure in the Mediterranean basin, with a pooled RR of 1.035 (95%CI 1.028-1.041) per 1 °C increase in temperature above local thresholds (I(2) = 79%). Risk was highest for respiratory mortality (RR = 1.063, 95% CI 1.052-1.074) and cardiovascular mortality (RR = 1.046, 95% CI 1.036-1.057). Hot ambient temperatures increase the mortality risk across the Mediterranean basin. Further studies, especially in North African, Asian Mediterranean, and eastern European countries, are needed to bolster regional preparedness against future heat-related health burdens.
BACKGROUND: Limited evidence exists on how temperature increases are associated with hospital visits from alcohol- and substance-related disorders, despite plausible behavioral and physiological pathways. METHODS: In the present study, we implemented a case-crossover design, which controls for seasonal patterns, long-term trends, and non- or slowly-varying confounders, with distributed lag non-linear temperature terms (0-6 days) to estimate associations between daily ZIP Code-level temperature and alcohol- and substance-related disorder hospital visit rates in New York State during 1995-2014. We also examined four substance-related disorder sub-causes (cannabis, cocaine, opioid, sedatives). RESULTS: Here we show that, for alcohol-related disorders, a daily increase in temperature from the daily minimum (-30.1 °C (-22.2 °F)) to the 75th percentile (18.8 °C (65.8 °F)) across 0-6 lag days is associated with a cumulative 24.6% (95%CI,14.6%-34.6%) increase in hospital visit rates, largely driven by increases on the day of and day before hospital visit, with an association larger outside New York City. For substance-related disorders, we find evidence of a positive association at temperatures from the daily minimum (-30.1 °C (-22.2 °F)) to the 50th percentile (10.4 °C (50.7 °F)) (37.7% (95%CI,27.2%-48.2%), but not at higher temperatures. Findings are consistent across age group, sex, and social vulnerability. CONCLUSIONS: Our work highlights how hospital visits from alcohol- and substance-related disorders are currently impacted by elevated temperatures and could be further affected by rising temperatures resulting from climate change. Enhanced social infrastructure and health system interventions could mitigate these impacts.
Drowning is a serious public health problem in the world. Several studies have found that ambient temperature is associated with drowning, but few have investigated the effect of heatwave on drowning. This study aimed to explore the associations between heatwave and drowning mortality, and further estimate the mortality burden of drowning attributed to heatwave in China. Drowning mortality data were collected in 71 prefectures in China during 2013-2018 from provincial vital register system. Meteorological data at the same period were collected from European Centre for Medium-Range Weather Forecasts (ECMWF). A distributed lag non-linear model (DLNM) was first to explore the association between heatwave and drowning mortality in each prefecture. Secondly, the prefecture-specific associations were pooled using meta-analysis. Finally, attributable fractions (AFs) of drowning deaths caused by heatwave were estimated. Compared to normal day, the mortality risk of drowning significantly increased during heatwave (RR = 1.20, 95%CI: 1.18-1.23). Higher risks were observed in males (RR = 1.23, 95%CI: 1.20-1.27) than females (RR = 1.18, 95%CI: 1.13-1.23), in children aged 5-14 years old (RR = 1.24, 95%CI: 1.15-1.33) than other age groups, in urban city (RR = 1.32, 95%CI: 1.28-1.36) than rural area (RR = 1.09, 95%CI: 1.07-1.12) and in Jilin province (RR = 2.85, 95%CI: 1.61-5.06) than other provinces. The AF of drowning deaths due to heatwave was 11.4 % (95%CI: 10.0 %-12.9 %) during heatwave and 1.0 % (95%CI: 0.9 %-1.1 %) during study period, respectively. Moreover, the AFs during study period were higher for male (1.2 %, 95%CI: 1.0 %-1.3 %), children 5-14 years (1.1 %, 95%CI: 0.7 %-1.6 %), urban city (1.6 %, 95%CI: 1.4 %-1.8 %) than their correspondents. These differences were also observed in AFs during heatwave. We found that heatwave may significantly increase the mortality risk of drowning mortality, and its mortality burden attributable to heatwave was noteworthy. Targeted intervention should be carried out to decrease drowning mortality during heatwave.
To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat-attributable occupational injury in Australia. Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014-19, based on Safe Work Australia (work-related traumatic injury fatalities and workers’ compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta-analysis of climate zone-specific risk data. Burden of heat-attributable occupational injuries as disability-adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen-Geiger climate zone, and by state and territory. During 2014-19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury-related DALYs were attributable to heat (2.3% of occupational injury-related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat-attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat-attributable occupational injury-related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%). An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry-based policies are needed to safeguard workplace health and safety, particularly in heat-exposed industries, such as agriculture, transport, and construction.
Heat stress is a harmful physical hazard in many occupational settings. However, consequences of occupational heat exposure among workers in a sugarcane factory in Ethiopia are not well characterized. This study aimed to assess the level of occupational heat exposure-related symptoms and contributing factors. In this cross-sectional study, five workstations were selected for temperature measurement. Heat stress levels were measured using a wet-bulb globe temperature index meter. A stratified random sampling technique was used to select 1,524 participants. Heat-related symptoms were assessed using validated questionnaires. The level of occupational heat exposure was 72.4% (95% CI: 70.2%-74.8%), while 71.6% (95% CI: 69.3%-74.9%) of participants experienced at least one symptom related to heat stress. The most common heat-related symptoms were swelling of hands and feet (78%), severe thirst (77.8%) and dry mouth (77.4%). The identified risk factors were a lack of reflective shields (AOR: 2.20, 95% CI: 1.53, 3.17), not-enclosed extreme heat sources (AOR: 1.76, 95% CI: 1.23, 2.51), a lack of access to shade (AOR: 9.62, 95% CI: 6.20, 14.92), and inappropriate protective clothing provision (AOR: 1.58, 95% CI: 1.27, 2.71). The burden of occupational heat exposure and heat-induced symptoms was high. Lack of reflective shields, the absence of enclosed extreme heat sources, a lack of access to shade, and inappropriate protective clothing provision were considerable attributes of heat stress. Therefore, the use of mechanical solutions to stop heat emissions at their sources and the key factors identified were areas for future intervention.
Climate change is currently regarded as the greatest global threat to human health, and its health-related consequences take different forms according to age, sex, socioeconomic level, and type of territory. The aim of this study is to ascertain the differences in vulnerability and the heat-adaptation process through the minimum mortality temperature (MMT) among the Spanish population aged ≥65 years by territorial classification. A retrospective, longitudinal, ecological time-series study, using provincial data on daily mortality and maximum daily temperature across the period 1983-2018, was performed, differentiating between urban and nonurban populations. The MMTs in the study period were higher for the ≥65-year age group in urban provinces, with a mean value of 29.6 °C (95%CI 29.2-30.0) versus 28.1 °C (95%CI 27.7-28.5) in nonurban provinces. This difference was statistically significant (p < 0.05). In terms of adaptation levels, higher average values were obtained for nonurban areas, with values of 0.12 (95%CI -0.13-0.37), than for urban areas, with values of 0.09 (95%CI -0.27-0.45), though this difference was not statistically significant (p < 0.05). These findings may contribute to better planning by making it possible to implement more specific public health prevention plans. Lastly, they highlight the need to conduct studies on heat-adaptation processes, taking into account various differential factors, such as age and territory.
INTRODUCTION: Heatwave is a major global health concern. Many countries including China suffered a record-breaking heatwave during the summer of 2022, which may have a significant effect on population health or health information-seeking behaviours but is yet to be examined. METHODS: We derived health information-seeking data from the Baidu search engine (similar to Google search engine). The data included city-specific daily search queries (also referred to Baidu Search Index) for heat-sensitive diseases from 2021 to 2022, including heatstroke, hospital visits, cardiovascular diseases and diabetes, respiratory diseases, mental health and urological diseases. For each city, the record-breaking heatwave days in 2022 were matched to days in the same calendar month in 2021. RESULTS: The 2022 record-breaking heatwave hit most cities (83.64%) in Mainland China. The average heatwave duration was 13 days and the maximum temperature was 3.60°C higher than that in 2021 (p<0.05). We observed increased population behaviours of seeking information on respiratory diseases (RR=1.014, 95% CI: 1.008 to 1.020), urological diseases (RR=1.011, 95% CI: 1.006 to 1.016) and heatstroke (RR=1.026, 95% CI: 1.016 to 1.036) associated with the heatwave intensity in 2022 (per 1°C increase). The heatwave duration in 2022 (per 1 day increase) was also associated with an increase in seeking information on cardiovascular diseases and diabetes (RR=1.003, 95% CI: 1.002 to 1.004), urological diseases (RR=1.005, 95% CI: 1.002 to 1.008), mental health (RR=1.009, 95% CI: 1.006 to 1.012) and heatstroke (RR=1.038, 95% CI: 1.032 to 1.043). However, there were substantial geographical variations in the effect of the 2022 heatwave intensity and duration on health information-seeking behaviours. CONCLUSION: This infodemiology study suggests that the 2022 summer unprecedented heatwave in Mainland China has significantly increased population demand for health-related information, especially for heatstroke, urological diseases and mental health. Population-based research of real-time disease data is urgently needed to estimate the negative health impact of the exceptional heatwave in Mainland China and elsewhere.
Plentiful sunlight and high temperatures in desert climates cause burn injuries from contact with sun-exposed surfaces. The peak temperature, times, and surfaces of greatest risk are not well described. This work recorded temperature measurements of six materials in a desert climate. Surface temperatures of asphalt, brick, concrete, sand, porous rock, and galvanized metal were measured throughout the summer, along with ambient temperature, and sunlight intensity. Samples were placed in both shade and direct sunlight for evaluation of sunlight effect. Seventy-five thousand individual measurements were obtained from March to August 2020. Maximum recorded temperatures for sunlight-exposed porous rock were 170°F, asphalt 166°F, brick 152°F, concrete 144°F, metal 144°F, and sand 143°F, measured on August 6, 2020 at 2:10 pm, when ambient temperature was 120°F and solar irradiation 940 W/m2. Sunlight-exposed materials ranged 36 to 56°F higher than shaded materials measured at the same time. The highest daily temperatures were achieved between 2:00 and 4:00 pm due to maximum solar irradiance. Contour plots of surface temperature as a function of both solar irradiation and time of day were created for all materials tested. A computational fluid dynamics model was created to validate the data and serve as a predictive model based upon temperature and sunlight inputs. This information is useful to inform the public of the risks of contact burn due to sunlight-exposed surfaces in a desert climate.
Increasing wind speed alleviates physiological heat strain; however, health policies have advised against using ventilators or fans under heat wave conditions with air temperatures above the typical skin temperature of 35 °C. Recent research, mostly with sedentary participants, suggests mitigating the effects of wind at even higher temperatures, depending on the humidity level. Our study aimed at exploring and quantifying whether such results are transferable to moderate exercise levels, and whether the Universal Thermal Climate Index (UTCI) reproduces those effects. We measured heart rates, core and skin temperatures, and sweat rates in 198 laboratory experiments completed by five young, semi-nude, heat-acclimated, moderately exercising males walking the treadmill at 4 km/h on the level for three hours under widely varying temperature-humidity combinations and two wind conditions. We quantified the cooling effect of increasing the wind speed from 0.3 to 2 m/s by fitting generalized additive models predicting the physiological heat stress responses depending on ambient temperature, humidity, and wind speed. We then compared the observed wind effects to the assessment performed by the UTCI. Increasing the wind speed lowered the physiological heat strain for air temperatures below 35 °C, but also for higher temperatures with humidity levels above 2 kPa water vapor pressure concerning heart rate and core temperature, and 3 kPa concerning skin temperature and sweat rate, respectively. The UTCI assessment of wind effects correlated positively with the observed changes in physiological responses, showing the closest agreement (r = 0.9) for skin temperature and sweat rate, where wind is known for elevating the relevant convective and evaporative heat transfer. These results demonstrate the potential of the UTCI for adequately assessing sustainable strategies for heat stress mitigation involving fans or ventilators, depending on temperature and humidity, for moderately exercising individuals.
Limited knowledge exists regarding the ramifications of climate warming on death burden from neurodegenerative diseases. Here, we conducted a nationwide, individual-level, case-crossover study between 2013 and 2019 to investigate the effects of non-optimal temperatures on various neurodegenerative diseases and to predict the potential death burden under different climate change scenarios. Our findings reveal that both low and high temperatures are linked to increased risks of neurodegenerative diseases death. We project that heat-related neurodegenerative disease deaths would increase, while cold-related deaths would decrease. This is characterized by a steeper slope in the high-emission scenario, but a less pronounced trend in the scenarios involving mitigation strategies. Furthermore, we predict that the net changes in attributable death would increase after the mid-21st century, especially under the unrestricted-emission scenario. These results highlight the urgent need for effective climate and public health policies to address the growing challenges of neurodegenerative diseases associated with global warming.
Understanding the relationships between high temperatures (HT) and heat waves (HW) is vital for enhancing human health, especially in areas with dense population. This paper analyzes the temporal and spatial characteristics of different HT and HW intensities, their spatial influence, and the population distribution risk at different HW intensities for 844 meteorological stations between 1951 and 2019. The results indicate that (1) HT and extreme temperature (ET) days are symmetrically distributed along the Huhuanyong Line, from southeast to northwest China. The times, days, and accumulated temperatures of HW, the times, days, and accumulated temperature of strong heat waves (SHW), and the times, days, and accumulated temperature of extreme heat waves (EHW) were distributed similarly; (2) with the increase in high temperatures or heat waves from HT to ET or from HW to SHW, the proportion of stations with an upward trend was always greater in China, while stations with a downward trend were mainly located in the North China Plain and Huai River Basin. For HW, SHW, and EHW, the increasing range of times and days were less than the accumulated temperatures; (3) between 1990 and 2019, there was an expansion of the HW and SHW distribution area with an annual average of more than 10 days, and the EHW distribution area with an annual average of more than 3 days. Moreover, the number of people exposed to HW, SHW, and EHW also increased during this period; and (4) considering the population distribution characteristics and the regional HT and HW characteristics, society needs to form regional adaptation actions for different HT and HW intensities.
People spend most of their time indoors. However, indoor temperature and individual thermal exposure are generally not considered in epidemiological studies of temperature and health. Based on the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) RP-884 Database, the ASHRAE Global Thermal Comfort Database II and the Chinese Thermal Comfort Database, this study first explored the relationship between outdoor temperature, indoor temperature and thermal sensation from a global perspective. Moreover, the potential influence of spatiotemporal heterogeneity on health studies was explored. A breakpoint was found at approximately 11.5 °C in the segmented regression of indoor and outdoor temperature, and the slope of the curve was greater when outdoor temperature was above the breakpoint (n = 67,896). Based on multi-group propensity score matching (PSM) and generalizedadditivemodels (GAM), spatiotemporal heterogeneity was found in the relationship between indoor and outdoor temperatures after adjusting for building type and year. Furthermore, the relationship between indoor temperature and thermal sensation was influenced by the outdoor temperature. This study highlights the importance of considering indoor temperature or individual thermal exposure in temperature-related health studies.
Temporal change in heat and cold-related burden of mortality needs to be investigated in Iran. In this study, the burden between 2015 and 2022 was compared with 2008-2014 in eight cities of Kurdistan which is located to the west of Iran. The overall dose-response association between temperature and mortality by different years (i.e., interaction effect between year and temperature) was assessed using bivariate response surface model and the framework of generalized additive model (GAM). The cumulative dose-response as well as lag-response associations in the two periods was compared by a time-varying distributed lag non-linear model. The associations were pooled using a two-stage regression model in which average temperature and temperature range were adjusted to control for the heterogenicity between cities. The attributable fraction (AF) and number (AN) were estimated in each city to ease the interpretation. Compared to 2008-2014, heat and extreme heat caused more mortality than cold and extreme cold in 2015-2022; the relative risk (RR) values of heat in second period were significantly higher than first period, and the cumulative RR of the extreme heat was 1.56 (%95 CI: 1.23-1.98) and 0.88 (%95 CI: 0.66-1.18) in second and first periods, respectively. Also, the cumulative RR of extreme cold was 1.01 (0.87, 1.17) and 0.89 (0.76, 1.05) in second and first periods, respectively. In second period, the extreme heat values approximately caused a minimum of 100 deaths in Marivan and a maximum of 400 in Sanandaj. The AF in Baneh, Kamyaran, and Sanandaj was significantly higher than other cities. All subgroups’ people were at risk of heat-related mortality in second period, and the cold had no significant impact in the period. Heat-related mortality was increased in recent years while cold had no significant impact. The results highlight the need for an adaptation or preventive strategy of heat-related mortality in the regions.
There is limited evidence of temporal changes in the association between air temperature and the risk of cause-specific cardiovascular [CVD] and respiratory [RD] mortality. METHOD: We explored temporal variations in the association between short-term exposures to air temperature and non-accidental and cause-specific CVD and RD mortality in the 15 largest German cities over 24 years (1993-2016) using time-stratified time series analysis. We applied location-specific confounder-adjusted Poisson regression with distributed lag non-linear models with a lag period of 14 days to estimate the temperature-mortality associations. We then pooled the estimates by a multivariate meta-analytical model. We analysed the whole study period and the periods 1993-2004 and 2005-16, separately. We also carried out age- and sex-stratified analysis. Cold and heat effects are reported as relative risk [RR] at the 1st and the 99th temperature percentile, relative to the 25th and the 75th percentile, respectively. RESULT: We analysed a total of 3,159,292 non-accidental, 1,063,198 CVD and 183,027 RD deaths. Cold-related RR for CVD mortality was seen to rise consistently over time from 1.04 (95% confidence interval [95% CI] 1.02, 1.06) in the period 1993-2004 to 1.10 (95% CI 1.09, 1.11) in the period 2005-16. A similar increase in cold-related RR was also observed for RD mortality with risk increasing from 0.99 (95% CI 0.96, 1.03) to 1.07 (95% CI 1.03, 1.10). Cold-related ischemic, cerebrovascular, and heart failure mortality risk were seen to be increasing over time. Similarly, COPD, the commonly speculated driver of heat-related RD mortality was found to have a constant heat-related risk over time. Males were increasingly vulnerable to cold with time for all causes of death. Females showed increasing sensitivity to cold for CVD mortality. Our results indicated a significant increased cold and heat vulnerability of the youngest age-groups (<64) to non-accidental and RD mortality, respectively. Similarly, the older age group (>65) were found to have significantly increased susceptibility to cold for CVD mortality. CONCLUSION: We found evidence of rising population susceptibility to both heat- and cold-related CVD and RD mortality risk from 1993 to 2016. Climate change mitigation and targeted adaptation strategies might help to reduce the number of temperature-related deaths in the future.
Rising global temperatures and more frequent heatwaves due to climate change have led to a growing body of research and increased policy focus on how to protect against the adverse effects of heat. In cold and temperate Europe, dwellings have traditionally been designed for cold protection rather than heat mitigation. There is, therefore, a need to understand the mechanisms through which indoor overheating can occur, its effects on occupants and energy consumption, and how we can design, adapt, and operate buildings during warm weather to improve thermal comfort and reduce cooling energy consumption. This paper brings together experts in overheating from across Europe to explore 10 key questions about the causes and risks from overheating in residential settings in Central and Northern Europe, including the way in which we define and measure overheating, its impacts, and its social and policy implications. The focus is not on summarising literature, but rather on identifying the evidence, key challenges and misconceptions, and limitations of current knowledge. Looking ahead, we outline actions needed to adapt, including the (re)design of dwellings, neighbourhoods, and population responses to indoor heat, and the potential shape of these actions. In doing so, we illustrate how heat adaptation is a multi-faceted challenge that requires urgent and coordinated action at multiple levels, but with feasible solutions and clear benefits for health and energy.
The current climate change is responsible for the growth in number of extreme climatic events like heat waves (HWs), which occur frequently with more intense effects. HW poses direct as well as indirect impact on health of population, urban heat island, air quality, and have consequences on the biological phenomena. Aim of this study is to review the available literature of research related to HW and its impact on human health and urban heat island. Science-direct is used as online database to identify the studies related to HW from 2000 to 2022 using the keyword HW impact, HW and mortality & HW extremes. To identify maximum variable information about HW and its effect throughout the world, during the extraction of articles, no constraints were added related to study area. Total 99 research articles are identified during online database search on science-direct using the mentioned keywords. After going through different inclusion and exclusion criteria, only 46 studies are included in this review article. After summarization, authors identified many effect categories, mainly were mortality, morbidity, thermal stress, air quality, biological consequences, effect of HW on demand of water and electricity, relationship between HW and Urban Heat Island, and HW related urban policies. It is observed on the basis of extracted articles that number of studies and publications on HW are increasing rapidly and sharp increase is observed in last decade. Present review clearly indicates that due to different natural and anthropogenic reasons, there is change in temperature range due to which the HW events are increasing and its studies are also increases. After reviewing the HW related articles it is recommended that it is right time to make some full proof strategies to adopt workplace heat stress standard and encourage people to planting a tree, installing cool and green roofs, etc.
AIMS: We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults. METHODS: This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June-August) in New York City from 2005 to 2011 from patients of three age groups (6-11, 12-17 and 18-25 years). Using a distributed lag non-linear model over 0-5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations. RESULTS: In New York City, there were 82,982 mental health-related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health-related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13-1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09-1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04-1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature. CONCLUSIONS: We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.
BACKGROUND: Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population. METHODS: Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES. RESULTS: No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS. CONCLUSION: Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.
Studies about the role of urban characteristics in modifying the health effect of temperature extremes are still unclear. This study is aimed at quantifying the morbidity risk of infectious diarrhea attributable to temperature extremes and the modified effect of a range of city-specific indicators. Distributed lag non-linear model and multivariate meta-regression were applied to estimate fractions of infectious diarrhea morbidity attributable to temperature extremes and to explore the effect modification of city-level characteristics. Extreme heat- and extreme cold-related infectious diarrhea amounted to 0.99% (95% CI: 0.57-1.29) and 1.05% (95% CI: 0.64-1.24) of the total cases, respectively. The attributable fraction of temperature extremes on infectious diarrhea varied between southern and northern China. Several city characteristics modified the association of extreme cold with infectious diarrhea, with a higher morbidity impact related to increased water consumption per capita and decreased latitude. Regions with higher levels of latitude or GDP per capita appeared to be more sensitive to extreme hot. In conclusion, exposure to temperature extremes was associated with increased risks of infectious diarrhea and the effect can be modified by urban characteristics. This finding can inform public health interventions to decrease the adverse effects of temperature extremes on infectious diarrhea.
Extreme weather episodes may increase the salience of climate change and worsen people’s well-being. Empirically studying these effects is however challenging, given limited data availability around difficult-to-predict such events. Addressing this issue, I use Google Trends information to assess how climate change salience and people’s wellness were affected by an unprecedented mid-July 2022 heatwave in the United Kingdom, when temperatures exceeded 40C for the first time in the country’s history. I document a significant rise in the search-intensity for ‘climate change’, as well as for ‘worry’ as a marker of psychological distress at the time of the heatwave. In contrast, I show that similar patterns did not emerge in 2019, when comparably high temperatures were recorded, but when the 40C-threshold was not exceeded. Taken together, my results suggest that the effects of the 2022 heatwave are partially driven by a climate anxiety mechanism, wherein extreme weather episodes constitute negative signals for climate change progression. I conclude by discussing several limitations of my study that future work may tackle.
Current practices in the U.S. health care industry drive climate change. This review summarizes the vast research on the negative health effects of the climate crisis on patients as relevant to obstetrics and gynecology. We further propose solutions to decarbonize operating rooms, labor and delivery units, and nurseries and neonatal intensive care units through evidence-based reduction in our single-use supply, energy, and water, as well as anesthetic gases and appropriate waste sorting.
Compared to previous decade, impact of heat waves (HWs) on mortality in recent years needs to be discussed in Iran. We investigated temporal change in added impact of summer HWs on mortality in eight cities of Iran. The pooled length of HWs was compared between 2015-2022 and 2008-2014 using random and fixed-effects of meta-analysis regression model. The temporal change in impact of HWs was evaluated through interaction effect between crossbasis function of HW and year in a two-stage time varying model. In order to pool the reduced coefficients of each period, multivariate meta-regression model, including city-specific temperature and temperature range as heterogenicity factors, was used. In addition to relative risk (RR), attributable fraction (AF) of HW in the two periods was also estimated in each city. In the last years, the frequency of all HWs was higher and the weak HWs were significantly longer. The only significant RR was related to the lowest and low severe HWs which was observed in the second period. In terms of AF, compared to the strong HWs, all weak HWs caused a considerable excess mortality in all cities and second period. The subgroup analysis revealed that the significant impact in the second period was mainly related to females and elderlies. The increased risk and AF due to more frequent and longer HWs (weak HWs) in the last years highlights the need for mitigation strategies in the region. Because of uncertainty in the results of severe HWs, further elaborately investigation of the HWs is need.
Urbanization has been a substantial force to change the natural environment, and several urbanization-related climatic issues, such as urban heat island (UHI) effect, would pose a great threat to public health. However, the climatic effects of urbanization and their possible links with human thermal comfort remain poorly understood. In this study, we examined the impact of urbanization on summertime air temperature, extreme hot events and human-perceived heat stress in Xiangjiang watershed, a typical inland highly urbanized area of China. Results showed that in the context of global warming Xiangjiang watershed experienced extensive summertime warming, especially nighttime warming in the past nearly half-century, and urbanization aggravated the warming effect in urban areas by increasing nighttime air temperature as well, creating the UHI effect. Meanwhile, all three types of extreme hot events, i.e. independent hot days (IHD), independent hot nights (IHN), and compound hot events (CHE) showed increasing trends. Urbanization significantly increased the occurrence, duration and intensity of CHE, which involved both the daytime and nighttime extreme hot temperatures. Urban expansion contributed 51.39%, 30.91% and 25.69% of the increases in occurrence, duration and intensity of CHE, respectively. Besides, increasing air temperature and extreme hot events would inevitably enhance the heat stress on people, especially in the nighttime, and urbanization exacerbated the nighttime discomfort on people with contribution to 26.92% of increases in nighttime heat stress index (HI). Nearly one quarter of summer nights in urban areas have reached very warm level of severe heat situation for human beings in the late stage (1996-2019). Urbanization-induced increases in CHE and nighttime HI caused an aggravation of human heat discomfort since people failed to relief the excess heat stress of daytime at night. This study provided new insights to understand urban climatic effect and its relation to human heat-related comfort.
BACKGROUND: Increasingly frequent and intense extreme heat events (EHEs) are indicative of climate change impacts, and urban areas’ social and built environments increase their risk for health consequences. Heat action plans (HAPs) are a strategy to bolster municipal EHE preparedness. The objective of this research is to characterize municipal interventions to EHEs and compare U.S. jurisdictions with and without formal heat action plans. METHODS: An online survey was sent to 99 U.S. jurisdictions with populations > 200,000 between September 2021 and January 2022. Summary statistics were calculated to describe the proportion of total jurisdictions, as well as jurisdictions with and without HAPs and in different geographies that reported engagement in extreme heat preparedness and response activities. RESULTS: Thirty-eight (38.4%) jurisdictions responded to the survey. Of those respondents, twenty-three (60.5%) reported the development of a HAP, of which 22 (95.7%) reported plans for opening cooling centers. All respondents reported conducting heat-related risk communications; however, communication approaches focused on passive, technology-dependent mechanisms. While 75.7% of jurisdictions reported having developed a definition for an EHE, less than two-thirds of responding jurisdictions reported any of the following activities: conducting heat-related surveillance (61.1%), implementing provisions for power outages (53.1%), increasing access to fans or air conditioners (48.4%), developing heat vulnerability maps (43.2%), or evaluating activities (34.2%). There were only two statistically significant (p ≥ .05) differences in the prevalence of heat-related activities between jurisdictions with and without a written HAP, possibly attributable to a relatively small sample size: surveillance and having a definition of extreme heat. CONCLUSIONS: Jurisdictions can strengthen their extreme heat preparedness by expanding their consideration of at-risk populations to include communities of color, conducting formal evaluations of their responses, and by bridging the gap between the populations determined to be most at-risk and the channels of communication designed to reach them.
Recently, the seriousness of global warming has become increasingly prominent worldwide. In this study, Hsian-tsao, a safe, heat-resistant ingredient that can be eaten and applied, and its extract products were examined for their potential applicability as a countermeasure for problems that may arise in the skin due to global warming. This includes being flexible and responsive to changes in consumer demand due to global warming. Furthermore, regarding global warming, the scientific community is considering ways to mitigate heat stress in humans and animals, and we hope to provide key data for future exploration. Although this review is a narrative review, we conducted a systematic review and searched sources such as PubMed, Medline, Scopus, ResearchGate, and Google Scholar according to PRISMA flow chart guidelines and using a chain of search words such as “global warming”, “green industry”, “Hsian-tsao”, “heat resistance”, “skin health”, “cosmetics”, and “consumer”. Accordingly, we searched a total of 1231 studies and selected 107 studies in the final stage. Considering the sustainability and safeness of Hsian-tsao, further studies to help mitigate human heat stress caused by global warming and evaluate its impact on beauty and health should analyze its utilization and reflect consumer needs that can contribute to the green industry. Therefore, in a situation where the growth of the green industry is urgently needed due to the acceleration of global warming, additional research is necessary on inner-beauty materials and heat-resistant plants that lower the temperature in line with future preparations for continuous global warming. Accordingly, the science community and nutrition, inner beauty, and cosmetics industries seem likely to bring more interest to the green industry, and this trend will continue in the future. We hope that Hsian-tsao will be used in a variety of skin health strategies and nutritional approaches to global warming and heat resistance.
With ongoing global warming, heatwave-related disasters are on the rise, exerting a multifaceted impact on both the natural ecosystem and human society. While temperature has been extensively studied in the effects of extreme heat on human health, humidity has often been ignored. It is crucial to consider the combined influence of temperature and humidity when assessing heatwave risks and safeguarding human well-being. This study, leveraging remote sensing products and reanalysis data, presented the first analysis of the spatiotemporal variations in global human-perceived heatwaves on a seasonal scale from 2000 to 2020, and further employed the Random Forest (RF) regression model to quantitatively assess the explanatory power of seven driving factors. The study found that since the 21st century (1) changes in Heat Index (HI) have varied significantly worldwide, with the majority of regions witnessing an increase, particularly at higher latitudes. The largest HI-increasing area was observed in the second quarter (S2), while the overall HI increase peaked in the third quarter (S3); (2) except for the decreasing area of none-risk regions, the regions under all other risk levels expanded (the proportion of high-risk areas in the world increased from 2.97% to 3.69% in S2, and from 0.04% to 0.35% in the fourth quarter (S4)); (3) aspect demonstrated the greatest explanatory power for the global heatwave distribution (0.69-0.76), followed by land-use coverage (LUCC, 0.48-0.55) and precipitation (0.16-0.43), while the explanatory power of slope and nighttime light (NTL) was rather low; (4) over the years, the explanatory power of each factor for heatwave distribution underwent a minor decrease without significant trend, but exhibited seasonal periodicity. Climatic factors and LUCC were most impactful in the first quarter (S1), while DEM and other human factors dominated in S2; and (5) interaction factors showed no significant trends over the years, but the explanatory power of DEM and slope increased notably when interacting with climate factor, aspect, and LUCC, respectively. The interactions between the aspect and LUCC with precipitation yielded the highest explanatory power (above 0.85) across all interactions. To effectively tackle heatwave risks, it is suggested to concentrate on high-latitude regions, reinforce land use and urban planning with eco-friendly strategies, scrutinize the interplay between precipitation and heatwaves, capitalize on topographic data for devising well-informed prevention measures, and tailor response strategies to accommodate seasonal fluctuations. This study offers valuable insights for enhancing climate change adaptation, disaster prevention, and mitigation strategies, ultimately contributing to the alleviation of extreme heatwaves and risk reduction.
Global warming has been affecting human health, including direct mortality and morbidity from extreme heat, storms, drought, and indirect infectious diseases. It is not only “global” but extremely “personal”-it is a matter of life and death for many of us. In this perspective, we propose the use of wearable technologies for localized personal thermoregulation as an innovative method to reduce the impact on health and enable wider adaptability to extreme thermal environments. The state-of-the-art thermoregulation methods and wearable sensing technologies are summarized. In addition, the feasibility of thermoregulation technology in preventive medicine for promoting health under climate change is comprehensively discussed. Further, we provide an outlook on health-oriented closed loop that can be achieved based on parallel thermoregulation and multiple data inputs from the physiological, environmental, and psychological cues, which could promote individuals and the public to better adapt to global warming.
Thermal health concerns have gained significant attention due to the heightened health risks faced by workers who are exposed to extreme thermal environments for prolonged periods. To ensure the occupational health and safety of such workers, and to enhance work efficiency, it is imperative to examine the characteristics of thermal health in the working environment. This study proposes three key elements of thermal health in the working environment, namely thermal health states, absence of heat-related illnesses, and heat adaptability, which can be used to develop a safety management framework for thermal health. By exploring the interconnections between these elements, the study summarizes their features and outlines the necessary precautions to safeguard them. The PDCA (plan/do/check/action) cycle management mode is utilized as a framework, with the three components of thermal health forming the core, to establish a safety management mode for thermal health. To ensure that employees work in a safe, healthy, comfortable, and productive environment, the assessment and control objectives of the thermal environment are regularly revised through the use of labor protection technology and thermal environment control technology. This paper presents a PDCA cycle safety management mode based on the characteristics of thermal health, which offers novel insights and approaches for assessing and managing workers’ thermal health.
Historical extreme heatwaves struck the Yangtze River Valley (YRV) in the boreal summer of 2022, severely impacting agricultural production, electricity supply, and resident health in China. This study shows that extreme heatwaves recurred over the YRV with distinct subseasonal processes. In early summer, from 14 June to 18 July, two extreme heatwaves were embedded in a mid-latitude 10-25-day intraseasonal oscillation (ISO), and hot-and-wet anomalies persisted over the YRV. A self-sustaining mechanism between the “cold vortex” over Northeast China and the “heat dome” around the YRV maintained this bi-weekly ISO. It fueled the heatwaves by modulating the meridional advection of upper-tropospheric potential vorticity, which firstly warmed the air via adiabatic processes and then later by diabatic heating. In late summer, from 30 July to 29 August, a 30-50-day ISO impacted the heatwave and drought over the YRV. This ISO originated from monsoon convection in the tropics, which regulated the meridional monsoonal circulation and enhanced the heatwave by intensifying the descending air motion and adiabatic heating over the YRV. The alternation of the two ISOs accompanied the northward migration of the subtropical westerly jet over East Asia. The combination of the above-normal 10-25 -day ISO and the moderate 30-50-day ISO led to the three consecutive extreme YRV heatwaves in 2022.
Persistent hot and dry conditions could lead to serious impacts on society, economy, and human health. Using statistically downscaled and bias corrected data, we investigate the changes in compound long-duration dry and hot (LDDH) events and the corresponding socioeconomic exposure over China in transient and stabilized warmer worlds. The transient response is identified with Coupled Model Intercomparison Project Phase 5 (CMIP5) and CMIP6 models, while the stabilized response is identified with the Community Earth System Model ensemble. Under 1.5 degrees C and 2 degrees C warming, the LDDH events in China will become more frequent and hotter. Substantial differences are found in LDDH features between transient and stabilized warming. For a given global temperature, the increase in frequency and temperature magnitude of LDDH events over most northern regions is significantly greater in a transient case than in a stabilized climate, while the increase over the southeastern China is substantially stronger under stabilized warming than transient warming. Future population exposure to LDDH events is projected to increase over China. For many regions, the aggregate exposure is two times greater in a transient climate than in a stabilized climate. Under transient warming, changes in LDDH events dominate the increase in population exposure whereas population change has smaller effects below 10%. For a stabilized warmer world, the negative population growth can largely offset the impact of climate change on exposure. Limiting global warming to 1.5 degrees C instead of 2 degrees C can reduce the exposure to LDDH events by 26.1% and 21.8% over China under transient and stabilized warming, respectively.
Due to climate change crisis, the risk of occupational heat stress for agricultural workers has recently increased. The temporal and spatial biometeorological conditions in different climatic regions of Slovenia during summer were analyzed using the Universal Thermal Climate Index (UTCI), and additionally the water loss index (SW) and the accepted level of physical activity (MHR). Term values of air temperature, relative air humidity, wind speed at 10 m and cloud cover at 14:00 CEST were used as input for the BioKlima 2.6 software package and were retrieved from the Slovenian Environment Agency for the summer months in the period 2000-2021. The rise in the average UTCI values was shown to be positive and statistically significant for summer (0.7 degrees C/decade) as well as for all three months, the highest being for June (0.9 degrees C/decade). The percentage of summer days during 2000-2021 that were under strong or very strong heat stress varied widely by location, ranging from one-third to more than one-half. Average monthly UTCI values at 14:00 CEST were the highest in July, reaching 30 degrees C in a submediterranean climate, Crnomelj is the only station with this average higher than 32 degrees C. Daily highest UTCI value was 47 degrees C (Crnomelj). It was shown that conditions in the middle of a hot summer day are not suitable for moderate or severe agricultural workloads.
Urban heat islands, where temperatures are elevated relative to non-urban surrounds, are near-ubiquitous in cities globally. Yet, the magnitude and form of urban heat islands in the tropics, where heat has a large morbidity and mortality burden, is not well understood, especially for those of urban informal settlements. We used 29 years of Landsat satellite-derived surface temperature, corroborated by in situ temperature measurements, to provide a detailed spatial and temporal assessment of urban heat islands in Makassar, Indonesia, a city that is representative of rapidly growing urban settlements across the tropics. Our analysis identified surface urban heat islands of up to 9.2 °C in long-urbanised parts of the city and 6.3 °C in informal settlements, the seasonal patterns of which were driven by change in non-urban areas rather than in urban areas themselves. In recently urbanised areas, the majority of urban heat island increase occurred before land became 50% urbanised, whereas the established heat island in long-urbanised areas remained stable in response to urban expansion. Green and blue space protected some informal settlements from the worst urban heat islands observed across the city and maintenance of such space will be essential to mitigate the growing heat burden from urban expansion and anthropogenic climate change. Settlements further than 4 km from the coast and with Normalised Difference Vegetation Index (NDVI) less than 0.2 had higher surface temperatures, with modelled effects of more than 5 °C. Surface temperature measurements were representative of in situ heat exposure, measured in a subset of 12 informal settlements, where mean indoor temperature had the strongest relationship with surface temperature (R(2) = 0.413, P = 0.001). We advocate for green space to be prioritised in urban planning, redevelopment and informal settlement upgrading programs, with consideration of the unique environmental and socioeconomic context of tropical cities.
Robust spatio-temporal delineation of extreme climate events and accurate identification of areas that are impacted by an event is a prerequisite for identifying population-level and health-related risks. In prior research, attributes such as temperature and humidity have often been linearly assigned to the population of the study unit from the closest weather station. This could result in inaccurate event delineation and biased assessment of extreme heat exposure. We have developed a spatio-temporal model to dynamically delineate boundaries for Extreme Heat Events (EHE) across space and over time, using a relative measure of Apparent Temperature (AT). Our surface interpolation approach offers a higher spatio-temporal resolution compared to the standard nearest-station (NS) assignment method. We show that the proposed approach can provide at least 80.8 percent improvement in identification of areas and populations impacted by EHEs. This improvement in average adjusts the misclassification of about one million Californians per day of an extreme event, who would be either unidentified or misidentified under EHEs between 2017 and 2021.
There is worldwide concern about how climate change -which involves rising temperatures- may increase the risk of contracting and developing diseases, reducing the quality of life. This study provides new research that takes into account parameters such as land surface temperature (LST), surface urban heat island (SUHI), urban hotspot (UHS), air pollution (SO(2), NO(2), CO, O(3) and aerosols), the normalized difference vegetation index (NDVI), the normalized difference building index (NDBI) and the proportion of vegetation (PV) that allows evaluating environmental quality and establishes mitigation measures in future urban developments that could improve the quality of life of a given population. With the help of Sentinel 3 and 5P satellite images, we studied these variables in the context of Granada (Spain) during the year 2021 to assess how they may affect the risk of developing diseases (stomach, colorectal, lung, prostate and bladder cancer, dementia, cerebrovascular disease, liver disease and suicide). The results, corroborated by the statistical analysis using the Data Panel technique, indicate that the variables LST, SUHI and daytime UHS, NO(2), SO(2) and NDBI have important positive correlations above 99% (p value: 0.000) with an excess risk of developing these diseases. Hence, the importance of this study for the formulation of healthy policies in cities and future research that minimizes the excess risk of diseases.
BACKGROUND: Scorpion stings in Brazil represent a major public health problem due to their incidence and their potential ability to lead to severe and often fatal clinical outcomes. A better understanding of scorpionism determinants is essential for a precise comprehension of accident dynamics and to guide public policy. Our study is the first to model the spatio-temporal variability of scorpionism across municipalities in São Paulo (SP) and to investigate its relationship with demographic, socioeconomic, environmental, and climatic variables. METHODOLOGY: This ecological study analyzed secondary data on scorpion envenomation in SP from 2008 to 2021, using the Integrated Nested Laplace Approximation (INLA) to perform Bayesian inference for detection of areas and periods with the most suitable conditions for scorpionism. PRINCIPAL FINDINGS: From the spring of 2008 to 2021, the relative risk (RR) increased eight times in SP, from 0.47 (95%CI 0.43-0.51) to 3.57 (95%CI 3.36-3.78), although there has been an apparent stabilization since 2019. The western, northern, and northwestern parts of SP showed higher risks; overall, there was a 13% decrease in scorpionism during winters. Among the covariates considered, an increase of one standard deviation in the Gini index, which captures income inequality, was associated with a 11% increase in scorpion envenomation. Maximum temperatures were also associated with scorpionism, with risks doubling for temperatures above 36°C. Relative humidity displayed a nonlinear association, with a 50% increase in risk for 30-32% humidity and reached a minimum of 0.63 RR for 75-76% humidity. CONCLUSIONS: Higher temperatures, lower humidity, and social inequalities were associated with a higher risk of scorpionism in SP municipalities. By capturing local and temporal relationships across space and time, authorities can design more effective strategies that adhere to local and temporal considerations.
A fast temperature rise has made the Middle East and North Africa (MENA) region a global hotspot of extreme heat events. Previous studies conducted in the region to evaluate extreme heat based on temperature were inadequate for assessing heat based on human thermal impacts. The present study employed the Universal Thermal Climate Index (UTCI). This index evaluates the changes in heat related to human thermal stress in MENA. This analysis employed the ERA5-HEAT dataset, derived from the Copernicus climate change service portal. The results showed that all the regions experienced an average daily UTCI representing extreme heat stress for 1 to 25 days. The daily maximum UTCI goes to the extreme level on average of 1 to 175 days a year, with the highest in the east and southwest. The annual mean UTCI in MENA is increasing from 0.1 to 0.7 degrees C/ decade, with the highest increase in the northeast, covering eastern Saudi Arabia and most parts of Iraq and Syria. This caused a decrease in cold stress and an increase in hot stress days, with the highest increase in strong thermal stress days in the range of 4 to 16 days/decade in most of MENA. The trend in daily maximum UTCI also showed an increase in the range of 0.1 to 0.6 degrees C/decade, which caused an increase in the number of daily maximum UTIC above 46 degrees C or extreme level by 1 to 16 days/per decade, with the highest increase in central Saudi Arabia, northern Sudan and southern Mauritania. This study is the first to investigate UTCI trends in the MENA region and is expected to provide valuable information on hotspots and temporal trends in UTCI, serving as a foundation for future heat action plans to prevent heat-related illnesses throughout the region.
Global warming causes a temperature rise and alteration of other meteorological variables that directly or indirectly affect human comfort. The wet bulb globe temperature (WBGT) incorporates the effects of multiple meteorological variables to provide a reliable measure of human thermal stress. Despite the large significance of WBGT on public health, studies related to characterization and trends assessment of WBGT are limited in the tropical humid region like Peninsular Malaysia due to the unavailability of all meteorological variables required for such analysis. This study employed reanalysis meteorological data of ERA5 to assess the characteristics and changes in hourly, daily, monthly, seasonal and annual outdoor WBGT over peninsular Malaysia for the period 1959-2021 using the Liljegren method. The WBGT values were classified into five categories to assess the human thermal stress levels defined by the United States Department of the Army (USDA). The mean daily WBGT in PM varies from 21.5 degrees C in the central south elevated region to 30.5 degrees C in the western coastal region. It always reaches a heat-related illness risk level (31.20 degrees C) in the afternoon during monsoon and extreme stress conditions during inter-monsoonal periods. The trend analysis revealed an increase in WBGT for all the time scales. The higher increase in the mean and maximum WBGT was estimated in the coastal and south regions, nearly by 0.10 to 0.25 degrees C/decade. The increase in mean nighttime WBGT was 0.24 degrees C/decade, while in mean daytime WBGT was 0.11 degrees C/decade. The increase in WBGT caused a gradual expansion of areas experiencing daily WBGT exceeding a high-risk level for 5 h (11 AM to 3 PM). The information and maps generated in this study can be used for mitigation planning of heat-related stress risk in PM, where temperature extremes have grown rapidly in recent years.
The rising global temperatures have posed challenges to human survival and well-being in various regions worldwide. However, little is known about human thermal stress exposure changes among populations living in extreme poverty and struggling to meet their basic needs. This study aimed to investigate the spatial patterns of changes in human thermal stress levels in South Asia using the Universal Thermal Climate Index (UTCI). ERA5 HEAT data from 1979 to 2021 were analyzed using Sen’s slope method and the Modified Mann-Kendall test to determine the changes in annual and seasonal thermal stress levels. The findings revealed that Bangladesh, located in the eastern part of South Asia, experiences the highest mean UTCI range (26 to 32 degrees C), while Afghanistan has the lowest among the South Asian nations. In contrast, the western part of South Asia, partic-ularly the region bordering India and Pakistan, exhibits the highest daily maximum UTCI range (38 to 46 degrees C). Trend analysis indicated an increase in mean and maximum UTCI levels across the western part of South Asia, including Pakistan, Afghanistan, and northwest India, at 0.25 to 0.75 degrees C/decade. This increase was more widespread during the June-September (JAS) period than in other seasons. In many regions of the study area, moderate and high thermal stress days increased by 4 to 8 days per decade. As a result, 27.6% of the area shifted from an average comfortable temperature to moderate thermal stress and 18.7% from moderate to strong thermal stress during JAS.
The 6th Assessment of the Intergovernmental Panel on Climate Change projects increasing thermal-associated morbidity and mortality under anthropogenically induced warming. Over 100 indices exist to quantify thermal stress, and among these, the Universal Thermal Climate Index (UTCI) was developed for regional investigations of thermal stress influences on human health. Although by definition a universal index, current applications are mainly limited to Europe. For regions such as Africa, use of the UTCI has been hampered by a lack of available requisite input variables from ground-based meteorological stations. To overcome this, a gridded dataset, derived from ERA5 reanalysis, of UTCI equivalent temperatures was developed by the European Centre for Medium-Range Weather Forecasts. Using this dataset for daily average, minimum and maximum UTCI values, we explore spatiotemporal patterns and changes thereof over annual, seasonal, and monthly scales across southern Africa from 1979 to 2021. Across these scales, 9 of 10 UTCI thermal stress categories were observed, ranging from very strong cold stress to extreme heat stress. Spatially, no thermal stress was most widespread for daily mean values, whereas for daily maximum (minimum) values there was a wider heat (cold) stress incidence, with frequent occurrences of moderate and strong heat stress (slight and moderate cold stress). Interannually, a clear El Nino-Southern Oscillation influence on thermal stress was evident during summer, with El Nino (La Nina) phases extending (reducing) heat stress incidences by up to 13.8% (2.9%). Over the study period, heat stress increased at statistically significant rates in many instances, with the strongest, most widespread increases, for the daily average and maximum (minimum), during spring (summer), averaging 0.28 and 0.29?center dot decade(-1) (0.23?center dot decade(-1)); few regions experienced statistically significant decreasing trends. Overall, the trend results highlight regions vulnerable to significant thermal climate changes, and thus should be considered in decision-making regarding outdoor activities.
Heatwaves occur frequently in summer, severely harming the natural environment and human society. While a few long-term spatiotemporal heatwave studies have been conducted in China at the grid scale, their shortcomings involve their discrete distribution and poor spatiotemporal continuity. We used daily data from 691 meteorological stations to obtain torridity index (TI) and heatwave index (HWI) datasets (0.01°) in order to evaluate the spatiotemporal distribution of heatwaves in the Chinese mainland for the period of 1990-2019. The results were as follows: (1) The TI values rose but with fluctuations, with the largest increase occurring in North China in July. The areas with hazard levels of medium and above accounted for 22.16% of the total, mainly in the eastern and southern provinces of China, South Tibet, East and South Xinjiang, and Chongqing. (2) The study areas were divided into four categories according to the spatiotemporal distribution of hazards. The “high hazard and rapidly increasing” and “low hazard and continually increasing” areas accounted for 8.71% and 41.33% of the total, respectively. (3) The “ten furnaces” at the top of the provincial capitals were Zhengzhou, Nanchang, Wuhan, Changsha, Shijiazhuang, Nanjing, Hangzhou, Haikou, Chongqing, and Hefei. While the urbanization level and population aging in the developed areas were further increased, the continuously increasing heatwave hazard should be fully considered.
This study examines future changes in extreme heat stress over East Asia and its sub-regions using wet bulb globe temperature (WBGT) based on the CORDEX East Asia Phase II multiple Regional Climate Model (RCM) simulations performed under Shared Socioeconomic Pathways (SSP) scenarios. Daily maximum WBGTs (WX) are obtained from 3-hourly bias-corrected WBGTs and their future changes in the late 21st century (2081-2100) are analyzed with respect to the current period (1979-2014). Summer mean WX is projected to increase by 3.2 degrees C (SSP1-2.6: low emission) to 7.6 degrees C (SSP5-8.5: high emission) over East Asia, dominated by temperature increases. Relative humidity decreases over many regions, slightly offsetting WX increases (up to-6%), while it increases in northeastern and northern China, intensifying WX increases (up to +14%). This humidity-induced WX increase becomes stronger during hottest WX days (summer top 5%) and also under low emission scenarios (up to +33%). For sub-regional projections, extreme heat stress day (EHD) is defined when WX exceeds its 95th percentile in at least 10% of the area. RCMs project on average a 10 times increase of EHD frequency under the SSP5-8.5 scenario. The EHD magnitude, which combines the intensity and area extent of EHD events, is also expected to increase dramatically throughout East Asia, reaching a range of 3.2-3.5 degrees C center dot fraction compared to the current (0.1-0.2 degrees C center dot fraction). Further, EHDs are projected to start earlier and end later, lasting much longer (85-140 days) than the current condition (5-6 days) in the SSP5-8.5 scenario. RCMs exhibit a good agreement in WX and EHD projections with some noticeable differences in in-land sub-regions. Our results indicate that severe heat stress will affect the whole East Asia throughout and beyond the summer season and, in particular, southern sub-regions will be affected by more-intense and longer-lasting extreme heat stress events.
The current study on spatiotemporal variability of temperature presents a holistic approach for quantifying the joint space-time variability of extreme temperature indices over the physio-climatically heterogeneous Tapi River basin (TRB) using two unsupervised machine learning algorithms, i.e., principal component analysis (PCA) and cluster analysis. The long-term variability in extreme temperature indices, recommended by the Expert Team on Climate Change Detection and Indices (ETCCDI), was evaluated for 1951-2016. The magnitude and statistical significance of the temporal trend in extreme temperature indices were estimated using non-parametric Sen’s slope estimator and modified Mann Kendall (MMK) tests, respectively. The multivariate assessment of temporal trends using PCA resulted in four principal components (PCs) encapsulating more than 90% variability. The cluster analysis of corresponding PCs resulted in two spatial clusters exhibiting homogeneous spatiotemporal variability. Cluster 1 is characterized by significantly increasing hottest, very hot, and extremely hot days with rising average maximum temperature and intraday temperature variability. On the other hand, cluster 2 showed significantly rising coldest nights, mean minimum, mean temperature, and Tx37 with significantly decreasing intraday and interannual temperature variability, very cold, and extremely cold nights with reducing cold spell durations. The summertime heat stress computation revealed that the Purna sub-catchment of the Tapi basin is more vulnerable to various health issues and decreased work performance (> 10%) for more than 45 days per year. The current study dealing with the associated effects of rising temperature variability on crop yield, human health, and work performance would help policymakers formulate better planning and management strategies to safeguard society and the environment.
The severe heatwaves and hot spells in Vietnam were observed more frequently in intensity and duration due to global warming and climate change impacts. The hot days and extreme summer events make the weather harsh and significantly affect human health and the environment. This study presents the spatiotemporal distribution of the number of hot days (NHDs) in Vietnam. The variability of NHD in seven climate subregions is also examined in association with the large-scale drivers. The European Center for Medium-Range Weather Forecasts (ECMWF) reanalysis version 5 (ERA5) data for the period 1981-2020 are used. Principal component analysis is also applied to the observed monthly NHD to obtain spatial patterns and time series. The results show that the NHD in the Highland and South subregions from March to May is linked with the subtropical high associated with decreased 500hPa-level vertical velocity (VV500). From May to June, the North and Central subregions seem related to deepening the Asiatic low and enhancement of southwest flows across the IndoChina Peninsula. Finally, both increased southwest flows and decreased VV500 can partly contribute to the intensification of NHD in the North and Central subregions during July and August. The long trends of NHD are also examined. The results reveal that the increasing trends in NHD occur in most subregions, except for the Central Highland, and changing trends of NHD in June greatly contribute to the annual trend of NHD. Finally, the examinations with the El Nino-Southern Oscillation events show that NHD is significantly higher in El Nino events than in La Nina events in March and April for the Northwest, South Central, Central Highlands, and South, in May and June for all subregions, and in July and August for only the Red River Delta subregion. This suggests that ENSO can provide the potential for improving seasonal climate forecasts and mitigating natural disaster risks for the community.
Cities are highly vulnerable areas affected by climate change. For sustainable urbanization, it is of great importance to determine the thermal conditions in cities and to make predictions for the future. Therefore, in this study, the spatial distribution of the thermal comfort conditions in the city of Diyarbakir, located in the southeastern Turkey, during the hot period of the year is explained and predictions for the future are made. In the study, measurement data from meteorological stations and the data of the SSP-2 and SSP-5 scenarios were used. Thermal comfort conditions were determined according to the PET (physiological equivalent temperature) index using RayMan software. The ArcGIS 10.5 program was used for defining the spatial distribution of thermal comfort conditions. As a result of the study, it is seen that the areas with dense construction and a low amount of green area in the old urbanized area, which is the central business district (CBD), have uncomfortable conditions. It is predicted that uncomfortable areas will increase in the near and distant future and threaten human health. For climate-resilient, healthy, and comfortable cities that can adapt to adverse effects of climate change, urban design and planning should be carried out with a holistic perspective.
Heatwaves, along with their affiliated illnesses and mortalities, are increasing in frequency and severity under climate change. Spatial analyses at the level of census output areas can produce detailed maps of heatwave risk factors and potential correlated damages, thus contributing to practical policies to reduce the risk of heatwave illnesses. This study analyzed the 2018 summer heatwave in Gurye and Sunchang counties in South Korea. To compare damages and analyze the detailed causes of heatwave vulnerability, spatial autocorrelation analyses were conducted, incorporating weather, environmental, personal, and disease factors. Gurye and Sunchang, although similar in demographics and region, exhibited large differences in heatwave damage specifically in the number of heat-related illness cases. In addition, exposure data were constructed at the census output area level by calculating the shadow pattern, sky view factor, and mean radiant temperature, revealing a higher risk in Sunchang. Spatial autocorrelation analyses revealed that the factors most highly correlated with heatwave damage were hazard factors, in the case of Gurye, and vulnerability factors, in the case of Sunchang. Accordingly, it was concluded that regional vulnerability factors were better distinguished at the finer scale of the census output area and when detailed and diversified weather factors were incorporated.
Abundant literature is available on an extremely high temperature associated with mortality for cities of the developed world, but there is a dearth in the literature for coastal, desert and dry cities of the developing world, especially for India. We examined all-cause mortality and extreme high temperature in three Indian cities representing coastal, desert and dry areas for summer months (March to June) from 2006 to 2015. We obtained the data on temperature and all-cause mortality for ten years for the summer months. The city-specific effect of ambient heat on all-cause mortality was assessed through time series ordinary least square linear regression model. A total of 75,571, 122,117 and 53,042 deaths for 1,203, 1,220 and 1,180 summer days from 2006 to 2015 were analysed with ambient temperature for Jaipur, Hyderabad and Surat, respectively. There were 994 (27.6%) out of 3,603 summer days having temperature & GE;40 & DEG;C and 2,495 (69.3%) out of 3,602 summer days having feel temperature/heat index (HI) of & GE;41 & DEG;C. According to the Indian Meteorological Department (IMD) criteria for the heatwave, Surat has the maximum number of 75 days with a maximum temperature of & GE;40 & DEG;C, whereas Hyderabad has only 4 days and Jaipur faced 35 days with a maximum temperature of & GE;45 & DEG;C during the study period. The per-day mean all-cause mortality increased to 39% and 11% for Jaipur and Hyderabad, respectively, at & GE;45 & DEG;C and 20% for the coastal city of Surat at & GE;40 & DEG;C as per IMD heatwave criteria. A time-series linear regression model shows that adjusted R-squared is 0.593, 0.629 and 0.348, which explained the variation of 59.3%, 62.9% and 34.8% for all-cause mortality (dependent variable) by independent variables (maximum temperature, humidity and HI) for Jaipur, Hyderabad and Surat, respectively. The maximum temperature threshold (cut-off) for all-cause mortality for Jaipur, Hyderabad and Surat is 42 & DEG;C, 41 & DEG;C and 40 & DEG;C, respectively. The impact of ambient heat in the rise of all-cause mortality for all study sites was evident. Hence, findings support the efforts for reducing the public health burden of high ambient temperature through developing and implementing city-specific heat action plans.
In the humid subtropics, rising temperatures can cause higher humidity via enhanced evaporation which exacerbates heat-related health problems. This study uses multi-station observational data to reveal the spatial-temporal changes of compound temperature-humidity extreme events in Hong Kong during 1961-2020. Based on the 90th and 10th percentiles of temperature and specific humidity, four types of compound events were identified, i.e., Compound Hot and Wet (CHW), Hot and Dry (CHD), Cold and Wet (CCW), and Cold and Dry (CCD) events. Over the past six decades, there has been a significant increase of CHW (+3.45 events/decade) and decrease of CCD (-3.00 events/decade). The greatest increase of CHW was observed during the warm period of the 2010s (+4 events/year/month). Meanwhile, the trends of CHD and CCW were less evident. Spatially, more frequent compound events (especially those with high humidity (CHW and CCW)) were observed in built-up areas compared to rural areas, while the intensity of these events remained similar. The results imply that both regional climate and urban factors contribute to the increase of extreme hot and humid weather. The study generalizes mechanisms for these spatial temporal changes, and discussed implications for compound extremes management in Hong Kong and other similar cities.
The population experiencing high temperatures in cities is rising due to anthropogenic climate change, settlement expansion, and population growth. Yet, efficient tools to evaluate potential intervention strategies to reduce population exposure to Land Surface Temperature (LST) extremes are still lacking. Here, we implement a spatial regression model based on remote sensing data that is able to assess the population exposure to LST extremes in urban environments across 200 cities based on surface properties like vegetation cover and distance to water bodies. We define exposure as the number of days per year where LST exceeds a given threshold multiplied by the total urban population exposed, in person center dot day. Our findings reveal that urban vegetation plays a considerable role in decreasing the exposure of the urban population to LST extremes. We show that targeting high-exposure areas reduces vegetation needed for the same decrease in exposure compared to uniform treatment.
This study examined the spatio-temporal dynamics of malaria epidemiological patterns considering environmental(vegetation, water bodies, slope, elevation) and climatic factors (rainfall, temperature and relative humidity) in Ondo State, Nigeria, from 2013 to 2017 using ArcGIS 10.4 and QGIS software. The factors influencing malaria were studied using a multi-criteria analysis (Analytical Hierarchical Process-AHP). The trend analysis revealed an increase in cases over time, indicating a significant increase in the occurrence of malaria in all study areas. The most important climatic variable impacting malaria transmission in the study was temperature. Nevertheless, other environmental and climatic factors causing transmission include vegetation, water bodies, slopes, elevation, rainfall, and relative humidity. With the exception of Okitipupa, the study identified high-risk locations (vulnerable areas/hot spots) in almost all of the local government areas, while Ondo East, Akure South, Akoko South West, and Owo are the most vulnerable areas. The findings reveal that the malaria incidence is high in the developed LGAs having more towns where temperature is higher due to several anthropogenesis activities, high population and increased land-use. Thus, in-depth epidemiological studies on malaria should be undertaken in Ondo State and other regions of Nigeria considering environmental factors impacting malaria incidence as this will enable one to ascertain the major factors influencing the disease, thereby taking adequate measures to curb the increase in incidence.
Growing evidence indicates that extreme environmental conditions in summer months have an adverse impact on mental and behavioral disorders (MBD), but there is limited research looking at youth populations. The objective of this study was to apply machine learning approaches to identify key variables that predict MBD-related emergency room (ER) visits in youths in select North Carolina cities among adolescent populations. Daily MBD-related ER visits, which totaled over 42,000 records, were paired with daily environmental conditions, as well as sociodemographic variables to determine if certain conditions lead to higher vulnerability to exacerbated mental health disorders. Four machine learning models (i.e., generalized linear model, generalized additive model, extreme gradient boosting, random forest) were used to assess the predictive performance of multiple environmental and sociodemographic variables on MBD-related ER visits for all cities. The best-performing machine learning model was then applied to each of the six individual cities. As a subanalysis, a distributed lag nonlinear model was used to confirm results. In the all cities scenario, sociodemographic variables contributed the greatest to the overall MBD prediction. In the individual cities scenario, four cities had a 24-hr difference in the maximum temperature, and two of the cities had a 24-hr difference in the minimum temperature, maximum temperature, or Normalized Difference Vegetation Index as a leading predictor of MBD ER visits. Results can inform the use of machine learning models for predicting MBD during high-temperature events and identify variables that affect youth MBD responses during these events.
Understanding the temperature regulation effects of urban vegetation and impervious surfaces, as well as how the effects interact with socioeconomic determinants of vulnerability to drive heat risk, is of critical importance for designing effective and equitable heat mitigation strategies. However, existing studies rarely compare temperature regulation efficiencies of diverse urban land cover types, nor do they examine whether distributions of urban vegetation and impervious surfaces could help reduce heat-related inequity by offering more cooling and less warming effects to marginalized communities. By employing satellite and socioeconomic data, this study quantified the cooling efficiencies of urban vegetation and warming efficiencies of impervious surfaces in 44 US cities, and then examined how these efficiencies change across neighborhoods of varying deprivation. We find that urban vegetation, especially trees, has strong cooling effects across different urban contexts, and the cooling efficiencies of urban trees and shrubs/grass are higher in neighborhoods of greater area deprivation. Conversely, buildings and roads produce the largest warming effects, and their warming efficiencies are either greater or at similar levels of magnitude in advantaged neighborhoods, when comparing with deprived neighborhoods. These findings suggest that strategically deploying green and built infrastructure could mitigate heat-related inequity in addition to improving health overall.
The effects extreme air temperature events are related with an increase in cardiovascular mortality among vulnerable groups worldwide. Therefore, we identify spatiotemporal mortality clusters associated with diseases of the cardiovascular system among people ≥ 65 years in São Paulo, from 2006 to 2015, and investigate whether high-risk mortality clusters occurred during or following extreme air temperature events. To detect the clusters, we used daily mortality data and a retrospective space-time scan analysis with a discrete Poisson model. Extreme air temperature events were defined by daily mean temperatures, below the 10th percentile for cold spells and above the 90th percentile for heatwaves, with two or more consecutive days. We found statistically significant high-risk mortality clusters located in the peripheral areas. The spatiotemporal clusters of risk areas for cardiovascular and ischemic heart disease occurred during or following cold spell events, whereas those for stroke and ischemic stroke events were related to heatwaves.
Anti-NMDAR encephalitis has been associated with multiple antigenic triggers (i.e., ovarian teratomas, prodromal viral infections) but whether geographic, climatic, and environmental factors might influence disease risk has not been explored yet. We performed a systematic review and a meta-analysis of all published papers reporting the incidence of anti-NMDAR encephalitis in a definite country or region. We performed several multivariate spatial autocorrelation analyses to analyze the spatial variations in the incidence of anti-NMDA encephalitis depending on its geographical localization and temperature. Finally, we performed seasonal analyses in two original datasets from France and Greece and assessed the impact of temperature using an exposure-lag-response model in the French dataset. The reported incidence of anti-NMDAR encephalitis varied considerably among studies and countries, being higher in Oceania and South America (0.2 and 0.16 per 100,000 persons-year, respectively) compared to Europe and North America (0.06 per 100,000 persons-year) (p < 0.01). Different regression models confirmed a strong negative correlation with latitude (Pearson's R = -0.88, p < 0.00001), with higher incidence in southern hemisphere countries far from the equator. Seasonal analyses showed a peak of cases during warm months. Exposure-lag-response models confirmed a positive correlation between extreme hot temperatures and the incidence of anti-NMDAR encephalitis in France (p = 0.03). Temperature analyses showed a significant association with higher mean temperatures and positive correlation with higher ultraviolet exposure worldwide. This study provides the first evidence that geographic and climatic factors including latitude, mean annual temperature, and ultraviolet exposure, might modify disease risk.
The spatial and seasonal distribution, abundance, and infection rates of human schistosomiasis intermediate host snails and interactions with other freshwater snails, water physicochemical parameters, and climatic factors was determined in this study. A longitudinal malacology survey was conducted at seventy-nine sites in seven districts in KwaZulu-Natal province between September 2020 and August 2021. Snail sampling was done simultaneously by two trained personnel for fifteen minutes, once in three months. A total of 15,756 snails were collected during the study period. Eight freshwater snails were found: Bulinus globosus (n = 1396), Biomphalaria pfeifferi (n = 1130), Lymnaea natalensis (n = 1195), Bulinus tropicus (n = 1722), Bulinus forskalii (n = 195), Tarebia granifera (n = 8078), Physa acuta (n = 1579), and Bivalves (n = 461). The infection rates of B. globosus and B. pfeifferi are 3.5% and 0.9%, respectively. In our study, rainfall, pH, type of habitats, other freshwater snails and seasons influenced the distribution, abundance, and infection rates of human schistosomiasis intermediate host snails (p-value < 0.05). Our findings provide useful information which can be adopted in designing and implementing snail control strategies as part of schistosomiasis control in the study area.
This study emphasizes the critical role of air conditioning (AC) in preventing heat-related illnesses such as heat exhaustion and heatstroke. The challenge of limited geographic coverage and outdated AC availability data hampers effective heat risk mapping and prevention efforts. We identified areas with significant AC needs and examined factors related to AC ownership in Florida, U.S. Local Indicators of Spatial Association results displayed distinct AC ownership disparities, with high-high clusters in coastal and metropolitan areas and AC-deficient clusters inland. Vulnerable urban communities, predominantly inhabited by marginalized groups, had limited to no AC availability. The Spatial Durbin Model results revealed a significant correlation between AC ownership and socioeconomic and urban factors. Notably, a higher proportion of AC-deficient households were in predominantly African-American neighborhoods, underscoring racial disparities in AC ownership. These findings provide valuable insights for targeted interventions to mitigate heat-related risks and adapt to evolving climate conditions in vulnerable neighborhoods.
Heat waves (HWs) with high humidity are dangerous to human health. However, existing studies on different types of HWs considering the effect of humidity are still limited. This study defines three types of wet summer HWs (that is, wet independent daytime and nighttime HWs and wet daytime-nighttime compound HWs) and investigates their spatial-temporal changes across China during 1961-2020. Results show significant upward trends of wet nighttime and compound HWs in terms of frequency, occurring days, duration, intensity and spatial extent, while changes for wet daytime HWs are weak and insignificant in nearly all sub-regions of China except for southwest and eastern northwest China. Compared with wet compound and daytime HWs, wet nighttime HWs accompanied by more elevated relative humidity exhibit larger growth rates in frequency, occurring days, duration and affected areas. Additionally, most wet nighttime and compound HWs with the longest duration and/or the maximum intensity are found to occur after the mid-1990s, compared to fewer than half for wet daytime HWs. Our findings emphasize the prominent intensifying trends in wet nighttime HWs across China for the last 60 years, and suggest more efforts on exploring humid HWs.
The study evaluates the performance of the Conformal Cubic Atmospheric Model (CCAM) when simulat-ing an urban heat island (UHI) over the city of eThekwini, located along the southeast coast of South Africa. The CCAM is applied at a grid length of 1 km on the panel with eThekwini, in a stretched-grid mode. The CCAM is coupled to the urban climate model called the Australian Town Energy Budget (ATEB). The ATEB incorporates measured urban parameters in-cluding building characteristics, emissions, and albedo. The ATEB incorporates the land-cover boundary conditions obtained from the Moderate Resolution Imaging Spectroradiometer (MODIS) satellite. The CCAM configuration applied realistically captured the orientation of the city and land-cover types. Simulations of meteorological variables such as temperatures and longwave radiation reproduced the spatial distribution and intensity of the UHI. Results show that the UHI is stronger during summer and weaker in all other seasons. The UHI developed because of natural factors (e.g., distribution of longwave radia-tion) and human factors (e.g., urban expansion, an increase in anthropogenic emissions, and additional heating). Because of the city’s location along the coast, the UHI simulation could be weakened by atmospheric circulations resulting from land and sea breezes. Mitigation methods such as applying reflective paints and revegetation of the city may increase albedo and latent heat fluxes but reduce the sensible heat fluxes and weaken the UHI. However, the UHI may not be completely elimi-nated since natural factors and emissions constantly influence its development. SIGNIFICANCE STATEMENT: The outcome of this study could be particularly valuable for municipalities in their disaster management planning since the occurrence of UHIs can cause heat-related diseases such as heatstrokes and even fatalities, especially for the elderly, in cities. Increases in temperatures also lead to higher demand for air condi-tioners, which in the long term lead to higher demand and pressure on the electricity grid system as well as increased costs for the individual. As higher temperatures increase heatwave events, increases in anthropogenic emissions also re-sult in degraded air quality that impacts health. UHIs impact human lives and can cause deterioration in health when individuals experience high temperatures in summer. Warmer temperatures also reduce energy demand (and in the long term assist with global environmental restoration).
The potential effects of global climate change on buildings are a growing concern worldwide, as rising tem-peratures can significantly impact their energy performance and indoor thermal comfort conditions. This article examines the impact of global warming across six different climate zones of Morocco by comparing under 2050 RCP8.5 scenario the current and future thermal energy requirements and indoor comfort levels of a light-weight ecologically-designed detached residential house. The reference case study building is in a semi-arid climate of Morocco and empirically validated following the ASHRAE guideline 14, with CV(RMSE) less than 3.2 and NMBE less than 1.4 for the two 38-day monitored thermal zones.The study includes a framework to evaluate the thermal energy needs for maintaining indoor thermal comfort and the overheating intensity triggered by climate change and varying due to spatial scale. Overall, the findings show that Morocco will suffer with differing magnitudes from the temperature increase linked to global warming, which will result in an upsurge in the thermal needs for cooling, particularly in the southern regions of Morocco, and a general reduction in the heating thermal energy needs across the different climates of Morocco, with an annual thermal energy demand change ranging from-2.7% to 17%, depending on the investigated city. This wide variation in thermal energy demand underlines the need to assess the effects of the warming climate in the local context. Besides, under conditions of Air Conditioning (AC) failure, the Indoor Overheating Hours (IOH) increase up to 27% between the current climate conditions and the 2050 climate conditions while indoor temperature changes exceed 1.5 degrees C during the hottest days of the summer.Strategically, the research study intends to support global efforts to build resilient societies by bringing awareness to how susceptible indoor occupants are to projected warming temperatures. The study also lays the groundwork for prioritizing and assessing adaptation solutions to protect people’s health, comfort, and pro-ductivity within buildings despite climate change in the most sustainable manner.
Societal concern about climate change and global warming has grown worldwide along with the concomitant awareness that health will be impacted deeply. Among living beings, humans have quite large capacities for adaptation to varied temperature conditions. Despite their tropical origin, they live under all Earth climates, such as polar, temperate, altitude, arid, and tropical climates, using a wide range of behavioral and physiological adaptive responses. We address the adaptive abilities of human sleep-wake regulation and its interplay with thermoregulation under different natural climates. Sleep represents one-third of our living time and is also a major determinant of morbidity and mortality; shortening sleep duration increases mortality and multimorbidity. In addition, major advances in sleep neurology have occurred in the last decades. Some have been extensively reviewed, notably comparative sleep physiology among animals, allowing one to hypothesize about the functions of the different sleep states, as well as their relation to cognitive neuroscience or body biorhythms. However, the question of the sleep adaptive capacity of humans to global warming has barely been addressed. We examine “normal” sleep and thermoregulation in young adults residing in temperate conditions. We then review the sleep and thermoregulatory reactions under various climatic conditions, demonstrating the role of sleep changes as potent adaptive responses to living under natural hot climatic conditions. As a result, we show that humans are well-equipped to adapt to severe climates.
Both the frequency and intensity of hot temperature extremes are expected to increase in the coming deca-des, challenging various socioeconomic sectors including public health. Therefore, societal attention data available in real time, such as Google search attention, could help monitor heat-wave impacts in domains with lagged data availability. Here, we jointly analyze societal attention and health impacts of heat waves in Germany at weekly time scales. We find that Google search attention responds similarly to hot temperatures as indicators of public health impacts, represented by excess mortality and hospitalizations. This emerges from piecewise linear relationships of Google search attention to and health impacts of temperature. We can then determine temperature thresholds above which both attention and public health are affected by heat. More generally, given the clear and similar response of societal indicators to heat, we conclude that heat waves can and should be defined from a joint societal and meteorological perspective, whereby temperatures are compared with thresholds established using societal data. A better joint understanding of societal attention and health im-pacts offers the potential to better manage future heat waves.
Current rising temperatures are threatening biodiversity. It is therefore crucial to understand how climate change impacts male and female fertility and whether evolutionary responses can help in coping with heat stress. We use experimental evolution to study male and female fertility during the real-time evolution of two historically differentiated populations of Drosophila subobscura under different thermal selection regimes for 23 generations. We aim to (a) tease apart sex-specific differences in fertility after exposure to warming conditions during development, (b) test whether thermal selection can enhance fertility under thermal stress, and (c) address the role of historically distinct genetic backgrounds. Contrary to expectations, heat stress during development had a higher negative impact on female fertility than on male fertility. We did not find clear evidence for enhanced fertility in males or females evolving under warming conditions. Population history had a clear impact on fertility response under thermal stress, particularly in males with those from lower latitude presenting better performance than their higher latitude counterparts. We show that the impact of thermal stress on fertility varies between traits, sexes, and genetic backgrounds. Incorporating these several levels of variation is crucial for a deeper understanding of how fertility evolves under climate change.
Heat vulnerability and homelessness are central public health concerns in cities globally, and public health implementation should address these two challenges in tandem to minimize preventable heat-related morbidity and mortality. Populations facing unsheltered homelessness use tents (or similar shelters) with shading features to minimize sun and heat exposure. This study evaluates the efficacy of different tent cover (shading) materials and how they moderate the in-tent air temperature (T(air)) exposures of tent users during extreme summer conditions. Within-tent T(air) monitoring using Kestrel Drop devices occurred across three full typical summer days in Phoenix, Arizona in July 2022. Intent T(air) were statistically compared between six small side-by-side identical tents with different cover materials (control (no cover), mylar, white bedsheet, tarp, sunbrella fabric, aluminum foil), as well as with ambient T(air). Using any tent resulted in higher daytime in-tent T(air) than ambient T(air). Further, compared to a control tent, the T(air) within tents shaded with sunbrella, tarp, and white bedsheet had significantly higher T(air) at all times (2.36 °C, 2.46 °C, and 1.11 °C higher T(air), respectively), controlling for T(air) and day/night. Adding cover materials over tents may increase heat risk to an already vulnerable population at certain times of the day. Higher in-tent T(air) is attributable to the reduced ability for heat and vapor to escape, largely due to reduced ventilation (mixing). Local authorities and welfare associations should reconsider using unventilated tents for shading and promote more widespread, ventilated tents and shade to ensure that prevention efforts do not further marginalize the most vulnerable. Future work should incorporate more comprehensive measurements of solar radiation to quantify overall heat stress for exposure reduction techniques.
Humid-heat extremes threaten human health and are increasing in frequency with global warming, so elucidating factors affecting their rate of change is critical. We investigate the role of wet-bulb temperature (T-W) frequency distribution tail shape on the rate of increase in extreme T-W threshold exceedances under 2 degrees C global warming. Results indicate that non-Gaussian T-W distribution tails are common worldwide across extensive, spatially coherent regions. More rapid increases in the number of days exceeding the historical 95th percentile are projected in locations with shorter-than-Gaussian warm side tails. Asymmetry in the specific humidity distribution, one component of T-W, is more closely correlated with T-W tail shape than temperature, suggesting that humidity climatology strongly influences the rate of future changes in T-W extremes. Short non-Gaussian T-W warm tails have notable implications for dangerous humid-heat in regions where current-climate T-W extremes approach human safety limits. Plain Language Summary Extreme heat is more dangerous to humans when it is combined with high humidity, so it is important to understand how the combination of heat and humidity will change under continued global warming. We investigate how the current distribution of wet-bulb temperatures, a heat-humidity measure, influences how future wet-bulb temperature extremes will increase. Results show that locations with an asymmetrical wet-bulb temperature probability distribution, such that the warm side of the distribution is shorter than if the distribution were normally shaped, are likely to see a faster increase in extreme wet-bulb temperature days under the same warming compared with other locations. Results suggest that the underlying humidity climatology is a more important driver of this distribution asymmetry compared to the underlying temperature climatology.
BACKGROUND: Whereas outdoor temperature is linked to both mortality and hydration status, the hormone vasopressin, measured through the surrogate copeptin, is a marker of cardiometabolic risk and hydration. We recently showed that copeptin has a seasonal pattern with higher plasma concentration in winter. Here, we aimed to investigate the association between outdoor temperature and copeptin. METHODS: Copeptin was analysed in fasting plasma from five cohorts in Malmö, Sweden (n = 26,753, 49.7% men, age 18-86 years). We utilized a multivariable adjusted non-linear spline model with four knots to investigate the association between short-term temperature (24 h mean apparent) and log copeptin z-score. FINDINGS: We found a distinct non-linear association between temperature and log copeptin z-score, with both moderately low and high temperatures linked to higher copeptin concentration (p < 0.0001). Between 0 °C and nadir at the 75th temperature percentile (corresponding to 14.3 °C), log copeptin decreased 0.13 z-scores (95% CI 0.096; 0.16), which also inversely corresponded to the increase in z-score log copeptin between the nadir and 21.3 °C. INTERPRETATION: The J-shaped association between short-term temperature and copeptin resembles the J-shaped association between temperature and mortality. Whereas the untangling of temperature from other seasonal effects on hydration warrants further study, moderately increased water intake constitutes a feasible intervention to lower vasopressin and might mitigate adverse health effects of both moderately cold and hot outdoor temperatures. FUNDING: Swedish Research Council, Å Wiberg, M Stephen, A Påhlsson, Crafoord and Swedish Heart-Lung Foundations, Swedish Society for Medical Research and Swedish Society of Medicine.
BACKGROUND: Ambient temperatures are projected to increase in the future due to climate change. Alzheimer’s disease (AD) and Alzheimer’s disease-related dementia (ADRD) affect millions of individuals and represent substantial health burdens in the US. High temperature may be a risk factor for AD/ADRD outcomes with several recent studies reporting associations between temperature and AD mortality. However, the link between heat and AD morbidity is poorly understood. METHODS: We examined short-term associations between warm-season daily ambient temperature and AD/ADRD emergency department (ED) visits for individuals aged 45 years or above during the warm season (May to October) for up to 14 years (2005-2018) in five US states: California, Missouri, North Carolina, New Jersey, and New York. Daily ZIP code-level maximum, average and minimum temperature exposures were derived from 1 km gridded Daymet products. Associations are assessed using a time-stratified case-crossover design using conditional logistic regression. RESULTS: We found consistent positive short-term effects of ambient temperature among 3.4 million AD/ADRD ED visits across five states. An increase of the 3-day cumulative temperature exposure of daily average temperature from the 50th to the 95th percentile was associated with a pooled odds ratio of 1.042 (95% CI: 1.034, 1.051) for AD/ADRD ED visits. We observed evidence of the association being stronger for patients 65-74 years of age and for ED visits that led to hospital admissions. Temperature associations were also stronger among AD/ADRD ED visits compared to ED visits for other reasons, particularly among patients aged 65-74 years. CONCLUSION: People with AD/ADRD may represent a vulnerable population affected by short-term exposure to high temperature. Our results support the development of targeted strategies to reduce heat-related AD/ADRD morbidity in the context of global warming.
While some studies report a possible association between heat waves and kidney disease and kidney-related conditions, there still is no consistent scientific consensus on the matter or on the role played by other variables, such as air pollution and relative humidity. Ecological retrospective time series study 01-01-2013 to 31-12-2018). Dependent variables: daily emergency hospitalisations due to kidney disease (KD), acute kidney injury (AKI), lithiasis (L), dysnatraemia (DY) and hypovolaemia (HPV). Independent variables: maximum and minimum daily temperature (Tmax, Tmin, °C), and daily relative humidity (RH, %). Other variables were also calculated, such as the daily temperature for risk of kidney disease (Theat, °C) and low daily hazardous relative humidity (HRH%). As variables of air pollution, we used the daily mean concentrations of PM(10), PM(2.5), NO(2) and O(3) in μg/m3. Based on these, we then calculated their daily excesses over World Health Organisation (WHO) guideline levels ((h)PM(10), (h)PM(2.5), (h)NO(2) and (h)O(3) respectively). Poisson family generalised linear models (GLMs) (link = log) were used to calculate relative risks (RRs), and attributable risks and attributable admissions. In the models, we controlled for the covariates included: seasonalities, trend, autoregressive component, day of the week, month and year. A statistically significant association was found between Theat and all the dependent variables analysed. The greatest AKI disease burden was attributable to Theat (2.2 % (1.7, 2.6) of attributable hospital admissions), followed by (h)NO(2) (1.7 % (0.9, 3.4)) and HRH (0.8 (0.6, 1.1)). In the case of hypovolaemia and dysnatraemia, the greatest disease burden again corresponded to Theat, with 6.9 % (6.2, 7.6) and 5.7 (4.8, 6.6) of attributable hospital admissions respectively. Episodes of extreme heat exacerbate daily emergency hospital admissions due to kidney disease and kidney-related conditions; and attributable risks are likewise seen for low relative humidity and high ozone levels.
BACKGROUND: Acute Kidney Injury (AKI) is a multifactorial condition which presents a substantial burden to healthcare systems. There is limited evidence on whether it is seasonal. We sought to investigate the seasonality of AKI hospitalisations in England and use unsupervised machine learning to explore clustering of underlying comorbidities, to gain insights for future intervention. METHODS: We used Hospital Episodes Statistics linked to the Clinical Practice Research Datalink to describe the overall incidence of AKI admissions between 2015 and 2019 weekly by demographic and admission characteristics. We carried out dimension reduction on 850 diagnosis codes using multiple correspondence analysis and applied k-means clustering to classify patients. We phenotype each group based on the dominant characteristics and describe the seasonality of AKI admissions by these different phenotypes. RESULTS: Between 2015 and 2019, weekly AKI admissions peaked in winter, with additional summer peaks related to periods of extreme heat. Winter seasonality was more evident in those diagnosed with AKI on admission. From the cluster classification we describe six phenotypes of people admitted to hospital with AKI. Among these, seasonality of AKI admissions was observed among people who we described as having a multimorbid phenotype, established risk factor phenotype, and general AKI phenotype. CONCLUSION: We demonstrate winter seasonality of AKI admissions in England, particularly among those with AKI diagnosed on admission, suggestive of community triggers. Differences in seasonality between phenotypes suggests some groups may be more likely to develop AKI as a result of these factors. This may be driven by underlying comorbidity profiles or reflect differences in uptake of seasonal interventions such as vaccines.
The set of meteorological data from the Jagiellonian University station in Krakow is one of the longest-recorded in central Europe. Measurement records date back to 1826. Based on the average monthly values of air temperature, total cloudiness, water vapour pressure and wind speed at 1200 UTC, the UTCI values were calculated and the occurrence of cold stress (UTCI < -13 degrees C) and heat stress (UTCI > 32 degrees C) was estimated. The variability of the applied mea-sures of thermal stress conditions was studied both annually and in individual seasons (MAM, JJA, SON, DJF). Statistically significant changes in the studied characteristics of the bioclimate were found. Average annual UTCI values increased at the rate of 0.27 degrees C/10 years. In individual seasons, the trend of UTCI changes ranged from 0.10 degrees C/10 years in summer to 0.43 degrees C/10 years in winter. The number of days with cold stress decreased by 1.8 days/10 years and the number of days with heat stress significantly increased (0.5 days/10 years). Two subperiods with different trends of changes were determined. The first covers the years 1826-1940, and the second, 1941-2021. The former indicates a negative UTCI trend of -0.17 degrees C/10 years, and the latter, an increasing trend of 1.09 degrees C/10 years. The last eight decades have brought a decrease in cold days of 6.5/10 years and an increase in heat days of 2.6/10 years.
OBJECTIVE: Spinal cord injury (SCI) interrupts motor, sensory, and autonomic pathways, impairing mobility and increasing heat storage during warm seasonal temperatures due to compromised autonomic control of vasodilation and sweating and recognition of body temperature. Thus, persons with SCI are more vulnerable to hyperthermia and its adverse effects. However, information regarding how persons with SCI perceive warmer seasons and whether thermal discomfort during warmer seasons restricts routine activities remains anecdotal. DESIGN: Cross-sectional, self-report surveys. SETTING: VA Medical Center and Kessler Institute for Rehabilitation. PARTICIPANTS: Three groups of 50 participants each: tetraplegia, paraplegia, and matched non-SCI controls. OUTCOME MEASURES: Tetraplegia, paraplegia, and control groups responded “yes” or “no” when asked whether warm seasonal temperatures adversely affected comfort or participation in routine activities. RESULTS: The percentage of responses differed among tetraplegia, paraplegia, and control groups when asked if they required ≥20 min to cool down once overheated (44 vs. 20 vs. 12%; X(2 )= 14.7, P < 0.001), whether heat-related discomfort limited their ability to go outside (62 vs. 34 vs. 32%; X(2 )= 11.5, P = 0.003), if they needed to use a water-mister because of the heat (70 vs. 44 vs. 42%; X(2 )= 9.8, P = 0.008), and if heat-related discomfort limited participation in social activities (40 vs. 20 vs. 16%; X(2 )= 8.7, P = 0.01). CONCLUSION: Warmer seasonal temperatures had a greater negative impact on reported comfort and daily activities of persons with SCI than non-SCI controls. Those with tetraplegia were most adversely affected. Our findings warrant increasing awareness and identifying interventions to address the vulnerability of persons with SCI to hyperthermia.
Accurate prediction of indoor temperature is critical for climate change adaptation and occupant health. The aim of this study is to investigate an improved deep ensemble machine learning framework (DEML), by adjusting the model architecture with several machine learning (ML) and deep learning (DL) approaches to forecast the sensor-based indoor temperature in the Australian urban environment. We collected ambient station-based temperatures, satellite-based outdoor climate characteristics, and low-cost sensor-based indoor environmental metrics from 96 devices from August 2019 to November 2022, and established DEML with a rolling windows approach to assess the prediction stability over time. The DEML model was compared with several benchmark models, including Random Forest (RF), Support Vector Machine (SVM), eXtreme Gradient Boosting (XGboost), Long-short term memory (LSTM), and Super Learner model (SL). A total of 13,715 days [median: 341 days; IQR (the interquartile range): 221-977 days] of low-cost sensorbased indoor temperature were included in 25 commercial and residential buildings across eight cities. The prediction performance of DEML was superior to the other five benchmark models in most of the sensors [coefficients of determination (R2) of 0.861-0.990 and root mean square error (RMSE) of 0.125-0.886 degrees C], followed by RF and SL algorithms. DEML consistently achieved high accuracy across different climate zones, seasons, and building types, which could be used as a crucial tool for optimizing energy use, maintaining occupant comfort and health, and adapting to the impacts of climate change.
Kidney stones are rising in incidence and prevalence worldwide. Given the temperature dependence of kidney stone presentations, climate change is projected to further increase the burden of disease for individuals and society. PATIENT SUMMARY: This mini-review reports current knowledge on climate change in relation to kidney stone disease. Kidney stones are more common in patients living in parts of the world that are hotter and more humid. Kidney stone problems are also more common after periods of high heat, which have a greater impact on men than on women. As temperatures rise with climate change, it is likely that the occurrence of kidney stones and the costs associated with their diagnosis and treatment will increase as well.
BACKGROUND AND OBJECTIVES: Chronic conditions and multimorbidity are increasing worldwide. Yet, understanding the relationship between climate change, air pollution, and longitudinal changes in multimorbidity is limited. Here, we examined the effects of sociodemographic and environmental risk factors in multimorbidity among adults aged 45+ and compared the rural-urban disparities in multimorbidity. RESEARCH DESIGN AND METHODS: Data on the number of chronic conditions (up to 14), sociodemographic, and environmental factors were collected in 4 waves of the China Health and Retirement Longitudinal Study (2011-2018), linked with the full-coverage particulate matter 2.5 (PM(2.5)) concentration data set (2000-2018) and temperature records (2000-2018). Air pollution was assessed by the moving average of PM(2.5) concentrations in 1, 2, 3, 4, and 5 years; temperature was measured by 1-, 2-, 3-, 4-, and 5-year moving average and their corresponding coefficients of variation. We used the growth curve modeling approach to examine the relationship between climate change, air pollution, and multimorbidity, and conducted a set of stratified analyses to study the rural-urban disparities in multimorbidity related to temperature and PM(2.5) exposure. RESULTS: We found the higher PM(2.5) concentrations and rising temperature were associated with higher multimorbidity, especially in the longer period. Stratified analyses further show the rural-urban disparity in multimorbidity: Rural respondents have a higher prevalence of multimorbidity related to rising temperature, whereas PM(2.5)-related multimorbidity is more severe among urban ones. We also found temperature is more harmful to multimorbidity than PM(2.5) exposure, but PM(2.5) exposure or temperature is not associated with the rate of multimorbidity increase with age. DISCUSSION AND IMPLICATIONS: Our findings indicate that there is a significant relationship between climate change, air pollution, and multimorbidity, but this relationship is not equally distributed in the rural-urban settings in China. The findings highlight the importance of planning interventions and policies to deal with rising temperature and air pollution, especially for rural individuals.
This work aims to discuss thermal comfort and school architecture in Brazil, within the Anthropocene framework. The objective traverses the fields of school management, curriculum, and educational policy. The importance of the environmental emergency in the context of the Anthropocene is recognized, understanding it as a space-time in which climate change biopolitically impacts both local and global daily life. In this way, we consider that the curricular dimension together with school architecture, in the Anthropocene scenario, tends to respond to the demands of biosecurity. The methodology of this article is the analysis of documentary sources, particularly current Brazilian legislation on school architecture, thermal comfort, and public funding. The initial hypothesis of this work operates with the argument that in Brazilian legislation there is a predominance of HVAC (Heating, Ventilating and Air Conditioning) systems over sustainable forms such as natural ventilation, design of classrooms, placement of windows, use of trees and vegetation and management of the student’s schedule. The assumption of the research lies in the need for reconfigurations of the principles of school architecture, considering both biosecurity and bioclimatic architecture essential for the future in the scenario of climate extremes along the Anthropocene.
Neighbourhoods in cities generate social inequality risks due to outdated climate passive control infrastructures. Previous research has explored thermal comfort related to health emergencies in energy-poverty areas. However, there is scant research on the courtyard’s thermodynamic performance and its implication on thermal comfort throughout the year. This study evaluates that performance in Seville’s social housing courtyards in extreme seasons. Monitoring campaigns were conducted to assess courtyard temperatures linked to outdoor environment. Results show that temperatures within the courtyards were 8.6-12.1 degrees C lower than the outdoor environment during the warm season and up to 3.3 degrees C warmer at night during the cold season. Thermal comfort in courtyards could reach comfortable conditions during 92% of the daytime hours in summer, reducing the sensation of extreme cold by more than 6 degrees C in winter when evaluated using Physiologically Equivalent Temperature. This highlights the ability of courtyards to mitigate health risks linked to extreme temperatures.
Environmental stresses including salinity, drought, cold, warmer temperatures, alterations in precipitation patterns, fluctuations of weather events, and increasing insect and disease infestations negatively affect crop production and nutritional values. This situation becomes further complicated due to the changing climatic conditions, thus raising concern about food security worldwide. Some worst-case projections indicated that by 2100, CO2 concentrations will reach 950 parts per million, temperatures will climb by 3.5 to more than 8 degrees C, sea level will rise by more than 2.4 meters, and the average farmland drought risk index will increase from 52.45 to 129. In addition, average precipitation will increase by 1%-3% in some areas and atmospheric water vapor will increase by 6%-7% for every degree of temperature rise. Rice (Oryza sativa L.) is a staple crop in many parts of the world. The main objective of this review is to highlight the prospects of rice for future climatic conditions. The present review depicts the advantages and prospects of rice and addresses why rice is a better option as a cereal crop for the future situations for food and nutritional sustainability. The impact of climate change on food and nutritional security can be mitigated by developing biotic and abiotic stress-tolerant and biofortified rice varieties. These rice cultivars can withstand the negative effects of climate change while also meeting the nutritional needs of future generations. Furthermore, this review underlines the forthcoming issues and measures that should be addressed to assure a sustainable food and nutritional supply in the era of global climate change.
The incidence and severity of heatwaves are increasing globally with concomitant health complications. Pregnancy is a critical time in the life course at risk of adverse health outcomes due to heat exposure. Dynamic physiological adaptations, which include altered thermoregulatory pathways, occur in pregnancy. If heat dissipation is ineffective, maternal and neonate health outcomes can be compromised. Indeed, epidemiological studies and animal models reveal that exposure to heat in pregnancy likely elicits an array of health complications including miscarriage, congenital anomalies, low birth weight, stillbirth, and preterm birth. Despite these associations, the reasons for why these complications occur are unclear. An array of physiological and endocrine changes in response to heat exposure in pregnancy likely underpin the adverse health outcomes, but currently, conclusive evidence is sparse. Accompanying these fundamental gaps in knowledge is a poor understanding of what exact climatic conditions challenge pregnant physiology. Moreover, the overlay of thermoregulatory-associated behaviours such as physical activity needs to be taken into consideration when assessing the risks to human health and identifying critical populations at risk. While the health impacts from heat are largely preventable through strategic interventions, for the related clinical practice, public health, and policy approaches to be effective, the gaps in basic science understanding urgently need to be addressed.
Continued warming trends lead to an increasing risk of exposure to extreme heatwaves, which threaten the health of urban residents, especially the ageing population. Here, we project the spatiotemporal trend of future exposure risk across 9188 global urban settlements between 2020 and 2100 under the shared socioeconomic pathway (SSP) 2-4.5 and SSP5-8.5 scenarios. Results show that urban heatwave exposure risk increases by 619% and 1740% for SSP2-4.5 and SSP5-8.5, respectively, and by 1642% to 5529% for the elderly. Notably, 69% of the elderly exposure risk comes from middle-income countries, where the increasing trend on the regional average is 1.2 times higher than that of high-income countries. There is an increasing trend towards greater concentration on large cities, especially in low- and lower-middle-income countries. In high-income countries, climate effects contribute 39% to 58% of increasing exposure for elderly individuals, whereas ageing effects play more prominent role in lower-income countries. This emphasizes the disproportionately higher heat-related burden for elderly individuals and inequitable trends in lower income countries. Understanding the vulnerable and priority regions in future heatwave exposure will inform adaptation strategies to support urban climate-resilient development.
The frequency of temperature extremes is rising due to global warming. During heatwaves, the older adults are more likely to experience heat-related illnesses due to impaired sweating and cardiovascular functions. Few existing studies have systematically examined the healthy elderly’s survival time and heatstroke/hyper-thermia prevention measures during prolonged heatwaves.Objectives: We aimed to systematically examine the core temperature responses of elderly during prolonged heatwaves and to predict survival time for the elderly using the modified Stolwijk thermoregulatory model.Methods: The Stolwijk thermoregulatory model was modified to account for sweating and vasodilation alterations in the elderly during exposure to high temperatures. The model was then used to study the influence of envi-ronmental conditions on core temperature responses during the onset of classic heatstroke (Tcore = 40.5-40.6 degrees C) and to estimate survival time.Results: Core temperature increases in three distinct stages under intense heat stress: an initial stage for ther-moregulatory equilibrium alignment, a thermoregulatory steady-state, and a last rapid progression due to uncompensable heat stress resulting from dehydration. At the third stage, dehydration led to a fatal classic heatstroke. The increased air temperature and relative humidity shortened the survival duration.Conclusions: The extended thermoregulation model was able to predict the core temperature responses of healthy elderly individuals exposed to extreme heat with reasonable accuracy (+/- 0.3 degrees C). Furthermore, the model can be used to predict survival time and aid in the selection of efficient heatstroke prevention measures suited to the elderly.
Due to the need to continuously monitor and understand the thermal environment and its socioeconomic implications, this study used remotely sensed data to analyze thermal comfort variation in LCZs, including along the rural to urban gradient of the eThekwini Municipality in KwaZulu-Natal province of South Africa. LCZs were mapped using multi-temporal and multi-spectral Landsat 8 and Landsat 9 data using the approach by World Urban Database and Access Portal Tools (WUDAPT), while thermal data were used to retrieve land surface temperatures (LSTs). Data for training classification of LCZs and accuracy assessment were digitized from GoogleEarth guided by knowledge gained and data collected during a field survey in March 2022 as well as pre-existing maps. LCZs were mapped using the random forest classifier in SAGA GIS software while a single channel algorithm based on band 10 was used to compute LST for different scenes. The LSTs were adjusted and further used to derive thermal comfort based on the Universal Thermal Comfort Index (UTCI) categories as an indicator for outdoor thermal comfort on the extremely low- and extremely high-temperature periods in the cool and hot seasons, respectively. LCZs were mapped with high accuracy (overall accuracy of 90.1% and kappa of 0.88) while inter-class separability was high (>1.5) for all LCZ pairs. Built-up LCZs dominate the eastern parts of the municipality, signifying the influence of the sea on development within the area. Average LST was coolest in the dense forest, open low-rise and water LCZs in the cool and hot seasons, respectively. The compact high-rise LCZ was the warmest in both the hot (36 degrees C) and the cool (23 degrees C) seasons. The sea sands were among coolest regions in both seasons due to their high water content, attributed to their high water table and close proximity to the ocean. There was no thermal stress during the cool season, while most areas recorded moderate to strong heat stress in the hot season. Some areas in the densely built-up LCZs recorded very strong heat stress in the hot season. The findings suggest that policies and strategies should enhance heat mitigation capacities in strong-heat-stress areas during the hot season. Municipal authorities and citizens must work together to build strategies to minimize temperature extremes and associated socioeconomic pressures. Urban development policies, plans and strategies should consider implications on the thermal environment as well as the value of conservation of LCZs with high-heat mitigation value such as dense forests and expansion of built-up LCZs with low-heat absorption levels such as open low-rise. The study was based mainly on remotely sensed temperatures with some ground data used to validate results, which may limit the assessment. Overall, the study provides insights towards achievement of global sustainable and climate-smart development targets.
Over data-sparse regions such as southern Africa, reanalysis products represent valuable proxies for observed weather data. These products are, however, associated with a range of strengths and weaknesses which cannot be overlooked. Hence, for the period 1979-2021, we explored the performance of three ERA5-based reanalysis products (i.e. AgERA5, ERA5 and ERA5-Land) for their spatiotemporal representation of mean summer (November-March) and winter (May-September) temperatures, and coldwave and heatwave characteristics of the seasonal average number of events and days, and magnitude across southern Africa. Compared to the National Oceanic and Atmospheric Administration Climatology Prediction Centre (NOAA CPC) gridded observation-based temperature reference dataset, the reanalysis datasets adequately reproduced spatiotemporal characteristics of mean daily temperatures, with high area average correlations (r > 0.8). Summer (winter) temperatures were, however, typically under-estimated (over-estimated), with area average biases ranging from-0.22 degrees C (ERA5) to-0.11 degrees C (AgERA5) for summer and 0.31 degrees C (ERA5) to 0.51 degrees C (ERA5-Land) for winter. These biases were reflected in the general tendency for under-estimation (over-estimation) of the average coldwave (heatwave) magnitudes, with biases ranging from an average of 1.04 degrees C2 (AgERA5) to 1.76 degrees C2 (ERA5Land) for coldwave magnitudes and-0.03 degrees C2 (AgERA5 and ERA5-Land) to-0.09 degrees C2 (ERA5) for heatwave magnitudes. Of the coldwave and heatwave indices investigated, the ERA5-based coldwave and heatwave seasonally averaged magnitudes were associated with the poorest performance, with the weakest correlations and most statistically significant biases, especially for regions outside South Africa which have substantially fewer observed temperature records. While the reanalysis products were spatiotemporally consistent in their performance for the seasonally averaged number of coldwave and heatwave days and events, they typically overestimated the number of days, by almost two days for both indices, contributing to these events, while they generally under-estimated (over-estimated) the number of coldwave (heatwave) events by less than one event for both indices. On average, seasonally averaged heatwave characteristics were somewhat better represented than that for coldwaves. Despite this, the ERA5-based reanalysis products performed relatively well overall and are valuable to apply in further research considering coldwaves and heatwaves across southern Africa, provided their limitations are acknowledged. Impact-based studies exploring heatwave and coldwave influences on human health, crop yields, livestock thermal comfort, and water availability, for instance, will, however, likely require higher grid resolutions offered by the AgERA5 and ERA5-Land products.
BACKGROUND: Residential green spaces (RGS) are a crucial aspect of urban life, which provide residents with a positive living environment both for mental and physical well-being. However, extreme heat events caused by global warming and local urban heat island effects are threatening the public health of rapidly growing populations. This is especially true for mental health. Depression is a mental illness that can be impacted by extreme heat events, i.e., heatwaves. OBJECTIVE: This study aimed to investigate the potential for residential green spaces (RGS) to alleviate depression by reducing heat stress sensitivity during extreme heat events. METHODS: We conducted a literature review using scientometric analysis with CiteSpace to summarize existing research on the relationships between RGS, depression, and heatwaves. We proposed a conceptual framework for the relationship between RGS and depression, and that extreme heat events may be an important contributor to depression. RESULTS: Our review found that RGS can provide ecosystem services that lower ambient temperatures through evaporative cooling, radiation reflection, humidity regulation, and shading. Different types of RGS, i.e., small green spaces, green roofs, green walls, and street trees, have varying cooling capacities. The mechanisms by which RGS alleviate depression during heatwaves involve green space composition, exposure, physical activity, social contacts, and cohesion. And we proposed a conceptual framework for the relationship between RGS and depression, and that extreme heat events may be an important contributor to depression. CONCLUSION: We present a multidimensional RGS evaluation roadmap to inform green space design for reducing depression during heatwaves. Establishing RGS multidimensional evaluation can guide future research on leveraging RGS to build resilience against extreme heat and improve public mental health.
Many publications dealt with the monitoring of heat-related mortality. Fewer analyses referred to indicators of heat-related morbidity. The aim of this work was to describe the heat-related morbidity using rescue service data from the city of Frankfurt/Main, Germany for the time period 2014-2022, with regard to the questions: 1) How do rescue service deployments develop over the years? Is there a trend identifiable towards a decrease in deployments over the years, e.g. as an effect of either (physiological) adaptation of the population or of the measures for prevention of heat-related morbidity? 2) Which heat parameters (days with a heat warning, heat days, heat weeks, heat waves) are most strongly associated with heat-related morbidity in terms of rescue service deployments and might therefore be additionally used as an easily communicable and understandable heat-warning indicator? Rescue service data were provided by the interdisciplinary medical supply compass system “IVENA” and adjusted for population development including age development. The effect of various indicators for heat exposure, such as days with a heat warning from the German meteorological service based on the scientific concept of “perceived heat”, heat days, heat wave days and heat week days on different endpoints for heat morbidity (deployments in total as well as for heat associated diagnoses) was calculated using both difference-based (difference ± 95% CI) and ratio-based (ratio ± 95% CI) effect estimators. Rescue services deployments in summer months increased overall from 2014 to 2022 in all age groups over the years (2698 to 3517/100.000 population). However, there was a significant decrease in 2020, which could be explained by the special situation of the COVID-19 pandemic, probably caused by the absence of tourists and commuters from the city. In addition, no data are available on the actual implementation of the measures by the population. Therefore, an effect of the measures taken to prevent heat-associated morbidity in Frankfurt am Main could not be directly demonstrated, and our first question cannot be answered on the basis of these data. Almost all heat definitions used for exposure (day with a heat warning, heat day, heat wave day, heat week day) showed significant effects on heat-associated diagnoses in every year. When analysing the effect on all deployments, the effect was in part strongly dependent on individual years: Heat wave days and heat week days even showed negative effects in some years. The definition heat day led to a significant increase in rescue service deployments in all single years between 2014 and 2022 (ratio 2014-2022 1.09 (95CI 1.07-1.11); with a range of 1.05 (95CI 1.01-1.09) in 2020 and 1.14 (95CI 1.08-1.21) in 2014), this was not the case for days with a heat warning (ratio 2014-2022 1.04 (95CI1.02-1.05); with a range of 1.01 (95CI 0.97-1.05) in 2017 and 1.16 (95CI 1.10-1.23). Thus being not inferior to the heat warning day, the “heat day” defined as ≥32 °C maximum temperature, easily obtainable from the weather forecast, can be recommended for the activities of the public health authorities (warning, surveillance etc.) regarding heat health action planning.
Diabetes is a serious public health issue in developing countries, particularly in urban regions. Heat exposure, measured by residential area land surface temperature (LST), may contribute to the risk of diabetes among urban dwellers due to rapid urbanisation and climate change. This might be useful to predict urban diabetes risk. However, this relationship has not been thoroughly assessed in developing countries. Additionally, residential area greenery may mitigate the detrimental effects of high LST. This study examines the association between residential area LST and diabetes among adults (aged & GE; 18 years) in urban regions of Bangladesh and whether residential area greenness modifies the association. Study data were derived from the latest Bangladesh Demographic and Health Survey 2017-2018, and survey cluster-level LST and enhanced vegetation index (i.e. greenness) were used to define residential area-level environmental features. A binary logistic regression was used to estimate the association, and stratified analysis was performed to examine the effect modification role of greenness. Living in areas with a greater LST increased the odds of having diabetes (AOR 1.23, 95% CI 1.01-1.50, p value = 0.035), whereas residing in areas with greater greenness decreased the odds of having diabetes (AOR 0.07, 95% CI 0.01-0.88, p value = 0.039). The effect of LST on diabetes was more pronounced in adults who lived in urban areas with less greenery (AOR 1.31, 95% CI 1.01-1.71, p value = 0.048). This evidence has significant ramifications for local communities, and the improvement of green infrastructure may reduce heat exposure-related health risks in the context of climate change and urbanisation.
Lutzomyia longipalpis is known as one of the primary insect vectors of visceral leishmaniasis. For such ectothermic organisms, the ambient temperature is a critical life factor. However, the impact of temperature has been ignored in many induced-stress situations of the vector life. Therefore, this study explored the interaction of Lu. longipalpis with temperature by evaluating its behaviour across a thermal gradient, thermographic recordings during blood-feeding on mice, and the gene expression of heat shock proteins (HSP) when insects were exposed to extreme temperature or infected. The results showed that 72 h after blood ingestion, Lu. longipalpis became less active and preferred relatively low temperatures. However, at later stages of blood digestion, females increased their activity and remained at higher temperatures. Real-time imaging showed that the body temperature of females can adjust rapidly to the host and remain constant until the end of blood-feeding. Insects also increased the expression of HSP90(83) during blood-feeding. Our findings suggest that Lu. longipalpis interacts with temperature by using its behaviour to avoid temperature-induced physiological damage during the gonotrophic cycle. However, the expression of certain HSP might be triggered to mitigate thermal stress in situations where a behavioural response is not the best option.
Increasing average temperatures and heat waves are having devasting impacts on human health and well-being but studies of heat impacts and how people adapt are rare and often confined to specific locations. In this study, we explore how analysis of conversations on social media can be used to understand how people feel about heat waves and how they respond. We collected global Twitter data over four months (from January to April 2022) using predefined hashtags about heat waves. Topic modelling identified five topics. The largest (one-third of all tweets) was related to sports events. The remaining two-thirds could be allocated to four topics connected to communication about climate-related heat or heat waves. Two of these were on the impacts of heat and heat waves (health impacts 20%; social impacts 16%), one was on extreme weather and climate change attribution (17%) and the last one was on perceptions and warning (13%). The number of tweets in each week corresponded well with major heat wave occurrences in Argentina, Australia, the USA and South Asia (India and Pakistan), indicating that people posting tweets were aware of the threat from heat and its impacts on the society. Among the words frequently used within the topic ‘Social impacts’ were ‘air-conditioning’ and ‘electricity’, suggesting links between coping strategies and financial pressure. Apart from analysing the content of tweets, new insights were also obtained from analysing how people engaged with Twitter tweets about heat or heat waves. We found that tweets posted early, and which were then shared by other influential Twitter users, were among the most popular. Finally, we found that the most popular tweets belonged to individual scientists or respected news outlets, with no evidence that misinformation about climate change-related heat is widespread.
The ready-made garment industry is critical to the Bangladesh economy. There is an urgent need to improve current working conditions and build capacity for heat mitigation as conditions worsen due to climate change. We modelled a typical, mid-sized, non-air-conditioned factory in Bangladesh and simulated how the indoor thermal environment is altered by four rooftop retrofits (1. extensive green roof, 2. rooftop shading, 3. white cool roof, 4. insulated white cool roof) on present-day and future decades under different climate scenarios. Simulations showed that all strategies reduce indoor air temperatures by around 2 °C on average and reduce the number of present-day annual work-hours during which wetbulb globe temperature exceeds the standardised limits for moderate work rates by up to 603 h – the equivalent of 75 (8 h) working days per year. By 2050 under a high-emissions scenario, indoor conditions with a rooftop intervention are comparable to present-day conditions. To reduce the growing need for carbon-intensive air-conditioning, sustainable heat mitigation strategies need to be incorporated into a wider range of solutions at the individual, building, and urban level. The results presented here have implications for factory planning and retrofit design, and may inform policies targeting worker health, well-being, and productivity.
As a result of climate change heatwaves are expected to increase in frequency and intensity and will have detrimental impacts on human health globally. EDs are often the critical point of care for acute heat illnesses and other conditions associated with heat exposure. Existing literature has focused on heatwave-related hospitalisation and mortality. This scoping review aimed to identify, evaluate and summarise current literature regarding patient characteristics and outcomes of ED admissions from heatwaves. A scoping review of the literature was conducted using six databases: Medline, EMBASE, EMCARE, CINAHL, PsycINFO, and Scopus, using MeSH terms and keywords related to ‘heatwave’ and ‘Emergency Department’. Articles were included if they were: published in English from January 2000 to August 2021, related to ED, and examined high temperature periods consistent with heatwave criteria. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). Thirty-one studies were included, mostly from the United States, Australia, and France. The study designs include retrospective case analysis, case-control, and time-series analysis. Eight studies examined known heatwaves, 21 used different criteria to identify heatwave occurrence, and two focused on heat-related illness. The selected articles display a moderate-high quality on MMAT. ED admissions for both heat-related illnesses and other conditions increased during heatwaves, with up to 18.5 times risk increase. The risk was elevated for all population groups, and substantially in the elderly, male patients with certain comorbidities, medications, or lower socioeconomic status. Outcomes including hospitalisation and mortality rates after ED admissions showed positive associations with heatwaves. The heatwaves resulting from climate change will place increasing demands on EDs providing care for increasingly susceptible populations. Significant public heatwave planning across multiple sectors is required to reduce the risk of overwhelming EDs with these patients.
Heat-related mortality has been identified as one of the key climate extremes posing a risk to human health. Current research focuses largely on how heat mortality increases with mean global temperature rise, but it is unclear how much climate change will increase the frequency and severity of extreme summer seasons with high impact on human health. In this probabilistic analysis, we combined empirical heat-mortality relationships for 748 locations from 47 countries with climate model large ensemble data to identify probable past and future highly impactful summer seasons. Across most locations, heat mortality counts of a 1-in-100 year season in the climate of 2000 would be expected once every ten to twenty years in the climate of 2020. These return periods are projected to further shorten under warming levels of 1.5 °C and 2 °C, where heat-mortality extremes of the past climate will eventually become commonplace if no adaptation occurs. Our findings highlight the urgent need for strong mitigation and adaptation to reduce impacts on human lives.
As the world warms, extremely hot days are becoming more frequent and intense, reaching unprecedented temperatures associated with excess mortality. Here, we assess how anthropogenic forcings affect the likelihood of maximum daily temperatures above 50 degrees C at 12 selected locations around the Mediterranean and the Middle East. We adopt a risk-based attribution methodology that utilises climate model simulations with and without human influence to estimate the probability of extremes. We find that at all locations, temperatures above 50 degrees C would have been extremely rare or impossible in the pre-industrial world, but under human-induced climate change their likelihood is rapidly increasing. At the hottest locations we estimate the likelihood has increased by a factor of 10-10(3), whereas by the end of the century such extremes could occur every year. All selected locations may see 1-2 additional months with excess thermal deaths by 2100, which stresses the need for effective adaptation planning.
Involuntary displacement from conflict and other causes leads to clustering of refugees and internally displaced people, often in long-term settlements. Within refugee-hosting countries, refugee settlements are frequently located in isolated and remote areas, characterized by poor-quality land and harsh climatic conditions. Yet, the exposure of refugee settlements to climatic events is underresearched. In this article, we study the exposure of the 20 largest refugee settlements worldwide to extreme variations in climatic conditions. The analysis integrates exposure of camp locations compared to the national trends for both slow- and rapid-onset events and includes descriptive statistics, signal-to-noise analyses, and trend analyses. Our findings show that most refugee settlements included face relatively high exposure to slow-onset events, including high temperatures (for settlements in Kenya, Ethiopia, Rwanda, Sudan, and Uganda), low temperatures (in the case of Jordan and Pakistan), and low levels of rainfall (in Ethiopia, Rwanda, Kenya, and Uganda) compared to national averages. Our findings for rapid-onset events-heatwaves, coldwaves, and extreme rainfall-are less conclusive compared to country trends, although we find relatively high exposure to extreme rainfall in Cox’s Bazar, Bangladesh. Our analyses confirm that refugee populations are exposed to extreme weather conditions postdisplacement, which, in combination with their sociopolitical exclusion, poses a threat to well-being and increased marginalization. Our findings call for an inclusive and integrated approach, including refugees and their host communities, in designing climate adaptation and sustainable development policies, in order to promote equitable sustainable development pathways in refugee-hosting countries.
Human heat stress depends jointly on atmospheric temperature and humidity. Wetter soils reduce tempera-ture but also raise humidity, making the collective impact on heat stress unclear. To better understand these interactions, we use ERA5 to examine the coupling between daily average soil moisture and wet-bulb temperature (Tw) and its seasonal and diurnal cycle at global scale. We identify a global soil moisture-Tw coupling pattern with both widespread negative and positive correlations in contrast to the well-established cooling effect of wet soil on dry-bulb temperature. Regions showing positive correlations closely resemble previously identified land-atmosphere coupling hotspots where soil mois-ture effectively controls surface energy partition. Soil moisture-Tw coupling varies seasonally closely tied to monsoon de-velopment, and the positive coupling is slightly stronger and more widespread during nighttime. Local-scale analysis demonstrates a nonlinear structure of soil moisture-Tw coupling with stronger coupling under relatively dry soils. Hot days with high Tw values show wetter-than-normal soil, anomalous high latent and low sensible heat flux from a cooler surface, and a shallower boundary layer. This supports the hypothesis that wetter soil increases Tw by concentrating surface moist enthalpy flux within a shallower boundary layer and reducing free-troposphere-air entrainment. We identify areas of par-ticular interest for future studies on the physical mechanisms of soil moisture-heat stress coupling. Our findings suggest that increasing soil moisture might amplify heat stress over large portions of the world including several densely populated areas. These results also raise questions about the effectiveness of evaporative cooling strategies in ameliorating urban heat stress. SIGNIFICANCE STATEMENT: The purpose of this study is to provide a global picture of the relationship between soil moisture anomalies and a heat stress metric that includes the joint effects of temperature and humidity. This is im-portant because a better understanding of this relationship will help improve the prediction of extreme heat stress events and inform strategies for ameliorating heat stress. We find a widespread positive correlation between soil mois-ture and heat stress, in contrast to studies relying on temperature alone. This raises the possibility that, over much of the world, and in the most populous regions, strategies like irrigation or “greening” that can reduce temperature might be ineffective or even harmful in heat stress withhumidity incorporated
The study objective was to determine the spatial and temporal variability of Poland’s bioclimatic conditions and to designate heat-stress regions with the Universal Thermal Climate Index (UTCI) application. The study was based on daily data from the multiannual period 1966-2021 obtained for 37 stations in Poland, provided from the resources of the Institute of Meteorology and Water Management-National Research Institute (IMGW-PIB). The aforementioned data provided the basis for the calculation of the Universal Thermal Climate Index (UTCI). The study revealed high variability of bioclimatic conditions in Poland, both in temporal and spatial terms. Bioclimatic regions characterised by the different occurrence of heat stress were distinguished and characterised. Regions in the south-west and west of Poland proved the most favourable in bioclimatic terms, with the highest number of days with no thermal stress. In these regions, the highest UTCI values were observed, while the lowest were recorded in the northeast of Poland and at the east coast of the Baltic Sea. Among unfavourable biometeorological conditions, the ones causing hypothermia have so far occurred more frequently than the ones causing overheating of the human organism. However, UTCI has increased during the study period; therefore, under proceeding global warming, an increase in the frequency of occurrence of heat stress can be expected. So far, the most intensive increase in UTCI values in Poland was recorded in spring and the weakest in winter.
Global warming and advancing urbanization lead to an increased heat exposure for city dwellers. Especially during summertime heatwaves, extreme daytime as well as high nighttime tempera-tures expose vulnerable people to potentially deadly heat risk. This applies specifically to indoor air temperatures, since people spend a lot of their time indoors. Against this background, this study relates outdoor and indoor air temperature measurements to area-wide geospatial data regarding summertime urban heat in the city of Augsburg, Germany. Air temperature data is collected from formalized as well as citizen science measurements, while remote sensing data with very-high spatial resolution (VHR) is utilized for assessment of their drivers and influencing factors. A land use regression approach is developed for city-wide modeling of outdoor and indoor air temperatures at the level of individual residential buildings. Daytime outdoor temperatures could be largely explained by vegetation parameters and imperviousness, whereas nighttime temperatures were more related to the building stock and radiation properties. For indoor tem-peratures, building density as well as building height and volume are additionally relevant. Outdoor air temperatures could be modeled with higher accuracies (mean absolute error (MAE) < 0.5 degrees C) compared to indoor temperatures (MAE < 1.5 degrees C), whereas outdoor and indoor modeling results are consistent with well-known patterns across different local climate zones (LCZ).
Occupants’ health is closely related to indoor environmental quality. The vast stock of vernacular houses, which were designed according to historical weather features, may be vulnerable to the effects of global warming. Assessing and improving the vernacular houses’ passive survivability under the up-to-date climate is of great significance to prevent occupants from the threat of heatrelated illnesses. This study aims to assess the current indoor overheating risks of four typical vernacular houses in the hot and humid region of China and to identify the potential of passive strategies for improving the indoor thermal environment. Two metrics, indoor overheating degree (IOD) and indoor overheating hour (IOH), are used to describe the thermal environment of the vernacular houses. The consequences of indoor environments under uncertain weather conditions are studied using 10 years of continuous ground measurements of weather data. The impacts of design strategies on indoor overheating were analyzed through sensitivity tests. It is shown that under natural ventilation, the ranges of IOD and IOH in vernacular houses can be as much as 0.7-1.5 degrees C and 40-70%, respectively. The ability of vernacular houses to resist thermal stress varies with different building characteristics. Implementing design strategies such as increasing the thermal performance of glazing and the operable area of windows, can effectively reduce the risk of indoor overheating in the summer. This research is expected to provide implications for improving the passive survivability of vernacular houses in hot and humid regions.
To prove the promotion of urban green to mitigate the regionally predetermined heat stress on the local urban scale, comprehensive numerical simulations using ENVI-met v5.0.2 were carried out in an E-W street canyon considering the representative urban structure in Jeju, Republic of Korea, on the heatwave day of August 15, 2020. The simulations consisted of 10 combinations of urban green infrastructure: street trees, grass, facade, and roof greening. Compared to the bare condition, combined green infrastructure led to the maximum reduction in mean air temperature (ATa) by 2.1 K, mean radiant temperature (ATmrt) to 25.3 K, and physiological equivalent temperature (APET) to 16.1 K. Street trees exhibited the greatest effect on the ATmrt and APET as a measure of human thermal comfort. The combination of various green infrastructures has a larger impact on ATmrt on the Sfacing sidewalk compared to the N-facing sidewalk, with a mean ATmrt of 21.2 K for the S-facing sidewalk and 8.0 K for the N-facing sidewalk. Green infrastructure brings about indoor ATa by 1.5 K at the N-bordering building. As relevant design guideline to reduce human heat stress in urban areas, the simulation results provide urban/landscape planners the quantitative effect of combinations of green infrastructure.
Drawing on recent research on the intersections of race and atmosphere, this essay considers thermal sensation as a nonrepresentational sensory modality for staging atmospheric racial disparities. I begin with discussions of research on the physical, psychological, and affective consequences of heat exposure and scholarship on the disparities encoded in thermal landscapes-especially “urban heat islands” where Black and Brown communities are disproportionately exposed to extreme temperatures that exacerbate preexisting health vulnerabilities. I consider a range of literary and cultural works by Nella Larsen, Chester Himes, and Spike Lee that represent the physical and affective implications of thermal disparities, and conclude with an extended discussion of the nonrepresentational, embodied affordances of thermal sensation in Rashid Johnson’s restaging of LeRoi Jones’s Dutchman in a Manhattan sauna.What kinds of knowledge and affective involvement might be afforded by a direct, nonrepresentational aesthetics of thermoception? . . . How might an immersive aesthetics of thermoception sensitize audiences to the spatial and atmospheric dynamics of racialization?
This work investigates the possible future changes and impacts in spatiotemporal variation and regional features of multivariate compound heatwaves (CHWs) in China using the latest Universal Thermal Climate Index from the Coupled Model Intercomparison Project Phase 6 simulations (CMIP6). Results indicate both strong CHWs and extremely threatening CHWs in China are projected to increase substantially in both frequency and spatial extent under different future climate scenarios while with discernible regional disparities. The more severe global warming is, and the greater the extremity of the heatwave events is, the faster the increase in CHWs is. These findings are derived from the CMIP6 projections calibrated using the robust empirical quantiles method. Climate change causes more areas and people to be exposed to CHWs. Notably, the population exposure to dangerous CHWs will increase significantly in northwest China and will appear in northeast China after the mid-21st century under the high emission scenario. Extreme multivariate compound heatwaves (CHWs) may have devastating impacts on human health and have attracted significant societal attention. We explored the possible future changes in dangerous multivariate CHWs in China based on the latest Universal Thermal Climate Index (UTCI) from the Coupled Model Intercomparison Project Phase 6 simulations (CMIP6) project. Results show that the CMIP6 UTCI in China has a warm bias compared to the observations. A nonparametric quantile mapping using a robust empirical quantiles method is employed which can effectively correct this bias and is used to constrain future CMIP6 projections to reduce uncertainties. Two categories of dangerous CHWs are investigated in the current work, that is, strong compound heatwaves and extremely threatening CHWs. Results indicate an expected acceleration in the rate of CHWs and population exposure after the mid-21st century, primarily driven by climate changes. Moreover, the rate of acceleration is found to be more pronounced for CHWs of higher extremities and in the context of the increased severity of global warming. Additionally, population exposure to extremely threatening CHWs will increase significantly not only in southeastern China but also in northwestern and northeastern regions. Our study highlights the critical importance of mitigating climate change to minimize the threat posed by dangerous CHWs to human populations. A nonparametric quantile mapping method can effectively correct the warm bias in the latest Coupled Model Intercomparison Project Phase 6 simulations Universal Thermal Climate Index in ChinaThe increasing rate of compound heatwaves (CHWs) in China will accelerate with the increase in the event extremity and severity of warmingPopulation exposure to CHWs will increase significantly in northwest and northeast China in a warmer world
Heat is a dangerous hazard that causes acute heat illness, chronic disease exacerbations, adverse pregnancy outcomes, and a range of injuries. Risks are highest during extreme heat events (EHEs), which challenge the capacity of health systems and other critical infrastructure. EHEs are becoming more frequent and severe, and climate change is driving an increasing proportion of heat-related mortality, necessitating more investment in health protection. Climate-resilient health systems are better positioned for EHEs, and EHE preparedness is a form of disaster risk reduction. Preparedness activities commonly take the form of heat action plans (HAPs), with many examples at various administrative scales. HAP activities can be divided into primary prevention, most important in the pre-event phase; secondary prevention, key to risk reduction early in an EHE;and tertiary prevention, important later in the event phase. After-action reports and other postevent evaluation activities are central to adaptive management of this climate-sensitive hazard.
Heat action plans should be urgently formulated to enable urban managers, planners, and designers to take appropriate actions for mitigation and adaptation. However, few studies have been conducted to investigate the societal needs and knowledge gaps regarding heat mitigation and adaptation. To address such research gaps, this paper presents an empirical study of 574 questionnaires in Chengdu, China, to explore heat-related impacts, public responses, and driving mechanisms. The results indicated that outdoor activities and work/study were more sensitive to extreme heat than transportation, sleep/rest, and diet. Heat-related impacts on physiological health were at the same level as those on psychological health, where digestive system illness and emotional irritability were the most prevalent physiological and psychological symptoms. Respondents’ knowledge of heat-related threats, adaptation awareness, and adaptation knowledge were insufficient, compared with heat severity. The payment willingness among the respondents was not strong and payment amount was not high. Poorer, healthier, and the less affected in outdoor activities were positive groups in payment willingness, while the group which experienced heat-related impacts on outdoor activities could pay more compared with other groups. Overall, these results help to shape the main contents of heat action plans.
One of the major climate threats is extreme heat events, as they pose significant risks to public health that are well documented in the epidemiologic literature. The effects of extreme heat events have been evident over the past years by several extreme heat events worldwide. With the growing concerns of future heat exposure, numerous studies in the literature have developed heat vulnerability indices based on determinants that have heat-related impacts. However, there has been limited guidance on heat vulnerability assessment that accounts for the impacts of the characteristics of the built environment and changes in population dynamics over time. This paper focuses on developing the methodology for heat vulnerability assessment in urban areas using System Dynamics (SD) based on integrating three levels of the physical urban environment: the urban level, the building level, and the human adaptive capacity to heat exposure. We examine the viability of using SD modeling as an approach to examine the key drivers in heat vulnerability assessment in urban areas. Thus, the paper assesses the dynamic relationship between heat vulnerability components, namely, Susceptibility, Exposure, Coping Capacity, and Adaptive Capacity, and their effect on increased or decreased vulnerability under extreme heat events. The paper concludes with an applied case study in Cairo, Egypt, to test the use of the SD approach in assessing heat vulnerability in urban settings. Results from the proposed SD model confirm the underlying hypothesis that vulnerability from heat exposure is dynamically linked to the coping and adaptive capacity of the surrounding built environment with the urban population’s socioeconomic characteristics. The main contribution of this approach is that it allows for parallel examination of the effect of the human system that simulation models cannot include and the performance of the built environment system that epidemic heat vulnerability studies cannot capture.
Urban areas are vulnerable to multiple risks associated with hydro-meteorological hazards (HMHs). The assessment of the climate benefits of implementing nature-based solutions (NBSs) in urban areas, especially in open spaces, is widely recognised and discussed within the scientific literature; however, the quantification of these benefits, in terms of the HMHs reduction, human safety and human well-being, is still a subject of debate. In this context, this contribution proposes a methodological approach that, starting from the analysis of the impacts of coastal flooding and in terms of the potential direct and tangible economic damages, heatwave events and vulnerability of open spaces, proposes the application and assessment of NBSs in terms of the reduction in these impacts. The process was developed in the GIS environment based on the processing of open-source data. The test was conducted in the case study of Naples’ waterfront to identify the potentialities and limitations of the approach. The results showed the contribution of NBSs in reducing the economic damages due to coastal flooding and the improved vulnerability conditions to heatwave events.
Heatwaves are weather hazards that can influence societal and natural systems. Recently, heatwaves have increased in frequency, duration, and intensity, and this trend is projected to continue as a consequence of climate change. The study of heatwaves is hampered by the lack of a common definition, which limits comparability between studies. This applies in particular to the considered time scale for utilised metrics. Here, we study which durations of heatwaves are most impact-relevant for various types of impacts. For this purpose, we analyse societal metrics related to health (heat-related hospitalisations, mortality) and public attention (Google trends, news articles) in Germany. Country-averaged temperatures are calculated for the period of 2010-2019 and the warmest periods of all time scales between 1 and 90 days are selected. Then, we assess and compare the societal response during those periods to identify the heatwave durations with the most pronounced impacts. Note that these durations are based on average temperatures across the given time frame while individual days may be less warm. The results differ slightly between the considered societal metrics but indicate overall that heatwaves induce the strongest societal response at durations between 2 weeks and 2 months for Germany. Finally, we show that heatwave duration affects the societal response independent of, and additionally to, heatwave temperatures. This finding highlights the relevance of making informed choices on the considered time scale in heatwave analyses. The approach we introduce here can be extended to other societal indices, countries, and hazard types to reveal more meaningful definitions of climate extremes to guide future research on these events.
BACKGROUND: Climate change is projected to result in increased heat events and decreased cold events. This will substantially impact human health, particularly when compounded with demographic change. This study employed the Spatial Synoptic Classification (SSC) to categorize daily weather into one of seven types. Here we estimated future mortality due to extremely hot and cold weather types under different climate change scenarios for one southern (Stockholm) and one northern (Jämtland) Swedish region. METHODS: Time-series Poisson regression with distributed lags was used to assess the relationship between extremely hot and cold weather events and daily deaths in the population above 65 years, with cumulative effects (6 days in summer, 28 days in winter), 1991 to 2014. A global climate model (MPI-M-MPI-ESM-LR) and two climate change scenarios (RCP 4.5 and 8.5) were used to project the occurrence of hot and cold days from 2031 to 2070. Place-specific projected mortality was calculated to derive attributable numbers and attributable fractions (AF) of heat- and cold-related deaths. RESULTS: In Stockholm, for the RCP 4.5 scenario, the mean number of annual deaths attributed to heat increased from 48.7 (CI 32.2-64.2; AF = 0.68%) in 2031-2040 to 90.2 (56.7-120.5; AF = 0.97%) in 2061-2070, respectively. For RCP 8.5, heat-related deaths increased more drastically from 52.1 (33.6-69.7; AF = 0.72%) to 126.4 (68.7-175.8; AF = 1.36%) between the first and the last decade. Cold-related deaths slightly increased over the projected period in both scenarios. In Jämtland, projections showed a small decrease in cold-related deaths but no change in heat-related mortality. CONCLUSIONS: In rural northern region of Sweden, a decrease of cold-related deaths represents the dominant trend. In urban southern locations, on the other hand, an increase of heat-related mortality is to be expected. With an increasing elderly population, heat-related mortality will outweigh cold-related mortality at least under the RCP 8.5 scenario, requiring societal adaptation measures.
BACKGROUND: The dual impacts of a warming climate and population ageing lead to an increasing kidney disease prevalence, highlighting the importance of quantifying the burden of kidney disease (BoKD) attributable to high temperature, yet studies on this subject are limited. The study aims to quantify the BoKD attributable to high temperatures in Australia across all states and territories, and project future BoKD under climatic, population and adaptation scenarios. METHODS: Data on disability-adjusted-life-years (DALYs) due to kidney disease, including years of life lost (YLL), and years lived with disability (YLD), were collected during 2003-2018 (baseline) across all states and territories in Australia. The temperature-response association was estimated using a meta-regression model. Future temperature projections were calculated using eight downscaled climate models to estimate changes in attributable BoKD centred around 2030s and 2050s, under two greenhouse gas emissions scenarios (RCP4.5 and RCP8.5), while considering changes in population size and age structure, and human adaptation to climate change. FINDINGS: Over the baseline (2003-2018), high-temperature contributed to 2.7% (Standard Deviation: 0.4%) of the observed BoKD in Australia. The future population attributable fraction and the attributable BoKD, projected using RCP4.5 and RCP8.5, showed a gradually increasing trend when assuming no human adaptation. Future projections were most strongly influenced by the population change, with the high temperature-related BoKD increasing by 18.4-67.4% compared to the baseline under constant population and by 100.2-291.2% when accounting for changes in population size and age structure. However, when human adaptation was adopted (from no to partial to full), the high temperature-related BoKD became smaller. INTERPRETATION: It is expected that increasing high temperature exposure will substantially contribute to higher BoKD across Australia, underscoring the urgent need for public health interventions to mitigate the negative health impacts of a warming climate on BoKD. FUNDING: Australian Research Council Discovery Program.
Advanced aging is expected to become a major social problem in China during the second half of the 21st century. Current projections of temperature-related mortality in the context of advanced aging are inadequate, and may underestimate the risks posed by global warming on people aged 90+ years. The present study addresses this issue in Nantong City, which was the city in China with the highest aging and advanced aging rates in the 2000, 2010, and 2020 population censuses. Based on 27 global climate models from the Coupled Model Intercomparison Project Phase 6 and statistical downscaling methods, the impacts of climate change and advanced aging on future temperature-related elderly mortality were explored. Our results indicate that global warming will continue to increase the proportion of people who die from non-optimal temperatures even without considering the impact of advanced aging. Moreover, a higher warming range led to a more significant increase in net-temperature-related mortality and advanced aging is likely to increase heat-related mortality and offset the decline in cold-related mortality. Our study demonstrates a “1 + 1 > 2” effect between advanced aging and climate change, under the four shared socioeconomic pathway climate change scenarios considered here. These findings contribute to a better understanding of the impact of climate change on elderly health and facilitate the development of more effective adaptive strategies for advanced aging societies.
Climate change and related events, such as rising temperatures and extreme weather, threaten population health and well-being. This study quantified the impact of climate change on temperature-related, cause-specific mortality while considering adaptations and future demographic changes in Lisbon Metropolitan Area, Portugal. A distributed lag non-linear model (DLNM) was applied to quantify the burden of temperature-related mortality during the present (or reference, 1986-2005) scenario and a future scenario (2046-2065). There was an increase of 0.33% in temperaturerelated excess mortality (95% CI: 0.02 to 0.59) and significantly lower all-cause deaths in the future. These measurements were attributable to extreme cold and considered an adaptation threshold of 1 degrees C with no population changes, resulting in an estimated net difference of -0.15% (95% CI: 0.26 to 0.02), a threshold of 1 degrees C with a high population scenario of -0.15% (95% CI: 0.26 to 0.01), and a threshold of 1 degrees C with a low population scenario of -0.15% (95% CI: 0.26 to 0.01). Moderate cold exposure under a threshold of 1 degrees C and a high population scenario reduced future temperature-related deaths and diabetes mellitus ( -1.32, 95% CI: 2.65 to 0.23). Similarly, moderate heat exposure under a threshold of 4 ffi C and a high population scenario had the highest increase in net changes (6.75, 95% CI: 5.06 to 15.32). The net difference in AF% was due to ischemic heart disease, which was the highest for moderate heat exposure with an adaptation threshold of 4 degrees C only. It decreased slightly with increasing adaptation levels. The most significant increase in net differences for temperature-related excess deaths occurred in respiratory diseases and was associated with heat. A significant decline in net differences was also observed in excess cold-related deaths due to respiratory disease. These findings contribute to the discussion of how climate change impacts human health. Furthermore, they can help guide and monitor adaptation policies in response to climate change.
Climate change is one of the biggest health threats of the 21st century. Although China is the biggest developing country, with a large population and different climate types, its projections of large-scale heat-related excess mortality remain understudied. In particular, the effects of climate change on aging populations have not been well studied, and may result in significantly underestimation of heat effects. In this study, we took four climate change scenarios of Tier-1 in CMIP6, which were combinations of Shared Socioeconomic Pathways (SSPs) and Representative Concentration Pathways (RCPs). We used the exposure-response functions derived from previous studies combined with baseline age-specific non-accidental mortality rates to project heat-related excess mortality. Then, we employed the Logarithmic Mean Divisia Index (LMDI) method to decompose the impacts of climate change, population growth, and aging on heat-related excess mortality. Finally, we multiplied the heat-related Years of Life Lost (YLL) with the Value of a Statistical Life Year (VSLY) to quantify the economic burden of premature mortality. We found that the heat-related excess mortality would be concentrated in central China and in the densely populated south-eastern coastal regions. When aging is considered, heat-related excess mortality will become 2.8-6.7 times than that without considering aging in 2081-2100 under different scenarios. The contribution analysis showed that the effect of aging on heat-related deaths would be much higher than that of climate change. Our findings highlighted that aging would lead to a severe increase of heat-related deaths and suggesting that regional-specific policies should be formulated in response to heat-related risks. (C) Higher Education Press 2023
OBJECTIVES: This study aimed to project future temperature-associated mortality risk and additional deaths among Taiwan’s elderly (aged >65 years) population. STUDY DESIGN: This study investigated retrospective temperature-mortality risk associations and future mortality projections. METHODS: A distributed lag non-linear model and random effect meta-analyses were employed to assess the risk of daily temperature-associated deaths in all-cause, circulatory, and respiratory diseases. Using the statistical downscaling temperature projections of the Representative Concentration Pathways (RCPs; i.e. RCP2.6, RCP6.0 and RCP8.5), future risk of mortalities were projected among the elderly for 2030-2039, 2060-2069 and 2090-2099, with a 30%, 40% and 50% expected increase in elderly population proportions, respectively. RESULTS: The baseline analysis from 2005 to 2018 identified that Taiwan’s population is more vulnerable to cold effects than heat, with the highest cold-related mortality risk being attributed to circulatory diseases, followed by all-cause and respiratory diseases. However, future projections suggest a declining trend in cold-related mortalities and a significant rise in heat-related mortalities under different RCP scenarios. Heat-attributable mortalities under the RCP8.5 scenario by 2090-2099 would account for almost 170,360, 36,557 and 29,386 additional annual deaths among the elderly due to all-cause, circulatory and respiratory diseases, respectively. Heat-attributable all-cause mortalities among the elderly would increase by 3%, 11% and 30% under RCP2.6, RCP6.0 and RCP8.5, respectively, by 2090-2099. CONCLUSIONS: The findings of this study provide predictions on future temperature-related mortality among the elderly in a developed, ageing society with a hot and humid climate. The results from this study can guide public health interventions and policies for climate change and ageing society-associated health risks.
BACKGROUND: The impact of climate change on mental health largely remains to be evaluated. Although growing evidence has reported a short-term association between suicide and temperature, future projections of temperature-attributable suicide have not been thoroughly examined. OBJECTIVES: We aimed to project the excess temperature-related suicide mortality in Japan under three climate change scenarios until the 2090s. METHODS: Daily time series of mean temperature and the number of suicide deaths in 1973-2015 were collected for 47 prefectures in Japan. A two-stage time-stratified case-crossover analysis was used to estimate the temperature-suicide association. We obtained the modeled daily temperature series using five general circulation models under three climate change scenarios from the latest Coupled Model Intercomparison Project Phase 6 (CMIP6) Shared Socioeconomic Pathways scenarios (SSPs): SSP1-2.6, SSP2-4.5, and SSP5-8.5. We projected the excess temperature-related suicide mortality until 2099 for each scenario and evaluated the net relative changes compared with the 2010s. RESULTS: During 1973-2015, there was a total of 1,049,592 suicides in Japan. Net increases in temperature-related excess suicide mortality were estimated under all scenarios. The net change in 2090-2099 compared with 2010-2019 was 1.3% [95% empirical confidence interval (eCI): 0.6, 2.4] for the intermediate-emission scenario (SSP2-4.5), 0.6% (95% eCI: 0.1, 1.6) for a low-emission scenario (SSP1-2.6), and 2.4% (95% eCI: 0.7, 3.9) for the extreme scenario (SSP5-8.5). The increases were greater the more extreme the scenarios were, with the highest increase under the most extreme scenario (SSP5-8.5). DISCUSSION: This study indicates that Japan may experience a net increase in excess temperature-related suicide mortality, especially under the intermediate and extreme scenarios. The findings underscore the importance of mitigation policies. Further investigations of the future impacts of climate change on mental health including suicide are warranted. https://doi.org/10.1289/EHP11246.
The high incidence of mental illness worldwide is a substantial economic burden on society. Temperature and the occurrence of mental and behavioral disorders (MDs) seem to have a relationship, but this has not been widely researched. Therefore, this study aimed to investigate the effect of temperature on the hospitalization rate of patients with MDs in a temperate monsoon climate region of northern China. METHODS: Patients with MDs hospitalized in the Mental Health Center of Hebei Medical University and Psychology Department in The third Hospital of Shijiazhuang, China, from January 2014 to December 2019 were included in the study. The delayed exposure – response relationship between temperature and the number of hospitalized MDs patients was analyzed using a quasi-Poisson generalized additive model combined with a distributed lag nonlinear model. RESULTS: With the reference of 15.3°C (temperature with the minimum hospitalizations), the single lag effect of low temperature (-2°C, 10th percentile) increased the hospitalization of patients with MDs, while the cumulative effect decreased the risk of hospitalization for some MD subtypes; it was an acute protective effect. The single and cumulative lag effect of high temperature statistically increased the hospitalization rates of patients with MDs. The optimum temperature for each subtype was different, and the males and the younger age group were more susceptible to high temperatures. CONCLUSIONS: Low temperature has an acute protective effect on the hospitalization of patients with MDs. In comparison, high temperature increases hospitalization rates. Men and younger people are more affected by temperature, which provides early warning and health intervention measures for patients with corresponding temperature changes.
BACKGROUND: Ambient heat exposure is increasing due to climate change and is known to affect the health of pregnant and postpartum women, and their newborns. Evidence for the effectiveness of interventions to prevent heat health outcomes in east Africa is limited. Codesigning and integrating local-indigenous and conventional knowledge is essential to develop effective adaptation to climate change. METHODS: Following qualitative research on heat impacts in a community in Kilifi, Kenya, we conducted a two-day codesign workshop to inform a set of interventions to reduce the impact of heat exposure on maternal and neonatal health. Participants were drawn from a diverse group of purposively selected influencers, implementers, policy makers, service providers and community members. The key domains of focus for the discussion were: behavioral practices, health facilities and health system factors, home environment, water scarcity, and education and awareness. Following the discussions and group reflections, data was transcribed, coded and emerging intervention priorities ranked based on the likelihood of success, cost effectiveness, implementation feasibility, and sustainability. RESULTS: Twenty one participants participated in the codesign discussions. Accessibility to water supplies, social behavior-change campaigns, and education were ranked as the top three most sustainable and effective interventions with the highest likelihood of success. Prior planning and contextualizing local set-up, cross-cultural and religious practices and budget considerations are important in increasing the chances of a successful outcome in codesign. CONCLUSION: Codesign of interventions on heat exposure with diverse groups of participants is feasible to identify and prioritize adaptation interventions. The codesign workshop was used as an opportunity to build capacity among facilitators and participants as well as to explore interventions to address the impact of heat exposure on pregnant and postpartum women, and newborns. We successfully used the codesign model in co-creating contextualized socio-culturally acceptable interventions to reduce the risk of heat on maternal and neonatal health in the context of climate change. Our interventions can be replicated in other similar areas of Africa and serve as a model for co-designing heat-health adaptation.
BACKGROUND: Climate change is causing an increase in extreme heat. Individuals with cardiovascular disease are at high risk of heat-related adverse health effects. How the burden of extreme heat-associated cardiovascular deaths in the United States will change with the projected rise in extreme heat is unknown. METHODS: We obtained data on cardiovascular deaths among adults and the number of extreme heat days (maximum heat index ≥90 °F [32.2 °C]) in each county in the contiguous United States from 2008 to 2019. Based on representative concentration pathway trajectories that model greenhouse gas emissions and shared socioeconomic pathways (SSP) that model future socioeconomic scenarios and demographic projections, we obtained county-level projected numbers of extreme heat days and populations under 2 scenarios for the midcentury period 2036 to 2065: SSP2-4.5 (representing demographic projections from a “middle-of-the-road” socioeconomic scenario and an intermediate increase in emissions) and SSP5-8.5 (demographic projections in an economy based on “fossil-fueled development” and a large increase in emissions). The association of cardiovascular mortality with extreme heat was estimated with a Poisson fixed-effects model. Using estimates from this model, the projected number of excess cardiovascular deaths associated with extreme heat was calculated. RESULTS: Extreme heat was associated with 1651 (95% CI, 921-2381) excess cardiovascular deaths per year from 2008 to 2019. By midcentury, extreme heat is projected to be associated with 4320 (95% CI, 2369-6272) excess deaths annually, which is an increase of 162% (95% CI, 142-182) under SSP2-4.5, and 5491 (95% CI, 3011-7972) annual excess deaths, which is an increase of 233% (95% CI, 206-259) under SSP5-8.5. Elderly adults are projected to have a 3.5 (95% CI, 3.2-3.8) times greater increase in deaths in the SSP2-4.5 scenario compared with nonelderly adults. Non-Hispanic Black adults are projected to have a 4.6 (95% CI, 2.8-6.4) times greater increase compared with non-Hispanic White adults. The projected change in deaths was not statistically significantly different for other race and ethnicity groups or between men and women. CONCLUSIONS: By midcentury, extreme heat is projected to be associated with a significantly greater burden of excess cardiovascular deaths in the contiguous United States.
This study explores the response of the increased global warning levels (GWLs) on the spatio-temporal characteristics of extreme precipitation and temperature events over Central Africa (CA). For this purpose, eight indices proposed by the Expert Team on Climate Change Detection and Indices have been computed based on an ensemble-mean of simulations from the COnsortium for Small-scale MOdelling in CLimate Mode (CCLM) regional climate model, under the Representative Concentration Pathways scenario RCP8.5. The ability of CCLM to represent the climatology of considered daily hydroclimatic extreme indices related to both precipitation and temperature was also assessed. The results showed that despite the presence of some biases, the precipitation and temperature indices are satisfactorily represented by CCLM, with some notable improvements compared to the GCMs driving fields. The climate change signals under 1.5 degrees C GWL threshold show mostly increases (decreases) in SDII, CDD, R95PTOT, T10, T90, WSDI, and DTR (RR1) over CA throughout the year, and these effects intensify towards a warmer world. Singularly, the strongest changes in these extreme events are generally recorded during the JJA season over the northern part of CA. The results also show on one hand a widespread decrease in mean precipitation (up to 2 mm center dot day(-1) corresponding to similar to 50%) associated with the increase/decrease in CDD/RR1, and on the other hand an increase in mean temperatures (up to 4 degrees C corresponding to similar to 18%) associated with the increase in both lowest and highest temperatures (T10, T90). This study suggests that the CA region will be prone to droughts and floods as well as heat waves in a warmer world and calls for climate action and adaptation strategies to mitigate the risks associated with the above changes on rain-fed agriculture, water resource, and human health.
Due to climate change, rapid warming and its further intensification over different parts of the globe have been recently reported. This has a direct impact on human health, agriculture, water availability, power generation, various ecosystems, and socioeconomic conditions of the exposed population. The current study thus investigates the frequency and duration of heatwaves, human discomfort, and exposure of the human population to these extremes using the high-resolution regional climate model experiments under two Representative Concentration Pathways (RCP2.6, RCP8.5) over India. We find that more than 90% of India will be exposed to uncomfortable warm nights by the end of the 21st century with the highest rise over western India, Madhya Pradesh (MP), Uttar Pradesh (UP), Punjab, and the Haryana region. States like Odisha, Chhattisgarh, eastern parts of MP and UP, and some parts of J&K will be the worst hit by the intense and frequent heatwaves and human discomfort followed by the densely populated Indo-Gangetic plains under RCP8.5. Strict enforcement of the stringent policies on stabilization of population growth, improvement of local adaptive capacities, and economic status of the vulnerable population along with enforcing effective measures to curb greenhouse gas emissions are important to reduce human exposure to future heat stress. We demonstrate that a proper mitigation-based development (RCP2.6) instead of a business-as-usual scenario (RCP8.5) may help to reduce 50-200 heatwave days, 3-10 heatwave spells, and 10-35% warm nights over the Indian region. Consequently, this can avoid the exposure of 135-143 million population to severe discomfort due to extreme heat conditions by the end of the 21st century.
Thermal bioclimate is a defining factor of agricultural production, ecological condition, public health, and species distribution. This study aimed at assessing the possible changes in the Middle East and North African (MENA) thermal bioclimate for two shared socioeconomic pathways (SSPs), SSP1-1.9 and SSP1-2.6, representing a temperature rise restricted to 1.5 and 2.0 degrees C above the pre-industrial level at the end of the century. Therefore, the study explains the probable least change in bioclimate due to climate change and what might happen for a 0.5 degrees C temperature rise above the 1.5 degrees C addressed by Paris Climate Agreement. A multimodel ensemble of eight global climate models was employed for this purpose. The results indicated a 0.5 degrees C further increase in temperature above the 1.5 degrees C temperature rise threshold would cause a nearly 0.8 to 1.0 degrees C increase in temperature in some parts of MENA, indicating a faster than global average increase in temperature in the region for higher temperature rise scenarios. Climate change would cause a decrease in thermal seasonality by 2-6% over nearly 90% of the study area. The diurnal temperature would decrease by 0.1 to 0.4 degrees C over the entire south, while the annual temperature range would decrease by 0.5 to 1.5 degrees C over a large area in the north. This would cause a decrease in isothermality nearly by 1% over most areas. The area with decreasing isothermality would expand by almost 150% for a further temperature rise by 0.5 degrees C. The results indicate a substantial change in bioclimate in MENA for a minor temperature change.
This study investigates the impact of increased global warming on heat stress changes and the potential number of people exposed to heat risks over Africa. For this purpose a heat index has been computed based on an ensemble-mean of high-resolution regional climate model simulations from the Coordinated Output for Regional Evaluations embedded in the COordinated Regional Climate Downscaling EXperiment, under two Representative Concentration Pathways (RCPs) scenarios (RCP2.6 and RCP8.5), combined with projections of population growth developed based on the Shared Socioeconomic Pathways (SSPs) scenarios (SSP1 and SSP5). Results show that by the late 21st century, the increased global warming is expected to induce a 12-fold increase in the area extent affected by heat stress of high-risk level. This would result in an increase of about 10%-30% in the number of days with high-risk heat conditions, as well as about 6%-20% in their magnitude throughout the seasonal cycle over West, Central, and North-East Africa. Therefore, and because of the lack of adaptation and mitigation policies, the exacerbation of ambient heat conditions could contribute to the exposure of about 2-8.5 million person-events to heat stress of high-risk level over Burkina Faso, Ghana, Niger, and Nigeria. Furthermore, it was found that the interaction effect between the climate change and population growth seems to be the most dominant in explaining the total changes in exposure due to moderate and high heat-related risks over all subregions of the African continent.
Climate change is expected to increase occupational heat stress, which will lead to diminished work performance and labor losses worldwide. However, sub-regional analyses remain insufficient, especially for countries with a heterogeneous spatial distribution of working populations, industries and climates. Here, we projected heat-induced labor losses in China, by considering local climate simulations, working population characteristics and developing an exposure-response function suitable for Chinese workers. We showed that the annual heat-induced work hours lost (WHL), compared to the baseline of 21.3 billion hours, will increase by 121.1% (111.2%-131.1%), 10.8% (8.3%-15.3%), and -17.8% (-15.3%–20.3%) by the end of the century under RCP(Representative Concentration Pathways)8.5, RCP4.5, and RCP2.6, respectively. We observed an approximately linear upward trend of WHL under RCP8.5, despite the decrease in future working population. Notably, WHL will be most prominent in the southern, eastern and central regions, with Guangdong and Henan accounting for a quarter of national total losses; this is largely due to their higher temperature exposure, larger population size, and higher shares of vulnerable population in total employment. In addition, limiting global warming to 1.5 °C would yield substantial gains. Compared to RCP2.6, RCP4.5, and RCP8.5, all provinces can avoid an average of 11.8%, 33.7%, and 53.9% of annual WHL if the 1.5 °C target is achieved, which is equivalent to avoiding 0.1%, 0.6%, and 1.4% of annual GDP losses in China, respectively. This study revealed climate change will exacerbate future labor losses, and adverse impacts can be minimized by adopting stringent mitigation policies coupled with effective adaptation measures. Policymakers in each province should tailor occupation health protection measures to their circumstances.
Heatwaves have significant adverse effects on human health. The frequency, duration, and intensity of heatwaves are projected to increase dramatically, in the context of global warming. However, there are few comprehensive assessments of the health impact of heatwaves considering different definitions, and their characteristics under climate change scenarios. OBJECTIVE: We aimed to compare future excess mortality related to heatwaves among different definitions under climate change, population, and adaptation scenarios in China and further explore the mortality burden associated with heatwave characteristics. METHODS: Daily data during 2010-2019 were collected in Guangzhou, China. We adopted nine common heatwave definitions and applied quasi-Poisson models to estimate the effects of heatwaves and their characteristics’ impact on mortality. We then projected the excess mortality associated with heatwaves and their characteristics concerning climate change, population, and adaptation scenarios. RESULTS: The relative risks of the nine common heatwave definitions ranged from 1.05 (95% CI: 1.01, 1.10) to 1.24 (95% CI: 1.13, 1.35). Heatwave-related excess mortality will consistently increase in the future decades considering multiple heatwave definitions, with more rapidly increasing rates under the Shared Socioeconomic Path5-8.5 and non-adaptability scenarios. Regarding heatwave characteristics, the intensity is the main factor involved in the threat of heatwaves. The increasing trend of characteristic-related mortality burden is similar to that of heatwaves, and the mortality burden caused by the duration of the heatwaves was the largest among all characteristics. CONCLUSIONS: This study provides a comprehensive picture of the impact of heatwaves and their characteristics on public health under various climate change scenarios, population changes, and adaptive assumptions. The results may provide important public health implications for policymakers in planning climate change adaptation and mitigation policies, and implementing specific plans.
Heat stress can have negative effects on human wellbeing with morbidity and mortality as harmful consequences, especially in vulnerable groups, e.g. children, elderly and chronically ill. Children is for example at higher risk of dehydration and heat stroke compared to healthy adults. Furthermore, children attending preschools are endorsed to spend time outdoors and engaging in physical activities. Therefore, thermally comfortable preschool yards are detrimental to sustain safe environments where the children can continue their physically active play. Here we show that preschoolers in five Swedish cities, Malmo center dot, Gothenburg, Stockholm, center dot Ostersund and Lulea, are exposed to heat stress on warm and clear days between May-August in preschool yards with insufficient shading, using three different thermal indices (COMFA, PET and UTCI). Furthermore, future number of heat stress days are evaluated using the SMHI RCA4 regional climate model from the EURO-CORDEX project, forced with six different global climate models. Results show that heat stress will increase under the RCP2.6, 4.5 and 8.5 climate change scenarios. In Malmo center dot, Gothenburg and Stockholm number of days with heat stress all hours 09:00-15:00 while playing in a sunlit sandbox have doubled from approximately 10 to 20 days for 2071-2100 (RCP8.5) compared to 2008-2020. These numbers are even higher if active play, e.g. running, is per-formed, estimating to around two weeks in July alone by the end of the century. Without adaptation this is likely to have adverse effects on the health and learning of children. If the preschool yard, on the other hand, is shaded by trees, days with heat stress are almost entirely diminished, indicating the importance of trees in preschool yard design as a tool to mitigate heat stress.
NEW FINDINGS: What is the topic of this review? Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non-modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes. What advances does it highlight? Cardiovascular stress tests performed in preterm-born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. ABSTRACT: Preterm-born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro- and micro-physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later-life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes.
The climate crisis is the greatest public health threat of the 21st century. Excessive heat is responsible for more deaths than any other extreme weather event, and the frequency, intensity, and duration of extreme heat events are increasing globally due to climate change. Exposure to excessive heat can result in heat related illnesses (HRIs) and long-term poor health outcomes. Physical exertion, sudden exposure to excessive heat, and the lack of physical or behavioral adaptation resources are all associated with greater HRI risk, which is expected to increase for visitors to Grand Canyon National Park (GCNP) and other public lands as climate change worsens. OBJECTIVES: Our objectives were to understand 1) the relationship between weather and HRI in GCNP visitors, 2) how future HRI rates may change, and 3) how land management agencies can update risk mitigation strategies to match changing risk and better manage an increased HRI burden. METHODS: We utilized previously published data on HRI in GCNP visitors, and records of daily visitation, temperatures, and maximum and minimum daily humidity from the same study period to develop a model estimate for HRI risk. We then used future climate projections from the World Climate Research Programme’s Coupled Model Intercomparison Project phase 5 multi-model dataset to model future HRI risk under different climate scenarios. RESULTS: The incidence of HRI was significantly associated with maximum daily temperature and minimum relative humidity, and was more common in the shoulder season months. We estimated that HRI will increase 29%-137% over 2004-2009 levels through 2100, assuming no change in visitation. DISCUSSION: Climate change will continue to increase HRI risk for GCNP visitors and poses risks to public land managers’ mission to provide for safe recreation experiences for the benefit of this and future generations in places like GCNP. Excessive risk during the shoulder season months presents an opportunity to increase preventative search and rescue and education efforts to mitigate increased risk.
Climate change may influence the incidence of infectious diseases including those transmitted by ticks. Rhipicephalus sanguineus complex has a worldwide distribution and transmits Rickettsial infections that could cause high mortality rates if untreated. We assessed the potential effects of climate change on the distribution of R. sanguineus in the Americas in 2050 and 2070 using the general circulation model CanESM5 and two shared socioeconomic pathways (SSPs), SSP2-4.5 (moderate emissions) and SSP2-8.5 (high emissions). A total of 355 occurrence points of R. sanguineus and eight uncorrelated bioclimatic variables were entered into a maximum entropy algorithm (MaxEnt) to produce 50 replicates per scenario. The area under the curve (AUC) value for the consensus model (>0.90) and the partial ROC value (>1.28) indicated a high predictive capacity. The models showed that the geographic regions currently suitable for R. sanguineus will remain stable in the future, but also predicted increases in habitat suitability in the Western U.S., Venezuela, Brazil and Bolivia. Scenario 4.5 showed an increase in habitat suitability for R. sanguineus in tropical and subtropical regions in both 2050 and 2070. Habitat suitability is predicted to remain constant in moist broadleaf forests and deserts but is predicted to decrease in flooded grasslands and savannas. Using the high emissions SSP5-8.5 scenario, habitat suitability in tropical and subtropical coniferous forests and temperate grasslands, savannas, and shrublands was predicted to be constant in 2050. In 2070, however, habitat suitability was predicted to decrease in tropical and subtropical moist broadleaf forests and increase in tropical and subtropical dry broadleaf forests. Our findings suggest that the current and potential future geographic distributions can be used in evidence-based strategies in the design of control plans aimed at reducing the risk of exposure to zoonotic diseases transmitted by R. sanguineus.
One of the negative consequences of increased air temperatures due to global warming is the associated increase in heat-related mortality and morbidity. Studies that focused on future predictions of heat-related morbidity do not consider the effect of long-term heat adaptation measures, nor do they use evidence-based methods. Therefore, this study aimed to predict the future heatstroke cases for all 47 prefectures of Japan, by considering long-term heat adaptation by translating current geographical differences in heat adaptation to future temporal heat adaptation. Predictions were conducted for age groups of 7-17, 18-64, and ≥65 years. The prediction period was set to a base period (1981-2000), mid-21st century (2031-2050), and the end of the 21st century (2081-2100). We found that the average heatstroke incidence (number of patients with heatstroke transported by ambulance per population) in Japan under five representative climate models and three greenhouse gas (GHG) emissions scenarios increased by 2.92- for 7-17 years, 3.66- for 18-64 years, and 3.26-fold for ≥65 years at the end of the 21st century without heat adaptation. The corresponding numbers were 1.57 for 7-17 years, 1.77 for 18-64 years, and 1.69 for ≥65 years with heat adaptation. Furthermore, the average number of patients with heatstroke transported by ambulance (NPHTA) under all climate models and GHG emissions scenarios increased by 1.02- for 7-17 years, 1.76- for 18-64 years, and 5.50-fold for ≥65 years at the end of 21st century without heat adaptation, where demographic changes were considered. The corresponding numbers were 0.55 for 7-17 years, 0.82 for 18-64 years, and 2.74 for ≥65 years with heat adaptation. The heatstroke incidence, as well as the NPHTA, substantially decreased when heat adaptation was considered. Our method could be applicable to other regions across the globe.
Few studies examined the association between prenatal long-term ambient temperature exposure and stillbirth and fewer still from developing countries. Rather than ambient temperature, we used a human thermophysiological index, Universal Thermal Climate Index (UTCI) to investigate the role of long-term heat stress exposure on stillbirth in Ghana. METHODS: District-level monthly UTCI was linked with 90,532 stillbirths of 5,961,328 births across all 260 local districts between 1(st) January 2012 and 31(st) December 2020. A within-space time-series design was applied with distributed lag nonlinear models and conditional quasi-Poisson regression. RESULTS: The mean (28.5 ± 2.1 °C) and median UTCI (28.8 °C) indicated moderate heat stress. The Relative Risks (RRs) and 95% Confidence Intervals (CIs) for exposure to lower-moderate heat (1st to 25th percentiles of UTCI) and strong heat (99th percentile) stresses showed lower risks, relative to the median UTCI. The higher-moderate heat stress exposures (75th and 90th percentiles) showed greater risks which increased with the duration of heat stress exposures and were stronger in the 90th percentile. The risk ranged from 2% (RR = 1.02, 95% CI 0.99, 1.05) to 18% (RR = 1.18, 95% CI 1.02, 1.36) for the 90th percentile, relative to the median UTCI. Assuming causality, 19 (95% CI 3, 37) and 27 (95% CI 3, 54) excess stillbirths per 10,000 births were attributable to long-term exposure to the 90th percentile relative to median UTCI for the past six and nine months, respectively. Districts with low population density, low gross domestic product, and low air pollution which collectively defined rural districts were at higher risk as compared to those in the high level (urban districts). DISCUSSION: Maternal exposure to long-term heat stress was associated with a greater risk of stillbirth. Climate change-resilient interventional measures to reduce maternal exposure to heat stress, particularly in rural areas may help lower the risk of stillbirth.
OBJECTIVE: From 2010 to 2022, the Victorian Department of Health operated a heat health alert system. We explored whether changes to morbidity occurred during or directly after these alerts, and how this differed for certain population groups. METHODS: We used a space-time-stratified case-crossover design and conditional logistic regression to examine the associations between heat health alerts and heat-related and all-cause emergency department (ED) presentations and hospital admissions at the state-wide level, with models created for the whole population and subgroups. Data were included for the warm season (November-March) from 2014 to 2021. RESULTS: Increases occurred in heat-related ED presentations (OR 1.73, 95% CI: 1.53-1.96) and heat-related hospital admissions (OR 1.23, 95% CI: 1.16-1.30) on days on or after heat health alerts. Effect sizes were largest for those 65 years and older, Aboriginal and Torres Strait Islander people, and those living in the most disadvantaged areas. CONCLUSIONS: We confirm that increases in morbidity occurred in Victoria during heat health alerts and describe which population groups are more likely to require healthcare in a hospital. IMPLICATIONS FOR PUBLIC HEALTH: These findings can inform responses before and during periods of extreme heat, data-driven adaptation strategies, and the development of heat health surveillance systems.
BACKGROUND: In June of 2021, a heatwave resulted in high mortality across the Pacific Northwest region. The city of Portland, Oregon, had many advantages: emergency response personnel, science-based policies, political support for climate change adaptation, and collaboration among municipal, county, state, and federal authorities. Though the city’s response likely prevented many deaths, heat-related mortality was high. METHODS: This study presents a retrospective case analysis of the 2021 Western North American Heatwave in Portland, Oregon. Specifically, the study examines the limitations of current heatwave response paradigms by means of a narrative review of the heatwave response and impacts. RESULTS: Most deaths occurred at home, and most of those who died lived alone. Most of the deceased did not have access to functioning air conditioning. CONCLUSIONS: Heatwaves exhibit high predictability in the demographics of those most affected and have rising rates of recurrence. Given the effectiveness of residential cooling systems in preventing heat-related mortality, findings suggest that future public health and policy initiatives should put increased focus on the primary prevention of heat exposure.
INTRODUCTION: Heatstroke mortality is highest among older adults aged 65 years and older, and the risk is even doubled among those aged 75 years and older. The incidence of heatstroke is expected to increase in the future with elevated temperatures owing to climate change. In the context of a super-aged society, we examined possible adaptation measures in Japan that could prevent heatstroke among older people using an epidemiological survey combined with mathematical modeling. METHODS: To identify possible interventions, we conducted a cross-sectional survey, collecting information on heatstroke episodes from 2018 to 2019 among people aged 75 years and older. Responses were analyzed from 576 participants, and propensity score matching was used to adjust for measurable confounders and used to estimate the effect sizes associated with variables that constitute possible interventions. Subsequently, a weather-driven statistical model was used to predict heatstroke-related ambulance transports. We projected the incidence of heatstroke-related transports until the year 2100, with and without adaptation measures. RESULTS: The risk factor with the greatest odds ratio (OR) of heatstroke among older adults was living alone (OR 2.5, 95% confidence interval: 1.2-5.4). Other possible risk factors included an inability to drink water independently and the absence of air conditioning. Using three climate change scenarios, a more than 30% increase in the incidence of heatstroke-related ambulance transports was anticipated for representative concentration pathways (RCP) 4.5 and 8.5, as compared with a carbon-neutral scenario. Given 30% reduction in single living, a 15% reduction in the incidence of heatstroke is expected. Given 70% improvement in all three risk factors, a 40% reduction in the incidence can be expected. CONCLUSION: Possible adaptation measures include providing support for older adults living alone, for those who have an inability to drink water and for those without air conditioning. To be comparable to carbon neutrality, future climate change under RCP 2.6 requires achieving a 30% relative reduction in all three identified risks at least from 2060; under RCP 4.5, a 70% reduction from 2050 at the latest is needed. In the case of RCP 8.5, the goal of heatstroke-related transports approaching RCP 1.9 cannot be achieved.
Heat waves have a catastrophic impact on ecosystems, economy, society and human health. Revealing the underlying physical drivers of heat waves is essential for improving extreme event forecasts and disaster prevention capabilities under climate change. Thus, this study provides an analysis of the maximum temperature, and heat wave frequency and duration during July-August in China from 1961 to 2022. Significant upward trends of different heat wave indexes were observed and broke the historical record in 2022. The influence of large-scale circulation on heat waves illustrates that the eastward South Asia High (SAH) and anomalously westward Western Pacific Subtropical High (WPSH) are closely associated with increased heat wave events, especially in 2022. We further demonstrate using reanalysis data that the Barents Sea ice shrinkage is associated with increased heat waves in China by modulating favourable atmospheric circulations. In addition, the North Atlantic Oscillation (NAO), which is closely linked to Arctic Sea ice, can provoke large-scale Rossby waves, which in turn can cause extreme heat events in China. In particular, the reduced sea ice coupled with NAO strengthens the anomalous eastward SAH and anomalous westward WPSH of their position and intensity especially in 2022 and provides favourable atmospheric circulation patterns for the occurrence of heat waves.
This study analyzed the association between heatstroke incidence and daily maximum wet bulb globe temperature (WBGT) for all 47 prefectures in Japan by age group and severity using time-series analysis, controlling for confounders, such as seasonality and long-term trends. With the obtained association, the relative risk between the reference WBGT (defined as the value at which heatstroke starts to increase) and the daily maximum WBGT at 30 °C (RR(wbgt30)) of each prefecture were calculated. For the heatstroke data, the daily number of heatstroke patients transported by ambulance at the prefecture level, provided by the Fire and Disaster Management Agency, was utilized. The analysis was conducted for age groups of 7-17 y, 18-64 y, and ≥65 y, and for severity of Deceased, Severe, Moderate (combined as DSM), and Mild. The analysis period was set from May 1 to September 30, 2015-2019. Finally, the correlation between RR(wbgt30) and the average daily maximum WBGT during the analysis period (aveWBGTms) of each prefecture was analyzed to examine the regionality of heatstroke incidence. The result showed that RR(wbgt30) is negatively correlated with aveWBGTms for the age group 18-64 y and ≥65 y (except for the age group 7-17 y) and for severity. The natural logarithm of the RR(wbgt30) of all 47 prefectures ranged from 2.0 to 8.2 for the age group 7-17 y, 1.1 to 4.0 for the age group 18-64 y, 1.8 to 6.0 for the age group ≥65 y, and 1.0 to 3.6 for DSM, and 0.9 to 4.0 for Mild. This regionality can be attributed to the effects of heat adaptation, where people in hotter regions are accustomed to implementing measures against hot environments and are more heat acclimatized than people in cooler regions.
With rising global temperatures, heat-related mortality is increasing, particularly among older adults. Although this is often attributed to declines in thermoregulatory function, little is known regarding the effect of age on the cellular processes associated with mitigating heat-induced cytotoxicity. We compared key components of the cellular stress response in 19 young (19-31 yr; 10 female) and 37 older adults (61-78 yr; 10 female) during 9 h of heat exposure (40°C, 9% relative humidity). Mean body temperature (T(body)) was calculated from core and skin temperatures. Changes in proteins associated with autophagy, apoptotic signaling, acute inflammation, and the heat shock response were assessed via Western blot in peripheral blood mononuclear cells harvested before and after exposure. T(body) increased by 1.5 (SD 0.3)°C and 1.7 (0.3)°C in the young and older adults, respectively. We observed similar elevations in autophagy-related proteins (LC3-II and LC3-II/I) in young and older adults (both P ≥ 0.121). However, the older adults displayed signs of autophagic dysfunction, evidenced by a 3.7-fold [95% CI: 2.4, 5.6] greater elevation in the selective autophagy receptor p62 (P < 0.001). This was paired with elevations in apoptotic responses, with a 1.7-fold [1.3, 2.3] increase in cleaved caspase-3 in the older relative to young adults (P < 0.001). Older adults also exhibited diminished heat shock protein 90 responses (0.7-fold [0.5, 0.9] vs. young, P = 0.011) and, at any given level of thermal strain (T(body) area under the curve), elevated tumor necrosis factor-α (1.5-fold [1.0, 2.5] vs. young, P = 0.008). Attenuated autophagic responses may underlie greater vulnerability to heat-induced cellular injury in older adults.NEW & NOTEWORTHY We demonstrate for the first time that peripheral blood mononuclear cells from older adults exhibit signs of autophagic impairments during daylong (9 h) heat exposure relative to their younger counterparts. This was paired with greater apoptotic signaling and inflammatory responses, and an inability to stimulate components of the heat shock response. Thus, autophagic dysregulation during prolonged heat exposure may contribute to age-related heat vulnerability during hot weather and heat waves.
For interscholastic athletes participating in outdoor sports, excessive heat can affect health, safety, and performance. Increasingly, many state high school associations have mandated weather-based activity modification and acclimatization policies, among other factors, to reduce exertional heat illnesses (EHIs) risk. Yet, modulating the practice schedule towards cooler times of the day, has not been widely used in interscholastic sports, in part because disruptions of predicable schedules can be difficult for athletic staff, athletes, and parents. We identified time-activity patterns of American football players in Georgia, U.S., to identify the variations in heat hazards and identify patterns that can be used for planning. Our dataset includes information on the date and time of practice, the activity type (game, scrimmage, practice), the wet bulb globe temperature (WBGT) and the occurrence of EHIs (i.e. heat exhaustion and heat syncope). We observed that practices tend to be held in the afternoon following the school day, while games/scrimmages mostly occur during the cooler evenings. These hotter afternoon conditions help explain the greater heat exhaustion / heat syncope illness rates observed for practices than for games or scrimmages. Our results show that shifting practices to the evening during the first four weeks of the season would reduce the likelihood of sessions exceeding 27.78oC WBGT by 32-55%. Adjusting practice schedules during the hottest weeks of the season is a way to reduce exposure to heat hazards and provide a predictable schedule for athletic staff, athletes and parents to follow.
To examine commonalities and gaps in the content of local US heat action plans (HAPs) designed to decrease the adverse health effects of extreme heat. Methods. We used content analysis to identify common strategies and gaps in extreme heat preparedness among written HAPs in the United States from jurisdictions that serve municipalities with more than 200 000 residents. We reviewed, coded, and analyzed plans to assess the prevalence of key components and strategies. Results. All 21 plans evaluated incorporated data on activation triggers, heat health messaging and risk communication, cooling centers, surveillance activities, and agency coordination, and 95% incorporated information on outreach to at-risk populations. Gaps existed in the specific applications of these broad strategies. Conclusions. Practice-based recommendations as well as future areas of research should focus on increasing targeted strategies for at-risk individuals and expanding the use of surveillance data outside of situational awareness. (Am J Public Health. 2023;113(5):559-567. https://doi.org/10.2105/AJPH.2022.307217).
BACKGROUND AND OBJECTIVES: The co-occurring trends of population aging and climate change mean that rising numbers of U.S. older adults are at risk of intensifying heat exposure. We estimate county-level variations in older populations’ heat exposure in the early (1995-2014) and mid (2050) 21st century. We identify the extent to which rising exposures are attributable to climate change versus population aging. RESEARCH DESIGN AND METHODS: We estimate older adults’ heat exposure in 3,109 counties in the 48 contiguous U.S. states. Analyses use NASA NEX Global Daily Downscaled Product (NEX-GDDP-CMIP6) climate data and county-level projections for the size and distribution of the U.S. age 69+ population. RESULTS: Population aging and rising temperatures are documented throughout the U.S., with particular “hotspots” in the Deep South, Florida, and parts of the rural Midwest. Increases in heat exposure by 2050 will be especially steep in historically colder regions with large older populations in New England, the upper Midwest, and rural Mountain regions. Rising temperatures are driving exposure in historically colder regions, whereas population aging is driving exposure in historically warm southern regions. DISCUSSION AND IMPLICATIONS: Interventions to address the impacts of temperature extremes on older adult well-being should consider the geographic distribution and drivers of this exposure. In historically cooler areas where climate change is driving exposures, investments in warning systems may be productive, whereas investments in healthcare and social services infrastructures are essential in historically hot regions where exposures are driven by population aging.
Climate change has reduced the comfort of community environments, and there is an urgent need to improve the health and well-being of low-income residents through design and technical measures. Therefore, this paper conducts research in the context of an ongoing social housing renovation project in Aosta, Italy, in a cold winter and hot summer Alpine environment. The study combined interviews, field measurements, and multiple software simulations to analyze the home of an older adult experiencing energy deprivation. The study found that the indoor acoustic environment quality meets the requirements of various sound-related standards. Still, the lighting and thermal environment must be designed to reduce glare and western sun exposure, and the air quality could improve. Residents’ demand for renovation is low technology, low cost, and high comfort. Therefore, suggestions for combining active and passive transformation measures and maximizing the use of climate and resources are proposed. The lighting and thermal environment are optimized based on the green wisdom of the Haylofts building of the Walser family in the Alps: increase ventilation and reduce indoor air age to improve air quality. Overall, a comprehensive assessment of extreme climatic conditions facilitates the quantitative and qualitative study and control of social housing environments, improves occupant comfort, and decarbonizes such social building stock.
BACKGROUND: Ragweed is an invasive plant in Europe, causing hay fever and asthma in allergic patients. Climate change is predicted to increase expansion and allergenicity. Elevated NO(2) induced upregulation of a new allergen in ragweed pollen, an enolase, Amb a 12. OBJECTIVE: of this study was producing ragweed enolase as a recombinant protein and characterizing its physicochemical and immunological features. METHODS: Amb a 12 was designed for E. coli and insect cell expression. Physicochemical features were determined by mass spectrometry, circular dichroism measurements and enzymatic activity assay. Immunological characteristics were determined in ELISA, in a mediator release assay and by investigation of association with clinical symptoms. Common allergen sources were screened for similar proteins. RESULTS: Ragweed enolase was produced as a 48 kDa protein forming oligomers in both expression systems, showing differences in secondary structure content and enzymatic activity depending on expression system. IgE frequency and allergenicity were low regardless of expression system. Enolase-specific serum bound to similar sized molecules in mugwort, timothy grass and birch pollen, as well as food allergen sources, while highest IgE inhibition was achieved with peach pulp extract. CONCLUSIONS: Amb a 12 had high sequence similarity and comparable IgE frequency to enolase allergens from different sources. 50 kDa proteins were found in other pollen and food allergen sources, suggesting that enolases might be pan-allergens in pollen and plant foods.
Aging is associated with an elevated risk of heat-related mortality and morbidity, attributed, in part, to declines in thermoregulation. However, comparisons between young and older adults have been limited to brief exposures (1-4 h), which may not adequately reflect the duration or severity of the heat stress experienced during heat waves. We therefore evaluated physiological responses in 20 young (19-31 yr; 10 females) and 39 older (61-78 yr; 11 females) adults during 9 h of rest at 40°C and 9% relative humidity. Whole body heat exchange and storage were measured with direct calorimetry during the first 3 h and final 3 h. Core temperature (rectal) was monitored continuously. The older adults stored 88 kJ [95% confidence interval (CI): 29, 147] more heat over the first 3 h of exposure (P = 0.006). Although no between-group differences were observed after 3 h [young: 37.6°C (SD 0.2°C) vs. older: 37.7°C (0.3°C); P = 0.216], core temperature was elevated by 0.3°C [0.1, 0.4] (adjusted for baseline) in the older group at hour 6 [37.6°C (0.2°C) vs. 37.9°C (0.2°C); P < 0.001] and by 0.2°C [0.0, 0.3] at hour 9 [37.7°C (0.3°C) vs. 37.8°C (0.3°C)], although the latter comparison was not significant after multiplicity correction (P = 0.061). Our findings indicate that older adults sustain greater increases in heat storage and core temperature during daylong exposure to hot dry conditions compared with their younger counterparts. This study represents an important step in the use of ecologically relevant, prolonged exposures for translational research aimed at quantifying the physiological and health impacts of hot weather and heat waves on heat-vulnerable populations.NEW & NOTEWORTHY We found greater increases in body heat storage and core temperature in older adults than in their younger counterparts during 9 h of resting exposure to hot dry conditions. Furthermore, the age-related increase in core temperature was exacerbated in older adults with common heat-vulnerability-linked health conditions (type 2 diabetes and hypertension). Impairments in thermoregulatory function likely contribute to the increased risk of heat-related illness and injury seen in older adults during hot weather and heat waves.
As summer heat waves become the new normal worldwide, modeling human thermal exposure and comfort to assess and mitigate urban overheating is crucial to uphold livability in cities. We introduce PanoMRT, an open source human-biometeorological model to calculate Mean Radiant Temperature (T(MRT)), Physiologically Equivalent Temperature (PET), and the Universal Thermal Climate Index (UTCI) from thermal equirectangular 360° panoramas and standard weather information (air temperature, relative humidity, wind speed). We validated the model for hot, dry, clear summer days in Tempe, Arizona, USA with in-situ observations using a FLIR Duo Pro R thermal camera on a rotating arm and the mobile human-biometeorological instrument platform MaRTy. We observed and modeled T(MRT) and thermal comfort for 19 sites with varying ground cover (grass, concrete, asphalt), sky view factor, exposure (sun, shade), and shade type (engineered, natural) six times per day. PanoMRT performed well with a Root Mean Square Error (RMSE) of 4.1 °C for T(MRT), 2.6 °C for PET, and 1.2 °C for UTCI, meeting the accuracy requirement of ±5 °C set in the ISO 7726 standard for heat and cold stress studies. RayMan reference model runs without measured surface temperature forcing reveal that accurate longwave radiative flux estimations are crucial to meet the ±5 °C threshold, particularly for shaded locations and during midday when surface temperatures peak and longwave modeling errors are largest. This study demonstrates the importance of spatially resolved 3D surface temperature data for thermal exposure and comfort modeling to capture complex longwave radiation exposure patterns resulting from heterogeneity in built configuration and material radiative and thermal properties in the built environment.
BACKGROUND: Extreme hot weather events are happening with increasing frequency, intensity and duration in Hong Kong. Heat stress is related to higher risk of mortality and morbidity, with older adults being particularly vulnerable. It is not clear whether and how the older adults perceive the increasingly hot weather as a health threat, and whether community service providers are aware and prepared for such future climate scenario. METHODS: We conducted semi-structure interviews with 46 older adults, 18 staff members of community service providers and two district councilors of Tai Po, a north-eastern residential district of Hong Kong. Transcribed data were analyzed using thematic analysis until data saturation was reached. RESULTS: It was agreed upon among the older adult participants that the weather in recent years has become increasingly hot and this led to some health and social problems for them, although some participants perceived that hot weather did not have any impact in their daily lives and they were not vulnerable. The community service providers and district councilors reported that there is a lack of relevant services in the community to support the older adults in hot weather; and there is generally a lack of public education regarding the heat-health issue. CONCLUSIONS: Heatwaves are affecting older adults’ health in Hong Kong. Yet, discussions and education effort regarding the heat-health issue in the public domain remain scarce. Multilateral efforts are urgently needed to co-create a heat action plan to improve community awareness and resilience.
Climate change has significantly enhanced dangerous heat events. Many of our institutions are ill-prepared to provide science-informed and rapid interventions to confront this. The GeoHealth community is working to bring science, public health, and medical professionals closer together to grapple with the challenges posed by extreme heat.
Combined heat and humidity is frequently described as the main driver of human heat-related mortality, more so than dry-bulb temperature alone. While based on physiological thinking, this assumption has not been robustly supported by epidemiological evidence. By performing the first systematic comparison of eight heat stress metrics (i.e., temperature combined with humidity and other climate variables) with warm-season mortality, in 604 locations over 39 countries, we find that the optimal metric for modelling mortality varies from country to country. Temperature metrics with no or little humidity modification associates best with mortality in similar to 40% of the studied countries. Apparent temperature (combined temperature, humidity and wind speed) dominates in another 40% of countries. There is no obvious climate grouping in these results. We recommend, where possible, that researchers use the optimal metric for each country. However, dry-bulb temperature performs similarly to humidity-based heat stress metrics in estimating heat-related mortality in present-day climate.
More frequent and severe extreme weather events such as heatwaves are among the most serious challenges to society in coping with the changing climate. To evaluate the impacts of the heatwave on large-scale urban areas, a multi-scale weather forecasting system is designed by integrating different resolutions of the Canadian urbanized version of the Global Environmental Multiscale (GEM) Numerical Weather Prediction (NWP) model, cascading from 10 km to 2.5 km, and 250 m. The multi-scale model is implemented in Montreal, Canada, for modeling the 2018 heatwave. Simulation results are well-validated against measurement data, including Moderate Resolution Imaging Spectroradiometer (MODIS) satellite imagery and ten weather stations in the city. The Universal Thermal Climate Index (UTCI) map was calculated to identify vulnerable regions in the city against the heatwave. Land-use types in hotspots and coldspots are analyzed to find dominant factors in the formation of hot and cold areas. It is found that natural landscapes such as vegetation, trees, and water bodies are the dominant features of most coldspots. On the other hand, roads, parking lots, less tree covers, and industrial activities are the common land use features in the hotspots. A weak correlation is found between heat-related death locations and the outdoor UTCI map, implying that the assessment of an outdoor heatwave may not address overheated buildings and communities. This paper shows the importance of built environments – their properties and occupants’ socio-demographic factors in the study of heat-related mortalities in cities.
Heat stress from the environment can be detrimental to athletes’ health and performance. No research, however, has explored how elite athletes conceptualize and experience heatwaves and climate change. Utilizing a qualitative approach, this study examined elite athletes’ perceptions, experiences, and responses to extreme heat in relation to climate change and explored the use of their platforms for climate activism. Fourteen elite athletes from the United Kingdom, Australia, the United States, Sweden, and Canada, who represented 10 different sports including race walking, netball, and cricket were recruited using snowball sampling. Data were collected using semistructured interviews. Thematic analysis revealed four broad themes. The first theme reflected uncertainty surrounding the causes of heatwaves and the impact of heat on athlete health and performance. The second theme reflected care and concern for sport and society, including concern for the well-being of athletes and spectators, the impact of heat on facilities and participation at the grassroots level, and how the nature of sport may change in the future. The third theme referred to the implications of heatwave experience on athlete health and performance, and how experience affected individual and organizational preparedness. The fourth theme referred to enablers and barriers to successful climate change communication. This study contributes to the sport ecology literature by introducing the subjective heat experiences of elite athletes. Educating athletes and event organizers about the impacts of heat on sport participation is imperative to increase awareness and, it is hoped, to limit illness for those training and competing.
Climatic and micro-climatic phenomena such as summer heat waves and Urban Heat Island (UHI) are increasingly endangering the city’s livability and safety. The importance of urban features on the UHI effect encourages us to consider the configuration of urban elements to improve cities’ sustainability and livability. Most solutions are viable when a city redevelops and new areas are built to focus on aspects such as optimum design and the orientation of building masses and streets, which affect thermal comfort. This research looks beyond outdoor thermal comfort studies using UHI data and geoprocessing techniques in Tallinn, Estonia. This study supposes that designing urban canyons with proper orientation helps to mitigate the UHI effect by maximizing outdoor thermal comfort at the pedestrian level during hot summer days. In addition, optimizing the orientation of buildings makes it possible to create shaded and cooler areas for pedestrians, reducing surface temperature, which may create more comfortable and sustainable urban environments with lower energy demands and reduced heat-related health risks. This research aims to generate valuable insights into how urban environments can be designed and configured to improve sustainability, livability, and outdoor thermal comfort for pedestrians. According to the study results, researchers can identify the most effective interventions to achieve these objectives by leveraging UHI data and geoprocessing techniques and using CFD simulations. This evaluation is beneficial in guiding urban planners and architects in proposing mitigation solutions to enhance thermal comfort in cities and creating suitable conditions for approved thermal comfort levels. Results of the study show that in the location used for the survey, Tallinn, Estonia, the orientation of West-East offers the optimum level of comfort regarding thermal comfort and surface temperature in the urban environment.
Heatwaves occur more frequently during the summer owing to global warming, which causes excessive heat stress and thermal discomfort. Heat stress increases overheating risk and impacts people’s health and outdoor activities. Assessing outdoor thermal risk and clarifying human thermal responses under outdoor high-temperature conditions are of particular importance. However, the effect of thermal adaptation on people’s thermal perception during heatwave conditions requires exploration. This paper aims to provide a comprehensive analysis of human outdoor thermal perception under non-heatwave and heatwave conditions to obtain adaptation based outdoor thermal benchmarks to estimate the threshold for thermal discomfort and heat stress. Longitudinal and cross-sectional questionnaire surveys are carried out during the summer in public squares in Chongqing. The results showed that thermal perceptions undergo a dynamic change process in summer, which is closely related to an individual’s past thermal experience. In comparison with thermal benchmarks under non-heatwave conditions, the neutral, comfortable, and 80% acceptable range of UTCI under heatwave conditions shifted to a higher temperature. For the heatwave period, the neutral UTCI range was from 21.5 degrees C to 27.9 degrees C. The modified UTCI ranges for heat stress classifications were obtained, including the 80% acceptable temperature range from 21.4 degrees C to 30.1 degrees C. The contributions of this study are in the method of determining outdoor thermal benchmarks in heatwave conditions and clarifying local people’s thermal demands. These findings can provide more refined guidance for heat stress assessment and enrich the possibilities for urban design and urban resilience responses to heatwave conditions.
Severe stress endangers outdoor workers who are in an exceedingly hot workplace. Although recent studies quantify stress levels on the human skin, they still rely on rigid, bulky sensor modules, causing data loss from motion artifacts and limited field-deployability for continuous health monitoring. Moreover, no prior work shows a wearable device that can endure heat exposure while showing continuous monitoring of a subject’s stress under realistic working environments. Herein, a soft, field-deployable, wearable bioelectronic system is introduced for detecting outdoor workers’ stress levels with negligible motion artifacts and controllable thermal management. A nanofabric radiative cooler (NFRC) and miniaturized sensors with a nanomembrane soft electronic platform are integrated to measure stable electrodermal activities and temperature in hot outdoor conditions. The NFRC exhibits outstanding cooling performance in sub-ambient air with high solar reflectivity and high thermal emissivity. The integrated wearable device with all embedded electronic components and the NFRC shows a lower temperature (41.1%) in sub-ambient air than the NFRC-less device while capturing improved operation time (18.2%). In vivo human study of the bioelectronics with agricultural activities demonstrates the device’s capability for portable, continuous, real-time health monitoring of outdoor workers with field deployability.
It is expected that heatwaves will strike more frequently and with higher temperatures with the contin-uation of global warming. More extreme heatwaves concurrent with disruptions in the cooling system can lead to significant overheating problems in buildings affecting occupants’ health, productivity, and comfort. This paper projects current and future heatwaves on an optimized nearly Zero-Energy terraced dwelling in Brussels, assuming the outage of the cooling system. Initially, a multi-objective optimization is performed considering 13 passive design strategies using the Genetic Algorithm (GA) based on the Non-dominated Sorting Genetic Algorithm 2 (NSGA-II) method. It is found that high ventilation rate, low infiltration rate, high insulation, high thermal mass, integration of green roof, and application of operable roller blinds are beneficial in reducing the final HVAC energy use up to 32% and enhancing ther-mal comfort up to 46%. Subsequently, three optimal solutions are selected and analyzed under the high-est maximal temperature heatwaves detected during the 2001-2020, 2041-2060, and 2081-2100 periods. It is found that non of the optimal solutions are able to fully suppress overheating during heat-waves and the cooling system outage. The indoor operative temperatures reach more than 29 degrees C; which can cause serious health issues for the occupants. The situation will be exacerbated in the future since an increase in maximum Heat Index (HI) between 0.28 degrees C and 0.49 degrees C, an increase in the maximum operative temperature between 1.34 degrees C and 2.33 degrees C, and a decrease in Thermal Autonomy (TA) between 17% and 28% are estimated. Finally, some recommendations are provided for practice and future research.(c) 2023 Elsevier B.V. All rights reserved.
Amidst rising ambient temperatures and frequent heatwaves, assessing summer indoor overheating is crucial. This study examined overheating in over 6000 apartments to show the temporal aspects of indoor overheating during the hot summer of 2021 compared to the average summer of 2020 in the Helsinki region of Finland, with additional consideration of the apartments’ design year, size, and number of rooms. Data analysis was conducted employing ANOVA and post hoc tests to assess the impact of apartment characteristics on overheating. Finnish building codes and health-related regulations defined three temperature thresholds to determine overheating: 27 & DEG;C, 30 & DEG;C, and 32 & DEG;C. The findings indicated that during the summer of 2020, 76%, 8%, and 1% of apartments exceeded 27 & DEG;C, 30 & DEG;C, and 32 & DEG;C, respectively. In the hot summer of 2021, these proportions increased significantly to 96%, 32%, and 4%. The average number of degree hours above 27 & DEG;C in 2021 was three times higher than in 2020. While nighttime temperatures were slightly lower, there was a considerable number of degree hours above 27 & DEG;C. Smaller apartments exhibited a higher risk of overheating. Those constructed after 2012 demonstrated lower overheating risks during the hot summer.
Climate heat waves occurring in urban centers are a serious threat to public health and wellbeing. Historically, most heat-related mortalities have arisen from excessive overheating of building interiors housing older occupants. This paper developed an approach that combines the results from building simulation and bioheat models to generate health-based limit criteria for overheating in long-term care homes (LTCHs) by which the body dehydration and core temperature of older residents are capped during overheating events. The models of the LTCHs were created for buildings representative of old and current construction practices for selected Canadian locations. The models were calibrated using measurements of indoor temperature and humidity acquired from monitoring the building interiors and the use of published building energy use intensity data. A general procedure to identify overheating events and quantify their attributes in terms of duration, intensity, and severity was developed and applied to LTCHs to generate the limit criteria. Comparing the limit criteria from the proposed and comfort-based methods showed evident differences. The proposed method predicted the overheating risk consistent with the overall thermal comfort during overheating events in contrast to the comfort-based methods. The new limit criteria are intended to be used in any study to evaluate overheating risk in similar buildings.
In the scenario of global warming and climate change, human thermal discomfort is about to rise. A rise in human thermal discomfort will undermine human health and well-being. It will also undermine labour productivity (as workers have to reduce work intensity and take longer breaks from work to prevent heat stress-related illness and injuries) and boost energy demand (as people will have to use more cooling instruments such as ACs, coolers, fan, etc., to get relief from thermal discomfort). Hence an assessment of spatio-temporal variability of thermal discomfort is necessary to develop a national strategy for the sustainable development of the country under changing climate scenarios. In this study, we have tried to analyze spatio-temporal variations of summertime thermal discomfort in India with the help of the Discomfort Index (DI). To calculate the DI, we have used high resolution (0.25 degrees x0.25 degrees) ERA-5 hourly 2-m air temperature and 2-m dewpoint temperature data. It is seen that March is the month of minimum discomfort and June is the month of maximum discomfort. In June, maximum discomfort occurs in the western region. The east coastal region and western region of India, particularly Rajasthan, experience maximum discomfort in terms of severity and prolonged discomfort hours. We have also calculated trends in DI, RH and temperature over the Indian region for March to June and observed a generally increasing trend with some spatial variations across India. It is also observed that the DI trend is more prominent in the western region in March and April, the southern region in May and the eastern region in June. We have also calculated the diurnal variations of thermal discomfort and the number of days with DI greater than 27 degrees C and 29 degrees C for different regions. It is observed that in most of the regions, DI reaches its peak around 09-10Z. Except for the north region, most of the regions show increasing trends in the number of discomfort days in April, May and June.
Increasing exposure to heat stress threatens the health and well-being of urban residents. However, existing studies on measuring human thermal comfort exposure remain uncertain without considering fine-scale humanheat interaction and its long-term dynamics. To inform this issue, we proposed a population-weighted exposure assessment framework with the integration of high-resolution land surface temperature and population data to evaluate human exposure to thermal comfort and the associated inequality across 398 major cities over 2000-2020 in the United States, and further explored the multifaceted associations between greenspace and thermal comfort. Results show that 199 United States cities (50.00 %) experience severe heat stress (i.e., thermal comfort exposure <0.44) and 99 of which (24.87 %) are unevenly exposed to heat stress (i.e., Gini index of thermal comfort exposure >0.36). Temporal analysis from 2000 to 2020 reveals that human exposure to thermal comfort decreases by a mean magnitude of -0.00081 yr- 1, and the associated inequality level decreases by a mean magnitude of -0.00153 yr- 1. By linking urban greenspace and heat exposure, we find that greenspace has multifaceted associations with heat stress, with a highly positive correlation between greenspace and thermal comfort (i.e., comfort regulation by physical cooling effect) and a coincided exposure inequality between greenspace and thermal comfort. This study offers an alternative framework to characterize fine-scale human exposure to thermal comfort across space and time, provides observational evidence of thermal comfort exposure inequality in the United States cities, and highlights the need for prioritizing greening policies and actions to mitigate heat stress and exposure disparity.
INTRODUCTION: Army recruits conducting BCT are among the most susceptible population of military personnel to experience exertional heat illness, a concern expected to become increasingly urgent due to steadily rising temperatures. In this study, we provide an empirical analysis of wet bulb globe temperature (WBGT) index trends at U.S. Army BCT installations and quantify the magnitude of these trends. Assuming these warming trends continue, the anticipated effects of increasing temperature trends are discussed in relation to potential impacts on recruit heat illness incidence and training disruption. MATERIALS AND METHODS: We obtained weather data beginning in the early 1960s, including WBGT index measurements derived by the U.S. Air Force 14th Weather Squadron. We apply these datasets to two classifications for high WBGT index days, including one classification accounting for heat illness susceptibility based on prior day heat exposure, to determine when recruits are most at risk of heat illness. The daily likelihood of extreme WBGT index values is described at each installation using a 30-year climatological average. Trends in the WBGT index are evaluated quantitatively during the warm season (May 1-September 30) and full year and compared between decades and by individual BCT classes. RESULTS: Trends in the WBGT index have increased at all four BCT installations. Between January 1960 and October 2022, the mean WBGT index value increased most quickly at Ft Jackson, SC (0.272°C decade-1, CI: 0.255-0.289) and least at Ft Moore, GA (0.190°C decade-1, CI: 0.170-0.210). Ft Moore experiences the greatest heat burden, with the daily likelihood of experiencing a “black flag” event (≥90°F WBGT index) peaking at nearly 50% in late July, while Ft Leonard Wood, MO, experiences the least heat burden. This heat burden is spread unevenly across installations and dependent on BCT class start date. Recruits beginning in mid-June will experience approximately 200 hours of hazardous heat during BCT at Ft Moore, GA; 100 hours at Ft Jackson, SC; 80 hours at Ft Sill, OK; and 61 hours at Ft Leonard Wood, MO. CONCLUSIONS: Temperatures measured on the WBGT index have steadily increased at US Army basic training installations since at least 1960. In the future, adaptation to the BCT program will be required to maintain rigorous standards without incurring unacceptable risk of recruit heat illness. The analysis provided by this study can help inform medical, training, and policy implementations needed to ensure continued BCT in a warming world.
BACKGROUND: Heat exposures occur in many occupations. Heat has been linked to key carcinogenic processes, however, evidence for associations with cancer risk is sparse. We examined potential associations between occupational heat exposure and prostate cancer risk in a multi-country study. METHODS: We analysed a large, pooled dataset of 3142 histologically confirmed prostate cancer cases and 3512 frequency-matched controls from three countries: Canada, France, and Spain. Three exposure indices: ever exposure, lifetime cumulative exposure and duration of exposure, were developed using the Finnish Job-Exposure Matrix, FINJEM, applied to the lifetime occupational history of participants. We estimated odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression models stratified by 5-year age groups and study, adjusting for potential confounders. Potential interactions with exposure to other occupational agents were also explored. RESULTS: Overall, we found no association for ever occupational heat exposure (OR 0.97; 95% CI 0.87, 1.09), nor in the highest categories of lifetime cumulative exposure (OR 1.04; 95% CI 0.89, 1.23) or duration (OR 1.03; 95% CI 0.88, 1.22). When using only the Spanish case-control study and a Spanish Job Exposure Matrix (JEM), some weakly elevated ORs were observed. CONCLUSIONS: Findings from this study provide no clear evidence for an association between occupational heat exposure and prostate cancer risk.
INTRODUCTION: While there is consistent evidence on the effects of heat on workers’ health and safety, the evidence on the resulting social and economic impacts is still limited. A scoping literature review was carried out to update the knowledge about social and economic impacts related to workplace heat exposure. METHODS: The literature search was conducted in two bibliographic databases (Web of Science and PubMed), to select publications from 2010 to April 2022. RESULTS: A total of 89 studies were included in the qualitative synthesis (32 field studies, 8 studies estimating healthcare-related costs, and 49 economic studies). Overall, consistent evidence of the socioeconomic impacts of heat exposure in the workplace emerges. Actual productivity losses at the global level are nearly 10% and are expected to increase up to 30-40% under the worst climate change scenario by the end of the century. Vulnerable regions are mainly low-latitude and low- and middle-income countries with a greater proportion of outdoor workers but include also areas from developed countries such as southern Europe. The most affected sectors are agriculture and construction. There is limited evidence regarding the role of cooling measures and changes in the work/rest schedule in mitigating heat-related productivity loss. CONCLUSION: The available evidence highlights the need for strengthening prevention efforts to enhance workers’ awareness and resilience toward occupational heat exposure, particularly in low- and middle-income countries but also in some areas of developed countries where an increase in frequency and intensity of heat waves is expected under future climate change scenarios.
Insufficient heat acclimatization is a risk factor for heat-related illness (HRI) morbidity, particularly during periods of sudden temperature increase. We sought to characterize heat exposure on days before, and days of, occupational HRIs. A total of 1241 Washington State workers’ compensation State Fund HRI claims from 2006 to 2021 were linked with modeled parameter-elevation regressions on independent slopes model (PRISM) meteorological data. We determined location-specific maximum temperatures (T(max,PRISM) ) on the day of illness (DOI) and prior days, and whether the T(max,PRISM) was ≥10.0°F (~5.6°C) higher than the average of past 5 days (“sudden increase”) for each HRI claim. Claims occurring on days with ≥10 HRI claims (“clusters”) were compared with “non-cluster” claims using t tests and χ(2) tests. RESULTS: Seventy-six percent of analyzed HRI claims occurred on days with a T(max,PRISM) ≥ 80°F. Claims occurring on “cluster” days, compared to “non-cluster” days, had both a significantly higher mean DOI T(max,PRISM) (99.3°F vs. 85.8°F [37.4°C vs. 29.9°C], t(148) = -18, p < 0.001) and a higher proportion of "sudden increase" claims (80.2% vs. 24.3%, χ(2) [1] = 132.9, p < 0.001). Compared to "cluster" days, HRI claims occurring during the 2021 Pacific Northwest "heat dome" had a similar increased trajectory of mean T(max,PRISM) on the days before the DOI, but with higher mean T(max,PRISM.) Occupational HRI risk assessments should consider both current temperatures and changes in temperatures relative to prior days. Heat prevention programs should include provisions to address acclimatization and, when increases in temperature occur too quickly to allow for sufficient acclimatization, additional precautions.
Seafood can vehiculate foodborne illnesses from water to humans. Climate changes, increasing water contamination and coastlines anthropization, favor the global spread of Vibrio spp. and the occurrence of antibiotic-resistant isolates. The aim of this study was to evaluate the spread of potentially pathogenic Vibrio spp. in fishery products collected in Sicily and to assess their antibiotic resistance. Bacteriological and molecular methods were applied to 603 seafood samples to detect V. parahaemolyticus, V. cholerae, V. vulnificus, and Vibrio alginolyticus in order to assess their pathogenicity and antimicrobial resistance. About 30% of bivalves and 20% of other fishery products were contaminated by Vibrio spp.; V. parahaemolyticus accounted for 43/165 isolates, 3 of which were carrying either tdh or trh; V. cholerae accounted for 12/165 isolates, all of them non-O1 non-O139 and none carrying virulence genes; and V. vulnificus accounted for 5/165 isolates. The highest rates of resistance were observed for ampicillin, but we also detected strains resistant to antibiotics currently included among the most efficient against Vibrio spp. In spite of their current low incidence, their rise might pose further issues in treating infections; hence, these results stress the need for a continuous monitoring of antimicrobial resistance among fishery products and an effective risk assessment.
OBJECTIVE: Climate change has implications for human health worldwide, with workers in outdoor occupations in low- to middle-income countries shouldering the burden of increasing average temperatures and more frequent extreme heat days. An overlooked aspect of the human health impact is the relationship between heat exposure and increased risk of occupational injury. In this study, we examined the association between occupational injury occurrence and changes in outdoor temperatures through the workday among a cohort of Guatemalan sugarcane harvesters. METHODS: Occupational injuries recorded for the 2014/2015 to 2017/2018 harvest seasons were collected from a large agribusiness employing male sugarcane harvesters in Southwest Guatemala. Wet Bulb Globe Temperature (WBGT) for the same period was collected from the El Balsamo weather station. We used a logistic mixed effects model to examine the association between injury occurrence and (1) the average WBGT during the hour injury was recorded, (2) the average WBGT during the hour prior to the injury being recorded, and (3) the change in the hourly average WBGT prior to the injury being recorded. RESULTS: There were 155 injuries recorded during the study period. Injuries were recorded most often between 14:00 and 16:00 (n = 62, 40%) followed by 8:00 and 10:00 (n = 56, 36%). There were significant differences in the average hourly WBGT and the hour in which injuries were recorded (p-value <.001). There were no observable associations between average hourly WBGT (OR: 1.00, 95%CI: 0.94, 1.05; p-value: 0.87), lagged average hourly WBGT (OR: 1.01, 95%CI: 0.97, 1.05; p-value: 0.71), or change in average hourly WBGT (OR: 0.96, 95%CI: 0.89, 1.04; p-value: 0.35) and recorded occupational injury. CONCLUSIONS: This is the first study that has examined how changes in WBGT throughout the day are related to occupational injury among agricultural workers. Although this study did not demonstrate an association, there is a need for future research to examine how various measurements of WBGT exposure are related to occupational injury in agricultural worker populations.
Heat waves impact the health of older adults, and occupations are important for health. An overview of research focussed on older adults’ occupations in heat waves can be useful for occupational therapy practice. OBJECTIVE: To identify what the literature shows about older adults’ experience and performance of, and participation in, occupations in heat waves. MATERIAL AND METHOD: This scoping review included a literature search in five academic databases, four databases for grey literature, and a manual search. Literature in English regarding older adults 60+ and their occupations in heat waves were eligible. FINDINGS: Twelve studies were included. Findings showed that older adults adapt their occupations using bodily, environmental, and social interaction strategies and by changing their daily routines. Personal, environmental, social, and economic factors facilitate and maintain occupations in heat waves. CONCLUSION: Older adults adapt their occupations in heat waves and different factors impact how they can be adapted. Future research is needed to explore how older adults experience their occupations in heat waves, and to deepen the knowledge about their heat-adaptive strategies. SIGNIFICANCE: The findings support the role of occupational therapists in the design and practice of interventions managing the impact of heat waves in daily life.
Heatwaves are among the most important global public health challenges of our time. Yet we know little about how exposure to heatwaves (as opposed to hot days) affects health at birth, which is a key contributor to health, development, and well-being in later life. This study addresses this shortcoming by investigating the relationship between in utero exposure to heatwave and birthweight by assessing both the timing and mechanisms of heatwave effects. I use novel georeferenced survey data on birth and pregnancy outcomes from the latest round of the Demographic and Health Surveys to link the birth outcomes of 64,210 infants across 11 sub-Saharan African countries with high-resolution daily climate data. I find that infants exposed to heatwave in the third trimester of gestation had significantly lower birthweight and that this effect is mediated by reduced gestational age at birth instead of reduced intrauterine growth. The effect of heatwave is concentrated among male babies and mothers with no or little formal education. By highlighting how exposure to environmental conditions early in life shapes health outcomes with far-reaching consequences, the findings carry lessons for policymakers to protect pregnant women from heatwave exposure to mitigate the negative impact of climate change.
With climate change, humans are at a greater risk for heat-related morbidity and mortality, often secondary to increased cardiovascular strain associated with an elevated core temperature (T(c)). Critical environmental limits (i.e., the upper limits of compensable heat stress) have been established based on T(c) responses for healthy, young individuals. However, specific environmental limits for the maintenance of cardiovascular homeostasis have not been investigated in the context of thermal strain during light activity. Therefore, the purposes of this study were to 1) identify the specific environmental conditions (combinations of ambient temperature and water vapor pressure) at which cardiovascular drift [i.e., a continuous rise in heart rate (HR)] began to occur and 2) compare those environments to the environmental limits for the maintenance of heat balance. Fifty-one subjects (27 F; 23 ± 4 yr) were exposed to progressive heat stress across a wide range of environmental conditions in an environmental chamber at two low metabolic rates reflecting minimal activity (MinAct; 159 ± 34 W) or light ambulation (LightAmb; 260 ± 55 W). Whether systematically increasing ambient temperature or humidity, the onset of cardiovascular drift occurred at lower environmental conditions compared with T(c) inflection points at both intensities (P < 0.05). Furthermore, the time at which cardiovascular drift began preceded the time of T(c) inflection (MinAct P = 0.01; LightAmb P = 0.0002), and the difference in time between HR and T(c) inflection points did not differ (MinAct P = 0.08; LightAmb P = 0.06) across environmental conditions for either exercise intensity. These data suggest that even in young adults, increases in cardiovascular strain precede the point at which heat stress becomes uncompensable during light activity.NEW & NOTEWORTHY To our knowledge, this study is the first to 1) identify the specific combinations of temperature and humidity at which an increase in cardiovascular strain (cardiovascular drift) occurs and 2) compare those environments to the critical environmental limits for the maintenance of heat balance. We additionally examined the difference in time between the onset of increased cardiovascular strain and uncompensable heat stress. We show that an increase in cardiovascular strain systematically precedes sustained heat storage in young adults.
High summer temperatures will become the norm as global warming intensifies due to massive energy consumption and greenhouse gas emissions. High-temperature environments will seriously threaten the health of outdoor workers. It is urgent to adopt new technologies to solve the problem of reducing the thermal stress of workers in an extremely hot environment. Herein, phase change material (PCM) and radiative sky cooling technology were combined and prepared successfully a new kind of flexible composite phase change material (CPCM) with paraffin wax (PW), polypropylene hollow fiber (PP fiber) and Linear styrene-b-(ethylene-co-butylene)-b-styrene triblock copolymer with 30 wt% styrene (SEBS). Compared with the traditional end sealing technology, the melted SEBS can close the end of the fiber easily and cost-effectively. The novel material (10PP) has a high enthalpy of 180.01 J/g, and the thermal conductivity is as low as 0.26 W/ (m center dot K), the low thermal conductivity of CPCM reduces the transfer of heat from the outside to the inside. Tensile strength is 3.89 MPa, the maximum force that 10PP can withstand reaches 147 N, and the contact angle for the hydrophobicity test is 114.8 degrees, which provides a guarantee for the wide application of the new material in an outdoor environment. Besides, the optical test shows an emissivity (atmospheric window) of 0.955, and the extremely high emissivity facilitates radiative cooling of the material at night. On a clear day, the average temperature difference and maximum temperature difference between 10PP and the environment are 6.403 degrees C and 13.414 degrees C respectively. In the simulation experiment of the tent, when the external temperature reaches 60 degrees C, the surface temperature
As our planet warms, a critical research question is when and where temperatures will exceed the limits of what the human body can tolerate. Past modeling efforts have investigated the 35°C wet-bulb threshold, proposed as a theoretical upper limit to survivability taking into account physiological and behavioral adaptation. Here, we conduct an extreme value theory analysis of weather station observations and climate model projections to investigate the emergence of an empirically supported heat compensability limit. We show that the hottest parts of the world already experience these heat extremes on a limited basis and that under moderate continued warming parts of every continent, except Antarctica, will see a rapid increase in their extent and frequency. To conclude, we discuss the consequences of the emergence of this noncompensable heat and the need for incorporating different critical thermal limits into heat adaptation planning.
BACKGROUND: Air conditioning (AC) presents a viable means of tackling the ill-effects of heat on human health. However, AC releases additional anthropogenic heat outdoors, and this could be detrimental to human health, especially in urban communities. This study determined the excess heat-related mortality attributable to anthropogenic heat from AC use under various projected global warming scenarios in seven Japanese cities. The overall protection from AC use was also measured. METHODS: Daily average 2-meter temperatures in the hottest month of August from 2000 to 2010 were modeled using the Weather Research and Forecasting (WRF) model with BEP+BEM (building effect parameterization and building energy model). Risk functions for heat-mortality associations were generated with and without AC use from a two-stage time series analysis. We coupled simulated August temperatures and heat-mortality risk functions to estimate averted deaths and unavoidable deaths from AC use. RESULTS: Anthropogenic heat from AC use slightly augmented the daily urban temperatures by 0.046 °C in Augusts of 2000-2010 and up to 0.181 °C in a future with 3 °C urban warming. This temperature rise was attributable to 3.1-3.5 % of heat-related deaths in Augusts of 2000-2010 under various urban warming scenarios. About 36-47 % of heat-related deaths could be averted by air conditioning use under various urban warming scenarios. DISCUSSION: AC has a valuable protective effect from heat despite some unavoidable mortality from anthropogenic heat release. Overall, the use of AC as a major adaptive strategy requires careful consideration.
Ambient temperatures trigger hospitalisation, mortality, and emergency department visits for myocardial infarction (MI). However, nonoptimum temperature-related risks of fatal and nonfatal MI have not yet been compared. From 2007 to 2019, 416,894 MI events (233,071 fatal and 183,823 nonfatal) were identified in Beijing, China. A time-series analysis with a distributed-lag nonlinear model was used to compare the relative and population-attributable risks of fatal and nonfatal MI associated with nonoptimum temperatures. RESULTS: The reference was the optimum temperature of 24.3°C. For single-lag effects, cold (-5.2°C) and heat (29.6°C) effects had associations that persisted for more days for fatal MI than for nonfatal MI. For cumulative-lag effects over 0 to 21 days, cold effects were higher for fatal MI (relative risk [RR] 1.99, 95% confidence interval [CI] 1.68-2.35) than for nonfatal MI (RR 1.60, 95% CI 1.32-1.94) with a P value for difference in effect sizes of 0.048. In addition, heat effects were higher for fatal MI (RR 1.33, 95% CI 1.24-1.44) than for nonfatal MI (RR 0.99, 95% CI 0.91-1.08) with a P value for difference in effect sizes of 0.002. The attributable fraction of nonoptimum temperatures was higher for fatal MI (25.6%, 95% CI 19.7%-30.6%) than for nonfatal MI (19.1%, 95% CI 12.1%-25.0%). Fatal MI was more closely associated with nonoptimum temperatures than nonfatal MI, as evidenced by single-lag effects that have associations which persisted for more days, higher cumulative-lag effects, and higher attributable risks for fatal MI. Strategies are needed to mitigate the adverse effects of nonoptimum temperatures.
We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019. METHOD: We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days. RESULTS: There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag(0-2) was 10.4 and in second heatwave definition, CER values in lag(0, 0-2, and 0-6) were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag(0 and 0-2) were 1.79 and 4.11 and in the second heatwave definition, CER values in lag(0, 0-2, and 0-6) were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults. CONCLUSION: However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups.
Heat exposure in pregnancy is associated with a range of adverse health and wellbeing outcomes, yet research on the lived experience of pregnancy in high temperatures is lacking. We conducted qualitative research in 2021 in two communities in rural Kilifi County, Kenya, a tropical savannah area currently experiencing severe drought. Pregnant and postpartum women, their male spouses and mothers-in-law, community health volunteers, and local health and environment stakeholders were interviewed or participated in focus group discussions. Pregnant women described symptoms that are classically regarded as heat exhaustion, including dizziness, fatigue, dehydration, insomnia, and irritability. They interpreted heat-related tachycardia as signalling hypertension and reported observing more miscarriages and preterm births in the heat. Pregnancy is conceptualised locally as a ‘normal’ state of being, and women continue to perform physically demanding household chores in the heat, even when pregnant. Women reported little support from family members to reduce their workload at this time, reflecting their relative lack of autonomy within the household, but also potentially the ‘normalisation’ of heat in these communities. Climate change risk reduction strategies for pregnant women in low-resource settings need to be cognisant of local household gender dynamics that constrain women’s capacity to avoid heat exposures.
Children cope with high temperatures differently than adults do, largely because of slight alterations in their body proportions and heat loss mechanisms compared to fully mature humans. Paradoxically, all current tools of assessing thermal strain have been developed on adults. As the Earth’s warming continues to accelerate, children are set to bear the health risk brunt of rising global temperatures. Physical fitness has a direct impact on heat tolerance, yet children are less fit and more obese than ever before. Longitudinal research reveals that children have 30% lower aerobic fitness than their parents did at the same age; this deficit is greater than can be recovered by training alone. So, as the planet’s climate and weather patterns become more extreme, children may become less capable of tolerating it. This comprehensive review provides an outline of child thermoregulation and assessment of thermal strain, before moving to summarize how aerobic fitness can modulate hyperthermia, heat tolerance, and behavioral thermoregulation in this under-researched population. The nature of child physical activity, physical fitness, and one’s physical literacy journey as an interconnected paradigm for promoting climate change resilience is explored. Finally, future research foci are suggested to encourage continued exploration of this dynamic field, notable since more extreme, multifactorial environmental stressors are expected to continue challenging the physiological strain of the human population for the foreseeable future.
Compound dry hot events (CDHEs), where hot events and droughts coexist, have received a lot of attention lately due to their catastrophic effects on the economy, environment and human health. In this study, we use two CDHE indices, the Standardized Compound Event Indicator (SCEI) and the Standardized Dry and Hot Index (SDHI), to assess changes in CDHE characteristics (severity, frequency, spatial extent) over the historical past and future CMIP6 simulations across the Indian subcontinent. To understand the role of the drought index selected on CDHE characterization two drought indices namely the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI) are employed in the calculation of the CDHE indices. Further, the role of climatic oscillations such as El Nino Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO), Equatorial Indian Ocean Monsoon Oscillation and Indian Ocean Dipole in modulating CDHE characteristics have also been explored. Results show that SPI and SPEI based CDHE indices exhibit contrasting trends in northern India, while similar trends are observed in southern India in the historical past. Also, more frequent, extended, and severe CDHEs are reported by CDHE indices calculated using SPEI than by SPI. Temperature is found to be the dominant factor contributing to increases in CDHEs in the recent past and ENSO phases significantly modulate the severity and frequency of CDHE events in India. CMIP6 simulations generally report an increase in CDHE events for a 3 degrees C global warming scenario. Overall, our findings show that the choice of the drought index has a greater impact on CDHE characterization than the choice of the CDHE index itself. Results from this study provide useful information towards understanding the risk of CDHEs in India under global warming and urge for the development and implementation of adaptation and mitigation measures.
INTRODUCTION: Growing evidence suggests that climate change-related extreme weather events adversely impact maternal and child health (MCH) outcomes, which requires effective, sustainable and culturally appropriate interventions at individual, community and policy levels to minimise these impacts. This scoping review proposes to map the evidence available on the type, characteristics and outcomes of multilevel interventions implemented as adaptational strategies to protect MCH from the possible adverse effects of climate change. METHODS: The following databases will be searched: Embase, MEDLINE, Emcare, EPPI-Centre database of health promotion research (BiblioMap) EPPI-Centre Database for promoting Health Effectiveness Reviews (DoPHER), Global Health, CINAHL, Joanna Briggs Institute EBP Database, Maternity and Infant Care Database, Education Resource Information Center, PsycINFO, Scopus, Web of Science and Global Index Medicus, which indexes Latin America and the Caribbean, Index Medicus for the South-East Asia Region, African Index Medicus, Western Pacific Region Index Medicus. Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, conference proceedings, thesis and dissertations, policy and guidelines and their reference lists will also be searched. Two reviewers will independently screen titles and abstracts and full text based on predefined eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews using the Population, Concept and Context framework and the Template for Intervention Description and Replication checklist will be used to structure and report the findings. ETHICS AND DISSEMINATION: Ethics permission to conduct the scoping review is not required as the information collected is publicly available through databases. Findings will be disseminated through a peer-reviewed publication and conference presentations.
Climate change and progressive population development (i.e., ageing and changes in population size) are altering the temporal patterns of temperature-related mortality in Switzerland. However, limited evidence exists on how current trends in heat- and cold-related mortality would evolve in future decades under composite scenarios of global warming and population development. Moreover, the contribution of these drivers to future mortality impacts is not well-understood. Therefore, we aimed to project heat- and cold-related mortality in Switzerland under various combinations of emission and population development scenarios and to disentangle the contribution of each of these two drivers using high-resolution mortality and temperature data. We combined age-specific (<75 and & GT;75 years) temperature-mortality associations in each district in Switzerland (1990-2010), estimated through a two-stage time series analysis, with 2 km downscaled CMIP5 temperature data and population and mortality rate projections under two scenarios: RCP4.5/SSP2 and RCP8.5/SSP5. We derived heat and cold-related mortality for different warming targets (1.5 & DEG;C, 2.0 & DEG;C and 3.0 & DEG;C) using different emission and population development scenarios and compared this to the baseline period (1990-2010). Heat-related mortality is projected to increase from 312 (116; 510) in the 1990-2010 period to 1274 (537; 2284) annual deaths under 2.0 & DEG;C of warming (RCP4.5/SSP2) and to 1871 (791; 3284) under 3.0 & DEG;C of warming (RCP8.5/SSP5). Cold-related mortality will substantially increase from 4069 (1898; 6016) to 6558 (3223; 9589) annual deaths under 2.0 & DEG;C (RCP4.5/SSP2) and to 5997 (2951; 8759) under 3.0 & DEG;C (RCP8.5/SSP5). Moreover, while the increase in cold-related mortality is solely driven by population development, for heat, both components (i.e., changes in climate and population) have a similar contribution of around 50% to the projected heat-related mortality trends. In conclusion, our findings suggest that both heat- and cold-related mortality will substantially increase under all scenarios of climate change and population development in Switzerland. Population development will lead to an increase in cold-related mortality despite the decrease in cold temperature under warmer scenarios. Whereas the combination of the progressive warming of the climate and population development will substantially increase and exacerbate the total temperature-related mortality burden in Switzerland.
The impact of natural hazards on nations and societies is a global challenge and concern. Worldwide, studies have been conducted within and between countries, to examine the spatial distribution and temporal evolution of fatalities and their impact on societies. In Brazil, no studies have comprehensively identified the fatalities associated with all natural hazards and their specificities by decade, region, sex, age, and other victim characteristics. This study carries out an in-depth analysis of the Brazilian Mortality Data of the Brazilian Ministry of Health, from 1979 to 2019, identifying the natural hazards that kill the most people in Brazil and their particularities. Lightning is the deadliest natural hazard in Brazil during this period, with a gradual decrease in the number of fatalities. The number of hydro-meteorological fatalities increases from 2000 onwards, with the highest number of fatalities occurring between 2010 and 2019. Although Brazil is a tropical country affected by severe droughts, extreme heat has the lowest number of fatalities compared to other natural hazards. The period from December to March has a higher number of fatalities, and the southeast is the most populous region where most people die. The number of male victims is twice as high as the number of female victims, across all ages groups, and unmarried victims are the most likely to die. It is therefore essential to recognize and disseminate the knowledge about the impact of different natural hazards on communities and societies, namely on people and their livelihoods, in order to assess the challenges and identify opportunities for reducing the effects of natural hazards in Brazil.
Due to climate change, the intensity, duration and frequency of heatwaves are likely to increase in the coming years. Excessive heat events can increase local urban heat island intensity affecting the health and wellbeing of urban dwellers vulnerable to heat stress. Heat-Health Warning Systems (HHWSs) have been developed to warn the public of impending heat events and to advise on preventable negative health outcomes. However, metrics upon which action triggers are made in HHWSs rely on reported critical outcomes, such as heat-related excess death. Thus, human exposure to heat is underestimated in current metrics and consequently, their capacity to prevent heat-related health risks remains uncertain, particularly indoors. This study investigates how indoor heat stress in urban dwellings at a city-scale can be modelled to enhance Heat-Health Warning and Planning. First, the effects of housing typologies on indoor thermal conditions are quantified in a local urban microclimate context. We then model the dynamic relationships between outdoor climate and indoor heat exposure to identify specific outdoor climatic thresholds as action triggers for alerting urban dwellers’ indoor heat stress. Based on urban microclimate data available for a city of Birmingham UK, a proof-of-principle study is presented. The result shows the presence of large variances in the heat-health action triggers across different housing typologies. This is further extended to consider the Birmingham climate projection scenarios provided by the UKCP18. Compared to the current UK Heat-Health Alert Service, we show how indoor heat stress warnings may look like and the implications for long-term heat-health planning.
Heat acclimation/acclimatisation (HA) mitigates heat-related decrements in physical capacity and heat-illness risk and is a widely advocated countermeasure for individuals operating in hot environments. The efficacy of HA is typically quantified by assessing the thermo-physiological responses to a standard heat acclimation state test (i.e. physiological biomarkers), but this can be logistically challenging, time consuming, and expensive. A valid molecular biomarker of HA would enable evaluation of the heat-adapted state through the sampling and assessment of a biological medium. This narrative review examines candidate molecular biomarkers of HA, highlighting the poor sensitivity and specificity of these candidates and identifying the current lack of a single ‘standout’ biomarker. It concludes by considering the potential of multivariable approaches that provide information about a range of physiological systems, identifying a number of challenges that must be overcome to develop a valid molecular biomarker of the heat-adapted state, and highlighting future research opportunities.
Indoor heat and air pollution pose concurrent threats to human health and wellbeing, and their effects are more pronounced for vulnerable individuals. This study investigates exposures to summertime indoor overheating and airborne particulate matter (PM2.5) experienced by low-income seniors and explores the potential of natural ventilation on maintaining good indoor thermal conditions and air quality (IAQ). Environmental and behavioural monitoring and a series of interviews were conducted during summer 2017 in 24 senior apartments on three public housing sites in NJ, USA (1930s’ low-rise, 1960s’ high-rise and LEED-certified 2010s’ mid-rise). All sites had high exposures to overheating and PM2.5 concentrations during heat waves and on regular summer days, but with substantial between-site and between-apartment variability. Overheating was higher in the 30s’ low-rise site, while pollutant levels were higher in the 60s’ high-rise. Mixed linear models indicated a thermal and air quality trade-off with window opening (WO), especially in some ‘smoking’ units from the older sites, but also improved both thermal and PM2.5 concentration conditions in 20% of the apartments. Findings suggest that with warmer future summers, greater focus is needed on the interdependencies among (1) thermal and IAQ outcomes and (2) technological and behavioural dimensions of efforts to improve comfort for vulnerable occupants.
Human thermal comfort representing the satisfaction of mind with ambient air conditions has significant effects on socioeconomic activities. Climate change is affecting thermal comfort conditions (TCCs) negatively. Therefore, it is important to estimate their past and future trends to take accurate measures for mitigation and adaptation efforts in especially urban areas. However, it is difficult to calculate TCCs for the future since they are the combined effect of several meteorological parameters on a person outdoor together with her/his own physiological characteristics, which must be evaluated individually. This study is aimed at determining the TCCs trends in the past compared to the present whilst estimating the future conditions using a new methodology in the case of Kayseri city in the Interior Anatolia Region of Turkey. As the result of the study, all the change trends considering temporal and spatial results show that thermal comfort conditions signal warmer and higher heat stress in the past and future trends. This means human thermal sensation ranges (e.g., very cold) have replaced with the next warmer range, and their spatial distribution in percentage has also changed towards warmer. Increase in the prevalence of unfavourable thermal comfort conditions causes the decrease in the liveability indicators in especially urban areas, including serious economic loses based on energy consumption, health care expenses, and efficiency of activities. It is required that both past and expected future trends be considered in the planning and design works to make cities resilient and have higher adaptive capacity to climate change.
The co-occurrence of day and night compound heat extremes has attracted much attention because of the amplified socioeconomic and human health impacts. Based on ERA5 hourly reanalysis data, this study characterized and compared extreme day-night compound humid-heat/high-temperature events (CHHEs/CHTEs) in China as well as the associated impacts. Results indicated that the spatial patterns of summer mean extreme CHHEs are consistent with those of extreme CHTEs, except in northwestern China. A greater magnitude of these two types of events dominates over southern China, but the high-frequency centers are mainly observed over northern China. Significant increasing trends in frequency are captured nationwide, but with much stronger trends detected in northern and western China. Further analysis shows that the anomalies of humidity play a more important role than those of temperature in the occurrence of extreme CHHEs in most parts of China, but particularly in eastern regions. Since 1961, the human population and land areas of China have experienced strongly increasing compound heat extremes, with a faster rate of exposure to extreme CHHEs than to extreme CHTEs. This study highlights the importance of understanding regional changes in humidity when considering heat stress in the future.
Heat waves are extreme events characterized by sweltering weather over an extended period. Skillful projections of heat waves and their impacts on human mortality can help develop appropriate adaptation strategies. Here, we provide nuanced projections of heat wave characteristics and their effect on human mortality over the Eastern Mediterranean based on ERA5 reanalysis and CORDEX ensemble simulations. Heat waves were identified according to the 90th percentile threshold of the Climatic Stress Index (CSI), specifically tailored for the summer conditions in this region. We provide evidence that heat waves in the region are projected to occur seven times more often and last three times longer by the end of the 21st century (RCP8.5). We find that heat waves will become more persistent in a warmer world. Finally, we offer a conservative estimate of excess mortality in Israel based on a simple linear model. The projected changes in heat stress intensity and frequency may result in ~330 excess deaths per summer at the end of the 21st century (RCP8.5) compared to the historical baseline of ~30 heat-related deaths, particularly pronounced in the elderly (65+ years). We conclude that heat waves increasingly threaten society in the vulnerable Eastern Mediterranean. We also emphasize that true interdisciplinary regional collaborations are required to achieve adequate public health adaptation to extreme weather events in a changing climate.
Rising summer temperatures lead to heat waves and tropical nights, which can result in health problems among the population. This work examined if mortality among Viennese people has increased under such weather conditions or whether the population was able to adapt to those periods of extreme heat. Therefore, the daily climatic data of the Austrian Weather Service and the number of daily deaths in Vienna from 1998 to 2022 have been put into relation. After calculating the mean values from those data sets, we analyzed the total number of daily deaths but also the death rate per 100,000 inhabitants for the total Viennese population, for men and women. The impact of age structure on possible trends was analyzed and ruled out. The analysis showed that the mortality on days with heat events was still higher, but the mean values of daily deaths decreased over time, despite a doubling of heatwaves and tropical nights, which speaks for an adaptation to heat events by the Viennese population.
The health effects of heat are well documented; however, limited information is available regarding the health risks of hot nights. Hot nights have become more common, increasing at a faster rate than hot days, making it urgent to understand the characteristics of the hot night risk. OBJECTIVES: We estimated the effects of hot nights on the cause- and location-specific mortality in a nationwide assessment over 43 y (1973-2015) using a unified analytical framework in the 47 prefectures of Japan. METHODS: Hot nights were defined as days with a) minimum temperature ≥ 25°C (HN25) and b) minimum temperature ≥ 95th percentile (HN95th) for the prefecture. We conducted a time-series analysis using a two-stage approach during the hot night occurrence season (April-November). For each prefecture, we estimated associations between hot nights and mortality controlling for potential confounders including daily mean temperature. We then used a random-effects meta-analytic model to estimate the pooled cumulative association. RESULTS: Overall, 24,721,226 deaths were included in this study. Nationally, all-cause mortality increased by 9%-10% [HN25 relative risk (RR) = 1.09, 95% confidence interval (CI): 1.08, 1.10; HN95th RR = 1.10, 95% CI: 1.09, 1.11] during hot nights in comparison with nonhot nights. All 11 cause-specific mortalities were strongly associated with hot nights, and the corresponding associations appeared to be acute and lasted a few weeks, depending on the cause of death. The strength of the association between hot nights and mortality varied among prefectures. We found a higher mortality risk from hot nights in early summer in comparison with the late summer in all regions. CONCLUSIONS: Our findings support the evidence of mortality impacts from hot nights in excess of that explicable by daily mean temperature and have implications useful for establishing public health policy and research efforts estimating the health effects of climate change. https://doi.org/10.1289/EHP11444.
Heatwaves are becoming more frequent and severe, intensifying cooling demand and reducing air conditioner efficiencies. This causes peaks in electricity demand that pose operational challenges to power grids. This paper provides methods to mitigate demand peaks and heat stress under heatwaves by jointly adjusting fan speeds and thermostat setpoints in buildings. The methods involve (1) learning baseline models to predict load and thermal comfort, (2) fitting perturbation models that relate fan speed and thermostat setpoint adjustments to perturbations in load and thermal comfort, and (3) optimizing peak load and thermal comfort. The methods are implementable in real buildings, providing fast, accurately predicted optimized solutions that flatten demand peaks and mitigate personal heat stress. This paper demonstrates the methodology through simulation-based case studies of a single building and a six-building neighbourhood. In case studies, the methods reduce peak load by 8-10% while maintaining occupants’ thermal comfort within safe and comfortable ranges.
Global warming is precipitating an amplification of severe meteorological occurrences such as prolonged dry spells and episodes of elevated temperatures. These phenomena are instigating substantial elevations in environmental warmth, with metropolitan regions bearing the brunt of these impacts. Currently, extreme heat is already impacting 30% of the global populace, and forecasts suggest that this figure will escalate to 74% in the forthcoming years. One of the objectives outlined in the United Nations 2030 agenda, specifically within Sustainable Development Goal 11 (SDG11), is the attainment of sustainable urban development. To achieve this, it is imperative to scrutinize and delve into urban environmental conditions in order to understand their dynamics comprehensively. This understanding serves as the foundation for implementing mitigation and resilience strategies against climate change, ultimately enhancing the well-being of city residents. In this context, the field of remote sensing and geographic information systems has made substantial advancements. Notably, the UrbClim model, developed by the European Space Agency, facilitates the assessment of environmental conditions within numerous European urban centers. This research, utilizing data from UrbClim, examines the evolution of the heat stress index (Hi) during extreme heat conditions in Barcelona during the summer of 2017. Leveraging Landsat 8 satellite imagery, we derived the following variables: the normalized difference vegetation index and the normalized building difference index. Our findings reveal that during extreme heat conditions, the Hi index experiences an escalation, with areas characterized by a higher population density and industrial zones displaying lower resistance in contrast to regions with a lower population density and rural areas, which exhibit greater resilience to Hi. This disparity can be attributed to higher vegetation coverage and reduced building density in the latter areas. In this way, Hi increases more quickly and intensely and decreases more slowly when using high temperatures compared to average temperatures. This is of utmost importance for the future planning of new urban developments.
Objectives. Occupational activities in open spaces can experience excessive heat exposure caused by sunlight and other artificial sources in these professional environments can be one of the current and future challenges of occupational safety and health due to increasing global warming. Use of lightweight portable parasols is the first available control measure to reduce the radiation emitted by the sun in outdoor workplaces, which has been used for a long time. Methods. Due to the lack of study and results on the effect of using parasols in scientific literature, this modeling study was conducted to investigate the effect of sunshade installation on radiant temperature reduction of the sun in outdoor work using COMSOL Multiphysics version 5.5. Results. In general, six different shapes of portable parasols in different positions were modeled and the average radiant temperature reduction effectiveness (TRE) was about 30% in the presence of different parasols. The designed conical, simple and pyramidal sunshades showed the most effectiveness, respectively. Conclusions. The results show that changing variables such as the axis, installation height and shape is more effective for improving parasol efficiency to reduce the radiant temperature below it.
Vibrio parahaemolyticus is a halophilic gram-negative bacterium commonly found in marine environments, particularly in warm coastal waters. This pathogen has been reported as a common cause of foodborne illness associated with the consumption of raw or undercooked seafood. The presence and density of this bacterium in seafood are often associated with the climatological conditions of the marine environment. Herein, we developed the quantitative risk assessment model for Vibrio parahaemolyticus in oysters in Taiwan by considering seasonal variations, time periods, climate change scenarios, and post-harvest interventions. This study showed that season, time period, shared socioeconomic pathway (SSP), and post-harvest intervention significantly influenced the risk level of becoming ill from consuming oysters. The mean estimates of risk in winter, spring, summer, and fall were estimated to be 9.1 x 10-5, 2.0 x 10-3, 2.0 x 10-2, 6.9 x 10-3 per serving, respectively. Our models predict that, if global temperatures continue to increase in the coming decades due to climate change, the risk per serving of oysters is likely to increase by 18-145% by 2041-2060 and by 18-718% by 2081-2100, depending on the season and SSP. The application of thermal processing or high hydrostatic pressure processing was found to be the most effective approach in reducing risk, even under the threat of increasing global temperatures.
Uropathogenic Escherichia coli (UPEC) is known to cause 65-75% of human urinary tract infection (UTI) cases. Poultry meat is a reservoir of UPEC, which is suspected to cause foodborne UTIs. In the present study, we aimed to determine the growth potential of UPEC in ready-to-eat chicken breasts prepared by sous-vide processing. Four reference strains isolated from the urine of UTI patients (Bioresource Collection and Research Center [BCRC] 10,675, 15,480, 15,483, and 17,383) were tested by polymerase chain reaction assay for related genes to identify their phylogenetic type and UPEC specificity. A cocktail of these UPEC strains was inoculated into sous-vide cooked chicken breast at 10(3-4) colony-forming unit (CFU)/g and stored at 4°C, 10°C, 15°C, 20°C, 30°C, and 40°C. Changes in the populations of UPEC during storage were analyzed by a one-step kinetic analysis method using the U.S. Department of Agriculture [USDA] Integrated Pathogen Modeling Program-Global Fit [IPMP-Global Fit]. The results showed that the combination of the no lag phase primary model and the Huang square-root secondary model fitted well with the growth curves to obtain the appropriate kinetic parameters. This combination for predicting UPEC growth kinetics was further validated using it to study additional growth curves at 25°C and 37°C, which showed that the root mean square error, bias factor, and accuracy factor were 0.49-0.59 (log CFU/g), 0.941-0.984, and 1.056-1.063, respectively. In conclusion, the models developed in this study are acceptable and can be used to predict the growth of UPEC in sous-vide chicken breast.
The urban expansion-induced heat can exacerbate heat stress for urban dwellers, especially during heat waves. With a focus on the intra-urban variability of urban heat islands (UHIs) and thermal comfort, the urban parameterization within the Community Land Model version 5 (CLM5) was modified incorporating the local climate zones (LCZs) framework, named CLM5-LCZs, to simulate the urban climate during a heat wave (HW) event in the summer of 2013. The evaluation of model performance demonstrated that it did a reasonable job of simulating surface energy balance and thermal regimes in cities against observational fluxes from a flux tower measurement site and temperatures from automatic meteorological stations in Nanjing, China. Then we investigated the characteristics and causes of UHIs associated with local background climate, intra-urban inhomogeneity and HW intensity in East China. The results exhibited that daytime and nighttime canopy urban heat island intensity (CUHII) were highest in the Compact Low Rise (LCZ3) and the Compact High Rise (LCZ1) areas, respectively, while surface urban heat island intensity (SUHII) peaked in the Large Low Rise (LCZ8) and the Compact High Rise (LCZ1) areas during daytime and nighttime, respectively. Urban dwellers were easier exposed to serious heat environment in LCZ3 and LCZ1 areas over the north subtropical climate zone. Contrasts of CUHII and SUHII among different urban classes could exceed 1.7? and 5.4?. The intra-urban heterogeneity may alter the dominant factors controlling SUHII, which were also modulated by local climate and HW intensity. Unlike other controlling factors, the impact of local climate on the contribution from the urban-rural contrast of convection efficiency was larger than urban features. Overall, CLM5-LCZs displayed potential of implementing detailed simulations for inter- and intra-city UHIs at a larger scale, and enhancing the capabilities in modeling urban climate and exploring the causes and controls of UHIs.
Climate change has significantly increased the frequency of our exposure to heat, adversely affecting human health and industries. Heat stress is an environmental stress defined as the exposure of organisms and cells to abnormally high temperatures. To comprehensively explain the mechanisms underlying an organism’s response to heat stress, it is essential to investigate and analyze genes that have been under-represented or less well-known in previous studies. In this study, we analyzed heat stress-responsive genes using a meta-analysis of numerous gene expression datasets from the public database. We obtained 322 human and 242 mouse pairs as the heat exposure and control data. The meta-analysis of these data identified 76 upregulated and 37 downregulated genes common to both humans and mice. We performed enrichment, protein-protein interaction network, and transcription factor target gene analyses for these genes. Furthermore, we conducted an integrated analysis of these genes using publicly available chromatin immunoprecipitation sequencing (ChIP-seq) data for HSF1, HSF2, and PPARGC1A (PGC-1α) as well as gene2pubmed data from the existing literature. The results identified previously overlooked genes, such as ABHD3, ZFAND2A, and USPL1, as commonly upregulated genes. Further functional analysis of these genes can contribute to coping with climate change and potentially lead to technological advancements.
BACKGROUND: An increasing number of systematic reviews (SRs) in the environmental field have been published in recent years as a result of the global concern about the health impacts of air pollution and temperature. However, no study has assessed and compared the methodological and reporting quality of SRs on the health effects of air pollutants and extreme temperatures. This study aims to assess and compare the methodological and reporting quality of SRs on the health effects of ambient air pollutants and extreme temperatures. METHODS: PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and Epistemonikos databases were searched. Two researchers screened the literature and extracted information independently. The methodological quality of the SRs was assessed through A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The reporting quality was assessed through Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA). RESULTS: We identified 405 SRs (286 for air pollution, 108 for temperature, and 11 for the synergistic effects). The methodological and reporting quality of the included SRs were suboptimal, with major deficiencies in protocol registration. The methodological quality of SRs of air pollutants was better than that of temperature, especially in terms of satisfactory explanations for any heterogeneity (69.6% v. 45.4%). The reporting quality of SRs of air pollution was better than temperature, however, adherence to the reporting of the assessment results of risk of bias in all SRs (53.5% v. 34.3%) was inadequate. CONCLUSIONS: Methodological and reporting quality of SRs on the health effect of air pollutants were higher than those of temperatures. However, deficiencies in protocol registration and the assessment of risk of bias remain an issue for both pollutants and temperatures. In addition, developing a risk-of-bias assessment tool applicable to the temperature field may improve the quality of SRs.
Anthropogenic climate change is causing a rise in global temperatures, with this trend projected to increase into the future. Rising temperatures result in an increase in the frequency and severity of heatwave events, with an associated increase in poor health outcomes for vulnerable individuals. This places an increasing strain on health care services. However, methods calculating future health care costs associated with this trend are poorly understood. We calculated health care costs attributable to heatwave events in Tasmania 2009-2019, using ambulance dispatches as a case study. We also modeled the expected health and economic burden for projected heatwave frequencies between 2010 and 2089. We developed our models based on two possible approaches to describing population adaptation to heatwaves-an adapted population calculated by determining heatwave episodes using a rolling baseline, and a non-adapted population calculated by determining heatwave episodes using a static baseline. Using a rolling baseline calculation for 2010 to 2089, we estimated additional ambulance costs averaging AUD$57,147 per year and totaling AUD$4,571,788. For the same period using a static baseline, we estimated additional ambulance costs averaging AUD$517,342 per year and totaling AUD$41,387,349. While this method is suitable for estimating the health care costs associated with heatwaves, it could be utilized for estimating health care costs related to other climate-related extreme events. Different methods of estimating heatwaves, modeling an adapted versus non-adapted population, provide substantial differences in projected costs. There is potential for considerable health system cost savings when a population is supported to adapt to extreme heat.
Today the most substantial threats facing cities relate to the impacts of climate change. Extreme temperature such as heat waves and the occurrence of Urban Heat Island (UHI) phenomena, present the main challenges for urban planning and design. Climate deterioration exacerbates the already existing weaknesses in social systems, which have been created by changes such as population increases and urban sprawl. Despite numerous attempts by researchers to assess the risks associated with the heat-health nexus in urban areas, no common metrics have yet been defined yet. The objective of this study, therefore, is to provide an empirical example of a flexible and replicable methodology to estimate the micro-scale UHI risks within an urban context which takes into account all the relevant elements regarding the heat-health nexus. For this purpose, the city of Turin has been used as a case study. The methodological approach adopted is based on risk assessment guidelines suggested and approved by the most recent scientific literature. The risk framework presented here used a quantitative estimate per each census tract within the city based on the interaction of three main factors: hazard, exposure, and vulnerability. Corresponding georeferenced maps for each indicator have been provided to increase the local knowledge on the spatial distribution of vulnerability drivers. The proposed methodology and the related findings represent an initial stage of the urban risk investigation within the case study. This will include participatory processes with local policymakers and health-stakeholders with a view to guiding the local planning agenda of climate change adaptation and resilience strategies in the City of Turin.
IntroductionHeat 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. MethodsLongitudinal 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. ResultsWBGT 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. ConclusionThis 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.
The geographic range of the blacklegged tick, Ixodes scapularis, is expanding northward from the United States into southern Canada, and studies suggest that the lone star tick, Amblyomma americanum, will follow suit. These tick species are vectors for many zoonotic pathogens, and their northward range expansion presents a serious threat to public health. Climate change (particularly increasing temperature) has been identified as an important driver permitting northward range expansion of blacklegged ticks, but the impacts of host movement, which is essential to tick dispersal into new climatically suitable regions, have received limited investigation. Here, a mechanistic movement model was applied to landscapes of eastern North America to explore 1) relationships between multiple ecological drivers and the speed of the northward invasion of blacklegged ticks infected with the causative agent of Lyme disease, Borrelia burgdorferi sensu stricto, and 2) its capacity to simulate the northward range expansion of infected blacklegged ticks and uninfected lone star ticks under theoretical scenarios of increasing temperature. Our results suggest that the attraction of migratory birds (long-distance tick dispersal hosts) to resource-rich areas during their spring migration and the mate-finding Allee effect in tick population dynamics are key drivers for the spread of infected blacklegged ticks. The modeled increases in temperature extended the climatically suitable areas of Canada for infected blacklegged ticks and uninfected lone star ticks towards higher latitudes by up to 31% and 1%, respectively, and with an average predicted speed of the range expansion reaching 61 km/year and 23 km/year, respectively. Differences in the projected spatial distribution patterns of these tick species were due to differences in climate envelopes of tick populations, as well as the availability and attractiveness of suitable habitats for migratory birds. Our results indicate that the northward invasion process of lone star ticks is primarily driven by local dispersal of resident terrestrial hosts, whereas that of blacklegged ticks is governed by long-distance migratory bird dispersal. The results also suggest that mechanistic movement models provide a powerful approach for predicting tick-borne disease risk patterns under complex scenarios of climate, socioeconomic and land use/land cover changes.
In the context of climate change, heat waves are a serious hazard having significant impacts on human health, especially vulnerable populations. Many studies have researched the association between extreme heat and mortality. In the context of urban planning, many studies have explored the cooling effect of green roofs, parks, urban forests and urban gardens. Nevertheless, few studies have analyzed the effect mechanism of specific ecosystem services (Ess) as mitigation measures to heat waves. This study aimed to determine the relationship among Ess, heat waves and the heat-related mortality risk of different groups by diseases, age and sex. The research was conducted in three cities in Jiangsu Province, including Nanjing, Suzhou and Yancheng. We quantified five ecosystem services, i.e., water supply service, carbon sequestration service, cooling service, biodiversity and cultural service. Based on the previous studies, we took the frequency of heat waves into account, extending the concept of the Heat Wave Magnitude Index (HWMI). A distributed lag nonlinear model (DLNM) was applied to estimate the effect of extreme heat on mortality. Then, the study used the process analysis method to explore the relationship among Ess, heat waves and heat-related mortality risks. The results indicated that (i) water supply service, carbon sequestration service, cooling service and biodiversity can reduce heat-related mortality while cultural service increases; (ii) the effects of carbon sequestration service and cultural service are stronger than other Ess; (iii) the effects of Ess on cardiorespiratory disease, stroke and chronic obstructive pulmonary disease (COPD) mortality risks are higher than others; and (iv) women and elderly heat-related mortality risks are more affected by the Ess. This study can provide a theoretical support for policy makers to mitigate heatwave events, thus limiting heat-related mortality.
Climate change is one of the great challenges of our time. The consequences of climate change on exposed biological subjects, as well as on vulnerable societies, are a concern for the entire scientific community. Rising temperatures, heat waves, floods, tornadoes, hurricanes, droughts, fires, loss of forest, and glaciers, along with disappearance of rivers and desertification, can directly and indirectly cause human pathologies that are physical and mental. However, there is a clear lack in psychiatric studies on mental disorders linked to climate change.
Macrosomia has increased rapidly worldwide in the past few decades, with a huge impact on health. However, the effect of PM(2.5) and extreme high-temperature (EHT) on macrosomia has been ignored. OBJECTIVE: This study aimed to explore the association between maternal exposure to EHT, PM(2.5) and macrosomia based on the Seventh Demographic and Health Survey (DHS) in 14 countries of Africa. METHODS: The study included detailed demographic information on 106 382 births and maternal. Satellite inversion models estimated monthly mean PM(2.5) and mean surface temperature of 2 m (SMT(2m) ). Macrosomia was defined as the birth weight ≥ 4000 g. We used a Cox proportional risk regression model to estimate the association between PM(2.5) , EHT and macrosomia. We further explored the susceptibility of exposure to EHT and PM(2.5) at different pregnancy periods to macrosomia, and plotted the expose-response curve between PM(2.5) and macrosomia risk using a restricted cubic spline function. In addition, the Interplot model was used to investigate the interaction between EHT and PM(2.5) on macrosomia. Finally, some potential confounding factors were analysed by stratification. RESULTS: There was the positive association between EHT, PM(2.5) and macrosomia, and the risk of macrosomia with the increase in concentrations of PM(2.5) without clear threshold. Meanwhile, EHT and PM(2.5) had a higher effect on macrosomia in middle/later and early/middle stages of pregnancy, respectively. There was a significant interaction between EHT and PM(2.5) on macrosomia. CONCLUSIONS: Maternal exposure to EHT, PM(2.5) during pregnancy was associated with an increased risk of macrosomia in Africa.
Climate change has led to a dramatic increase in extreme events worldwide. Predictions for a + 1.5 degrees C world indicate that 13.8% of the global population will be exposed to heat waves (HWs), a proportion rising to 36.9% in a + 2 degrees C scenario. At present, about 9.6 M people in the EU and UK are exposed to extreme heat every year. Overheating has various impacts on cities, including urban infrastructure failures and changes in ecological processes. However, scarce attention is currently paid to the distribution of HWs impacts and the differential vulnerabilities of different social groups, raising the issue of climate justice in cities. HWs directly impact the health of the most vulnerable social groups resulting in an increase in mortality and morbidity rates. This research focuses on the city of Padua (Italy) as a pilot study to assess the effects of urban HWs and heat islands (UHI) combined. By framing the unequal spatial distribution of socially vulnerable groups, this study aims to i) provide a replicable spatially explicit open-access methodology to assess the heat-related risk of UHI; ii) propose the first climate justice heat-related risk index to be adopted in inclusive and just adaptation plans. Specifically, it aims to i) identify HWs and map critical hotspots during summer 2022 at suburban scale; ii) assess the spatial correlations among impervious areas and UHI; iii) map the climate risk to vulnerable social groups; and iv) propose a global climate justice risk index for all the vulnerable groups considered. Images from Landsat 8-9 were processed, and territorial data were acquired from public databases. It was found that three extreme HWs hit Padua in summer 2022, on 2-7 June, 21-23 July, and 4-8 August, when maximum temperatures were 35.1 degrees C, 36.1 degrees C, and 35.8 degrees C, respectively. The intensity and magnitude of UHIs were considerable, with land surface temperatures of 33.8 degrees C on average (& sigma; = 1.7, min = 27.9, max = 41.4). UHI intensity reached 5-8 degrees C of difference with rural contexts, mainly in strongly urbanized sectors. Ordinary least squares regression indicated a positive correlation with impervious surfaces, with a & beta; coefficient showing an average increase of 0.3 degrees C per 10% of soil sealing. Six different hotspots were identified both in industrial areas and within the city centre. However, the integrated climate risk analyses highlight that most critical areas are in sectors where there is a large number of the elderly, migrants, children, and low-income households. Our findings reveal the need for urgent heat island mitigation measures and that the distributive dimension of climate justice should be respected in adaptation planning.
Rapid changes in the global climate are deepening existing health disparities from resource scarcity and malnutrition. Rising ambient temperatures represent an imminent risk to pregnant women and infants. Both maternal malnutrition and heat stress during pregnancy contribute to poor fetal growth, the leading cause of diminished child development in low-resource settings. However, studies explicitly examining interactions between these two important environmental factors are lacking. We leveraged maternal and neonatal anthropometry data from a randomized controlled trial focused on improving preconception maternal nutrition (Women First Preconception Nutrition trial) conducted in Thatta, Pakistan, where both nutritional deficits and heat stress are prevalent. Multiple linear regression of ambient temperature and neonatal anthropometry at birth (n = 459) showed a negative association between daily maximal temperatures in the first trimester and Z-scores of birth length and head circumference. Placental mRNA-sequencing and protein analysis showed transcriptomic changes in protein translation, ribosomal proteins, and mTORC1 signaling components in term placenta exposed to excessive heat in the first trimester. Targeted metabolomic analysis indicated ambient temperature associated alterations in maternal circulation with decreases in choline concentrations. Notably, negative impacts of heat on birth length were in part mitigated in women randomized to comprehensive maternal nutritional supplementation before pregnancy suggesting potential interactions between heat stress and nutritional status of the mother. Collectively, the findings bridge critical gaps in our current understanding of how maternal nutrition may provide resilience against adverse effects of heat stress in pregnancy.
OBJECTIVES: Cross-population variation in age at menarche is related to many factors. The purpose of this study was to examine climate variables in relation to mean age at menarche among 87 modern human populations. We hypothesized a later age at menarche among populations living in areas with high precipitation variability, heavy seasonal rainfall, and high temperatures year-round due to water-borne diseases and periods of resource scarcity. METHODS: Using a comparative dataset, we examined geospatial distribution and climate variables in relation to age at menarche for 87 modern human populations. RESULTS: We found the strongest predictor of a later age at menarche was higher fertility followed by a later mean age at death. In addition, higher annual rainfall, higher precipitation seasonality, and lower annual mean temperature were moderate predictors of age at menarche. CONCLUSIONS: We propose that later ages at menarche in countries with high fertility may be a life-history strategy developed in response to climatic conditions that have resulted in higher immunological load. In these conditions, females may prioritize growth rather than reproduction. Shifts in climate and global population growth may change the future biological landscape of age at menarche.
Nowadays, the measurement of heat stress indices is of principal importance due to the escalating impact of global warming. As temperatures continue to rise, the well-being and health of individuals are increasingly at risk, which can lead to a detrimental effect on human performance and behavior. Hence, monitoring and assessing heat stress indices have become necessary for ensuring the safety and comfort of individuals. Thermal comfort indices, such as wet-bulb globe temperature (WBGT), Tropical Summer Index (TSI), and Predicted Heat Strain (PHS), as well as parameters like mean radiant temperature (MRT), are typically used for assessing and controlling heat stress conditions in working and urban environments. Therefore, measurement and monitoring of these parameters should be obtained for any environment in which people are constantly exposed. Modern cities collect and publish this relevant information following the Smart City concept. To monitor large cities, cost-effective solutions must be developed. This work presents the results of a Heat Stress Monitoring (HSM) system prototype network tested in the Benicalap-Ciutat Fallera district in Valencia, Spain. The scope of this work is to design, commission, and test a low-cost prototype that is able to measure heat stress indices. The Heat Stress Monitoring system comprises a central unit or receiver and several transmitters communicating via radiofrequency. The transmitter accurately measures wind speed, air temperature, relative humidity, atmospheric pressure, solar irradiation, and black globe temperature. The receiver has a 4G modem that sends the data to an SQL database in the cloud. The devices were tested over one year, showing that radio data transmission is reliable up to 700 m from the receiver. The system’s power supply, composed of a Photovoltaic panel and Lithium-ion batteries, provided off-grid capabilities to the transmitter, with a tested backup autonomy of up to 36 days per charge. Then, indicators such as WBGT, TSI, and MRT were successfully estimated using the data collected by the devices. The material cost of a 12-point network is around EUR 2430 with a competitive price of EUR 190 per device.
Health risk resulting from non-optimal temperature exposure, referred to as “systematic risk”, has been a sustainable-development challenge in the context of global warming. Previous studies have recognized interactions between and among system components while assessing the vulnerability to climate change, but have left open the question of indicator directional interactions. The question is important, not least because indicator directional association analysis provides guidance to address climate risks by revealing the key nodes and pathways. The purpose of this work was to assess health vulnerability to short-term summer heat exposure based on a directional interaction network. Bayesian network model and network analysis were used to conduct a directional interaction network. Using indicator directional associations as weights, a weighted technique for the order of preference by similarity to ideal solution method was then proposed to assess heat-related health vulnerability. Finally, hotspots and coping strategies were explored based on the directional interaction network and health vulnerability assessments. The results showed that (1) indicator directional interactions were revealed in the health vulnerability framework, and the interactions differed between northern and southern China; (2) there was a dramatic spatial imbalance of health vulnerability in China, with the Beijing-Tianjin-Hebei Region and the Yangtze River Basin identified as hotspots; (3) particulate matter and ozone were recognized as priority indicators in the most vulnerable cities of northern China, while summer heat exposure level and variation were priority indicators in southern China; and (4) adaptive capacity could alter the extent of risk; thus, mitigation and adaptation should be implemented in an integrated way. Our study has important implications for strengthening the theoretical basis for the vulnerability assessment framework by providing indicator directional associations and for guiding policy design in dealing with heat-related health vulnerability in China.
Individuals with serious mental illness are vulnerable to extreme heat due to biological, social, and place-based factors. We examine the spatial correlation of prevalence of individuals treated at a community mental health center to heat vulnerability. We applied a heat vulnerability index (HVI) to the catchment of the Connecticut Mental Health Center in New Haven, Connecticut. Geocoded addresses were mapped to correlate patient prevalence with heat vulnerability of census tracts. Census tracts closer to the city center had elevated vulnerability scores. Patient prevalence was positively correlated with HVI score (Pearson’s r(44) = 0.67, p < 0.01). Statistical significance persists after correction for spatial autocorrelation (modified t-test p < 0.01). The study indicates that individuals treated at this community mental health center are more likely to live in census tracts with high heat vulnerability. Heat mapping strategies can help communicate risk and target resources at the local scale.
As the shallow mineral resources are nearly depleted, the mining of deep resources has become an urgent problem to be studied. The increase in mine depth can lead to the increase of mine heat hazard, which is a critical concern for mining safety/occupational health and safety. However, there are limited review articles available regarding the prevention of mine heat hazard. To fill in this gap, a bibliometric analysis and knowledge mapping of the field of mine heat hazard prevention are presented in this paper. A total of 314 papers from the Web of Science (WOS) core collection database that published between January 1998 and July 2022 were analyzed using VOSviewer and CiteSpace. China, South Africa, Poland, USA, and Australia are the top five countries in this field. The important journals are Applied Thermal Engineering, Applied Energy, Energies, and International Journal of Mining Science and Technology. In addition, the research focal points and two research fronts were identified and discussed. The knowledge base of mine heat hazard research focuses on mine cooling technology, energy efficiency optimization of cooling systems, thermodynamic theory, and occupational health. There are two research fronts. One is to use the numerical simulation method to study various problems such as simulate the performance of refrigeration systems and thermal comfort in mines. The second is to study the occupational health impact of climate change on miners. Therefore, this paper provides readers and academics with an overview of the intellectual structure and knowledge body that have been developed on the subject of mine heat hazard.
Extreme heat events pose a significant threat to population health that is amplified by climate change. Traditionally, statistical models have been used to model heat-health relationships, but they do not consider potential interactions between temperature-related and air pollution predictors. Artificial intelligence (AI) methods, which have gained popularity for health applications in recent years, can account for these complex and non-linear interactions, but have been underutilized in modelling heat-related health impacts. In this paper, six machine and deep learning models were considered to model the heat-mortality relationship in Montreal (Canada) and compared to three statistical models commonly used in the field. Decision Tree (DT), Random Forest (RF), Gradient Boosting Machine (GBM), Single- and Multi-Layer Perceptrons (SLP and MLP), Long Short-Term Memory (LSTM), Generalized Linear and Additive Models (GLM and GAM), and Distributed Lag Non-Linear Model (DLNM) were employed. Heat exposure was characterized by air temperature, relative humidity and wind speed, while air pollution was also included in the models using five pollutants. The results confirmed that air temperature at lags of up to 3 days was the most important variable for the heat-mortality relationship in all models. NO(2) concentration and relative humidity (at lags 1 to 3 days) were also particularly important. Ensemble tree-based methods (GBM and RF) outperformed other approaches to model daily mortality during summer months based on three performance criteria. However, a partial validation during two recent major heatwaves highlighted that non-linear statistical models (GAM and DLNM) and simpler decision tree may more closely reproduce the spike of mortality observed during such events. Hence, both machine learning and statistical models are relevant for modelling heat-health relationships depending on the end user goal. Such extensive comparative analysis should be extended to other health outcomes and regions.
To quantify the current literature and limitations associated with research examining thermoregulatory and cardiovascular strain in laborers working in the heat. PubMed, SCOPUS, and SPORTDiscus were searched for terms related to the cardiovascular system, heat stress, and physical work. Qualifying studies included adult participants (18-65 years old), a labor-intensive environment or exercise protocol simulating a labor environment, a minimum duration of 120 min of physical work, and environmental heat stress (ambient temperature ≥26.0°C and ≥30% relative humidity). Studies included at least one of the following outcomes: pre- and peak physical work, core temperature, heart rate (HR), systolic blood pressure, diastolic blood pressure, HR variability, and rate pressure product.Twenty-one out of 1559 potential studies qualified from our search. There was a total of 598 participants (mean = 28 ± 50 participants per study, range = 4-238 participants per study), which included 51 females (8.5%) and 547 males (91.5%). Of the participants, 3.8% had cardiovascular risk factors (diabetes: n = 10; hypertension: n = 13) and 96.2% were characterized as “healthy”. Fifty-seven percent of the included studies were performed in a laboratory setting. Studies were predominantly in men (91.5%), laboratory settings (57%), and “healthy” individuals (96.2%). To advance equity in protection against occupational heat stress and better inform future heat safety recommendations to protect all workers, future studies must focus on addressing these limitations. Employers, supervisors, and other safety stakeholders should consider these limitations while implementing current heat safety recommendations.
There is increasing evidence that climate change impacts have been particularly critical in the case of heat waves during the last years. Many cities around the globe have been affected by heat waves and their cascading effects, threatening public health and urban life and disrupting services and infrastructure. Unfortunately, cities in developing countries are not paying attention to heatwaves’ impacts. This is the case in Mexico. Although there are studies on extreme heat exposure, there are no vulnerability assessments. The central research question of our study is the analysis of social vulnerability to extreme temperature and heatwaves in two Mexican cities at the U.S.-Mexico border, Tijuana, and Mexicali. Our results show that urban planning and state and municipal development policies in both cities have neglected the impact of heat waves despite their increasing frequency, intensity, and duration in the last two decades. The results also show significant differences in exposure, sensitivity, and adaptive capacity to extreme temperatures within each city. Areas with higher vulnerability in both cities are informal settlements and low-income neighborhoods. This information can support local governments in making sound use of scarce resources to create efficient responses to current impacts and future risks of climate change.
Electrical power outages are of increasing interest to US urban scholars, government officials and stakeholders, as they have increased in number and duration with significant health and economic, among other, impacts. This analysis examines reports of power outages in New York City in relation to socioeconomic and health characteristics of neighborhoods. Using the city’s 311-call database we examine complaint calls for power outages from 2014 to 2022. While 311-calls for power outages occur all year long, volume trended higher during the warmer months (June, July and August), and as minimum daily temperatures exceeded 20 degrees C (68 degrees F), the number of calls increased dramatically. Spatial clusters of high call areas were in Census tracts with high energy burdens, lower-income households, and high percentages of people of color. Furthermore, we found the higher call areas were associated with higher vulnerability to heat-exacerbated deaths. As climate change is expected to raise temperatures and increase the frequency and intensity of heat waves around the world, and as power outages are becoming more common, these findings will help to provide guidance for adaptation and energy reliability policies in New York City and have implications for other cities globally.
Temperature is increasingly understood to impact mental health. However, evidence of the long-term effect of temperature exposure on the risk of depressive symptoms is still scarce. Based on the China Health and Retirement Longitudinal Study (CHARLS), this study estimated associations between long-term apparent temperature, extreme temperature, and depressive symptoms in middle-aged and older adults. Results showed that a 1 °C increase or decrease from optimum apparent temperature (12.72 °C) was associated with a 2.7% (95% CI: 1.3%, 4.1%) and 2.3% (95% CI: 1.1%, 3.5%) increased risk of depressive symptoms, respectively. This study also found that each percent increase in annual change in ice days, cool nights, cool days, cold spell durations, and tropical nights was associated with higher risk of depressive symptoms, with HRs (95%CI) of 1.289 (1.114-1.491), 2.064 (1.507-2.825), 1.315 (1.061-1.631), 1.645 (1.306-2.072), and 1.344 (1.127-1.602), respectively. The results also indicated that people living in northern China have attenuated risk of low apparent temperature. Older people were also observed at higher risk relating to more cool nights. Middle-aged people, rural residents, and people with lower household income might have higher related risk of depressive symptoms due to increased tropical nights. Given the dual effect of climate change and global aging, these findings have great significance for policy making and adaptive strategies for long-term temperature and extreme temperature exposure.
INTRODUCTION: Heat-related illnesses are a global concern, affecting millions of people and leading to numerous deaths annually. Since military personnel are exposed to heat, the purpose of the study was to evaluate military personnel’s knowledge, attitudes, and practices (KAP) related to heat-related illnesses. Their KAP may help to prevent heat-related illness. Methods: We conducted a cross-sectional study using a structured online questionnaire on 168 military personnel who were training and working in a high-temperature and high-humidity environment all year round in Jeddah, Saudi Arabia. The questionnaire assessed the KAP and associated factors and was distributed as a Google Form. RESULTS: The mean knowledge score was 9.04 (range = 2-13, SD = 1.832), the mean awareness score was 9.61 (range = 4-15, SD = 2.415), and the mean practice score was 3.39 (range = 0-6, SD = 1.703). Most participants correctly identified symptoms (n=130; 77.4%). In terms of attitudes, most participants showed a good attitude (n=151; 81%), though 24.4% did not perceive the risk. Regarding practice, most were attentive to heat-related illness signs and hydration(75.6%), but there were gaps in receiving briefings from doctors (69%) and adequate guidance on treatment (56%). There was a split opinion on whether commanders adjust field activities based on temperature warnings (54.8% Yes, 45.2% No). There were no significant differences in knowledge scores based on age or educational level (both p>0.05), while some age and education-related differences were noted in practice scores (p<0.05). There was a positive correlation between knowledge and attitudes (r = 0.222, p = 0.004), knowledge and practices (r = 0.165, p = 0.033), and attitudes and practice (r=0.326, p < 0.001). CONCLUSION: Our study found that military personnel generally possess good knowledge of heat-related illnesses and good attitudes and practices concerning heat-related illnesses. However, there are areas in need of improvement, and enhancing awareness and practical implementation of preventive measures, along with the development of precise guidance and protocols, should involve active collaboration between military commanders and healthcare professionals.
OBJECTIVES: to provide evidence of the health impacts of climate change in Italy. DESIGN: descriptive study. SETTING AND PARTICIPANTS: the indicators published in the 2022 Lancet Countdown report were adapted and refined to provide the most recent data relevant to Italy. MAIN OUTCOME MEASURES: twelve indicators were measured, organized within five sections mirroring those of the 2022 Lancet Countdown report: climate change impacts, exposures, and vulnerabilities; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. RESULTS: the overall picture depicted by the analysis of the 12 indicators reveals two key findings. First, climate change is already affecting the health of Italian populations, with effects not being uniform across the Country and with the most vulnerable groups being disproportionately at risk. Second, results showed that Italy’s mitigation response has been partial, with major costs to human health. Accelerated climate change mitigation through energy system decarbonisation and shifts to more sustainable modes of transport could offer major benefits to health from cleaner air locally and from more active lifestyles, and to climate change from reduction of global warming. The decarbonisation of agricultural systems would similarly offer health co-benefits to Italian population. Conclusions: through accelerated action on climate change mitigation, Italy has the opportunity of delivering major and immediate health benefits to its population. Developing a key set of local indicators to monitor the impacts of climate change and evaluate response actions, in terms of adaptation and mitigation, can help support and enhance policy and action to fight climate changes.
India’s land use pattern has witnessed significant changes over time. Various studies have pointed out that land use changes in India indicate a trend towards increasing urbanisation and deforestation (particularly for native forests). A priori, such changes in land use patterns may lead to a higher incidence of natural disasters. The study examines whether these land use changes have led to higher fatalities (and damages) due to floods and other natural disasters , controlling for various socio-economic factors. Our results indicate that land use changes, specifically deforestation, and urbanisation, are detrimental to environmental health, causing greater flood damages and natural disaster fatalities. Specifically, ‘forest cover’ is found to have a negative impact on ‘flood damages’, whereas ‘urbanisation’ has a positive impact, as per a priori expectations. Similarly, forest cover is found to be inversely related to total ‘natural disaster fatalities’ (which includes deaths due to floods, cyclones, landslides, heat waves, cold waves, and lightning), whereas ‘urbanisation’ is found to have a positive impact on disaster fatalities, according to a priori expectations. Our results confirm that land use changes in the direction of deforestation and urbanisation have increased fatalities and damages due to natural disasters. Another important finding of our study is that financial development has a mitigating impact on flood fatalities as well as overall natural disaster fatalities.
The heat reduction effect of trees has been investigated through numerical simulations; however, there are still challenges to applying the scientific results to the planning process due to the model’s complexity and the computational resources required. This study investigates a rapid spatial evaluation method for heat stress potential, measured by mean radiant temperature (MRT), by decomposing radiation into sub-radiation using a multilayer MRT model. This method also enables the reproduction of optimized layouts considering the effect of tree arrangement in residential buildings. Multi-objectives were achieved through an evolutionary algorithm, resulting in more effective design layouts combining tree types and arrangements, all within a standard budget. By adopting this study’s approach, landscape designers can create climate-responsive tree layouts with reduced heat exposure and generate customized planting designs tailored to their preferences.
Many urban climates are characterized by increased temperature and decreased relative humidity, under climate change and compared to surrounding rural landscapes. The two trends have contrasting effects on human-perceived heat stress. However, their combined impact on urban humid heat and adaptation has remained largely unclear. Here, we use simulations from an earth system model to investigate how urbanization coupled with climate change affects urban humid heat stress, exposure, and adaptation. Our results show that urban humid heat will increase substantially across the globe by 3.1 degrees C by the end of the century under a high emission scenario. This projected trend is largely attributed to climate change-driven increases in specific humidity (1.8 degrees C), followed by air temperature (1.4 degrees C)-with urbanization impacts varying by location and of a smaller magnitude. Urban humid heat stress is projected to be concentrated in coastal, equatorial areas. At least 44% of the projected urban population in 2100, the equivalent of over 3 billion people worldwide, is projected to be living in an urban area with high humid heat stress. We show a critical, climate-driven dilemma between cooling efficacy and water limitation of urban greenery-based heat adaptation. Insights from our study emphasize the importance of using urban-explicit humid heat measures for more accurate assessments of urban heat exposure and invite careful evaluation of the feasibility of green infrastructure as a long-term cooling strategy.
Circulatory-system diseases (CSDs) are responsible for 50-60% of all deaths in Romania. Due to its continental climate, with cold winters and very warm summers, there is a strong temperature dependence of the CSD mortality. Additionally, within its capital Bucharest, the urban heat island (UHI) is expected to enhance (reduce) heat (cold)-related mortality. Using distributed lag non-linear models, we establish the relation between temperature and CSD mortality in Bucharest and its surroundings. A striking finding is the strong temperature-related response to high urban temperatures of women in comparison with men from the total CSDs mortality. In the present climate, estimates of the CSDs attributable fraction (AF) of mortality at high temperatures is about 66% higher in Bucharest than in its rural surroundings for men, while it is about 100% times higher for women. Additionally, the AF in urban areas is also significantly higher for elderly people, and for those with hypertensive and cerebrovascular diseases than in the rural surroundings. On the other hand, in rural areas, men but especially women are currently more vulnerable with respect to low temperatures than in the urban environment. In order to project future thermal-related mortality, we have used five bias-corrected climate projections from regional circulation models under two climate-change scenarios, RCP4.5 and RCP8.5. Analysis of the temperature-mortality associations for future climate reveals the strongest signal under the scenario RCP8.5 for women, elderly people as well as for groups with hypertensive and cerebrovascular diseases. The net AF increase is much larger in urban agglomeration for women (8.2 times higher than in rural surroundings) and elderly people (8.5 times higher than in rural surroundings). However, our estimates of thermal attributable mortality are most likely underestimated due to the poor representation of UHI and future demography.
Heat waves and air pollution extremes exert compounding effects on human health and food security and may worsen under future climate change. On the basis of reconstructed daily O(3) levels in China and meteorological reanalysis, we found that the interannual variability of the frequency of summertime co-occurrence of heat wave and O(3) pollution in China is regulated mainly by a combination of springtime warming in the western Pacific Ocean, western Indian Ocean, and Ross Sea. These sea surface temperature anomalies impose influences on precipitation, radiation, etc., to modulate the co-occurrence, which were also confirmed with coupled chemistry-climate numerical experiments. We thus built a multivariable regression model to predict co-occurrence a season in advance, and correlation coefficient could reach 0.81 (P < 0.01) for the North China Plain. Our results provide useful information for the government to take actions in advance to mitigate damage from these synergistic costressors.
The necessity of exploring the relationship between sleep quality and the thermal environment has amplified regarding increasing heat stress risk on the human body due to climate change, particularly in vulnerable uninsulated buildings in Ankara. Within this scope, this study investigated occupants’ sleep quality and human thermal comfort in insulated and uninsulated buildings under three local extreme heat event thresholds: (1) typical summer days (TSD25), (2) very hot days (VHD33), and lastly, (3) heat wave events (HWE31). Within a two-tiered approach to thermal comfort evaluations, the human thermal comfort of occupants was identified through the calculation of physiologically equivalent temperature (PET) from the climatic data of local meteorological stations. The psychological thermal comfort and sleep quality of participants were evaluated by questionnaires during each heat event. The results of this study demonstrated that the physiological thermal load of the participants was highest during VHD33s, given that both outdoor and indoor PET values presented their highest values within VHD33 events. Furthermore, the outdoor PET values reached extreme heat stress based on physiological stress grades with 43.5 degrees C, which indicated the exacerbated vulnerability of Ankara during extreme heat events. The PET values were consistently higher in uninsulated buildings than in insulated buildings. Also, most of the mean psychological thermal comfort votes and sleep quality votes were better in uninsulated buildings than in insulated ones during TSD25s and HWE31s, while it was the opposite within extreme conditions of VHD33s. The outputs of this study contribute to interdisciplinary efforts to attenuate the existing and impending risks of climate change on human life by defining the influence of increasing outdoor heat stress on indoor spaces, thermal comfort, and the sleep quality of occupants.
Assessing heat-related health risks is important for sustainable urban development. Although fine-scale infor-mation (e.g., at the community/neighborhood or city block level) is ideal for identifying and mitigating these risks, previous studies have preferred to work at the administrative unit level. High-resolution Local Climate Zone (LCZ) maps, i.e., maps of urban “zones” with different microclimates, could help to standardize the analyzing units. In this study, we proposed an LCZ-based risk assessment approach for this purpose. First, an LCZ map of the study site (Changzhou, China) was generated using multisource big data and machine-learning techniques. Next, Crichton’s Risk Triangle framework, based on the hazard-exposure-vulnerability risk compo-nents, was employed to estimate heat-related health risks. Finally, the relationship between LCZ types and heat -related health risk levels was quantitatively analyzed in detail. The results indicated that at least 60% of LCZ1-5 (compact high-/mid-/low-rise, open high-/mid-rise areas) were designated as high-risk areas, while heat hazard mitigation and climate adaptation strategies in urban planning would benefit more from LCZ 6 (open low-rise). This study, based on the LCZ concept, shows the risk difference at the community level, and can be used for informing and implementing area-level urban planning strategies. It could contribute to global heat-related health risk analysis, since the LCZ is a globally consistent system for urban microclimate analysis.
Rapid urbanization and global warming have triggered frequent heat waves that pose a threat to human survival, with a marked increase in childhood morbidity. While previous studies have explored the thermal environment of children’s public activity places, only limited studies have focused on the commute of school children, which is a regular activity causing potential risk of heat stress. From an urban design perspective, this study systematically investigated the influence of building shade, road orientation and tree species on the thermal environment of commuting roads. The simulation results indicated that, regarding the reduction of road heat stress, the building shade has a greater impact that can reduce the mean radiant temperature by 3.22 degrees C to 21.25 degrees C, compared to the effect of tree shade (0.02-6.04 degrees C). Furthermore, planting street trees in a flexible manner to add building shade areas can enhance thermal safety. For road orienta-tions, increasing shade areas of north-south road generates more benefits in heat stress mitigation (in the northern hemisphere). Finally, from the perspective of urban design/management and school children, a set of heat stress mitigation strategies are proposed to promote the thermal safety of school children and stimulate the development of a sustainable and healthy urban environment.
The urban heat island is a climate, public health, and environmental justice issue. Sustainable urban infrastructure needs improvements in public transport to protect citizens’ health from the urban heat island. This case study investigates the local microenvironment and social vulnerability of heat-vulnerable bus stops in Knoxville, Tennessee, using publicly available data from a variety of sources. These included ground and satellite measurements of heat and humidity from the Knoxville Heat Mapping Campaign, characteristics of land surface from the National Land Cover Dataset 2019 of the United States Geological Survey, and the 2018 Social Vulnerability Index from the U.S. Centers for Disease Control and Prevention. A geographic information system and a principal component analysis were used to identify social vulnerability in areas where the bus stops are located. The results show that most heat-vulnerable bus stops are poor microenvironments without trees and shelters. The hottest bus stops are concentrated in the highly developed and densely populated areas of West Knoxville and downtown Knoxville and in South, North, Northeast, and Northwest Knoxville, which are relatively high vulnerability clustered and have poor public infrastructure. The findings provide the foundation for mitigation strategies to better prepare local communities for climate change by identifying public transportation areas negatively impacted by the urban heat island.
Leishmania is a genus of parasitic protozoa that causes a disease called leishmaniasis. Leishmaniasis is transmitted to humans through the bites of infected female sandflies. There are several different species of Leishmania that can cause various forms of the disease, and the symptoms can range from mild to severe, depending on species of Leishmania involved and the immune response of the host. Leishmania parasites have a variety of reservoirs, including humans, domestic animals, horses, rodents, wild animals, birds, and reptiles. Leishmaniasis is endemic of 90 countries, mainly in South American, East and West Africa, Mediterranean region, Indian subcontinent, and Central Asia. In recent years, cases have been detected in other countries, and it is already an infection present throughout the world. The increase in temperatures due to climate change makes it possible for sandflies to appear in countries with traditionally colder regions, and the easy movement of people and animals today, facilitate the appearance of Leishmania species in new countries. These data mean that leishmaniasis will probably become an emerging zoonosis and a public health problem in the coming years, which we must consider controlling it from a One Health point of view. This review summarizes the prevalence of Leishmania spp. around the world and the current knowledge regarding the animals that could be reservoirs of the parasite.
This paper analyzes the relationship between temperature, mortality, and adaptation oppor-tunities in a tropical country. Such countries host almost 40% of the world’s population and face inherently different environmental, demographic, and socio-economic conditions than their counterparts in temperate areas. Using detailed data from all Colombian municipalities, I show that anomalously hot or cold days increase mortality even at narrow temperature ranges, which are characteristic of the tropics. An additional day with a mean temperature above 27 degrees C (80.6 degrees F) increases mortality rates by approximately 0.24 deaths per 100,000, equivalent to 0.7% of monthly death rates. Unlike temperate locations, I find that deaths attributed to infectious diseases and respiratory illnesses drive this relationship in the hot part of the distribution, mainly affecting children aged 0-9. These findings uncover new factors and populations at risk and imply that the average person who dies after a hot temperature shock loses approximately 30 years of life. I also provide evidence that access to health care and quality of services could mediate between temperature and mortality.
Increased risk of occupational injuries and illnesses (OI) is associated with ambient temperature. However, most studies have reported the average impacts within cities, states, or provinces at broader scales. METHODS: We assessed the intra-urban risk of OI associated with ambient temperature in three Australian cities at statistical area level 3 (SA3). We collected daily workers’ compensation claims data and gridded meteorological data from July 1, 2005, to June 30, 2018. Heat index was used as the primary temperature metric. We performed a two-stage time series analysis: we generated location-specific estimates using Distributed Lag Non-Linear Models (DLNM) and estimated the cumulative effects with multivariate meta-analysis. The risk was estimated at moderate heat (90th percentile) and extreme heat (99th percentile). Subgroup analyses were conducted to identify vulnerable groups of workers. Further, the OI risk in the future was estimated for two projected periods: 2016-2045 and 2036-2065. RESULTS: The cumulative risk of OI was 3.4% in Greater Brisbane, 9.5% in Greater Melbourne, and 8.9% in Greater Sydney at extreme heat. The western inland regions in Greater Brisbane (17.4%) and Greater Sydney (32.3%) had higher risk of OI for younger workers, workers in outdoor and indoor industries, and workers reporting injury claims. The urbanized SA3 regions posed a higher risk (19.3%) for workers in Greater Melbourne. The regions were generally at high risk for young workers and illness-related claims. The projected risk of OI increased with time in climate change scenarios. CONCLUSIONS: This study provides a comprehensive spatial profile of OI risk associated with hot weather conditions across three cities in Australia. Risk assessment at the intra-urban level revealed strong spatial patterns in OI risk distribution due to heat exposure. These findings provide much-needed scientific evidence for work, health, and safety regulators, industries, unions, and workers to design and implement location-specific preventative measures.
Linkages between climate and human activity are often calibrated at daily or monthly resolutions, which lacks the granularity to observe intraday adaptation behaviors. Ignoring this adaptation margin could mischaracterize the health consequences of future climate change. Here, we construct an hourly outdoor leisure activity database using billions of cell phone location requests in 10,499 parks in 2017 all over China to investigate the within-day outdoor activity rhythm. We find that hourly temperatures above 30 °C and 35 °C depress outdoor leisure activities by 5% (95% confidence interval, CI 3-7%) and by 13% (95% CI 10-16%) respectively. This activity-depressing effect is larger than previous daily or monthly studies due to intraday activity substitution from noon and afternoon to morning and evening. Intraday adaptation is larger for locations and dates with time flexibility, for individuals more frequently exposed to heat, and for parks situated in urban areas. Such within-day adaptation substantially reduces heat exposure, yet it also delays the active time at night by about half an hour, with potential side effect on sleep quality. Combining empirical estimates with outputs from downscaled climate models, we show that unmitigated climate change will generate sizable activity-depressing and activity-delaying effects in summer when projected on an hourly resolution. Our findings call for more attention in leveraging real-time activity data to understand intraday adaptation behaviors and their associated health consequences in climate change research.
Exposure to ambient high temperature has been associated with numerous health outcomes. It remains largely unclear whether the heat effect may vary in the course of the warm season. This study aimed to explore the intraseasonal variation of the association between heat exposure and mortality risk during the warm season in Shandong province between 2013 and 2018. Daily data on mortality and meteorological conditions were collected from each of the 1822 sub-districts in Shandong Province during the 2013-2018 warm seasons (June-September). Conditional logistic regression with a distributed lag non-linear model was used to fit the heat-mortality association over lag 0-10 days from early (June-July) to late (August-September). The extreme heat effect was defined as the cumulative odds ratio (OR) at the 97.5th percentile of the temperature range compared to the minimum mortality temperature (MMT). Stratified analysis was conducted by sex, age-group, educational level, and cause of mortality. A J-shaped association between ambient heat and mortality risk was consistently observed across the warm season, with the MMT located at 22.5 degrees C. The extreme heat effect (OR) decreased significantly from 3.52 (95%CI: 3.10, 4.00) in the early warm season to 2.85 (95%CI: 2.48, 3.28) in the late warm season (P = 0.028). Females, elderly aged over 75 years, individuals with junior high school education or lower, and cardiorespiratory patients were more vulnerable to heat exposure compared to other population subgroups, especially in the early warm season. In conclusion, this study observed a J-shaped association between ambient warm temperature and mortality risk, with the effect size of extreme heat decreasing substantially from the early to the late warm season. The findings highlight the importance of developing health promotion strategies to offset the adverse impact of early heat.
BACKGROUND: Mosquito research in Europe has a long history, primarily focused on malaria vectors. In recent years, invasive mosquito species like the Asian tiger mosquito (Aedes albopictus) and the spread of arboviruses like dengue virus, chikungunya virus or bluetongue virus have led to an intensification of research and monitoring in Europe. The risk of further dissemination of exotic species and mosquito-borne pathogens is expected to increase with ongoing globalization, human mobility, transport geography, and climate warming. Researchers have conducted various studies to understand the ecology, biology, and effective control strategies of mosquitoes and associated pathogens. MAIN BODY: Three invasive mosquito species are established in Europe: Asian tiger mosquito (Aedes albopictus), Japanese bush mosquito (Ae. japonicus), and Korean bush mosquito (Aedes koreicus). Ae. albopictus is the most invasive species and has been established in Europe since 1990. Over the past two decades, there has been an increasing number of outbreaks of infections by mosquito-borne viruses in particular chikungunya virus, dengue virus or Zika virus in Europe primary driven by Ae. albopictus. At the same time, climate change with rising temperatures results in increasing threat of invasive mosquito-borne viruses, in particular Usutu virus and West Nile virus transmitted by native Culex mosquito species. Effective mosquito control programs require a high level of community participation, going along with comprehensive information campaigns, to ensure source reduction and successful control. Control strategies for container breeding mosquitoes like Ae. albopictus or Culex species involve community participation, door-to-door control activities in private areas. Further measures can involve integration of sterile insect techniques, applying indigenous copepods, Wolbachia sp. bacteria, or genetically modified mosquitoes, which is very unlike to be practiced as standard method in the near future. CONCLUSIONS: Climate change and globalization resulting in the increased establishment of invasive mosquitoes in particular of the Asian tiger mosquito Ae. albopictus in Europe within the last 30 years and increasing outbreaks of infections by mosquito-borne viruses warrants intensification of research and monitoring. Further, effective future mosquito control programs require increase in intense community and private participation, applying physical, chemical, biological, and genetical control activities.
Climate change is the greatest threat to global public health, although the impacts on mental health are relatively understudied. Furthermore, there is a lack of consensus about the effects of climate change on individuals with pre-existing mental health problems. This review aimed to identify the health impacts of climate change on people with pre-existing mental health problems. The search was conducted across three databases; studies were included if they involved participants who had mental health problem(s) before a climate-driven event and reported on health outcomes post-event. A total of thirty-one studies met the full inclusion criteria. The study characteristics included 6 climate-driven events: heat events, floods, wildfires, wildfire and flood, hurricanes, and droughts, and 16 categories of pre-existing mental health problems, with depression, and non-specified mental health problems being the most common. The majority of the studies (90%, n = 28) suggest an association between the presence of pre-existing mental health problems and the likelihood of adverse health impacts (e.g., increased mortality risk, new symptom presentation, and an exacerbation of symptoms). To mitigate the exacerbation of health inequalities, people with pre-existing mental health problems should be included in adaption guidance and/or plans that mitigate the health impacts of climate change, future policy, reports, and frameworks.
With a concentration of people, activities, and infrastructures, urban areas are particularly vulnerable to the negative effects of climate change. Among others, the intensification of the Urban Heat Island (UHI) effect is leading to an increased impact on citizen health and the urban ecosystem. In this context, this study aims to investigate the effect of urban morphology and land cover composition-which are established by exploiting the Local Climate Zone (LCZ) classification system-on two urban climate indicators, i.e., Land Surface Temperature (LST) and air temperature. The study area is the Metropolitan City of Milan (northern Italy). LCZ and LST maps are derived by leveraging satellite imagery and building height datasets. Both authoritative and crowdsourced in situ measurements are used for the analysis of air temperature. Several experiments are run to investigate the mutual relation between LCZ, LST, and air temperature by measuring LST and air temperature patterns in different LCZs and periods. Besides a strong temporal correlation between LST and air temperature, results point out vegetation and natural areas as major mitigating factors of both variables. On the other hand, higher buildings turn out to increase local air temperature while buffering LST values. A way lower influence of building density is measured, with compact building areas experiencing slightly higher air temperature yet no significant differences in terms of LST. These outcomes provide valuable tools to urban planners and stakeholders for implementing evidence-based UHI mitigation strategies.
Nocturnal temperature is observed increasing with global warming. However, evidence on night-time non-optimal temperature on the risk of preterm birth (PTB) is limited, and the potential interactions with air pollution on PTB has not been well clarified. We therefore conducted a population-based retrospective cohort study to evaluate the effect of night-time temperature extremes on the risk of PTB and its interaction with air pollution. Records of 196,780 singleton births from 4 counties in Huai River Basin (2013-2018) were obtained. Gridded data on night-time temperature were collected from a high-quality Chinese Air Quality Reanalysis dataset. We used a multivariate logistic regression to evaluate the effects of night-time heat and cold exposure on the risk of PTB as well as its subtypes. Potential interactions between night-time temperature extremes and fine particulate matter < 2.5 µm (PM(2.5)) were examined using the relative excess risk due to interaction (RERI). We found that the risk of PTB was positively associated with third trimester night-time extremely heat and cold exposure, with adjusted OR of 1.898 (95 %CI: 1.655-2.177) and 2.044 (95 %CI: 1.786-2.339). Similar effects were observed for PTB subtypes, moderately PTB (mPTB) and very PTB (vPTB). Synergistic effects (RERI greater than 0) of each trimester night-time temperature extremes exposure and PM(2.5) on PTB were observed. We identified consistent positive interactions between night-time temperature extremes and PM(2.5) on mPTB. No significant interaction of night-time temperature extremes and PM(2.5) on vPTB was found. In conclusion, this large retrospective cohort study found that third trimester night-time heat and cold exposure significantly increased the risk of PTB and its subtypes. There is a synergistic effect between night-time temperature extremes and high PM(2.5) levels on PTB and mPTB. In the context of climate warming, our results add new evidence to the current understanding of night-time non-optimal temperature exposure on PTB.
BACKGROUND: The number of heatstroke victims hit record numbers in 2022 as global warming continues. In heat-induced injuries, circulatory shock is the most severe and deadly complication. This review aims to examine the mechanisms and potential approaches to heat-induced shock and the life-threatening complications of heatstroke. METHODS: A computer-based online search was performed using the PubMed database and Web of Science database for published articles concerning heatstroke, shock, inflammation, coagulopathy, endothelial cell, cell death, and heat shock proteins. RESULTS: Dehydration and heat-induced cardiomyopathy were reported as the major causes of heat-induced shock, although other heat-induced injuries are also involved in the pathogenesis of circulatory shock. In addition to dehydration, the blood volume decreases considerably due to the increased vascular permeability as a consequence of endothelial damage. Systemic inflammation is induced by factors that include elevated cytokine and chemokine levels, dysregulated coagulation/fibrinolytic responses, and the release of damage-associated molecular patterns (DAMPs) from necrotic cell death that cause distributive shock. The cytoprotective heat shock proteins can also facilitate circulatory disturbance under excess heat stress. CONCLUSIONS: Multiple mechanisms are involved in the pathogenesis of heat-induced shock. In addition to dehydration, heat stress-induced cardiomyopathy due to the thermal damage of mitochondria, upregulated inflammation via damage-associated molecular patterns released from oncotic cells, unbalanced coagulation/fibrinolysis, and endothelial damage are the major factors that are related to circulatory shock.
Urban populations face increasing heat stress in cities. However, the influence of the built environment of new and old urban blocks on pedestrian thermal comfort remains unclear. This study selected typical old (Yongqingfang) and new urban areas (Knowledge City) in Guangzhou, China, as our research sites. Through field monitoring and surveys, we used physiological equivalent temperature (PET) and thermal comfort vote (TCV) to evaluate outdoor thermal comfort by thermal walk experiments. We analyzed the relationships between built environment variables, meteorological variables, and pedestrian thermal comfort at the two sites. Our analysis revealed significant differences in the built environment and meteorological conditions between the new and old urban blocks within the 60-m buffer zone. PET and TCV showed noticeable spatiotemporal variations in both sites, and their correlation was stronger in the morning (r = 0.87-0.89) than late afternoon (r = 0.60-0.70). Our stepwise regression model indicated that sky view factor and building coverage ratio significantly affected outdoor thermal comfort in old and new urban blocks. Built environment variables explained a higher percentage of the variance in PET (Yongqingfang R2: 0.59-0.82, Knowledge City R2: 0.32-0.81) than TCV (Yongqingfang R2: 0.45-0.57, Knowledge City R2: 0.48-0.69). In short, built environment variables affected thermal indices more than thermal perception. The impact of built environment variables on TCV is also greater in new urban areas than in old urban blocks. Our findings provide insights into the complex relationship between built environments and outdoor thermal comfort in different urban landscapes, which informs climate-resilient urban design.
Previous studies reported higher incidence of surgical site infection (SSI) after procedures performed in summer or with high temperatures. However, no study used detailed climate data to assess this risk after hip and knee arthroplasty, and no study specifically investigated the role of heatwaves. AIM: To assess the impact of higher environmental temperatures and heatwaves on SSI rates after hip and knee arthroplasty. METHODS: Data on hip and knee arthroplasty procedures performed between January 2013 and September 2019 in hospitals participating in the Swiss SSI surveillance were linked to climate data extracted from weather stations located in their vicinity. The association between temperature, heatwaves and SSI was studied using mixed effects logistic regression models fitted at the patient level. Poisson mixed models were fitted for both calendar year and month of the year to investigate the SSI incidence trajectory over time. RESULTS: We included 116,981 procedures performed in 122 hospitals. Significantly higher SSI rates were observed for procedures performed in the summertime (incidence rate ratio 1.39, 95% CI (1.20-1.60), P<0.001; reference: autumn) or in calendar months in which the mean temperature was above 20 °C (reference 5-10 °C; odds ratio 1.59, 95% CI (1.27, 1.98), P<0.001). We observed a slight but non-significant increase in the rate of SSI during heatwaves (1.44% versus 1.01%, P=0.2). CONCLUSION: SSI rates after hip and knee replacement appear to increase with higher environmental temperature. To establish whether, and to what extent, heatwaves increase the risk of SSI, studies involving geographical areas with larger variability in temperature are needed.
Greenery can improve the outdoor thermal environment in elderly care centers during heat wave in summer. However, it lacks quantitative results and rules. This study investigated the summer outdoor thermal environment of four representative elderly care centers in Tianjin to establish the thermal demand of seniors. The different thermal effects of greenery types (GTs) were revealed in elderly care centers. To improve the quality of the outdoor recreational space, this study utilized numerical simulation to quantitatively establish the influence of tree-shrub coverage rate (TSCR) on the thermal comfort of seniors. The results showed that the thermal neutral physiologically equivalent temperature (PET) of elderly people was 27.0 degrees C in summer, and the thermal acceptance range of PET was 23.6-36.8 degrees C. Shrubs overall could significantly increase the tree’s ability to improve the outdoor thermal environment. Furthermore, this study proposed different TSCR strategies. TSCR of the elderly care center should be greater than 31.5% to obtain great thermal acceptance for the elderly in summer; when the TSCR of the elderly care center could not reach 31.5% due to the reality, TSCR = 10.0% was the efficient strategy to improve outdoor thermal comfort. This research provided a scientific reference for the greenery configuration plan of elderly care centers in summer.
Heatwaves, which are defined as prolonged periods of time when the weather is much hotter than usual, have been always serious threats to the occupational health and productivity of workers. To reduce the risk of occupational health hazards during heatwaves, various heat protection methods have been developed and applied. One of the proposed methods is to apply personal cooling onto a certain local body part of the worker, like one’s neck or one’s torso, using thermoelectric coolers. Several commercial solutions of this type are already available in the market, but a rigorous analysis of the effects of local cooling of body parts is not yet widely available. In this study, we use a human thermal behavior model, i.e., the FIALA-FE model, to assess the effectiveness of such a personal local cooling device under heatwaves. A whole-body thermal comfort index, i.e., predicted mean vote (PMV), and a local thermal sensation index, i.e., Zhang’s local thermal comfort index, are calculated under local cooling conditions of various body parts and compared to those without any cooling to assess the effectiveness of such a local cooling strategy. Our result shows that the local cooling strategy may provide only limited protection against extreme thermal conditions like heatwaves, suggesting that basic measures for the protection of workers including assured access to drinking water, frequent rest breaks, reduction of working hours, and suspension of work must remain as the primary means for protecting workers during heatwaves.
Previous studies have proved that exposure to extreme temperature in specific windows of pregnancy could cause some complications, such as pregnancy induced hypertension (PIH) and gestational diabetes mellitus (GDM), but differences in the effect of extreme temperature on the 2 complications are rarely studied. We carried a retrospective study on the impact of temperature on GDM/PIH in different trimesters based on data from a maternal and child health center in Beijing, China. Ambient temperatures (°C) were obtained from the China Meteorological Administration from January 1st, 2013 to May 15th, 2018. We use distributed lag non-linear models (DLNMs) combined with logistic regression to calculate the lag exposure-response relationships between the temperature and GDM/PIH from 1st to 24th/20th weeks of pregnancy. In both first and second trimesters, the risk of GDM was increased in summer with high temperatures; in second trimester, the risk of GDM increased in winter with low temperatures. In first half of pregnancy, risk of PIH was decreased in winter with low temperatures. These findings can provide the guideline for preventing the GDM and PIH induced by extreme temperature during pregnancy.
The summer outdoor thermal environment is gradually deteriorating in most cities in low and middle latitudes under global warming, threatening human health and life. This study was conducted to improve this situation, in which urban surface compositions were seen as the main influencing factors at vertical and horizontal levels. Results showed urban surface compositions affected the outdoor thermal environment at both levels. CVI and GVI were the key vertical factors, while NDBI and NDVI were the crucial horizontal ones. More importantly, synergies on the outdoor thermal environment between the two levels were found, and they were higher than any single level; the sums of the independent effects were 27.05% and 64.21%, and the synergetic explanatory powers were 9.10% and 34.37% for air temperature and humidity, respectively. The potential reason for the synergy between the two levels was attributed to their correlation, especially for the CVI and GVI to the NDBI and NDVI. The TVoEs of the CVI and GVI were 0.31 and 0.17, respectively, regulating air temperature at the vertical level, and the TVoE of the NDVI was 0.33, coordinating humidity at the horizontal level. These results provide scientific evidence and data support for urban planning and landscape design.
Arboviral infections such as Zika, chikungunya, dengue, and yellow fever pose significant health problems globally. The population at risk is expanding with the geographical distribution of the main transmission vector of these viruses, the Aedes aegypti mosquito. The global spreading of this mosquito is driven by human migration, urbanization, climate change, and the ecological plasticity of the species. Currently, there are no specific treatments for Aedes-borne infections. One strategy to combat different mosquito-borne arboviruses is to design molecules that can specifically inhibit a critical host protein. We obtained the crystal structure of 3-hydroxykynurenine transaminase (AeHKT) from A. aegypti, an essential detoxification enzyme of the tryptophan metabolism pathway. Since AeHKT is found exclusively in mosquitoes, it provides the ideal molecular target for the development of inhibitors. Therefore, we determined and compared the free binding energy of the inhibitors 4-(2-aminophenyl)-4-oxobutyric acid (4OB) and sodium 4-(3-phenyl-1,2,4-oxadiazol-5-yl)butanoate (OXA) to AeHKT and AgHKT from Anopheles gambiae, the only crystal structure of this enzyme previously known. The cocrystallized inhibitor 4OB binds to AgHKT with K (i) of 300 μM. We showed that OXA binds to both AeHKT and AgHKT enzymes with binding energies 2-fold more favorable than the crystallographic inhibitor 4OB and displayed a 2-fold greater residence time τ upon binding to AeHKT than 4OB. These findings indicate that the 1,2,4-oxadiazole derivatives are inhibitors of the HKT enzyme not only from A. aegypti but also from A. gambiae.
In this study, we have used thirteen statistically downscaled bias-corrected General Circulation Models (GCMs) from Coupled Model Intercomparison Project Phase 6 (CMIP6) under the Shared Socioeconomic Pathways (SSP) scenarios. Based on these models, the projected changes in mean rainfall and daily extremes (number of rainy days and simple daily intensity) during the southwest (SW) and northeast (NE) monsoon seasons in the near (2021-2050) and far future (2071-2100) under the SSP2-4.5 & SSP5-8.5 scenarios relative to the baseline period (1985-2014) are studied. In addition to the rainfall, the maximum, minimum, and mean temperature changes and their daily extremes are also examined. Our results show that the Multi-Model Mean (MMM) slightly underestimated (overestimated) the SW (NE) monsoon rainfall compared to the observed rainfall in the baseline period. A considerable increase in future rainfall during the SW monsoon season is noticed in central India, the Himalayan region, and over the northwestern parts of India. In the NE monsoon season, south peninsular India experiences more rainfall under SSP5-8.5 than SSP2-4.5. In general, both SSPs scenarios shows increase in monsoon rainfall from the mid-century onwards. Interestingly, by the end of the 21st century the number of rainy days are projected to reduce, whereas the intensity of rainfall projected to be drastically increase over many areas of India. Analysis of temperature revealed that there is increase in the projected warming with maximum temperature is around 4.5 degrees C during summertime, with minimum temperatures of about 5 degrees C in the wintertime in northern parts of India by the end of the 21st century. Under the SSP5-8.5 scenario, increase in the highest maximum temperatures is seen in the Himalayan region and elevated minimum temperature pattern over the Indo-Gangetic Basin (IGB) is noted. This increased warming may affect the agriculture, water, health, and power sectors severely.
Combining the comprehensive effects of temperature and humidity, this study applies a heat stress index to project future population exposure to high temperature and related health-risks over China under different climate change scenarios. Results show that the number of high temperature days, population exposure and their related health-risks will increase significantly in the future compared to the reference period (1985-2014), which is mainly caused by the change of >T99p (the wet bulb globe temperature >99th percentile derived from the reference period). The population effect is absolutely dominant in influencing the decrease in exposure to T90-95p (the wet bulb globe temperature is in the range of (90th, 95th]) and T95-99p (the wet bulb globe temperature is in the range of (95th, 99th]), and the climate effect is the most prominent contributor to the upsurge in exposure to > T99p in most areas. An additional 0.1 billion person-days increase in population exposure to T90-95p, T95-99p and >T99p in a given year is associated with the number of deaths by 1002 (95% CI: 570-1434), 2926 (95% CI: 1783-4069) and 2635 (95% CI: 1345-3925), respectively. Compared with the reference period, total exposure to high temperature under the SSP2-4.5 (SSP5-8.5) scenario will increase to 1.92 (2.01) times in the near-term (2021-2050) and 2.16 (2.35) times in the long-term (2071-2100), which will increase the number of people at heat risk by 1.2266 (95% CI: 0.6341-1.8192) [1.3575 (95% CI: 0.6926-2.0223)] and 1.5885 (95% CI: 0.7869-2.3902) [1.8901 (95% CI:0.9230-2.8572)] million, respectively. Significant geographic variations exist in the changes of exposure and related health-risks. The change is greatest in the southwest and south, whereas it is relatively small in the northeast and north. The findings provide several theoretical references for climate change adaptation.
Public health agencies recommend that older adults without home air-conditioning visit cooling centres to mitigate physiological strain from high ambient temperatures during heat waves. However, there is little evidence regarding their influence on self-reported environmental symptoms and mood-state after returning to the heat. METHODS: Forty adults (64-79 years) underwent a daylong laboratory-based indoor overheating simulation (9-hours, heat index: 37 °C) with (cooling, n = 20) or without (control, n = 20) a 2-hour air-conditioning intervention (hours 5-6). Mean skin and core temperature areas under the curve (AUC, hours 0-9) were used to assess cumulative thermal strain. Group differences in total symptom scores and subjective heat illness (68-item environmental symptoms questionnaire) as well as total mood disturbance and energy index (40-item profile of mood states questionnaire) were evaluated at end-heating (adjusted for pre-exposure scores). RESULTS: Cooling reduced mean skin and core temperature AUCs by 4.0 [0.1, 0.8] and 1.6 [0.4, 2.8] °C·hour compared to control (both p < 0.048). However, at end-heating neither mean skin nor core temperatures differed between groups (both p > 0.999). Total symptom scores and subjective heat illness were 0.58-fold [0.44, 0.77] and 0.56-fold [0.40, 0.78] lower in the cooling compared to control group (both p < 0.001). Mood disturbance was 0.91-fold [0.83, 0.99] lower for cooling than control (p = 0.036), although energy index was not different between groups (p = 0.141). CONCLUSION: Cooling centres can have sustained positive effects on perceived thermal strain and mood-state in older adults after returning to the heat. However, continued vigilance and use of appropriate countermeasures to mitigate physiological strain from indoor overheating should be encouraged as body temperatures can rapidly return to pre-cooling levels.
BACKGROUND: Heat exposure, which can negatively affect human health and wellbeing, is heterogeneous within US cities. However, little is known about who can avoid heat stress by adjusting their everyday behaviour. We aimed to analyse the effect of ambient temperature on mobility, specifically subway (ie, the underground railway system) use, in New York City, NY, USA, during 2014-19. METHODS: For this empirical study, subway use across New York City was measured with turnstile data from the New York City Metropolitan Transportation Authority between Jan 1, 2014, and Dec 31, 2019. Passenger numbers were then aggregated to the zip code tabulation area (ZCTA) level. Daily observational climate data were obtained from the US National Weather Service between Jan 1, 2014, and Dec 31, 2019. Socioeconomic data at the ZCTA level originated from the American Community Survey 2019. We extracted data on population age, ethnicity, commuting, employment, median household income, rent, and health-insurance coverage. We used a fixed-effects panel-regression model to assess the influence of temperature on subway use in New York City, which was the main outcome of our study. FINDINGS: We obtained data for 438 subway stations across New York City. After data cleaning and preprocessing, the final aggregated data sample consisted of 238 508 instances of subway use in 1955 days across 6 years for 122 ZCTAs, with 168 days missing in the raw data and 67 days removed as outliers. The results of the fixed-effects panel-regression analysis showed a strong, non-linear effect of daily maximum temperature on subway use. Subway use was highest at 11·5°C and substantially decreased for temperatures that were colder and warmer than that, with reductions reaching 6·5% (95% CI 2·5-10·5) for the coldest temperature (ie, -6·5°C) and 10·5% (6·0-14·0) for the hottest temperature (ie, 34·5°C). Reductions differed between weekdays and weekends, when residents generally had more freedom to adjust their behaviour. Neighbourhoods that were at a socioeconomic disadvantage experienced smaller or no reductions in mobility in heat; mobility increased in neighbourhoods with beach access. INTERPRETATION: Our study showed that temperature had a strong, non-linear effect on subway use, but the magnitude of the effect on subway use was heterogeneous across areas of the city on warm days. Weaker avoidance of heat stress correlated with less privilege, indicating compounding health risks. Everyday behavioural adaptation to heat is therefore an effect pathway that contributes to unequal heat effects and should be explored in future research. FUNDING: The Volkswagen Foundation and the Werner Siemens Foundation.
Climate change is an active and growing threat to human health. This review examines the evidence linking climate change to kidney diseases, with a focus on acute kidney injury (AKI). RECENT FINDINGS: A growing body of evidence documents the adverse impact of various environmental and occupational exposures on kidney health. Extreme heat exposure increases the risk for AKI in vulnerable populations, particularly outdoor workers. These effects are being seen in both developed and developing nations, impacting equatorial as well as more northern climates. Climate change is also increasing the risk of water-borne and vector-borne infections, which are important causes of AKI in tropical regions. Due to overlapping environmental and social risk factors, populations in low-income and middle-income countries are likely to be disproportionately affected by climate-related health impacts, including heightened risk for kidney diseases. SUMMARY: Climate change will adversely impact global kidney health over the course of the century through effects on temperature and risk of endemic infections. Alongside efforts to aggressively reduce carbon emissions, additional research is needed to guide public and environmental health policies aimed at mitigating the impact of climate change on human health.
The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting. METHODS: A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition-measured by increased frequency of diagnosing heat emergencies and improved management-measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention. RESULTS: Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention. CONCLUSION: The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.
Exposure to climate hazards is increasing, and the experiences of frontline communities warrant meaningful and urgent attention towards how to mitigate, manage, and adapt to hazards. We report results from a community-engaged pilot (November 2021-June 2022) of N = 30 participants in four frontline communities of the San Francisco Bay Area, California, USA. The study region is an area where low-income, non-English-speaking residents are inequitably exposed and vulnerable to wildfire smoke, extreme heat, and other climate hazards. Building from a yearslong partnership of researchers, community organizations, and community members, we report the feasibility of a project piloting (1) instruments to monitor indoor air quality, temperature, and participant sleep health, and (2) interventions to improve indoor air quality and support protective behaviors. Data collection included experience-based survey data (via in-person administered surveys and a smartphone application) and interviews about heat and air quality, as well as data from an air monitoring protocol. Results cover the prevalence of hazard exposure and protective actions among participants. We discuss throughout methods for conducting and evaluating a community-engaged pilot, particularly by using a community ambassador program. Implications include the feasibility of community-engaged research projects, including discussion of resources required to accomplish this work.
We reflect on our fieldwork experience from the Climate Heat Maternal and Neonatal Health Africa (CHAMNHA) project in Kilifi, Kenya, which focused on studying the effects of extreme heat on women during pregnancy, delivery and the post-partum period. We describe the ethical and practical challenges encountered, highlighting valuable lessons learned. We propose potential solutions to address issues concerning the reciprocity of vulnerable participants and the provision of childcare and food for accompanying children. Further, we address challenges related to engaging specific participants, interview cancellations attributed to extreme temperatures and discuss the perpetuation of inequalities by ethics and academic institutions. With the anticipated increase in research at the intersection of climate change-induced heat exposure and its impacts on human populations, research institutions and ethics committees in low- and middle-income countries are responsible for instituting guidelines that account for the risks for the subjects under study and the field researchers.
Urban environments influence child behaviours, exposures and experiences and may affect health, development, achievement and realization of fundamental human rights. We examined the status of eleven UN Convention on the Rights of the Child articles, in a multi-case study across four global cities. Within all study cities, children experienced unequal exposure to urban environmental risks and amenities. Many violations of child rights are related to car-based transportation systems and further challenged by pressures on urban systems from rapid population increases in the context of climate change. A child rights framework provides principles for a collective, multi-sectoral re-imagination of urban environments that support the human rights of all citizens.
Despite evidence to suggest a relationship between time of year and hidradenitis suppurativa (HS) flaring, no studies have been conducted to date to establish a relationship directly between temperature and flaring. In this study, we aim to validate a classification approach based on administrative data for identifying medical encounters that likely represent HS flares in patient with a known diagnosis of HS within the Mass General Brigham Health System (MGB) and examine the relationship between average daily temperatures and HS disease flaring among patients in Boston. This is a retrospective cohort study. Participants were individuals with HS presenting to emergency departments or dermatology outpatient clinics with disease flares between January 2017 and January 2022. The average number of encounters for HS flares was compared with the temperature for that day and the 3- and 7-day periods prior. There were 2567 patient encounters for HS flares included in the study. Of the total identified HS flares, 75.6% occurred in females and 39.1% occurred in patients who identified as Black. Uniformly small but statistically significant relationships were noted between increased temperature and presentations for hidradenitis suppurativa flare with the highest correlation coefficient (0.0768) noted with a 3-day lag time between the heat experienced and day of presentation for flare. Increased temperature is associated with a small, but statistically significant increase in HS disease flaring. As such, HS disease flaring may rise as global temperatures do, suggesting an increase in the global burden of HS as climate change persists.
Increases in population exposure to humid heat extremes in agriculturally-dependent areas of the world highlights the importance of understanding how the location and timing of humid heat extremes intersects with labor-intensive agricultural activities. Agricultural workers are acutely vulnerable to heat-related health and productivity impacts as a result of the outdoor and physical nature of their work and by compounding socio-economic factors. Here, we identify the regions, crops, and seasons when agricultural workers experience the highest hazard from extreme humid heat. Using daily maximum wet-bulb temperature data, and region-specific agricultural calendars and cropland area for 12 crops, we quantify the number of extreme humid heat days during the planting and harvesting seasons for each crop between 1979-2019. We find that rice, an extremely labor-intensive crop, and maize croplands experienced the greatest exposure to dangerous humid heat (integrating cropland area exposed to >27 degrees C wet-bulb temperatures), with 2001-2019 mean rice and maize cropland exposure increasing 1.8 and 1.9 times the 1979-2000 mean exposure, respectively. Crops in socio-economically vulnerable regions, including Southeast Asia, equatorial South America, the Indo-Gangetic Basin, coastal Mexico, and the northern coast of the Gulf of Guinea, experience the most frequent exposure to these extremes, in certain areas exceeding 60 extreme humid heat days per year when crops are being cultivated. They also experience higher trends relative to other world regions, with certain areas exceeding a 15 day per decade increase in extreme humid heat days. Our crop and location-specific analysis of extreme humid heat hazards during labor-intensive agricultural seasons can inform the design of policies and efforts to reduce the adverse health and productivity impacts on this vulnerable population that is crucial to the global food system.
Climate change, in particular the exposure to heat, impacts on human health and can trigger diseases. Pregnant people are considered a vulnerable group given the physiological changes during pregnancy and the potentially long-lasting consequences for the offspring. Evidence published to date on higher risk of pregnancy complications upon heat stress exposure are from geographical areas with high ambient temperatures. Studies from geographic regions with temperate climates are sparse; however, these areas are critical since individuals may be less equipped to adapt to heat stress. This study addresses a significant gap in knowledge due to the temperature increase documented globally. METHODS: Birth data of singleton pregnancies (n = 42,905) from a tertiary care centre in Hamburg, Germany, between 1999 and 2021 were retrospectively obtained and matched with climate data from the warmer season (March to September) provided by the adjacent federal meteorological station of the German National Meteorological Service to calculate the relative risk of heat-associated preterm birth. Heat events were defined by ascending temperature percentiles in combination with humidity over exposure periods of up to 5 days. Further, ultrasound data documented in a longitudinal prospective pregnancy cohort study (n = 612) since 2012 were used to identify pathophysiological causes of heat-induced preterm birth. FINDINGS: Both extreme heat and prolonged periods of heat exposure increased the relative risk of preterm birth (RR: 1.59; 95% CI: 1.01-2.43; p = 0.045; RR: 1.20; 95% CI: 1.02-1.40; p = 0.025). We identified a critical period of heat exposure during gestational ages 34-37 weeks that resulted in increased risk of late preterm birth (RR: 1.67; 95% CI: 1.14-1.43; p = 0.009). Pregnancies with a female fetus were more prone to heat stress-associated preterm birth. We found heat exposure was associated with altered vascular resistance within the uterine artery. INTERPRETATION: Heat stress caused by high ambient temperatures increases the risk of preterm birth in a geographical region with temperate climate. Prenatal routine care should be revised in such regions to provide active surveillance for women at risk. FUNDING: Found in acknowledgements.
Climate change is a key factor that profoundly affects aquatic environments. Because of climate warming, the increase in the intensity and frequency of extreme climate events has aggravated the uncertainty of nitrogen pollution. However, the risk of nitrogen loss under different climatic conditions has not been well assessed, which is of great significance for controlling diffuse pollution. In this study, we used the upper and middle Wei River Basin (UMWB) as the study area, and selected organic nitrogen (Org-N) and nitrate (NO3-N) as the two forms of nitrogen pollution. Then, we quantified the contributions of 10 climate factors and combined the Soil and Water Assessment Tool (SWAT) and copula to analyze the risk of pollution when extreme weather occurs. Our results showed that during periods of high precipitation and temperature, Org-N loss accounted for 96% and 83% of the total loss, and nitrate loss accounted for 74% and 67%, respectively. Org-N loss responded more strongly to high precipitation than nitrate loss because Org-N was transported with soil particles. The attribution analysis indicated that high precipitation amount (R95P) contributed to the largest Org-N loss. As for the nitrate loss, R95P, normal precipitation amount, and consecutive days with no precipitation were the most important climatic drivers, accounting for 35%, 32%, and 13% of the watershed area, respectively. After selecting critical source areas by identification method, an optimized copula model for nitrogen loss and the main climatic factors was proposed. The risk of nitrogen pollution under the defined climate severity was then quantified. The probabilities of Org-N and nitrate loss exceeding the top 1%-20% were 0.2%-15% and 0.8%-10% when the precipitation exceeded the top 20%. The pollution risk caused by high temperatures is lower than that caused by precipitation. This study emphasized the dominant role of extreme climate in driving nitrogen loss and proposed a method for quantifying the risk of nitrogen pollution under specific climate conditions, which enabled man-agers to identify high-risk pollution areas and optimize management measures to prevent diffuse nitrogen pollution.
China faces increasing health risks from climate change. The structure and function of the eye and vision were affected by extreme heat and cold. The study aimed to evaluate the impacts of heatwaves and cold spells on glaucoma. A national cross-sectional study of the Rural Epidemiology for Glaucoma (REG-China) was conducted in ten provinces of China, and 36,081 adults aged 40 years or more were included. Glaucoma signs were assessed via a standard examination. A total of 15 heatwave definitions, based on intensity (95th to 99th percentiles of temperature distribution) and duration (≥2 days, 3 days, and 4 days), were used to quantify heatwave effects, and 6 cold spell definitions were defined based on threshold temperature percentile (5th and 10th) and duration (3 days, 5 days, and 9 days). Multivariable-adjusted logistic regression models paired with interaction analysis were performed to investigate the impacts of heatwaves and cold spells on glaucoma, and the dose-response relationships were assessed using a restricted cubic spline (RCS) model. Subgroup analysis was conducted stratified by gender, age, smoking status, occupation, and family history of glaucoma. The overall prevalence of glaucoma was 2.1% (95% CI 1.94-2.25%). Higher heatwaves were significantly correlated with higher OR of glaucoma, with the OR (95% CI) ranging from 1.014 (1.009, 1.018) to 1.090 (1.065, 1.115) by different definitions. Glaucoma was affected by heatwaves more strongly than by cold spells. The effects of both heatwaves and cold spells were higher in males than females and in smokers than nonsmokers. These results of the present study evoked the attention of prospective research to elucidate the relationship between extreme temperatures and eye diseases.
Workers in many industries are frequently exposed to hot weather conditions. To protect workers’ health and safety, it is important to evaluate the existing heat-related policies practiced in workplaces in accordance with national guidelines. We used a case study design to evaluate the existing heat-related policies of a large con-struction company and five of its subcontractors according to the guidelines provided by safe work Australia (SWA). We used snowball sampling to acquire documents from the companies. The retrieved documents were analysed thematically using the framework approach. The main guidance themes and categories were developed deductively based on “the guide for working in heat” provided by SWA. The data was interpreted and summarized. Our results suggest that all policies advised on some administrative control measures, safe work practices for workers, use of personal protective equipment, and emergency response plans. The majority of policies focus on administrative control measures, which may not be practicable at all times and are not a high level of health and safety control if implemented alone. The policies do not comprehensively cover some most important aspects of heat stress management such as consultation with workers, risk assessment of heat hazard, promoting training and awareness programs among workers, and reviewing and evaluating control measures and heat stress in-cidents. Priorities for heat-related policy development include an increased emphasis on preparation and plan-ning for hot weather in consultation with workers, along with considering location-specific, workplace, and individual risk factors in assessing the heat hazard at the workplace.
Ocean warming and marine heatwaves significantly alter environmental conditions in marine and estuarine environments. Despite their potential global importance for nutrient security and human health, it is not well understood how thermal impacts could alter the nutritional quality of harvested marine resources. We tested whether short-term experimental exposure to seasonal temperatures, projected ocean-warming temperatures, and marine heatwaves affected the nutritional quality of the eastern school prawn (Metapenaeus macleayi). In addition, we tested whether nutritional quality was affected by the duration of exposure to warm temperatures. We show the nutritional quality of M. macleayi is likely to be resilient to short- (28 d), but not longer-term (56 d) exposure to warming temperatures. The proximate, fatty acid and metabolite compositions of M. macleayi were unchanged after 28 d exposure to simulated ocean warming and marine heatwaves. The ocean-warming scenario did, however, show potential for elevated sulphur, iron and silver levels after 28 d. Decreasing saturation of fatty acids in M. macleayi after 28 d exposure to cooler temperatures indicates homeoviscous adaptation to seasonal changes. We found that 11 % of measured response variables were significantly different between 28 and 56 d when exposed to the same treatment, indicating the duration of exposure time and time of sampling are critical when measuring this species’ nutritional response. Further, we found that future acute warming events could reduce harvestable biomass, despite survivors retaining their nutritional quality. Developing a combined knowledge of the variability in seafood nutrient content with shifts in the availability of harvested seafood is crucial for understanding seafood-derived nutrient security in a changing climate.
Studies on the health effects of heat are particularly limited in Texas, a U.S. state in the top 10 highest number of annual heat-related deaths per capita from 2018 to 2020. This study assessed the effects of heat on all-cause and cause-specific mortality in 12 metropolitan statistical areas (MSAs) across Texas from 1990 to 2011. METHODS: First, we determined the heat thresholds for each MSA above which the relation between temperature and mortality is linear. We then conducted a distributed lag non-linear model for each MSA, followed by a random effects meta-analysis to estimate the pooled effects for all MSAs. We repeated this process for each mortality cause and age group to achieve the effect estimates. RESULTS: We found a 1 °C temperature increase above the heat threshold is associated with an increase in the relative risk of all-cause mortality of 0.60% (95%CI [0.39%, 0.82%]) and 1.10% (95%CI [0.65%, 1.56%]) for adults older than 75. For each MSA, the relative risk of mortality for a 1 °C temperature increase above the heat threshold ranges from 0.10% (95%CI [0.09%, 0.10%]) to 1.29% (95%CI [1.26%, 1.32%]). Moreover, elevated temperatures showed a slight decrease in cardiovascular mortality (0.37%, 95%CI [-0.35%, 1.09%]) and respiratory disease (1.97%, 95%CI [-0.11%, 4.08%]), however this effect was not considered statistically significant.. CONCLUSION: Our study found that high temperatures can significantly impact all-cause mortality in Texas, and effect estimates differ by MSA, age group, and cause of death. Our findings generate critical information on the impact of heat on mortality in Texas, providing insights for policymakers on resource allocation and strategic intervention to reduce heat-related health effects.
Studies exploring the racial/ethnicity disparity of the impact of heat on hospital admission are notably limited, especially in Texas, a state with a diverse population and consistently ranking among the top ten U.S. states for heat-related deaths per capita from 2018 to 2020. OBJECTIVE: Our objective is to determine the correlation between elevated temperatures and emergency hospital admissions for various causes and age groups across 12 Metropolitan Statistical Areas(MSAs) in Texas. Additionally, we aim to investigate health inequalities in the five largest MSAs in Texas between 2004 and 2013. METHODS: We used MSA-level hospital admission and weather data to estimate the relationship between heat and emergency hospital admissions. We applied a Generalized Additive Model and random effects meta-analysis to calculate MSA-specific associations and overall correlation, repeating the analysis for age groups and specific causes of admission. We also investigated health disparities across racial and ethnic groups and performed a sensitivity analysis. RESULTS: The results showed that a 1 °C increase in temperature was associated with a 0.50% (95% CI [0.38%, 0.63%]) increase in all-cause emergency hospital admissions. Heat’s impact on hospital admissions varied among age groups and causes, with children under 6 years showing the highest effect estimate (0.64% (95% CI [0.32%,0.96%])). Statistically significant associations were found for Cardiovascular Diseases (0.27% (95% CI [0.07%,0.47%])), Ischemic Heart Diseases (0.53% (95% CI [0.15%,0.92%])), Pneumonia (0.70% (95% CI [0.25%,1.16%])), and Respiratory Diseases (0.67% (95% CI [0.18%,1.17%])). Health disparities were found among racial and ethnic groups in the five largest MSAs. IMPACT STATEMENT: Studies exploring the impact of heat on hospital admission in Texas are notably limited. Our research provided a comprehensive examination of the connection between heat and emergency hospital admissions throughout Texas. Furthermore, we are the first to examine racial/ethnic disparities, identifying African American and Hispanic groups as disproportionately affected. These insights provide valuable insights for policymakers to allocate resources and implement strategies to mitigate the negative consequences of rising temperatures.
OBJECTIVES: Quantify the risk of mental health (MH)-related emergency department visits (EDVs) due to heat, in the city of Curitiba, Brazil. DESIGN: Daily time series analysis, using quasi-Poisson combined with distributed lag non-linear model on EDV for MH disorders, from 2017 to 2021. SETTING: All nine emergency centres from the public health system, in Curitiba. PARTICIPANTS: 101 452 EDVs for MH disorders and suicide attempts over 5 years, from patients residing inside the territory of Curitiba. MAIN OUTCOME MEASURE: Relative risk of EDV (RR(EDV)) due to extreme mean temperature (24.5°C, 99th percentile) relative to the median (18.02°C), controlling for long-term trends, air pollution and humidity, and measuring effects delayed up to 10 days. RESULTS: Extreme heat was associated with higher single-lag EDV risk of RR(EDV) 1.03(95% CI 1.01 to 1.05-single-lag 2), and cumulatively of RR(EDV) 1.15 (95% CI 1.05 to 1.26-lag-cumulative 0-6). Strong risk was observed for patients with suicide attempts (RR(EDV) 1.85, 95% CI 1.08 to 3.16) and neurotic disorders (RR(EDV) 1.18, 95% CI 1.06 to 1.31). As to demographic subgroups, females (RR(EDV) 1.20, 95% CI 1.08 to 1.34) and patients aged 18-64 (RR(EDV) 1.18, 95% CI 1.07 to 1.30) were significantly endangered. Extreme heat resulted in lower risks of EDV for patients with organic disorders (RR(EDV) 0.60, 95% CI 0.40 to 0.89), personality disorders (RR(EDV) 0.48, 95% CI 0.26 to 0.91) and MH in general in the elderly ≥65 (RR(EDV) 0.77, 95% CI 0.60 to 0.98). We found no significant RR(EDV) among males and patients aged 0-17. CONCLUSION: The risk of MH-related EDV due to heat is elevated for the entire study population, but very differentiated by subgroups. This opens avenue for adaptation policies in healthcare: such as monitoring populations at risk and establishing an early warning systems to prevent exacerbation of MH episodes and to reduce suicide attempts. Further studies are welcome, why the reported risk differences occur and what, if any, role healthcare seeking barriers might play.
Work accidents result in consequences to the employment of the population and increasing public spendings. Caused by workplace and work activity characteristics, occupational accidents may also derive from ergonomics and comfort issues. Heat stress is a discomfort factor that affects workers when exposed to temperatures above the body limits, resulting in exhaustion, dizziness, reduced cognitive performance and, eventually, injuries and accidents. Under the current climate change scenario characterized by increase of temperature projections all around the world, the heat stress issue becomes even more significant. However, in Brazil, this topic is yet little explored, especially regarding the investigation of historical data on occupational accidents considering the climatic variables. This paper aims at filling a part of this gap by presenting a new database that unifies a work accident database -recording from 2006 to 2019 -with meteorological data of the place and time of the accident. We investigate the relationship between these two datasets through the application of Multiple Correspondence Analysis (MCA) in the R Software. Our results show some association between accident variables and heat stress variables. We identify some of the more critical workers’ characteristics in this context and the most exposed regions of Brazil. Our database allows the continuity and expansion of this type of research in Brazil, and the MCA results point to a positive association between the occurrence of accidents with climatic variables. It may pave a new path for research that can detail and deepen the discussion on the behavior of these variables.
Urban heat islands (UHIs) have become an especially relevant phenomenon as a consequence of global warming and the growing proportion of people living in cities. The health impacts that are sometimes attributed to the rise in temperature generated in an UHI are not always adequately justified. The objective is to analyse what effect UHIs have on maximum (Tmax) and minimum daily temperatures (Tmin) recorded in urban and non-urban observatories, and quantify the impact on morbidity and mortality during heat waves in Spain’s five cities. Data were collected on natural-cause daily mortality and unscheduled emergency hospital admissions (ICD-10: A00-R99) registered in these 5 cities across the period 2014-2018. We analysed daily Tmax and Tmin values at urban and non-urban observatories in these cities, and quantified the impact of Tmax and Tmin values during heat waves in each of these cities, using GLM models that included Tmax only, Tmin only, and both. We controlled for air pollution and other meteorological variables, as well as for seasonalities, trend and the autoregressive nature of the series. The UHI effect was observed in Tmin but not in Tmax, and proved to be greater in coastal cities than in inland and more densely populated cities. The UHI value in relation to the mean Tmin in the summer months ranged from 1.2 °C in Murcia to 4.1 °C in Valencia (difference between urban/non-urban observatories). The modelling process showed that, while a statistically significant association (p < 0.05) was observed in inland cities with Tmax for mortality and hospital admissions in heat waves, in coastal cities the association was obtained with Tmin, and the only impact in this case was the UHI effect on morbidity and mortality. No generalisations can be made about the impact of UHI on morbidity and mortality among the exposed population in cities. Studies on a local scale are called for, since it is local factors that determine whether the UHI effect will have a greater or lesser impact on health during heat-wave events.
With rising temperature extremes, older workers are becoming increasingly vulnerable to heat-related injuries because of age- and disease-associated decrements in thermoregulatory function. Endothelial monocyte-activating polypeptide-II (EMAP-II) is a proinflammatory cytokine that has not yet been well-characterized during heat stress, and which may mediate the inflammatory response to high levels of physiological strain. We evaluated serum EMAP-II concentrations before and after 180 min of moderate-intensity work (200 W/m(2) ) in temperate (wet-bulb globe temperature [WBGT] 16°C) and hot (WBGT 32°C) environments in heat-unacclimatized, healthy young (n = 13; mean [SD]; 22 [3] years) and older men (n = 12; 59 [4] years), and unacclimatized older men with hypertension (HTN) (n = 10; 60 [4] years) or type 2 diabetes (T2D) (n = 9; 60 [5] years). Core temperature and heart rate were measured continuously. In the hot environment, work tolerance time was lower in older men with HTN and T2D compared to healthy older men (both p < 0.049). While core temperature and heart rate reserve increased significantly (p < 0.001), they did not differ across groups. End-exercise serum EMAP-II concentrations were higher in young men relative to their older counterparts due to higher baseline levels (both p ≤ 0.02). Elevations in serum EMAP-II concentrations were similar between healthy older men and older men with HTN, while serum EMAP-II concentrations did not change in older men with T2D following prolonged work in the heat.Serum EMAP-II concentrations increased following prolonged moderate-intensity work in the heat and this response is influenced by age and the presence of HTN or T2D.
Human health in Odisha is directly vulnerable to climate change in the form of mortality as a result of climate-induced natural disasters (CINDs) and heatwaves. More frequent and intensified CIND has become an inevitable part of the state and its impact on human health has been detrimental. The magnitude of the impact of climate change on human health depends on the vulnerability and adaptation approaches of the state. The objectives of the paper are to study the changing pattern of climatic variability over 20 years in the state and to analyze the direct impact of climate change on human health in Odisha. Linear trend analysis is performed for annual average, pre-monsoon, monsoon, and post-monsoon rainfall as well as annual maximum and minimum temperature and for the heatwave period to show the changing pattern of climate in the state over 20 years. Regression analysis is performed between the indexed value of vulnerability and adaptation coefficients considered in the study as independent variables and mortality due to CIND as the dependent variable to analyze the impact of climate change on human health in the state. Also, correlation analysis is conducted to show the association between heatwave mortality and the maximum temperature of the heatwave period. The rainfall trend of the state for 20 years from 2000 to 2020 is found to increase in pre-monsoon and post-monsoon periods, while the annual average rainfall of the state for 20 years is slightly increasing and the monsoon period rainfall has remained consistent throughout the years. The annual maximum and minimum temperature and the heatwave period are found to be increasing. The regression analysis has shown a significant positive relationship between vulnerability coefficients and mortality as a direct impact of CIND on human health, whereas adaptation coefficients exhibit negative relation with it. Also, there is a moderate but significant association between the maximum temperature of the heatwave period with heatwave mortality. Odisha has been vulnerable to climate change during 2000-2020 as indicated by the high vulnerability score compared to the adaptation score for each year. However, years with better adaptive approaches, having high adaptive index scores, experienced less human mortality even with high vulnerability scores.
Climate warming poses a serious threat to public health, especially in South China. This study analyzes the impact of climate warming on population mortality and adaptive behavior in South China from the perspective of economic heterogeneity. The study constructs a temperature-mortality response model using mortality data from 134 major cities in South China from 1999 to 2019. The two-way fixed effects method is used for empirical estimation. The following are the main findings. (1) High temperature has a significant impact on mortality in South China. Compared with rich cities, high temperature significantly increases mortality in poor cities. (2) Under the RCP8.5 concentration scenario, climate warming will increase population mortality by 19.37% in South China and 34.32% in poor cities over the period 2080-2099. (3) Outmigration by the rural population is an important adaptive behavior to high temperatures. This behavior also shows economic heterogeneity. These findings have several policy implications for mitigating the impact of climate warming on mortality. Policymakers should provide more support to poor areas to improve their ability to adapt to climate change.
Thailand is a tropical developing country which has a serious increase in health risk due to hot weather exposure among outdoor workers. OBJECTIVES: The aims of this study were to compare the factors related to environmental heat exposure in three different seasons, and to assess the relationship between environmental heat and dehydration status in each season among farmworkers in Nakhon Ratchasima, Thailand. METHODS: A semi-longitudinal study was carried out in 22 male farmworkers throughout a year of farming. The primary data were collected in farmworkers for socio-demographic information, clinical assessments, and heat-related illnesses. RESULTS: Average of environmental heat index (Median, SD) were severe in summer (WBGT=38.1, 2.8°C), rainy season (WBGT=36.1, 2.1°C), and winter (WBGT=31.5, 2.7°C). Average urine Sp. Gr. in summer, rainy season, and winter were 1.022, 1.020, and 1.018 respectively. The third sentence should be corrected as follows: The Friedman analysis revealed a statistically significant difference between the three different seasons in WBGT (wet bulb globe temperature), body temperature, heart rate (P<0.01), and respiratory rate (P<0.05). There was a statistically significant difference between the three different seasons for skin rash/itching, dizziness, muscle cramp dyspnea (P<0.05), and weakness (P<0.01). Wilcoxon signed-ranks analysis found a significant difference in the medians of the paired sets of urine Sp. Gr. values between baseline and summer (P<0.05). Spearman's rank correlation coefficient did not find a relationship between WBGT and urine Sp. Gr. in the three different seasons. CONCLUSIONS: This study demonstrated that farmworkers had exposure to environmental heat stress which was expressed through physical changes. Therefore, there is a need for either interventions or guidelines to prevent dehydration for outdoor workers in this region.
Children in developing countries such as India will experience severe consequences of climate change. Primary school students, in particular, are the most vulnerable to extreme weather conditions, such as heat waves intensifying due to climate change. This will adversely impair their development, well-being, and learning outcomes. However, significant research gaps exist in understanding and mitigating children’s vulnerabilities. There is an urgent need for a deeper understanding of the impact of heat waves on children’s health and well-being in India. Further, the discussion on the state of heat safety in Indian primary schools is limited. This study addresses these gaps by surveying 335 primary school teachers in seven Indian cities. The data gathered from the field survey offers a better understanding of classroom experiences and challenges encountered by children and teachers during heat waves. It underscores several aspects of students’ vulnerability to heat exposure and its adverse impact on their health, such as absence from school, physical symptoms of heat distress, etc. Furthermore, it highlights the pressing need for classroom heat risk management in light of climate change and makes several policy prescriptions in primary schools.
With the influence of climate change resulting in more extreme days, a rise in the number of work-related injuries could be expected. The literature has addressed the performance evaluation of a work-related injury insurance (WII) system via a two-stage structure with input/output correlation as well as the impact of extreme temperatures under different scenarios. This article thus evaluates the performance of a system comprised of operational and service sub-systems under three scenarios of extreme temperatures and proposes a hybrid two-stage dynamic data envelopment analysis (DEA) model with nondiscretionary variables for measuring integrated WII efficiency under the three scenarios. The results are as follows: (1) the poor performance of the operational and service sub-systems leads to the integrated WII system’s low efficiency for 30 provinces in China during 2010-2019, except for Zhejiang, Hainan, and Qinghai. (2) Extreme temperatures must be considered when measuring WII efficiency and its stage efficiencies, or otherwise WII efficiency and operational efficiency will be underestimated in 19 provinces. (3) The negative impacts of extreme temperatures on the efficiency of the integrated WII system should be taken notice of, especially for Sichuan.
Objective: This review will provide better insight into developing and validating a heat vulnerability assessment tool for Pakistan.Methods: A literature search was done to identify studies onon heat vulnerability assessment published from January 2012 to January 2021 (10 years). Online databases PubMed, Google Scholar, Scopus, and Web of science were used for the literature search.Results: Heat vulnerability can be evaluated by some specific determinants that have heat-related health events, including social, economic, environmental, housing, and geographical factors.Conclusion: This tool will identify heat vulnerability risks and mitigate morbidity and mortality.
The local climate zone (LCZ) has been an important land surface classification used to differentiate urban climate between localities. The general knowledge maps of LCZ studies are needed when LCZ-related research has attracted great attention. This study integrated bibliometrics and critical review to understand the status quo and suggest future research directions. Bibliometrics provided a statistical technique to explore large volumes of article data from the Web of Science, ScienceDirect, and Scopus databases, based on the Co-Occurrence 13.4 (COOC) software. The bibliometric results indicated a rapid increase in LCZ publications and identified the high-frequency keywords which can be clustered into two groups, including a human thermal comfort-related group and the other urban climatology-related one. From 2011 to 2020, the effects of land use and urban morphology on urban climate and heat island effects predominated the LCZ-related research. Since 2021, the research focuses had shifted to the fields of thermal environment and heatwave, due to the growing demand for human thermal comfort and heat risk reduction. Moreover, this study identified ‘Land Surface Temperature’ and ‘Heatwave’ as two focuses of LCZ-related research during the last decade. Their critical reviews demonstrated the need for additional in-depth LCZ-heatwave studies that consider the risk of human exposure. This study also recommended incorporating hydrological concerns and social issues into the LCZ plan for a more integrated LCZ research outlook. Overall, this study provides not only a comprehensive understanding of LCZ knowledge networks, but also critical details on research focuses and potential research prospects.
The potential critical windows for extreme ambient temperature, air pollution exposure and small for gestational age (SGA) are still unclear, and no study has explored their joint effects on SGA. In a national multi-center prospective cohort, we included 179,761 pairs of mother-infant from 16 counties of 8 provinces in China during 2014-2018. Daily averaged temperature and PM(2.5) concentration were matched to the maternal residential address to estimate personal exposure. Extreme temperature exposures were categorized by a series of percentile in each meteorological and geographic division for the entire pregnancy, each trimester and gestational week (GA-week). Generalized linear mixed models (GLMMs) and distributed lag nonlinear models (DLNMs) were used to estimate the whole pregnancy-, trimester-specific, and weekly-specific associations of extreme temperature and PM(2.5) exposures with SGA. Combined effects were evaluated with the relative excess risk due to interaction (RERI) and proportion attributable to interaction (AP). We observed that by referring to temperature at the 41st – 50th percentile, heat (>90th percentile) exposure during 13th – 29th GA-weeks was associated with SGA; odds ratio (OR) and 95 % confidence intervals (CI) was 1.16 (1.06, 1.28). For cold (<=10th percentile), inverse associations were observed during the 1st - 8th GA-weeks. PM(2.5) exposure during the 2nd - 5th and 19th - 27th GA-weeks was associated with SGA, with the strongest association in the 2nd GA-week (OR = 1.0017, 95 %CI: 1.0001, 1.0034, for a 10 μg/m(3) increase). No interactive effects between ambient temperature and PM(2.5) on SGA were observed. Our findings suggest the weekly susceptibility windows for heat and PM(2.5) exposure were primarily the gestational weeks within the 2nd trimester, therefore, corresponding protective measures should be conveyed to pregnant women during routine prenatal visits to reduce exposures.
The production and quality of human life have been impacted by the extreme heat wave events caused by global warming and urbanization. This study analyzed the prevention of air pollution and the strategies of emission reduction based on decision trees (DT), random forests (RF), and extreme random trees (ERT). Additionally, we quantitatively investigated the contribution rate of atmospheric particulate pollutants and greenhouse gases to urban heat wave occurrences by combining numerical models and big data mining technology. This study focuses on changes in the urban environment and climate. The main findings of this study are as follows. The average concentrations of PM(2.5) in the northeast of Beijing-Tianjin-Hebei in 2020 were 7.4%, 0.9%, and 9.6% lower than those in the corresponding years of 2017, 2018, and 2019, respectively. The carbon emissions in the Beijing-Tianjin-Hebei region showed an increasing trend during the previous 4 years, which was consistent with the spatial distribution of PM(2.5). In 2020, there were fewer urban heat waves, which was attributable to a reduction of 75.7% in emissions and an improvement of 24.3% in the prevention and management of air pollution. These results suggest that the government and environmental protection agencies need to pay attention to changes in the urban environment and climate to diminish the negative effects of heatwaves on the health and economic growth of the urban population.
A growing body of literature recognises the importance of nature-based solutions in providing resilience to the effects of climate change by mitigating urban heat islands. However, a knowledge gap exists regarding the contribution of blue spaces to the urban environment. Recent evidence suggests that blue spaces within urban canyons can promote pollutant removal via the vertical transport of air under certain conditions, but this is inconclusive. Using a numerical solver that accounts for evaporation effects, we investigate the influence of blue space size and shape on the in-canyon flow structure, temperature and water vapour distribution. Simulations were performed for water bodies of varying size and shape at different temperatures compared to the surrounding air. Results suggest that inadequately sized warmer water bodies are unable to promote sufficient vertical transport for pollutant removal, leading to overturning and increased temperature and humidity levels at the pedestrian level, thereby worsening environmental conditions and increasing the risk of heat-related illness and mortality. Hence, larger water bodies are better suited to nocturnal transport of pollutants and accumulated warm air away from the urban surface, while smaller water bodies are better suited to providing localised evaporative cooling. Lastly, irregular water bodies may have a greater cooling effect across a larger area.
Policy Points After decades of scientific progress and growth in academic literature, there is a recognition that climate change poses a substantial threat to the health and well-being of individuals and communities both in the United States and globally. Solutions to mitigate and adapt to climate change can have important health cobenefits. A vital component of these policy solutions is that they must also take into consideration historic issues of environmental justice and racism, and implementation of these policies must have a strong equity lens.
Ambient temperatures exceeding 40 °C are projected to become common in many temperate climatic zones due to global warming. Therefore, understanding the health effects of continuous exposure to high ambient temperatures on populations living in hot climatic regions can help identify the limits of human tolerance. OBJECTIVE: We studied the relationship between ambient temperature and non-accidental mortality in the hot desert city of Mecca, Saudi Arabia, between 2006 and 2015. METHODS: We used a distributed lag nonlinear model to estimate the mortality-temperature association over 25 days of lag. We determined the minimum mortality temperature (MMT) and the deaths that are attributable to heat and cold. RESULTS: We analyzed 37,178 non-accidental deaths reported in the ten-year study period among Mecca residents. The median average daily temperature was 32 °C (19-42 °C) during the same study period. We observed a U-shaped relationship between daily temperature and mortality with an MMT of 31.8 °C. The total temperature-attributable mortality of Mecca residents was 6.9% (-3.2; 14.8) without reaching statistical significance. However, extreme heat, higher than 38 °C, was significantly associated with increased risk of mortality. The lag structure effect of the temperature showed an immediate impact, followed by a decline in mortality over many days of heat. No effect of cold on mortality was observed. IMPACT STATEMENT: High ambient temperatures are projected to become future norms in temperate climates. Studying populations familiar with desert climates for generations with access to air-conditioning would inform on the mitigation measures to protect other populations from heat and on the limits of human tolerance to extreme temperatures. We studied the relationship between ambient temperature and all-cause mortality in the hot desert city of Mecca. We found that Mecca population is adapted to high temperatures, although there was a limit to tolerance to extreme heat. This implies that mitigation measures should be directed to accelerate individual adaptation to heat and societal reorganization.
Cities around the world are experiencing the effects of climate change via increasing extreme heat wors-ened by urbanization. Within cities, there are disparities in extreme heat exposure that are apparent in various surface and remotely sensed observations, as well as in the health impacts. There are, however, large data gaps in our ability to quantify the heat experienced by people in their daily lives across urban areas. In this paper, we use hyperlocal observations to mea-sure heat around Miami-Dade County, Florida. Temperature and humidity measurements were collected at sites through-out the county between 2018 and 2021 with low-cost sensors. By comparing these hyperlocal observations with a National Weather Service (NWS) site at the Miami International Airport (MIA), we show that maximum temperatures are on aver-age 6 degrees F (3.3 degrees C) higher and maximum heat index values are 11F (6.1 degrees C) higher at sites in the county than at MIA. These measurements show that many sites frequently record a heat index above the local threshold value for heat advisory. This is in contrast with the fact that few forecast advisories are issued, and there are correspondingly few exceedances of the threshold at MIA. We use these results to motivate a discussion about the issues of this particular threshold for Miami- Dade County. We highlight the need for data that are closer to residents’ lived experience to assess the impacts of heat and help inform local and regional decision-making, particularly where heat exposure may be underappreciated as a potential public health hazard.
Urban heat is a critical problem due to global warming and heat island effects. Urban heat will be further aggravated in the coming decades. It is essential to develop heat action plans for heat mitigation and adaptation, while limited studies have been carried out to support this. Focusing on the payment for heat-resilient infrastructure, this study investigated public willingness to pay (WTP), based on an empirical study in Guangzhou, China. In particular, this study analyzed heat -related impacts on daily functions, heat-related physiological and psychological impacts and associated symptoms, heat-related perception, awareness, knowledge, and familiarity, the WTP and payment amount, and the associated mechanisms. The results indicated that outdoor activ-ities and work/study were the two most affected daily functions. The levels of the respondents’ heat-related awareness, knowledge, and familiarity were significantly lower than their perceived heat severity. Moreover, the severity of psychological impacts was the same as that of physio-logical impacts. Heat-related psychological impacts have received less attention, in both research and practice, compared with physiological impacts, so that psychological impacts deserve more attention in future studies. With the analysis of 352 valid questionnaires, this study showed that >90% of the respondents expected the government to be involved in the payment for heat -resilient infrastructure, while about 42.3% of the respondents could support the payment. About 38.4% of the respondents directly expressed that they could pay for heat-resilient infra-structure, and 27.3% of the respondents did not care. At last, it is estimated that the average payment amount could be 19.9, 23.8, and 27.6 Yuan, among all respondents, according to the conservative, median and aspirational scenarios. The results also found that heat-related impacts on sleep/rest and heat adaptation awareness had significantly positive impacts on payment willingness. The experience of heat-related psychological illness and heat adaptation awareness had significantly positive impacts on the payment amount. Overall, this paper provides a reference for understanding heat-related payment issues and is conducive to formulating effective and proper economic support for improving heat mitigation and adaptation capacity.
The thermal comfort perceptions of transit users at streetcar stops are critical to their overall ridership experience and health. Extreme heat is increasing due to climate change and the urban heat island effect, exposing transit users to greater heat stress. Through a survey of streetcar users and interviews with streetcar decisionmakers, we explored the outdoor thermal comfort perceptions and transit stop design preferences of the Sun Link streetcar in Tucson, Arizona. Perceptions of heat among streetcar users varied by stop, with survey data revealing that 82.4 % of users reported feeling hot at the stops. Additionally, 56.08 % of users surveyed reported that more shade and trees would improve their thermal comfort. Heat risk is recognized by most decision-makers at Sun Link streetcar, primarily for their employees but also for users. Decision-makers reported needing additional resources to address transit user heat risk. We recommend increased awareness about extreme heat and heat resilience strategies at the stops, such as more shade and more frequent service, to help improve users’ thermal experience. Other transit systems facing increasing heat should also consider increasing heat risks and the thermal comfort perceptions of their users.
BACKGROUND: Studies which analyse the joint effect of acoustic or chemical air pollution variables and different meteorological variables on neuroendocrine disease are practically nonexistent. This study therefore sought to analyse the impact of air pollutants and environmental meteorological variables on daily unscheduled admissions due to endocrine and metabolic diseases in the Madrid Region from January 01, 2013 to December 31, 2018. MATERIAL AND METHODS: We conducted a longitudinal, retrospective, ecological study of daily time series analysed by Poisson regression, with emergency neuroendocrine-disease admissions in the Madrid Region as the dependent variable. The independent variables were: mean daily concentrations of PM(10), PM(2.5), NO(2) and O(3); acoustic pollution; maximum and minimum daily temperatures; hours of sunlight; relative humidity; wind speed; and air pressure above sea level. Estimators of the statistically significant variables were used to calculate the relative risks (RRs). RESULTS: A statistically significant association was found between the increase in temperatures in heat waves, RR: 1.123 95% CI (1.001-1.018), and the number of emergency admissions, making it the main risk factor. An association between a decrease in sunlight and an increase in hospital admissions, RR: 1.005 95% CI (1.002 1.008), was likewise observed. Similarly, ozone, in the form of mean daily concentrations in excess of 44 μg/m(3), had an impact on admissions due to neuroendocrine disease, RR: 1.010 95% CI (1.007-1.035). The breakdown by sex showed that in the case of women, NO(2) was also a risk factor, RR: 1.021 95% CI (1.007-1.035). CONCLUSION: The results obtained in this study serve to identify risk factors for this disease, such as extreme temperatures in heat waves, O(3) or NO(2). The robust association found between the decrease in sunlight and increase in hospital admissions due to neuroendocrine disease serves to spotlight an environmental factor which has received scant attention in public health until now.
The impact of rising greenhouse gases (GHGs) in the atmosphere on the temperature distributions is felt not only in the mean values but primarily in the extremes. The temperature distributions are becoming slightly flattened and more broadened towards higher values, leading to a decrease in extreme cold events and more importantly to a considerable increase in the frequency and intensity of extreme hot events. These changes are no longer simple projections but are already occurring. It is thus imperative an assessment of the projected changes even under reduced emissions scenarios for the entire 21st century. In this study, a multi-variable ensemble based on 13 EURO-CORDEX high-resolution simulations at 0.11 degrees resolution, was used to analyse the extreme heat events as well as the Universal Thermal Climate Index (UTCI) for such extremes between March and November over Portugal. The 13 simulations have in common three Representative Concentration Pathways (RCP), RCP2.6, RCP4.5 and RCP8.5 as well as data covering a historical period (1971-2000) and three future consecutive periods, 2011-2040, 2041-2070 and 2071-2 100. The results show that severe future heatwaves will develop beyond the extended summer months in all scenarios. Even under a high mitigation scenario (RCP2.6), the number of heatwaves will more than double in number, relative to the historical record. In the high emission scenario (RCP8.5), a sharp increase in the number, severity and areal extension of heatwaves is projected for the end of the 21st century. The analysis of the heat stress indicates that most of the projected future heatwaves will induce heat stress and the projected increase in areal extension and the number of occurrences will have an impact on morbidity and mortality rates simply due to the shear rise in the number of the affected population and the increased frequency of occurrence.
This commentary on a case outlines 4 interventions that would help to prevent or mitigate illness and attendant loneliness affecting vulnerable patients during extreme weather events. It suggests that an individualistic approach to the collective problem of climate change is inadequate and that health professionals and health organizations should (1) transition from reactive climate change strategies to integrating disaster preparedness into daily operations and (2) advocate for changes in society that address harms and begin to mitigate the negative effects of climate change, especially on marginalized people.
Southeast Asia (SEA) is experiencing rapid warming, leading to more extreme heatwaves. Sustained compound heatwaves, with high temperatures during day and at night, pose profound threats in highly vulnerable regions, resulting in great stress on society. We estimated the changes in the compound heatwave characteristics and population exposure over SEA at the end of the 21st century based on the model outputs from the Coupled Model Intercomparison Project Phase 6. Results show that the projected compound heatwaves have significant intensified over SEA linked to increasing greenhouse gas emissions. Contemporary younger generations will face more potential risks than their parents’ generation. A child born in the 2010s will experience 1,000 discrete heatwaves in their lifetime, a threefold increase compared with the 1980s. Climate change and population growth combine to drive increased population exposure. The climate effect accounts for 125% in the 0-24-year-old cohort, whereas the interaction effect accounts for 85% in the 75+ age group. The relative importance of effects evolves dynamically across age groups, gradually shifting from a predominance of climate effects to a synergy of the climate and population effects. Significant regional inequalities exist in the increased population exposure over SEA. The largest increase occurs in Indonesia, where the aggregate exposure ranges from 45 billion person-days under the SSP1-2.6 scenario to 81 and 108 billion person-days, respectively, in the higher SSP2-4.5 and SSP5-8.5 scenarios. The study emphasizes the need for the SEA countries to focus on heat-stress adaptation strategies, while also working toward fulfilling emission reduction commitments.
The climate change leads to periods of extreme events (i.e. reduction of cold seasons, heat waves, overheating, urban heat island among others) that affect the performance of residential and tertiary buildings with high occupancy (i.e. hospitals, schools, commercial centres, offices etc). However, most of low-carbon policies do not consider the ventilation as a mitigation measure. In fact, a lack of studies on natural ventilation (NV) and mixedmode (MM) strategies was detected, especially for warm regions or areas with hot and humid climates. This paper aims to carry out a bibliometric analysis from 1928 to 2023, to observe the evolution of the topic. After identifying the main research clusters (thermal comfort, energy efficiency, indoor air quality and simulation tools) by science mapping, the most relevant publications of the last 20 years were assessed (2003-2023). The results of this study revealed that only 1.51 % of the scientific documents in 95 years corresponded to an extensive literature review, although epidemic or disease outbreaks led to peaks of production in this topic. This emphasizes the importance of observing what was done and how was implemented over the years. Regarding the clusters, some relevant aspects can be highlighted: (i) non-homogeneity of studies on NV or MM related to building type; (ii) interregional projects should be drawn up to check the effectiveness of NV and MM, especially when other architectural techniques are adopted (i.e. solar chimneys, window wall ratio -WWR-, thermally activated building structures -TABS- etc); (iii) the optimization of simulation tools should be based on the incorporation of BIM and generative design for NV and MM.
This article contributes to theoretical understandings of the relationships among extreme heat vulnerability, energy equity and home thermal security (HTS) – the ability to maintain a home thermal environment consistent with basic health, social and financial needs. Based on three years of mixed-methods qualitative research among social service practitioners, landlords and residents of mobile and manufactured housing (MH) communities, we argue that thermal insecurity is a socially produced, rather than intrinsic, feature of MH. We use the thermal struggles of MH residents to illustrate how gaps in research, markets, landlord-tenant law, policy, and specific government programs overlap to produce MH as a site of hyper-exclusion from many tools used to mitigate and adapt to climate risk. We find that most MH residents, despite barriers and a warming climate, are able to maintain some level of HTS. We highlight the small-scale, improvisational strategies that households use to cope and adapt to the extreme temperatures. HTS is an achievement sustained by a variety of elements that cannot be reduced to simple metrics (e.g., presence of air conditioning). We conclude with a practical set of policy rec-ommendations as well as a call for an expansive “climate finance” that includes the improvisational practices of excluded groups as innovations worth learning from and investing in.
Increased temperature risk in cities threatens the health and well-being of urban population and is fueled by climate change and intensive urbanization. Consequently, further steps must be taken for assessing temperature conditions in cities and their association with public health, in order to improve public health prevention at local or regional level. This study contributes to solving the problems by analyzing the connection between extreme temperatures and the tendencies of all-cause hospital admissions. The analyses used (a) 1-h air temperature data, and (b) daily data of all-cause hospital admissions. The datasets include the summer period (June, July, August) for the years 2016 and 2017. We tested the effects of two temperature indices, day-to-day change in maximum temperature – T(max,c) and daily temperature range – T(r), with all-cause hospital admission subgroups, such as all-cause cases – H(a), hospital admissions in the population below 65 – H(a)<65, and hospital admissions in the population aged 65 and over - H(a)≥65. The results show the highest values of H(a) when T(max,c) is between 6 and 10 °C. Therefore, more intensive hospital admissions can be expected when T(max) increases from day-to-day (positive values of T(max,c)), and it is more visible for H(a) and H(a)<65 (1 °C = 1% increase in hospital admissions). Also, T(r) values between 10 °C and 14 °C cause an increase in the number of hospital admissions, and it is more noticeable for H(a)≥65.
BACKGROUND AND OBJECTIVES: Extremely hot temperature affects psychological well-being negatively, especially for older adults with lower socioeconomic status (SES). The objectives of this study are to examine: (a) the impact of hot instantaneous temperature on older adults’ emotional well-being and (b) whether meaningful engagement could reduce the above impact, particularly for those of lower SES. RESEARCH DESIGN AND METHODS: We conducted a quantitative time-sampling study during hot-weather months (May-September) in 2021 and 2022. The sample comprises 344 participants aged 60 years or older (M(age) = 67.15, SD(age) = 5.26) living in urban areas of Hong Kong, where hot days (daily maximum temperature ≥33°C) accounted for 23% of the study days. Participants reported positive and negative affect, and engagement in meaningful activities, three times a day over a 10-day period, and wore sensors that tracked the instantaneous temperature of their immediate environment. Multilevel modeling was employed to examine the impacts on affect from temperature, SES, and meaningful activity engagement. RESULTS: Hotter instantaneous temperature predicted greater momentary negative affect and less positive affect immediately afterwards. Meaningful engagement significantly buffered against the affective impacts of hotter temperature, and this buffering effect was more salient among older adults of lower SES. DISCUSSION AND IMPLICATIONS: This study highlights the role of meaningful engagement in reducing the impact of hotter instantaneous temperature on older adults’ emotional well-being, particularly for those of lower SES. Meaningful activity engagement may be capitalized on, as a strategy, to reduce climate-related social inequality.
BACKGROUND: Previous research has shown that cocaine-associated deaths occur more frequently in hot weather, which has not been described for other illicit drugs or combinations of drugs. The study objective was to evaluate the relation between temperature and risk of death related to cocaine, opioids and amphetamines in British Columbia, Canada. METHODS: We extracted data on all deaths with cocaine, opioid or amphetamine toxicity recorded as an underlying or contributing cause from BC vital statistics for 1998-2017. We used a time-stratified case-crossover design to estimate the effect of temperature on the risk of death associated with acute drug toxicity during the warmer months (May through September). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each 10°C increase in the 2-day average maximum temperature at the residential location. RESULTS: We included 4913 deaths in the analyses. A 10°C increase in the 2-day average maximum temperature was associated with an OR of 1.43 (95% CI 1.11-1.86) for deaths with only cocaine toxicity recorded (n = 561), an OR of 1.15 (95% CI 0.99-1.33) for deaths with opioids only (n = 1682) and an OR of 1.11 (95% CI 0.60-2.04) for deaths with amphetamines only (n = 133). There were also elevated effects when toxicity from multiple drugs was recorded. Sensitivity analyses showed differences in the ORs by sex, by climatic region, and when the location of death was used instead of the location of residence. INTERPRETATION: Increasing temperatures were associated with higher odds of death due to drug toxicity, especially for cocaine alone and combined with other drugs. Targeted interventions are necessary to prevent death associated with toxic drug use during hot weather.
This paper aims to investigate the following research questions: (1) what are the hourly patterns of heat index and heat-related emergency medical service (EMS) incidents during summertime?; and (2) how do the lagged effects of heat intensity and hourly excess heat (HEH) vary by heat-related symptoms? Using the hourly weather and heat-related EMS call data in Austin-Travis County, Texas, this paper reveals the relationship between heat index patterns on an hourly basis and heat-related health issues and evaluates the immediate health effects of extreme heat events by utilizing a distributed lag non-linear model (DLNM). Delving into the heat index intensity and HEH, our findings suggest that higher heat intensity has immediate, short-term lagged effects on all causes of heat-related EMS incidents, including in cardiovascular, respiratory, neurological, and non-severe cases, while its relative risk (RR) varies by time. HEH also shows a short-term cumulative lagged effect within 5 h in all-cause, cardiovascular, and non-severe symptoms, while there are no statistically significant RRs found for respiratory and neurological cases in the short term. Our findings could be a reference for policymakers when devoting resources, developing extreme heat warning standards, and optimizing local EMS services, providing data-driven evidence for the effective deployment of ambulances.
Optimizing the built environment helps alleviate the adverse impact of extreme heat on public health and sus-tainable urban development. To this end, this study measured the daily land surface temperature (LST) in August 2022 (when extreme heat occurred) in Chengdu and introduced the 3D street view characteristics extracted from street view images. By employing OLS and spatial regression models, we probed the combined effects of 2D and 3D built environments on LST and their relationships under disparate circle spaces. The results show that: (1) compared with the 2D built environment, the 3D built environment presents a superior impact on LST. (2) urban land use that is 3D, compact, and has a high-floor area ratio diminishes LST, as evidenced by the finding that floor area ratio (FAR) reduces LST, but building density enhances it. (3) the green view index exhibits a stronger cooling effect than green space areas. (4) the built environment beneath distinct circle spaces displays a spatially varying impact on LST. For example, FAR is positively correlated with LST in the urban center, while in the urban periphery, it is prominently negative. Our empirical findings are conducive to formulating strategies from both 2D and 3D built environments for the formation and implementation of healthy urban design and development.
The recent concurrence of electrical grid failure events in time with extreme temperatures is compounding the population health risks of extreme weather episodes. Here, we combine simulated heat exposure data during historical heat wave events in three large U.S. cities to assess the degree to which heat-related mortality and morbidity change in response to a concurrent electrical grid failure event. We develop a novel approach to estimating individually experienced temperature to approximate how personal-level heat exposure changes on an hourly basis, accounting for both outdoor and building-interior exposures. We find the concurrence of a multiday blackout event with heat wave conditions to more than double the estimated rate of heat-related mortality across all three cities, and to require medical attention for between 3% (Atlanta) and more than 50% (Phoenix) of the total urban population in present and future time periods. Our results highlight the need for enhanced electrical grid resilience and support a more spatially expansive use of tree canopy and high albedo roofing materials to lessen heat exposures during compound climate and infrastructure failure events.
Climate change is recognized as a major contributor to the increase in heat-related deaths, and the frequency of heatwave days is expected to continue rising in the future. Addressing the impacts of climate change is a critical component of the United Nations’ sustainable development goals, emphasizing the need for urgent action. To aid decision-makers in this process, the heat vulnerability index (HVI) serves as a valuable tool for identifying areas most susceptible to heatwaves, informing adaptation plans, and assessing influential factors. In this comprehensive review article, we examined 104 relevant studies that focus on the HVI. Our analysis explores key indicators of exposure, sensitivity, and adaptive capacity that contribute to the vulnerability index, and which are associated with increased mortality. While certain indicators are locationspecific, others-such as building characteristics-have broader applicability but require more focused consideration. Furthermore, we present various data analysis and visualization options, as well as potential weaknesses of the indicators. This information will aid researchers and practitioners in selecting appropriate indicators for their specific areas and developing robust heat vulnerability indexes. By understanding these factors, we can prioritize interventions and strategies to reduce heat-related excess mortality and improve overall human health outcomes.
Heatwaves are becoming more common and impact health. We conducted a representative survey in June 2022 in Germany to determine people’s knowledge and protective behaviours on heat days. In data from 953 respondents, we found that a large proportion informed themselves about upcoming heat days, but there are considerable gaps in knowledge. While knowledge was not related to taking up protecting behaviour, other predictors were (e.g. risk perception). Health campaigns should therefore not only aim to improve knowledge but also address risk perceptions, facilitate social learning, communicate social norms and remove barriers that prevent protective behaviours.
OBJECTIVE: To critically assess the impacts of very hot weather on (i) frontline staff in hospitals in England and (ii) on healthcare delivery and patient safety. STUDY DESIGN: A qualitative study design using key informant semi-structured interviews, preinterview survey and thematic analysis. SETTING: England. PARTICIPANTS: 14 health professionals in the National Health Service (clinicians and non-clinicians, including facilities managers and emergency preparedness, resilience and response professionals). RESULTS: Hot weather in 2019 caused significant disruption to health services, facilities and equipment, staff and patient discomfort, and an acute increase in hospital admissions. Levels of awareness varied between clinical and non-clinical staff of the Heatwave Plan for England, Heat-Health Alerts and associated guidance. Response to heatwaves was affected by competing priorities and tensions including infection control, electric fan usage and patient safety. CONCLUSIONS: Healthcare delivery staff experience difficulty in managing heat risks in hospitals. Priority should be given to workforce development and strategic, long-term planning, prevention and investment to enable staff to prepare and respond, as well as to improve health system resilience to current and future heat-health risks. Further research with a wider, larger cohort is required to develop the evidence base on the impacts, including the costs of those impacts, and to assess the effectiveness and feasibility of interventions. Forming a national picture of health system resilience to heatwaves will support national adaptation planning for health, in addition to informing strategic prevention and effective emergency response.
With the increasing impacts of climate change, heatwaves are placing an enormous burden on health and social systems and threatening ecological diversity around the world. Heatwaves are increasing not only in frequency but also in severity and magnitude. They are causing the deaths of thousands of people. Research is needed on a multidisciplinary, supra-regional, and regional level. METHODS: A detailed evaluation of the research conducted is not yet available. Therefore, this study provides a detailed insight into the publication landscape to identify key players, incentives, and requirements for future scientific efforts that are useful not only for scientists but also to stakeholders and project funders. RESULTS: The number of publications on heatwaves is increasing, outpacing the trend of research indexed by the Science Citation Index Expanded. However, funding is lagging behind comparatively. Looking at absolute numbers, the USA, Australia, China, and some European countries have been identified as major players in heatwave research. If socio-economic numbers are included, Switzerland and Portugal lead the way. Australia and the UK dominate if the change in heatwave-exposed people is included. Nevertheless, exposure and economic strength of publishing countries were identified as the main drivers of national research interests. Previous heatwaves, in particular, have driven research efforts primarily at the national level. CONCLUSION: For an efficient monitoring or early detection system that also includes the economically weak regions, internationally networked efforts are necessary to enable preventive measures and damage limitation against heatwaves. Regardless of previous regional extreme heat events, research approaches should be focused to the global level.
BACKGROUND: Few studies have examined the effect of ambient temperature on upper urolithiasis in developing countries, with even fewer considering individual factors. METHODS: The present study analyzed data on emergency department visits for upper urolithiasis from three hospital sites of a large hospital in Hefei, China, during 2016-2020. Data on environmental factors during the same period were also analyzed. A time series analysis employing a generalized Poisson regression model (GPRM) combined with a distributed lag non-linear model (DLNM) was conducted to evaluate the effect of ambient temperature on the number of emergency department visits for upper urolithiasis. RESULTS: We found that ambient temperatures above 9 °C were positively associated with the frequency of upper urolithiasis visits, with the relationship being most significant on the current day and with a one-day lag. In the single-day lag effect, the most significant relative risk (RR) for mild heat (75th percentile) and high heat (95th percentile) was 1.229 (95% CI: 1.100-1.373) and 1.337 (95% CI: 1.134-1.577), respectively. The cumulative lag effect was significantly higher than the single-day lag effect, with maximum relative risks (RRs) of 1.779 (95% CI: 1.356-2.335) and 2.498 (95% CI: 1.688-3.697), respectively. The maximum lag time was 7 days. RRs were also higher among women and individuals aged 30-44 years. CONCLUSIONS: Increased ambient temperature is a risk factor for upper urolithiasis, and there is a hysteresis effect. Women and individuals aged 30-44 years are the most susceptible.
Injury is a significant health burden for children and young adult and may be an increasing concern in a warming climate. Research reveals many impacts to children’s health associated with hot weather and heatwave events, including a growing literature on the association between high ambient temperature and injury, which may vary by intent such as injury resulting from violence. However, little is known about how this association varies across different types of injury and subgroups of young people. We examined relationships between warm season ambient temperature and intentional and unintentional injury among children and young adults in New York City (NYC). Within a case-crossover design, our study observed injury-related emergency department (ED) visits from the New York Statewide Planning and Research Cooperative System administrative dataset. Injuries were categorized as unintentional or intentional injuries during the warm season (May through September) in NYC from 2005 to 2011 among patients (0, 1-4, 5-9, 10-14, 15-19, 20-25 years old (y.o.)). Conditional logistic regression models with distributed lag non-linear functions were used to model the cumulative odds ratio (OR) injury-related ED visit over 0-5 lag days. Analyses were stratified by age group and sex to understand how associations vary across young people of different age and sex. There were a total of 572 535 injury-related ED visits. The largest effect of elevated temperature (daily minimum 77°F vs 48°F) was for unintentional injury among 5-9 y.o. (OR 1.32, 95% CI 1.23, 1.42) and for intentional injury among 20-25 y.o. (OR 1.54, 95% CI 1.28, 1.85). Further stratified analyses revealed that the highest risk of unintentional injury was among 5-9 y.o. males and 20-25 y.o. males for intentional injury. Our results suggest that high ambient temperatures are associated with higher odds of unintentional and intentional injuries among children. This work adds to a growing body of literature demonstrating the adverse impacts of heat on children, and suggests the need for messaging to parents and children about adopting adaptive strategies to prevent injuries when it is hot outside.
Cities in the Sahel are heavily impacted by heat stress. Climate change, growing population rates and urbanization will increase the magnitude and intensity of urban heat stress towards the future. This study provides a comprehensive analysis of the current status of heat stress in Niamey (Niger) and future impacts by combining the results of two models operating at city-level: UrbClim which simulates (future) climate and GeoDynamiX, providing future city spatial extents combined with the results of a measurement campaign. Additionally, a meter-scale assessment of heat stress within the city is executed for a selection of city districts. Urban green and trees are effective mitigation tools for heat stress, which is observed in both measurements and model results, being most effective during the hottest hours of the day when they lower heat stress to less health-impacting levels. Future simulations show a strong increase in the spatial extent and intensity of extreme temperatures within the city. This impacts city dwellers, which will consequently experience much more days with extreme heat stress levels towards the future, doubling or tripling depending on the climate scenario. Socio-economic impacts for mid-century are quantified, noting increases in heat-related mortality of several percentages compared to present-day values. Additionally, negative economic impacts of several percentages of the Gross Domestic Product are projected as heat stress will prohibit performing moderate or high-intensity activities during the hottest hours of the day, even in the shade.
As climate warms, the impact of existing urban heat islands on the health of residents in towns and cities will worsen. A reduction in impervious in cities may help to reduce temperatures, but the relationship between tree canopy coverage and land surface temperature (LST) is not well characterised. Here, we quantified the summer LST of the temperate city of Leeds, UK using Landsat 8 TIRS remote sensing image and explored the spatial relationships between LST and impervious land cover, greenspace coverage, type of greenspace and canopy cover. We found a strong relationship between LST and canopy coverage across the built-up region of Leeds and use this relationship to project the impact of future canopy cover expansion. We found that of the nine main types of greenspaces in Leeds, private gardens occupied the greatest fraction of the total greenspace area and offered most potential for canopy cover expansion. Results suggest that a doubling of canopy coverage across the city, could reduce the mean LST by around 2.5 degrees C during the warmest summer months. Such a temperature reduction adds further weight to efforts by cities and countries globally to increase tree cover to both mitigate for and adapt to climate change.
BACKGROUND: Heat stroke is a significant cause of mortality in response to high summer temperatures. There is limited evidence on the pattern and magnitude of the association between temperature and heat stroke mortality. We examined this association in Spain, using data from a 27-year follow-up period. METHODS: We used a space-time-stratified case-crossover design. We analyzed data using conditional quasi-Poisson regression with distributed lag nonlinear models. RESULTS: Spain recorded a total of 285 heat stroke deaths between 1990 and 2016. Heat stroke deaths occurred in 6% of the days in the summer months. The mean temperature was, on average, 5 °C higher on days when a heat stroke was recorded than on days without heat stroke deaths. The overall relative risk was 1.74 (95% confidence interval = 1.54, 1.96) for a 1 °C rise in mean temperature above the threshold of 16 °C, at which a heat stroke death was first recorded. We observed lagged effects as long as 10 days. CONCLUSIONS: Although heat stroke represents a small fraction of total heat-attributable mortality during the summer, it is strongly associated with high temperatures, providing an immediately visible warning of heat-related risk.
Shade is crucial for thermally comfortable cities that promote physical activity. City-wide shade and thermal exposure data are essential for managing heat health risks but are difficult to obtain at fine scales due to limited sensing and modeling capabilities. To address this gap and assist municipalities with “cool corridor” planning, we generated 1-m resolution shade and mean radiant temperature (TMRT) maps from LiDAR point clouds for the Phoenix-Tempe metropolitan area using the SOLWEIG model. TMRT estimates were validated using 763 obser-vations with a mobile human-biometeorological 6-directional setup. SOLWEIG had an overall RMSE of 5.6 degrees C with an error of 6.2 degrees C at open sites, 5.4 degrees C under trees, and 4.4 degrees C in building canyons. Hourly TMRT and shade maps were generated from 7:00 h to 20:00 h for June 27, 2012, a typical clear, dry, calm summer day. We assessed sidewalk shade coverage based on the Maricopa Association of Government’s Active Transportation Plan. Only 8% of all sidewalks met the recommended minimum of 20% shade coverage at all times. Less than 50% of all sidewalks met the goal for parts of the day, indicating that the urban area is not walkable during extreme heat. Results from this study will inform municipal cool corridor planning to optimize site selection for heat mitigation.
As the globe warms, people will increasingly need affordable, safe methods to stay cool and minimize the worst health impacts of heat exposure. One of the cheapest cooling methods is electric fans. Recent research has recommended ambient air temperature thresholds for safe fan use in adults. Here we use hourly weather reanalysis data (1950-2021) to examine the temporal and spatial evolution of ambient climate conditions in the continental United States (CONUS) considered safe for fan use, focusing on high social vulnerability index (SVI) regions. We find that although most hours in the day are safe for fan use, there are regions that experience hundreds to thousands of hours per year that are too hot for safe fan use. Over the last several decades, the number of hours considered unsafe for fan use has increased across most of the CONUS (on average by ∼70%), with hotspots across the US West and South, suggesting that many individuals will increasingly need alternative cooling strategies. People living in high-SVI locations are 1.5-2 times more likely to experience hotter climate conditions than the overall US population. High-SVI locations also experience higher rates of warming that are approaching and exceeding important safety thresholds that relate to climate adaptation. These results highlight the need to direct additional resources to these communities for heat adaptive strategies.
Urban heat islands (UHIs) aggravate urban heat stress and, therefore, exacerbate heat-related morbidity and mortality as global warming continues. Numerous studies used surface urban heat island intensity (SUHII) to quantify the change in the UHI effect and its drivers for heat mitigation. However, whether the variations in SUHII among cities can demonstrate the physical difference and fluctuation of the urban thermal environment is poorly understood. Here, we present a comparison study on the temporal trends of SUHII and LST in urban and nonurban areas in 13 cities of the Beijing-Tianjin-Hebei (BTH) megaregion in China and further identify different types of changes in SUHII based on the temporal trends of land surface temperature (LST) in urban and nonurban areas from 2000 to 2020. We also measured the effect of the changes in four socioecological factors (i.e., population density, vegetation greenness (EVI), GDP, and built-up area) on the trends of SUHII to understand the dynamic interaction between the UHI effect and socioecological development. We found the following. (1) Nine out of thirteen cities showed a significant increasing trend in SUHII, indicating that the SUHI effects have been intensified in most of the cities in the BTH megaregion. (2) The spatial pattern of summer mean SUHII and LST in urban areas varied greatly. Among the 13 cities, Beijing had the highest mean SUHII, but Handan had the highest urban temperature, which suggests that a city with stronger SUHII does not necessarily have a higher urban temperature or hazardous urban thermal environment. (3) Four types of changes in SUHII were identified in the 13 cities, which resulted from different temporal trends of LST in urban areas and nonurban areas. In particular, one type of increasing trend of SUHII in seven cities resulted from a greater warming trend (increasing LST) in urban than nonurban areas (SUHII up arrow 1), and another type of increasing trend of SUHII in Beijing and Chengde was attributed to the warming trends (increasing LST) in urban areas and the cooling trends (decreasing LST) in nonurban areas (SUHII up arrow 2). Meanwhile, the third type of increasing trend of SUHII in Zhangjiakou was due to a greater cooling (decreasing LST) trend in nonurban areas than in urban areas (SUHII up arrow 3). In contrast, three cities with a decreasing trend of SUHII were caused by the increase in LST in urban and nonurban areas, but the warming trend in nonurban areas was greater than in urban areas (SUHII down arrow 1). (4) Among the relationship between the trend of SUHII (TrendSUHII) and the changes in socioecological factors (Trendpopulation density, TrendGDP per captica, TrendEVI, and Trendbuild-up area), a significantly positive correlation between TrendSUHII and TrendEVI indicated that the change in SUHII was significantly related to an increased rate of EVI. This is mainly because increased vegetation in nonurban areas would result in lower temperatures in nonurban areas.
The factors that drive dengue virus (DENV) evolution, and selection of virulent variants are yet not clear. Higher environmental temperature shortens DENV extrinsic incubation period in mosquitoes, increases human transmission, and plays a critical role in outbreak dynamics. In the present study, we looked at the effect of temperature in altering the virus virulence. We found that DENV cultured at a higher temperature in C6/36 mosquito cells was significantly more virulent than the virus grown at a lower temperature. In a mouse model, the virulent strain induced enhanced viremia and aggressive disease with a short course, hemorrhage, severe vascular permeability, and death. Higher inflammatory cytokine response, thrombocytopenia, and severe histopathological changes in vital organs such as heart, liver, and kidney were hallmarks of the disease. Importantly, it required only a few passages for the virus to acquire a quasi-species population harboring virulence-imparting mutations. Whole genome comparison with a lower temperature passaged strain identified key genomic changes in the structural protein-coding regions as well as in the 3’UTR of the viral genome. Our results point out that virulence-enhancing genetic changes could occur in the dengue virus genome under enhanced growth temperature conditions in mosquito cells.
Understanding heat-related impacts is crucial to improving public awareness of addressing urban heat challenges and enabling decision makers to mainstream heat action plans. This study explores heat-related physiological and psychological impacts, symptoms, and demographic determinants based on 4210 questionnaires across nine large Chinese cities, including Chengdu, Chongqing, Guangzhou, Hangzhou, Nanchang, Nanjing, Shanghai, Shenyang, and Xi’an in August 2020. The results indicate that heat-related psychological impacts are equally severe as physiological impacts. Chongqing is under the most severe heat-related health impact on both the physiological and psychological aspects. Skin heat damage (SKI), digestive system illnesses (DIG), respiratory illnesses (RES), and cardiovascular illnesses (CAR) are prominent physiological illnesses in all cities, while emotional irritability (EMO), easy to lose control temper (EAS), low mood (LOW), and insomnia (INS) are prominent psychological symptoms. Chongqing and Guangzhou are the most vulnerable cities in terms of physiological and psychological symptoms. Chengdu, Hangzhou, Nanjing, and Shanghai are more resilient in terms of physiological symptoms, whereas Chengdu, Hangzhou, and Shanghai are more resistant to psychological symptoms. Heat-related health impacts, symptoms, and demographic determinants are spatially heterogeneous. The elderly and patients are more vulnerable, while such a conclusion is not always true. The spatial heterogeneity of heat-related physiological and psychological impacts, symptoms, and drivers highlights the significance of developing city-specific heat health action plans. Heat-related psychological impacts are equally severe as physiological impacts. Heat-related health types, severity, and symptoms are highly heterogeneous in regional and demographic dimensions. Chongqing and Guangzhou are the most vulnerable cities in terms of physiological and psychological symptoms. The elderly and patients are more vulnerable, but such a conclusion is not always the case.image
Heatwaves have pronounced impacts on human health and the environment on a global scale. Although the characteristics of heatwaves has been well documented, there still remains a lack of dynamic studies of population exposure to heatwaves (PEH), particularly in the arid regions. In this study, we analyzed the spatio-temporal evolution characteristics of heatwaves and PEH in Xinjiang using the daily maximum temperature (T(max)), relative humidity (RH), and high-resolution gridded population datasets. The results revealed that the heatwaves in Xinjiang occur more continually and intensely from 1961 to 2020. Furthermore, there is substantial spatial heterogeneity of heatwaves with eastern part of the Tarim Basin, Turpan, and Hami been the most prone areas. The PEH in Xinjiang showed an increasing trend with high areas mainly in Kashgar, Aksu, Turpan, and Hotan. The increase in PEH is mainly contributed from population growth, climate change and their interaction. From 2001 to 2020, the climate effect contribution decreased by 8.5%, the contribution rate of population and interaction effects increased by 3.3% and 5.2%, respectively. This work provides a scientific basis for the development of policies to improve the resilience against hazards in arid regions.
Heat waves can be one of the most dangerous climatic hazards affecting the planet, having dramatic impacts on the health of humans and natural ecosystems as well as on anthropogenic activities, infrastructures and economy. Based on climatic conditions in West Africa, the urban centres of the region appear to be vulnerable to heat waves. The goals of this work are firstly to assess the potential uncertainties encountered in heat wave detection and secondly to analyse their recent trend in West Africa cities during the period 1993-2020. This is done using two state-of-the-art reanalysis products, namely the fifth-generation European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis (ERA5) and Modern-Era Retrospective analysis for Research and Applications (MERRA), as well as two local station datasets, namely Dakar-Yoff in Senegal and Aeroport Felix Houphouet-Boigny, Abidjan, in Cote d’Ivoire. An estimate of station data from reanalyses is processed using an interpolation technique: the nearest neighbour to the station with a land sea mask = 0.5. The interpolated temperatures from local stations in Dakar and Abidjan show slightly better correlation with ERA5 than with MERRA. Three types of uncertainty are discussed: the first type of uncertainty is related to the reanalyses themselves, the second is related to the sensitivity of heat wave frequency and duration to the threshold values used to monitor them, and the last one is linked to the choice of indicators and the methodology used to define heat waves. Three sorts of heat wave have been analysed, namely those occurring during daytime, nighttime, and both daytime and nighttime concomitantly. Four indicators have been used to analyse heat waves based on 2 m temperature, humidity, 10 m wind or a combination of these. We found that humidity plays an important role in nighttime events; concomitant events detected with wet-bulb temperature are more frequent and located over the northern Sahel. Strong and more persistent heat waves are found in the continental (CONT) region. For all indicators, we identified 6 years with a significantly higher frequency of events (1998, 2005, 2010, 2016, 2019 and 2020), possibly due to higher sea surface temperatures in the equatorial Atlantic Ocean corresponding to El Nino events for some years. A significant increase in the frequency, duration and intensity of heat waves in the cities has been observed during the last decade (2012-2020); this is thought to be a consequence of climate change acting on extreme events.
COVID-19 pandemic appeared summer surge in 2022 worldwide and this contradicts its seasonal fluctuations. Even as high temperature and intense ultraviolet radiation can inhibit viral activity, the number of new cases worldwide has increased to >78% in only 1 month since the summer of 2022 under unchanged virus mutation influence and control policies. Using the attribution analysis based on the theoretical infectious diseases model simulation, we found the mechanism of the severe COVID-19 outbreak in the summer of 2022 and identified the amplification effect of heat wave events on its magnitude. The results suggest that approximately 69.3% of COVID-19 cases this summer could have been avoided if there is no heat waves. The collision between the pandemic and the heatwave is not an accident. Climate change is leading to more frequent extreme climate events and an increasing number of infectious diseases, posing an urgent threat to human health and life. Therefore, public health authorities must quickly develop coordinated management plans to deal with the simultaneous occurrence of extreme climate events and infectious diseases.
Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves. METHOD: ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table. RESULTS: In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design. CONCLUSION: The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves. PROSPERO REGISTRATION NUMBER: CRD42021257747.
The Brazilian Amazon faces overlapping socio-environmental, sanitary, and climate challenges, and is a hotspot of concern due to projected increases in temperature and in the frequency of heat waves. Understanding the effects of extreme events on health is a central issue for developing climate policies focused on the population’s health. OBJECTIVES: We investigated the effects of heat waves on mortality in the Brazilian Amazon, examining effect modification according to various heat wave definitions, population subgroups, and causes of death. METHODS: We included all 32 Amazonian municipalities with more than 100,000 inhabitants. The study period was from 2000 to 2018. We obtained mortality data from the Information Technology Department of the Brazilian Public Healthcare System, and meteorological data were derived from the ERA5-Land reanalysis dataset. Heat waves were defined according to their intensity (90th; 92.5th; 95th; 97.5th and 99th temperature percentiles) and duration (≥2, ≥3, and ≥4 days). In each city, we used a time-stratified case-crossover study to estimate the effects of each heat wave definition on mortality, according to population subgroup and cause of death. The lagged effects of heat waves were estimated using conditional Poisson regression combined with distributed lag non-linear models. Models were adjusted for specific humidity and public holidays. Risk ratios were pooled for the Brazilian Amazon using a univariate random-effects meta-analysis. RESULTS: The pooled relative risks (RR) for mortality from total non-external causes varied between 1.03 (95% CI: 1.01-1.06), for the less stringent heat wave definition, and 1.18 (95% CI: 1.04-1.33) for the more stringent definition. The mortality risk rose as the heat wave intensity increased, although the increase from 2 to 3, and 3-4 days was small. Although not statistically different, our results suggest a higher mortality risk for the elderly, this was also higher for women than men, and for cardiovascular causes than for non-external or respiratory ones. CONCLUSIONS: Heat waves were associated with a higher risk of mortality from non-external causes and cardiovascular diseases. Heat wave intensity played a more important role than duration in determining this risk. Suggestive evidence indicated that the elderly and women were more vulnerable to the effects of heat waves on mortality.
Indian cities have frequently observed intense and severe heat waves for the last few years. It will be primarily due to a significant increase in the variation in heat wave characteristics like duration, frequency, and intensity across the urban regions of India. This study will determine the impact of future climate scenarios like SSP 245 and 585 over the heat wave characteristics. It will present the comparison between heat waves characteristics in the historical time (1981 to 2020) with future projections, i.e., D(1) (2021-2046), D(2) (2047-2072), and D(3) (2073-2098) for different climate scenarios across Indian smart cities. It is observed that the Coastal, Interior Peninsular, and North-Central regions will observe intense and frequent heat waves in the future under SSP 245 and 585 scenarios. A nearly two-fold increase in heat wave’ mean duration will be observed in the smart cities of the Interior Peninsular, Coastal, and North Central zones. Thiruvananthapuram city on the west coast has the maximum hazard associated with heat waves among all the smart cities of India under both SSPs. This study assists smart city policymakers in improving the planning and implementation of heat wave adaptation and mitigation plans based on the proposed framework for heat action plans and heat wave characteristics for improving urban health well-being under hot weather extremes in different homogeneous temperature zones.
With the increase in outdoor events, there is an inevitable rise in climate-related environmental emergencies. Heat exposure can place athletes at risk for life-threatening heatstroke which requires emergent diagnosis and rapid in-field management. Cold exposure can lead to hypothermia, frostbite, and other nonfreezing injuries that require prompt evaluation and management to minimize morbidity and mortality. Altitude exposure can lead to acute mountain sickness or other serious neurologic or pulmonary emergencies. Finally, harsh climate exposure can be life-threatening and require appropriate prevention and event planning.
Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.
Under climate change, many parts of the world are warming with increasing frequencies and intensities of heatwaves, bringing heat-health risks to places including those that have a historically temperate or cool climate. These places may have extensive experience in managing cold-health risks, while experience is lacking in dealing with heat-health risks due to their lack of historical exposure to high temperatures. This paper explores this overlooked area of the challenges and opportunities of heat-health governance in cool places using Scotland as a case study. Various important themes of heat-health governance in cool places were identified by the study, including socio-cultural barriers to intervention, vulnerable population overlaps, temporal and geographical scales, and governance arrangements. The study found challenges in managing heat-health risks including a perceived lack of heat-health risks and policy priority as well as unsuitable building stock. Meanwhile, it also identified opportunities for governing cold and heat risks holistically within existing institutional systems and creating co-benefits of improving communication and information dissemination, reducing inequality and improving indoor thermal comfort of both cold and heat as well as providing good quality greenspace. Our findings contribute to the development or improvement of national/regional strategies to manage heat-health risks not only in Scotland but also in other places with a historically cool or temperate climate.
Many studies have explored the heat-mortality relationship; however, comparability of results is hindered by the studies’ use of different exposure methods. OBJECTIVE: This study evaluated different methods for estimating exposure to temperature using individual-level data and examined the impacts on the heat-mortality relationship. METHODS: We calculated different temperature exposures for each individual death by using a modeled, gridded temperature dataset and a monitoring station dataset in North Carolina for 2000-2016. We considered individual-level vs. county-level averages and measured vs. modeled temperature data. A case-crossover analysis was conducted to examine the heat-mortality risk under different exposure methods. RESULTS: The minimum mortality temperature (MMT) (i.e., the temperature with the lowest mortality rate) for the monitoring station dataset was 23.87 °C and 22.67 °C (individual monitor and county average, respectively), whereas for the modeled temperature dataset the MMT was 19.46 °C and 19.61 °C (individual and county, respectively). We found higher heat-mortality risk while using temperature exposure estimated from monitoring stations compared to risk based on exposure using the modeled temperature dataset. Individual-aggregated monitoring station temperature exposure resulted in higher heat mortality risk (odds ratio (95% CI): 2.24 (95% CI: 2.21, 2.27)) for a relative temperature change comparing the 99th and 90th temperature percentiles, while modeled temperature exposure resulted in lower odds ratio of 1.27 (95% CI: 1.25, 1.29). SIGNIFICANCE: Our findings indicate that using different temperature exposure methods can result in different temperature-mortality risk. The impact of using various exposure methods should be considered in planning health policies related to high temperatures, including under climate change. IMPACT STATEMENT: (1) We estimated the heat-mortality association using different methods to estimate exposure to temperature. (2) The mean temperature value among different exposure methods were similar although lower for the modeled data, however, use of the monitoring station temperature dataset resulted in higher heat-mortality risk than the modeled temperature dataset. (3) Differences in mortality risk from heat by urbanicity varies depending on the method used to estimate temperature exposure.
Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations. OBJECTIVES: We investigated the effects of heat on cardiovascular and respiratory mortality and its modification by air pollution during summer months (six consecutive hottest months) in 482 locations across 24 countries. METHODS: Location-specific daily death counts and exposure data (e.g., particulate matter with diameters ≤ 2.5 µm [PM(2.5)]) were obtained from 2000 to 2018. We used location-specific confounder-adjusted Quasi-Poisson regression with a tensor product between air temperature and the air pollutant. We extracted heat effects at low, medium, and high levels of pollutants, defined as the 5th, 50th, and 95th percentile of the location-specific pollutant concentrations. Country-specific and overall estimates were derived using a random-effects multilevel meta-analytical model. RESULTS: Heat was associated with increased cardiorespiratory mortality. Moreover, the heat effects were modified by elevated levels of all air pollutants in most locations, with stronger effects for respiratory than cardiovascular mortality. For example, the percent increase in respiratory mortality per increase in the 2-day average summer temperature from the 75th to the 99th percentile was 7.7% (95% Confidence Interval [CI] 7.6-7.7), 11.3% (95%CI 11.2-11.3), and 14.3% (95% CI 14.1-14.5) at low, medium, and high levels of PM(2.5), respectively. Similarly, cardiovascular mortality increased by 1.6 (95%CI 1.5-1.6), 5.1 (95%CI 5.1-5.2), and 8.7 (95%CI 8.7-8.8) at low, medium, and high levels of O(3), respectively. DISCUSSION: We observed considerable modification of the heat effects on cardiovascular and respiratory mortality by elevated levels of air pollutants. Therefore, mitigation measures following the new WHO Air Quality Guidelines are crucial to enhance better health and promote sustainable development.
While climate change and population ageing are expected to increase the exposure and vulnerability to extreme heat events, there is emerging evidence suggesting that social inequalities would additionally magnify the projected health impacts. However, limited evidence exists on how social determinants modify heat-related cardiovascular morbidity. This study aims to explore the association between heat and the incidence of first acute cardiovascular event (CVE) in adults in Madrid between 2015 and 2018, and to assess how social context and other individual characteristics modify the estimated association. We performed a case-crossover study using the individual information collected from electronic medical records of 6514 adults aged 40-75 living in Madrid city that suffered a first CVE during summer (June-September) between 2015 and 2018. We applied conditional logistic regression with a distributed lag non-linear model to analyse the heat-CVE association. Estimates were expressed as Odds Ratio (OR) for extreme heat (at 97.5th percentile of daily maximum temperature distribution), compared to the minimum risk temperature. We performed stratified analyses by specific diagnosis, sex, age (40-64, 65-75), country of origin, area-level deprivation, and presence of comorbidities. Overall, the risk of suffering CVE increased by 15.3% (OR: 1.153 [95%CI 1.010-1.317]) during extreme heat. Males were particularly more affected (1.248, [1.059-1.471]), vs 1.039 [0.810-1.331] in females), and non-Spanish population (1.869 [1.28-2.728]), vs 1.084 [0.940-1.250] in Spanish). Similar estimates were found by age groups. We observed a dose-response pattern across deprivation levels, with larger risks in populations with higher deprivation (1.228 [1.031-1.462]) and almost null association in the lowest deprivation group (1.062 [0.836-1.349]). No clear patterns of larger vulnerability were found by presence of comorbidity. We found that heat unequally increased the risk of suffering CVE in adults in Madrid, affecting mainly males and deprived populations. Local measures should pay special attention to vulnerable populations.
Forestry workers play a crucial role in implementing forest management programs, but their outdoor work exposes them to rising temperatures caused by global climate change, which poses potential health risks related to heat. This study specifically investigates the relationship between knowledge of heat-related issues, risk perception, and precautionary behavior among Indonesian forestry workers and paddy farmers in response to the escalating workplace heat exposure. Developing effective precautionary behavior is essential for preventing heat-related health disorders and promoting health protection programs. To investigate the association of the latent variables comprehensively, structured interviews were conducted with two occupational groups of outdoor workers, comprising 210 forestry workers and 215 paddy farmers. The findings indicate that increasing knowledge about heat-related issues promotes precautionary behavior, and risk perception acts as a mediator between knowledge and behavior. Additionally, the study highlights that the emotion of “dread” intensifies the perceived risk and predicts positive behavior changes. To enhance heat-related knowledge, exploring the potential use of a “fear” tone is important. In conclusion, comprehensive strategies should be implemented to promote precautionary behavior among forestry workers, particularly manual laborers, who are more vulnerable compared to farmers.
Over 70,000 excess deaths occurred in Europe during the summer of 2003. The resulting societal awareness led to the design and implementation of adaptation strategies to protect at-risk populations. We aimed to quantify heat-related mortality burden during the summer of 2022, the hottest season on record in Europe. We analyzed the Eurostat mortality database, which includes 45,184,044 counts of death from 823 contiguous regions in 35 European countries, representing the whole population of over 543 million people. We estimated 61,672 (95% confidence interval (CI) = 37,643-86,807) heat-related deaths in Europe between 30 May and 4 September 2022. Italy (18,010 deaths; 95% CI = 13,793-22,225), Spain (11,324; 95% CI = 7,908-14,880) and Germany (8,173; 95% CI = 5,374-11,018) had the highest summer heat-related mortality numbers, while Italy (295 deaths per million, 95% CI = 226-364), Greece (280, 95% CI = 201-355), Spain (237, 95% CI = 166-312) and Portugal (211, 95% CI = 162-255) had the highest heat-related mortality rates. Relative to population, we estimated 56% more heat-related deaths in women than men, with higher rates in men aged 0-64 (+41%) and 65-79 (+14%) years, and in women aged 80+ years (+27%). Our results call for a reevaluation and strengthening of existing heat surveillance platforms, prevention plans and long-term adaptation strategies.
Rising temperatures and heatwaves increase mortality. Many of the subpopulations most vulnerable to heat-related mortality are in prisons, facilities that may exacerbate temperature exposures. Yet, there is scare literature on the impacts of heat among incarcerated populations. We analyzed data on mortality in U.S. state and private prisons from 2001-2019 linked to daily maximum temperature data for the months of June, July, and August. Using a case-crossover approach and distributed lag models, we estimated the association of increasing temperatures with total mortality, heart disease-related mortality, and suicides. We also examined the association with extreme heat and heatwaves (days above the 90th percentile for the prison location) and assessed effect modification by personal, facility, and regional characteristics. There were 12,836 deaths during summer months. The majority were male (96%) and housed in a state-operated prison (97%). A 10°F increase was associated with a 5.2% (95% CI: 1.5%, 9.0%) increase in total mortality and a 6.7% (95% CI: -0.6%, 14.0%) increase in heart disease mortality. The association between temperature and suicides was delayed, peaking around lag 3 (exposure at three days prior death). Two- and three-day heatwaves were associated with increased total mortality of 5.5% (95% CI: 0.3%, 10.9%) and 7.4% (95% CI: 1.6%, 13.5%), respectively. The cumulative effect (lags 1-3) of an extreme heat day was associated with a 22.8% (95% CI: 3.3%, 46.0%) increase in suicides. We found the greatest increase in mortality among people ≥ 65 years old, incarcerated less than one year, held in the Northeast region, and in urban or rural counties. These findings suggest that warm temperatures are associated with increased mortality in prisons, yet this vulnerable population’s risk has largely been overlooked.
BACKGROUND: Extreme heat may discourage physical activity of children while shade may provide thermal comfort. The authors determined the associations between ambient temperature, shade, and moderate to vigorous physical activity (MVPA) of children during school recess. METHODS: Children aged 8-10 (n = 213) wore accelerometers and global positioning system monitors during recess at 3 school parks in Austin, Texas (September-November 2019). Weather data originated from 10 sensors per park. The authors calculated shade from imagery using a geographic information system (GIS) and time-matched physical activity, location, temperature, and shade data. The authors specified piecewise multilevel regression to assess relations between average temperature and percentage of recess time in MVPA and shade. RESULTS: Temperature ranged 11 °C to 35 °C. Each 1 °C higher temperature was associated with a 0.7 percentage point lower time spent in MVPA, until 33 °C (91 °F) when the association changed to a 1.5 lower time (P < .01). Each 1 °C higher temperature was associated with a 0.3 percentage point higher time spent under shade, until 33 °C when the association changed to a 3.4 higher time (P < .001). At 33 °C or above, the direct association between shade and MVPA weakened (P < .05), with no interaction effect above 33 °C (P > .05). Children at the park with the most tree canopy spent 6.0 percentage points more time in MVPA (P < .01). CONCLUSIONS: Children engage in less MVPA and seek shade during extreme heat and engage in more MVPA in green schoolyards. With climate change, schools should consider interventions (eg, organizing shaded play, tree planting) to promote heat safe MVPA.
Physical health has been associated with ambient temperature and heatwave. With the frequent occurrence of heatwave, the adaptive effects and mechanisms on mental health remain uncertain. On the basis of the China Health and Nutrition Survey, we estimated the relationship between heatwaves and self-assessed mental health scores in the Chinese population aged 50 and above. This study has identified that with each additional heatwave event, mental health scores decreased by an average of 0.027 points, which is equivalent to 0.3% of the average level. Heat is more likely to affect groups with low education, no medical insurance, and living in rural areas. In mechanistic exploration, we found that stress emotion is a fully mediating effect. Heat led to reduced health activities and more frequent drinking, which may lead to lower psychological well-being. Moreover, good dietary preference is a regulator that can help mitigate the adverse effects of heat on mental health. This study corroborates the impact of heat on spiritual welfare, and demonstrates the mechanisms and channels of impact, which can help reduce global economic losses due to mental health problems.
We aimed to analyze recent literature on heat effects on cardiovascular morbidity and mortality, focusing on the adopted heat definitions and their eventual impact on the results of the analysis. Methods: The search was performed on PubMed, ScienceDirect, and Scopus databases: 54 articles, published between January 2018 and September 2022, were selected as relevant. In total, 21 different combinations of criteria were found for defining heat, 12 of which were based on air temperature, while the others combined it with other meteorological factors. By a simulation study, we showed how such complex indices could result in different values at reference conditions depending on temperature. Heat thresholds, mostly set using percentile or absolute values of the index, were applied to compare the risk of a cardiovascular health event in heat days with the respective risk in non-heat days. The larger threshold’s deviation from the mean annual temperature, as well as higher temperature thresholds within the same study location, led to stronger negative effects. To better analyze trends in the characteristics of heatwaves, and their impact on cardiovascular health, an international harmonization effort to define a common standard is recommendable.
The World Meteorological Organization considers a heatwave as “a period of statistically unusual hot weather persisting for a number of days and nights”. Accompanying the ongoing global climate change, sharp heatwave bouts occur worldwide, growing in frequency and intensity, and beginning earlier in the season. Heatwaves exacerbate the risk of heat-related illnesses, hence human morbidity and mortality, particularly in vulnerable elderly and children. Heat-related illnesses present a continuum from normothermic (prickly heat, heat edema, heat cramps, heat tetany) to hyperthermic syndromes (from heat syncope and heat exhaustion to lethal heat stroke). Heat stroke may occur through passive heating and/or exertional exercise. “Normal sleep”, such as observed in temperate conditions, is altered during heatwaves. Brisk excessive heat bouts shorten and fragment human sleep. Particularly, deep N3 sleep (formerly slow-wave sleep) and REM sleep are depleted, such as in other stressful situations. The resultant sleep loss is deleterious to cognitive performance, emotional brain function, behavior, and susceptibility to chronic health conditions and infectious diseases. Our group has previously demonstrated that sleep constitutes an adaptive mechanism during climatic heat acclimatization. In parallel, artificial heat acclimation procedures have been proposed in sports and military activities, and for the elderly. Other preventive actions should be considered, such as education and urban heat island cooling (vegetation, white paint), thus avoiding energy-hungry air conditioning.
Heatwaves are a significant cause of adverse health outcomes and mortality in Australia, worsening with climate change. In Queensland, the northeastern-most state, little is known about the impact of heatwaves outside of the capital city of Brisbane. This study aims to explore the impact of heatwaves on mortality across various demographic and environmental conditions within Queensland from 2010 to 2019. The Excess Heat Factor was used to indicate heatwave periods at the Statistical Area 2 (SA2) level. Registered deaths data from the Australian Bureau of Statistics and heatwave data from the Bureau of Meteorology were matched using a case-crossover approach. Relative risk and 95% confidence intervals were calculated across years, regions, age, sex, rurality, socioeconomic status, and cause of death. Heatwaves were associated with a 5% increase in all-cause mortality compared to deaths on non-heatwave days, with variability across the state. The risk of death on a heatwave day versus a non-heatwave day varied by heatwave severity. Individuals living in urban centers, the elderly, and those living in regions of lower socioeconomic status were most impacted by heatwave mortality. The relative risk of dying from neoplasms, nervous system conditions, respiratory conditions, and mental and behavioral conditions increased during heatwaves. As heatwaves increase in Queensland due to climate change, understanding the impact of heatwaves on mortality across Queensland is important to tailor public health messages. There is considerable variability across communities, demographic groups, and medical conditions, and as such messages need to be tailored to risk.
Heatwaves have become a public health emergency raising great public health concerns. Correspondingly, due to climate change, the increase in extreme weather events, such as heatwaves, floods and hurricanes, is predicted through state-of-the-art models and robust statistical analyses. Since the Mediterranean basin is recognized as the most prominent global climate change hot spot, further scientific research on the future impacts of heatwaves on human mortality, as well as human health and well-being, in the Mediterranean region is critical. Methods: The aim of the present study is to compare the relationship between three different causes of mortality (i.e., cardiological, respiratory and cardiorespiratory) and temperature between two countries (Spain and Greece) and five cities (i.e., Madrid, Barcelona, Valencia, Attica and Thessaloniki). To compare the five cities under examination, a robust statistical methodological framework (i.e., Threshold Regression Analysis (TRA)) was applied so as to examine the critical value above which the mean temperature affects cardiological, respiratory and cardiorespiratory mortality. Results: Our results prove that the relationship between mortality and temperature is a nonlinear relationship shaping a U- or J-shaped curve, meaning that mortality is affected by temperature in a non-constant way, indicating that mortality increases during both low and high temperatures. Conclusions: By calculating different temperature thresholds for the five cities under examination, we show that different temperature thresholds are more accurate for different climatic conditions. Hence, climatic conditions should be taken into account when examining the impacts of temperature on human health.
Concerns about climate change are driving the development of novel technologies for mitigation and adaptation. Some of them include electricity generating and water harvesting based on atmospheric humidity. The latter is already commercial and can generate 50 L of drinking water per day per capita for dozens of people; however, besides energy, operation requires sufficient levels and durations of humidity and temperature. Our study focuses on the 33 megacities of the world, characterising the humidity and heat stress regimes during the last decade, using data from meteorological stations in their vicinity, and ranking them by their exposure and vulnerability to intense heat stress and their suitability to use these moisture-reliant technologies. Our findings indicate the dominance of severe heat stress conditions in megacities located in developing countries. Ranking the megacities according to the intensity and duration of the heat stress shows the annual, monthly and hourly courses. The five most affected are the cities of Chennai, Bangkok, Kolkata, Karachi and New Delhi. Seven megacities suffer continuous, at least 12 h, of intense heat stress during 1-4 months. The ranking also considered the level of income of the countries, hence their vulnerability. On an annual basis, approximately half of the megacities are highly suited for moisture-reliant technologies, among them megacities ranked as the top three in exposure to intense heat stress conditions-Chennai, Bangkok and Kolkata. When focusing on the humid season, 27 out of 33 megacities (82%) obtain suitable conditions for the new technologies and thus can benefit from them, at least part of the year. The implementation of humidity technologies for green energy and clean water could be of great help as our world gets more populated, warmer with higher water demand, especially for populations with insufficient infrastructure and resources. Our study focuses on the 33 megacities of the world, characterising the humidity and heat stress regimes during the last decade, using data from meteorological stations in their vicinity, and ranking them by their exposure and vulnerability to intense heat stress and their suitability to use these moisture-reliant technologies.image
Globally, more people die from cardiovascular disease than any other cause. Extreme heat can have serious implications for heart health, especially in people with pre-existing cardiovascular conditions. In this review, we examined the relationship between heat and the leading causes of cardiovascular diseases as well as the proposed physiological mechanisms for the deleterious effect of heat on the heart. The body’s response to high temperatures, including dehydration, increased metabolic demand, hypercoagulability, electrolyte imbalances, and systemic inflammatory response, can place a significant strain on the heart. Epidemiological studies showed that heat can result in ischemic heart disease, stroke, heart failure, and arrhythmia. However, targeted research is needed to understand the underlying mechanisms of hot temperatures on these main causes of cardiovascular disease. Meanwhile, the absence of clinical guidance on how to manage heart diseases during heat events highlights the need for cardiologists and other health professionals to lead the charge in addressing the critical relationship between a warming climate and health.
Extreme heat negatively impacts cognition, learning, and task performance. With increasing global temperatures, workers may therefore be at increased risk of work-related injuries and illness. This study estimates the effects of temperature on worker health using records spanning 1985-2020 from an Australian mandatory insurance scheme. High temperatures are found to cause significantly more claims, particularly among manual workers in outdoor-based industries. These adverse effects have not diminished across time, with the largest effect observed for the 2015-2020 period, indicating increasing vulnerability to heat. Within occupations, the workers most adversely affected by heat are female, older-aged and higher-earning. Finally, results from firm-level panel analyses show that the percentage increase in claims on hot days is largest at “safer” firms.
Climate change is increasing human exposure to heat, especially in tropical regions such as Brazil where temperature reaches up to 40 degrees C in summer. However, the association between heat exposure and epileptic seizures has not been well demonstrated in Brazil, where lifetime preva-lence of epilepsy can range from 11.9/1000 to 21/1000. We collected a total of 225,699 hospi-talisation records for epileptic seizures of 1816 municipalities in Brazil, during the hot season from 2000 to 2015, covering nearly 79% of the national population. We implemented a time -stratified case-crossover design combined with distributed lag model with further stratified in-vestigations regarding sex, age, socioeconomic status and region. We found temperature impact threshold was 26 degrees C in Brazil nationally. Every 1 degrees C increase from the threshold was associated with an overall 4.3% increased risk of hospitalisation for epileptic seizures on the current day of hospital admission and up to seven days before, which was most pronounced on the second-day exposure to heat. Females, individuals aged 20-30 and persons living in high-income or Southeast regions were more vulnerable. Our results highlight the enhanced risk of heat exposure for epi-lepsy patients and could contribute to epilepsy management, such as forecasting epileptic sei-zures. Multi-dimensional adaptive strategies were proposed, covering individual protection, occupational health surveillance, and urban planning management, aiming to reduce heat -induced hospitalisations for epilepsy, and be generalizable to other heat-related diseases.
Climate change profoundly shapes the population health at the global scale. However, there was still insufficient and inconsistent evidence for the association between heat exposure and chronic kidney disease (CKD). METHODS: In the present study, we studied the association of heat exposure with hospitalizations for cause-specific CKD using a national inpatient database in China during the study period of hot season from 2015 to 2018. Standard time-series regression models and random-effects meta-analysis were developed to estimate the city-specific and national averaged associations at a 7 lag-day span, respectively. RESULTS: A total of 768,129 hospitalizations for CKD was recorded during the study period. The results showed that higher temperature was associated with elevated risk of hospitalizations for CKD, especially in sub-tropical cities. With a 1 °C increase in daily mean temperature, the cumulative relative risks (RR) over lag 0-7 d were 1.008 [95% confidence interval (CI) 1.003-1.012] for nationwide. The attributable fraction of CKD hospitalizations due to high temperatures was 5.50%. Stronger associations were observed among younger patients and those with obstructive nephropathy. Our study also found that exposure to heatwaves was associated with added risk of hospitalizations for CKD compared to non-heatwave days (RR = 1.116, 95% CI 1.069-1.166) above the effect of daily mean temperature. CONCLUSIONS: Short-term heat exposure may increase the risk of hospitalization for CKD. Our findings provide insights into the health effects of climate change and suggest the necessity of guided protection strategies against the adverse effects of high temperatures.
Background Despite the impact of heat exposure caused by global warming, few studies have investigated the hourly effects of heat exposure and the risk of cardiovascular disease (CVD) in the elderly. We examined the associations between short-term heat exposure and the risk of CVD in the elderly in Japan and evaluated possible effect-measure modifications by rainy seasons that occur in East Asia. Methods and Results We conducted a time-stratified case-crossover study. The study included 6527 residents in Okayama City, Japan, aged ≥65 years who were transported to emergency hospitals between 2012 and 2019 for the onset of CVD during and a few months after the rainy seasons. We examined the linear associations between temperature and CVD-related emergency calls for each year and for hourly preceding intervals before the emergency call during the most relevant months. Heat exposure during 1 month after the end of the rainy season was associated with CVD risk; the odds ratio (OR) for a 1° C increase in temperature was 1.34 (95% CI, 1.29-1.40). When we further explored the nonlinear association by using the natural cubic spline model, we found a J-shaped relationship. Exposures 0 to 6 hours before the case event (preceding intervals 0-6 hours) were associated with CVD risk, particularly for the preceding interval 0 to 1 hour (OR, 1.33 [95% CI, 1.28-1.39]). For longer periods, the highest risk was at preceding intervals 0 to 23 hours (OR, 1.40 [95% CI, 1.34-1.46]). Conclusions Elderly individuals may be more susceptible to CVD after heat exposure during the month after the rainy season. As shown by finer temporal resolution analyses, short-term exposure to increasing temperature can trigger CVD onset.
BACKGROUND: Climate change has led to the frequent occurrence of high-temperature weather, which has various adverse effects on health, ranging from blood metabolism to systemic organ function. In particular, the sequelae of heat stress injury in most people are related to the nervous system. However, the mechanisms between heat stress and mental health conditions, especially heat stress and anxiety, remain unclear. OBJECTIVE: We attempted to elucidate the effect of heat exposure intervention on anxiety levels in the population and its mechanism. METHODS: We first carried out a randomized controlled trial in 20 college students in Beijing, China, to observe the results of the effects of heat exposure intervention on human anxiety. Then, we collected blood samples before and after heat exposure experiment and used metabolomic and transcriptomic approaches to quantify serum metabolites and ELISA measurements to explore the underlying mechanisms. RESULTS: We found that even 1.5-hour heat exposure intervention significantly increased anxiety levels. Heat stress-induced anxiety was mediated by the activation of the HPA axis, inflammation, oxidative stress, and subsequently unbalanced neurotransmitters. Metabolites such as BDNF, GABA, and glucocorticoids released by the adrenal glands are biomarkers of heat stress-induced anxiety. CONCLUSIONS: We have demonstrated a causal link between heat stress and anxiety, explored possible biological pathway between heat stress and anxiety. Heat stress can cause the activation of the HPA axis and lead to changes in the body’s metabolism, resulting in a series of changes such as inflammation and oxidative stress, leading to anxiety. This study reveals hidden health cost of climate change that has been underexplored, and also reminds us the importance of immediate climate actions.
Excessive relative humidity (RH) in combination with high temperature can lead to heat stress, often measured by the Wet Bulb Globe Temperature (WBGT). The Clausius-Clapeyron (CC) relationship implies that warming reduces RH if no extra moisture is added. Over coastal regions like eastern Asia, however, the predominant summer monsoon favours increased moisture transport from surrounding oceans as a result of enhanced evaporation driven by surface temperature increase. This would lessen the RH reduction by potentially two-thirds. Based on two ensembles of climate model simulations, this paper examines the competing effects of near-surface temperature, humidity and circulation patterns in this region and the consequential health risks. Under a high emissions scenario (RCP8.5/SSP5-8.5), surface temperature could increase by 4 – 7 degrees C with WBGT increases of several degrees by the end of the 21st century. Devastating extreme heat health events could therefore become a frequent occurrence as a result. Overall, our results show how humidity can be just as important as temperature when considering the risks to society of excessive heat.
AimExtreme heat events caused by climate change continue to increase in frequency, duration, and intensity. People living in cities in particular are exposed to heat as a result of the urban heat island effect. Although negative effects can be mitigated by heat health action plans (HHAPs), it remains unknown how many German cities have implemented such plans or other measures to reduce the health risks from heat. Therefore, this study surveyed the status of planned or published HHAPs and measures in German cities.Subject and methodsApproximately 10% of German cities with the greatest population density were sampled for the study (n = 70 cities). A frequency analysis of city concepts and city webpages was conducted to determine whether cities have already introduced concepts for climate adaptation, climate protection or an HHAP, and which measures are planned in detail.ResultsFifty-one cities have implemented measures to protect health from heat events. Forty-one cities integrated such measures into concepts, and only one city formulated an HHAP. Large cities in particular published measures. Long-term measures proved most common, for example, improved building envelope insulation and urban greening. Other than advice on individual behavior, hardly any acute heat health measures are being taken.ConclusionPublic health authorities can play an active role in communicating the health risks of heat and implementing HHAPs. To this end, the health risks of climate change need to be addressed consistently by all policy fields in Germany. There is also a need for further research in the evaluation of measures and HHAPs.
BACKGROUND: Climate change has already led to a significant temperature increase in Germany. The average temperature in the past decade was approximately 2°C above the pre-industrial level and eight of the ten hottest summers since the beginning of systematic weather records in 1881 were recorded in the last 30 years. METHODS: Based on a selective literature search and authors’ own results, the article summarises the current state of knowledge on heat and its health impacts for Germany, addresses adaptation measures, and gives an outlook on implementation and research questions. RESULTS: Heat can aggravate pre-existing conditions such as diseases of the cardiovascular system, the respiratory tract, or the kidneys and trigger potentially harmful side effects for numerous medications. A significant increase in mortality is regularly observed during heat events. Previous approaches to mitigate the health impact of high temperatures include, for example, the heat alerts of the German Meteorological Service and recommendations for the preparation of heat-health action plans. CONCLUSIONS: Evidence on health impacts of heat and awareness of the need for heat-related health protection have grown in recent years, but there is still a need for further action and research.
OBJECTIVE: To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women. DESIGN: Prospective cohort. SETTING: Workplaces in Tamil Nadu, India. SAMPLE: A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022. METHODS: Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. ‘Heat exposed’ was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire. MAIN OUTCOME MEASURES: The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage. RESULTS: Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3). CONCLUSIONS: High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.
There is growing attention on occupational heat stress in Central America, as workers in this region are affected by a unique form of chronic kidney disease. Previous studies have examined wet bulb globe temperatures and estimated metabolic rates to assess heat stress, but there are limited data characterizing heat strain among these workers. OBJECTIVE: The aims were to characterize heat stress and heat strain and examine whether job task, break duration, hydration practices, and kidney function were associated with heat strain. METHODS: We used data from the MesoAmerican Nephropathy Occupational Study, a cohort of 569 outdoor workers in El Salvador and Nicaragua who underwent workplace exposure monitoring, including continuous measurement of core body temperature (T(c)), heart rate (HR), physical activity, and wet bulb globe temperature (WBGT), over the course of three days in January 2018 – May 2018. Participants represented five industries: sugarcane, corn, plantain, brickmaking, and construction. RESULTS: Median WBGTs were relatively high (>27 °C) at most sites, particularly when work shifts spanned the afternoon hours (e.g., 29.2 °C among plantain workers). Sugarcane workers, especially cane cutters in both countries and Nicaraguan agrichemical applicators, had the highest estimated metabolic rates (medians: 299-318 kcal/hr). Most workers spent little time on break (<10% of the shift), as determined by physical activity data. Overall, sugarcane workers-particularly those in Nicaragua-experienced the highest T(c) and HR values. However, a few workers in other industries reached high T(c) (>39 °C) as well. Impaired kidney function (estimated glomerular filtration rate <90 mL/min/1.73 m(2)) was associated with higher T(c) and HR values, even after adjustment. SIGNIFICANCE: This is the largest study to-date examining heat stress and strain among outdoor workers in Central America. Workers at sugar companies regularly experienced T(c) > 38°C (76.9% of monitored person-days at Nicaraguan companies; 46.5% at Salvadoran companies). Workers with impaired kidney function had higher measures of T(c) and HR. IMPACT STATEMENT: This study examined levels of occupational heat stress and heat strain experienced among outdoor workers in five industries in El Salvador and Nicaragua. We characterized heat stress using wet bulb globe temperatures and estimated metabolic rate and heat strain using core body temperature and heart rate. Sugarcane workers, particularly cane cutters and Nicaraguan agrichemical applicators, performed more strenuous work and experienced greater levels of heat strain. Impaired kidney function was associated with higher heart rates and core body temperatures.
The observed continuous rise in the frequency of extreme heat events in South America (SA) poses a serious challenge for public health. However, there is a lack on the understanding of the large-scale and long-term variability and trends of thermal stress in this continent. Accordingly, here we developed the first comprehensive bioclimatology of thermal stress over SA during the past four decades. Consecutive heat stress hours were analyzed using the Universal Thermal Climate Index (UTCI) from ERA5-HEAT reanalysis according to the Koppen-Geiger climate classification and also focusing on the 31 most populated cities of SA. Results show an inland/coastline contrast and a marked latitudinal northward increase in the number of hours under heat stress. Heat stress hotspots are located mostly around the Amazon, northern and central parts of SA with 26-35% of the hours between 1979 and 2020 under strong heat stress. The annual number of hours within heat stress increased significantly between 1979 and 2020, varying from + 1.16 h/year to + 8.25 h/year depending on the Koppen-Geiger class. The past 20 years (2000 forward) presented not only more consecutive hours under heat stress than the previous two decades in all the analyzed cities, but also a higher persistence of such conditions. The bioclimatology of thermal stress developed here may provide important guidelines to decision-makers for exploring adaptation strategies to increase societal resilience.
Crop failure is largely caused by various climate hazards, and among them, heat stress is the primary factor hindering crop production. The significant global loss of crop yield is primarily due to heat-related damage during the reproductive phase. Terminal heat stress has been well documented in wheat, causing morphophysiological alterations, biochemical disruptions, and reduction of genetic potential. The formation of shoots and roots, the effect on the double ridge stage, and early biomass in the vegetative stage are also impacted by heat stress. The final negative outcomes of heat stress include reduced grain number and weight, slower grain filling rate, reduced grain quality, and shorter grain filling duration. Plants have developed mechanisms to adapt to heat stress through modifications in their morphological or growth responses, physiological and biochemical pathways, and changes in enzyme reactions. Numerous heat tolerance genes have been identified in wheat, but the more extensive study is needed to increase heat tolerance in crops to satisfy the food demands of the world’s growing population. The global food policy needs to prioritize and promote additional joint research and the development of heat-tolerant wheat breeding to ensure the world’s food security.
Introduction: Heat stress is harmful to the health of humans and animals, more and more common, as a consequence of global warming, while the mechanism that heat stress modulates skeletal development remains unknown. Hence, we conducted a model of heat stress in vitro. Methods: We used Hu sheep myoblasts as the research object, real-time quantitative PCR (RT-qPCR) and western blot (WB) were conducted to detect the expression of mRNA and protein in heat-stressed myoblasts. The would-healing assay was used to detect the migration of myoblasts. The mitochondria were observed by a transmission electron microscope. Results: mRNA and protein expression of HSP60 was significantly enriched in the heat-stressed myoblasts during proliferation and differentiation (p < 0.05). In our study, we indicated that heat stress enriched the intracellular ROS of the myoblasts (p < 0.001), leading to an increase in autophagy in the myoblasts to induce apoptosis. The results demonstrated that the protein expression of LC3B-1 and BCL-2 was significantly increased in myoblasts under heat stress during proliferation and differentiation (p < 0.05). Additionally, heat stress inhibited mitochondrial biogenesis and function and reduced the mitochondrial membrane potential and downregulated the expression of mtCo2, mtNd1 and DNM1L (p < 0.05) in myoblasts during proliferation and differentiation. Consequently, heat stress inhibited the proliferation and differentiation of the myoblasts, in accordance with the downregulation of the expression of PAX7, MYOD, MYF5, MYOG and MYHC (p < 0.05). Moreover, heat stress also inhibited the cell migration of the myoblasts. Discussion: This work demonstrates that heat stress inhibits proliferation and differentiation, and accelerates apoptosis by impairing mitochondrial function and promoting autophagy, which provides a mechanism to understand heat stress affects the development of the skeletal muscle.
The present study examined heat stress vulnerability of apparently healthy older vs. young adults and characterized critical environmental limits for older adults in an indoor setting at rest (Rest) and during minimal activity associated with activities of daily living. Critical environmental limits are combinations of ambient temperature and humidity above which heat balance cannot be maintained (i.e., becomes uncompensable) for a given metabolic heat production. Here we exposed fifty-one young (23 +/- 4 yrs) and 49 older (71 +/- 6 yrs) adults to progressive heat stress across a wide range of environments in an environmental chamber during Minimal Activity (young and older subjects) and Rest (older adults only). Heat compensability curves were shifted leftward for older adults indicating age-dependent heat vulnerablity (p < 0.01). During Minimal Activity, critical environmental limits were lower in older compared to young adults (p < 0.0001) and lower than those at Rest (p < 0.0001). These data document heat vulnerability of apparently healthy older adults and define critical environmental limits for indoor settings in older adults at rest and during activities of daily living, and can be used to develop evidence-based recommendations to minimize the deleterious impacts of extreme heat events in this population.
Average global temperatures continue to trend upward, and this phenomenon is part of the more complex climate change taking place on our planet over the past century. Human health is directly affected by environmental conditions, not only because of communicable diseases that are clearly affected by climate, but also because of the relationship between rising temperatures and increased morbidity for psychiatric diseases. As global temperatures and the number of extreme days increase, so does the risk associated with all those acute illnesses related to these factors. For example, there is a correlation between out-of-hospital cardiac arrest and heat. Then, there are pathologies that recognize excessive heat as the main etiological agent. This is the case with so-called “heat stroke”, a form of hyperthermia accompanied by a systemic inflammatory response, which causes multi-organ dysfunction and sometimes death. Starting with a case that came to their attention of a young man in good general health who died while working unloading fruit crates from a truck, the authors wanted to express some thoughts on the need to adapt the world of work, including work-specific hazards, in order to protect the worker exposed to this “new risk” and develop multidisciplinary adaptation strategies that incorporate climatology, indoor/building environments, energy use, regulatory perfection of work and human thermal comfort.
Stressors are especially widespread in urban agglomerations. Common themes of built environment interventions that support health and well-being are blue and green infrastructure, indoor and outdoor air quality, thermal comfort, access to natural lighting, and acoustics. Given the current megatrends of increasing summer temperatures and the high popularity of home offices, we aimed at modeling thermal comfort changes of people working at home in three Austrian cities (Vienna, Innsbruck, and Graz) during the next decades until 2090. We present findings based on (I) an inter-disciplinary literature search and (II) indoor and outdoor climate simulations for actual and future climate scenarios. Based on the results, we discuss the potential impacts for work and human health and well-being, and we suggest a framework for the home office in “post-COVID-19 Austria” that integrates social, ecological, and economic aspects. The results of our study indicate that, in future climate scenarios, overheating of the interior can no longer be prevented without active cooling measures and nature-based solutions. Recommendations on the adjustment of behavior under climate change, including greening, adequate ventilation, and cooling techniques, are thus urgently needed for employees who are working from home in order to maintain physical and mental health and wellbeing.
Heatwaves and urban heat islands disproportionately affect residents of urban areas. Past studies on the heat vulnerability indexes (HVI) to evaluate the heat-related risk have two major limitations: the inability to capture street-level human heat stress and reliance on single meteorological proxies to measure heat exposure. To address these gaps, this study examines the impact of streetlevel outdoor thermal comfort (OTC) on heat vulnerability in the city of Houston, Texas. OTC refers to an individual’s thermal perception of their surroundings. The study estimates the impacts of HVI scores and energy budget (EB) values of OTC on heat-related disease while investigating their spatial distributions and clusters. The results show that the explanatory power of the suggested models on the number of emergency department (ED) visits improved when the streetlevel OTC had higher HVI scores and more comfortable conditions. A positive bivariate relationship was found between the HVI scores and EB values, showing the highest explanatory power (adj-r2) of around 36%. Chronic disease and heat exposure significantly affected the HVI, whereas tree and sky view factors were crucial determinants of the EB values. These findings provide a new approach to heat vulnerability evaluation at the human scale to effectively address heat-related risk.
BACKGROUND: Previous studies have suggested an association between non-optimum ambient temperature and decreased semen quality. However, the effect of exposure to heat waves on semen quality remains unclear. METHODS: Volunteers who intended to donate sperm in Guangdong provincial human sperm bank enrolled. Heat waves were defined by temperature threshold and duration, with a total of 9 definitions were employed, specifying daily mean temperature exceeding the 85th, 90th, or 95th percentile for at least 2, 3, or 4 consecutive days. Residential exposure to heat waves during 0-90 days before ejaculation was evaluated using a validated gridded dataset on ambient temperature. Association and potential windows of susceptibility were evaluated and identified using linear mixed models and distributed lag non-linear models. RESULTS: A total of 2183 sperm donation volunteers underwent 8632 semen analyses from 2018 to 2019. Exposure to heat wave defined as daily mean temperature exceeding the 95th percentile for at least 4 consecutive days (P95-D4) was significantly associated with a 0.11 (95% confidence interval [CI]: 0.03, 0.18) ml, 3.36 (1.35, 5.38) × 10(6)/ml, 16.93 (7.95, 25.91) × 10(6), and 2.11% (1.4%, 2.83%) reduction in semen volume, sperm concentration, total sperm number, and normal forms, respectively; whereas exposure to heat wave defined as P90-D4 was significantly associated with a 1.98% (1.47%, 2.48%) and 2.08% (1.57%, 2.58%) reduction in total motility and progressive motility, respectively. Sperm count and morphology were susceptible to heat wave exposure during the early stage of spermatogenesis, while sperm motility was susceptible to exposure during the late stage. CONCLUSION: Heat wave exposure was significantly associated with a reduction in semen quality. The windows of susceptibility during 0-90 days before ejaculation varied across sperm count, motility, and morphology. Our findings suggest that reducing heat wave exposure before ejaculation may benefit sperm donation volunteers and those attempting to conceive.
Climate vulnerability can make urban space unhealthy and accentuate existing health (in)justice and (economic) segregation. Drawing on the vulnerability-readiness nexus and measuring health justice (i.e., health poverty, health distribution, and health access) and economic segregation (through indices), we strive to investigate the plausible pathways of the two constructs at the heat risks. Our work, focusing on metropolitan cities in South Korea, addresses the role of heat vulnerability and readiness nexus regarding health justice and economic segregation through correlational analysis and a time-trend comparative approach between 2011 and 2015 (as five year-long effects). Our results show that potential positive links exist between health poverty as a component of health justice and economic segregation. Moreover, climate readiness, as opposed to vulnerability, plays a crucial role in reducing economic segregation in the context of health justice and heat risks.
Continuous global warming and frequent extreme high temperatures keep the urban climate health risk increasing, seriously threatening residents’ emotional health. Therefore, analysis on spatial distribution of the health risk that the urban heat island (UHI) effect imposes on emotional health as well as basic research on the characteristics of vulnerable populations need to be conducted. This study, with Tianjin city as the case, analyzed data from Landsat remote-sensing images, meteorological stations, and digital maps, explored the influence of summer UHI effect on distress (a typical negative emotion factor) and its spatiotemporal evolution, and conducted difference analysis on the age groups, genders, family state, and distress levels of vulnerable populations. The results show: (1) During the period of 1992-2020, the level and area of UHI influence on residents’ distress drastically increased-influence level elevated from level 2-4 to level 4-7, and highlevel influence areas were concentrated in six districts of central Tianjin. (2) Influence of the UHI effect on distress varied in different age groups-generally dropping with fluctuations as residents got older, especially residents aged 50-59. (3) Men experienced a W-shaped pattern in distress and were more irritable and unsteady emotionally; while women were more sensitive to distress in the beginning, but they became more placid as temperature got higher. (4) Studies on family status show that couples living together showed sound heat resistance in the face of heat stress, while middle-aged and elderly people living alone or with children were relatively weak in adjusting to high ambient temperature.
An integrated environmental, economic, and health-informed approach was developed as a decision making framework to assess the associated benefits of enriching the urban greenery cover to provide city cooling potential. The framework used an evidence-based statistical-simulation approach to support decision-making processes associated with heat mitigation strategies. A novel health-informed statistical modeling was developed by introducing log-linear Poisson regression based on clustering factors to increase model fit, control dataset overdispersion, and enhance model prediction. The statistical model was utilized to predict mortality records and emergency department visits based on changes in heat behavior. Microclimate simulations were developed utilizing an updated version of the Urban Weather Generator to assess the impacts of increasing greenery cover in York Region, Southern Ontario, Canada on ambient temperature, outdoor heat stress, and buildings’ energy consumption. The heat-based health predictions of the York Region community confirmed the possible hazardous impact of climate change on health and the impact of extreme heat on mortality records and health system use. By intensifying the urban greenery cover, the results demonstrated significant reductions in ambient temperature, outdoor heat stress, neighborhood average daily energy use, expected mortality counts, and emergency department visits. The economic module has reported the expected benefits in terms of lower visits to emergency departments, avoiding premature mortality, reduced energy consumption, and reduced productivity losses. The proposed framework was developed as a flexible decision-making tool for policy-makers and stakeholders to assess environmental, economic, and health benefits of heat mitigation strategies within urban contexts.
Extreme heat, also known as the silent killer that conceal its lethal effect behind heat-related deaths, has become one of the deadliest natural hazards globally. However, the evaluation of heat risks in many countries remains incomplete, overlooking an important component on population health conditions in the evaluation framework. Drawing on the IPCC’s risk assessment framework, this study presents, for the first time, a comprehensive heat health risk assessment in Australian capital cities, consisting of three individual indexes-the heat exposure index, heat hazard index and heat vulnerability index-at the finest census unit, and an overall heat health risk index (HHRI). By involving health-related indicators in heat risk assessment, our evaluation takes into account people’s sensitivity to heat in developing the heat health risk indexes. Using the HHRI, we identify high heat risk areas appearing primarily in higher density residential areas with some distances away from the inner cities. We also find that the inequity of demographic and socioeconomic characteristics, housing features, and built envi-ronment features exists in areas with different levels of heat risks. Our findings contribute not only to profiling heat risks in Australian cities, but also empirically advance our understanding of place-based risk reduction in the Southern Hemisphere by linking climate science with health and spatial science research.
Climate extremes and rising energy prices present interconnected global health risks. Technical solutions can be supplemented with biomedical approaches to promote healthy longevity in hot and cold conditions. In summer, reducing basal metabolic rate through mild caloric restriction or CR mimetics, such as resveratrol, can potentially be used to lower body temperature. In winter, activating brown adipose tissue (BAT) for non-shivering thermogenesis and improved metabolic health can help adaptation to colder environments. Catechins found in green tea and in other food could be alternatives to drugs for these purposes. This review examines and discusses the biomedical evidence supporting the use of CR mimetics and BAT activators for health benefits amid increasingly extreme temperatures.
The capacity for adaptation to climate change is limited, and the elderly rank high among the most exposed population groups. To date, few studies have addressed the issue of heat adaptation, and little is known about the long-term effects of exposure to heat. One indicator that allows the ascertainment of a population’s level of adaptation to heat is the minimum mortality temperature (MMT), which links temperature and daily mortality. The aim of this study was to ascertain, firstly, adaptation to heat among persons aged ≥ 65 years across the period 1983 to 2018 through analysis of the MMT; and secondly, the trend in such adaptation to heat over time with respect to the total population. A retrospective longitudinal ecological time series study was conducted, using data on daily mortality and maximum daily temperature across the study period. Over time, the MMT was highest among elderly people, with a value of 28.6 °C (95%CI 28.3-28.9) versus 28.2 °C (95%CI 27.83-28.51) for the total population, though this difference was not statistically significant. A total of 62% of Spanish provinces included populations of elderly people that had adapted to heat during the study period. In general, elderly persons’ level of adaptation registered an average value of 0.11 (°C/decade).
The co-occurrence of more frequent, intense and prolonged heat and drought events can lead to severe socio-economic impacts. The integration of different types of urban green infrastructures (GIs; e.g., urban parks and building greens), and urban and building design measures (DMs; e.g., a network of cool urban spaces and passive cooling), at various scales, can help reduce outdoor air temperature, energy use and heat stress. Numerous accessible or emerging GI and DM solutions exist, highlighting the need for guidelines that evaluate their suitability in enhancing resilience to extreme heat. Those should consider broader aspects such as geographical conditions, urban morphology and development, social-economic background, governance and sustainability, as well as more specific considerations like maintenance, adaptability and soil and water resources. To facilitate decision-making, this study proposes guidelines based on a narrative literature review, discussing the potential impact of GIs and DMs and their role in enhancing the city’s climate resilience.
Marine heatwaves (MHWs) have doubled in frequency since the 1980s and are projected to be exacerbated during this century. MHWs have been shown to trigger harmful algal blooms (HABs), with severe consequences to marine life and human populations. Within this context, this study aims to understand, for the first time, how MHWs impact key biological and toxicological parameters of the paralytic shellfish toxin (PST) producer Gymnodinium catenatum, a dinoflagellate inhabiting temperate and tropical coastal waters. Two MHW were simulated-category I (i.e., peak: 19.9 °C) and category IV (i.e., peak: 24.1 °C)-relative to the estimated baseline in the western coast of Portugal (18.5 °C). No significant changes in abundance, size, and photosynthetic efficiency were observed among treatments. On the other hand, chain-formation was significantly reduced under category IV MHW, as was PSP toxicity and production of some PST compounds. Overall, this suggests that G. catenatum may have a high tolerance to MHWs. Nevertheless, some sublethal effects may have occurred since chain-formation was affected, suggesting that these growth conditions may be sub-optimal for this population. Our study suggests that the increase in frequency, intensity, and duration of MHWs may lead to reduced severity of G. catenatum blooms.
Global climate change has increased the probability and intensity of extreme weather events. The adverse health effect of extreme temperature has gone through a temporal variation over years. Time-series data including city-level daily cardiovascular death records and meteorological data were collected from 136 Chinese cities during 2006 and 2019. A time-varying distributed lag model with interaction terms was applied to assess the temporal change of mortality risk and attributable mortality of heat wave and cold spell. The mortality effect of heat wave generally increased and that of cold spell decreased significantly in the total population during the study period. The heat wave effect increased especially among the female and people aged 65 to 74. As for the cold spell, the reduced susceptibility was detected both in the temperate and cold climatic zone. Our findings appeal for counterpart measures corresponding to sub-populations and regions responding to future extreme climate events from the public and individuals.
Childhood anemia constitutes a global public health problem, especially in low- and middle-income countries (LMICs). However, it remains unknown whether global warming has an impact on childhood anemia. Here, we examined the association between annual temperatures and childhood anemia prevalence in sub-Saharan Africa and then projected childhood anemia burden attributable to climate change. Each 1°C increment in annual temperature was associated with increased odds of childhood anemia (odd ratio = 1.138, 95% confidence interval: 1.134-1.142). Compared with the baseline period (1985-2014), the attributable childhood anemia cases would increase by 7,597 per 100,000 person-years under a high-emission scenario in the 2090s, which would be almost 2-fold and over 3-fold more than those projected in moderate- and low-emission scenarios. Our results reveal the vulnerabilities and inequalities of children for the excess burden of anemia due to climate warming and highlight the importance of climate mitigation and adaptation strategies in LMICs.
As heatwaves become more frequent, intense, and longer-lasting due to climate change, the question of breaching thermal limits becomes pressing. A wet-bulb temperature (T(w)) of 35 °C has been proposed as a theoretical upper limit on human abilities to biologically thermoregulate. But, recent-empirical-research using human subjects found a significantly lower maximum T(w) at which thermoregulation is possible even with minimal metabolic activity. Projecting future exposure to this empirical critical environmental limit has not been done. Here, using this more accurate threshold and the latest coupled climate model results, we quantify exposure to dangerous, potentially lethal heat for future climates at various global warming levels. We find that humanity is more vulnerable to moist heat stress than previously proposed because of these lower thermal limits. Still, limiting warming to under 2 °C nearly eliminates exposure and risk of widespread uncompensable moist heatwaves as a sharp rise in exposure occurs at 3 °C of warming. Parts of the Middle East and the Indus River Valley experience brief exceedances with only 1.5 °C warming. More widespread, but brief, dangerous heat stress occurs in a +2 °C climate, including in eastern China and sub-Saharan Africa, while the US Midwest emerges as a moist heat stress hotspot in a +3 °C climate. In the future, moist heat extremes will lie outside the bounds of past human experience and beyond current heat mitigation strategies for billions of people. While some physiological adaptation from the thresholds described here is possible, additional behavioral, cultural, and technical adaptation will be required to maintain healthy lifestyles.
Green vegetation may protect against heat-related death by improving thermal comfort. Few studies have investigated associations of green vegetation with heat-related mortality in Latin America or whether associations are modified by the spatial configuration of green vegetation. We used data from 323 Latin American cities and meta-regression models to estimate associations between city-level greenness, quantified using population-weighted normalized difference vegetation index values and modeled as three-level categorical terms, and excess deaths from heat (heat excess death fractions [heat EDFs]). Models were adjusted for city-level fine particulate matter concentration (PM(2.5)), social environment, and country group. In addition to estimating overall associations, we derived estimates of association stratified by green space clustering by including an interaction term between a green space clustering measure (dichotomized at the median of the distribution) and the three-level greenness variable. We stratified analyses by climate zone (arid vs. temperate and tropical combined). Among the 79 arid climate zone cities, those with moderate and high greenness levels had modestly lower heat EDFs compared to cities with the lowest greenness, although protective associations were more substantial in cities with moderate versus high greenness levels and confidence intervals (CI) crossed the null (Beta: -0.41, 95% CI: -1.06, 0.25; Beta -0.23, 95% CI: -0.95, 0.49, respectively). In 244 non-arid climate zone cities, associations were approximately null. We did not observe evidence of effect modification by green space clustering. Our results suggest that greenness may offer modest protection against heat-related mortality in arid climate zone Latin American cities.
PurposeThe adverse impacts of climate change coupled with rapid informal urbanization in the Southern African region are increasing the vulnerability of already sensitive population groups. Consequently, these urban regions are highly vulnerable to urban heat island effects and heatwaves due to exogenous and endogenous factors. While the dynamic interplay between the built environment, climate and response strategies is known, this paper highlights the lived experience of informal settlement residents. It presents work from a project undertaken in Melusi, an informal settlement in Tshwane, South Africa, as a multi-disciplinary project focusing on improving the local resilience to climate change associated heat stress.Design/methodology/approachFollowing a mixed method approach, a semi-structured observational analysis of the spatial layout and material articulation of selected dwellings along with the continuous monitoring and recording of their indoor environments were undertaken.FindingsThe paper presents the research results in terms of the dwelling characteristics, as spatial and material-use strategies and documented heat stress exposure in these structures. The findings highlight that informal dwellings perform poorly in all cases due to endogenous factors and that inhabitants experience extreme heat stress conditions for between 6 and 10 h daily during the peak summer period.Originality/valueCurrently, there are little empirical data on the heat stress residents living in informal settlements in Southern Africa are experiencing. This article provides insight into the indoor environments of informal dwellings and hopes to contribute future guidelines or heat health policies.
Despite recent progress in assessing future population exposure, few studies have focused on the exposure of certain vulnerable groups, such as working people. Working in hot environments can increase the heat-related risk to human health and reduce worker productivity, resulting in broad social and economic implications. Based on the daily climatic simulations from the Coupled Model Intercomparison Project phase 6 (CMIP6) and the age group-specific population projections, we investigate future changes in working-age population exposure to heat extremes under multiple scenarios at global and continental scales. Projections show little variability in exposure across scenarios by mid-century (2031-2060), whereas significantly greater increases occur under SSP3-7.0 for the late century (2071-2100) compared to lower-end emission scenarios. Global exposure is expected to increase approximately 2-fold, 6-fold and 16-fold relative to the historical time (1981-2010) under SSP1-2.6, SSP2-4.5 and SSP3-7.0, respectively. Asia will have the largest absolute exposure increase, while in relative terms, the most affected region is Africa. At the global level, future exposure increases are primarily caused by climate change and the combined effect of climate and working-age population changes. Climate change is the dominant driver in enhancing future continental exposure except in Africa, where the main contributor is the combined effect.
OBJECTIVE: This study aimed to estimate spatiotemporal variations of global heat-related cardiovascular disease (CVD) burden from 1990 to 2019. METHODS: Data on the burden of heat-related CVD were derived from the Global Burden of Disease Study 2019. Deaths and disability-adjusted life years (DALYs) were used to quantify heat-induced CVD burden. We calculated the age-standardized mortality rate (ASMR) and DALY rate (ASDR) per 100,000 population to compare this burden across regions. Generalized linear models were applied to evaluate estimated annual percentage changes (EAPC) for temporal trends from 1990 to 2019. The correlation between the socio-demographic index (SDI) and age-standardized rate was measured using the Spearman rank test. RESULTS: Heat-induced CVD caused approximately 90 thousand deaths worldwide in 2019. Global ASMR and ASDR of heat-related CVD in 2019 were 1.17 [95% confidence interval ( CI): 0.13-1.98] and 25.59 (95% CI: 2.07-44.17) per 100,000 population, respectively. The burden was significantly increased in middle and low-SDI regions and slightly decreased in high-SDI regions from 1990 to 2019. ASMR showed an upward trend, with the most considerable increase in low-latitude countries. We observed a negative correlation between SDI and EAPC in ASMR ( r (s) = -0.57, P < 0.01) and ASDR ( r (s) = -0.59, P < 0.01) among 204 countries. CONCLUSION: Heat-attributable CVD burden substantially increased in most developing countries and tropical regions.
The increasing exposure to extreme heatwaves in urban areas from both climate change and the urban heat island (UHI) effect poses multiple threats and challenges to human society. Despite a growing number of studies focusing on extreme exposure, research advances are still limited in some aspects such as oversimplification of human exposure to heatwaves and neglect of perceived temperature as well as actual body comfort, resulting in unreliable and unrealistic estimates of future results. In addition, little research has performed comprehensive and fine-resolution global analyses in future scenarios. In this study, we present the first global fine-resolution projection of future changing urban population exposure to heatwaves by 2100 under four shared socioeconomic pathways (SSPs) considering urban expansion at global, regional, and national scales. Overall, global urban population exposure to heatwaves is rising under the four SSPs. Temperate and tropical zones predictably have the greatest exposure among all climate zones. Coastal cities are projected to have the greatest exposure, followed closely by cities at low altitudes. Middle-income countries have the lowest exposure and the lowest inequality of exposure among countries. Individual climate effects contributed the most (approximately 46.4%) to future changes in exposure, followed by the interactive effect between climate and urbanization (approximately 18.5%). Our results indicate that more attention needs to be paid to policy improvements and sustainable development planning of global coastal cities and some low-altitude cities, especially in low- and high-income countries. Meanwhile, this study also highlights the impact of continued future urban expansion on population exposure to heatwaves.
Impacts of climate change rank among the century’s most significant ecological and medical concerns. As a result of climatic changes, the distribution of some bacterial species will alter across time and space. Numerous bacterial infections will reorganize as a result worldwide. Acinetobacter baumannii Bouvet and Grimont is one of the most significant and frequently occurring bacteria identified in soil and air. The COVID-19 pandemic has changed how bacteriologists perceive this species as a new threat to human health. In order to estimate the existing and future worldwide distribution of A. baumannii under various climate change scenarios, about 1000 A. baumannii occurrence records were employed. Given its superior accuracy and dependability versus alternative modeling techniques, maximum entropy implemented in MaxEnt was selected as the modeling tool. The bioclimatic variable that contributes the most to the distribution of A. baumannii is the mean temperature of the coldest quarter (bio_11). The created current distribution model agreed with the species’ actual globally dispersed distribution. It is projected that A. baumannii will experience a severe range expansion due to the increase in temperature brought on by global warming in different regions of its range. According to the risk maps created for 2050 and 2070 using two alternative RCPs, there are various regions that will be under risk of this bacterium as a result of rising temperature. Future data science and GIS evaluation of the current results are necessary, especially on a local level.
Global warming is a result of the increased emission of greenhouse gases. The consequences of this climate change threaten society, biodiversity, food and resource availability. The consequences include an increased risk of cardiovascular (CV) disease and cardiovascular mortality. In this position paper, we summarize the data from the main studies that assess the risks of a temperature increase or heat waves in CV events (CV mortality, myocardial infarction, heart failure, stroke, and CV hospitalizations), as well as the data concerning air pollution as an enhancer of temperature-related CV risks. The data currently support global warming/heat waves (extreme temperatures) as cardiovascular threats. Achieving neutrality in emissions to prevent global warming is essential and it is likely to have an effect in the global health, including the cardiovascular health. Simultaneously, urgent steps are required to adapt the society and individuals to this new climatic context that is potentially harmful for cardiovascular health. Multidisciplinary teams should plan and intervene healthcare related to temperature changes and heat waves and advocate for a change in environmental health policy.
While improvement of soybean productivity under a changing climate will be integral to ensuring sustainable food security, the relative importance of genetic progress attributed to historical yield gains remains uncertain. Here, we compiled 16,934 cultivar-site-year observations from experiments during the period of 2006-2020 to dissect effects of genetic progress and climate variability on China’s soybean yield gains over time. Over the past 15 years, mean yields in the Northeast China (NEC), Huang-Huai-Hai Plain (HHH), and Southern Multi-cropping Region (SMR) were 2830, 2852, and 2554 kg ha(-1), respectively. Our findings show that genetic progress contributed significantly to yield gains, although underpinning mechanisms varied regionally. Increased pod number per plant (PNPP) drove yield gains in the NEC, while both PNPP and 100-grain weight (100-GW) contributed to yield gains in the HHH. In all regions, incremental gains in the reproductive growing periods increased PNPP, 100-GW, and yields. While heat stress in the reproductive period reduced average yields in all regions, superior yielding cultivars (top 25%) in the HHH and SMR were less sensitive to heat stress during the reproductive phases, indicating that the higher yielding cultivars benefited from genetic improvement in heat stress tolerance. Our results highlight the importance of genetic improvements in enabling sustainable food security under global warming and increasingly frequent heat stress.
Driven by globalization, urbanization and climate change, the distribution range of invasive vector species has expanded to previously colder ecoregions. To reduce health-threatening impacts on humans, insect vectors are extensively studied. Population genomics can reveal the genomic basis of adaptation and help to identify emerging trends of vector expansion. By applying whole genome analyses and genotype-environment associations to populations of the main dengue vector Aedes aegypti, sampled along an altitudinal gradient in Nepal (200-1300 m), we identify putatively adaptive traits and describe the species’ genomic footprint of climate adaptation to colder ecoregions. We found two differentiated clusters with significantly different allele frequencies in genes associated to climate adaptation between the highland population (1300 m) and all other lowland populations (≤800 m). We revealed nonsynonymous mutations in 13 of the candidate genes associated to either altitude, precipitation or cold tolerance and identified an isolation-by-environment differentiation pattern. Other than the expected gradual differentiation along the altitudinal gradient, our results reveal a distinct genomic differentiation of the highland population. Local high-altitude adaptation could be one explanation of the population’s phenotypic cold tolerance. Carrying alleles relevant for survival under colder climate increases the likelihood of this highland population to a worldwide expansion into other colder ecoregions.
Extreme heat is a major health hazard that is exacerbated by ongoing human-caused climate change. However, how populations perceive the risks of heat in the context of other hazards like COVID-19, and how perceptions vary geographically, are not well understood. Here we present spatially explicit estimates of worry among the U.S. public about the risks of heat and COVID-19 during the summer of 2020, using nationally representative survey data and a multilevel regression and poststratification (MRP) model. Worry about extreme heat and COVID-19 varies both across states and across demographic groups, in ways that reflect disparities in the impact of each risk. Black or African American and Hispanic or Latino populations, who face greater health impacts from both COVID-19 and extreme heat due to institutional and societal inequalities, also tend to be much more worried about both risks than white, non-Hispanic populations. Worry about heat and COVID-19 were correlated at the individual and population level, and patterns tended to be related to underlying external factors associated with the risk environment. In the face of a changing climate there is an urgent need to address disparities in heat risk and develop responses that ensure the most at-risk populations are protected.
Global warming leads to more frequent and intense heatwaves, putting urban populations at greater risk. Previous related studies considered only surface air temperature or one or two Shared Socioeconomic Pathways (SSPs) and were limited to specific regions. Moreover, no research focused on heatwave exposure in highly-populated global megacities facing severe threats. This study is the first to project future population exposure to heatwaves in 83 global megacities by 2100 using fine-resolution data, suitable indices reflecting human comfort in heatwaves by incorporating temperature and humidity, and a future population exposure projection and analysis framework. The results show that (1) the global frequency of extreme heatwave events and average change rate in each megacity sequentially increase from SSP1-2.6 to SSP5-8.5, and the change rate is generally larger in megacities in the Southern Hemisphere; (2) the increases in heatwave exposure are greatest under SSP370, and the change rates are generally larger for megacities in Southern Asia; (3) there is a high degree of inequality (Gini of 0.6 to 0.63) in future heatwave exposure globally, with the highest inequality under SSP5-8.5 and the lowest under SSP3-7.0; (4) the average exposure, increase rate, and change are highest in low-income megacities and lowest in high-income megacities. The distribution of exposure is the most balanced in middle-income megacities and the least balanced in high-income megacities; and (5) population growth contributes more to the change in exposure than total warming in high-income megacities under SSP1-2.6, and total urban warming contributes much more than population growth in all other cases. Every effort should be made to avoid the SSP3-7.0 scenario and pursue sustainable and rational urban economic development. Mumbai, Manila, Kolkata, and Jakarta warrant particular attention due to their rapid exposure growth. Additionally, policymakers and urban planners must focus on improving sustainable development planning for megacities in southern Asia and low-income megacities.
Future climate changes are projected to adversely affect mortality risk of cardiovascular disease (CVD) in urbanized regions. However, future temperature-related excess CVD hospitalizations in rural residents with poorer socioeconomic status is not well understood. Moreover, influence of aging and declining rural population are rarely considered. Using CVD hospitalizations in rural residents during 2010-2016 in eight regions in southeastern China, the region-specific temperature-CVD associations were estimated by generalized additive models, which were combined by a meta-regression. We projected excess CVD hospitalizations due to temperature using regional associations for 27 climate models under scenarios of climate change for 2010-2099. To reveal the influences of aging and declining rural population, age-specific associations and future population change ratio were used to estimate age-specific number of temperature-related hospitalizations. We found that heat-related hospitalizations in rural residents from ischemic stroke, ischemic heart disease and cerebrovascular disease are projected to increase in the 2090 s, although the excess CVD hospitalizations associated with future temperature in rural residents will reduce in the 2090 s. Rural population aging amplifies temperature-related CVD burden by >2.34-fold under SSPs in the 2050 s compared to scenarios with only population declining, although rural population reduction will reduce the temperature-related CVD hospitalizations in the 2090 s. The elderly, male and those lived in Longyan and Sanming could be more affected. These findings suggest that future heat is projected to increase hospitalizations of some CVD subcategories. Policies are needed to mitigate increasing temperature and baseline hospitalization rate. The impact of population aging is noteworthy.
Urbanization and warming climate suggest that health impacts from extreme heat will increase in cities, thus locating vulnerable populations is pivotal. However, heat vulnerability indices (HVI) overwhelmingly interpret one model that may be inaccurate or methodologically flawed without considering how results compare with other HVI. Accordingly, this analysis applied a multimodal approach incorporating underrepresented health and adaptability measures to analyze heat vulnerability more comprehensively and better identify vulnerable populations. The Southeast Florida HVI (SFHVI) blends twenty-four physical exposure, sensitivity, and adaptive capacity indicators using uncommon statistical weights removing overlap, then SFHVI scores were compared statistically and qualitatively with ten models utilizing alternative methods. Urban areas with degraded physical settings, socioeconomic conditions, health, and household resources were particularly vulnerable. Rural and agricultural areas were also vulnerable reflecting socioeconomic conditions, health, and community resources. Three alternative models produced vulnerability scores not statistically different than SFHVI. The other seven differed significantly despite geospatial consistency regarding the most at-risk areas. Since inaccurate HVI can mislead decisionmakers inhibiting mitigation, future studies should increasingly adopt multimodal approaches that enhance analysis comprehensiveness, illuminate methodological strengths and flaws, as well as reinforce conviction about susceptible populations.
It is acknowledged that climate change exacerbates social inequalities, and women have been reported as more vulnerable to heat than men in many studies in Europe, including the Czech Republic. This study aimed at investigating the associations between daily temperature and mortality in the Czech Republic in the light of a sex and gender perspective, taking into account other factors such as age and marital status. Daily mean temperature and individual mortality data recorded during the five warmest months of the year (from May to September) over the period 1995-2019 were used to fit a quasi-Poisson regression model, which included a distributed lag non-linear model (DLNM) to account for the delayed and non-linear effects of temperature on mortality. The heat-related mortality risks obtained in each population group were expressed in terms of risk at the 99th percentile of summer temperature relative to the minimum mortality temperature. Women were found generally more at risk to die because of heat than men, and the difference was larger among people over 85 years old. Risks among married people were lower than risks among single, divorced, and widowed people, while risks in divorced women were significantly higher than in divorced men. This is a novel finding which highlights the potential role of gender inequalities in heat-related mortality. Our study underlines the relevance of including a sex and gender dimension in the analysis of the impacts of heat on the population and advocates the development of gender-based adaptation policies to extreme heat.
The changes in the characteristics of heatwaves over Romania have been analyzed using the excess heat factor calculated for two climate change scenarios (RCP4.5 and RCP8.5) from the EURO-CORDEX project. The changes were evaluated for the near future (2021-2050) using the historical period (1971-2000) as reference. The frequency of occurrence and the duration of heatwaves is projected to increase for both climate scenarios in particular over southern Romania. In this region, the percentage of change in the near future for the number of heatwaves is between 50 and 60% for the RCP4.5 scenario and 60-80% for the RCP8.5 scenario. Also for the same region, the duration of heatwaves will increase by 30-50% for the RCP4.5 scenario and 60-80% for the RCP8.5 scenario. These results indicate that the human exposure to heatwaves will increase in Romania in the near future. To increase awareness on heatwaves and their impact, we propose a series of immediate actions that include (1) improving the communication of the impact of heatwaves, (2) identification of the regions where the population is more vulnerable to heatwaves, and (3) better understanding of the mortality and morbidity associate with heatwaves in Romania.
Changes in extreme human bioclimate conditions are accepted evidence for and serve as a broad measure of anthropogenic climate change. The essential objective of the current study was to investigate past and future thermal bioclimate conditions across West Bengal (WB), India. The daily physiologically equivalent temperature (PET) was calculated by considering definite climate variables as inputs. These meteorological variables were captured from the Coordinated Regional Downscaling Experiment (CORDEX)-South Asia. The initial results from this research work present the mean monthly distribution of each PET class over the considered stations of WB during the period (1986-2005) and three future time periods: (i) near future (2016-2035), (ii) mid-future (2046-2065), and (iii) far future (2080-2099). It was observed that the months from April to June comprise heat stress months in terms of human thermal perception, whereas thermally acceptable conditions begin in November and continue until March for most stations. Results from future PET changes over WB in the context of the reference period (1986-2005) reveal a prominent increase in warm and hot PETs for all future time periods in two different greenhouse gas emission scenarios. During the far-future time period, stations within a kilometer of the Bay of Bengal such as Digha, Diamond Harbour, Canning, and Baruipur account for the highest percentage in the warm PET class (35.7-43.8 degrees C) in high-end emission scenarios. Simultaneously, during the period from 2080 to 2099, Kolkata, Dum Dum, Kharagpur, and Siliguri will experience a PET greater than 43.8 degrees C for close to 10% of the days in the year and more than 10% in Sriniketan, Malda, Asansol, and Birbhum. During the far-future period, a negative change in the very cool PET class (<3.3 degrees C) indicating a decrease in cold days was the largest for Darjeeling.
BACKGROUND: Physical activity (PA) can be affected by extreme temperatures, however fewer studies have identified factors impacting this relationship. This study sought to identify factors associated with changes of outdoor PA during extreme cold/heat events in a sub-tropical Chinese urban population, including factors of sociodemographic, health conditions, temperature-related awareness and attitude, and protective behaviours. METHODS: Two telephone surveys were conducted a week after extreme cold/heat events in 2016 and 2017 among a cohort of Hong Kong residents over age 15. Data was collected on self-reported changes in outdoor PA level during the periods of extreme temperatures, health status, comorbidities, sociodemographic, and temperature-related awareness, and behavioural variables. We conducted multivariable logistic regression analyses to assess predictors of change in outdoor PA over the two extreme temperature events. RESULTS AND CONCLUSION: Among 435 participants (42.8% response rate), over a third of the participants reported decreased outdoor PA level in extreme temperature events, while 10% reported an increase in extreme heat. Self-reported cardiovascular diseases were associated with decreased PA level in extreme cold, while hypertension was associated with unchanged/increased PA level in extreme heat. These results suggest physical activity to be an important consideration in the understanding of climate change-and-health pathways and meriting further research.
Heatwaves pose an important risk for population health and are associated with an increased demand for emergency care. To find factors causing such overload, an online Delphi study included 15 experts in emergency medicine, disaster medicine, or public health. One open-ended question was delivered in the first round. After content analysis, the obtained statements were sent to the experts in two rounds to be rated on a 7-point linear scale. Consensus was defined as a standard deviation ≤ 1.0. Thirty-one statements were obtained after content analysis. The experts agreed on 18 statements, mostly focusing on the input section of patient processing and identifying stakeholders, the population, and primary care as targets of potential interventions. Additional dedicated resources and bed capacity were deemed important as per throughput and output sections, respectively. These findings could be used in the future to implement and test solutions to increase emergency healthcare resilience during heatwaves and reduce disaster risk due to climatic change.
Since the advent of coronavirus disease 2019 (COVID-19), healthcare workers (HCWs) wearing personal protective equipment (PPE) has become a common phenomenon. COVID-19 outbreaks overlap with heat waves, and healthcare workers must unfortunately wear PPE during hot weather and experience excessive heat stress. Healthcare workers are at risk of developing heat-related health problems during hot periods in South China. The investigation of thermal response to heat stress among HCWs when they do not wear PPE and when they finish work wearing PPE, and the impact of PPE use on HCWs’ physical health were conducted. The field survey were conducted in Guangzhou, including 11 districts. In this survey, HCWs were invited to answer a questionnaire about their heat perception in the thermal environment around them. Most HCWs experienced discomfort in their back, head, face, etc., and nearly 80% of HCWs experienced “profuse sweating.” Up to 96.81% of HCWs felt “hot” or “very hot.” The air temperature had a significant impact on thermal comfort. Healthcare workers’ whole thermal sensation and local thermal sensation were increased significantly by wearing PPE and their thermal sensation vote (TSV) tended towards “very hot.” The adaptive ability of the healthcare workers would decreased while wearing PPE. In addition, the accept range of the air temperature (T (a)) were determined in this investigation. Graphical Abstract.
Increasing heatwave frequency due to climate change threatens outdoor workers’ health. We aimed to assess the on-site heat strain level of outdoor workers using wearable sensors and identify the factors for consideration in developing individual-based heat adaptation strategies. Seven road construction workers were recruited and asked to wear necklace-form temperature loggers and smartwatches monitoring heart rate (HR). The questionnaire was delivered daily to ask about their psychological comfort level during work. Workers were exposed to up to 5.4 degrees C higher temperature than the official air temperature, indicating that the national heatwave alarm does not reflect on-site heat conditions. Based on the measured HR data, heat strain levels were defined. When HR exceeded the level of “180-age,” we assumed extreme heat strain occurred, which requires immediate cessation of work. When HR exceeded 40% of the individual heart rate reserve (the difference between the maximum and resting HR), we assumed high heat strain occurred, indicating a stressed condition. High heat strain occurred in all workers on 9 of the 13 monitored days, whereas the official heatwave alarms were issued only on four dates. Additionally, three workers experienced extreme heat strain on two dates. The main factor for workers experiencing extreme heat strain was age. Comparing the heat strain levels from HR with the survey results, we found that the older workers considered their condition comfortable even under extreme and high heat strain. Thus, an individual sensor-based early-warning system is needed to prevent heat strain not perceived by outdoor workers. The findings emphasize the need for a personalized adaptation strategy for heatwaves and will be a baseline for developing a new work manual that mainstreams climate change impacts.
In summer 2020, New York City (NYC) implemented a free air conditioner (AC) distribution program in response to the threats of extreme heat and COVID-19. The program distributed and installed ACs in the homes of nearly 73,000 older, low-income residents of public and private housing. To evaluate the program’s impact, survey data were collected from October 2020 to February 2021 via mail and online from 1447 program participants and 902 non-participating low-income NYC adults without AC as a comparison group. Data were examined by calculating frequencies, proportions, and logistic regression models. Participants were 3 times more likely to report staying home during hot weather in summer 2020 compared to non-participants (adjusted odds ratio [AOR] = 3.0, 95% confidence interval [CI] = 2.2, 4.1), with no difference between groups in summer 2019 (AOR = 1.0, CI = 0.8, 1.3). Participants were less likely to report that 2020 hot weather made them feel sick in their homes compared to non-participants (AOR = 0.2, CI = 0.2, 0.3). The program helped participants-low-income residents and primarily people of color-stay home safely during hot weather. These results are relevant for climate change health-adaptation efforts and heat-health interventions.
Hot, desert Gulf countries are host to millions of migrant workers doing outdoor jobs such as construction and hospitality. The Gulf countries apply a summertime ban on midday work to protect workers from extreme heat, although without clear evidence of effectiveness. We assessed the risk of occupational injuries associated with extreme hot temperatures during the summertime ban on midday work in Kuwait. METHODS: We collected daily occupational injuries in the summer months that are reported to the Ministry of Health’s Occupational Health Department for 5 years from 2015 to 2019. We fitted generalised additive models with a quasi-Poisson distribution in a time series design. A 7-day moving average of daily temperature was modelled with penalised splines adjusted for relative humidity, time trend and day of the week. RESULTS: During the summertime ban, the daily average temperature was 39.4°C (±1.8°C). There were 7.2, 7.6 and 9.4 reported injuries per day in the summer months of June, July and August, respectively. Compared with the 10th percentile of summer temperatures in Kuwait (37.0°C), the average day with a temperature of 39.4°C increased the relative risk of injury to 1.44 (95% CI 1.34 to 1.53). Similarly, temperatures of 40°C and 41°C were associated with relative risks of 1.48 (95% CI 1.39 to 1.59) and 1.44 (95% CI 1.27 to 1.63), respectively. At the 90th percentile (42°C), the risks levelled off (relative risk 1.21; 95% CI 0.93 to 1.57). CONCLUSION: We found substantial increases in the risk of occupational injury from extremely hot temperatures despite the ban on midday work policy in Kuwait. ‘Calendar-based’ regulations may be inadequate to provide occupational heat protections, especially for migrant workers.
IMPORTANCE: Extreme heat poses a distinct risk to the 2.1 million incarcerated people in the United States, who have disparately high rates of behavioral health conditions. Suicide is a leading cause of death among people in prisons. OBJECTIVE: To examine associations of extreme heat, solitary confinement, and an indicator of suicidal behaviors among incarcerated men in a Deep South US prison system. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal case series panel study included adult men in prisons in Louisiana, a state with one of the largest prison systems in the United States that has been engaged in litigation due to lack of air conditioning and extreme heat. The unit of analysis was prison facility-days. A facility-level data set was created by merging administrative data files, which included demographic characteristics, health classification, housing location and movement, disciplinary records, and involvement in suicide-watch incidents for all incarcerated men in Louisiana during the observation period. Individual-level variables were aggregated to facility-days to merge in daily maximum heat index data from the US Local Climatological Data, which were linked to the zip codes of prisons. The observation period was January 1, 2015, to December 31, 2017. Data set construction occurred from August 2020 to September 2022, and analysis was conducted from December 2022 to February 2023. EXPOSURE: The focal exposure was extreme heat days. Daily maximum heat index data were categorized into 6 bins (<30 °F, 30-39 °F, 40-49 °F, 50-59 °F, 70-79 °F, and ≥80 °F) and as an indicator for any facility-day where the maximum heat index exceeded the 90th percentile of heat indices for total days in observation period. Conditional fixed-effects negative binomial regression models were used to calculate incident rate ratios to test associations between extreme heat and suicide watch incidents, while controlling for covariates. MAIN OUTCOMES AND MEASURES: The focal outcome was daily count of suicide watch incidents that were recorded in a carceral system database. Covariates included daily percentages of incarcerated persons at each prison with serious mental illness diagnosis, daily rate of solitary confinement, and total facility population. RESULTS: The sample of 6 state-operated prisons provided 6576 facility-days for the analysis. Results suggest a dose-responsive association between extreme heat and daily counts of suicide-watch incidents; compared with days with temperatures between 60 and 69 °F, the rate of daily suicide incidents increased by 29% when the heat index reached the level of caution (ie, 80-89 °F) and by 36% when reaching extreme caution (90-103 °F) (80-89 °F: incidence rate ratio [IRR], 1.29; 95% CI, 1.17-1.43; P < .001; 90-103 °F: IRR, 1.36; 95% CI, 1.15-1.61; P < .001). Compared with other days, those with the extreme heat indicator were significantly associated with a 30% increase in the incident rate of daily suicide-watch incidents (IRR, 1.30; 95% CI, 1.18-1.45; P < .001). CONCLUSIONS AND RELEVANCE: Findings suggest an association between extreme heat and an indicator of suicidality among an incarcerated sample, contribute to an emerging literature exploring linkages between climatological events and health outcomes in prisons, and may have implications for legal interventions and advocacy seeking to abate heat-induced morbidity and mortality in carceral contexts.
BACKGROUND AND OBJECTIVES: Extreme heat is an environmental health equity concern disproportionately impacting low-income older adults and people of color. Exposure factors, such as living in rental housing and lack of air conditioning, and sensitivity factors, such as chronic disease and social isolation, increase mortality risk among older adults. Older persons face multiple barriers to adaptive heat mitigation, particularly for those living in historically temperate climates. This study measures two heat vulnerability indices to identify areas and individuals most vulnerable to extreme heat and discusses opportunities to mitigate vulnerability among older adults. RESEARCH DESIGN AND METHODS: We constructed two heat vulnerability indices for the Portland, Oregon metropolitan area: one using area scale proxy measures extracted from existing regional data and another at the individual scale using survey data collected following the 2021 Pacific Northwest Heat Dome event. These indices were analyzed using principal component analysis (PCA) and Geographic Information Systems (GIS). RESULTS: Results indicate that the spatial distribution of areas and individuals vulnerable to extreme heat are quite different. The only area found among the most vulnerable on both indices has the largest agglomeration of age- and income-restricted rental housing in the metropolitan area. DISCUSSION AND IMPLICATIONS: Due to spatial variations in heat-related risk at the individual and area scales, measures addressing heat risk should not be spatially uniform. By focusing resources on older adult individuals and areas in particular need of assistance, heat risk management policies can be both highly efficient and cost-effective.
The global climate has changed, and there are concerns about the effects on both humans and the environment, necessitating more research for improved adaptation. In this study, we analyzed extreme temperature and rainfall events and projected future climate change scenarios for the coastal Savannah agroecological zone (CSAZ) of Ghana. We utilized the ETCCDI, the RClimDex software (version 1.0), the Mann-Kendall test, Sen’s slope estimator, and standardized anomalies to analyze homogeneity, trends, magnitude, and seasonal variations in temperature (T-max and T-min) and rainfall datasets for the zone. The SDSM was also used to downscale future climate change scenarios based on the CanESM2 (RCP 2.6, 4.5, and 8.5 scenarios) and HadCM3 (A2 and B2 scenarios) models for the zone. Model performance was evaluated using statistical methods such as R-2, RMSE, and PBIAS. Results revealed more changepoints in T-min than in T-max and rainfall. Results again showed that the CSAZ has warmed over the last four decades. The SU25, TXn, and TN90p have increased significantly in the zone, and the opposite is the case for the TN10p and DTR. Spatially varied trends were observed for the TXx, TNx, TNn, TX10p, TX90p, and the CSDI across the zone. The decrease in RX1day, RX5day, SDII, R10, R95p, and R99p was significant in most parts of the central region compared to the Greater Accra and Volta regions, while the CDD significantly decreased in the latter two regions than in the former. The trends in CWD and PRCPTOT were insignificant throughout the zone. The overall performance of both models during calibration and validation was good and ranged from 58-99%, 0.01-1.02 degrees C, and 0.42-11.79 degrees C for R-2, RMSE, and PBIAS, respectively. T-max is expected to be the highest (1.6 degrees C) and lowest (-1.6 degrees C) across the three regions, as well as the highest (1.5 degrees C) and lowest (-1.6 degrees C) for the entire zone, according to both models. T-min is projected to be the highest (1.4 degrees C) and lowest (-2.1 degrees C) across the three regions, as well as the highest (1.4 degrees C) and lowest (-2.3 degrees C) for the entire zone. The greatest (1.6 degrees C) change in mean annual T-max is expected to occur in the 2080s under RCP8.5, while that of the T-min (3.2 degrees C) is expected to occur in the 2050s under the same scenario. Monthly rainfall is expected to change between -98.4 and 247.7% across the three regions and -29.0 and 148.0% for the entire zone under all scenarios. The lowest (0.8%) and highest (79%) changes in mean annual rainfall are expected to occur in the 2030s and 2080s. The findings of this study could be helpful for the development of appropriate adaptation plans to safeguard the livelihoods of people in the zone.
The effect of exposure to extreme temperature events (ETEs) on dementia mortality remains largely unknown. We aimed to quantify the association of ETE exposure with dementia mortality. METHODS: We conducted a population-based, case-crossover study among 57 791 dementia deaths in Jiangsu province, China, during 2015-20. Daily mean temperatures were extracted from a validated grid dataset at each subject’s residential address, and grid-specific exposures to heat wave and cold spell were assessed with a combination of their intensity and duration. We applied conditional logistic regression models to investigate cumulative and lag effects for ETE exposures. RESULTS: Exposure to ETE with each of all 24 definitions was associated with an increased odds of dementia mortality, which was higher when exposed to heat wave. Exposure to heat wave (daily mean temperature ≥95th percentile, duration ≥3 days (d); P95_3d) and cold spell (≤5th percentile, duration ≥3 d; P5_3d) was associated with a 75% (95% CI: 61%, 90%) and 30% (19%, 43%) increase in odds of dementia mortality, respectively. Definitions with higher intensity were generally associated with a higher odds of dementia mortality. We estimated that 6.14% of dementia deaths were attributable to exposure to heat wave (P90_2d) and cold spell (P10_2d). No effect modifications were observed by sex or age, except that the association for heat wave was stronger among women. CONCLUSIONS: Exposure to both heat wave and cold spell was associated with an increased odds of dementia mortality. Our findings highlight that reducing individual ETE exposures may be helpful in preventing deaths from dementia, especially among women in summer.
Extreme temperature events (ETEs), including heat wave and cold spell, have been linked to myocardial infarction (MI) morbidity; however, their effects on MI mortality are less clear. Although ambient fine particulate matter (PM(2.5)) is suggested to act synergistically with extreme temperatures on cardiovascular mortality, it remains unknown if and how ETEs and PM(2.5) interact to trigger MI deaths. METHODS: A time-stratified case-crossover study of 202 678 MI deaths in Jiangsu province, China, from 2015 to 2020, was conducted to investigate the association of exposure to ETEs and PM(2.5) with MI mortality and evaluate their interactive effects. On the basis of ambient apparent temperature, multiple temperature thresholds and durations were used to build 12 ETE definitions. Daily ETEs and PM(2.5) exposures were assessed by extracting values from validated grid datasets at each subject’s geocoded residential address. Conditional logistic regression models were applied to perform exposure-response analyses and estimate relative excess odds due to interaction, proportion attributable to interaction, and synergy index. RESULTS: Under different ETE definitions, the odds ratio of MI mortality associated with heat wave and cold spell ranged from 1.18 (95% CI, 1.14-1.21) to 1.74 (1.66-1.83), and 1.04 (1.02-1.06) to 1.12 (1.07-1.18), respectively. Lag 01-day exposure to PM(2.5) was significantly associated with an increased odds of MI mortality, which attenuated at higher exposures. We observed a significant synergistic interaction of heat wave and PM(2.5) on MI mortality (relative excess odds due to interaction >0, proportion attributable to interaction >0, and synergy index >1), which was higher, in general, for heat wave with greater intensities and longer durations. We estimated that up to 2.8% of the MI deaths were attributable to exposure to ETEs and PM(2.5) at levels exceeding the interim target 3 value (37.5 μg/m(3)) of World Health Organization air quality guidelines. Women and older adults were more vulnerable to ETEs and PM(2.5). The interactive effects of ETEs or PM(2.5) on MI mortality did not vary across sex, age, or socioeconomic status. CONCLUSIONS: This study provides consistent evidence that exposure to both ETEs and PM(2.5) is significantly associated with an increased odds of MI mortality, especially for women and older adults, and that heat wave interacts synergistically with PM(2.5) to trigger MI deaths but cold spell does not. Our findings suggest that mitigating both ETE and PM(2.5) exposures may bring health cobenefits in preventing premature deaths from MI.
BACKGROUND: Prior literature has found that extreme temperature exposure is associated with preterm birth (PTB). However, current evidence provides heterogeneous conclusions, and data on extreme cold and across different pre-pregnancy body mass index (BMI) statuses are limited. METHODS: We conducted a population-based retrospective cohort of 251,257 women between 2014 and 2017 in Guangdong, China, to evaluate whether the association between extreme temperature exposure and PTB varied in pre-pregnancy BMI status. Participants were divided into three categories based on pre-pregnancy BMI: underweight (BMI < 18.5 kg/m(2)), normal weight (18.5-23.9 kg/m(2)), overweight or obesity (≥ 24.0 kg/m(2)). We fitted Cox proportional hazards models to assess the association between daily mean temperature and PTB at each trimester for each BMI category separately. The hazard ratios (HRs) at the 5th and 95th percentiles of temperature (defined as low and high temperatures respectively) were provided using the median temperature at each trimester as a reference. RESULTS: 58,220 (23.2%) were underweight, and 27,865 (11.1%) were overweight or obese. Of the 251,257 women, 18,612 (7.41%) had PTB delivery. Both low-and high-temperature exposure increased the risk of PTB in the third trimester, while cold exposure mostly mitigated the risk for the first and second trimesters. The association with low temperature was the strongest in the third trimester, especially for underweight women (HR: 1.825; 95%CI: 1.529 ~ 2.179), while the association with high temperature was the strongest also in the third trimester, especially for obese or overweight women (HR:1.825; 95%CI:1.502 ~ 2.218). Furthermore, the attributable fractions of PTB risk in the third trimester were estimated as 5.59% (95% CI: 3.58, 7.98%) for cold exposure among underweight women and 3.31% (95% CI: 2.01, 4.88%) for hot exposure among overweight or obese women. CONCLUSION: Exposure to either low temperature in the third trimester or high temperature during pregnancy was associated with a higher risk of PTB. Moreover, pre-pregnancy BMI status might affect the susceptibility of pregnant women. Such findings would be useful to develop targeted measures for vulnerable populations.
Previous studies have reported that ambient temperature may affect perinatal outcomes. However, whether extreme temperature affects the risk of preterm birth (PTB) remains controversial. Studies on the associations of extreme temperature with PTB subtypes are lacking. OBJECTIVES: We aimed to investigate the associations of extreme climate events with the risks of PTB and its subtypes, discerning possible modifiers. METHODS: Data on all singleton deliveries were obtained from the China Labor and Delivery Survey (CLDS), a nationwide investigation implemented in 2015 and 2016. PTB was defined as gestational weeks < 37 and then categorized as early (24-34 wk) and late PTBs (35-36 wk), and clinical subtypes [spontaneous PTB, preterm premature rupture of the fetal membranes (PPROM), iatrogenic PTB]. Ambient temperature data were provided by the China National Weather Data Sharing System. Five heat indexes and five cold indexes were used to define heat waves and cold spells. Generalized linear mixed models with a random term by hospital unit were used to assess the associations of short-term prenatal extreme temperature exposure. The Cox proportional hazard regression model was applied to assess the nonlinear associations of low- or high-temperature exposure at the whole and different trimesters of pregnancy with the risk of PTB. Stratified analyses were conducted to assess the possible modification by geographic region and fetal sex. RESULTS: A total of 70,818 singleton births from 96 hospitals in China were included, among which 4,965 (7.01%) were PTBs. Exposure to extreme cold events 1 wk before delivery was associated with an increased PTB risk, with an adjusted odds ratio (aOR) [95% confidence intervals (CIs)] of 1.07 (95% CI: 1.04, 1.10) and 1.06 (1.04, 1.09) for the total days when the daily average temperature below the fifth percentile (fifth-days) and the 10th percentile (10th-days), 1.18 (1.04, 1.34) for the cold spells when the daily average temperature below the fifth percentile for two consecutive days (fifth-2D), 1.09 (1.03, 1.16) and 1.12 (1.06, 1.19) for the cold spells when the daily average temperature below the 10th percentile for three and two consecutive days (10th-3D and 10th-2D), respectively. Results of extreme temperature exposure during 2 weeks before delivery showed similarly significant associations. The association between cold spells and PTB tended to be stronger for late PTB than for early PTB. Cold spells were mainly associated with spontaneous PTB and late PPROM. A stratified analysis indicated that pregnant women in western and northern regions tended to be more sensitive to cold spells, and pregnant women with a female fetus appeared to be at a higher risk of PTB when exposed to cold spells. Pregnant women in late pregnancy were more susceptible to extreme temperatures. No significant or stable association was found between heat waves and preterm birth. DISCUSSION: Exposure to cold spells was associated with an increased risk of PTB, especially late, spontaneous PTB and PPROM. The associations appeared to be more pronounced in the north and west regions and in pregnancies with female fetuses. https://doi.org/10.1289/EHP10831.
OBJECTIVES: This study aims to assess the association between daily temperature and sickness absence episodes in the Mediterranean province of Barcelona between 2012 and 2015, according to sociodemographic and occupational characteristics. METHODS: Ecological study of a sample of salaried workers affiliated to the Spanish social security, resident in Barcelona province between 2012 and 2015. The association between daily mean temperature and risk of new sickness absence episodes was estimated with distributed lag non-linear models. The lag effect up to 1 week was considered. Analyses were repeated separately by sex, age groups, occupational category, economic sector and medical diagnosis groups of sickness absence. RESULTS: The study included 42,744 salaried workers and 97,166 episodes of sickness absence. The risk of sickness absence increased significantly between 2 and 6 days after the cold day. For hot days there was no association with risk of sickness absence. Women, young, non-manual and workers in the service sector had a higher risk of sickness absence on cold days. The effect of cold on sickness absence was significant for respiratory system diseases (RR: 2.16; 95%CI: 1.68-2.79) and infectious diseases (RR: 1.31; 95%CI: 1.04-1.66). CONCLUSION: Low temperatures increase the risk of having a new episode of sickness absence, especially due to respiratory and infectious diseases. Vulnerable groups were identified. These results suggest the importance of working in indoor and possibly poorly ventilated spaces in the spread of diseases that eventually lead to an episode of sickness absence. It is necessary to develop specific prevention plans for cold situations.
This pilot study aimed to evaluate the effects of extremely hot ambient temperatures on the total number of fatal injuries. Data were collected from a population-based mortality registry of Thanh Hoa, a province in the North Central region of Vietnam. This study qualified the distributed lag non-linear model and calculated the RR and 95% CI adjusted for long-term trend and absolute humidity. For the entire study population with 3,949 registered deaths due to injuries collected during 2005-2007, after the onset of extremely hot ambient temperatures, an increased risk of death was observed on the 9th day RR (95% CI) = 1.44 (1.06-1.97), and reached the peak on the 12th day RR (95% CI) = 1.58 (1.14-2.17), and at the 15th day RR (95% CI) = 1.49 (1.08-2.06). Men and old adults were identified as the most vulnerable groups. This study confirmed a positive association between hot temperatures and injury-related deaths in the province of 3.6 million people. The findings motivated further investigation into the effect of warm climate changes and the risk of deaths related to other specific causes such as road traffic, work-related injury, and etc.
Heat events increase the risk of preterm birth (PTB), and identifying the risk-related event thresholds contributes to developing early warning system for pregnant women and guiding their public health response. However, the event thresholds that cause the risk remain unclear. We aimed to investigate the effects of heat events defined with different intensities and durations on PTB throughout pregnancy, and to determine thresholds for the high-risk heat events. METHODS: Using a population-based birth cohort data, we included 210,798 singleton live births in eight provinces in China during 2014-2018. Daily meteorological variables and inverse distance weighted methods were used to estimate exposures at a resolution of 1 km × 1 km. A series of cut off temperature intensities (50th-97.5th percentiles, or 18 °C-35 °C) and durations (at least 1, 2, 3, 4 or 5 consecutive days) were used to define the heat events. Cox regression models were used to estimate the effects of heat events on PTB in various gestational weeks during the entire pregnancy, and event thresholds were determined by calculating population attributable fractions. FINDINGS: The hazard ratios of heat event exposure on PTB ranged from 1.07 (95% CI: 1.00, 1.13) to 1.43 (1.15, 1.77). Adverse effects of heat event exposure were prominently detected in gestational week 1-4, week 21-32 and the four weeks before delivery. The heat event thresholds were determined to be daily maximum temperature at the 90th percentile of the distribution or 30 °C lasting for at least one day. If pregnant women were able to avoid the heat exposures from the early warning systems triggered by these thresholds, approximately 15% or 17% of the number of total PTB cases could have been avoided. INTERPRETATION: Exposure to heat event can increase the risk of PTB when thermal event exceeds a specific intensity and duration threshold, particularly in the first four gestational weeks, and between week 21 and the last four weeks. This study provides compelling evidence for the development of heat-health early warning systems for pregnant women that could substantially mitigate the risk of PTB. FUNDING: National Key R&D Program of China (No. 2018YFA0606200), National Natural Science Foundation of China (No. 42175183), Sanming Project of Medicine in Shenzhen (No. SZSM202111001).
Defining health-based thresholds for effective heat warnings is crucial for climate change adaptation strategies. Translating the non-linear function between heat and health effects into an effective threshold for heat warnings to protect the population is a challenge. We present a systematic analysis of heat indicators in relation to mortality. We applied distributed lag non-linear models in an individual-level case-crossover design to assess the effects of heat on mortality in Switzerland during the warm season from 2003 to 2016 for three temperature metrics (daily mean, maximum, and minimum temperature), and various threshold temperatures and heatwave definitions. Individual death records with information on residential address from the Swiss National Cohort were linked to high-resolution temperature estimates from 100 m resolution maps. Moderate (90th percentile) to extreme thresholds (99.5th percentile) of the three temperature metrics implied a significant increase in mortality (5 to 38%) in respect of the median warm-season temperature. Effects of the threshold temperatures on mortality were similar across the seven major regions in Switzerland. Heatwave duration did not modify the effect when considering delayed effects up to 7 days. This nationally representative study, accounting for small-scale exposure variability, suggests that the national heat-warning system should focus on heatwave intensity rather than duration. While a different heat-warning indicator may be appropriate in other countries, our evaluation framework is transferable to any country.
AIM: to assess the Heat (HW) and Cold Waves (CW) risks on health in the urban municipality of Getafe. METHODOLOGY: time series analysis between 01/01/1999-31/10/2013. DEPENDENT VARIABLE: daily mortality due to natural causes – (ICD-10): A99-R99-. INDEPENDENT VARIABLES: the maximum (T(max)) and minimum (T(min)) daily temperature. The mortality-temperature relationship was analysed to determine the thresholds of HW (Threshold(heat)) and CW (Threshold(cold)). Using Poisson GLM (link = log), the Relative Risk (RR), Attributable Risk (AR) and Attributable Mortality (AM) were determined for each degree of the T(max) exceeding the Threshold(heat) (T(heat)) and for each degree of T(min) under the Threshold(cold) (T(cold)). Finally, socioeconomic variables were analysed descriptively. RESULTS: Threshold(heat) was 36 °C while Threshold(cold) was 0 °C. The RRs associated with T(heat), i.e. 1.08 (1.03 1.14), are akin to those obtained for T(cold,) i.e. 1.05 (1.03 1.08). There were 202 HW and 430 CW episodes. The AM to HW totalled 61 (25, 96) deaths, while that attributable to CW reached 146 (82,211) deaths. The vulnerability in Getafe seems to be lower than in surrounding similar urban and rural cities. CONCLUSIONS: The singular urban development of the municipality may have granted it an advantage over surrounding municipalities regarding temperature extremes.
Bedrooms are important spaces that are often overlooked in the design of residential properties. The interior environment of bedrooms directly affects our sleep quality, which affects the quality of our lives and impacts productivity, health, and wellbeing. Insufficient sleep is a well-known problem in society, having significant negative consequences for health. This is compounded during heatwaves when it can be challenging to get sufficient sleep because of high night-time temperatures, especially in temperate climate zones with no tradition of mechanical cooling. A narrative review was used to explore the inter-relationship between sleep quality, bedroom design, indoor environmental quality (IEQ) and overheating. In addition to highlighting the different focus between health research and built environment research, the outcomes indicate that greater attention needs to be given to bedroom design in domestic properties. The originality of the findings relates to the need for evidence to help inform building designers to mitigate the effects of extreme heat on sleep quality, helping to improve resilience and the health of residents in a warming climate.
Whenever people spend time outdoors during hot weather, they are putting themselves in potentially stressful situations. Being able to predict whether a person is overheating can be critical in preventing heat-health issues. There is a clear relationship between body core temperature and heat health. However, measuring body core temperature is expensive. Identifying a non-invasive measure that could indicate a person’s thermal strain would be valuable. This study investigated five physiological measures as possible surrogates: finger mean skin temperature (FSKT), finger maximum skin temperature (FMSKT), skin conductance level (SCL), heart rate (HR), and heart rate variability (HRV). Furthermore, they were compared against the results of participants’ subjective thermal sensation and thermal comfort in a range of hot microclimatic conditions in a hot and humid climate. Results showed that except for SCL, each of the other four physiological measures had a positive significant relationship with thermal sensation, but a negative relationship with thermal comfort. Furthermore, through testing by cumulative link mixed models, HRV was found to be the most suitable surrogate for predicting thermal sensation and thermal comfort through a simple, non-invasive measure in outdoor environment in summer in a hot and humid area. This study highlights the method for predicting human thermal strain and contributes to improve the public health and well-being of urban dwellers in outdoor environments.
Climate change has led to an increase in heat-related morbidity and mortality. The impact of heat on health is unequally distributed amongst different socioeconomic and demographic groups. We use high-resolution daily air temperature-based heat wave intensity (HWI) and neighborhood-scale sociodemographic information from the conterminous United States to evaluate the spatial patterning of extreme heat exposure disparities. Assuming differences in spatial patterns at national, regional, and local scales; we assess disparities in heat exposure across race, housing characteristics, and poverty level. Our findings indicate small differences in HWI based on these factors at the national level, with the magnitude and direction of the differences varying by region. The starkest differences are present over the Northeast and Midwest, where primarily Black neighborhoods are exposed to higher HWI than predominantly White areas. At the local level, we find the largest difference by socioeconomic status. We also find that residents of nontraditional housing are more vulnerable to heat exposure. Previous studies have either evaluated such disparities for specific cities and/or used a satellite-based land surface temperature, which, although correlated with air temperature, does not provide the true measure of heat exposure. This study is the first of its kind to incorporate high-resolution gridded air temperature-based heat exposure in the evaluation of sociodemographic disparities at a national scale. The analysis suggests the unequal distribution of heat wave intensities across communities-with higher heat exposures characterizing areas with high proportions of minorities, low socioeconomic status, and homes in need of retrofitting to combat climate change.
Heat- and cold-related mortality risks are highly variable across different geographies, suggesting a differential distribution of vulnerability factors between and within countries, which could partly be driven by urban-to-rural disparities. Identifying these drivers of risk is crucial to characterize local vulnerability and design tailored public health interventions to improve adaptation of populations to climate change. We aimed to assess how heat- and cold-mortality risks change across urban, peri-urban and rural areas in Switzerland and to identify and compare the factors associated with increased vulnerability within and between different area typologies. We estimated the heat- and cold-related mortality association using the case time-series design and distributed lag non-linear models over daily mean temperature and all-cause mortality series between 1990-2017 in each municipality in Switzerland. Then, through multivariate meta-regression, we derived pooled heat and cold-mortality associations by typology (i.e. urban/rural/peri-urban) and assessed potential vulnerability factors among a wealth of demographic, socioeconomic, topographic, climatic, land use and other environmental data. Urban clusters reported larger pooled heat-related mortality risk (at 99th percentile, vs. temperature of minimum mortality (MMT)) (relative risk=1.17(95%CI:1.10;1.24, vs peri-urban 1.03(1.00;1.06), and rural 1.03 (0.99;1.08)), but similar cold-mortality risk (at 1st percentile, vs. MMT) (1.35(1.28;1.43), vs rural 1.28(1.14;1.44) and peri-urban 1.39 (1.27-1.53)) clusters. We found different sets of vulnerability factors explaining the differential risk patterns across typologies. In urban clusters, mainly environmental factors (i.e. PM(2.5)) drove differences in heat-mortality association, while for peri-urban/rural clusters socio-economic variables were also important. For cold, socio-economic variables drove changes in vulnerability across all typologies, while environmental factors and ageing were other important drivers of larger vulnerability in peri-urban/rural clusters, with heterogeneity in the direction of the association. Our findings suggest that urban populations in Switzerland may be more vulnerable to heat, compared to rural locations, and different sets of vulnerability factors may drive these associations in each typology. Thus, future public health adaptation strategies should consider local and more tailored interventions rather than a one-size fits all approach. size fits all approach.
BACKGROUND: Exposure to heat waves could result in adverse effects on human health, especially in male testicles. PIWI-interacting RNA (piRNA) is a novel type of small non-coding RNA, which can notably impact mRNA turnover and preserve germline maintenance in germline cells. However, piRNA’s expression status when adapting to testicular heat stress remains largely unclear. OBJECTIVES: To investigate the function and mechanisms of relevant piRNAs during testicular heat stress. MATERIALS AND METHODS: In this study, a mouse testicular heat stress model was constructed, and the testes were removed for piRNA-sequencing. Bioinformatics analysis was used to discover the differential expressed piRNAs, piRNA clusters, and enriched pathways. A cell heat stress model was constructed to validate the top five upregulated piRNAs. Proliferation and apoptosis assays were utilized to validate the function of selected piRNA. Bioinformatics prediction, western blotting, and immunohistochemistry were used to illustrate the downstream mechanisms. RESULTS: Through the bioinformatics analysis, we identified the differential expression profile and enriched pathways of piRNAs and piRNA clusters during testicular hyperthermia. Besides, piR-020492 was proved to be upregulated in heat stress mouse testes and a germ cell model. A series of in vitro assays illustrated that an overexpression of piR-020492 could restrain the proliferation and promote the apoptosis of mouse germ cells. Kyoto Encyclopedia of Genes and Genomes analysis of piRNA-generating genes in the testicular heat stress model and piR-020492 targeting genes showed that the overlap pathways are adenosine monophosphate-activated protein kinase (AMPK) and insulin pathways. Validation experiments demonstrated that the key genes of AMPK and insulin pathway exhibit differential expression after an overexpression of piR-020492 or testicular heat stress. DISCUSSION AND CONCLUSION: In conclusion, our findings revealed the expression profile of piRNAs in testicular heat stress and illustrated the function and mechanisms of piR-020492 in germ cells, which could provide novel insights into the mechanism of hyperthermia-induced testicular injury.
Under global warming scenarios, heat waves of this magnitude will become much more common. Adaptation and planning efforts are needed to protect residents of the historically temperate Pacific Northwest for a range of health outcomes. (Am J Public Health. 2023;113(6):657-660. https://doi.org/10.2105/AJPH.2023.307269).
Airtight and highly insulated buildings are subjected to overheating risks, even in moderate climates, due to unforeseeable events like frequent heatwaves and power outages. Educational buildings share a major portion of building stocks and a large percentage of the energy is expended in maintaining thermal comfort in these buildings. Overheating risks in educational buildings can lead to heat-stress and negatively impact the health conditions and also cognitive performance of the occupants. In the light of increasing severity and longevity of heat waves in future climate scenarios, and associated power outages occurring during the heatwaves, measures to reduce overheating risk while limiting the cooling energy is gaining importance. Since the performance of existing buildings are not guaranteed during events like heatwaves, power outages, it is crucial for these buildings to be resilient to overheating. (Building) resilience is a method to deal with these uncertainties and is stated as ‘an ability of the building to withstand disruptions; and to maintain the capacity to adapt, learn and transform’. The focus of this paper is to evaluate thermal resilience for two test lecture equipped with low-energy cooling strategies like natural night ventilation (NNV) and indirect evaporative cooling (IEC) rooms, by dynamic Building Energy Simulations (BES). To assess the thermal resilience to overheating three different heatwaves (HW) files (intense, severe, and longest) for 3 future scenarios (1) Historical (2010-2020), (2) mid-term (2041-2060) and (3) long-term (2081-2100) and a 24h power outage (PO)scenario was simulated. Benchmarking was done with a base case – Typical Meteorological year(TMY) with no power outage. The heatwave files were developed adopting the methodology proposed by the ‘Weather Data Task Force’ of International Energy Agency Energy in Buildings and Communities Programme (IEA EBC) Annex 80 ‘Resilient Cooling of Buildings’. This study shows, IEC has high to moderate recovery capacity in TMY period and low recovery capacity in HW period, for a power outage of 24 h. Recovery capacity is low during HW period, especially during an intense and longer HW period when outdoor temperature influences the cooling capacity of the IEC. The results also demonstrates the impact of the thermal mass on the resilience to overheating. Passive survivability assessment indicates, the lecture room with lighter thermal mass does not violate 30 degrees C threshold during a power outage in TMY period and additionally,. recovers faster (11% times faster) from peak temperature compared to lecture room with heavy thermal mass. There is a steep increase in unmet degree hours (occupied hours above24 degrees C threshold) during HW compared to TMY period. This paper gives a directive towards assessment of resilience to overheating and also points out the gap in the existing indicators to assess the resilience.
Perinatal exposure to heat and air pollution has been shown to affect the risk of preterm birth (PTB). However, limited evidence exists regarding their joint effects, particularly in heavily polluted regions like China. This study utilized data from the ongoing China Birth Cohort Study, including 103 040 birth records up to December 2020, and hourly measurements of air pollution (PM2.5, NO2, and O-3) and temperature. We assessed the nonlinear associations between air pollution and temperature extereme exposures and PTB by employing generalized additive models with restricted cubic slines. Air pollution and temperature thresholds (corresponding to minimum PTB risks) were determined by the lowest Akaike Information Criterion. We found that maternal exposures to PM2.5, NO2, O-3, and both low and high temperature during the third trimester of pregnancy were independently associated with increased risk of PTB. The adjusted risk ratios for PTB of PM2.5, O-3, NO2, and temperature at the 95th percentile against thresholds were 1.32 (95% CI: 1.23, 1.42), 1.33 (95% CI: 1.18, 1.50), 1.44 (95% CI: 1.33, 1.56) and 1.70 (95% CI: 1.56, 1.85), respectively. Positive additive interactions [relative excess risk due to interaction (RERI) > 0] of PM2.5-high temperature (HT), O-3-HT, O-3-low temperature (LT) are identified, but the interactive effects of PM2.5 and LT were negative (RERI < 0). These observed independent effects of air pollution and temperature, along with their potential joint effects, have important implications for future studies and the development of public health policies aimed at improving perinatal health outcomes.
The heatwave event to which the Ontario-Quebec area was subjected in 2018 resulted in significant morbidity and mortality. In this study, an investigation was conducted on how this heatwave affected the respective urban heat islands (UHIs) in Montreal and Ottawa. The modelled urban climates were compared before, during and after the heatwave using a Weather Research and Forecast (WRF) model having a 1 km spatial resolution. The UHI was calculated using two methods. As a first method, the “rural-ring” method was used to calculate the UHI in regard to temperature differences between urban and surrounding rural areas. The second method used the “urban-increment” approach where simulation results were compared to another simulation in which urban cells are replaced by croplands. Results show that urban land can raise temperatures by up to 12 °C at surfaces and 6 °C in the near-surface air. A synoptic anticyclone in the lower atmosphere was responsible for the heatwave, although both cities were located in areas peripheral to the anticyclone. During the heatwave, precipitation at the initial stage of the event and low wind conditions largely varied the pattern of the UHI effect within each urban center. The UHI was generally unchanged or even reduced during this heatwave, but there was substantial diurnal variation. Around noon and in the afternoon, the UHI was amplified by up to 3 °C, whereas it was suppressed or even negative at sunrise.
Extreme heat has been linked to increased mortality and morbidity across the globe. Increasing temperatures due to climatic change will place immense stress on healthcare systems. This review synthesises Australian literature that has examined the effect of hot weather and heatwaves on various health outcomes. Databases including Web of Science, PubMed and CINAHL were systematically searched for articles that quantitatively examined heat health effects for the Australian population. Relevant, peer-reviewed articles published between 2010 and 2023 were included. Two authors screened the abstracts. One researcher conducted the full article review and data extraction, while another researcher randomly reviewed 10% of the articles to validate decisions. Our rapid review found abundant literature indicating increased mortality and morbidity risks due to extreme temperature exposures. The effect of heat on mortality was found to be mostly immediate, with peaks in the risk of death observed on the day of exposure or the next day. Most studies in this review were concentrated on cities and mainly included health outcome data from temperate and subtropical climate zones. There was a dearth of studies that focused on tropical or arid climates and at-risk populations, including children, pregnant women, Indigenous people and rural and remote residents. The review highlights the need for more context-specific studies targeting vulnerable population groups, particularly residents of rural and remote Australia, as these regions substantially vary climatically and socio-demographically from urban Australia, and the heat health impacts are likely to be even more substantial.
OBJECTIVE: Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. METHODS: We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. RESULTS: Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. CONCLUSION: Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk.
Few studies have assessed extreme temperatures’ impact on gestational diabetes mellitus (GDM). We examined the relation between GDM risk with weekly exposure to extreme high and low temperatures during the first 24 weeks of gestation and assessed potential effect modification by microclimate indicators. METHODS: We utilized 2008-2018 data for pregnant women from Kaiser Permanente Southern California electronic health records. GDM screening occurred between 24 and 28 gestational weeks for most women using the Carpenter-Coustan criteria or the International Association of Diabetes and Pregnancy Study Groups criteria. Daily maximum, minimum, and mean temperature data were linked to participants’ residential address. We utilized distributed lag models, which assessed the lag from the first to the corresponding week, with logistic regression models to examine the exposure-lag-response associations between the 12 weekly extreme temperature exposures and GDM risk. We used the relative risk due to interaction (RERI) to estimate the additive modification of microclimate indicators on the relation between extreme temperature and GDM risk. RESULTS: GDM risks increased with extreme low temperature during gestational weeks 20–24 and with extreme high temperature at weeks 11-16. Microclimate indicators modified the influence of extreme temperatures on GDM risk. For example, there were positive RERIs for high-temperature extremes and less greenness, and a negative RERI for low-temperature extremes and increased impervious surface percentage. DISCUSSION: Susceptibility windows to extreme temperatures during pregnancy were observed. Modifiable microclimate indicators were identified that may attenuate temperature exposures during these windows, which could in turn reduce the health burden from GDM.
BACKGROUND: Globally, drowning is a leading cause of injury-related harm, which is heavily impacted by environmental conditions. In Australia, fatal unintentional drowning peaks in summer, yet the impact of prolonged periods of hot weather (heatwave) on fatal drowning has not previously been explored. METHODS: Using a case-crossover approach, we examined the difference in drowning risk between heatwave and non-heatwave days for the Australian state of Queensland from 2010 to 2019. Heatwave data, measured by the excess heat factor, were acquired from the Bureau of Meteorology. Incidence rate ratios (IRRs) were calculated by sex, age of drowning decedent, category of drowning incident (International Classification of Diseases-10 codes) and heatwave severity. Excess drowning mortality during heatwaves was also calculated. RESULTS: Analyses reveal increased fatal drowning risk during heatwave for males (IRR 1.22, 95% CI 0.92 to 1.61), people aged 65+ years (IRR 1.36, 95% CI 0.83 to 2.24), unintentional drowning (IRR 1.28, 95% CI 0.98 to 1.69) and during severe heatwaves (IRR 1.26, 95% CI0.88 to 1.82). There were 13 excess drowning deaths due to heatwave over the study period. DISCUSSION: The findings confirm an increased risk of fatal drowning during heatwaves. With increased likelihood and severity of heatwaves, this information should be used to inform drowning prevention, in particular the timing of public awareness campaigns and patrolling of supervised aquatic locations. CONCLUSIONS: Water safety and patrolling organisations, as well as first responders, need to prepare for more drowning deaths during heatwave conditions. In addition, drowning prevention education ahead of heatwaves is needed for recreational swimmers, and older people, particularly those with comorbidities which may be further exacerbated by a heatwave.
The UK government has announced its ten-point plan to annually install 600,000 low-carbon heat pumps by 2028. However, there is a lack of evidence showing potential overheating risk in dwellings retrofitted with heat pumps. This paper examines the prevalence and magnitude of summertime overheating across 24 naturally ventilated social housing dwellings retrofitted with ground source heat pumps (GSHPs). The dwellings are located in a socially deprived area in Oxford (UK). The empirical study included longitudinal monitoring of indoor temperatures in the living rooms and bedrooms during the non-heating seasons of 2021 and 2022 (May-September), which included a record-breaking heatwave in July 2022. Indoor temperature and CO2 levels in bedrooms were monitored across a subset of six dwellings alongside the monitoring of window opening state in three bedrooms to understand the effect of natural ventilation in removing excess heat. About 136 thermal comfort surveys were conducted to ascertain the subjective responses of residents. Overheating risk assessment was carried out using CIBSE static and adaptive methods, which revealed that summertime overheating was prevalent across half of the dwellings in the non-heating season of 2022, as compared to 17% overheated dwellings in 2021. Bungalows with upgraded cavity wall insulation and top floor flats facing south and south-west had a propensity to overheat. The variation in indoor temperature and CO2 levels across a small sample also indicated the relationship between overheating and residents’ behaviour. Given that the majority of the dwellings were occupied by retired elderly people with low incomes who are vulnerable to heat and cannot afford active forms of cooling, it is vital to deploy passive design measures, such as appropriate shading devices that are suitable for a heating-dominated climate and enhanced ventilation, as part of home energy retrofits. Implementing reversible heat pumps coupled with solar PVs can provide cooling during heatwaves while delivering low-carbon heat in the winter.
Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks. METHODS: We included urban areas across Europe between Jan 1, 2000, and Dec 12, 2019, using the Urban Audit dataset of Eurostat and adults aged 20 years and older living in these areas. Data were extracted from Eurostat, the Multi-country Multi-city Collaborative Research Network, Moderate Resolution Imaging Spectroradiometer, and Copernicus. We applied a three-stage method to estimate risks of temperature continuously across the age and space dimensions, identifying patterns of vulnerability on the basis of city-specific characteristics and demographic structures. These risks were used to derive minimum mortality temperatures and related percentiles and raw and standardised excess mortality rates for heat and cold aggregated at various geographical levels. FINDINGS: Across the 854 urban areas in Europe, we estimated an annual excess of 203 620 (empirical 95% CI 180 882-224 613) deaths attributed to cold and 20 173 (17 261-22 934) attributed to heat. These corresponded to age-standardised rates of 129 (empirical 95% CI 114-142) and 13 (11-14) deaths per 100 000 person-years. Results differed across Europe and age groups, with the highest effects in eastern European cities for both cold and heat. INTERPRETATION: Maps of mortality risks and excess deaths indicate geographical differences, such as a north-south gradient and increased vulnerability in eastern Europe, as well as local variations due to urban characteristics. The modelling framework and results are crucial for the design of national and local health and climate policies and for projecting the effects of cold and heat under future climatic and socioeconomic scenarios. FUNDING: Medical Research Council of UK, the Natural Environment Research Council UK, the EU’s Horizon 2020, and the EU’s Joint Research Center.
Extreme temperatures are triggering and exacerbating hospital admissions and health burdens; however, it is still understudied. Therefore, we evaluated the effects of the average temperature on overall hospitalisation and the average length of hospital stay. METHODS: Daily area-specific age-sex stratified hospitalisation records from 2006 to 2020 were collected from the National Health Research Institutes of Taiwan. The distributed lag non-linear model was used to estimate the area-specific relative risk (RR) and 95% CI associated with daily average temperature. Overall cumulative RR was pooled from area-specific RRs using random effects meta-analysis. Temperature effects of extreme high and low thresholds were also evaluated based on the 99th (32°C) and 5th (14°C) percentiles, respectively. RESULTS: Our findings suggested that the elderly (age ≥65 years) are vulnerable to temperature effects, while differential gender effects are not explicit in Taiwan. A higher risk of in-patient visits was seen among the elderly during extreme low temperatures (RR 1.08; 95% CI 1.04 to 1.11) compared with extreme high temperatures (RR 1.07; 95% CI 1.05 to 1.10). Overall, high-temperature extremes increased the risk of hospitalisation with an RR of 1.05 (95% CI 1.03 to 1.07) among the all-age-sex population in Taiwan. Additionally, lag-specific analysis of the study revealed that high-temperature effects on in-patient visits are effective on the same day of exposure, while cold effects occurred after 0-2 days of exposure. The average length of hospital stays can also increase with high-temperature extremes among age group 41-64 years and the elderly. CONCLUSION: Public health preparedness should consider the increased load on health facilities and health expenditures during extreme temperatures.
During summer heat waves, road workers are easily exposed to heat stress and faced with a high risk of thermal diseases and death, and thus preventive measures are required for their safety at the work site. To prepare response measures, it is necessary to estimate workers’ perceived temperature (PT) according to exposure time, road environment, clothing type, and work intensity. This study aimed to examine radiation (short-wave radiation and long-wave radiation) and other meteorological factors (temperature, humidity, and wind) in an actual highway work environment in summer and to estimate PT using the observation data. Analysis of radiation and meteorological factors on the road according to pavement type and weather revealed that more heat was released from asphalt than from concrete. Regression model analysis indicated that compared with young workers (aged 25-30 years), older workers (aged >= 60 years) showed a rapid increase in PT as the temperature increased. The temperatures that people actually feel on concrete and asphalt roads in heat wave conditions can be predicted using the PT values calculated by the regression models. Our findings can serve as a basis for measures to prevent workers from thermal diseases at actual road work sites.
The number of patients with heat illness transported by ambulance has been gradually increasing due to global warming. In intense heat waves, it is crucial to accurately estimate the number of cases with heat illness for management of medical resources. Ambient temperature is an essential factor with respect to the number of patients with heat illness, although thermophysiological response is a more relevant factor with respect to causing symptoms. In this study, we computed daily maximum core temperature increase and daily total amount of sweating in a test subject using a large-scale, integrated computational method considering the time course of actual ambient conditions as input. The correlation between the number of transported people and their thermophysiological temperature is evaluated in addition to conventional ambient temperature. With the exception of one prefecture, which features a different Köppen climate classification, the number of transported people in the remaining prefectures, with a Köppen climate classification of Cfa, are well estimated using either ambient temperature or computed core temperature increase and daily amount of sweating. For estimation using ambient temperature, an additional two parameters were needed to obtain comparable accuracy. Even using ambient temperature, the number of transported people can be estimated if the parameters are carefully chosen. This finding is practically useful for the management of ambulance allocation on hot days as well as public enlightenment.
BACKGROUND: The increase in global temperature and urban warming has led to the exacerbation of heatwaves, which negatively affect human health and cause long-term loss of work productivity. Therefore, a global assessment in temperature variation is essential. OBJECTIVE: This paper is the first of its kind to propose land-use based spatial machine learning (LBSM) models for predicting highly spatial-temporal variations of wet-bulb globe temperature (WBGT), which is a heat stress indicator used to assess thermal comfort in indoor and outdoor environments, specifically for the main island of Taiwan. METHODS: To develop spatiotemporal prediction models for both the working period and noon period, we calculated the WBGT of each weather station from 2001 to 2019 using temperature, humidity, and solar radiation data. These WBGT estimations were then used as the dependent variable for developing the spatiotemporal prediction models. To enhance model performance, we used innovative approaches that combined SHapley Additive exPlanations (SHAP) values for the selection of non-linear variables, along with machine learning algorithms for model development. RESULTS: When incorporating temperature along with other land-use/land cover predictor variables, the performance of LBSM models was excellent, with an R(2) value of up to 0.99. The LBSM models explained 98% and 99% of the spatial-temporal variations in WBGT for the working and noon periods, respectively, within the complete models. In the temperature-excluded models, the explained variances were 94% and 96% for the working and noon periods, respectively. IMPACT: WBGT is a common method used by many organizations to access the impact of heat stress on human beings. However, limited studies have mentioned the association between WBGT and health impacts due to the absence of spatiotemporal databases. This study develops a new approach using land-use-based spatial machine learning (LBSM) models to better predict the fine spatial-temporal WBGT levels, with a 50-m × 50-m grid resolution for both working time and noontime. Our proposed methodology could be used in future studies aimed at evaluating the potential long-term loss of work productivity due to the effects of global warming or urban heat island.
The heat health early warning model serves as an effective strategy for reducing health risks related to heatwaves and improving population adaptability. Several high-income countries have taken the lead in conducting research and implementing measures aimed at safeguarding their populations. WHAT IS ADDED BY THIS REPORT? The graded heat health risk early warning model (GHREWM) in Jinan City has demonstrated efficacy in safeguarding males, females, individuals aged above 75 years, and those with cardiopulmonary diseases. During the summer of 2022, the warning stage of GHREWM contributed to the prevention of 10.9 deaths per million individuals, concurrently averting health-related economic losses estimated at approximately 227 million Chinese Yuan (CNY). WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? The GHREWM has the potential to enhance cities’ adaptability to climate change. It is crucial to incorporate additional adverse health endpoint data in the development of early warning models, as this will improve their applicability and protective efficacy.
With the expectation of increasing frequency and magnitude of extreme events caused by climate change, one of the most critical yet overlooked aspects of building design in the industry is thermal resilience. An effective way to assess and quantify a building’s resilience in the design phase is through modeling and simulation; however, there has been limited effort invested in operationalizing this practice. The purpose of this paper is to provide a critical review of past modeling and simulation research focused on quantifying the thermal resilience of buildings, and to discuss future areas of research that are needed to enhance and standardize practice, as well as building codes and standards. The paper begins by defining a framework for building performance simulationaided resilience quantification. Next, we review the current state of the art research on a variety of topics such as heat stress and resilience metrics, model assumptions and setup, simulation tool capabilities, weather file type selection, and methods to visualize and communicate resilience. Finally, a discussion on the fundamental research and future tool development needs to accelerate transition from research into practice is presented.
The main reason for technological developments is to make human life more comfortable. Bioclimatic comfort areas are areas where people feel the most comfortable and comfortable in terms of climate. As a result of global climate changes, the temperature in the world is increasing day by day moreover increase in terms of people living in our country and other countries which the need for comfortable and comfortable spaces increases in all seasons. Bioclimatic comfort areas are the most needed in the summer months. However, the average temperature increases day by day in all seasons due to climate change. For this reason, within the scope of this study, the most suitable bioclimatic comfort areas were calculated with the HEAT index by using the average temperature and humidity maps for the fall, winter, spring, and summer seasons of 2019. While creating temperature and humidity maps, a point database was created for the neighborhoods in Kocaeli Province, temperature and humidity data were combined in this database. The temperature and humidity map for each season was open-source code the Inverse Distance Weighted (IDW) interpolation method in the QGIS 3.16 software was transformed into a map in raster format. The heat index was created by using temperature and relative humidity maps in raster format. Then, the relationship between the created heat index maps and morphological factors was examined.
Candia auris is an emerging human pathogenic yeast; yet, despite phenotypic attributes and genomic evidence suggesting that it probably emerged from a natural reservoir, we know nothing about the environmental phase of its life cycle and the transmission pathways associated with it. The thermotolerant characteristics of C. auris have been hypothesised to be an environmental adaptation to increasing temperatures due to global warming (which may have facilitated its ability to tolerate the mammalian thermal barrier that is considered a protective strategy for humans against colonisation by environmental fungi with pathogenic potential). Thus, C. auris may be the first human pathogenic fungus to have emerged as a result of climate change. In addition, the release of antifungal chemicals, such as azoles, into the environment (from both pharmaceutical and agricultural sources) is likely to be responsible for the environmental enrichment of resistant strains of C. auris; however, the survival and dissemination of C. auris in the natural environment is poorly understood. In this paper, we critically review the possible pathways through which C. auris can be introduced into the environment and evaluate the environmental characteristics that can influence its persistence and transmission in natural environments. Identifying potential environmental niches and reservoirs of C. auris and understanding its emergence against a backdrop of climate change and environmental pollution will be crucial for the development of effective epidemiological and environmental management responses.
INTRODUCTION AND OBJECTIVE: Prior studies have provided variable results regarding environmental risk factors for epistaxis. These studies were conducted in varying climate zones, which may explain discrepancies in results. The objective of this study is to investigate correlations between season, temperature, and humidity on frequency of pediatric epistaxis across climate zones. METHODS: Children seen in the outpatient setting for epistaxis were identified from the 2007-2010 IBM MarketScan database. Climate zones were assigned according to International Energy Conservation Code (IECC) classification, where temperature zones in the United States and territories were assigned on an ordinal scale from 1 (tropical) to 8 (subarctic), and humidity zones were categorized as moist, dry, or marine. The control population was a sample of all well-child visits matched by age and county. RESULTS: We identified 184,846 unique children seen for epistaxis and 1,897,012 matched controls. Moderate temperature zones were associated with lower odds of epistaxis compared with the hottest and coldest zones. Humidity was associated inversely with epistaxis rates in moderate temperature zones but was not a significant predictor of epistaxis in climates with extreme heat. Additionally, summer was associated with lower odds of epistaxis compared to winter. Interestingly, however, there were significantly higher rates of cautery procedures during summer months, driven largely by increased procedures performed in clinic, as opposed to the operating room or emergency room. CONCLUSIONS: Environmental risk factors for epistaxis vary by climate zone. The model presented reconciles prior reports and may allow for more personalized clinical management based on regional climate. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2023.
Australia has objectively suffered climate extreme-driven loss and damage-climate change impacts that cannot or will not be avoided. Recent national surveys demonstrate a growing awareness of the link between climate change and climate extremes. However, climate extremes interact with existing environmental subjectivities (i.e., how people perceive, understand, and relate to the environment), which leads to different social, cultural, and political responses. For example, people in northern Australia are familiar with climate extremes, with the heat, humidity, fires, floods, storms, and droughts intimately connected to identities and sense of place. In this climate ethnography, I demonstrate the value of undertaking environmental subjectivities analyses for research on climate-society relations. I detail how environmental subjectivities influence people’s experiences, or non-experiences, of climate extreme-driven loss and damage in northern Australia. I identify a growing concern for climate change and climate extremes are influencing environmental subjectivities. Yet, many northern Australians-even people concerned about climate change-are not, for now, connecting extreme events to climate change. A widespread subjectivity of anticipatory loss supplied people with an imagined temporal buffer, which contributes to non-urgency in political responses. Together with more structural political-economic barriers and a sense of helplessness to affect progressive change, limited action beyond individual consumer decisions and small-scale advocacy are occurring. These, amongst other, findings extend research on the role of climate extremes in climate opinion, lived experiences of loss and damage in affluent contexts, and the environmental value-action gap.
Climate change is an urgent public health crisis that significantly impacts disease development, health outcomes, and access to care. The major approaches to climate change are mitigation and adaptation. The purpose of this review is to discuss the effects of climate change on health and health disparities, review the carbon footprint of surgical care and discuss strategies for surgeons to reduce emissions and advocate for sustainability. RECENT FINDINGS: Recent studies increasingly demonstrate the direct and indirect health effects of climate change, including the relationship between climate and otolaryngologic disease. Within the domain of otolaryngology, we summarize findings related to climate change and health and healthcare delivery; health disparities; healthcare-associated emissions; and the role of otolaryngologists in mitigating and adapting to the climate crisis. There are many recent studies that identify impactful sustainability opportunities and initiatives for healthcare providers. Climate solutions may also reduce cost and have potential clinical benefits. SUMMARY: Climate change and air pollution directly impact disease burden in otolaryngology patients and are underrecognized social determinants of health. Surgeons can lead on climate change by implementing sustainability initiatives in the operating room and engaging in research and advocacy.
As Earth’s climate warms, outdoor thermal conditions that threaten human life are becoming more frequent and severe. To prepare and adapt effectively to this challenge, an understanding of both current baseline thermal conditions and how thermal conditions will change throughout the 21st century is vital. However, current efforts to measure and model baseline thermal conditions have generally ignored the contributions of radiation, and have been performed at coarse temporal and spatial resolutions. In this study, we present the first hourly multidecadal bioclimatology of mean radiant temperature and the Universal Thermal Climate Index, driven by meteorological reanalysis data and processed using the Solar and LongWave Environmental Irradiance Geometry model. This process allows for the calculation of the influence of urban geometry on radiation fluxes at 1 m spatial scale. The results demonstrated that this technique provides significant insight into thermal stress conditions, while also presenting some inherent challenges. The presence of bimodal thermal stress conditions driven by shade, significant variability of heat stress conditions on multiple time scales, and differences in the factors that drive extreme heat and cold stress were revealed. Our study showed that such high-resolution modelling of thermal stress is a feasible technique with the potential to provide significant value in understanding outdoor thermal stress in complex urban environments.
Amidst climate change, the importance of climate-adaptive design in architecture and landscape design has surged, particularly in residential courtyards, where optimizing the microclimate is paramount to residents’ wellbeing. Traditional spatial indices, however, fall short in accurately characterizing complex courtyards and local spatial features. To overcome these limitations, this study introduces pixel-level spatial indicators that effectively overcome these constraints. These indicators are implemented using computational geometry algorithms such as Ray Tracing, Flood Fill, and A*, enabling simulation of various courtyard spatial indicator maps. We also utilize Graphics Processing Unit (GPU)-based rapid thermal comfort simulation technology to generate thermal comfort maps. By applying data mining methods such as Partial Least Squares Regression (PLSR), Pearson correlation, and Nearest-neighbor interpolation, we explore the relationships between spatial indicators and thermal comfort, ultimately identifying key indicators and determining the guiding thresholds and influencing trends corresponding to heat discomfort frequency. Six key indicators and th emerge: Building View Factor (BVF), indicating building coverage visibility (prefer above 0.11); Solar Beam Fraction (BEAM), illustrating Summer solstice sun shading condition (prefer below 0.78); Averaged View Factor (AVF), showing overall visibility (prefer below 0.40); Directional Sky View Factor (DSVF(W)), reflecting sky visibility in a specific orientation (prefer below 0.73); Tree View Factor (TVF), denoting tree coverage visibility (prefer above 0.18); and Plan Water Ratio (PWR), signifying water surface proportion (aim for below 0.44). These insights, integrated into design tools, contribute to evidence-based microclimate regulation strategies, thereby enhancing urban residents’ thermal comfort and overall well-being.
Focused on the case of Ankara, human thermophysiological thresholds were investigated in association with typical morphological characteristics to determine the frequency of seasonal Heat/ Cold Stress. The study further developed methodical means to better understand the relationship with local radiation exposure within in-situ settings, allowing for the better understanding of seasonal thermophysiological exposure upon human biometeorology. To approach future vulnerability and frequency of thermophysiological stress, daily EURO-CORDEX data was processed to determine Representative Concentration Pathway scenario projections (for air temperature and Physiologically Equivalent Temperature (PET)). The study highlighted the already significant urban frequencies of heat stress (ranging up to 82.7%) due to all districts witnessing an elevated frequency of low aspect ratios. The fewer midrange aspect ratios also revealed to be frequently in orientations with higher heat stress susceptibilities (i.e., between 105 degrees and 150 degrees). Bioclimatic planning recommendations were presented for Ankara. Nevertheless, given the high vulnerability for existing/future urban human health and welfare, these recommendations were further associated with the call for immediate heat action plans and heat warning/mapping systems. In these first type of projections for Ankara, even for the milder/stabilization future scenario by 2100, PET based projections revealed frequencies remaining at 100% between 35.1 degrees C-41.1 degrees C, with further values exceeding 46.1 degrees C.
The construction industry is significantly influenced by various outdoor weather factors, which affect the thermal comfort of workers and, subsequently their productivity and health. Existing studies regarding outdoor thermal comfort only consider the daytime or a specific season. However, this study considers all seasons and regions based on accident data and aims to analyze the relationship between construction accidents and the outdoor thermal comfort index based on the frequency and probabilities by using accident data from the construction industry. In addition, Physiological equivalent temperature groups based on their impact on accidents are developed to classify the accident probability by climate index level. This study is conducted in the following five steps: (i) collection of data, (ii) calculation of the outdoor thermal comfort, (iii) calculation of the relative frequency, and (iv) conducting statistical analyses. As a result of the relative probability analysis, which is the concept of probability, it was found that the probability of accidents was the highest at PET temperature of 34.7 degrees C and 2.95. That is, as the PET temperature decreases or increases, the relative frequency indicating the probability of an accident increases. In addition, seven outdoor thermal comfort index grades were classified based on relative frequency.
Antimicrobial resistance (AMR) and the possible consequences of rising ambient temperatures brought on by global warming have been extensively discussed. However, the epidemiological evidence on the effects of temperature on AMR is rare and little is known about the role of socioeconomic inequities. This ecological study obtained 31 provinces AMR data of Escherichia Coli (E. coli) from the China Antimicrobial Resistance Surveillance System (CARSS) over the period from 2014 to 2020, which were linked to the meteorological and socioeconomic data published in the China Statistical Yearbook. Modified difference-in-differences (DID) analyses were performed to estimate the effect of ambient temperature on AMR of E. coli to third-generation cephalosporins (ceftriaxone and cefotaxime), carbapenems, and quinolones, adjusting for variations in meteorological and socioeconomic factors. We estimated that every 1 °C increase in average ambient temperature was associated with 2.71 % (95 % confidence interval [CI]: 1.20-4.24), 32.92 % (95 % CI: 15.62-52.81), and 1.81 % (95 % CI: 0.47-3.16) increase in the prevalence of E. coli resistance to third-generation cephalosporins (ceftriaxone and cefotaxime), carbapenems and quinolones, respectively. The link was more profound in the regions with lower temperature and a median level of average humidity, and the regions with lower income, lower expenditure (in economics), lower health resources, and lower hospital admissions. Neither the replacement of the temperature variable nor the alternative approaches for confounding adjustment changed the positive association between ambient temperature and AMR. In general, there exists a positive association between ambient temperature and AMR, although the strength of such an association varies by socioeconomic and health services factors. The association is possibly nonlinear, especially for E. coli resistance to third-generation cephalosporins. The findings suggest that AMR control programs should explicitly incorporate weather patterns to increase their effectiveness.
Refurbishing buildings to minimize lifecycle costs and increase reliance on natural ventilation may reduce building resilience to extreme weather. This is critical for elderly whose health is affected by exposure to thermally stressful conditions. This study proposes a novel approach for refurbishing elderly houses to enhance their sustainability and heatwave resilience with the aim of supporting low-income groups. This approach involves using multi-objective optimization to identify refurbishment parameters and an autonomous control strategy to provide thermoneutral indoor conditions at a low cost. The optimization procedure and control strategy were applied to a case study for a representative apartment in the Mediterranean climate using a validated building model. The strategy led to substantial reduction (61%) in cooling energy, while the optimization yielded Pareto solutions that showed trade-offs between lifecycle cost and resilience. A selected solution resulted in reduced electrical usage for heating (37%) and cooling (45%) and decreased indoor overheating during heatwaves. The study recommends design features for cost-effective and resilient elderly housing in the Mediterranean climate, such as lim-ited window area, enhanced thermal properties, and a modest air conditioning system for low-income populations. Larger windows and AC systems are recommended for high income populations seeking reduced operational expenses and improved sustainability. (c) 2023 Elsevier B.V. All rights reserved.
Prolonged heat exposure during outdoor physical exertion can result in adverse renal health outcomes, and it is also supposed to be a driver of chronic kidney disease of uncertain etiology (CKDu) in tropical regions. School students are more likely to experience high heat exposure during outdoor sports practices, and the current knowledge on potential renal health outcomes associated with heat exposure carries many knowledge gaps. Hence, the present study aimed to perform biomarker-based assessment of the likelihood of pediatric renal injury focusing the communities in the dry climatic zone in Sri Lanka, where it prevails relatively harsh climate and high prevalence of CKDu. School students who engaged in regular outdoor sports practices (high-heat exposure), and an age-matched control of students who did not engage in sports practices (low-heat exposure) from four educational zones: Padavi Sripura (N = 159) and Medirigiriya (N = 171), Uhana (N = 165) and Thanamalwila (N = 169) participated in this cross-sectional study representing CKDu endemic and non-endemic regions. Effective temperature (ET), wet-bulb globe temperature (WBGT), heat index (HI) and humidex were used for comparison of thermal comfort in the environment. The intensity of environmental heat measured by thermal comfort indices showed no significant difference (p > 0.05) among the study regions. Urinary kidney injury molecule (KIM-1) and albumin-creatinine ratio (ACR) in participants with high heat exposure did not differ significantly from those in the control groups in the four study zones, where urinary neutrophil gelatinase-associated lipocalin showed substantial differences in some groups. Irrespective of heat exposure, increased KIM-1 excretion was observed (p < 0.01) in participants of CKDu endemic regions compared to those in non-endemic areas. Within the context of our findings, there is no plausibly strong evidence to establish potential association of heat exposure with the likelihood of developing renal injury or abnormal renal outcomes in dry zone school students in Sri Lanka.
Global changes have influenced our societies in several ways with both positive (e.g., technology, transportation, and food security), and negative impacts (e.g., mental health problems, spread of diseases, and pandemics). Overall, these changes have affected the distribution patterns of parasites and arthropod vectors with the introduction and spreading of alien species in new geographical areas, eventually posing new challenges in public health. In this framework, the Acta Tropica Special Issue “Emerging parasites and vectors in a rapidly changing world: from ecology to management” provides a focus on the biology, ecology and management of emerging parasites and vectors of human and veterinary importance. Herein we review and discuss novel studies dealing with interactions of parasites and vectors with animals in changing environmental settings. In our opinion, a special focus on the implementation of management strategies of parasitic diseases to face anthropogenic environmental changes still represent a priority for public health. In the final section, key research challenges in this rapidly changing scenario are outlined.
Following the Fukushima nuclear accident, Japan gradually shut down all its nuclear power plants, causing a countrywide power shortage. In response the government launched large-scale energy-saving campaigns to reduce electricity consumption. Exploiting the electricity-saving targets across regions and over time, we show that the campaigns significantly increased mortality, par-ticularly during extremely hot days. The impact is primarily driven by people using less air conditioning, as encouraged by the govern-ment. Nonpecuniary incentives can explain most of the reduction in electricity consumption. Our findings suggest there exists a trade-off between climate change mitigation and climate change adaptation. (JEL I12, L94, L98, Q48, Q54, Q58)
This article analyses local practices concerning energy saving in the context of summer heat. It argues that the analysis of people’s thermal regulation activities in a situation of energy marginalization is central to understanding the social dynamics of energy vulnerability. The research combines architectural/urban and ethnographic perspectives to investigate the adaptive capacities of users and how external factors and regulations influence local practices concerning energy saving. Older adults are one of the most vulnerable groups to summer heat, as well as most prone to suffering energy vulnerability. The article examines how adults over 65 years of age in Madrid experience heat stress and adapt to extreme temperatures through the analysis of a collaborative documentary film, ‘The Wave’ (30 & PRIME;), written and designed by research participants to show the ways in which they experience summer heat. It explores older adults’ adaptation practices and the various external factors influencing their use of energy dependent adaptation strategies, including climate change (rising temperatures), existing conditions (urban, cultural, and social) and policies/economy (energy prices). The article highlights how these factors govern citizens’ energy consumption and how they are negotiated locally through embodied, environmental, and social adjustments.
Despite the threat that nighttime heatwave poses to public health and the environment in the developing world, it remains relatively understudied in Africa, especially in its rapidly expanding urban areas with large populations. Using meteorological observations, climate reanalysis, remote sensing datasets, and integrated methodology, we found that during 1981-2020, nighttime heatwaves dramatically increased with early onset dates over Africa. Large scale circulation induced dry conditions over land which explains the major heatwaves across all climate zones. Meanwhile, the increasing trend of nighttime heatwaves in urban areas than rural areas in both tropical and temperate climates is largely due to urbanization, which amplifies heatwaves with urban heat island (UHI) effects. The strongest contribution of urbanization to nighttime heatwaves was observed in temperate climate, leading to a 46% increase in the heatwave duration. In arid climate, urban expansion has a negative impact on nighttime heatwaves, due to the cool island effect of urban greens and weak urbanization. The major contribution of urbanization to the urban-rural contrast of nighttime heatwave trends in temperate climate can be attributed to stronger UHI intensity resulting from lower windspeed and less evapotranspiration. Without appropriate adaptation efforts to reduce heatwave exposure, the risks posed in Africa’s urban areas will continue to increase under future warming.
Researchers agree that there is substantial evidence of an increasing trend in both the frequency and duration of extreme temperature events. Increasing extreme temperature events will place more pressure on public health and emergency medical resources, and societies will need to find effective and reliable solutions to adapt to hotter summers. This study developed an effective method to predict the number of daily heat-related ambulance calls. Both national- and regional-level models were developed to evaluate the performance of machine-learning-based methods on heat-related ambulance call prediction. The national model showed a high prediction accuracy and can be applied over most regions, while the regional model showed extremely high prediction accuracy in each corresponding region and reliable accuracy in special cases. We found that the introduction of heatwave features, including accumulated heat stress, heat acclimatization, and optimal temperature, significantly improved prediction accuracy. The adjusted coefficient of determination (adjusted R(2)) of the national model improved from 0.9061 to 0.9659 by including these features, and the adjusted R(2) of the regional model also improved from 0.9102 to 0.9860. Furthermore, we used five bias-corrected global climate models (GCMs) to forecast the total number of summer heat-related ambulance calls under three different future climate scenarios nationally and regionally. Our analysis demonstrated that, at the end of the 21st century, the total number of heat-related ambulance calls in Japan will reach approximately 250,000 per year (nearly four times the current amount) under SSP-5.85. Our results suggest that disaster management agencies can use this highly accurate model to forecast potential high emergency medical resource burden caused by extreme heat events, allowing them to raise and improve public awareness and prepare countermeasures in advance. The method proposed in Japan in this paper can be applied to other countries that have relevant data and weather information systems.
This study investigated the associations between heatwaves and daily hospital admissions for cardiovascular and respiratory diseases in two provinces in Viet Nam known to be vulnerable to droughts during 2010-2018. This study applied a time series analysis with data extracted from the electronic database of provincial hospitals and meteorological stations from the corresponding province. To eliminate over-dispersion, this time series analysis used Quasi-Poisson regression. The models were controlled for the day of the week, holiday, time trend, and relative humidity. Heatwaves were defined as the maximum temperature exceeding P90th over the period from 2010 to 2018 during at least three consecutive days. Data from 31,191 hospital admissions for respiratory diseases and 29,056 hospitalizations for cardiovascular diseases were investigated in the two provinces. Associations between hospital admissions for respiratory diseases and heatwaves in Ninh Thuan were observed at lag 2, with excess risk (ER = 8.31%, 95% confidence interval: 0.64-16.55%). However, heatwaves were negatively associated with cardiovascular diseases in Ca Mau, which was determined amongst the elderly (age above 60), ER = -7.28%, 95%CI: -13.97–0.08%. Heatwaves can be a risk factor for hospital admission due to respiratory diseases in Vietnam. Further studies need to be conducted to assert the link between heat waves and cardiovascular diseases.
Climate change may impact human health through the influence of weather on environmental transmission of diarrhea. Previous studies have found that high temperatures and heavy precipitation are associated with increased diarrhea prevalence, but the underlying causal mechanisms have not been tested and validated. We linked measurements of Escherichia coli in source water (n = 1673), stored drinking water (n = 9692), and hand rinses from children <2 years old (n = 2634) with publicly available gridded temperature and precipitation data (at ≤0.2 degree spatial resolution and daily temporal resolution) by the GPS coordinates and date of sample collection. Measurements were collected over a 3-year period across a 2500 km(2) area in rural Kenya. In drinking water sources, high 7-day temperature was associated with a 0.16 increase in log(10) E. coli levels (p < 0.001, 95% CI: 0.07, 0.24), while heavy 7-day total precipitation was associated with a 0.29 increase in log(10) E. coli levels (p < 0.001, 95% CI: 0.13, 0.44). In household stored drinking water, heavy 7-day precipitation was associated with a 0.079 increase in log(10) E. coli levels (p = 0.042, 95% CI: 0.07, 0.24). Heavy precipitation did not increase E. coli levels among respondents who treated their water, suggesting that water treatment can mitigate effects on water quality. On child hands, high 7-day temperature was associated with a 0.39 decrease in log(10) E. coli levels (p < 0.001, 95% CI: -0.52, -0.27). Our findings provide insight on how climate change could impact environmental transmission of bacterial pathogens in Kenya. We suggest water treatment is especially important after heavy precipitation (particularly when preceded by dry periods) and high temperatures.
It has been suggested that heat exposure prior to exercise could induce changes in anaerobic exercise. Therefore, the purpose of this study was to observe the effects of high temperature heat exposure prior to an anaerobic test. Twenty-one men (age: 19.76 ± 1.22 years; height: 1.69 ± 0.12 m; weight: 67.89 ± 11.78 kg) voluntarily participated in this investigation. All of them performed two Wingate tests, vertical jump and macronutrient intake control. On the first day, the test was performed under normal environmental conditions. On the second day, it was performed in a similar way, but with previous exposure to heat at high sauna temperatures (15 min; 100 ± 2 °C). There were no differences in the vertical jump and macronutrient intake. However, the results showed an improvement in power (W) (p < 0.05), relative power (W/kg) (p < 0.01) and revolutions per minute (p < 0.05) 10 s after the start of the test. There was also an increase in thigh (p < 0.01) and skin temperature (p < 0.01) with pre-heat exposure. The results obtained suggest that this pre-exercise protocol could improve power in short and intensive actions.
The United States of America (USA) was afflicted by extreme heat in the summer of 2021 and some states experienced a record-hot or top-10 hottest summer. Meanwhile, the United States was also one of the countries impacted most by the coronavirus disease 2019 (COVID-19) pandemic. Growing numbers of studies have revealed that meteorological factors such as temperature may influence the number of confirmed COVID-19 cases and deaths. However, the associations between temperature and COVID-19 severity differ in various study areas and periods, especially in periods of high temperatures. Here we choose 119 US counties with large counts of COVID-19 deaths during the summer of 2021 to examine the relationship between COVID-19 deaths and temperature by applying a two-stage epidemiological analytical approach. We also calculate the years of life lost (YLL) owing to COVID-19 and the corresponding values attributable to high temperature exposure. The daily mean temperature is approximately positively correlated with COVID-19 deaths nationwide, with a relative risk of 1.108 (95% confidence interval: 1.046, 1.173) in the 90th percentile of the mean temperature distribution compared with the median temperature. In addition, 0.02 YLL per COVID-19 death attributable to high temperature are estimated at the national level, and distinct spatial variability from -0.10 to 0.08 years is observed in different states. Our results provide new evidence on the relationship between high temperature and COVID-19 deaths, which might help us to understand the underlying modulation of the COVID-19 pandemic by meteorological variables and to develop epidemic policy response strategies.
Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally. METHODS: A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1 °C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). FINDINGS: The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR = 1.13; 95% confidence interval (CI): 1.11-1.16, I(2) = 98.0%) for each 1 °C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR = 1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR = 1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR = 1.08; 95% CI: 0.95-1.23, I(2) = 88.9%), despite a wide confidence interval. The overall strength of evidence was found to be “sufficient” for high temperatures but “limited” for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income. INTERPRETATION: High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention. FUNDING: Australian Research Council Discovery Program.
Pharmacological agents used to treat or manage diseases can modify the level of heat strain experienced by chronically ill and elderly patients via different mechanistic pathways. Human thermoregulation is a crucial homeostatic process that maintains body temperature within a narrow range during heat stress through dry (i.e., increasing skin blood flow) and evaporative (i.e., sweating) heat loss, as well as active inhibition of thermogenesis, which is crucial to avoid overheating. Medications can independently and synergistically interact with aging and chronic disease to alter homeostatic responses to rising body temperature during heat stress. This review focuses on the physiologic changes, with specific emphasis on thermolytic processes, associated with medication use during heat stress. The review begins by providing readers with a background of the global chronic disease burden. Human thermoregulation and aging effects are then summarized to give an understanding of the unique physiologic changes faced by older adults. The effects of common chronic diseases on temperature regulation are outlined in the main sections. Physiologic impacts of common medications used to treat these diseases are reviewed in detail, with emphasis on the mechanisms by which these medications alter thermolysis during heat stress. The review concludes by providing perspectives on the need to understand the effects of medication use in hot environments, as well as a summary table of all clinical considerations and research needs of the medications included in this review. SIGNIFICANCE STATEMENT: Long-term medications modulate thermoregulatory function, resulting in excess physiological strain and predisposing patients to adverse health outcomes during prolonged exposures to extreme heat during rest and physical work (e.g., exercise). Understanding the medication-specific mechanisms of altered thermoregulation has importance in both clinical and research settings, paving the way for work toward refining current medication prescription recommendations and formulating mitigation strategies for adverse drug effects in the heat in chronically ill patients.
The objective of this study was to determine the relationship between weather conditions and hospital admissions for cardiovascular diseases (CVD). The analysed data of CVD hospital admissions were part of the database of the Policlinico Giovanni XXIII of Bari (southern Italy) within a reference period of 4 years (2013-2016). CVD hospital admissions have been aggregated with daily meteorological recordings for the reference time interval. The decomposition of the time series allowed us to filter trend components; consequently, the non-linear exposure-response relationship between hospitalizations and meteo-climatic parameters was modelled with the application of a Distributed Lag Non-linear model (DLNM) without smoothing functions. The relevance of each meteorological variable in the simulation process was determined by means of machine learning feature importance technique. The study employed a Random Forest algorithm to identify the most representative features and their respective importance in predicting the phenomenon. As a result of the process, the mean temperature, maximum temperature, apparent temperature, and relative humidity have been determined to be the most suitable meteorological variables as the best variables for the process simulation. The study examined daily admissions to emergency rooms for cardiovascular diseases. Using a predictive analysis of the time series, an increase in the relative risk associated with colder temperatures was found between 8.3 °C and 10.3 °C. This increase occurred instantly and significantly 0-1 days after the event. The increase in hospitalizations for CVD has been shown to be correlated to high temperatures above 28.6 °C for lag day 5.
Management of adverse health-related effects from heat waves requires comprehensive and accessible sour-ces of information. This paper examines the effects of temperature and air pollution on human health and identifies areas with increased occurrence of emergency ambulance dispatches in the city of Wu & BULL;rzburg, Bavaria, Germany, and discusses the applicability for health care interventions and urban planning. An overdispersed Poisson generalized additive model was used to examine and predict the association and potential lag of exposure between temperature, air pollution, and three types of emergency ambulance dispatches during the study period from 2011 to 2019. A linear model was used to esti-mate heat-wave effects. A line density function was used to identify areas with increased occurrence of dispatches. Signifi- cant effects of temperature were detected for nontraumatic and cardiovascular diseases after exceeding a threshold temperature. The exposure-response relationships showed an increased relative risk up to two days after exposure for non-traumatic and cardiovascular diseases. Results indicate a significant association between presence of heat waves and cardio-vascular diseases with up to 17% (95% confidence interval: 5.9%-30.0%) increased relative risk on a heat-wave day relative to a non-heat-wave day. Dispatches for cardiovascular diseases occur more often in areas with a high population and building density, especially in summer. The analyses identified hotspots of heat-related dispatches in areas with in-creased population and building density and provides baseline information for interventions in future urban planning and public health care management based on data commonly available even in small cities. SIGNIFICANCE STATEMENT: The purpose of this study is to demonstrate how authorities in even medium-and small-sized cities can assess health impacts of heat stress or air pollution using free accessible emergency ambulance data and software to incorporate the outcomes in their spatial planning or health care management. This is important as ongoing climate change requires all urban communities to adapt and reduce adverse impacts of climate change and air pollution. Our results show that extreme heat leads to increased emergency ambulance dispatches in a medium-sized city in Germany and provide a spatial overview of where health care interventions and urban planning can focus to mitigate adverse effects.
The effects of heat on health have been well documented, while less is known about the effects among agricultural workers. Our aim is to estimate the effects and impacts of heat on occupational injuries in the agricultural sector in Italy. Occupational injuries in the agricultural sector from the Italian national workers’ compensation authority (INAIL) and daily mean air temperatures from Copernicus ERA5-land for a five-year period (2014-2018) were considered. Distributed lag non-linear models (DLNM) were used to estimate the relative risk and attributable injuries for increases in daily mean air temperatures between the 75th and 99th percentile and during heatwaves. Analyses were stratified by age, professional qualification, and severity of injury. A total of 150,422 agricultural injuries were considered and the overall relative risk of injury for exposure to high temperatures was 1.13 (95% CI: 1.08; 1.18). A higher risk was observed among younger workers (15-34 years) (1.23 95% CI: 1.14; 1.34) and occasional workers (1.25 95% CI: 1.03; 1.52). A total of 2050 heat-attributable injuries were estimated in the study period. Workers engaged in outdoor and labour-intensive activities in the agricultural sector are at greater risk of injury and these results can help target prevention actions for climate change adaptation.
The comfort level of outdoor thermal environments is affected by several factors. Previous studies of thermal comfort have generally investigated the main microclimatic factors as dependent variables, such as the temperature, wind speed, humidity, and thermal radiation, but the influence of the air quality has rarely been explored. In this study, we acquired meteorological element observations and conducted questionnaire surveys in Peach Blossom Park, Hebei University of Technology, and Xigu Park in Tianjin. We analyzed the effects of the outdoor air quality and thermal environment on the thermal comfort in order to provide a theoretical basis for comprehensive evaluations of the outdoor environment and the mechanism. The results showed that thermal resistance of clothing and ambient temperature followed a negative step change, where people generally reduced the minimum amount of clothing when the temperature exceeded 28 °C. One unit change in the thermal sensation vote (TSV) occurred for every 11 °C rise in the physiological equivalent temperature (PET). The neutral PET was 21.68 °C, and the comfortable PET was about 23 °C. The air quality index (AQI) and air satisfaction were negatively correlated, and satisfaction decreased by 1 unit for every change of 230 AQI. The transitional season was most comfortable when the temperature felt slightly cool (TSV = -0.70). The neutral TSV was 0.507 in the summer and -0.334 in the winter. Air quality had a significant effect on the thermal comfort vote (TCV) (p = 0.0485 < 0.05). The effect of PET on TCV was highly significant (p < 0.01).
Due to the time-sensitive nature of heat-related illnesses, disparities in access to heat-related emergency medical services (EMS) services may contribute to urban health disparities. This paper is an empirical study utilizing Austin-Travis County EMS data to estimate the delays in response time due to traffic congestion through spatiotemporal analysis and to conduct the Ordinary Least Square (OLS) and Geographically Weighted Regression (GWR) models to examine the underlying factors affecting delays in peak traffic rush hours. Our results reveal that heat-related EMS is most delayed in the morning and the evening; there are higher clustering patterns of EMS travel time difference in Austin’s metropolitan outskirts, notably in the east and west Austin. OLS and GWR analyses suggest that larger EMS counts, longer distances from an EMS station to the scene and from the scene to a hospital, and neighborhoods with a greater black and Hispanic population exacerbate heat-related EMS delays. Road density, average speed limit, and open space growth rate are statistically significant in the OLS model, although GWR findings suggest coefficient signs vary locally, requiring more investigation. Our findings provided additional insights through the spatial patterns of EMS delays to practitioners for their reference to reduce local response times.
Health agencies, including the U.S. Centers for Disease Control and Prevention and the World Health Organization, recommend that heat-vulnerable older adults without home air-conditioning should visit cooling centers or other air-conditioned locations (e.g., a shopping mall) during heat waves. However, experimental evidence supporting the effectiveness of brief air-conditioning is lacking. OBJECTIVE: We evaluated whether brief exposure to an air-conditioned environment, as experienced in a cooling center, was effective for limiting physiological strain in older adults during a daylong laboratory-based heat wave simulation. METHODS: Forty adults 64-79 years of age underwent a 9-h simulated heat wave (heat index: 37°C) with (cooling group, n = 20) or without (control group, n = 20) a cooling intervention consisting of 2-h rest in an air-conditioned room ( ∼ 23°C, hours 5-6). Core and skin temperatures, whole-body heat exchange and storage, cardiovascular function, and circulating markers of acute inflammation were assessed. RESULTS: Core temperature was 0.8°C (95% CI: 0.6, 0.9) lower in the cooling group compared with the control group at the end of the cooling intervention (p < 0.001; hour 6), and it remained 0.3°C (95% CI: 0.2, 0.4) lower an hour after returning to the heat (p < 0.001; hour 7). Despite this, core temperatures in each group were statistically equivalent at hours 8 and 9, within ±0.3°C (p ≤ 0.005). Cooling also acutely reduced demand on the heart and improved indices of cardiovascular autonomic function (p ≤ 0.021); however, these outcomes were not different between groups at the end of exposure (p ≥ 0.58). DISCUSSION: Brief air-conditioning exposure during a simulated heat wave caused a robust but transient reduction in core temperature and cardiovascular strain. These findings provide important experimental support for national and international guidance that cooling centers are effective for limiting physiological strain during heat waves. However, they also show that the physiological impacts of brief cooling are temporary, a factor that has not been considered in guidance issued by health agencies. https://doi.org/10.1289/EHP11651.
Urban heat exposure is an increasing health risk among urban dwellers. Many cities are considering accommodating active mobility, especially walking and biking, to reduce greenhouse gas emissions. However, promoting active mobility without proper planning and transportation infrastructure to combat extreme heat exposure may cause more heat-related morbidity and mortality, particularly in future with projected climate change. This study estimated the effectiveness of active trip heat exposure mitigation under built environment and travel behavior change. Simulations of the Phoenix metro region’s 624,987 active trips were conducted using the activity-based travel model (ABM), mean radiant temperature (T-MRT, net human radiation exposure), transportation network, and local climate zones. Two scenarios were designed to reduce traveler exposure: one that focuses on built environment change (making neighborhoods cooler) and the other on travel behavior (switching from shorter travel time but higher exposure routes to longer travel time but cooler routes) change. Travelers experienced T-MRT heat exposure ranging from 29 degrees C to 76 degrees C (84 degrees F to 168 degrees F) without environmental or behavioral change. Active trip T-MRT exposures were reduced by an average of 1.2-3.7 degrees C when the built environment was changed from a hotter to cooler design. Behavioral changes cooled up to 10 times more trips than changes in built environment changes. The marginal benefit of cooling decreased as the number of cooled corridors transformed increased. When the most traveled 10 km of corridors were cooled, the marginal benefit affected over 1,000 trips/km. However, cooling all corridors results in marginal benefits as low as 1 trip/km. The results reveal that heavily traveled corridors should be prioritized with limited resources, and the best cooling results come from environment and travel behavior change together. The results show how to surgically invest in travel behavior and built environment change to most effectively protect active travelers.
OBJECTIVE: To evaluate the association between the risk of death from COPD and air temperature events in ten major Brazilian microregions. METHODS: This was a time series analysis of daily COPD deaths and daily mean air temperatures between 1996 and 2017. Using distributed nonlinear lag models, we estimated the cumulative relative risks of COPD mortality for four temperature percentiles (representing moderate and extreme cold and heat events) in relation to a minimum mortality temperature, with a lag of 21 days, in each microregion. RESULTS: Significant associations were found between extreme air temperature events and the risk of death from COPD in the southern and southeastern microregions in Brazil. There was an association of extreme cold and an increased mortality risk in the following microregions: 36% (95% CI, 1.12-1.65), in Porto Alegre; 27% (95% CI, 1.03-1.58), in Curitiba; and 34% (95% CI, 1.19-1.52), in São Paulo; whereas moderate cold was associated with an increased risk of 20% (95% CI, 1.01-1.41), 33% (95% CI, 1.09-1.62), and 24% (95% CI, 1.12-1.38) in the same microregions, respectively. There was an increased COPD mortality risk in the São Paulo and Rio de Janeiro microregions: 17% (95% CI, 1.05-1.31) and 12% (95% CI, 1,02-1,23), respectively, due to moderate heat, and 23% (95% CI, 1,09-1,38) and 32% (95% CI, 1,15-1,50) due to extreme heat. CONCLUSIONS: Non-optimal air temperature events were associated with an increased risk of death from COPD in tropical and subtropical areas of Brazil.
BACKGROUND: The progression of global warming and increase in instances of extreme weather have received considerable attention. We conducted a cohort study on women of childbearing age in Yunnan Province, examined the association between ambient temperature and humidity on preterm birth and evaluated the effects of extreme weather during early pregnancy and before parturition on preterm birth. METHODS: We conducted a population-based cohort study on women of childbearing age 18-49 years who participated in National Free Preconception Health Examination Project (NFPHEP) in Yunnan Province from January 1, 2010, to December 31, 2018. Meteorological data, namely daily average temperature (°C) and daily average relative humidity (%), were obtained from China National Meteorological Information Center. Four exposure windows were explored: 1 week of pregnancy, 4 weeks of pregnancy, 4 weeks before delivery, and 1 week before delivery. We used a Cox proportional hazards model and adjusted the potential risk factors for preterm birth to obtain the effects of exposure to temperature and humidity on preterm birth among the stages of pregnancy. RESULTS: At 1 week of pregnancy and at 4 weeks of pregnancy, the association between temperature and preterm birth was U-shaped. The correlation between relative humidity and the risk of preterm birth was n-type at 1 week of pregnancy. The correlation between preterm birth and temperature and relative humidity at 4 weeks before delivery and at 1 week before delivery is J-shaped. Low temperature and low humidity were protective factors against preterm birth, whereas high temperature and high humidity were risk factors for preterm birth.The effects of high temperature and extremely high temperature were the strongest at 4 weeks before delivery, with HRs of 1.417 (95% CI: 1.362-1.474) and 1.627 (95% CI: 1.537-1.722), respectively. The effects of extremely low humidity and low humidity were strongest at 1 week before delivery, with HRs of 0.681 (95% CI: 0.609-0.761) and 0.696 (95% CI: 0.627-0.771), respectively. CONCLUSION: Temperature and relative humidity affect preterm birth differently for each pregnancy stage. The effects of meteorological factors on pregnancy outcomes such as premature birth should not be ignored.
Climate change is one of the most significant global challenges and is already having detrimental effects on people’s health. Pollution levels and ambient temperatures continue to increase, resulting in higher levels of humidity and pollen production. These environmental threats can affect many vulnerable patients, particularly those with respiratory and cardiovascular conditions, and nurses have a crucial role in raising awareness of the health implications of climate change. This article explores the pathophysiological effects of climate change on patients with asthma, chronic obstructive pulmonary disease and cardiovascular disease, and aims to enhance nurses’ understanding of the health challenges of climate change.
Rural populations are at risk of climate-related impacts due to ecological and geographical determinants, potentially leading to greater morbidity and health utilization. They are often highly dependent on primary care services. However, no rural- or primary care specific synthesis of these issues has ever been conducted. This review aimed to identify, characterize, and summarize existing research on the effects of climate-related events on utilization and health outcomes of primary care in rural and remote areas and identify related adaptation strategies used in primary care to climate-related events. METHODS: A scoping review following PRISMA-ScR guidelines was conducted, examining peer-reviewed English-language articles published up to 31 October 2022. Eligible papers were empirical studies conducted in primary care settings that involved climate-related events as exposures, and health outcomes or utilization as study outcomes. Two reviewers independently screened and extracted relevant information from selected papers. Data were analysed using content analysis and presented using a narrative approach. RESULTS: We screened 693 non-duplicate papers, of those, 60 papers were analysed. Climate-related events were categorized by type, with outcomes described in terms of primary, secondary, and tertiary effects. Disruption of primary care often resulted from shortages in health resources. Primary care may be ill-prepared for climate-related events but has an important role in supporting the development of community. CONCLUSIONS: Findings suggest various effects of climate-related events on primary care utilization and health outcomes in rural and remote areas. There is a need to prepare rural and remote primary care service before and after climate-related events.
BACKGROUND: Cyanobacterial harmful algal blooms (CyanoHABs) originate from the excessive growth or bloom of cyanobacteria often referred to as blue-green algae. They have been on the rise globally in both marine and freshwaters in recently years with increasing frequency and severity owing to the rising temperature associated with climate change and increasing anthropogenic eutrophication from agricultural runoff and urbanization. Humans are at a great risk of exposure to toxins released from CyanoHABs through drinking water, food, and recreational activities, making CyanoHAB toxins a new class of contaminants of emerging concern. OBJECTIVES: We investigated the toxic effects and mechanisms of microcystin-LR (MC-LR), the most prevalent CyanoHAB toxin, on the ovary and associated reproductive functions. METHODS: Mouse models with either chronic daily oral or acute intraperitoneal exposure, an engineered three-dimensional ovarian follicle culture system, and human primary ovarian granulosa cells were tested with MC-LR of various dose levels. Single-follicle RNA sequencing, reverse transcription-quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, western blotting, immunohistochemistry (IHC), and benchmark dose modeling were used to examine the effects of MC-LR on follicle maturation, hormone secretion, ovulation, and luteinization. RESULTS: Mice exposed long term to low-dose MC-LR did not exhibit any differences in the kinetics of folliculogenesis, but they had significantly fewer corpora lutea compared with control mice. Superovulation models further showed that mice exposed to MC-LR during the follicle maturation window had significantly fewer ovulated oocytes. IHC results revealed ovarian distribution of MC-LR, and mice exposed to MC-LR had significantly lower expression of key follicle maturation mediators. Mechanistically, in both murine and human granulosa cells exposed to MC-LR, there was reduced protein phosphatase 1 (PP1) activity, disrupted PP1-mediated PI3K/AKT/FOXO1 signaling, and less expression of follicle maturation-related genes. DISCUSSION: Using both in vivo and in vitro murine and human model systems, we provide data suggesting that environmentally relevant exposure to the CyanoHAB toxin MC-LR interfered with gonadotropin-dependent follicle maturation and ovulation. We conclude that MC-LR may pose a nonnegligible risk to women’s reproductive health by heightening the probability of irregular menstrual cycles and infertility related to ovulatory disorders. https://doi.org/10.1289/EHP12034.
As the global greenhouse effect intensifies, the urban heat island effect becomes increasingly severe; consequently, people are exposed to high-temperature and metabolically intensive thermal environments. The issue of thermal safety is becoming increasingly serious. This study investigated the human thermal comfort requirements at different temperatures and metabolic rates. Twenty participants were made to perform four tasks at four ambient temperatures (Ta; 28, 30, 32, and 34 degrees C) and metabolic rate levels (2.4, 3.2, 4.0, and 4.4 met), and their physiological reactions, symptoms, and responses to subjective thermal comfort were continuously measured. The results revealed that 15.2% of the participants exhibited adverse symptoms when Ta = 28 degrees C, whereas 53.2% of the participants exhibited adverse symptoms when Ta = 34 degrees C. The symptoms included intense sweating, facial heat, rapid heartbeat, dyspnea, chest tightness, feebleness, general weakness, blurry vision, skin sensitivity, and nausea. Prolonged exercise in high-temperature environments may affect the body’s heat resistance, resulting in discomfort such as fatigue, headaches, and nausea. Furthermore, participants with high metabolic rates preferred higher wind speeds and lower humidity to improve their thermal comfort in warmer thermal environments. The results offer valuable insights towards mitigating heat exposure-related occupational health risks during work or exercise in high-temperature environments.
Previous epidemiological findings on extreme temperature and preterm birth (PTB) were heterogeneous, especially for extreme cold exposure. Measured and unmeasured individual-level factors such as genetic factors or lifecourse exposures may constitute important contributors but have not been addressed. OBJECTIVES: We aimed to examine the association of gestational heat and cold exposure with PTB using a novel sibling-matched study. METHODS: Based on a multi-center population-based birth cohort across 16 counties in China, we included 10,826 sibling pairs born from March 2013 to December 2018. Conditional logistic and Cox Proportional Hazard regression models were used to estimate the effects of heat and cold exposure on PTB in each trimester, one and four weeks before delivery and the entire pregnancy. We also tested the heterogeneity in the association of temperature with PTB between siblings. FINDINGS: Exposure to heat during the third trimester and the entire pregnancy increased the risk of PTB. For heat (> 90th) defined with mean temperature, the odds ratios were 2.32 (1.63, 3.30) and 3.19 (2.22, 4.58), respectively. Cold exposure (< 10th) during the first, the third, and the entire pregnancy was associated with a higher PTB risk, with ORs (95%CIs) of 2.04 (1.43, 2.90), 3.13 (2.14, 4.58), and 4.26 (2.94, 6.19), respectively. We found slightly stronger associations of heat exposure during the entire pregnancy with the firstborn PTB, and stronger associations of cold exposure during one week and four weeks before delivery with secondborn PTB. CONCLUSIONS: Using a sibling-matched study, we took into account some mother-level unobserved confounding. Our research strengthens the evidence that gestational exposure to heat and cold increases the risk of PTB. Our findings may have important implications for improving the health of newborns in the context of climate change.
Heat waves are becoming more intense and extreme as a consequence of global warming. Epidemiological evidence reveals the health impacts of heat waves in mortality and morbidity outcomes, however, few studies have been conducted in tropical regions, which are characterized by high population density, low income and low health resources, and susceptible to the impacts of extreme heat on health. The aim of this paper is to estimate the effects of heat waves on cardiovascular and respiratory mortality in the city of Rio de Janeiro, Brazil, according to sex, age, and heat wave intensity. METHODS: We carried out a time-stratified case-crossover study stratified by sex, age (0-64 and 65 or above), and by sex for the older group. Our analyses were restricted to the hot season. We included 42,926 participants, 29,442 of whom died from cardiovascular and 13,484 from respiratory disease, between 2012 and 2017. The death data were obtained from Rio de Janeiro’s Municipal Health Department. We estimated individual-level exposure using the inverse distance weighted (IDW) method, with temperature and humidity data from 13 and 12 stations, respectively. We used five definitions of heat waves, based on temperature thresholds (90th, 92.5th, 95th, 97.5th, and 99th of individual daily mean temperature in the hot season over the study period) and a duration of two or more days. Conditional logistic regression combined with distributed lag non-linear models (DLNM) were used to estimate the short-term and delayed effects of heat waves on mortality over a lag period (5 days for cardiovascular and 10 for respiratory mortality). The models were controlled for daily mean absolute humidity and public holidays. RESULTS: The odds ratios (OR) increase as heat waves intensify, although some effect estimates are not statistically significant at 95% level when we applied the most stringent heat wave criteria. Although not statistically different, our central estimates suggest that the effects were greater for respiratory than cardiovascular mortality. Results stratified by sex and age were also not statistically different, but suggest that older people and women were more vulnerable to the effects of heat waves, although for some heat wave definitions, the OR for respiratory mortality were higher among the younger group. The results also indicate that older women are the most vulnerable to heat wave-related cardiovascular mortality. CONCLUSION: Our results show an increase in the risk of cardiovascular and respiratory mortality on heat wave days compared to non-heat wave ones. These effects increase with heat wave intensity, and evidence suggests that they were greater for respiratory mortality than cardiovascular mortality. Furthermore, the results also suggest that women and the elderly constitute the groups most vulnerable to heat waves.
As the climate warms, increasing heat-related health risks are expected, and can be exacerbated by the urban heat island (UHI) effect. UHIs can also offer protection against cold weather, but a clear quantification of their impacts on human health across diverse cities and seasons is still being explored. Here we provide a 500 m resolution assessment of mortality risks associated with UHIs for 85 European cities in 2015-2017. Acute impacts are found during heat extremes, with a 45% median increase in mortality risk associated with UHI, compared to a 7% decrease during cold extremes. However, protracted cold seasons result in greater integrated protective effects. On average, UHI-induced heat-/cold-related mortality is associated with economic impacts of €192/€ - 314 per adult urban inhabitant per year in Europe, comparable to air pollution and transit costs. These findings urge strategies aimed at designing healthier cities to consider the seasonality of UHI impacts, and to account for social costs, their controlling factors, and intra-urban variability.
BACKGROUND: The protective effect of urban greenery from adverse heat impacts remains inconclusive. Existing inconsistent findings could be attributed to the different estimation techniques used. OBJECTIVES: We investigated how effect modifications of urban greenery on heat-mortality associations vary when using different greenery measurements reflecting overhead-view and eye-level urban greenery. METHODS: We collected meteorological and daily mortality data for 286 territory planning units between 2005 and 2018 in Hong Kong. Three greenery measurements were extracted for each unit: a) the normalized difference vegetation index (NDVI) from Landsat remote sensing images, b) the percentage of greenspace based on land use data, and c) eye-level street greenery from street view images via a deep learning technique. Time-series analyses were performed using the case time series design with a linear interaction between the temperature term and each of the three greenery measurements. Effect modifications were also estimated for different age groups, sex categories, and cause-specific diseases. RESULTS: Higher mortality risks were associated with both moderate and extreme heat, with relative risks (RRs) of 1.022 (95% CI: 1.000, 1.044) and 1.045 (95% CI: 1.013, 1.079) at the 90th and 99th percentiles of temperatures relative to the minimum mortality temperature (MMT). Lower RRs were observed in greener areas whichever of the three greenery measurements was used, but the disparity of RRs between areas with low and high levels of urban greenery was more apparent when using eye-level street greenery as the index at high temperatures (99th percentile relative to MMT), with RRs for low and high levels of greenery, respectively, of 1.096 (95% CI: 1.035, 1.161) and 0.985 (95% CI: 0.920, 1.055) for NDVI (p = 0.0193), 1.068 (95% CI: 1.021, 1.117) and 0.990 (95% CI: 0.906, 1.081) for the percentage of greenspace (p = 0.1338), and 1.103 (95% CI: 1.034, 1.177) and 0.943 (95% CI: 0.841, 1.057) for eye-level street greenery (p = 0.0186). Health discrepancies remained for nonaccidental mortality and cardiorespiratory diseases and were more apparent for older adults ( ≥ 65 years of age) and females. DISCUSSION: This study provides new evidence that eye-level street greenery shows stronger associations with reduced heat-mortality risks compared with overhead-view greenery based on NDVI and percentage of greenspace. The effect modification of urban greenery tends to be amplified as temperatures rise and are more apparent in older adults and females. Heat mitigation strategies and health interventions, in particular with regard to accessible and visible greenery, are needed for helping heat-sensitive subpopulation groups in coping with extreme heat. https://doi.org/10.1289/EHP12589.
Previous epidemiological evidence suggests that the impact of heat waves on mortality may change over time within the summer season. The consideration of heat wave timing could help to optimize the implementation of heat alert systems. We explored the effect of the timing of extreme heat events on mortality risk during the summer season in France. METHODS: Summertime daily mortality data for 21 French cities from 2000 to 2015 were obtained from the French National Institute of Health and Medical Research. Heat waves were defined according to the official definition of Météo France. The order of heat wave over time, from June to August, was assessed. We also used ambient temperature and considered different summer periods. To quantify mortality risk (for cardiovascular and respiratory causes) for the first and second or later heat waves, quasi-Poisson models were performed. We used distributed lag non-linear models to estimate whether the non-linear exposure-response associations between temperature and mortality differ across different summer periods. RESULTS: Compared with non-heat wave days, the second and later heat waves of the summer season were associated with a higher relative risk (RR) for cardiovascular and respiratory mortality (RR, 95%CI: 1.38, 1.23-1.53; RR, 95%CI: 1.74, 1.45-2.08, respectively) as compared to first heat wave (RR, 95%CI: 1.30, 1.17-1.45, RR, 95%CI: 1.56, 1.33-1.83, respectively). Small increase from the median temperature was associated to an increased risk in mortality in the first stage of the summer (from June to mid-July), while only more extreme temperatures were harmful later in the summer. After the exclusion from the analysis of the August 2003 heat-wave, only results for earlier heat waves episodes and first-period exposures were confirmed. CONCLUSIONS: The timing of extreme temperatures modulates heat-related risks in France. Such information could be used to update local heat action plans to optimize health benefits.
Although ambient temperature has been linked to asthma exacerbation, impacts associated with extreme temperature events remain unclear. This study aims to identify the events characteristics that elevate risk of asthma hospital visits, and to assess whether healthy behavior changes due to the COVID-19 prevention and control policy may modify the relationships. Data of asthma hospital visits from all medical facilities in Shenzhen, China during 2016-2020 were assessed in relation to extreme temperature events using a distributed lag model. Stratified analysis was conducted by gender, age and hospital department to identify susceptible populations. Through events defined by various duration days and temperature thresholds, we explored the modification by events intensity, length, occurrence time and healthy behaviors. The cumulative relative risk of asthma during heat waves compared to other days was 1.06 (95%CI: 1.00-1.13) and for cold spells was 1.17 (95%CI: 1.05-1.30), and that of males and school-aged children were generally higher than other sub-groups. There were significant effects of heat waves and cold spells on asthma hospital visits when the mean temperature was above 90th percentile (30 °C) and below 10th percentile (14 °C) respectively, and the relative risks were higher when events lasted longer, became stronger, occurred in daytime and in early summer or winter. During the healthy behaviors maintaining period, the risk of heat waves increased whilst the risk of cold spells reduced. Extreme temperatures may pose considerable impact on asthma and the health effect can be modified by the event characteristics and anti-epidemic healthy behaviors. Strategies of asthma control should consider the heightened threats of the intense and frequent extreme temperature events in the context of climate change.
The synergistic effect of heat waves and urban heat islands (UHI) adversely affect the urban environment, building energy consumption, and human health. The absorption and storage of short-wave radiation by hardened pavement is the primary reason for high-temperature heat waves and the UHI effect. Three mitigation strategies were assessed to alleviate the influence of high-temperature hardened pavement on the thermal environment and thermal comfort of pedestrians, water-spray vehicles (spray) and pavement watering (watering) to take advantage of evaporative cooling, and a fan based on convective heat transfer. In addition, the fanspray and fan-watering combinations were evaluated to increase the evaporative cooling rate. Field measurements showed that the five heat mitigation strategies improved the thermal environment and reduced environmental thermal stress. The thermal sensation, comfort sensation, and mean skin temperature (MST) were analyzed in thermal perception experiments. The result indicated that the mitigation strategies changed the subjects’ thermal perception. Moreover, regression analysis between the universal thermal climate index (UTCI) and the thermal response showed that the neutral temperature and the range of comfort threshold of UTCI and MST increased after implementing the mitigation strategies.
BACKGROUND: Meteorological factors and air pollutants are believed to be associated with cardiovascular disease. Ischemic heart disease (IHD) is a major public health issue worldwide. Few studies have investigated the associations among meteorological factors, air pollutants and IHD daily hospital admissions in Lanzhou, China. METHODS: We conducted a distributed lag non-linear model (DLNM) on the basis of five years data, aiming at disentangling the impact of meteorological factors and air pollutants on IHD hospital admissions. All IHD daily hospital admissions recorded from January 1, 2015 and December 31, 2019 were obtained from three hospitals in Lanzhou, China. Daily air pollutant concentrations and meteorological data were synchronously collected from Gansu Meteorological Administration and Lanzhou Environmental Protection Administration. Stratified analyses were performed by sex and two age-groups. RESULTS: A total of 23555 IHD hospital admissions were recorded, of which 10477 admissions were for coronary artery disease (CAD), 13078 admissions were for acute coronary syndrome (ACS). Our results showed that there was a non-linear (J-shaped) relationship between temperature and IHD hospital admissions. The number of IHD hospital admissions were positively correlated with NO2, O3, humidity and pressure, indicating an increased risk of hospital admissions for IHD under NO2, O3, humidity and pressure exposure. Meanwhile, both extremely low (-12ºC) and high (30ºC) temperature reduced IHD hospital admissions, but the harmful effect increased with the lag time in Lanzhou, China, while the cold effect was more pronounced and long-lasting than the heat effect. Subgroup analysis demonstrated that the risk on CAD hospital admissions increased significantly in female and <65 years of age at -12ºC. CONCLUSION: Our findings added to the growing evidence regarding the potential impact of meteorological factors, air pollutants on policymaking from the perspective of hospital management efficiency.
The present study concerns the determination of the characteristics of bioclimatic conditions, as well as the synoptic situations related to the occurrence of thermal stress conditions, in Poland. The study was based on daily data obtained from the Institute of Meteorology and Water Management – National Research Institute from the period 1966-2020 for 37 synoptic stations in Poland. Based on the obtained data, values of the Universal Thermal Climate Index (UTCI) were calculated. The occurrence of heat stress increases from the north to the south, corresponding with the variability of influx of solar radiation, and is modified by factors at a smaller spatial scale. The results of this paper evidently point to the cooling effect of the waters of the Baltic Sea. In circulation conditions favouring strong and very strong heat stress, e.g. in two of the designated circulation types (T1 and T2), the occurrence of an expansive high-pressure ridge in the Atlantic-European area is typical, stretching from the region of the Azores High towards the north-east, with a secondary high developed within its boundaries. In the third of the designated circulation types (T3), the high-pressure area extends from the Azores eastwards, reaching the Black Sea. Each of the three circulation patterns associated with the unfavourable biometeorological conditions of very strong and extreme cold stress in Poland is characterised by strong pressure centres formed in the Euroatlantic region, triggering the airflow from the northern (T4) or eastern (T5, T6) sector.
AIM: To evaluate the effect of the historic Spanish heatwave (9th-26th July 2022) over glycemic control in adults with type 1 diabetes (T1D). METHODS: Cross-sectional retrospective analysis of adult patients with T1D in Castilla-La Mancha (south-central Spanish region) using intermittently scanned continuous glucose monitoring (isCGM) during and after the heatwave. Primary outcome was change in time in range (TIR) 3.0-10 mmol/L (70-180 mg/dL) of interstitial glucose in the two weeks following the heatwave. RESULTS: A total of 2701 T1D patients were analyzed. We detected a TIR reduction of 4.0 % (95 % CI -3.4, -4.6; P < 0.001) in the two weeks following the heatwave. Patients in the highest daily scan frequency quartile (>13 scans/day) during the heatwave showed the greatest deterioration in TIR after it concluded (-5.4 % [95 % CI -6.5, -4.3; P < 0.001]). The percentage of patients meeting all the recommendations of the International Consensus of Time in Range was greater during the heatwave than after it ended (10.6 % vs. 8.4 %, P < 0.001). CONCLUSIONS: Adults with T1D had better glycemic control during the historic Spanish heatwave compared to the following period.
Climate change is one of the most serious issues in the recent world. Climate change is known as caused by the increase of carbon dioxide and many countries are forced to take measures. The first big measure was the Paris Agreement in 2015, and many countries joined the agreement. According to the agreement, many of the countries declared major shifts, such as the shift to electric vehicles in the car industry. The biggest concern about climate change at this moment is the rise of the temperature and it causes more death by heat stroke in summer. It also causes more usage of air conditioning systems and emits more carbon dioxide. It became a serious vicious circle. For that reason, it is important to analyze the mechanism of the human thermal sensation, which can be affected by the environmental history of the person, such as the residential area, the length of stay, and so on. In addition, it is expected that the effect of these histories especially appears strongly outdoors. For that reason, the outdoor experiment targeting short-term residents was carried out in Bangkok. For the experiment, 5 measuring points were selected. As a result, a different tendency was grasped at one of the measuring points with an open sky.
Cardiovascular drift-a progressive increase in heart rate (HR) and decrease in stroke volume (SV) during prolonged exercise-is exacerbated by heat stress and thermal strain, and often accompanied by a decrease in work capacity (indexed as maximal oxygen uptake [V.O(2max)]). To attenuate physiological strain during work in the heat, use of work:rest ratios is recommended by the National Institute for Occupational Safety and Health. The purpose of this study was to test the hypothesis that during moderate work in hot conditions, utilizing the recommended 45:15 min work:rest ratio would result in cardiovascular drift ‘accumulating’ over consecutive work:rest cycles and accompanying decrements in V.O(2max). Eight people (5 women; (mean ± SD) age = 25 ± 5 y; body mass = 74.8 ± 11.6 kg; V.O(2max) = 42.9 ± 5.6 mL·kg(-1)·min(-1)) performed 120 min of simulated moderate work (201-300 kcal·h(-1)) in hot conditions (indoor wet-bulb globe temperature = 29.0 ± 0.6 °C). Participants completed two 45:15 min work:rest cycles. Cardiovascular drift was evaluated at 15 and 45 min of each work bout; V.O(2max) was measured after 120 min. On a separate day, V.O(2max) was measured after 15 min under identical conditions for comparison before and after cardiovascular drift occurred. HR increased 16.7% (18 ± 9 beats·min(-1), p = 0.004) and SV decreased 16.9% (-12.3 ± 5.9 mL, p = 0.003) between 15 and 105 min, but V.O(2max) was unaffected after 120 min (p = 0.14). Core body temperature increased 0.5 ± 0.2 °C (p = 0.006) over 2 h. Recommended work:rest ratios preserved work capacity but did not prevent the accumulation of cardiovascular and thermal strain.
Anthropogenic climate change will likely put dwellings at risk of overheating and potentially increase cooling demand in the decades ahead, leading to higher greenhouse gas (GHG) emissions due to the energy consumed for mechanical cooling. Contemporary constructions with highly insulated fabric have been found to suffer from periodic overheating in today’s climate, the occurrence of which is projected to increase in frequency as the temperature rises. This critical review investigates the factors affecting overheating risks in dwellings and passive cooling strategies to mitigate overheating impacts on occupant thermal comfort and wellbeing. The cooling efficiency of passive strategies is affected by the design, construction and operation of buildings, as well as climate and occupancy. A framework has been developed to illustrate the effect of overheating factors on the cooling efficacy of passive strategies. Findings suggest that a combination of passive strategies is required to minimise overheating risks by the 2080s. External solar shading is the most effective method for retrofitting insulated dwellings. On the other hand, cool paint is ideal for uninsulated dwellings. In addition, thermal mass and natural ventilation require occupant interaction for optimal air circulation and cooling performance.
Significant increases in both heatwaves and heavy precipitation were reported under global warming, leading to detrimental social, economic, and environmental impacts. However, future variations of such compound heatwave and heavy precipitation events (CHWHPs) were barely analyzed in Guangdong. Therefore, a downscaled compound heatwave-precipitation analysis approach (DCHP) was developed to explore the spatio-temporal variations of CHWHPs in Guangdong under two shared socioeconomic pathways (i.e., SSPs). Potential changes in four parameters (i.e., the occurrence frequency, the average duration, the total intensity, and the longest duration) of projected CHWHPs for the future (i.e., 2025-2054 and 2066-2095) and historical (i.e., 1985-2014) periods were analyzed based on the multi-model ensemble of 15 global climate models (GCMs) from the Coupled Model Intercomparison Projected Phase 6 (CMIP6). Additionally, the effects of multiple impact factors (GCM, SSP, and their interactions) on the compound events were investigated through a multilevel factorial analysis approach. The results showed that the majority of Guangdong would undergo a significant increasing trend in the projected temperature and precipitation (e.g., 0.43-0.61 degrees C per decade and – 7.79 to 43.02 mm per decade under SSP5-8.5). Spatial changes and interannual trends suggested that Guangdong would suffer more CHWHP events in the future, especially for 2066-2095 under SSP5-8.5. The variations of four parameters are projected to increase by 13.86 events, 2.27 days per event, 55.32 degrees C, and 7.13 days during 2066-2095 under SSP5-8.5, respectively; the MK test of four parameters are statistically significant and the Sen’s slopes are 0.0125%, 0.0027%, 0.1946%, and 0.0097% per decade, respectively. The higher increases in such parameters are expected to be concentrated in western, northwestern, and northeastern Guangdong. The factorial analysis results indicate that the GCM choice is a major impacting factor on the projected CHWHP parameters in two future periods; the contribution of such factor would decrease slightly from 2025-2054 to 2066-2095. The results can help support informed decision-making to mitigate and adapt to potential risks from compound events in multiple sectors under climate change, such as human health and agriculture.
BACKGROUND: A number of studies have reported reductions in mortality risk due to heat and cold over time. However, questions remain about the drivers of these adaptation processes to ambient temperatures. We aimed to analyse the demographic and socioeconomic drivers of the downward trends in vulnerability to heat- and cold-related mortality observed in Spain during recent decades (1980-2018). METHODS: We collected data on all-cause mortality, temperature and relevant contextual indicators for 48 provinces in mainland Spain and the Balearic Islands between Jan 1, 1980, and Dec 31, 2018. Fourteen contextual indicators were analysed representing ageing, isolation, urbanicity, heating, air conditioning (AC), house antiquity and ownership, education, life expectancy, macroeconomics, socioeconomics, and health investment. The statistical analysis was separately performed for the range of months mostly causing heat- (June-September) and cold- (October-May) related mortality. We first applied a quasi-Poisson generalised linear regression in combination with distributed lag non-linear models (DLNM) to estimate province-specific temperature-mortality associations for different periods, and then we fitted univariable and multivariable multilevel spatiotemporal meta-regression models to evaluate the effect modification of the contextual characteristics on heat- and cold-related mortality risks over time. FINDINGS: The average annual mean temperature has risen at an average rate of 0·36 °C per decade in Spain over 1980-2012, although the increase in temperature has been more pronounced in summer (0·40 °C per decade in June-September) than during the rest of the year (0·33 °C per decade). This warming has been observed, however, in parallel with a progressive reduction in the mortality risk associated to both hot and cold temperatures. We found independent associations for AC with heat-related mortality, and heating with cold-related mortality. AC was responsible for about 28·6% (31·5%) of the decrease in deaths due to heat (extreme heat) between 1989 and 1993 and 2009-2013, and heating for about 38·3% (50·8%) of the reductions in deaths due to cold (extreme cold) temperatures. Ageing (ie, proportion of population over 64 years) attenuated the decrease in cold-related mortality. INTERPRETATION: AC and heating are effective societal adaptive measures to heat and cold temperatures. This evidence holds important implications for climate change health adaptation policies, and for the projections of climate change impacts on human health.
The Murray-Darling Basin (MDB) is Australia’s prime agricultural region, where drought and hotter weather pose a significant threat to rural residents’ mental health – hence increasing their potential suicide risk. We investigate the impact of drought and hotter temperatures on monthly suicide within local areas in the MDB, from 2006-2016. Using Poisson fixed-effects regression modeling, we found that extreme drought and hotter temperatures were associated with increased total suicide rates. The effects of extreme drought and temperature on suicide were heterogeneous across gender and age groups, with younger men more vulnerable. Areas with higher percentages of Indigenous and farmer populations were identified as hot spots, and were vulnerable to increased temperatures and extreme drought. Green space coverage (and to some extent higher incomes) moderated the drought and suicide relationship. Providing targeted interventions in vulnerable groups and hot spot areas is warranted to reduce the suicide effect of climate change.
Urban vegetation is valuable in alleviating local heatwaves. However, drought may decrease vegetation health and limit this cooling effect. Here we use satellite-based Normalized Difference Vegetation Index (NDVI) and Palmer Drought Severity Index (PDSI) to investigate the sensitivity of urban vegetation to drought in Coastal Greater Los Angeles (CGLA) from 2001 to 2020. We applied four statistical models to analyze the relations between 15 socioeconomic variables and the vegetation’s sensitivity to drought. We then examined the changes in the cooling effect of the urban vegetation during drought and non-drought periods using remotely sensed land surface temperature (LST) data. The results suggest that economically disadvantaged areas with higher pro-portions of Hispanics and Blacks are typified by vegetation more sensitive to drought, which is likely linked to inequality in water use. Moreover, these populations experience a lower degree of vegetation cooling effects and higher exposure to heatwaves. The findings of this study imply that the potential of a community’s vegetation in mitigating heatwaves is significantly influenced by the socioeconomic conditions of the community. Increasing the resilience of urban vegetation to drought in disadvantaged communities may help promote environmentally sustainable and socially resilient cities under a warming climate.
Heat stress has an adverse impact on worker health and well-being, and the effects will increase with more frequent and severe heat events associated with global warming. Acclimatization to heat stress is widely considered to be a critical mitigation strategy and wet bulb globe temperature- (WBGT-) based occupational standards and guidelines contain adjustments for acclimatization. The purpose here was to 1) compare the mean values for the upper limit of the prescriptive zone (ULPZ, below which the rise in core temperature is minimal) between unacclimatized and acclimatized men and women; 2) demonstrate that the change in the occupational exposure limit (ΔOEL) due to acclimatization is independent of metabolic rate; 3) examine the relation between ΔOEL and body surface area (BSA); and 4) compare the exposure-response curves between unacclimatized and acclimatized populations. Empirically derived ULPZ data for unacclimatized participants from Pennsylvania State University (PSU) and acclimatized participants from University of South Florida (USF) were used to explore the difference between unacclimatized and acclimatized heat exposure limits. The findings provide support for a constant 3°C WBGT OEL decrease to account for unacclimatized workers. Body surface area explained part of the difference in ULPZ values between men and women. In addition, the pooled PSU and USF data provide insight into the distribution of individual values for the ULPZ among young, healthy unacclimatized and acclimatized populations in support of occupational heat stress guidelines.NEW & NOTEWORTHY Occupational exposure limit guidelines using wet bulb globe temperature (WBGT) distinguish between acclimatized and unacclimatized workers with about a 3°C difference between them. For the first time, empirical data from two laboratories provide support for acclimatization state adjustments. Using a constant difference rather than increasing differences with metabolic rate better describes the limit for unacclimatized participants. Furthermore, the lower upper limit of the prescriptive zone (ULPZ) values set forth for women do not relate to fitness level but are partly explained by their smaller body surface area (BSA). An examination of individual ULPZ values suggests that many unacclimatized individuals should be able to sustain safe work at the exposure limit for acclimatized workers.
Physiological equivalent temperature (PET) is one of most used indices for outdoor human well-being evaluation; its determination is particularly helpful for adaptation strategies in built-up areas affected by the urban heat island (UHI) phenomenon. In this work, we presented a methodology to compute spatially and temporally resolved PET values during a heatwave at the city level, based on a combination of satellite products, in situ measurements and Envi-met model runs upscaled from specific test areas to the broader city. The method exploits the ECOSTRESS sensor to detect surface thermal patterns at different diurnal times by developing an hourly based index called hUHTI (hourly urban heatwave thermal index) that serves as a proxy. A case study on Prato (Italy) municipality during the 2021 summer heatwave events is presented. Based on the available satellite products, a set of six hourly diurnal PET maps at 10 m spatial resolution were derived and daytime outdoor thermal patterns and trends were investigated according to land cover. hUHTI index resulted a more suitable tool as PET proxy compared to the sole ECOSTRESS land surface temperature (LST) product, especially for morning and evening times. Hourly PET maps were summarized by the use of an average exceedance map providing public administrations and stakeholders a synthetic tool for urban regeneration purposes at city scale.
Previous heat risk assessments have limitations in obtaining accurate heat hazard sources and capturing population distributions, which change over time. This study proposes a diurnal heat risk assessment framework incorporating spatiotemporal air temperature and real-time population data. Daytime and nighttime heat risk maps were generated using hazard, exposure, and vulnerability components in Seoul during the summer of 2018. The hazard was derived from the daily extreme air temperatures obtained using the stacking machine learning model. Exposure was calculated using de facto population density, and vulnerability was assessed using demographic and socioeconomic indicators. The resulting maps revealed distinct diurnal spatial patterns, with high-risk areas in the urban core during the day and dispersed at night. Daytime heat risk was strongly correlated with heat-related illness ratios (R = 0.8) and accurately captured temporal fluctuations in heat-related illness incidence. The proposed framework can guide site-specific adaptation and response plans for dynamic urban heat events.
It is unclear if ambient temperature changes affect eczema. It is also unclear if people with worse disease are more susceptible to weather-related flares, or specific types of emollient offer protection. OBJECTIVES: To investigate the effect of short-term temperature variations on eczema symptoms in children. METHODS: Data from a UK cohort of 519 children with eczema were combined with data from the Hadley Centre’s Integrated Surface Database. Hot and cold weeks were defined by average regional temperature > 75th or < 25th percentile, January 2018 to February 2020. Eczema flares were defined as ≥ 3-point change in Patient-Oriented Eczema Measure (POEM). Random-effects logistic regression models were used to estimate the odds ratios of flares in hot and cold weeks (reference group: temperate weeks). RESULTS: The baseline mean age was 4.9 years (SD 3.2) and the POEM score was 9.2 (SD 5.5). From the 519 participants, there were 6796 consecutively paired POEMs and 1082 flares. Seasonal variation in POEM scores was observed, suggesting symptoms worsening in winter and improving in summer. Odds ratios of flares were: 1.15 [95% confidence interval (CI) 0.96-1.39, P = 0.14] in cold weeks and 0.85 (95% CI 0.72-1.00, P = 0.05) in hot weeks. The likelihood ratio test showed no evidence of this differing by disease severity (P = 0.53) or emollient type used (P = 0.55). CONCLUSIONS: Our findings are consistent with previous studies demonstrating either improvements in eczema symptoms or reduced flares in hot weather. Worse disease and different emollient types did not increase susceptibility or provide protection against temperature changes. Further work should investigate the role of sunlight, humidity, pollution and other environmental factors.
Outdoor air temperature is associated with increased morbidity and mortality. Other thermal indices theoretically confer greater physiological relevance by incorporating additional meteorological variables. However, the optimal metric for predicting excess deaths or hospitalizations owing to extreme heat among US Medicare beneficiaries remains unknown. METHODS: We calculated daily maximum, minimum, and mean outdoor air temperature (T), heat index (HI), wet-bulb globe temperature (WBGT), and Universal Thermal Climate Index (UTCI) for populous US counties and linked estimates with daily all-cause mortality and heat-related hospitalizations among Medicare beneficiaries (2006-2016). We fit distributed-lag nonlinear models for each metric and compared relative risks (RRs) at the 99th percentile. RESULTS: Across all heat metrics, extreme heat was statistically significantly associated with elevated risks of morbidity and mortality. Associations were more pronounced for maximum daily values versus the corresponding minimum for the same metric. The starkest example was between HI(max) (RR = 1.14; 95% confidence interval [CI] = 1.12, 1.15) and HI(min) (RR = 1.10; 95% CI = 1.09, 1.11) for hospitalizations. When comparing RRs across heat metrics, we found no statistically significant differences within the minimum and maximum heat values (i.e., no significant differences between T(max)/HI(max)/WBGT(max)/UTCI(max) or between T(min)/HI(min)/WBGT(min)/UTCI(min)). We found similar relationships across the National Climate Assessment regions. CONCLUSION: Among Medicare beneficiaries in populous US counties, daily maximum and mean values of outdoor heat are associated with greater RRs of heat-related morbidity and all-cause mortality versus minimum values of the same metric. The choice of heat metric (e.g., temperature versus HI) does not appear to substantively affect risk calculations in this population.
AIM: Coronavirus is an airborne and infectious disease and it is crucial to check the impact of climatic risk factors on the transmission of COVID-19. The main objective of this study is to determine the effect of climate risk factors using Bayesian regression analysis. METHODS: Coronavirus disease 2019, due to the effect of the SARS-CoV-2 virus, has become a serious global public health issue. This disease was identified in Bangladesh on March 8, 2020, though it was initially identified in Wuhan, China. This disease is rapidly transmitted in Bangladesh due to the high population density and complex health policy setting. To meet our goal, The MCMC with Gibbs sampling is used to draw Bayesian inference, which is implemented in WinBUGS software. RESULTS: The study revealed that high temperatures reduce confirmed cases and deaths from COVID-19, but low temperatures increase confirmed cases and deaths. High temperatures have decreased the proliferation of COVID-19, reducing the virus’s survival and transmission. CONCLUSIONS: Considering only the existing scientific evidence, warm and wet climates seem to reduce the spread of COVID-19. However, more climate variables could account for explaining most of the variability in infectious disease transmission.
Long-term exposure to extreme temperatures could threaten individuals’ mental health and psychological wellbeing. This study aims to investigate the long-term impact of cumulative exposure to extreme temperature. Differently from existing literature, we define extreme temperature exposure in relative terms based on local temperature patterns. Combining the China Health and Retirement Longitudinal Study and environmental data from the U.S. National Oceanic and Atmospheric Administration from 2011 to 2015, this study demonstrates that heat and cold exposure days in the past year significantly increase the measured depression level of adults over age 45 by 1.75 and 3.00 per cent, respectively, controlling for the city, year, and individual fixed effects. The effect is heterogeneous across three components of depression symptoms as well as age, gender, and areas of residency, and air conditioning and heating equipment are effective in alleviating the adverse impact of heat and cold exposure. The estimation is robust and consistent across a variety of temperature measurements and model modifications. Our findings provide evidence on the long-term and accumulative cost of extreme temperature to middle-aged and elderly human capital, contributing to the understanding of the social cost of climate change and the consequent health inequality.
Under global warming and rapid urbanization, heat extremes, ozone pollution, and their co-occurrences are emerging and posing severe risks to human health. However, possibly different characteristics of independent heat days (IHD), independent ozone pollution (IOP) and compound heat-ozone pollution (CHOP) events are unclear. In this study, we present an investigation of the spatial distribution and mechanisms associated with IHD, IOP and CHOP events during May-October in 2014-2022 by taking the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) of China as an example. The results show that central GBA faces higher compound risk than northwestern and southeastern regions. IHD events are primarily driven by extremely high temperatures and accompanied by anomalous anticyclone and high pressure at both lower and upper troposphere levels, under the joint effects of the South Asian high and western North Pacific subtropical high. IOP events are predominantly accompanied by decreased cloud cover, air humidity and enhanced downward solar radiation. CHOP events are influenced by increases in both temperature and downward solar radiation. The circulation patterns of CHOP events are somewhat similar to IOP but with much stronger magnitude and faster developing process, and both are likely related to tropical cyclone activities. Our findings can strengthen the early forecasting of these extreme events and mitigate their negative impacts.
Natural and human-made disasters have long played a role in shaping the environment and microbial communities, also affecting non-microbial life on Earth. Disaster microbiology is a new concept based on the notion that a disaster changes the environment causing adaptation or alteration of microbial populations -growth, death, transportation to a new area, development traits, or resistance- that can have downstream effects on the affected ecosystem. Such downstream effects include blooms of microbial populations and the ability to colonize a new niche or host, cause disease, or survive in former extreme conditions. Throughout history, fungal populations have been affected by disasters. There are prehistoric archeological records of fungal blooms after asteroid impacts and fungi implicated in the fall of the dinosaurs. In recent times, drought and dust storms have caused disturbance of soil fungi, and hurricanes have induced the growth of molds on wet surfaces, resulting in an increased incidence of fungal disease. Probably, the anticipated increase in extreme heat would force fungi adaptation to survive at high temperatures, like those in the human body, and thus be able to infect mammals. This may lead to a drastic rise of new fungal diseases in humans.
Heat waves and extreme weather events caused by climate change increase people’s need for predictable, healthy, and appropriate thermal thresholds in urban areas. The Mediterranean region, where alarming effects are expected, poses a danger to many species and threatens the quality of human life. In the research, predictions were made according to SSP 245 and SSP 585 scenarios from CNRM-CM6-1 climate models using the data of meteorological stations for 2020 in the Eastern Mediterranean region via CMIP6 and WorldClim database. The study aims to predict the change in the bioclimatic comfort situation of the region at 20-year intervals until 2100, depending on the periods. The highest annual temperatures seen in the area are 18-20 degrees C. In the 2100 estimations, areas with a value of 22-24 degrees C according to SSP 245 and 24-26 degrees C according to SSP 585 are modeled spatially. While the largest area in the basin today is the area with a humidity range of 62-64%, according to SSP 245, in 2100 predictions, the largest area will be 23% with a humidity level of 56-58%. While the wind speed in the area is currently 0.5-1 m/s, it decreases to 0-0.5 m/s in 36% of the area, according to SSP 585. According to the ETv index, quite cool areas are effective on a 36% area surface. However, in the 2100, compared to the SSP 245, the most comprehensive range is the slightly cool areas with 40%. According to SSP 585, mild areas will have a share of 42%. Warm areas, the most critical class of the index, will begin to form. According to DI, the field has a 58% share in the cold class. According to SSP 585, hot areas have a rate of 26%, and comfortable areas have a rate of 52%. Findings of thermal disturbance variation can help develop solutions to conditions in the context of the climatic values of the region.
To evaluate if changes in preterm birth (PTB, <37 weeks of gestation) incidence differed between non-Hispanic (NH) Black and NH white births following the July 1995 Chicago heat wave-among the most severe U.S. heat waves since 1950. METHODS: We used an ecologic study design. We obtained birth data from January 1990-December 1996 from the National Vital Statistics File to calculate the mean monthly PTB incidence in Chicago's Cook County, Illinois. Births between July 1995 and February 1996 were potentially exposed to the heat wave in utero. We generated time series models for NH Black and NH white births, which incorporated synthetic controls of Cook County based on unexposed counties. We ran a secondary analysis considering socioeconomic status (SES). RESULTS: From 1990-1996, the mean monthly PTB incidence among NH Black births was 18.6% compared to 7.8% among NH white births. The mean monthly PTB incidence among NH Black births from August 1995-January 1996 was 16.7% higher than expected (three additional PTBs per 100 live births per month [95% confidence interval (CI): 1, 5]). A similar increase occurred among low-SES NH Black births. No increase appeared among NH white births. CONCLUSIONS: Severe heat waves may increase racial disparities in PTB incidence.
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? An association between prenatal heatwave exposure and the risk of preterm birth was found. However, the disparities in heatwave-related preterm birth across different climate types have not been examined. WHAT IS ADDED BY THIS REPORT? This nationwide case-crossover study investigated the association between heatwave exposure and preterm birth across different Köppen-Geiger climate types. Among pregnant women residing in the arid-desert-cold climate type, exposure to compound heatwaves was found to be associated with a significantly higher risk of preterm birth {adjusted odds ratios (AORs) ranged from 1.55 [95% confidence interval ( CI): 1.21-1.97] to 2.11 (95% CI: 1.35-3.31)}. In contrast, among pregnant women residing in the tropical monsoonal climate type, exposure to daytime-only heatwaves was associated with an increased risk of preterm birth [AORs ranged from 1.25 (95% CI: 1.03-1.51) to 1.37 (95% CI: 1.05-1.77)]. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? Specific interventions should be implemented in China to mitigate the risk of preterm birth related to heatwaves, particularly for pregnant women residing in arid-desert-cold and tropical monsoonal climates.
Climate change constitutes an unprecedented challenge for public health and one of its main direct effects are extreme temperatures. It varies between intra-urban areas and this difference is called surface urban heat island (SUHI) effect. We aimed to assess SUHI distribution among socioeconomic levels in Lima, Peru by conducting a cross-sectional study at the block-level. The mean land surface temperature (LST) from 2017 to 2021 were estimated using the TIRS sensor (Landsat-8 satellite [0.5 km scale]) and extracted to block level. SUHI was calculated based on the difference on mean LST values (2017-2021) per block and the lowest LST registered in a block. Socioeconomic data were obtained from the 2017 Peruvian census. A principal component analysis was performed to construct a socioeconomic index and a mixture analysis based on quantile g-computation was conducted to estimate the joint and specific effects of socioeconomic variables on SUHI. A total of 69 618 blocks were included in the analysis. In the Metropolitan Lima area, the mean SUHI estimation per block was 6.44 (SD = 1.44) Celsius degrees. We found that blocks with high socioeconomic status (SES) showed a decreased exposure to SUHI, compared to those blocks where the low SES were predominant (p-value < 0.001) and that there is a significant SUHI exposure variation (p-value < 0.001) between predominant ethnicities per block (Non-White, Afro-American, and White ethnicities). The mixture analysis showed that the overall mixture effect estimates on SUHI was -1.01 (effect on SUHI of increasing simultaneously every socioeconomic variable by one quantile). Our study highlighted that populations with low SES are more likely to be exposed to higher levels of SUHI compared to those who have a higher SES and illustrates the importance to consider SES inequalities when designing urban adaptation strategies aiming at reducing exposure to SUHI.
Land surface temperature (LST) estimates often serve as urban heat islands maps and to infer human thermal comfort. Parallel to this, physiological heat balance calculations have been well documented to measure changes in body core temperature and measure risk of heat-related illness. However, there is a need for an improved spatially explicit method to assess human thermal comfort. Using spatial climate data measuring temperature, airflow, and humidity, we developed a geographic body heat storage (BHS) model based on heat exchange and evaporative heat loss from the human body. As proof of concept, we used heat-related illness emergency department visits in two Arizona metropolitan areas to demonstrate that BHS can improve LST’s shortcomings, with its increased explanatory power of and linear fit to emergency records. The BHS model can support decision making for public health outcomes as heat risk increases with climate change and urban overheating to more closely approximate the human heat experience. BHS allows can be implemented in different climate regions and with investigations of additional physiological and community variables to better describe risk of heat-related illness.
The urban thermal environment has a direct impact on the outdoor thermal comfort of city dwellers and pedestrians, which can have negative effects on their health and overall quality of life. Therefore, it is crucial to estimate the influence of the thermal environment in micro-scale urban spaces. Previous studies have used estimation models that only consider a limited number of meteorological elements and urban geometry. This study developed a new model that incorporates the concept of micro-scale heat islands (MHIs) using field measurements to estimate the micro-scale thermal environment in urban spaces. The study found that factors such as sky view factor (SVF), floor area ratio (FAR), and building coverage ratio (BCR) have a significant impact on the thermal environment of urban street canyons. Based on these results, an MHI model was developed and tested. In this process, the aspect ratio (H/W) concept was extended to a three-dimensional perspective and used to calculate the amount of heat contained in the air volume in a street canyon. This study applied a method of maximizing the use of data collected in the study area using a mobile weather station. SVF, air temperature, and surface temperature were reflected in calculating the net radiation and sensible heat flux. The MHI model showed 86.19% explanatory power in estimating the thermal environment of urban canyons. The model would benefit from further refinement by incorporating data from various cities and reflecting the characteristics of different climatic regions and urban forms.
Exposure to heat is a recognized occupational risk factor. Deaths and accidents at work caused by high temperatures are underestimated. With the aim of detecting and monitoring heat-related illnesses and injuries, a prototype database of occupational events attributable to critical thermal conditions reported in Italian newspapers was created. Information was analyzed from national and local online newspapers using a web application. The analysis was conducted from May to September during the three-year period 2020-2022. Articles concerning 35 occupational heat-related illnesses and injuries were selected; 57.1% of the events were reported in 2022, and 31.4% of total accidents occurred in the month of July 2022, when the Universal Thermal Climate Index daily mean values corresponded to “moderate heat stress” (51.0%) and “strong heat stress” (49.0%). Fatal heat-related illnesses were the most frequent conditions described. In most cases, workers had been involved in outdoor activities in the construction sector. A comprehensive report was created by compiling all relevant newspaper articles to enhance awareness of this issue among relevant stakeholders and promote heat-risk prevention strategies in the current context where heatwaves are becoming increasingly frequent, intense and long-lasting.
Extreme heat contributes to heat-related illnesses resulting from heat intolerance, which is the inability to maintain a thermal balance to tolerate heat stress. In the United States, heat-related mortality for older persons has almost doubled in the past 20 years. Other populations at risk for heat-related illness (HRI) include children, pregnant people, those who work outside, young people participating in outdoor sports, and at-risk populations such as Black, indigenous, and populations of color. The classic heat tolerance test used for decades monitoring physiological responses to repetitive motions is impractical across large and potentially health challenged populations and does not identify environmental or social factors or specific vulnerable populations. To address this issue, we developed a heat-related illness screening tool (HIST) to identify individuals at risk for HRI morbidity and mortality based on their physical, environmental, and social vulnerabilities with an emphasis on populations of concern. The HIST has the potential to be used as routine clinical screening in the same way as other commonly used screening tools. Heat intolerance affects patient outcomes and quality of life; therefore, early screening with a simple, easy-to-administer screening tool such as the HIST can identify people at risk and refer them to services that address heat exposure and/or create safety nets to prevent heat-related illnesses.
Climate change will be a major challenge for the world’s health systems in the coming decades. Elevated temperatures and increasing frequencies of heat waves, wildfires, heavy precipitation and other weather extremes can affect health in many ways, especially if chronic diseases are already present. Impaired responses to heat stress, including compromised vasodilation and sweating, diabetes-related comorbidities, insulin resistance and chronic low-grade inflammation make people with diabetes particularly vulnerable to environmental risk factors, such as extreme weather events and air pollution. Additionally, multiple pathogens show an increased rate of transmission under conditions of climate change and people with diabetes have an altered immune system, which increases the risk for a worse course of infectious diseases. In this review, we summarise recent studies on the impact of climate-change-associated risk for people with diabetes and discuss which individuals may be specifically prone to these risk conditions due to their clinical features. Knowledge of such high-risk groups will help to develop and implement tailored prevention and management strategies to mitigate the detrimental effect of climate change on the health of people with diabetes.
Introduction: Climate change and hot processes in the workplaces has led to an increase in the effects of heat stress on employed people, which has become a major concern, especially in tropical and subtropical countries. Early detection of biomarkers in induction of heat stress-related DNA damage can be used in the identification and evaluation of health and safety, including occupational health professionals, as well as to prevent serious diseases caused by heat stress in various occupations with the nature of hot processes or to help different warm seasons of the year. Therefore, this review study was conducted to identify diagnostic biomarkers heat stress induced- DNA damage in occupational exposure. Material and Methods: Databases such as PubMed, Scopus, Google Scholar, and Web of Science were systematically searched to meet the study’s goals. Moreover, references to relevant publications were examined. Finally, suitable articles were selected and analyzed using the inclusion (studies on different occupations, different biomarkers in hot work environments, all articles published without time limit until the end of April 2022 , and English and Persian language) and exclusion criteria.Results: The results of search in databases showed that 9234 articles were found in the initial search. After removing duplicate and unrelated articles, 2209 eligible articles were selected. Based on abstract full-text screening, 7166 studies were excluded, and based on abstract full-text screening, 21 studies were not accessible. Finally, seven articles were selected to be reviewed. The evidence showed that diagnostic biomarkers included the measurement of 8-hydroxy-2-deoxyguanosine (8-OHdG), micronuclei semen quality, heat shock proteins (HSP70), and leukocytes were extracted to heat stress induced- DNA damage in occupational exposure. Conclusion: Based on a review of studies, biomarkers identified are suitable for heat stress induced- DNA damage as a result of occupational exposure to extremely high heat climate conditions. Understanding and identifying appropriate biomarkers in inducing DNA damage can help health and safety professionals determine the amount and magnitude of heat stress responses in occupational exposure to different temperatures and take appropriate measures and interventions to control and reduce the hazard effects of thermal stress. This study can also be considered as a preliminary study for research in the future.
Objective: The purpose of this work is to carry out a descriptive analysis of occupational accidents and to evaluate the relationship between heatwaves and work accidents in Spain’s three most populated provinces: Madrid, Barcelona and Valencia.Methods: Daily data of work accidents (including for each case: gender, age, date, length of time in the position, type of work, place of accident and duration of medical leave) was collected. A heatwave was defined when daily mean temperatures above the threshold (95th percentile) of the climatological period (1990-2021) were recorded for at least three consecutive days. To estimate the association between daily workplace accidents and heatwave events, we applied a Generalized Additive Model combined with a Distributed Lag Non-linear Model with a quasi-Poisson distribution.Results: The average annual accident rate was 33.2 work accidents/100,000 employees in Madrid, 35.8 work accidents/100,000 employees in Barcelona and 31.8 work accidents/100,000 employees in Valencia. The total accident rates followed a downward trend between 2005 and 2021. The difference in work accident rates between sex decreased over the studied period (p < 0.005). In the first month of work, the highest casualty rate occurs among construction workers in Madrid and Barcelona, and in primary sector workers in Valencia. Work accidents tend to increase during heatwaves. The highest risk was recorded when considering a cumulative lagged effect of 3 days in Madrid and Barcelona and 5 days in Valencia.Conclusions: Since work accidents increase during heatwaves, risk prevention services and public administrations must take special measures to prevent them.
Based upon a ‘human-centred approach’, combinations of existing and new methodologies were applied to determine how Ankara’s morphological characteristics influenced the magnitude/frequency of Cold Stress (CS) and Heat Stress (HS) to detect/quantify seasonal and yearly human thermal stress frequency. To quantify these conditions upon the human biometeorological system, the Physiologically Equivalent Temperature (PET) was utilised by processing climatic variables from Ankara’s Meteorological Station (AMS). In situ assessments of human thermophysiological thresholds were undertaken within characteristic existing/future Urban Canyon Cases (UCCs), with a further stipulation of three interior Reference Points (RPs). Indoor PET values were moreover calculated within a stereotypical vulnerable residential dwelling. Seasonal frequencies revealed that winter PET values frequently ranged between 0.0 and – 19.9 degrees C, with corresponding summer values frequently ranging between 35.1 and 46.0 degrees C. Accounting for Ankara’s urban morphology, yearly frequency of No Thermal Stress remained at similar to 48%, CS remained at similar to 26%, and HS similar to 28%. HS varied the most between the eight evaluated Aspect Ratios (ARs). It reduced by up to 7.1% (114 min) within the Centre (RPC) area of UCCs with an orientation of 90 degrees. Out of twelve orientations, the highest HS frequency took place between 105 and 135 degrees Including in UCC3.50, the frequency of HS almost always remained above 72% (2592 min).
With its rapid rise in temperatures and accelerated urbanization in recent decades, eastern China may be affected by both global warming and the urban heat island effect. To investigate the influence of anthropogenic forcing and urbanization on extreme temperature, the authors conducted detection and attribution analyses on 16 extreme indices using extended observational data during 1958-2020 and the models that participated in CMIP5 and CMIP6. The extended observational data till 2020 show continued warming in extreme temperatures in recent years. Most of the indices display an increase in warm extremes and decrease in cold extremes. Both CMIP5 and CMIP6 models are able to reflect these warming features, albeit the models can over-or underestimate some extreme indices. The two-signal detection with anthropogenic and urbanization effects jointly considered showed that the anthropogenic and urban signals can be simultaneously detected and separated only in two frequency indices, i.e., the frequency of warm and cold nights. The anthropogenic forcing explains about two-thirds of the warming, while URB contributes about one-third for these two indices. For most of the other indices, only the anthropogenic signal can be detected. This indicates that the urban signal is distinct from the natural variability mainly for the nighttime frequency indices but not for the other extreme temperature indies. Given the important influence of nighttime extremes on human health, this suggests an urgent need for cities to adapt to both global warming and urbanization.
BACKGROUND: Traffic enforcers are vulnerable to work accidents, injuries, and illnesses because they are commonly exposed to ergonomic risk factors while performing their tasks. OBJECTIVE: The purpose of this study is to determine the effects of environmental risk factors and postural risk factor to the prevalence of musculoskeletal disorders (MSDs) among traffic enforcers in Manila City, Philippines using binary logistic regression analysis. METHODS: A total of 120 participants were included in the study. The Nordic Musculoskeletal Questionnaire (NMQ) and Rapid Entire Body Assessment (REBA) were utilized. In addition, several devices such as a noise dosimeter, digital air thermometer, and IAQ sensors were also utilized to measure the environmental exposure of enforcers during their work shift. RESULTS: The prevalence of MSDs among traffic enforcers was high, with 71% of the respondents reporting symptoms of MSDs in more than one part of the body for the past 7 days. The body part that has highest prevalence was upper back, followed by lower back, and legs/ankles. Logistic regression analysis revealed that awkward work posture (OR = 4.61, 95% CI = 2.17, 9.83), noise exposure (OR = 1.42, 95% CI = 1.11, 1.82), heat exposure (OR = 0.53, 95% CI = 0.85, 1.05), and pollution exposure (OR = 0.94, 95% CI = 0.85, 1.05) were significant contributors for the prevalence of MSDs among traffic enforcers in Manila City. CONCLUSION: The prevalence of MSDs among traffic enforcers is caused by their work posture and exposure to psychosocial factors such as noise, heat, and poor air quality. Thus, to minimize the risk of MSDs, it is suggested to provide administrative controls, such as job rotation or shifting, and introduce frequent rest breaks. It is also recommended to provide enforcers with appropriate personal protective equipment, such as cooling vests, noise-canceling earplugs and N95 facemasks. This would help in uplifting musculoskeletal health for traffic enforcers and other workers in a similar field.
Heatwaves are a significant and growing threat to the health and well-being of the residents of Queensland, Australia. This threat is increasing due to climate change. Excess heat increases the demand for health services, including ambulance calls, and the purpose of this study was to explore this impact across Queensland. A state-wide retrospective analysis of heatwaves and emergency ‘Triple Zero’ (000) calls to Queensland Ambulance (QAS) from 2010-2019 was undertaken. Call data from the QAS and heatwave data from the Bureau of Meteorology were analysed using a case-crossover approach at the postcode level. Ambulance calls increased by 12.68% during heatwaves. The effect was greatest during low-severity heatwaves (22.16%), followed by severe (14.32%) and extreme heatwaves (1.16%). The impact varied by rurality, with those living in very remote areas and major cities most impacted, along with those of low and middle socioeconomic status during low and severe intensity heat events. Lag effects post-heatwave continued for at least 10 days. Heatwaves significantly increase ambulance call centre workload, so ambulance services must actively prepare resources and personnel to address increases in heatwave frequency, duration, and severity. Communities must be informed of the risks of heatwaves at all severities, particularly low severity, and the sustained risks in the days following a heat event.
BACKGROUND: Specialized occupational health and safety (OHS) issues are covered at the EU level through detailed legislation and guidelines. Unfortunately, this does not extend to occupational heat stress, not only in Greece but also (with few exceptions) internationally. One possible explanation could be the difficulty in accurately identifying the dangerous conditions, as many environmental and individualized elements are involved, and hundreds of “thermal stress indicators” are available. Another explanation could be the difficulty in adequately measuring hazardous conditions for workers affected more (i.e., outdoor and high intensity) since the biological protection framework is based on the human body’s internal temperature. METHODS: The Wet Bulb Globe Temperature (WBGT) has been proposed as the most efficacious thermal stress indicator. Since 2021, the Hellenic National Meteorological Service has provided 48-h WBGT forecast predictions to serve as a first level of alert. Real-time measurements and 48-h forecasts of WBGT are also available through a smartphone application. Additionally, as revealed when developing the occupational heat stress legislation in Cyprus and Qatar, crucial first steps are identifying the specific characteristics of worker exposure and the tripartite collaboration between employers, workers, and the State. RESULTS: Evaluating the simplified WBGT forecasted values and the smartphone application estimates proved well-established. The sound scientific basis can be effectively combined with administrative measures based on the EU OHS legislative experience to produce practical solutions. CONCLUSIONS: As the climate crisis exacerbates, worker productivity and well-being will decline, underscoring the urgent need for an integrated protection framework. Such a framework is proposed here.
Prolonged exposure to high temperatures can cause heat-related illnesses and accelerate death, especially in the elderly. We developed a locally-appropriate Healthy Environment Assessment Tool, or ‘HEAT’ tool, to assess heat-health risks among communities. HEAT was co-developed with stakeholders and practitioners/professionals from the Rustenburg Local Municipality (RLM), a setting in which heat was identified as a risk in an earlier study. Feedback was used to identify vulnerable groups and settings in RLM, consider opportunities and barriers for interventions, and conceptualize a heat-health vulnerability assessment tool for a heat-resilient town. Using information provided by the RLM Integrated Development Plan, the HEAT tool was applied in the form of eight indicators relating to heat-health vulnerability and resilience and areas were evaluated at the ward level. Indicators included population, poverty, education, access to medical facilities, sanitation and basic services, public transport, recreation/community centres, and green spaces. Out of 45 wards situated in the municipality, three were identified as critical risk (red), twenty-eight as medium-high risk (yellow), and six as low risk (green) in relation to heat-health vulnerability. Short-term actions to improve heat health resilience in the community were proposed and partnerships between local government and the community to build heat health resilience were identified.
High-resolution air temperature data is indispensable for analysing heatwave-related non-accidental mortality. However, the limited number of weather stations in urban areas makes obtaining such data challenging. Multi-source data fusion has been proposed as a countermeasure to tackle such challenges. Satellite products often offered high spatial resolution but suffered from being temporally discontinuous due to weather conditions. The characteristics of the data from reanalysis models were the opposite. However, few studies have explored the fusion of these datasets. This study is the first attempt to integrate satellite and reanalysis datasets by developing a two-step downscaling model to generate hourly air temperature data during heatwaves in London at 1 km resolution. Specifically, MODIS land surface temperature (LST) and other satellite-based local variables, including normalised difference vegetation index (NDVI), normalized difference water index (NDWI), modified normalised difference water index (MNDWI), elevation, surface emissivity, and ERA5-Land hourly air temperature were used. The model employed genetic programming (GP) algorithm to fuse multi-source data and generate statistical models and evaluated using ground measurements from six weather stations. The results showed that our model achieved promising performance with the RMSE of 0.335 ?& DEG;C, R-squared of 0.949, MAE of 1.115 ?, and NSE of 0.924. Elevation was indicated to be the most effective explanatory variable. The developed model provided continuous, hourly 1 km estimations and accurately described the temporal and spatial patterns of air temperature in London. Furthermore, it effectively captured the temporal variation of air temperature in urban areas during heatwaves, providing valuable insights for assessing the impact on human health.
Short-term exposure to ambient high temperature (heat) could increase the risk of cardiovascular disease (CVD). However, available evidence on the burden of daytime and nighttime heat on CVD is limited and vulnerable populations remain unknown so far. We aimed to examine and differentiate the impact of daytime and nighttime heat on CVD in China. Data on daily outpatient visits for CVD were collected from 15 Chinese cities spanning multiple geographical regions, climates, and socio-economic conditions. The population-weighted temperature was used to calculate excess heat exposure in warm seasons (June-September) from 2011 to 2015. Hot day excess (HDE) and hot night excess (HNE), the sum of temperature above the heat threshold during daytime and nighttime respectively, were used to represent daytime and nighttime excess heat. A distributed lag non-linear model was employed to estimate the city-level association between HDE/HNE and daily CVD cases. The city-level association was then pooled by multivariate meta-analysis. We further estimated the disease burden of CVD attributable to HDE and HNE by geographical regions, gender, and age. A total of 729,409 cases of CVD were included in this study. Both HDE and HNE were associated with an increased risk of CVD, with greater effects from nighttime heat (relative risk (RR): 1.38; 95% confidence interval (CI): 1.18-1.61) than daytime heat (RR: 1.10; 95% CI: 1.05-1.15). The proportion of CVD cases attributable to HNE was 15.7%, which was almost three times as high as HDE (4.6%, p for difference <0.05). Males, people living in northern cities, and those aged less than 45 years were more vulnerable to HNE. Our findings for the first time revealed an intra-day difference in the heat effect on CVD, with a greater impact from nighttime heat exposure, which should be considered to protect vulnerable populations on hot days.
NEW FINDINGS: What is the central question of this study? What are the independent effects of air temperature and humidity on performance, physiological and perceptual responses during endurance exercise? What is the main finding and its importance? When examined independently, elevated air temperature increased heat strain and impaired aerobic exercise performance, but to a lesser extent than has been reported previously. These findings highlight the importance of absolute humidity relative to temperature when exercising or working under severe heat stress. ABSTRACT: Many studies have reported that ambient heat stress increases physiological and perceptual strain and impairs endurance exercise, but effects of air temperature per se remain almost unexamined. Most studies have used matched relative humidity, thereby exponentially increasing absolute humidity (water content in air) concurrently with temperature. Absolute (not relative) humidity governs evaporative rate and is more important at higher work rates and air temperatures. Therefore, we examined the independent effects of air temperature and humidity on performance, thermal, cardiovascular and perceptual measures during endurance exercise. Utilizing a crossover design, 14 trained participants (7 females) completed 45 min fixed-intensity cycling (70% V̇O2peak ) followed by a 20-km time trial in each of four environments: three air temperatures at matched absolute humidity (Cool, 18°C; Moderate, 27°C; and Hot, 36°C; at 1.96 kPa, air velocity ∼4.5 m/s), and one at elevated humidity (Hot Humid, 36°C at 3.92 kPa). Warmer air caused warmer skin (0.5°C/°C; P < 0.001), higher heart rate (1 bpm/°C; P < 0.001), sweat rate (0.04 l/h/°C; P < 0.001) and thermal perceptions during fixed-intensity exercise, but minimally affected core temperature (<0.01°C/°C; P = 0.053). Time-trial performance was comparable between Cool and Moderate (95% CI: -1.4, 5.9%; P = 0.263), but 3.6-6% slower in Hot (95% CI: ±2.4%; P ≤ 0.006). Elevated humidity increased core temperature (P < 0.001), perceived temperature and discomfort but not skin temperature or heart rate, and reduced mean blood pressure (P = 0.046) during fixed-intensity exercise. Elevated humidity impaired time-trial performance by 3.4% (95% CI: ±2.2%; P = 0.006). In conclusion, these findings quantify the importance of absolute humidity alongside air temperature when exercising under severe heat stress.
Dengue is a vector borne disease caused by virus serotypes DENV-1, DENV-2, DENV-3, and DENV-4, representing a significant public health concern in the Region of the Americas (2,997,097 cases in 2023). This study explores the relationship between dengue incidence and climate changes in the city of São Paulo-Brazil. During the first semester of 2023, Brazil reported the highest number of dengue cases in Americas’ Region. Our data reveals a correlation between the high temperature and rainfall season persistence and the extension of dengue incidence into the winter season. The findings highlight the importance of understanding the relationship between climate change and disease transmission patterns to develop effective strategies for prevention and control.
Heatwaves in California manifest as both dry and humid events. While both forms have become more prev-alent, recent studies have identified a shift toward more humid events. Understanding the complex interactions of each heatwave type with the urban heat island is crucial for impacts but remains understudied. Here, we address this gap by con -trasting how dry versus humid heatwaves shape the intraurban heat of the greater Los Angeles area. We used a consecu-tive contrasting set of heatwaves from 2020 as a case study: a prolonged humid heatwave in August and an extremely dry heatwave in September. We used MERRA-2 reanalysis data to compare mesoscale dynamics, followed by high-resolution Weather Research and Forecasting modeling over urbanized Southern California. We employ moist thermodynamic varia-bles to quantify heat stress and perform spatial clustering analysis to characterize the spatiotemporal intraurban variability. We find that, despite temperatures being 10 & DEG; & PLUSMN; 3 & DEG;C hotter in the September heatwave, the wet-bulb temperature, closely related to the risk of human heat stroke, was higher in August. While dry and humid heat display different spatial patterns, three distinct spatial clusters emerge based on nonheatwave local climates. Both types of heatwaves diminish the intraur-ban heat stress variability. Valley areas such as San Bernardino and Riverside experience the worst impacts, with up to 6 & DEG; & PLUSMN; 0.5 & DEG;C of additional heat stress during heatwave nights. Our results highlight the need to account for the disparity in small-scale heatwave patterns across urban neighborhoods in designing policies for equitable climate action.
Heat exposure poses health risks that disproportionately burden disadvantaged communities. Trees protect against heat, but significant barriers exist to growing robust urban forests. In drier climates, complex logistics of watering during a multi-year establishment period pose a challenge because street trees are typically unirrigated and funding for maintenance is generally unavailable. This study tested the impacts of varying theory-guided community engagement approaches on beliefs, attitudes, knowledge, and behaviors related to foster street tree stewardship and individual-level heat mitigation actions in 116 households in Los Angeles County, USA. We tested a control intervention against experimental messaging focused on either public health or environmental health, and also segmented participants by the degree of prior household engagement with a local tree planting group. Outcomes measured were soil moisture, tree health, and survey responses indicating benefits and barriers related to tree stewardship. Results indicate that intervention messages had limited effect on these outcomes, and that level of engagement by the tree planting group was a stronger predictor of tree stewardship. We also found that tree stewardship correlated positively to heat protection measures, suggesting that environmental engagement may be an effective portal to reducing heat risk.
High ambient temperatures are associated with many health effects, including premature mortality. The combination of global warming due to climate change and the expansion of the global built environment mean that the intensification of urban heat islands (UHIs) is expected, accompanied by adverse effects on population health. Urban green infrastructure can reduce local temperatures. We aimed to estimate the mortality burden that could be attributed to UHIs and the mortality burden that would be prevented by increasing urban tree coverage in 93 European cities. METHODS: We did a quantitative health impact assessment for summer (June 1-Aug 31), 2015, of the effect of UHIs on all-cause mortality for adults aged 20 years or older in 93 European cities. We also estimated the temperature reductions that would result from increasing tree coverage to 30% for each city and estimated the number of deaths that could be potentially prevented as a result. We did all analyses at a high-resolution grid-cell level (250 × 250 m). We propagated uncertainties in input analyses by using Monte Carlo simulations to obtain point estimates and 95% CIs. We also did sensitivity analyses to test the robustness of our estimates. FINDINGS: The population-weighted mean city temperature increase due to UHI effects was 1·5°C (SD 0·5; range 0·5-3·0). Overall, 6700 (95% CI 5254-8162) premature deaths could be attributable to the effects of UHIs (corresponding to around 4·33% [95% CI 3·37-5·28] of all summer deaths). We estimated that increasing tree coverage to 30% would cool cities by a mean of 0·4°C (SD 0·2; range 0·0-1·3). We also estimated that 2644 (95% CI 2444-2824) premature deaths could be prevented by increasing city tree coverage to 30%, corresponding to 1·84% (1·69-1·97) of all summer deaths. INTERPRETATION: Our results showed the deleterious effects of UHIs on mortality and highlighted the health benefits of increasing tree coverage to cool urban environments, which would also result in more sustainable and climate-resilient cities. FUNDING: GoGreenRoutes, Spanish Ministry of Science and Innovation, Institute for Global Health, UK Medical Research Council, European Union’s Horizon 2020 Project Exhaustion.
Young people today are predicted to experience more climate change related stressors and harms than the previous generation, yet they are often excluded from climate research, policy, and advocacy. Increasingly, this exposure is associated with experience of common mental health disorders (CMD). The VoCes-19 study collected surveys from 168,407 young people across Mexico (ages 15-24 years) through an innovative online platform, collecting information on various characteristics including CMD and experience of recent climate harms. Logistic regression models were fit to explore characteristics associated with CMD. Structural equation models were fit to explore pathways between exposure, feeling of concern about climate change, and a sense of agency (meaning the respondent felt they could help address the climate crisis) and how these relate to CMD. Of the respondents, 42% (n = 50,682) were categorized as experiencing CMD, higher among those who experienced a climate stressor (51%, n = 4,808) vs those not experiencing climate stressors (41%, n = 43,872). Adjusting for key demographic characteristics, exposure to any climate event increased the odds of CMD by 50% (Odd Ratio = 1.57; 95% Confidence Interval (CI) 1.49, 1.64), highest for heatwaves. Specific climate impacts such as housing damage, loss of or inability to work, damage to family business, leaving school and physical health affected were adversely related to CMD, though for different climate hazards. More concern and less agency were related to CMD through different pathways, particularly for those exposed to recent events. Future research regarding the cumulative exposures to climate change, not just acute events but as an ongoing crisis, and various pathways that influence the mental health and well-being of young people must be clearly understood to develop programs and policies to protect the next generation.
BACKGROUND: Extreme temperatures and air pollution have raised widespread concerns about their impact on population health. AIM: To explore the quantitative exposure risks of high/low temperatures and types of air pollutants on the health of various populations in urban areas in China, this study assessed the effects of temperature and air pollutants on daily non-accidental deaths in Rencheng District, Jining City, China from 2019 to 2021. METHODS: A combination of Poisson regression models and distributed lag non-linear models was used to examine the relationships between temperature, air pollutants, and daily non-accidental deaths. We found that temperature and air pollutants had a significant non-linear effect on non-accidental mortality. Both high and low temperatures had a noticeable impact on non-accidental deaths, with heat effects occurring immediately and lasting 2-3 days, while cold effects lasted for 6-12 days. The relative risks of non-accidental deaths from PM(2.5), NO(2), and SO(2) were highest in winter and lowest in autumn. The relative risk of non-accidental deaths from O(3) was highest in spring, with no significant variations in other seasons. Older adults (≥75) and outdoor workers were at the greatest risk from temperature and air pollutant exposure. CONCLUSIONS/INTERPRETATION: Exposure to extreme temperatures and air pollutants in the Rencheng District was associated with an increased mortality rate. Under the influence of climate change, it is necessary for policymakers to take measures to reduce the risk of non-accidental deaths among residents.
The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status. METHODS: Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older. RESULTS: We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods. CONCLUSION: Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.
INTRODUCTION: The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia. MATERIALS AND METHODS: Climate and workers’ compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065). RESULTS: The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11-0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%), equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation. DISCUSSION: Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs.
The Middle East and North Africa (MENA) is one of the regions that is most vulnerable to the negative effects of climate change, yet the potential public health impacts have been underexplored compared to other regions. We aimed to examine one aspect of these impacts, heat-related mortality, by quantifying the current and future burden in the MENA region and identifying the most vulnerable countries. METHODS: We did a health impact assessment using an ensemble of bias-adjusted statistically downscaled Coupled Model Intercomparison Project phase 6 (CMIP6) data based on four Shared Socioeconomic Pathway (SSP) scenarios (SSP1-2·6 [consistent with a 2°C global warming scenario], SSP2-4·5 [medium pathway scenario], SSP3-7·0 [pessimistic scenario], and SSP5-8·5 [high emissions scenario]) and Bayesian inference methods. Assessments were based on apparent temperature-mortality relationships specific to each climate subregion of MENA based on Koppen-Geiger climate type classification, and unique thresholds were characterised for each 50 km grid cell in the region. Future annual heat-related mortality was estimated for the period 2021-2100. Estimates were also presented with population held constant to quantify the contribution of projected demographic changes to the future heat-mortality burden. FINDINGS: The average annual heat-related death rate across all MENA countries is currently 2·1 per 100 000 people. Under the two high emissions scenarios (SSP3-7·0 and SSP5-8·5), most of the MENA region will have experienced substantial warming by the 2060s. Annual heat-related deaths of 123·4 per 100 000 people are projected for MENA by 2100 under a high emissions scenario (SSP5-8·5), although this rate would be reduced by more than 80% (to 20·3 heat-related deaths per 100 000 people per year) if global warming could be limited to 2°C (ie, under the SSP1-2·6 scenario). Large increases are also expected by 2100 under the SSP3-7·0 scenario (89·8 heat-related deaths per 100 000 people per year) due to the high population growth projected under this pathway. Projections in MENA are far higher than previously observed in other regions, with Iran expected to be the most vulnerable country. INTERPRETATION: Stronger climate change mitigation and adaptation policies are needed to avoid these heat-related mortality impacts. Since much of this increase will be driven by population changes, demographic policies and healthy ageing will also be key to successful adaptation. FUNDING: National Institute for Health Research, EU Horizon 2020.
Extreme climate events threaten human health, economic development, and ecosystems. Many studies have been conducted on extreme precipitation and temperature changes in the Yarlung Zangbo River Basin (YZRB). However, little attention has been paid to compound climate extremes. In this study, the variations of wet/warm compound extreme events in summer and dry/cold compound extreme events in winter over the past 42 years in the YZRB were investigated using eight extreme climate indices that were estimated using monthly temperature and precipitation observations. The results showed that the numbers of frost days and ice days tended to decrease on the spatiotemporal scale, while the maximum values of daily maximum temperature and daily minimum temperature exhibited increasing trends. The frequency of wet/warm compound extreme events was significantly higher from 1998 to 2018 than from 1977 to 1997. Dry/cold compound extreme events became less frequent from 1998 to 2018 than from 1977 to 1997. The rate of increase of wet/warm compound extreme events was about ten times the absolute rate of decrease of dry/cold compound extreme events. With regard to the spatial pattern, the frequency of wet/warm compound extreme events increased significantly in almost all parts of the YZRB, while that of dry/cold compound extreme events decreased across the basin. This study helps to improve our understanding of the changes in compound precipitation and temperature extremes in the YZRB from a multivariable perspective. (c) 2022 Hohai University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Hot extremes and ozone pollution have long been known detrimental to public health, but until very recently disproportionate health impacts from their joint occurrence-compound hot and ozone extremes (CHOEs)-have not been sufficiently aware of. Based on high-quality observations of air temperature and surface ozone concentration, we here examined the features of urban CHOEs and their dependence on city population and background climates. Results show the ozone-temperature slope (m(O3-T)) is significantly correlated with city population size, and the correlation is much weaker (0.38) in moister and cloudier cities (Cluster I) as opposed to that (0.69) in drier and sunnier cities (Cluster II). Larger cities are more susceptible to CHOEs with Cluster II megacities (population > 10 million) registering about 8 days of CHOEs during ozone season but similar to 3 days for small cities (population <= 1 million). Most cities experience elevated risks of CHOEs in urban areas relative to surrounding rural areas, especially so for densely-populated cities and those located in drier and sunnier environments. This study emphasizes the importance and urgency of emission reduction to mitigate the health burden from not only hot extremes but also their hazardous compounding with surface ozone.
The adverse impacts of extreme heat on human health when a concurrent daytime and nighttime heatwave (CDNHW) occurs are greater than when daytime or nighttime heatwaves occur individually, because of the reduced recovery time from heat exposure. This study projects increases in CDNHW over the whole of East Asia under two Representative Concentration Pathway scenarios (RCP2.6 and RCP8.5) and two Shared Socioeconomic Pathway scenarios (SSP1-2.6 and SSP5-8.5). The daily maximum and minimum temperatures, which are used to define a CDNHW, are calculated of 3-hourly temperatures of 25 km horizontal resolution produced by 12 general circulation model and regional climate model chains participating in the Coordinated Regional Climate Downscaling Experiment East Asia phase 2 project. In Historical simulation (1981-2005), occurrence period and occurrence rate of CDNHW from April to September area-averaged in East Asia are 10.9 days and 0.9%, respectively. In projections for the future (2071-2100), occurrence period and occurrence rate of CDNHW will be 3 weeks and 3.7% (RCP2.6), 2 months and 20.5% (RCP8.5), 2 months and 15.6% (SSP1-2.6), and 3 months and 45.7% (SSP5-8.5). In addition, it is expected that the CDNHW intensity will increase, and the spatial extent of CDNHW will be extended. Although a CDNHW lasting less than 3 days is the most common, the proportion of CDNHWs lasting more than 10 days, compared to the total CDNHW frequency, will increase to 1.2% (RCP2.6), 7.2% (RCP8.5), 6.1% (SSP1-2.6), and 17.3% (SSP5-8.5) from 0.2% (Historical). Both occurrence rate and intensity of CDNHW will increase to a relatively large extent in IndoChina, East and West China, and India. If the current greenhouse gas emissions continue, East Asia will experience unprecedented heat stress because the frequency and intensity of CDNHWs, which rarely occur during present-day, will increase significantly over all regions by the end of the 21st century.
Recent studies show an increase in the frequency of compound extremes in air temperature and precipitation in many parts of the world, especially under dry and hot conditions. Compound extremes have a significant impact on all spheres of human activity, such as health, agriculture, and energy. Features of atmospheric circulation are closely related to the occurrence of anomalies in air temperature and precipitation. The article analyzes the relationship of atmospheric circulation modes with compound extremes that have had the greatest impact on the Atlantic-European region over the territory of Eastern Europe over the past 60 years on extreme air temperature and precipitation. Combinations of extreme temperature and humidity conditions (indices)-cold-dry (CD), cold-wet (CW), warm-dry (WD) and warm-wet (WW)-were used as compound extremes. Indices of compound extremes were calculated according to the E-OBS reanalysis data. Estimates of the relationship between two time series were carried out using standard correlation and composite analyses, as well as cross wavelet analysis. Phase relationships and time intervals for different climatic indices were different. The period of most fluctuations in the indices of compound extremes was from 4 to 12 years and was observed during 1970-2000. The coherent fluctuations in the time series of the WD and WW indices and the North Atlantic oscillation (NAO) index occurred rather in phase, those in the time series of the CD and WD indices and the Arctic oscillation (AO) index occurred in antiphase, and those in the time series of the WD and WW indices and the Scandinavia pattern (SCAND) index occurred in antiphase. Statistically significant increase in the number of warm compound extremes was found for the northern parts of the study region in the winter season with positive NAO and AO phases.
Global warming causes new challenges for urban citizens and metropolitan governments in adapting to the changing thermal environment. However, fine-scale spatiotemporal mapping of urban thermal environments has been inadequate. Therefore, this study takes a typical highdensity city, Hong Kong, as an example and utilises a machine learning algorithm, the random forest (RF), to carry out 100 m resolution hourly thermal environment mapping, including air temperature (Ta), relative humidity (RH) and the net effective temperature (NET), for the summer season (May to September) of 2008-2018, considering meteorological drivers, topography and local-climate-zone-based landscape drivers. The validation results show that the developed dataset achieves satisfactory accuracy. The mean values of R2, root mean square error (RMSE) and mean absolute error (MAE) for Ta achieve 0.8723, 1.1160 degrees C and 0.8227 degrees C, respectively, while those for RH reach 0.7970, 5.3816% and 3.8641%. In addition, the thermal comfort index, NET, reveals that people in built-up areas feel hotter than measured by Ta during the night due to the urban heat island effect. We believe this newly developed thermal comfort dataset can provide novel, reliable and fine-grained data support for urban climate research areas such as urban heat islands, heat exposure, heat-related health risk assessment, and urban energy consumption estimation.
Irrigation and urban greening can mitigate extreme temperatures and reduce adverse health impacts from heat. However, some recent studies suggest these interventions could actually exacerbate heat stress by increasing humidity. These studies use different heat stress indices (HSIs), hindering intercomparisons of the relative roles of temperature and humidity. Our method uses calculus of variations to compare the sensitivity of HSIs to temperature and humidity, independent of HSI units. We explain the properties of different HSIs and identify conditions under which they disagree. We highlight recent studies where the use of different HSIs could have led to opposite conclusions. Our findings have significant implications for the evaluation of irrigation and urban greening as adaptive responses to overheating and climate adaptation measures in general. We urge researchers to be critical in their choice of HSIs, especially in relation to health outcomes; our method provides a useful tool for making informed comparisons.
It is necessary to consider the phenomenon of urbanism in the global context. The exponential growth of urban population accounts for an increase in the emission of greenhouse gases. Land use changes and greenhouse gas emissions lead to changes that are inextricably linked with the local environment and regional climate. Urban climate change risks have also escalated due to increased extreme weather events induced by climate change and rise in the number of residents living in climate-sensitive areas. This study aimed to understand community perception about climate change and extreme heat influences on health. It was conducted in the Kolkata Metropolitan Region through a comprehensive interview of 56 participants by using purposive sampling methods. The information was obtained through in-depth interviews and focus group discussions. The data was analyzed using the narrative analysis method based on the transcribed notes. The collected information was made into a summary and then categorized with the chronology. Information was presented in the subsections of urban expansion influence on the regional climate, contributory factors of climate change, and climate change or extreme heat influences on health. Summaries of results are restoried into the narrative chronology. Study findings show that older adults and marginalized and low-income communities are more vulnerable to climate change-related health problems. Respondents also reported that climate change takes catastrophic forms resulting in increased hospital admissions due to heat-related illness in the summer season. Major health problems consist of illness, eye irritation, heat stroke, red, and warm skin, dizziness, headache, and muscle pain. The central and state governments have developed a framework of health action plan keeping in mind the climate change-related health issues. Public health professionals and policymakers must be aware of the magnitude of specific health concerns of citizens and the need for urgent action.
Cities in the global south face dire climate impacts. It is in socioeconomically marginalized urban communities of the global south that the effects of climate change are felt most deeply. Santiago de Chile, a major mid-latitude Andean city of 7.7 million inhabitants, is already undergoing the so-called “climate penalty” as rising temperatures worsen the effects of endemic ground-level ozone pollution. As many cities in the global south, Santiago is highly segregated along socioeconomic lines, which offers an opportunity for studying the effects of concurrent heatwaves and ozone episodes on distinct zones of affluence and deprivation. Here, we combine existing datasets of social indicators and climate-sensitive health risks with weather and air quality observations to study the response to compound heat-ozone extremes of different socioeconomic strata. Attributable to spatial variations in the ground-level ozone burden (heavier for wealthy communities), we found that the mortality response to extreme heat (and the associated further ozone pollution) is stronger in affluent dwellers, regardless of comorbidities and lack of access to health care affecting disadvantaged population. These unexpected findings underline the need of a site-specific hazard assessment and a community-based risk management.
Heatwaves pose potential risks to the environment, energy, society, and public health, and compound daytime and nighttime air and surface temperature heatwaves have the most severe effects. In this study, Southwest China was taken as a case to explore the characteristics of daytime, nighttime, and concurrent daytime and nighttime heatwaves events using air and surface temperatures based on a dynamic method for classifying urban, suburban, and rural stations with 30 m resolution land use and cover data based on absolute (i.e., same threshold for the entire Southwest China) and relative thresholds (i.e., thresholds for Chongqing municipality, Sichuan, Yunnan, and Guizhou Provinces calculated separately based on built-up areas for each period). We found that heatwaves events became more frequent and more severe in urban, suburban, and rural areas based on absolute and relative thresholds for both air and surface temperatures. Overall, the positive contributions towards warming by urbanization in urban and suburban areas to different heatwaves events obviously differed among different buffer areas and the influence of urbanization was different for air and surface temperature heatwaves events based on absolute and relative thresholds. Spatially persistent compound heatwaves mainly occurred in three urban agglomerations for air temperature. This study provides an original research perspective by using air and surface temperatures during daytime, nighttime, and concurrent daytime and nighttime heatwaves to calculate indices based on absolute (fixed threshold) and relative thresholds (considering the social and economic development level of different regions) in the complex topography of the Southwest China. In addition, this study observed for the first time that the calculated heatwaves indices based on air and surface temperatures were obviously different, illustrating that results obtained using different data sources (e.g., air temperature, surface temperature, and remote sensing data) to evaluate heatwaves will differ, indicating that data sources need to be carefully considered in Southwest China and other regions.
Climate-change-induced extreme weather events increase heat-related mortality and health risks for urbanites, which may also affect urbanites’ expressed happiness (EH) and well-being. However, the links among EH, climate, and socioeconomic factors remain unclear. Here we collected ∼6 million geotagged tweets from 44 Chinese prefecture-level cities based on Sina Weibo and performed a quadratic regression model to explore the relationships between summer heat and EH. A three-stage analysis was developed to examine spatiotemporal heterogeneity and identify factors contributing to disparities in urbanites’ EH. Results show that all cities exhibited a similar hump-shaped relationship, with an overall optimal temperature (OT) of 22.8 °C. The estimated OT varied geographically, with 25.3, 23.8, and 20.0 °C from north to south. Moreover, a 1 standard deviation increase in heatwave intensity was associated with a 0.813 (95% CI: 0.177, 1.449) standard deviation decrease in EH. Notably, within the geographic scope of this study, it was observed that urbanites in northern China and economically underdeveloped cities faced significantly lower heat risks during the summer heat. This research provides insight for future studies and practical applications concerning extreme weather events, urbanites’ mental health, and sustainable urban development goal.
Cities, the main place of human settlements, are under various mega challenges such as climate change, population increase, economic growth, urbanization, and pandemic diseases, and such challenges are mostly interlinked. Urban heat, due to heatwaves and heat islands, is the combined effect of climate change and urbanization. The COVID-19 is found to be a critical intervention of urban heat. However, the interrelationship between COVID-19 and urban heat has not been fully understood, constraining urban planning and design actions for improving the resilience to the dual impacts of heat and the pandemic. To close this research gap, this paper conducted a review on the co-occurrence of urban heat and the COVID-19 pandemic for a better understanding of their synergies, conflicts or trade-offs. The research involves a systematic review of urban temperature anomalies, variations in air pollutant concentrations, unbalanced energy development, and thermal health risks during the pandemic lockdown. In addition, this paper further explored data sources and analytical methods adopted to screen and identify the interventions of COVID-19 to urban heat. Overall, this paper is of significance for understanding the impact of COVID-19 on urban heat and provides a reference for coping with urban heat and the pandemic simultaneously. The world is witnessing the co-existence of heat and the pandemic, even in the post-pandemic era. This study can enlighten city managers, planners, the public, and researchers to collaborate for constructing a robust and resilient urban system for dealing with more than one challenges.
Attenuated cognitive performances caused by the hot-humid environment have been widely reported. However, the objective evaluation of the cognitive performance is still an open question. In pursuit of a possible biomarker of the cognitive performance under hot-humid exposures, 14 right-handed participants were recruited and exposed to 4 different hot-humid environments for 150 min, during which 5 kinds of cognitive tasks were administrated continuously till they gave up and quitted the experiment. The electrocardiogram (ECG) data were recorded during the whole experiment. Then the heart rate variability (HRV) analysis was conducted based on the ECG data, through which the time-domain indices, frequency-domain indices and non-linear indices were obtained. Thereafter, changes of these HRV indices with the exposure temperature and exposure time were investigated. Subsequently, the correlation analysis between the relative cognitive performance (RCP) calculated from the cognitive task results and these 3 kinds of HRV indices was conducted, producing the most correlated index, the mean LF/HF that represented the ratio of the low frequency and high frequency power from the HRV frequency analysis results. Based on that, the relationship between the mean LF/HF and RCP under different hothumid exposures was scrutinized. Results showed that the HRV indices changed with both the exposure temperatures and time, with certain patterns. Most importantly, a multi-segment negative relation was obtained between the mean LF/HF and the RCP. The mean RCP kept reducing when the mean LF/HF rose up to 3.5, or when the LF/HF was greater than 5, approximately. Between 3.5 and 5, however, slower reduction of the RCP was observed. This study produced a physiological approach to evaluate the cognitive performance alterations in hot-humid environments, which was of great significance to the productivity, safety and health of outdoor workers, especially under the circumstance of global warming.
Extreme heat exposure has been associated with hypertension. However, its interactive influences with air pollution, green and blue spaces are unclear. This study aimed to explore the interaction between heatwaves, air pollution, green and blue spaces on hypertension. Cohort data enrolled 6448 Chinese older adults aged 65 years and over were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018. Nine heatwave definitions, combining three heat thresholds (92.5th, 95th, and 97.5th percentiles of daily maximum temperature) and three durations (≥2, 3 and 4 days) were used as time-varying variables in the analysis and were the one-year exposure before survival events. Fine particulate matter (PM ≤2.5 μm in aerodynamic diameter (PM(2.5))), the Normalized Difference Vegetation Index (NDVI) and the average proportion of open water bodies were used to reflect the air pollution, green and blue space exposures, respectively. PM(2.5), green and blue space exposures were time-varying indicators and contemporaneous with heatwaves. Mixed Cox models with time-varying variables were fitted to assess the multiplicative and additive interaction of heatwaves, PM(2.5), and green and blue spaces on hypertension, measured by a traditional product term with the ratio of hazard ratio (HR) and relative risk due to interaction (RERI), respectively. A positive multiplicative (HRs >1) and additive interaction (RERIs >0) between heatwaves and higher PM(2.5) levels was observed. There was a synergistic effect between heatwaves and decreasing greenness levels on hypertension incidence on additive and multiplicative scales. No significant interaction between heatwaves and blue space was observed in the analysis. The combined effects of heatwaves, air pollution, green and blue space exposures on the risk of hypertension varied with age, gender, and educational attainment. This study’s findings complemented the existing evidence and revealed synergistic harmful impacts for heatwaves with air pollution and lack of green space on hypertension incidence.
RationaleThe aim of this paper is to present research examining how the climate hazard of extreme heat impacts varsity-level sport athletes and facilities, current responses, and options for adaptation.MethodsA sample of 30 participants from a higher education institution athletics department was used with a two-phase Delphi study method that applied two iterations of questionnaires and mixed method analysis. The institution was situated in a region with a Koppen classification of “Warm Summer Continental Climate”.FindingsHeat hazards aligned primarily with slow-onset, rather than fast-onset, climate impact categories. Adapting to heat hazards aligned with incremental adaptation rather than transformative adaptation. These findings suggest climate adaptation is a new concept for university sport and so is at a pioneering stage of practice.Practical implicationsIdentifies options for sport managers for integrating adaptation into the strategic and operational thinking of sport organizations.Research contributionThis paper extends knowledge by presenting evidence of heat risks to the sport as perceived by sport managers and participants during an era of climate change. The results address gaps in the existing literature by using primary source data to add to the evidence base for sport and climate change, and by identifying options for climate adaptation.
Developing a better scientific understanding of anthropogenic climate change and climate variability, especially the prediction/projection of climate futures with useful temporal and geographical resolution and quantified uncertainties, and using that knowledge to inform adaptation planning and action will become crucially important in the coming years. Generating such policy-relevant knowledge may be particularly important for developing countries such as India. It is with this backdrop that, in this paper, we analyze future heat waves in India by using observations and a large number of model simulations of historical, + 1.5 degrees C, and + 2.0 degrees C warmer worlds. In both the future scenarios, there is an increased probability of heat waves during June and July when the Indian monsoon is in full swing and humidity is high, which makes the heat events even more of a health risk. While the highest temperatures in heat waves may not increase much in future climates, the duration and areal extent of the heat waves will most likely increase, leading to the emergence of new heat wave-prone zones in India. The results indicate that the joint frequencies of the longest duration and large area events could be nearly threefold greater in the + 1.5 degrees C and fivefold greater in the + 2.0 degrees C future scenarios compared to historical simulations. Thus, overall, the study indicates a substantial increase in the risk of heat events that typically elicit warnings from forecasters. The likely widespread and persistent nature of heat wave events in the future, as revealed by this study, will require planning and adaptation measures beyond the short-term disaster planning frameworks currently in place. Exploring what these measures might look like is beyond the scope of this study, but it underlines the importance of developing climate knowledge with high temporal and geographical resolution capable of informing adaptation policy and planning.
Under hot conditions the human body is able to regulate its core temperature via sweat evaporation, but this ability is reduced when air humidity is high. These conditions of high temperature and high humidity invoke heat stress which is a major problem for humans, in particular for vulnerable groups of the population and people under physical stress (e.g. heavy duty work without appropriate cooling systems). It is generally expected that the frequency, duration and magnitude of such unfavorable conditions will increase with further climate warming. In this respect, climate services play a crucial role by putting together climatological information and adaptation solutions to reduce future heat stress. We here assess the recently developed CH2018 scenarios for Switzerland (https://www.climate-scenarios.ch) in terms of heat stress conditions including their future projections. For this purpose, we characterize future extreme heat conditions with the use of climate analogs. By doing so, we attempt to produce more accessible climate information which might foster the use and understanding of regional-scale climate scenarios. Here heat stress is expressed through the Wet Bulb Temperature (TW), which is a relatively simple proxy for heat stress on the human body and which depends non-linearly on temperature and humidity. It is assessed in terms of single-day events and heat stress spells. Projections based on the CH2018 scenarios indicate increasing heat stress over Switzerland, which is accentuated towards the end of the century. High heat stress conditions might be about 3-5 times more frequent for an emission scenario without mitigation (RCP 8.5) than for the mitigation scenario (RCP 2.6) by the end of the 21st century. The projected increase of heat stress results in more and longer heat stress spells, thus highlighting the importance of timely and precise prevention strategies in the context of heat-health action plans. Spatial climate analogs based on heat stress spells in Switzerland greatly vary depending on the emission scenario and are found in Central Europe under a mitigation scenario and in southern Europe under unmitigated warming.
Climate change will alter environmental risks that influence pulmonary health, including heat, air pollution, and pollen. These exposures disproportionately burden populations already at risk of ill health, including those at vulnerable life stages, with low socioeconomic status, and systematically targeted by oppressive policies. Climate change can exacerbate existing environmental injustices by affecting future exposure, as well as through differentials in the ability to adapt; this is compounded by disparities in rates of underlying disease and access to health care. Climate change is therefore a dire threat not only to individual and population health but also to health equity.
Climate change presents a major public health concern in Australia, marked by unprecedented wildfires, heatwaves, floods, droughts, and the spread of climate-sensitive infectious diseases. Despite these challenges, Australia’s response to the climate crisis has been inadequate and subject to change by politics, public sentiment, and global developments. This study illustrates the spatiotemporal patterns of selected climate-related environmental extremes (heatwaves, wildfires, floods, and droughts) across Australia during the past two decades, and summarizes climate adaptation measures and actions that have been taken by the national, state/territory, and local governments. Our findings reveal significant impacts of climate-related environmental extremes on the health and well-being of Australians. While governments have implemented various adaptation strategies, these plans must be further developed to yield concrete actions. Moreover, Indigenous Australians should not be left out in these adaptation efforts. A collaborative, comprehensive approach involving all levels of government is urgently needed to prevent, mitigate, and adapt to the health impacts of climate change.
Global warming is a pressing problem that necessitates immediate action. This phenomenon is particularly affecting the quality of life in larger cities due to population growth and human mobility. Understanding the space-time variability of the heat stress that various locations will face in the future is therefore crucial for us. Taking into account the aforementioned facts, the current study examined the evolution of the Hi heat stress index in four European capitals – Berlin, Madrid, Paris, and Rome – during the months of July, August, and September between 2008, 2012, and 2017. The European Space Agency (ESA) UrbClim climate model was used to collect environmental data. Furthermore, Local Climatic Zones (LCZ) classifications and land use/cover change (LULC) coverages were used to improve the evaluation and extrapolation of the results. According to the findings, the studied areas experienced significant increases in environmental temperatures and the heat stress index Hi between 2008 and 2017. The four cities’ average increase is 0.31 degrees C per decade, with the southern cities experiencing greater intensity and the northern cities experiencing less intensity. When comparing the spatiotemporal variability of heat stress in different zones, the study discovered that areas with more impervious areas and fewer green areas are more vulnerable to potential increases in heat stress. As a result, future urban developments with more green areas can be able to create spaces that are more resistant to heat stress, improving people’s quality of life.
BACKGROUND: Climate change scenarios illustrate various pathways in terms of global warming ranging from “sustainable development” (Shared Socioeconomic Pathway SSP1-1.9), the best-case scenario, to ‘fossil-fueled development’ (SSP5-8.5), the worst-case scenario. OBJECTIVES: We examined the extent to which increase in daily average urban summer temperature is associated with future cause-specific mortality and projected heat-related mortality burden for the current warming trend and these two scenarios. METHODS: We did an observational cohort study of 363,754 participants living in six cities in Finland. Using residential addresses, participants were linked to daily temperature records and electronic death records from national registries during summers (1 May to 30 September) 2000 to 2018. For each day of observation, heat index (average daily air temperature weighted by humidity) for the preceding 7 d was calculated for participants’ residential area using a geographic grid at a spatial resolution of 1 km × 1 km. We examined associations of the summer heat index with risk of death by cause for all participants adjusting for a wide range of individual-level covariates and in subsidiary analyses using case-crossover design, computed the related period population attributable fraction (PAF), and projected change in PAF from summers 2000-2018 compared with those in 2030-2050. RESULTS: During a cohort total exposure period of 582,111,979 summer days (3,880,746 person-summers), we recorded 4,094 deaths, including 949 from cardiovascular disease. The multivariable-adjusted rate ratio (RR) for high ( ≥ 21°C) vs. reference (14 – 15°C) heat index was 1.70 (95% CI: 1.28, 2.27) for cardiovascular mortality, but it did not reach statistical significance for noncardiovascular deaths, RR = 1.14 (95% CI: 0.96, 1.36), a finding replicated in case-crossover analysis. According to projections for 2030-2050, PAF of summertime cardiovascular mortality attributable to high heat will be 4.4% (1.8%-7.3%) under the sustainable development scenario, but 7.6% (3.2%-12.3%) under the fossil-fueled development scenario. In the six cities, the estimated annual number of summertime heat-related cardiovascular deaths under the two scenarios will be 174 and 298 for a total population of 1,759,468 people. DISCUSSION: The increase in average urban summer temperature will raise heat-related cardiovascular mortality burden. The estimated magnitude of this burden is > 1.5 times greater if future climate change is driven by fossil fuels rather than sustainable development. https://doi.org/10.1289/EHP12080.
PURPOSE: Climate change poses one of the greatest risks to human health as air pollution increases, surface temperatures rise, and extreme weather events become more frequent. Environmental exposures related to climate change have a disproportionate effect on pregnant women through influencing food and water security, civil conflicts, extreme weather events, and the spread of disease. Our research team sought to identify the current peer-reviewed research on the effects of climate change-related environmental exposures on perinatal and maternal health in the United States. DESIGN AND METHODS: A systematic literature review of publications identified through a comprehensive search of the PubMed and Web of Science databases was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. The initial search across both databases identified a combined total of 768 publications. We removed 126 duplicates and 1 quadruplet, and the remaining 639 publications were subjected to our pre-set inclusion and exclusion criteria. We excluded studies outside of the United States. A total of 39 studies met our inclusion criteria and were retained for thematic analysis. FINDINGS: A total of 19 studies investigated the effect of either hot or cold temperature exposure on perinatal and maternal health outcomes. The effect of air pollution on perinatal outcomes was examined in five studies. A total of 19 studies evaluated the association between natural disasters (hurricanes, flash floods, and tropical cyclones) and perinatal and maternal health outcomes. High and low temperature extremes were found to negatively influence neonate and maternal health. Significant associations were found between air pollutant exposure and adverse pregnancy outcomes. Adverse pregnancy outcomes were linked to hurricanes, tropical cyclones, and flash floods. CONCLUSIONS: This systematic review suggests that climate change-related environmental exposures, including extreme temperatures, air pollution, and natural disasters, are significantly associated with adverse perinatal and maternal health outcomes across the United States.
Global heating is subjecting more of the planet to longer periods of higher heat stress categories commonly employed to determine safe work durations. This study compared predicted worker heat strain and labour capacity for a recent normal climate (1986-2005) and under commonly applied climate scenarios for the 2041-2080 period for selected Australian locations. Recently published heat indices for northern (Darwin, Townsville, and Tom Price) and south-eastern coastal and inland Australia locations (Griffith, Port Macquarie, and Clare) under four projected climate scenarios, comprising two representative concentration pathways (RCPs), RCP4.5 and RCP8.5, and two time periods, 2041-2060 and 2061-2080, were used. Safe work durations, before the threshold for core temperature (38.0 °C) or sweat loss (5% body mass) are attained, were then estimated for each scenario using the predicted heat strain model (ISO7933). The modelled time to threshold core temperature varied with location, climate scenario, and metabolic rate. Relative to the baseline (1986-2005), safe work durations (labour capacity) were reduced by >50% in Port Macquarie and Griffith and by 20-50% in northern Australia. Reaching the sweat loss limit restricted safe work durations in Clare and Griffith. Projected future climatic conditions will adversely impact the predicted heat strain and labour capacity of outdoor workers in Australia. Risk management strategies must adapt to warming conditions to protect outdoor workers from the deleterious effects of heat.
Climate-related hazards such as heatwaves, flooding, wildfires, and storms will increase morbidity and mortality unless infrastructure decision-makers-including urban planners, infrastructure asset managers, and utility providers-implement preventive measures to protect public health from these hazards. Existing research and policies have not systematically identified the key risk factors that these decision-makers need to manage to protect public health in a changing climate. This gap leads to unclarity regarding what infrastructure interventions are required to prevent climate-related health risks and what actors have a responsibility to manage these risks. The Climate-Health-Infrastructure-Pathways Model is introduced in this paper to address this gap and provide a conceptual map that captures the role of physical infrastructure systems in the pathways between climate-related hazards and health risks. The model surpasses what can be found in existing climate change research and policy, including the latest IPCC reporting, and is a conceptual qualitative tool that offers a typology of climate and health risks for infrastructure management. Decision-makers can use the model as a starting point to review the coverage of their current climate risk management plans and identify further opportunities to develop preventive infrastructure responses to protect public health in a changing climate.
At present, climate change is considered a considerable future threat due to its possible catastrophic impacts on humans, their properties, and also the environment. Therefore, most people and organizations have paid attention to this area. Thus, special consideration should be given to building operations, as buildings and building operations are capable of being impacted by various negative consequences of climate change. As facade-maintenance workers experience considerable climate change impacts as they perform their work for prolonged hours, at height, on the exterior of buildings, this study focuses on identifying the impacts of climate change on facade-access methods and facade-maintenance workers. Thus, in this study, a qualitative research approach was undertaken with an interview research design. A comprehensive literature review was conducted along with 12 semi-structured expert interviews selected through judgmental sampling. Software-aided thematic content analysis was carried out to analyze the collected data. The findings indicated that climate change could have significant impacts on building operations, as the attention paid to climate change adaptation by building operations is negligible in various countries, especially in developing countries. A significant impact was identified on facade-maintenance workers and facade-access methods caused by climate change, creating various risk factors for their occupational health and safety. Furthermore, the research methods that have been applied in this study are also capable of expanding to address various other probable operations. Accordingly, this research is exploring a new field of study that should be given more consideration by researchers due to its significant importance in scenarios that are experienced worldwide.
Anthropogenic climate change adversely impacts human health. In this perspective, we examine the impact of climate change on respiratory health risk. We describe five respiratory health threats-heat, wildfires, pollen, extreme weather events, and viruses-and discuss their impact on health outcomes in a warming climate. The risk of experiencing an adverse health outcome occurs at the intersection of exposure and vulnerability, consisting of sensitivity and adaptive capacity. Exposed individuals and communities most at risk are those with high sensitivity and low adaptive capacity, as influenced by the social determinants of health. We call for the implementation of a transdisciplinary strategy for accelerating respiratory health research, practice, and policy in the context of climate change.
Pregnant women are highly vulnerable to adverse environments. Accumulating evidence highlights that increasing temperatures associated with the ongoing climate change pose a threat to successful reproduction. Heat stress caused by an increased ambient temperature can result in adverse pregnancy outcomes, e.g., preterm birth, stillbirth and low fetal weight. The pathomechanisms through which heat stress interferes with pregnancy maintenance still remain vague, but emerging evidence underscores that the endocrine system is severely affected. It is well known that the endocrine system pivotally contributes to the physiological progression of pregnancy. We review – sometimes speculate – how heat stress can offset hormonal dysregulations and subsequently derail other systems which interact with hormones, such as the immune response. This may account for the heat-stress related threat to successful pregnancy progression, fetal development and long-term children’s health.
BACKGROUND: Climate change and globalization contribute to the expansion of mosquito vectors and their associated pathogens. Long spared, temperate regions have had to deal with the emergence of arboviruses traditionally confined to tropical regions. Chikungunya virus (CHIKV) was reported for the first time in Europe in 2007, causing a localized outbreak in Italy, which then recurred repeatedly over the years in other European localities. This raises the question of climate effects, particularly temperature, on the dynamics of vector-borne viruses. The objective of this study is to improve the understanding of the molecular mechanisms set up in the vector in response to temperature. METHODS: We combine three complementary approaches by examining Aedes albopictus mosquito gene expression (transcriptomics), bacterial flora (metagenomics) and CHIKV evolutionary dynamics (genomics) induced by viral infection and temperature changes. RESULTS: We show that temperature alters profoundly mosquito gene expression, bacterial microbiome and viral population diversity. We observe that (i) CHIKV infection upregulated most genes (mainly in immune and stress-related pathways) at 20°C but not at 28°C, (ii) CHIKV infection significantly increased the abundance of Enterobacteriaceae Serratia marcescens at 28°C and (iii) CHIKV evolutionary dynamics were different according to temperature. CONCLUSION: The substantial changes detected in the vectorial system (the vector and its bacterial microbiota, and the arbovirus) lead to temperature-specific adjustments to reach the ultimate goal of arbovirus transmission; at 20°C and 28°C, the Asian tiger mosquito Ae. albopictus was able to transmit CHIKV at the same efficiency. Therefore, CHIKV is likely to continue its expansion in the northern regions and could become a public health problem in more countries than those already affected in Europe.
The informal economy is crucial for making cities function, and it provides the main means of income for a significant proportion of all workers globally. At the same time, informal workers are extremely vulnerable to the effects of climate change, with higher temperatures and more intense weather events causing direct physical harm and contributing to ill-health. This paper analyzes research from three cities in India and Zimbabwe (Indore, Harare, and Masvingo) to describe the vulnerability of informal workers in several sectors. It highlights the ways in which the direct impacts of climate change are compounded by other factors, including low-quality living conditions and the absence of provision for Occupational Health and Safety (OHS). Informal workers in the three cities have adopted a range of responses to reduce risk, and there are some recent inclusive engagements with local officials to enhance living and working conditions. However, key interventions such as expanding access to social protection (which has important potential to foster climate resilience) often fail to reach the most vulnerable urban informal workers. We conclude with recommendations and an agenda for more equitable policy and practice that can support multiple benefits for informal workers’ health, livelihoods, and climate resilience in urban areas.
Climate change should be of special concern for the nephrologist, as the kidney has a critical role in protecting the host from dehydration, but it is also a favorite target of heat stress and dehydration. Here we discuss how rising temperatures and extreme heat events may affect the kidney. The most severe presentation of heat stress is heat stroke, which can result in severe electrolyte disturbance and both acute and chronic kidney disease (CKD). However, lesser levels of heat stress also have multiple effects, including exacerbating kidney disease and precipitating cardiovascular events in subjects with established kidney disease. Heat stress can also increase the risk for kidney stones, cause multiple electrolyte abnormalities and induce both acute and chronic kidney disease. Recently there have been multiple epidemics of CKD of uncertain etiology in various regions of the world, including Mesoamerica, Sri Lanka, India and Thailand. There is increasing evidence that climate change and heat stress may play a contributory role in these conditions, although other causes, including toxins, could also be involved. As climate change worsens, the nephrologist should prepare for an increase in diseases associated with heat stress and dehydration.
Pavement burns are more common in locations familiarised with high temperatures and a dry climate zone, but have not previously been reported in temperate climates. We present two cases of patients who suffered pavement burns in the United Kingdom during an unprecedentedly hot day in July 2022. The first case involved a 66-year-old male who suffered partial and full thickness burns requiring excision and skin grafting. The second case involved a 58-year-old female with partial thickness burns also requiring excision and skin grafting. Both patients had pre-existing co-morbidities and their pavement burns were precipitated by heat stroke. Pavement burns represent a mechanism of injury that necessitates increased operative management, length of hospital stay and cost per surface area burned when compared to flame or scald burns (Silver et al., 2015). As a result of global warming, we anticipate extreme heat events, and subsequently pavement burns, to increase in incidence in the United Kingdom. There is opportunity for education of the public and health professionals for prevention.
Gaseous emissions have contributed to global warming, an increase in the frequency of extreme weather events and poorer air quality. The associated health impacts have been well reported in temperate regions. In Singapore, key climate change adaptation measures and activities include coastal and flood protection, and mitigating heat impacts. We systematically reviewed studies examining climate variability and air quality with population health in Singapore, a tropical city-state in South-East Asia (SEA), with the aim to identify evidence gaps for policymakers. We included 14 studies with respiratory illnesses, cardiovascular outcomes, foodborne disease and dengue. Absolute humidity (3 studies) and rainfall (2 studies) were positively associated with adverse health. Extreme heat (2 studies) was inversely associated with adverse health. The effects of mean ambient temperature and relative humidity on adverse health were inconsistent. Nitrogen dioxide and ozone were positively associated with adverse health. Climate variability and air quality may have disease-specific, differing directions of effect in Singapore. Additional high quality studies are required to strengthen the evidence for policymaking. Research on effective climate action advocacy and adaptation measures for community activities should be strengthened. FUNDING: There was no funding source for this study.
Global climate change has been increasingly recognized as one of the most significant threats to global health, including mental health. Although many studies have explored the link between mental health problems and climate change, the findings are inconclusive, especially regarding the effect on depressive disorders. A possible limitation is the lack of comprehensive assessment of climate change.This study aimed to comprehensively investigate the effects of temperature-related consequences of climate change (including changes in average temperature, temperature variability, heat waves, cold spells, and hot nights) on depressive disorders among middle-aged and older people who are more vulnerable to climate change because of their reduced thermoregulation capacity with aging. Our findings suggest that both hot nights and cold spells significantly exacerbate depressive disorders (hot nights: Excess Risk (ER) = 9.60% (95%CI: 1.59%, 18.24%); cold spells: ER = 3.63% (95%CI: 0.77%, 6.57%)). However, we did not find sufficient evidence to support the effect of average temperature, temperature variability, and heat waves on depressive disorders among middle-aged and older people in China. To conclude, depressive disorders was sensitive to extreme hot at night and cold. The government should propose some measures to mitigate the impact of extreme temperature events, such as launching campaigns to promote air conditioning in rural areas where the penetration rate of air conditioning is low.
Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain. OBJECTIVES: A systematic review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Mecca, Saudi Arabia. METHODS: We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics. RESULTS: Forty-four studies, including 2632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95% confidence interval (CI): 41.9, 42.1], range 40-44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean Glasgow Coma Scale <8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild-to-moderate rhabdomyolysis, acute kidney, liver, heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]). CONCLUSIONS: The findings of this review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.
Climate change adaptation planning and implementation have proliferated over the past years. However, we still lack an understanding of how society adapts itself outside of policy sectors and as part of what some refer to as “autonomous adaptation.” The way people respond to risk without deliberate interventions of public actors is not well understood. Given the increasing occurrence of climatic changes that affect our daily lives, the topic is regaining attention with an emphasis on behavioral adaptation. This angle, however, does little to enhance our understanding of how society adapts collectively and which practices and routines groups choose to adopt. This study investigates autonomous heat-stress adaptation efforts in two small towns in Germany. Autonomous heat-stress adaptation is approached through a lens of (social) adaptation practices. Small towns are understudied in adaptation research and have played only a minor role when it comes to public adaptation planning due to their lack of formal resources to develop public adaptation strategies. Based on empirical data, consisting of qualitative problem-centered interviews and a quantitative survey, concrete examples of (social) adaptation practices are identified and classified. The presented classification of practices goes beyond earlier attempts by generating insights on the role politics can play in providing a fruitful ground for enabling autonomous adaptation. The paper emphasizes the need for researchers and decision-makers to take a closer look at the wide variety of social adaptation practices already in place. This discloses insights on public-private adaptation mixes, which could ultimately also lift autonomous adaptation from its ad hoc and reactive nature. SIGNIFICANCE STATEMENT: Social adaptation practices are not yet at the center of research and decision-making. We believe that adding practice-based approaches to adaptation governance widens the debate on who is vulnerable and possible coping mechanisms from within society. It shows that vulnerability and adaptation lie in people’s everyday actions. We provide a first classification of heat-health adaptation practices according to their heat-health target, the involved individuals and actors, the degree of coordination involved, and the spatial and temporal scales. This classification draws attention to potential governance leverage points to initiate heat-adaptation practices. Focusing more strongly on already-in-use and possible heat-health adaptation practices puts citizens’ wants and needs at the center of adaptation governance by including them directly in the adaptation process. This can be of special interest for small towns that want to introduce citizen-based approaches to heat-risk adaptation.
Using an extensive database of every resident death in Virginia from 2005 to 2020, climate-mortality relationships are examined for 12 climatically homogeneous regions within the Commonwealth. Each region is represented by a first-order weather station from which archived temperature and humidity data are used to generate a variety of biometeorologically relevant indices. Using these indices and other variables (such as air quality and heat and cold waves), daily mortality and climate relationships are modeled for each region over a 21-day lag period utilizing generalized additive models and distributed lag non-linear models. Optimal models are identified for each region, and a consensus model was also run based on maximum temperature to facilitate inter-regional comparisons. The relative risk of mortality varies markedly as a function of climate between regions, with U-shaped, J-shaped, and inverse linear relationships evident. Cold mortality exceeds heat mortality across most of Virginia (typical relative risks are 1.10 for cold and 1.03 for heat), with cold risks strongest at lags 3 to 10. Low temperatures (or low humidity) are protective at lags 0-2 days except in the colder, western parts of state. Heat mortality occurs at short lags (0-2 days) for three-fourths of the stations, but the spatial pattern is random. Mortality displacement is evident for most regions for several days following the heat-related spike. Although the use of region-specific models is justified, the simple consensus model based on a consistent set of predictors provides similar results.
Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1,614 deaths from 25 June to 02 July 2021 with 6,524 deaths on the same dates from 2012 to 2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non-heat-related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high-risk individuals based on underlying chronic conditions.
Through conversion of land cover to more built-up, impervious surfaces, cities create hotter environments than their surroundings for urban residents, with large differences expected between different parts of the city. Existing measurements of ambient air temperature and heat stress, however, are often insufficient to capture the intra-urban variability in heat exposure. This study provides a replicable method for modeling air temperature, humidity, and moist heat stress over the urban area of Chapel Hill while engaging citizens to collect high-temporal and spatially-resolved air temperature and humidity measurements. We use low-cost, consumer-grade sensors combined with satellite remote sensing data and machine learning to map urban air temperature and relative humidity over various land-cover classes to understand intra-urban spatial variability of ambient heat exposure at a relatively high resolution (10 m). Our findings show that individuals may be exposed to higher levels of air temperature and moist heat stress than weather station data suggest, and that the ambient heat exposure varies according to land cover type, with tree-covered land the coolest and built-up areas the warmest, and time of day, with higher air temperatures observed during the early afternoon. Combining our resulting dataset with sociodemographic data, policymakers and urban planners in Chapel Hill can use data output from this method to identify areas exposed to high temperature and moist heat stress as a first step to design effective mitigation measures.
As global studies of climate change depict increasingly dire outcomes of extreme heat, there is an urgent need to understand the appropriateness of heatwave definitions and temperature datasets in different parts of the world. We carry out an intercomparison of the CHIRTS gridded station-satellite temperature dataset with three reanalysis products, ERA5, NCEP-DOE Reanalysis 2, and MERRA2, to assess biases in the absolute value of extreme heat events and the distribution of extreme events. We find close agreement between all four datasets in the magnitude and distribution of extreme temperatures, with a cold bias in the reanalyses over mountainous areas. However, there is little to no agreement between datasets on the timing of extreme heat events in the tropics, and the datasets do not even agree on which month is the hottest month climatologically in these regions. Second, we compare how the four datasets represent the frequency and timing of extreme heat events, using two different types of heatwave definitions: 5-day duration-based extremes and extreme temperature-humidity combinations (heat index). In the case of 5-day heatwaves, there are almost zero events recorded historically in tropical regions. In contrast, high absolute values of the heat index are most common in dry climates, likely due to the dominance of high temperature spikes in these regions, and high heat index events also occur in temperate and tropical regions. There is little agreement between datasets, however, on when these extreme heat index events have happened historically in the tropics. Given these results, we highlight the need for locally developed heatwave metrics for different parts of the world, and we urge against the use of a single heatwave definition in global studies. We also recommend that any studies assessing heat-health relationships in tropical regions beware of the lack of agreement between observational and reanalysis datasets and compare results from different gridded dataset products to estimate uncertainty in heat-health relationships.
Global warming is expected to exacerbate heat stress. Additionally, biogeophysical effects of land cover and land management changes (LCLMC) could substantially alter temperature and relative humidity locally and non-locally. Thereby, LCLMC could affect the occupational capacity to safely perform physical work under hot environments (labor capacity). However, these effects have never been quantified globally using a multi-model setup. Building on results from stylized sensitivity experiments of (a) cropland expansion, (b) irrigation expansion, and (c) afforestation conducted by three fully coupled Earth System Models (ESMs), we assess the local as well as non-local effects on heat stress and labor capacity. We found that LCLMC leads to substantial changes in temperature; however, the concomitant changes in humidity could largely diminish the combined impact on moist heat. Moreover, cropland expansion and afforestation cause inconsistent responses of day- and night-time temperature, which has strong implications for labor capacity. Across the ESMs, the results are mixed in terms of sign and magnitude. Overall, LCLMC result in non-negligible impacts on heat stress and labor capacity in low-latitude regions during the warmest seasons. In some locations, the changes of monthly average labor capacity, which are induced by the local effects of individual LCLMC options, could reach -14 and +15 percentage points. Thus, LCLMC-induced impacts on heat stress and their consequences for adaptation should be accounted for when designing LCLMC-related policies to ensure sustainable development.
Heatwaves are projected to increase in frequency, intensity, and duration as the climate warms. However, it is unclear whether human mortality from heatwaves is changing in frequency with time. We used Quasi-Poisson regression with a distributed non-linear model (DLNM) to examined associations of heatwaves and their char-acteristics (intensity, duration, and timing) with human mortality due to different diseases and total non-accidental diseases (TND) for different sociodemographic subgroups between 2002 and 2004 and 2012-2014 in Shanghai, China. We found that heatwaves showed a significant association with cause-specific mortality and TND for socio-demographic subgroups during the two study periods. Relative risks (RR) of mortality decreased for most demographic subgroups from 2002 to 2004 to 2012-2014, while RR of respiratory diseases (RD) increased over time. The association between heatwave characteristics and human mortality changed over time. RRs of heatwaves on mortality were higher for females, the elderly, and low-and middle-educational level populations than for males, younger and highly educated counterparts, respectively. Overall, heatwaves had a stronger association with the mortality of RD from 2002 to 2004 to 2012-2014. Heatwave duration also had an enhanced association with all subgroups over time. Our research findings could provide insights into the design of sustainable cities and society.
Among the various thermal stress indices, apparent temperature (AT) is closely related to public health indicators, and consequently is widely used by weather agencies around the world. Therefore, in this paper we estimate the changes in AT and contributing components in Korea as a whole and in five major cities (Seoul, Gwanju, Daegu, Daejeon, and Busan) using national standard climate scenarios based on the coupled model inter-comparison project (CMIP6). In the present day, high AT occurs in major cities due to high temperature (TAS) and relative humidity (RH). Our findings reveal that even when TAS is relatively low, large AT occurs with higher humidity. Notably, in future warmer climate conditions, high AT may first appear in the five major cities and then extend to the surrounding areas. An increase in TAS and RH during the pre-hot season (March to June) may lead to earlier occurrence of thermal risks in future warmer climate conditions and more frequent occurrence of high thermal stress events. Our study can serve as a reference for future information on thermal risk changes in Korea. Considering those who have not adapted to high temperature environments, our findings imply that thermal risks will become more serious and that heat adaptation strategies will be needed during the pre-hot season under future warmer climate conditions.
Heat risks, such as those associated with heatwaves, are increasing in frequency, severity, and duration due to climate change. The ways in which people around the globe perceive and respond to heat risks are now of great importance to reduce a range of negative health outcomes. A growing body of literature aims to assess the factors that influence people’s behaviors in relation to heat risks. This research can inform better interventions, such as improved communications approaches, that attempt to facilitate adaptive behavioral responses to such risks. This review focuses on how insights from behavioral and attitudinal studies about heat risk responses can inform communication approaches. These insights are organized into three key themes: (1) Behaviors-What types of actions can be taken by people, and what evidence is there for adaptive behavior? (2) Antecedents-Which individual and contextual factors can influence people’s behaviors? (3) Communications-How can existing insights be better integrated into interventions? Aspects of communication, including the role of message characteristics, messenger, and imagery, are discussed, with examples of messages and narratives that target influential antecedents of adaptive responses to heat risks. The paper makes three important contributions. First, it organizes literature on the antecedents and behavioral responses to heat risk; second, it provides a typology of the range of heat risk behaviors; and, third, it discusses how antecedents can be integrated into communication interventions. The review concludes with a proposed agenda for research, highlighting the need for substantial testing and evaluation of heat risk communication, applying insights from the literature.This article is categorized under:Perceptions, Behavior, and Communication of Climate Change > CommunicationPerceptions, Behavior, and Communication of Climate Change > Behavior Change and Responses
The aim of the study was to characterise bioclimatic conditions in Poland in the times of progressing warming. This type of research permits the verification whether the progressing climate warming also translates into a change in bioclimatic conditions. This study was based on data obtained for the period 1966-2021 from 37 synoptic stations located in Poland. All the data series were uniform and obtained from the data base of the Institute of Meteorology and Water Management-National Research Institute (IMGW-PIB). The study revealed high variability of bioclimatic conditions in Poland both in spatial and in temporal terms. The lowest mean annual PET values were recorded in the north and north-east of the country and the highest in the south-west of Poland. The study revealed changes in the frequency of occurrence of days with cold and heat stress, as well as days with no thermal stress. The most intensive changes were determined for days with cold stress. A decrease in the number of days in this category translated into an increase in the number of days with no thermal stress and days with heat stress.
OBJECTIVE: This study describes the characteristics of workers experiencing occupational heat-related injuries/illnesses in the United States and explores the associations between states’ average annual temperatures and heat-related injury/illness rates. METHODS: The number and rate of occupational environmental heat injuries/illnesses were calculated according to age group, gender, race/ethnicity, occupation group, and state from 2011 to 2019. RESULTS: Injury/illness rates were higher among Black and Hispanic workers. Workers in farming, fishing, and forestry; installation, maintenance, and repair; and construction/extraction occupations had the highest rates. There was a positive correlation between states’ average annual temperatures and heat-related injury/illness rates. DISCUSSION: There are demographic and occupational disparities in occupational environmental heat-related injuries/illnesses in the United States and a correlation between these injuries/illnesses and state average annual temperatures. There is a need for policies and other interventions to protect workers from occupational environmental heat injuries/illnesses.
One of the climate problems that causes the most environmental impact worldwide is the trend of increasing occurrence of events of maximum extreme temperature, signaled by indicators such as hot extremes (HE) and maximum maximorum (highest maximum) temperature (MmT). These events can cause conditions ranging from severe droughts to heat stroke, which can cause death in any population. Indicators of maximum extreme temperature in one of the most important agricultural areas in northwestern Mexico were calculated based on significant trends (ST) and adjusted return periods. To calculate the trends of the maximum extreme tempera-ture, frequency (FR), annual average duration (AAD), annual daily duration (ADD), intensity (IN) of HE, and MmT, the Mann-Kendall and Sen’s slope tests were applied to data obtained for 19 weather stations from the CLImate COMputing database for the period 1982-2014. Adjusted return periods (ARP) were calculated for each indicator of maximum extreme temperature by fitting a probability distribution function. For the study area, the ST and maximum extreme temperature shows a prevailing cooling trend. This can be deduced by observing the proportion of negative ST compared with positive ST. The highest positive magnitudes of ST were recorded at stations CUL (FR = 3.44 HE dec-1), GUT (AAD = 6.15 day HE-1 dec-1and IN = 13.62 degrees C dec-1), IXP (ADD = 35.00 day dec-1) and POT (MmT = 2.50 degrees C day-1 dec-1). For ARP, the estimate of the average occurrence frequency of extreme events per100 years are FR = 6.11 HE dec-1 (1 time), AAD = 6.64 day HE-1 dec-1 (4 times), ADD = 38.68 day dec-1 (1 time), IN = 39.09 degrees C dec-1 (6 times) and MmT = 41.95 degrees C day-1 dec-1 (1 time). These findings are of key importance for the economic sectors related to agricultural production in the state known, at least to date, as “the breadbasket of Mexico” (Sinaloa). The results will help to develop adaptation/prevention measures before the coming socioeconomic and hydrological disasters.
The Arctic is warming at four times the global rate, changing the diversity, activity and distribution of vectors and associated pathogens. While the Arctic is not often considered a hotbed of vector-borne diseases, Jamestown Canyon virus (JCV) and Snowshoe Hare virus (SSHV) are mosquito-borne zoonotic viruses of the California serogroup endemic to the Canadian North. The viruses are maintained by transovarial transmission in vectors and circulate among vertebrate hosts, both of which are not well characterized in Arctic regions. While most human infections are subclinical or mild, serious cases occur, and both JCV and SSHV have recently been identified as leading causes of arbovirus-associated neurological diseases in North America. Consequently, both viruses are currently recognised as neglected and emerging viruses of public health concern. This review aims to summarise previous findings in the region regarding the enzootic transmission cycle of both viruses. We identify key gaps and approaches needed to critically evaluate, detect, and model the effects of climate change on these uniquely northern viruses. Based on limited data, we predict that (1) these northern adapted viruses will increase their range northwards, but not lose range at their southern limits, (2) undergo more rapid amplification and amplified transmission in endemic regions for longer vector-biting seasons, (3) take advantage of northward shifts of hosts and vectors, and (4) increase bite rates following an increase in the availability of breeding sites, along with phenological synchrony between the reproduction cycle of theorized reservoirs (such as caribou calving) and mosquito emergence.
Athletes are a group of people who have good activity, regular muscular exercise, an almost standard lifestyle, and should be in good condition with low rates of medical, particularly cardiovascular, complications. However, cardiac attacks, sudden cardiac deaths, and fatal arrhythmogenic syndromes have been reported in athletes with low incidences. We can determine external and internal factors that lead to cardiac attacks in athletes. The former include abnormal cardiac structures and genetics, while the latter include environmental conditions like extreme temperatures, smoking, and drug abuse. Here, we report a case of a cardiac attack with non-ST elevation myocardial infarction (NSTEMI) in a young athlete who was a non-smoker, did not have any abnormal heart structures or a history of drug abuse, and did not have a family history of cardiac disease or arrest. High humidity levels and temperatures were the main causes of the cardiac attack, which occurred during a sports exercise at high temperatures with high humidity levels. We hope to prevent the recurrence of such a case. We need to understand when and where sports exercises can be performed without the risk of medical complications.
Global warming has contributed to more frequent and severe extreme weather events, which has led to increased research on the health impacts of extreme heat. However, research on heatwaves, air quality, and their spatial impact on health service demand is limited. This study used machine learning (ML) approaches to obtain the optimised model to predict health service demand associated with those risk factors for an all-age model and compared it with young children (0-4 years) model in Perth. Ten years’ data (2006-2015) on emergency department attendances (EDA), socioeconomic status (SES), heatwaves, landscape fires, and gaseous and particulate air pollutants were collected. ML approaches, including decision tree, random forest (RF), and geographical random forest (GRF) models, were used to compare and select the best model for predicting EDA and identify important risk factors. Five-hundred cross validations were performed using the testing data, and a construct validation was performed by comparing actual and predicted EDA data. The results showed that the RF model outperformed other models, and SES, air quality, and heatwaves were among the important risk factors to predict EDA. The GRF model was fitted well to the data (R-2 = 0.975) and further showed that heatwaves had significant geographic variations and a joint effect with PM2.5 in the southern suburbs of the study area for young children. The RF and GRF models have satisfactory performance in predicting the impact of heatwaves, air quality, and SES on EDA. Heatwaves and air quality have great spatial heterogeneity. Spatial interactions between heatwaves, SES, and air quality measures were the most important predictive risk factors of EDA for young children in the Perth southern suburbs. Future studies are warranted to confirm the findings from this study on a wider scale.
Climate change has made disastrous heatwaves more frequent. Heatwave-related health impacts are much more devastating for more intense heatwaves. In the summer of 2017, exceptional heatwaves occurred in many regions, including China. This study aims to evaluate the cardiovascular mortality risk associated with the 2017 exceptional heatwaves and compare the mortality risk of the severe heatwaves with those in other years. Using daily data for a spectrum of cardiovascular mortality and temperature for 102 Chinese counties (2014-2017), we estimated the association between heatwave and mortality by generalized linear mixed-effects models. Compared with matched non-heatwave days, mortality risks on heatwaves days in 2017 increased 27.8% (95% CI, 14.8-42.3%), 26.7% (8.0-48.5%), 30.1% (10.2-53.7%), 27.3% (1.4-59.9%), 32.2% (3.4-68.4%), and 25.2% (1.0-57.7%) for total circulatory diseases, cerebrovascular disease, ischemic heart disease (IHD), acute IHD, chronic IHD, and myocardial infarction. The 2017 exceptional heatwaves impacted ischemic heart disease mortality and myocardial infarction mortality more than heatwaves in 2014-2016. Here we show that the severe heatwaves in 2017 posed catastrophic death threats for those under-studied cardiovascular diseases.
Urban heat has affected numerous cities with increasingly severe environmental, social, economic, and health impacts. It is urgent to develop plans and take actions to beat the heat before cities are locked into unintended consequences. An understanding of heat injustice is important to support heat plans and actions for accurately alleviating heat-related risks and threats, scientifically avoiding unexpected conflicts and disputes, and actively driving citizens to participate in actual implementation. Existing studies have primarily focused on effect-related injustice (e.g., morbidity and mortality), while a systematic understanding of heat injustice is lacking. To overcome this research gap, this study framed heat injustice in terms of cause-related, effect-related, and processrelated injustice, and empirically verified them based on a questionnaire survey in the Yangtze River Delta (YRD) and Chengdu-Chongqing Economic Circle (CCEC) regions. The survey results from 2704 respondents indicated that effect-related injustice and process-related injustice were geographically prominent in the YRD and CCEC regions. Socioeconomically, cause-related, effect-related, and process-related injustice occurred with the identification of groups who thought the heat was more severe were more susceptible to physiological and psychological impacts, and had lower levels of heat-related awareness and knowledge. The results also indicated that both YRD and CCEC regions should urgently develop heat action plans, which should be regionalized and group-specific. Urban planning and design for heat-resilient cities and setting temporary cooling shelters should be prioritized. Moreover, this study identified inconsistencies among higher levels of heat-related knowledge, lower levels of cooling strategy familiarity, and lower urgency of heat actions among the elderly, less educated, unhealthy, and wealthy groups. Overall, this study provides a reference for understanding heat injustice and formulating unbiased and implementable heat action plans.
Electric fans are proposed to mitigate indoor heat stress during heatwaves. Fan cooling threshold temperatures were determined by biophysical models. However, such models could only account for sweating adjustment and disregarded evident cardiovascular impairment in older adults. This study demonstrated the contribution of cardiovascular function adjustment to core temperature responses. Results revealed that focusing just on sweating adjustment greatly underestimated the actual heat stress experienced by older adults. It is not recommended to use biophysical models to determine the threshold temperature of electric fan use for older adults during heatwaves because cardiovascular adjustment was not possible.
Heatwaves have become increasingly frequent and intense, posing a significant threat to the survival and health of marine bivalves. The temperature fluctuations associated with heatwaves can cause significant alterations in the composition and quantity of microbial communities in bivalves, resulting in changes to their immunological responses, gut microbiome, oxidative stress levels, and other physiological processes and eventually making them more susceptible to diseases and mass mortalities. This is particularly concerning because some of these bivalves are consumed raw, which could represent a risk to human health. This paper provides an overview of the current state of knowledge regarding the impact of marine heatwaves on bivalves and their microbial communities, demonstrating the intricate relationship between heatwaves, microbial ecosystems, and bivalve health. Our analysis highlights the need for additional research to establish the underlying mechanisms of these reactions and to develop appropriate conservation and management strategies to limit the impact of heatwaves on bivalves and their microbial ecosystems.
Heat waves can cause dangerous elevations in body temperature that can compromise cellular function and increase the risk of heat stroke and major cardiovascular events. Visiting a cooling center or other air-conditioned location is commonly recommended by health agencies to protect heat-vulnerable older persons but the associated cellular effects remain underexplored. We evaluated cellular stress responses in peripheral blood mononuclear cells (PBMC) from 19 older adults [71 (SD 2) yr; 9 females] before and after a 9-h heat exposure [40.3°C and 9.3% relative humidity (RH)], with participants moved to a cool room (∼23°C) for hours 5 and 6 (cooling group). Responses were compared with 17 older adults [72 (4) yr; 7 females] who remained in the heat for the entire 9 h (control group). Changes in proteins associated with autophagy, apoptotic signaling, acute inflammation, and the heat shock response (HSR) were assessed via Western blot. Although both groups experienced similar elevations in physiological strain before the cooling center intervention, brief cooling resulted in stark albeit transient reductions in core temperature and heart rate. At end-exposure, autophagy proteins LC3-II and p62 were elevated 1.9-fold [95% CI: 1.2, 2.8] and 2.3-fold [1.4, 3.8], respectively, in the control group relative to cooling group. This was paired with a 2.8-fold [1.6, 4.7] greater rise in apoptotic protein cleaved-caspase-3 in the control group compared with the cooling group. Our findings indicate that 2 h of ambient cooling midway through a 9-h simulated heat wave may preserve autophagy and mitigate heat-induced cellular stress in older adults.NEW & NOTEWORTHY Heat waves can lead to dangerous elevations in body temperature, increasing the risk of life-threatening health conditions. Visiting a cooling center or other air-conditioned location is commonly recommended to protect heat-vulnerable older persons, although the effects on the cellular stress response remain unknown. We found that 2 h of ambient cooling midway through a 9 h simulated heat wave preserves autophagy, a vital cellular survival mechanism, and mitigates accompanying pathways of cellular stress in older adults.
While shade and air flow are recognised factors that reduce outdoor heat exposure, the level of reduction in terms of labour capacity at varying air temperature and humidity levels is poorly understood. This study investigated cooling effects on the commonly used heat index, wet bulb globe temperature (WBGT), and subsequent impact on labour capacity, for a range of air flow and shade conditions in warm to hot climates. We modelled heat exposure using a physics-based method to map WBGT for a case study region which experiences a range of heat categories with varying levels of health risks for outdoor workers. Continent-scale modelling confirmed significant spatial variability in the effect of various shade and wind speed scenarios across a range of real-world mid-summer daytime conditions. At high WBGTs, increasing shade or air flow for outdoor workers lowered heat exposure and increases labour capacity, with shade giving the greatest benefit, but cooling varied considerably depending upon underlying air temperature and humidity. Shade had the greater cooling effect; reducing incident radiation by 90% decreased WBGT by 2-6 °C depending on location. Wind had a lower cooling effect in the hottest regions, with a decreasing exponential relationship between wind speed and WBGT observed.
One Health is the collaborative efforts of multiple disciplines to attain optimal health for people, animals and the environment, a concept that historically owes much to the study of brucellosis, including recent political and ethical considerations. Brucellosis One Health actors include Public Health and Veterinary Services, microbiologists, medical and veterinary practitioners and breeders. Brucellosis awareness, and the correct use of diagnostic, epidemiological and prophylactic tools is essential. In brucellosis, One Health implementation faces inherited and new challenges, some aggravated by global warming and the intensification of breeding to meet growing food demands. In endemic scenarios, disease awareness, stakeholder sensitization/engagement and the need to build breeder trust are unresolved issues, all made difficult by the protean characteristics of this zoonosis. Extended infrastructural weaknesses, often accentuated by geography and climate, are critically important. Capacity-building faces misconceptions derived from an uncritical adoption of control/eradication strategies applied in countries with suitable means, and requires additional reference laboratories in endemic areas. Challenges for One Health implementation include the lack of research in species other than cattle and small ruminants, the need for a safer small ruminant vaccine, the need to fill in the infrastructure gap, the need for realistic capacity-building, the creation of reference laboratories in critical areas, and the stepwise implementation of measures not directly transposed from the so-called developed countries.
Chronic obstructive pulmonary disease (COPD) has been the third leading cause of death worldwide. As the traditional risk factors (like smoking and ambient air pollution) on the burden of COPD being well characterized, the burden of COPD due to non-optimal temperature has been widely concerned. In this study, we extracted the relevant burden data of COPD attributable to non-optimal temperature from GBD 2019 and adopted estimated annual percent changes, Gaussian process regression (GPR), and age-period-cohort model to evaluate the spatiotemporal patterns, relationships with socio-demographic level, and the independent effects of age, period and cohort from 1990 to 2019. In brief, the global COPD burden attributable to non-optimal temperatures showed declining trends but was still more severe in the elderly, males, Asia, and regions with low socio-demographic index (SDI). And cold had a greater burden than heat. The inverted U-shape is expected for the relationship between SDI and the burden of COPD caused by non-optimal temperatures according to the GPR model, with the inflection point around SDI 0.45. Besides, the improvements were observed in period and cohort effects but were relatively limited in low and low-middle SDI regions. Public health managers should execute more targeted programs to lessen this burden predominantly among lower SDI countries.
AIMS: To determine the global and regional burden of stroke due to high temperature and the spatiotemporal trends in 204 countries and territories from 1990 to 2019. METHODS: Based on Global Burden of Disease Study 2019, deaths, disability-adjusted life years (DALYs), and age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) for stroke attributable to high temperature (i.e. a daily mean temperature warmer than the theoretical minimum-risk exposure level (TMREL)) were calculated in global, geographical location, and country and analyzed by age, sex, subtypes, and socio-demographic index (SDI) from 1990 to 2019. The trends in ASMR and ASDR from 1990 to 2019 were estimated by linear regression model. The regression coefficients (β) referred to a mean change of per year for ASMR or ASDR attributable to high temperature. RESULTS: The global burden of stroke attributable to high temperature had an increase trend from 1990 to 2019 (β = 0.005, 95% uncertainty interval (UI) = 0.003-0.007 for ASMR and β = 0.104, 95% UI = 0.066-0.142 for ASDR, respectively). Globally, in 2019, an estimated 0.048 million deaths and 1.01 million DALYs of stroke were attributable to high temperature, and the global ASMR and ASDR of stroke attributable to high temperature were 0.60 (95% UI = 0.07-1.30) and 13.31 (1.40-28.97) per 100,000 population, respectively. The largest burden occurred in Western Sub-Saharan Africa, followed by South Asia, Southeast Asia, and North Africa and the Middle East. ASMR and ASDR increased with age and were higher in males and for intracerebral hemorrhage, and were the highest in the low SDI regions. In 2019, the region with the largest percentage increase in ASMR and ASDR attributable to high temperature was Eastern Sub-Saharan Africa from 1990 to 2019. CONCLUSIONS: Stroke burden due to high temperature has been increasing, and a higher burden was observed in people aged 65-75 years, males, and countries with a low SDI. Stroke burden attributable to high temperature constitutes a major global public health concern in the context of global warming.
The frequency and intensity of extreme thermal stress conditions during summer are expected to increase due to climate change. This study examines sixteen models from the Coupled Model Intercomparison Project Phase 6 (CMIP6) that have been bias-adjusted using the quantile delta mapping method. These models provide Universal Thermal Climate Index (UTCI) for summer seasons between 1979 and 2010, which are regridded to a similar spatial grid as ERA5-HEAT (available at 0.25° × 0.25° spatial resolution) using bilinear interpolation. The evaluation compares the summertime climatology and trends of the CMIP6 multi-model ensemble (MME) mean UTCI with ERA5 data, focusing on a regional hotspot in northwest India (NWI). The Pattern Correlation Coefficient (between CMIP6 models and ERA5) values exceeding 0.9 were employed to derive the MME mean of UTCI, which was subsequently used to analyze the climatology and trends of UTCI in the CMIP6 models.The spatial climatological mean of CMIP6 MME UTCI demonstrates significant thermal stress over the NWI region, similar to ERA5. Both ERA5 and CMIP6 MME UTCI show a rising trend in thermal stress conditions over NWI. The temporal variation analysis reveals that NWI experiences higher thermal stress during the summer compared to the rest of India. The number of thermal stress days is also increasing in NWI and major Indian cities according to ERA5 and CMIP6 MME. Future climate projections under different scenarios (SSP1-2.6, SSP2-4.5, and SSP5-8.5) indicate an increasing trend in thermal discomfort conditions throughout the twenty-first century. The projected rates of increase are approximately 0.09 °C per decade, 0.26 °C per decade, and 0.56 °C per decade, respectively. Assessing the near (2022-2059) and far (2060-2100) future, all three scenarios suggest a rise in intense heat stress days (UTCI > 38 °C) in NWI. Notably, the CMIP6 models predict that NWI could reach deadly levels of heat stress under the high-emission (SSP5-8.5) scenario. The findings underscore the urgency of addressing climate change and its potential impacts on human well-being and socio-economic sectors.
Testing for bacteria in water is done based on intended purposes, such as drinking, producing ice, utilizing it in the house, producing water taps, and processing water. Bacterial growth and survival in water are influenced by environmental factors, which may have consequences for human health. The purpose of this study was to identify factors influencing the failing standard of water quality for consumption. Water quality data from the annual report of Regional Medical Sciences Center and meteorological data from the National Statistical Office of Thailand were obtained for the fiscal years 2002-2021. A logistic regression model was used to identify factors associated with the failing standard of water quality for consumption. The findings revealed that 16.6% of the total sample did not meet the consumption standard, with Public Health Area (PHA) 11 and 12, failing at rates of 49.6% and 38.3%, respectively. Overall, water produced in PHA 11 was statistically (p-value < 0.05) substantially associated with bacterial contamination, which increased with production year, air temperature, and precipitation. In conclusion, environmental factors and other water quality were influential on biological water quality in Southern Thailand. Therefore, necessary measures must be taken to improve water quality standards in this area to safeguard the protection of consumers.
To prevent anthropogenic warming of the climate system above dangerous thresholds, governments are required by the Paris Agreement to peak global anthropogenic CO(2) emissions and to reach a net zero CO(2) emissions level (also known as carbon neutrality). Growing concerns are being expressed about the increasing heat stress caused by the interaction of changes in temperature and humidity in the context of global warming. Although much effort has been made to examine future changes in heat stress and associated risks, gaps remain in understanding the quantitative benefits of heat-risk avoidance from carbon-neutral policies, limited by the traditional climate projections from the Coupled Model Intercomparison Project Phase 6 (CMIP6). Here we quantify the avoided heat risk during 2040-2049 under two scenarios of global carbon neutrality by 2060 and 2050, i.e., moderate green (MODGREEN) and strong green (STRGREEN) recovery scenarios, relative to the baseline scenario (FOSSIL), based on multi-model large ensemble climate projections from a new climate model intercomparison project (CovidMIP) that endorsed by CMIP6. We show that global population exposure to extreme heat stress increases by approximately four times its current level during 2040-2049 under the FOSSIL scenario, whereas the heat exposure could be reduced by as much as 12 % and 23 % under the MODGREEN and STRGREEN scenarios, respectively. Moreover, global mean heat-related mortality risk is mitigated by 14 % (24 %) under the MODGREEN (STRGREEN) scenario during 2040-2049 relative to the FOSSIL scenario. Additionally, the aggravating heat risk could be mitigated by around a tenth by achieving carbon neutrality 10 years earlier (2050 versus 2060). In terms of spatial pattern, this heat-risk avoidance from low-carbon policies is typically greater in low-income countries. Our findings assist governments in advancing early climate change mitigation policy-making.
Using non-accidental mortality records from 195 sites and 11 model simulations from the Coupled Model Intercomparison Project phase 6, we assessed future avoidable heat-related deaths associated with emission mitigation after accounting for population changes in China. Without human-induced climate change in the 21st century, China’s heat-related mortality would drop by 48-72% (95% confidence interval (CI): 40-76%), especially at high latitudes and altitudes (up to 80%). Nationally, 15,576-87,612 (95% CI: 6605-106,736) heat-related deaths per year would potentially be avoided by reducing emissions. For most of China, temperature changes dominate the variation in heat-related deaths, while in Central and South China, population changes will have a greater influence. These not only reinforce the necessity of mitigating emissions but also suggest that adjusting population structure and spatial distribution could be applied in some areas to minimize warming impacts on public health. Notably, given that abatement will hardly bring immediate success within the next twenty years, more healthcare infrastructures are urgently needed to manage potential growing heat risks. Particularly in Northwest and South China, where future heat-related deaths would still be 110-140% of current levels (1995-2014) even without anthropogenic warming. We also found that without historical human-induced emissions, China’s low level of technology (medical and economic) might increase current heat-related mortality by 57%, even though warming could be mitigated. Consequently, we believe that mitigating climate change risks also requires consideration of the economic/medical losses from lowering emissions.
Global climate change has resulted in an increase in the number and intensity of environmental heat waves, both in areas traditionally associated with hot temperatures and in areas where heat waves did not previously occur. For military communities around the world, these changes pose progressively increasing risks of heat-related illnesses and interference with training sessions. This is a significant and persistent “noncombat threat” to both training and operational activities of military personnel. In addition to these important health and safety concerns, there are broader implications in terms of the ability of worldwide security forces to effectively do their job (particularly in areas that historically already have high ambient temperatures). In the present review, we attempt to quantify the impact of climate change on various aspects of military training and performance. We also summarize ongoing research efforts designed to minimize and/or prevent heat injuries and illness. In terms of future approaches, we propose the need to “think outside the box” for a more effective training/schedule paradigm. One approach may be to investigate potential impacts of a reversal of sleep-wake cycles during basic training during the hot months of the year, to minimize the usual increase in heat-related injuries, and to enhance the capacity for physical training and combat performance. Regardless of which approaches are taken, a central feature of successful present and future interventions will be that they are rigorously tested using integrative physiological approaches.
Insufficient sleep is known to have an impact on health, wellbeing, and productivity. Sleep has been explored extensively in the medical literature but has received scant attention in the built environment journals. With the climate becoming unpredictable, combined with the climate emergency and concerns over energy poverty, questions need to be asked about the suitability of the housing stock and, especially, bedrooms. This is pertinent for vulnerable individuals (e.g., very young, elder members of society, and those with medical conditions) who may be unable to adapt their sleep environment in extreme and prolonged heat events. The aim of this narrative review is to raise awareness of the complex inter-relationship between the sleeper and the bedroom in domestic properties. It highlights the vulnerability of sleepers and the need for adaptation strategies to cope with extreme heat events without resorting to mechanical air conditioning. It emphasises the need for interdisciplinary research to better inform stakeholders of the risks posed to sleep quality by climate change, and contributes positively to the promotion of health.
Climate change has led to significant health effects. This study uses data from the China Health and Nutrition Survey (CHNS) to analyze the effects of extreme heat on health. The results show that extreme heat increases morbidity, disease severity, hospitalization, and treatment costs. Each additional day of extreme high temper-ature leads to an increase of approximately CNY 38.97 million in health expenditure, which is a non-negligible health cost. We further consider the environmental migration situation and model specifications, and the results remain consistent. In addition, we find that male, rural, and unemployed residents are more vulnerable to extreme heat. Education and income can moderate the negative effects of extreme heat, while increasing age increases the health effects of extreme heat. In addition to the negative health effects of extreme heat, we find that extreme heat affects individual health by reducing physical activity and reducing walking commutes.
Extreme weather events and extreme poverty are two sides of the same coin, with far-reaching consequences for emerging nations like Pakistan. Rural people are more likely to experience poverty and inequality as climate change worsens. This research aspires to close the gap between environmental ethics and justice by investigating how climate change issues contribute to poverty in Pakistan. The study used Robust Least Squares (RLS) regression to analyze the impact of water scarcity, extreme temperatures, and excessive rainfall on rural poverty in Pakistan from 1990Q1 to 2022Q4. Further, the study examines the effect of environmental justice interventions, access to healthcare and education, agricultural value-added and agricultural mechanization on the country’s rural poverty. Results reveal that climate change contributes to rural poverty in Pakistan, while environmental justice initiatives, healthcare access, and agricultural automation alleviate poverty incidence. The Impulse Response Function (IRF) estimates suggested that rural poverty will be exacerbated over the next decade by water scarcity, high temperatures, and low agricultural value added but alleviated by excessive rainfall, environmental justice intervention, healthcare access, and agricultural mechanization. According to Variance Decomposition Analysis (VDA) projections, agricultural value added will substantially impact rural poverty by 2032, increasing it by 11.431%. Addressing these problems requires policymakers to prioritize the interests of the most marginalized groups by fostering fair results. Policies should cut GHG emissions and encourage sustainable development to combat climate change. Modernizing farming techniques and expanding access to healthcare are also necessary for increasing efficiency and production. It is essential to execute environmental justice interventions so that all communities have access to environmental resources and protections equitably. Promoting equitable outcomes and reducing poverty in Pakistan’s climate change context may be achieved by closing the gap between environmental ethics and justice.
The U.S. National Weather Service issues extreme heat warnings at 105 degrees F. The desert city of Phoenix, AZ, in the Southwest USA, regularly exceeds temperatures of 105 degrees between May and September. Yet, there is no word beyond ” extreme ” to describe these temperatures. Many residents of Metro Phoenix (including 24 municipalities and 5 + million people) have adapted to extreme heat by managing indoor temperatures using air conditioning, including low-cost and energy-efficient water-based evaporative (” swamp ”) coolers. The City of Phoenix implemented its first Heat Response Plan in 2022. However, record-breaking heat in 2023 disrupted long-standing heat and water management adaptations, and exacerbated existing heat vulnerabilities and water insecurities with disproportionate negative impacts on the growing population of people experiencing houselessness in Metro Phoenix. Beginning in late June, Phoenix experienced a record 31 consecutive days of temperatures over 110 degrees. The average high in July was 114.7 degrees and the average low was 90.8 degrees. We build upon and update the findings of our earlier study of the experiences of unsheltered individuals and communities in Phoenix between 2013 and 2016 (Palta et al., 2016).
Fine-scale personal heat exposure (PHE) information can help prevent or minimize weather-related deaths, illnesses, and reduced work productivity. Common methods to estimate heat risk do not simultaneously account for the intensity, frequency, and duration of thermal exposures, nor do they include inter-individual factors that modify physiological response. This study demonstrates new whole-body net thermal load estimations to link PHE to heat stress and strain over time. We apply a human-environment heat exchange model to examine how time-varying net thermal loads differ across climate contexts, personal attributes, and spatiotemporal scales. First, we investigate summertime climatic PHE impacts for three US cities: Phoenix, Miami, and New York. Second, we model body morphology and acclimatization for three profiles (middle-aged male/female; female >65 years). Finally, we quantify model sensitivity using representative data at synoptic and micro-scales. For all cases, we compare required and potential evaporative heat losses that can lead to dangerous thermal exposures based on (un)compensable heat stress. Results reveal misclassifications in heat stress or strain due to incomplete environmental data and assumed equivalent physiology and activities between people. Heat strain is most poorly represented by PHE alone for the elderly, non-acclimatized, those engaged in strenuous activities, and when negating solar radiation. Moreover, humid versus dry heat across climates elicits distinct thermal responses from the body. We outline criteria for inclusive PHE evaluations connecting heat exposure, stress, and strain while using physiological-based methods to avoid misclassifications. This work underlines the value of moving from “one-size-fits-all” thermal indices to “fit-for-purpose” approaches using personalized information.
The concentration of human activities in urban areas, increasing greenhouse gas emissions, and high global temperature values in urban areas have accelerated the research on global warming. They are the most widely used bioclimatic indices to describe the level of thermal sensation experienced by a person due to the changing climatic conditions of an urban area. Thermal comfort is an interdisciplinary spatial issue and a parameter directly affecting urban outdoor land uses. Thom’s discomfort index was used to simulate two different climate change scenarios. This study aimed to predict the temporal and spatial changes of surface temperature, relative humidity, and bioclimatic comfort zones of Kocaeli province in terms of climate comfort in the context of SSP 245 and SSP 585 scenarios of IPCC. The current bioclimatic comfort areas throughout the region and their possible situations in 2040, 2060, 2080, and 2100 were modeled using ArcGIS 10.8 software. In the current map, 79.6% of the city consists of cool areas, 18.6% of cold, and 1.8% of comfortable regions. According to the SSP 245 scenario for the year 2100, it is observed that the cool and cold areas warm up, and the comfortable areas increase to 23.5%. According to the SSP 585 scenario, it was determined that comfortable areas reached 82.6%, and hot areas were formed in the province. The geographical structure’s effect on the regions’ heating draws attention.
Substance use disorder is a growing public health challenge in the United States. People who use drugs may be more vulnerable to ambient heat due to the effects of drugs on thermoregulation and their risk environment. There have been limited population-based studies of ambient temperature and drug-related morbidity. We examined short-term associations between daily ambient temperature and emergency department (ED) visits for use or overdose of amphetamine, cocaine and opioids in California during the period 2005 to 2019. Daily ZIP code-level maximum, mean, and minimum temperature exposures were derived from 1-km data Daymet products. A time-stratified case-crossover design was used to estimate cumulative non-linear associations of daily temperature for lag days 0 to 3. Stratified analyses by patient sex, race, and ethnicity were also conducted. The study included over 3.4 million drug-related ED visits. We found positive associations between daily temperature and ED visits for all outcomes examined. An increase in daily mean temperature from the 50th to the 95th percentile was associated with ED visits for amphetamine use (OR = 1.072, 95% CI: 1.058, 1.086), cocaine use (OR = 1.044, 95% CI: 1.021, 1.068 and opioid use (OR = 1.041, 95% CI: 1.025, 1.057). Stronger positive associations were also observed for overdose: amphetamine overdose (OR = 1.150, 95% CI: 1.085, 1.218), cocaine overdose (OR = 1.159, 95% CI: 1.053, 1.276), and opioid overdose (OR = 1.079, 95% CI: 1.054, 1.106). In summary, people who use stimulants and opioids may be a subpopulation sensitive to short-term higher ambient temperature. Mitigating heat exposure can be considered in harm reduction strategies in response to the substance use epidemic and global climate change.
Evidence describing the relationship between short-term temperature exposure and kidney-related conditions is insufficient. It remains unclear how temperature specification affects estimation of these associations. This study aimed to assess associations between short-term temperature exposure and seven kidney-related conditions and to evaluate the influence of temperature specification. METHODS: We obtained data on hospital encounters in New York State (2007-2016). We assessed associations with a case-crossover design using conditional logistic regression with distributed lag non-linear models. We compared model performance (i.e., AIC) and association curves using 1) five temperature spatial resolutions; 2) temperature on an absolute versus relative scale; 3) seven temperature metrics incorporating humidity, wind speed, and/or solar radiation; and 4) five intraday temperature measures (e.g., daily minimum and daytime mean). RESULTS: We included 1,209,934 unplanned adult encounters. Temperature metric and intraday measure had considerably greater influence than spatial resolution and temperature scale. For outcomes not associated with temperature exposure, almost all metrics or intraday measures showed good model performance; for outcomes associated with temperature, there were meaningful differences in performance across metrics or intraday measures. For parsimony, we modelled daytime mean outdoor wet-bulb globe temperature, which showed good performance for all outcomes. At lag 0-6 days, we observed increased risk at the 95(th) percentile of temperature versus the minimum morbidity temperature for acute kidney failure (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.09, 1.69), urolithiasis (OR = 1.41, 95% CI: 1.16, 1.70), dysnatremia (OR = 1.26, 95% CI: 1.01, 1.59), and volume depletion (OR = 1.88, 95% CI: 1.41, 2.51), but not for glomerular diseases, renal tubulo-interstitial diseases, and chronic kidney disease. CONCLUSIONS: High-temperature exposure over one week is a risk factor for acute kidney failure, urolithiasis, dysnatremia, and volume depletion. The differential model performance across temperature metrics and intraday measures indicates the importance of careful selection of exposure metrics when estimating temperature-related health burden.
Previous studies have reported an association between warm temperature and asthma hospitalisation. They have reported different sex-related and age-related vulnerabilities; nevertheless, little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation and warm temperature and investigate vulnerabilities by age, sex, time and space. METHODS: We retrieved individual-level data on summer asthma hospitalisation at high temporal (daily) and spatial (postcodes) resolutions during 2002-2019 in England from the NHS Digital. Daily mean temperature at 1 km×1 km resolution was retrieved from the UK Met Office. We focused on lag 0-3 days. We employed a case-crossover study design and fitted Bayesian hierarchical Poisson models accounting for possible confounders (rainfall, relative humidity, wind speed and national holidays). RESULTS: After accounting for confounding, we found an increase of 1.11% (95% credible interval: 0.88% to 1.34%) in the asthma hospitalisation risk for every 1°C increase in the ambient summer temperature. The effect was highest for males aged 16-64 (2.10%, 1.59% to 2.61%) and during the early years of our analysis. We also found evidence of a decreasing linear trend of the effect over time. Populations in Yorkshire and the Humber and East and West Midlands were the most vulnerable. CONCLUSION: This study provides evidence of an association between warm temperature and hospital admission for asthma. The effect has decreased over time with potential explanations including temporal differences in patterns of heat exposure, adaptive mechanisms, asthma management, lifestyle, comorbidities and occupation.
Diagnosing dynamical changes in the climate system, such as those in atmospheric circulation patterns, remains challenging. Here, we study 1950 to 2021 trends in the frequency of occurrence of atmospheric circulation patterns over the North Atlantic. Roughly 7% of atmospheric circulation patterns display significant occurrence trends, yet they have major impacts on surface climate. Increasingly frequent patterns drive heatwaves across Europe and enhanced wintertime storminess in the northern part of the continent. Over 91% of recent heatwave-related deaths and 33% of high-impact windstorms in Europe were concurrent with increasingly frequent atmospheric circulation patterns. While the trends identified are statistically significant, they are not necessarily anthropogenic. Atmospheric patterns which are becoming rarer correspond instead to wet, cool summer conditions over northern Europe and wet winter conditions over continental Europe. The combined effect of these circulation changes is that of a strong, dynamically driven year-round warming over most of the continent and large regional and seasonal changes in precipitation and surface wind.
Though building-scale energy demand and indoor thermal comfort have been extensively covered by recent studies, the automation of middle- and larger-scale outdoor microclimate evaluation in parametric design is less covered. The relatively slow computation and the need for sophisticated expertise are some of the current issues. This paper proposes a Rhino-Grasshopper custom script to automatically compute spatial indicators for a quick thermal comfort estimation. The Galapagos evolutionary algorithm is used to optimize thermal comfort and select the best combinations of spatial indicators. In a summer case study located in Shantou, China, the proposed workflow was three times faster than a non-automated indicator calculation in ArcGIS, while the optimization method achieved 25% to 33% reduction in land areas under extreme heat stress. This automated process applies to existing states and new urban designs. It is adaptable to customized prediction models under different climatic zones.
In this review, we first assess the state of agricultural health and safety research as it pertains to the dynamic challenges facing automating agriculture on a warming planet. Then, we turn to social science fields such as rural sociology, science and technology studies, and environmental studies to leverage relevant insights on the introduction of new technologies, environmental risks, and associated workplace hazards. Increased rates of automation in agriculture alongside new risks associated with climate change create the need for anticipatory governance and adaptive research to study novel mechanisms of worker health and safety. The use of the PRISMA framework led to the 137 articles for our review. We identify three themes in the literature on agricultural health and safety: (1) adoption outcomes, (2) discrete cases of health risks, and (3) an emphasis on care and wellbeing in literature on dairy automation Our review led to the identification of research gaps, noting that current research (a) tends to examine these forces separately, instead of together, (b) has not made robust examination of these forces as socially embedded, and (c) has hesitated to examine the broad, transferable themes for how these forces work across industries. In response to these gaps, we suggest that attention to outside disciplines may provide agricultural health and safety research with a toolset to examine needed inquiry into the multiplicity of experiences of rural stakeholders, the industry specific problems arising from automation and climate change, and the socially embedded aspects of agricultural work in the future.
Although the association between ambient temperature and mortality in local populations is evident, this relationship remains unclear in transient populations (e.g., due to immigration, mass gatherings, or displacement). The holy city of Mecca annually shelters two populations comprising its residents and the transitory Hajj pilgrims ( > 2 million people from > 180 countries). Both live side by side in a hot desert climate, rendering the development of evidence-based heat-protective measures challenging. OBJECTIVES: We aimed to characterize the ambient temperature-mortality relationship and burden for the Mecca resident and Hajj transient populations, which have distinct levels of adaptation to ambient temperature. METHODS: We analyzed daily air temperature and mortality data for Mecca residents and pilgrims over nine Hajj seasons between 2006 and 2014, using a fitted standard time-series Poisson model. We characterized the temperature-mortality relationship with a distributed lag nonlinear model with 10 d of lag. We determined the minimum mortality temperature (MMT) and attributable deaths for heat and cold for the two populations. RESULTS: The median average daily temperature during the Hajj seasons was 30°C (19°C-37°C). There were 8,543 and 10,457 nonaccidental deaths reported during the study period among Mecca residents and pilgrims, respectively. The MMT was 2.5°C lower for pilgrims in comparison with the MMT for Mecca residents (23.5°C vs. 26.0°C). The temperature-mortality relationship shape varied from inverted J to U shape for the Mecca and pilgrim populations, respectively. Neither hot nor cold temperatures had a statistically significant association with mortality in Mecca residents. In contrast, for pilgrims, elevated temperatures were associated with significantly high attributable mortality of 70.8% [95% confidence interval (CI): 62.8, 76.0]. The effect of heat on pilgrims was immediate and sustained. DISCUSSION: Our findings indicate that pilgrims and Mecca residents exposed to the same hot environmental conditions exhibited distinct health outcomes. This conclusion suggests that a precision public health approach may be warranted to protect against high environmental temperature during mass gatherings of diverse populations. https://doi.org/10.1289/EHP9838.
IMPORTANCE: Intimate partner violence (IPV), including physical, sexual, and emotional violence, constitutes a critical public health problem, particularly in low- and middle-income countries. While climate change could escalate violent events, data quantifying its possible association with IPV are scant. OBJECTIVE: To evaluate the association of ambient temperature with the prevalence of IPV among partnered women in low- and middle-income countries in South Asia, and to estimate the association of future climate warming with IPV. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Demographic and Health Survey and included 194 871 ever-partnered women aged 15 to 49 years from 3 South Asian countries (India, Nepal, and Pakistan). The study applied the mixed-effect multivariable logistic regression model to investigate the association of ambient temperature with IPV prevalence. The study further modeled the change in IPV prevalence under various future climate change scenarios. The data included in the analyses were collected from October 1, 2010, to April 30, 2018, and the current analyses were performed from January 2, 2022, to July 11, 2022. EXPOSURE: Annual ambient temperature exposure for each woman, estimated based on an atmospheric reanalysis model of the global climate. MAIN OUTCOMES AND MEASURES: The prevalence of IPV and its types (physical, sexual, and emotional violence) were assessed based on self-reported questionnaires from October 1, 2010, to April 30, 2018, and the changes in the prevalence with climate changes were estimated through the 2090s. RESULTS: The study included 194 871 ever-partnered women aged 15 to 49 years (mean [SD] age, 35.4 [7.6] years; overall IPV prevalence, 27.0%) from 3 South Asian countries. The prevalence of physical violence was highest (23.0%), followed by emotional (12.5%), and sexual violence (9.5%). The annual temperature ranges were mostly between 20 °C and 30 °C. A significant association was found between high ambient temperature and the prevalence of IPV against women, with each 1 °C increase in the annual mean temperature associated with a mean increase in IPV prevalence of 4.49% (95% CI, 4.20%-4.78%). According to the study’s projections under the unlimited emissions scenarios (SSPs [shared socioeconomic pathways], as defined by the Intergovernmental Panel on Climate Change] 5-8.5), IPV prevalence would increase by 21.0% by the end of the 21st century, while it would only moderately increase under increasingly stricter scenarios (SSP2-4.5 [9.8%] and SSP1-2.6 [5.8%]). In addition, the projected increases in the prevalence of physical (28.3%) and sexual (26.1%) violence were greater than that of emotional violence (8.9%). In the 2090s, India was estimated to experience the highest IPV prevalence increase (23.5%) among the 3 countries, compared with Nepal (14.8%) and Pakistan (5.9%). CONCLUSIONS AND RELEVANCE: This cross-sectional, multicountry study provides ample epidemiological evidence to support that high ambient temperature may be associated with the risk of IPV against women. These findings highlight the vulnerabilities and inequalities of women experiencing IPV in low- and middle-income countries in the context of global climate warming.
Further research is needed to examine the nationwide impact of temperature on health in Brazil, a region with particular challenges related to climate conditions, environmental characteristics, and health equity. To address this gap, in this study, we looked at the relationship between high ambient temperature and hospital admissions for circulatory and respiratory diseases in 5572 Brazilian municipalities between 2008 and 2018. We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by PM(2.5), O(3), relative humidity, and time-varying confounders. We estimated relative risks (RRs) of the association of heat (percentile 99th) with hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. In the second stage, we applied meta-analysis with random effects to estimate the national RR. Our study population includes 23,791,093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. The robustness of the RR and the effect size varied significantly by region, sex, age group, and health outcome. Overall, our findings suggest that i) respiratory admissions had the highest RR, while circulatory admissions had inconsistent or null RR in several subgroup analyses; ii) there was a large difference in the cumulative risk ratio across regions; and iii) overall, women and the elderly population experienced the greatest impact from heat exposure. The pooled national results for the whole population (all ages and sex) suggest a relative risk of 1.29 (95% CI: 1.26; 1.32) associated with respiratory admissions. In contrast, national meta-analysis for circulatory admissions suggested robust positive associations only for people aged 15-45, 46-65, >65 years old; for men aged 15-45 years old; and women aged 15-45 and 46-65 years old. Our findings are essential for the body of scientific evidence that has assisted policymakers to promote health equity and to create adaptive measures and mitigations.
IMPORTANCE: Associations between heat waves and preterm birth (PTB) have been reported. However, associations of daytime-only, nighttime-only, and compound heat waves with PTB have yet to be explored at a national level. Furthermore, possible heterogeneity across urban-rural communities with different socioeconomic statuses needs to be explored. OBJECTIVE: To examine the association between daytime-only, nighttime-only, and compound heat waves and PTB in China and to find variations between urban and rural regions. DESIGN, SETTING, AND PARTICIPANTS: This case-crossover study used nationwide representative birth data between January 1, 2012, and December 31, 2019, from China’s National Maternal Near Miss Surveillance System. This multisite study covered 30 provinces in China and ensured the representation of urban and rural populations across 3 socioeconomic regions. Singleton live births delivered in the warm seasons from April to October during the study period were included. Exclusion criteria consisted of gestational age younger than 20 or older than 45 weeks, maternal ages younger than 13 or older than 50 years, conception dates earlier than 20 weeks before January 1, 2012, and later than 45 weeks before December 31, 2019, and an inconsistent combination of birthweight and gestational age according to growth standard curves of Chinese newborns. Data were analyzed from September 10, 2021, to April 25, 2023. EXPOSURES: Eighteen definitions of heat waves by 3 distinct types, including daytime only (only daily maximum temperature exceeds thresholds), nighttime only (only daily minimum temperature exceeds thresholds), and compound (both daily maximum and minimum temperature exceeds thresholds) heat waves, and 6 indexes, including 75th percentile of daily temperature thresholds for 2 or more (75th-D2), 3 or more (75th-D3), or 4 or more (75th-D4) consecutive days and 90th percentile of daily temperature thresholds for 2 or more (90th-D2), 3 or more (90th-D3), and 4 or more (90th-D4) consecutive days. MAIN OUTCOMES AND MEASURES: Preterm births with less than 37 completed weeks of gestation. RESULTS: Among the 5 446 088 singleton births in the final analytic sample (maternal mean [SD] age, 28.8 [4.8] years), 310 384 were PTBs (maternal mean [SD] age, 29.5 [5.5] years). Compared with unexposed women, exposure of pregnant women to compound heat waves in the last week before delivery was associated with higher risk for PTB, with the adjusted odds ratios (AORs) ranging from 1.02 (95% CI, 1.00-1.03) to 1.04 (95% CI, 1.01-1.07) in 6 indexes. For daytime-only heat wave exposures, AORs ranged from 1.03 (95% CI, 1.01-1.05) to 1.04 (95% CI, 1.01-1.08) in the 75th-D4, 90th-D2, 90th-D3, and 90th-D4 indexes. Such associations varied by rural (AOR range, 1.05 [95% CI, 1.01-1.09] to 1.09 [95% CI, 1.04-1.14]) and urban (AOR range, 1.00 [95% CI, 0.98-1.02] to 1.01 [95% CI, 0.99-1.04]) regions during exposure to daytime-only heat waves in the 75th-D3 and 90th-D3 indexes. CONCLUSIONS AND RELEVANCE: In this case-crossover study, exposure to compound and daytime-only heat waves in the last week before delivery were associated with PTB, particularly for pregnant women in rural regions exposed to daytime-only heat waves. These findings suggest that tailored urban-rural preventive measures may improve maternal health in the context of climate change.
Extreme temperatures are a major public health concern, as they have been linked to an increased risk of mortality from circulatory and respiratory diseases. Brazil, a country with vast geographic and climatic variations, is particularly vulnerable to the health impacts of extreme temperatures. In this study, we examined the nationwide (considering 5572 municipalities) association of low and high ambient temperature (1st and 99th percentiles) with daily mortality for circulatory and respiratory diseases in Brazil between 2003 and 2017. We used an extension of the two-stage time-series design. First, we applied a case time series design in combination with distributed lag non-linear modeling (DLMN) framework to assess the association by Brazilian region. Here, the analyses were stratified by sex, age group (15-45, 46-65, and >65 years), and cause of death (respiratory and circulatory mortality). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our study population included 1,071,090 death records due to cardiorespiratory diseases in Brazil over the study period. We found increased risk of respiratory and circulatory mortality associated with low and high ambient temperatures. The pooled national results for the whole population (all ages and sex) suggest a relative risk (RR) of 1.27 (95% CI: 1.16; 1.37) and 1.11 (95% CI: 1.01; 1.21) associated with circulatory mortality during cold and heat exposure, respectively. For respiratory mortality, we estimated a RR of 1.16 (95% CI: 1.08; 1.25) during cold exposure and a RR of 1.14 (95% CI: 0.99; 1.28) during heat exposure. The national meta-analysis indicated robust positive associations for circulatory mortality on cold days across several subgroups by sex and age, while only a few subgroups presented robust positive associations for circulatory mortality on warm days and respiratory mortality on both cold and warm days. These findings have important public health implications for Brazil and suggest the need for targeted interventions to mitigate the adverse effects of extreme temperatures on human health.
OBJECTIVE: Heat exposure and heat stress/strain is a concern for many workers. There is increasing interest in potential chronic health effects of occupational heat exposure, including cancer risk. We examined potential associations of occupational heat exposure and colorectal cancer (CRC) risk in a large Spanish multi-case–control study. METHODS: We analyzed data on 1198 histologically confirmed CRC cases and 2690 frequency-matched controls. The Spanish job-exposure matrix, MatEmEsp, was used to assign heat exposure estimates to the lifetime occupations of participants. Three exposure indices were assessed: ever versus never exposed, cumulative exposure and duration (years). We estimated odds ratios (OR) and 95% confidence intervals (CI) using unconditional logistic regression adjusting for potential confounders. RESULTS: Overall, there was no association of ever, compared with never, occupational heat exposure and CRC (OR 1.09, 95% CI 0.92-1.29). There were also no associations observed according to categories of cumulative exposure or duration, and there was no evidence for a trend. There was no clear association of ever occupational heat exposure and CRC in analysis conducted among either men or women when analyzed separately. Positive associations were observed among women in the highest categories of cumulative exposure (OR 1.81, 95% CI 1.09-3.03) and duration (OR 2.89, 95% CI 1.50-5.59) as well as some evidence for a trend (P<0.05). CONCLUSION: Overall, this study provides no clear evidence for an association between occupational heat exposure and CRC.
IMPORTANCE: Little is known about long-term associations of early-life exposure to extreme temperatures with child health and lung function. OBJECTIVES: To investigate the association of prenatal and postnatal heat or cold exposure with newborn lung function and identify windows of susceptibility. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study (SEPAGES) recruited pregnant women in France between July 8, 2014, and July 24, 2017. Data on temperature exposure, lung function, and covariates were available from 343 mother-child dyads. Data analysis was performed from January 1, 2021, to December 31, 2021. EXPOSURES: Mean, SD, minimum, and maximum temperatures at the mother-child’s residence, estimated using a state-of-the-art spatiotemporally resolved model. MAIN OUTCOMES AND MEASURES: Outcome measures were tidal breathing analysis and nitrogen multiple-breath washout test measured at 2 months of age. Adjusted associations between both long-term (35 gestational weeks and first 4 weeks after delivery) and short-term (7 days before lung function test) exposure to ambient temperature and newborn lung function were analyzed using distributed lag nonlinear models. RESULTS: A total of 343 mother-child pairs were included in the analyses (median [IQR] maternal age at conception, 32 [30.0-35.2] years; 183 [53%] male newborns). A total of 246 mothers and/or fathers (72%) held at least a master’s degree. Among the 160 female newborns (47%), long-term heat exposure (95th vs 50th percentile of mean temperature) was associated with decreased functional residual capacity (-39.7 mL; 95% CI, -68.6 to -10.7 mL for 24 °C vs 12 °C at gestational weeks 20-35 and weeks 0-4 after delivery) and increased respiratory rate (28.0/min; 95% CI, 4.2-51.9/min for 24 °C vs 12 °C at gestational weeks 14-35 and weeks 0-1 after delivery). Long-term cold exposure (5th vs 50th percentile of mean temperature) was associated with lower functional residual capacity (-21.9 mL; 95% CI, -42.4 to -1.3 mL for 1 °C vs 12 °C at gestational weeks 15-29), lower tidal volume (-23.8 mL; 95% CI, -43.1 to -4.4 mL for 1 °C vs 12 °C at gestational weeks 14-35 and weeks 0-4 after delivery), and increased respiratory rate (45.5/min; 95% CI, 10.1-81.0/min for 1 °C vs 12 °C at gestational weeks 6-35 and weeks 0-1 after delivery) in female newborns as well. No consistent association was observed for male newborns or short-term exposure to cold or heat. CONCLUSIONS AND RELEVANCE: In this cohort study, long-term heat and cold exposure from the second trimester until 4 weeks after birth was associated with newborn lung volumes, especially among female newborns.
Recent record-breaking hot temperatures in Alaska have raised concerns about the potential human health implications of heat exposure among this unacclimated population. OBJECTIVES: We estimated cardiorespiratory morbidity associated with days above summer (June-August) heat index (HI, apparent temperature) thresholds in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) for the years 2015-2019. METHODS: We implemented time-stratified case-crossover analyses of emergency department (ED) visits for International Classification of Diseases, 10(th) Revision codes indicative of heat illness and major cardiorespiratory diagnostic codes using data from the Alaska Health Facilities Data Reporting Program. Using conditional logistic regression models, we tested maximum hourly HI temperature thresholds between 21.1°C (70°F) and 30°C (86°F) for a single day, 2 consecutive days, and the absolute number of previous consecutive days above the threshold, adjusting for the daily average concentration of particulate matter ≤ 2.5 μg. RESULTS: There were increased odds of ED visits for heat illness above a HI threshold as low as 21.1°C (70°F) [odds ratio (OR) = 13.84; 95% confidence interval (CI): 4.05, 47.29], and this increased risk continued for up to 4 d (OR = 2.43; 95% CI: 1.15, 5.10). Asthma and pneumonia were the only respiratory outcomes positively associated with the HI: ED visits for both were highest the day after a heat event (Asthma: HI > 27°C (80°F) OR = 1.18; 95% CI: 1.00, 1.39; Pneumonia: HI > 28°C (82°F) OR = 1.40; 95% CI: 1.06, 1.84). There was a decreased odds of bronchitis-related ED visits when the HI was above thresholds of 21.1-28°C (70-82°F) across all lag days. We found stronger effects for ischemia and myocardial infarction (MI) than for respiratory outcomes. Multiple days of warm weather were associated with an increased risk of health impacts. For each additional preceding day above a HI of 22°C (72°F), the odds of ED visits related to ischemia increased 6% (95% CI: 1%, 12%); for each additional preceding day above a HI of 21.1°C (70°F), the odds of ED visits related to MI increased 7% (95% CI: 1%, 14%). DISCUSSION: This study demonstrates the importance of planning for extreme heat events and developing local guidance for heat warnings, even in areas with historically mild summertime climates. https://doi.org/10.1289/EHP11363.
OBJECTIVE: Growing evidence suggests that environmental heat stress negatively influences fetal growth and pregnancy outcomes. However, few studies have examined the impact of heat stress on pregnancy outcomes in low-resource settings. We combined data from a large multi-country maternal-child health registry and meteorological data to assess the impacts of heat stress. DESIGN: Retrospective cohort study. SETTING: Three sites based in south Asia as part of the Global Network for Women’s and Children’s Health research in India (Belagavi and Nagpur) and Pakistan (Thatta). POPULATION OR SAMPLE: Data from women enrolled between 2014 and 2020 in the Global Network’s Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnancies, were used. METHODS: A total of 126 273 pregnant women were included in this analysis. Daily maximal air temperatures (T(max) ) were acquired from local meteorological records. Associations between averages of daily maximal temperatures for each trimester and main outcomes were analysed using a modified Poisson regression approach. MAIN OUTCOMES MEASURES: Incidence of stillbirth, preterm birth, low birthweight (<2500 g) or evidence of pregnancy hypertension or pre-eclampsia. RESULTS: In the overall cohort, risk of preterm birth was positively associated with greater temperature in the second trimester (relative risk [RR] 1.05, 95% CI 1.02-1.07, p = 0.0002). Among individual sites, the risk of preterm birth was greatest in Nagpur (RR 1.07, 95% CI 1.03-1.11, p = 0.0005) and associated with second-trimester temperature. The overall risk of low birthweight was associated with ambient temperature in second trimester (RR 1.02, 95% CI 1.01-1.04, p = 0.01). The risk for LBW was associated with first-trimester heat in Thatta and with second-trimester heat in Nagpur. Finally, the overall risk of gestational hypertensive disease was associated with greater temperature in the third trimester among all sites (RR 1.07, 95% CI 1.02-1.12, p = 0.005) and was particularly significant for Nagpur (RR 1.13, 95% CI 1.05-1.23, p = 0.002). These findings highlight the increased risk of detrimental obstetric and neonatal outcomes with greater temperature. CONCLUSION: In a multi-country, community-based study, greater risk of adverse outcomes was observed with increasing temperature. The study highlights the need for deeper understanding of covarying factors and intervention strategies, especially in regions where high temperatures are common.
BACKGROUND: Hypertensive disorders in pregnancy (HDP) are a major cause of maternal mortality and morbidity. Recent studies indicated that pregnant women are the most vulnerable populations to ambient temperature influences, but it affected HDP with inconsistent conclusions. Our objective is to systematically review whether extreme temperature exposure is associated with a changed risk for HDP. METHOD: We searched PubMed, EMBASE, Web of Science and Cochrane Library databases. We included cohort or case control studies examining the association between extreme temperature exposure before or during pregnancy and HDP. Heat sources such as saunas and hot baths were excluded. We pooled the odds ratio (OR) to assess the association between extreme temperature exposure and preeclampsia or eclampsia. RESULTS: Fifteen studies involving 4,481,888 patients were included. Five studies were included in the meta-analysis. The overall result demonstrated that in the first half of pregnancy, heat exposure increases the risk of developing preeclampsia or eclampsia and gestational hypertension, and cold exposure decreases the risk. The meta-analysis revealed that during the first half of pregnancy, heat exposure increased the risk of preeclampsia or eclampsia (OR 1.54, 95% confidence interval (CI): 1.10, 2.15), whereas cold exposure decreased the risk (OR 0.90, 95% CI: 0.84, 0.97). CONCLUSION: The ambient temperature is an important determinant for the development of HDP, especially for preeclampsia or eclampsia. The effects of extreme temperatures may be bidirectional during the different trimesters of pregnancy, which should be evaluated by future studies. This review provided hints of temperature regulation in HDP administration.
Urbanisation has changed local meteorological conditions worldwide. The physical features of outdoor spaces are critical in determining outdoor thermal comfort through changes in meteorological parameters. Past studies comparing subjective thermal perception between local climate zones (LCZ) were mainly conducted in humid subtropical regions. This study aims to investigate this relationship using outdoor thermal comfort survey data collected in three research projects in Melbourne, Australia (temperate oceanic climate) (n = 4717). The physical features investigated included the sky view factor (SVF) and LCZ classification. During Melbourne’s summer, people preferred a higher PET value than neutral PET across all LCZs. People in urban green spaces (LCZs B and C) were more likely to feel ‘neutral’ when Physiological Equivalent Temperature (PET) was 15.5 degrees C-24.5 degrees C and less likely to feel ‘slightly warm to hot’ when PET was 24.6 degrees C-55.6 degrees C. Furthermore, LCZ 6 (LCZ C) reported the highest (lowest) percentage of unacceptable votes. Cluster analysis identified two thermal comfort patterns (neutral and warm groups) representing various thermal sensations and preferences. The thermal comfort pat-terns proportion differed between built LCZs (5, 6) and land cover LCZs (B, C). Logistic regression revealed that PET values and urban morphology (i.e., LCZ) contributed significantly to people’s thermal sensations and acceptability for neutral and warm groups. SVF significantly predicted the thermal sensation and acceptability for the warm group but not the neutral group. Our study approach informs further research to understand the implications of urban design in outdoor spaces using thermal comfort patterns as a benchmark.
The urgent need to adapt urban environments to extreme weather conditions due to global warming has become a priority when allocating European funds. Current regional retrofitting plans focus on improving the well-being of the most vulnerable families by upgrading their homes. However, as there is no adequate characterization of the environmental behaviour of housing stock, local agents in charge of the management of social housing lack a procedure to identify the urban areas most urgently in need of retrofitting.This research aims to present a protocol for evaluating the vulnerability to overheating of social housing stock at a regional scale, as a prioritization decision support system. Parametric tech-niques for Building Stock Modelling were used in the development of 3000 models located in four climatic zones of southern Spain to assess their thermal behaviour considering adaptive comfort equations. Moreover, an index of vulnerability to overheating has been defined by normalizing comfort assessment through cooling degree-days. The comfort assessment outcome corresponds more closely with the analysis of cooling degree-days than with the Spanish regulations’ climatic zoning. According to the results, in the hottest climatic zone, occupants frequently endure discomfort up to 40% of the summertime, with hourly deviations of up to 7 degrees C above the indoor temperature comfort range.
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, ranking first in the global disease burden. Evidence on association between temperature and cardiovascular disease is insufficient and inconsistent in developing countries. In this study, a distributed lag nonlinear model (DLNM) was used to determine the association between daily mean temperature and cardiovascular diseases (CVD) related admission in Lanzhou 2015-2019. We included 41,389 patients with CVD in this study. The relative risk (RR) of CVD admission increased significantly with temperature in lag 5-10 days, and we found harvesting effect of temperature in the study, shown as decreased RR in lag 15-30 days. The maximum RR was 1.15 (95% confidence interval [CI]: 1.03-1.30), corresponding to 24 °C. Both cold and heat effects of temperature could impact the CVD admission. Compared with the 25th percentile of temperature (2 °C), the cumulative relative risk (cumRR) of extreme cold (-5 °C, the 2.5th percentile of the temperature) was 0.69 (95% CI: 0.51-0.94) in lag 0-14, whereas the cumRR of moderate cold (-2 °C, the 10th percentile) was 0.83 (95% CI:0.71-0.97). Compared with the 75th percentile of temperature (20-°C), the cumRR of extreme heat (27 °C, the 97.5th percentile) was 0.93 (95% CI: 0.78-1.10) in lag 0, whereas the cumRR of moderate heat (24 °C, the 90th percentile) was 1.01 (95% CI: 0.94-1.08). In the stratified analysis, cold decreased RR significantly in female and ≥65 years, whereas heat increased it more obviously in male and ≥65 years. Ambient temperature and CVD admissions were positively associated, with the harvesting effect. Our findings demonstrate the adaption of residents in Lanzhou to cold temperature. Public and environmental policies and measures aimed at moderate heat may minimize CVD burden effectively.
Substantial evidence suggests that non-optimal temperatures can increase the risk of cardiovascular disease (CVD) mortality and morbidity; however, limited studies have reported inconsistent results for hospital admissions depending on study locations, which also lack national-level investigations on cause-specific CVDs. METHODS: We performed a two-stage meta-regression analysis to examine the short-term associations between temperature and acute CVD hospital admissions by specific categories [i.e., ischemic heart disease (IHD), heart failure (HF), and stroke] in 47 prefectures of Japan from 2011 to 2018. First, we estimated the prefecture-specific associations using a time-stratified case-crossover design with a distributed lag nonlinear model. We then used a multivariate meta-regression model to obtain national average associations. RESULTS: During the study period, a total of 4,611,984 CVD admissions were reported. We found cold temperatures significantly increased the risk of total CVD admissions and cause-specific categories. Compared with the minimum hospitalization temperature (MHT) at the 98(th) percentile of temperature (29.9 °C), the cumulative relative risks (RRs) for cold (5(th) percentile, 1.7 °C) and heat (99(th) percentile, 30.5 °C) on total CVD were 1.226 [95% confidence interval (CI): 1.195, 1.258] and 1.000 (95% CI: 0.998, 1.002), respectively. The RR for cold on HF [RR = 1.571 (95% CI: 1.487, 1.660)] was higher than those of IHD [RR = 1.119 (95% CI: 1.040, 1.204)] and stroke [RR = 1.107 (95% CI: 1.062, 1.155)], comparing to their cause-specific MHTs. We also observed that extreme heat increased the risk of HF with RR of 1.030 (95% CI: 1.007, 1.054). Subgroup analysis showed that the age group ≥85 years was more vulnerable to these non-optimal temperature risks. CONCLUSIONS: This study indicated that cold and heat exposure could increase the risk of hospital admissions for CVD, varying depending on the cause-specific categories, which may provide new evidence to reduce the burden of CVD.
Chronic exposure to particulate matter air pollution (PM(2.5) ) is associated with chronic rhinosinusitis (CRS). Elevated ambient temperature may increase PM(2.5) levels and thereby exacerbate sinonasal symptoms. This study investigates the association between high ambient temperature and the risk of CRS diagnosis. METHODS: Patients with CRS were diagnosed at Johns Hopkins hospitals from May to October 2013-2022, and controls were matched patients without CRS meanwhile. A total of 4752 patients (2376 cases and 2376 controls) were identified with a mean (SD) age of 51.8 (16.8) years. The effect of maximum ambient temperature on symptoms was estimated with a distributed lag nonlinear model (DLNM). Extreme heat was defined as 35.0°C (95(th) percentile of the maximum temperature distribution). Conditional logistic regression models estimated the association between extreme heat and the risk of CRS diagnosis. RESULTS: Exposure to extreme heat was associated with increased odds of exacerbation of CRS symptoms (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.03-1.19). The cumulative effect of extreme heat during 0-21 lag days was significant (OR 2.37, 95% CI 1.60-3.50) compared with the minimum morbidity temperature (MMT) at 25.3°C. Associations were more pronounced among young and middle-aged patients and patients with abnormal weight. CONCLUSIONS: We found that short-term exposure to high ambient temperature is associated with increased CRS diagnosis, suggesting a cascading effect of meteorological phenomena. These results highlight climate change’s potentially deleterious health effects on upper airway diseases, which could have a significant public health impact.
Previous studies have suggested that ambient temperature is associated with the morbidity and mortality of stroke although results among these investigations remained unclear. Therefore, the purpose of present meta-analysis was to summarize the evidence of the relationship between ambient temperature and stroke morbidity and mortality. METHODS: A systematic search of the PubMed, Embase, and Web of Science databases was from inception to April 13, 2022. The pooled estimates for heat ambient temperature and cold ambient temperature, which were defined as comparison between extreme hot or cold conditions and the reference or threshold temperature, were calculated utilizing a random-effects model. A total of 20 studies were included in the meta-analysis. RESULTS: The pooled estimated show that the heat ambient temperature was significant associated with 10% (relative risk [RR], 1.10; 95% confidence interval [95%CI]: 1.02-1.18) and 9% (RR, 1.09; 95%CI: 1.02-1.17) increase in the risk of stroke morbidity and mortality, respectively. In addition, the pooled estimated show that the cold ambient temperature was significant associated with 33% (RR, 1.33; 95%CI: 1.17-1.51) and 18% (RR, 1.18; 95%CI: 1.06-1.31) increase in the risk of stroke morbidity and mortality, respectively. CONCLUSION: Integrated epidemiological evidence supports the hypothesis that both heat and cold ambient temperature have positive association with the risk of stroke morbidity and mortality. Targeted measures should be promoted in public health to reduce this risk.
This study explored the relationship between body temperature and adverse outcomes in patients with heat stroke to identify the optimal target body temperature within the first 24 h. This retrospective, multicentre study enrolled 143 patients admitted to the emergency department and diagnosed with heat stroke. The primary outcome was the in-hospital mortality rate, while secondary outcomes included the presence and number of damaged organs and neurological sequelae at discharge. A body temperature curve was built using a generalized additive mixed model, and the association between body temperatures and outcomes was established by logistic regression. The threshold and saturation effects were used to explore the targeted body temperature management. Cases were divided into the surviving and non-surviving groups. The cooling rate within the first 2 h was significantly higher in the survival group than the non-survival group (β: 0.47; 95% confidence interval [CI]: 0.09-0.84; P = 0.014), while the non-survival group exhibited a lower body temperature within 24 h (β: – 0.06; 95% CI: – 0.08 to – 0.03; P ≤ 0.001). Body temperature after 2 h (odds ratio [OR]: 2.27; 95% CI: 1.14-4.50; P = 0.019) and lowest temperature within 24 h (OR: 0.18; 95% CI: 0.06-0.55; P = 0.003) were significantly related to in-hospital mortality rate. When the body temperature at 0.5 h was 38.5-40.0 °C, the number of damaged organs was at its lowest. In patients with heat stroke, both hyperthermia and hypothermia were associated with adverse outcomes. Hence, an accurate body temperature management is required during the early stages of care.
STUDY QUESTION: Does ambient temperature exposure affect outcomes including clinical pregnancy and live birth in women undergoing IVF? SUMMARY ANSWER: Both extreme cold and hot ambient temperatures were significantly associated with adverse pregnancy outcomes of IVF cycles. WHAT IS KNOWN ALREADY: Heat exposure has been linked to adverse pregnancy outcomes worldwide. However, the effect of ambient temperature on infertile women undergoing IVF treatment is unclear. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study was conducted from a database of 3452 infertile women who underwent their first fresh or frozen embryo transfer in the Shanghai First Maternity and Infant Hospital from April 2016 to December 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: Daily mean ambient temperature exposure for each patient was obtained based on their residential address. Temperature-stratified multiple logistic regression analysis was performed to investigate associations between temperature exposure and pregnancy outcomes after controlling for confounders. Vulnerable sub-groups were identified using forest plots. MAIN RESULTS AND THE ROLE OF CHANCE: The clinical pregnancy rate and live birth rate were 45.7% and 37.1%, respectively. Regarding clinical pregnancy, a higher temperature during cold weather was significantly associated with a higher pregnancy rate in the period about 11 weeks before ovarian stimulation (adjusted odds ratio (aOR) = 1.102, 95% CI: 1.012-1.201). Regarding live birth, an increased temperature during cold weather was significantly related to a higher live birth rate in the period after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs of 6.299 (95% CI: 3.949-10.047) or 10.486 (95% CI: 5.609-19.620), respectively. However, a higher temperature during hot weather was negatively associated with the live birth rate in the periods after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs at 0.186 (95% CI: 0.121-0.285) or 0.302 (95% CI: 0.224-0.406), respectively. Moreover, the decline in live birth rates during cold and hot weather was accompanied by increased rates of early miscarriage (P < 0.05). Stratified analyses identified susceptibility characteristics among the participants. LIMITATIONS, REASONS FOR CAUTION: Climate monitoring data were used to represent individual temperature exposure levels according to the patient's residential address in the study. We were not able to obtain information of personal outdoor activity and use of indoor air conditioners in this retrospective study, which may affect actual temperature exposure. WIDER IMPLICATIONS OF THE FINDINGS: This study highlights that the ambient temperature exposure should be taken into account during IVF treatment and afterwards. There is a need to be alert to extremes in cold and hot ambient temperatures, especially during the period of follicle development and pregnancy. With this knowledge, clinicians can scientifically determine the timing of IVF treatment and reinforce patients' awareness of self-protection to minimize adverse pregnancy outcomes associated with extreme temperatures. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by a grant from the Clinical Research Plan of Shanghai Hospital Development Center [SHDC2020CR4080], a grant from the Science and Technology Commission of Shanghai Municipality [19411960500], and two grants from the National Natural Science Foundation of China [81871213, 81671468]. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva, and research grants from Merck KGaA, Ferring and Guerbet. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: N/A.
While previous research has identified populations susceptible to non-optimal temperatures, disability has been largely overlooked. Given the growing number of persons with disabilities (PwD) and their social and health disadvantages, understanding how disability intersects with temperature-related health effects is crucial. This study aimed to investigate the associations between non-optimal temperatures and cardiovascular disease (CVD) hospitalization and examine how these associations vary over time considering the existence of disability. METHODS: We used the National Health Insurance Service-National Sample Cohort to investigate the association between non-optimal temperatures and CVD hospitalization in South Korea, 2002-2019. We obtained daily mean temperature from the Korea Meteorological Administration’s automated synoptic observing system. We applied a space-time-stratified case-crossover design using a conditional quasi-Poisson regression with a distributed lag non-linear model, adjusting for relative humidity, wind speed, and public holidays. We examined temporal variations in temperature-CVD hospitalization associations using a time window approach. All analyses used the minimum hospitalization temperature (20.0 °C) as reference and were stratified by disability status. RESULTS: The cumulative exposure-response curve in persons without disabilities showed a J-shape with a relative risk (RR) of 1.07 (95 % confidence interval [CI]: 0.99, 1.15) at extreme heat (99th percentile) and 1.09 (95 % CI: 0.97, 1.23) at extreme cold (1st percentile). The cumulative exposure-response curve in PwD showed an M-shape with the highest RR at chill (1.22 [95 % CI: 1.13, 1.32]) and moderate cold temperature (1.11 [95 % CI: 1.01, 1.21]), defined as the 30th and 5th percentiles, respectively. The impacts of heat and cold decreased over time for persons without disabilities but increased for PwD. CONCLUSIONS: Our study found differential temperature-related impacts on CVD hospitalization based on disability status, and PwD were maladapted to heat and cold over time. This suggests the importance of considering disability when investigating temperature-related health disparity and adopting disability-inclusive adaptation strategies.
PURPOSE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has the adverse influence on quality of life and creates significant healthcare costs. However, there were sparse studies investigating the correlation between AECOPD hospital admissions and temperature change. Therefore, it is noteworthy to investigate the impact of various temperature differences and recognize the susceptible population. The purpose of this study was to investigate the impact of temperature differences on AECOPD hospital admissions, and to give potentially helpful material for disease preventative efforts. METHODS: The distributed lag non-linear model was adopted to characterize the exposure-response relationship and to assess the impact of temperature difference. The stratified analysis and sensitivity analysis were also conducted to determine the susceptible populations and examine the robustness of the results. RESULTS: There were 143,318 AECOPD hospital admissions overall during the study period. The AECOPD hospital admissions had significant association with the daily mean temperature difference (DTDmean) such as the extreme-cold temperature difference (1st DTDmean), the ultra-cold temperature difference (5th DTDmean), the ultra-hot temperature difference (95th DTDmean) and the extreme-hot temperature difference (99th DTDmean). Besides, there was the “U-shaped” association between DTDmean and 21 days cumulative relative risk of AECOPD. CONCLUSION: The AECOPD hospital admissions was correlated with the DTDmean temperature differences, especially the extreme-cold and extreme-hot temperature difference. Moreover, people older than 65 years were more susceptible to the extreme-hot and extreme-cold temperature difference.
Hazardous thermal conditions resulting from climate change may play a role in cardiovascular disease development. We chose the Universal Thermal Climate Index (UTCI) as the exposure metric to evaluate the relationship between thermal conditions and cardiovascular mortality in Shenzhen, China. We applied quasi-Poisson regression non-linear distributed lag models to evaluate the exposure-response associations. The findings suggest that cardiovascular mortality risks were significantly increased under heat and cold stress, and the adverse effects of cold stress were stronger than heat stress. Referencing the 50th percentile of UTCI (25.4°C), the cumulative risk of cardiovascular mortality was 75% (RR(lag0-21) =1.75, 95%CI: 1.32, 2.32) higher in the 1st percentile (3.5°C), and 40% (RR(lag0-21)=1.40, 95%CI: 1.09, 1.80) higher in the 99th percentile (34.1°C). We observed that individuals older than 65 years were more vulnerable to both cold and heat stress, and females were identified as more susceptible to heat stress than males. Moreover, increased mortality risks of hypertensive disease and cerebrovascular disease were observed under cold stress, while heat stress was related to higher risks of mortality for hypertensive disease and ischemic heart disease. We also observed a stronger relationship between cold stress and ischemic heart disease mortality during the cold season, as well as a significant impact of heat stress on cerebrovascular disease mortality in the warm season when compared to the analysis of the entire year. These results confirm the significant relationship between thermal stress and cardiovascular mortality, with age and sex as potential effect modifiers of this association. Providing affordable air conditioning equipment, increasing the amount of vegetation, and establishing comprehensive early warning systems that take human thermoregulation into account could all help to safeguard the well-being of the public, particularly vulnerable populations, in the event of future extreme weather.
Extreme hot and cold weather events are becoming more frequent, intense, and longer due to climate change. When these events occur coincidentally with power outages, the resulting extreme indoor temperatures pose a severe health hazard for occupants. This study conducted a holistic modeling and analysis of an assisted living facility, where senior residents live, to assess its thermal resilience performance under a six-day heat wave in 2015 and a three-day cold snap in 2021 with power outages. Impacts of 13 energy efficiency measures on thermal resilience and backup power capacity of the facility were evaluated. Three thermal resilience metrics: the SET (standard effective temperature) degree-hours, the Heat Index, and the Hours of Safety, were used and calculated from the EnergyPlus simulation models. Major findings are: (1) the facility would suffer from extreme temperatures during the cold and hot events without a power supply, not meeting the passive survivability requirements; (2) most passive envelope measures improve thermal resilience for both hot and cold events, but making the building envelope airtight results in conflicting performance between the hot and cold events; (3) natural ventilation is an effective measure to mitigate summer indoor overheating; and (4) the energy efficiency package can reduce backup power capacity by 19% for the three-day cold snap. It is recommended that building technologies and design strategies be evaluated to consider co-benefits of energy use, thermal resilience, and backup power needs through building energy codes or policies for existing and new buildings, which are transitioning for decarbonization and climate resilience.
Short-term associations between heat and cardiovascular disease (CVD) mortality have been examined mostly in large cities. However, different vulnerability and exposure levels may contribute to spatial heterogeneity. This study assessed heat effects on CVD mortality and potential vulnerability factors using data from three European countries, including urban and rural settings. METHODS: We collected daily counts of CVD deaths aggregated at the small-area level in Norway (small-area level: municipality), England and Wales (lower super output areas), and Germany (district) during the warm season (May-September) from 1996 to 2018. Daily mean air temperatures estimated by spatial-temporal models were assigned to each small area. Within each country, we applied area-specific Quasi-Poisson regression using distributed lag nonlinear models to examine the heat effects at lag 0-1 days. The area-specific estimates were pooled by random-effects meta-analysis to derive country-specific and overall heat effects. We examined individual- and area-level heat vulnerability factors by subgroup analyses and meta-regression, respectively. RESULTS: We included 2.84 million CVD deaths in analyses. For an increase in temperature from the 75th to the 99th percentile, the pooled relative risk (RR) for CVD mortality was 1.14 (95% CI: 1.03, 1.26), with the country-specific RRs ranging from 1.04 (1.00, 1.09) in Norway to 1.24 (1.23, 1.26) in Germany. Heat effects were stronger among women [RRs (95% CIs) for women and men: 1.18 (1.08, 1.28) vs. 1.12 (1.00, 1.24)]. Greater heat vulnerability was observed in areas with high population density, high degree of urbanization, low green coverage, and high levels of fine particulate matter. CONCLUSION: This study provides evidence for the heat effects on CVD mortality in European countries using high-resolution data from both urban and rural areas. Besides, we identified individual- and area-level heat vulnerability factors. Our findings may facilitate the development of heat-health action plans to increase resilience to climate change.
Outdoor thermal comfort (OTC) is critical for public health, labor productivity, and human life. Growing extreme heat events caused by climate change have a serious impact on OTCs, especially in urban areas. Quantitatively characterizing and evaluating the spatiotemporal changes in OTCs are essential, and more applications are needed in urban agglomerations. Therefore, taking the Beijing-Tianjin-Hebei (BTH) urban agglomeration as the study area, this study aimed to quantitatively assess the summer regional OTC from 1981 to 2020. First, the Universal Thermal Climate Index (UTCI) was used as the indicator of daily thermal stress, and then a Composite Thermal Comfort Score was proposed to evaluate the long-term, summertime, regional OTC considering the extent, duration, and intensity of daytime and nighttime thermal stress. The results showed that (a) the increase in UTCI (0.32°C/10a at daytime and 0.21°C/10a at nighttime) and heat stress frequency (0.88 at daytime and 0.39 d/10a at nighttime) were manifested over BTH, indicating a worse OTC. Spatial and temporal heterogeneity was also demonstrated. (b) The general OTC showed a decreasing north-south gradient pattern. At daytime, the northern mountainous zone presented the best OTC, the southern plain zone, especially Hengshui, Langfang, and Cangzhou, showed the worst. At nighttime, the mountain-plain transition zone showed the best OTC, the northern mountainous zone showed the worst since more cold stress occurred. Our findings will be useful in informing climate change adaptation strategies to ensure urban resilience as extreme heat increases in the context of climate change.
Climate change adaptation decisions often require the consideration of risk rather than the envi-ronmental hazard alone. One approach for quantifying risk is to use a risk assessment framework which combines information about hazard, exposure and vulnerability to estimate risk in a spatially consistent way. In recent years, publicly available, open-source risk assessment frameworks have been made available, including the CLIMADA platform. Such tools are increasingly being used in combination with ensembles of climate model projections to quantify risk on climate time-scales, presenting the ensemble spread as a measure of climate model uncertainty. As climate models are computationally expensive to run, this quantification of uncertainty derived from the ensemble of projections is often limited by the number of members available. We present a novel framework involving the application and extension of the CLIMADA open-source climate risk assessment platform, demonstrating an approach for overcoming this limitation. We first show how the CLI-MADA platform can be applied to an ensemble of UKCP18 regional climate projections to assess climate risk coherently across space in an idealised example for the UK. We then show how a Generalised Additive Model, involving an ‘ensemble member’ random effect term, can be used to statistically represent the climate model ensemble summary of risk and be used to simulate many more realisations of risk, representative of a larger collection of plausible ensemble members. Specifically, we apply the framework to an idealised example related to heat-stress and the asso-ciated risk of reduced outdoor physical working capacity in the UK, based on three global warming levels (recent past, 2 degrees C and 4 degrees C warmer than pre-industrial). We show how, in this idealised example, in a 2 degrees C warmer world (relative to pre-industrial), the UK could lose on average 15 million (or 2.5% of) days of outdoor physical work in a working year (225 days) as a result of heat-stress, which could equate to more than 1.5 pound billion of economic loss (roughly 0.07% of UK annual GDP). The uncertainty quantification provided by the framework allows for an upper range estimate which better quantifies climate model uncertainty. In a 4 degrees C warmer world this indicates the plausibility of38 million (or 6.2% of) working days lost in a year, possibly equating to more than 3.8 pound billion of economic loss (roughly 0.17% of UK annual GDP). Finally, we discuss limitations of the approach and recommend a number of extensions and areas of future work.
This study utilizes China’s records of non-accidental mortality along with twenty-five simulations from the NASA Earth Exchange Global Daily Downscaled Projections to evaluate forthcoming heat stress and heat-related mortality across China across four distinct scenarios (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). The findings demonstrate a projected escalation in the heat stress index (HSI) throughout China from 2031 to 2100. The most substantial increments compared to the baseline (1995-2014) are observed under SSP5-8.5, indicating a rise of 7.96°C by the year 2100, while under SSP1-2.6, the increase is relatively modest at 1.54°C. Disparities in HSI growth are evident among different subregions, with South China encountering the most significant elevation, whereas Northwest China exhibits the lowest increment. Projected future temperatures align closely with HSI patterns, while relative humidity is anticipated to decrease across the majority of areas. The study’s projections indicate that China’s heat-related mortality is poised to surpass present levels over the forthcoming decades, spanning a range from 215% to 380% from 2031 to 2100. Notably, higher emission scenarios correspond to heightened heat-related mortality. Additionally, the investigation delves into the respective contributions of humidity and temperature to shifts in heat-related mortality. At present, humidity exerts a greater impact on fluctuations in heat-related mortality within China and its subregions. However, with the projected increase in emissions and global warming, temperature is expected to assume a dominant role in shaping these outcomes. In summary, this study underscores the anticipated escalation of heat stress and heat-related mortality across China in the future. It highlights the imperative of emission reduction as a means to mitigate these risks and underscores the variances in susceptibility to heat stress across different regions.
In Sub-Saharan Africa, many cities are facing an increased risk of heat due to climate change and rapid urbanization. This poses a particular threat in areas with limited adaptive capacity. However, there is a lack of comprehensive heat risk assessment in the region, possibly due to the absence of high-resolution weather data. This study aims to address this gap by proposing and demonstrating a methodology for mapping high-risk areas in a tropical humid city, specifically focusing on Lagos, Nigeria. The approach utilises advanced numerical modelling techniques and open-source geospatial data. The urbanised Weather Research and Forecasting (WRF) model is employed to simulate Humidex-based heat stress during a specific heatwave event in March 2020. Open-source high resolution geospatial datasets were used to assess heat exposure and vulnerability. The urban areas were classified based on the Local Climate Zone (LCZ) scheme. Spatial analysis techniques, including Moran’s I test and Optimized Hot Spot Analysis (OHSA), were used to identify spatial clustering patterns and hot spots of heat risk areas. Moreover, using Gi* statistics in OHSA, the risk layer was categorised into hot, cold, and non-significant spots at various levels of significance (90 %, 95 %, and 99 %). Mapping the hot spots at the highest confidence level of 99 % identified Critical Heat Risk Zones (CHRZ), covering an area of approximately 423 km2. The results showed significant heat risk in highly urbanised LCZs. Further investigation indicated that the largest proportion of highrisk zones corresponded to densely populated and highly urbanised LCZs- LCZ3 (59 %), LCZ 6(21 %), and LCZ 7 (17 %). Notably, these areas coincide with two well-known slums in Lagos, emphasizing the need for targeted interventions and planning measures in these areas. The findings highlight the magnitude and extent of heat risk within the city and emphasize the urgent need for targeted climate change adaptation and mitigation strategies in the identified high-risk zones.
Heat-related illness is a growing concern for workers in temperate climates as rising temperatures and heatwaves put them at risk of exertional heat stroke. Monitoring biometrics that predict heat stroke, such as core temperature, is increasingly important. To monitor biometrics, wearable sensing technologies have been proposed as an alternative to the ingestible telemetric pill. However, limited studies have validated the accuracy of these sensors in different temperature conditions. Therefore, this study aims to assess the validity of wearable devices placed on different areas of the body for measuring core body temperature (CT) during repetitive physical activity in high temperature conditions. Ten male participants performed dumbbell curling exercises at 33 degrees C and roughly 50% relative humidity, and data from the pill (the criterion standard) were compared to data from two wearable sensors-Slate Safety and Zephyr. Results showed that Slate Safety [Bias (Precision) = 0.20 (0.35) degrees C) and Zephyr [Bias (Precision) = -0.03 (0.35) degrees C] recorded bias and precision within acceptable limits. The correlation analysis showed that wearable sensors are suitable for real-time monitoring of an individual’s level of heat stress in high temperatures. However, there was a proportional bias with these CT measuring devices, meaning that the reported temperature values are consistently deviated from the true values. The results of this study contribute to the ongoing discussion of the most appropriate methods for monitoring heat stress and provide valuable information for practitioners working in this field.
The health of older populations in the Southeastern U.S. receives threats from recurrent tropical cyclones and extreme heat, which may exacerbate the mortality caused by heart diseases and strokes. Such threats can escalate when these extremes form compound disasters, which may be more frequent under climate change. However, a paucity of empirical evidence exists concerning the health threats of compound disasters, and anticipations regarding the health risks of older populations under future compound disaster scenarios are lacking. Focusing on Florida, which has 67 counties and the second-largest proportion of older populations among U.S. states, we calibrate Poisson regression models to explore older populations’ mortality caused by heart diseases and strokes under single and compound disasters. The models are utilized to estimate the mortality across future disaster scenarios, the changing climate, and the growing population. We identify that under multiple hurricanes or heat, current-month hurricanes or heat can affect mortality more heavily than previous-month hurricanes or heat. Under future scenarios, co-occurring hurricanes and extreme heat can exacerbate the mortality more severely than other disaster scenarios. The same types of compound disasters can coincide with an average of 20.5% higher mortality under RCP8.5-SSP5 than under RCP4.5-SSP2. We assess older populations’ future health risks, alerting health agencies to enhance preparedness for future “worst-case” scenarios of compound disasters and proactively adapt to climate change.
OBJECTIVE: Climate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and provide advice on protective health behaviour against heat. Data is lacking on whether and what topic of GP advice people are interested in, and whether specific person characteristics are associated with such interests. DESIGN: Cross-sectional, nationwide, face-to-face household survey, conducted during winter 2022/2023. SETTING: Germany. PARTICIPANTS: Population-based sample of 4212 respondents (aged 14-96 years), selected by using multistratified random sampling (50%) combined with multiquota sampling (50%). MAIN OUTCOME MEASURE: Interest in receiving GP advice on health protection during heatwaves (yes/no), and the topic people find most important (advice on drinking behaviour, nutrition, cooling, cooling rooms, physical activity or medication management). Associations between predefined person characteristics and the likelihood of interest were estimated using adjusted logistic regressions. RESULTS: A total of 4020 respondents had GP contact and provided data on the outcome measure. Of these, 23% (95% CI=22% to 25%) expressed interest in GP advice. The likelihood of expressing interest was positively associated with being female, older age (particularly those aged 75+ years: 38% were interested), having a lower level of educational attainment, having a migration background, living in a more urban area, and living in a single-person household. It was negatively associated with increasing income. Advice on medication management received highest interest (25%). CONCLUSIONS: During winter season 2022/2023, around one quarter of the German population with GP contact-and around 40% of those aged 75+ years-was estimated to have a stated interest in receiving GP advice on protective health behaviour during heatwaves, especially on medication management. Climate change is creating new demands for healthcare provision in general practice. This study provides initial relevant information for research and practice aiming to address these demands.
This study compared the relative risks of heat days on mortalities by vulnerable groups (elderly, single-person households, less-educated) in the past decade (1999-2008) and the recent decade (2009-2018) in four cities, Seoul, Incheon, Daegu, and Gwangju, in Korea. It has been known that the health impacts of heatwaves have gradually decreased over time due to socio-economic development, climate adaptation, and acclimatization. Contrary to general perception, we found that the recent relative risk of mortality caused by heat days has increased among vulnerable groups. It may associate with recent increasing trends of severe heat days due to climate change. The increasing relative risk was more significant in single-person households and less-educated groups than in the elderly. It implies that the impacts of climate change-induced severe heat days have been and will be concentrated on vulnerable groups. It suggests that social polarization and social isolation should be addressed to reduce heatwave impacts. Furthermore, this study shows the necessity of customized heatwave policies, which consider the characteristics of vulnerable groups.
Human health, energy and comfort are determined by the climate that remains in the physical environment. Regarding urban climate, few studies assess the urban heat island effect, heat stress, and public health as geographical representations. This study seeks to fill this gap by selecting Colombo, Sri Lanka, and Shenzhen, China, comparatively, two coastal cities with different climate conditions. We quantified and compared the effects of heat waves and their impacts on public health and the effect of urbanization on urban heat islands (UHI). Heat-related public health issues have been calculated using the Wet-Bulb Globe Temperature (WBGT) index. The Urban Heat Island (UHI) effect was analyzed using Land Surface Temperature (LST), created based on Landsat images obtained in 1997, 2009 and 2019. A rapid increase in temperature and humidity creates an uncomfortable environment in both cities, but apparent differences can be observed in climatic phenomena. During the summer (June to August), the prevailing atmospheric condition in Shenzhen makes a “Very severe stress” with Heatstroke highly likely. Nevertheless, seven months (November to April) are found as “Comfortable” without having any heat-related health injuries. However, Colombo has never been classified as “Comfortable” throughout the year. Out of twelve, five months (April to August) are found as “Very severe stress” with Heatstroke highly likely. When considering the urban expansion and UHI, a fast expansion can be observed in Colombo than in Shenzhen. Consequently, with the more severe heat-related public health and rapid urban heat island expansion, Colombo makes it more stressful than Shenzhen city. Our findings highlight the comparison between heat-related public health and urban heat island between two coastal cities with different climate conditions and under rapid urbanization processes. Therefore, it is imperative to assess these risks and respond effectively.
Global climate change, especially warming, has significant implications for human health. There are currently research gaps in the attribution of urban heat environment (UHE) changes and the exploration of heat exposure based on land use types. This study proposed a UHE change attribution algorithm based on land use types, separated contributions of natural factors (NAT), land use change (LUC), and other anthropogenic activities (OANT) in Chinese cities under Shared socioeconomic pathway-Representative concentration pathway (SSPRCP) scenarios over different periods in the 21st century, further evaluated population heat exposure changes of the same three factors during extreme heat (i.e., maximum daily temperatures exceeding 35 degrees C). The average UHE changes were projected to be positive over each future period. Total OANT contribution would be slightly higher than that of NAT in the same period and scenario, while in most cases, contribution intensity of NAT would be greater than that of OANT. Total contribution and intensity of LUC would remain low. Population heat exposure changes of OANT would be 15.46 and 15.21 times higher than those of NAT and LUC, respectively. The outcomes of this study will help guide adaptation and mitigation of UHE changes under future scenarios and reduce negative impacts on human health.
The successive flood-heat extreme (SFHE) event, which threatens the securities of human health, economy, and building environment, has attracted extensive research attention recently. However, the potential changes in SFHE characteristics and the global population exposure to SFHE under anthropogenic warming remain unclear. Here, we present a global-scale evaluation of the projected changes and uncertainties in SFHE characteristics (frequency, intensity, duration, land exposure) and population exposure under the Representative Concentration Pathway (RCP) 2.6 and 6.0 scenarios, based on the multi-model ensembles (five global water models forced by four global climate models) within the Inter-Sectoral Impact Model Intercomparison Project 2b framework. The results reveal that, relative to the 1970-1999 baseline period, the SFHE frequency is projected to increase nearly globally by the end of this century, especially in the Qinghai-Tibet Plateau (>20 events/30-year) and the tropical regions (e.g., northern South America, central Africa, and southeastern Asia, >15 events/30-year). The projected higher SFHE frequency is generally accompanied by a larger model uncertainty. By the end of this century, the SFHE land exposure is expected to increase by 12 % (20 %) under RCP2.6 (RCP6.0), and the intervals between flood and heatwave in SFHE tend to decrease by up to 3 days under both RCPs, implying the more intermittent SFHE occurrence under future warming. The SFHE events will lead to the higher population exposure in the Indian Peninsula and central Africa (<10 million person-days) and eastern Asia (<5 million person-days) due to the higher population density and the longer SFHE duration. Partial correlation analysis indicates that the contribution of flood to the SFHE frequency is greater than that of heatwave for most global regions, but the SFHE frequency is dominated by the heatwave in northern North America and northern Asia.
Under climate change, extreme heat events are projected to become more frequent and intense. With people spending approximately 90% for their time indoors and buildings having long lifetimes, it is important that the built environment is resilient to these changes. Current methods to assess building performance in a future climate typically use morphed weather files and annual metrics. We compare 30 metrics and 2 weather data sources to assess and improve the representation of extreme heat events in building simulation. We show that morphing an extreme observed year may not necessarily result in an equally extreme year under the future climate and that current annual metrics do not correlate well with heatwave severity. We suggest that weather data from climate models is more robust in representing future weather for the UK and explore the recent UKCP18 data. We propose novel metrics which are able to capture heatwave severity inside buildings.
Exposure to extreme heat in pregnancy increases the risk of stillbirth. Progress in reducing stillbirth rates has stalled, and populations are increasingly exposed to high temperatures and climate events that may further undermine health strategies. This narrative review summarises the current clinical and epidemiological evidence of the impact of maternal heat exposure on stillbirth risk. Out of 20 studies, 19 found an association between heat and stillbirth risk. Recent studies based in low- to middle-income countries and tropical settings add to the existing literature to demonstrate that all populations are at risk. Additionally, both short-term heat exposure and whole-pregnancy heat exposure increase the risk of stillbirth. A definitive threshold of effect has not been identified, as most studies define exposure as above the 90th centile of the usual temperature for that population. Therefore, the association between heat and stillbirth has been found with exposures from as low as >12.64°C up to >46.4°C. The pathophysiological pathways by which maternal heat exposure may lead to stillbirth, based on human and animal studies, include both placental and embryonic or fetal impacts. Although evidence gaps remain and further research is needed to characterise these mechanistic pathways in more detail, preliminary evidence suggests epigenetic changes, alteration in imprinted genes, congenital abnormalities, reduction in placental blood flow, size and function all play a part. Finally, we explore this topic from a public health perspective; we discuss and evaluate the current public health guidance on minimising the risk of extreme heat in the community. There is limited pregnancy-specific guidance within heatwave planning, and no evidence-based interventions have been established to prevent poor pregnancy outcomes. We highlight priority research questions to move forward in the field and specifically note the urgent need for evidence-based interventions that are sustainable.
Tourism is one of the most vulnerable sectors to climate change since outdoor leisure activities are only possible in appropriate climate conditions for them. Among several climate or weather-related factors effective on tourist satisfaction, the concept of outdoor thermal comfort conditions gains importance with climate change because it is the combined effect of all atmospheric conditions on human body. Therefore, tourism-climate indices to reflect the favourability of destinations begin to include this parameter as a component. Mediterranean basin harbours world famous summer and cultural tourism destinations among others and climate change is expected to impact the region which covers the third largest primary destination of Turkey. The aim of this study is to analyse human thermal comfort conditions in the southwest part of Turkey, world-famous summer tourism region using Physiologically Equivalent Temperature (PET) and Mean Radiant Temperature (Tmrt) values and Geographic Information System (GIS) as a tool to show their spatial distribution as a component of tourism climate indices. As the result of the study, the most influential factors on human thermal comfort conditions in the region are mean radiant temperature, moisture content, air movement and increasing dense urbanisation in 12 districts, where meteorological measurements were taken. As the result of the study, suggestions were proposed to reduce the effect of higher PET and Tmrt values on tourists in the study.
The number of non-accidental deaths and heat-related illnesses due to the co-occurrence of heatwaves and COVID-19 has been identified to estimate compound health impacts between two risks. We have analyzed data from historical years (2013-2019) to calculate the baseline values of the number of non-accidental deaths and heat-related illness patients from May to September using a quasi-Poisson generalized linear model and compared them to data from 2020 in Korea. We also assessed the relative risk and absolute cumulative number of non-accidental deaths and heat-related illnesses in the summer of 2020 in Seoul, Daegu, and Gyeongnam region of Korea. In the Summer of 2020, Korea experienced 0.8% of non-accidental excess deaths, with the highest in August, and 46% of reduction was observed in heat-related throughout the study period, except in Daegu, where excess of heat-related illness occurred in August. The relative risk (RR) of non-accidental deaths at 33.1 °C, was 1.00 (CI 0.99-1.01) and 1.04 (CI 1.02-1.07) in 2013-2019 and 2020, respectively. The RR of heat-related illness at 33.1 °C, was 1.44 (CI 1.42-1.45) and 1.59 (CI 1.54-1.64) in 2013-2019 and 2020, respectively. The absolute cumulative trends of non-accidental deaths and heat-related illnesses were similar in the three regions, indicating increased non-accidental deaths and decreased heat-related illnesses at similar temperatures in 2020. During the COVID-19 pandemic, the fear of infection by the virus and the limited access to healthcare services led to changes in health-seeking behaviors. These results indicate social distancing could have had adverse impacts on other health conditions. A comprehensive health risk assessment is important when facing simultaneous risks, such as heatwaves and pandemics, in the implementation of effective countermeasures.
Heatwaves have caused significant damage to human health, infrastructure, and economies in recent decades, and the occurrences of heatwaves are becoming more frequent and severe across the globe under climate change. The previous studies on heatwaves have primarily focused on air temperature, neglecting other variables like wind speed, relative humidity, and radiation, which could lead to a serious underestimation of the adverse effects of heatwaves. To address this issue, this study proposed to the use of more sophisticated thermal indices, such as universal thermal climate index (UTCI) and apparent temperature (AT), to define heatwaves and carry out a comprehensive heatwave assessment over mainland southeast Asia (MSEA) from 1961 to 2020. The traditional temperature-based method was also compared. The results of the study demonstrate that the annual maximum temperature in heatwave days (HWA) and the annual average temperature in heatwave days (HWM) are significantly underestimated if only air temperature is considered. However, UTCI and AT tend to predict a lower frequency of yearly heatwave occurrences and shorter durations. Trend analysis indicates a general increase in heatwave occurrences across MSEA under all thermal indices in the past six decades, particularly in the last 30 years. This study’s approach and findings provide a holistic view of heatwave characteristics based on thermal indices and highlight the risk of intensified heat stress during heatwaves in MSEA.
IMPORTANCE: The rate of severe maternal morbidity (SMM) is continuously increasing in the US. Evidence regarding the associations of climate-related exposure, such as environmental heat, with SMM is lacking. OBJECTIVE: To examine associations between long- and short-term maternal heat exposure and SMM. DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based epidemiological cohort study took place at a large integrated health care organization, Kaiser Permanente Southern California, between January 1, 2008, and December 31, 2018. Data were analyzed from February to April 2023. Singleton pregnancies with data on SMM diagnosis status were included. EXPOSURES: Moderate, high, and extreme heat days, defined as daily maximum temperatures exceeding the 75th, 90th, and 95th percentiles of the time series data from May through September 2007 to 2018 in Southern California, respectively. Long-term exposures were measured by the proportions of different heat days during pregnancy and by trimester. Short-term exposures were represented by binary variables of heatwaves with 9 different definitions (combining percentile thresholds with 3 durations; ie, ≥2, ≥3, and ≥4 consecutive days) during the last gestational week. MAIN OUTCOMES AND MEASURES: The primary outcome was SMM during delivery hospitalization, measured by 20 subconditions excluding blood transfusion. Discrete-time logistic regression was used to estimate associations with long- and short-term heat exposure. Effect modification by maternal characteristics and green space exposure was examined using interaction terms. RESULTS: There were 3446 SMM cases (0.9%) among 403 602 pregnancies (mean [SD] age, 30.3 [5.7] years). Significant associations were observed with long-term heat exposure during pregnancy and during the third trimester. High exposure (≥80th percentile of the proportions) to extreme heat days during pregnancy and during the third trimester were associated with a 27% (95% CI, 17%-37%; P < .001) and 28% (95% CI, 17%-41%; P < .001) increase in risk of SMM, respectively. Elevated SMM risks were significantly associated with short-term heatwave exposure under all heatwave definitions. The magnitude of associations generally increased from the least severe (HWD1: daily maximum temperature >75th percentile lasting for ≥2 days; odds ratio [OR], 1.32; 95% CI, 1.17-1.48; P < .001) to the most severe heatwave exposure (HWD9: daily maximum temperature >95th percentile lasting for ≥4 days; OR, 2.39; 95% CI, 1.62-3.54; P < .001). Greater associations were observed among mothers with lower educational attainment (OR for high exposure to extreme heat days during pregnancy, 1.43; 95% CI, 1.26-1.63; P < .001) or whose pregnancies started in the cold season (November through April; OR, 1.37; 95% CI, 1.24-1.53; P < .001). CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, long- and short-term heat exposure during pregnancy was associated with higher risk of SMM. These results might have important implications for SMM prevention, particularly in a changing climate.
Long- and short-term biometeorological conditions in the Republic of Serbia were analyzed using official meteorological data from numerous weather stations located across the country. Selected biometeorological indices HUMIDEX, Physiologically Equivalent Temperature (PET), and Universal Thermal Climate Index (UTCI) are calculated based on air temperature, relative humidity, wind speed, and cloudiness data from the meteorological stations on annual and summer level as well as during selected heat wave periods during 2000-2020. Application of different biometeorological indices provides similar but somewhat different results. For example, average annual HUMIDEX and UTCI values indicate no thermal stress and no discomfort at all stations, while PET indicates the occurrence of slight to moderate cold stress at all stations. Average summer PET and UTCI indicate the occurrence of slight to moderate heat stress throughout the country, while HUMIDEX indicates no discomfort. Trends of biometeorological indices on annual and summer level show a general increase throughout the country. Furthermore, heat wave analysis indicated that the most populated cities of Serbia are under dangerous and extreme heat stress during these extreme temperature events, which can influence human health and well-being. The obtained biometeorological information can be used for the preparation of climate adaptation strategies that consider the human biometeorological conditions, with a special focus on developing climate-sensitive and comfortable cities.
The increasing number of extremely hot days globally has made outdoor workers more vulnerable to heat-related illnesses such as heat syncope, heat exhaustion, heat edema, and heat stress. The objective of this article is to identify and analyze the challenges experienced by construction workers who work in extremely hot weather conditions for extended periods of time. To achieve this objective, a questionnaire was developed and distributed through the online platform QuestionPro. The 100 responses that were collected were analyzed using the Kruskal-Wallis test, and analyses were performed based on physiological indicators such as heart rate and blood pressure and personal indicators such as climate acclimatization and clothing comfort. The results of the analyses revealed that challenges such as physical fatigue, dehydration, excessive sweating, inability to concentrate, and frequent mood fluctuations were unique to individuals based on their acclimatization level, heart rate, and blood pressure. Optimized work-rest hours, the provision of adequate time for workers to acclimate to extreme conditions, and adoption of technologies such as cooling vests and continuous monitoring of workers’ physical parameters are some of the strategies that can be used to protect workers from heat-related health hazards. The article also briefly discusses the practices and regulations that are currently in effect to protect construction workers who are exposed to prolonged hot weather conditions. The findings presented in this article will help professionals in the construction sector effectively manage and safeguard workers’ health in extreme hot weather conditions.
Climate change-driven temperature increases worsen air quality in places where coal combustion powers electricity for air conditioning. Climate solutions that substitute clean and renewable energy in place of polluting coal and promote adaptation to warming through reflective cool roofs can reduce cooling energy demand in buildings, lower power sector carbon emissions, and improve air quality and health. We investigate the air quality and health co-benefits of climate solutions in Ahmedabad, India-a city where air pollution levels exceed national health-based standards-through an interdisciplinary modeling approach. Using a 2018 baseline, we quantify changes in fine particulate matter (PM(2.5)) air pollution and all-cause mortality in 2030 from increasing renewable energy use (mitigation) and expanding Ahmedabad’s cool roofs heat resilience program (adaptation). We apply local demographic and health data and compare a 2030 mitigation and adaptation (M&A) scenario to a 2030 business-as-usual (BAU) scenario (without climate change response actions), each relative to 2018 pollution levels. We estimate that the 2030 BAU scenario results in an increase of PM(2.5) air pollution of 4.13 µg m(-3) from 2018 compared to a 0.11 µg m(-3) decline from 2018 under the 2030 M&A scenario. Reduced PM(2.5) air pollution under 2030 M&A results in 1216-1414 fewer premature all-cause deaths annually compared to 2030 BAU. Achievement of National Clean Air Programme, National Ambient Air Quality Standards, or World Health Organization annual PM(2.5) Air Quality Guideline targets in 2030 results in up to 6510, 9047, or 17 369 fewer annual deaths, respectively, relative to 2030 BAU. This comprehensive modeling method is adaptable to estimate local air quality and health co-benefits in other settings by integrating climate, energy, cooling, land cover, air pollution, and health data. Our findings demonstrate that city-level climate change response policies can achieve substantial air quality and health co-benefits. Such work can inform public discourse on the near-term health benefits of mitigation and adaptation.
To assess the impacts of ambient temperature on hospitalizations of people experiencing homelessness. Methods. We used daily time-series regression analysis employing distributed lag nonlinear models of 148 177 emergency inpatient admissions with “no fixed abode” and 20 804 admissions with a diagnosis of homelessness in London, United Kingdom, in 2011 through 2019. Results. There was a significantly increased risk of hospitalization associated with high temperature; at 25°C versus the minimum morbidity temperature (MMT), relative risks were 1.359 (95% confidence interval [CI] = 1.216, 1.580) and 1.351 (95% CI = 1.039, 1.757) for admissions with “no fixed abode” and admissions with a homelessness diagnosis, respectively. Between 14.5% and 18.9% of admissions were attributable to temperatures above the MMT. No significant associations were observed with cold. Conclusions. There is an elevated risk of hospitalization associated with even moderately high temperatures in individuals experiencing homelessness. Risks are larger than those reported in the general population. Public Health Implications. Greater emphasis should be placed on addressing homeless vulnerabilities during hot weather rather than cold. Activation thresholds for interventions such as the Severe Weather Emergency Protocol (SWEP) could be better aligned with health risks. Given elevated risks at even moderate temperatures, our findings support prioritization of prevention-oriented measures, rather than crisis response, to address homelessness. (Am J Public Health. 2023;113(9):981-984. https://doi.org/10.2105/AJPH.2023.307351).
Maternal exposure to ambient heat may be associated with congenital anomalies, but evidence is still limited. OBJECTIVES: We aimed to estimate the association between maternal exposure to ambient heat during the 3-12 weeks post-conception (critical window of organogenesis) and risk of total and various diagnostic categories of major structural anomalies among live singleton births in the contiguous United States (US). METHODS: We included data on 2,352,529 births with the first day of critical developmental windows falling within months of May through August from 2000 to 2004 across 525 US counties. We used a validated spatial-temporal model to estimate daily county-level population-weighted temperature. We used logistic regression to estimate the association between ambient temperature and risk of diagnostic categories of anomalies during the critical window after adjusting for individual and county-level factors. We conducted subgroup analysis to identify potential susceptible subpopulations. RESULTS: A total of 29,188 anomalies (12.4 per 1000 births) were recorded during the study period. Maternal exposure to extreme heat (> 95th percentile) was associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies with an odds ratio (OR) of 1.05 (95 % CI: 1.00, 1.11), 1.17 (95 % CI: 1.01, 1.37), and 1.16 (95 % CI: 1.04, 1.29) compared with minimum morbidity temperature, respectively. The associations were homogeneous across subgroups defined by maternal age, maternal race/ethnicity, marital status, educational attainment, and parity, but were more pronounced among mothers residing in more socially vulnerable counties and births with multiple anomalies. CONCLUSIONS: Among US live singleton births, maternal exposure to ambient heat may be associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies. We suggest additional research is carried out to better understand the relations between maternal heat exposure and congenital anomalies in the presence of global warming.
Pregnancy is increasingly considered a period of vulnerability for extreme heat exposure. Multiple lines of evidence support that heat stress is associated with placental insufficiency, poor fetal growth and decreased birth weight. In this narrative review, we first summarize evidence linking ambient temperature or experimentally-induced heat stress with fetal and placental growth outcomes in humans, ruminants and murine species. We then synthesize the literature on putative underlying biological pathways with a focus on the placenta. Reviewed mechanisms include: reduced uterine-placental blood flow, impaired supply of metabolic substrates to the fetus, activation of the maternal stress-response system, and disruption of other endocrine and immune system endpoints. Taken together, this body of evidence supports that exposure to extreme ambient heat likely has adverse consequences for placental development and function. However, research investigating placenta-mediated pathophysiological mechanisms in humans remains extremely limited.
Increasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes. METHODS: We did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach. FINDINGS: 114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8-2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3-3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associated with a risk ratio of 1·01 (95% CI 1·00-1·01, p<0·001; n=111 794, six effects pooled from three studies). Three meta-analyses were conducted for hospital attendance or admission for mental illness: heatwaves versus non-heatwave periods were associated with an increase in incidence of 9·7% (95% CI 7·6-11·9, p<0·001; n=362 086, three studies); the risk ratio at the 99th percentile of daily mean temperature compared with the 50th percentile was 1·02 (95% CI 1·01-1·03, p=0·006; n=532 296, three studies); and no significant association was found between a 10°C increase in daily mean temperature and hospital attendance. In a qualitative narrative synthesis, we found that ambient outdoor temperature (including absolute temperatures, temperature variability, and heatwaves) was positively associated with attempted and completed suicides (86 studies), hospital attendance or admission for mental illness (43 studies), and worse outcomes for community mental health and wellbeing (19 studies), but much of the evidence was of low certainty with high heterogeneity. INTERPRETATION: Increased temperature and temperature variability could be associated with increased cases of suicide and suicidal behaviour, hospital attendance or admission for mental illness, and poor community health and wellbeing. Climate change is likely to increase temperature anomalies, variability, and heatwaves as well as average temperatures; as such, health system leaders and policy makers must be adequately prepared and should develop adaptation strategies. More high-quality, standardised research is required to improve our understanding of these effects. FUNDING: None.
Compound warm-dry spells over land, which is expected to occur more frequently and expected to cover a much larger spatial extent in a warming climate, result from the simultaneous or successive occurrence of extreme heatwaves, low precipitation, and synoptic conditions, e.g., low surface wind speeds. While changing patterns of weather and climate extremes cannot be ameliorated, effective mitigation requires an understanding of the multivariate nature of interacting drivers that influence the occurrence frequency and predictability of these extremes. However, risk assessments are often focused on univariate statistics, incorporating either extreme temperature or low precipitation; or at the most bivariate statistics considering concurrence of temperature versus precipitation, without accounting for synoptic conditions influencing their joint dependency. Based on station-based daily meteorological records from 23 urban and peri-urban locations of India, covering the 1970-2018 period, this study identifies four distinct regions that show temporal clustering of the timing of heatwaves. Further, combining joint probability distributions of interacting drivers, this analysis explored compound warm-dry potentials that result from the co-occurrence of warmer temperature, scarcer precipitation, and synoptic wind patterns. The results reveal 50-year severe heat stress solely based on the temperature at each location tends to be more frequent and is expected to become 5 to 17-year compound warm-dry events considering interdependence between attributes. Notably, considering dependence among drivers, a median 6-fold amplification (ranging from 3 to 10-fold) in compound warm-dry spell frequency is apparent relative to the expected annual number of a local (univariate) 50-year severe heatwave episode, indicating warming-induced desiccation is already underway over most of the urbanized areas of the country. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00382-022-06324-y.
Climate change has had a detrimental impact on global health, particularly through the rise of extreme heatwaves. Presently, the early warning system for heatwave-related health risks can forecast potential dangers several days in advance; however, long-term warnings fall short. WHAT IS ADDED BY THIS REPORT? This report introduces a novel early warning system aimed at predicting heatwave-induced health risks in China at sub-seasonal to seasonal timescales. The outcomes of the assessment suggest this system holds significant potential. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICES? The system facilitates advanced assessment of both the scale and dispersal of risk among various demographic groups. This allows for the proactive management of potential risks with extended lead times.
Rapid hospital arrival decreases mortality risk in heat-related illnesses. We investigated an easy-to-use indicator of life-threatening severity of heat-related illnesses in a community setting to enable quick hospitalization by using data extracted from prehospital transportation records of a database from 2016 that included information on the clinical severity of suspected heat-related illnesses in patients (n = 2528) upon hospital arrival. Patient-related risk factors (adjusted odds ratio, aOR [95% confidence interval, CI]) included age, vital signs, location of the patient, and illness severity, and respiratory rate (3.34 [1.80-6.22]), heart rate (2.88 [1.57-5.29]), axillary body temperature (7.79 [4.02-15.1]), and consciousness level (38.3 [5.22-281.1]) were independent risk factors for heat-related illness severity. On-site blood pressure was not an independent factor for illness severity. Heart rate > 120 beats/min, respiratory rate > 24 breaths/min, and temperature > 38.6 °C (highest areas under the receiver operating characteristic curves [95% CI]: 0.80 [0.75-0.87]; 0.73 [0.67-0.81]; and 0.83 [0.77-0.91], respectively) predicted life-threatening illness severity. Changes in the vital signs of patients with heat-related illnesses, particularly tachycardia and tachypnea, constitute sensitive, easy-to-use indicators that facilitate rapid identification of severity by laypersons and transport of patients before aggravation to a life-threatening situation.
The paper exposes the experience of Valencia in applying climate-resilient thinking to the current revision of the city’s General Urban Development Plan. A semi-quantitative, indicator-based risk assessment of heat stress was carried out on the 23 functional areas of the city sectorized by the Plan, including modeling and spatial analysis exercises. A data model of 18 indicators was built to characterize vulnerability. A thermal stress map was developed using the URbCLim model and a heat index was then calculated using Copernicus hourly data (air temperature, humidity, and wind speed) for the period of January 2008-December 2017 at a spatial resolution of 100 m x 100 m. General recommendations at the city level as well as guidelines for development planning in the functional areas at risk are provided, with specifications for the deployment of nature-based solutions as adaptation measures. From a planning perspective, the study positively informs the General Urban Development Plan, the City Green and Biodiversity Plan, and contributes to City Urban Strategy 2030 and City Missions 2030 for climate adaptation and neutrality. Applying the same approach to other climate change-related hazards (i.e., water scarcity, pluvial flooding, sea level rise) will allow better informed decisions towards resilient urban planning.
Evidence linking temperature with adverse perinatal and pregnancy outcomes is emerging. We searched for literature published until 30 January 2023 in PubMed, Web of Science, and reference lists of articles focusing on the outcomes that were most studied like preterm birth, low birth weight, stillbirth, and hypertensive disorders of pregnancy. A review of the literature reveals important gaps in knowledge and several methodological challenges. One important gap is the lack of knowledge of how core body temperature modulates under extreme ambient temperature exposure during pregnancy. We do not know the magnitude of non-modulation of body temperature during pregnancy that is clinically significant, i.e., when the body starts triggering physiologic counterbalances. Furthermore, few studies are conducted in places where extreme temperature conditions are more frequently encountered, such as in South Asia and sub-Saharan Africa. Little is also known about specific cost-effective interventions that can be implemented in vulnerable communities to reduce adverse outcomes. As the threat of global warming looms large, effective interventions are critically necessary to mitigate its effects.
Older adults are at greater risk for heat-related morbidity and mortality, due in part to age-related reductions in heat dissipating capabilities. Previous studies investigating the impact of age on responses to heat stress used approaches that lack activities of daily living and therefore may not accurately depict the thermal/physiological strain that would occur during actual heatwaves. We sought to compare the responses of young (18-39 yr) and older (≥65 yr) adults exposed to two extreme heat simulations. Healthy young (n = 20) and older (n = 20) participants underwent two 3-h extreme heat exposures on different days: 1) DRY (47°C and 15% humidity) and 2) HUMID (41°C and 40% humidity). To mimic heat generation comparable with activities of daily living, participants performed 5-min bouts of light physical activity dispersed throughout the heat exposure. Measurements included core and skin temperatures, heart rate, blood pressure, local and whole body sweat rate, forearm blood flow, and perceptual responses. Δ core temperature (Young: 0.68 ± 0.27°C vs. Older: 1.37 ± 0.42°C; P < 0.001) and ending core temperature (Young: 37.81 ± 0.26°C vs. Older: 38.15 ± 0.43°C; P = 0.005) were greater in the older cohort during the DRY condition. Δ core temperature (Young: 0.58 ± 0.25°C vs. Older: 1.02 ± 0.32°C; P < 0.001), but not ending core temperature (Young: 37.67 ± 0.34°C vs. Older: 37.83 ± 0.35°C; P = 0.151), was higher in the older cohort during the HUMID condition. We demonstrated that older adults have diminished thermoregulatory responses to heat stress with accompanying activities of daily living. These findings corroborate previous reports and confirm epidemiological data showing that older adults are at a greater risk for hyperthermia.NEW & NOTEWORTHY Using an experimental model of extreme heat exposure that incorporates brief periods of light physical activity to simulate activities of daily living, the extent of thermal strain reported herein more accurately represents what would occur during actual heatwave conditions. Despite matching metabolic heat generation and environmental conditions, we show that older adults have augmented core temperature responses, likely due to age-related reductions in heat dissipating mechanisms.
Profound heat stress can damage the gastrointestinal barrier, leading to microbial translocation from the gut and subsequent systemic inflammation. Despite the greater vulnerability of older people to heat wave-related morbidity and mortality, it is unknown if age modulates gastrointestinal barrier damage and inflammation during heat stress. Therefore, the aim of this study was to determine if aging impacted enterocyte damage and systemic inflammatory responses to a 3-h exposure to very hot and dry (47 °C, 15% humidity) heat with accompanying activities of daily living (intermittent activity at 3 METS). Data from 16 young (age 21 to 39 years) and 16 older (age 65 to 76 years) humans were used to address this aim. In each group, log-transformed plasma concentrations of intestinal fatty acid binding protein (I-FABP(log)), interleukin-8 (IL-8(log)), and tissue factor (TF(log)) were assessed as indices of enterocyte damage, systemic inflammation, and blood coagulation, respectively, before and after the 3-h heat exposure. In the younger cohort, I-FABP(log) concentration did not increase from pre to post heat exposure (p = 0.264, d = 0.20), although it was elevated in the older group (p = 0.014, d = 0.67). The magnitude of the increase in I-FABP(log) was greater in the older participants (p = 0.084, d = 0.55). Across all participants, there was no correlation between the change in core temperature and the change in IFABP(log). There was no change in IL-8(log) in the younger group (p = 0.193, d = 0.23) following heat exposure, but we observed a decrease in IL-8(log) in the older group (p = 0.047, d = 0.48). TF(log) decreased in the younger group (p = 0.071, d = 0.41), but did not change in the older group (p = 0.193, d = 0.15). Our data indicate that I-FABP(log) concentration (an index of enterocyte damage) is increased in older humans during a 3-h extreme heat exposure. Future studies should determine whether this marker reflects increased gastrointestinal barrier permeability in older individuals during heat exposure.
OBJECTIVE: The purpose of this study was to understand the experiences of agricultural workers during periods of heat and wildfire smoke exposure and to support the development and implementation of protective workplace interventions. METHODS: Using community-engaged research and the Center for Disease Control (CDC) framework for policy evaluation, a qualitative descriptive study was conducted with current and former agricultural workers in Central Washington (WA). Twelve participants answered semi-structured questions via interviews or by attending a focus group. Interviews and focus groups were conducted in Spanish, recorded, transcribed, and translated into English; one interview was conducted in English. RESULTS: Using Braun and Clarke’s Reflexive Thematic Analysis, five themes were identified among workers from various worksites: 1) Extreme weather and working conditions are becoming increasingly hazardous to worker health, 2) Employers and supervisors lack training and education on current labor laws, and health and safety rules, 3) Employers and supervisors use intimidation and retaliation to ensure productivity and to evoke feelings of replaceability among workers, 4) Workers do not trust regulatory agencies to enforce rules or hold employers accountable, 5) Solutions to climate-driven problems in the agricultural industry need to value worker health and safety, not just productivity. Participants reported experiencing adverse health symptoms related to heat and smoke exposure at work. Workers proposed solutions including improving education, training, and communication, and increased enforcement of existing and forthcoming occupational health and safety rules. CONCLUSION: The agricultural workforce is essential for ensuring a robust food supply and is facing extreme weather events due to climate change. Western states impacted by wildfires and heat are working to develop and implement occupational health and safety rules. Developing effective policies and interventions inclusive of worker perspectives is critical to adapt to a changing climate, retain a stable workforce and promote optimal health.
Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.
This study developed a gradient-boosted regression tree-based artificial intelligence (AI) model–temperature reduction effect AI model (TREAM)–to determine the temperature reduction effect of fog cooling that varies with weather conditions. According to the trend of global warming, our society is suffering from serious damage from urban heat islands, especially negatively affecting human health and thermal comfort. Therefore, it is very important to develop and evaluate adaptive technology for providing pleasant thermal comfort to humans. This study select fog cooling as adaptive technology for human thermal comfort, and indoor and outdoor simulation were performed using STAR CCM+, a computational fluid dynamics(CFD) program. Moreover, transient analysis to validate the outdoor model of CFD and parametric study to identify the correlation between the environmental factors and fog cooling were performed. When initial temperature set as 45 degrees C at a relative humidity of 90% and wind speed of 1 m/s, a temperature reduction of 8.92% can be obtained. Regardless of the temperature and humidity conditions, the temperature reduction effect of fog cooling was similar to 1% if the wind speed increased above 5 m/s. This study contributed to the quantitative analysis of the temperature reduction effect according to the change of environmental factors.
Due to global warming and the energy crisis, incorporating passive radiative cooling into personal thermal management has attracted extensive attention. However, developing a wearable textile that reflects incoming sunlight and allows mid-infrared radiation transmission is still a tough challenge. Herein, a shish-kebab superstructure film was produced via a flow-induced crystallization strategy for personal radiative cooling. The resulting film endowed a high infrared transmittance (87%) and improved sunlight reflectivity (83%). A device was developed to simulate the human body skin, and the temperatures of the shish-kebab film were 2.5 and 2.6 °C lower than that of traditional textile in outdoor and indoor tests, respectively. In order to make the shish-kebab film more wearable, a series of modifications were then carried out. This study demonstrates the substantial potential to personal thermal management textiles.
The increasing frequency and severity of weather extremes caused by climate change evidence the need to assess buildings beyond their typical thermal and energy performance under normal operation. It is also essential to evaluate thermal resilience to safeguard occupants’ health during extreme events and power outages. This study proposes a simulation framework to evaluate and enhance the thermal resilience of buildings against indoor overheating using an integrated set of performance metrics. This work also addresses how to aggregate resilience profiles of single buildings into the urban scale, supporting the evaluation of thermally resilient communities. This is the first step to connecting building and urban scales in a resilience analysis, seeking to further address other stakeholders’ needs in the future. The application of the framework is exemplified through a case study considering three different climates in Brazil. This analysis allowed identifying cases with poor thermal resilience and essential dependence on air conditioning to guarantee the survivability of occupants during extreme hot weather. Nonetheless, by only changing the envelope’s thermal transmittance and thermal mass, buildings’ thermal autonomy increased up to 65% points and cooling loads were reduced by up to 61% in the hottest climate, Sa similar to o Luis. However, additional strategies are necessary to mitigate remaining indoor extreme thermal conditions, such as solar shading and increased air movement.
BACKGROUND: Urban areas are disproportionately affected by multiple pressures from overbuilding, traffic, air pollution, and heat waves that often interact and are interconnected in producing health effects. A new synthetic tool to summarize environmental and climatic vulnerability has been introduced for the city of Rome, Italy, to provide the basis for environmental and health policies. METHODS: From a literature overview and based on the availability of data, several macro-dimensions were identified on 1,461 grid cells with a width of 1 km(2) in Rome: land use, roads and traffic-related exposure, green space data, soil sealing, air pollution (PM(2.5), PM(10), NO(2), C(6)H(6), SO(2)), urban heat island intensity. The Geographically Weighted Principal Component Analysis (GWPCA) method was performed to produce a composite spatial indicator to describe and interpret each spatial feature by integrating all environmental dimensions. The method of natural breaks was used to define the risk classes. A bivariate map of environmental and social vulnerability was described. RESULTS: The first three components explained most of the variation in the data structure with an average of 78.2% of the total percentage of variance (PTV) explained by the GWPCA, with air pollution and soil sealing contributing most in the first component; green space in the second component; road and traffic density and SO(2) in the third component. 56% of the population lives in areas with high or very high levels of environmental and climatic vulnerability, showing a periphery-centre trend, inverse to the deprivation index. CONCLUSIONS: A new environmental and climatic vulnerability indicator for the city of Rome was able to identify the areas and population at risk in the city, and can be integrated with other vulnerability dimensions, such as social deprivation, providing the basis for risk stratification of the population and for the design of policies to address environmental, climatic and social injustice.
Urban thermal comforts are increasingly holding people’s attention due to global warming and urban heat islands. Urban parks can absorb sunlight radiation, which reduces air temperature, improving urban microclimates. Various factors in the park are confirmed to be effective in heat mitigation. However, there are few studies on thermal comfort in urban mountain parks, and mountain areas might cause peculiar climatic conditions owing to their particular landforms. To fill this gap in the research, this study explored thermal comfort in mountain parks and the environmental factors that would affect thermal comfort. A field measurement in the summertime (July & August) of 2018, it was found that trees, the river, and the area of parks could adjust the thermal comforts of mountain parks. Their effects varied throughout the day, and the impacts of trees were most pronounced at noon and late afternoon, while the influence of rivers and park areas was most pronounced at noon. Increasing the leaf area index by 1 point could result in decreases in physiological equivalent temperature, land surface temperature, and solar radiation level by 3.90 °C, 2.69 °C, and 270.10 W/m(2), respectively. The findings have practical implications for future urban mountain park design works.
Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.
Hot extremes may adversely impact human health and agricultural production. Owing to anthropogenic and climate changes, the close and dynamic interaction between drought and hot extremes in most areas of China need to be revisited from the perspective of nonstationarity. This study therefore proposes a time-varying Copulabased model to describe the nonstationary dependence structure of summer extreme temperature (SET) and antecedent soil moisture condition to quantify the dynamic risk of hot extremes conditioned on dry/wet condition. A general statistical inspection procedure which was composed of maximum likelihood (ML)-based estimation, nonstationary Goodness-of-fit (GOF) tests, the log likelihood ratio (LR) tests and minimum corrected Akaike information criterion-based selection was promoted to select the best-fitted nonstationary models efficiently. This study proposed a new approach to identify the soil moisture driving law over extreme temperature from the point view of tail monotonicity and nonstationary risk assessment. Owing to the LTI-RTD (left tail increasing and right tail decreasing) tail monotonicity for dependence structure of these two extremes derived from most areas, two kinds of the driving laws of soil moisture over SET were detected. Because of the spatiotemporal divergence of sensitivity index derived from tail monotonicity (SITM), we can conclude that the spatial and temporal heterogeneity of response degree of ET over the variations of antecedent dry/wet conditions is evident. Incorporation of nonstationarity and tail monotonicity helps identify the changes of driving mechanism (laws) between soil moisture and hot extremes.
Extreme heat events are occurring more frequently and with greater intensity due to climate change. They result in increased heat stress to populations causing human health impacts and heat-related deaths. The urban environment can also exacerbate heat stress because of man-made materials and increased population density. Here we investigate the extreme heatwaves in the western U.S. during the summer of 2021. We show the atmospheric scale interactions and spatiotemporal dynamics that contribute to increased temperatures across the region for both urban and rural environments. In 2021, daytime maximum temperatures during heat events in eight major cities were 10-20 °C higher than the 10-year average maximum temperature. We discuss the temperature impacts associated with processes across scales: climate or long-term change, the El Niño-Southern Oscillation, synoptic high-pressure systems, mesoscale ocean/lake breezes, and urban climate (i.e., urban heat islands). Our findings demonstrate the importance of scale interactions impacting extreme heat and the need for holistic approaches in heat mitigation strategies.
The aim of this research is to propose a novel methodology that exploits Earth Observation (EO) data to accurately produce high-resolution bioclimatic maps at large spatiotemporal scales. This method directly links EO products (i.e., land surface temperature – LST and Normalized Difference Vegetation Index – NDVI) to air temperature (Tair) and such thermal indices as the Universal Thermal Climate Index (UTCI), and the Physiologically Equivalent Temperature (PET) to produce large-scale high-quality bioclimatic maps at a spatial resolution of 100 m. The proposed methodology is based on Artificial Neural Networks (ANNs), and the bioclimatic maps are developed with the use of Geographical Information Systems. High-resolution LST maps are produced from the spatial downscaling of EO images and the application of the methodology in the case of the island of Cyprus highlights the ability of EO parameters to estimate accurately T(air) as well as the above mentioned thermal indices. The results are validated for different conditions and the overall Mean Absolute Error for each case ranges from 1.9 °C for Tair to 2.8 °C for PET and UTCI. The trained ANNs could be used in near real-time for estimating the spatial distribution of outdoor thermal conditions and for assessing the relationship between human health and the outdoor thermal environment. On the basis of the developed bioclimatic maps, high-risk areas were identified. Furthermore, the study examines the relationship between land cover and Tair, UTCI, and PET, and the results provide evidence of the suitability of the method to monitor the dynamics of the urban environment and the effectiveness of urban nature-based solutions. Studies on bioclimate analysis monitor thermal environment, raise awareness and enhance the capacity of national public health systems to respond to thermally-induced health risks.
The adverse health impacts of climate change are increasingly apparent and the need for adaptation activities is pressing. Risks, drivers, and decision contexts vary significantly by location, and high-resolution, place-based information is needed to support decision analysis and risk reduction efforts at scale. METHODS: Using the Intergovernmental Panel on Climate Change (IPCC) risk framework, we developed a causal pathway linking heat with a composite outcome of heat-related morbidity and mortality. We used an existing systematic literature review to identify variables for inclusion and the authors’ expert judgment to determine variable combinations in a hierarchical model. We parameterized the model for Washington state using observational (1991-2020 and June 2021 extreme heat event) and scenario-driven temperature projections (2036-2065), compared outputs against relevant existing indices, and analyzed sensitivity to model structure and variable parameterization. We used descriptive statistics, maps, visualizations and correlation analyses to present results. RESULTS: The Climate and Health Risk Tool (CHaRT) heat risk model contains 25 primary hazard, exposure, and vulnerability variables and multiple levels of variable combinations. The model estimates population-weighted and unweighted heat health risk for selected periods and displays estimates on an online visualization platform. Population-weighted risk is historically moderate and primarily limited by hazard, increasing significantly during extreme heat events. Unweighted risk is helpful in identifying lower population areas that have high vulnerability and hazard. Model vulnerability correlate well with existing vulnerability and environmental justice indices. DISCUSSION: The tool provides location-specific insights into risk drivers and prioritization of risk reduction interventions including population-specific behavioral interventions and built environment modifications. Insights from causal pathways linking climate-sensitive hazards and adverse health impacts can be used to generate hazard-specific models to support adaptation planning.
Most studies projecting human survivability limits to extreme heat with climate change use a 35 °C wet-bulb temperature (T(w)) threshold without integrating variations in human physiology. This study applies physiological and biophysical principles for young and older adults, in sun or shade, to improve current estimates of survivability and introduce liveability (maximum safe, sustained activity) under current and future climates. Our physiology-based survival limits show a vast underestimation of risks by the 35 °C T(w) model in hot-dry conditions. Updated survivability limits correspond to T(w)~25.8-34.1 °C (young) and ~21.9-33.7 °C (old)-0.9-13.1 °C lower than T(w) = 35 °C. For older female adults, estimates are ~7.2-13.1 °C lower than 35 °C in dry conditions. Liveability declines with sun exposure and humidity, yet most dramatically with age (2.5-3.0 METs lower for older adults). Reductions in safe activity for younger and older adults between the present and future indicate a stronger impact from aging than warming.
Significant heat-related casualties underlie the urgency of establishing a heat-health warning system (HHWS). This paper presents an evidence-based pilot HHWS developed for Taipei City, Taiwan, through a co-design process engaging stakeholders. In the co-design process, policy concerns related to biometeorology, epidemiology and public health, and risk communication aspects were identified, with knowledge gaps being filled by subsequent findings. The biometeorological results revealed that Taipei residents were exposed to wet-bulb globe temperature (WBGT) levels of health concern for at least 100 days in 2016. The hot spots and periods identified using WBGT would be missed out if using temperature, underlining the importance of adopting an appropriate heat indicator. Significant increases in heat-related emergency were found in Taipei at WBGT exceeding 36°C with reference-adjusted risk ratio (RaRR) of 2.42, taking 30°C as the reference; and residents aged 0-14 had the highest risk enhancement (RaRR = 7.70). As for risk communication, occurring frequency was evaluated to avoid too frequent warnings, which would numb the public and exhaust resources. After integrating knowledge and reconciling the different preferences and perspectives, the pilot HHWS was co-implemented in 2018 by the science team and Taipei City officials; accompanying responsive measures were formulated for execution by ten city government departments/offices. The results of this pilot served as a useful reference for establishing a nationwide heat-alert app in 2021/2022. The lessons learnt during the interactive co-design processes provide valuable insights for establishing HHWSs worldwide.
Urban outdoor space is an important activity place for residents, and its thermal environment directly affects residents’ quality of life and physical and mental health. Due to global climate change and the acceleration of urbanization, the outdoor thermal comfort of urban residents has seriously declined, causing more and more scholars to pay attention to this problem and to carry out research. This paper summarizes the development history and evaluation principles of outdoor thermal comfort evaluation indices and sorts out the methods for achieving outdoor thermal comfort. This paper reviews the effects of urban climate, local microclimate, physiological, psychological, social, and cultural factors on outdoor thermal comfort. In addition, strategies for improving thermal comfort in urban outdoor spaces are discussed from the aspects of urban geometry, vegetation, surface materials, and water bodies. Finally, the existing problems and development directions of current urban outdoor space thermal comfort studies are pointed out. This review paper can provide a reference for the scientific planning and construction of urban outdoor spaces to improve people’s thermal comfort.
Extreme weather can cause ill health in older persons due to a direct thermal effect on the body’s thermoregulation and difficulties in maintaining a healthy lifestyle and accessing the health services they need. To understand experiences in relation to their exposures to extreme weather and how they responded to such weather conditions, including cold snaps, heat and air pollution in northern Thai communities, a descriptive qualitative study was conducted to uncover details and the essence of perspectives and experiences of older persons and family members. Three focus group discussions with 15 older persons and 15 family members occurred in three communities in Chiang Rai, a northern province of Thailand. Thematic analysis was performed. Experiences of older persons and families in relation to extreme weather conditions were described in five themes: local actions against weather changes, the double challenges, awareness and reactions to weather changes, protective and comfortable living environments, and mitigation of the impacts of weather conditions. Seasonal adaptability was key for older persons to stay safe and healthy during extreme weather changes. Heat, cold snaps, and air pollution made health and daily living routine maintenance among older persons challenging, especially among those with declining health. Older persons and families employed predictive and adaptive strategies to avoid and minimise extreme weather impacts and maximise their comfort and optimal living.
Extreme heat is a burgeoning public health concern facing cities, thus composite indicators (CI) are useful identifying at-risk populations and directing resources. Nonetheless, heat risk assessments regularly overlook fundamental CI components like weighting, aggregation, and exploring links to other models. This analysis examined how weighting and aggregation alter CI scores, associated spatial distribution, and performance. Models were validated with heat-related mortality data. The Florida urban heat risk index (FUHRI) demonstrated how weighting and aggregation influence model outputs. Applying uncommon statistical weights performed better than traditional approaches, and multiplicative aggregation outperformed conventional additive aggregation. Results support further exploring non-traditional methods to enhance extreme heat risk assessment while underscoring importance of comparing multiple CI. Despite FUHRI score and performance variation, there was often agreement about at-risk geographies; however, consistency does not guarantee accuracy identifying areas needing adaptation and mitigation. Decision makers should use caution interpreting CI unless validation analysis demonstrates adequate performance, and even then, models must be continuously refined using the most recent public health data and desirable methods available.
The rapidly advancing knowledge of the interactions between people and their environment provides opportunities for designers to practice evidence-based landscape architecture (EBLA) in designing outdoor spaces. Recent studies have proposed some characteristics of successful EBLA projects, including the following: amicable skepticism; the questioning of assumptions; the verification of information; the application of evidence to the problem at hand; and data that is openly reported and replicable. These five steps were the basis for a framework that was developed and tested through the redesign of a downtown area in a hot-climate city, El Paso, Texas. The process started with the collection of base information, including local climate conditions and evidence on heat-related illness. Case studies and a search of the literature led to the questioning of some assumptions, including the expectation that the air temperature on the site could be substantially modified through design. On-site microclimate measurements were used to confirm this insight, and were used to validate computer models. The validated models were used to assess the thermal comfort conditions across the site. A human energy budget model was used to identify the key atmospheric elements that both strongly affect a person’s heat health, and that can also be readily modified through landscape architectural design. These led to the development of guidelines, which were developed as a ‘tool kit’ and applied to the design. Amicable skepticism was practiced throughout the process to confirm that the decisions were made based on evidence, not opinions or preconceived notions. The resulting design was tested using computer models to check whether the goal of thermally comfortable conditions was met. The quantitative results illustrated the amount of improvement to the thermal comfort of site visitors. This process is universal and can be applied to any landscape.
Against the background of the climate crisis, there is an urgent need to include environmental sustainability recommendations in clinical practice guidelines. We highlight five domains for which suitable recommendations could help in mitigating the environmental impact of urology practice. PATIENT SUMMARY: Climate change is an urgent issue that requires global action. Guidelines published by urological societies should include recommendations for minimizing the impact of urology practice on the environment.
To explore the frequency and effect of extreme temperature on the non-accidental death rate in Hulunbuir, a Chinese ice city.MethodsFrom 2014 to 2018, mortality data of residents residing in Hulunbuir City were collected. The lag and cumulative effects of extreme temperature conditions on non-accidental death and respiratory and circulatory diseases were analyzed by distributed lag non-linear models (DLNM).ResultsThe risk of death was the highest during high-temperature conditions, the RR value was 1.111 (95% CI 1.031 similar to 1.198). The effect was severe and acute. The risk of death during extreme low-temperature conditions peaked on the fifth day, (RR 1.057; 95% CI 1.012 similar to 1.112), then decreased and was maintained for 12 days. The cumulative RR value was 1.289 (95% CI 1.045 similar to 1.589). Heat significantly influenced the incidence of non-accidental death in both men (RR 1.187; 95% CI 1.059-1.331) and women (RR 1.252; 95% CI 1.085-1.445).ConclusionsRegardless of the temperature effect, the risk of death in the elderly group (>= 65 years) was significantly higher than that of the young group (0-64 years). High-temperature and low-temperature conditions can contribute to the increased number of deaths in Hulunbei. While high-temperature has an acute effect, low-temperature has a lagging effect. Elderly and women, as well as people with circulatory diseases, are more sensitive to extreme temperatures.
With climate change and the recurring heat waves in arid lands, human well-being and activities in oasis set-tlements can be critical subjects for the ongoing years. This paper introduces a methodological approach to investigate the potential passive cooling effect inside the oasis palm groves, their spatial characteristics, and microclimatic thresholds. Based on the Physiological Equivalent Temperature (PET) index, the paper evaluates oasis palm groves’ ability to ensure a neutral human outdoor thermal comfort zone. The research aims to determine guidance of an optimal and nearly optimal thermal comfort threshold based on a series of parametric scenarios of oasis configurations. The study provides a cross of 12 ideal oasis scenarios. The paper evaluates the oasis cooling effect and thermal comfort and recommends aligning urban planning with thermal thresholds. Results reveal that PET neutral zone can be assured into ranges of 29 degrees C to 37 degrees C, 19 degrees C to 20 degrees C, 55% to 58%, and 1m/s to 2m/s of mean radiant temperature, air temperature, relative humidity and air velocity, respectively. The results refer policymakers and urban planners to invest in the passive cooling effect of the oasis palm grove in future urban design strategies to maintain the maximum neutral comfort hours during heat waves.
Our aim was to compare the ambient temperature thresholds for warm thermal discomfort, thermal unacceptability, and preference for cooler environment between post- and pre-menopausal women at different metabolic rates. A total of 38 women (15 pre-menopausal (46 +/- 5 years); 23 post-menopausal (55 +/- 3 years)), completed up to 3 experimental trials at different metabolic rates (1.2 MET, 1.8 MET, 2.5 MET) generated by intermittent stepping throughout an air temperature ramp protocol. Ambient air temperature thresholds for warm thermal discomfort (thermal sensation rating of +1.5), warm thermal unacceptability, and a preference for a cooler environment, were determined. Skin temperature at 12 points was measured throughout. While a higher metabolic rate yielded a lower air temperature threshold for warm thermal discomfort (P < 0.001), there was no difference (P = 0.61) between pre-menopausal (28.7 +/- 2.3 degrees C) and post-menopausal (28.5 +/- 2.4 degrees C) women, irrespective of metabolic rate. The threshold of thermal unacceptability and the temperature at which a preference to be cooler was expressed were decreased by 1 degrees C, regardless of metabolic rate in post-menopausal women (P = 0.021; P = 0.049). Mean body T-sk at the thresholds for warm thermal discomfort, thermal unacceptability, and preference for cooler temperature (all P > 0.05) did not differ between pre-menopausal and postmenopausal women. However, the forehead T-sk thresholds for thermal unacceptability (pre-menopausal: 34.5 +/- 1.1 degrees C; post-menopausal: 33.9 +/- 1.2 degrees C; P = 0.005) and preference for cooler temperature (pre-menopausal: 34.2 +/- 1.2 degrees C; post-menopausal: 33.7 +/- 1.3 degrees C; P = 0.025) were lower in post-menopausal women. These data indicate that while the temperature threshold for warm thermal discomfort is unaltered by menopause status, post-menopausal women report an environment to be unacceptably warm, and express a preference for a cooler temperature, at a lower ambient and forehead skin temperature.
The aim of this study is to evaluate and compare the human-biometeorological conditions at two resorts in Ukraine: a coastal resort located at Odesa in southern Ukraine and an inland resort situated by the lake at Svityaz situated in northwest Ukraine. The results of this study can facilitate the assessment of the tourist potentials of both locations by the tourism industry, tour operators, and tourists. The evaluation is based on an analysis of the Physiologically Equivalent Temperature (PET) and parameters presented through the Climate-Tourism/Transfer-Information Scheme (CTIS) for the period 1991-2020. The CTIS data reveal that better conditions in terms of thermal comfort can be found during the warm period from May to September at both sites. The results show that the highest frequency of all grades of heat stress are observed in the last 10-day period of July and in the first 10-day period of August at both stations, but at Odesa, the frequency of heat stress of any grade is approximately 10% higher than at Svityaz. The frequency of moderate, strong and extreme heat stress during the daytime in July and in the first two 10-day periods of August at Odesa ranged from 51.3% to 66.5%, and at Svityaz it ranged between 40.2 and 54.6%. Human-biometeorological conditions during heat waves are more strenuous at Odesa. The frequency of days with extreme heat stress at 12 UTC during summer heat waves is 48.4% at Odesa and 35.6% at Svityaz. The results show a higher frequency of thermal stress at Odesa, which makes this resort less comfortable for people vulnerable to heat stress.
Sugarcane cutters are vulnerable to extreme heat and are at risk for heat-related illness and chronic kidney disease, potentially due to high heat strain. We performed a comprehensive assessment of the physiological demands of sugarcane cutters via measurements of metabolic, thermal, and cardiovascular responses. In addition, we assessed cross-shift changes in markers of kidney function. Nine male sugarcane cutters were monitored while working during the spring harvest season in Brazil. Core temperature (Tcore) and heart rate (HR) were continuously recorded, and oxygen consumption was measured during the work shift. Urine and blood samples were collected pre- and postwork shifts. Total sweat loss was calculated using body weight changes and adjusting for water ingestion and urine output. A wet-bulb globe temperature (WBGT) station was used to monitor environmental heat stress. WBGT was ≥30°C on 7 of the 8 study days. Mean and peak Tcore during the work shift were 37.96 ± 0.47°C and 38.60 ± 0.41°C, respectively, with all participants surpassing a Tcore of 38°C. Mean and peak HR during the work shift were 137 ± 14 and 164 ± 11 beats/min, respectively. Percent of maximal oxygen consumption was, on average, 53 ± 11%. Workers had a total sweat loss of 7.63 ± 2.31 L and ingested 6.04 ± 1.95 L of fluid. Kidney function (estimated glomerular filtration rate) was reduced from pre- to postwork shift (Δ -20 ± 18 mL·min·1.73 m(2)). We demonstrated that sugarcane cutters performing prolonged work during a period of high environmental heat stress display high levels of heat strain, high water turnover, and reduced kidney function.NEW & NOTEWORTHY We demonstrate that a shift of sugarcane cutting performed outdoors during the spring harvest season results in a high level of heat strain. In fact, all the studied workers sustained core temperatures above 38°C and heart rates above 75% of the measured maximum heart rate. Additionally, workers displayed a high water turnover with sweat loss close to 10% of their body weight. Finally, we report elevated muscle damage and reductions in kidney function following the work shift.
INTRODUCTION: High workplace/ambient temperatures have been associated with Adverse Pregnancy Outcomes (APO). Millions of women working in developing nations suffer due to the rising temperatures caused by climate change. There are few pieces of research linking occupational heat stress to APO, and fresh evidence is required. METHODOLOGY: We used databases including PubMed, Google Scholar, and Science Direct to search for research on high ambient/workplace temperatures and their effects. Original articles, newsletters, and book chapters were examined. The literature we analysed was categorised as follows: Heat, strain, and physical activity harming both mother and fetus. After categorising the literature, it was examined to identify the major results. RESULTS: We found a definite association between heat stress and APOs such as miscarriages, premature birth, stillbirth, low birthweight, and congenital abnormalities in 23 research articles. Our work provides important information for future research into the biological mechanisms that create APOs and various prevention measures. CONCLUSION: Our data suggest that temperature has long-term and short-term effects on maternal and fetal health. Though small in number, this study stressed the need for bigger cohort studies in tropical developing countries to create evidence for coordinated policies to safeguard pregnant women.
RATIONALE: Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. METHODS: A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test [CAT]), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity [RH]), 2) hot and humid (≥ 25°C, > 50% RH) and 3) cold and dry (≤ 5°C, < 30% RH) weather conditions. Participants were ≥ 40 years old with COPD or related chronic respiratory diseases (e.g., asthma, sleep apnea, interstitial lung disease, lung cancer) and residing in Canada for ≥ 1 year. Negative responders to weather extremes were a priori defined as having a change of ≥ 2 points in the CAT. MAIN RESULTS: Thirty-six participants responded; the mean age (SD) was 65 (11) years, and 23 (64%) were females. Compared to ideal conditions, 23 (66%) and 24 (69%) were negatively affected by cold/dry and hot/humid weather, respectively. Health status was significantly lower, and PA amount and difficulty level were reduced in hot/humid and cold/dry conditions compared with ideal conditions. The number of exacerbations in hot/humid was significantly higher compared to ideal conditions. CONCLUSIONS: More participants were negatively affected by extremes of weather: health status worsened, PA decreased, and frequency of exacerbations was higher compared to ideal. Future prospective studies should directly and objectively investigate different combinations of extreme temperature and humidity levels on symptoms and PA to understand their long-term health outcomes.
Human-perceived temperature (HPT) describes the joint effects of multiple climatic factors such as temperature and humidity. Extreme HPT events may reduce labor capacity and cause thermal discomfort and even mortality. These events are becoming more frequent and more intense under global warming, posing severe threats to human and natural systems worldwide, particularly in populated areas with intensive human activities, e.g., the North China Plain (NCP). Therefore, a fine-scale HPT dataset in both spatial and temporal dimensions is urgently needed. Here we construct a daily high-resolution (~1 km) human thermal index collection over NCP from 2003 to 2020 (HiTIC-NCP). This dataset contains 12 HPT indices and has high accuracy with averaged determination coefficient, mean absolute error, and root mean squared error of 0.987, 0.970 °C, and 1.292 °C, respectively. Moreover, it exhibits high spatiotemporal consistency with ground-level observations. The dataset provides a reference for human thermal environment and could facilitate studies such as natural hazards, regional climate change, and urban planning.
Mosquito-borne diseases have been spreading across Europe over the past two decades, with climate change contributing to this spread. Temperature and precipitation are key factors in a mosquito’s life cycle, and are greatly affected by climate change. Using a machine learning framework, Earth Observation data, and future climate projections of temperature and precipitation, this work studies three different cases (Veneto region in Italy, Upper Rhine Valley in Germany and Pancevo, Serbia) and focuses on (i) evaluating the impact of climate factors on mosquito abundance and (ii) long-term forecasting of mosquito abundance based on EURO-CORDEX future climate projections under different Representative Concentration Pathways (RCPs) scenarios. The study shows that increases in precipitation and temperature are directly linked to increased mosquito abundance, with temperature being the main driving factor. Additionally, as the climatic conditions become more extreme, meaning higher variance, the mosquito abundance increases. Moreover, we show that in the upcoming decades mosquito abundance is expected to increase. In the worst-case scenario (RCP8.5) Serbia will face a 10% increase, Italy around a 40% increase, and Germany will reach almost a 200% increase by 2100, relative to the decade 2010-2020. However, in terms of absolute numbers both in Italy and Germany, the expected increase is similar. An interesting finding is that either strong (RCP2.6) or moderate mitigation actions (RCP4.5) against greenhouse gas concentration lead to similar levels of future mosquito abundance, as opposed to no mitigation action at all (RCP8.5), which is projected to lead to high mosquito abundance for all cases studied.
Prolonged heat exposure may cause various physiological responses to outdoor workers. This will result in economic and productivity losses for a company and also may affect the sustainable development speed of cities. To avoid the above adverse effects, an alerting system is designed for outdoor workers to prevent them from overtime working in high-temperature scenarios. In the system, multiple sensors embedded micro-electromechanical system (MEMS) wearable device is used for real-time working status data collection, and a hybrid deep learning model is adopted to recognise the working status of outdoor workers. This hybrid model, called C-LSTM, combines the advantages of convolutional neural networks (CNN) and long short-term memory networks (LSTM) to extract useful spatial and temporal features of working status efficiently. Experimental results show that the performance on the inference time and accuracy of the C-LSTM model is better than that of conventional ones. The working status recognition accuracy of the C-LSTM model reaches 97.91%, and the inference time of the model reduces to less than 51 ms. In addition, the C-LSTM model has the best stability. The designed system can not only be used in outdoor high-temperature environment but also applied to medical and industrial scenarios, which further extends the application fields.
Heatstroke is a heat stress-induced, life-threatening condition associated with circulatory failure and multiple organ dysfunctions. If global warming continues, heatstroke might become a more prominent cause of mortality worldwide, but its pathogenic mechanism is not well understood. We found that Z-DNA binding protein 1 (ZBP1), a Z-nucleic acid receptor, mediated heatstroke by triggering receptor-interacting protein kinase 3 (RIPK3)-dependent cell death. Heat stress increased the expression of ZBP1 through heat shock transcription factor 1 (HSF1) and activated ZBP1 through a mechanism independent of the nucleic acid sensing action. Deletion of ZBP1, RIPK3, or both mixed lineage kinase domain-like (MLKL) and caspase-8 decreased heat stress-induced circulatory failure, organ injury, and lethality. Thus, ZBP1 appears to have a second function that orchestrates host responses to heat stress.
A large area including the central-northern part of Argentina, southern Bolivia, central Chile, and most of Paraguay and Uruguay, experienced record-breaking temperatures during two consecutive heatwaves in late November and early December 2022. During the second heatwave, nine locations in northern Argentina registered their highest maximum temperature of December since at least 1961. Our analysis based on observational and reanalysis datasets indicate that South America, like the rest of the world, has experienced heatwaves increasingly frequently in recent years. The December 2022 heatwave has an estimated return time of 1 in 20 years in the current climate, meaning it has about a 5% chance of happening each year. To estimate how human-caused climate change has influenced the likelihood and intensity of the observed heatwave, we combined climate models with the observation-based data. We found that human-caused climate change made the event about 60 times more likely. A heatwave with a return period of 20 years would be about 1.4 & DEG;C less hot in a world without anthropogenic global warming. Heatwaves this early in the summer season pose a substantial risk to human health and are potentially lethal. This risk is aggravated by climate change, but also by other factors such as an aging population, urbanisation and the built environment, and individual behavior and susceptibility to the heat. This highlights the importance of attribution studies in a region already threatened and vulnerable to climate change.
Background: Heat waves caused by climate change are increasingly challenging the wellbeing of individuals across the lifespan. Current efforts to understand the thermal perceptions and behaviours of people throughout the lifespan during heat waves are limited. Methods: Since June 2021, the Active Heatwave project has been recruiting households to better understand how individuals perceive, cope, and behave during heat waves. Using our novel web platform, participants were prompted to answer our Heat Alert Survey on days when a participants geolocation corresponded to a broadcasted local heat alert. Participants provided 24-h movement behaviour, thirst, thermal perception, and cooling strategies via validated questionnaires. Results: A total of 285 participants (118 children) from 60 distinct weather station locations globally participated between June and September 2021 and 2022. At least 1 heat alert (834 total) were identified from 95% (57/60) of the weather stations. Children reported spending more time performing vigorous intensity exercise compared to adults (p < 0.05), but no differences in thermal sensation, thermal comfort, or thirst sensation (all p > 0.31) were observed. For thirst management, 88% of respondents used water to relieve thirst, although notably, 15% of adults reported using alcohol. Regardless of age, staying indoors was the most common heat management strategy, whereas visiting cooling centres was the least. Conclusion: The present study presents a proof-of-concept combining local heat alert notifications with e-questionnaires for collecting near-real-time perceptual and behavioural data for both children and adults during heat waves. The observed patterns of behaviour suggest that present public heat-health guidelines are often ignored, children engage in fewer heat management strategies compared to adults, and these disparities highlight the need to improve public health communication and knowledge dissemination around promoting effective and accessible cooling solutions for children and adults.
In this study, the human thermal stress was quantified across Central Africa (C.A.) using the Universal Thermal Climate Index (UTCI). Although many of the documented studies on the use of UTCI in relation to human health are currently restricted to countries in the northern hemisphere, this contribution constitutes a prerequisite of information for future research in the region. To mitigate the problem of lack of field data in the Central African sub-region, we downloaded UTCI data via the ERA5 reanalysis portal. Based on this data source, we have explored the spatiotemporal characteristics and the resulting behaviour at annual, seasonal and monthly scales in Central Africa over the period 1982 to 2022. On these different scales, 4 of the 10 UTCI thermal stress categories were experienced, ranging from mild cold stress to strong heat stress. Spatially, cases of moderate heat stress were the most widespread, with cases of strong intensity occurring in a few isolated areas in the centre, east and west. Slight cold stress is confined to the south-east domain, particularly in autumn and winter. From 1982 to 2022, heat stress has increased significantly in the region, with peaks observed in January and October; very few areas have been spared the phenomenon of thermal stress. However, a slight decreasing trend was noticed along coastal regions and the south of C.A. Thereafter, the trend values showed the degree of C.A. vulnerability to global warming, and thus appropriate measures should be taken in relation to outdoor occupations and its impacts on the population of this region.
The impact of climate change in recent years on public health risks continues to intensify, and rational arrangement of trees can effectively reduce urban heat islands. As a gathering place for residents’ outdoor activities, the small squares widespread in a city have a high risk of daytime heat exposure during summer due to their lack of shelter. How to maintain a balance between openness and shading has become a challenge for urban design. The tree canopy plan that forms a continuous shaded area during the hottest hours of a typical summer day is provided based on the principles of planting economy, activity space adequacy, and heat stress relief effectiveness. Taking 5 typical squares in Dalian, China as an example, we calculated the spatio-temporal distribution of the mean radiant temperature (Tmrt) before and after tree canopy planning using the validated SOLWEIG model, and quantified the corresponding changes in risk levels. This study aims to provide climate change adaptation strategies for small squares to deal with health risks through implementing tree canopies. The results showed that the average Tmrt decreased by 3.5 degrees C-7.7 degrees C during the hottest period of the day (11:00-15:00, August 14, 2020). The high-risk areas were reduced by 27%-50.4%. The improvement rate of canopy planning is 53%-94% in the high-risk area, but only 36% in the medium-risk area. We concluded that square height-to-width ratios are associated with the degree of heat exposure risk, and squares with high levels of heat exposure risk have greater overall cooling potential after tree canopy planning. Implementing tree canopy planning can create continuous low-risk paths, while keeping the square open and protecting those who need to pass during the hottest hours. Compared with the medium-risk areas planted in squares, the planning benefits of high-risk areas are better.
Heat extremes severely affect human-health. Their impacts can be further exacerbated when humidity is included, which forms a kind of compound extremes called as compound humidity-heat extremes (CHEs). Previous works mainly focus on the spatiotemporal patterns and causes of CHEs, limited studies are devoted to the coupling strength between the involved two variables, which quantifies the coherence between the two fields and also plays a key role in determining the intensity and persistence of such CHEs. Based on Dynamical System (DS) method, this study takes the successive reanalysis data of daily mean 2-m air temperature (Tmean) and relative humidity (RH) over a given region as two DSs, then an instantaneous coupling metric is computed to quantify the coupling strength of CHEs. Although all CHEs are with a high value of Heat Index (HI), they show a marked discrepancy in coupling strength, which may be mainly related to the stability of large-scale atmosphere from four favorable underlying mechanisms: (1) westward extension and intensification of the Western North Pacific Subtropical High; (2) wave trains in mid-latitude; (3) barotropic structure and (4) no tropical cyclone. Strong coupled CHEs can meet all the requirements while weak coupled not. These novel findings provide further understandings on the compound extreme events and contribute considerably to heat-related risk assessment and management.
Under heat problem, the combined effects of heatwaves and urban heat island effects, has been one of the deadliest climate-related disasters. Uncovering heat-induced health problems is of significance to inform people of urban heat impacts and improve people’s awareness of addressing urban heat problems. Existing studies have primarily done this through panel analysis based on second-hand data from local or national authorities. However, there are limited studies directly concentrating on the heat responses of people. To address this gap, this study aims to investigate public responses to urban heat and heat-related illness on the individual side. The study was conducted through a questionnaire survey in three Chinese cities including Nanchang, Shenyang and Xi’an. Based on 1154 valid responses, this study analysed respondents’ understanding of urban heat problems, symptoms of physiological illnesses and their behaviours of hospitalisation. The results indicate that the knowledge of heat-related risks (2.29 out of 5) was significantly lower than the perceived urban heat severity (3.24) and the perceived severity of physiological impacts (2.40). The skin heat damage (44.7%), among 873 respondents who underwent physiological impacts, was the most frequent physiological illness, followed by the digestive systems (34.0%) and then respiratory (24.1%) and cardiovascular diseases (18.2%). Among the 873 respondents, only 4.0% and 17.7% of respondents would like or were mostly yes to visit hospitals, while 14.2% and 26.4% of the respondents would not like or were mostly not to visit hospitals. Moreover, perceived urban heat severity, knowledge of heat-related risks, perceived severity of physiological impacts, symptoms of physiological illnesses and behaviours of hospitalisation were city-specific and demography-dependent. Overall, the empirical analysis provides new evidence of urban heat problems and generates theoretical and policy implications for heat-induced impact estimation and prevention.
Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers’ risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers’ needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June-October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers’ perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries’ risk factors.
Heat stress is associated with numerous health effects that potentially harm workers, especially in a warming world. This investigation occurred in a setting where laborers are confronted with occupational heat stress from physically demanding work in high environmental temperatures. Collaboration with a major Nicaraguan sugarcane producer offered the opportunity to study interventions to prevent occupational heat-stress-related kidney disease. Two aims for this study of a rest-shade-water intervention program were: (1) describe the evolving intervention, summarize findings that motivated proposed improvements, assess impact of those improvements, and identify challenges to successful implementation and (2) extract primary lessons learned about intervention research that have both general relevance to investigations of work-related disease prevention and specific relevance to this setting. The learning curve for the various stakeholders as well as the barriers to success demonstrate that effectiveness of an intervention cannot be adequately assessed without considerations of implementation. Designing, effectively implementing, and assessing both health impacts and implementation quality is a resource-intensive endeavor requiring a transdisciplinary approach. Both general and specific lessons learned are presented for decisions on study design and study elements, implementation assessment, and management engagement in understanding how productivity and health can be successfully balanced and for building effective communication between investigators and all levels of management.
Despite years of social mobility, indigenous people in India stand low in most development indices, and the substandard living conditions make them highly vulnerable to natural disasters. In this communication, we unfold the vulnerabilities and coping strategies of the Paniya tribal community of Kerala during the unusual rain and flood that the state faced in 2018 and 2019. The vulnerability arises primarily from food scarcity, malnutrition, low physical well-being, unemployment and financial instability. Climate change and related events seem to heighten the prevailing exposure of the indigenous community, and women are generally more vulnerable to the impacts of natural disasters. The study also points out the psychological impact of the flood and the various coping mechanisms adopted over individual and community levels to alleviate the effect. The community members have an optimistic outlook towards life, even after experiencing catastrophic floods and landslides. Nevertheless, this outlook is not a visionary outcome of the rehabilitation process but rather an optionless strategy for the community to get along.
In human experience, it has been well known that temperature induced aggravations, such as heatstroke, heat cramps, dehydration, and frostbite, are among the most common health hazards. For those who live or work in prolonged and extreme temperature conditions, the aggravation may lead to fatal consequences. Temperature control systems such as air conditioning and central heating have been investigated and implemented to provide people a comfortable, and more importantly, livable temperature. However, these systems could be cumbersome to implement in an outdoor or confined environment. Moreover, they lack flexibility such mobility and adaptable temperature for individual needs. In this study, a wearable bio-inspired pulsating (discontinuous) flow cooling system with superior heat exchange efficiency to conventional steady (continuous) flow system, is proposed. Based on a novel array of the cooling tubes, an empirical approach is adopted to avoid complex numerical analysis of the thermal fluid dynamic involved. The prototypes of the two cooling flow systems are built and their performances compared. The results show that the proposed system not only demonstrates better cooling, but also offers potential flexibility that allows personalized temperature conditioning in a ‘live’ garment.
Around the world people are rapidly moving to cities. The rapid urbanization has led to changes in land use and land cover, which (i) modify the urban surface energy balance making the cities hotter than the surrounding rural area, (ii) exacerbate the impact of extreme weather events like heatwaves and (iii) lead to poor quality of life. City administrations around the world are undertaking drastic measures to mitigate extreme heat. Here, in this study we test a wearable sensing platform to both study pedestrian-level microclimate boundary conditions as well as the impact of urban greening on moderating excess heat in dense urban areas. The experiment presented here was conducted in New York City. Typically, the urban thermal state is estimated by means of direct observations from ground-based sensors, satellite based remote sensing techniques, and high-resolution urban climate modeling, all of which are too coarse to resolve pedestrian-level impacts, a key parameter in determining heat stress for citizens occupying the outdoors. Here a wearable and a portable sensing apparata were used to monitor key environmental parameters – air temperature, relative humidity, wind speed, mean radiant temperature and solar radiation. The coupled monitoring platform included multiple sensors and a wireless data logging system which were all prototyped by the authors on open source technologies. The sensor platform was able to accurately map the thermal environment of multiple dense urban spaces, being to reproduce the spatial variability in key microclimate parameters, and the performance was comparable to traditional stationary ground-based weather stations. The results, which may be of key help also for validating microclimate forecasting models, indicate high spatial variability in temperature, humidity and solar radiation within the same urban parks. Our findings also indicate that on average small urban parks in a dense urban setting were able to reduce the air temperature by 3-7 degrees C in New York City with major gains during the mid-afternoon periods.
BACKGROUND: Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecological momentary assessment, and some studies have used wearables in the field of climate change and health. However, these studies vary in study design, demographics, and outcome variables, and existing research has not been mapped. OBJECTIVE: In this review, we aimed to map existing research on wearables used to detect direct health impacts and individual exposure during climate change-induced weather extremes, such as heat waves or wildfires. METHODS: We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and systematically searched 6 databases (PubMed [MEDLINE], IEEE Xplore, CINAHL [EBSCOhost], WoS, Scopus, Ovid [MEDLINE], and Google Scholar). The search yielded 1871 results. Abstracts and full texts were screened by 2 reviewers (MK and IM) independently using the inclusion and exclusion criteria. The inclusion criteria comprised studies published since 2010 that used off-the-shelf wearables that were neither invasive nor obtrusive to the user in the setting of climate change-related weather extremes. Data were charted using a structured form, and the study outcomes were narratively synthesized. RESULTS: The review included 55,284 study participants using wearables in 53 studies. Most studies were conducted in upper-middle-income and high-income countries (50/53, 94%) in urban environments (25/53, 47%) or in a climatic chamber (19/53, 36%) and assessed the health effects of heat exposure (52/53, 98%). The majority reported adverse health effects of heat exposure on sleep, physical activity, and heart rate. The remaining studies assessed occupational heat stress or compared individual- and area-level heat exposure. In total, 26% (14/53) of studies determined that all examined wearables were valid and reliable for measuring health parameters during heat exposure when compared with standard methods. CONCLUSIONS: Wearables have been used successfully in large-scale research to measure the health implications of climate change-related weather extremes. More research is needed in low-income countries and vulnerable populations with pre-existing conditions. In addition, further research could focus on the health impacts of other climate change-related conditions and the effectiveness of adaptation measures at the individual level to such weather extremes.
As global warming intensifies, hot extremes and heavy precipitation frequently happen in East of China. Meanwhile, severe surface ozone (O-3) pollution resulting from the interactions of anthropogenic emissions and meteorological conditions also occur more frequently. In this study, we quantified the impact of weather extremes on ground-level O-3 concentration during the summers of 2015-2021 and associated premature deaths in East of China. The O-3 pollution influenced by hot extremes [maximum 8-h average O-3 concentration (MDA8 O-3) = 152.7 mu g m(-3)] was 64.2% more severe than that associated with heavy rain (MDA8 O-3 = 93 mu g m(-3)) on the daily time scale. The compound hot and dry air extremes had a larger impact, and the associated MDA8 O-3 could be up to 165.5 mu g m(-3). Thus, weather extremes could drastically perturb the O-3 level in the air to exhibit large variability. Based on GEOS-Chem simulations with fixed anthropogenic emissions, forcing of weather extremes could successfully reproduce the large daily variability of O-3 concentration because the weather extremes significantly influenced the physicochemical processes in the atmosphere. Furthermore, hot extremes magnified the single-day O-3-related premature death to 153% of that under other-condition events, while heavy rain events decreased it to 70% in East of China. The findings of the present study have the potential to promote daily to weekly O-3 forecasts and further improve our comprehensive understanding of the health effects of weather extremes and air pollution.
Heat stroke is a serious heat-related health outcome that can eventually lead to death. Due to the poor accessibility of heat stroke data, the large-scale relationship between heat stroke and meteorological factors is still unclear. This work aims to clarify the potential relationship between meteorological variables and heat stroke, and quantify the meteorological threshold that affected the severity of heat stroke. We collected daily heat stroke search index (HSSI) and meteorological data for the period 2013-2020 in 333 Chinese cities to analyze the relationship between meteorological variables and HSSI using correlation analysis and Random forest (RF) model. Temperature and relative humidity (RH) accounted for 62% and 9% of the changes of HSSI, respectively. In China, cases of heat stroke may start to occur when temperature exceeds 36°C and RH exceeds 58%. This threshold was 34.5°C and 79% in the north of China, and 36°C and 48% in the south of China. Compared to RH, the threshold of temperature showed a more evident difference affected by altitude and distance from the ocean, which was 35.5°C in inland cities and 36.5°C in coastal cities; 35.5°C in high-altitude cities and 36°C in low-altitude cities. Our findings provide a possible way to analyze the interaction effect of meteorological variables on heat-related illnesses, and emphasizes the effects of geographical environment. The meteorological threshold quantified in this research can also support policymaker to establish a better meteorological warning system for public health.
BACKGROUND: Literature reporting the association between heat stress defined by universal thermal climate index (UTCI) and emergency department visits is mainly conducted in Europe. This study aimed to investigate the association between heat stress, as defined by the UTCI, and visits to the accident and emergency department (AED) in Hong Kong, which represents a subtropical climate region. METHODS: A retrospective study involving 13,438,846 AED visits in the public sector from May 2000 to September 2016, excluding 2003 and 2009, was conducted in Hong Kong. Age-sex-specific ANCOVA models of daily AED rates on heat stress and prolonged heat stress, adjusting for air quality, prolonged poor air quality, typhoon, rainstorm, year, day of the week, public holiday, summer vacation, and fee charging, were used. RESULTS: On a day with strong heat stress (32.1 °C ≤ UTCI ≤ 38.0 °C), the AED visit rate (per 100,000) increased by 0.9 (95% CI: 0.5, 1.3) and 1.7 (95% CI: 1.3, 2.1) for females and males aged 19-64 and 4.1 (95% CI: 2.7, 5.4) and 4.1 (95% CI: 2.6, 5.6) for females and males aged ≥ 65, while keeping other variables constant. On a day with very strong heat stress (38.1 °C ≤ UTCI ≤ 46.0 °C), the corresponding rates increased by 0.6 (95% CI: 0.1, 1.2), 2.2 (95% CI: 1.7, 2.7), 4.9 (95% CI: 3.1, 6.7), and 4.7 (95% CI: 2.7, 6.6), respectively. The effect size of heat stress associated with AED visit rates was negligible among those aged ≤ 18. Heat stress showed the greatest effect size for males aged 19-64 among all subgroups. CONCLUSION: Biothermal condition from heat stress was associated with the health of the citizens in a city with a subtropical climate and reflected in the increase of daily AED visit. Public health recommendations have been made accordingly for the prevention of heat-related AED visits.
BACKGROUND: Heatwaves have received major attention globally due to their detrimental effects on human health and the environment. The frequency, duration, and severity of heatwaves have increased recently due to changes in climatic conditions, anthropogenic forcing, and rapid urbanization. Australia is highly vulnerable to this hazard. Although there have been an increasing number of studies conducted in Australia related to the heatwave phenomena, a systematic review of heatwave vulnerability has rarely been reported in the literature. OBJECTIVES: This study aims to provide a systematic and overarching review of the different components of heatwave vulnerability (e.g., exposure, sensitivity, and adaptive capacity) in Australia. METHODS: A systematic review was conducted using the PRISMA protocol. Peer-reviewed English language articles published between January 2000 and December 2021 were selected using a combination of search keywords in Web of Science, Scopus, and PubMed. Articles were critically analyzed based on three specific heatwave vulnerability components: exposure, sensitivity, and adaptive capacity. RESULTS AND DISCUSSION: A total of 107 articles meeting all search criteria were chosen. Although there has been an increasing trend of heat-related studies in Australia, most of these studies have concentrated on exposure and adaptive capacity components. Evidence suggests that the frequency, severity, and duration of heatwaves in Australian cities has been increasing, and that this is likely to continue under current climate change scenarios. This study noted that heatwave vulnerability is associated with geographical and climatic factors, space, time, socioeconomic and demographic factors, as well as the physiological condition of people. Various heat mitigation and adaptation measures implemented around the globe have proven to be efficient in reducing the impacts of heatwaves. CONCLUSION: This study provides increased clarity regarding the various drivers of heatwave vulnerability in Australia. Such knowledge is crucial in informing extreme heat adaptation and mitigation planning.
Human beings are adversely affected by climate extremes, pertinent to an increase in frequency and intensity of warm temperatures, eventually inducing warming on a global and regional scale. In a tropical nation like India, high summer temperature and increased moisture with the arrival of the southwest monsoon (hereafter referred to as monsoon) aggravate the sultriness of the ambient environment. Irrespective of global climate change, cities alter their climate due to urban materials’ impervious surfaces and thermal properties, which upsurge moisture and temperature in urban settings. Thus, urban dwellers are peculiarly vulnerable to heat stress health hazards. Heat stress indices allow quantitative assessment of thermal stress to determine the safe limits of thermal exposure. In the present study, statistical trends in Heat Index were evaluated to analyze heat stress over 41 urban stations of southern peninsular India over the summer and monsoon season from 1969 to 2015. Results indicated that almost all stations registered a significant increase at 95% confidence level in heat stress except for an insignificant decrease at a few stations. Changepoint detection depicted an increase in heat stress initiated in the late 1990s and early years of the decade 2000 at most urban stations. Hierarchical cluster analysis partitioned data into seven spatial units. Accordingly, the highest magnitude of increase was observed over cities located in the northeastern part of the study area and the southern tip of peninsular India. The study demands attention to perilous health risks related to India’s increasing heat stress casualties and the need for an indigenous thermal stress alerts system.
Little is known of how low-income residents of urban heat islands engage their knowledge, attitudes, behaviors, and resources to mitigate the health impacts of heat waves. In this qualitative study, we conducted semi-structured interviews with 40 adults in two such neighborhoods in Los Angeles California to explore their adaptation resources and behaviors, the impacts of heat waves on physical and mental health, and threat assessments of future heat waves. Eighty percent of participants received advanced warning of heat waves from television news and social media. The most common resource was air conditioning (AC) units or fans. However, one-third of participants lacked AC, and many of those with AC engaged in limited use due primarily to the high cost of electricity. Adaptation behaviors include staying hydrated, remaining indoors or going to cooler locations, reducing energy usage, and consuming certain foods and drinks. Most of the participants reported some physical or mental health problem or symptom during heat waves, suggesting vulnerability to heat waves. Almost all participants asserted that heat waves were likely to increase in frequency and intensity with adverse health effects for vulnerable populations. Despite limited resources, low-income residents of urban heat islands utilize a wide range of behaviors to minimize the severity of health impacts, suggesting they are both vulnerable and resilient to heat waves.
BACKGROUND: Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. OBJECTIVES: We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. METHODS: This multicenter time-series study leveraged administrative data on 3.8 million ED visits by children and adolescents ≤ 18 years of age to the EDs of 47 U.S. children’s hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association. RESULTS: Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders (RR = 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. CONCLUSION: During the warm season, days with higher temperatures were associated with higher rates of visits to children’s hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083.
BACKGROUND: In recent summers, some populous mid-latitude to high-latitude regions have experienced greater heat intensity, more at night than by day. Such warming has been associated with increased cause-specific adult mortality. Sex-specific and age-specific associations between summer nocturnal surface air temperatures (SAT) and cardiovascular disease (CVD) deaths have yet to be established. METHODS: A monthly time series analysis (June-July, 2001-2015) was performed on sex-specific CVD deaths in England and Wales of adults aged 60-64 and 65-69 years. Using negative binomial regression with autocorrelative residuals, associations between summer (June-July) nocturnal SAT anomalies (primary exposure) and CVD death rates (outcome) were computed, controlling for key covariates. To explore external validity, similar associations with respect to CVD death in King County, Washington, USA, also were calculated, but only for men aged 60-64 and 65-69 years. Results are reported as incidence rate ratios. RESULTS: From 2001 to 2015, within these specific cohorts, 39 912 CVD deaths (68.9% men) were recorded in England and Wales and 488 deaths in King County. In England and Wales, after controlling for covariates, a 1°C rise in anomalous summer nocturnal SAT associated significantly with a 3.1% (95% CI 0.3% to 5.9%) increased risk of CVD mortality among men aged 60-64, but not older men or either women age groups. In King County, after controlling for covariates, a 1°C rise associated significantly with a 4.8% (95% CI 1.7% to 8.1%) increased risk of CVD mortality among those <65 years but not older men. CONCLUSION: In two mid-latitude regions, warmer summer nights are accompanied by an increased risk of death from CVD among men aged 60-64 years.
Heatwaves in the summer and extreme rainfall in the following summer monsoon season over the same regions in India pose severe challenges for adaptation in agriculture, infrastructure, and public health. However, the risks and drivers of the sequential extremes in India remain unrecognized. Here, we show that the mega-heatwaves in summer and extreme rainfall in the summer monsoons of 1995 and 1998 affected 20% and 8% of India, respectively. The area affected by the sequential extremes is significantly (p < 0.05) higher during the positive phase (El Nino) than the negative phase. The fraction of the total population and urban area exposed to sequential extremes will increase rapidly if the global mean temperature rises above 1.5 degrees C from the pre-industrial level. A considerable improvement in socioeconomic livelihood and infrastructure will be needed to reduce vulnerability and maintain the same level of risk at 1.5 degrees C at higher global warming levels.
In Australia, heatwaves are more deadly than any other natural hazard and predicted to increase in frequency and intensity as a result of climate change. Heatwaves are directly connected to human health through heat-related illnesses such as heat exhaustion and heat stroke. Vulnerable people, particularly those without effective cooling in their homes, are at high risk of illness or death during heatwaves. Heat refuges-typically air-conditioned or cooled buildings that have been designated as a site to provide respite and safety during extreme heat-are commonly used in the Northern Hemisphere for vulnerable people during heatwaves but are less prevalent in Australia. In Australia, heat refuges tend to be managed by local councils as part of local planned climate adaptation measures. This article discusses the development of a heat refuge strategy in Blacktown City Local Government Area in western Sydney. Blacktown City has higher summer average temperatures than coastal Sydney, caused by its local geography and urban heat island effects that limit the inflow of cooler coastal winds. The draft Blacktown City heat refuge strategy is based on some of the key components of disaster risk reduction including risk assessment, early warning systems, emergency management planning, evacuation centres and community participation.
Extreme heat events and consequent detrimental heat-health outcomes have been increasing in recent decades and are expected to continue with future climate warming. While many indices have been created to quantify the combined atmospheric contributions to heat, few have been validated to determine how index-defined heat conditions impact human health. However, this subset of indices is likely not valid for all situations and populations nor easily understood and interpreted by health officials and the public. In this study, we compare the ability of thresholds determined from the National Weather Service’s (NWS) Heat Index (HI), the Wet Bulb Globe Temperature (WBGT), and the Universal Thermal Climate Index (UTCI) to predict the compensability of human heat stress (upper limits of heat balance) measured as part of the Pennsylvania State University’s Heat Environmental Age Thresholds (PSU HEAT) project. While the WBGT performed the best of the three indices for both minimal activities of daily living (MinAct; 83 W·m(-2)) and light ambulation (LightAmb; 133 W·m(-2)) in a cohort of young, healthy subjects, HI was likewise accurate in predicting heat stress compensability in MinAct conditions. HI was significantly correlated with subjects’ perception of temperature and humidity as well as their body core temperature, linking perception of the ambient environment with physiological responses in MinAct conditions. Given the familiarity the public has with HI, it may be better utilized in the expansion of safeguard policies and the issuance of heat warnings during extreme heat events, especially when access to engineered cooling strategies is unavailable.
Black widow spiders (Latrodectus sp.) are distributed worldwide, and in Albania the L. tredecimguttatus Rossi, 1790 has been the dominant spider. Other medically important spiders in Albania include the brown recluse with symptoms known as loxoscelism, the false black widow and the egg sac spiders; the last two inducing similar symptoms to a wasp sting. METHODS: The data analyzed is from a decade-long study of 125 patients hospitalized in the regional hospital of Fier County, in the Western Lowland of Albania from May 2009 and to October 2018. OBJECTIVE: Although the venom is rarely fatal, the recent spider bites raise questions about the influence of higher air temperatures on their possibly increased toxicity. RESULTS: Significantly the severity of the α-latrotoxin rises during the summer, when human-spider contact frequency is higher and when the black widow spiders have an increased motivation to protect their egg sacs. CONCLUSION: This study revealed an increased severity of the black widow bites with respect to patient health, shown via all the severe systemic symptoms, during those months with higher temperatures.
Heat stress is an important threat for human health and urban areas are affected at higher rates compared to rural environments. Additionally, climate change will increase the vulnerability towards urban heat stress in the future. Current high-resolution urban heat stress assessments are limited in time and space due to the high computational costs. In this paper, the UrbClim numerical model is used to simulate urban heat accurately at a fast rate and high spatial resolution for the cities of Johannesburg and Ekurhuleni, South Africa. Using detailed terrain information, (future) urban heat stress assessments are provided at 30 m resolution for both city agglomerations, while meter-scale simulations are executed for a selection of neighborhoods. These model simulations are evaluated using an extensive monitoring campaign in which the local community was heavily engaged. Distinct spatial differences in the urban heat island effect are observed, with greatest heat stress in areas with high building densities and low vegetation numbers. These areas are often characterized by lower socio-economic living conditions. The meter-scale analysis further shows the importance of shade provided by vegetation to lower heat stress in both present and future climate. These assessments offer assistance in the design of climate-resilient urban planning strategies.
Extreme heat caused by global climate change has become a serious threat to the sustainable development of urban areas. Scientific assessment of the impacts of extreme heat on urban areas and in-depth knowledge of the cross-scale mechanisms of heat vulnerability forming in urban systems are expected to support policymakers and stakeholders in developing effective policies to mitigate the economic, social, and health risks. Based on the perspective of the human-environment system, this study constructed a conceptual framework and index system of “exposure-susceptibility-adaptive capacity” for urban heat vulnerability (UHV) and proposed its assessment methods. Taking Xiamen City, a coastal metropolis, as an example, spatial analysis and Geodetector were used to explore the spatial and temporal changes, spatial characteristics, and patterns of UHV under multiple external disturbances from natural to anthropological factors, and to reveal the main factors influencing UHV forming and spatial differentiation. Results showed that the exposure, susceptibility, adaptive capacity, and UHV in Xiamen City had a spatial structure of “coastal-offshore-inland”. On the hot day, both the exposure and UHV showed a temporal pattern of “rising and then falling, peaking at 14:00” and a spatial pattern of “monsoonal-like” movement between coast and inland. Coastal zoning with favorable socioeconomic conditions had less magnitude of changes in UHV, where the stability of the urban system was more likely to be maintained. During the hot months, the high UHV areas were mainly distributed in the inland, while coastal areas showed low UHV levels. Further, coastal UHV was mainly dominated by “heat exposure”, offshore by “comprehensive factors”, and inland in the northern mountainous areas by “lack of adaptive capacity”. Multi-scale urban adaptive capacity was confirmed to alter spatial distribution of exposure and reshape the spatial pattern of UHV. This study promotes the application of multi-scale vulnerability framework to disaster impact assessment, enriches the scientific knowledge of the urban system vulnerability, and provides scientific references for local targeted cooling policy development and extreme heat resilience building programs.
Urban dwellers experience overheating due to both global and urban warming. The rapid urbanisation, especially in hot, humid cities, lead to greater exposure to heat risk, both due to increasing urban populations as well as overheating due to global/urban warming. However, a nation-wide exploration of thermal comfort trends, especially in the hot, humid tropics, remains relatively unexplored. In this paper, we explore the recent historical trends (1991-2020) in outdoor thermal comfort across the entire island of Sri Lanka and evaluate the likely effects of known urban climate mitigation strategies – shade and vegetative cover. We find that ‘very strong heat stress’ is moving towards ‘extreme heat stress’ that was barely registered in 1990s and is now common across two-thirds of the landmass of Sri Lanka in the hottest month (April). Even in the coolest month (January), ‘moderate heat stress’ unknown in the 1990s is now becoming a common trend across the most densely populated parts of the country. High shading and vegetation could reduce heat stress, even in the hottest month, but its utility will diminish as the warming continues in future. As such, policies to reduce global warming needs to be urgently pursued while simultaneously adapting to urban warming in Sri Lanka.
Aim Social inequalities are widened by climate change, which increases extreme temperature events that disproportionally affect the most vulnerable people. While the diseases impacted have been reviewed in the literature, how this reflects upon pharmaceutical consumption remains unknown. We assess that effect on a panel of the most prescribed drug classes in terms of volume in the National Health Service (NHS) database. Subject and methods A retrospective econometric analysis of NHS prescription data was carried out, focusing on antibiotics, antidepressants and bronchodilators (drugs associated to priority diseases in addition to being among the most prescribed ones) between 2011 and 2018. Data linkage enabled prescriptions to be related to the Index of Multiple Deprivation (IMD), disability adjusted life-years (DALYs) and temperature data. The analysis was then undertaken at lower layer super output areas (LSOAs) level, using fixed-effect negative binomial regression models. Results Our results show that prescription rates were higher across the most deprived LSOAs, even after adjusting for the associated disease DALYs. In addition, prescription volume also progressively increased under colder temperatures below 15 degrees C, with an exacerbated effect in the most deprived areas. Conclusion Therefore, health inequalities in England affect prescription volumes, with higher levels in the most deprived areas which are not fully explained by morbidity differences. Lowest temperature conditions appear to intensify vulnerabilities while hot temperatures do not increase these differences in terms of prescriptions. Populations residing in the most deprived LSOAs could be more sensitive to environmental variables, leading to higher consumption of medicine under cold temperature and increased air pollution.
The outdoor thermal comfort of urban residents is negatively affected by heatwaves that are becoming more frequent and severe with the ongoing climate crisis. As such, the assessment of outdoor perception and comfort during heatwaves has become an important ingredient of successful urban adaptation strategies. However, systematic assessment of long-term thermal perception across a large number of places and large populations of people is difficult. In this study, we consider an approach to the assessment of long-term thermal perception that combines features of currently used approaches (i.e., use of rating scales of thermal perception, use of surveys, and the use of photographs representing places) and we provide some preliminary validation of this approach. Specifically, across three studies conducted in two Czech cities, we show that long-term thermal perceptions for a large sample of 1,856 urban places can be elicited in a large sample of city residents (total N = 1,812) using rating scales in off-site surveys complemented with visual representations of the target locations. In Studies 1 and 2, we partially validate this approach by showing that such long-term thermal perceptions can be traced back to average surface temperature, sky-view factor, and the presence of blue and green infrastructure, all factors that the literature relates to thermal perception. Moreover, we show evidence that observers can reliably glean these properties from the visual representation of places. In Study 3, we provide additional evidence of the predictive validity of such long-term thermal perceptions by showing that they predict place-related activities (waiting and walking) and the place preference of other people more than one year later. Thus, this approach to the measurement of long-term thermal perception related to heatwaves can be a useful addition to currently used approaches.
High concentration levels of air pollutants may cause damage to plants, animals, and the health of some groups of human beings. Therefore, it is important to investigate different topics related to the high air pollution levels and to find reliable answers to the questions about the possible damages, which might take place when these levels exceed some limits. A few of the numerous questions, the answers of which are highly desirable, are listed below: (a) When are the air pollution levels dangerous? (b) What is the reason for the increased air pollution levels? (c) How can the air pollution levels be decreased? (d) Will the future climate changes result in higher and more dangerous air pollution levels? It is necessary to study carefully many issues connected with the distribution of air pollutants in a given region and with the reasons for the increases of the concentrations to high levels, which might be damaging. In order to do this, it is necessary to develop a Digital Twin of all relevant physical processes in the atmosphere and to use after that this tool in different applications. Such a tool, its name is DIGITAL AIR, has been created. Digital Twins are becoming more and more popular). Many complex problems, arising taking place in very complicated surroundings, can be handled and resolved successfully by applying Digital Twins. The preparation of such a digital tool as well as its practical implementation in the treatment of a special problem, the increase of some potentially dangerous ozone levels, will be discussed and tested in this paper. The Unified Danish Eulerian Model (UNI-DEM) is a very important part of DIGITAL AIR. This mathematical model, UNI-DEM, can be applied in many different studies related to damaging effects caused by high air pollution levels. We shall use it in this paper to get a reliable answer to a very special but extremely important question: will the future climatic changes lead to an increase in the ozone pollution levels in Bulgaria and Europe, which can potentially become dangerous for human health?
BACKGROUND: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures. METHODS: A time series analysis using a distributed lag nonlinear model was used to explore the exposure-response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014-2017) and future periods (2034-2037 and 2054-2057) under three climate representative concentration pathways (RCPs). RESULTS: The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s. CONCLUSIONS: Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.
In the United States, Latino farmworkers are disproportionately at risk for death from heat-related illnesses. To elicit Latino farmworker perceptions on their fluid intake and heat stress, a qualitative descriptive, community-informed research study was conducted in eastern North Carolina. A total of 28 Mexican farmworkers participated in one of 4 focus groups. Using content analysis and guided by Intersectionality theory, themes and subthemes were identified. The first theme was Absence of Protection, represented by 2 subthemes: (1a) Intense Climate Considerations; and (1b) Workplace Exploitation. The second theme, Freedom to Drink, included 2 subthemes: (2a) Distance and Distaste; and (2b) Culture of Farm Work. Farmworkers perceived extreme outdoor temperatures as the greatest workplace barrier to staying hydrated and reported water accessibility and quality issues. Farmworker fluid intake was influenced by interlocking social categories and power systems. Policy recommendations that prevent farmworker heat-related illness and promote hydration are discussed.
Increasingly people, especially those residing in urban areas with the urban heat island effect, are getting exposed to extreme heat due to ongoing global warming. A number of methods have been developed, so far, to assess urban heat vulnerability in different locations across the world concentrating on diverse aspects of these methods. While there is growing literature, thorough review studies that compare, contrast, and help understand the prospects and constraints of urban heat vulnerability assessment methods are scarce. This paper aims to bridge this gap in the literature. A systematic literature review with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach is utilized as the methodological approach. PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. The results are analyzed in three aspects-i.e., indicators and data, modelling approaches, and validation approaches. The main findings disclose that: (a) Three types of indicators are commonly used-i.e., demographic properties and socioeconomic status, health conditions and medical resources, and natural and built environmental factors; (b) Heat vulnerability indexing models, equal weighting method, and principal component analysis are commonly used in modelling and weighting approaches; (c) Statistical regressions and correlation coefficients between heat vulnerability results and adverse health outcomes are commonly used in validation approaches, but the performance varies across studies. This study informs urban policy and generates directions for prospective research and more accurate vulnerability assessment method development.
BACKGROUND: Climate change may jeopardize the health of mothers and their offspring. There are few studies on the association between increasing temperature and pregnancy outcomes. The aim of this study was to investigate the relation between Universal Thermal Climate Index (UTCI) and adverse pregnancy outcomes including stillbirth, low birth weight (LBW), preterm labor (PTL), spontaneous abortion (SA), preeclampsia and hypertension in Ahvaz, Iran. METHODS: Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to research the effect of UTCI on adverse pregnancy outcomes. The effect of time trend, air pollutants (NO(2), SO(2) and PM(10)), and weekdays were adjusted. RESULTS: The results showed that the low values of UTCI index (11.6 °C, in lags 0-6, 0-13) caused significant increase in the risk of preterm labor. However, hot thermal stress (high UTCI) significantly increased the risk of stillbirth in lag 0-13. We did not observe any significant relation between UTCI and other pregnancy outcomes in this study. CONCLUSIONS: It seems like both hot and cold weathers can be associated with adverse pregnancy outcomes.
Heatstroke is a serious heat-related illness that can even cause death. Heat alert systems play an important role in reducing the number of patients experiencing heat illness, as they encourage preventive actions such as the use of air conditioning, hydration, or other strategies. However, to date, the Japanese hazard classification has not considered seasonal and regional variations, despite clear differences in meteorological conditions across different regions in Japan. Moreover, several studies have reported a difference in thermoregulation between older and younger adults, implying that the hazard classification should also consider age differences. This study examined the relationship between the number of ambulance dispatches related to heat illness (ADRHI) and the Japanese heat hazard classification from 2010 to 2019, focusing on monthly and regional differences. Data from 47 prefectures during the 10-year period were collected and analyzed. ADRHI and wet bulb globe temperature (WBGT) data were collected from Japan’s Ministry of Internal Affairs and Communications and the Ministry of the Environment Heat Illness Prevention Information website, respectively. The findings showed a significant relationship between ADRHI and WBGTmax (p < 0.05, r = 0.74). ADRHI per 100,000 people showed significant differences across months. The post hoc test detected the first steep increase in ADRHI at a WBGTmax of 23°C than at 22°C in June, and at a WBGTmax of 26°C, 27°C, and 25°C in July, August, and September, respectively. Moreover, the first significant increase in ADRHI per 100,000 people at WBGTmax differed across each region, at a WBGTmax of 24°C in Hokkaido-Tohoku, 25°C in Kanto, Kansai, and Chugoku, 26°C in Chubu, 27°C in Shikoku, and 28°C in Kyushu-Okinawa. Further, Poisson regression analysis revealed that the relative risks differed across each region and month. These results imply that the hazard classification should be adjusted according to region and month in Japan.
Extreme heat is often overlooked as a public health concern in Minnesota, where intraseasonal summer variability limits acclimatization to oppressive heat conditions. Specific categories of synoptic-scale air masses are linked to summer excess mortality and elevated health risk in the Midwestern United States, particularly within urban areas. Between 1948 and 2019, Minnesota’s four largest urban areas have experienced decreased nighttime cooling, while warmer and more humid air masses have increased in frequency at the expense of cooler and drier ones. We used downscaled CMIP5 climate projections for 21st-century Minnesota, under RCP4.5 and RCP8.5 emissions scenarios, to generate daily synoptic classifications and evaluate projected frequency and character trends in the highest-risk air masses. Projections show dramatic increases in both the frequency and temperature of days within the Dry Tropical category, neither of which have changed significantly thus far across Minnesota’s historical record. Frequency and duration of consecutive-day episodes of excess heat, as identified either by synoptic classifications or by the Excess Heat Factor, are likewise expected to increase more substantially in the future than they have in the past. Other projected trends, such as rising dew point temperatures and nighttime air temperatures, represent continuations of already existing historical trends.
Exposure to non-optimal temperatures remains the single most deathful direct climate change impact to health. The risk varies based on the adaptation capacity of the exposed population which can be driven by climatic and/or non-climatic factors subject to fluctuations over time. We investigated temporal changes in the exposure-response relationship between daily mean temperature and mortality by cause of death, sex, age, and ethnicity in the megacity of São Paulo, Brazil (2000-2018). We fitted a quasi-Poisson regression model with time-varying distributed-lag non-linear model (tv-DLNM) to obtain annual estimates. We used two indicators of adaptation: trends in the annual minimum mortality temperature (MMT), i.e., temperature at which the mortality rate is the lowest, and in the cumulative relative risk (cRR) associated with extreme cold and heat. Finally, we evaluated their association with annual mean temperature and annual extreme cold and heat, respectively to assess the role of climatic and non-climatic drivers. In total, we investigated 4,471,000 deaths from non-external causes. We found significant temporal trends for both the MMT and cRR indicators. The former was decoupled from changes in AMT, whereas the latter showed some degree of alignment with extreme heat and cold, suggesting the role of both climatic and non-climatic adaptation drivers. Finally, changes in MMT and cRR varied substantially by sex, age, and ethnicity, exposing disparities in the adaptation capacity of these population groups. Our findings support the need for group-specific interventions and regular monitoring of the health risk to non-optimal temperatures to inform urban public health policies.
In Australia, tropospheric ozone measurements in rural locations are scarce with measurements mostly made in cities. This limits the ability to estimate background ozone levels that inform policy development. The few studies that have assessed rural ozone in Australia have been associated with short campaign monitoring or specific, short-term research programs. Recognising this deficit of information, the New South Wales Government has established long-term ozone monitoring at two rural locations. This paper presents results from the first three years of monitoring at Gunnedah. We assess seasonal, diurnal and sectoral patterns of ozone. Several events are analysed, including high ozone associated with the 2019/20 Australian Bushfire Emergency and an extreme heatwave event. We find that ozone levels at Gunnedah exceed the screening standards set by Australia’s National Environmental Protection (Ambient Air Quality) Measure, emphasising the need for additional ozone monitoring in rural and regional Australia. Our early results indicate that in NSW, background ozone mixing ratios for airmasses of continental origin is likely in the range of 36-39 ppb, higher than the 14-30 ppb associated with air masses of marine origin and greater than the 30 ppb background mixing ratio used for monitoring design and standard setting in Australia. Maximum 8-hourly ozone in non-bushfire impacted events is as high as 64 ppb, demonstrating the challenges that rural/regional communities may face in always meeting the new Australian 8-h ozone standard of 65 ppb. These results add to our understanding of rural background ozone within Australia and in the southern hemisphere.
Climate change is an important issue that affects energy consumption, causes health problems, such as heat stroke, and requires urgent countermeasures. Serious health problems, including cardiac arrest, often occur in winter in traditional residences in Japan. Cooling-heating energy is required to maintain a healthy thermal environment. Although energy efficiency standards for buildings have been introduced worldwide to reduce energy consumption and various passive energy-saving methods are being investigated, traditional residences still face difficulties in conducting renovations because of various restrictions, such as the conservation of historical or aesthetic values. In this study, these issues and their appropriate countermeasures were investigated for a traditional townhouse in Kyoto, Japan, “Kyo-machiya” (including its new form “Heisei-no-Kyo-machiya”). The potential of reducing heating and cooling loads was examined by conducting numerical analysis considering residents’ lifestyles. Field surveys of the indoor environment were conducted in both summer and winter. It was revealed that by optimizing the times and positions of opening and closing the windows and indoor partitions, the indoor air flow could be adjusted from both thermal comfort (cooling in summer) and discomfort (cold drafts in winter) perspectives, leading to improving the indoor environment without using energy.
BACKGROUND: Climate change caused by environmental pollution is the most important one of many environmental health hazards currently faced by human beings. In particular, the extreme temperature is an important risk factor for death from respiratory and circulatory diseases. This study aims to explore the meteorological-health effect and find out the vulnerable individuals of extreme temperature events in a less developed city in western China. METHOD: We collected the meteorological data and data of death caused by respiratory and circulatory diseases in Mianyang City from 2013 to 2019. The nonlinear distributed lag model and the generalized additive models were combined to study the influence of daily average temperature (DAT) on mortality from respiratory and circulatory diseases in different genders, ages. RESULTS: The exposure-response curves between DAT and mortality from respiratory and circulatory diseases presented a nonlinear characteristic of the “V” type. Cumulative Relative Risk of 30 days (CRR(30)) of deaths from respiratory diseases with 4.48 (2.98, 6.73) was higher than that from circulatory diseases with 2.77 (1.96, 3.92) at extremely low temperature, while there was no obvious difference at extremely high temperature. The health effects of low temperatures on the respiratory system of people of all ages and genders were persistent, while that of high temperatures were acute and short-term. The circulatory systems of people aged < 65 years were more susceptible to acute effects of cold temperatures, while the effects were delayed in females and people aged ≥65 years. CONCLUSION: Both low and high temperatures increased the risk of mortality from respiratory and circulatory diseases. Cold effects seemed to last longer than heat did.
Recent advances in numerical tools and data for the study of urban microclimates have helped to evaluate countermeasures for urban heat in heterogeneous and high-rise cities such as Hong Kong. Thus, two ventilation strategy designs, point (‘oases’) and linear (‘corridors’) features, were numerically simulated during a typical heatwave using the multi-layer coupled MesoNH-SURFEX-TEB mesoscale atmospheric model. These strategies proved to be effective at night with respect to thermal comfort but caused a localised increase in heat stress during the day in the ventilated areas, which were less shaded. There was no significant deterioration in the wind performance around the developments that were redesigned to accommodate the displaced population due to the construction of the ventilation features; however, an improvement was observed in thermal comfort during the daytime. The simulated impacts were relatively localised, suggesting the importance of increasing porosity across the entire urban fabric. The corridors, especially when built along the axis of the prevailing winds, exhibited better ventilation at the pedestrian level than the oases. Nevertheless, the oases remain interesting features in the context of progressive urban ventilation planning that involve the implementation of isolated, connected, and eventually a network of features to provide benefits at the megalopolis scale.
Heat is one of the most serious hazards in the world as it affects human health and is extremely dangerous to vulnerable populations such as the elderly, people with preexisting cardiovascular or respiratory conditions, and even healthy people with prolonged sunlight exposure during heat waves. As the globe has warmed over the past several decades, extreme heat has become more frequent and intense than ever before, and Africa, especially the Sahel in West Africa, is one of the regions of the world where heat is a major public health concern exacerbated by livelihood activities during the heat season. Yet, there is a major gap in monitoring and forecasting heat waves in Africa. This paper describes NOAA’s role in enabling heat-health early warning in Africa, working with meteorological services and health professionals. Emphasis is on real-time heat wave forecasting at week 2, including the postprocessing of the NCEP model outputs, and providing the information to the meteorological services in Africa to serve as guidance in national heat wave forecasts. In addition, the paper describes the end-to- end process of heat hazard outlooks and translating the forecasts into early action and early planning to reduce heat risk to human health. Furthermore, the paper addresses the very important aspect of capacity development tailored at enhancing forecasters’ skills to prepare and issue heat wave forecasts and training of a cadre of health professionals to work with meteorologists to coproduce heat- health bulletins and to issue heat-health early warnings.
Climate warming, rapid economic development, and urbanisation in (sub)tropical regions lead to increasing electricity demand for building air-conditioning that could jeopardise the efforts of decarbonisation required to meet the climate change mitigation goals. This study investigates two strategies to reduce building energy consumption due to air-conditioning: 1) the bottom-up adoption of an Adaptive Thermal Comfort (ATC)-based cooling setpoint temperature and 2) the top-down implementation of efficient District Cooling Systems (DCS). The subtropical high-density city of Hong Kong is chosen for case study since detailed data on the city’s current and realistic future urban form and function are available. Numerical simulations representing the feedback between urban climate and building energy consumption are conducted by employing a mesoscale atmospheric model coupled to an urban climate and building energy model for a scenario of future (mid-21st century) Hong Kong. A prolonged high temperature event representative of future extreme conditions is simulated, during which the ATC and DCS strategies reduce building cooling energy consumption by 9.7% and 5.9%, respectively. The ATC has almost no effect on the local meteorological conditions, whereas the DCS reduces daytime sensible heat flux by up to 600 W/m(2) and near-surface air temperature by almost 1 °C in the districts where it is adopted. The DCS thus also contributes to lowering outdoor heat stress in these areas. The cost-free ATC strategy is easily applicable in residential buildings worldwide and can break the vicious cycle in overcooled buildings, where occupants are acclimatised to lower indoor temperature and thus require more air-conditioning than necessary. Apart from reducing energy consumption and near-surface air temperature, the DCS brings additional benefits in building space utilisation and rooftop design. Future policy orientations should therefore encourage a societal change towards the ATC lifestyle and incorporate DCS in the planning of new development areas.
Extreme weather events present significant global threats to health. The National Ambulance Syndromic Surveillance System collects data on 18 syndromes through chief presenting complaint (CPC) codes. We aimed to determine the utility of ambulance data to monitor extreme temperature events for action. Daily total calls were observed between 01/01/2018−30/04/2019. Median daily ’Heat/Cold’ CPC calls during “known extreme temperature” (identified a priori), “extreme temperature”; (within 5th or 95th temperature percentiles for central England) and meteorological alert periods were compared to all other days using Wilcoxon signed-rank test. During the study period, 12,585,084 calls were recorded. In 2018, median daily “Heat/Cold” calls were higher during periods of known extreme temperature: heatwave (16/day, 736 total) and extreme cold weather events (28/day, 339 total) compared to all other days in 2018 (6/day, 1672 total). Median daily “Heat/Cold” calls during extreme temperature periods (16/day) were significantly higher than non-extreme temperature periods (5/day, p < 0.001). Ambulance data can be used to identify adverse impacts during periods of extreme temperature. Ambulance data are a low resource, rapid and flexible option providing real-time data on a range of indicators. We recommend ambulance data are used for the surveillance of presentations to healthcare related to extreme temperature events.
In 2019, the World Meteorological Organization published its “Guidance on Integrated Urban Hydrometeorological, Climate and Environment Services (Volume I: Concept and Methodology)” to assist WMO Members in developing and implementing the urban services that address the needs of city stakeholders in their countries. The guidance has relevant implications for not only protecting infrastructures from the impacts of climate change in the urban environment, but its proper declination strongly supports health-related policies to protect the population from direct and indirect impacts. Utilizing some principles of the guidance, the urbanized area of Bologna (Italy) was analyzed in order to furnish the municipality with tools coherent with the best practices actually emerging from the international bibliography to protect the citizens’ health of this city. Specifically, the analysis concentrated on the public spaces and the potential vulnerabilities of the fragile population to high-temperature regimes in the city. Utilizing the guidance as a methodological framework, the authors developed a methodology to define the microclimate vulnerabilities of the city and specific cards to assist the policymakers in city regeneration. Because the medieval structure of the city does not allow the application of a wide set of nature-based solutions, our main attention was placed on the possibility of furnishing the city with a great number of pocket parks obtainable from spaces actually dedicated to parking lots, thus introducing new green infrastructures in a highly deprived area in order to assure safety spaces for the fragile population.
In recent years, semi-outdoor space has become an important research subject in the field of thermal comfort. Overhead space located on the ground floor is a common type of semi-outdoor space in China’s Lingnan region with a hot and humid climate. Its thermal comfort has been scarcely studied. This study aims to reveal the importance and influencing factors of overhead public spaces in hot and humid areas, and to explore the corresponding adaptive behaviors of people. In this research, several overhead public spaces in Shenzhen University were selected to conduct field measurements and questionnaire surveys (n = 509) in hot and cold seasons. The results indicated that the acceptable physiologically equivalent temperature (PET) range for 90% of the population was 26.2-30.4 degrees C in hot season, 9.9-19.2 degrees C in cold season, and 17.6-25.3 degrees C for the whole year. The respondents preferred “neutral” in cold season and “slightly cool” in hot season. Respondents in hot season were more eager to adjust their thermal comfort, while those in cold season were more comfortable exposing themselves to the sun. Concurrently, the neutral temperature and neutral temperature range for different seasons was obtained and compared with the results of other studies. The results provide references for thermal comfort adjustment in hot and humid areas as well as optimization suggestions for the planning and design of overhead spaces.
Globally, the population is ageing and extreme weather scenarios are expected, especially in southern European countries. In this context, the study assessed the thermal comfort of older people in five nursing homes in a continental Mediterranean climate in Spain during summer, through environmental measurements and surveys on site. A total of 1412 people were interviewed, including residents (older people) and non-residents (adults). The results showed that under the same environmental conditions, adults felt that the environment was warmer and they were less tolerant than older people. There was a 2.4 degrees C difference between the neutral temperature of older people (25.6 degrees C) and adults (23.2 degrees C). Older people were less sensitive to thermal changes and their comfort zone was wider than that of adults. The comparison with similar studies from other climatic zones concluded that the neutral temperature for elderly in different climatic zones is similar but the thermal comfort zones are different. Older people were less sensitive to temperature changes than the predicted mean vote (PMV) model predicted. Therefore, this model would not be suitable for older people in cooling conditions in the Mediterranean continental climate. These results could be a starting point for the development of more accurate, healthy indoor spaces that meet the needs of older people as a vulnerable group, while improving energy efficiency and reducing emissions.
Climate change and the urban heat island (UHI) effects are increasing heat stress and adversely impacting outdoor thermal comfort in urban areas. The study demonstrates that thermal comfort conditions can be improved by reducing air temperature and surface temperature with the integration of street trees into the urban environment. In this work, computational fluid dynamics (CFD) simulations using unsteady Reynolds-averaged Navier-Stokes (URANS) equations have been performed to analyze the cooling effect of street trees for heatwave period (18-22 June 2015) in a hot-humid urban environment. The results are then compared in-term-of air/surface temperature, flow-velocity and apparent temperature for the vegetation case, open-space case, and built case. The analysis shows that the vegetation can effectively decrease surrounding temperature (a reduction of 1.2 K), thereby reducing energy consumption and effectively promote thermal comfort conditions. The study findings will encourage city planners and citizens to take action for urban greening.
Sanitary issues, combined with the effects of climate change, emphasize the comfort of outdoor spaces in cities. Numerous comfort models exist and can predict thermal sensation. However, these comfort indices need to be validated in hot zones and quantify the neutral range considering people’s thermal resilience. The present study investigates the outdoor thermal comfort of people who live in hot areas and are accustomed to this and quantifies this effect. For that, predictions provided by the COMFA thermal comfort model were compared with the occupants’ perceptions given in the field campaigns’ questionnaires. The field campaigns were associated with on-site monitoring of local climate variables. It was observed that during the survey period, the entire space was predicted to be uncomfortable by the COMFA model. On the contrary, the results of the questionnaires showed that the most frequently encountered thermal sensations were distributed between the comfort zone and the hot zone. The proposed methodology has been designed to be used by other researchers, and it is adaptable to other outdoor thermal comforts such as PET or ITS. The comparison between the model’s predictions and the users’ responses to space highlighted the tendency of the COMFA to overestimate the thermal sensations. This work’s results allow extending the neutral comfort band from 50 W/m(2) (value of literature) to 80 W/m(2). So, the paper quantifies that the effect of the thermal resilience of the people increases the thermal band of comfort by around 60%. These results will allow an accurate assessment of the effectiveness of future mitigation solutions implemented to improve outdoor thermal comfort in other world areas. It is due to the propose of a higher neutrality range researchers or designers could achieve outdoor thermal comfort in effective and reliable ways, even in hot climates.
With the aging of the human body, some physiological changes occur, compromising thermoregulatory mechanisms, negatively influencing the individual’s thermal sensation. Given this fact, the present study aimed to build a predictive model to determine the thermal sensation index for elderly people (TSIEP) in a hot climate region, considering their sensitivity in the perception of climate change in the city of Campina Grande, in the semi-arid region of Paraíba/Brazil. For this purpose, an observational study was carried out from April to December 2016 with elderly people inside their homes. The responses of the sample units (elderly people) to the categories of thermal sensation (hot, comfortable, and cold) were transformed into probit estimates, and, using the multivariate modeling statistical technique (canonical correlation), the TSIEP was determined. Finally, TSIEP showed that the thermal sensation of elderly people residing in Campina Grande tends to be more sensitive to cold and less sensitive to heat.
Climate change brings an increase in temperatures and a higher frequency of heatwaves. Both have been linked to a rise in suicide rates and violent crime on a population level. However, little is known about the link between mental health and ambient temperatures on an individual level and for particular subgroups. Overheating poses health risks to children and disturbs sleep; leading to the expectation that parents are more worried about their homes getting too hot than non-parents. Two online survey studies (N = 1000 each) were conducted in the UK and the US to understand to what extent parents and an age-matched comparison group without children are worried about overheating and how they differ in their mitigation actions. Findings did not support the main hypotheses around greater overheating worry amongst parents in general, mothers or those with very young children. However, parents indicated a greater likelihood to upgrade or install air-conditioning (US) and to get electric fans (UK). Parents in the UK indicated using more mitigation options to cope with overheating than non-parents. Parents in the US, whilst not reporting doing more actions, were more likely to use air-conditioning to deal with overheating than non-parents. Finally, those parents who mentioned health impacts on children as a reason for worry about overheating, were more concerned about overheating than parents who had other reasons than children’s health as a reason for being concerned about overheating. In summary, parental status might have implications for cooling energy use and concern for children’s health might increase overheating worry; however, many open questions remain.
Heat-related illness is becoming more problematic due to ongoing global warming. Heat-related injury causes systemic inflammation and coagulopathy, due to leukocyte, platelet, and vascular endothelial cell activation and injury. Hyperthermia directly modulates platelet function and can induce cellular damage. Meanwhile, heat also affects platelet function via activated coagulation, excess inflammation, production of cytokines, and heat shock proteins. Aberrant hyperthermia-induced interactions between leukocytes and endothelial cells are also involved in platelet regulation. Heat-induced coagulopathy commonly progresses to disseminated intravascular coagulation (DIC), leading to multiple organ failure and in some cases enhanced bleeding. Consequently, platelet count, prothrombin time, and DIC score are useful for evaluating the severity of heat-related illness in addition to other organ damage markers such as Glasgow Coma Scale, creatinine, and bilirubin. Despite the increasing risk, therapeutic modalities targeting platelets are limited and no established therapy exists. In this review, we summarize the current knowledge about the role of platelets in the pathogenesis, diagnosis, and management of heat-related illness.
Exposure to heat and heatwaves are associated with mortality and may amplify morbidities. In a climate change context, projections suggest temperatures will likely rise in the foreseeable future. Our paper assesses the current knowledge on human health effects of heat exposure and gathered local knowledge of heat-health effects in a rural area of the Agincourt sub-district of South Africa. Existing, peer-reviewed published literature on heat effects on human health as well as heat-health indicators was reviewed. Interviews and structured observations to collect data on heat effects on human health in Agincourt sub-district were conducted. The Lancet Countdown heat-related indicators were applied as a framework against which to discuss our findings. A total of 93 participants who lived in Agincourt sub-district for 5 years and more were interviewed. Participants reported that temperatures, especially summertime temperatures, had been rising over the past years. Health effects of heat were deemed more apparent in relation to morbidity. Heatwaves were not easily comprehensible as singular ‘events’, and their effects were poorly understood. The population groups disproportionately affected by heat included infants, the elderly, those living with disability and outdoor workers. High ambient temperatures were deemed to be associated with reduced labour productivity of outdoor workers. Community-level perceptions of heat impacts on health were mainly related to illnesses and diseases, with no understanding of mortality risk. Future health awareness campaigns that encompass the full range of heat-health impacts are essential to reduce vulnerability, morbidity, and mortality. Our study provided location-specific, qualitative, and indicator-aligned data for a geographic area expected to undergo significant heat stress in the future. The study findings have significant research, policy, and practice implications in similar resource-limited settings.
Heat stroke (HS) is a life-threatening systemic disease characterized by an elevated core body temperature of more than 40 ℃ and subsequent multiple organ dysfunction syndrome. With the growing frequency of global heatwaves, the incidence rate of HS has increased significantly, which has caused a huge burden on people’s lives and health. Liver injury is a well-documented complication of HS and usually constitutes the direct cause of patient death. In recent years, a lot of research has been carried out on the pathogenesis and treatment strategies of HS-induced liver injury. In this review, we summarized the important pathogenesis of HS-induced liver injury that has been confirmed so far. In addition to the comprehensive effect of systemic factors such as heat cytotoxicity, coagulopathy, and systemic inflammatory response syndrome, excessive hepatocyte cell pyroptosis, dysfunction of Kupffer cells, abnormal expression of heat shock protein expression, and other factors are also involved in the pathogenesis of HS-induced liver injury. Furthermore, we have also established the current therapeutic strategies for HS-induced liver injury. Our study is of great significance in promoting the understanding of the pathogenesis and treatment of HS-induced liver injury.
The urban heat island (UHI) phenomenon has become a major concern for city sustainability in the wake of global warming and rapid urbanization.This has resulted in increased heat stress and worsened outdoor thermal comfort in urban microclimates.The study demonstrates that heat stress can be mitigated by reducing air temperature and surface temperature with the integration of cool materials into the urban environment using computational fluid dynamics, under representative climatic conditions. The thermal comfort conditions are examined at pedestrian height and the diverse vertical levels by evaluating two climatic parameters: first, the reduction of ambient air temperature and surface temperature characterizing the mitigation (cooling) intensity, and second, the alteration of airflow velocity. The analysis shows that the proposed intervention can effectively decrease surrounding temperature and promote airflow. Cool materials, when applied simultaneously on both buildings and ground, generate a more pronounced mitigation effect than on only the ground or the buildings as it results in a large reduction of air and surface temperature, that is, of 2 degrees C and 6 degrees C, respectively. For airflow velocity, it is highest for combined cool materials, with maximum effect at the time of highest solar irradiance. The study is expected to inform architects, urban designers and people involved in construction engineering regarding retrofitting mitigation of UHI under representative climatic conditions.
Extremes in temperature and precipitation are associated with damaging floods, prolonged drought, destructive wildfires, agricultural challenges, compromised human health, vulnerable infrastructure, and threatened ecosystems and species. Often, the steady and progressive trends (or presses) of rising global temperature are the central focus in how climate impacts are described. However, observations of extreme weather events (or pulses) increasingly show that the intensity, duration and/or frequency of acute events are also changing, resulting in greater impacts on communities and the environment. Describing how the influence of extreme events may shape water management in the Colorado River Basin in clear terms is critical to sound future planning and efforts to manage risk. Three scenario planning workshops in 2019 and 2020 were held as part of a Colorado River Conversations series, identifying potential impacts from multiple intersecting extreme events. Water managers identified climate-related events of concern in the Colorado River Basin that necessitate greater attention and adaptive responses. To support efforts to include consideration of climate-change-driven extremes in water management and planning, we explore the current state of knowledge at the confluence of long-term climate shifts and extreme weather in the Colorado River Basin related to the events of concern that were identified by scenario planning participants.
Objective: The aim of this study was to examine the prevalence of heat-related illnesses (HRI) and their associated factors among rice farmers in Central Vietnam. Methods: A cross-sectional study was conducted using a sample of 379 farmers from August to September 2021 in Ha Tinh province on the north-central coast of Vietnam. A structured questionnaire was used to collect demographic information, farming activities, heat exposure, and health issues. Multivariable logistic regression was used to identify the factors associated with HRI. Results: At least one HRI symptom was experienced by 83.4% of farmers, and two or more HRI symptoms were experienced by 55.1% of farmers during the last harvesting season (the summer-autumn rice season, 2021). Factors significantly associated with HRI were age, having chronic diseases, type of farming tasks, the number of hours working in the heat, and water intake. Farmers working outdoors for more than 4 hours in the heat were 2.3 times [95%CI: 1.14-4.69] more likely to experience HRI than those working fewer than 2 hours. A higher risk of HRI was also associated with heavy farming tasks (OR = 2.35, [1.34-4.14]), having hypertension (OR = 3.75, [1.90-7.81]), cardiovascular diseases (OR = 2.53, [1.03-6.93]), and other chronic conditions (OR = 2.51, [1.51-4.25]). In contrast, a lower risk of HRI was found in the older group (OR = 0.44, [0.22-0.87]) and increased water intake (OR = 0.46, [0.27-0.77]). Conclusions: Hot weather is a significant occupational health risk for farmers in Vietnam. Changing the working schedule, working in shorter intervals, and remaining well-hydrated should be considered in HRI prevention strategies.
Combined effects of global warming and rapid urbanization replace green spaces with urban facilities. Children in urban areas are at a higher risk of heat-related adverse health effects. Our study aimed to examine the protective effect of urban green space on heat-related respiratory hospitalization among children under 5 years of age in Hanoi, the capital city of Vietnam. We estimated district-specific meteorological conditions from 2010 to 2014 by using a dynamic downscaling approach with a fine-resolution numerical climate model. The green space in each district was calculated using satellite data. The attributable fraction of heat-related respiratory hospitalization was estimated using a two-stage model, including a distributed lag non-linear model (DLNM) coupled with multivariate meta-analysis. The association between heat-related respiratory hospitalization and green spaces at the district level was explored using a linear regression model. The central districts were more crowded and hotter, with less green spaces than the outer districts. At temperatures > 34 °C (extreme heat threshold), the hospitalizations in the central districts increased significantly; however, in the outer districts, the hospitalization rate was insignificant. On average, extreme heat attributed 0.33% to citywide hospitalization, 0.35% in the center, and 0.32% in the outer region. Every 1% increase in the green space fraction will reduce heat-related respiratory hospitalization risk by 3.8%. Heat significantly increased the risk of respiratory hospitalization among children under 5 years in Hanoi, Vietnam. These findings are valuable for authorities to consider strategies to protect children’s health against the effects of heat, including increasing green space.
Summertime ozone (O(3)) pollution has frequently occurred in the Beijing-Tianjin-Hebei (BTH) region, China, since 2013, resulting in detrimental impacts on human health and ecosystems. The contribution of weather shifts to O(3) concentration variability owing to climate change remains elusive. By combining regional air chemistry model simulations with near-surface observations, we found that anthropogenic emission changes contributed to approximately 23% of the increase in maximum daily 8-h average O(3) concentrations in the BTH region in June-July-August (JJA) 2017 (compared with that in 2013). With respect to the weather shift influence, the frequencies, durations, and magnitudes of O(3) exceedance were consistent with those of the heat wave events in the BTH region during JJA in 2013-2017. Intensified heat waves are a significant driver for worsening O(3) pollution. In particular, the prolonged duration of heat waves creates consecutive adverse weather conditions that cause O(3) accumulation and severe O(3) pollution. Our results suggest that the variability in extreme summer heat is closely related to the occurrence of high O(3) concentrations, which is a significant driver of deteriorating O(3) pollution.
Atmospheric conditions in any place can affect people’s health. In recent years, researchers have focused on heat stress and its effect on the exacerbation of some diseases. The main objective of this study is to identify the bioclimatic conditions and its relationship with the admission rate of cardiovascular patients in of Tabriz city. In addition to meteorological variables, daily cardiovascular patient admission rates were obtained from Shahid Madani Heart Hospital in Tabriz during the statistical period of March 27th, 2007 to February 17th, 2017. To do so, the bioclimatic conditions of Tabriz were identified on a daily scale based on bioclimatic indices including Perceived Temperature (PT), Physiological Equivalent Temperature (PET) and Predicted Mean Vote (PMV). Then, the relationship between each bioclimatic condition and the number of cardiovascular patients’ referrals in Tabriz was investigated using Kruskal-Wallis test. Findings illustrated that the impact of cold stress in the rate of cardiovascular patients was more than that of the warm stress, which was obtained for all study indicators in a similar way. On the other hand, the results showed that based on PET and PMV indices, there is a significant difference between various bioclimatic classes in the rate of cardiovascular patients’ admission. The results of Kruskal-Wallis test include Sig = 0.040 and Sig = 0.049 for PET and PMV, respectively. However, Sig values for and PT indice showed no significant difference between bioclimatic classes in the rate of admission of cardiovascular patients. Generally, it was found that there is a significant difference (Sig = 0.000) between the three classes of bioclimatic cold, warm and comfort with the number of hospital admissions of cardiovascular patients.
High-density living and heatwaves are increasing, at the same time as the population is ageing. The aim of this literature review was to examine the intersection between older and/or vulnerable people, who live in high-density/high-rise situations, and their health during heatwaves. Using electronic databases, the literature was examined. Articles were included if they were: (1) published in English, (2) examined the relationship between building, health, and extreme heat, and (3) included older or vulnerable populations. A total of 241 articles were identified of which 15 were duplicates and 209 did not meet the inclusion criteria. Of the 17 studies included in the review, 4 were conducted following heatwaves in Chicago and Europe. These identified a relationship between age, vulnerability, and floor of residence, in people who died because of the heatwave. High-rise living is increasing globally, and residents are getting older. This, in combination with increased heatwave intensity and frequency, highlights the risk of morbidity and mortality in this group, particularly where there is no access to air-conditioning because of power grid overload in the heat. This research benefits older and vulnerable people who live in high-rise buildings, the health professionals who care for them, architects, urban planners, and policy makers.
Workplace and environmental exposures pose health risks for racial/ethnic minorities in rural agricultural communities, placing them at a disadvantage in accessing needed health care. Over three fourths (76%) of the 2.4 million farmworkers in the United States are immigrants, mostly from Mexico. However, little is known of the community health concerns and barriers to care of Latinx farmworkers in inland southern California. This qualitative study used a community-based participatory research approach, conducting nine in-home meetings to obtain meaningful community input on health concerns and barriers to access healthcare services among rural residents of the Eastern Coachella Valley, who are also located near the desert-bound Salton Sea of inland southern California. All interviews were audio-recorded and analyzed via listening to the audio recordings and summarizing data in templates and matrices. Participants discussed health concerns related to agricultural labor, including heat-related illness, musculoskeletal ailments and injuries, skin disorders, respiratory illness, and trauma. Participants raised concerns about environmental exposures related to agriculture and the nearby Salton Sea, a highly saline lakebed, and proposed solutions to improve the health of their communities. The findings from this study suggest farmworkers are aware of the health risks posed by living and working in rural farmlands but lack resources and information to act upon and advocate for improved public health.
Given the increasing frequency, duration, and intensity of heat waves around the globe, more research is needed on the allocation and operations of cooling shelters for efficient heat mitigation. To address this need, this study considers a cooling shelter operating system that uses shuttle buses to transport heat-vulnerable people and presents a binary integer programming model for the multi-depot location routing problem (LRP) that decides optimal locations of cooling shelters and routes of shuttle buses simultaneously with the objective of minimizing the total operating cost for full accommodation of the heat-vulnerable population. Since the LRP is NP-hard, we further present the simulated annealing to efficiently derive a near-optimal solution. We then validate the proposed methodology with an application to the 14 administrative regions of Ulsan Metropolitan City in the Republic of Korea to assign heat-vulnerable residents and provide them with ride services to the associated cooling shelters. The overall results demonstrate the proposed methodology’s competitive performance compared with the traditional two-phased solution approach that separately solves the location problem and routing problem. In particular, our results show that the proposed methodology can save up to 49,000 USD in addressing the cooling shelter location routing problem compared to the two-phased solution approach. Subsequently, a sensitivity analysis is conducted regarding three factors that are likely to impact the effectiveness and efficiency of cooling shelter operations: shuttle bus capacity, traveling cost, and maximum walking distance. Our research provides recommendations for policymakers to carry out the best heat mitigation strategy for their unique circumstances and reduce heat-related illness and death.
BACKGROUND: Heatwaves have long been recognised as a serious public health concern. This study was aimed at developing and validating a Malay-version of a questionnaire for evaluating knowledge, risk perception, attitudes, and practices regarding heatwaves. METHOD: The knowledge construct was evaluated with item analysis and internal reliability. The psychometric characteristics, construct and discriminant validity, and internal consistency of the risk perception, attitude and practice constructs were evaluated with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). RESULTS: The 16 items in the knowledge construct had a good difficulty, discrimination, and reliability index of 0.81. A total of 16 items were maintained in EFA with Cronbach’s alpha of 0.84 and 0.82, 0.78 and 0.84 obtained for total items and risk perception, attitude, and practice constructs, respectively. A total of 15 items were retained after CFA. The finalised model met the fitness indices threshold. The convergent and discriminant validity were good. CONCLUSION: This newly developed Malay-version KRPAP questionnaire is reliable and valid for assessing Malaysians’ knowledge, risk perception, attitudes, and practices regarding heatwaves.
BACKGROUND: This study aims to investigate the current impacts of extreme temperature and heatwaves on human health in terms of both mortality and morbidity. This systematic review analyzed the impact of heatwaves on mortality, morbidity, and the associated vulnerability factors, focusing on the sensitivity component. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. Four databases (Scopus, Web of Science, EBSCOhost, PubMed) were searched for articles published from 2012 to 2022. Those eligible were evaluated using the Navigation Guide Systematic Review framework. RESULTS: A total of 32 articles were included in the systematic review. Heatwave events increased mortality and morbidity incidence. Sociodemographic (elderly, children, male, female, low socioeconomic, low education), medical conditions (cardiopulmonary diseases, renal disease, diabetes, mental disease), and rural areas were crucial vulnerability factors. CONCLUSIONS: While mortality and morbidity are critical aspects for measuring the impact of heatwaves on human health, the sensitivity in the context of sociodemographic, medical conditions, and locality posed a higher vulnerability to certain groups. Therefore, further research on climate change and health impacts on vulnerability may help stakeholders strategize effective plans to reduce the effect of heatwaves.
BACKGROUND: Global warming, lifestyle, or working in a high temperature environment leads to have increased health risk factors. This meta-analysis was conducted to determine the impact of high ambient temperature on male reproductive function. METHODS: Scientific articles were screened in the database including MEDLINE, EMBASE, National center for biotechnology information (NCBI) or Web of Science with relating keywords. Impact data of high ambient temperature on semen parameters were extracted and analyzed by STATA software according to the Random Effects Model. The high ambient temperature exposure group and Non-exposure group were compared using the standard mean difference (SMD). Publications were evaluated for publication bias by Egger test. RESULTS: Nine articles were finally selected from databases examining the effect of high ambient temperature on male reproductive health of 356 men from Iran, Italy, Thailand, China, Egypt. High ambient temperature showed a significant decrease in the seminal parameters, semen volume during each ejaculation (SMD = -0.74; 95% CI -1.11, -0.36), sperm concentration (SMD = -1.07; 95% CI -1.42, -0.72), total sperm count (SMD = -1.52; 95% CI -2.96, -0.08), sperm motility (SMD = -1.93; 95% CI -2.83, -1.04), sperm progressive motility (SMD = -1.65; 95% CI -2.39, -0.91) and normal morphology (SMD = -2.41; 95% CI -3.30, -1.52). CONCLUSION: High ambient temperature negatively affects sperm quality, including decreased semen volume, sperm count, sperm concentration, motility and normal morphology. This might lead to protective strategies to avoid the adverse effects of high ambient temperature on male fertility.
Rapid urbanisation is affecting people in different ways, with some becoming more vulnerable to the impacts of climate change. Africa’s cities are projected to be home to nearly 60% of the continent’s population by 2050. In conjunction with climate change, these cities are experiencing critical environmental challenges, including changes in the urban thermal environment. Urban areas generally exhibit significantly higher air and surface temperatures than their surrounding rural areas, resulting in urban heat islands. However, little has been done to synthesise existing knowledge and identify the key research gaps in this area, particularly in Africa. This paper focuses on the combined effects of urbanisation and climate change on the urban thermal environment in Africa, and provides a comprehensive review of results, major advances and the dominant direction of research. Our review of 40 publications from peer-reviewed journals from 2000 to 2021 revealed that South Africa, Ethiopia and Nigeria were most frequently studied, and satellite imagery-based data and analysis were used predominantly. Results from a few studies have shown the practical implications for urban land-use planning, informal settlement management, human wellbeing and productivity, energy use, air pollution and disease spread. Integrated approaches, strengthening planning institutions, and early warning systems are proposed to address climate change. Low-income groups are emphasised in efforts to help people cope with heat stress. Solutions based on land use and land cover dynamics and blue-green infrastructure are mentioned but are in need of further research. Cities with similar patterns of urbanisation, geographies and climate conditions could benefit from multi-disciplinary research collaboration to address the combined impacts of rapid urbanisation and climate change.
Publications on ambient temperature-related mortality among Arctic or subarctic populations are extremely rare. While circumpolar areas cover large portions of several European countries, Canada, and the USA, the population of these territories is relatively small, and the data needed for statistical analysis of the health impacts of extreme temperature events are frequently insufficient. This study utilizes standard time series regression techniques to estimate relative increases in cause- and age-specific daily mortality rates during heat waves and cold spells in four Russian cities with a subarctic climate. The statistical significance of the obtained effect estimates tends to be greater in the continental climate than in the marine climate. A small meta-analysis was built around the obtained site-specific health effects. The effects were homogeneous and calculated for the selected weather-dependent health outcomes. The relative risks of mortality due to ischemic heart disease, all diseases of the circulatory system, and all non-accidental causes during cold spells in the age group ≥ 65 years were 1.20 (95% CI: 1.11-1.29), 1.14 (1.08-1.20), and 1.12 (1.07-1.17), respectively. Cold spells were more harmful to the health of the residents of Murmansk, Archangelsk, and Magadan than heat waves, and only in Yakutsk, heat waves were more dangerous. The results of this study can help the public health authorities develop specific measures for the prevention of excess deaths during cold spells and heat waves in the exposed subarctic populations.
INTRODUCTION: As global warming continues at its current rate, heatwaves are likely to become an increasing phenomenon. At present, knowledge of the influence of heatwave temperatures on fracture patient presentation to hospital remains limited. METHODS: This was a retrospective descriptive epidemiology study performed through hospital database review, linked to meteorological data. Emergency Department and Fracture Patient Presentation Data was obtained for the adult (16+) South Glasgow population (population count – 525,839) and the adult (16+) population covered by the West of Scotland Major Trauma Centre (population count – 2,218,326) from May 2021 to August 2021. This was combined with maximum temperature data, along with humidity and humidex data. Humidex is a measure which quantifies the temperature experienced by the patient, through a combined score incorporating both maximum temperature and humidity RESULTS: During the study period, there was one temperature heatwave (19th to 25th July), and four humidex heatwaves (27(th) June to 3rd July, 15th to 17th July, 19th to 27th July, 22nd to 26th August). During the temperature heatwave, there was a significantly higher incidence of orthopaedic polytrauma patient presentation (IRR 2.37: p < 0.027), as well as ED patient presentation (IRR 1.07: p < 0.036). The humidex heatwaves were associated with a significantly higher incidence of orthopaedic polytrauma patient presentation (IRR 2.31: p < 0.002) and overall fracture patient presentation (IRR 1.18: p < 0.002). Positive correlations were found between orthopaedic polytrauma patient presentation vs temperature (R=0.217: p < 0.016), ED patient presentation vs temperature (R=0.427: p < 0.001), fracture patient presentation vs temperature (R=0.394: p < 0.001), and distal radius fracture patient presentation vs temperature (R=0.246: p < 0.006). CONCLUSION: This study finds that heatwave temperatures result in a significantly increased number of orthopaedic polytrauma patients presenting to a Major Trauma Centre. Given the significant resources these patients require for care, Major Trauma Centres should be aware of such findings, and consider staff and resources profiles in response.
This paper reviews and extends the recent empirical literature on the impact of climate change on mortality and adaptation in the United States. The analysis produces several new facts. First, the reductions in the impact of extreme heat on mortality risk previously documented up to 2004 have continued up to 2019, consistent with continued investments in health-protecting adaptations to high temperatures. The second part of the paper examines the private and external costs of electricity generation and consumption related to high temperatures, a commonly used proxy for measuring the consumption of adaptation services. Extreme temperatures increase electricity demand in the residential sector (relative to moderate temperatures), but not in the commercial, industrial and transportation end-use sectors. The additional electricity demand in response to high temperatures results in significant external costs due to the release of local and global pollutants caused by the combustion of fossil fuels in order to produce electricity. These external costs, documented for the first time in this paper, are one order of magnitude larger than the private cost of adaptation associated with electricity consumption.
With the accelerating process of climate change, long-term exposure to extreme temperatures could threaten individuals’ physical health, especially for the vulnerable population. This paper aims to investigate the long-term effects of extreme temperature exposure on the health of the elderly in the context of climate change and aging. Different from most of the existing literature in environmental economics, we define the relative extreme temperature exposure based on the local temperature pattern. By combining a large national household survey and nationwide meteorologic historical data, this study provides empirical evidence that heat exposure days and cold exposure days during the past year both significantly affect the physical health of middle-aged and elderly groups, controlling for city, year, and individual fixed effects. The effect on individual physical health has certain seasonal characteristics and is heterogeneous across populations. Additionally, cooling and heating equipment are effective in alleviating the reverse impact of heat and cold exposure. The estimation is robust and consistent across a variety of temperature measurements and model modifications. Our findings provide evidence of the long-term and accumulative cost of extreme temperature to middle-aged and elderly human capital, contributing to helping the public to better understand the full impact of climate change.
BACKGROUND: Exposure to excessive heat can impact kidney health. Climate change is projected to aggravate this impact. An analysis of articles published between 1958 and 2021 was conducted to explore the progress of the research on this issue. METHODS: This study included a bibliometric analysis wherein Web of Science was used to generate a list of all published articles related to the impact of heat on kidney health. Basic information about the articles, such as titles, authors’ names, keywords, and citations, were recorded and analyzed. RESULTS: A total of 226 published articles related to the impact of heat on kidney health were identified as of November 20, 2021. Most of these articles (93%) were published within the last decade. The United States was the most prominent country in terms of research productivity and collaboration. Researchers from the United States were well represented among the top 20 contributors of published articles on the study issue. The productivity of the top 20 authors varied between 6 and 32 articles each. A total of 25 common words used by the authors were identified. The most frequently used keywords were chronic kidney disease, heat stress, acute kidney injury, Mesoamerican nephropathy, and climate change. Keyword analysis revealed 3 distinct major research clusters in the existing scientific research on the impact of heat on kidney health: chronic kidney disease of unknown etiology, heat stress and renal physiology, and the effect of climate change on kidney health. CONCLUSIONS: Research on heat-related kidney injury has witnessed rapid development in recent decades, motivated by the emergence of chronic kidney disease of unknown etiology and climate change. Developing countries in hot regions must increase their productivity in this research area through international collaboration and partnerships.
The risk of kidney stone presentations increases after hot days, likely due to greater insensible water losses resulting in more concentrated urine and altered urinary flow. It is thus expected that higher temperatures from climate change will increase the global prevalence of kidney stones if no adaptation measures are put in place. This study aims to quantify the impact of heat on kidney stone presentations through 2089, using South Carolina as a model state. We used a time series analysis of historical kidney stone presentations (1997-2014) and distributed lag non-linear models to estimate the temperature dependence of kidney stone presentations, and then quantified the projected impact of climate change on future heat-related kidney stone presentations using daily projections of wet-bulb temperatures to 2089, assuming no adaptation or demographic changes. Two climate change models were considered-one assuming aggressive reduction in greenhouse gas emissions (RCP 4.5) and one representing uninibited greenhouse gas emissions (RCP 8.5). The estimated total statewide kidney stone presentations attributable to heat are projected to increase by 2.2% in RCP 4.5 and 3.9% in RCP 8.5 by 2085-89 (vs. 2010-2014), with an associated total excess cost of ~ $57 million and ~ $99 million, respectively.
In our current global warming climate, the growth of record-breaking heat waves (HWs) is expected to increase in its frequency and intensity. Consequently, the considerably growing and agglomerated world’s urban population becomes more exposed to serious heat-related health risks. In this context, the study of Surface Urban Heat Island (SUHI) intensity during HWs is of substantial importance due to the potential vulnerability urbanized areas might have to HWs in comparison to their surrounding rural areas. This article discusses Land Surface Temperatures (LST) reached during the extreme HW over Western North America during the boreal summer of 2021 using Thermal InfraRed (TIR) imagery acquired from TIR Sensor (TIRS) (30 m spatial resolution) onboard Landsat-8 platform and Moderate Resolution Imaging Spectroradiometer (MODIS) (1 km spatial resolution) onboard Terra/Aqua platforms. We provide an early assessment of maximum LSTs reached over the affected areas, as well as impacts in terms of SUHI over the main cities and towns. MODIS series of LST from 2000 to 2021 over urbanized areas presented the highest recorded LST values in late June 2021, with maximum values around 50 degrees C for some cities. High spatial resolution LSTs (Landsat-8) were used to map SUHI intensity as well as to assess the impact of SUHI on thermal comfort conditions at intraurban space by means of a thermal environmental quality indicator, the Urban Field Thermal Variance Index (UFTVI). The same high resolution LSTs were used to verify the existence of clusters and employ a Local Indicator of Spatial Association (LISA) to quantify its degree of strength. We identified the spatial distribution of heat patterns within the intraurban space as well as described its behavior across the thermal landscape by fitting a polynomial regression model. We also qualitatively analyze the relationship between both UFTVI and LST clusters with different land cover types. Findings indicate that average daytime SUHI intensity for the studied cities was typically within 1 to 5 degrees C, with some exceptional values surpassing 7 degrees C and 9 degrees C. During night, the SUHI intensity was reduced to variations within 1-3 degrees C, with a maximum value of +4 degrees C. The extreme LSTs recorded indicate no significant influence of HW on SUHI intensity. SUHI intensity maps of the intraurban space evidence hotspots of much higher values located at densely built-up areas, while urban green spaces and dense vegetation show lower values. In the same manner, UTFVI has shown “no” SUHI for densely vegetated regions, water bodies, and low-dense built-up areas with intertwined dense vegetation, while the “strongest” SUHI was observed for non-vegetated dense built-up areas with low albedo material such as concrete and pavement. LST was evidenced as a good marker for assessing the influence of HWs on SUHI and recognizing potential thermal environmental consequences of SUHI intensity. This finding highlights that remote-sensing based LST is particularly suitable as an indicator in the analysis of SUHI intensity patterns during HWs at different spatial resolutions. LST used as an indicator for analyzing and detecting extreme temperature events and its consequences seems to be a promising means for rapid and accurate monitoring and mapping.
The urban heat island (UHI) effect is the main problem regarding a city’s climate. It is the main adverse effect of urbanization and negatively affects human thermal comfort levels as defined by physiological equivalent temperature (PET) in the urban environment. Blue and green infrastructure (BGI) solutions may mitigate the UHI effect. First, however, it is necessary to understand the problem from the degrading side. The subject of this review is to identify the most essential geometrical, morphological, and topographical parameters of the urbanized environment (UE) and to understand the synergistic relationships between city and nature. A four-stage normative procedure was used, appropriate for systematic reviews of the UHI. First, one climate zone (temperate climate zone C) was limited to unify the design guidelines. As a result of delimitation, 313 scientific articles were obtained (546 rejected). Second, the canonical correlation analysis (CCA) was performed for the obtained data. Finally, our research showed the parameters of the UE facilities, which are necessary to mitigate the UHI effect. Those are building density and urban surface albedo for neighborhood cluster (NH), and distance from the city center, aspect ratio, ground surface albedo, and street orientation for street canyon (SC), as well as building height, material albedo, and building orientation for the building structure (BU). The developed guidelines can form the basis for microclimate design in a temperate climate. The data obtained from the statistical analysis will be used to create the blue-green infrastructure (BGI) dynamic modeling algorithm, which is the main focus of the future series of articles.
The fungal kingdom represents an extraordinary diversity of organisms with profound impacts across animal, plant, and ecosystem health. Fungi simultaneously support life, by forming beneficial symbioses with plants and producing life-saving medicines, and bring death, by causing devastating diseases in humans, plants, and animals. With climate change, increased antimicrobial resistance, global trade, environmental degradation, and novel viruses altering the impact of fungi on health and disease, developing new approaches is now more crucial than ever to combat the threats posed by fungi and to harness their extraordinary potential for applications in human health, food supply, and environmental remediation. To address this aim, the Canadian Institute for Advanced Research (CIFAR) and the Burroughs Wellcome Fund convened a workshop to unite leading experts on fungal biology from academia and industry to strategize innovative solutions to global challenges and fungal threats. This report provides recommendations to accelerate fungal research and highlights the major research advances and ideas discussed at the meeting pertaining to 5 major topics: (1) Connections between fungi and climate change and ways to avert climate catastrophe; (2) Fungal threats to humans and ways to mitigate them; (3) Fungal threats to agriculture and food security and approaches to ensure a robust global food supply; (4) Fungal threats to animals and approaches to avoid species collapse and extinction; and (5) Opportunities presented by the fungal kingdom, including novel medicines and enzymes.
BACKGROUND: Sustained elevated concentration of GHGs is predicted to increase global mortality. With the Australian health sector responsible for 7% of the nation’s GHG emissions, the benefits and costs of various decarbonisation trajectories are currently being investigated. To assist with this effort, we model the impact earlier decarbonisation has on temperature-related mortality. DESIGN: We used DICE-EMR, an Integrated Assessment Model with an endogenous mortality response, to simulate Australian GHG trajectories and estimate the temperature-related mortality impact of early decarbonisation. We modelled a linear decline of the Australian health sector’s and economy’s GHG annual emissions to net-zero targets of 2040 and 2050. MAIN OUTCOME MEASURE: Deaths averted and monetary-equivalent welfare gain. RESULTS: Decarbonisation of the Australian health sector by 2050 and 2040 is projected to avert an estimated 69,000 and 77,000 global temperature-related deaths respectively in a Baseline global emissions scenario. Australian economy decarbonisation by 2050 and 2040 is projected to avert an estimated 988,000 and 1,101,000 global deaths respectively. Assuming a low discount rate and high global emissions trajectory, we estimate a monetary equivalent welfare gain of $151 billion if the Australian health sector decarbonises by 2040, only accounting for the benefits in reducing temperature-related mortality. CONCLUSIONS: Earlier decarbonisation has a significant impact on temperature-related mortality. Many uncertainties exist and health impacts other than temperature-related mortality are not captured by this analysis. Nevertheless, such models can help communicate the health risk of climate change and improve climate policy decision making.
Green infrastructure has the potential to cool urban environments and reduce the health burden due to heatwaves. This study develops a new method to quantify the benefits of urban heat mitigation technologies on human heat balance and population mortality. The Heat Health Impact (HHI) method is based on the state-ofthe-art, multi-parameter model, Universal Thermal Climate Index (UTCI).A proof-of-concept exercise applied the HHI method to Sydney, Australia (population = 5.7 million). All available weather stations (10) were selected for full spatial coverage of the Sydney region (12,367 km2), and average hourly UTCI was calculated from meteorological observations spanning the entire year 2017. In the baseline analysis, average daily UTCI values were calculated for each of the 10 observation sites, and then spatially interpolated across the entire Sydney region for Feb 9, 2017, a representative heatwave day for Sydney. Three different greening intervention scenarios were investigated, and daily average change in UTCI (Delta UTCI) was calculated under each by comparison with the baseline scenario; this Delta UTCI was named Urban Cooling Effect (UCE). We implemented a health impact assessment methodology to estimate the change in attributable mortality due to each greening scenario for the Sydney GMR population for the representative heatwave day. Urban greening infrastructure scenarios reduced daily average UTCI between -0.2 and -1.7 degrees C on the heatwave day, with the health impact assessment indicating heat attributable deaths reducing up to 11.7 per day across the Sydney GMR compared to the baseline scenario. Our results highlight the health benefits of greening infrastructure to cool urban environments.
Extreme heat is annually the deadliest weather hazard in the United States and is strongly amplified by climate change. In Florida, summer heat waves have increased in frequency and duration, exacerbating negative human health impacts on a state with a substantial older population and industries (e.g., agriculture) that require frequent outdoor work. However, the combined impacts of temperature and humidity (heat stress) have not been previously investigated. For eight Florida cities, this study constructs summer climatologies and trend analyses (1950-2020) of two heat stress metrics: heat index (HI) and wet-bulb globe temperature (WBGT). While both incorporate temperature and humidity, WBGT also includes wind and solar radiation and is a more comprehensive measure of heat stress on the human body. With minor exceptions, results show increases in average summer daily maximum, mean, and minimum HI and WBGT throughout Florida. Daily minimum HI and WBGT exhibit statistically significant increases at all eight stations, emphasizing a hazardous rise in nighttime heat stress. Corresponding to other recent studies, HI and WBGT increases are largest in coastal subtropical locations in central and southern Florida (i.e., Daytona Beach, Tampa, Miami, and Key West) but exhibit no conclusive relationship with urbanization changes. Danger (103 degrees-124 degrees F; 39.4 degrees-51.1 degrees C) HI and high (>88 degrees F; 31.1 degrees C) WBGT summer days exhibit significant frequency increases across the state. Especially at coastal locations in the Florida Peninsula and Keys, danger HI and high WBGT days now account for >20% of total summer days, emphasizing a substantial escalation in heat stress, particularly since 2000. Significance StatementExtreme heat is the deadliest U.S. weather hazard. Although Florida is known for its warm and humid climate, it is not immune from heat stress (combined temperature and humidity) impacts on human health, particularly given its older population and prevalence of outdoor (e.g., agriculture) work. We analyze summer trends in two heat stress metrics at eight Florida cities since 1950. Results show that heat stress is increasing significantly, particularly at coastal locations in central and southern Florida and at night. The number of dangerous heat stress days per summer is also increasing across Florida, especially since 2000. Our analysis emphasizes that despite some acclimation, Florida is still susceptible to a serious escalation in extreme heat as the climate warms.
Heat waves are extreme weather and climate events that threaten public health by increasing morbidity and mortality. To reduce the health effects of heat waves, it is necessary to increase the knowledge level of the public, conduct awareness and protection activities and monitor these activity outcomes. The present study aimed to develop and validate a Turkish language scale of heat wave knowledge, awareness, practice and behavior for Turkish nationality. After item generation and creating dimensions, content validity analysis was performed. To evaluate the validity and reliability of the knowledge construct, the difficulty index, discriminant index and Kuder Richardson 20 (KR20) were used. The validity and reliability of the awareness, practice and behavior constructs were evaluated with exploratory and confirmatory factor analyses, and Cronbach’s alpha was used. The 15 items had a good difficulty, discrimination index and KR20 in the knowledge construct. The 14 items were yielded in EFA; 13 items were retained in CFA, and Cronbach’s alpha values of 0.878, 0.768, 0.855, and 0.858 were obtained for total items, practice, awareness and behavior, respectively. Eventually, a Turkish language scale was developed that is reliable and valid for assessing heat wave knowledge, awareness, practice and behavior.
It is well-established that exposure to non-optimum temperatures adversely affects public health, with the negative impact varying with latitude, as well as various climatic and population characteristics. This work aims to assess the relationship between ambient temperature and mortality from cardiorespiratory diseases in Eastern Macedonia and Thrace, in Northern Greece. For this, a standard time-series over-dispersed Poisson regression was fit, along with a distributed lag nonlinear model (DLNM), using a maximum lag of 21 days, to capture the non-linear and delayed temperature-related effects. A U-shaped relationship was found between temperature and cardiorespiratory mortality for the overall population and various subgroups and the minimum mortality temperature was observed around the 65th percentile of the temperature distribution. Exposure to extremely high temperatures was found to put the highest risk of cardiorespiratory mortality in all cases, except for females which were found to be more sensitive to extreme cold. It is remarkable that the highest burden of temperature-related mortality was attributed to moderate temperatures and primarily to moderate cold. The elderly were found to be particularly susceptible to both cold and hot thermal stress. These results provide new evidence on the health response of the population to low and high temperatures and could be useful to local authorities and policy-makers for developing interventions and prevention strategies for reducing the adverse impact of ambient temperature.
This paper studies the impact of climate change on the nutritional status of very young children between the ages of 0-3 years by using weather data from the last half century merged with rich information on child, mother, and household characteristics in rural coastal Bangladesh. We evaluate the health consequences of rising temperature and relative humidity and varying rainfall jointly employing alternate functional forms. Leveraging models that control for annual trends and location-specific seasonality, and that allow the impacts of temperature to vary non-parametrically while rainfall and humidity have flexible non-linear forms, we find that temperatures that exceed 25 °C (the “comfortable” benchmark) in the month of birth exert negative effects on children’s nutritional status as measured by mid upper arm circumference. Humidity has a positive impact which persists when child, mother and household controls are included. We find that exposure to changing climate in utero also matters. Explanations for these results include consequences of weather fluctuations on the extent of pasture, cropland, and rainfed lands planted with rice and other crops, and on mother’s age at first marriage. Our results underline that climate change has real consequences for the health of very young populations in vulnerable areas.
Rationale: Extremes of heat and particulate air pollution threaten human health and are becoming more frequent because of climate change. Understanding the health impacts of coexposure to extreme heat and air pollution is urgent. Objectives: To estimate the association of acute coexposure to extreme heat and ambient fine particulate matter (PM(2.5)) with all-cause, cardiovascular, and respiratory mortality in California from 2014 to 2019. Methods: We used a case-crossover study design with time-stratified matching using conditional logistic regression to estimate mortality associations with acute coexposures to extreme heat and PM(2.5). For each case day (date of death) and its control days, daily average PM(2.5) and maximum and minimum temperatures were assigned (0- to 3-day lag) on the basis of the decedent’s residence census tract. Measurements and Main Results: All-cause mortality risk increased 6.1% (95% confidence interval [CI], 4.1-8.1) on extreme maximum temperature-only days and 5.0% (95% CI, 3.0-8.0) on extreme PM(2.5)-only days, compared with nonextreme days. Risk increased by 21.0% (95% CI, 6.6-37.3) on days with exposure to both extreme maximum temperature and PM(2.5). Increased risk of cardiovascular and respiratory mortality on extreme coexposure days was 29.9% (95% CI, 3.3-63.3) and 38.0% (95% CI, -12.5 to 117.7), respectively, and were more than the sum of individual effects of extreme temperature and PM(2.5) only. A similar pattern was observed for coexposure to extreme PM(2.5) and minimum temperature. Effect estimates were larger over age 75 years. Conclusions: Short-term exposure to extreme heat and air pollution alone were individually associated with increased risk of mortality, but their coexposure had larger effects beyond the sum of their individual effects.
PURPOSE: This study assesses the potential acute effects of heatwaves on human morbidities in primary care settings. METHODS: We performed a time-stratified case-crossover study to assess the acute effects of heatwaves on selected morbidities in primary care settings in Flanders, Belgium, between 2000 and 2015. We used conditional logistic regression models. We assessed the effect of heatwaves on the day of the event (lag 0) and X days earlier (lags 1 to X). The associations are presented as Incidence Density Ratios (IDR). RESULTS: We included 22,344 events. Heatwaves are associated with increased heat-related morbidities such as heat stroke IDR 3.93 [2.94-5.26] at lag 0, dehydration IDR 3.93 [2.94-5.26] at lag 1, and orthostatic hypotension IDR 2.06 [1.37-3.10] at lag 1. For cardiovascular morbidities studied, there was only an increased risk of stroke at lag 3 IDR 1.45 [1.04-2.03]. There is no significant association with myocardial ischemia/infarction or arrhythmia. Heatwaves are associated with decreased respiratory infection risk. The IDR for upper respiratory infections is 0.82 [0.78-0.87] lag 1 and lower respiratory infections (LRI) is 0.82 [0.74-0.91] at lag 1. There was no significant effect modification by age or premorbid chronic disease (diabetes, hypertesnsion). CONCLUSION: Heatwaves are associated with increased heat-related morbidities and decreased respiratory infection risk. The study of heatwaves’ effects in primary care settings helps evaluate the impact of heatwaves on the general population. Primary care settings might be not suitable to study acute life-threatening morbidities.
BACKGROUND: The health impacts of climate warming are usually quantified based on daily average temperatures. However, extra health risks might result from hot nights. We project the future mortality burden due to hot nights. METHODS: We selected the hot night excess (HNE) to represent the intensity of night-time heat, which was calculated as the excess sum of high temperature during night time. We collected historical mortality data in 28 cities from three east Asian countries, from 1981 to 2010. The associations between HNE and mortality in each city were firstly examined using a generalised additive model in combination with a distributed lag non-linear model over lag 0-10 days. We then pooled the cumulative associations using a univariate meta-regression model at the national or regional levels. Historical and future hourly temperature series were projected under two scenarios of greenhouse-gas emissions from 1980-2099, with ten general circulation models. We then projected the attributable fraction of mortality due to HNE under each scenario. FINDINGS: Our dataset comprised 28 cities across three countries (Japan, South Korea, and China), including 9 185 598 deaths. The time-series analyses showed the HNE was significantly associated with increased mortality risks, the relative mortality risk on days with hot nights could be 50% higher than on days with non-hot nights. Compared with the rise in daily mean temperature (lower than 20%), the frequency of hot nights would increase more than 30% and the intensity of hot night would increase by 50% by 2100s. The attributable fraction of mortality due to hot nights was projected to be 3·68% (95% CI 1·20 to 6·17) under a strict emission control scenario (SSP126). Under a medium emission control scenario (SSP245), the attributable fraction of mortality was projected to increase up to 5·79% (2·07 to 9·52), which is 0·95% (-0·39 to 2·29) more than the attributable fraction of mortality due to daily mean temperature. INTERPRETATION: Our study provides evidence for significant mortality risks and burden in association with night-time warming across Japan, South Korea, and China. Our findings suggest a growing role of night-time warming in heat-related health effects in a changing climate. FUNDING: The National Natural Science Foundation of China, Shanghai International Science and Technology Partnership Project.
We examine the effects of ambient temperatures on mental health using a nationally representative longitudinal survey of Chinese individuals. We find that temperatures over 30?C significantly increase the likelihood of depression. High temperatures have larger detrimental effects on the mental health of the middle-aged and elderly, females, the less-educated, and agricultural workers. We discuss two likely mechanisms for the mental health impact of high temperatures: raising the incidence of physical illness and reducing sleeping time. We find suggestive evidence of air conditioners moderating the adverse impacts of high temperatures and of adaptation to high temperatures in the long term. We reveal that without any government interventions or private adaptation, mental health will deteriorate by 3.1% in the medium term and 5.3% in the long term based on the Hadley GEM2-ES climate-change projection.
Deadly humid heat conditions exceeding human thermoregulatory capacity have been reported; however, whether and where the deadly humid heat events occur consecutively across the land surface are largely unknown. We calculate the maximum consecutive days of deadly humid heat, defined as daily maximum wet-bulb temperature (TWmax) >= 35 degrees C, for observations of 9,278 meteorological stations and for simulations of 14 global climate models. We further define short and long deadly humid heatwaves as a period of 3-4 and >= 5 consecutive days with daily TWmax >= 35 degrees C, respectively. Our analyses show that six stations in some subtropical regions have experienced deadly humid heat with daily TWmax >= 35 degrees C, but only occurs in individual days. Deadly humid heatwaves increase exponentially as the global mean temperature rising. When limiting global warming within 1.5 degrees C, long deadly humid heatwaves will not occur across the land surface, and short deadly humid heatwaves will only emerge in some drylands but not in humid areas. Under 2 degrees C warming, 0.09% of the global land, 0.42% of the human population, and 0.56% of the global centres of crop diversity are projected to be exposed to long deadly humid heatwaves. Meanwhile, 18% of the deadly humid heatwaves lasting >= 3 consecutive days will occur in humid areas; the fractions are projected to rapidly increase in humid areas as temperature rising further. At the end of the century, the percentage of land areas and human population exposed to deadly humid heatwaves lasting >= 3 consecutive days are expected to be 76-times higher than that under 1.5 degrees C warming level. Our finding suggests that keeping global warming within 1.5 degrees C will significantly constrain the emergence of prolonged deadly humid heatwaves and thus reduce the risk of the human population especially outdoor agricultural workers.
The Mediterranean has been identified as a ‘climate change hot spot’, already experiencing faster warming rates than the global average, along with an increased occurrence of heat waves (HWs), prolonged droughts, and forest fires. During summer 2021, the Mediterranean faced prolonged and severe HWs, triggering hundreds of wildfires across the region. Greece, in particular, was hit by one of the most intense HWs in its modern history, with national all-time record temperatures being observed from 28 July to 6 August 2021. The HW was associated with extreme wildfires in many parts of the country, with catastrophic environmental and societal consequences. The study accentuated the rarity and special characteristics of this HW (HW2021) through the analysis of the historical climate record of the National Observatory of Athens (NOA) on a centennial time scale and comparison with previous HWs. The findings showed that HW2021 was ranked first in terms of persistence (with a total duration of 10 days) and highest observed nighttime temperatures, as well as ‘cumulative heat’, accounting for both the duration and intensity of the event. Exceptionally hot conditions during nighttime were intensified by the urban heat island effect in the city of Athens. Human exposure to heat-related stress during the event was further assessed by the use of bioclimatic indices such as the Universal Thermal Climate Index (UTCI). The study points to the interconnected climate risks in the area and especially to the increased exposure of urban populations to conditions of heat stress, due to the additive urban effect.
Multiple studies imply a strong relationship between global warming (GW) and complex disorders. This review summarizes such reports concentrating on three disorders-mental disorders (MD), primary hypertension, and type 2 diabetes (T2D). We also attempt to point at potential mechanisms mediating the effect of GW on these disorders. Concerning mental disorders, immediate candidates are brain levels of heat-shock proteins (HSPs). In addition, given that heat stress increases reactive oxygen species (ROS) levels which may lead to blood-brain barrier (BBB) breakdown and, hence, enhanced protein extravasation in the brain, this might finally cause, or exacerbate mental health. As for hypertension, since its causes are incompletely understood, the mechanism(s) by which heat exposure affects blood pressure (BP) is an open question. Since the kidneys participate in regulating blood volume and BP they are considered as a site of heat-associated disease, hence, we discuss hyperosmolarity as a potential mediator. In addition, we relate to autoimmunity, inflammation, sodium excretion, and HSP70 as risk factors that might play a role in the effect of heat on hypertension. In the case of T2D, we raise two potential mediators of the effect of exposure to ambient hot environment on the disease’s incidence-brown adipose tissue metabolism and HSPs.
Children, and particularly infants, have physiological, anatomic, and social factors that increase vulnerability to temperature extremes. We performed a systematic review to explore the association between acute adverse infant outcomes (children 0-1 years) and exposure to high and low ambient temperatures. MEDLINE (Pubmed), Embase, CINAHL Plus, and Global Health were searched alongside the reference lists of key papers. We included published journal papers in English that assessed adverse infant outcomes related to short-term weather-related temperature exposure. Twenty-six studies met our inclusion criteria. Outcomes assessed included: infant mortality (n = 9), sudden infant death syndrome (n = 5), hospital visits or admissions (n = 5), infectious disease outcomes (n = 5), and neonatal conditions such as jaundice (n = 2). Higher temperatures were associated with increased risk of acute infant mortality, hospital admissions, and hand, foot, and mouth disease. Several studies identified low temperature impacts on infant mortality and episodes of respiratory disease. Findings on temperature risks for sudden infant death syndrome were inconsistent. Only five studies were conducted in low- or middle-income countries, and evidence on subpopulations and temperature-sensitive infectious diseases was limited. Public health measures are required to reduce the impacts of heat and cold on infant health.
BACKGROUND: Physical activity is an important factor in premature mortality reduction, non-communicable disease prevention, and well-being protection. Climate change will alter temperatures globally, with impacts already found on mortality and morbidity. While uncomfortable temperature is often perceived as a barrier to physical activity, the actual impact of temperature on physical activity has been less well studied, particularly in China. This study examined the associations between temperature and objectively measured physical activity among adult populations in five major Chinese cities. METHODS: Aggregated anonymized step count data was obtained between December 2017-2018 for five major Chinese cities: Beijing, Shanghai, Chongqing, Shenzhen, and Hong Kong. The associations of temperature with daily aggregated mean step count were assessed using Generalized Additive Models (GAMs), adjusted for meteorological, air pollution, and time-related variables. RESULTS: Significant decreases in step counts during periods of high temperatures were found for cold or temperate climate cities (Beijing, Shanghai, and Chongqing), with maximum physical activity occurring between 16 and 19.3 °C. High temperatures were associated with decreases of 800-1500 daily steps compared to optimal temperatures. For cities in subtropical climates (Shenzhen and Hong Kong), non-significant declines were found with high temperatures. Overall, females and the elderly demonstrated lower optimal temperatures for physical activity and larger decreases of step count in warmer temperatures. CONCLUSIONS: As minor reductions in physical activity could consequentially affect health, an increased awareness of temperature’s impact on physical activity is necessary. City-wide adaptations and physical activity interventions should seek ways to sustain physical activity levels in the face of shifting temperatures from climate change.
BACKGROUND: Farmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting. METHODS: We conducted a parallel, comparison group intervention study from May-September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention (n = 37 participants) and alternative-training comparison (n = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSI(max)) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSI(max), and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers. RESULTS: We observed larger decreases in PSI(max) in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HI(max)), but this was not statistically significant (interaction - 0.91 for high versus low/medium-low effort, t = - 1.60, p = 0.11). We observed a higher PSI(max) with high versus low/medium-low effort (main effect 1.96, t = 3.81, p < 0.001) and a lower PSI(max) with older age (- 0.03, t = - 2.95, p = 0.004), after covariate adjustment. There was no clear relationship between PSI(max) and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HI(max), 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work. CONCLUSIONS: Effort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT04234802 , date first posted 21/01/2020.
Urban residents suffer more from heat stress, compared to people living in rural areas, due to the urban heat island (UHI) effect. Mitigation of UHI is thus essential to improving human thermal comfort and living environment in urban residential areas. However, little attention has been paid to the integrated effect of UHI mitigation strategies on human thermal comfort, which is influenced by the combination of temperature, humidity, wind, and radiation. This study evaluates the effectiveness of two promising UHI mitigation strategies, cool and green roofs, in improving human thermal comfort during a heatwave in Berlin. Human thermal comfort is represented by the Universal Thermal Climate Index (UTCI), calculated by combining the Weather Research and Forecasting model coupled with the Urban Canopy Model (WRF/UCM) with the RayMan model. The results show that cool roofs outperform green roofs in reducing urban temperatures, especially at night. Besides temperature reduction, both strategies show lower wind speed, lower mean radiant temperature, and higher relative humidity. These combined effects lead to a city-scale decrease in UTCI. Cool roofs reduce more UTCI than green roofs, although they both shorten the duration of strong heat stress from 7 h d-1 to 5 h d-1. A higher albedo and irrigation can strengthen the cooling effect of cool and green roofs, respectively. Our study can deepen the understanding of the mechanism of natural infrastructure in improving human thermal comfort, providing scientific guidance for future city management.
Frequent heatwaves under global warming can increase the risk of preterm birth (PTB), which in turn will affect physical health and human potential over the life course. However, what remains unknown is the extent to which anthropogenic climate change has contributed to such burdens. We combine health impact and economic assessment methods to comprehensively evaluate the entire heatwave-related PTB burden in dimensions of health, human capital and economic costs. Here, we show that during 2010-2020, an average of 13,262 (95%CI 6,962-18,802) PTBs occurred annually due to heatwave exposure in China. In simulated scenarios, 25.8% (95%CI 17.1%-34.5%) of heatwave-related PTBs per year on average can be attributed to anthropogenic climate change, which further result in substantial human capital losses, estimated at over $1 billion costs. Our findings will provide additional impetus for introducing more stringent climate mitigation policies and also call for more sufficient adaptations to reduce heatwave detriments to newborn.
BACKGROUND: The expected increase in heat in The Gambia is one of the most significant health threats caused by climate change. However, little is known about the gendered dynamics of exposure and response to heat stress, including women’s perceived health risks, their adaptation strategies to heat, and their perceptions of climate change. This research project aims to answer the question of whether and how pregnant farmers in The Gambia perceive and act upon occupational heat stress and its health impacts on both themselves and their unborn children, against the backdrop of current and expected climatic changes. METHOD: In-depth semi-structured interviews were conducted with 12 women who practice subsistence farming and were either pregnant or had delivered within the past month in West Kiang, The Gambia. Participants were selected using purposive sampling. Translated interview transcripts were coded and qualitative thematic content analysis with an intersectional lens was used to arrive at the results. RESULTS: All women who participated in the study experience significant heat stress while working outdoors during pregnancy, with symptoms often including headache, dizziness, nausea, and chills. The most common adaptive techniques included resting in the shade while working, completing their work in multiple shorter time increments, taking medicine to reduce symptoms like headache, using water to cool down, and reducing the amount of area they cultivate. Layered identities, experiences, and household power structures related to age, migration, marital situation, socioeconomic status, and supportive social relationships shaped the extent to which women were able to prevent and reduce the effects of heat exposure during their work whilst pregnant. Women who participated in this study demonstrated high awareness of climate change and offered important insights into potential values, priorities, and mechanisms to enable effective adaptation. CONCLUSION: Our findings reveal many intersecting social and economic factors that shape the space within which women can make decisions and take adaptive action to reduce the impact of heat during their pregnancy. To improve the health of pregnant working women exposed to heat, these intersectionalities must be considered when supporting women to adapt their working practices and cope with heat stress.
We investigate the effect of extreme temperatures on mortality and emergency hospital admissions, and whether local social care allows to mitigate their adverse effects. We merge monthly administrative data on mortality and hospital discharge from Italian municipalities for the period 2001-2015 with daily data on local weather conditions, and yearly data on disaggregated municipal expenditure. We compare two different measures of temperature shocks, one using the conventional approach based on absolute levels (without accounting for regional heterogeneity) and the other based on deviations from local mean temperatures. The former approach shows noisy evidence of an increase in mortality due to extremely hot days while the latter approach shows a large increase in mortality and hospital admissions for cardiovascular and respiratory diseases due to both cold and hot days. These effects are mostly driven by the oldest age group and partially by young children. Then, we report evidence of a mitigating effect of social expenditure on the impact of extremely hot and cold days on both emergency hospital admission and mortality rates. A back of the envelope calculation suggests that the additional social care expenditure is fully compensated by the benefits arising from the lower impact of temperature shocks.
This study addresses the limited work related to Heat Stress (HS) vulnerability within indoor/outdoor contexts and its relationship with local Extreme Heat Events (EHEs). Centred upon Ankara, the study focuses on building upon its weaker approach to human thermophysiological vulnerabilities in an era of climate change, and unregulated urban densification. Through newly defined local EHEs, the physiologically equivalent temperature (PET) (and its cumulative derivatives), were utilised to develop the limited approaches that utilise Energy Based Models in the scope of EHE risk management. The study was undertaken by processing hourly data from 2008 to 2020 from Ankara’s Meteorological Station, and Esenboga Meteorological Station. At a finer 10 min resolution, an interior Kestrel Heat-stress Station was used to assess summer thermal conditions in 2020 within a thermally vulnerable, yet still very frequent, residential Turkish construction typology. Among other outcomes, the results indicated the permanency of indoor PET that remained above 27 degrees C during non EHE periods. In the case of a Very Hot Day (VHD33), PET remained between 29 and 32.9 degrees C for almost 24 h. The thermal index also indicated how forced convective cooling led to indoor reductions of PET by 3-4 K, and in duration of such HS levels to less than 2 h.
Diabetes mellitus imposes a significant and increasing health burden on the US population. Our objective is to determine if weather is related to daily variations in emergency department (ED) visits for diabetes mellitus in Roanoke, Virginia. A time series of daily ED visits for diabetes mellitus at the Carilion Clinic in southwestern Virginia is associated with daily minimum temperature from 2010-2017. Associations between ED visits (through a 14-day lag period) and temperature are examined using generalized additive models and distributed lag nonlinear models. Heat and cold waves are identified at low and high thresholds, and ED visitation during these events is compared to prior control periods using a time-stratified case crossover approach. ED visits for diabetes exhibit a U-shaped relationship with temperature, with a higher relative risk (RR) during cold events (RR = 1.05) vs. warm events (RR = 1.02). When minimum temperatures are below freezing, ED visitation peaks starting 2 days afterward, with RRs approaching 1.04. The RR on warm days (minimum temperature > 10 °C) approaches 1.02 but peaks on the day of or the day following the elevated temperatures. Cold waves increase the odds of ED visits by up to 11% (p = 0.01), whereas heat waves exhibit no significant effect (p = 0.07). The increasing health burden linked to diabetes requires new research on environmental factors that might exacerbate related illness. When examined in the context of climate change impacts on local weather variations, these kinds of linkages between environment and disease can aid in facility staffing and public health messaging during extreme weather events.
BACKGROUND: People with pre-existing medical conditions, who spend a large proportion of their time indoors, are at risk of emergent morbidities from elevated indoor heat exposures. In this study, indoor heat of structures wherein exposed people received Grady Emergency Services based care in Atlanta, GA, U.S., was measured from May to September 2016. METHOD: ology: In this case-control study, analyses were conducted to investigate the effect of indoor heat on the odds of 9-1-1 calls for diabetic (n = 90 cases) and separately, for respiratory (n = 126 cases), conditions versus heat-insensitive emergencies (n = 698 controls). Generalized Additive Models considered both linear and non-linear indoor heat and health outcome associations using thin-plate regression splines. RESULTS: Hotter and more humid indoor conditions were non-linearly associated with an increasing likelihood of receiving emergency care for complications of diabetes and severe respiratory distress. Higher heat indices were associated with increased odds of a diabetes (odds ratio for change from 30 to 31 °C: 1.12, 95% CI: 1.08-1.16) or respiratory 9-1-1 medical call versus control (odds ratio for change from 34 to 35 °C: 1.18, 95% CI: 1.09-1.28) call. Both diabetic and respiratory distress patients were more likely to be African-American and/or have comorbidities. CONCLUSIONS: In this study, the statistical association of indoor heat exposure with emergency morbidities (diabetic, respiratory) was demonstrated. The study also showcased the value and utility of data gathered by emergency medical dispatch and services from inaccessible private indoor sources (i.e., domiciles) for environmental health.
BACKGROUND: Stroke is a leading cause of death and disability in East Asia. Owing to the aging population and high prevalence of stroke, East Asia might suffer a disproportionately heavy burden of stroke under the changing climate. However, the evidence relevant is still limited in this area. OBJECTIVE: To evaluate the stroke mortality risk due to heat exposure in East Asia and predict its burden under various future climate change scenarios. METHODS: We conducted a multi-center observational study and collected data from 22 representative cities in three main East Asian countries (i.e., China, Japan, and South Korea) from 1972 to 2015. The two-stage time-series analyses were applied to estimate the effects of heat on stroke mortality at the regional and country level. We further projected the burden of heat-related stroke mortality using 10 global climate models (GCMs) under four shared socioeconomic pathway and representative concentration pathway (SSP-RCP) scenarios, including SSP1-RCP1.9, SSP1-RCP2.6, SSP2-RCP4.5, and SSP5-RCP8.5 scenarios. RESULTS: In the present study, a total of 287,579 stroke deaths were collected during the warm season. Heat was significantly associated with an increased risk of stroke mortality. Overall, compared with the 2010 s, the heat-related attributable fraction (AF) was projected to increase in the 2090 s, with increments ranging from 0.8 % to 7.5 % across various climate change scenarios. The heat-related AF was projected to reach 11.9 % (95 % empirical confidence interval [eCI]: 6.1 %, 17.5 %) in the 2090 s under the SSP5-RCP8.5 scenario in China, while the corresponding estimates were 6.6 % (95 % eCI: 2.5 %, 11.0 %) and 5.1 % (95 % eCI: 1.2 %, 9.1 %) for Japan and South Korea, respectively. CONCLUSIONS: Climate change will exacerbate the burden of heat-related stroke mortality but with considerable geographical heterogeneity in East Asia.
Climate change threatens sustainable development by influencing myriad of outcomes. We examine if temperature shocks contribute to the gambling, which is a major public health concern globally. We use longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey coupled with satellite data capturing neighbourhood temperature shocks. Our results suggest that temperature shocks increase the prevalence of gambling, and that psychological distress and social capital are channels through which temperature shocks transmit to gambling behaviour. Our results point to the need for policies that promote mental health and encourage social capital amidst extreme weather events in order to offset the effects of weather shocks on gambling behaviour.
BACKGROUND: Climate change has led to increased interest in studying adverse health effects relating to ambient temperatures. It is unclear whether incident chest pain is associated with non-optimal temperatures and how chest pain presentation rates might be affected by climate change. METHODS: The study included ambulance data of chest pain presentations in Melbourne, Australia from 1/1/2015 to 30/6/2019 with linkage to hospital and emergency discharge diagnosis data. A time series quasi-Poisson regression with a distributed lag nonlinear model was fitted to assess the temperature-chest pain presentation associations overall and according to age, sex, socioeconomic status, and event location subgroups, with adjustment for season, day of the week and long-term trend. Future excess chest pain presentations associated with cold and heat were projected under six general circulation models under medium and high emission scenarios. RESULTS: In 206,789 chest pain presentations, mean (SD) age was 61.2 (18.9) years and 50.3 % were female. Significant heat- and cold-related increased risk of chest pain presentations were observed for mean air temperatures above and below 20.8 °C, respectively. Excess chest pain presentations related to heat were observed in all subgroups, but appeared to be attenuated for older patients (≥70 years), patients of higher socioeconomic status (SES), and patients developing chest pain at home. We projected increases in heat-related chest pain presentations with climate change under both medium- and high-emission scenarios, which are offset by decreases in chest pain presentations related to cold temperatures. CONCLUSIONS: Heat- and cold- exposure appear to increase the risk of chest pain presentations, especially among younger patients and patients of lower SES. This will have important implications with climate change modelling of chest pain, in particular highlighting the importance of risk mitigation strategies to minimise adverse health impacts on hotter days.
BACKGROUND: Adverse health impacts have been found under extreme temperatures in many parts of the world. The majority of such research to date for the UK has been conducted on populations in England, whilst the impacts of ambient temperature on health outcomes in Scottish populations remain largely unknown. METHODS: This study uses time-series regression analysis with distributed lag non-linear models to characterise acute relationships between daily mean ambient temperature and mortality in Scotland including the four largest cities (Aberdeen, Dundee, Edinburgh and Glasgow) and three regions during 1974-2018. Increases in mortality risk under extreme cold and heat in individual cities and regions were aggregated using multivariate meta-analysis. Cold results are summarised by comparing the relative risk (RR) of death at the 1(st) percentile of localised temperature distributions compared to the 10(th) percentile, and heat effects as the RR at the 99(th) compared to the 90(th) percentile. RESULTS: Adverse cold effects were observed in all cities and regions, and heat effects were apparent in all cities and regions except northern Scotland. Aggregate all-cause mortality risk in Scotland was estimated to increase by 10% (95% confidence interval, CI: 7%, 13%) under extreme cold and 4% (CI: 2%, 5%) under extreme heat. People in urban areas experienced higher mortality risk under extreme cold and heat than those in rural regions. The elderly had the highest RR under both extreme cold and heat. Males experienced greater cold effects than females, whereas the reverse was true with heat effects, particularly among the elderly. Those who were unmarried had higher RR than those married under extreme heat, and the effect remained after controlling for age. The younger population living in the most deprived areas experienced higher cold and heat effects than in less deprived areas. Deaths from respiratory diseases were most sensitive to both cold and heat exposures, although mortality risk for cardiovascular diseases was also heightened, particularly in the elderly. Cold effects were lower in the most recent 15 years, which may be linked to policies and actions in preventing the vulnerable population from cold impacts. No temporal trend was found with the heat effect. CONCLUSIONS: This study assesses mortality risk associated with extreme temperatures in Scotland and identifies those groups who would benefit most from targeted actions to reduce cold- and heat-related mortalities.
The human body can withstand high temperatures to some extent, but exposure to temperatures exceeding human heat tolerance leads to sickness and, at very high temperatures, to death. In this study, using the analyzed data on the maximum temperature at 2 m above the surface in a 73-year period from 1948 to 2020, the seasonal, annual, decadal and centennial frequency of lethal temperatures above 50 degrees C (TU50c) in the Northern Hemisphere (NH) was analyzed. The aim of this research was to extract the frequency and trend in TU50c in the NH. In this study, regression analysis, trend component analysis and wavelet analysis were used. Examination of the frequency of TU50c occurrence in the NH showed that the trend of annual changes in the frequency of TU50c in the NH is upward and significant. Inter-decadal changes indicate that in the fifth decade (1980-1989) and sixth decade (1990-1999), there was an unprecedented increase in the frequency of TU50c. Inter-century changes also show that the incidence of TU50c has increased gradually from the twentieth to the twenty-first century. The highest incidence of twentieth-century TU50c extreme temperatures occurred between 1986 and 1988. Spatially, the region with the highest frequency and strongest TU50c is in Africa, especially Sudan, West Asia (between Iraq, southwestern Iran, Kuwait and Saudi Arabia) and India in the Indian subcontinent. These temperatures are not uncommon in the United States, but TU50c has not been reported in Europe and East Asia. The results of statistical analysis show that the frequency of occurrence of TU50c in the NH is related to the annual frequency of sunspots and also, to a much lesser extent, to the concentration of carbon dioxide.
While previous research on historical changes in heat-related mortality observed decreasing trends over the recent decades, future projections suggest increasing impact of heat on mortality in most regions of the world. This study aimed to analyse temporal changes in temperaturemortality relationships in Prague, Czech Republic in the warm season (May-September), using a daily mortality time series from 1982 to 2019. To investigate possible effect of adaptation to increasing temperature, we divided the study period into four decades (1980s-2010s). We used conditional Poisson regression models to identify decade-specific relative risk of heat-related mortality and to calculate the annual number of heat-attributable deaths and the heatattributable fraction of total warm season deaths. We estimated their trends over the whole study period by a generalized additive model with non-parametric smoothing spline. Our results showed that the unprecedentedly hot 2010s was associated with approximately twice as large relative risk of heat-related mortality than in previous decades. This resulted in the reversal of the trend in heat-attributable mortality in the 1990s and its increase during the last two decades. Our findings highlight the importance of further improvement of adaptation measures such as heatand-health warning systems to protect the heat-susceptible population.
To examine the temporal trends of the association between heat exposure and hospitalizations for renal disease in Queensland, Australia, between the summer season of 1 December 1995 and 31 December 2016. A total of 238 427 de-identified hospitalization records for renal disease were collected from Queensland Health. Meteorological data was obtained from the Scientific Information for Land Owners. Summer season means four consecutive months with higher daily mean temperatures. We conducted a time-stratified case-crossover study using conditional quasi-Poisson regression model and applied a time-varying distributed lag non-linear model were used to evaluate the temporal trends of the associations between 1 degrees C increase in daily mean temperatures (over 0-10 lags) and hospitalizations for renal diseases. We also conducted stratified analyses by sex, age, climate zone, socioeconomic status, and cause-specific renal diseases. Overall, the associations between high temperature and hospitalizations for renal diseases showed a decreasing trend during the summer seasons from 1995 to 2016. However, the heat-related effects in males increased from 3.0% (95% CI: 2.2%, 3.9%) in 1995 to 4.8% (95% CI: 3.9%, 5.6%) in 2016. In the elderly cohort (both sexes), there was a similar increase over time 2.0% (95% CI: 1.0%, 3.0%) in 1995 to 6.3% (95% CI: 5.4%, 7.3%) in 2016. People living in hotter climate zones and those living in relatively socioeconomically disadvantaged areas also showed an increasing trend. In the cause-specific disease analysis, the increasing trend was found in renal failure, with heat-related effects increased from 3.45% (95% CI: 2.31%, 4.60%) in 1995 to 8.19% (95% CI: 7.03%, 9.36%) in 2016. Although the association between temperature and hospitalizations for renal diseases showed a decreasing trend in Queensland’s hot season between 1995 and 2016, the susceptibility to high temperatures is increasing in males, the elderly of both sexes, those living in hotter climate areas, and socioeconomically disadvantaged areas. This increasing trend of susceptibility is a great concern and indicates a strong need for targeted public health promotion campaigns.
According to the United Nations Office for Disaster Risk Reduction (UNDRR), a heat-health action plan should address various impacts of hazards at different levels, including an early warning system to monitor risks and behaviour enhancement to increase disaster preparedness. It is necessary to comply with guidelines regarding heat duration/intensity. In this study, we developed a data-driven approach to rapidly and systematically estimate the impacts of various heat events on emergency admissions among the adult population (n = 7,086,966) in Hong Kong in order to enhance the heat-health action plan. Immediate, short-term, and long-term impacts determined by 1-day, 4-day, and 8-day windows were estimated to identify specific heat events suitable for early warnings. In addition, underestimated risk, determined by a continuous increase in heat risk after days without significant emergency admissions, was estimated to evaluate potential maladaptive behaviours among a specific subpopulation. Based on age- and gender-specific analyses, 1D, 1D1N, and 2D2N were observed to have a stronger immediate impact on emergency admissions. 1D1N and 2D2N also showed notable short-term and long-term impacts. Based on heat vulnerability factors (age and gender), 2D2N was a higher-priority extreme heat event for early warning measures than 1D1N. Furthermore, men aged 19 to 64 had the highest underestimated risk. Specifically, they had IRR values of 1.113 [1.087, 1.140], 1.061 [1.035, 1.087], and 1.069 [1.043, 1.095] during lag days 3-5 of 3D2N, respectively, possibly due to a lack of adaptive behaviour. By adopting our approach, the duration of heat events with significant health impacts can be identified in order to further enhance relevant heat stress information. This framework can be applied to other cities with a similar background for rapid assessment.
OBJECTIVES: Heatwaves have been linked to increased levels of health service demand in Australia. This systematic literature review aimed to explore health service demand during Australian heatwaves for hospital admissions, emergency department presentations, ambulance call-outs, and risk of mortality. STUDY DESIGN: A systematic review to explore peer-reviewed heatwave literature published from 2000 to 2020. DATA SOURCES: Articles were reviewed from six databases (MEDLINE, Scopus, Web of Science, PsychINFO, ProQuest, Science Direct). Search terms included: heatwave, extreme heat, ambulance, emergency department, and hospital. Studies were included if they explored heat for a period of two or more consecutive days. Studies were excluded if they did not define a threshold for extreme heat or if they explored data only from workers compensation claims and major events. DATA SYNTHESIS: This review was prospectively registered with PROSPERO (# CRD42021227395 ). Forty-five papers were included in the final review following full-text screening. Following a quality assessment using the GRADE approach, data were extracted to a spreadsheet and compared. Significant increases in mortality, as well as hospital, emergency, and ambulance demand, were found across Australia during heatwave periods. Admissions for cardiovascular, renal, respiratory, mental and behavioural conditions exhibited increases during heatwaves. The most vulnerable groups during heatwaves were children (< 18 years) and the elderly (60+). CONCLUSIONS: Heatwaves in Australia will continue to increase in duration and frequency due to the effects of climate change. Health planning is essential at the community, state, and federal levels to mitigate the impacts of heatwaves on health and health service delivery especially for vulnerable populations. However, understanding the true impact of heatwaves on health service demand is complicated by differing definitions and methodology in the literature. The Excess Heat Factor (EHF) is the preferred approach to defining heatwaves given its consideration of local climate variability and acclimatisation. Future research should explore evidence-based and spatially relevant heatwave prevention programs. An enhanced understanding of heatwave health impacts including service demand will inform the development of such programs which are necessary to promote population and health system resilience.
Climate change induced rising temperatures will pose a detrimental threat to decent health in the coming decades. Especially at risk are individuals with chronic diseases, since heat can exacerbate a variety of health conditions. In this article, I examine the heat-morbidity relationship in the context of Indonesia, focusing on chronic, non-communicable diseases, namely diabetes, cardiovascular and respiratory diseases. Using a novel dataset from the Indonesian national health insurance scheme Jaminan Kesehatan Nasional/Badan Penyelenggara Jaminan Sosial (BPJS) and linking it with meteorological data on the daily-district level, I estimate the causal effect of high temperatures on the daily number of primary health care visits. The results show that on a hot day all-cause visits and visits with a diagnosis of diabetes and cardiovascular diseases increase by 8%, 25% and 14%, respectively. These increases are permanent and not offset by visit displacement or ‘harvesting’. Visits related to respiratory diseases seem not to be affected by high temperatures. I use several climate change scenarios to predict the increase in visits and costs by the end of the century, which all forecast a substantial financial burden for the health care system. These results might have relevance for other middle-income countries with similar climatic conditions.
Due to climate change, urban populations will be affected by worsening heat stress. The use of blue-green infrastructure can be an effective countermeasure for urban planners. In this study, the ENVI-met modelling system is used to investigate the impacts of different heat adaptation strategies, such as additional urban trees, irrigation policies, and the use of high reflective surface materials. However, under certain local conditions, these measures can have conflicting effects, e.g., trees can provide shadow but also reduce the cooling ventilation. To address such conflicts, we developed an online tool visualising urban climate simulation data and applying a new decomposition algorithm that translates the biophysical processes (i.e., radiation, ventilation, evapotranspiration, and heat storage) into surface temperature changes during heat wave events. This approach allows us to (1) identify factors responsible for heat, (2) comparatively evaluate heat mitigation of different land development scenarios, and (3) find trade-offs for conflicting adaptation measures. This online tool can support the decision-making of local stakeholders.
Purpose of Review Sporotrichosis is a disease caused by fungi belonging to the genus of Sporothrix. Infection with this fungus in humans causes symptoms that range from cutaneous to systemic. Moreover, immunocompromised patients are more susceptible to the severity of the infection. The fungus can be found in various organic materials such as plants and soil. Until the end of the 1990s, sporotrichosis was considered an occupational and work-related disease, and high-risk individuals were those who had permanent contact with these materials. However, what is the role of animals in the transmission of the fungus to humans? What role is the environment playing in this transmission process? This literature review aims to compile knowledge to answer these questions. Recent Findings Epidemiological studies have shown an increase in the cases of infection in domestic animals with the fungus, which have transmitted the infection to humans. This is to be expected due to changes in human behavior towards animals, which now have a very close relationship. Additionally, soil and water contamination with the fungus has increased, perhaps due to changes in land use, increased humidity, and temperature associated with climate change. Summary The endemic regions of this fungus are characterized by warm or tropical climates, which favor disease transmission through direct or indirect contact with animals or contaminated soil. The climate change that our planet is currently experiencing has had an impact on various regions of the world where infected cases of Sporothrix spp. in humans have increased. Due to this, it is relevant to promote research associated with the prevalence of sporotrichosis in humans and animals, as well as soil contamination monitoring in order to prevent infection.
Extreme weather alerting systems are one of the central tools utilised in adapting to changing weather patterns resulting from climate change. This paper evaluates the effectiveness of the current alerting systems for hot and cold weather used in England to notify the health and social care sector of upcoming extreme weather events. We consider the views of stakeholders on the current system and explore their perspectives on the proposal to move towards an impact-based system. The paper concludes that while the current system is an effective tool, stakeholders feel they need to draw on additional material to assist with the development of an appropriate response. We also highlight that many stakeholders are concerned about the potential for creating alert fatigue due to a lack of clarity of the geographical area impact of some of the alerts. Consequently, there was a high level of support from stakeholders for the move towards an impact-focused system.
Multiple environmental stressors threaten the environmental quality in urban areas. Several policies were implemented in Italy to improve environmental quality, following the rationale that the more populated municipalities need high intervention priority and funds. Nevertheless, this approach not necessarily ensures to address real environmental challenges. This study aims to provide an innovative approach to explore interventions’ priority at the national scale, based on Environmental Quality Standards (EQS) of five factors related to three environmental stressors, air pollution (O-3, PM10, NO2), thermal stress (heatwave days), and hydraulic vulnerability (flooding events). A multi-criteria analysis assessed the cumulative effect of factors by combining them into a single Aggregate Index of Challenge (AIC), and a hotspot analysis identified AIC spatial aggregation through the territory. Finally, the spatial mismatch between Italian environmental policies and the co-occurrence of factors was explored. Results evidenced EQS exceedances in the national territory of O-3 for 89%, PM10 for 8%, NO2 for less than 1%, heatwaves for 45%, and hydraulic vulnerability for 10%. AIC highlighted that 43% of the national surface shows the coexistence of at least two factors in EQS exceedance. Results highlighted that administrative boundaries are not sufficient to delimit an area of analysis and intervention as opposed to an evidence-based approach which seems promising for enhancing the costeffectiveness of funds allocation as well as their return in terms of human wellbeing. This study provides a novel approach to enhance environmental policies and planning, giving insight for future research, especially for Nature-Based Solutions implementation, performance, and multifunctionality.
The purpose of this study is to evaluate the potential for using the spaces integrating the roads and sidewalks in the street canyon as human-centered spaces, and to investigate more appropriate measures to improve the thermal environment for pedestrians and visitors in these spaces. Based on the spatial distribution of SET* throughout the day, as possible human-centered street space uses, north-south streets with restricted widths and south sidewalks on east-west streets are candidates. Spatiotemporal distributions of SET* were calculated when water was sprinkled on the road surface in the street canyon and when water surface, sunshade, and trees were introduced in the street canyon. Assuming people walk or stay on the water surface, the MRT decreases, causing SET* to be below 31.5 degrees C at any time, so if a continuous supply of water is guaranteed and people can approach the water surface, the water surface can be expected to have a significant impact anywhere at any time. On the east-west street, shading by sunshades and trees occurs along the lanes at any time, allowing pedestrians moving through the lanes to pass through the shaded areas on a periodic cycle. On north-south street, the time required for the countermeasures is limited to around noon, so the measure is effective even if the shade does not occur in the target lanes only around noon.
Urban planning must consider the outdoor thermal comfort of city dwellers, particularly in cities where climate and the effects of climate change may severely influence human health and wellbeing in increasingly hot summers. The role of the urban forest in ameliorating this problem is decisive. The present study is based on a campaign of meteorological measurements in a large number of sites using a mobile data collection system to allow a human-centred approach. The aim is to quantify the different microclimates and thermal comfort conditions in six classes of urban morphology, discriminating landtypes with or without trees. In the case study of Florence, local physical characteristics of the sites; Sky View Factor (SVF), tree shade, ground surface cover, and canyon effect, can moderate human exposure to potentially uncomfortable thermal conditions during a typical Mediterranean summer. Significant differences in Universal Thermal Comfort Index (UTCI) were observed between treeless piazzas and streets and landtypes with trees or high height to width ratio (narrow alleys). Varying levels of SVF and tree cover in the sites allowed the construction of multivariate models, which revealed that, during common summer afternoon conditions, decreases of SVF by 12.5% or increases of tree cover by 25% can reduce the UTCI by 1 degrees. Additionally, the total site factor, by incorporating temporally integrated sun exposure with the sky view factor, revealed itself a promising variable for future studies to use.
Many studies in the last few years have been dedicated to the increasing temperatures and extreme heat in Europe since the second half of the 20th century because of their adverse effects on ecosystems resilience, human health, and quality of life. The present research aims to analyze the spatio-temporal variations of extreme heat events in Southeastern Europe using daily temperature data from 70 selected meteorological stations and applying methodology developed initially for the quantitative assessment of hot weather in Bulgaria. We demonstrate the suitability of indicators based on maximum temperature thresholds to assess the intensity (i.e., magnitude and duration) and the tendency of extreme heat events in the period 1961-2020 both by individual stations and the Koppen’s climate zones. The capability of the used intensity-duration hot spell model to evaluate the severity of extreme heat events has also been studied and compared with the Excess Heat Factor severity index on a yearly basis. The study provides strong evidence of the suitability of the applied combined approach in the investigation of the spatio-temporal evolution of the hot weather phenomena over the considered domain.
To address future environmental change and consequent social vulnerability, a better understanding of future population (FPOP) dynamics is critical. In this regard, notable progress has been made in producing FPOP projections that are consistent with the Shared Socioeconomic Pathways (SSPs) at low resolutions for the globe and high resolutions for specific regions. Building on existing endeavors, here we contribute a new set of 1 km SSP-consistent global population projections (FPOP in short for the dataset) under a machine learning framework. Our approach incorporates a recently available SSP-consistent global built-up land dataset under the Coupled Model Intercomparison Project 6, with the aim to address the misestimation of future built-up land dynamics underlying existing datasets of future global population projections. We show that the overall accuracy of our FPOP outperforms five existing datasets at multiple scales and especially in densely-populated areas (e.g. cities and towns). Followingly, FPOP-based assessments of future global population dynamics suggest a similar trend by population density and a spatial Matthew effect of regional population centralization. Furthermore, FPOP-based estimates of global heat exposure are around 300 billion person-days in 2020 under four SSP-Representative Concentration Pathway (RCPs), which by 2100 could increase to as low as 516 billion person-days under SSP5-RCP4.5 and as high as 1626 billion person-days under SSP3-RCP8.5-with Asia and Africa contributing 64%-68% and 21%-25%, respectively. While our results shed lights on proactive policy interventions for addressing future global heat hazard, FPOP will enable future-oriented assessments of a wide range of environmental hazards, e.g. hurricanes, droughts, and flooding.
The increasingly intensifying global warming and urban heat island (UHIs) are seriously damaging the physical and mental health of urban residents. However, the spatiotemporal evolution of how high temperatures affect human health in megacities remains unclear. Therefore, in this study, with Tianjin during 2006-2020 as an example, and based on data from meteorological stations, Landsat remote sensing images, and point of interest big data, this study applied hot- and cold-spot statistics and remote sensing retrieval in numerical modeling and established an appraisal system to assess how and to what extent UHIs affect resident health. The results showed that the overall influence of UHIs on respiratory and cardiovascular diseases and mental health increased to 373 km(2) in area and two levels in intensity; the influence was mainly concentrated in the downtown area, with a rising influence level. Owing to the dual-core structure of the city, the influence was distributed along the main traffic lines in Binhai New District, having a strong influence in the area mainly concentrated in the southeastern part. Many cold spots clustered in the central urban area to cool the thermal environment: the cooled area was 6.5 times larger than the area of intense cooling influence. Our study provides a method for identifying health risks in urban spaces, lays a theoretical foundation to improve the planning of urban green space systems, and offers some decision-making guidance for the planning of healthy cities.
Exposure to excessive heat can lead to adverse health outcomes in both healthy and vulnerable individuals. This study examines the spatiotemporal variability of exposure to severe heat at the sub-neighborhood scale using temperature and relative humidity measurements of a wireless distributed sensor network (WDSN). First, we demonstrate a multi-sensor calibration scheme for the temperature and the relative humidity sensors. Next, exposure to heat was calculated using the heat index (HI) scale, which enables linking exposure to HI and heat-related health risks. We noticed repeated exposures to excessive heat above the safe threshold for about 8 h per day throughout July-August, 2015, in Haifa, Israel. Persistent exposure to such conditions is unhealthy. The areas that experienced high HI were scattered across the study area, with the HI showing spatiotemporal variability. In general, in some microenvironments, the HI peaked earlier during the day than in other microenvironments. This was attributed to variability in urban physical drivers, which were found to be good predictors of the morning HI variability buildup but less so of the HI variability in the afternoon. Our results are consistent with summer HI occurrence in the study area in the past 20 years. Since exposure to excessive heat in the east Mediterranean is expected to increase in the future due to climate changes, it may result in a grave health toll.
Global warming increases the number and severity of deadly heatwaves. Recent heatwaves often coincided with soil droughts that intensify air temperature but lower air humidity. Since lowering air humidity may reduce human heat stress, the net impact of soil desiccation on the morbidity and mortality of heatwaves remains unclear. Combining weather balloon and satellite observations, atmospheric modelling, and meta-analyses of heatwave mortality, we find that soil droughts—despite their warming effect—lead to a mild reduction in heatwave lethality. More specifically, morning dry soils attenuate afternoon heat stress anomaly by ~5%. This occurs because of reduced surface evaporation and increased entrainment of dry air aloft. The benefit appears more pronounced during specific events, such as the Chicago 1995 and Northern U.S. 2006 and 2012 heatwaves. Our findings suggest that irrigated agriculture may intensify lethal heat stress, and question recently proposed heatwave mitigation measures involving surface moistening to increase evaporative cooling.
Climate change and urbanisation have exacerbated social inequities. Increasing urban heat has made high density housing units a vulnerability hotspot. Alternatives to extended air-conditioning are required. This research sought evidence on using urban parks as a sustainable alternative by low-income households deprived of adequate living space. We interviewed occupants of tiny flats (approx. 10 m(2)), known as subdivided units, and compared their park visiting routines and thermal comfort practices with other urban dwellers in Hong Kong. The substandard conditions of these small units have contributed to dwellers’ sensitivity and lower capacity to adapt to summer heat, resulting in heat-related illness. The space-poor households have taken a wider range of adaptive actions and visited urban parks more frequently for cooling. Their higher mobility between home and nearby parks has shortened their home-stay time that would otherwise demand residential space cooling. The findings are important for reconsidering and redressing the uneven distribution of urban green spaces. Poor housing conditions and heat stress have forced disadvantaged households to seek refuge from natural cool spaces, such as vegetated and shaded areas of urban parks. Measures for increasing their accessibility, availability and capacity for heat mitigation are conducive to pro-poor and pro-climate spatial planning.
Public heat alerts are important risk communication tools, but there has been no systematic analysis of how frequently they are issued or how patterns in alert frequency relate to regional climatology or heat-health impacts. We compiled and analyzed all excessive heat warnings and heat advisories (collectively, heat alerts) issued by the U.S. National Weather Service for 2010-19. Heat alert frequency was correlated to climatological indicators derived from reanalysis data aggregated to Weather Forecast Office (WFO) polygons and to estimates of heat-attributable mortality for 134 metropolitan areas. The type of heat alerts used and the frequency with which they were issued were highly variable. Across 77% of the country, heat advisories were the primary product issued. The median location experienced 2.3 heat alert days per year. Regions with the highest frequency (approaching 25 heat alert days per year) included the southern Midwest and Great Plains, as well as the desert Southwest. The 95th-percentile daily maximum heat index was the climatological indicator most strongly correlated with heat alert frequency across all WFOs (r = 0.71). Locations that issued heat alerts more frequently than would be expected based on climatology were primarily located along the Pacific coast; those that issued heat alerts less frequently than expected were in southern Texas and southern Florida, the latter of which includes multiple cities with high rates of heat-attributable mortality. Our results suggest that the public may be receiving mixed signals about the severity of the heat hazard, with some hotter locations particularly underserved by heat risk messaging.
Wet bulb globe temperature (WBGT) is commonly used to assess human physical activity limits and risk exposure to heat-related injury. Using Australia as a case study location, rates of change in WBGT across a range of temperate to hot and dry to humid climates in response to selected projected climate scenarios were investigated. An established physics-based method for estimating WBGT using standard meteorological data was incorporated into a spatial modelling framework to map WBGT for a baseline period (1986-2005) for mid-summer daytime, mid-summer early morning and mid-winter daytime scenarios, under clear sky conditions and both light (0.5 ms(-1)) and moderate (3.0 ms(-1)) wind speeds at a nominal resolution of 0.05 decimal degrees. The resulting maps of WBGT revealed significant spatial variability in the range and pattern of increased WBGT across the three baseline scenarios in response to projected change under RCP4.5 and RCP8.5 for 2041-2060 and 2061-2080 generated by the ACCESS1.0 climate model. Moderate wind speed scenarios produced significantly cooler WBGTs than the equivalent low wind speed scenarios, reducing mean modelled summer daytime WBGT by 3.2 & DEG;C, summer morning WBGT by 0.8 & DEG;C, and winter daytime WBGT by 3.0 & DEG;C. Projected future summer daytime WBGT under unshaded clear atmospheric conditions with light wind speeds can be expected to exceed the range of the commonly used heat categorisation system used to inform recommended restrictions on physical activity and regularly exceed 35 & DEG;C in northern Australia’s equatorial and tropical climates by mid-century under RCP4.5 and RCP8.5. Summer early morning WBGT and winter daytime WBGT were projected to reach heat categories that would result in recommended restrictions in physical activity continuously (across consecutive 24-h periods) in summer and intermittently (for at least part of the day) year-round by 2050 with more severe conditions by 2070 and/or under RCP8.5 scenarios. Investigations into physical activity limits beyond the current highest heat category and the efficacy of the employed methodology to estimate WBGT above 35 & DEG;C using standard meteorological data are required to prepare for the projected warmer climate.
Green infrastructure (GI) has emerged as a feasible strategy for promoting adaptive capacities of cities to climate change by alleviating urban heat island (UHI) and thus heat stress for humans. However, GI can also intensify the winter cold stress. To understand the extent of UHI within a city as well as the link between outdoor thermal stress both diurnally and seasonally, we carried out an empirical study in Würzburg, Germany from 2018 to 2020. At sub-urban sites, relative humidity and wind speed (WS) was considerably higher and air temperature (AT) lower compared to the inner city sites. Mean AT of inner city sites were higher by 1.3 °C during summer and 5 °C during winter compared to sub-urban sites. The magnitude followed the spatial land use patterns, in particular the amount of buildings. Consequently, out of 97 hot days (AT > 30 °C) in 3 years, 9 days above the extreme threshold of wet bulb globe temperature of 35 °C were recorded at a centre location compared to none at a sub-urban site. Extreme heat stress could be halved with 30-40% cover of greenspaces including grass lawns, green roofs, and green walls with little compromise in increasing winter cold stress.
The effects of global urbanization and climate warming on public health, including the health risk caused by the urban heat environment, have drawn extensive attention. Therefore, methods to appraise the spatiotemporal response mechanism of climate warming and the high temperature exposure dose (HTED) of urban residents need to be investigated to achieve sustainable cities. Based on an environmental health risk appraisal model and using the six ring roads in Beijing of China, this study simulated the spatial distribution of future high temperatures in three shared socioeconomic pathways (SSPs), SSP1-2.6, SSP3-7.0, and SSP5-8.5, by determining the correlation between the future mean maximum temperatures and sunny-day mean temperatures. Additionally, the HTED of commuting on foot or by bicycle was assessed based on the point of interest data of subway stations, architectural composition, and traffic surveys. Results demonstrate that during 2020-2040, 66.57% and 50.07% of areas for commuting on foot and by bicycle within the sixth ring road exposed to high temperatures (including low, medium, and high-risk areas). The exposure risks of both commuting methods were concentrated, and the exposure dose was the highest between the fifth and sixth ring roads, whereas the first to fourth ring roads were dominated by non-risk, minimum-risk, and low-risk areas. Moreover, compared with SSP1-2.6 and SSP5-8.5, SSP3-7.0 exhibited low HTED in both commuting methods. The proposed method provides a scientific basis to aid in identifying urban areas with high temperature exposure risk and a reference in assisting the planning of resilient and sustainable cities.
Research on urban thermal environments based on thermal comfort can help formulate effective measures to improve urban thermal and human settlement environments, which is of great significance for improving urban quality, urban climate change adaptation, and sustainable development. Taking 344 municipal administrative districts in China as study areas, the Universal Thermal Climate Index (UTCI) of each city in the last 20 years was calculated to evaluate thermal comfort. We then analyzed the thermal comfort and spatiotemporal heterogeneity of each city during a typical heat wave. Finally, the driving forces of the potential socioeconomic, natural, and landscape factors influencing thermal comfort were analyzed using geographic detectors. The results show that the thermal comfort index had similar spatial patterns and differentiation characteristics in different years, and the interannual variation was not obvious. Cities in the typical heat wave period were mainly distributed in East and Northwest China. The driving factor in the contribution rate of the same index in different years was basically the same and was not affected by the change in years, and the highest contribution rate was the natural factor.
BACKGROUND: Epidemiological literature on the health risks associated with non-optimal temperature has mostly reported average estimates across large areas or specific population groups. However, the heterogeneous distribution of drivers of vulnerability can result in local differences in health risks associated with heat and cold. We aimed to analyse the association between ambient air temperature and all-cause mortality across England and Wales and characterise small scale patterns in temperature-related mortality risks and impacts. METHODS: We performed a country-wide small-area analysis using data on all-cause mortality and air temperature for 34 753 lower super output areas (LSOAs) within 348 local authority districts (LADs) across England and Wales between Jan 1, 2000, and Dec 31, 2019. We first performed a case time series analysis of LSOA-specific and age-specific mortality series matched with 1 × 1 km gridded temperature data using distributed lag non-linear models, and then a repeated-measure multivariate meta-regression to pool LAD-specific estimates using area-level climatological, socioeconomic, and topographical predictors. FINDINGS: The final analysis included 10 716 879 deaths from all causes. The small-area assessment estimated that each year in England and Wales, there was on average 791 excess deaths (empirical 95% CI 611-957) attributable to heat and 60 573 (55 796-65 145) attributable to cold, corresponding to standardised excess mortality rates of 1·57 deaths (empirical 95% CI 1·21-1·90) per 100 000 person-years for heat and 122·34 deaths (112·90-131·52) per 100 000 person-years for cold. The risks increased with age and were highly heterogeneous geographically, with the minimum mortality temperature ranging from 14·9°C to 22·6°C. Heat-related mortality was higher in urban areas, whereas cold-related mortality showed a more nuanced geographical pattern and increased risk in areas with greater socioeconomic deprivation. INTERPRETATION: This study provides a comprehensive assessment of excess mortality related to non-optimal outdoor temperature, with several risk indicators reported by age and multiple geographical levels. The analysis provides detailed risk maps that are useful for designing effective public health and climate policies at both local and national levels. FUNDING: Medical Research Council, Natural Environment Research Council, EU Horizon 2020 Programme, National Institute of Health Research.
Extreme heat events are one of the deadliest weather-related hazards in the United States and are increasing in frequency and severity as a result of anthropogenic greenhouse gas emissions. Further, some subpopulations may be more vulnerable than others because of social, economic, and political factors that create disparities in hazard impacts and responses. Vulnerability is also affected by risk perceptions, which can influence protective behaviors. In this study, we use national survey data to investigate the association of key sociodemographic factors with public risk perceptions of heatwaves. We find that risk perceptions are most associated with income, race/ethnicity, gender, and disability status. Age, an important predictor of heat mortality, had smaller associations with heat risk perceptions. Low-income, nonwhite, and disabled individuals tend to perceive themselves to be at greater risks from heatwaves than other subpopulations, corresponding to their elevated risk. Men have lower risk perceptions than women despite their higher mortality and morbidity from heat. This study helps to identify subpopulations in the United States who see themselves as at risk from extreme heat and can inform heat risk communication and other risk reduction practices.
Evidence exists that exposure to weather hazards, particularly in cities subject to heat island and climate change impacts, strongly affects individuals’ physical and mental health. Personal exposure to and sentiments about warm conditions can currently be expressed on social media, and recent research noted that the geotagged, time-stamped, and accessible social media databases can potentially be indicative of the public mood and health for a region. This study attempts to understand the relationships between weather and social media sentiments via Twitter and weather data from 2012 to 2019 for two cities in hot climates: Singapore and Phoenix, Arizona. We first detected weather-related tweets, and subsequently extracted keywords describing weather sensations. Furthermore, we analyzed frequencies of most used words describing weather sensations and created graphs of commonly occurring bigrams to understand connections between them. We further explored the annual trends between keywords describing heat and heat-related thermal discomfort and temperature profiles for two cities. Results showed significant relationships between frequency of heat-related tweets and temperature. For Twitter users exposed to no strong temperature seasonality, we noticed an overall negative cluster around hot sensations. Seasonal variability was more apparent in Phoenix, with more positive weather-related sentiments during the cooler months. This demonstrates the viability of Twitter data as a rapid indicator for periods of higher heat experienced by public and greater negative sentiment toward the weather, and its potential for effective tracking of real-time urban heat stress.
BACKGROUND: Acute kidney injury (AKI) is a severe clinical syndrome that places a massive burden on medical systems worldwide, yet the seasonality of AKI remains unexplored in China. The aim of this study was to describe the seasonal variation in the detection rate and all-cause in-hospital mortality of AKI in China based on a nationwide cohort study. METHODS: This was a retrospective cohort recruiting a national sample of 7,291 adult patients treated in hospitals in 22 provinces of mainland China during January or July 2013. AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes AKI creatinine criteria or expanded criteria of increase or decrease in serum creatinine level of 50% during the hospital stay. The seasonal group was determined according to the corresponding admission date for each patient. The detection rate of AKI refers to the ratio of identified AKI cases to the total number of adult admissions from the same regional or seasonal group. RESULTS: Both the detection rate (2.31 vs. 2.08%, p = 0.001) and in-hospital mortality rate (13.3 vs. 10.7%, p = 0.001) of AKI were higher in winter than in summer. The patients with AKI detected in winter had higher proportions of prehistory diseases, cardiac or vascular kidney injury factors, and severe comorbidities than those in summer (all p < 0.05). In the multivariable analysis, winter was an independent risk factor for in-hospital mortality of patients with AKI [odds ratio (OR) = 1.22, 95% confidence interval (CI), 1.03-1.44, p = 0.02] after adjusting for demographic factors, medical history, comorbidity, and climatic confounders. Higher ambient temperature (OR = 0.91, 95% CI, 0.86-0.97, p = 0.002, per 10°C increase), higher relative humidity level (OR = 1.14, 95% CI, 1.04-1.25, p = 0.005, per 10% increase), and living in temperate continental region (OR = 2.18, 95% CI, 1.63-2.91, p < 0.001) were each independently associated with in-hospital mortality. CONCLUSION: The detection rate and all-cause in-hospital mortality of AKI showed a winter predominance in patients with AKI in China. Winter appeared to be an independent risk factor for all-cause in-hospital mortality in patients with AKI. Environmental factors, including lower ambient temperature, higher relative humidity level, and living in temperate continental climatic regions, were each independently associated with increased risks of in-hospital mortality in patients with AKI.
INTRODUCTION: The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the U.S. Army have been well documented. The “heat season”, when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as May 1 through September 30, while the “cold season” is understood to occur from October 1 to April 30 each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. We also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations. METHODS: The U.S. Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defense Medical Surveillance System. Installation-specific denominator data were obtained from the Defense Manpower Data Center, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons. RESULTS: Our analysis indicates that the heat season starts around April 22 and ends around September 9. The cold season starts on October 3 and ends on March 24. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the “heat season” of May 1 to September 30, while 10.3% occurred before the heat season started (January1 to April 30) and 7.3% occurred after the heat season ended (October 1 to December 31). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons. CONCLUSIONS: The present study indicates that the traditional heat season definition should be revised to begin ∼3 weeks earlier than the current date of May 1; our data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations.
This paper investigates whether associations between birth weights and prenatal ambient environmental conditions-pollution and extreme temperatures-differ by 1) maternal education; 2) children’s innate health; and 3) interactions between these two. We link birth records from Guangzhou, China, during a period of high pollution, to ambient air pollution (PM(10) and a composite measure) and extreme temperature data. We first use mean regressions to test whether, overall, maternal education is an “effect modifier” in the relationships between ambient air pollution, extreme temperature, and birth weight. We then use conditional quantile regressions to test for effect heterogeneity according to the unobserved innate vulnerability of babies after conditioning on other confounders. Results show that 1) the negative association between ambient exposures and birth weight is twice as large at lower conditional quantiles of birth weights as at the median; 2) the protection associated with college-educated mothers with respect to pollution and extreme heat is heterogeneous and potentially substantial: between 0.02 and 0.34 standard deviations of birth weights, depending on the conditional quantiles; 3) this protection is amplified under more extreme ambient conditions and for infants with greater unobserved innate vulnerabilities.
Ambient temperatures are rising worldwide, with the greatest increases recorded at night. Concurrently, the prevalence of insufficient sleep is rising in many populations. Yet it remains unclear whether warmer-than average temperatures causally impact objective measures of sleep globally. Here, we link billions of repeated sleep measurements from sleep-tracking wristbands comprising over 7 million sleep records (n = 47,628) across 68 countries to local daily meteorological data. Controlling for individual, seasonal, and time varying confounds, increased temperature shortens sleep primarily through delayed onset, increasing the probability of insufficient sleep. The temperature effect on sleep loss is substantially larger for residents from lower-income countries and older adults, and females are affected more than males. Those in hotter regions experience comparably more sleep loss per degree of warming, suggesting limited adaptation. By 2099, suboptimal temperatures may erode 50-58 h of sleep per person-year, with climate change producing geographic inequalities that scale with future emissions.
BACKGROUND: Climate change is a global health crisis. In most regions, heat waves are expected to become longer and more frequent and air quality is expected to worsen. Few physicians discuss climate and health with patients, and related guidelines are lacking. Our objective was to quantify the prevalence of risk factors for illness related to climate change in the U.S. ambulatory setting. METHODS: From the 2018 National Ambulatory Medical Care Survey, a national probability sample of nonfederal, ambulatory encounters, we identified adults with risk factors for illness related to heat or air pollution exposure. RESULTS: We found 91.4% of encounters involved a patient with at least 1 risk factor, while 46.7% had 2 or more. CONCLUSION: A high prevalence of patients with climate-related health risk factors exists in the ambulatory setting, representing a significant opportunity for evidence-based climate and health patient education and preventative care.
BACKGROUND: Cystic echinococcosis (CE) is one of the most important parasitic infections in subgroup seven common neglected diseases of humans and animals. It is in the list of 18 neglected tropical diseases of the WHO. We aimed to analyze the situation of the disease in Iran using Geographical Information System (GIS) and satellite data analysis. METHODS: The data obtained from the Ministry of Health and Medical Education, Tehran, Iran and other related centers from 2009 to 2018 were analyzed using GIS. Then, the spatial distribution maps of the disease were generated, and the hot spots of the disease in Iran were determined using spatial analysis of ArcGIS10.5 software. Geographically weighted regression (GWR) analysis in ArcGIS10.5 was used to correlate the variables affecting the disease including temperature, relative humidity, normalized different vegetation index (NDVI) and incidence of hydatidosis. Data analysis was performed by Linear regression analysis and SPSS 21 software using descriptive statistics and chi-square test. RESULTS: Zanjan, Khorasan Razavi, North Khorasan, Chaharmahal Bakhtiari, Hamedan, Semnan, and Ardabil provinces were the hot spots of CE. The results of geographical weighted regression analysis showed that in Khorasan Razavi, North Khorasan, Chaharmahal Bakhtiari, Hamedan, Semnan, Ardabil, Zanjan, Qazvin, and Ilam provinces, the highest correlation between temperature, humidity, vegetation density and the incidence of hydatidosis was observed (P<0.001). CONCLUSION: The use of maps could provide reliable estimates of at-risk populations. Climatic factors of temperature, humidity, NDVI had a greater impact on the probability of hydatidosis. These factors can be an indicator used to predict the presence of disease. Environmental and climatic factors were associated with echinococcosis.
Extreme heat, particularly if combined with humidity, poses a severe risk to human health. To estimate future global risk of extreme heat with humidity on health, we calculate indicators of heat stress that have been commonly used: the Heat Index, the Wet-Bulb Globe Temperature and the Wet-Bulb Temperature, from the latest Climate Model Intercomparison Project (CMIP6) projections. We analyse how and where different levels of heat stress hazards will change, from severe to deadly, and how results are sensitive to the choice of the index used. We evaluate this risk at country-level and use population and GDP vertical bar PPP growth scenario to estimate the vulnerability of each nation. Consistent with previous studies, we find that South and East Asia, and the Middle-East, are highly exposed to heat stress hazards, and that this exposure increases by 20%-60% with global mean temperature change from 1.5 to 3 degrees C. However, we also find substantial increases in heat health risk for some vulnerable countries with less adaptive capacity, such as West Africa, and Central and South America. For these regions, about 20 to more than 50% of the population could be exposed to severe heat stress each year on average, independent of the index used. For global warming of 3 degrees, European countries and the USA will also be exposed several times per year to conditions with daily mean heat stress level equal to the maximum heat stress of the 2003 heat wave.
Urban green space (UGS) could contribute to sustainable urban development. Studying residents’ perception of UGS ecological benefits could provide the empirical basis to improve UGS management and quality of life. Based on the questionnaire surveys of 432 residents in Beijing, assisted by non-parametric statistical tests, this paper assessed the relationships between residents’ living environments and self-rated health status and their impacts on residents’ perceptions of UGS ecological benefits. We paid attention to residents’ perceptions of UGS’s notable thermal environmental benefits under the climate-change backdrop. The results showed that: (1) Residents were inclined to perceive direct UGS ecological benefits better than the indirect types; (2) Residents growing up in the city had better self-rated health status than those growing up in the suburb and the village; and residents growing up in the suburb had a better understanding of the cooling benefits of green walls; (3) Residents currently dwelling in the city had a better understanding of UGS benefits, including shading, cooling by green roofs, mitigating the heat island effect and enhancing urban biodiversity, than those dwelling in the village; and (4) Residents with “very good” self-rated health status had a significantly better understanding of UGS benefits regarding shading, providing varied colors and habitats, storing carbon, purifying air, and collecting rainwater.
Addressing the fallouts of a +1.5 degrees C world is one of the key challenges for urban management in African cities. This article reports a work dealing with climate adaptation in informal urban settlements, with focus on responses to heat stress among the urban poor. The study involved a survey of 405 residents in Keko Machungwa -an unplanned neighborhood in Dar es Salaam, Tanzania. We found that the most popular behavioral responses are taking a shower, wearing light clothing,. drinking cold drinks, and opening doors and windows. The rarest forms of responses are swimming and contributing to savings group. Heat-related health problems experienced by the residents were also identified. Enhancing human responses to heat stress will involve improvement in basic services and infrastructure, awareness, and education among the residents.
INTRODUCTION: The Singapore Armed Forces (SAF) collaborated with the Meteorological Service Singapore (MSS) to study the relationship between weather parameters and the incidents of exertional heat injury (EHI) to mitigate the risk of EHI in a practical manner. METHODS: Data from the SAF’s heat injury registry and MSS’ meteorological data from 2012 to 2018 were used to establish a consolidated dataset of EHI incidents and same-day weather parameters rank-ordered in deciles. Poisson regression modelling was used to determine the incidence rate ratios (IRRs) of the EHI, referencing the first decile of weather parameters. Two frames of analysis were performed – the first described the relationship between the weather parameters and the adjusted IRR for the same day (D), and the second described the relationship between the weather parameters and the adjusted IRR on the following day (D + 1). RESULTS: For wet-bulb temperature, the IRR on D + 1 approximated unity for the first nine deciles but rose to 3.09 at the tenth decile. For dew-point temperature, the IRR on D + 1 approximated unity for the first nine deciles but rose to 3.48 at the tenth decile. By designating a single dew-point temperature cut-off at ≥25.1°C (transition between the ninth and tenth decile), the adjusted IRR on D + 1 was 2.26 on days with dew-point temperature ≥25.1°C. CONCLUSION: Integrating the data from the SAF and MSS demonstrated that a dew-point temperature ≥25.1°C on D correlates statistically with the risk of EHI on D + 1 and could be used to supplement the risk mitigation system.
Introduction: Heat stress is a physical hazard and a potential health risk which can result in various conditions ranging from discomfort, headaches, psychological disorders, heat stroke and even death in extreme cases. Factors which cause heat stress include high ambient temperature, limited air movement, strenuous physical work and direct exposure to the heat of the engine/sun. Continuous heat stress, exacerbated by dehydration, can lead to kidney disease. This study is a literature review conducted to explore factors that influence heat stress and the relationship of heat stress with acute kidney disease and chronic kidney disease. Methods: Literature search was conducted in September 2021. Research sources were taken from several databases, namely Science Direct, ProQuest, PubMed, and Google Scholar. From the databases, 23,316 articles were from Science Direct, 140,319 articles were from ProQuest, 670 articles were from PubMed, and 288,000 articles were from Google Scholars. Out of the total database only 24 articles met the inclusion criteria. The variables in this study were heat stress, acute kidney disease, and chronic kidney disease. Results: This literature review shows that several factors which can affect heat stress are heat exposure, workload, rehydration, and rest period arrangements. Heat stress experienced by workers can cause decreased kidney function and chronic kidney disease. Heat stress conditions that are continuously experienced by workers can cause chronic kidney disease. Conclusion: Heat stress can be experienced by workers due to heat exposure, heavy workload, poor rehydration, and poor rest period arrangements. Heat stress can cause acute kidney disease and chronic kidney disease.
BACKGROUND: Under a warming climate, adverse health effects of heat are an increasing concern. We evaluated associations between short-term ambient temperature exposure and hospital admission for kidney disease in Vietnam. METHODS: We linked province-level meteorologic data with admission data from 14 province-level hospitals (2003-2015). We used a case-crossover design to evaluate associations between daily ambient temperature metrics (mean, maximum, and minimum temperature and mean heat index) and risk of hospitalization for four kidney disease subtypes: glomerular diseases, renal tubulo-interstitial diseases, chronic kidney disease, and urolithiasis, including lagged (≤lag 14 days) and cumulative (≤lag 0-6 days) associations, during the warm season. We also evaluated independent associations with extreme heat days (defined as days with daily maximum temperature >95(th) percentile of the provincial daily maximum temperature distribution). Akaike’s information criterion and patterns of risk estimates across cumulative exposure time windows and single-day lags informed our selection of final models. RESULTS: We included 58,330 hospital admissions during the warm season. Daily mean temperature averaged over the same day and the previous six days (lag 0-6 days) was associated with risk of hospitalization for each kidney disease outcome with odds ratios (per 1 °C increase in daily mean temperature) of 1.07 (95% confidence interval [CI]: 0.99, 1.16) for glomerular diseases, 1.06 (95% CI: 0.96, 1.17) for renal tubulo-interstitial diseases, 1.12 (95% CI: 1.00, 1.24) for chronic kidney disease, and 1.09 (95% CI: 1.02, 1.16) for urolithiasis. We found no additional independent associations with extreme heat. Results for the four temperature metrics were similar. CONCLUSIONS: High ambient temperature was associated with increased risk of hospitalization for each kidney disease subtype, with the most convincing associations for chronic kidney disease and urolithiasis. Further laboratory and epidemiologic research is needed to confirm the findings and disentangle the underlying mechanisms.
With the increasing requirements of healthy habitat environments, landscape microclimates have been widely concerned. To comprehensively grasp the development history and research status of the landscape microclimates in China and other countries, CiteSpace software was used to comparatively analyze and visually present the literature related to landscape microclimates in CNKI and WOS databases for the past 20 years. The results show that: (1) The number of publications on landscape microclimate research shows an increasing trend in China and other countries, and the number of publications increased significantly after 2016. Although the number of publications by Chinese scholars is less than that of foreign scholars, they have developed rapidly in recent years, and their international influence has increased significantly. (2) A positive exchange has been formed among international scholars, and the number of collaborative studies has been increasing. China’s microclimate research has formed relatively stable teams that have conducted numerous studies in the fields of urban communities, street greening, and plant communities, respectively. Although the links between research teams and institutions in China and other countries are relatively close, they still need to be further strengthened. (3) In the past decade, the theoretical system of landscape microclimates has been improved, and the research themes have become more concentrated, but it still has remained close to the early basic research. (4) Future research will remain centered on “mitigating the urban heat island effect” and “optimizing human heat perception”. New topics such as “biodiversity”, “carbon cycle”, and “climate change” have been added. In conclusion, the research needs to continue to explore the evaluation system of microclimates and verify the evaluation index of outdoor thermal comfort for human thermal adaptation in different regions. The standards and systems of human habitat adapted to different regional characteristics should be formed.
Adverse health outcomes caused by extreme heat represent the most direct human health threat associated with the warming of the Earth’s climate. Socioeconomic, demographic, health, land cover, and temperature determinants contribute to heat vulnerability; however, nationwide patterns of residential and race/ethnicity disparities in heat vulnerability in the United States are poorly understood. This study aimed to develop a Heat Vulnerability Index (HVI) for the United States; to assess differences in heat vulnerability across geographies that have experienced historical and/or contemporary forms of marginalization; and to quantify HVI by race/ethnicity. Principal component analysis was used to calculate census tract level HVI scores based on the 2019 population characteristics of the United States. Differences in HVI scores were analyzed across the Home Owners’ Loan Corporation (HOLC) “redlining” grades, the Climate and Economic Justice Screening Tool (CEJST) disadvantaged versus non-disadvantaged communities, and race/ethnicity groups. HVI scores were calculated for 55,267 U.S. census tracts. Mean HVI scores were 17.56, 18.61, 19.45, and 19.93 for HOLC grades “A”-“D,” respectively. CEJST-defined disadvantaged census tracts had a significantly higher mean HVI score (19.13) than non-disadvantaged tracts (16.68). The non-Hispanic African American or Black race/ethnicity group had the highest HVI score (18.51), followed by Hispanic or Latino (18.19). Historically redlined and contemporary CEJST disadvantaged census tracts and communities of color were found to be associated with increased vulnerability to heat. These findings can help promote equitable climate change adaptation policies by informing policymakers about the national distribution of place- and race/ethnicity-based disparities in heat vulnerability.
Swimming and other recreational water activities at public beaches are popular outdoor leisure activities among Canadians. However, these activities can lead to increased risks of acquiring acute gastrointestinal illness and other illnesses among beachgoers. Young children have much higher rates of exposure and illness than other age groups. These illnesses have a significant health and economic burden on society. Climate change is expected to influence both the risk of exposure and illness. A warming climate in Canada, including more severe summer heatwave events, will likely lead to increased recreational water use. Warmer temperatures will also contribute to the growth and increased range of harmful algal blooms and other climate-sensitive pathogens. Increased precipitation and heavy rainfall events will contribute to fecal and nutrient contamination of beach waters, increasing risks of gastrointestinal illness and harmful algal bloom events. There is a need to enhance recreational water research and surveillance in Canada to prepare for and adapt to these changing risks. Key research and policy needs are suggested and discussed, including evaluating and monitoring risks of recreational water illness in Canadian contexts, improving timely reporting of recreational water quality conditions, and enhancing approaches for routine beach water surveillance.
Increasing severity of extreme heat is a hallmark of climate change. Its impacts depend on temperature but also on moisture and solar radiation, each with distinct spatial patterns and vertical profiles. Here, we consider these variables’ combined effect on extreme heat stress, as measured by the environmental stress index, using a suite of high-resolution climate simulations for historical (1980-2005) and future (2074-2099, Representative Concentration Pathway 8.5 (RCP8.5)) periods. We find that observed extreme heat stress drops off nearly linearly with elevation above a coastal zone, at a rate that is larger in more humid regions. Future projections indicate dramatic relative increases whereby the historical top 1% summer heat stress value may occur on about 25%-50% of future summer days under the RCP8.5 scenario. Heat stress increases tend to be larger at higher latitudes and in areas of greater temperature increase, although in the southern and eastern US moisture increases are nearly as important. Imprinted on top of this dominant pattern we find secondary effects of smaller heat stress increases near ocean coastlines, notably along the Pacific coast, and larger increases in mountains, notably the Sierra Nevada and southern Appalachians. This differential warming is attributable to the greater warming of land relative to ocean, and to larger temperature increases at higher elevations outweighing larger water-vapor increases at lower elevations. All together, our results aid in furthering knowledge about drivers and characteristics that shape future extreme heat stress at scales difficult to capture in global assessments.
An increase in heat-related mortality risk has emerged to accompany the ravages of climate change, but its unambiguous assessment remains an onerous task, owing to the non-linear associations between the severity of hot temperatures and human body response. The present study assesses the future heat-related mortality risk under different levels of warming (1.5 degrees C vs. 2 degrees C) using the multi-models’ large ensemble simulations. In order to augment the robustness of the patterns for future changes in heat-related mortality risk, multiple indices representing the excess mortality risk solely attributed to higher temperature are estimated from different meteorological variables (maximum temperature, maximum wet-bulb temperature and mean temperature). The ensemble projections reveal a worldwide surge in heat-related mortality risk, albeit with a regionally diverse pattern. Although comparisons of the different indices show some quantitative differences, they provide remarkably consistent regional hotspots, thus amplifying the possible benefit of a mitigation equivalent to 0.5 degrees C less warming in the equatorial region. In addition to the severity of hot temperatures, the demographic changes evolving along the different shared socio-economic pathways also determine the exposure to heat-related mortality risk. Based on multiple indices and large ensemble simulations, this study contributes to the identification of regional hotspots in terms of the exposure of (the elderly) population to heat-related mortality risk, underscoring the necessity of regionally-tailored adaptation strategies.
Hot and cold seasonal temperature fluctuations pose a serious public health threat. Radiative thermal management has been shown to be an effective method for personal thermal management. However, the currently available materials cannot maintain human thermal comfort against the hot and cold seasonal temperature fluctuations, such as heating in cold weather or cooling in hot weather. Here, a Janus film that integrates the two opposite requirements of heating and cooling into one functional dual-mode film is fabricated. In cooling mode, the Al backing and embedded silicon dioxide (SiO2) microparticle can achieve a high solar reflectivity (similar to 0.85) and high IR emissivity (similar to 0.95) to induce a temperature drop of similar to 2 degrees C. In contrast, the embedded carbon nanotubes (CNTs) can improve solar absorption (similar to 0.95) and induce a temperature increase of similar to 7 degrees C. Owing to its radiative cooling and solar heating capability and compatibility with large-scale production, this Janus film is promising to bring new insights into the design of the next-generation functional textiles.
A wearable textile that is engineered to reflect incoming sunlight and allow the transmission of mid-infrared radiation simultaneously would have a great impact on the human body’s thermal regulation in an outdoor environment. However, developing such a textile is a tough challenge. Using nanoparticle-doped polymer (zinc oxide and polyethylene) materials and electrospinning technology, we have developed a nanofabric with the desired optical properties and good applicability. The nanofabric offers a cool fibrous structure with outstanding solar reflectivity (91%) and mid-infrared transmissivity (81%). In an outdoor field test under exposure of direct sunlight, the nanofabric was demonstrated to reduce the simulated skin temperature by 9 °C when compared to skin covered by a cotton textile. A heat-transfer model is also established to numerically assess the cooling performance of the nanofabric as a function of various climate factors, including solar intensity, ambient air temperature, atmospheric emission, wind speed, and parasitic heat loss rate. The results indicate that the nanofabric can completely release the human body from unwanted heat stress in most conditions, providing an additional cooling effect as well as demonstrating worldwide feasibility. Even in some extreme conditions, the nanofabric can also reduce the human body’s cooling demand compared with traditional cotton textile, proving this material as a feasible solution for better thermoregulation of the human body. The facile fabrication of such textiles paves the way for the mass adoption of energy-free personal cooling technology in daily life, which meets the growing demand for healthcare, climate change, and sustainability.
Jellyfish are ubiquitous animals registering a high and increasing number of contacts with humans in coastal areas. These encounters result in a multitude of symptoms, ranging from mild erythema to death. This work aims to review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic aspects of jellyfish stings. There are three major classes of jellyfish, causing various clinical scenarios. Most envenomations result in an erythematous lesion with morphological characteristics that may help identify the class of jellyfish responsible. In rare cases, the sting may result in delayed, persistent, or systemic symptoms. Lethal encounters have been described, but most of those cases happened in the Indo-Pacific region, where cubozoans, the deadliest jellyfish class, can be found. The diagnosis is mostly clinical but can be aided by dermoscopy, skin scrapings/sticky tape, confocal reflectance microscopy, immunological essays, among others. Treatment is currently based on preventing further envenomation, inactivating the venom, and alleviating local and systemic symptoms. However, the strategy used to achieve these effects remains under debate. Only one antivenom is currently used and covers merely one species (Chironex fleckeri). Other antivenoms have been produced experimentally but were not tested on human envenomation settings. The increased number of cases, especially due to climate changes, justifies further research in the study of clinical aspects of jellyfish envenoming.
This study aimed to investigate the association between the heat-related illness (HRI) and the risk of developing psychiatric disorders. From 2000 to 2015, there were 3126 patients with newly diagnosed HRI selected from the National Health Insurance Research Database, along with 31,260 controls matched for gender and age. Fine and Gray’s analysis was used to compare the risk of psychiatric disorders during the 16 years of follow-up. Among the subjects, 523 of the HRI patients and 3619 of the control group (1774.18 vs. 1193.78 per 100,000 person-years) developed psychiatric disorders. Compared with non-HRI patients, the HRI ones had a 3.849-fold risk of being attacked by psychiatric disorders (95% CI: 3.632−4.369, p < 0.001) after adjusting for potential confounders. The sensitivity analysis revealed that the relationship between the HRI and the listed psychiatric disorders was determined by the exclusion of the first-year psychiatric events after the HRI. In spite of deleting the psychiatric diagnoses of the first five years, the HRI was still correlated with the development of psychiatric disorders with the exception of schizophreniform disorders, posttraumatic stress disorders, and acute stress disorder. Therefore, our findings concluded that the HRI could be a potential influence on the increased hazard of psychiatric disorders.
Urban overheating aggravated by climate change and rapid urbanization poses a severe threat to thermal health of urban residents. To more realistically represent street-level heat stress, we propose a new urban climate -human coupling system by integrating an advanced urban canopy model (UCM) with a new human -environment adaptive thermal stress (HEATS) module. The coupled UCM-HEATS system features a state-of-the-art solution to complicated human-street radiative exchanges and incorporates dynamic human thermo-regulatory responses to microclimatic changes. The UCM-HEATS system was evaluated in a typical hot and humid city, Hong Kong, and then applied to investigate street-level thermal stress in various urban settings and under different personal conditions. By explicitly resolving shading effects of buildings and trees on human radiation budgets, our study emphasizes the marked effectiveness of active shade management using green and gray infrastructure on daytime heat mitigation, proposing a “right shade, right place, right time” paradigm for regulating important street canyon geometries (building height, road width, and tree crown width) and orien-tations. Additionally, human evaporative heat dissipation can be hindered by urban moisture islands and wind impediments; thus, a detailed urban ventilation strategy is suggested considering different temperature-humidity combinations. For personal heat protection, we identified an evident cooling effect of high-albedo clothing and a thermal-comfort-optimal walking speed. Special attention is paid to heat-vulnerable groups, especially older people who suffer from notably higher heat risks during pandemics with facemask-induced heat burden. Bridging urban climate and human ergonomics, this study aims to advance human-centric urban design toward future smart, resilient, and inclusive cities.
With the rapid process of urbanization and global warming, extreme heat events occur frequently, endangering urban dwellers’ health. Urban parks could alleviate the severe urban heating climate. However, due to the scarcity of urban land, it is impractical to plan and design urban parks by increasing the blue-green space without restriction. Few studies have focused on optimization and the equity of the parks’ cooling service. This study quantifies four cooling indicators of urban parks in Wuhan city, park’s cooling intensity (PCI), park’s cooling area (PCA), park’s cooling gradient (PCG), and park’s cooling efficiency (PCE), analyze the drivers for four indicators, discuss different cooling bundles (urban parks with similar specific cooling ability are grouped into bundles) for the specific heat mitigation demands, and map the spatial accessibility for residents to parks’ PCA using spatial network analysis. We find that 54 of 60 urban parks have significant cooling effect, with average PCI of 3.5 & PLUSMN; 0.2 ?, PCA of 131.6 & PLUSMN; 29.6 ha, PCG of 17.9 & PLUSMN; 1.5 ?/km, PCE of 4.5 & PLUSMN; 0.8. Blue and green infrastructure inside parks and impervious surface ratio surrounding the parks play significant roles in cooling service. Larger urban parks usually have larger PCA, but lower PCG and PCE. Five cooling bundles clustered with specific dominant cooling indicators could be references for the specific demand considering tradeoffs in urban parks’ design and planning. Taking one step further, we unmask the unequal accessibility of the urban parks cooling service in one extreme heat day: 83.6% of the residents in the central area can enjoy the urban parks’ cooling service within 30-min walk, while most residents (74.4%) in suburbs are not able to access to the cooling service within 30-min walk. Our study should be valuable for the urban planning and practice to find heat mitigation solutions and improve residents’ heat comfort, also helpful for local municipalities to consider the urban parks’ service provision for marginal groups.
BACKGROUND: In metropolitan Tokyo in 2014, Japan experienced its first domestic dengue outbreak since 1945. The objective of the present study was to quantitatively assess the future risk of dengue in Japan using climate change scenarios in a high-resolution geospatial environment by building on a solid theory as a baseline in consideration of future adaptation strategies. METHODS: Using climate change scenarios of the Model for Interdisciplinary Research on Climate version 6 (MIROC6), representative concentration pathway (RCP) 2.6, 4.5, and 8.5, we computed the daily average temperature and embedded this in the effective reproduction number of dengue, R(T), to calculate the extinction probability and interepidemic period across Japan. RESULTS: In June and October, the R(T) with daily average temperature T, was <1 as in 2022; however, an elevation in temperature increased the number of days with R(T) >1 during these months under RCP8.5. The time period with a risk of dengue transmission gradually extended to late spring (April-May) and autumn (October-November). Under the RCP8.5 scenario in 2100, the possibility of no dengue-free months was revealed in part of southernmost Okinawa Prefecture, and the epidemic risk extended to the entire part of northernmost Hokkaido Prefecture. CONCLUSION: Each locality in Japan must formulate action plans in response to the presented scenarios. Our geographic analysis can help local governments to develop adaptation policies that include mosquito breeding site elimination, distribution of adulticides and larvicides, and elevated situation awareness to prevent transmission via bites from Aedes vectors.
Outdoor workers perform critical societal functions, often despite higher-than-average on-the-job risks and below-average pay. Climate change is expected to increase the frequency of days when it is too hot to safely work outdoors, compounding risks to workers and placing new stressors on the personal, local, state, and federal economies that depend on them. After quantifying the number of outdoor workers in the contiguous United States and their median earnings, we couple heat-based work reduction recommendations from the U.S. Centers for Disease Control and Prevention with an analysis of hourly weather station data to develop novel algorithms for calculating the annual number of unsafe workdays due to extreme heat. We apply these algorithms to projections of the frequency of extreme heat days to quantify the exposure of the outdoor workforce to extreme heat and the associated earnings at risk under different emissions scenarios and, for the first time, different adaptation measures. With a trajectory of modest greenhouse gas emissions reductions, outdoor worker exposure to extreme heat would triple that of the late 20th-century baseline by mid-century, and earnings at risk would reach an estimated $39.3 billion annually. By the late century with that same trajectory, exposure would increase four-fold compared to the baseline with an estimated $49.2 billion in annual earnings at risk. Losses are considerably higher with a limited-mitigation trajectory. While universal adoption of 2 specific adaptation measures in conjunction could reduce mid-century and late-century economic risks by roughly 90% and 93%, respectively, practical limitations to their adoption suggest that emissions mitigation policies will be critical for ensuring the well-being and livelihoods of outdoor workers in a warming climate.
Urban heat islands (UHIs) exert a substantially negative impact on human health and urban sustainability. The role of two-dimensional (2D) landscape patterns in UHIs are well documented; while the effects and contributions of three-dimensional (3D) urban structures remain unclear, especially across different climatic zones. Here we investigated the relationship between 2D/3D urban morphology and the urban thermal environment in summer and winter during the day and at night in 62 representative large cities across four major climate zones in China. First, we extracted the seasonal surface regional heat island intensity (SRHII) using the MODIS 8-Day land surface temperature product. Subsequently, we constructed 25 2D and five 3D urban features and explored their relative importance and respective roles in UHIs in different climatic contexts. Results show that: (1) significant differences (p < 0.05) exist in SRHII between various climate zones; cities with a humid subtropical climate experience temperatures approximately 2 degrees C higher during the day in summer compared to those with the other climate types. (2) 3D urban features can effectively improve the interpretation of urban features for SRHII, with an average optimization level of 21%. (3) Urban trees have a higher cooling effect than other green spaces, whereas tall buildings can also reduce the UHI effect. (4) On summer days, equal proportions of tree to building volume provide the greatest cooling effects. This study provides new insights into the effect of 3D urban characteristics on SRHII and has promising implications for climate resilience planning and heat-related risk management
Climate change has led to increased frequency, intensity, and duration of extreme heat events with dire consequences for health. These are the deadliest of climate change impacts with preventable mortality from heat-related illnesses and increased threat to safe participation in physical activity and sports. Nurse practitioners can collaborate with community and professional sports health organizations to ensure evidence based health and safety policies to reduce health-related risks. Adverse consequences on engagement in key health-promoting physical activity and sports may catalyze urgent action to address climate change.(c) 2021 Elsevier Inc. All rights reserved.
BACKGROUND: In China, most previous projections of heat-related mortality have been based on modeling studies using global climate models (GCMs), which can help to elucidate the risks of extreme heat events in a changing climate. However, spatiotemporal changes in the health effects of climate change considering specific regional characteristics remain poorly understood. We aimed to use credible climate and population projections to estimate future heatwave-attributable deaths under different emission scenarios and to explore the drivers underlying these patterns of changes. METHODS: We derived climate data from a regional climate model driven by three CMIP5 GCM models and calculated future heatwaves in China under Representative Concentration Pathway (RCP) 2.6, RCP4.5, and RCP8.5. The future gridded population data were based on Shared Socioeconomic Pathway 2 assumption with different fertility rates. By applying climate zone-specific exposure-response functions to mortality during heatwave events, we projected the scale of heatwave-attributable deaths under each RCP scenario. We further analyzed the factors driving changes in heatwave-related deaths and main sources of uncertainty using a decomposition method. We compared differences in death burden under the 1.5°C target, which is closely related to achieving carbon neutrality by mid-century. FINDINGS: The number of heatwave-related deaths will increase continuously to the mid-century even under RCP2.6 and RCP4.5 scenarios, and will continue increasing throughout the century under RCP8.5. There will be 20,303 deaths caused by heatwaves in 2090 under RCP2.6, 35,025 under RCP4.5, and 72,260 under RCP8.5, with half of all heatwave-related deaths in any scenario concentrated in east and central China. Climate effects are the main driver for the increase in attributable deaths in the near future till 2060, explaining 78% of the total change. Subsequent population decline cannot offset the losses caused by higher incidence of heatwaves and an aging population under RCP8.5. Although health loss under the 1.5°C warming scenario is 1.6-fold higher than the baseline period 1986-2005, limiting the temperature rise to 1.5°C can reduce the annual mortality burden in China by 3,534 deaths in 2090 compared with RCP2.6 scenarios. INTERPRETATION: With accelerating climate change and population aging, the effects of future heatwaves on human health in China are likely to increase continuously even under a low emission scenario. Significant health benefits are expected if the optimistic 1.5°C goal is achieved, suggesting that carbon neutrality by mid-century is a critical target for China’s sustainable development. Policymakers need to tighten climate mitigation policies tailored to local conditions while enhancing climate resilience technically and infrastructurally, especially for vulnerable elderly people. FUNDING: National Key R&D Program of China (2018YFA0606200), Wellcome Trust (209734/Z/17/Z), Natural Science Foundation of China (41790471), and Guangdong Major Project of Basic and Applied Basic Research (2020B0301030004).
Studies have shown that ambient extreme temperatures (heat and cold) were associated with an increased risk of childhood pneumonia, but the evidence is very limited in low-middle-income countries. It also remains unknown whether pneumococcal conjugate vaccine (PCV) could prevent temperature-related childhood pneumonia. This study collected data on ambient temperature and hospitalizations for childhood pneumonia in Matlab, Bangladesh from 2012 to 2016. Interrupted time series (ITS) analysis was employed to assess the impact of PCV (10-valent) intervention on childhood pneumonia hospitalizations. A time-stratified case-crossover analysis with a conditional logistic regression was performed to examine the association of childhood pneumonia hospitalizations with extreme temperatures and heatwaves before and after PCV10 intervention. Subgroup analyses were conducted to explore the modification effects of seasons, age, gender, and socioeconomic levels on temperature-related childhood pneumonia hospitalizations. We found that after PCV10 intervention, there was a sharp decrease in hospitalizations for childhood pneumonia (relative risk (RR): 0.59, 95% confidence interval (CI): 0.43-0.83). During the study period, heat effects on childhood pneumonia appeared immediately on the current day (odds ratio (OR): 1.28; 95% CI: 1.02-1.60, lag 0), while cold effects appeared 4 weeks later (OR: 1.53, 95% CI: 1.06-2.22, lag 28). Importantly, cold effects decreased significantly after PCV10 (p-value＜0.05), but heat and heatwave effects increased after PCV10 (p-value＜0.05). Particularly, children from families with a middle or low socioeconomic level, boys, and infants were more susceptible to heat-related pneumonia. This study suggests that PCV10 intervention in Bangladesh may help decrease cold-related not heat-related childhood pneumonia.
IMPORTANCE: There is a large body of epidemiologic evidence that heat is associated with increased risk of mortality. One of the most effective strategies to mitigate the effects of heat is through air conditioning (AC); Texas regulates the internal temperature of jails to stay between 65 and 85 °F degrees, but these same standards do not apply to state and private prisons. OBJECTIVE: To analyze whether heat during warm months is associated with an increased risk of mortality in Texas prisons without AC. DESIGN, SETTING, AND PARTICIPANTS: This case-crossover study included individuals who died in Texas prisons between 2001 and 2019. The association of heat in warm months with mortality in Texas prisons with and without AC was estimated. Data analysis was conducted from January to April 2022. EXPOSURES: Increasing daily heat index above 85 °F and extreme heat days (days above the 90th percentile heat index for the prison location). MAIN OUTCOMES AND MEASURES: Daily mortality in Texas prisons. RESULTS: There were 2083 and 1381 deaths in prisons without and with AC, respectively, during warm months from 2001 to 2019. Most of the deceased were male (3339 of 3464 [96%]) and the median (IQR) age at death was 54 (45-62) years. A 1-degree increase above 85 °F heat index and an extreme heat day were associated with a 0.7% (95% CI, 0.1%-1.3%) and a 15.1% (95% CI, 1.3%-30.8%) increase in the risk of mortality in prisons without AC, respectively. Approximately 13% of mortality or 271 deaths may be attributable to extreme heat during warm months between 2001 to 2019 in Texas prison facilities without AC. In prisons with AC, a negative percentage change in mortality risk was observed, although the 95% CI crossed zero (percentage change in mortality risk: -0.6%; 95% CI, -1.6% to 0.5%). The estimates in prisons without AC were statistically different than the estimates in prisons with AC (P = .05). CONCLUSIONS AND RELEVANCE: This study found an average of 14 deaths per year between 2001 to 2019 were associated with heat in Texas prisons without AC vs no deaths associated with heat in prisons with AC. Adopting an AC policy in Texas prisons may be important for protecting the health of one of our most vulnerable populations.
The Heat Index is a metric that quantifies heat exposure in human beings. Here, using probabilistic emission projections, we show that changes in the Heat Index driven by anthropogenic CO2 emissions will increase global exposure to dangerous environments in the coming decades. Even if the Paris Agreement goal of limiting global warming to 2 degrees C is met, the exposure to dangerous Heat Index levels will likely increase by 50-100% across much of the tropics and increase by a factor of 3-10 in many regions throughout the midlatitudes. Without emissions reductions more aggressive than those considered possible by our statistical projection, it is likely that by 2100, many people living in tropical regions will be exposed to dangerously high Heat Index values during most days of each typical year, and that the kinds of deadly heat waves that have been rarities in the midlatitudes will become annual occurrences. Exposure to dangerous heat index levels will likely increase by 50-100% in the tropics and by a factor of 3-10 in the mid-latitudes by 2100, even if the Paris Agreement goal of limiting warming to 2 degrees C is met, according to probabilistic projections of global warming.
In recent decades, rising trend in the number of heat waves (HWs) has exacerbated the risk of heat-related mortality and morbidity. The frequent deadly HWs precipitated a multitude of national and sub-national heathealth prevention and research efforts. In 2008, the WHO Regional Office for Europe developed and published guidance on heat-health action plans (HHAPs). This provided a blueprint for countries to design heat-related prevention efforts. Since then, a large corpus of new evidences and implementation experiences has emerged around adaptive measures, alert systems and urban planning interventions. The present study conducts a systematic review to critically assess the advent and development of HHAPs with a special focus on its integration with urban planning policies. It reviews the concept of threshold, indicators for heat event determination and measurement of HWs to understand trigger setting mechanisms. The results show that implementation of core elements of HHAPs varies significantly in the areas of long-term urban planning, real-time surveillance, monitoring and evaluation. Moreover, low levels of inclusion of HHAPs with national policies hinder the overall potential of adaptation measures. The growing impacts of HWs emphasize the urgent need to address spatial heat vulnerability and build urban heat resilience into implementable action plans.
The risk of heatwave events and their persistence has intensified in recent past and is expected to increase faster in future. However, the anticipated changes in socioeconomic exposure to heatwaves are still unexplored. Here, we investigate the projected heat stress and associated socioeconomic exposure across South Asia (SA) and its subregions using the newly released ensemble mean of 23 global climate models from the Coupled Model Intercomparison Project Phase 6 (CMIP6), population, and Gross Domestic Product (GDP) projections. We used two Shared Socioeconomic Pathways (SSPs), namely SSP2-4.5 and SSP5-8.5, and three-time periods, that is, near-term, midterm, and long-term relative to the base period (1985-2005). We found that SA region has the potential for widespread changes to Wet bulb globe temperature (WBGT) of 6.5 degrees C, which can exceed the theoretical limits of human tolerance by the mid of 21st century. The SA population’s exposure significantly increases during midterm and long-term periods by similar to 750×106 10(6) person-hours under the SSP5-8.5 scenario. The GDP exposure is the greatest for the same period’s up to 200×109 10(9) dollar-hours under the SSP2-4.5. Moreover, the foothills Himalayans and northern parts of Pakistan are presently unaffected by WBGT during midterm and long-term periods under both scenarios. Among subregions (hereafter R1, R2, R3, and R4), the frequency of subdaily WBGT is projected to increase in the region R2 and R4 by similar to 70% and similar to 90% under the SSP2-4.5 and SSP5-8.5 scenarios relative to the base period. The highest upsurge in exposure is anticipated for R2, including southern Pakistan and southwestern India, followed by R1 and R3. Notably, the climate effect is more dominant than the population, whereas changes in GDP effect contribute to the total change in GDP exposure.
Human-induced climate change will increase surface temperatures globally over the next several decades. Climate models project that global mean surface temperature could increase by over 2 C by 2050 relative to the preindustrial period, with even greater changes at the regional level. These temperature changes have clear and pertinent implications for extremes, and consequentially, heat-induced health issues for people living in particularly hot climates. Here, we study future projections in the demand for AC globally in the 2050 s associated with extreme heat events. To do this, we employ an ensemble of CMIP6 models under high and low emissions scenarios. We find that the increasing frequency of extreme temperatures will cause a significant portion of the global population to be exposed to conditions that require cooling. This issue will be especially pervasive in poor countries such as India and Indonesia, which at present lack the AC units required to handle rapidly growing populations and increased frequencies of extreme temperatures. The electricity needed for cooling in these countries could reach as high as 75% of the current total annual electricity demand, which could place serious strain on the electricity grid infrastructure during peak cooling hours. We conclude that demand for cooling in the future will pose a significant challenge for poorer countries whose people will require AC units to handle extreme temperatures. In some countries, the grid infrastructure is insufficient at present to meet projected AC demands, and this need must be considered in future power systems planning. (C) 2022 The Authors. Published by Elsevier B.V.
Extreme temperatures have reached unprecedented levels in many regions of the globe due to climate change, and a further increase is expected. Besides other consequences, high temperatures increase the mortality risk and severely affect the labour productivity of workers. We perform a high-resolution spatial analysis to assess the impacts of heat on mortality and labour productivity in Switzerland and project their development under different Representative Concentration Pathway (RCP) scenarios, considering that no socio-economic changes take place. The model is based on the risk framework of the Intergovernmental Panel on Climate Change (IPCC), which combines the three risk components: hazard, exposure, and vulnerability. We model the two impact categories in the same spatially explicit framework, and we integrate uncertainties into the analysis by a Monte Carlo simulation. We model first that about 658 deaths are associated with heat exposure currently each year in Switzerland. Second, the economic costs caused by losses in labour productivity amount to around CHF 665 million (approx. USD 700 million) per year. Should we remain on an RCP8.5 emissions pathway, these values may double (for mortality) or even triple (for labour productivity) by the end of the century. Under an RCP2.6 scenario impacts are expected to slightly increase and peak around mid-century, when climate is assumed to stop warming. Even though uncertainties in the model are large, the underlying trend in impacts is unequivocal. The results of the study are valuable information for political discussions and allow for a better understanding of the cost of inaction.
Summer heat extremes in the UK pose a risk to health (amongst other sectors) and this is exacerbated by localised socio-economic factors that contribute to vulnerability. Here, regional climate model simulations from the UK Climate Projections are used to assess how different elements of extreme heat will vary across the UK in the future under global mean surface temperature warming levels of +1.5 degrees C, +2.0 degrees C and +3.0 degrees C above pre-industrial. Heat stress metrics incorporating daily maximum and minimum temperature, temperature variability and vapour pressure are included. These show qualitatively similar spatial patterns for the recent past, with the most pronounced heat hazards found in south-eastern regions of the UK. Projected heat hazard changes across the UK are not homogeneous, with southern regions (e.g. Greater London, South East) showing greater increases in maximum temperatures and northern regions (e.g. Scotland and Northern Ireland) showing greater increases in humidity. With +3.0 degrees C warming, the relative change in combined heat hazards is found to be greatest in the south-western UK, however, in absolute terms, south-eastern regions will still experience the greatest hazards. When combined with socio-economic factors, hotspots of high heat stress risk emerge in parts of London, the Midlands and eastern England along with southern and eastern coastal regions. Weighting of different heat risk factors is subjective and to this end we have developed and made available an interactive app which allows users to assess sensitivities and uncertainties in the projected UK heat risk.
BACKGROUND: Previous studies projecting future temperature-related mortality under climate change have mostly used short-term temperature-mortality associations based on daily time series data. The present study aimed to project mortality under different Representative Concentration Pathways (RCPs) in 21st century in Hong Kong by using analysis of annual data during 1976-2018. METHODS: We employed a degree-days approach, calculating the sum of daily degrees above or below certain temperature threshold within a relevant historical year. The yearly age-standardized mortality rates (ASMRs) were regressed on annual hot and cold degree-days in quasi-Poisson generalized additive models to assess the exposure-response function that was subsequently used to calculate future changes in ASMR. The projection was performed without and with certain human adaptation assumed. RESULTS: ASMRs were projected to have net increases under RCPs 4.5, 6.0, and 8.5, with increased mortality attributable to excess hot days exceeding decreases attributable to excess cold days. The average net changes under RCP8.5 was estimated to be 0.12%, 12.44%, 38.99%, and 89.25% during 2030s, 2050s, 2070s, and 2090s, respectively. Higher projected ASMRs were estimated for those aged over 75 years and for cardiovascular deaths. When human adaptation was considered, slope reduction alone under RCP4.5 and 6.0 and all adaptation assumptions under RCP8.5 might still not offset its corresponding adverse impact. CONCLUSIONS: The projected decreases in cold-related mortality do not compensate for projected increases in heat-related mortality in Hong Kong. Better public adaptations strategies are warranted for coping with the adverse health impacts of climate change on a local scale.
BACKGROUND: Enteric infections cause significant deaths, and global projection studies suggest that mortality from enteric infections will increase in the future with warmer climate. However, a major limitation of these projection studies is the use of risk estimates derived from nonmortality data to project excess enteric infection mortality associated with temperature because of the lack of studies that used actual deaths. OBJECTIVE: We quantified the associations of daily temperature with both mortality and hospital admissions due to enteric infections in the Philippines. These associations were applied to projections under various climate and population change scenarios. METHODS: We modeled nonlinear temperature associations of mortality and hospital admissions due to enteric infections in 17 administrative regions of the Philippines using a two-stage time-series approach. First, we quantified nonlinear temperature associations of enteric infections by fitting generalized linear models with distributed lag nonlinear models. Second, we combined regional estimates using a meta-regression model. We projected the excess future enteric infections due to nonoptimal temperatures using regional temperature-enteric infection associations under various combinations of climate change scenarios according to representative concentration pathways (RCPs) and population change scenarios according to shared socioeconomic pathways (SSPs) for 2010-2099. RESULTS: Regional estimates for mortality and hospital admissions were significantly heterogeneous and had varying shapes in association with temperature. Generally, mortality risks were greater in high temperatures, whereas hospital admission risks were greater in low temperatures. Temperature-attributable excess deaths in 2090-2099 were projected to increase over 2010-2019 by as little as 1.3% [95% empirical confidence intervals (eCI): – 3.1%, 6.5%] under a low greenhouse gas emission scenario (RCP 2.6) or as much as 25.5% (95% eCI: – 3.5%, 48.2%) under a high greenhouse gas emission scenario (RCP 8.5). A moderate increase was projected for temperature-attributable excess hospital admissions, from 0.02% (95% eCI: – 2.0%, 1.9%) under RCP 2.6 to 5.2% (95% eCI: – 12.7%, 21.8%) under RCP 8.5 in the same period. High temperature-attributable deaths and hospital admissions due to enteric infections may occur under scenarios with high population growth in 2090-2099. DISCUSSION: In the Philippines, futures with hotter temperatures and high population growth may lead to a greater increase in temperature-related excess deaths than hospital admissions due to enteric infections. Our results highlight the need to strengthen existing primary health care interventions for diarrhea and support health adaptation policies to help reduce future enteric infections. https://doi.org/10.1289/EHP9324.
Epidemiologic evidence on acute heat and cold stress and preterm birth (PTB) is inconsistent and based on ambient temperature rather than a thermophysiological index. The aim of this study was to use a spatiotemporal thermophysiological index (Universal Thermal Climate Index, UTCI) to investigate prenatal acute heat and cold stress exposures and spontaneous PTB. We conducted a space-time-stratified case-crossover analysis of 15,576 singleton live births with spontaneous PTB between January 1, 2000 and December 31, 2015 in Western Australia. The association between UTCI and spontaneous PTB was examined with distributed lag nonlinear models and conditional quasi-Poisson regression. Relative to the median UTCI, there was negligible evidence for associations at the lower range of exposures (1st to 25th percentiles). We found positive associations in the 95th and 99th percentiles, which increased with increasing days of heat stress in the first week of delivery. The relative risk (RR) and 95% confidence interval (CI) for the immediate (delivery day) and cumulative short-term (up to six preceding days) exposures to heat stress (99th percentile, 31.2 °C) relative to no thermal stress (median UTCI, 13.8 °C) were 1.01 (95% CI: 1.01, 1.02) and 1.05 (95% CI: 1.04, 1.06), respectively. Elevated effect estimates for heat stress were observed for the transition season, the year 2005-2009, male infants, women who smoked, unmarried, ≤ 19 years old, non-Caucasians, and high socioeconomic status. Effect estimates for cold stress (1st percentile, 0.7 °C) were highest in the transition season, during 2005-2009, and for married, non-Caucasian, and high socioeconomic status women. Acute heat stress was associated with an elevated risk of spontaneous PTB with sociodemographic vulnerability. Cold stress was associated with risk in a few vulnerable subgroups. Awareness and mitigation strategies such as hydration, reducing outdoor activities, affordable heating and cooling systems, and climate change governance may be beneficial. Further studies with the UTCI are required.
The recent increase in the global incidence of dengue fever resulted in over 2.7 million cases in Latin America and many cases in Southeast Asia and has warranted the development and application of early warning systems (EWS) for futuristic outbreak prediction. EWS pertaining to dengue outbreaks is imperative; given the fact that dengue is linked to environmental factors owing to its dominance in the tropics. Prediction is an integral part of EWS, which is dependent on several factors, in particular, climate, geography, and environmental factors. In this study, we explore the role of increased susceptibility to a DENV serotype and climate variability in developing novel predictive models by analyzing RT-PCR and DENV-IgM confirmed cases in Singapore and Honduras, which reported high dengue incidence in 2019 and 2020, respectively. A random-sampling-based susceptible-infected-removed (SIR) model was used to obtain estimates of the susceptible fraction for modeling the dengue epidemic, in addition to the Bayesian Markov Chain Monte Carlo (MCMC) technique that was used to fit the model to Singapore and Honduras case report data from 2012 to 2020. Regression techniques were used to implement climate variability in two methods: a climate-based model, based on individual climate variables, and a seasonal model, based on trigonometrically varying transmission rates. The seasonal model accounted for 98.5% and 92.8% of the variance in case count in the 2020 Singapore and 2019 Honduras outbreaks, respectively. The climate model accounted for 75.3% and 68.3% of the variance in Singapore and Honduras outbreaks respectively, besides accounting for 75.4% of the variance in the major 2013 Singapore outbreak, 71.5% of the variance in the 2019 Singapore outbreak, and over 70% of the variance in 2015 and 2016 Honduras outbreaks. The seasonal model accounted for 14.2% and 83.1% of the variance in the 2013 and 2019 Singapore outbreaks, respectively, in addition to 91% and 59.5% of the variance in the 2015 and 2016 Honduras outbreaks, respectively. Autocorrelation lag tests showed that the climate model exhibited better prediction dynamics for Singapore outbreaks during the dry season from May to August and in the rainy season from June to October in Honduras. After incorporation of susceptible fractions, the seasonal model exhibited higher accuracy in predicting outbreaks of higher case magnitude, including those of the 2019-2020 dengue epidemic, in comparison to the climate model, which was more accurate in outbreaks of smaller magnitude. Such modeling studies could be further performed in various outbreaks, such as the ongoing COVID-19 pandemic to understand the outbreak dynamics and predict the occurrence of future outbreaks.
Dengue fever is a severe disease spread by Aedes mosquito-borne dengue viruses (DENVs) in tropical areas such as Bangladesh. Since its breakout in the 1960s, dengue fever has been endemic in Bangladesh, with the highest concentration of infections in the capital, Dhaka. This study aims to develop a machine learning model that can use relevant information about the factors that cause Dengue outbreaks within a geographic region. To predict dengue cases in 11 different districts of Bangladesh, we created a DengueBD dataset and employed two machine learning algorithms, Multiple Linear Regression (MLR) and Support Vector Regression (SVR). This research also explores the correlation among environmental factors like temperature, rainfall, and humidity with the rise and decline trend of Dengue cases in different cities of Bangladesh. The entire dataset was divided into an 80:20 ratio, with 80 percent used for training and 20% used for testing. The research findings imply that, for both the MLR with 67% accuracy along with Mean Absolute Error (MAE) of 4.57 and SVR models with 75% accuracy along with Mean Absolute Error (MAE) of 4.95, the number of dengue cases reduces throughout the winter season in the country and increases mainly during the rainy season in the next ten months, from August 2021 to May 2022. Importantly, Dhaka, Bangladesh’s capital, will see the maximum number of dengue patients during this period. Overall, the results of this data-driven analysis show that machine learning algorithms have enormous potential for predicting dengue epidemics.
Urban warming has become increasingly serious in recent years. Especially in the case of hot summer days (with maximum daily temperature greater than 30C), the number of people suffering from heat stroke increases every year. To mitigate urban warming and adapt to it, many researchers have focused on improving outdoor thermal comfort. The mean radiant temperature (MRT) is one of the most important variables affecting human thermal comfort in outdoor urban spaces; however, the process of MRT calculation requires a lot of computing power and time. The main objective of this study is the optimization of the back propagation and genetic algorithms on the basis of a multilayer neural network (MLNN), as an alternative to the time-consuming and computationally intensive process for quick MRT prediction. In this research work, a neural network was trained using the relevant weather-related and building morphology-related parameters that may affect the MRT from 2014-2018 as training parameters, the distributions of MRT around buildings in hot summer days of 2019 were predicted using an optimized neural network model. The results show that the mean absolute percentage error (MAPE) and root-mean-square error (RMSE) of the optimized model were lower than 1% and 1C.
Dysentery is a water- and food-borne infectious disease and its incidence is sensitive to climate change. Although the impact of climate change on dysentery is being studied in specific areas, a study in Iran is lacking. In this study, RCP 4.5 and RCP 8.5 scenarios were used to predict the prevalence of dysentery in Iran between 2050 and 2070. This study is a secondary analysis using Geographically Weighted Regression, and 273 cities of Iran were analyzed between March 2011 and March 2017. Bioclimate variables were used as independent variables. Ecological data about the prevalence and incidence of dysentery, which were collected between 2011 and 2017, were used as the dependent variables. The result shows the incidence of dysentery is significantly associated with bioclimate change exposure, in 2050 and 2070, based on RCP 4.5 and RCP 8.5. Our findings showed that in the absence of adaptation of the population, an increase in the risk of bioclimate-related diseases is expected by around 95.6% in the mid-century compared with the beginning of the century with regional variations. Based on these findings, the geographical distribution of the disease will also change. In 2050, the pattern of disease distribution would be changed, and the north of Iran will be included in the vulnerable regions. In 2070, the southeastern and northern parts of Iran will have the most vulnerability to climate change. Our study contributes important knowledge to this perspective by providing insightful findings and pieces of evidence for climate change adaptation and mitigation.
BACKGROUND: Rodent infestation is a global biological problem. Rodents are widely distributed worldwide, cause harm to agriculture, forestry, and animal husbandry production and spread a variety of natural focal diseases. In this study, 10 ecological niche models were combined into an ensemble model to assess the distribution of suitable habitats for Rhombomys opimus and to predict the impact of future climate change on the distribution of R. opimus under low, medium and high socioeconomic pathway scenarios of CMIP6. RESULTS: In general, with the exception of extreme climates (2090-SSP585), the current and potential future ranges of R. opimus habitat are maintained at approximately 220 × 10(4) km(2) . In combination with human footprint data, the potential distribution area of R. opimus was found to coincide with areas with a moderate human footprint. In addition, this distribution area will gradually shift to higher-latitude regions, and the suitable habitat area of R. opimus will gradually shrink in China, Iran, Afghanistan, and Turkmenistan while increasing in Mongolia and Kazakhstan. CONCLUSIONS: These results help identify the impact of climate change on the potential distribution of R. opimus and provide supportive information for the development of management strategies to protect against future ecological and human health risks. © 2022 Society of Chemical Industry.
Southern Brazil concentrates a considerable number of cases of cutaneous leishmaniasis reported since 1980, and Paraná is the state that most records CL cases in the region. The main sand fly species incriminated as vectors of Leishmania (Viannia) braziliensis (Vianna,1911) are Migonemyia (Migonemyia) migonei (França, 1920), Nyssomyia (Nyssomyia) neivai (Pinto, 1926) and Nyssomyia (Nyssomyia) whitmani (Antunes & Coutinho, 1936). In this study, we evaluated areas with climatic suitability for the distribution of these vectors and correlated these data with CL incidence in the state. The occurrence points of Mg. migonei, Ny. neivai, and Ny. whitmani were extracted from a literature review and field data. For CL analysis in the state of Paraná, data were obtained from the Informatics Department of the Unified Health System of Brazil (DATASUS), covering the period from 2001 to 2019. The layers of bioclimatic variables from the WorldClim database were used in the study. Species distribution modeling was developed using the MaxEnt Software version 3.4.4. ArcGIS software version 10.5 was used to develop suitability maps and the graphical representation of disease incidence. The AUC values were acceptable for all models (> 0,8). Bioclimatic variables BIO13 and BIO14 were the most influential in the distribution of Mg. migonei, while BIO19 and BIO6 were the variables that most influenced the distribution of Ny. neivai, and Ny. whitmani was most influenced by variables BIO5 and BIO9. During 19 years, 4992 cases of CL were reported in the state by 286 municipalities (71,6%). Northern Paraná showed the highest number of areas with very high and high climatic suitability for the occurrence of these species, coinciding with the highest number of CL cases. The modeling tools allowed analyzing the association between climatic variables and the geographical distribution of CL in the state. Moreover, they provided a better understanding of the climatic conditions related to the distribution of different species, favoring the monitoring of risk areas, the implementation of preventive measures, risk awareness, early and accurate diagnosis, and consequent timely treatment.
BACKGROUND: The global prevalence of childhood obesity has risen dramatically recently. Previous studies found an association between rapid infant weight gain and childhood overweight. Evidence suggests that exposure to high ambient air temperatures during prenatal life and during adulthood is associated with birthweight and obesity respectively. OBJECTIVE: The objective of this study was to examine whether exposure to high ambient temperatures during infancy is associated with rapid infant weight gain in Israel. METHODS: This is a population-based historical cohort study using data from the Israeli national public network of maternal and child health clinics between 2008 and 2013. We assessed exposure to ambient temperature in the first year of life using a high-resolution hybrid spatio-temporal model and calculated annual mean and minimum temperatures for each infant based on daily mean and minimum temperatures at the community clinic location. We defined rapid infant weight gain as a World Health Organization weight z-score difference >0.67 between birthweight and weight at age one year. We estimated these associations using log-linear and general additive models and adjusted for population group, district, maternal age, parental education, parity, sex, gestational age, birthweight, calendar year and calendar month of birth. RESULTS: The study population included 217,310 singleton-term infants. Adjusted models demonstrated a positive association between ambient temperature exposure and rapid infant weight gain. Compared to the third quintile of minimum temperature, infants exposed to the first and second quintile had an adjusted relative risk of 0.98 (95% CI 0.96, 1.00) and 0.97 (95% CI 0.95, 0.98), respectively, while those exposed to the fourth and fifth quintiles had an adjusted relative risk of 1.06 (95% CI 1.04, 1.07) and 1.02 (95% CI 1.00, 1.04) respectively. The associations with mean temperature were similar but slightly weaker. CONCLUSIONS: Exposure to higher ambient temperatures, of emerging importance in the climate change era, is associated with rapid infant weight gain in Israel. Future studies should use additional exposure, covariate, and outcome data to analyse the nature and the source of this association in more detail.
The increasing heat stress from the combined effect of changes such as temperature and humidity in the context of global change receives growing concerns. However, there is limited information for future changes in heat stress, as well as its potential socioeconomic impact, under the intended nationally determined mitigation scenarios. This study established an efficient evaluation method to quantify the benefits from the potential heat stress reduction from a continued intended nationally determined contributions (INDC) mitigation effort. The future heat stress over global land, quantified by the wet bulb globe temperature, was investigated based on the temperature sensitivity approach and multi-model simulations from the latest generation global climate models. The INDC continuous-effort scenario and the delayed-effort scenario, as well as the target-control scenarios of 2 degrees C warming, were compared. We found that with the delayed mitigation efforts, the increase in frequency, duration, and cumulative intensity of extreme heat stress relative to the INDC continuous-effort scenario in the late 21st century could reach to 113%, 193%, and 212%, respectively. If more ambitious efforts above current INDC pledges were implemented to achieve the 2 degrees C global temperature goal, the corresponding avoided impact of heat stress frequency, duration, and cumulative intensity in the late 21st century was estimated to be 32%, 37%, and 40%, respectively. Future changes in heat stress in low latitudes, where most developing countries are located, are most sensitive to emission reduction. Our results highlighted the potential avoided heat stress-related impact of global warming from efforts towards climate change mitigation.
Occupational heat exposure is associated with substantial morbidity and mortality among outdoor workers. We sought to descriptively evaluate spatiotemporal variability in heat threshold exceedances and describe potential impacts of these exposures for crop and construction workers. We also present general considerations for approaching heat policy-relevant analyses. We analyzed county-level 2011-2020 monthly employment (Bureau of Labor Statistics Quarterly Census of Employment and Wages) and environmental exposure (Parameter-elevation Relationships on Independent Slopes Model (PRISM)) data for Washington State (WA), USA, crop (North American Industry Classification System (NAICS) 111 and 1151) and construction (NAICS 23) sectors. Days exceeding maximum daily temperature thresholds, averaged per county, were linked with employment estimates to generate employment days of exceedances. We found spatiotemporal variability in WA temperature threshold exceedances and crop and construction employment. Maximum temperature exceedances peaked in July and August and were most numerous in Central WA counties. Counties with high employment and/or high numbers of threshold exceedance days, led by Yakima and King Counties, experienced the greatest total employment days of exceedances. Crop employment contributed to the largest proportion of total state-wide employment days of exceedances with Central WA counties experiencing the greatest potential workforce burden of exposure. Considerations from this analysis can help inform decision-making regarding thresholds, timing of provisions for heat rules, and tailoring of best practices in different industries and areas.
Coccidioidomycosis (Valley fever) is a disease caused by the fungal pathogens Coccidioides immitis and Coccidioides posadasii that are endemic to the southwestern United States and parts of Mexico and South America. Throughout the range where the pathogens are endemic, there are seasonal patterns of infection rates that are associated with certain climatic variables. Previous studies that looked at annual and monthly relationships of coccidioidomycosis and climate suggest that infection numbers are linked with precipitation and temperature fluctuations; however, these analytic methods may miss important nonlinear, nonmonotonic seasonal relationships between the response (Valley fever cases) and explanatory variables (climate) influencing disease outbreaks. To improve our current knowledge and to retest relationships, we used case data from three counties of high endemicity in southern Arizona paired with climate data to construct a generalized additive statistical model that explores which meteorological parameters are most useful in predicting Valley fever incidence throughout the year. We then use our model to forecast the pattern of Valley fever cases by month. Our model shows that maximum monthly temperature, average PM10, and total precipitation 1 month prior to reported cases (lagged model) were all significant in predicting Valley fever cases. Our model fits Valley fever case data in the region of endemicity of southern Arizona and captures the seasonal relationships that predict when the public is at higher risk of being infected. This study builds on and retests relationships described by previous studies regarding climate variables that are important for predicting risk of infection and understanding this fungal pathogen. IMPORTANCE The inhalation of environmental infectious propagules from the fungal pathogens Coccidioides immitis and Coccidioides posadasii by susceptible mammals can result in coccidioidomycosis (Valley fever). Arizona is known to be a region where the pathogen is hyperendemic, and reported cases are increasing throughout the western United States. Coccidioides spp. are naturally occurring fungi in arid soils. Little is known about ecological factors that influence the growth of these fungi, and a higher environmental burden may result in increases in human exposure and therefore case rates. By examining case and climate data from Arizona and using generalized additive statistical models, we were able to examine the relationship between disease outbreaks and climatic variables and predict seasonal time points of increased infection risk.
Population aging, an increasing share of the elderly to the total population, can exacerbate heat vulnerability to intensified heat hazards. However, the aging impacts on increases in exposure of the elderly to unprecedented hot summers (UHSs) could be variable in the warming climate. Here, we present considerable contribution of age structure changes to increases in the elders’ exposure to intensified UHSs in countries with a high percentage of youth population, namely, China, India, and Brazil, by analyzing combined scenarios of climate change with population structure. In the aforementioned regions, increases in exposure to stronger UHSs relevant to rapid aging will exceed at least half of the warming impact, which primarily causes frequent occurrence of stronger UHSs. Conversely, the United States and Europe, which have already entered an aged society, show a negligible aging impact. These results suggest that the future evolution of a society’s age structure is an important constraint for projecting population exposure to strengthened summer heat. Plain Language Summary Population aging can worsen social heat tolerance for unprecedented hot summers (UHSs), which will get stronger by future warming. We show that aging will induce considerable increases in the elder’s exposure to stronger UHSs in countries with a high percentage of youth population, such as China, India, and Brazil. In these regions, the growth of elderly exposed to stronger UHSs due to rapid aging will exceed at least half of the warming-induced increase. In contrast, the impacts of aging is negligible in already aged societies, namely, United States and Europe. Future policy to reduce heat vulnerability of society to intensified summer heat should consider the future evolution of a society’s age structure, especially in countries with younger populations.
PURPOSE OF REVIEW: Leishmaniasis is a leading cause of parasitic death, with incidence rising from decreased resources to administer insecticide and anti-leishmanial treatments due to the COVID-19 pandemic. Leishmaniasis is nonendemic in the United States (U.S.), but enzootic canine populations and potentially competent vectors warrant monitoring of autochthonous disease as a fluctuating climate facilitates vector expansion. Recent studies concerning sand fly distribution and vector capacity were assessed for implications of autochthonous transmission within the U.S. RECENT FINDINGS: Climate change and insecticide resistance provide challenges in sand fly control. While most Leishmania-infected dogs in the U.S. were infected via vertical transmission or were imported, autochthonous vector-borne cases were reported. Autochthonous vector-borne human cases have been reported in four states. Further vaccine research could contribute to infection control. SUMMARY: Both cutaneous and visceral leishmaniasis cases in the U.S. are increasingly reported. Prevention measures including vector control and responsible animal breeding are critical to halt this zoonotic disease.
Climate change threatens to impact wheat productivity, quality and global food security. Maintaining crop productivity under abiotic stresses such as high temperature is therefore imperative to managing the nutritional needs of a growing global population. The article covers the current knowledge on the impact of post-anthesis heat on grain yield and quality of wheat crops. The objectives of the current article were to review (1) the effect of post-anthesis heat stress events (above 30.0 degrees C) on wheat grain yield, (2) the effect of heat stress on both the physical and chemical quality of wheat grain during grain development, (3) identify wheat cultivars that display resilience to heat stress and (4) address gaps within the literature and provide a direction for future research. Heat stress events at the post-anthesis stage impacted wheat grain yield mostly at the grain filling stage, whilst the effect on physical and chemical quality was varied. The overall effect of post-anthesis heat on wheat yield and quality was genotype-specific. Additionally, heat tolerance mechanisms were identified that may explain variations in yield and quality data obtained between studies.
The construction industry is regarded as one of the most highly hazardous industries. Workers are vulnerable to numerous injuries every day due to a lack of efficient safety management at their workplaces, and despite every accident being recorded, efforts with minimum impacts are made to improve the workers’ safety. Construction laborers often have to perform their activities in severe weather, enduring both extremely hot and cold temperatures, and as a result, they are prone to developing various health issues leading to accidents. This paper aims to identify strategies and recommendations to improve the occupational health and safety of construction laborers who work in extreme environments. To achieve the objectives of this study, a survey was developed and distributed among workers through an online platform, which yielded 27 responses, then the collected data were analyzed, and the results were used to devise ways to improve the safety and health of workers. The survey results revealed that construction field workers are unable to perform in extreme temperatures because of the lack of proper cooling and heating systems and that most of them experience physical fatigue while exerting themselves in extreme heat. Such circumstances can be managed, and the workers’ productivity can improve by establishing an efficient plan for rotating the jobs and providing work/rest cycles. The recommendations of this study can be helpful to construction practitioners who strive to improve the physical, mental, and emotional safety and health of those working under extreme temperatures on construction sites.
PURPOSE: Construction worker health and safety is a primary concern for construction companies and researchers. Arabian Gulf region, like Saudi Arabia, has been experiencing extremely hot and humid (EHH) weather, which directly affects construction workers’ health and safety. This study aims to address the problem of EHH weather conditions and their impacts on construction workers’ physiological status. METHODS: This study assesses the impacts of EHH weather on construction workers’ physiological status through the measurement of workers’ physical body parameters (age, height, and weight); type of activities; and assigned tasks. Thirty-five multinational workers participated in the measurements, which were conducted in real construction site conditions A quantitative analysis was then applied to quantify the physiological impacts of the weather conditions. Several hypotheses were tested to identify the significant impacts of individual and working aspects on the workers’ physiological responses. RESULTS AND CONCLUSION: The results provide empirical evidence that the recorded Heart Rate (HR) exceeded the acceptable physiological zones for construction workers exposed to extremely hot and humid weather conditions. Physical body parameters, work activities, and worker status significantly influence construction workers’ physiological responses. This study recommends adopting a continuous monitoring approach as an early warning system under extremely hot and humid weather conditions.
Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the effect of high ambient temperature on pregnancy. A literature search was conducted in advance of the meeting to identify existing hypotheses and develop a series of questions and themes for discussion. Numerous hypotheses have been generated based on animal models and limited observational studies. There is growing evidence that pregnant women are able to appropriately thermoregulate; however, when exposed to extreme heat, there are a number of processes that may occur which could harm the mother or fetus including a reduction in placental blood flow, dehydration, and an inflammatory response that may trigger preterm birth. There is a lack of substantial evidence regarding the processes that cause heat exposure to harm pregnant women. Research is urgently needed to identify what causes the adverse outcomes in pregnancy related to high ambient temperatures so that the impact of climate change on pregnant women can be mitigated.
Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the “circadian landscape,” with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities.
New York City, the most populated urban center in the United States, is exposed to a variety of natural hazards. These range from extratropical storms and coastal flooding to extreme heat and cold temperatures, and have been shown to unevenly impact the various vulnerable groups in the city. As the COVID-19 pandemic hit in March 2020 and the city became an early epicenter, disparities in exposure led to widely uneven infection and mortality rates. This study maps the overlapping heat and COVID-19 risks in New York City with a multi-hazard risk framework during Summer 2020. To do so, we simulate neighborhood scale temperatures using the Weather Research and Forecasting model coupled with a multi-layer urban parameterization. Simulation outputs were combined with zipcode-scale COVID-19 and sociodemographic data to compute a multi-hazard risk index. Our results highlight several regions where high social vulnerability, COVID-19 infection rates, and heat coincide. Moreover, we use the local indicators of spatial association technique to map regions of spatially correlated high multi-hazard risk in the NYC boroughs of The Bronx and parts of Brooklyn and Queens. These high risk locations account for nearly a quarter of the city’s population, with households earning less than half than those in the lowest risk zones.
Children (<5 years) are highly vulnerable during hot weather due to their reduced ability to thermoregulate. There has been limited quantification of the burden of climate change on health in sub-Saharan Africa, in part due to a lack of evidence on the impacts of weather extremes on mortality and morbidity. Using a linear threshold model of the relationship between daily temperature and child mortality, we estimated the impact of climate change on annual heat-related child deaths for the current (1995-2020) and future time periods (2020-2050). By 2009, heat-related child mortality was double what it would have been without climate change; this outweighed reductions in heat mortality from improvements associated with development. We estimated future burdens of child mortality for three emission scenarios (SSP119, SSP245 and SSP585), and a single scenario of population growth. Under the high emission scenario (SSP585), including changes to population and mortality rates, heat-related child mortality is projected to double by 2049 compared to 2005-2014. If 2050 temperature increases were kept within the Paris target of 1.5 degrees C (SSP119 scenario), approximately 4000-6000 child deaths per year could be avoided in Africa. The estimates of future heat-related mortality include the assumption of the significant population growth projected for Africa, and declines in child mortality consistent with Global Burden of Disease estimates of health improvement. Our findings support the need for urgent mitigation and adaptation measures that are focussed on the health of children.
Extreme high temperature poses significant threats to public health. Its slow-onset nature allows people to perceive discomfort and protect themselves from negative health consequences, but higher risk perception does not necessarily lead to precautions. Our study understands this gap by arguing that subjective heat-health symptoms are more direct motivations for some heat adaptive behaviours. Through a survey into households (n = 2008) in Taiwan, we assess negative perception of heat impacts during hot days against demographic and socio-economic factors and their relationship with adaptive behaviours. The results show that the frequency of feeling moody and ill varies with age, gender, and health condition, which is also connected to the use of um-brellas and hats. Older people, diabetic patients, and men tend to be less sensitive to high tem-perature, leaving them with higher heat risk. A sign of biophysical acclimatisation and adaptation of behaviours was found with people frequently working outdoors. They do not necessarily experience discomfort more frequently, but are more likely to use umbrellas and hats. Also, electricity cost may outweigh cooling benefits from using air conditioning in low-income and ethnic minority groups. These results reflect the subtropical Asian context, reinforcing the importance of biophysical as well as socio-cultural components in shaping heat vulnerability of individuals and the need for comprehensive and targeted policy interventions.
Urban heat, the combined effect of heatwaves and urban heat islands (UHIs), is a severe challenge for many cities around the world. While there have been numerous studies on urban heat, society’s understanding of it is still insufficient, hindering its mitigation and adaptation. This paper aims to investigate people’s vulnerability to, and perception, awareness and knowledge of, urban heat. A questionnaire survey was conducted with 562 re-spondents in the hot and humid city of Chongqing, China in the summer of 2020. Data were analysed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test and logistic regression. Results indicated that urban heat is generally understood as having a moderate severity, while there is limited knowledge of heat-related risks. The perceived heat-related psychological impacts are more severe than physiological impacts. There is limited awareness and knowledge of heat-impact reduction methods. Nevertheless, people’s awareness, perception and knowledge of urban heat increase once they suffer heat-induced impacts, indicating exposure/ experience-driven awareness and knowledge. Moreover, climate injustice among different groups (e.g. gender, age, education, income, health) of people related to heat challenges was identified. People’s perception, vulnerability, awareness and knowledge increased with age, but interestingly decreased with increasing edu-cation level and improved health conditions. Economic factor was not critical to heat-related responses. Men could be more vulnerable to physiological symptoms and daily functioning than women. The results of this study provide an understanding of urban heat perception and adaptive knowledge, enabling practitioners and policy makers to formulate effective urban heat mitigation and adaptation policies and regulations.
Global heating is considered one of the greatest threats to human health and well-being. Supporting human resilience to heating threats is imperative, but under-investigated. In response, this article reports a study that drew together results from quantitative data on perceptions of thermal comfort and mechanisms for coping with thermal discomfort among 406 households in a study in Giyani, Limpopo province. Indoor dwelling and outdoor temperatures were also analysed. Most participants perceived their dwellings to be too hot when it was hot outdoors. People relied on recommended heat health actions such as sitting outdoors in the shade or opening windows. While this agency is meaningful, resilience to climate change requires more than personal action. In light of the climate threats and climate-related disaster risks facing South Africa, an all-encompassing approach, including education campaigns, climate-proofed housing, access to basic services, and financial considerations that will help support resilient coping among South Africans, is urgently required.
Extreme heatwaves represent a health hazard that is expected to increase in the future, and which particularly affects urban populations worldwide due to intensification by urban heat islands. To analyze the impact of such extreme heatwaves on urban areas, urban climate models are a valuable tool. This study examines the perfor-mance of the urban climate model MUKLIMO_3 in modelling spatial air temperature patterns in the greater urban area of Bern, Switzerland, a city in complex topography, during three distinct extreme heatwaves in 2018 and 2019 over a total of 23 days. The model is validated using low-cost air temperature data from 79 (2018) and 84 (2019) measurement sites. The intercomparison of the three extreme heatwaves shows that during the first extreme heatwave 2019 at lower elevation regions in the outskirts of the city, modelled air temperature was higher than observation, which was likely due to pronounced mesoscale cold air advection. During calm and dry days, the air temperature distribution was modelled realistically over all three extreme heatwaves investigated. During daytime, modelled air temperatures were lower across all evaluation sites and all extreme heatwaves when compared to the measured values, with highest median air temperature differences of-3.7 K to-4.8 K found in the late afternoon. At night, MUKLIMO_3 generally shows a slowed cooling, so that higher air tem-peratures were modelled when compared to measured values, with median air temperature biases of +1.5 K to +2.8 K at midnight. By sunrise, the model biases continuously decreased, so that the lowest air temperatures at 7 a.m. were modelled with a bias of +0.2 K to +0.7 K. Peak biases exceed 7 K both during day and night. In sum, our results show that MUKLIMO_3 allows to realistically model the urban air temperature distributions during the peaks of the heatwaves investigated with the highest day and night air temperatures, which may assist in the development of heat mitigation measures to reduce the impacts of heat extremes and improve public health in cities with complex topography.
Bias correction method (BCM) is useful in reducing the statistically downscaled biases of global climate models’ (GCM) outputs and preserving statistical moments of the hydrological series. However, BCM is less efficient under changed future conditions due to the stationary assumption and performs poorly in removing bias at extremes, thereby producing unreliable bias-corrected data. Thus, the existing BCM with normal distribution is improved by incorporating skewed distributions into the model with linear covariate (BCM-QM(skewed)). In this study, BCM-QM(skewed) is developed to reduce biases in the extreme temperature data of peninsular Malaysia. The input is the MIROC5 model output gridded data and observations sourced by the Malaysian Department of Irrigation and Drainage (1976-2005). BCM-QM(skewed) with lognormal (LGNORM) and Gumbel (GUM) has shown considerable skills in correcting biases, capturing extreme and nonstationarity of current and future extreme temperatures data series corresponding to the representative concentration pathways (RCPs) for 2006-2100 based on model diagnostics and precision analysis. Higher projection of extreme temperatures is more pronounced under RCP8.5 than RCP4.5 with precise estimates ranging from 33 to 42 degrees C and 30 to 32 degrees C, respectively. Finally, the projection of extreme temperatures is used to calculate cardiovascular disease (CVD) mortality rate which coincides with high extreme temperatures ranging between 0.002 and 0.014.
Surfaces in outdoor playgrounds get hot in the sun and can cause serious skin burns in children. In-situ measurements from 10 playgrounds in Sydney showed that the maximum and average surface temperatures of sun -exposed playground equipment and flooring surfaces were frequently above skin contact burn thresholds. Black and dark-coloured wet pour rubber and synthetic turf were the hottest floor materials, all having maximum surface temperatures (T-s_max) > 80 ?C. A blue rubber dolphin was the hottest piece of play equipment, with a T-s_max of 91.8 ?C. A systematic assessment of common synthetic flooring materials exposed to full sun showed notable differences in T(s_max )between material types and colour-tones. Synthetic turf with 40 mm long grass blades (STlng-GR) was the hottest material (T-s_max = 84.5 ?C), followed by dark blue styrene butadiene rubber (SBRD-BL, T-s_max = 81.1 ?C), dark green ethylene propylene diene polymer (EPDMD-GR-2, (Ts_max )= 77.8 ?C), dark brown thermoplastic vulcanizate (TPVD-BR, T-s_max = 71.8 ?C), and intermediate blue thermoplastic polyolefin (TPOI-BL, T-s_max = 65.0 ?C). All these materials were hot enough to cause contact burns on typical, warm summer days when children are likely to visit outdoor playgrounds. Surface temperatures were significantly reduced in the shade and never reached burn threshold temperatures. Selection of appropriate material type and colour -tone, together with the provision of shade can remove the hazard risk for contact skin burns from outdoor playgrounds. Results of this work will assist playground designers and managers to provide safer places for our children to play longer in increasingly warmer summers.
Increasing surface air temperature is a fundamental characteristic of a warming world. Rising temperatures have potential impacts on human health through heat stress. One heat stress metric is the wet-bulb globe temperature, which takes into consideration the effects of radiation, humidity, and wind speed. It also has broad health and environmental implications. This study presents wet-bulb globe temperatures calculated from the fifth-generation European Centre for Medium-Range Weather Forecasts atmospheric reanalysis and combines it with health guidelines to assess heat stress variability and the potential for reduction in labor hours over the past decade on both the continental and urban scale. Compared to 2010-2014, there was a general increase in heat stress during the period from 2015 to 2019 throughout the northern hemisphere, with the largest warming found in tropical regions, especially in the northern part of the Indian Peninsula. On the urban scale, our results suggest that heat stress might have led to a reduction in labor hours by up to ~20% in some Asian cities subject to work-rest regulations. Extremes in heat stress can be explained by changes in radiation and circulation. The resultant threat is highest in developing countries in tropical areas where workers often have limited legal protection and healthcare. The effect of heat stress exposure is therefore a collective challenge with environmental, economic, and social implications.
As cities are extremely vulnerable to the impacts of climate change, they are fundamental in addressing these changes. However, streets, which are external spaces accessed by citizens in daily life, play an important role in improving the urban environment and public health. This study considered Busan in South Korea as a case study to investigate street canyons, including street canyon geometries and tree configurations, of old, present, and new city centers. The influence of morphological factors on the microclimate and outdoor thermal comfort was evaluated using the ENVI-met program for extremely hot weather. Changes in the street width, street orientation, and street canyon aspect ratio had a significantly higher impact on the microclimate and thermal comfort index (p < 0.01). These results indicated that the orientation of the main street should be consistent with the prevailing wind direction of Busan. Further, the shading of adjacent buildings improved the outdoor thermal comfort and reduced the significance of tree configuration in deeper street canyons. In addition, tree height had a more significant impact on street environment than other tree configuration factors, especially when the tree height increased from 9 m to 12 m. We recommended that the thermal comfort level can be improved by dynamically adjusting the relationship between the planting distance and tree height in streets having shallow street canyons.
OBJECTIVE: More patients are reaching end-stage kidney disease without evident cause. This study aims to explore occupational risk factors associated with hemodialysis. METHODS: A multicenter matched case-control study included dialysis patients and age, sex, and diabetes-matched controls (normal kidney function). Conditional logistic regression analysis assessed occupational factors associated with dialysis. RESULTS: Two hundred thirty eight hemodialysis patients and 238 controls were included. History of occupational heat exposure (odds ratio [OR] = 1.93; 95% confidence interval [CI]: 1.24 to 3.00), working as a cook (OR = 12; 95% CI: 1.56 to 92.29), as construction worker (OR = 10; 95% CI: 1.28 to 78.12) were associated with higher risk of dialysis. These results were significant in men and in those with kidney disease of unknown etiology. CONCLUSIONS: Occupational heat exposure was found to be associated with hemodialysis. This is an important step for future development of preventive strategies in high-risk professions.
The present comprehensive review (i) summarizes the current knowledge on the impacts of occupational heat stress on outdoor workers, (ii) provides a historical background on this issue, (iii) presents a meta-analysis of published data, (iv) explores inter-individual and intra-individual factors, (v) discusses the available heat mitigation strategies, (vi) estimates physical work capacity, labour productivity, and metabolic rate for the year 2030, and (vii) provides an overview of existing policy and legal frameworks on occupational heat exposure. Meta-analytic findings from 38 field studies that involved monitoring 2,409 outdoor workers across 41 jobs in 21 countries suggest that occupational heat stress increases the core (r = 0.44) and skin (r = 0.44) temperatures, as well as the heart rate (r = 0.38) and urine specific gravity (r = 0.13) of outdoor workers (all p < 0.05). Moreover, it diminishes the capacity of outdoor workers for manual labour (r = -0.82; p < 0.001) and is responsible for more than two thirds of the reduction in their metabolic rate. Importantly, our analysis shows that physical work capacity is projected to be highly affected by the ongoing anthropogenic global warming. Nevertheless, the metabolic rate and, therefore, labour productivity are projected to remain at levels higher than the workers' physical work capacity, indicating that people will continue to work more intensely than they should to meet their financial obligations for food and shelter. In this respect, complementary measures targeting self-pacing, hydration, work-rest regimes, ventilated garments, and mechanization can be adopted to protect outdoor workers.
Climate change is expected to lead to changes in seasonal temperature-related mortality. However, this impact on health risk does not necessarily scale linearly with increasing temperature. By examining changes in risk relative to degrees of global warming, we show that there is a delayed emergence of the increase in summer mean mortality risk in England and Wales. Due to the relatively mild summer mean temperatures under the current climate and the non-linearity of the exposure-response relationships, minimal changes in summer mean risk are expected at lower levels of warming and an escalation in risk is projected beyond 2.5 degrees C of global warming relative to pre-industrial levels. In contrast, a 42% increase in mortality risk during summer heat extremes is already expected by 2 degrees C global warming. Winter attributable mortalities, on the other hand, are projected to decrease largely linearly with global warming in England and Wales.
A large population in China has been exposed to both severe ozone (O-3) pollution and extreme heat under global warming. Here, the spatiotemporal characteristics of coupled extremes in surface O-3 and heat (OPCs) over China are investigated using surface observations, a process-based chemical transport model (GEOS-Chem), and multi-model simulations from Phase 6 of the Coupled Model Intercomparison Project (CMIP6). North China Plain (NCP; 37-41 degrees N; 114-120 degrees E) is identified as a hot spot of OPCs, where more than half of the O-3 pollution days are accompanied by high temperature extremes. OPCs over NCP exceeded 40 d during 2014-2019, exhibiting an increasing trend. Both O-3 concentrations and temperatures are elevated during OPCs compared with O-3 pollution days occurring individually (OPIs). Therefore, OPCs impose more severe health impacts to humans than OPIs, but the stronger health effects are mainly driven by the higher temperatures. GEOS-Chem simulations further reveal that enhanced chemical production resulting from hot and stable atmospheric conditions under anomalous weather patterns primarily contributes to the exacerbated O-3 levels during OPCs. In the future, CMIP6 projections suggest increased occurrences of OPCs over NCP in the middle of this century, but by the end of this century, OPCs may decrease or increase depending on the pollutant emission scenarios. However, for all future scenarios, extreme high temperatures will play an increasingly important role in modulating O-3 pollution in a warming climate.
INTRODUCTION: Wheat is grown and consumed worldwide, making it an important staple food crop for both its calorific and nutritional content. In places where wheat is used as a staple food, suboptimal micronutrient content levels, especially of grain iron (Fe) and zinc (Zn), can lead to malnutrition. Grain nutrient content is influenced by abiotic stresses, such as drought and heat stress. The best method for addressing micronutrient deficiencies is the biofortification of food crops. The prerequisites for marker-assisted varietal development are the identification of the genomic region responsible for high grain iron and zinc contents and an understanding of their genetics. METHODS: A total of 193 diverse wheat genotypes were evaluated under drought and heat stress conditions across the years at the Indian Agricultural Research Institute (IARI), New Delhi, under timely sown irrigated (IR), restricted irrigated (RI) and late sown (LS) conditions. Grain iron content (GFeC) and grain zinc content (GZnC) were estimated from both the control and treatment groups. Genotyping of all the lines under study was carried out with the single nucleotide polymorphisms (SNPs) from Breeder’s 35K Axiom Array. RESULT AND DISCUSSION: Three subgroups were observed in the association panel based on both principal component analysis (PCA) and dendrogram analysis. A large whole-genome linkage disequilibrium (LD) block size of 3.49 Mb was observed. A genome-wide association study identified 16 unique stringent marker trait associations for GFeC, GZnC, and 1000-grain weight (TGW). In silico analysis demonstrated the presence of 28 potential candidate genes in the flanking region of 16 linked SNPs, such as synaptotagmin-like mitochondrial-lipid-binding domain, HAUS augmin-like complex, di-copper center-containing domain, protein kinase, chaperonin Cpn60, zinc finger, NUDIX hydrolase, etc. Expression levels of these genes in vegetative tissues and grain were also found. Utilization of identified markers in marker-assisted breeding may lead to the rapid development of biofortified wheat genotypes to combat malnutrition.
Cities are one of the major contributors of climate change. The built environment urgently needs to significantly reduce its impact on resource depletion and its CO2 emissions. At the same time, urban environments must adapt to guarantee livability and safety in increasingly frequent severe conditions. To aid this process, assessment methods and indexes have been developed to help designers and researchers investigate optimal solutions for outdoor thermal comfort. Temperature increase during summer is a growing concern also in northern European cities such as Tallinn, Estonia. This paper presents a study on the comfort conditions of the outdoor areas of the TalTech campus in Tallinn during summer and investigates the cooling potential of vegetated surfaces and trees in the local micro-climate. A parametric design workflow was developed that integrates building and climate modeling, environmental and building simulations and outdoor comfort assessment through the metrics of Universal Thermal Climate Index and Outdoor Thermal Comfort Autonomy. The results show that heat stress can be experienced on the outdoor areas of the campus. The quantity and the optimal location of vegetated surfaces and trees to provide comfort were determined through the developed algorithm. The methods and the generated vegetation patterns are presented and discussed.
Climate change is most directly felt by people who cannot escape its impacts, including workers whose source of livelihood may put them directly at risk from high heat. Research on these impacts for Australian workers, especially the sociopolitical determinants of effective workplace heat management, remains limited. This article presents findings from a national research project that investigated these issues in collaboration with the Australia-based United Workers Union. It reports on the experiences of members exposed to high heat, explores how they address heat stress and how they relate this to climate change. The article expands understanding of the impacts of workplace heat, especially for indoor workers and those in lower paid jobs, through a focus on how workers articulate their experiences and understand and exercise their agency at work. JEL codes: Q54, J28
OBJECTIVE: To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS: This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS: A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS: The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect.
Heatwaves can have severe impacts on human health extending from illness to mortality. These health effects are related to not only the physical phenomenon of heat itself but other characteristics such as frequency, intensity, and duration of heatwaves. Therefore, understanding heatwave characteristics is a crucial step in the development of heat-health warning systems (HHWS) that could prevent or reduce negative heat-related health outcomes. However, there are no South African studies that have quantified heatwaves with a threshold that incorporated a temperature metric based on a health outcome. To fill this gap, this study aimed to assess the spatial and temporal distribution and frequency of past (2014 – 2019) and future (period 2020 – 2039) heatwaves across South Africa. Heatwaves were defined using a threshold for diurnal temperature range (DTR) that was found to have measurable impacts on mortality. In the current climate, inland provinces experienced fewer heatwaves of longer duration and greater intensity compared to coastal provinces that experienced heatwaves of lower intensity. The highest frequency of heatwaves occurred during the austral summer accounting for a total of 150 events out of 270 from 2014 to 2019. The heatwave definition applied in this study also identified severe heatwaves across the country during late 2015 to early 2016 which was during the strongest El Niño event ever recorded to date. Record-breaking global temperatures were reported during this period; the North West province in South Africa was the worst affected experiencing heatwaves ranging from 12 to 77 days. Future climate analysis showed increasing trends in heatwave events with the greatest increases (80%-87%) expected to occur during summer months. The number of heatwaves occurring in cooler seasons is expected to increase with more events projected from the winter months of July and August, onwards. The findings of this study show that the identification of provinces and towns that experience intense, long-lasting heatwaves is crucial to inform development and implementation of targeted heat-health adaptation strategies. These findings could also guide authorities to prioritise vulnerable population groups such as the elderly and children living in high-risk areas likely to be affected by heatwaves.
Climate change is likely to have wide-ranging impacts on maternal and neonatal health in Africa. Populations in low-resource settings already experience adverse impacts from weather extremes, a high burden of disease from environmental exposures, and limited access to high-quality clinical care. Climate change is already increasing local temperatures. Neonates are at high risk of heat stress and dehydration due to their unique metabolism, physiology, growth, and developmental characteristics. Infants in low-income settings may have little protection against extreme heat due to housing design and limited access to affordable space cooling. Climate change may increase risks to neonatal health from weather disasters, decreasing food security, and facilitating infectious disease transmission. Effective interventions to reduce risks from the heat include health education on heat risks for mothers, caregivers, and clinicians; nature-based solutions to reduce urban heat islands; space cooling in health facilities; and equitable improvements in housing quality and food systems. Reductions in greenhouse gas emissions are essential to reduce the long-term impacts of climate change that will further undermine global health strategies to reduce neonatal mortality.
Extreme heat shocks are increasingly linked to poor economic and health outcomes. This paper constructs hour-degree bins of temperature exposure to assess the effects of extreme heat on early child nutrition, a health outcome correlated with educational attainment and income in adulthood. Linking 15 rounds of repeated cross-section data from five West African countries to geo-coded weather data, we find that extreme heat exposure increases the prevalence of both chronic and acute malnutrition. We find that a 2 degrees C rise in temperature will increase the prevalence of stunting by 7.4 percentage points, reversing the progress made on improving nutrition during our study period.
In the coming few decades, projected increases in global temperature and humidity are generally expected to exacerbate human exposure to climate extremes (e.g., humid-heat and rainfall extremes). Despite the growing risk of humid-heat stress (measured by wet-bulb temperature), it has received less attention in East Africa, where arid and semi-arid climatic conditions prevail. Moreover, no consensus has yet been reached across models regarding future changes in rainfall over this region. Here, we screen Global Climate Models (GCMs) from CMIP5 and CMIP6 and use, for boundary conditions, simulations from only those GCMs that simulate successfully recent climatic trends. Based on these GCMs and Regional Climate Model (RCM) simulations, we project that annual mean temperature is likely to rise by 2 celcius toward midcentury (2021-2050) at a faster rate than the global average (about 1.5 celcius), under the RCP8.5 and SSP5-8.5 scenarios, associated with more frequent and severe climate extremes. In particular, low-lying regions in East Africa will be vulnerable to severe heat stress, with an extreme wet-bulb temperature approaching or exceeding the US National Weather Service’s extreme danger threshold of 31 celcius. On the other hand, population centers in the highlands of Ethiopia will receive significantly more precipitation during the autumn season and will see more extreme rainfall events, with implications for flooding and agriculture. The robustness of these results across all GCM and RCM simulations, and for both of CMIP5 and CMIP6 frameworks (CMIP: Coupled Model Inter-comparison Project) supports the reliability of these future projections. Our simulations of near-term climate change impacts are designed to inform the development of sound adaptation strategies for the region.
Countries with abundant solar radiation have the potential to invest in simple technologies for deactivation of many bacteria and viruses in medical solid waste. In addition to the traditional Infection and Prevention Control (IPC) measures, these simple technologies contribute to better protection of health care workers in countries with compromised solid management schemes. Monitoring of temperature, relative humidity and ultraviolet inside containers soundly designed to collect disposal infectious waste illustrated to deactivate several viruses and bacteria. Casanova et al., 2010, used some surrogate viruses to overcome the challenges of working with SARS-CoV, concluded that by temperature above 40 °C most of viruses become below levels of detection after 90 min. Here we are proposing a model of a simple transparent container almost 200 L in volume that allow solar energy to be accumulated inside. In summer conditions in the testing site, temperature inside the container reached above 50 °C when the ambient air temperature was around 30 °C. The container was built using epoxy glass to guarantee maximum heat penetration. Actual temperature measurement inside the container was measured in real time against ambient air temperature. We present a mathematical model for predication of maximum temperature at different positions inside the container and their relation to different ambient air temperature scenarios. The mathematical formulas used are based on the conservation laws and a good agreement of a full month of field measurements were obtained. Even in winter conditions in many of developing countries air temperature can maintain levels above 20 °C, which will produce temperature around 30 °C and viruses can reach levels below detection limit in maximum 3 h.
The goal of this article is to consider data solutions to investigate the differential pathways that connect climate/weather variability to child health outcomes. We apply several measures capturing different aspects of climate/weather variability to different time periods of in utero exposure. The measures are designed to capture the complexities of climate-related risks and isolate their impacts based on the timing and duration of exposure. Specifically, we focus on infant birth weight in Mali and consider local weather and environmental conditions associated with the three most frequently posited potential drivers of adverse health outcomes: disease (malaria), heat stress, and food insecurity. We focus this study on Mali, where seasonal trends facilitate the use of measures specifically designed to capture distinct aspects of climate/weather conditions relevant to the potential drivers. Results indicate that attention to the timing of exposures and employing measures designed to capture nuances in each of the drivers provides important insight into climate and birth weight outcomes, especially in the case of factors impacted by precipitation. Results also indicate that high temperatures and low levels of agricultural production are consistently associated with lower birth weights, and exposure to malarious conditions may increase likelihood of nonlive birth outcomes.
More recurrent heat waves and extreme ozone (O(3)) episodes are likely to occur during the next decades and a key question is about the concurrence of those hazards, the atmospheric patterns behind their appearance, and their joint effect on human health. In this work, we use surface maximum temperature and O(3) observations during extended summers in two cities from Morocco: Casablanca and Marrakech, between 2010 and 2019. We assess the connection between these data and climate indices (North Atlantic Oscillation (NAO), Mediterranean Oscillation (MO), and Saharan Oscillation (SaO)). We then identify concurrent heat waves and O(3) episodes, the weather type behind this concurrence, and the combined health risks. Our findings show that the concurrence of heat waves and O(3) episodes depends both on the specific city and the large-scale atmospheric circulation. The likely identified synoptic pattern is when the country is under the combined influence of an anticyclonic area in the north and the Saharan trough extending the depression centered in the south. This pattern generates a warm flow and may foster photochemical pollution. Our study is the first step toward the establishment of an alert system. It will help to provide recommendations for coping with concurrent heat waves and air pollution episodes.
With heat stress as a notable climate-related challenge in Africa, the need to limit heat exposure and enhance adaptation becomes important. Behavioural responses and heat-resistant characteristics of residential buildings are key aspects of exposure and adaptation to heat stress. We report a study that investigates heat exposure and adaptation responses across two neighbourhoods of different socio-economic status in Akure, Nigeria. The study involved a survey of 70 residents in each of the neighbourhoods. The study shows differences and commonalities in personal behavioural responses to heat stress, further revealing that education (p < 0.000), household income (p < 0.001) and gender (p < 0.002) were significant predictors of behavioural responses. Heat-resistant features in dwellings in both neighbourhoods were also identified. The poorer neighbourhood was more disadvantaged in this regard as their housing features did not completely prevent heat exposure. People in the richer neighbourhood, much more than the poorer one, were able to include features such as A/C, ceramic tiles, shady plants to cope with heat. These findings highlight intra-urban inequality in heat exposure and adaptation. They show the need for initiatives towards improved awareness and comprehensive retrofitting of dwellings to enhance their heat-resistant capacity.A
The disruptions of anthropogenic climate change are increasingly severe. People living in sub-Saharan Africa are especially exposed to these risks, and amongst them young people. It is well established that climate disruptions have the potential to halt education, displace populations, and wreck infrastructure. This rigorous literature review focuses on climate change in the landlocked East African country of Uganda, demographically the world’s third youngest country, where young people struggle to get by due to insufficient work opportunities. Extended to other countries in the Eastern and Central African region, the review considers what is known about the intersection of youth livelihoods and climate change; young people’s susceptibility to climate disruption due to limited resources and livelihood options; and the constraints around their responses. The review findings suggest the need for substantial youth informed interventions to bolster young people’s economic resilience and adaptive capacity given the worsening climate change and prolonged population growth.
Climate change presents significant threats to human health, especially for low-income urban communities in the Global South. Despite numerous studies of heat stress, surprisingly little is known about the temperatures actually encountered by people in their homes, or the benefits of affordable adaptations. This paper examines indoor air temperature measurements gathered from 47 living rooms within eight low-income communities of Accra and Tamale, Ghana. Using multiple temperature indices and a tiered analysis, we evaluate indoor temperature variations linked to roof type, ceiling insulation, presence of fans, and tree shade, for different housing types and locations. Our data reveal indoor temperatures in the range 22.4 degrees C to 45.9 degrees C for Accra, and 22.2 degrees C to 43.0 degrees C in Tamale. Using dummy regression analysis, we find that tree shade reduces the number of very hot days (>40 degrees C) and nights (>30 degrees C) by about 12 and 15 d per year, respectively. Building materials also strongly moderate indoor temperatures but in opposing ways: rooms with traditional mud walls and thatch roofs are on average 4.5 degrees C cooler than rooms in concrete block houses with uninsulated metal roofs during the day but are 1.5 degrees C warmer at night; rooms with ceiling insulation are on average 6.9 degrees C cooler in the day but 1.4 degrees C warmer at night. We conclude that sub-daily data are necessary for reporting extreme indoor temperatures, and that trade-offs between minimum and maximum temperatures require interventions to be assessed carefully before attempting to counter extreme heat inside homes.
Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures. Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be co-designed and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent.
Although mixed methods research proves significant in understanding complex social phenomenon, inadequate research has explored its utility in heat exposure studies. The convergent mixed methods analysis comprising 320 surveys and two focus group interviews were used to evaluate the social impacts of occupational heat stress on Ghanaian mineworkers to enlighten policy choices for the purpose of complementarity. The study contributes to mixed methods study by affirming the practical use of between-method triangulation and complementarity. The merged quantitative and qualitative results also showed adequate corroboration and complementarity between both data, to illustrate the social impacts of work-related heat stress on mining workers as heat-related comorbidity, productive capacity loss, anxiety, slow pace of work, and inadequate social well-being. The mixed methods results would inform policy options on the health and safety of work settings, managing occupational heat stress, and adaptation guidelines in the mining industry.
As global temperatures continue to rise unabated, episodes of heat-related catastrophes across the world have intensified. In Kenya, heatwave phenomena and their associated impacts are ignored and neglected due to several reasons, including unreliable and inconsistent weather datasets and heatwave detection metrics. Based on CHIRTS satellite infrared estimates and station blended temperature, this study investigated the spatiotemporal distribution of the heatwave events over Kenya during 1987-2016 using the Heatwave Magnitude Index daily (HWMId). The results showed that contrary to the absence of heatwave records in official national and international disaster database about Kenya, the country experienced heatwaves ranging from less severe (normal) to deadly (super-extreme) between 1987 and 2016. The most affected areas were located in the eastern parts of the country, especially in Garissa and Tana River, and in the west-northern side around the upper side of Turkana county. It was also found that the recent years’ heatwaves were more severe in magnitude, duration, and spatial extent. The highest magnitude of the heatwaves was recorded in 2015 (HWMId = 22.64) while the average over the reference period is around 6. CHIRTS and HWMId were able to reveal and capture most critical heatwave events over the study period. Therefore, they could be used respectively as data source and detection metrics, for heatwaves disaster emergency warning over short period as well as for long-term projection to provide insight for adaptation strategies.
The ability of poor urban populations in developing countries to adapt to rapid increase in surface temperature and likely health effect of a 1.5 °C increase in global temperature is uncertain. Rapid urbanization and poor socio, economic, and technological development may increase heat vulnerabilities of poor urban populations in tropical cities. This study examines the thermal perception of urban populations in Ibadan, south western Nigeria, and sociodemographic characteristics of individuals that influence thermal perception, self-reported health effects, and coping strategies to heat stress using a purposefully designed questionnaire and interviews with aged individuals in the five local government areas of Ibadan metropolis. Differences in sociodemographic characteristics of respondents such as inequalities in monthly income, occupation, ethnicity, housing characteristics, and length of stay in Ibadan significantly influence thermal perception, self-reported health effects of heat exposure, and coping strategies adopted. Perceived thermal conditions reported were warmer temperatures during the day and night (43.75%), warmer day-time temperatures (40.25%), and warmer night-time temperatures (16%). Dehydration and sweating (56%): heat rash, heat exhaustion, headaches, sleep disturbances and dehydration (15.25%), and sleep disturbance and sweating (12.25%) were major combinations of self-reported health effects. Other effects include fainting, diarrhea, raised blood pressure, and restlessness. Temperature variations (minimum and maximum) examined from 1971 to 2018 shows that warmer conditions are being experienced in Ibadan. Increased heat-health awareness and urban designs that respond to people’s thermal perception should be encouraged in developing thermally comfortable environments in Ibadan.
The Sahelian zone of Senegal experienced heat waves in the previous decades, such as 2013, 2016 and 2018 that were characterised by temperatures exceeding 45°C for up to 3 successive days. The health impacts of these heat waves are not yet analysed in Senegal although their negative effects have been shown in many countries. This study analyses the health impacts of observed extreme temperatures in the Sahelian zone of the country, focusing on morbidity and mortality by combining data from station observation, climate model projections, and household survey to investigate heat wave detection, occurrence of climate-sensitive diseases and risk factors for exposure. To do this, a set of climatic (temperatures) and health (morbidity, mortality) data were collected for the months of April, May and June from 2009 to 2019. These data have been completed with 1246 households’ surveys on risk factor exposure. Statistical methods were used to carry out univariate and bivariate analyses while cartographic techniques allowed mapping of the main climatic and health indicators. The results show an increase in temperatures compared to seasonal normal for the 1971-2000 reference period with threshold exceedances of the 90th percentiles (42°C) for the maxima and (27°C) the minima and higher temperatures during the months of May and June. From health perspective, it was noted an increase in cases of consultation in health facilities as well as a rise in declared morbidity by households especially in the departments of Kanel (17.7%), Ranérou (16.1 %), Matam (13.7%) and Bakel (13.7%). The heat waves of May 2013 were also associated with cases of death with a reported mortality (observed by medical staff) of 12.4% unequally distributed according to the departments with a higher number of deaths in Matam (25, 2%) and in Bakel (23.5%) than in Podor (8.4%) and Kanel (0.8%). The morbidity and mortality distribution according to gender shows that women (57%) were more affected than men (43%). These health risks have been associated with a number of factors including age, access to drinkable water, type of fuel, type of housing and construction materials, existence of fan and an air conditioner, and health history.The heat wave recurrence has led to a frequency in certain diseases sensitive to rising temperatures, which is increasingly a public health issue in the Sahelian zone of Senegal.
Climate change poses a major threat to the future of today’s youth. Globally, young people are at the forefront of climate change activism. Their ability to engage, however, depends on the level of knowledge of climate change and concern about the topic. We sought to examine levels of knowledge and concerns about climate change among youth in South Africa, and their experiences of heat exposure. Ten questions on climate change knowledge, concerns and experiences were nested within a cross-sectional survey conducted in a cluster randomised trial among 924 secondary school learners in 14 public schools in low-income Western Cape areas. Learners’ mean age was 15.8 years and they were predominately female. While 72.0% of respondents knew that climate change leads to higher temperatures, only 59.7% agreed that human activity is responsible for climate change, and 58.0% believed that climate change affects human health. Two thirds (68.7%) said that climate change is a serious issue and 65.9% indicated action is needed for prevention. Few learners indicated climate change events had affected them, although many reported difficulties concentrating during hot weather (72.9%). Female learners had lower knowledge levels than male learners, but more frequent heat-related symptoms. Learners scoring high on knowledge questions expressed the most concern about climate change and had the highest heat impacts. Many youth seem unaware that climate change threatens their future. Heat-related symptoms are common, likely undermining educational performance, especially as temperatures escalate. More is needed to mainstream climate change into South African school curricula.
Increasing air temperature coupled with high humidity due to ongoing climate change across most parts of South Africa is likely to induce and intensify heat exposure, particularly in densely populated areas. The adverse health implications, including heatstroke, are expected to be common and more severe during extreme heat and heat wave events. The present study was carried out to examine heat stress conditions and long-term trends in South Africa. The study aimed to identify geographical locations exposed to elevated heat stress based on over two decades of hourly ground-based data. Selected heat stress indicators were calculated based on Steadman’s apparent temperature (AT in degrees C). The trends in AT were assessed based on the non-parametric Mann-Kendall (MK) trend test at 5% significance level. Positive trends were detected in 88% of the selected weather stations except in Welkom-FS, Ficksburg-FS, Langebaanweg-WC, Lambertsbaai Nortier-WC, Skukuza-MP, and Thabazimbi-LP. Approximately 47% of the detected positive trends are statistically significant at 5% significant level. Overall, high climatological annual median (ATmed) values (>32 degrees C) were observed at 42 stations, most of which are in low altitude regions, predominately along the coastlines. The hottest towns with ATmed values in the danger category (i.e., 39-50 degrees C) were found to be Patensie-EC (41 degrees C), Pietermaritzburg-KZN (39 degrees C), Pongola-KZN (39 degrees C), Knysna-WC (39 degrees C), Hoedspruit-LP (39 degrees C), Skukuza-MP (45 degrees C), and Komatidraai-MP (44 degrees C). The results provide insight into heat stress characteristics and pinpoint geographical locations vulnerable to heat stress conditions at the community level in South Africa. Such information can be useful in monitoring hotspots of heat stress and contribute to the development of local heat-health adaptation plans.
Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22-43 weeks’ gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017-June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low and high temperatures were defined as the 5th and 95th percentiles of daily mean temperature, respectively. Of 7986 women included, 844 (10.6%) had a hypertensive disorder of which 432 (51.2%) had high blood pressure/hypertension/gestational hypertension and 412 (48.8%) had pre-eclampsia/eclampsia/HELLP. High temperature in early pregnancy was associated with an increased risk of pre-eclampsia/eclampsia/HELLP. High temperature (23 °C vs 18 °C) in the third and fourth weeks of pregnancy posed the greatest risk, with hazard ratios of 1.76 (95% CI 1.12-2.78) and 1.79 (95% CI 1.19-2.71), respectively. Whereas, high temperatures in mid-late pregnancy tended to protect against pre-eclampsia/eclampsia/HELLP. Low temperature (11°) during the third trimester (from 29 weeks’ gestation) was associated with an increased risk of high blood pressure/hypertension/gestational hypertension, however the strength and statistical significance of low temperature effects were reduced with model adjustments. Our findings support the hypothesis that high temperatures in early pregnancy increase risk of severe hypertensive disorders, likely through an effect on placental development. This highlights the need for greater awareness around the impacts of moderately high temperatures in early pregnancy through targeted advice, and for increased monitoring of pregnant women who conceive during periods of hot weather.
Both climate change and rapid urbanization accelerate exposure to heat in the city of Kampala, Uganda. From a network of low-cost temperature and humidity sensors, operational in 2018-2019, we derive the daily mean, minimum and maximum Humidex in order to quantify and explain intra-urban heat stress variation. This temperature-humidity index is shown to be heterogeneously distributed over the city, with a daily mean intra-urban Humidex Index deviation of 1.2 degrees C on average. The largest difference between the coolest and the warmest station occurs between 16:00 and 17:00 local time. Averaged over the whole observation period, this daily maximum difference is 6.4 degrees C between the warmest and coolest stations, and reaches 14.5 degrees C on the most extreme day. This heat stress heterogeneity also translates to the occurrence of extreme heat, shown in other parts of the world to put local populations at risk of great discomfort or health danger. One station in a dense settlement reports a daily maximum Humidex Index of >40 degrees C in 68% of the observation days, a level which was never reached at the nearby campus of the Makerere University, and only a few times at the city outskirts. Large intra-urban heat stress differences are explained by satellite earth observation products. Normalized Difference Vegetation Index has the highest (75%) power to predict the intra-urban variations in daily mean heat stress, but strong collinearity is found with other variables like impervious surface fraction and population density. Our results have implications for urban planning on the one hand, highlighting the importance of urban greening, and risk management on the other hand, recommending the use of a temperature-humidity index and accounting for large intra-urban heat stress variations and heat-prone districts in urban heat action plans for tropical humid cities.
Over the past years, cities have become more prone to extreme and frequent heatwaves. In this regard, urban form plays an important role and several typomorphological classifications have been developed to describe the urban form characteristics that can exacerbate heat stress and influence people’s health and comfort negatively (i.e. the environmental dimension of heat-stress resilience). Nevertheless, evidence from past heatwave disasters indicates that other urban form characteristics, not included in existing typomorphological classifications, can significantly affect heat-stress resilience by influencing the conditions of social interaction and the state of social ties and solidarities in urban neighborhoods (i.e. the social dimension). Therefore, this paper proposes a broader approach combining the aforementioned environmental and social dimensions in the classification of urban form types; and demonstrates its application in a real-world case by developing a data-driven typomorphological classification that complements existing ones with the missing social dimension. The results showed the possi-bility of numerically identifying neighborhood types that, through distinct urban form characteristics, have different potentials for enhancing the social dimension of heat-stress resilience. This has direct planning and design relevance as the quantifiable characteristics of these types can be translated into guidelines/rules and incorporated into local regulations/codes.
Heat stress-related illness attributed to the changing climate, particularly the more frequent extreme high temperatures, is becoming a theme of public concern, especially in the most vulnerable regions, such as the African continent. Knowledge of the existing research directions and gaps on heat stress and human health is vital for informing future strategic research foci capable of influencing policy development, planning, adaptation, and mitigation efforts. In this regard, a bibliometric analysis was conducted, with an emphasis on Africa, to assess regional research contributions to heat stress impacts on human health. The goals of the study were to review publication growth and patterns of the scientific publications and to identify key players (especially collaborating institutions and countries) and the evolution of research themes on the African continent, while paying attention to global trends and emergent hot topics and methodology of heat stress research. Using the Web of Science (WoS) and Scopus core collection databases, a structured keyword search was undertaken, which yielded 463 and 58 research publications from around the world and Africa, respectively. The retrieved scientific documents, published between 1968 and 2020, were analyzed and visualized using a bibliometric analysis technique and the VOSviewer software tool. The results indicate low statistics and slow scientific growth in publication output, with the highest peak having been reached in 2018, resulting in 13 scientific publications. While global research collaborations are successfully reflected in the literature, there is a considerable gap in understanding heat stress and related collaborations between African countries and international institutions. The review study has identified key opportunities that can benefit Africa through the expansion of the scope of heat stress and human health research on the continent. These opportunities can be achieved by closing the following research gaps: (1) vulnerability assessments within demographic classes, such as the elderly, (2) personal exposure and associated risks, (3) Urban Heat Island (UHI) evaluation for urban environments, and (4) heat adaptation research, which will enable informed and targeted preventive actions that will limit future heat health impacts. The authors opine that the pursuit of such studies will be most impactful if the current knowledge gaps are bridged through transdisciplinary research supported by local, regional, and international collaborators.
Climate change and expected weather patterns in the long-term threaten the livelihood inside oases settlements in arid lands, particularly under the recurring heat waves during the harsh months. This paper investigates the impact of climate change on the outdoor thermal comfort within a multifamily housing neighborhood that is considered the most common residential archetype in Algerian Sahara, under extreme weather conditions in the summer season, in the long-term. It focuses on assessing the outdoor thermal comfort in the long-term, based on the Perceived Temperature index (PT), using simulation software ENVI-met and calculation model RayMan. Three different stations in situ were conducted and combined with TMY weather datasets for 2020 and the IPCC future projections: A1B, A2, B1 for 2050, and 2080. The results are performed from two different perspectives: to investigate how heat stress evolution undergoes climate change from 2020 till 2080; and for the development of a mathematical algorithm to predict the outdoor thermal comfort values in short-term, medium-term and long-term durations. The results indicate a gradual increase in PT index values, starting from 2020 and progressively elevated to 2080 during the summer season, which refers to an extreme thermal heat-stress level with differences in PT index averages between 2020 and 2050 (+5.9 degrees C), and 2080 (+7.7 degrees C), meaning no comfortable thermal stress zone expected during 2080. This study gives urban climate researchers, architects, designers and urban planners several insights into predicted climate circumstances and their impacts on outdoor thermal comfort for the long-term under extreme weather conditions, in order to take preventive measures for the cities’ planning in the arid regions.
BACKGROUND: Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus. METHODS: We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain. FINDINGS: Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase. INTERPRETATION: Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions. FUNDING: The Wellcome Trust.
Indoor thermal comfort is essential for occupants’ well-being, productivity, and efficiency. Global climate change is leading to extremely high temperatures and more intense solar radiation, especially in hot, humid areas. Passive cooling is considered to be one of the environmental design strategies by which to create indoor thermal comfort conditions and minimize buildings’ energy consumption. However, little evidence has been found regarding the effect of passive cooling on the thermal comfort of historical buildings in hot-dry or hot-humid areas. Therefore, we explored the passive cooling features (north-south orientation, natural ventilation, window shading, and light color painted walls) applied in historic residential buildings in Zanzibar and evaluated the residents’ thermal responses and comfort perception based on questionnaires and field surveys. The results showed that the average predicted mean votes (PMVs) were 1.23 and 0.85 for the two historical case study buildings; the average predicted percentages of dissatisfaction (PPD) were 37.35% and 20.56%, respectively. These results indicate that the thermal conditions were not within the acceptable range of ASHRAE Standard 55. Further techniques, such as the use of lime plaster, wash lime, and appropriate organization, are suggested for the improvement of indoor thermal comfort in historical buildings in Zanzibar. This study provides guidelines to assist architects in designing energy-efficient residential buildings, taking into account cultural heritage and thermal comfort in buildings.
Nearly 1 billion people live without electricity at home. Energy poverty limits their ability to take autonomous actions to improve air circulation and the cooling of their homes. It is therefore important that electricity-access planners explicitly evaluate the current and future air circulation and cooling needs of energy-poor households, in addition to other basic energy needs. To address this issue, we combine climate, socio-economic, demographic and satellite data with scenario analysis to model spatially explicit estimates of potential cooling demand from households that currently lack access to electricity. We link these demand factors into a bottom-up electrification model for sub-Saharan Africa, the region with the world’s highest concentration of energy poverty. Accounting for cooling needs on top of baseline household demand implies that the average electrification investment requirements grow robustly (a scenario mean of 65.5% more than when considering baseline household demand only), mostly due to the larger generation capacity needed. Future climate change could increase the investment requirements by an additional scenario mean of 4%. Moreover, the share of decentralised systems as the lowest-cost electrification option falls by a scenario mean 4.5 percentage points of all new connections. The crucial determinants for efficient investment pathways are the adoption and use of cooling appliances, the extent of climate change, and the baseline electricity demand. Our results call for a more explicit consideration of climate-adaptative energy needs by infrastructure planners in developing countries.
Extreme weather events are major causes of loss of life and damage infrastructure worldwide. High temperatures cause heat stress on humans, livestock, crops and infrastructure. Heat stress exposure is projected to increase with ongoing climate change. Extremes of temperature are common in Africa and infrastructure is often incapable of providing adequate cooling. We show how easily accessible cooling technology, such as evaporative coolers, prevent heat stress in historic timescales but are unsuitable as a solution under climate change. As temperatures increase, powered cooling, such as air conditioning, is necessary to prevent overheating. This will, in turn, increase demand on already stretched infrastructure. We use high temporal resolution climate model data to estimate the demand for cooling according to two metrics, firstly the apparent temperature and secondly the discomfort index. For each grid cell we calculate the heat stress value and the amount of cooling required to turn a heat stress event into a non heat stress event. We show the increase in demand for cooling in Africa is non uniform and that equatorial countries are exposed to higher heat stress than higher latitude countries. We further show that evaporative coolers are less effective in tropical regions than in the extra tropics. Finally, we show that neither low nor high efficiency coolers are sufficient to return Africa to current levels of heat stress under climate change.
Investigating the effects of the increased global warming through the lens of the Paris agreements would be of particular importance for Central African countries, which are already experiencing multiple socio-political and socio-economic constraints, but are also subject to severe natural hazards that interact to limit their adaptive capacity and thus increase their vulnerability to the adverse effects of climate change. This study explores changes in heat stress and the proportion of population at risk of discomfort over Central Africa, based on an ensemble-mean of high-resolution regional climate model simulations that cover a 30-year period, under 1.5, 2 and 3 °C Global Warming Levels (GWLs). The heat index was computed according to Rothfusz’s equation, while the discomfort index was obtained from Thom’s formula. The results show that throughout the year but with a predominance from March to August, the spatial extent of both heat and discomfort categories is projected to gradually increase according to the considered GWLs (nearly threefold for an increasing warming thresholds from 1.5 to 3 °C). As these heat conditions become more frequent, they lead to the emergence of days with potentially dangerous heat-related risks, where almost everyone feels discomfort due to heat stress. It thus appears that the majority of populations living in countries located along the Atlantic coast and in the northern and central part of the study area are likely to be more vulnerable to certain health problems, which could have repercussions on the socio-economic development of the sub-region through decreased workers’ productivity and increased cooling degree days. Overall, these heat-related risks are more extended and more frequent when the GWL reaches 2 °C and above.
Objectives This study of Samburu pastoralists (Kenya) employs a same-sex sibling design to test the hypothesis that exposure in utero to severe drought and maternal psychosocial stress negatively influence children’s growth and adiposity. As a comparison, we also hypothesized that regional climate contrasts would influence children’s growth and adiposity based on ecogeographical patterning. Materials and Methods Anthropometric measurements were taken on Samburu children ages 1.8-9.6 years exposed to severe drought in utero and younger same-sex siblings (drought-exposed, n = 104; unexposed, n = 109) in two regions (highland, n = 128; lowland, n = 85). Mothers were interviewed to assess lifetime and pregnancy-timed stress. Results Drought exposure associated to lower weight-for-age and higher adiposity. Drought did not associate to tibial growth on its own but the interaction between drought and region negatively associated to tibial growth in girls. In addition, drought exposure and historically low rainfall associated to tibial growth in sensitivity models. A hotter climate positively associated to adiposity and tibial growth. Culturally specific stressors (being forced to work too hard, being denied food by male kin) associated to stature and tibial growth for age. Significant covariates for child outcomes included lifetime reported trauma, wife status, and livestock. Discussion Children exposed in utero to severe drought, a hotter climate, and psychosocial stress exhibited growth differences in our study. Our results demonstrate that climate change may deepen adverse health outcomes in populations already psychosocially and nutritionally stressed. Our results also highlight the value of ethnography to identifying meaningful stressors.
This paper evaluates the short-term health effects of in utero drought shock using repeated cross-section household data on Malawi. The main finding reveals that the effects of in utero harvest variability caused by rainfall shocks on child growth indices are driven by the deleterious effects of negative rainfall deviations, namely droughts. Negative rainfall deviation during the agricultural season prior to the gestational period of a child leads to a 21.8 per cent average local level reduction in age-standardized height scores, with the counterpart positive rainfall deviation having no apparent effect. The paper also uses harvest and consumption patterns to establish an important link between early-life malnutrition and growth serving as a precursor for the fetal period programming hypothesis in the literature. The direct impact of embryonic period shocks on growth provides supportive evidence on potential interaction between nutritional and environmental pathways.
Extreme Temperature Events (ETEs), including heatwaves, warm spells, cold waves and cold spells, have disastrous impacts on human health and ecosystems. The frequency, intensity, and duration of ETEs is projected to increase due to climate change. However, very little research has been done on ETEs in South Africa, and only a few attempts have been made to identify and examine trends. Currently, ten known publications have examined ETEs across South Africa, the majority of which use the South African Weather Service (SAWS) climate database as the primary source. The general findings indicate that the incidence and duration of extreme warm temperatures are increasing, while cold extremes are decreasing. However, inconstancies exist in the indices used to identify ETEs, selection of meteorological stations, study period, and statistical methods used to examine trends. We review the methodological approaches to define ETEs, the extreme temperature indices adopted, the selection of meteorological stations, study periods, data quality and homogeneity, statistical trend analysis, and results. From these, we propose an approximate number of stations to adequately portray temperature variability on a national and regional level. Finally, we reflect on projections of ETEs under current climate change conditions, and the implications of cold and warm ETEs in a South African context.
According to the Intergovernmental Panel on Climate Change (IPCC), the global mean temperature is expected to increase from 1.4°C to 5.8°C by 2100. The implications will be particularly significant in urban areas as indoor and outdoor comfort levels will be disrupted, leading to significant health impacts. One of the expected impacts is indoor overheating, as it has been identified as one of the major causes of thermal discomfort and is directly linked to the potential increase in mortality levels in the future. This paper focuses on the potential implications of increased overheating hours on human health in an old low-income residential neighborhood. We study the effect of three main factors: population coping capacity, building thermal performance, and human physiological response to heat exposure. This is achieved by examining an old low-income neighborhood in Cairo, Egypt, whose residents have limited cooling systems access. Results indicate higher overheating risks in older buildings with a projected increase of 18% in indoor temperature and higher health risks, especially for elderly residents. The study’s findings can be considered a starting point to examine the relationship between exposure duration, indoor air temperature range, and potential health risks for vulnerable urban communities with limited access to cooling mechanisms such as AC units.
BACKGROUND: Temperature and precipitation are known to affect Vibrio cholerae outbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought. METHODS: Here, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO(2) emissions, socio-economic development, and population growth. RESULTS: The best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous. CONCLUSIONS: Despite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis.
Climate change threatens the health and well-being of populations. We conducted a risk assessment of two climate-related variables (i.e., temperature and rainfall) and associated water, sanitation and hygiene (WASH)-related exposures and vulnerabilities for people living in Mopani District, Limpopo province, South Africa. Primary and secondary data were applied in a qualitative and quantitative assessment to generate classifications of risk (i.e., low, medium, or high) for components of hazard/threat, human exposure, and human vulnerability. Climate-related threats were likely to impact human health due to the relatively high risk of waterborne diseases and WASH-associated pathogens. Vulnerabilities that increased the susceptibility of the population to these adverse outcomes included environmental, human, physical infrastructure, and political and institutional elements. People of low socio-economic status were found to be least likely to cope with changes in these hazards. By identifying and assessing the risk to sanitation services and water supply, evidence exists to inform actions of government and WASH sector partners. This evidence should also be used to guide disaster risk reduction, and climate change and human health adaptation planning.
Malaria is a critical health issue across the world and especially in Africa. Studies based on dynamical models helped to understand inter-linkages between this illness and climate. In this study, we evaluated the ability of the VECTRI community vector malaria model to simulate the spread of malaria in Cameroon using rainfall and temperature data from FEWS-ARC2 and ERA-interim, respectively. In addition, we simulated the model using five results of the dynamical downscaling of the regional climate model RCA4 within two time frames named near future (2035-2065) and far future (2071-2100), aiming to explore the potential effects of global warming on the malaria propagation over Cameroon. The evaluated metrics include the risk maps of the entomological inoculation rate (EIR) and the parasite ratio (PR). During the historical period (1985-2005), the model satisfactorily reproduces the observed PR and EIR. Results of projections reveal that under global warming, heterogeneous changes feature the study area, with localized increases or decreases in PR and EIR. As the level of radiative forcing increases (from 2.6 to 8.5 W.m(-2)), the magnitude of change in PR and EIR also gradually intensifies. The occurrence of transmission peaks is projected in the temperature range of 26-28 °C. Moreover, PR and EIR vary depending on the three agro-climatic regions of the study area. VECTRI still needs to integrate other aspects of disease transmission, such as population mobility and intervention strategies, in order to be more relevant to support actions of decision-makers and policy makers.
The study examined the effect of heat stress on the well-being of outdoor workers and their coping strategies. A cross-sectional survey study was conducted between September 2019 and December 2019 to collect data from outdoor workers including hawkers and traffic wardens from 13 urban areas (N = 322) and analyzed using SPSS v.23. The results of the study show that most of the outdoor workers were in a good health state based on their self-health assessment. However, the respondents expressed concerns and symptoms of heat stress including heat cramps, heat exhaustion, heat stroke and sleep disorders. The findings also show that male outdoor workers were 1.3 times more likely than females to be affected by heat stress. Respondents in their 20s were more likely to be affected by heat stress, as a result of temperatures and humidity conditions, than those in their 30s (OR = 0.389, CI = 0.158-0962) and 40s (OR = 0.395, CI = 0.147-1.063). Coping strategies identified include the use of breathable cotton attires, drinking a lot of water, hiding under shades and reducing outdoor activity intermittently.
The 2019 and 2020 sporadic outbreaks of yellow fever (YF) in Sub-Saharan African countries had raised a lot of global health concerns. This article aims to narratively review the vector biology, YF vaccination program, environmental factors and climatic changes, and to understand how they could facilitate the reemergence of YF. This study comprehensively reviewed articles that focused on the interplay and complexity of YF virus (YFV) vector diversity/competence, YF vaccine immunodynamics and climatic change impacts on YFV transmission as they influence the 2019/2020 sporadic outbreaks in Sub-Saharan Africa (SSA). Based on available reports, vectorial migration, climatic changes and YF immunization level could be reasons for the re-mergence of YF at the community and national levels. Essentially, the drivers of YFV infection due to spillover are moderately constant. However, changes in land use and landscape have been shown to influence sylvan-to-urban spillover. Furthermore, increased precipitation and warmer temperatures due to climate change are likely to broaden the range of mosquitoes’ habitat. The 2019/2020 YF outbreaks in SSA is basically a result of inadequate vaccination campaigns, YF surveillance and vector control. Consequently, and most importantly, adequate immunization coverage must be implemented and properly achieved under the responsibility of the public health stakeholders.
BACKGROUND: Malaria has continued to be a life-threatening disease among under-five children in sub-Saharan Africa. Recent data indicate rising cases in Rwanda after some years of decline. We aimed at estimating the spatial variations in malaria prevalence at a continuous spatial scale and to quantify locations where the prevalence exceeds the thresholds of 5% and 10% across the country. We also consider the effects of some socioeconomic and climate variables. METHODS: Using data from the 2014-2015 Rwanda Demographic and Health Survey, a geostatistical modeling technique based on stochastic partial differential equation approach was used to analyze the geospatial prevalence of malaria among under-five children in Rwanda. Bayesian inference was based on integrated nested Laplace approximation. RESULTS: The results demonstrate the uneven spatial variation of malaria prevalence with some districts including Kayonza and Kirehe from Eastern province; Huye and Nyanza from Southern province; and Nyamasheke and Rusizi from Western province having higher chances of recording prevalence exceeding 5%. Malaria prevalence was found to increase with rising temperature but decreases with increasing volume for rainfall. The findings also revealed a significant association between malaria and demographic factors including place of residence, mother’s educational level, and child’s age and sex. CONCLUSIONS: Potential intervention programs that focus on individuals living in rural areas, lowest wealth quintile, and the locations with high risks should be reinforced. Variations in climatic factors particularly temperature and rainfall should be taken into account when formulating malaria intervention programs in Rwanda.
Construction workers are at a high risk of exposure to excessive heat generated by several factors such as intensive physical activities, personal protective clothing, and frequent heat events at construction sites. Previous studies attempted to evaluate the occupational risk of heat stress by concentrating on environmental variables or the self-assessment measures of perceived heat. Despite their potentials, most of these approaches were intrusive, inaccurate, and intermittent. More importantly, they mainly overlooked the disparities in workers’ physical and physiological characteristics. To address these limitations, this study proposes a heat-stress risk-assessment process to evaluate workers’ bodily responses to heat – heat strain – based on the continuous measurement of their physiological signals. To this end, workers’ physiological signals were captured using a wristband-type biosensor. Subsequently, their physiological signals were decontaminated from noises, resampled into an array of informative features, and finally interpreted into distinct states of individuals’ heat strain by employing several supervised learning algorithms. To examine the performance of the proposed process, physiological signals were collected from 18 subjects while performing specific construction tasks under three predetermined environmental conditions with a different probability of exposure to heat stress. The analysis results revealed the proposed process could predict the risk of heat strain with more than 92% accuracy, illuminating the potentials of wearable biosensors to continuously assess workers’ heat strain. The long-term implications of this study can be capitalized as guidelines to improve systematic evaluation of heat strain and promote workers’ occupational safety and well-being through early detection of heat strain at construction sites.
Heat stress illnesses represent a rising public health threat; however, associations between environmental heat and observed adverse health outcomes across populations and geographies remain insufficiently elucidated to evaluate risk and develop prevention strategies. In particular, military-relevant large-scale studies of daily heat stress morbidity responses among physically active, working-age adults to various indices of heat have been limited. We evaluated daily means, maximums, minimums, and early morning measures of temperature, heat index, and wet bulb globe temperature (WBGT) indices, assessing their association with 31,642 case-definition heat stroke and heat exhaustion encounters among active duty servicemembers diagnosed at 24 continental US installations from 1998 to 2019. We utilized anonymized encounter data consisting of hospitalizations, ambulatory (out-patient) visits, and reportable events to define heat stress illness cases and select the 24 installations with the highest case counts. We derived daily indices of heat from hourly-scale gridded climate data and applied a case-crossover study design incorporating distributed-lag, nonlinear models with 5 days of lag to estimate odds ratios at one-degree increments for each index of heat. All indices exhibited nonlinear odds ratios with short-term lag effects throughout observed temperature ranges. Responses were positive, monotonic, and exponential in nature, except for maximum daily WBGT, minimum daily temperature, temperature at 0600 h (local), and WBGT at 0600 h (local), which, while generally increasing, showed decreasing risk for the highest heat category days. The risk for a heat stress illness on a day with a maximum WBGT of 32.2 °C (90.0 °F) was 1.93 (95% CI, 1.82 – 2.05) times greater than on a day with a maximum WBGT of 28.6 °C (83.4 °F). The risk was 2.53 (2.36-2.71) times greater on days with a maximum heat index of 40.6 °C (105 °F) compared to 32.8 °C (91.0 °F). Our findings suggest that prevention efforts may benefit from including prior-day heat levels in risk assessments, from monitoring temperature and heat index in addition to WBGT, and by promoting control measures and awareness across all heat categories.
BACKGROUND: Maternal exposure to weather-related extreme heat events (EHEs) has been associated with congenital heart defects (CHDs) in offspring. Certain medications may affect an individual’s physiologic responses to EHEs. We evaluated whether thermoregulation-related medications modified associations between maternal EHE exposure and CHDs. METHODS: We linked geocoded residence data from the U.S. National Birth Defects Prevention Study, a population-based case-control study, to summertime EHE exposures. An EHE was defined using the 90(th) percentile of daily maximum temperature (EHE90) for each of six climate regions during postconceptional weeks 3-8. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between EHE90 and the risk of CHDs were estimated by strata of maternal thermoregulation-related medication use and climate region. Interaction effects were evaluated on multiplicative and additive scales. RESULTS: Over 45% of participants reported thermoregulation-related medication use during the critical period of cardiogenesis. Overall, these medications did not significantly modify the association between EHEs and CHDs. Still, medications that alter central thermoregulation increased aORs (95% CI) of EHE90 from 0.73 (0.41, 1.30) among non-users to 5.09 (1.20, 21.67) among users in the Southwest region, U.S. This effect modification was statistically significant on the multiplicative (P = 0.03) and additive scales, with an interaction contrast ratio (95% CI) of 1.64 (0.26, 3.02). CONCLUSION: No significant interaction was found for the maternal use of thermoregulation-related medications with EHEs on CHDs in general, while medications altering central thermoregulation significantly modified the association between EHEs and CHDs in Southwest U.S. This finding deserves further research.
BACKGROUND: Elevated temperature is well-recognized as a health hazard, and may be particularly harmful to pregnant women, including increasing risk of stillbirth. We conducted a study in Northern and Central Florida, an area prone to periodic extreme heat but with significant seasonal variation, focusing on the most socioeconomically vulnerable populations least able to mitigate the impact of heat. METHODS: We obtained electronic health records data from the OneFlorida Data Trust for the period 2012-2017, with 1876 stillbirths included in the analysis. We used a case-crossover design to examine the risk of stillbirth associated with acute exposures to elevated heat prior to the outcome, contrasting the case period (the week preceding the stillbirth) with a control period (the week prior to the case period and the week after the stillbirth). Average heat index and maximum warning level during the case and control periods of each woman were assigned by ZIP code. Conditional logistic regression models were used to assess the association between stillbirth and heat exposure, controlling for PM(2.5) and O(3). RESULTS: The adjusted odds ratio showed no overall association with stillbirth except for a weak association for exposure above the 90th percentile which was larger among the most socioeconomically deprived and non-Hispanic Black women. In the hot months, there was a clear association for all indices of heat exposure, but largest again for the most socioeconomically deprived population (aOR = 2.4, 95% CI: 1.2-5.2 in the 4th vs. 1st quartile) and among non-Hispanic Black women (aOR = 1.8, 95% CI: 1.0-3.2 in the 4th vs. 1st quartile). CONCLUSIONS: Our results provide further evidence that elevated ambient heat is related to stillbirth and encourage a focus on the most susceptible individuals and possible clinical pathways.
South Asia, with more than one-fifth of the world’s population, is highly vulnerable to heatwaves and associated health consequences. The population experiences considerably higher residential vulnerability due to limited infrastructural capacities, economic resources, and health and environmental quality deficiencies. However, a limited number of studies are available from the region to account for the health effects of heatwaves. Therefore, this study has conducted a comprehensive review to characterize heatwaves across South Asian countries. The review explicitly identifies the population’s vulnerability to heatwaves during recent years and heatwave management policies in the region. The literature review suggests increased heat-related deaths in most South Asian countries, with few exceptions. In addition, the analysis of historical temperature records identified an upward trend in annual average temperature across the South Asian countries. The study highlights various heatwave definitions that have been used in the region to facilitate comparative evidence. The review of policies identified that only a few South Asian countries have functional heatwave management plans and majorly lack community and residential preparedness for heatwaves. Therefore, this study identifies potential community- and residential-based adaptation strategies to mitigate heat discomfort. As prospective solutions, the study recommends adaptation strategies such as blue-green spaces, indoor passive cooling, infrastructural adjustments, heat action plans, etc. However, such adaptation measures require a holistic amalgamation of different stakeholders to fabricate heatwave-resilient cities.
Despite recent advancements in global population well-being and food security, climate change threatens to undermine child nutritional health, particularly for marginalized populations in tropical low- and middle-income countries. South Asia is at particular risk for climate-driven undernutrition due to a combination of historical weather exposures, existing nutritional deficits, and a lack of sanitation access. Previous studies have established that precipitation extremes increase rates of undernutrition in this region, but the existing literature lacks adequate consideration of temperature anomalies, mediating social factors, and the developmentally-relevant timing of exposure. We combine high-resolution temperature and precipitation data with large-sample survey data on household demographics and child anthropometry, using an approach that incorporates three key developmental periods and a rigorous fixed effects design. We find that precipitation extremes in the first year of life significantly decrease children’s height-for-age (HAZ) in South Asia. The detrimental effects of extreme precipitation are especially concentrated in under-resourced households, such as those lacking access to proper sanitation and education for women, while anomalous heat is particularly harmful for children in Pakistan, though it tends to benefit children in some demographic groups. These results indicate that nutritional status in South Asia is highly responsive to climate exposures, and that addressing sanitation infrastructure and other development priorities is a pathway towards reducing this vulnerability.
Urban parks play an essential role in urban settings; significantly contribute to the health of every age group person. Parks provide opportunities for families to connect with nature and breathe in the fresh air. Due to global climate change and increased urbanisation in the past few decades, extreme heat can be experienced in urban areas. Mental and physical health issues arise primarily due to a sedentary lifestyle in cities. Staying at parks for a longer duration could promote stress reduction and perceived physical health. The present study aims to assess the thermal comfort conditions at an urban park in the hot semi-arid climate(BSh) of Haryana, India. The present study investigated the outdoor thermal comfort range and thermal sensations of visitors at a park during the summer season using the onsite monitoring of the microclimate parameters and questionnaire survey in the hot-semi arid region of India. Thermal comfort indices, Physiological equivalent temperature (PET) and Universal Thermal Climate Index (UTCI) and Wet bulb globe temperature(WBGT) have been applied to investigate the outdoor thermal comfort conditions. The seven-point sensation scale has been used to record the visitors’ thermal sensations. The results indicated that:1) WBGT was found to be the most suitable index to investigate the OTC conditions. The neutral UTCI, PET, and WBGT ranged within 28.03 degrees C to 35.6 degrees C, 24.04 degrees C to 37.5 degrees C, and 23.5 degrees C to 26.1 degrees C, respectively. 2) The neutral PET ,UTCI, and WBGT were found to be 30.8 degrees C, 31.8 degrees C, and 24.8 degrees C, respectively.3) Dry bulb temperature is the most significant thermal comfort parameter affecting visitors’ thermal sensations, followed by mean radiant temperature.4) Thermal comfort indices were found to be most significantly affected by globe temperature. The study’s outcome could provide theoretical design reference to urban designers to develop new parks and existing parks, ultimately promoting public health. Copyright (c) 2022 Elsevier Ltd. All rights reserved. Selection and peer-review under responsibility of the scientific committee of the F-EIR Conference 2021 on Environment Concerns and its Remediation: Materials Science
Climate change has significantly increased the frequency and intensity of human thermal stress, with relatively more severe impacts than those of pure temperature extremes. Despite its major threats to public health, limited studies have assessed spatiotemporal changes in human thermal stress in densely populated regions, like South Asia (SAS). The present study assessed spatiotemporal changes in human thermal stress characteristics in SAS, based on daily minimum, maximum, and mean Universal Thermal Climate Indices (i.e. UTCImin, UTCImax, and UTCImean) using the newly developed high-spatial-resolution database of the thermal-stress Indices over South and East Asia for the period 1981-2019. This study is the first of its kind to assess spatiotemporal changes in UTCI indices over the whole of SAS. The study also carried out extreme events analysis of the UTCI indices and explored their nexus with El Nino-Southern Oscillation (ENSO) index. Results revealed a significant increase in heat stress in SAS, with the highest human thermal stress in western Afghanistan, the Indo-Gangetic Plain, and southeastern, and central parts. The extreme event analysis showed that the study region is likely to observe more frequent and intense heat extremes in the coming decades. The correlation of UTCI indices with ENSO exhibited a robust positive coherence in southeastern and central India, southern Pakistan, and northwestern Afghanistan. The findings of the study are critical in understanding human thermal stress and adopting effective risk reduction strategies against heat extremes in SAS. To better understand the dynamic mechanism of thermal extremes, the study recommends a detailed investigation of the underlying drivers of UTCI variability in SAS.
INTRODUCTION: Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors. METHODS: We enrolled 480 patients who presented to emergency medical services with chief complaints consistent with AHI in Ahmedabad, India, from April-June 2016 in a cross-sectional study. We evaluated AHI case definition test characteristics in reference to trained prehospital provider impressions, compared on-scene heat index measured by portable loggers to weather station measurements, and identified AHI behavioral and environmental risk factors using logistic regression. RESULTS: The case definition for heat exhaustion was 23.8% (12.1-39.5%) sensitive and 93.6% (90.9-95.7%) specific. The positive and negative predictive values were 33.5% (20.8-49.0%) and 90.1% (88.5-91.5%), respectively. Mean scene heat index was 6.7°C higher than the mean station heat index (P < 0.001), and station data systematically underestimated heat exposure, particularly for AHI cases. Heat exhaustion cases were associated with on-scene heat index ≥ 49°C (odds ratio [OR] 2.66 [1.13-6.25], P = 0.025) and a history of recent exertion (OR 3.66 [1.30-10.29], P = 0.014), while on-scene air conditioning was protective (OR 0.29 [0.10-0.85], P = 0.024). CONCLUSION: Systematic collection of prehospital data including recent activity history and presence of air conditioning can facilitate early AHI detection, timely intervention, and surveillance. Scene temperature data can be reliably collected and improve heat exposure and AHI risk assessment. Such data may be important elements of surveillance, clinical practice, and climate change adaptation.
Extreme weather conditions, especially heatwave, are a threat to society, affecting livability, wellbeing, and social interactions. The present study aims to assess the monthly heat stress in the outdoor environment from 2010 to 2019 in Sonepat’s municipality, representing a hot semi-arid climate. The authors applied three heat stress indices, namely, Wet bulb globe temperature (WBGT), Physiological equivalent temperature (PET), and Universal thermal climate index (UTCI), to estimate the grade of heat stress. While calculations, the highest average WBGT was found in July (33.4 +/- 0.77 degrees C), demonstrating July in the “Extreme heat stress” category. The highest mean PET was found in June (42.47 +/- 2.34 degrees C), indicating June in the “Extreme heat stress” category. The highest mean UTCI was found in June (38.58 +/- 1.82 degrees C), demonstrating “Very strong heat stress.” The dry bulb temperature was found to be the most dominant parameter among meteorological parameters promoting extreme heat stress. It was concluded that extreme heat stress was observed in the Pre-monsoon hot weather season and summer monsoon season (especially in June), making the population vulnerable to mortality and morbidity. The findings could provide valuable information to people from various disciplines like Climate scientists, landscape designers, architects, and all relevant stakeholders to develop a heatwave action plan against adverse heat stress.(c) 2021 Elsevier Ltd. All rights reserved. Selection and peer-review under responsibility of the scientific committee of the F-EIR Conference 2021 on Environment Concerns and its Remediation: Materials Science.
OBJECTIVES: Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem. METHODS: This retrospective observational study reviewed patients presenting to Telangana’s prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients’ characteristics and prehospital intervention. RESULTS: There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned. CONCLUSION: This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.
This study investigated children’s perceptions and adaptive behaviors related to indoor thermal conditions of classrooms in primary schools with no air-conditioning systems during both summer and winter in Dehradun City, Uttarakhand, India. Responses were collected from 5297 school children aged 6-13 years. During the measurement periods, 100% and 94% of the samples were obtained under conditions outside an 80% thermally acceptable comfort range in winter and summer, respectively. The analysis using receiver operating characteristics suggested that the students had the least sensitivity to the temperature variation for all scales of the thermal sensation vote (TSV). Approximately 95.1% of students were “very satisfied”, “satisfied”, or “slightly satisfied” with the thermal conditions under the condition of “extreme caution” or “danger” of heat risk. In contrast, adaptive thermal behaviors, such as adjusting clothing insulation ensembles, opening or closing classroom windows and doors, and utilizing ceiling fans, were found to be the most affordable options for optimizing indoor thermal comfort. Children’s reports of thermal sensations and thermal satisfaction did not correspond to the actual physical environment. This draws attention to the adequacy of applying widely used methods of TSV-based identification of the thermal comfort range in classrooms for children, especially in hot environments. The findings of this study are expected to serve as an evidence-based reference for local governments and authorities to take appropriate measures to mitigate heat risks for schoolchildren in the future.
The climate of a place has a decisive role in human adaptations. Man’s health, adaptability, behavioural patterns, food, shelter, and clothing are mainly influenced by the temperatures of the area. Hence, a study is undertaken to analyse the spatial distribution, frequency, and trend in the heat waves over the country. The statistical characteristics of heat waves over India are addressed in this study. Gridded daily temperature data sets for the period 1951-2019 were used to compute the arithmetic mean (AM), standard deviation (SD), coefficient of variation (CV), and trends of monthly maximum temperature. The number of heat wave days were identified using the criteria given by India Meteorological Department (IMD) i.e., a heat wave is recognized when the daily normal maximum temperature of a station is less than or equal to (greater than) 40 degrees C than it will be considered as a heat wave if the daily maximum temperature exceeds the daily normal maximum temperature by 5 degrees C (4 degrees C). The analysis was confined to the two summer months of April and May only. The spatial distribution of the AM shows higher values during May, and the core hot region with temperatures exceeding 40 degrees C lies over central India extending towards the northwest. The SD distribution shows higher values over the northeast of central India decreasing towards the southwest. The CV distribution shows higher values over the north decreasing toward the south. Higher numbers of heat waves are observed during May and the number is higher over Andhra Pradesh and south Telangana regions of southeast India. This study concludes that a moderate hot region experiences a higher number of heat wave days over India.
In the present research work, the authors investigated the seasonal thermal environment and thermal perception of university subjects in a naturally ventilated workshop building under the composite climate of India. Total 1460 subjective responses were collected during the field study in the year, 2019. Standard Effective Temperature (SET*) has been used as a rationally derived thermal comfort index to study the combined effects of air temperature, relative humidity and airspeed on perceived thermal sensation and occupant’s preference under high metabolic rates. Probit analysis showed more than 80% of subjects were voting comfortable (+/- 1 Thermal sensation votes) when SET* ranged between 25 degrees C-33 degrees C. Seasonal mean comfort temperature varied more than 4.8 degrees C, while, preferred temperature was noted about 3 degrees C lower than their mean Griffiths comfort temperature. The adaptive relation developed from the collected database under high metabolic activities was compared with existing national and international comfort standards. The slope coefficient for adaptive relation was observed close to the adaptive model of ASHRAE Standard 55-2017 but lower than the National Building Code of India, 2016. Further, adaptive use of fans and windows were analyzed using logistic regression models and predicted about 80% of fans and windows were in operation at 30 degrees C. To confirm the adaptive mechanism, the interrelation of other contextual factors like gender, clothing insulation, airspeed, metabolic activities, etc. to thermal comfort expectations of subjects were also studied.
BACKGROUND: Studies have documented a significant association between temperature and all-cause mortality for various cities but such data are unavailable for Hyderabad City. OBJECTIVE: The objective of this work was to assess the association between the extreme heat and all-cause mortality for summer months (March to June) from 2006 to 2015 for Hyderabad city population. METHODS: We obtained the data on temperature and all-cause mortality for at least ten years for summer months. Descriptive and Bivariate analysis were conducted. Pearson correlation coefficient was used to study the relationship between heat and all-cause mortality for lag time effect. RESULTS: A total of 122,117 deaths for 1,220 summer days (2006 to 2015) were analyzed with mean daily all-cause mortality was 100.1±21.5. There is an increase of 16% and 17% per day mean all-cause mortality at the maximum temperature of less than or equal to 40 degrees C and for extreme danger days (Heat Index greater than 54 degrees C) respectively. The mean daily all-cause mortality shows a significant association with maximum temperature (P < 0.001) and Heat Index from caution to extreme danger risk days (P<0.0183). The lag effect of extreme heat on all-cause mortality for the study period (2006 to 2015) was at peak on same day of the maximum temperature (r = 0.273 at p<0.01). CONCLUSION: The study concludes that the impact of ambient heat in the rise of all-cause mortality is clearly evident (16% mean deaths/day). There was no lag effect from the effect of extreme heat on all-cause mortality as the peak period was the same as the maximum temperature. Hence heat action plans are needed. However, extreme heat-related mortality merits further analysis.
The present paper is an attempt to study the heat waves associated fatalities over space and time in India. For this, ‘Disastrous Weather Events’ reports statistics have been used for the period 1978-2014. The analysis has shown that a total of 660 heat wave events have caused 12,273 fatalities (about 332 fatalities every year). Only five states namely, Andhra Pradesh (42%), Rajasthan (17%), Odisha (10%), Uttar Pradesh (7%) and Bihar (7%) have accounted more than 80% of the heat wave fatalities, although nine states namely, Arunachal Pradesh, Nagaland, Manipur, Meghalaya, Tripura, Sikkim, Mizoram, Uttarakhand and Goa have never reported heat wave events and fatalities during 1978-2014. Interestingly, each event has resulted about 104 fatalities in Andhra Pradesh state. Further, fatality and density rates have been witnessed to the tune of 0.35 and 3.81 respectively. Temporally, heat wave events have displayed large differences with a significant increasing trend (P < 0.01), whereas no trend could be noticed in fatalities. Majority of events have been witnessed in May and June months. It has been observed that men have been more harshly affected compared to women and children. Finally, it is believed that this study may provide new insight towards making better disaster management guidelines for minimizing the shocks of harsh temperature.
Heat waves are often termed as the silent killer and have become even more important as recent studies suggest that the heat wave have become second most devastating extreme weather events in terms of human deaths and losses. It is also been largely realised by scientific community that it is not just the high temperatures which are responsible for the gruesome effect of heat waves but several other meteorological parameters play a vital role in aggravating the impact and causing much more damages. In view of the above the attention of scientific community, weather forecasters as well as disaster managers has shifted to also take into account the different meteorological parameters like maximum and minimum temperatures, relative humidity, wind speed, duration/spell of heat waves and its intensity which are aggravating the impact of heat stress. In this background, this study is undertaken as an attempt to quantify the effect of different meteorological parameters on heat wave on different regions of India for different summer months (March, April, May and June). In this study the impact of individual meteorological parameter as well their cumulative effect is studied based on data of 30 years (1981-2010) for 300 stations. The effect of different meteorological parameters is identified for different months for different regions of the country. Also the cumulative scores are calculated for different regions considering different meteorological parameters, as a first initiative to perform heat hazard analysis and zonation over the entire country. This could serve as initial step for planning mitigation and adaptation strategies throughout the country. These scores as thresholds for different regions may be also useful for operational forecaster’s for early impact based warning services as well as for the disaster managers, for taking effective and timely actions.
The heatwave is a disastrous hazard having significant impacts on health and society. This study analyses the heatwave hazards and risk for India’s current and future scenarios using socioeconomic vulnerability and temperature datasets during the summer (April-June) season. The Census of India (CoI) 2011 datasets were considered to assess current vulnerability and projected from the SocioEconomic Data And Application Center (SEDAC) population at Shared Socioeconomic Pathway (SSP) 4 for future vulnerability. Whereas IMD temperature data used for hazard assessment for the present scenario (1958-2005) while projected temperature data from regional earth system model REMO-OASIS-MPIOM (ROM) were used for the future (2006-2099) scenario. The study exhibited the most hazardous, vulnerable, and risk-prone regions identified as the south-eastern coast and Indo-Gangetic plains and some populous districts with metropolitan regions (Mumbai, Delhi, and Kolkata) under the current scenario. The coupled model ROM has efficiently captured the critical districts with higher and lower risk, showing its future projection capability. The study highlighted that the heatwave hazard-risk would significantly worsen in future scenarios in all districts under enhanced global warming and largely affecting the districts in the eastern and middle Indo-Gangetic plains and Malabar region. The present study will provide sufficient insights into designing mitigation strategies and future adaptive planning for the heatwave risk, which is one of the targets under Sustainable Development Goal 13 (Goal 13: Climate Action).
A considerable association between temperature and all-cause mortality has been documented in various studies. Further insights can be obtained from studying the impact of temperature and heat index (HI) for Jaipur city’s all-cause mortality. The objective of this work was to assess the association between the extreme heat (daily maximum temperature, daily minimum temperature, daily mean temperature, relative humidity and HI) and all-cause mortality for summer months (March to June) from 2006 to 2015 for urban population of Jaipur. For summer months, we collected the data on various temperature and all-cause mortality parameters for at least 10 years. The student’s t-test and ANOVA were used to analyse variations in mean temperature, maximum temperature and HI. The Pearson correlation coefficient was used to study the relationship between ambient heat and lag time effect all-cause mortality. A total of 75,571 deaths (all-cause mortality) for 1,203 summer days (2006-2015) were analysed in relation to temperature and relative humidity. The mean daily all-cause mortality has been estimated at 62.8 +/- 15.2 for the study period. There is a significant increase of 39% per day all-cause mortality at the maximum temperature of 45 degrees C and above. However only 10% rise per day all-cause mortality for extreme danger days (HI > 54 degrees C). The mean daily all-cause mortality shows a significant association with daily maximum temperature (F = 34.6, P < .0001) and HI (discomfort index) from caution to extreme danger risk days (F = 5.0, P < .0019). The lag effect of extreme heat on all-cause mortality for the study period (2006 to 2015) was at a peak period on the same day of the maximum temperature (r = 0.245 at P < .01) but continues up to four days. The study concludes that the effect of ambient heat on all-cause mortality increase is clearly evident (rise of 39% deaths/day). Accordingly, focus should be put on developing adaptation measures against ambient heat. This analysis may satisfy policy makers' needs. Extreme heat-related mortality needs further study to reduce adverse effects on health among Jaipur's urban population.
Heat waves are quite frequent over the Indian subcontinent during the summer season (April-July) owing to an increase in anthropogenic activities and global temperatures. These extreme heat conditions induce a high level of outdoor discomfort, adverse health effects and mortality, depending on the degree of thermal stress. The present study investigates the climatology of thermal stress and its trends over northwest (NW) India during the summer. The Universal Thermal Climate Index (UTCI) derived from Human thErmAl comforT (ERAS-HEAT) dataset was used for the period of 1981-2019. The monthly and seasonal climatological mean of UTCI exhibits moderate to strong thermal stress over NW India (ranges from 27 to 34.5 degrees C) than in the rest of the country (below 25.5 degrees C), with a peak during the months of June (34.5 degrees C) and July (33.5 degrees C) months. The seasonal mean UTCI shows significant rising trends (0.9 degrees C per 39 years) over NW India and entire India (0.6 degrees C per 39 years), indicating that the thermal discomfort amplifies at a faster pace compared to the rest of India. Similar rising trends are also noticed in the major cities of the study region. Surface temperature and relative humidity also exhibit a substantial increasing trend, which resulted in the intensification of thermal discomfort over NW India. Furthermore, the number of thermal discomfort days over NW India exhibits an increasing trend during 1981-2019. The composite analysis of UTCI greater than 32 degrees C (referred to as strong heat stress) depicts the highest thermal discomfort conditions in NW India. During summer, strong soil temperatures and high sensible heat fluxes over the study region may enhance the warming at the surface during UTCI (> 32 degrees C) days as it depends on surface radiative fluxes through the mean radiant temperature. In addition to high temperatures, a substantial amount of moisture transported by strong westerly wind from the Arabian Sea towards the NW India during strong thermal stress days seems to have contributed to high thermal stress conditions in the region.
BACKGROUND: Record-breaking temperatures have occurred more frequently worldwide under the trend of climate change. It has increased the number of people at heat related medical conditions resulting in both mortality and morbidity from heat stress. This study aimed to assess factors associated with vulnerability to heat stress, its health effects among people of Nepalgunj Sub-metropolitan, and identify various coping strategies adopted. METHODS: Cross-sectional analytical study was conducted among 366 research participants selected through multi-stage random sampling technique in Nepalgunj Sub-metropolitan. Heat Index was assessed using secondary analysis of meteorological data of Nepalgunj (Airport) station. Chi-square test was done to analyze the primary data. RESULTS: Out of 366 participants, 224 (61.2%) participants had heat related symptoms in the past 6 months (April to September) from the date of the interview. Sex, education, income, roof construction, Cross-ventilation, working hour per day, presence of chronic disease, and medications use had a significant association with heat related symptoms among the participants (p<0.05) The most common coping strategies adopted to manage heat stress were the use of cooling methods, wearing light clothing, and bathing by cold water. The average monthly heat index was highest in August (42 °C) and lowest in April (29°C). CONCLUSIONS: The majority of the participants had heat related symptoms in the study area. In order to mitigate the heat stress in the urban town like Nepalgunj, measures such as tree plantation, reducing vehicle smoke emissions, and developing proper housing ventilation can be applied.
As a result of global climate change, the frequency and intensity of heat waves have increased significantly. According to the World Meteorological Organization (WMO), extreme temperatures in southwestern Pakistan have exceeded 54 degrees C in successive years. The identification and assessment of heat-health vulnerability (HHV) are important for controlling heat-related diseases and mortality. At present, heat waves have many definitions. To better describe the heat wave mortality risk, we redefine the heat wave by regarding the most frequent temperature (MFT) as the minimum temperature threshold for HHV for the first time. In addition, different indicators that serve as relevant evaluation factors of exposure, sensitivity and adaptability are selected to conduct a kilometre-level HHV assessment. The hesitant analytic hierarchy process (H-AHP) method is used to evaluate each index weight. Finally, we incorporate the weights into the data layers to establish the final HHV assessment model. The vulnerability in the study area is divided into five levels, high, middle-high, medium, middle-low and low, with proportions of 3.06%, 46.55%, 41.85%, 8.53% and 0%, respectively. Health facilities and urbanization were found to provide advantages for vulnerability reduction. Our study improved the resolution to describe the spatial heterogeneity of HHV, which provided a reference for more detailed model construction. It can help local government formulate more targeted control measures to reduce morbidity and mortality during heat waves.
Background: Climate change is evident around the globe causing heat stress as an emerging public health problem for people working in tropical and subtropical areas. Occupational heat stress can impact the health and productivity of small and mid-sized enterprise workers. Objective: This study aimed to profile the indoor thermal environmental conditions and modify the working practices by recommending the work/rest cycle according to the international organization for standardization 7243. Study Design: This cross-sectional study design included eight industrial (Iron spare parts manufacturing) small and mid-size enterprises in Lahore, Pakistan. The indoor thermal environment, including globe temperature, natural wet bulb temperature, ambient temperature, relative humidity, and air velocity, were recorded during summer to measure the wet bulb globe temperature (WBGT). Quest heat stress meter (model 2500), modified Testo loggers (177-T4), and EL-USB-2-LCD data loggers were placed at different working stations to measure these thermal environmental parameters. A self-administered questionnaire was used to measure the workers’ demographic characteristics and working practices. The International Organization for Standardization 7243 reference was used to estimate and recommend the work/rest cycle. Results: 138 workers aged 28.59 +/- 10.46 years participated in this study. Continuous work of 8.8 +/- 1.5 hours per day with a conventional resting period of 30-60 minutes was recorded on a typical working day. The indoor wet bulb globe temperature ranged from 26.8 degrees C to 36.4 degrees C. The workers were registered for low (72.5%), moderate (18.1%), and high (9.4%) metabolic rates according to the International Organization for Standardization 7243 reference values. Conclusion: A high wet bulb globe temperature was recorded in the selected small and mid-sized enterprises making these workers vulnerable to heat stress and related illnesses. Work/rest cycle evaluation suggested that the workers were required to improve their cool-down time by avoiding continuous exposure to high temperatures and reducing the metabolic rate.
BACKGROUND: Extreme heat exposure is a growing public health concern. In this trial, we tested the impact of a community health worker (CHW) led heat education programme on all-cause mortality, unplanned hospital visits and changes in knowledge and practices in Karachi, Pakistan. METHODS: The Heat Emergency Awareness and Treatment trial was a community-based, open-label, two-group, unblinded cluster-randomised controlled trial that implemented a CHW-led educational intervention between March and May 2018 in Karachi, Pakistan. We randomly assigned (1:1) 16 clusters, each with ~185 households or 1000 population, to the intervention or usual care (control group). We collected data on all-cause mortality, unplanned hospital visits, evidence of heat illness through surveillance and a knowledge and practice survey during the summer months of 2017 (preintervention) and 2018 (postintervention). FINDINGS: We recruited 18 554 participants from 2991 households (9877 individuals (1593 households) in the control group and 8668 individuals (1398 households) in the intervention group). After controlling for temporal trends, there was a 38% (adjusted OR 0.62, 95% CI 0.49 to 0.77) reduction in hospital visits for any cause in the intervention group compared with the control group. In addition, there was an improvement in many areas of knowledge and practices, but there was no significant difference in all-cause mortality. INTERPRETATION: A CHW-led community intervention was associated with decreased unscheduled hospital visits, improved heat literacy and practices but did not impact all-cause mortality. CHWs could play an essential role in preparing communities for extreme heat events. TRIAL REGISTRATION NUMBER: NCT03513315.
Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.
The objective of this paper is to model and study the impact of high temperature on mortality in Pakistan. For this purpose, we have used mortality and climate data consisting of maximum temperature, variation in monthly temperature, average rainfall, humidity, dewpoint, as well as average air pressure in the country over the period from 2000 to 2019. We have used the Generalized Linear Model with Quasi-Poisson link function to model the number of deaths in the country and to assess the impact of maximum temperature on mortality. We have found that the maximum temperature in the country has a significant impact on mortality. The number of deaths in Pakistan increases as the maximum temperature increases. We found that, as the maximum temperature increase beyond 30 degrees C, mortality increases significantly. Our results indicate that mortality increases by 27% when the maximum temperature in the country increases from medium category to a very high level. Similarly, the number of deaths in the country increases by 11% when the temperature increases from medium temperature to high level. Furthermore, our study found that when the maximum temperature in the country decreases from a medium level to a low level, the number of deaths in the country decreases by 23%. This study does not consider the impact of other factors on mortality, such as age, medical conditions, gender, geographical location, as well as variability of temperature across the country.
Internally displaced people (IDP) due to conflict and violence were estimated as 41.3 million in 55 countries as the end of the year 2019, the highest figure ever recorded. Sri Lanka has not yet prioritized the health and wellbeing of households in building designing, with the emerging heat island effect making the lives more desperate for IDP. This study focused on the effect of energy poverty on occupant comfort in determining the quality of life of people and adaptive behaviors to manage heat strain in overheated interiors of rehabilitated residences in Jaffna, Sri Lanka. Field investigations consisted of personal monitoring, questionnaire surveying and physical measurements in four clusters of rehabilitation residence programmes in four regions. The study found that IDP were suffering from hidden energy poverty, with mean electricity consumption of 52 kWh per household per month. Residents have marginal (29%) access to clean fuels for cooking and accountable for an abnormal particulate matter count of 360 951 particles per cubic centimeter. Findings explicitly revealed the presence of overheated spaces with mean thermal preference of-0.6 conveying the need of cooler indoor environment. People tend to exhibit behavioral adjustments to cope up with prevailing extreme temperatures. Severity of heat stress informed by modified wet bulb globe temperature (WBGT) reporting 90% (28-31 degrees C) of households facing higher risk of heat strain while remaining 10% (>31 degrees C) are in hazardous situation. Predicted mean vote (PMV) was 1.29 explains warm sensation with predicted percentage of dissatisfied (PPD) 44.1% not complying to ASHRAE 55 standards. This detrimental combination of fuel poverty, lack of thermal comfort, and unacceptable indoor air quality has been a significant factor for 62% of the residences reporting at least one type of illness and being more prone to cardiovascular and respiratory disorders (37%). Thus, the study evidenced the presence of energy poverty and overheated interiors in the IDP’s residences in hot tropics of Sri Lanka. (c) 2021 Elsevier B.V. All rights reserved.
Extreme heat is an increasing climate risk due to climate change and the urban heat island (UHI) effect and can jeopardize points of dispensing (PODs) for COVID-19 vaccination distribution and broader public health emergency preparedness (PHEP) response operations. These PODs were often located on large parking lot sites with high heat severity and did not take heat mitigation or management strategies into account for unacclimated workers and volunteers. To investigate the personal heat exposure of workers, volunteers, and clients at three PODs in Tucson, Arizona, we collected ambient air temperatures, wet bulb globe temperatures (WBGT), surface temperatures, and thermal images. We also made qualitative observations and compared data against daily meteorological records. Ambient air temperatures at all three PODs exceeded the meteorological recorded high. WBGT on average were 8°F (4.4 °C) higher in full sun locations than shaded locations such as tents. Evaporative cooling decreased ambient air temperatures by 2°F (1.2 °C) when placed one per tent, but decreased ambient air temperatures by 7°F (3.9 °C) when placed en masse in a larger tent. Vehicle surface temperatures exceeded recommended safe limits of 140°F (60 °C) at all three sites, with a maximum temperature recorded at 170.9°F (77.2 °C). Public health professionals should consider heat resilience, including heat mitigation and management measures, in POD and PHEP response operations to reduce exposure. This includes considering the UHI effect in the siting of PODs, applying heat mitigation strategies in the design of PODs such as the adaptive use of solar panels for shading, and improving heat safety guidance for workers and volunteers.
This study is an assessment of the effects of outdoor air pollution and extreme weather events on the health of outdoor workers in Delhi, including auto rickshaw drivers, street vendors, and sweepers. To carry it out, a cross-sectional and perception-based epidemiological research design was used, and the primary tool used for data collection was a questionnaire. Two hundred twenty-eight people participated in the survey, and a pulmonary function test (PFT) was performed on 63 participants. Most of the respondents from different occupational groups complained about headaches/giddiness, nausea, and muscular cramps during extreme heat events due to the physically demanding nature of their jobs in the outdoor environment. Furthermore, autorickshaw drivers reported the highest prevalence of ophthalmic symptoms, such as eye redness (44%) and eye irritation (36%). In comparison, vendors reported a higher prevalence of headaches (43%) and eye redness (40%) due to increased exposure to vehicular emissions. Among sweepers, musculoskeletal problems like joint pain (40%), backache (38%), and shoulder pain (35%) were most prevalent due to occupation-related ergonomic factors. In addition, the majority of autorickshaw drivers (47%), vendors (47%), and sweepers (48%) considered that air quality had a severe impact on their health. PFT results showed that most respondents had restricted lung function. Binary logistic regression analysis showed that lung function impairment had a significant association with smoking (p = 0.023) and age (0.019). The odds ratio for smoking, which was around 4, indicated that respondents who smoked had a nearly four times greater risk of developing lung impairment. The study also highlighted the need for using personal protective equipment and developing guidelines to reduce their exposure level.
BACKGROUND: Exposure to high and low ambient temperatures is associated with morbidity and mortality across the globe. Most of these studies assessing the effects of non-optimum temperatures on health and have been conducted in the developed world, whereas in India, the limited evidence on ambient temperature and health risks and has focused mostly on the effects of heat waves. Here we quantify short term association between all temperatures and mortality in urban Pune, India. METHODS: We applied a time series regression model to derive temperature-mortality associations based on daily mean temperature and all-cause mortality records of Pune city from year January 2004 to December 2012. We estimated high and low temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model (DLNM). We calculated temperature attributable mortality fractions for total heat and total cold. FINDINGS: The analysis provides estimates of the total mortality burden attributable to ambient temperature. Overall, 6∙5% [95%CI 1.76-11∙43] of deaths registered in the observational period were attributed to non-optimal temperatures, cold effect was greater 5.72% [95%CI 0∙70-10∙06] than heat 0∙84% [0∙35-1∙34]. The gender stratified analysis revealed that the highest burden among men both for heat and cold. CONCLUSION: Non-optimal temperatures are associated with a substantial mortality burden. Our findings could benefit national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately due to climate change.
In the Indian subcontinent, the annual average extreme weather events (EWEs) are reported to be increasing during the last few decades. The impact of increased EWEs on mortality has become a key issue in terms of minimizing it, even with the increasing population. In the present study, based on 50 years’ data (1970-2019) of India Meteorological Department, mortality rates of different EWEs viz., floods, tropical cyclones, heat waves, cold waves, lightning, etc. were analysed, both at the national and state level. The analysis was done based on different periods, i.e. annual, decadal and twenty-year slice periods. Various statistical analyses were carried out. Out of these EWEs, floods accounted for maximum mortality of 46.1%, followed by tropical cyclones with 28.6% mortality. Over the decades, despite a significant rise in EWEs (except for tropical cyclones), there has been a decrease in the mortality rate (mortalities per year per million population). The number of mortalities per event had a significant negative trend for heatwaves and floods, during the last 50 years. The total EWEs had a mortality rate of 3.86 during 1980-1999 and it reduced to 2.14 during 2000-2019. The mortality rate of tropical cyclones reduced by 94% in the past 20 years, whereas for heatwaves and lightning it increased by 62.2% and 52.8%, respectively. However, the change in mortality rate was not found to be statistically significant due to high year to year variability in mortality associated with floods, lightning, and tropical cyclones in the last two decades as compared to earlier decades. In India, among the major states, Odisha, Andhra Pradesh, Assam, Bihar, Kerala, and Maharashtra were found to be having maximum mortality rates due to EWEs in the last two decades and thus there is a need to consider these states with priority for developing disaster management action plans.
The Intergovernmental Panel on Climate Change (IPCC) report highlights the projected increase in heat wave (HW) frequency, intensity, and duration. Globally, HW events have caused massive deaths in the past. India has also experienced severe HWs and thousands have reportedly died during the past decade. The study uses the Local Climate Zone (LCZ) classification developed by Stewart and Oke (2012) for evaluating heat stress at the city level during the summer period. Stationery surveys were conducted to collect micro-meteorological data in different LCZs. The study analyses the unique behaviour of mapped LCZs in Nagpur, a tropical landlocked Indian city using widely adopted heat indices (heat index and humidex). It investigates two kinds of probabilities, the distribution of heat stress levels in a particular LCZ and how vulnerable are various LCZs to a given heat stress level. It adopts a statistical approach fitting a predictive logit model to estimate the probability of heat stress in various LCZs. The results show that temperature regimes differ significantly across the LCZs. Secondly, heat stress varies greatly depending upon the LCZs. The mapping scheme and the corresponding heat stress provides indispensable information for targeted heat response planning and heat stress mitigation strategies in heat-prone areas.
The unplanned and uncontrolled urbanization of Indian cities has put them under different ecological and environmental threats. Urban heat island (UHI) is one such critical ecological hazard, whereby an urban area is experiencing higher land surface temperature (LST) as compared to the surrounding rural area. In the present study, the relationship of LST and surface urban heat island (SUHI) with the degree of impervious surface (IS) and green spaces (GS) in four rapidly growing Indian cities is presented. This study utilizes different geospatial techniques, including urban-rural gradient analysis, surface urban heat island estimation using Landsat OLI/TIRS data. The results signify a strong negative correlation of LST with the IS for Ahmedabad, Jodhpur, and Nagpur, while a positive correlation is seen over Guwahati. The negative correlation is the manifestation of the urban cool island, pertaining to higher LST over rural areas. On the other hand, Guwahati is surrounded by green vegetation, which provides natural cooling and thus lowers the LST, resulting in positive SUHI. The density of GS is found to be a significant contributor of SUHI in Guwahati city, whereas in the other three cities, its impact is insignificant due to its presence in very less amount in rural surroundings.
In a rapidly warming world, sustainable cooling is directly related to the protection of fresh and nutritious food, medicines, and the population from extreme heat for work conditions, the economic productivity of the working population, and income generation. This study aimed to understand how rural communities are meeting their nutrition, livelihood, health, living space, and mobility requirements regarding the role of cooling. We selected three villages as case studies in Maharashtra, India and conducted household surveys, in-depth interviews of key informants, focus group discussions (FGDs), and social mapping building typology study. The objective was to assess the rural community cooling to propose a community cooling hub (CCH) framework that could be economically, environmentally, and socially sustainable for the three villages. Our study showed that agriculture, dairy, buildings (domestic and commercial), and healthcare require cooling intervention in the studied communities. Based on the needs assessment for cooling, we proposed a CCH framework to provide cooling solutions in an integrated system for rural contexts.
Extreme heat and heat waves have been established as disasters which can lead to a great loss of life. Several studies over the years, both within and outside of India, have shown how extreme heat events lead to an overall increase in mortality. However, the impact of extreme heat, similar to other disasters, depends upon the vulnerability of the population. This study aims to assess the extreme heat vulnerability of the population of four cities with different characteristics across India. This cross-sectional study included 500 households from each city across the urban localities (both slum and non-slum) of Ongole in Andhra Pradesh, Karimnagar in Telangana, Kolkata in West Bengal and Angul in Odisha. Twenty-one indicators were used to construct a household vulnerability index to understand the vulnerability of the cities. The results have shown that the majority of the households fell under moderate to high vulnerability level across all the cities. Angul and Kolkata were found to be more highly vulnerable as compared to Ongole and Karimnagar. Further analysis also revealed that household vulnerability is more significantly related to adaptive capacity than sensitivity and exposure. Heat Vulnerability Index can help in identifying the vulnerable population and scaling up adaptive practices.
Climate change and rapid urbanization currently pose major challenges for equitable development in megacities of the Global South, such as Delhi, India. This study considers how urban social inequities are distributed in terms of burdens and benefits by quantifying exposure through an urban heat risk index (UHRI), and proximity to greenspace through the normalized difference vegetation index (NDVI), at the ward level in Delhi. Landsat derived remote sensing imagery for May and September 2011 is used in a sensitivity analysis of varying seasonal exposure. Multivariable models based on generalized estimating equations (GEEs) reveal significant statistical associations (p < 0.05) between UHRI/NDVI and several indicators of social vulnerability. For example, the proportions of children (β = 0.922, p = 0.024) and agricultural workers (β = 0.394, p = 0.016) are positively associated with the May UHRI, while the proportions of households with assets (β = -1.978, p = 0.017) and households with electricity (β = -0.605, p = 0.010) are negatively associated with the May UHRI. In contrast, the proportions of children (β = 0.001, p = 0.633) and agricultural workers (β = 0.002, p = 0.356) are not significantly associated with the May NDVI, while the proportions of households with assets (β = 0.013, p = 0.010) and those with electricity (β = 0.008, p = 0.006) are positively associated with the May NDVI. Our findings emphasize the need for future research and policies to consider how socially vulnerable groups are inequitably exposed to the impact of climate change-related urban heat without the mitigating effects of greenspace.
The combined effects of global warming, urbanization, and demographic change influence climate risk for urban populations, particularly in metropolitan areas with developing economies. To inform climate change adaptation and spatial planning, it is important to study urban climatic hazards and populations at risk in relation to urban growth trends and development patterns. However, this relationship has not been adequately investigated in studies dedicated to climate vulnerability. This study identifies the typologies of development patterns within Lahore, Pakistan, investigates the heat vulnerability of residents at a neighborhood scale, and establishes a relationship between both of these factors. We identified urban clusters with diverse development patterns. Fourteen context- and site-specific indicators were selected to construct a human heat vulnerability index. Weighted sum, cluster analysis, and ANOVA test of variance were conducted to analyze the data. Our results demonstrate that development patterns significantly influence human vulnerability to heat stress, e.g., vulnerability is higher in older cities and undeveloped neighborhoods with less diverse land uses. These findings are essential for informing policy-makers, decision-makers and spatial planners about proactive adaptation planning in dynamic urban environments.
Heat waves are expected to intensify around the globe in the future, with a potential increase in heat stress and heat-induced mortality in the absence of adaptation measures. India has high current exposure to heat waves, and with limited adaptive capacity, impacts of increased heat waves might be quite severe. This paper presents a comparative analysis of urban heat stress/heatwaves by combining temperature and vapour pressure through two heat stress indices, i.e., Wet Bulb Globe Temperature (WBGT) and humidex index. For the years 1970-2000 (historical) and 2041-2060 (future), these two indicators were estimated in Jaipur. Another goal of this research is to better understand Jaipur land use changes and urban growth. For the land use study, Landsat 5 TM and Landsat 8 OLI satellite data from the years 1993, 2010, and 2015 were examined. During the research period, urban settlement increased and the majority of open land is converted to urban settlements. In the coming term, all months except three, namely July to September, have seen an increase in the WBGT index values; however, these months are classified as dangerous. Humidex’s historical value has been 21.4, but in RCP4.5 and RCP8.5 scenarios, it will rise to 25.5 and 27.3, respectively, and slip into the danger and extreme danger categories. The NDVI and SAVI indices are also used to assess the city’s condition during various periods of heat stress. The findings suggest that people’s discomfort levels will rise in the future, making it difficult for them to work outside and engage in their usual activities.
Urban climate changes and the warming of the cities are serious issues that cannot be overlooked. One of the most common inferences for these changes is unprecedented and unplanned urbanization, which further causes a rise in local, regional, and even global temperatures. Although the rate of urbanisation defines and greatly influences the city’s socioeconomic worth and GDP per capita, if the urban expansion is hap-hazardous, it can cause serious environmental harm.There has been a steep rise in global urban population over the past three decades, and the highest growth rates have been observed in Asian and African cities. These two continents have been predicted to contribute to almost 90% of the total urban growth from the present to 2050. India is one of the few highly susceptible countries to the harsh effects of climate change in terms of rise in temperatures. After 1990s’, India has observed substantial changes in the landscape due to urbanization, which has led to a significant rise in the surface and ambient air temperatures, further affecting the planet’s health. Elevated temperature drastically affects the health of urban dwellers leading to a rise in stress and discomfort levels. Estimation of Land Surface Temperature (LST) can play a vital role in understanding the region-specific alterations in temperatures as it uses satellite data that captures the entire region and provides the information in the form of pixels. Traditionally, the temperature was measured at meteorological stations and extrapolated for the entire region,whichinduces inaccuracies. This ambiguity can be amended by developing a relationship between LST and ambient air temperature. This communication focuses on LST estimation using Radiative Transfer Equation algorithm corresponding to various Landuse categories. The study also attempts to create a relationship between the LST and the ambient air temperature observed at two meteorological stations. An overall assessment of the number of days under stress for the residents was also performed over several years. Kolkata Metropolitan Area was considered the study area to represent the results and understand the complete analysis. A rise of 6.77 degrees C was observed in LST over the study period (2000-2019) due to an increment of 200% in the urban area. Analysis of the number of days under stress showed an increasing trend for the study area due to alterations in urban temperatures. These results and the suggestions from the scientific community, urban planners, and climate experts will help develop or modify the current policy frameworks for creating a balance between development and the environment, thus creating sustainable urban development.
We investigated the time evolution of heat waves and warm nights over the 7 agroclimatic zones of Tamil Nadu, India, during the period 1951-2016, including the spatiotemporal patterns of concurrent hot day and hot night (CHDHN) episodes and the concurrent warm spells in daytime temperature and drought (CWD) episodes. The research relied upon gridded temperature and rainfall observations from the India Meteorological Department. We used the Heat-Wave Magnitude Index daily to study the warm spells in daytime and nighttime temperature, while the analysis of droughts was based on the Standardized Precipitation Evapotranspiration Index. We observed a considerable increase in the count, intensity and duration of heat waves and warm night episodes across Tamil Nadu between the periods 1951-1983 and 1984-2016. Particularly, the number of heat wave events almost doubled in the second half of the study period. We observed a west-east gradient in the severity of heat waves. The intensity and duration of warm night events increased up to 3-fold in the second half of the study period, especially over central Tamil Nadu. The study recorded a multi-fold increase in the number and frequency of CHDHN episodes and the number of CWD episodes during 1984-2016 compared to the base period 1951-1983. More importantly, the incidence of compound events that coexisted with anomalous phases of sea surface temperatures registered a statistically significant spike in many locations. These changes in temperature-induced extremes pose an exceptional public health threat that can increase morbidity and mortality, disproportionately affecting vulnerable sections of Tamil Nadu’s populace engaged in outdoor work.
Due to global warming, increase in air temperature is a growing concern at present. This rise in temperature may cause mild to severe thermal discomfort and heat related hazards mostly for the people who are engaged in outside activities throughout the day. The present study shows the inter-spatial monthly distribution of thermal patches over major stations of Madhya Pradesh, viz., Bhopal, Gwalior, Indore, Jabalpur, Hoshangabad, Rewa, Ratlam, Ujjain, Dhar etc. In this study, various Heat Indices applicable for tropical climate including Wet Bulb Globe Temperature (WBGT) are used to estimate the thermal stress by analyzing the meteorological data of Summer-2018 in Madhya Pradesh. Study was carried out for computing indoor, shady and outdoor heat stress separately and heat transfer rates to identify the places vulnerable to severe heat stroke in the month of March, April and May in 2018.It is observed that declaration of heat wave alone at any station is not sufficient for the administration and health organizations to take precautionary actions; also, discomfort indices should be referred for impact based monitoring and making work schedules. It is found that March and April fall in the partial discomfort category for at least half of the districts in Madhya Pradesh. It is interesting to note that several districts fall in discomfort category in outdoor conditions but not in indoor or shady conditions in May month. Severe stresses are observed mainly in the West and Central Madhya Pradesh during April and May months. Comparison of various Heat Indices is too performed along with computing Tropical Summer Index (TSI) and Apparent Temperature (AT) to indicate real feel-like temperatures in Madhya Pradesh during extreme temperature events.
BACKGROUND: Studies on high temperatures and mortality have not focused on underdeveloped tropical regions and have reported the associations of different temperature metrics without conducting model selection. METHODS: We collected daily mortality and meteorological data including ambient temperatures and humidity in Ahmedabad during summer, 1987-2017. We proposed two cross-validation (CV) approaches to compare semiparametric quasi-Poisson models with different temperature metrics and heat wave definitions. Using the fittest model, we estimated heat-mortality associations among general population and subpopulations. We also conducted separate analyses for 1987-2002 and 2003-2017 to evaluate temporal heterogeneity. FINDINGS: The model with maximum and minimum temperatures and without heat wave indicator gave the best performance. With this model, we found a substantial and significant increase in mortality rate starting from maximum temperature at 42 °C and from minimum temperature at 28 °C: 1 °C increase in maximum and minimum temperatures at lag 0 were associated with 9.56% (95% confidence interval [CI]: 6.64%, 12.56%) and 9.82% (95% CI: 6.33%, 13.42%) increase in mortality risk, respectively. People aged ≥65 years and lived in South residential zone where most slums were located, were more vulnerable. We observed flatter increases in mortality risk associated with high temperatures comparing the period of 2003-2017 to 1987-2002. INTERPRETATION: The analyses provided better understanding of the relationship of high temperatures with mortality in underdeveloped tropical regions and important implications in developing heat warning system for local government. The proposed CV approaches will benefit future scientific work.
The elderly are one of the most vulnerable groups to heat-related illnesses and mortality. In tropical countries like India, where heat waves have increased in frequency and severity, few studies have focused on the level of stress experienced by the elderly. The study presented here included 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages about 75 km south of Kolkata. It used miniature monitoring devices to continuously measure temperature, humidity, and heat index experienced during everyday activities over 24-h study periods, during hot summer months. In the Kolkata slum, construction materials and the urban heat island effect combined to create hotter indoor than outdoor conditions throughout the day, and particularly at night. As a result, elderly slum residents were 4.3 times more likely to experience dangerous heat index levels (≥ 45°C) compared to rural village elderly. In both locations, the median 24-h heat indexes of active elderly were up to 2°C higher than inactive/sedentary elderly (F = 25.479, p < 0.001). Among Kolkata slums residents, there were no significant gender differences in heat exposure during the day or night, but in the rural village, elderly women were 4 times more likely to experience dangerous heat index levels during the hottest times of the day compared to elderly men. Given the decline in thermoregulatory capacity associated with aging and the increasing severity of extreme summer heat in India, these results forecast a growing public health challenge that will require both scientific and government attention.
The impact of heat stress among the elderly in India-particularly the elderly poor-has received little or no attention. Consequently, their susceptibility to heat-related illnesses is virtually unknown, as are the strategies they use to avoid, or deal with, the heat. This study examined perceptions of comfort, heat-related symptoms, and coping behaviors of 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages south of Kolkata during a 90-day period when the average 24-h heat indexes were between 38.6 °C and 41.8 °C. Elderly participants in this study reported being comfortable under relatively warm conditions-probably explained by acclimatization to the high level of experienced heat stress. The prevalence of most heat-related symptoms was significantly greater among elderly women, who also were more likely to report multiple symptoms and more severe symptoms. Elderly women in the rural villages were exposed to significantly hotter conditions during the day than elderly men, making it likely that gender differences in symptom frequency, number and severity were related to gender differences in heat stress. Elderly men and elderly village residents made use of a greater array of heat-coping behaviors and exhibited fewer heat-related symptoms than elderly women and elderly slum residents. Overall, heat measurements and heat-related symptoms were less likely to be significant predictors of most coping strategies than personal characteristics, building structures and location. This suggests that heat-coping behaviors during hot weather were the result of complex, culturally influenced decisions based on many different considerations besides just heat stress.
Cities are becoming hotter day-by-day because heat is trapped near the earth’s surface due to a decrease in green cover, rapid urbanization, energy-intensity activities, and concrete structures. The four major metropolitan cities of India, i.e. Kolkata, Chennai, Delhi and Mumbai, have experienced heat waves and heat stress frequently during the summer season. This study analyses heat wave and heat stress patterns in these cities using 30 years of data from 1990 to 2019 during the summer season. We used daily maximum temperature, relative humidity, wind speed and solar radiation datasets for the above mentioned period in this study. To understand the episode of a heat wave, we have used the 95th percentile method. Furthermore, we have also used Humidity Index (HD) to evaluate the degree of discomfort and the Universal Thermal Climate Index (UTCI) to categorize the level of heat stress. The analysis indicates that the number of heat wave events in the Delhi region is 26.31%, 31.58% and 63.16% higher than Kolkata, Chennai, and Mumbai regions respectively. It is also seen that the risks of extreme heat stress and dangerous-heat stroke events in the Chennai region during heat wave periods are higher than that experienced in other metropolitan cities because of high temperature with higher values of relative humidity. The risk of extreme heat stress is less in Delhi because of lower relative humidity compared to other metropolitan cities although temperature is higher in this region. However, the risk of extreme heat stress is lower in Mumbai region because of relatively lower temperature than Chennai during summer season. The likelihood of experiencing great discomfort during heat wave periods in Kolkata city is higher than that experienced in other metropolitan cities in India, however, during non-heat wave periods the probability of extreme discomfort is higher in Chennai.
Extreme heat events (EHEs) have been linked to increased mortality rates, rendering them a valuable research topic in both climate and public health. Early warning systems are highly impactful in prevention and management of heat-related illnesses. We aimed to determine the preliminary maximum temperature thresholds for Nagpur and Rajkot city of India by analyzing the meteorological and mortality data to enable the heat-health response system based on the heat wave disaster risk of a particular state and city. We conducted a trend analysis with daily maximum temperature and all-cause mortality data of Nagpur and Rajkot (2003-2017) cities, also city-specific thresholds evaluated for both cities. There was a significant association between all-cause mortality and extreme heat events and it was more profound when temperatures were above 40.1 degrees C, but V-shaped relationship of mortality-temperature was noted only for Nagpur city. The dose-response relationship between maximum temperatures and deaths alert thresholds to activate heat health response for red alert set at 46 degrees C and 44 degrees C for Nagpur and Rajkot city respectively. This study suggests that determining local thresholds is important for developing and implementing scientific early warning systems to prevent heat-related illnesses.
BACKGROUND: Dengue, transmitted by Aedes mosquitoes, is a major public health problem in Sri Lanka. Weather affects the abundance, feeding patterns, and longevity of Aedes vectors and hence the risk of dengue transmission. We aimed to quantify the effect of weather variability on dengue vector indices in ten Medical Officer of Health (MOH) divisions in Kalutara, Sri Lanka. METHODS: Monthly weather variables (rainfall, temperature, and Oceanic Niño Index [ONI]) and Aedes larval indices in each division in Kalutara were obtained from 2010 to 2018. Using a distributed lag non-linear model and a two-stage hierarchical analysis, we estimated and compared division-level and overall relationships between weather and premise index, Breteau index, and container index. FINDINGS: From Jan 1, 2010, to Dec 31, 2018, three El Niño events (2010, 2015-16, and 2018) occurred. Increasing monthly cumulative rainfall higher than 200 mm at a lag of 0 months, mean temperatures higher than 31·5°C at a lag of 1-2 months, and El Niño conditions (ie, ONI >0·5) at a lag of 6 months were associated with an increased relative risk of premise index and Breteau index. Container index was found to be less sensitive to temperature and ONI, and rainfall. The associations of rainfall and temperature were rather homogeneous across divisions. INTERPRETATION: Both temperature and ONI have the potential to serve as predictors of vector activity at a lead time of 1-6 months, while the amount of rainfall could indicate the magnitude of vector prevalence in the same month. This information, along with knowledge of the distribution of breeding sites, is useful for spatial risk prediction and implementation of effective Aedes control interventions. FUNDING: None.
Dengue is endemic in Bangladesh and is an important cause of morbidity and mortality. Suppressing the mosquito vector activity at the optimal time annually is a practical strategy to control dengue outbreaks. The objective of this study was to estimate the monthly growth factor (GF) of dengue cases over the past 12 years as a means to identify the optimal time for a vector-control programme in Bangladesh. We reviewed the monthly cases reported by the Institute of Epidemiology, Disease Control and Research of Bangladesh during the period of January 2008-December 2019. We calculated the GF of dengue cases between successive months during this period and report means and 95% confidence intervals (CI). The median number of patients admitted to the hospital with dengue fever per year was 1554 (range: 375-101,354). The mean monthly GF of dengue cases was 1.2 (95% CI: 0.4-2.4). The monthly GF lower CI between April and July was > 1, whereas from September to November and January the upper CI was <1. The highest GF of dengue was recorded in June (mean: 2.4; 95% CI: 1.7-3.5) and lowest in October (mean: 0.43; 95% CI: 0.24-0.73). More than 81% (39/48) months between April and July for the period 2008-2019 had monthly GF >1 compared to 20% (19/96) months between August and March of the same period. The monthly GF was significantly correlated with monthly rainfall (r = 0.39) and monthly mean temperature (r = 0.30). The growth factor of the dengue cases over the last 12 years appeared to follow a marked periodicity linked to regional rainfall patterns. The increased transmission rate during the months of April-July, a seasonally determined peak suggests the need for strengthening a range of public health interventions, including targeted vector control efforts and community education campaigns.
Numerous studies on climate change and variability have revealed that these phenomena have noticeable influence on the epidemiology of dengue fever, and such relationships are complex due to the role of the vector—the Aedes mosquitoes. By undertaking a step-by-step approach, the present study examined the effects of climatic factors on vector abundance and subsequent effects on dengue cases of Dhaka city, Bangladesh. Here, we first analyzed the time-series of Stegomyia indices for Aedes mosquitoes in relation to temperature, rainfall and relative humidity for 2002–2013, and then in relation to reported dengue cases in Dhaka. These data were analyzed at three sequential stages using the generalized linear model (GLM) and generalized additive model (GAM). Results revealed strong evidence that an increase in Aedes abundance is associated with the rise in temperature, relative humidity, and rainfall during the monsoon months, that turns into subsequent increases in dengue incidence. Further we found that (i) the mean rainfall and the lag mean rainfall were significantly related to Container Index, and (ii) the Breteau Index was significantly related to the mean relative humidity and mean rainfall. The relationships of dengue cases with Stegomyia indices and with the mean relative humidity, and the lag mean rainfall were highly significant. In examining longitudinal (2001–2013) data, we found significant evidence of time lag between mean rainfall and dengue cases.
Alabama currently experiences an above-average threat from extreme heat events compared to the remaining states in the USA. More than 160,000 people living in the state (infants, elderly age groups, or poverty-ridden populations) remain vulnerable to heat events. The risk of heat-related mortalities and morbidities disproportionately impacts the growing Alabama cities due to increasing hot-weather episodes and several underlying social vulnerability factors. The exposure threat in 2050 is projected to increase by more than 90 average heat days a year and the number of heat-wave days is predicted to increase from 15 to more than 70 days a year. Although the state’s hazard mitigation plan covers extreme heat issues and heat emergency plans, Alabama lacks heat adaptation plans and is conducting heat vulnerability assessments from time to time. This study focused on determining the social drivers of heat vulnerability and identifying regions within the state that experienced intense heat island effects over the course of five years (2015-2019). 15 sociodemographic factors data from the 2018 American Community Survey (ACS), and 6 health outcome variables (asthma, obesity, stroke, high blood pressure, diabetes) were analyzed to assess cumulative social vulnerability using principal component analysis (PCA). Using Spatial Autoregression (SAR) model, exposure risk was measured as a function of environmental parameters including proportional vegetation, normalized difference water index (NDWI), digital elevation model (DEM), and percent imperviousness of land surface. A heat risk index calculated as a product of social vulnerability and exposure risk was analyzed for Alabama’s eight largest and growing cities (Birmingham, Huntsville, Hoover, Montgomery, Mobile, Tuscaloosa, Auburn, and Dothan) at the block-group census resolution. Spatial data depicting the physical landscape characteristics across the cities revealed differing levels of and factors in exposure to urban heat effects across the city.
BACKGROUND: In the United States (US), urinary tract infections (UTI) lead to more than 10 million office visits each year. Temperature and season are potentially important risk factors for UTI, particularly in the context of climate change. METHODS: We examined the relationship between ambient temperature and outpatient UTI diagnoses among patients followed from 2015 to 2017 in two California healthcare systems: Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. We identified UTI diagnoses in adult patients using diagnostic codes and laboratory records from electronic health records. We abstracted patient age, sex, season of diagnosis, and linked community-level Index of Concentration at the Extremes (ICE-I, a measure of wealth and poverty concentration) based on residential address. Daily county-level average ambient temperature was assembled from the Parameter-elevation Regressions on Independent Slopes Model (PRISM). We implemented distributed lag nonlinear models (DLNM) to assess the association between UTI and lagged daily temperatures. Main analyses were confined to women. In secondary analyses, we stratified by season, healthcare system, and community-level ICE-I. RESULTS: We observed 787,186 UTI cases (89% among women). We observed a threshold association between ambient temperature and UTI among women: an increase in daily temperature from the 5th percentile (6.0 ˚C) to the mean (16.2 ˚C) was associated with a 3.2% (95% CI: 2.4, 3.9%) increase in same-day UTI diagnosis rate, whereas an increase from the mean to 95th percentile was associated with no change in UTI risk (0.0%, 95% CI: -0.7, 0.6%). In secondary analyses, we observed the clearest monotonic increase in the rate of UTI diagnosis with higher temperatures in the fall. Associations did not differ meaningfully by healthcare system or community-level ICE-I. Results were robust to alternate model specifications. DISCUSSION: Increasing temperature was related to higher rate of outpatient UTI, particularly in the shoulder seasons (spring, autumn).
Exertional heat illness (EHI) presents significant risks for National Guard (NG) disaster response teams, especially when they are performing operations in impermeable personal protective equipment (PPE). Impermeable PPE does not allow passage of air or fluids either from the outside or inside of the equipment. While EHI prevention and management strategies are well documented, these strategies do not account for the additional heat-related risks NG teams confront when responding to disasters requiring PPE that protects against any hazards. NG personnel who wear the full gamut of impermeable PPE (including Trek coveralls and respirators) experience core body temperature increase as a result of builtup body heat or accumulated perspiration. We conducted a qualitative descriptive study using thematic analysis with three focus groups to identify EHI-related factors during disaster response operations that require PPE. We organized focus group data into phases of disaster response operation: pre-event, event, and post-event to reflect four conceptual groups: human (host), agent (energy transfer), environmental, and workplace/social conditions. Participants identified 12 themes covering the 3 phases and situated in the 4 conceptual groups. Results of this study serve as an evidence-based foundation for enhancing pre-event, event, and post-event assessments administered by NG medical personnel and can be applied to other professionals who are required to wear PPE.
Background: There remains a dearth of cross-city comparisons on the impact of climate change through extreme temperature and precipitation events on road safety. We examined trends in traffic fatalities, injuries and property damage associated with high temperatures and heavy rains in Boston (USA) and Santo Domingo (Dominican Republic). Methods: Official publicly available data on daily traffic outcomes and weather conditions during the warm season (May to September) were used for Boston (2002-2015) and Santo Domingo (2013-2017). Daily maximum temperatures and mean precipitations for each city were considered for classifying hot days, warm days, and warm nights, and wet, very wet, and extremely wet days. Time-series analyses were used to assess the relationship between temperature and precipitation and daily traffic outcomes, using a quasi-Poisson regression. Results: In Santo Domingo, the presence of a warm night increased traffic fatalities with a rate ratio (RR) of 1.31 (95% CI [confidence interval]: 1.00,1.71). In Boston, precipitation factors (particularly, extremely wet days) were associated with increments in traffic injuries (RR 1.25, 95% CI: 1.18, 1.32) and property damages (RR 1.42, 95% CI: 1.33, 1.51). Conclusion: During the warm season, mixed associations between weather conditions and traffic outcomes were found across Santo Domingo and Boston. In Boston, increases in heavy precipitation events were associated with higher traffic injuries and property damage. As climate change-related heavy precipitation events are projected to increase in the USA, the associations found in this study should be of interest for road safety planning in a rapidly changing environment.
Forty years (1980-2019) of reanalysis data were used to investigate climatology and trends of heat stress in the Caribbean region. Represented via the Universal Thermal Climate Index (UTCI), a multivariate thermophysiological-relevant parameter, the highest heat stress is found to be most frequent and geographically widespread during the rainy season (August, September, and October). UTCI trends indicate an increase of more than 0.2 degrees C center dot decade(-1), with southern Florida and the Lesser Antilles witnessing the greatest upward rates (0.45 degrees C center dot decade(-1)). Correlations with climate variables known to induce heat stress reveal that the increase in heat stress is driven by increases in air temperature and radiation, and decreases in wind speed. Conditions of heat danger, as depicted by the heat index (HI), have intensified since 1980 (+1.2 degrees C) and are found to occur simultaneously to conditions of heat stress suggesting a synergy between heat illnesses and physiological responses to heat. This work also includes the analysis of the record-breaking 2020 heat season during which the UTCI and HI achieved above average values, indicating that local populations most likely experienced heat stress and danger higher than the ones they are used to. These findings confirm the gradual intensification of heat stress in the Caribbean and aim to provide a guidance for heat-related policies in the region.
The projected increase in the frequency and intensity of extreme heat events due to climate change means an associated increase in risk of heat-related illnesses and mortality. Public health systems need to be prepared to identify and reduce the susceptibility of vulnerable populations to increased occurrence of heat-related illness and stress. To facilitate this, climate services have begun developing climate change projections for heat-stress indices based on exceedances of thresholds used operationally in meteorological heat warning systems. This task is complicated by the fact that heat-stress indices are generally computed using hourly data whereas climate model outputs are often archived at daily or longer time steps. This study focuses on Humidex, a heat-stress index used in heat alerts issued by the Meteorological Service of Canada. Several potential solutions for computing robust Humidex indices using daily data are examined, including a new approximation method. Indices obtained with the new method are compared with indices obtained using the classic method based on hourly data as well as with other two methods based on average daily values. The new approximation gives good estimations for humidex indices, while the daily-average-value methods present biases with respect to the hourly-value method.
To mitigate excessive rises in core temperature (>1 °C) in non-heat acclimatized workers, the American Conference of Governmental Industrial Hygienists (ACGIH) provides heat stress limits (Action Limit Values; ALV), defined by the wet-bulb globe temperature (WBGT) and a worker’s metabolic rate. However, since these limits are based on data from men, their suitability for women remains unclear. We therefore assessed core temperature and heart rate in men (n = 19; body surface area-to-mass ratio: 250 (SD 17) cm(2)/kg) and women (n = 15; body surface area-to-mass ratio: 268 (SD 24) cm(2)/kg) aged 18-45 years during 180 min of walking at a moderate metabolic rate (200 W/m(2)) in WBGTs below (16 and 24 °C) and above (28 and 32 °C) ACGIH ALV. Sex did not significantly influence (i) rises in core temperature, irrespective of WBGT, (ii) the proportion of participants with rises in core temperature >1 °C in environments below ACGIH limits, and (iii) work duration before rises in core temperature exceeded 1 °C or volitional termination in environments above ACGIH limits. Although further studies are needed, these findings indicate that for the purpose of mitigating rises in core temperature exceeding recommended limits (>1 °C), ACGIH guidelines have comparable effectiveness in non-heat acclimatized men and women during moderate-intensity work. Novelty: Sex did not appreciably influence thermal strain nor the proportion of participants with core temperatures exceeding recommended limits. Sex did not significantly influence tolerance to uncompensable heat stress. Despite originating from data obtained in only men, current occupational heat stress guidance offered comparable effectiveness in men and women.
BACKGROUND: Many countries have developed heat-health watch and warning systems (HHWWS) or early-warning systems to mitigate the health consequences of extreme heat events. HHWWS usually focuses on the four hottest months of the year and imposes the same threshold over these months. However, according to climate projections, the warm season is expected to extend and/or shift. Some studies demonstrated that health impacts of heat waves are more severe when the human body is not acclimatized to the heat. In order to adapt those systems to potential heat waves occurring outside the hottest months of the season, this study proposes specific health-based monthly heat indicators and thresholds over an extended season from April to October in the northern hemisphere. METHODS: The proposed approach, an adoption and extension of the HHWWS methodology currently implemented in Quebec (Canada). The latter is developed and applied to the Greater Montreal area (current population 4.3 million) based on historical health and meteorological data over the years. This approach consists of determining excess mortality episodes and then choosing monthly indicators and thresholds that may involve excess mortality. RESULTS: We obtain thresholds for the maximum and minimum temperature couple (in °C) that range from (respectively, 23 and 12) in April, to (32 and 21) in July and back to (25 and 13) in October. The resulting HHWWS is flexible, with health-related thresholds taking into account the seasonality and the monthly variability of temperatures over an extended summer season. CONCLUSIONS: This adaptive and more realistic system has the potential to prevent, by data-driven health alerts, heat-related mortality outside the typical July-August months of heat waves. The proposed methodology is general and can be applied to other regions and situations based on their characteristics.
Climate change has led to prolonged, more frequent, intense, and severe extreme weather events, such as summertime heatwaves, creating many challenges on the economy and society and human health and energy resources. For example, the 2010 and 2018 heatwave in Quebec, Canada, resulted in about 280 and 93 heat-related deaths, and there were around 500 fatalities due to overheated indoor environments in 2021 around entire Canada. Therefore, it is imperative to understand and evaluate the overheating conditions in buildings, for which selecting suitable future reference weather data under climate change is one of the first critical steps. This study evaluated a reference year selection method in terms of typical and extreme reference years based on future climate datasets to assess both outdoor and indoor overheating in the future. The future climate data were collected from the Coordinated Regional Downscaling Experiment (CORDEX) program. Three Canadian cities (Montreal, Toronto, Vancouver) were selected for the overheating evaluation during three selected periods (2001-2020, 2041-2060, 2081-2100). The CORDEX climate projections were first bias-corrected by the multivariate quantile mapping correction method with the observational data. Then, the typical and extreme reference year data were generated as well as climate data from the design summer year for comparison. The performance of the reference year selection method was evaluated by comparing the maximum, minimum, and average overheating hours for the 20-years data of each period. This study demonstrates that the multivariate quantile mapping bias correction method can improve the reliability of future climate data making it one of the most important steps for any future weather projection study. Besides, the reference year selection method could efficiently capture maximum and minimum monthly overheating hours providing the upper and lower boundary of possible outdoor and indoor overheating conditions.. In contrast, neither the severest nor the typical monthly outdoor and indoor overheating conditions could be predicted by the design summer year method. Finally, owing to the effects of climate change, average monthly overheating hours normally increase by around one time (from 50% to 150%) until the mid-term future (2041-2060) and by around two to three times (even up to nine times for some scenarios) during the long-term future (2081-2100).
BACKGROUND: Studies have shown that prenatal heat exposure may impact fetal growth, but few studies have examined the critical windows of susceptibility. As extreme heat events and within season temperature variability is expected to increase in frequency, it is important to understand how this may impact gestational growth. OBJECTIVES: We investigated associations between various measures of weekly prenatal heat exposure (mean and standard deviation (SD) of temperature and heat index (HI), derived using temperature in °C and dew point) and term birthweight or odds of being born small for gestational age (SGA) to identify critical windows of susceptibility. METHODS: We analyzed data from mother-child dyads (n = 4442) in the Boston-based Children’s HealthWatch cohort. Birthweights were collected from survey data and electronic health records. Daily temperature and HI values were obtained from 800 m gridded spatial climate datasets aggregated by the PRISM Climate Group. Distributed lag-nonlinear models were used to assess the effect of the four weekly heat metrics on measures of gestational growth (birthweight, SGA, and birthweight z-scores). Analyses were stratified by child sex and maternal homelessness status during pregnancy. RESULTS: HI variability was significantly associated with decreased term birthweight during gestational weeks 10-29 and with SGA for weeks 9-26. Cumulative effects for these time periods were -287.4 g (95% CI: -474.1 g, -100.8 g for birthweight and 4.7 (95% CI: 1.6, 14.1) for SGA. Temperature variability was also significantly associated with decreased birthweight between weeks 15 and 26. The effects for mean heat measures on term birthweight and SGA were not significant for any gestational week. Stratification by sex revealed a significant effect on term birthweight in females between weeks 23-28 and in males between weeks 9-26. Strongest effects of HI variability on term birthweight were found in children of mothers who experienced homelessness during pregnancy. Weekly HI variability was the heat metric most strongly associated with measures of gestational growth. The effects observed were largest in males and those who experienced homelessness during pregnancy. DISCUSSION: Given the impact of heat variability on birthweight and risk of SGA, it is important for future heat warnings to incorporate measure of heat index and temperature variability.
Trend assessments suggest that poverty and health will worsen in the United States in the coming decades and that climate change will exacerbate these trends. An aging society, lack of affordable housing, and automation threaten the economic sustainability of millions of households. Despair, drug abuse, and unhealthy lifestyles have led to the first decline in life spans in the U.S. during a non-war period. Extreme weather events caused by climate change can be anticipated to disrupt economic activities and destroy homes and infrastructure, pushing millions of more Americans into poverty. A warming climate threatens vulnerable individuals, such as elders, with heat stress, increasing levels of air pollution, and increasing risks from new tropical diseases entering the country. It is anticipated that climate change will force tens of millions of Americans from their homes, creating The Great Migration (TGM) scenario. The welfare of the migrants will depend on what types of human settlements they migrate to. Seven different types of settlements are depicted within the TGM scenario, such as Willow Pond settlements that represent radical redesigns of suburbs to make them sustainable and resilient to climate change. Numerous recommendations are provided to foster positive outcomes with respect to TGM, including having the U. S. formally designate that the right to safe and adequate housing is a human right.
The troubling trend of rising heat-associated mortalities in an urban desert region (Maricopa County, AZ, USA) has motivated us to explore the extent to which environmental factors may contribute to increased heat-health risks. Summertime data from 2010 to 2019 were used to construct a suite of models for daily heat-associated mortalities. The best-performing full model included the following predictors, ordered from strongest to weakest influence: daily average air temperature, average of previous 5 days daily average air temperature, year, day of year, average of previous 5 days daily average dew point temperature, average of previous 5 days daily average PM(2.5), and daily average PM(10). This full model exhibited a 5.39% reduction in mean absolute error in daily heat-associated mortalities as compared to the best-performing model that included only air temperature as an environmental predictor. The extent to which issued and modeled excessive heat warnings (from both the temperature only and full models) corresponded with heat-associated mortalities was also examined. Model hindcasts for 2020 and 2021 showed that the models were able to capture the high number of heat-associated mortalities in 2020, but greatly undercounted the highest yet observed number of heat-associated mortalities in 2021. Results from this study lend insights into environmental factors corresponding to an increased number of heat-associated mortalities and can be used for informing strategies towards reducing heat-health risks. However, as the best-performing model was unable to fully capture the observed number of heat-associated mortalities, continued scrutiny of both environmental and non-environmental factors affecting these observations is needed.
Concerns over regional climate change include its impact on air quality. A major contributor to unhealthy air quality is surface-based temperature inversions. Poor air quality is a serious public health concern that is often addressed by public health agencies. To assist with understanding the climatology and trend of temperature inversions for a large public health department, innovative pragmatic criteria were developed and used to determine morning and evening surface-based temperature inversions from datasets derived from Pittsburgh National Weather Service (NWS) radiosonde measurements made from 1 January 1991 through 31 December 2020. During this 30-year period, the strength of the morning (7 a.m. EST; 12 UTC) inversions was 3.9 °C on average. The depth of the inversion layer measured an average height of 246 m above the ground. The inversions tended to dissipate by 10 a.m. EST. The frequency of occurrence of morning inversions averaged 47%. The mean strength of the evening (7 p.m. EST; 00 UTC) inversions was 1.1 °C with a mean depth of 101 m above the ground. The frequency of evening inversion occurrence averaged 20% during this period. The 30-year climatology revealed generally declining frequency of inversions in the Pittsburgh area. Morning surface-based inversion strengths usually declined while morning depths and break times were steady. Evening inversion strengths and depths increased overall during the 30-year period. Monthly means showed a morning-evening overlap of some months that record the most frequent substantial inversions during the fall time of the year, coinciding with the time when the worst air pollution events occur.
The smart helmet is designed for a wildland firefighter to send vital data to their supervisor while they are working to extinguish an active fire. The smart helmet collects temperature, heart rate, and acceleration data from each firefighter via sensors inside and around the helmet. The data is used to alert the supervisor of potential health or emergency issues, such as heat-related illness, dehydration, potential falls or abnormal heart rates. A mobile app that the supervisor connects to their smart helmet device collects data in real time from the firefighters, without the need of any cellular coverage or WiFi.
Extreme temperature events are linked to increased emergency department visits, hospitalizations, and mortality for individuals with behavioral health disorders (BHD). This study aims to characterize risk factors for concurrent temperature-related illness among BHD hospitalizations in New York State. Using data from the NYS Statewide and Planning Research and Cooperative System between 2005-2019, multivariate log binomial regression models were used in a population of BHD hospitalizations to estimate risk ratios (RR) for a concurrent heat-related (HRI) or cold-related illness (CRI). Dementia (RR 1.65; 95% CI:1.49, 1.83) and schizophrenia (RR 1.38; 95% CI:1.19, 1.60) were associated with an increased risk for HRI among BHD hospitalizations, while alcohol dependence (RR 2.10; 95% CI:1.99, 2.22), dementia (RR 1.52; 95% CI:1.44, 1.60), schizophrenia (RR 1.41; 95% CI:1.31, 1.52), and non-dependent drug/alcohol use (RR 1.20; 95% CI:1.15, 1.26) were associated with an increased risk of CRI among BHD hospitalizations. Risk factors for concurrent HRI among BHD hospitalizations include increasing age, male gender, non-Hispanic Black race, and medium hospital size. Risk factors for concurrent CRI among BHD hospitalizations include increasing age, male gender, non-Hispanic Black race, insurance payor, the presence of respiratory disease, and rural hospital location. This study adds to the literature by identifying dementia, schizophrenia, substance-use disorders, including alcohol dependence and non-dependent substance-use, and other sociodemographic factors as risk factors for a concurrent CRI in BHD hospitalizations.
INTRODUCTION: The purpose of this study was to evaluate heat stress occurring in wildfire management activities with variable environmental conditions. METHODS: Direct observation and real-time wireless physiological monitoring allowed for weather and physiological metrics, including heart rate, core temperature (T(c)), skin temperature, and physiological strain index (PSI), of male (n=193) and female (n=28) wildland firefighters (WLFFs) to be recorded during wildfire management activities. Accelerometry data were used to categorize intensity level of activity. RESULTS: Ambient temperature and relative humidity values were used to compute the heat index (HI; n=3891 h) and divided into quartiles (Q1: 13.3-25.1°C; Q2: 25.2-26.4°C; Q3: 26.5-28.9°C; Q4: 29.0-49.1°C). Activity levels remained relatively constant across all HI quartiles. The percentage of time spent performing moderate/vigorous activities was lowest during the hotter Q4 (Q1: 3%; Q2: 2%; Q3: 2%; Q4: 1%). Heart rate, T(c), PSI, and skin temperature associations with HI varied by resource type. Sixty-one percent of WLFFs (n=134) experienced a T(c) ≥38.0°C, and 50% of WLFFs (n=111) experienced a PSI ≥6.0. CONCLUSIONS: Heat stress was prevalent as WLFFs performed job tasks of varying intensities in all ambient conditions. Spontaneous bouts of arduous labor, duration of work shifts, and other occupation characteristics present the possibility for substantial durations of hyperthermia, although no heat-related injuries occurred in this study. Despite chronic exposure to rugged sloped terrain, load carriage, and environmental conditions, self-regulation and individual attention to managing work:rest appears to be the primary management strategy in mitigating excessive accumulation of body heat in this occupation.
Uncompensable heat from wildland firefighter personal protective equipment decreases the physiological tolerance while exercising in the heat. Our previous work demonstrated that the standard wildland firefighter helmet significantly increases both perceived and actual head heat. This study compared heat accumulation under simulated working conditions while wearing a standard non-vented helmet versus a vented helmet. Ten male subjects randomly completed two trials separated by a 2-week washout. Subjects walked 180 min (5.6 km h−1, 5% grade) in a heat chamber (35°C, 30% relative humidity) broken into three segments of 50 min of exercise and 10 min rest, followed by a work capacity test to exhaustion. Each trial measured the physiological strain index, perceived head heat, helmet temperature and relative humidity, rating of perceived exertion and heart rate. At the end of the 3-h trial heart rate, physiological strain, perceived exertion, helmet temperature and humidity showed the main effects of time (P < 0.05) but were not different between trials. Work capacity was significantly greater in the vented trial (P = 0.001). End-trial strain and heart rate were significantly related to work performed (r = –0.8, P < 0.001). Elevated work, trends for changes in perceived exertion, helmet microenvironment and perceived head heat suggest greater heat dissipation and comfort with the vented helmet.
High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.
OBJECTIVE: Climate and social vulnerability contribute to morbidity and health care utilization. We examined associations between the neighborhood Social Vulnerability Index (SVI) and the Heat Vulnerability Index (HVI) and recurrent hospitalizations among individuals with rheumatic conditions. METHODS: Using a Massachusetts multihospital centralized clinical data repository, we identified individuals ≥18 years of age with a rheumatic condition who received rheumatology care within 3 years of April 2021. We defined the index date as 2 years before the last encounter and the baseline period as 1 year pre-index date. Addresses were geocoded and linked by census tract to the SVI and the HVI. We used multilevel, multinomial logistic regression to examine the odds of 1-3 and ≥4 hospitalizations (reference = 0) over 2 years post index date by vulnerability index, adjusting for age, gender, race/ethnicity, insurance, and comorbidities. RESULTS: Among 14,401 individuals with rheumatic conditions, the mean ± age was 61.9 ± 15.7 years, 70% were female, 79% White, 7% Black, and 2% Hispanic. There were 8,251 hospitalizations; 11,649 individuals (81%) had 0 hospitalizations, 2,063 (14%) had 1-3, and 689 (5%) had ≥4. Adjusting for individual-level factors, individuals living in the highest versus lowest SVI areas had 1.84 times higher odds (95% confidence interval [95% CI] 1.43-2.36) of ≥4 hospitalizations. Individuals living in the highest versus lowest HVI areas had 1.64 times greater odds (95% CI 1.17-2.31) of ≥4 hospitalizations. CONCLUSION: Individuals with rheumatic conditions living in areas with high versus low social and heat vulnerability had significantly greater odds of recurrent hospitalizations. Studies are needed to determine modifiable factors to mitigate risks.
The prevention of snake envenomations in North America often focuses on avoiding interactions between humans and snakes. Previous strategies have focused on the influence of geography, type of habitat, and time of year, though a detailed analysis of weather patterns on snakebite envenomation behavior is lacking. We present a case-crossover study of non-pregnant adults (n = 489) who reported snake envenomations to a single state’s poison control center from 2014 to 2018. Age and gender of the individual, as well as the date, time, zip code associated with the envenomation, and snake descriptions were collected. Information regarding barometric pressure, actual temperature, high and low daily temperature, and weather condition (fair, cloudy, or rain/precipitation) was collected and compared to the same zip code, date, and time exactly one week and one year prior to the envenomation using historical data from the Weather Underground database. Paired t-tests and Stuart-Maxwell tests were used to determine differences in weather conditions during the study period. This study was IRB-approved. At the time of envenomation, the weather was most often fair (52.2%), followed by cloudy (44%), and least frequently demonstrated rain/precipitation (3.9%). Snake envenomations increased significantly (p < 0.0001) on days with an elevated daily high temperature. There were statistical differences in the distribution of weather conditions (fair, cloudy, or rain/precipitation) on the day of envenomation compared to one week prior (p < 0.0001) and one year prior (p < 0.0008). Comparisons based on both control groups indicated that envenomations were significantly less likely to occur during rain/precipitation and cloudy weather than during fair weather. Limitations include its retrospective nature and low total number of envenomations. In our single-center study, snake envenomation behavior as it relates to readily reportable weather measurements, appears to be associated with the warmer days, the overall high temperature on the day of envenomation, and fair weather conditions. Actual temperature at the time of envenomation, low temperature, barometric pressure, and precipitation at the time of envenomation do not appear to be associated with an increased risk of envenomation. Additional studies to determine the cause of these associations would be beneficial in further delineating the findings of this study.
OBJECTIVES: High ambient temperatures may contribute to acute asthma exacerbation, a leading cause of morbidity in children. We quantified associations between hot-season ambient temperatures and asthma exacerbation in children ages 0-18 years in Philadelphia, PA. METHODS: We created a time series of daily counts of clinical encounters for asthma exacerbation at the Children’s Hospital of Philadelphia linked with daily meteorological data, June-August of 2011-2016. We estimated associations between mean daily temperature (up to a 5-day lag) and asthma exacerbation using generalised quasi-Poisson distributed models, adjusted for seasonal and long-term trends, day of the week, mean relative humidity,and US holiday. In secondary analyses, we ran models with adjustment for aeroallergens, air pollutants and respiratory virus counts. We quantified overall associations, and estimates stratified by encounter location (outpatient, emergency department, inpatient), sociodemographics and comorbidities. RESULTS: The analysis included 7637 asthma exacerbation events. High mean daily temperatures that occurred 5 days before the index date were associated with higher rates of exacerbation (rate ratio (RR) comparing 33°C-13.1°C days: 1.37, 95% CI 1.04 to 1.82). Associations were most substantial for children ages 2 to <5 years and for Hispanic and non-Hispanic black children. Adjustment for air pollutants, aeroallergens and respiratory virus counts did not substantially change RR estimates. CONCLUSIONS: This research contributes to evidence that ambient heat is associated with higher rates of asthma exacerbation in children. Further work is needed to explore the mechanisms underlying these associations.
Adaptation across systems’ in agriculture is essential for sustainability under ongoing climate change. Farmers and agricultural employers implement changes in their work (e.g., mechanization, changing crops, managing workspaces) in ways that may directly impact worker health. In this study, semi-structured interviews were conducted with farmers and farm labor contractors in three agriculturally productive regions of California. We investigated (1) how farmers view changing climate in terms of worker safety and health; (2) how they are currently adapting to long-term weather patterns; (3) how their choices of management practices might impact their workers; (4) how they view their responsibility for their workers; and (5) what their overall observations are concerning environmental changes. Many employers made a clear distinction between weather and climate but not all agreed on whether they were experiencing climate change. Heat was notably the biggest climate hazard farmers identified. Most of the employers interviewed were proud of their longevity and ability to adapt to changing conditions in the field; however, they did not have established emergency procedures. Despite regulations that put the onus on employers, most participants believed that workers needed to take individual responsibility to keep themselves safe in the workplace. This research is one step in an ongoing research process designed to address the impacts of health and safety for agricultural workers in the context of climate change.
OBJECTIVES: To characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries. METHODS: Two data sources were analysed: archived case files of the Occupational Safety and Health Administration’s (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture-recapture analysis assessed under-reporting in SIR. RESULTS: There were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis. CONCLUSIONS: Workers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI.
Multiple sclerosis (MS) is a neurological disorder that progressively distorts the myelination of axons within the central nervous system (CNS). Increased core body temperature or metabolism as a result of exercise are common causes of short-term exacerbations of neurological symptoms in MS. About 60-80% of patients with MS experience a worsening of their symptoms when exposed to heat. In comparison, less data are available on the relationship between ambient meteorological conditions (e.g., temperature and relative humidity (RH)) and fluctuations in such variables in relation to MS symptoms. Thus, this study examined associations between time-lagged exposure to meteorological conditions and risk of a clinic visit due to MS among US veterans between 2010 and 2013. This study leveraged data from the Veterans Affairs (VA) and National Climactic Data Center (NCDC) for the continental US, partitioned into eight climate zones. We used a case crossover design to assess the risk of a MS clinic visit with respect to several meteorological conditions. Location-specific time-lagged daily (ambient) exposure to temperature, RH, and temperature variations (standard deviation (SD) of temperature) were computed (up to 30 days) for each case (i.e., day of MS visit) and control (a randomly assigned date ± 90-270 days prior to visit). Statistical analyses were conducted to examine independent associations between the selected meteorological conditions and risk of MS visits at the national and regional levels. A total of 533,066 patient visits received a MS diagnosis (International Classifications of Diseases (ICD)-9 code = 340). The Northeast (NE) and Upper Midwest (UMW) regions reported the highest frequency of clinic visits due to MS. Clinic visits were 9% more likely to occur in the spring, summer, and fall months (March-October) than in the winter (OR = 1.089; 95% CI = 1.076-1.103; p < 0.01). In the univariate analyses, the SD of temperature, temperature, and temperature-RH interaction were positively associated with an elevated risk of a MS clinic visit, while the RH was negatively associated with the risk for a clinic visit. In multivariate analyses, the strongest association of a MS clinic visit was observed with the SD of the temperature (OR = 1.012; 95% CI 1.008-1.017; p < 0.01). These associations between MS clinic visits and meteorological conditions varied across climate regions, with the strongest associations being observed in the LMW, UMW, DSW, and NE zones. The SD of the temperature was again the strongest associated predictor when examined regionally. Temperature variations and temperature-RH interactions (a proxy of the heat index) showed significant associations with MS clinic visits. These associations varied across climate regions when examined geographically. Our findings have implications for the management of MS in severe or recurrent cases, especially considering the impending changes in the daily temperature variations and intensity of the heatwaves expected with the intensification of global warming.
BACKGROUND: Increasing temperatures negatively impact health and increases demands on healthcare systems. However, this has been poorly studied in Rhode Island (RI). Here we characterize the impact of heat on emergency medical services (EMS) utilization in RI. METHODS: The Rhode Island National Emergency Services Information System V3 dataset was merged with data from the National Center for Environmental Information of the National Oceanic and Atmospheric Administration from the summers of 2018 and 2019. The outcome of daily mean EMS runs were compared against the exposure increasing daily temperatures, measured as daily maximum, minimum and daily average °F, using Poisson regressions. Patient characteristics were included across temperature models. RESULTS: Increasing daily temperatures were associated with increasing EMS encounters. The adjusted incident rate ratio (IRR) for mean daily EMS encounters by increasing maximum daily temperature was 1.006 (95% CI 1.004-1.007, Table 3). This resulted in a projected 17.2% increase in EMS runs on days with a maximum temperature of 65°F compared to days with a maximum temperature of 95°F. The adjusted IRR for mean daily EMS encounters by the daily minimum temperature was 1.004 (1.003-1.006) and the adjusted IRR for the mean daily EMS encounters by the daily average temperature was 1.006 (1.005-1.008). CONCLUSIONS: Increasing minimum, maximum, and average daily temperatures were associated with increasing EMS utilization across Rhode Island in the summers of 2018 and 2019. Further research into these trends may help with planning and resource allocation as summer temperatures continue to rise.
Acute heat exposure protects against endothelial ischemia-reperfusion (I/R) injury in humans. However, the mechanism/s mediating this protective effect remain unclear. We tested the hypothesis that inhibiting the increase in shear stress induced by acute heat exposure would attenuate the protection of endothelial function following I/R injury. Nine (3 women) young healthy participants were studied under three experimental conditions: 1) thermoneutral control; 2) whole body heat exposure to increase body core temperature by 1.2°C; and 3) heat exposure + brachial artery compression to inhibit the temperature-dependent increase in shear stress. Endothelial function was assessed via brachial artery flow-mediated dilatation before (pre-I/R) and after (post-I/R) 20 min of arm ischemia followed by 20 min of reperfusion. Brachial artery shear rate was increased during heat exposure (681 ± 359 s^(−1)), but not for thermoneutral control (140 ± 63 s−1; P < 0.01 vs. heat exposure) nor for heat + brachial artery compression (139 ± 60 s−1; P < 0.01 vs. heat exposure). Ischemia-reperfusion injury reduced flow-mediated dilatation following thermoneutral control (pre-I/R, 5.5 ± 2.9% vs. post-I/R, 3.8 ± 2.9%; P = 0.06), but was protected following heat exposure (pre-I/R, 5.8 ± 2.9% vs. post-I/R, 6.1 ± 2.9%; P = 0.5) and heat + arterial compression (pre-I/R, 4.4 ± 2.8% vs. post-I/R, 5.8 ± 2.8%; P = 0.1). Contrary to our hypothesis, our findings demonstrate that shear stress induced by acute heat exposure is not obligatory to protect against endothelial I/R injury in humans.NEW & NOTEWORTHY Acute heat exposure protects against endothelial ischemia-reperfusion injury in humans. However, the mechanism/s mediating this protective effect remain unclear. We utilized arterial compression to inhibit the temperature-dependent increase in brachial artery blood velocity that occurs during acute heat exposure to isolate the contribution of shear stress to the protection of endothelial function following ischemia-reperfusion injury. Our findings demonstrate that shear stress induced by acute heat exposure is not obligatory to protect against endothelial I/R injury.
Upward trends in ground-level warming are expected to intensify, affecting the health of human populations. Specific to the United States, the Northeast (NE) region is one of the most vulnerable to these warming trends. Previous research has found social disparities in the distribution of heat, while recent studies have examined associations between metropolitan racial/ethnic segregation and heat exposures. We advance upon previous research by including a novel measure of neighborhood-level racial/ethnic diversity in our examination of social inequalities in heat for NE neighborhoods (census tracts). We paired data derived from the United States Geological Survey on mean land surface temperature (LST) for the summer months of 2013-2017 with sociodemographic data from the American Community Survey (5-year estimates, 2013-2017). We use multivariable generalized estimating equations (GEEs) that adjust for geographic clustering. Findings reveal heat exposure disparities across NE neighborhoods. Neighborhoods with higher proportions of racial/ethnic minorities, people of lower socioeconomic status, households without access to an automobile, and greater diversity experience higher temperatures. Diversity was more strongly related to increased heat in neighborhoods with lower Latinx and lower Black composition suggesting that neighborhood homogeneity confers a differentially greater cooling effect based on higher White composition. The social groups that carry the unequal thermal burdens are also those who are most vulnerable. Interventions to reduce heat risks in the NE should therefore prioritize reducing the burden on historically disadvantaged communities.
In recent years, demographic growth has caused cities to expand their urban areas, increasing the risk of overheating, creating insurmountable microclimatic conditions within the urban area, which is why studies have been carried out on the urban heat island effect (UHI) and its mitigation. Therefore, this research aims to evaluate the cooling potential in the application of strategies based on biomimicry for the microclimate in a historical heritage city of Panama. For this, three case studies (base case, case 1, and case 2) of outdoor thermal comfort were evaluated, in which the Envi-met software was used to emulate and evaluate the thermal performance of these strategies during March (highest temperature month) and October (rainier month). The strategies used were extracted from the contrast of zebra skin, human skin, evaporative cooling, and ant skin. The results showed a reduction of 2.8 °C in the air temperature at 11:00, the radiant temperature decreased by 2.2 °C, and the PET index managed to reduce the thermal comfort indicator among its categories. The importance of thinking based on biomimicry in sustainable strategies is concluded; although significant changes were obtained, high risks of discomfort persist due to the layout and proximity of the building.
Emerging research suggests that internet search patterns may provide timely, actionable insights into adverse health impacts from, and behavioral responses to, days of extreme heat, but few studies have evaluated this hypothesis, and none have done so across the United States. We used two-stage distributed lag nonlinear models to quantify the interrelationships between daily maximum ambient temperature, internet search activity as measured by Google Trends, and heat-related emergency department (ED) visits among adults with commercial health insurance in 30 US metropolitan areas during the warm seasons (May to September) from 2016 to 2019. Maximum daily temperature was positively associated with internet searches relevant to heat, and searches were in turn positively associated with heat-related ED visits. Moreover, models combining internet search activity and temperature had better predictive ability for heat-related ED visits compared to models with temperature alone. These results suggest that internet search patterns may be useful as a leading indicator of heat-related illness or stress.
Place-based structural inequalities can have critical implications for the health of vulnerable populations. Historical urban policies, such as redlining, have contributed to current inequalities in exposure to intra-urban heat. However, it is unknown whether these spatial inequalities are associated with disparities in heat-related health outcomes. The aim of this study is to determine the relationships between historical redlining, intra-urban heat conditions, and heat-related emergency department visits using data from 11 Texas cities. At the zip code level, the proportion of historical redlining was determined, and heat exposure was measured using daytime and nighttime land surface temperature (LST). Heat-related inpatient and outpatient rates were calculated based on emergency department visit data that included ten categories of heat-related diseases between 2016 and 2019. Regression or spatial error/lag models revealed significant associations between higher proportions of redlined areas in the neighborhood and higher LST (Coef. = 0.0122, 95% CI = 0.0039-0.0205). After adjusting for indicators of social vulnerability, neighborhoods with higher proportions of redlining showed significantly elevated heat-related outpatient visit rate (Coef. = 0.0036, 95% CI = 0.0007-0.0066) and inpatient admission rate (Coef. = 0.0018, 95% CI = 0.0001-0.0035). These results highlight the role of historical discriminatory policies on the disparities of heat-related illness and suggest a need for equity-based urban heat planning and management strategies.
Much research has shown a general decrease in the negative health response to extreme heat events in recent decades. With a society that is growing older, and a climate that is warming, whether this trend can continue is an open question. Using eight additional years of mortality data, we extend our previous research to explore trends in heat-related mortality across the United States. For the period 1975-2018, we examined the mortality associated with extreme-heat-event days across the 107 largest metropolitan areas. Mortality response was assessed over a cumulative 10-day lag period following events that were defined using thresholds of the excess heat factor, using a distributed-lag nonlinear model. We analyzed total mortality and subsets of age and sex. Our results show that in the past decade there is heterogeneity in the trends of heat-related human mortality. The decrease in heat vulnerability continues among those 65 and older across most of the country, which may be associated with improved messaging and increased awareness. These decreases are offset in many locations by an increase in mortality among men 45-64 (+1.3 deaths per year), particularly across parts of the southern and southwestern United States. As heat-warning messaging broadly identifies the elderly as the most vulnerable group, the results here suggest that differences in risk perception may play a role. Further, an increase in the number of heat events over the past decade across the United States may have contributed to the end of a decades-long downward trend in the estimated number of heat-related fatalities.
Construction workers often expose to heat stress hazards as temperature and humidity increase. Heat-related illnesses include heat stroke, heat exhaustion, heat cramps, and heat rash conditions. Without immediate and correct treatments, patients may suffer from brain damage or other organ failures, and even death. Heat exposure can also cause fatigue and then lead to other construction accidents. It is crucial to raise awareness of heat-related illnesses and equip people with the means and methods to prevent them from happening. This study aims to assess the current status of people’s knowledge of heat-related illnesses using an online survey questionnaire. The results suggest that further heat-related training should put more focus on the training topics of heat-related illnesses prevention strategies, first-aid, and symptom identifications. The participants whose work is directly related to safety have a better understanding of heat-related illness symptoms than the rest. The results also indicate that the participants’ knowledge of heat-related illness prevention is related to their age and whether they had participated in heat-related training. The findings of this research can help with the development of future heat-related illnesses training and facilitate construction companies to improve their current safety culture and practices.
OBJECTIVE: To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance. DESIGN: Time stratified case crossover analyses with distributed lag non-linear models. SETTING: US nationwide administrative healthcare claims database. PARTICIPANTS: All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019. MAIN OUTCOME MEASURES: Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes. RESULTS: 21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100?Çë000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate. CONCLUSIONS: Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.
Extreme temperature significantly affects workforce health during the summer in locations with sustained high temperatures. The exposure of workers to excessive heat has increased in the last decades, and it is correlated with reduced productivity and work efficiency. The effects of extreme heat on the health of outdoor workers in the southwestern USA were assessed using the heat index (HI) calculated using temperature and humidity information from National Oceanic and Atmospheric Administration and data on occupational injuries/illnesses from the US Bureau of Labor Statistics. The analysis of the data was performed using the Spearman’s rho nonparametric analysis. A statistically significant increase in the heat index was found in two of the three locations selected for this study. At the Phoenix Sky Harbor Airport (Phoenix, AZ) and Harry Reid International Airport (Las Vegas, NV) stations, seasonal maximum HI values exceeded the extreme danger threshold and seasonal average HI ranges were found within the dangerous range. The number of nonfatal occupational heat-related injuries/illnesses in Arizona, California, and Nevada were also analyzed and were found to be steadily increasing in all three states over the study period (2011-2018). The overall number of nonfatal occupational injuries/illnesses were also analyzed as a function of the length of service with the employer, which showed an increase in the number of events with an increase in the length of service. The time of the day and number of hours worked were also found to significantly affect the overall number of nonfatal occupational injuries/illnesses in the three locations studied. In addition, the number of days away from work after the occurrence of a heat-related, nonfatal occupational injury/illness event was significantly higher for events during which the worker remained away from work for more than 30 days. Results from this study suggest that extreme heat poses a real threat for outdoor workers and decision-making devoted to addressing this risk is required to prevent undesirable effects.
Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.
BACKGROUND: Some socioeconomically vulnerable groups may experience disproportionately higher risk of extreme heat illness than other groups, but no study has utilized the presence/absence of a social security number (SSN) as a proxy for vulnerable sub-populations. METHODS: This study focused on the warm season from 2008 to 2012 in Florida, U.S. With a total number of 8,256,171 individual level health outcomes, we devised separate case-crossover models for five heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease), type of health care visit (emergency department (ED) and hospitalization), and patients reporting/not reporting an SSN. Each stratified model also considered potential effect modification by sex, age, or race/ethnicity. RESULTS: Mean temperature raised the odds of five heat-sensitive health outcomes with the highest odds ratios (ORs) for heat-related illness. Sex significantly modified heat exposure effects for dehydration ED visits (Males: 1.145, 95 % CI: 1.137-1.153; Females: 1.110, 95 % CI: 1.103-1.117) and hospitalization (Males: 1.116, 95 % CI: 1.110-1.121; Females: 1.100, 95 % CI: 1.095-1.105). Patients not reporting an SSN between 25 and 44 years (1.264, 95 % CI: 1.192-1.340) exhibited significantly higher dehydration ED ORs than those reporting an SSN (1.146, 95 % CI: 1.136-1.157). We also observed significantly higher ORs for cardiovascular disease hospitalization from the no SSN group (SSN: 1.089, 95 % CI: 1.088-1.090; no SSN: 1.100, 95 % CI: 1.091-1.110). CONCLUSIONS: This paper partially supports the idea that individuals without an SSN could experience higher risks of dehydration (for those 25-45 years), renal disease, and cardiovascular disease than those with an SSN.
IMPORTANCE: Firearm violence is a leading public health crisis in the US. Understanding whether and how ambient temperature is associated with firearm violence may identify new avenues for prevention and intervention. OBJECTIVE: To estimate the overall and regional association between hotter temperatures and higher risk of firearm violence in the US. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used distributed lag nonlinear models, controlling for seasonality and long-term time trends by city and pooled results overall and by climate region. The most populous cities in the US with the highest number of assault-related firearm incidence (ie, shootings) from 2015 to 2020 were analyzed. Data analysis was performed from October 2021 to June 2022. EXPOSURES: Maximum daily temperature by city. MAIN OUTCOMES AND MEASURES: The primary outcome was the number of assault-related firearm shootings by city. RESULTS: A total of 116 511 shootings in 100 cities were included in this analysis. The pooled analysis estimated that 6.85% (95% CI, 6.09%-7.46%) of all shootings were attributable to days hotter than city-specific median temperatures. This equates to 7973 total shootings (95% CI, 7092-8688 total shootings) across the 100 cities over the 6-year study period, although the number of total persons injured or killed would be higher. Estimated risk of firearm incidents increased almost monotonically with higher temperatures, with a local peak at the 84th percentile of the temperature range corresponding to a relative risk of 1.17 (95% CI, 1.12-1.21) compared with the median temperature. However, even moderately hot temperatures were associated with higher risk of shootings. Although significant, there was low heterogeneity between cities (I2 = 11.7%; Cochran Q test, P = .02), indicating regional or climate-specific variation in the daily temperature and incident shootings relationship. CONCLUSIONS AND RELEVANCE: These findings underscore the importance of heat adaptation strategies broadly throughout the year to reduce shootings, rather than focusing on only the hottest days.
Here we use remotely sensed land surface temperature measurements to explore the distribution of the United States’ urban heating burden, both at high resolution (within cities or counties) and at scale (across the whole contiguous United States). While a rich literature has documented neighborhood-level disparities in urban heat exposures in individual cities, data constraints have precluded comparisons across locations. Here, drawing on urban temperature anomalies during extreme summer surface temperature events from all 1,056 US counties with more than 10 developed census tracts, we find that the poorest tracts (and those with lowest average education levels) within a county are significantly hotter than the richest (and more educated) neighborhoods for 76% of these counties (54% for education); we also find that neighborhoods with higher Black, Hispanic, and Asian population shares are hotter than the more White, non-Hispanic areas in each county. This holds in counties with both large and small spreads in these population shares, and for 71% of all counties the significant racial urban heat disparities persist even when adjusting for income. Although individual locations have different histories that have contributed to race- and class-based geographies, we find that the physical features of the urban environments driving these surface heat exposure gradients are fairly uniform across the country. Systematically, the disproportionate heat surface exposures faced by minority communities are due to more built-up neighborhoods, less vegetation, and—to a lesser extent—higher population density.
BACKGROUND: Emerging literature has documented heat-related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups and comparing emergency department (ED) and hospitalisation risks. OBJECTIVES: To examine the differing associations between high ambient temperatures and risk of ED visits and hospitalisations among children by age group in New York City (NYC). METHODS: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to NYC EDs (n = 2 252 550) and hospitals (n = 228 006) during the warm months (May-September) between 2005 and 2011. Using a time-stratified, case-crossover design, we estimated the risk of ED visits and hospitalisations associated with daily maximum temperature (Tmax) for children of all ages and by age group. RESULTS: The average Tmax over the study period was 80.3°F (range 50°, 104°F). Tmax conferred the greatest risk of ED visits for children aged 0-4, with a 6-day cumulative excess risk of 2.4% (95% confidence interval [CI] 1.7, 3.0) per 13°F (ie interquartile range) increase in temperature. Children and adolescents 5-12 years (0.8%, 95% CI 0.1, 1.6) and 13-18 years (1.4%, 95% CI 0.6, 2.3) are also sensitive to heat. For hospitalisations, only adolescents 13-18 years had increased heat-related risk, with a cumulative excess risk of 7.9% (95% CI 2.0, 14.2) per 13°F increase in Tmax over 85°F. CONCLUSIONS: This urban study in NYC reinforces that young children are particularly vulnerable to effects of heat, but also demonstrates the sensitivity of older children and adolescents as well. These findings underscore the importance of focussing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise.
Climate change is expected to exacerbate the urban heat island (UHI) effect in cities worldwide, increasing the risk of heat-related morbidity and mortality. Solar reflective ‘cool pavement’ is one of several mitigation strategies that may counteract the negative effects of the UHI effect. An increase in pavement albedo results in less heat absorption, which results in reduced surface temperatures (T (surface)). Near surface air temperatures (T (air)) could also be reduced if cool pavements are deployed at sufficiently large spatial scales, though this has never been confirmed by field measurements. This field study is the first to conduct controlled measurements of the impacts of neighborhood-scale cool pavement installations. We measured the impacts of cool pavement on albedo, T (surface), and T (air). In addition, pavement albedo was monitored after installation to assess its degradation over time. The field site (similar to 0.64 km(2)) was located in Covina, California; similar to 30 km east of Downtown Los Angeles. We found that an average pavement albedo increase of 0.18 (from 0.08 to 0.26) corresponded to maximum neighborhood averaged T (surface) and T (air) reductions of 5 degrees C and 0.2 degrees C, respectively. Maximum T (surface) reductions were observed in the afternoon, while minimum reductions of 0.9 degrees C were observed in the morning. T (air) reductions were detected at 12:00 local standard time (LST), and from 20:00 LST to 22:59 LST, suggesting that cool pavement decreases T (air) during the daytime as well as in the evening. An average albedo reduction of 30% corresponded to a similar to 1 degrees C reduction in the T (surface) cooling efficacy. Although we present here the first measured T (air) reductions due to cool pavement, we emphasize that the tradeoffs between T (air) reductions and reflected shortwave radiation increases are still unclear and warrant further investigation in order to holistically assess the efficacy of cool pavements, especially with regards to pedestrian thermal comfort.
Extreme heat events pose a threat to human health. Forecasting and warning strategies have been developed to mitigate heat-health hazards. Yet, studies have found that the public lacks knowledge about their heat-health risks and preventive actions to take to reduce risks. Local governmental websites are an important means to communicate preparedness to the public. The purpose of this study is to examine information provided to the public on municipal government web pages of the 10 most populous U.S. cities. A two-level document and content analyses were conducted. A direct content analysis was conducted using federal government websites and documents to create the Extreme Heat Event Public Response Rubric. The rubric contains two broad categories of populations and actions that are further specified. The rubric was then used to examine local government extreme heat event websites for the 10 most populous cities in the United States. The examination of the local government sites found that information included on the websites failed to identify the breadth of populations at greater risk for adverse heat-health outcomes and omitted some recommended actions designed to prevent adverse heat-health events. Local governments often communicated concrete and simple content to the public but more complex information was not included on their websites. SIGNIFICANCE STATEMENT: Extreme heat is the leading weather-related cause of mortality in the United States annually. Public response to extreme heat events requires that the public understand their risk and know the actions to take to mitigate that risk. The public seeks information from local government websites. Our results found that many local government websites did not provide the information to the public on the array of conditions and factors that put people at a greater risk for an adverse heat-health event, nor did the websites include information on the variety of actions that the public should take in response to an extreme heat event in order to reduce their risks. Addressing the omission of the information on these websites may improve public response to extreme heat events.
The occurrence of extreme weather and climate events has increased in recent decades. This increasing frequency has adversely impacted economic and health outcomes, leading to an increasingly urgent need to study climate extremes. The National Centers for Environmental Information (NCEI) created the Climate Extremes Index (CEI) in 1996 to quantify climate extremes. In this article, we explore the potential for enhancing the CEI via the use of the Z-score statistic to calculate the CEI on a numerical scale, to increase usability at smaller spatial scales, and to allow the creation of a new climate Extremes Vulnerability Index (EVI). The EVI combines the results from the revised CEI with values from the Social Vulnerability Index from the Centers for Disease Control and Prevention (CDC). The EVI can be used by policy-makers, planners, and the public to understand a subregion’s vulnerability to climate extremes. This information from the EVI could then be used to implement policies and changes in infrastructure that mitigate risk in vulnerable climate divisions. In a trial application, it is found that the southeastern and portions of the central United States had the highest levels of vulnerability for the abnormal month of December 2015.
BACKGROUND: Heatwaves are becoming more frequent and may acutely increase the risk of stillbirth, a rare and severe pregnancy outcome. OBJECTIVES: Examine the association between multiple heatwave metrics and stillbirth in six U.S. states. METHODS: Data were collected from fetal death and birth records in California (1996-2017), Florida (1991-2017), Georgia (1994-2017), Kansas (1991-2017), New Jersey (1991-2015), and Oregon (1991-2017). Cases were matched to controls 1:4 based on maternal race/ethnicity, maternal education, and county, and exposure windows were aligned (gestational week prior to stillbirth). County-level temperature data were obtained from Daymet and linked to cases and controls by residential county and the exposure window. Five heatwave metrics (1 categorical, 3 dichotomous, 1 continuous) were created using different combinations of the duration and intensity of hot days (mean daily temperature exceeding the county-specific 97.5(th) percentile) during the exposure window, as well as a continuous measure of mean temperature during the exposure window modeled using natural splines to allow for nonlinear associations. State-specific odds ratios (ORs) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. State-specific results were pooled using a fixed-effects meta-analysis. RESULTS: In our data set of 140,428 stillbirths (553,928 live birth controls), three of the five heatwave metrics examined were not associated with stillbirth. However, four consecutive hot days during the previous week was associated with a 3% increase in stillbirth risk (CI: 1.01, 1.06), and a 1 °C average increase over the threshold was associated with a 10% increase in stillbirth risk (CI: 1.04, 1.17). In continuous temperature analyses, there was a slight increased risk of stillbirth associated with extremely hot temperatures (≥ 35 °C). DISCUSSION: Most heat wave definitions examined were not associated with acute changes in stillbirth risk; however, the most extreme heatwave durations and temperatures were associated with a modest increase in stillbirth risk.
BACKGROUND: Extreme-heat events are increasing as a result of climate change. Prior studies, typically limited to urban settings, suggest an association between extreme heat and cardiovascular mortality. However, the extent of the burden of cardiovascular deaths associated with extreme heat across the United States and in different age, sex, or race and ethnicity subgroups is unclear. METHODS: County-level daily maximum heat index levels for all counties in the contiguous United States in summer months (May-September) and monthly cardiovascular mortality rates for adults ≥20 years of age were obtained. For each county, an extreme-heat day was identified if the maximum heat index was ≥90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979-2007) for that day. Spatial empirical Bayes smoothed monthly cardiovascular mortality rates from 2008 to 2017 were the primary outcome. A Poisson fixed-effects regression model was estimated with the monthly number of extreme-heat days as the independent variable of interest. The model included time-fixed effects and time-varying environmental, economic, demographic, and health care-related variables. RESULTS: Across 3108 counties, from 2008 to 2017, each additional extreme-heat day was associated with a 0.12% (95% CI, 0.04%-0.21%; P=0.004) higher monthly cardiovascular mortality rate. Extreme heat was associated with an estimated 5958 (95% CI, 1847-10 069) additional deaths resulting from cardiovascular disease over the study period. In subgroup analyses, extreme heat was associated with a greater relative increase in mortality rates among men compared with women (0.20% [95% CI, 0.07%-0.33%]) and non-Hispanic Black compared with non-Hispanic White adults (0.19% [95% CI, 0.01%-0.37%]). There was a greater absolute increase among elderly adults compared with nonelderly adults (16.6 [95% CI, 14.6-31.8] additional deaths per 10 million individuals per month). CONCLUSIONS: Extreme-heat days were associated with higher adult cardiovascular mortality rates in the contiguous United States between 2008 and 2017. This association was heterogeneous among age, sex, race, and ethnicity subgroups. As extreme-heat events increase, the burden of cardiovascular mortality may continue to increase, and the disparities between demographic subgroups may widen.
IMPORTANCE: The number of extreme heat events is increasing because of climate change. Previous studies showing an association between extreme heat and higher mortality rates generally have been limited to urban areas, and whether there is heterogeneity across different populations is not well studied; understanding whether this association varies across different communities, particularly minoritized racial and ethnic groups, may allow for more targeted mitigation efforts. OBJECTIVE: To the assess the association between extreme heat and all-cause mortality rates in the US. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study involved a longitudinal analysis of the association between the number of extreme heat days in summer months from 2008 to 2017 (obtained from the Centers for Disease Control and Prevention’s Environmental Public Health Tracking Program) and county-level all-cause mortality rates (obtained from the National Center for Health Statistics), using a linear fixed-effects model across all counties in the contiguous US among adults aged 20 years and older. Data analysis was performed from September 2021 to March 2022. EXPOSURES: The number of extreme heat days per month. Extreme heat was identified if the maximum heat index was greater than or equal to 90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979 to 2007). MAIN OUTCOMES AND MEASURES: County-level, age-adjusted, all-cause mortality rates. RESULTS: There were 219 495 240 adults aged 20 years and older residing in the contiguous US in 2008, of whom 113 294 043 (51.6%) were female and 38 542 838 (17.6%) were older than 65 years. From 2008 to 2017, the median (IQR) number of extreme heat days during summer months in all 3108 counties in the contiguous US was 89 (61-122) days. After accounting for time-invariant confounding, secular time trends, and time-varying environmental and economic measures, each additional extreme heat day in a month was associated with 0.07 additional death per 100 000 adults (95% CI, 0.03-0.10 death per 100 000 adults; P = .001). In subgroup analyses, greater increases in mortality rates were found for older vs younger adults (0.19 death per 100 000 individuals; 95% CI, 0.04-0.34 death per 100 000 individuals), male vs female adults (0.12 death per 100 000 individuals; 95% CI, 0.05-0.18 death per 100 000 individuals), and non-Hispanic Black vs non-Hispanic White adults (0.11 death per 100 000 individuals; 95% CI, 0.02-0.20 death per 100 000 individuals). CONCLUSIONS AND RELEVANCE: These findings suggest that from 2008 to 2017, extreme heat was associated with higher all-cause mortality in the contiguous US, with a greater increase noted among older adults, men, and non-Hispanic Black individuals. Without mitigation, the projected increase in extreme heat due to climate change may widen health disparities between groups.
RATIONALE & OBJECTIVE: Extreme heat exposure is associated with multiple diseases. However, our current understanding of the specific impact of extreme heat exposure on kidney disease is limited. STUDY DESIGN: Case-crossover study. SETTING & PARTICIPANTS: 1,114,322 emergency department (ED) visits with a principal diagnosis of kidney disease were identified in New York state, 2005-2013. EXPOSURE: Extreme heat exposure was defined as when the daily temperature exceeded the 90th percentile temperature of that month during the study period in the county. OUTCOME: ED visits with a principal diagnosis of kidney disease and its subtypes (ICD-9 [International Classification of Diseases, Ninth Revision] codes 580-599, 788). ANALYTICAL APPROACH: Extreme heat exposure on the ED visit days was compared with extreme heat exposure on control days using a conditional logistic regression model, controlling for humidity, air pollutants, and holidays. The excess risk of kidney disease was calculated for a week (lag days 0-6) after extreme heat exposure during the warm season (May through September). We also stratified our estimates by sociodemographic characteristics. RESULTS: Extreme heat exposure was associated with a 1.7% (lag day 0) to 3.1% (lag day 2) higher risk of ED visits related to kidney disease; this association was stronger with a greater number of extreme heat exposure days in the previous week. The association with extreme heat exposure lasted for an entire week and was stronger in the transitional months (ie, May and September; excess rates ranged from 1.8% to 5.1%) rather than the summer months (June through August; excess rates ranged from 1.5% to 2.7%). The strength of association was greater among those with ED visits related to acute kidney injury, kidney stones, and urinary tract infections. Age and sex may modify the association between extreme heat exposure and ED visits. LIMITATIONS: Individual exposure to heat-how long people were outside or whether they had access to air conditioning-was unknown. CONCLUSIONS: Extreme heat exposure was significantly associated with a dose-dependent greater risk of ED visits for kidney disease.
BACKGROUND: Climate change is increasing the frequency and intensity of heatwaves. Prior studies associate high temperature with preterm birth. OBJECTIVES: We tested the hypotheses that acute exposure to extreme heat was associated with higher risk of live spontaneous preterm birth (≥20 and <37 completed weeks), and that risks were higher among people of colour and neighbourhoods with heat-trapping landcover or concentrated racialised economic disadvantage. METHODS: We conducted a retrospective cohort study of people giving birth between 2007 and 2011 in Harris County, Texas (Houston metropolitan area) (n = 198,013). Exposures were daily ambient apparent temperature (AT(max) in 5°C increments) and dry-bulb temperatures (T(max) and T(min) >historical [1971-2000] summertime 99(th) percentile) up to a week prior for each day of pregnancy. Survival analysis controlled for individual-level risk factors, secular and seasonal trends. We considered race/ethnicity, heat-trapping neighbourhood landcover and Index of Concentration at the Extremes as effect modifiers. RESULTS: The frequency of preterm birth was 10.3%. A quarter (26.8%) of people were exposed to AT(max) ≥40°C, and 22.8% were exposed to T(max) and T(min) >99(th) percentile while at risk. The preterm birth rate among the exposed was 8.9%. In multivariable models, the risk of preterm birth was 15% higher following extremely hot days (hazard ratio [HR] 1.15 (95% confidence interval [CI] 1.01, 1.30) for AT(max) ≥40°C vs. <20°C; HR 1.15 (95% CI 1.02, 1.28) for T(max) and T(min) >99(th) percentile). Censoring at earlier gestational ages suggested stronger associations earlier in pregnancy. The risk difference associated with extreme heat was higher in neighbourhoods of concentrated racialised economic disadvantage. CONCLUSIONS: Ambient heat was associated with spontaneous preterm birth, with stronger associations earlier in pregnancy and in racially and economically disadvantaged neighbourhoods, suggesting climate change may worsen existing social inequities in preterm birth rates.
BACKGROUND: Previous extreme heat and human health studies have investigated associations either over time (e.g. case-crossover or time series analysis) or across geographic areas (e.g. spatial models), which may limit the study scope and regional variation. Our study combines a case-crossover design and spatial analysis to identify: 1) the most vulnerable counties to extreme heat; and 2) demographic and socioeconomic variables that are most strongly and consistently related to heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, acute renal disease, and respiratory disease) across 67 counties in the state of Florida, U. S over 2008-2012. METHODS: We first used a case-crossover design to examine the effects of air temperature on daily counts of health outcomes. We employed a time-stratified design with a 28-day comparison window. Referent periods were extracted from ±7, ±14, or ± 21 days to address seasonality. The results are expressed as odds ratios, or the change in the likelihood of each health outcome for a unit change in heat exposure. We then spatially examined the case-crossover extreme heat and health odds ratios and county level demographic and socioeconomic variables with multiple linear regression or spatial lag models. RESULTS: Results indicated that southwest Florida has the highest risks of cardiovascular disease, dehydration, acute renal disease, and respiratory disease. Results also suggested demographic and socioeconomic variables were significantly associated with the magnitude of heat-related health risk. The counties with larger populations working in farming, fishing, mining, forestry, construction, and extraction tended to have higher risks of dehydration and acute renal disease, whereas counties with larger populations working in installation, maintenance, and repair workers tended to have lower risks of cardiovascular, dehydration, acute renal disease, and respiratory disease. Finally, our results showed that high income counties consistently have lower health risks of dehydration, heat-related illness, acute renal disease, and respiratory disease. CONCLUSIONS: Our study identified different relationships with demographic/socioeconomic variables for each heat-sensitive health outcome. Results should be incorporated into vulnerability or risk indices for each health outcome.
The effects of heat waves on traffic collisions require investigation to improve traffic safety during extreme heat events. A time-stratified case-crossover design was used to examine associations between heat waves and traffic collisions in Alabama between May and September from 2009 to 2018. We derived a heat wave index, defined as the daily mean temperature greater than the 95th percentile for two or more consecutive days, by meteorological data from Phase 2 of the North American Land Data Assimilation System. We obtained traffic collision records from the Alabama Department of Transportation. A nonsignificant and negative association between traffic collisions and heat waves was noted, with a 1.4 percent decrease (95 percent confidence interval [CI] [-3.1 percent, 0.4 percent]) in traffic collisions on heat wave days compared to non-heat wave days. Similar results were found when the analysis was stratified by driver-related factors (i.e., gender, age, race, employment status, and driver residence distances), vehicle-related factors (i.e., vehicle usage), and collision-related factors (i.e., rural or urban roads, speed limits, and intersections). A significant and positive association was observed on heat wave days without precipitation, however (23.5 percent increase; 95 percent CI [7.3 percent, 42.3 percent]). In conclusion, traffic collisions were not associated with heat waves in many collision-related conditions in Alabama.
Extreme heat is one of the most important pathways illustrating the connection between climate and human health, and climate change is expected to exacerbate this public health issue. This study first used a case-crossover analysis to characterize the historical (1980-2018) association between summertime heat and non-traumatic mortality in Washington State. A separate analysis was conducted for each of the state’s ten climate divisions to produce distinct exposure-response curves expressing odds of mortality as a function of humidex. Stratified analyses were used to assess the impact of age, sex, race/ethnicity, and select causes of death, and the reported results are pooled across all divisions using meta-analysis. The historical heat-mortality relationship was combined with climate projections to estimate the impact of climate change on heat-related deaths in 2030, 2050, and 2080 under two warming scenarios. The odds ratio (OR) and 95% confidence intervals of mortality at the 99th percentile of humidex compared to the 50th percentile did not include the null value in four climate divisions (E Olympic Cascade Foothills, NE Olympic San Juan, Northeastern, and Puget Sound Lowlands). The statewide odds of mortality are 8% higher (6%, 10%) on 99th percentile days compared to 50th percentile days, driven primarily by an OR of 1.09 (1.06, 1.11) in the Puget Sound Lowlands. Risk is higher for women than men and for Blacks than Whites. Risk increases with age and for diabetic, circulatory, cardiovascular, ischemic, cerebrovascular, and respiratory deaths. The 95% confidence intervals of projected heat-attributable mortality did not overlap with zero in three climate divisions (E Olympic Cascade Foothills, NE Olympic San Juan, and Puget Sound Lowlands). In these three divisions, the average percent increase in heat-attributable mortality across both warming scenarios is 35%, 35%, and 603% in 2030, 2050, and 2080, respectively. This research is the most extensive study of heat-related mortality in Washington to date and can help inform public health initiatives aiming to improve present and future health outcomes in the state.
The earth is rapidly warming, driven by increasing atmospheric carbon dioxide and other gases that result primarily from fossil fuel combustion. In addition to causing arctic ice melting and extreme weather events, climatologic factors are linked strongly to the transmission of many infectious diseases. Changes in the prevalence of infectious diseases not only reflect the impacts of temperature, humidity, and other weather-related phenomena on pathogens, vectors, and animal hosts but are also part of a complex of social and environmental factors that will be affected by climate change, including land use, migration, and vector control. Vector- and waterborne diseases and coccidioidomycosis are all likely to be affected by a warming planet; there is also potential for climate-driven impacts on emerging infectious diseases and antimicrobial resistance. Additional resources for surveillance and public health activities are urgently needed, as well as systematic education of clinicians on the health impacts of climate change.
BACKGROUND: Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, “alerts”) issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS: In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS: We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM(2.5). CONCLUSIONS: Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.
BACKGROUND: Typical thermoregulatory responses to elevated temperatures among healthy individuals include reduced blood pressure and perspiration. Individuals with end-stage kidney disease (ESKD) are susceptible to systemic fluctuations caused by ambient temperature changes that may increase morbidity and mortality. We investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight gain (IDWG) can independently mediate the association between ambient temperature, all-cause hospital admissions (ACHA), and all-cause mortality (ACM). METHODS: The study population consisted of ESKD patients receiving hemodialysis treatments at Fresenius Medical Care facilities in Philadelphia County, PA, from 2011 to 2019 (n = 1981). Within a time-to-event framework, we estimated the association between daily maximum dry-bulb temperature (TMAX) and, as separate models, ACHA and ACM during warmer calendar months. Clinically measured preSBP and IDWG responses to temperature increases were estimated using linear mixed effect models. We employed the difference (c-c’) method to decompose total effect models for ACHA and ACM using preSBP and IDWG as time-dependent mediators. Covariate adjustments for exposure-mediator and total and direct effect models include age, race, ethnicity, blood pressure medication use, treatment location, preSBP, and IDWG. We considered lags up to two days for exposure and 1-day lag for mediator variables (Lag 2-Lag 1) to assure temporality between exposure-outcome models. Sensitivity analyses for 2-day (Lag 2-only) and 1-day (Lag 1-only) lag structures were also conducted. RESULTS: Based on Lag 2- Lag 1 temporal ordering, 1 °C increase in daily TMAX was associated with increased hazard of ACHA by 1.4% (adjusted hazard ratio (HR), 1.014; 95% confidence interval, 1.007-1.021) and ACM 7.5% (adjusted HR, 1.075, 1.050-1.100). Short-term lag exposures to 1 °C increase in temperature predicted mean reductions in IDWG and preSBP by 0.013-0.015% and 0.168-0.229 mmHg, respectively. Mediation analysis for ACHA identified significant indirect effects for all three studied pathways (preSBP, IDWG, and preSBP + IDWG) and significant indirect effects for IDWG and conjoined preSBP + IDWG pathways for ACM. Of note, only 1.03% of the association between temperature and ACM was mediated through preSBP. The mechanistic path for IDWG, independent of preSBP, demonstrated inconsistent mediation and, consequently, potential suppression effects in ACHA (-15.5%) and ACM (-6.3%) based on combined pathway models. Proportion mediated estimates from preSBP + IDWG pathways achieved 2.2% and 0.3% in combined pathway analysis for ACHA and ACM outcomes, respectively. Lag 2 discrete-time ACM mediation models exhibited consistent mediation for all three pathways suggesting that 2-day lag in IDWG and preSBP responses can explain 2.11% and 4.41% of total effect association between temperature and mortality, respectively. CONCLUSION: We corroborated the previously reported association between ambient temperature, ACHA and ACM. Our results foster the understanding of potential physiological linkages that may explain or suppress temperature-driven hospital admissions and mortality risks. Of note, concomitant changes in preSBP and IDWG may have little intermediary effect when analyzed in combined pathway models. These findings advance our assessment of candidate interventions to reduce the impact of outdoor temperature change on ESKD patients.
Background: Higher temperatures have been associated with increased stone formation and subsequent utilization of hospital resources, including inpatient admission. However, these observations have been derived from the adult population. We sought to examine if this purported association extends to the pediatric population. Methods: We used the 2016 Kids’ Inpatient Database to identify nationwide pediatric inpatient admissions related to nephrolithiasis. Temperature data from the National Oceanic and Atmospheric Administration was linked to each admission. Comparative statistics analyzed patient and admission characteristics. Multivariable logistic regression analyzed associations between stone-related admissions and temperature. As a frame of reference, this analysis was replicated using the National Inpatient Sample from 2016 to evaluate associations in the adult population. Results: Of the 2,496,257 pediatric admissions, 8453 (0.33%) were related to nephrolithiasis. Temperatures at the time of stone admission were higher than those during nonstone admission (55.9°F vs 54.8°F, p < 0.001). The stone admission group had a higher proportion of females than the nonstone admission group (64.8% vs 55.4%, p < 0.001). Stone admission was significantly associated with temperature (odds ratio [OR] 1.025 per 10°F, confidence interval [95% CI] 1.003-1.049, p = 0.03) and female gender (OR 1.097, 95% CI 1.027-1.171, p = 0.006). In the adult population, 380,520 out of 30,000,941 patients (1.3%) were admitted with a stone. The effect of temperature on stone admissions was similar to that in the pediatric population (OR 1.020, 95% CI 1.014-1.026, p < 0.001), but women were >20% less likely to be admitted for stones than men (OR 0.770, 95% CI 0.757-0.784, p < 0.001). Conclusions: Increased temperatures were associated with an increased risk of stone-related admission in both the pediatric and adult populations. Females were at increased risk for stone-related admissions during childhood, but this trend reverses in adulthood.
Heat stroke is the most severe manifestation of heat-related illnesses. Classic heat stroke (CHS), also known as passive heat stroke, occurs at rest, whereas exertional heat stroke (EHS) occurs during physical activity. EHS differs from CHS in etiology, clinical presentation, and sequelae of multi-organ dysfunction. Until recently, only models of CHS have been well established. This protocol aims to provide guidelines for a refined preclinical mouse model of EHS that is free from major limiting factors such as the use of anesthesia, restraint, rectal probes, or electric shock. Male and female C57Bl/6 mice, instrumented with core temperature (Tc) telemetric probes were utilized in this model. For familiarization with the running mode, mice undergo 3 weeks of training using both voluntary and forced running wheels. Thereafter, mice run on a forced wheel inside a climatic chamber set at 37.5 °C and 40%-50% relative humidity (RH) until displaying symptom limitation (e.g., loss of consciousness) at Tc of 42.1-42.5 °C, although suitable results can be obtained at chamber temperatures between 34.5-39.5 °C and humidity between 30%-90%. Depending on the desired severity, mice are removed from the chamber immediately for recovery in ambient temperature or remain in the heated chamber for a longer duration, inducing a more severe exposure and a higher incidence of mortality. Results are compared with sham-matched exercise controls (EXC) and/or naïve controls (NC). The model mirrors many of the pathophysiological outcomes observed in human EHS, including loss of consciousness, severe hyperthermia, multi-organ damage as well as inflammatory cytokine release, and acute phase responses of the immune system. This model is ideal for hypothesis-driven research to test preventative and therapeutic strategies that may delay the onset of EHS or reduce the multi-organ damage that characterizes this manifestation.
Workers in the electric power industry commonly perform physically demanding jobs in hot environments, which combined with the protective clothing worn, places them at risk of disease and health problems related to occupational heat stress. With climate change fueling an increase in the occurrence of hot weather, a targeted approach to heat stress management within the industry is needed. To better understand current heat management practices and identify opportunities for refinement, we conducted an exploratory survey among 33 electric utility companies operating in the United States (n = 32) and Canada (n = 1). Forty-six employees responsible for health and safety of company workers completed 26 questions assessing heat stress as a workplace hazard and heat management practices within five categories: (1) use and administration of heat stress management program; (2) surveillance of heat stress and heat strain; (3) job evaluation and heat-mitigation guidance; (4) education and training programs; and (5) treatment of heat-related illness. While a majority of the respondents (87.0%) indicated heat stress is a workplace hazard and their organization has a heat stress management program (78.3%), less than half reported performing real-time monitoring of heat stress in the workplace (47.8%) or tracking worker heat strain (19.6%) (i.e., physiological response to heat stress). However, most organizations indicated they conducted pre-job evaluations for heat stress (71.7%) and implemented an employee training program on managing heat stress (73.9%). The latter included instruction on various short- and long-term heat-mitigation guidance for workers (e.g., use of work exposure limits, hydration protocols) and the prevention (52.2%) and treatment (63.1%) of heat-related illnesses. Altogether, our survey demonstrates that although many companies employ some form of a heat management program, the basic components defining the programs vary and are lacking for some companies. To maximize worker health and safety during work in hot environments, a consensus-based approach, which considers the five basic components of a heat management program, should be employed to formulate effective practices and methodologies for creating an industry-specific heat management strategy.
OBJECTIVE: Determine compliance with and effectiveness of California regulations in reducing farmworkers’ heat-related illness (HRI) risk and identify main factors contributing to HRI. METHODS: In a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT. RESULTS: Although farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 – 11.54]), WBGT (1.22 [1.08 – 1.38]), work rate (1.004 [1.002 – 1.006]), and increased BMI (1.11 [1.10 – 1.29]) were all independently associated with elevated CBT. CONCLUSION: Risk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations.
With global warming, much attention has been paid to the upper limits of human adaptability. However, the time to reach a generally accepted core temperature criterion (40.2°C) associated with heat-related illness above (uncompensable heat stress) and just below (compensable heat stress) the upper limits for heat balance remains unclear. Forty-eight (22 men/26 women; 23 ± 4 yr) subjects were exposed to progressive heat stress in an environmental chamber during minimal activity (MinAct, 159 ± 34 W) and light ambulation (LightAmb, 260 ± 55 W) in warm-humid (WH; ∼35°C, >60% RH) and hot-dry (HD; 43°C-48°C, <25% RH) environments until heat stress became uncompensable. For each condition, we compared heat storage (S) and the change in gastrointestinal temperature (ΔT(gi)) over time during compensable and uncompensable heat stress. In addition, we examined whether individual characteristics or seasonality were associated with the rate of increase in T(gi). During compensable heat stress, S was higher in HD than in WH environments (P < 0.05) resulting in a greater but more variable ΔT(gi) (P ≥ 0.06) for both metabolic rates. There were no differences among conditions during uncompensable heat stress (all P > 0.05). There was no influence of sex, aerobic fitness, or seasonality, but a larger body size was associated with a greater ΔT(gi) during LightAmb in WH (P = 0.003). The slopes of the T(gi) response during compensable (WH: MinAct, 0.06, LightAmb, 0.09; HD: MinAct, 0.12, LightAmb, 0.15°C/h) and uncompensable (WH: MinAct, 0.74, LightAmb, 0.87; HD: MinAct, 0.71, LightAmb, 0.93°C/h) heat stress can be used to estimate the time to reach a target core temperature from any given starting value.NEW & NOTEWORTHY This study is the first to examine heat storage and the rate of change in core temperature above (uncompensable heat stress) and just below (compensable heat stress) critical environmental limits to human heat balance. Furthermore, we examine the influence of individual subject characteristics and seasonality on the change in core temperature in warm-humid versus hot-dry environments. We provide the rate of change in core temperature, enabling projections to be made to and from any hypothetical core temperature.
In the United States, there is a growing interest in understanding heat stress in lower-income and racially isolated neighborhoods. This study spatially identifies heat-vulnerable neighborhoods, evaluates the relationship between race/ethnicity and temperature exposure, and emphasizes differences among Hispanics by origin to capture environmental injustices in Santa Clara County (SCC), CA. The current methodology uses Landsat 8 via Google Earth Engine to measure the Land Surface Temperature (LST) and Normalized Difference Vegetation Index (NDVI) to assess the physical environment. The human environment is evaluated using the Modified Darden-Kamel Composite Socioeconomic Index to determine the spatial variability of socioeconomic status (SES) and the Index of Dissimilarity to determine the level of segregation between Hispanics and non-Hispanic Whites and among Hispanics/Latinos. The combination of these assessments comprises a comprehensive human-environment approach for health exposure evaluation by which to define environmental injustice. Results reveal socioeconomic inequalities and an uneven residential distribution between Hispanics and non-Hispanic Whites. Low NDVI and high LST values were found in Mexican neighborhoods, implying possible environmental racism. Almost half the Mexican population lives in highly segregated neighborhoods with low and very low SES, mainly located in East San Jose, where, historically, they have been ghettoized. Mexicans, in general, could be at a higher risk of heat stress and heat mortality during heat waves. Future work should examine additional variables (e.g., housing characteristics, crime, social cohesion, and collective behaviors) to comprehensively evaluate the at-risk Mexican population.
An urban atmospheric modeling study was undertaken with the goal of informing the development of a heat-mitigation plan for the greater Sacramento Valley, California. Realistic levels of mitigation measures were characterized and ranked in terms of their effectiveness in producing urban cooling under current conditions and future climate and land use. An urban heat-island index was computed for current and future climates based on each location’s time-varying upwind temperature reference points and its hourly temperatures per coincident wind direction. For instance, the UHII for the period 16-31 July 2015, for all-hours averaged temperature equivalent (i.e., degrees C center dot h hr(-1)), ranged from 1.5 to 4.7 degrees C across the urban areas in the region. The changes in local microclimates corresponding to future conditions were then quantified by applying a modified high-resolution urban meteorology model in dynamically downscaling a climate model along with future urbanization and land use change projections for each area. It was found that the effects of urbanization were of the same magnitude as that of the local climate change. Considering the urban areas in the region and the selected emissions scenarios, the all-hours temperature equivalent of the UHII (degrees C center dot h hr(-1)) increased by between 0.24 and 0.80 degrees C, representing an increase of between 17% and 13% of their respective values in the current climate. Locally, instantaneous (e.g., hourly) temperatures could increase by up to similar to 3 degrees C because of climate effects and up to similar to 5 degrees C because of both climate and urbanization changes. The efficacies of urban heat mitigation measures were ranked both at the county level and at local project scales. It was found that urban cooling measures could help decrease or offset exceedances in the National Weather Service heat index (NWS HI) above several warning thresholds and reduce the number of heatwave or excessive heat event days. For example, measures that combine increased albedo and urban forests can reduce the exceedances above NWS HI Danger level by between 50% and 100% and the exceedances above Extreme Caution level by between 18% and 36%. UHII offsets from each mitigation measure were quantified for two situations: (1) a scenario where a community implements cooling measures and no other nearby communities take any action and (2) a scenario where both the community and its upwind neighbors implement cooling measures. In this second situation, the community benefits from cooler air transported from upwind areas in addition to the local cooling resulting from implementation of its own heat mitigation strategies. The modeling of future climates showed that except for a number of instances, the ranking of measures in each respective urban area remains unchanged into the future.
Little is known about the separate and combined influences of humidity conditions, sex, and aerobic fitness on heat tolerance in unacclimatized males and females. The purpose of the current study was to describe heat tolerance, in terms of critical WBGT (WBGT(crit)), in unacclimatized young males and females in hot-dry (HD) and warm-humid (WH) environments. Eighteen subjects (9 M/9F; 21 ± 2 yr) were tested during exercise at 30% V̇O(2max) in a controlled environmental chamber. Progressive heat stress exposures were performed with either (1) constant dry-bulb temperature (T(db)) of 34 and 36 °C and increasing ambient water vapor pressure (P(a)) (P(crit) trials; WH); or (2) constant P(a) of 12 and 16 mmHg and increasing T(db) (T(crit) trials; HD). Chamber T(db) and P(a), and subject esophageal temperature (T(es)), were continuously monitored throughout each trial. After a 30-min equilibration period, progressive heat stress continued until subject heat balance could no longer be maintained and a clear rise in T(es) was observed. Absolute WBGT(crit) and WBGT(crit) adjusted to a metabolic rate of 300 W (WBGT(300)), and the difference between WBGT(crit) and occupational exposure limits (OEL; ΔOEL) was assessed. WBGT(crit), WBGT(300), and ΔOEL were higher in WH compared to HD (p < 0.0001) for females but were the same between environments for males (p ≥ 0.21). WBGT(crit) was higher in females compared to males in WH (p < 0.0001) but was similar between sexes in HD (p = 0.44). When controlling for metabolic rate, WBGT(300) and ΔOEL were higher in males compared to females in WH and HD (both p < 0.0001). When controlling for sex, V̇O(2max) was not associated with WBGT(300) or ΔOEL for either sex (r ≤ 0.12, p ≥ 0.49). These findings suggest that WBGT(crit) is higher in females compared to males in WH, but not HD, conditions. Additionally, the WBGT(crit) is lower in females, but not males, in HD compared to WH conditions.
Wearable sensors have been used to collect information on individual exposure to excessive heat and humidity. To date, no consistent diurnal classification method has been established, potentially resulting in missed opportunities to understand personal diurnal patterns in heat exposure. Using individually experienced temperatures (IET) and heat indices (IEHI) collected in the southeastern United States, this work aims to determine whether current methods of classifying IETs and IEHIs accurately characterize “day,” which is typically the warmest conditions, and “night,” which is typically the coolest conditions. IET and IEHI data from four locations were compared with the closest hourly weather station. Different day/night classifications were compared to determine efficacy. Results indicate that diurnal IET and IEHI ranges are higher than fixed-site ranges. Maximum IETs and IEHIs are warmer and occur later in the day than ambient conditions. Minimum IETs are lower and occur earlier in the day than at weather stations, which conflicts with previous assumptions that minimum temperatures occur at night. When compared to commonly used classification methods, a method of classifying day and night based on sunrise and sunset times best captured the occurrence of maximum IETs and IEHIs. Maximum IETs and IEHIs are often identified later in the evening, while minimum IETs and IEHIs occur throughout the day. These findings support future research focusing on nighttime heat exposure, which can exacerbate heat-related health issues, and diurnal patterns of personal exposure throughout the entire day as individual patterns do not necessarily follow the diurnal pattern seen in ambient conditions.
This study characterized associations between annually scaled thermal indices and annual heat stress illness (HSI) morbidity outcomes, including heat stroke and heat exhaustion, among active-duty soldiers at ten Continental U.S. (CONUS) Army installations from 1991 to 2018. We fit negative binomial models for 3 types of HSI morbidity outcomes and annual indices for temperature, heat index, and wet-bulb globe temperature (WBGT), adjusting for installation-level effects and long-term trends in the negative binomial regression models using block-bootstrap resampling. Ambulatory (out-patient) and reportable event HSI outcomes displayed predominately positive association patterns with the assessed annual indices of heat, whereas hospitalization associations were mostly null. For example, a one-degree Fahrenheit (°F) (or 0.55°C) increase in mean temperature between May and September was associated with a 1.16 (95% confidence interval [CI]: 1.11, 1.29) times greater rate of ambulatory encounters. The annual-scaled rate ratios and their uncertainties may be applied to climate projections for a wide range of thermal indices to estimate future military and civilian HSI burdens and impacts to medical resources.
OBJECTIVE: The aim of this study was to model the effect of body armor coverage on body core temperature elevation and wet-bulb globe temperature (WBGT) offset. BACKGROUND: Heat stress is a critical factor influencing the health and safety of military populations. Work duration limits can be imposed to mitigate the risk of exertional heat illness and are derived based on the environmental conditions (WBGT). Traditionally a 3°C offset to WBGT is recommended when wearing body armor; however, modern body armor systems provide a range of coverage options, which may influence thermal strain imposed on the wearer. METHOD: The biophysical properties of four military clothing ensembles of increasing ballistic protection coverage were measured on a heated sweating manikin in accordance with standard international criteria. Body core temperature elevation during light, moderate, and heavy work was modeled in environmental conditions from 16°C to 34°C WBGT using the heat strain decision aid. RESULTS: Increasing ballistic protection resulted in shorter work durations to reach a critical core temperature limit of 38.5°C. Environmental conditions, armor coverage, and work intensity had a significant influence on WBGT offset. CONCLUSION: Contrary to the traditional recommendation, the required WBGT offset was >3°C in temperate conditions (<27°C WBGT), particularly for moderate and heavy work. In contrast, a lower WBGT offset could be applied during light work and moderate work in low levels of coverage. APPLICATION: Correct WBGT offsets are important for enabling adequate risk management strategies for mitigating risks of exertional heat illness.
PURPOSE: To mitigate rises in core temperature >1°C, the American Conference of Governmental Industrial Hygienists (ACGIH) recommends upper limits for heat stress (action limit values [ALV]), defined by wet-bulb globe temperature (WBGT) and a worker’s metabolic rate. However, these limits are based on data from young men and are assumed to be suitable for all workers, irrespective of age or health status. We therefore explored the effect of aging, type 2 diabetes (T2D), and hypertension (HTN) on tolerance to prolonged, moderate-intensity work above and below these limits. METHODS: Core temperature and heart rate were assessed in healthy, heat unacclimatized young (18-30 yr, n = 13) and older (50-70 yr) men (n = 14) and heat unacclimatized older men with T2D (n = 10) or HTN (n = 13) during moderate-intensity (metabolic rate: 200 W·m-2) walking for 180 min (or until termination) in environments above (28°C and 32°C WBGT) and below (16°C and 24°C WBGT) the ALV for continuous work at this intensity (25°C WBGT). RESULTS: Work tolerance in the 32°C WBGT was shorter in men with T2D (median [IQR]; 109 [91-173] min; P = 0.041) and HTN (120 [65-170] min; P = 0.010) compared with healthy older men (180 [133-180] min). However, aging, T2D, and HTN did not significantly influence (i) core temperature or heart rate reserve, irrespective of WBGT; (ii) the probability that core temperature exceeded recommended limits (>1°C) under the ALV; and (iii) work duration before core temperature exceeded recommended limits (>1°C) above the ALV. CONCLUSION: These findings demonstrate that T2D and HTN attenuate tolerance to uncompensable heat stress (32°C WBGT); however, these chronic diseases do not significantly impact thermal and cardiovascular strain, or the validity of ACIGH recommendations during moderate-intensity work.
Heat waves are the deadliest weather-related hazard in the United States while also increasing in frequency, intensity, and duration. Population growth is also occurring in places most exposed to extreme heat. Current US National Weather Service (NWS) guidelines to issue heat alerts vary geographically and may not facilitate optimal heat risk communication. This study focuses on professionals’ decision making and communication in the context of extreme heat risk in Utah, a state with historically low but increasing heat risk due to climate change, a growing population, and rising outdoor recreation visitation. We analyze the mental models of decision-makers responsible for forecasting, communicating, and managing heat risk in Utah using interviews with 32 weather forecasters, media broadcasters, and public officials including park managers. Results demonstrate that institutional norms have influenced how forecasters characterize extreme heat in the western region of the US. NWS heat alerts and tools are new and unfamiliar to many decision-makers, especially in areas of the state where previous criteria did not warrant alerts. Only 44% of participants from these areas were familiar with NWS heat alerts compared to 100% of participants from areas with a history of heat events. While experience with NWS heat alerts and tools varied widely among participants, 100% were familiar with heat protective behaviors. 94% stated they had personally experienced extreme heat and 66% stated that this experience influenced their decisions. Personal experience may be an effective means to communicate heat risk and promote adaptive practices. These insights may be generalizable to other settings where risk is changing and communication strategies are underdeveloped.
Extreme heat puts tremendous stress on human health and limits people’s ability to work, travel, and socialize outdoors. To mitigate heat in public spaces, thermal conditions must be assessed in the context of human exposure and space use. Mean Radiant Temperature (MRT) is an integrated radiation metric that quantifies the total heat load on the human body and is a driving parameter in many thermal comfort indices. Current sensor systems to measure MRT are expensive and bulky (6-directional setup) or slow and inaccurate (globe thermometers) and do not sense space use. This engineering systems paper introduces the hardware and software setup of a novel, low-cost thermal and visual sensing device (MaRTiny). The system collects meteorological data, concurrently counts the number of people in the shade and sun, and streams the results to an Amazon Web Services (AWS) server. MaRTiny integrates various micro-controllers to collect weather data relevant to human thermal exposure: air temperature, humidity, wind speed, globe temperature, and UV radiation. To detect people in the shade and Sun, we implemented state of the art object detection and shade detection models on an NVIDIA Jetson Nano. The system was tested in the field, showing that meteorological observations compared reasonably well to MaRTy observations (high-end human-biometeorological station) when both sensor systems were fully sun-exposed. To overcome potential sensing errors due to different exposure levels, we estimated MRT from MaRTiny weather observations using machine learning (SVM), which improved RMSE. This paper focuses on the development of the MaRTiny system and lays the foundation for fundamental research in urban climate science to investigate how people use public spaces under extreme heat to inform active shade management and urban design in cities.
PURPOSE: This study examines risk factors for heat-related mortality due to hyperthermia in emergency department patients, a vulnerable population. METHODS: This matched case-control study used statewide, longitudinally linked emergency department (ED) data and death records from California. Cases comprised California residents (≥18 years) who presented to a state-licensed ED and died of hyperthermia during the study period (2009-2012). For each case, up to five ED patients were randomly selected as live controls and matched on sex and age. Patients’ demographic characteristics and history of ED utilization for alcohol use, drug use, psychiatric disorders, heart-related conditions, chronic respiratory disease, neurodegenerative disorders, and cerebrovascular disease were assessed in relationship to hyperthermia mortality. RESULTS: Using multivariate conditional logistic regression models, hyperthermia mortality cases had higher odds of prior ED utilization for alcohol use (OR = 11.16, 95% CI = 3.87, 32.17) compared to controls. Cases were also more likely than controls to have Medicare insurance (OR = 5.80, 95% CI = 1.70, 15.15) or self-pay (OR = 5.39, 95% CI = 1.73, 16.79), at their most recent ED visit. CONCLUSIONS: ED patients presenting with alcohol problems may face increased risk of hyperthermia mortality. To help reduce heat-related mortality, EDs should consider interventions that target patients vulnerable to heat exposure.
BACKGROUND: The effect of heatwaves on adverse birth outcomes is not well understood and may vary by how heatwaves are defined. The study aims to examine acute associations between various heatwave definitions and preterm and early-term birth. METHODS: Using national vital records from 50 metropolitan statistical areas (MSAs) between 1982 and 1988, singleton preterm (< 37 weeks) and early-term births (37-38 weeks) were matched (1:1) to controls who completed at least 37 weeks or 39 weeks of gestation, respectively. Matching variables were MSA, maternal race, and maternal education. Sixty heatwave definitions including binary indicators for exposure to sustained heat, number of high heat days, and measures of heat intensity (the average degrees over the threshold in the past 7 days) based on the 97.5(th) percentile of MSA-specific temperature metrics, or the 85(th) percentile of positive excessive heat factor (EHF) were created. Odds ratios (OR) for heatwave exposures in the week preceding birth (or corresponding gestational week for controls) were estimated using conditional logistic regression adjusting for maternal age, marital status, and seasonality. Effect modification by maternal education, age, race/ethnicity, child sex, and region was assessed. RESULTS: There were 615,329 preterm and 1,005,576 early-term case-control pairs in the analyses. For most definitions, exposure to heatwaves in the week before delivery was consistently associated with increased odds of early-term birth. Exposure to more high heat days and more degrees above the threshold yielded higher magnitude ORs. For exposure to 3 or more days over the 97.5(th) percentile of mean temperature in the past week compared to zero days, the OR was 1.027 for early-term birth (95%CI: 1.014, 1.039). Although we generally found null associations when assessing various heatwave definitions and preterm birth, ORs for both preterm and early-term birth were greater in magnitude among Hispanic and non-Hispanic black mothers. CONCLUSION: Although associations varied across metrics and heatwave definitions, heatwaves were more consistently associated with early-term birth than with preterm birth. This study's findings may have implications for prevention programs targeting vulnerable subgroups as climate change progresses.
OBJECTIVE: Schools with aging infrastructure may expose students to extreme temperatures. Extreme outdoor temperatures have previously been linked to more asthma-related health care utilization. Explore the relationship between classroom temperatures and school-based health care visits for asthma in an urban school building with an outdated heating and cooling system. METHODS: Participants were students in grades K-8 who received health care from a school-based health center (SBHC) (n = 647) or school nurse (n = 1244) in 2 co-located urban public schools between 2016 and 2018. The probability of an asthma visit to the SBHC or school nurse was modeled as a function of indoor temperature exposure using generalized estimating equations with covariates accounting for grade, sex, outdoor temperature, days at risk of asthma visit, nonasthma visits, month, and year fixed effects. RESULTS: Classroom temperatures ranged from 48.0 °F to 100.6 °F. Higher mean grade-level indoor temperatures from a baseline of approximately 70 °F to 76 °F were associated with increased rates of asthma-related visits to the SBHC or school nurse on same day of exposure. Model-generated estimates suggest that an increase of 10 degrees F in indoor temperature relative to a baseline of 75 °F was associated with a 53% increase in the rate of asthma-related SBHC visits. CONCLUSIONS: Elevated classroom temperatures may be associated with more school-based health care utilization for asthma. Low-income and students from racial and ethnic minority groups have disproportionately higher rates of asthma and are also more likely to attend schools with poor infrastructure. The potential benefits of school infrastructure investments for student health, health care costs, and health equity merit further investigation.
Objectives. To determine the effect of heat waves on emergency department (ED) visits for individuals experiencing homelessness and explore vulnerability factors. Methods. We used a unique highly detailed data set on sociodemographics of ED visits in San Diego, California, 2012 to 2019. We applied a time-stratified case-crossover design to study the association between various heat wave definitions and ED visits. We compared associations with a similar population not experiencing homelessness using coarsened exact matching. Results. Of the 24 688 individuals identified as experiencing homelessness who visited an ED, most were younger than 65 years (94%) and of non-Hispanic ethnicity (84%), and 14% indicated the need for a psychiatric consultation. Results indicated a positive association, with the strongest risk of ED visits during daytime (e.g., 99th percentile, 2 days) heat waves (odds ratio = 1.29; 95% confidence interval = 1.02, 1.64). Patients experiencing homelessness who were younger or elderly and who required a psychiatric consultation were particularly vulnerable to heat waves. Odds of ED visits were higher for individuals experiencing homelessness after matching to nonhomeless individuals based on age, gender, and race/ethnicity. Conclusions. It is important to prioritize individuals experiencing homelessness in heat action plans and consider vulnerability factors to reduce their burden. (Am J Public Health. 2022;112(1):98-106. https://doi.org/10.2105/AJPH.2021.306557).
Elevated air temperatures in urban neighborhoods due to the Urban Heat Island effect is a form of heat pollution that causes thermal discomfort, higher energy consumption, and deteriorating public health. Mitigation measures can be expensive, with the need to maximize benefits from limited resources. Here we show that significant mitigation can be achieved through a limited application of reflective surfaces. We use a Computational Fluid Dynamics model to resolve the air temperature within a prototypical neighborhood for different wind directions, building configurations, and partial application of reflective surfaces. While reflective surfaces mitigate heat pollution, their effectiveness relative to cost varies with spatial distribution. Although downstream parts experience the highest heat pollution, applying reflective surfaces to the upstream part has a disproportionately higher benefit relative to cost than applying them downstream.
Heat-related illness is a spectrum of conditions progressing from heat exhaustion, heat injury, to life-threatening heat stroke. Heat stroke is a clinical constellation of symptoms that include a severe elevation in body temperature which typically, but not always, is greater than 40°C. Also, there must be clinical signs of central nervous system dysfunction that may include ataxia, delirium, or seizures, in the setting of exposure to hot weather or strenuous physical exertion. Risk factors include environmental variables, medications, drug use, and other medical comorbidities.
The potential for critical infrastructure failures during extreme weather events is rising. Major electrical grid failure or “blackout” events in the United States, those with a duration of at least 1 h and impacting 50,000 or more utility customers, increased by more than 60% over the most recent 5 year reporting period. When such blackout events coincide in time with heat wave conditions, population exposures to extreme heat both outside and within buildings can reach dangerously high levels as mechanical air conditioning systems become inoperable. Here, we combine the Weather Research and Forecasting regional climate model with an advanced building energy model to simulate building-interior temperatures in response to concurrent heat wave and blackout conditions for more than 2.8 million residents across Atlanta, Georgia; Detroit, Michigan; and Phoenix, Arizona. Study results find simulated compound heat wave and grid failure events of recent intensity and duration to expose between 68 and 100% of the urban population to an elevated risk of heat exhaustion and/or heat stroke.
Extreme heat is a major threat to human health worldwide. The COVID-19 pandemic, with its complexity and global reach, created unprecedented challenges for public health and highlighted societal vulnerability to hazardous hot weather. In this study, we used data from a three-wave nationally representative survey of 3036 American adults to examine how the COVID-19 pandemic affected extreme heat vulnerability during the summer of 2020. We used mixed effects models to examine the roles of socio-demographic characteristics and pandemic-related factors in the distribution of negative heat effects and experiences across the United States. The survey findings show that over a quarter of the US population experienced heat-related symptoms during the summer of 2020. Mixed effects models demonstrate that among all socio-economic groups, those who were most vulnerable were women, those in low-income households, unemployed or on furlough, and people who identify as Hispanic or Latino or as other non-white census categories (including Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and multi-racial US residents). The study findings indicate that millions of people in the US had difficulty coping with or responding to extreme heat because of the direct and indirect effects of the COVID-19 pandemic. Limited access to cooling as well as COVID-19 related social isolation played a major role in adverse heat health effects. Geographically, the South and the West of the US stood out in terms of self-reported negative heat effects. Overall, the study suggests that the intersection of two health hazards-extreme heat and coronavirus SARS-CoV2-amplified existing systemic vulnerabilities and expanded the demographic range of people vulnerable to heat stress.
Exposure to high temperatures is detrimental to human health. As climate change is expected to increase the frequency of extreme heat events, and raise ambient temperatures, an investigation into the trend of heat-related emergency department (ED) visits over the past decade is necessary to assess the human health impact of this growing public health crisis. ED visits were examined using the Nationwide Emergency Department Sample. Visits were included if the diagnostic field contained an ICD-9-CM or ICD-10-CM code specific to heat-related emergency conditions. Weighted counts were generated using the study design and weighting variables, to estimate the national burden of heat-related ED visits. A total of 1,078,432 weighted visits were included in this study. The annual incidence rate per 100,000 population increased by an average of 2.85% per year, ranging from 18.21 in 2009, to 32.34 in 2018. The total visit burden was greatest in the South (51.55%), with visits increasing to the greatest degree in the Midwest (8.52%). ED visit volume was greatest in July (29.79%), with visits increasing to the greatest degree in July (15.59%) and March (13.18%). An overall increase in heat-related ED visits for heat-related emergency conditions was found during the past decade across the United States, affecting patients in all regions and during all seasons.
Efforts to understand the complex, multidimensional nature of environmental vulnerability can generate new knowledge by deploying a convergence research framework within a community-engaged approach. We explore the benefits and shortcomings of what we call engaged convergence research (ECR) by narrating a case study that uncovered a pattern of indoor heat-related deaths that was previously unexplained: Although only 5 percent of Maricopa County, Arizona, residents live in mobile homes, residents of mobile homes account for 29 percent of indoor heat-related deaths. Exploring the multiplicative threats of economic precarity, population sensitivity to environmental exposure, site, and shelter type, we recharacterize the reality faced by mobile home dwellers to find them falling between the cracks of available heat resilience options. Beyond contributing to scholarship on indoor heat-related deaths, we demonstrate the potential for novel and actionable insights emerging from ECR. We also elucidate some of the challenges faced when enlisting community actors as coproducers of knowledge in geographic research.
Climate change is known to increase the frequency and intensity of hot days (daily maximum temperature ≥30°C), both globally and locally. Exposure to extreme heat is associated with numerous adverse human health outcomes. This study estimated the burden of heat-related illness (HRI) attributable to anthropogenic climate change in North Carolina physiographic divisions (Coastal and Piedmont) during the summer months from 2011 to 2016. Additionally, assuming intermediate and high greenhouse gas emission scenarios, future HRI morbidity burden attributable to climate change was estimated. The association between daily maximum temperature and the rate of HRI was evaluated using the Generalized Additive Model. The rate of HRI assuming natural simulations (i.e., absence of greenhouse gas emissions) and future greenhouse gas emission scenarios were predicted to estimate the HRI attributable to climate change. Over 4 years (2011, 2012, 2014, and 2015), we observed a significant decrease in the rate of HRI assuming natural simulations compared to the observed. About 3 out of 20 HRI visits are attributable to anthropogenic climate change in Coastal (13.40% [IQR: -34.90,95.52]) and Piedmont (16.39% [IQR: -35.18,148.26]) regions. During the future periods, the median rate of HRI was significantly higher (78.65%: Coastal and 65.85%: Piedmont), assuming a higher emission scenario than the intermediate emission scenario. We observed significant associations between anthropogenic climate change and adverse human health outcomes. Our findings indicate the need for evidence-based public health interventions to protect human health from climate-related exposures, like extreme heat, while minimizing greenhouse gas emissions.
Exposure to extreme heat is a known risk factor that is associated with increased heat-related illness (HRI) outcomes. The relevance of heat wave definitions (HWDs) could change across health conditions and geographies due to the heterogenous climate profile. This study compared the sensitivity of 28 HWDs associated with HRI emergency department visits over five summer seasons (2011−2016), stratified by two physiographic regions (Coastal and Piedmont) in North Carolina. The HRI rate ratios associated with heat waves were estimated using the generalized linear regression framework assuming a negative binomial distribution. We compared the Akaike Information Criterion (AIC) values across the HWDs to identify an optimal HWD. In the Coastal region, HWDs based on daily maximum temperature with a threshold > 90th percentile for two or more consecutive days had the optimal model fit. In the Piedmont region, HWD based on the daily minimum temperature with a threshold value > 90th percentile for two or more consecutive days was optimal. The HWDs with optimal model performance included in this study captured moderate and frequent heat episodes compared to the National Weather Service (NWS) heat products. This study compared the HRI morbidity risk associated with epidemiologic-based HWDs and with NWS heat products. Our findings could be used for public health education and suggest recalibrating NWS heat products.
The Army Heat Center at Fort Benning, GA was established to identify and disseminate best practices for the prevention, field care, evacuation, hospital care, and return to duty of exertional heat casualties. During the 2017-2021 surveillance period, there were 1,911 heat casualties treated at Ft. Benning’s Martin Army Community Hospital. Most patients were junior enlisted and officer personnel who were engaged in initial entry training. Heat exhaustion, heat injury, heat stroke, and hyponatremia accounted for 52.6%, 18.4%, 18.2%, and 2.0% of total heat illnesses, respectively. The annual proportion of heat casualties that were due to heat exhaustion rose steadily during the surveillance period, reaching 77.7% in 2021, while the incidence of heat injury and heat stroke did not increase during this period. Data are presented on the occurrence of clusters of heat illness, the association of cases of heat stroke with arduous physical activities, and the seasonal variation in incidence of heat illnesses. It is important that unit leaders and trainers understand the risk factors for heat illness among those being trained and that early first aid measures be employed in the field (especially rapid cooling).
OBJECTIVES: To understand how health departments implemented the response to the dual hazards of Heat Related Illness (HRI) and COVID-19 in Summer 2020. METHODS: We interviewed five health jurisdictions with a Building Resilience Against Climate Effects (BRACE) Framework HRI project to understand impacts to organizational roles and preparedness activities, capacity to respond to the heat season, challenges experienced with resources and personnel, and how partners influenced their capacity to respond to dual hazards. RESULTS: Health jurisdictions working in both heat preparedness and on the COVID-19 response highlighted three components as integral to maintaining public health capacity throughout the pandemic: 1) adapting to changing roles and responsibilities, 2) building and strengthening inter-organizational partnerships, and 3) maintaining flexibility through cross-training as themes to maintain the public health capacity throughout the pandemic. CONCLUSIONS: With impacts of the changing climate, including resultant extreme events with subsequent public health impacts, simultaneous responses are likely to arise again in the future. Developing cross-training programs, fostering flexibility and adaptability within the workforce, and building and sustaining external partnerships can support health departments anticipating the need to respond to simultaneous public health hazards in the future.
BACKGROUND: Agricultural workers are disproportionately at risk for heat-related morbidity and mortality. The purpose of this study was to explore how sociocultural and occupational factors, and environmental heat stress influenced fluid intake and hydration status among Latino farmworkers working in eastern North Carolina. METHODS: A community-informed, mixed methods research study was conducted in partnership with staff at a federally qualified health center. In summer 2020, we recruited Latino farmworkers at migrant camps. Twenty-eight male, migrant farmworkers participated in focus group discussions and 30 completed surveys and provided urine specimens. Wet bulb globe temperatures were measured in fields where workers labored. Content analysis and parametric analyses were performed. Data integration was completed using a meta-matrix. RESULTS: Prior to work, 46.7% of farmworkers’ urine specific gravity measurements indicated dehydration, which increased to 100% after work. The farmworkers spent between 2 and 7.5 hours of their day working in conditions above the recommended limits for workplace heat exposure. Farmworkers described exposure to extreme heat and inconsistent occupational policy compliance. Farmworkers expressed the opportunity to drink water but accessibility and poor water quality limited hydration. The integrated data supported congruent findings of extreme heat, few work breaks, and substandard housing. CONCLUSION/APPLICATION TO PRACTICE: Farmworkers are dehydrated at work, placing them at higher risk for heat-related illness (HRI). By engaging with agricultural stakeholders, occupational health nurses can combine efforts and advocate for effective health and safety work policies to reduce HRIs and deaths among farmworkers. Legislation stipulating cooling and hydration practices would support safer work environments.
In the wake of growing concern for climate change, heat waves and their potential health effects (McGeehin and Mirabelli, 2001) [37] have become a recurring phenomenon (Beniston, 2004; Fouillet et al., 2006) [8,21]. Extreme heat events in the USA are responsible for more deaths as compared to other weather events such as hurricanes, lightning, tornadoes and floods (Luber and McGeehin, 2008) [33]. Heat exposure in buildings has risen due to global warming in conjunction with other factors like urban-ization and associated heat island effects (Kolokotroni et al., 2012) [25], lack of thermal mass (Lomas and Porritt, 2017a) [31], exposure to solar insolation on higher stories, absence of window shading, over-crowding and envelope properties exacerbate the overheating inside the dwellings (Vellei et al., 2017). [45]. Stone et al. specialIntscript [43] provides a macro view of the indoor environments in buildings due to the concurrent event of power outage during heat wave in face of climate change. This paper builds on the previous publication and provides a detailed view of modeling methodology, building physics that explains the sources/sinks of heat and entails a detailed evaluation of the current building stock for the low to moderate income residences in the city of Phoenix, Arizona in terms of their thermal performance. Finite Element models of building stock were simulated using MATLAB for microclimate weather files of Phoenix generated by Weather Research and Forecasting (WRF) simulation. Significant differences in temperature were noted in same building archetypes in different pockets of the city indicating the role of urbanization in aggravating the impact of heat wave. Dwellings with high thermal mass are found to be much more resilient to high ambient temperatures as compared to code compliant residences with base-ments being the coolest zones in all prototypes. (C) 2021 Elsevier B.V. All rights reserved.
The disorders of hyperthermia, also known as heat-related injury or illness, exist on a continuum, which is marked by dysregulation of the body’s thermoregulatory capacity. This condition can vary both in presentation and in severity, from benign conditions, including heat cramps and heat edema, to life-threatening hyperthermia, also known as heatstroke. This article will discuss non-life-threatening heat-related illnesses. It is essential to be able to identify and manage these conditions appropriately as moderate hyperthermia can progress to life-threatening heatstroke. As such, including these injuries in medical decision-making, prompt identification, and appropriate treatment is important. This article will also review the epidemiology, including at-risk populations, red-flag features of patient presentations, treatment options and strategies, and preventative techniques, which all play a significant role in decreasing the morbidity, mortality, and healthcare costs associated with these injuries.
Globally, there is increasing recognition that agricultural workers are at risk for chronic kidney disease of unknown etiology (CKDu). Recurrent heat exposure, physical exertion, dehydration, muscle damage, and inflammation are hypothesized to contribute to the development of CKDu, but the relative importance of these processes and the interactions among them remain unclear. Moreover, there is a need to identify biomarkers that could distinguish individuals who are at greatest risk for kidney damage to target preventative interventions for CKDu. In this study, we evaluated dehydration and markers of inflammation, muscle damage, and renal function in agricultural workers at a non-workday baseline assessment. Urine specific gravity and kidney function were measured before and after work shifts on three subsequent days, and heat index, core body temperature, and heart rate were monitored during the work shifts. A combination of direct comparisons and machine learning algorithms revealed that reduced levels of uromodulin and sodium in urine and increased levels of interleukin-6 and C-reactive protein in serum were indicative of dehydration at baseline, and that dehydration, high body mass index, reduced urine uromodulin, and increased serum interleukin-6, C-reactive protein, and lipopolysaccharide-binding protein at baseline were predictive of acute kidney injury on subsequent workdays. Our findings suggest a method for identifying agricultural workers at greatest risk for kidney injury and reveal potential mechanisms responsible for this process, including pathways overlapping in dehydration and kidney injury. These results will guide future studies confirming these mechanisms and introducing interventions to protect kidney health in this vulnerable population.
Wet bulb temperatures (T(wet)) during extreme heat events are commonly 31°C. Recent predictions indicate that T(wet) will approach or exceed 34°C. Epidemiological data indicate that exposure to extreme heat events increases kidney injury risk. We tested the hypothesis that kidney injury risk is elevated to a greater extent during prolonged exposure to T(wet) = 34°C compared with T(wet) = 31°C. Fifteen healthy men rested for 8 h in T(wet) = 31 (0)°C and T(wet) = 34 (0)°C. Insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinase 2 (TIMP-2), and thioredoxin 1 (TRX-1) were measured from urine samples. The primary outcome was the product of IGFBP7 and TIMP-2 ([IGFBP7·TIMP-2]), which provided an index of kidney injury risk. Plasma interleukin-17a (IL-17a) was also measured. Data are presented at preexposure and after 8 h of exposure and as mean (SD) change from preexposure. The increase in [IGFBP7·TIMP-2] was markedly greater at 8 h in the 34°C [+26.9 (27.1) (ng/mL)(2)/1,000) compared with the 31°C [+6.2 (6.5) (ng/mL)(2)/1,000] trial (P < 0.01). Urine TRX-1, a marker of renal oxidative stress, was higher at 8 h in the 34°C [+77.6 (47.5) ng/min] compared with the 31°C [+16.2 (25.1) ng/min] trial (P < 0.01). Plasma IL-17a, an inflammatory marker, was elevated at 8 h in the 34°C [+199.3 (90.0) fg/dL; P < 0.01] compared with the 31°C [+9.0 (95.7) fg/dL] trial. Kidney injury risk is exacerbated during prolonged resting exposures to T(wet) experienced during future extreme heat events (34°C) compared with that experienced currently (31°C), likely because of oxidative stress and inflammatory processes.NEW AND NOTEWORTHY We have demonstrated that kidney injury risk is increased when men are exposed over an 8-h period to a wet bulb temperature of 31°C and exacerbated at a wet bulb temperature of 34°C. Importantly, these heat stress conditions parallel those that are encountered during current (31°C) and future (34°C) extreme heat events. The kidney injury biomarker analyses indicate both the proximal and distal tubules as the locations of potential renal injury and that the injury is likely due to oxidative stress and inflammation.
Exposure to excessive heat is associated with a higher risk of death. Although the relative risk of death on extreme-heat days has decreased over the past several decades in the United States, the drivers of this decline have not been fully characterized. In particular, while extreme heat earlier in the warm season has been shown to confer greater risk of mortality than exposure later in the season, it is unknown whether this within-season variability in susceptibility has changed over time and whether it is modified by region, climatic changes, or social vulnerability. METHODS: We used distributed-lag nonlinear models and meta-regression to estimate the association between ambient maximum daily temperature during the early, late, and overall warm seasons and the relative risk of mortality for two decades, 1973-1982 and 1997-2006, in 186 metropolitan areas in the United States. We assessed changes in relative risk nationally, regionally, and between places with differential changes in early-season relative extreme heat and indicators of social vulnerability. RESULTS: Most of the reduction in heat-related mortality nationally between the two decades is driven by decreases in late-season mortality, while substantial early-season risk remains. This difference is most apparent in the Northeast, in cities with greater increases in early-season relative extreme heat, and in places that have become more socially vulnerable. CONCLUSIONS: Early-season heat mortality risks have persisted despite overall adaptations, particularly in places with greater warming and increasing social vulnerability. Interventions to reduce heat mortality may need to consider greater applicability to the early warm season.
BACKGROUND: There is a compelling need to identify agricultural workers at risk for heat related illness (HRI). METHODS: Data from Florida agricultural workers (N = 221) were collected over 3 summer workdays (2015 to 2017) to examine risk factors for exceeding NIOSH-recommended core temperature (Tc) thresholds (38 °C [Tc38] and 38.5 °C [Tc38.5]) using generalized linear mixed models. RESULTS: On an average workday, 49% of participants exceeded Tc38 and 10% exceeded Tc38.5. On average, participants first exceeded both thresholds early in the day; the Tc38 threshold mid-morning (10:38 AM), and Tc38.5 about a half hour later (11:10 AM). Risk factors associated with exceeding Tc38 included years working in US agriculture, body mass index, time performing moderate-to-vigorous physical activity, increasing heat index, and field crop work. CONCLUSIONS: The high prevalence of core temperatures exceeding recommended limits emphasizes the serious need for mandated HRI prevention programs for outdoor workers.
Among persons with high spinal cord injury (Hi-SCI: > T5), changes in core body temperature (Tcore) and cognitive performance during heat exposure appear related to degree of sympathetic interruption. Twenty men with Hi-SCI (C4-T4, American Spinal Injury Association Impairment Scale [AIS] A-B) and 19 matched, able-bodied controls were acclimated to 27°C baseline (BL) before exposure to 35°C heat challenge (HC). Two groups, differentiated by increase in Tcore during HC, were identified: high responders (HR-SCI: ΔTcore ≥0.5°C; n = 13, C4-T2) and low responders (LR-SCI: ΔTcore <0.5°C; n = 7, C4-T4). Tcore, distal skin temperatures (Tsk(avg)), and distal microvascular perfusion (LDF(both feet)) were measured, as were indices of sympathetic integrity, mean arterial pressure (MAP), and extremity sweat rate (SR(avg)). Cognitive performance was assessed at BL and post-HC, using the Stroop Color and Word and Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span tests. At BL, Tcore of the HR-SCI group (36.6 ± 0.4°C) was lower than that for the LR-SCI (37.1 ± 0.3°C; p = 0.011) and control groups (37.3 ± 0.3°C; p < 0.001). After HC, Tcore was not different among groups. MAP of the HR-SCI group (70.9 ± 9.8 mm Hg) was lower than that of the LR-SCI (81.8 ± 7.0 mm Hg; p = 0.048) and control groups (89.9 ± 9.9 mm Hg; p < 0.001). SR(avg) increased more in the control group (77.0 ± 52.5 nL/cm(2)/min) than in the HR-SCI group (15.5 ± 22.0 nL/cm(2)/min; p = 0.001). Only the HR-SCI group had significant increases in T-Scores of Stroop Word (7.5 ± 4.4; p < 0.001), WAIS-IV Digit Span Sequence (1.9 ± 1.8; p = 0.002), and WAIS-IV Digit Span Total (1.4 ± 1.6; p = 0.008). Persons with SCI who responded to HC with a greater change in Tcore demonstrated evidence of greater sympathetic interruption and had an associated improvement in cognitive performance.
The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.
Background: Outdoor workers are exposed to hot work environments and are at risk of heat-related morbidity and mortality. The purpose of this study was to evaluate the knowledge of migrant farmworkers about first aid for heat-related illness (HRI) symptoms. Methods: The authors recruited 60 migrant farmworkers out of 66 who were approached from vegetable farms in Georgia. They were workers who participated in the 2018 Farmworker Family Health Program (FWFHP). The authors surveyed the workers to assess demographics, prevalence of HRI symptoms, hydration practices, and knowledge of HRI first aid. Descriptive statistics for worker demographics, HRI symptoms, and hydration data were calculated, as were the percentages of correctly answered pilot questions. Findings: Of the 60 workers who chose to participate in this study, more than 50% incorrectly answered pilot questions related to their knowledge of HRI first aid. The two most common HRI symptoms reported were heavy sweating and muscle cramps. More than two thirds reported experiencing at least one HRI symptom during the workday. Mean liquid consumption within this sample was 72.95 oz per day, which is much less than the recommended 32 oz per hour. Conclusion/Application to Practice: Until larger structural change can occur to protect farmworkers, farm owners can prevent morbidity and mortality from inadequate hydration practices and working in high-heat conditions by providing migrant farmworkers with training in heat-related first aid. Appropriate heat-illness interventions should focus on first aid measures to reduce morbidity and mortality related to heat illness in farmworkers.
BACKGROUND: The burden of adverse health effects from heat exposure is substantial, and outdoor workers who perform heavy physical work are at high risk. Though heat prevention interventions have been developed, studies have not yet systematically evaluated the effectiveness of approaches that address risk factors at multiple levels. OBJECTIVE: We sought to test the effectiveness of a multi-level heat prevention approach (heat education and awareness tools [HEAT]), which includes participatory training for outdoor agricultural workers that addresses individual and community factors and a heat awareness mobile application for agricultural supervisors that supports decisions about workplace heat prevention, in the Northwest United States. DESIGN: We designed the HEAT study as a parallel, comparison, randomized group intervention study that recruited workers and supervisors from agricultural workplaces. In intervention arm crews, workers received HEAT training, and supervisors received the HEAT awareness application. In comparison arm crews, workers were offered non-HEAT training. Primary outcomes were worker physiological heat strain and heat-related illness (HRI) symptoms. In both worker groups, we assessed HRI symptoms approximately weekly, and heat strain physiological monitoring was conducted at worksites approximately monthly, from June through August. DISCUSSION: To our knowledge, this is the first study to evaluate the effectiveness of a multi-level heat prevention intervention on physiological heat strain and HRI symptoms for outdoor agricultural workers. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT04234802.
Practitioners and researchers use vulnerability indices to understand the conditions that influence hazard risk. However, there has been little research on how well such indices depict household-scale vulnerability to specific hazards. We examined relationships between an all-hazard index and a hazard-specific index with householdlevel adaptive resources, adaptive behaviors, proximate sensitivities, and self-reported health outcomes related to extreme heat. Household measures were drawn from a stratified random sample survey conducted in Phoenix, Arizona, USA (n = 163). The results point to different experiences between households in more and less heat vulnerable areas. The largest differences between households stratified by the hazard-specific index (Heat Vulnerability Index) primarily involved adaptive resources and behaviors, whereas indicators of proximate sensitivity were more strongly differentiated by the all-hazard index (Social Vulnerability Index). Differences in health outcomes between more and less vulnerable neighborhoods were more evident using HVI than SoVI, although effect sizes using either index were small and confidence intervals were wide. The relationship between vulnerability indices and several survey measures varied across four study sites. The specific ways in which more and less vulnerable communities differ from one another varies based on the adaptation, sensitivity, or outcome measure of interest, location within the city, and choice of vulnerability index.
There is a pressing need for strategies to prevent the heat-health impacts of climate change. Cooling urban areas through adding trees and vegetation and increasing solar reflectance of roofs and pavements with higher albedo surface materials are recommended strategies for mitigating the urban heat island. We quantified how various tree cover and albedo scenarios would impact heat-related mortality, temperature, humidity, and oppressive air masses in Los Angeles, California, and quantified the number of years that climate change-induced warming could be delayed in Los Angeles if interventions were implemented. Using synoptic climatology, we used meteorological data for historical summer heat waves, classifying days into discrete air mass types. We analyzed those data against historical mortality data to determine excess heat-related mortality. We then used the Weather Research and Forecasting model to explore the effects that tree cover and albedo scenarios would have, correlating the resultant meteorological data with standardized mortality data algorithms to quantify potential reductions in mortality. We found that roughly one in four lives currently lost during heat waves could be saved. We also found that climate change-induced warming could be delayed approximately 40-70 years under business-as-usual and moderate mitigation scenarios, respectively.
Urban tree cover contributes to human well-being through a variety of ecosystem services. In this study, we focus on the role that trees can play in reducing temperature during warm seasons and associated impacts on human health and well-being. We introduce a method for quantifying and valuing changes in premature mortality from extreme heat due to the changes in urban tree cover and apply this method to Baltimore City, Maryland. The model i-Tree Cool Air uses a water and energy balance to estimate hourly changes in air temperature due to alternative scenarios of tree cover applied across 653 Census Block Groups. The changes in temperature are applied to existing temperature?mortality models to estimate changes in health outcomes and associated values. Existing tree cover in Baltimore is estimated to reduce annual mortality by 543 deaths as compared to a 0% tree cover scenario. Increasing the area of current tree cover by 10% of each Census Block Group reduced baseline annual mortality by 83 to 247 deaths (valued at $0.68 ?2.0 billion applying Value of Statistical Life estimates). Over half of the reduced mortality is from the over 65 year age group, who are among the most vulnerable to extreme heat. Reductions in air temperature due to increased tree cover were greatest in downtown Baltimore where tree cover is relatively low and impervious cover is relatively high. However, the greatest reductions in mortality occurred in the outskirts of Baltimore where a greater number of people who are over 65 years in age reside. Quantifying and valuing the health benefits of changes in air temperatures due to increased tree cover can inform climate adaptation and mitigation plans by decision makers. Developing adaptation strategies to effectively address these issues will become increasingly important in the future under changing climates and an aging population.
BACKGROUND: Short-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations. METHODS: Logic regression is a statistical learning method for constructing decision trees based on Boolean combinations of binary predictors. We describe how logic regression can be utilized as a data-driven approach to identify extreme heat exposure definitions using health outcome data. We evaluated the performance of the proposed algorithm in a simulation study, as well as in a 20-year time-series analysis of extreme heat and emergency department visits for 12 outcomes in the Atlanta metropolitan area. RESULTS: For the Atlanta case study, our novel application of logic regression identified extreme heat exposure definitions that were associated with several heat-sensitive disease outcomes (e.g., fluid and electrolyte imbalance, renal diseases, ischemic stroke, and hypertension). Exposures were often characterized by extreme apparent minimum temperature or maximum temperature over multiple days. The simulation study also demonstrated that logic regression can successfully identify exposures of different lags and duration structures when statistical power is sufficient. CONCLUSION: Logic regression is a useful tool for identifying important characteristics of extreme heat exposures for adverse health outcomes, which may help improve future heat warning systems and response plans.
Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.
Cities inadvertently create warmer and drier urban climate conditions than their surrounding areas through urbanization that replaces natural surfaces with impervious materials. These changes cause heat-related health problems and many studies suggest microclimatic urban design (MUD) as an approach to address these problems. In MUD-related research, although terrestrial radiation plays an important role in human thermal comfort and previous studies use thermal comfort models to identify human heat stress, few studies have addressed the effect of terrestrial radiation. This study develops the ground ratio factor (GRF) model to estimate the different terrestrial radiation according to different ground conditions. Three types of ground materials (asphalt, concrete, and grass) were considered in the model, and field studies were conducted in humid subtropical climate (Cfa) zone during the hot season (13 July to 19 September 2020). The model was validated by comparing the predicated terrestrial radiation (PTR) from the model with the actual terrestrial radiation (ATR). The results showed that there is a statistically significant strong correlation between PTR and ATR. The model can contribute to MUD strategies by updating existing human energy budget models, which can lead to the measurement of more accurate human thermal comfort for mitigating thermal environments.
Background: Extreme heat is a leading cause of morbidity and mortality during summer months in the United States. Risk of heat exposure and associated health outcomes are disproportionately experienced by people with lower incomes, people of color, and/or immigrant populations.Methods: As qualitative research on the experiences of residents in heat islands is limited, this community-based study examined barriers and coping strategies for keeping cool among residents of Chelsea and East Boston, Massachusetts-environmental justice (EJ) areas that experience the urban heat island effect-through semistructured interviews and qualitative content analysis.Results: Results indicate that all participants (n = 12) had air conditioning, but high energy bills contributed to low use. Eight participants were self-described heat-sensitive, with five experiencing poor health in heat. In addition, nine reported insufficient hydration due to work schedules, distaste of water, or perceptions of it being unsafe.Discussion: This research highlights the importance of understanding perceptions of residents in EJ communities to contextualize vulnerability and identify multipronged heat coping strategies and targeted interventions.
Beliefs in climate change are influenced by personal experiences and sociodemographic charac-teristics; yet justice considerations are often overlooked. We unveil the influence of these factors? on climate change beliefs in a large American city facing substantial climate change impacts, Phoenix, Arizona. Using the Phoenix Area Social Survey that includes data collected from (n = 806) households across fourteen cities in the Phoenix metropolitan area, we investigate what factors influence a belief that ?global warming and climate change are already occurring.? Engaging adaptive capacity and justice literatures with climate belief models, we find that belief in climate change and global warming is positively associated with race specifically other than non-Hispanic Whites, high levels of education, personal experience with heat-related illnesses, and liberal beliefs. Widespread agreement about climate change is found within the scientific community, but general populations, especially in the USA, lag behind in accepting climate change. Critically, there are important justice dimensions absent in the existing literature relevant to understanding belief in and the impacts of climate change. Unpacking these factors could help inform policy makers and civil society organizations in their efforts to design more ?just adaptation? strategies.
Recent studies have characterized individually experienced temperatures or individually experienced heat indices, including new exposure metrics that capture dimensions of exposure intensity, frequency, and duration. Yet, few studies have examined the personal thermal exposure in underrepresented groups, like outdoor workers, and even fewer have assessed corresponding changes in physiologic heat strain. The objective of this paper is to examine a cohort of occupationally exposed grounds and public safety workers (n = 25) to characterize their heat exposure and resulting heat strain. In addition, a secondary aim of this work is to compare individually heat index exposure (IHIE) across exposure metrics, fixed-site in situ weather stations, and raster-derived urban heat island (UHI) measurements in Charleston, SC, a humid coastal climate in the Southeastern USA. A Bland-Altman (BA) analysis was used to assess the level of agreement between the personal IHIE measurements and weather-station heat index (HI) and Urban Heat Island (UHI) measurements. Linear mixed-effect models were used to determine the association between individual risk factors and in situ weather station measurements significantly associated with IHIE measurements. Multivariable stepwise Cox proportional hazard modeling was used to identify the individual and workplace factors associated with time to heat strain in workers. We also examined the non-linear association between heat strain and exposure metrics using generalized additive models. We found significant heterogeneity in IHIE measurements across participants. We observed that time to heat strain was positively associated with a higher IHIE, older age, being male, and among Caucasian workers. Important nonlinear associations between heat strain occurrence and the intensity, frequency, and duration of personal heat metrics were observed. Lastly, our analysis found that IHIE measures were significantly similar for weather station HI, although differences were more pronounced for temperature and relative humidity measurements. Conversely, our IHIE findings were much lower than raster-derived UHI measurements. Real-time monitoring can offer important insights about unfolding temperature-health trends and emerging behaviors during thermal extreme events, which have significant potential to provide situational awareness.
The growing frequency, intensity, and duration of extreme heat events necessitates interventions to reduce heat exposures. Local opportunities for heat adaptation may be optimally identified through collection of both quantitative exposure metrics and qualitative data on perceptions of heat. In this study, we used mixed methods to characterize heat exposure among urban residents in the area of Boston, Massachusetts, US, in summer 2020. Repeated interviews of N = 24 study participants ascertained heat vulnerability and adaptation strategies. Participants also used low-cost sensors to collect temperature, location, sleep, and physical activity data. We saw significant differences across temperature metrics: median personal temperature exposures were 3.9 °C higher than median ambient weather station temperatures. Existing air conditioning (AC) units did not adequately control indoor temperatures to desired thermostat levels: even with AC use, indoor maximum temperatures increased by 0.24 °C per °C of maximum outdoor temperature. Sleep duration was not associated with indoor or outdoor temperature. On warmer days, we observed a range of changes in time-at-home, expected given our small study size. Interview results further indicated opportunities for heat adaptation interventions including AC upgrades, hydration education campaigns, and amelioration of energy costs during high heat periods. Our mixed methods design informs heat adaptation interventions tailored to the challenges faced by residents in the study area. The strength of our community-academic partnership was a large part of the success of the mixed methods approach.
Temperature profiles of the lower atmosphere (<3 km) over complex urban areas are related to health risks, including heat stress and respiratory illness. This complexity leads to uncertainty in numerical simulations, and many studies call for more observations of the lower atmosphere over cities. Using 20 years of observations from the Aircraft Meteorological Data Relay (AMDAR) program over Dallas-Fort Worth, Texas, average profiles every 0.5 h are created from the 1.5 million individual soundings. Dallas-Fort Worth is ideal because it is a large urban area in the central Great Plains, has no major topographic or coastal influences, and has two major airports near the center of the urban heat island. With frequent and high-quality measurements over the city, we investigate the evolution of the lower atmosphere around sunrise to quantify the stability, boundary layer height, and duration of the morning transition when there are southerly winds, few clouds, and no precipitation so as to eliminate transient synoptic events. Characteristics of the lower atmosphere are separated by season and maximum wind speed because the the Great Plains low-level jet contributes to day-to-day variability. In all seasons, stronger wind over the city leads to a weaker nocturnal temperature inversion at sunrise and a shorter morning transition period, with the greatest difference during autumn and the smallest difference during summer. During summer, the boundary layer height at sunrise is higher on average, deepens the most as wind strengthens, and has the fewest days exhibiting a surface temperature inversion over the city. Significance StatementCities impact health by creating an urban heat island caused by more heating at the surface, less evaporative cooling, and increased anthropogenic waste heat, and they can have high pollution. Cooling overnight stabilizes the lower atmosphere and traps pollutants near the surface until surface heating after sunrise mixes them away. Inadequate pollution observations make it difficult to study these issues. The greatest mixing occurs about 2 h after sunrise but can be modulated by wind speed. Observations from 1.5 million aircraft landing and taking off over Dallas-Fort Worth, Texas, reveal that strong low-level wind leads to morning transitions ending 0.84 h earlier on average than with light wind. Details from this vast dataset contribute to improved understanding of the lower atmosphere over cities and provide a baseline for simulations.
Extreme heat is a recognized threat to human health. This study examines projected future trends of multiple measures of extreme heat across Texas throughout the next century, and evaluates the expected climate changes alongside Texas athletic staff (coach and athletic trainer) attitudes toward heat and climate change. Numerical climate simulations from the recently published Community Earth System Model version 2 and the Climate Model Intercomparison Project were used to predict changes in summer temperatures, heat indices, and wet bulb temperatures across Texas and also within specific metropolitan areas. A survey examining attitudes toward the effects of climate change on athletic programs and student athlete health was also distributed to high-school and university athletic staff. Heat indices are projected to increase beyond what is considered healthy/safe limits for outdoor sports activity by the mid-to-late 21st century. Survey results reveal a general understanding and acceptance of climate change and a need for adjustments in accordance with more dangerous heat-related events. However, a portion of athletic staff still do not acknowledge the changing climate and its implications for student athlete health and their athletic programs. Enhancing climate change and health communication across the state may initiate important changes to athletic programs (e.g., timing, duration, intensity, and location of practices), which should be made in accordance with increasingly dangerous temperatures and weather conditions. This work employs a novel interdisciplinary approach to evaluate future heat projections alongside attitudes from athletic communities toward climate change.
Background: Little is known about menopausal symptoms in underserved women. Aim: To better understand self-reported menopausal symptoms in underserved and homeless women living in extreme heat during different seasons. Methods: A cross-sectional study, including the Greene Climacteric Scale (GCS), climate-related questions, and demographics was administered June to August of 2017 and December to February 2018 to women 40-65 years of age. Results: In 104 predominantly Hispanic (56%), uninsured (53%), menopausal (56%), and mid-aged (50 ± 9.5) women, 57% reported any bother, while 20% of these women reported “quite a bit” or “extreme” bother from hot flushes. The total GCS score was a mean of 41 ± 15.0; out of 63 indicating significant symptoms, the psychological and somatic clusters were highest. Women did not think temperature outside influenced their menopausal symptoms at either time point (69% in winter vs. 57% in summer, p = 0.23). In multivariable analyses after adjusting for race, body mass index, and living situation neither season nor temperature was associated with self-reported hot flush bother. While one-third of women reported becoming ill from the heat, 90% of women reported not seeking care from a doctor for their illness. Conclusion: Menopausal, underserved, homeless women living in Arizona reported few vasomotor symptoms regardless of season, and endorsed psychological and somatic complaints. Socioeconomic factors may influence types of bothersome menopausal symptoms in this population of women.
Extreme heat exposure increases the risk for heat-related illnesses (HRIs) and deaths, and comprehensive strategies to prevent HRIs are increasingly important in a warming climate (1). An estimated 702 HRI-associated deaths and 67,512 HRI-associated emergency department visits occur in the United States each year (2,3). In 2020, Phoenix and Yuma, Arizona, experienced a record 145 and 148 days, respectively, of temperatures >100°F (37.8°C), and a record 522 heat-related deaths occurred in the state. HRIs are preventable through individual and community-based strategies*(,)(†); cooling centers,(§) typically air-conditioned or cooled buildings designated as sites to provide respite and safety during extreme heat, have been established in Maricopa and Yuma counties to reduce HRIs among at-risk populations, such as older adults. This analysis examined trends in HRIs by age during 2010-2020 for Maricopa and Yuma counties and data from a survey of older adults related to cooling center availability and use in Yuma County during 2018-2019. Data from CDC’s Social Vulnerability Index (SVI) were also used to overlay cooling center locations with SVI scores. During 2010-2020, heat days, defined as days with an excessive heat warning issued by the National Weather Service Phoenix Office,(¶) for any part of Maricopa and Yuma counties (4), increased in both Maricopa County (1.18 days per year) and Yuma County (1.71 days per year) on average. Adults aged ≥65 years had higher rates of HRI hospitalization compared with those aged <65 years. In a survey of 39 adults aged ≥65 years in Yuma County, 44% reported recent HRI symptoms, and 18% reported electricity cost always or sometimes constrained their use of air conditioning. Barriers to cooling center access among older adults include awareness of location and transportation. Collaboration among diverse community sectors and health profession education programs is important to better prepare for rising heat exposure and HRIs. States and communities can implement adaptation and evaluation strategies to mitigate and assess heat risk, such as the use of cooling centers to protect communities disproportionately affected by HRI during periods of high temperatures.
It is predicted that heat waves will increase as climate changes. Related public health interventions have expanded over the past decades but are primarily targeted at health outcomes occurring during heat waves. However, heat adaptation is dynamic and adverse outcomes related to heat injuries occur with moderate increases in temperature throughout the summertime. We analyzed outpatient and inpatient heat related injuries from 2013 to 2019. National Weather Service event summaries were used to characterize reported heat wave days and weather data was linked to individual cases. Despite the higher rate of heat injury on heat wave days, only 12.7% of the 17,662 heat-related injuries diagnosed from 2013 to 2019 occurred during reported heat waves. In addition, the National Weather Service surveillance system monitoring heat related injuries only captured 2.1% of all heat related injuries and 30.6% of heat related deaths. As climate changes and warmer conditions become more common, public health response to moderate increases in temperature during summertime needs to be strengthened as do the surveillance systems used to monitor adverse heat related health events. Improved surveillance systems, long-term interventions and strategies addressing climate change may help mitigate adverse health outcomes attributable to heat related injuries over the summertime.
As climate change increases the frequency and intensity of devastating and unpredictable extreme heat events, developments to the built environment should consider instigating practices that minimize the likelihood of indoor overheating during hot weather. Heatwaves are the leading cause of death among weather-related causes worldwide, including in developed and developing countries. In this empirical study, a four-step approach was used to collect, extract and analyze data from twenty-seven states in the United States. Three housing characteristic categories (i.e., general housing conditions, living conditions, and housing thermal inertia) and eight variables were extracted from the American Housing Survey database, ResStock database and CDC’s National Environmental Public Health Tracking Network. Multivariable regression models were used to understand the influential variables, a multicollinearity test was used to determine the dependence of those variables, and then a logistic model was used to verify the results. Three variables-housing age (HA), housing crowding ratio (HCR), and roof condition (RC)-were found to be correlated with the risk of heat-related illness (HRI) indexes. Then, a logistic regression model was generated using the three variables to predict the risk of heat-related emergency department visits (EDV) and heat-related mortality (MORD) on a state level. The results indicate that the proposed logistic regression model correctly predicted 100% of the high-risk states for MORD for the eight states tested. Overall, this analysis provides additional evidence about the housing character variables that influence HRI. The outcomes also reinforce the concept of the built environment determined health and demonstrate that the built environment, especially housing, should be considered in techniques for mitigating climate change-exacerbated health conditions.
Although extreme heat exposure (EHE) was reported to be associated with increased risks of multiple diseases, little is known about the effects of EHE on pregnancy complications. We examined the EHE-pregnancy complications associations by lag days, subtypes, sociodemographic characteristics, and areas in New York State (NYS). We conducted a case-crossover analysis to assess the EHE-pregnancy complications associations in summer (June-August) and transitional months (May and September). All emergency department (ED) visits and hospital admissions due to pregnancy complications (ICD 9 codes: 630-649) from 2005 to 2013 in NYS were included. Daily mean temperature > 90th percentile of the monthly mean temperature in each county was defined as an EHE. We used conditional logistic regression while controlling for other weather factors, air pollutants and holidays to assess the EHE-pregnancy complications associations. EHE was significantly associated with increased ED visits for pregnancy complications in summer (ORs ranged: 1.01-1.04 from lag days 0-5). There was also a significant and stronger association in transitional months (ORs ranged: 1.02-1.06, Lag 0). Furthermore, we found EHE affected multiple subtypes of pregnancy complications, including threatened/spontaneous abortion, renal diseases, infectious diseases, diabetes, and hypertension (ORs range: 1.13-1.90) during transitional months. A significant concentration response effect between the number of consecutive days of EHE and ED visits in summer (P for trend <0.001), ED visits in September (P for trend =0.03), and hospital admission in May (P for trend<0.001) due to pregnancy complications was observed, respectively. African Americans and residents in lower socioeconomic position (SEP) counties were more susceptible to the effects of EHE. In conclusion, we found an immediate and prolonged effect of EHE on pregnancy complications in summer and a stronger, immediate effect in transitional months. These effects were stronger in African Americans and counties with lower SEP. Earlier warnings regarding extreme heat are recommended to decrease pregnancy complications.
Extreme heat events are the deadliest weather-related event in the United States. Cities throughout the United States have worked to develop heat adaptation strategies to limit the impact of extreme heat on vulnerable populations. However, the COVID-19 pandemic presented unprecedented challenges to local governments. This paper provides a preliminary review of strategies and interventions used to manage compound COVID-19-extreme heat events in the 25 most populous cities of the United States. Heat adaptation strategies employed prior to the COVID-19 pandemic were not adequate to meet during the co-occurring compound hazard of COVID-19-EHE. Long-term climate-adaptation strategies will require leveraging physical, financial, and community resources across multiple city departments to meet the needs of compound hazards, such as COVID-19 and extreme heat.
Globally, heat stress (HS) is nearly certain to increase rapidly over the coming decades, characterized by increased frequency, severity, and spatiotemporal extent of extreme temperature and humidity. While these characteristics have been investigated independently, a holistic analysis integrating them is potentially more informative. Using observations, climate projections from the CMIP5 model ensemble, and historical and future population estimates, we apply the IPCC risk framework to examine present and projected future potential impact (PI) of summer heat stress for the contiguous United States (CONUS) as a function of non-stationary HS characteristics and population exposure. We find that the PI of short-to-medium duration (1-7 days) HS events is likely to increase more than three-fold across densely populated regions of the U.S. including the Northeast, Southeast Piedmont, Midwest, and parts of the Desert Southwest by late this century (2060-2099) under the highest emissions scenario. The contribution from climate change alone more than doubles the impact in the coastal Pacific Northwest, central California, and the Great Lakes region, implying a substantial increase in HS risk without aggressive mitigation efforts.
OBJECTIVE: The aim of this study was to describe the incidence of heat-related illness among workers in British Columbia (BC), Canada, 2001-2020. METHODS: Cases of heat-related illness occurring among workers aged 15 years and older were identified from accepted lost-time claims from WorkSafeBC, the provincial workers’ compensation board. Incidence rates were calculated using monthly estimates of the working population from Statistics Canada’s Labour Force Survey as the denominator. RESULTS: Between 2000 and 2020, there were 528 heat-related illness claims, corresponding to a rate of 1.21 (95% confidence interval, 1.10-1.31) claims per 100,000 workers. Eighty-four percent of claims occurred between June and August. Rates were higher among male workers, younger workers, and among those working in occupations related to primary industry; trades, transport, and equipment operators; and processing, manufacturing, and utilities. CONCLUSIONS: In BC, lost-time claims for heat-related illness occurred disproportionately among certain subgroups of the workforce.
SETTING: Planning and designing thermally comfortable outdoor spaces is increasingly important in the context of climate change, particularly as children are more vulnerable than adults to environmental extremes. However, existing playground standards focus on equipment and surfacing to reduce acute injuries, with no mention of potential negative health consequences related to heat illness, sun exposure, and other thermal extremes. The goal of this project was to develop proposed guidelines for designing thermally comfortable playgrounds in Canada for inclusion within the CAN/CSA-Z614 Children’s playground equipment and surfacing standard. INTERVENTION: The project to develop guidance for thermally comfortable playgrounds was initiated with a municipal project in Windsor, Ontario, to increase shade, vegetation, and water features at parks and playgrounds to provide more comfortable experiences amid the increased frequency of hot days (≥30°C). The lack of available information to best manage environmental conditions led to a collaborative effort to build resources and raise awareness of best practices in the design of thermally comfortable playgrounds. OUTCOMES: A group of multidisciplinary experts developed technical guidance for improving thermal comfort at playgrounds, including a six-page thermal comfort annex adopted within a national playground and equipment standard. The annex has been used by Canadian schools in a competition to design and implement green playgrounds. IMPLICATIONS: Both the technical report and the thermal comfort annex provide increased awareness and needed guidance for managing environmental conditions at playgrounds. Thermally safe and comfortable play spaces will help ensure that Canada’s playgrounds are designed to minimize environmental health risks for children.
Urban areas have complex thermal distribution. We examined the association between extreme temperature and mortality in urban Ontario, using two temperature data sources: high-resolution and weather station data. We used distributed lag non-linear Poisson models to examine census division-specific temperature-mortality associations between May and September 2005-2012. We used random-effect multivariate meta-analysis to pool results, adjusted for air pollution and temporal trends, and presented risks at the 99th percentile compared to minimum mortality temperature. As additional analyses, we varied knots, examined associations using different temperature metrics (humidex and minimum temperature), and explored relationships using different referent values (most frequent temperature, 75th percentile of temperature distribution). Weather stations yielded lower temperatures across study months. U-shaped associations between temperature and mortality were observed using both high-resolution and weather station data. Temperature-mortality relationships were not statistically significant; however, weather stations yielded estimates with wider confidence intervals. Similar findings were noted in additional analyses. In urban environmental health studies, high-resolution temperature data is ideal where station observations do not fully capture population exposure or where the magnitude of exposure at a local level is important. If focused upon temperature-mortality associations using time series, either source produces similar temperature-mortality relationships.
INTRODUCTION: Mean daily temperatures in Canada rose 1.7°C between 1948 and 2016, and the frequency, severity, and duration of extreme heat events has increased. These events can exacerbate underlying health conditions, bringing patients to emergency departments (EDs). This retrospective analysis assessed the impact of temperature and humidex on ED volume and length of stay (LOS). METHODS: LOS is an indicator of ED overcrowding and system performance. Using daily maximum temperatures and humidex values, this study investigated the impact of mean 3-d temperatures and humidex preceding ED presentation on the median and maximum ED LOS and patient volume in 2 community hospitals in Montreal, Quebec, during the summer months of 2016 to 2018. Data were analyzed with 1-way analysis of variance with post hoc Fisher least significant difference tests and Spearman correlation tests. RESULTS: The mean maximum temperature and humidex were 26.1°C and 30.4°C, respectively (n=276 d). Mean 3-d temperatures ≥30°C were associated with higher daily ED volumes in both hospitals (138 vs 121, P=0.002 and 132 vs 125, P=0.03) and with increased median LOS at 1 hospital (8.9 vs 7.6 h, P=0.03). Mean 3-d humidex ≥35 was associated with higher daily ED volumes at both hospitals as well (136 vs 123, P=0.01 and 133 vs 125, P=0.009) with an increased median LOS at 1 hospital (8.6 vs 6.9 h, P=0.0001) with humidex values of 25 to 29.9°C. CONCLUSIONS: Heat events were associated with increased ED presentations and LOS. This study suggests that a warming climate can impede emergency service provision by increasing the demand for and delaying timely care.
Due to climate change, heat events in Canada have become more extreme in intensity and frequency and will continue to do so according to the Intergovernmental Panel on Climate Change’s global predictions. Environmental justice research has indicated that extreme heat exposure disproportionally affects socio-economically disadvantaged populations in cities. The objective of this research was to determine whether such a phenomenon exists in Montreal, Canada. Temperature data were obtained through in-situ sensors and governmental weather stations, while census data were retrieved from Statistics Canada through the Census mapper. Correlation tests were run between temperature and five demographic and socio-economic variables measured inside a 500 m buffer around the temperature sensors. The variables included Indigenous Peoples (IND), people of 65 years old and over (Over 65), people between 25 and 64 years old without a high school degree (No HS), and low-income (LI). A positive correlation was found for LI and No HS (p < 0.05). A regression test performed with interpolated temperature and the demographic and socio-economic variables across the study area revealed no significant correlation due to spatial heterogeneity.
Heat-related mortality is an increasingly important public health burden that is expected to worsen with climate change. In addition to long-term trends, there are also interannual variations in heat-related mortality that are of interest for efficient planning of health services. Large-scale climate patterns have an important influence on summer weather and therefore constitute important tools to understand and predict the variations in heat-related mortality. METHODS: In this article, we propose to model summer heat-related mortality using seven climate indices through a two-stage analysis using data covering the period 1981-2018 in two metropolitan areas of the province of Québec (Canada): Montréal and Québec. In the first stage, heat attributable fractions are estimated through a time series regression design and distributed lag nonlinear specification. We consider different definitions of heat. In the second stage, estimated attributable fractions are predicted using climate index curves through a functional linear regression model. RESULTS: Results indicate that the Atlantic Multidecadal Oscillation is the best predictor of heat-related mortality in both Montréal and Québec and that it can predict up to 20% of the interannual variability. CONCLUSION: We found evidence that one climate index is predictive of summer heat-related mortality. More research is needed with longer time series and in different spatial contexts. The proposed analysis and the results may nonetheless help public health authorities plan for future mortality related to summer heat.
Previous field studies monitoring small groups of participants showed that heat stress in the electrical utilities industry may be detrimental to worker health and safety. Our aim in this study was to characterize heat stress and strain in electrical utilities workers across North America. A total of 428 workers in the power generation, transmission and distribution industry across 16 US states and three Canadian Provinces completed a two-part on-line questionnaire anonymously. The first part comprised 13 general questions on the employee’s workplace location, role in the organization, years of experience, general duties, average work shift duration, and other job-related information. It also included two questions on self-reported heat stress. The second part consisted of the “Heat Strain Score Index” (HSSI), a validated questionnaire which evaluates heat stress at the workplace as “safe level” (score ≤13.5: worker experiences no/low heat strain), “caution level” (score 13.6 to 18.0: moderate risk for heat strain), and “danger level” (score >18.0: high risk for heat strain). In addition to the survey, we obtained meteorological data from weather stations in proximity (12.3 ± 12.2 km) to the work locations. Based on the HSSI, 32.9%, 22.3%, 44.4% of the responders’ workplaces were diagnosed as “safe level”, “caution level”, and “danger level”, respectively. The HSSI varied significantly depending on the occupation from 4.9 ± 3.2 in contact center workforce to 19.1 ± 5.4 in mechanics (p < 0.001), and demonstrated moderate linear relationships with summertime (June, July, August) midday air temperature (r = 0.317, p < 0.001) and outdoor midday Wet-Bulb Globe Temperature (r = 0.322, p < 0.001). The highest HSSI was observed in mechanics, machine operators in line installations, line workers, electricians, and meter-readers. We conclude that electrical utilities workers experience instances of severe environmental heat stress resulting in elevated levels of heat strain, particularly when performing physically demanding tasks (e.g., manually climbing utility poles, installing lines).
This article describes results from a survey of firefighters designed to identify conditions that contribute to heat strain in structural firefighting. Based on responses from about 3000 firefighters across the USA and Canada, the article provides invaluable information about how firefighters associate environmental conditions, work tasks and other factors with heat strain. One-half of firefighters surveyed have experienced heat stress during their service. They can wear fully deployed turnout gear for 2 h or more at the fire scene, reinforcing the importance of turnout suit breathability as a factor in heat strain. Survey results are useful in weighing the comparative value of total heat loss (THL) and evaporative heat resistance (Ref) for predicting turnout-related heat strain. Survey findings support the inclusion of a performance criterion in the National Fire Protection Association 1971 standard for firefighter personal protective equipment based on limiting Ref of turnout materials along with current THL requirement.
The spectrum of historical features and clinical presentations of heat illness and heatstroke in the pediatric population has received limited focus in the emergency medicine literature. The majority of published cases involve children trapped in closed spaces and adolescent athletes undergoing high-intensity training regimens in geographical regions with moderately high ambient temperatures and high humidity. There has been less research on the potential impact of extreme temperatures and radiant heat that are the hallmarks of the US southwest region. We performed a retrospective review of pediatric heat illness at our facility located in a North American desert climate.
Heatwave warning systems rely on forecasts made for fixed-point weather stations (WS), which do not reflect variation in temperature and humidity experienced by individuals moving through indoor and outdoor locations. We examined whether neighborhood measurement improved the prediction of individually experienced heat index in addition to nearest WS in an urban and rural location. Participants (residents of Birmingham, Alabama [N = 89] and Wilcox County, Alabama [N = 88]) wore thermometers clipped to their shoe for 7 days. Shielded thermometers/hygrometers were placed outdoors within participant’s neighborhoods (N = 43). Nearest WS and neighborhood thermometers were matched to participant’s home address. Heat index (HI) was estimated from participant thermometer temperature and WS humidity per person-hour (HI[individual]), or WS temperature and humidity, or neighborhood temperature and humidity. We found that neighborhood HI improved the prediction of individually experienced HI in addition to WS HI in the rural location, and neighborhood heat index alone served as a better predictor in the urban location, after accounting for individual-level factors. Overall, a 1 °C increase in HI[neighborhood] was associated with 0.20 °C [95% CI (0.19, 0.21)] increase in HI[individual]. After adjusting for ambient condition differences, we found higher HI[individual] in the rural location, and increased HI[individual] during non-rest time (5 a.m. to midnight) and on weekdays.
It is important to quantify human heat exposure in order to evaluate and mitigate the negative impacts of heat on human well-being in the context of global warming. This study proposed a human-centric framework to examine human personal heat exposure based on anonymous GPS trajectories data mining and urban microclimate modeling. The mean radiant temperature (T-mrt) that represents human body’s energy balance was used to indicate human heat exposure. The meteorological data and high-resolution 3D urban model generated from multispectral remotely sensed images and LiDAR data were used as inputs in urban microclimate modeling to map the spatio-temporal distribution of the T-mrt, in the Boston metropolitan area. The anonymous human GPS trajectory data collected from fitness Apps was used to map the spatio-temporal distribution of human outdoor activities. By overlaying the anonymous GPS trajectories on the generated spatio-temporal maps of T-mrt, this study further examined the heat exposure of runners in different age-gender groups in the Boston area. Results show that there is no significant difference in terms of heat exposure for female and male runners. The female runners in the age of 45-54 are exposed to more heat than female runners of 18-24 and 25-34, while there is no significant difference among male runners. This study proposed a novel method to estimate human heat exposure, which would shed new light on mitigating the negative impacts of heat on human health.
Extreme heat in the United States is a leading cause of weather-related deaths, disproportionately affecting low-income communities of color who tend to live in substandard housing with limited indoor cooling and fewer trees. Trees in cities have been documented to improve public health in many ways and provide climate regulating ecosystem services via shading, absorbing, and transpiring heat, measurably reducing heat-related illnesses and deaths. Advancing “urban forest equity” by planting trees in marginalized neighborhoods is acknowledged as a climate health equity strategy. But information is lacking about the efficacy of tree planting programs in advancing urban forest equity and public wellbeing. There is a need for frameworks to address the mismatch between policy goals, governance, resources, and community desires on how to green marginalized neighborhoods for public health improvement-especially in water-scarce environments. Prior studies have used environmental management-based approaches to evaluate planting programs, but few have focused on equity and health outcomes. We adapted a theory-based, multi-dimensional socio-ecological systems (SES) framework regularly used in the public health field to evaluate the Tree Ambassador, or Promotor Forestal, program in Los Angeles, US. The program is modeled after the community health worker model-where frontline health workers are trusted community members. It aims to address urban forest equity and wellbeing by training, supporting, and compensating residents to organize their communities. We use focus groups, surveys, and ethnographic methods to develop our SES model of community-based tree stewardship. The model elucidates how interacting dimensions-from individual to society level-drive urban forest equity and related public health outcomes. We then present an alternative framework, adding temporal and spatial factors to these dimensions. Evaluation results and our SES model highlight drivers aiding or hindering program trainees in organizing communities, including access to properties, perceptions about irrigation responsibilities, and lack of trust in local government. We also find that as trainee experience increases, measures including self- and collective efficacy and trust in their neighbors increase. Findings can inform urban forestry policy, planning, and management actions at the government and non-profit levels that aim to increase tree cover and reduce heat exposure in marginalized communities.
Extreme heat events induced by climate change present a growing risk to transit passenger comfort and health. To reduce exposure, agencies may consider changes to schedules that reduce headways on heavily trafficked bus routes serving vulnerable populations. This paper develops a schedule optimization model to minimize heat exposure and applies it to local bus services in Phoenix, Arizona, using agent-based simulation to inform travel demand and rider characteristics. Rerouting as little as 10% of a fleet is found to reduce network-wide exposure by as much as 35% when operating at maximum fleet capacity. Outcome improvements are notably characterized by diminishing returns, owing to skewed ridership and the inverse relationship between fleet size and passenger wait time. Access to spare vehicles can also ensure significant reductions in exposure, especially under the most extreme temperatures. Rerouting, therefore, presents a low-cost, adaptable resilience strategy to protect riders from extreme heat exposure.
BACKGROUND: This article describes the first Community Assessment for Public Health Emergency Response (CASPER) rapid needs assessment project to be conducted in Wisconsin. The project focused on extreme heat preparedness. METHODS: Fifteen teams conducted household surveys in 30 census blocks in the city of Milwaukee, Wisconsin. RESULTS: Survey results indicated that the majority of households were unaware of the location of a nearby cooling center. Although the vast majority of households reported some form of air conditioning in their house, over half felt too hot inside their home sometimes, most of the time, or always. DISCUSSION: The community partnerships ensured that this project was conducted with local partner input and that the data could be used to inform extreme heat response.
Problem, research strategy, and findings Extreme heat is the deadliest climate hazard in the United States. Climate change and the urban heat island effect are increasing the number of dangerously hot days in cities worldwide and the need for communities to plan for extreme heat. Existing literature on heat planning focuses on heat island mapping and modeling, whereas few studies delve into heat planning and governance processes. We surveyed planning professionals from diverse cities across the United States to establish critical baseline information for a growing area of planning practice and scholarship that future research can build on. Survey results show that planners are concerned with extreme heat risks, particularly environmental and public health impacts from climate change. Planners already report impacts from extreme heat, particularly to energy and water use, vegetation and wildlife, public health, and quality of life. Especially in affected communities, planners claim they address heat in plans and implement heat mitigation and management strategies such as urban forestry, emergency response, and weatherization, but perceive many barriers related to human and financial resources and political will. Takeaway for practice Planners are concerned about extreme heat, especially in the face of climate change. They are beginning to address heat through different strategies and plan types, but we see opportunities to better connect planners to existing heat information sources and leverage existing planning tools, including vegetation, land use regulations, and building codes, to mitigate risks. Although barriers to heat planning persist, including human and capital resources, planners are uniquely qualified to coordinate communities’ efforts to address the rising threat of extreme heat.
Long-term community resilience, which privileges a long view look at chronic issues influencing communities, has begun to draw more attention from city planners, researchers and policymakers. In Phoenix, resilience to heat is both a necessity and a way of life. In this paper, we attempt to understand how residents living in Phoenix experience and behave in an extreme heat environment. To achieve this goal, we introduced a smartphone application (ActivityLog) to study spatio-temporal dynamics of human interaction with urban environments. Compared with traditional paper activity log results we have in this study, the smartphone-based activity log has higher data quality in terms of total number of logs, response rates, accuracy, and connection with GPS and temperature sensors. The research results show that low-income residents in Phoenix mostly stay home during the summer but experience a relatively high indoor temperature due to the lack/low efficiency of air-conditioning (AC) equipment or lack of funds to run AC frequently. Middle-class residents have a better living experience in Phoenix with better mobility with automobiles and good quality of AC. The research results help us better understand user behaviors for daily log activities and how human activities interact with the urban thermal environment, informing further planning policy development. The ActivityLog smartphone application is also presented as an open-source prototype to design a similar urban climate citizen science program in the future.
Extreme heat does not affect all urban residents equally. While vulnerability is often defined as a combination of exposure, sensitivity, and adaptive capacity, many scholars have argued that the quantitative representation of adaptive capacity is particularly difficult. How people who live in vulnerable situations change their behavior to cope with and manage extreme urban temperatures, and the resources necessary to prevent adverse health effects, highlight different adaptive capacity within a city. Our understanding and depiction of how and why the impacts of urban heat vary between individuals and groups is constrained by contemporary approaches to quantify vulnerability using aggregate-scale data drawn from censuses, surveys, and administrative records. Thus, adaptive capacity is likely poorly represented in modern heat vulnerability analyses and their applications. This article explores how different city residents understand and adapt to increasing extreme urban heat, the tradeoffs different populations must make between generic and specific adaptive capacity, and the coping strategies that influence heat adaptive capacity at various scales. Using metropolitan Phoenix as a test site, open-ended interviews were conducted in which residents told their stories about past and present extreme heat adaptive capacity and adaptive behaviors. Three narratives emerged: heat is an inconvenience, heat is a manageable problem, and heat is a catastrophe. Framing heat vulnerability using these differing narratives can help evaluate if standard recommendations for coping with heat adequately represent solutions for the lived experiences of different vulnerable groups. Learning how and under what circumstances vulnerable people are motivated to make necessary changes to increase thermal comfort and safeguard public health will ensure that targeted heat mitigation and adaptation policies are widely adopted. Heat adaptation and mitigation policy makers need to be cognizant of the gap in heat risk perception across different segments of the population and reflect on whether those decisions reflect their experience (of likely belonging to the inconvenience group) or incorporate differing scales of heat adaptive capacity.
Current bioclimate and air quality indices provide insufficient information about the combined effect on human physiology in outdoor spaces. This work examined, large scale gridded meteorological observations, including air temperature, wind speed, solar radiation, and relative humidity, to derive Universal Thermal Climate Index (UTCI) at hourly intervals along with the air quality index (AQI) derived from Environmental Protection Agency (EPA) observation stations. UTCI and AQI were combined into a single framework using geospatial analytics and a newly developed lookup table approach. High risk areas for heat stress and poor air quality were identified using Moran’s I and Getis-Ord GI* statistics. Moderate to strong heat stress was observed during the summer months of 2015-2019, with UTCI ranging from 26 degrees C to 38 degrees C. Coastal regions consistently experienced higher UTCI during noon due to higher humidity but the effect subsided with cooler air circulation from the ocean, especially in the morning and evening. Results also indicated the vulnerability of this region due to the combined impact of heat stress and poor air quality based on 95th percentile values. The final products from this analysis can provide valuable insights for urban planning and preventative measures to ensure improved public health in outdoor environments.
Exposure to heat is a growing public health concern as climate change accelerates worldwide. Different socioeconomic and racial groups often face unequal exposure to heat as well as increased heat-related sickness, mortality, and energy costs. We provide new insight into thermal inequities by analyzing 20 Southwestern U.S. metropolitan regions at the census block group scale for three temperature scenarios (average summer heat, extreme summer heat, and average summer nighttime heat). We first compared average temperatures for top and bottom decile block groups according to demographic variables. Then we used spatial regression models to investigate the extent to which exposure to heat (measured by land surface temperature) varies according to income and race. Large thermal inequities exist within all the regions studied. On average, the poorest 10% of neighborhoods in an urban region were 2.2 °C (4 °F) hotter than the wealthiest 10% on both extreme heat days and average summer days. The difference was as high as 3.3-3.7 °C (6-7 °F) in California metro areas such as Palm Springs and the Inland Empire. A similar pattern held for Latinx neighborhoods. Temperature disparities at night were much smaller (usually ~1 °F). Disparities for Black neighborhoods were also lower, perhaps because Black populations are small in most of these cities. California urban regions show stronger thermal disparities than those in other Southwestern states, perhaps because inexpensive water has led to more extensive vegetation in affluent neighborhoods. Our findings provide new details about urban thermal inequities and reinforce the need for programs to reduce the disproportionate heat experienced by disadvantaged communities.
Extreme heat exposure and sensitivity have been a growing concern in urban regions as the effects of extreme heat pose a threat to public health, the water supply, and the infrastructure. Heat-related illnesses demand an immediate Emergency Medical Service (EMS) response since they might result in death or serious disability if not treated quickly. Despite increased concerns about urban heat waves and relevant health issues, a limited amount of research has investigated the effects of heat vulnerability on heat-related illnesses. This study explores the geographical distribution of heat vulnerability in the city of Austin and Travis County areas of Texas and identifies neighborhoods with a high degree of heat vulnerability and restricted EMS accessibility. We conducted negative binomial regressions to investigate the effects of heat vulnerability on heat-related EMS incidents. Heat-related EMS calls have increased in neighborhoods with more impervious surfaces, Hispanics, those receiving social benefits, people living alone, and the elderly. Higher urban capacity, including efficient road networks, water areas, and green spaces, is likely to reduce heat-related EMS incidents. This study provides data-driven evidence to help planners prioritize vulnerable locations and concentrate local efforts on addressing heat-related health concerns.
The U-shaped association between health outcomes and ambient temperatures has been extensively investigated. However, such analyses cannot fully estimate the mortality burden of climate change because the features of the association (e.g., minimum mortality temperature) vary with human adaptation; thus, they are not generalizable to different locations. In this study, we assumed that humans could adapt to regular temperature variations; and thus examined the all-cause mortality attributable to temperature anomaly (TA), an indicator widely utilized in climate science to measure irregular temperature fluctuations, across 115 cities in the United States (US). We first used quasi-Poisson regressions to obtain the city-specific TA-mortality associations, then used meta-regression to pool these city-specific estimates. Finally, we calculated the number of TA-related deaths using the uniform pooled association, then compared it to the estimates from city-specific associations, which had been controlled for adaptation. Meta-regression showed a U-shaped TA-mortality association, centered at a TA near 0. According to the pooled association, 0.579 % (95 % confidence interval [CI]: 0.465-0.681 %), 0.394 % (95 % CI: 0.332-0.451 %), and 0.185 % (95 % CI: 0.107-0.254 %) of all-cause deaths were attributable to all anomalous temperatures (TA ≠ 0), anomalous heat (TA > 0), and anomalous cold (TA < 0), respectively. At the city level, heat-related deaths estimated from the pooled association were in good agreement with heat-related deaths estimated from the city-specific associations (R(2) = 0.84). However, the cold-related deaths estimated from the two methods showed a weaker correlation (R(2) = 0.07). Our findings suggest that TA constitutes a generalizable indicator that can uniformly evaluate deaths attributable to anomalous heat in distinct geographical locations.
We use temperature variation within narrowly defined geographic and demographic cells to show that exposure to extreme temperature increases the risk of maternal hospitalization during pregnancy. This effect is driven by emergency hospitalizations for various pregnancy complications, suggesting that it represents a deterioration in underlying maternal health rather than a change in women’s ability to access health care. The effect is larger for black women than for women of other races, suggesting that without significant adaptation, projected increases in extreme temperatures over the next century may further exacerbate racial disparities in maternal health.
BACKGROUND: British Columbia, Canada, was impacted by a record-setting heat dome in early summer 2021. Most households in greater Vancouver do not have air conditioning, and there was a 440% increase in community deaths during the event. Readily available data were analyzed to inform modifications to the public health response during subsequent events in summer 2021 and to guide further research. METHODS: The 434 community deaths from 27 June through 02 July 2021 (heat dome deaths) were compared with all 1,367 community deaths that occurred in the same region from 19 June through 09 July of 2013-2020 (typical weather deaths). Conditional logistic regression was used to examine the effects of age, sex, neighborhood deprivation, and the surrounding environment. Data available from homes with and without air conditioning were also used to illustrate the indoor temperatures differences. RESULTS: A combined index of material and social deprivation was most predictive of heat dome risk, with an adjusted odds ratio of 2.88 [1.85, 4.49] for the most deprived category. Heat dome deaths also had lower greenness within 100 m than typical weather deaths. Indoor temperatures in one illustrative home without air conditioning ranged between 30°C and 40°C. CONCLUSIONS: Risk of death during the heat dome was associated with deprivation, lower neighborhood greenness, older age, and sex. High indoor temperatures likely played an important role. Public health response should focus on highly deprived neighborhoods with low air conditioning prevalence during extreme heat events. Promotion of urban greenspace must continue as the climate changes.
Extreme heat events are becoming more frequent and more severe in the Pacific Northwest and in comparable dry-summer climates worldwide, increasing the occurrence of heat-related illness and death. Much of this risk is attributed to overheating in multifamily dwellings, particularly in neighborhoods with abundant asphalt, few trees, and limited financial resources. Air-conditioning expansion is problematic, however, because it creates vulnerability to operational costs and power outages, while expelled hot air intensifies urban heat island effects. In contrast, passive cooling strategies that deflect solar radiation and recruit the cool night air typical of Mediterranean, semi-arid, and arid climates are quite promising, but their abilities to improve residential survivability during extreme heat have not yet been explored. To understand this potential, here we investigate the extent to which well-controlled shading and natural ventilation, in some cases with fan assistance, could have diminished the hours in which indoor heat index levels exceeded ‘caution’, ‘extreme caution’, ‘danger’, and ‘extreme danger’ thresholds during the June 2021 heat wave in the Pacific Northwest; building thermal performance was simulated in EnergyPlus under conditions experienced by Vancouver BC, Seattle WA, Spokane WA, Portland OR, and Eugene OR. Strikingly, we find that in Portland, where the highest temperatures occurred, integrated shading and natural ventilation eliminated all hours above the danger threshold during the 3-day event, lowering peak indoor air temperatures by approximately 14 degrees C (25 degrees F); without cooling, all 72h exceeded this threshold. During the encompassing 10-day period, these passive measures provided 130-150h of thermal relief; baseline conditions without cooling provided none. Additionally, passive cooling reduced active cooling loads by up to 80%. Together, these results show the immediate, substantial value of requiring effective operable shading and secure operable windows in apartments in mild dry-summer climates with rising heatwave intensity, as well as public health messaging to support the productive operation of these elements.
Rising global temperatures and the urban heat island effect can amplify heat-related health risks to urban res-idents. Cities are considering various heat adaptation actions to improve public health, enhance social equity, and cope with future conditions beyond past experience. We present the City-Heat Equity Adaptation Tool (City -HEAT), which suggests optimal investments for mitigating urban heat and reducing health impacts through modifications of built (cool roofs/pavements) and natural (urban afforestation) environments and reductions of people’s heat exposure (cooling centers). The optimization considers multiple public health and social objectives under a wide range of future scenarios. An application to Baltimore, MD (USA) demonstrates how City-HEAT can generate Pareto-efficient multi-year heat adaptation plans. We quantify effectiveness-efficiency-equity tradeoffs among alternative plans and show the advantages of flexible decision-making. City-HEAT can be adapted to the natural, built, and social environments of other cities to support their urban heat adaptation planning, recog-nizing local objectives and uncertainty.
Although research indicates health and well-being benefits of greenspace, little is known regarding how greenspace may influence adaptation to health risks from heat, particularly how these risks change over time. Using daily hospitalization rates of Medicare beneficiaries ≥65 years for 2000-2016 in 40 U.S. Northeastern urban counties, we assessed how temperature-related hospitalizations from cardiovascular causes (CVD) and heat stroke (HS) changed over time. We analyzed effect modification of those temporal changes by Enhanced Vegetation Index (EVI), approximating greenspace. We used a two-stage analysis including a generalized additive model and meta-analysis. Results showed that relative risk (RR) (per 1 °C increase in lag0-3 temperature) for temperature-HS hospitalization was higher in counties with the lowest quartile EVI (RR = 2.7, 95% CI: 2.0, 3.4) compared to counties with the highest quartile EVI (RR = 0.40, 95% CI: 0.14, 1.13) in the early part of the study period (2000-2004). RR of HS decreased to 0.88 (95% CI: 0.31, 2.53) in 2013-2016 in counties with the lowest quartile EVI. RR for HS changed over time in counties in the highest quartile EVI, with RRs of 0.4 (95% CI: -0.7, 1.4) in 2000-2004 and 2.4 (95% CI: 1.6, 3.2) in 2013-2016. Findings suggest that adaptation to heat-health associations vary by greenness. Greenspace may help lower risks from heat but such health risks warrant continuous local efforts such as heat-health plans.
Cooling centers have played a significant role in reducing the risks of adverse health impacts of extreme heat exposure. However, there have been no comparative studies investigating cooling center preparedness in terms of population coverage, location efficiency, and population coverage disparities among different subpopulation groups. Using a catchment area method with a 0.8 km walking distance, we compared three aspects of cooling center preparedness across twenty-five cities in the U.S. We first calculated the percentage of the population covered by a single cooling center for each city. Then, the extracted values were separately compared to the city’s heat indexes, latitudes, and spatial patterns of cooling centers. Finally, we investigated population coverage disparities among multiple demographics (age, race/ethnicity) and socioeconomic (insurance, poverty) subpopulation groups by comparing the percentage of population coverage between selected subpopulation groups and reference subpopulation groups. Our results showed that cooler cities, higher latitude cities, and cities with dispersed cooling centers tend to be more prepared than warmer cities, lower latitude cities, and cities with clustered cooling centers across the U.S. Moreover, older people (≥65) had 9% lower population coverage than younger people (≤64). Our results suggest that the placement of future cooling centers should consider both the location of other nearby cooling centers and the spatial distribution of subpopulations to maximize population coverage and reduce access disparities among several subpopulations.
A wet-bulb temperature of 35°C has been theorized to be the limit to human adaptability to extreme heat, a growing concern in the face of continued and predicted accelerated climate change. Although this theorized threshold is based in physiological principles, it has not been tested using empirical data. This study examined the critical wet-bulb temperature (T(wb,crit)) at which heat stress becomes uncompensable in young, healthy adults performing tasks at modest metabolic rates mimicking basic activities of daily life. Across six experimentally determined environmental limits, no subject’s T(wb,crit) reached the 35°C limit and all means were significantly lower than the theoretical 35°C threshold. Mean T(wb,crit) values were relatively constant across 36°C -40°C humid environments and averaged 30.55 ± 0.98°C but progressively decreased (higher deviation from 35°C) in hotter, dry ambient environments. T(wb,crit) was significantly associated with mean skin temperature (and a faster warming rate of the skin) due to larger increases in dry heat gain in the hot-dry environments. As sweat rates did not significantly differ among experimental environments, evaporative cooling was outpaced by dry heat gain in hot-dry conditions, causing larger deviations from the theoretical 35°C adaptability threshold. In summary, a wet-bulb temperature threshold cannot be applied to human adaptability across all climatic conditions and where appropriate (high humidity), that threshold is well below 35°C.NEW & NOTEWORTHY This study is the first to use empirical physiological observations to examine the well-publicized theoretical 35°C wet-bulb temperature limit for human to extreme environments. We find that uncompensable heat stress in humid environments occurs in young, healthy adults at wet-bulb temperatures significantly lower than 35°C. In addition, uncompensable heat stress occurs at widely different wet-bulb temperatures as a function of ambient vapor pressure.
In this study, we examine how climatic heat stress can be mediated by green infrastructure outcomes and how energy justice effort contributes to health adaptation within the U.S. Great Lakes regions and their primary metropolitan areas over a recent 10-year period (2005–2015). Through the lens of policy innovation and the vulnerability-readiness nexus, we explore how climate policy intervention contributes to the mitigation of heat stress by using a quantitative approach. Empirical results suggest that green infrastructure outcomes and energy justice efforts have the potential to mitigate heat stress and enhance health adaptation. Additional results reflect that climate policy innovation and readiness efforts were viable factors in health adaptation to heat events.
OBJECTIVES: To derive an empirical model for the impact of aerobic fitness (maximal oxygen consumption; V̇O(2max) in mL∙kg(-1)∙min(-1)) on physical work capacity (PWC) in the heat. DESIGN: Prospective, repeated measures. METHODS: Total work completed during 1 h of treadmill walking at a fixed heart rate of 130 b∙min(-1) was assessed in 19 young adult males across a variety of warm and hot climate types, characterised by wet-bulb globe temperatures (WBGT) ranging from 12 to 40 °C. For data presentation and obtaining initial parameter estimates for modelling, participants were grouped into low (n = 6, 74 trials), moderate (n = 8, 76 trials), and high (n = 5, 29 trials) fitness, with group mean V̇O(2max) 42, 52, and 64 mL∙kg(-1)∙min(-1)(,) respectively. For the heated conditions (WBGT 18 to 40 °C), we calculated PWC% by expressing total energy expenditure (kJ above resting) in each trial relative to that achieved in a cool reference condition (WBGT = 12 °C = 100% PWC). RESULTS: The relative reduction in energy expenditure (PWC%) caused by heat was significantly smaller by up to 16% for the fit participants compared to those with lower aerobic capacity. V̇O(2max) also modulated the relationship between sweat rate and body temperature changes to increasing WBGT. Including individual V̇O(2max) data in the PWC prediction model increased the predicting power by 4%. CONCLUSIONS: Incorporating individual V̇O(2max) improved the predictive power of the heat stress index WBGT for Physical Work Capacity in the heat. The largest impact of V̇O(2max) on PWC was observed at a WBGT between 25 and 35 °C.
BACKGROUND: Latinx children in the United States are at high risk for nature-deficit disorder, heat-related illness, and physical inactivity. We developed the Green Schoolyards Project to investigate how green features-trees, gardens, and nature trails-in school parks impact heat index (i.e., air temperature and relative humidity) within parks, and physical activity levels and socioemotional well-being of these children. Herein, we present novel methods for a) observing children’s interaction with green features and b) measuring heat index and children’s behaviors in a natural setting, and a selection of baseline results. METHODS: During two September weeks (high temperature) and one November week (moderate temperature) in 2019, we examined three joint-use elementary school parks in Central Texas, United States, serving predominantly low-income Latinx families. To develop thermal profiles for each park, we installed 10 air temperature/relative humidity sensors per park, selecting sites based on land cover, land use, and even spatial coverage. We measured green features within a geographic information system. In a cross-sectional study, we used an adapted version of System for Observing Play and Recreation in Communities (SOPARC) to assess children’s physical activity levels and interactions with green features. In a cohort study, we equipped 30 3rd and 30 4th grade students per school during recess with accelerometers and Global Positioning System devices, and surveyed these students regarding their connection to nature. Baseline analyses included inverse distance weighting for thermal profiles and summing observed counts of children interacting with trees. RESULTS: In September 2019, average daily heat index ranged 2.0 °F among park sites, and maximum daily heat index ranged from 103.4 °F (air temperature = 33.8 °C; relative humidity = 55.2%) under tree canopy to 114.1 °F (air temperature = 37.9 °C; relative humidity = 45.2%) on an unshaded playground. 10.8% more girls and 25.4% more boys interacted with trees in September than in November. CONCLUSIONS: We found extreme heat conditions at select sites within parks, and children positioning themselves under trees during periods of high heat index. These methods can be used by public health researchers and practitioners to inform the redesign of greenspaces in the face of climate change and health inequities.
Concurrent with a rapid rise in temperatures within US cities, the frequency of regional electric grid system failures is also rising in recent decades, resulting in a growing number of blackouts during periods of extreme heat. As mechanical air conditioning is a primary adaptive technology for managing rising temperatures in cities, we examine in this paper the impact of a prolonged blackout on heat exposure in residential structures during heat wave conditions, when air conditioning is most critical to human health. Our approach combines a regional climate modeling system with a building energy model to simulate how a concurrent heat wave and grid failure event impacts residential building-interior temperatures across Phoenix. Our results find a substantial increase in heat exposure across residential buildings in response to the loss of electrical power and mechanical cooling systems, with such an event potentially exposing more than one million residents to hazardous levels of heat. We further find the installation of cool roofing to measurably lower the risk of extreme heat exposure for residents of single-story structures.
The urban heat island (UHI) effect is caused by intensive development practices in cities and the diminished presence of green space that results. The evolution of these phenomena has occurred over many decades. In many cities, historic zoning and redlining practices barred Black and minority groups from moving into predominately white areas and obtaining financial resources, a practice that still affects cities today, and has forced these already disadvantaged groups to live in some of the hottest areas. In this study, we used a new dataset on the spatial distribution of temperature during a heat wave in Richmond, Virginia to investigate potential associations between extreme heat and current and historical demographic, socioeconomic, and land use factors. We assessed these data at the census block level to determine if blocks with large differences in temperature also had significant variation in these covariates. The amount of canopy cover, percent impervious surface, and poverty level were all shown to be strong correlates of UHI when analyzed in conjunction with afternoon temperatures. We also found strong associations of historical policies and planning decisions with temperature using data from the University of Richmond’s Digital Scholarship Lab’s “Mapping Inequality” project. Finally, the Church Hill area of the city provided an interesting case study due to recent data suggesting the area’s gentrification. Differences in demographics, socioeconomic factors, and UHI were observed between north and (more gentrified) south Church Hill. Both in Church Hill and in Richmond overall, our research found that areas occupied by people of low socioeconomic status or minority groups disproportionately experienced extreme heat and corresponding impacts on health and quality of life.
Climate change-related natural disasters, including wildfires and extreme weather events, such as intense storms, floods, and heatwaves, are increasing in frequency and intensity. These events are already profoundly affecting human health in the United States and globally, challenging the ability of communities to prepare, respond, and recover. The purpose of this research was to examine the peer-reviewed literature on community resilience initiatives in one of the most densely populated and economically important regions, the Northeastern United States, and to identify evidence-based interventions and metrics that had been field-tested and evaluated. This paper addresses two critical gaps in the literature: (1) what strategies or interventions have been implemented to build or enhance community resilience against climate change-related natural disasters; and (2) what metrics were used to measure community resilience as an outcome of those strategies or interventions? This review provides a succinct list of effective interventions with specific health outcomes. Community or state-level health officials can use the results to prioritize public health interventions. This review used existing database search tools to discover 205 studies related to community resilience and health outcomes. Methods set criteria to assess if interventions were able to measure and change levels of community resilience to the health impacts associated with a changing climate. Criteria included: (a) alignment with the United States’ National Preparedness Goal for reducing risks to human health and for recovering quickly from disasters; (b) derived from publicly available data sources; (c) developed for use by communities at a local scale; and (d) accessible to modestly resourced municipalities and county health agencies. Five (5) peer-reviewed, evidence-based studies met all of the selection criteria. Three of these articles described intervention frameworks and two reported on the use of standardized tools. Health-related outcomes included mental health impacts (PTSD/depression), mental stress, emergency preparedness knowledge, social capital skills, and emergency planning skills. The paper recommends the COAST project, COPEWELL Rubric for self-assessment, and Ready CDC intervention as examples of strategies that could be adapted by any community engaged in building community resilience.
IMPORTANCE: The implications of extreme heat for physical health outcomes have been well documented. However, the association between elevated ambient temperature and specific mental health conditions remains poorly understood. OBJECTIVE: To investigate the association between ambient heat and mental health-related emergency department (ED) visits in the contiguous US among adults overall and among potentially sensitive subgroups. DESIGN, SETTING, AND PARTICIPANTS: This case-crossover study used medical claims data obtained from OptumLabs Data Warehouse (OLDW) to identify claims for ED visits with a primary or secondary discharge psychiatric diagnosis during warm-season months (May to September) from 2010 through 2019. Claims for adults aged 18 years or older with commercial or Medicare Advantage health insurance who were living in 2775 US counties were included in the analysis. Emergency department visits were excluded if the Clinical Classifications Software code indicated that the visits were for screening for mental health outcomes and impulse control disorders. EXPOSURES: County-specific daily maximum ambient temperature on a continuous scale was estimated using the Parameter-Elevation Relationships on Independent Slopes model. Extreme heat was defined as the 95th percentile of the county-specific warm-season temperature distribution. MAIN OUTCOMES AND MEASURES: The daily incidence rate of cause-specific mental health diagnoses and a composite end point of any mental health diagnosis were assessed by identifying ED visit claims using primary and secondary discharge diagnosis International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Conditional logistic regression models were used to estimate the incidence rate ratio (IRR) and 95% CIs for the association between daily temperature and incidence rates of ED visits. RESULTS: Data from 3 496 762 ED visits among 2 243 395 unique individuals were identified (56.8% [1 274 456] women; mean [SD] age, 51.0 [18.8] years); of these individuals, 14.3% were aged 18 to 26 years, 25.6% were aged 27 to 44 years, 33.3% were aged 45 to 64 years, and 26.8% were aged 65 years or older. Days of extreme heat were associated with an IRR of 1.08 (95% CI, 1.07-1.09) for ED visits for any mental health condition. Associations between extreme heat and ED visits were found for specific mental health conditions, including substance use disorders (IRR, 1.08; 95% CI, 1.07-1.10); anxiety, stress-related, and somatoform disorders (IRR, 1.07; 95% CI, 1.05-1.09); mood disorders (IRR, 1.07; 95% CI, 1.05-1.09); schizophrenia, schizotypal, and delusional disorders (IRR, 1.05; 95% CI, 1.03-1.07); self-harm (IRR, 1.06; 95% CI, 1.01-1.12); and childhood-onset behavioral disorders (IRR, 1.11; 95% CI, 1.05-1.18). In addition, associations were higher among men (IRR, 1.10; 95% CI, 1.08-1.12) and in the US Northeast (IRR, 1.10; 95% CI, 1.07-1.13), Midwest (IRR, 1.11; 95% CI, 1.09-1.13), and Northwest (IRR, 1.12; 95% CI, 1.03-1.21) regions. CONCLUSIONS AND RELEVANCE: In this case-crossover study of a large population of US adults with health insurance, days of extreme heat were associated with higher rates of mental health-related ED visits. This finding may be informative for clinicians providing mental health services during periods of extreme heat to prepare for increases in health service needs when times of extreme heat are anticipated.
This study aims to estimate the impacts of climate variation on suicide rates in the USA by using county-level data on temperature, and mental health-related suicides between 2011 and 2020. In addition to climate factors, several socio-economic factors such as uninsured population rate, access to mental health providers, and unemployment rate are included to estimate their impacts on suicides. The estimation is separately performed for female, male and overall groups. The results indicate that while there is limited evidence of the impact of precipitation on suicidal behaviours, the average daily minimum air temperature is an important determinant of the suicides in the US counties.
INTERVENTION: Ontario’s Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat. RESEARCH QUESTION: Was implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada? METHODS: We conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region. RESULTS: Over the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278). CONCLUSION: In urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate.
Heat-related mortality (HRM) is increasing because of the climate change and urbanization leading to extreme heat events. This paper summarizes the results of the excess mortality attributed to excessive heat events in two largest cities in Canada, Toronto and Montreal, during three heat wave periods. We present an application of a fine-resolution, urban-mesoscale model to assess the impacts of heat and heat mitigation strategy on heat death. The Weather Research and Forecasting model (WRF) is coupled with a multi-layer of the Urban Canopy Model (ML-UCM) to assess the impacts of heat and heat mitigation strategy on heat-related death. The background albedo of 0.2 for urban surfaces are respectively increased to 0.65, 0.60, and 0.45 for roofs, walls, and grounds. The changes of the air mass category, ambient and apparent temperatures interpret the impacts of extreme heat and the potential of increasing surface albedo (ISA) on HRM. Here, the calculations and estimations of HRM is based on the data obtained from Canadian Environmental Health Atlas (CEHA) indicating an average of 120 heat-induced deaths in Toronto and Montreal. ISA affords a reduction in air temperature (1-2 degrees C), a decrease in dew point temperature (0.2-0.5 degrees C), and a slight increase in near-surface wind speed (-0.01 to-0.4 m/s). Increase in albedo shifts days into more benign conditions by nearly 60%. The HRM will lessen by 3-7%, pointing that seven to eighteen lives could be saved. Cooling the urban climate will improve discomfort index, lessen the impacts of elevated temperature, enhance human thermal comfort, and decrease HRM to some significant extent. (c) 2020 Elsevier B.V. All rights reserved.
BACKGROUND: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. OBJECTIVE: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26°C. METHODS: We used secondary data-indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non-air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. RESULTS: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non-heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non-air conditioned houses. CONCLUSIONS: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses.
SETTING: In 2018, a regional health authority in British Columbia (BC) initiated a multi-year project to support planning and response to extreme heat. Climate projections indicate that temperatures in the southern interior of BC will continue to increase, with concomitant negative impacts on human health. Successful climate change adaptation must include cross-sectoral action, inclusive of the health sector, to plan for and respond to climate-related events, including extreme heat. INTERVENTION: The objective of this project was to support the development and implementation of a Heat Alert and Response System (HARS) in a small, rural community. The health authority facilitated collaboration among provincial and local governments, community organizations, and First Nations partners to assess community assets, draft a plan for extreme heat, and prepare for a community-supported response during heat events. OUTCOMES: Stakeholders expressed the importance of utilizing existing partnerships and community resources, such as physical and procedural infrastructure, in which to embed the HARS. It was imperative that the plan be simple, concise, and considerate of the community’s unique context. Educational materials and a tailored method of dissemination were important for collective and individual risk mitigation. IMPLICATIONS: A community-driven approach that utilized existing assets allowed for integration of HARS within municipal response plans and established infrastructure. The result is a sustainable public health intervention that has the potential to mitigate the negative health effects of extreme heat. Knowledge acquired through this initiative is informing similar HARS planning processes in other rural BC communities.
As global warming impacts the climate, severe cases of droughts, abnormalities in precipitations, unusual patterns of hurricanes, and excessive heat are becoming more frequent. Excessive heat and droughts in US have made dehydration a problem on construction job sites. Despite the studies about the efficient use of water in buildings post occupancy, little has been explored about water consumption during the construction phase. Given this lack of focus, this study investigates drinking water consumption by construction personnel during construction of a new academic building located in Fort Myers, Florida. Daily potable water consumption data on a jobsite have been recorded during construction through daily interviews with site personnel. Regression analysis is used to examine the existence of correlations between daily humidity, temperature and precipitation data, and daily drinking water consumption by each construction worker. An artificial neural network model is also deployed to examine the existence of such a link.
The impacts of climate change on agricultural production are a global concern and have already begun to occur (Kawasaki 2018 Am. J. Agric. Econ. 101 172-92; Ortiz-Bobea et al 2021 Nat. Clim. Change 11 306-12), with major drivers including warmer temperatures and the occurrence of extreme weather events (Lobell and Field 2007 Environ. Res. Lett. 2 014002; Challinor et al 2014 Nat. Clim. Change 4 287; Rosenzweig et al 2001 Glob. Change Hum. Health 2 90-104; Schlenker and Roberts 2009 Proc. Natl Acad. Sci. USA 106 15594-8; Lobell et al 2014 Science 344 516-9; Ortiz-Bobea et al 2019 Environ. Res. Lett. 14 064003). An important dimension of the climate change-crop yield relationship that has often been overlooked in the empirical literature is the influence that warming temperatures can have on plant damage arriving through biotic channels, such as pest infestation or fungal infection (Rosenzweig et al 2001 Glob. Change Hum. Health 2 90-104). Aflatoxins are carcinogenic chemicals produced by the fungi Aspergillus flavus and A. parasiticus, which commonly infect food crops. Currently, in the United States, aflatoxin is a perennial contaminant in corn grown in the South, but rare in the Corn Belt and northern states. Climate change may expand aflatoxin’s geographical prevalence, however; because hot, dry summers promote aflatoxin accumulation. Here we model aflatoxin risk as a function of corn plant growth stages and weather to predict US regions with high aflatoxin risk in 2031-2040, based on 16 climate change models. Our results suggest that over 89.5% of corn-growing counties in 15 states, including the Corn Belt, will experience increased aflatoxin contamination in 2031-2040 compared to 2011-2020. Interestingly, the results are spatially heterogeneous and include several southern counties expected to have lower aflatoxin risk, because the causative fungi become inactivated at very high temperatures.
Health researchers have examined the physiological impacts of extreme air temperature on the human body. Yet, the mental health impacts of temperature have been understudied. Research has shown that the environment can create circumstances that exacerbate mental health issues. This may be particularly challenging for some of the fastest growing cities, located in hot, dry climates. Given the theoretical relationship between air temperature and mental health, we seek to measure the association between temperature and schizophrenia hospital admissions in an arid urban climate and quantify the associated public health burden. We collected 86,672 hospitalization records for schizophrenia from 2006 to 2014 in Maricopa County, Arizona, USA. Using a distributed lag non-linear model (DLNM), we tested for a statistical association between temperature and schizophrenia hospital admissions after controlling for year, season, weekends, and holidays. We calculated the cumulative attributable risk of nighttime temperature on schizophrenia for the entire dataset as well as among demographic subgroups. The relative risk of schizophrenia hospital admissions increased with both high and low temperatures. Statistical models using daily minimum temperature were more strongly associated with hospitalization than those using mean or maximum. Schizophrenia hospital admissions increased on days with minimum temperatures above 30 °C and below 3 °C, with some subgroups experiencing higher rates of hospitalization. The total fraction of schizophrenia hospital admissions attributable to non-optimal minimum temperature is 3.45 % (CI: -4.91-10.80 %) and high minimum temperature is 0.28 % (CI: -1.18-1.78 %). We found that non-whites and males appear to be at a slightly increased risk than the general population, although there did not appear to be a statistically significant difference. A conservative estimate of healthcare costs annually from non-optimal temperature attributed schizophrenia hospitalization is $1.95 million USD. Therefore, nighttime cooling strategies and efforts could increase the accessibility of shelters to reduce overnight exposure to extreme air temperature.
We examine the impact of temperature on mortality in Mexico using daily data over the period 1998-2017 and find that 3.8 percent of deaths in Mexico are caused by suboptimal temperature (26,000 every year). However, 92 percent of weather-related deaths are induced by cold (<12 degrees C) or mildly cold (12-20 degrees C) days and only 2 percent by outstandingly hot days (>32 degrees C). Furthermore, temperatures are twice as likely to kill people in the bottom half of the income distribution. Finally, we show causal evidence that the Seguro Popular, a universal health care policy, has saved at least 1,600 lives per year from cold weather since 2004.
BACKGROUND: Health disparities exist between urban and rural populations, yet research on rural-urban disparities in temperature-mortality relationships is limited. As inequality in the United States increases, understanding urban-rural and regional differences in the temperature-mortality association is crucial. OBJECTIVE: We examined regional and urban-rural differences of the temperature-mortality association in North Carolina (NC), USA, and investigated potential effect modifiers. METHODS: We applied time-series models allowing nonlinear temperature-mortality associations for 17 years (2000-2016) to generate heat and cold county-specific estimates. We used second-stage analysis to quantify the overall effects. We also explored potential effect modifiers (e.g. social associations, greenness) using stratified analysis. The analysis considered relative effects (comparing risks at 99th to 90th temperature percentiles based on county-specific temperature distributions for heat, and 1st to 10th percentiles for cold) and absolute effects (comparing risks at specific temperatures). RESULTS: We found null effects for heat-related mortality (relative effect: 1.001 (95% CI: 0.995-1.007)). Overall cold-mortality risk for relative effects was 1.019 (1.015-1.023). All three regions had statistically significant cold-related mortality risks for relative and absolute effects (relative effect: 1.019 (1.010-1.027) for Coastal Plains, 1.021 (1.015-1.027) for Piedmont, 1.014 (1.006-1.023) for Mountains). The heat mortality risk was not statistically significant, whereas the cold mortality risk was statistically significant, showing higher cold-mortality risks in urban areas than rural areas (relative effect for heat: 1.006 (0.997-1.016) for urban, 1.002 (0.988-1.017) for rural areas; relative effect for cold: 1.023 (1.017-1.030) for urban, 1.012 (1.001-1.023) for rural areas). Findings are suggestive of higher relative cold risks in counties with the less social association, higher population density, less green-space, higher PM(2.5,) lower education level, higher residential segregation, higher income inequality, and higher income (e.g., Ratio of Relative Risks 1.72 (0.68, 4.35) comparing low to high education). CONCLUSION: Results indicate cold-mortality risks in NC, with potential differences by regional, urban-rural areas, and community characteristics.
BACKGROUND: Accurate and precise estimates of ambient air temperatures that can capture fine-scale within-day variability are necessary for studies of air temperature and health. METHOD: We developed statistical models to predict temperature at each hour in each cell of a 927-m square grid across the Northeast and Mid-Atlantic United States from 2003 to 2019, across ~4000 meteorological stations from the Integrated Mesonet, using inputs such as elevation, an inverse-distance-weighted interpolation of temperature, and satellite-based vegetation and land surface temperature. We used a rigorous spatial cross-validation scheme and spatially weighted the errors to estimate how well model predictions would generalize to new cell-days. We assess the within-county association of temperature and social vulnerability in a heat wave as an example application. RESULTS: We found that a model based on the XGBoost machine-learning algorithm was fast and accurate, obtaining weighted root mean square errors (RMSEs) around 1.6 K, compared to standard deviations around 11.0 K. We found similar accuracy when validating our model on an external dataset from Weather Underground. Assessing predictions from the North American Land Data Assimilation System-2 (NLDAS-2), another hourly model, in the same way, we found it was much less accurate, with RMSEs around 2.5 K. This is likely due to the NLDAS-2 model’s coarser spatial resolution, and the dynamic variability of temperature within its grid cells. Finally, we demonstrated the health relevance of our model by showing that our temperature estimates were associated with social vulnerability across the region during a heat wave, whereas the NLDAS-2 showed a much weaker association. CONCLUSION: Our high spatiotemporal resolution air temperature model provides a strong contribution for future health studies in this region.
BACKGROUND: Older adults are particularly vulnerable to the adverse health effects of extreme temperature-related events. A growing body of literature highlights the importance of the natural environment, including air pollution and sunlight, on cognitive health. However, the relationship between exposure to outdoor temperatures and cognitive functioning, and whether there exists any differences across climate region, remains largely unexplored. We address this gap by examining the temperature-cognition association, and whether there exists any variation across climate regions in a national cohort of aging adults. METHODS: In this cross-sectional study, we obtained data on temperature exposure based on geocoded residential location of participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. For each participant, this information was linked to their cognitive scores from Word List Learning and Recall tests to assess cognitive functioning. We used distributed lag non-linear models (dlnm) to model temperature effects over 2 days. Multivariable linear regression was used to compute temperature-cognitive functioning associations, adjusted for important covariates. Region-specific (“Dry”, “Mediterranean/oceanic”, “Tropical” and “Continental”) associations were examined by including an interaction term between climate region and temperature. RESULTS: Amongst 20,687 individuals (mean age = 67.8; standard deviation = 9.2), exposure to region-specific extreme cold temperatures in the “dry” region (e.g., Arizona) over 2 days was associated with lower cognitive scores (Mean Difference [MD]: -0.76, 95% Confidence Interval [CI]: - 1.45, - 0.07). Associations remained significant for cumulative effects of temperature over 2 days. Extremely cold exposure in the “Mediterranean/oceanic” region (e.g., California) over 2 days was also associated with significantly lower cognitive performance (MD: -0.25, 95% CI: - 0.47, - 0.04). No significant associations were observed for exposure to hot temperatures. Cognitive performance was slightly higher in late summer and fall compared to early summer. CONCLUSION: We noted adverse cognitive associations with cold temperatures in traditionally warmer regions of the country and improved cognition in summer and early fall seasons. While we did not observe very large significant associations, this study deepens understanding of the impact of climate change on the cognitive health of aging adults and can inform clinical care and public health preparedness plans.
BACKGROUND: Extreme heat exposure can lead to premature death. Climate change is expected to increase the frequency, intensity, and duration of extreme heat events, resulting in many additional heat-related deaths globally, as well as changing the nature of extreme cold events. At the same time, vulnerability to extreme heat has decreased over time, probably due to a combination of physiological, behavioural, infrastructural, and technological adaptations. We aimed to account for these changes in vulnerability and avoid overstated projections for temperature-related mortality. We used the historical observed decrease in vulnerability to improve future mortality estimates. METHODS: We used historical mortality and temperature data from 208 US cities to quantify how observed changes in vulnerability from 1973 to 2013 affected projections of temperature-related mortality under various climate scenarios. We used geographically structured meta-regression to characterise the relationship between temperature and mortality for these urban populations over the specified time period. We then used the fitted relationships to project mortality under future climate conditions. FINDINGS: Between Oct 26, 2018, and March 9, 2020, we established that differences in vulnerability to temperature were geographically structured. Vulnerability decreased over time in most areas. US mortalities projected from a 2°C increase in mean temperature decreased by more than 97% when using 2003-13 data compared with 1973-82 data. However, these benefits declined with increasing temperatures, with a 6°C increase showing only an 84% decline in projected mortality based on 2003-13 data. INTERPRETATION: Even after accounting for adaptation, the projected effects of climate change on premature mortality constitute a substantial public health risk. Our work suggests large increases in temperature will require additional mitigation to avoid excess mortality from heat events, even in areas with high air conditioning coverage in place. FUNDING: The US Environmental Protection Agency and Abt Associates.
Aedes aegypti mosquitoes are the main vector of dengue viruses globally and are present throughout much of the state of Florida (FL) in the United States of America. However, local transmission of dengue viruses in FL has mainly occurred in the southernmost counties; specifically Monroe and Miami-Dade counties. To get a better understanding of the ecologic risk factors for dengue fever incidence throughout FL, we collected and analyzed numerous environmental factors that have previously been connected to local dengue cases in disease-endemic regions. We analyzed these factors for each county-year in FL, between 2009-2019, using negative binomial regression. Monthly minimum temperature of 17.5-20.8 °C, an average temperature of 26.1-26.7 °C, a maximum temperature of 33.6-34.7 °C, rainfall between 11.4-12.7 cm, and increasing numbers of imported dengue cases were associated with the highest risk of dengue incidence per county-year. To our knowledge, we have developed the first predictive model for dengue fever incidence in FL counties and our findings provide critical information about weather conditions that could increase the risk for dengue outbreaks as well as the important contribution of imported dengue cases to local establishment of the virus in Ae. aegypti populations.
Amblyomma maculatum (Gulf Coast tick), and Dermacentor andersoni (Rocky Mountain wood tick) are two North American ticks that transmit spotted fevers associated Rickettsia. Amblyomma maculatum transmits Rickettsia parkeri and Francisella tularensis, while D. andersoni transmits R. rickettsii, Anaplasma marginale, Coltivirus (Colorado tick fever virus), and F. tularensis. Increases in temperature causes mild winters and more extreme dry periods during summers, which will affect tick populations in unknown ways. Here, we used ecological niche modeling (ENM) to assess the potential geographic distributions of these two medically important vector species in North America under current condition and then transfer those models to the future under different future climate scenarios with special interest in highlighting new potential expansion areas. Current model predictions for A. maculatum showed suitable areas across the southern and Midwest United States, and east coast, western and southern Mexico. For D. andersoni, our models showed broad suitable areas across northwestern United States. New potential for range expansions was anticipated for both tick species northward in response to climate change, extending across the Midwest and New England for A. maculatum, and still farther north into Canada for D. andersoni.
Aedes aegypti and Aedes albopictus are important pathogen-carrying vectors that broadly exhibit similar habitat suitability, but that differ at fine spatial scales in terms of competitive advantage and tolerance to urban driven environmental parameters. This study evaluated how spatial and temporal patterns drive the assemblages of these competing species in cemeteries of New Orleans, LA, applying indicators of climatic variability, vegetation, and heat that may drive habitat selection at multiple scales. We found that Ae. aegypti was well predicted by urban heat islands (UHI) at the cemetery scale and by canopy cover directly above the cemetery vase. As predicted, UHI positively correlate to Ae. aegypti, but contrary to predictions, Ae. aegypti, was more often found under the canopy of trees in high heat cemeteries. Ae. albopictus was most often found in low heat cemeteries, but this relationship was not statistically significant, and their overall abundances in the city were lower than Ae. aegypti. Culex quinquefasciatus, another important disease vector, was also an abundant mosquito species during the sampling year, but we found that it was temporally segregated from Aedes species, showing a negative association to the climatic variables of maximum and minimum temperature, and these factors positively correlated to its more direct competitor Ae. albopictus. These findings help us understand the mechanism by which these three important vectors segregate both spatially and temporally across the city. Our study found that UHI at the cemetery scale was highly predictive of Ae. aegypti and strongly correlated to income level, with low-income cemeteries having higher UHI levels. Therefore, the effect of excessive heat, and the proliferation of the highly competent mosquito vector, Ae. aegypti, may represent an unequal disease burden for low-income neighborhoods of New Orleans that should be explored further. Our study highlights the importance of considering socioeconomic aspects as indirectly shaping spatial segregation dynamics of urban mosquito species.
Ixodes cookei Packard, the groundhog tick or woodchuck tick, is the main known vector of Powassan virus (POWV) disease in North America and an ectoparasite that infests diverse small- and mid-size mammals for blood meals to complete its life stages. Since I. cookei spends much of its life cycle off the host and needs hosts for a blood meal in order to pass to the next life stage, it is susceptible to changes in environmental conditions. We used a maximum-entropy approach to ecological niche modeling that incorporates detailed model-selection routes to link occurrence data to climatic variables to assess the potential geographic distribution of I. cookei under current and likely future climate conditions. Our models identified suitable areas in the eastern United States, from Tennessee and North Carolina north to southern Canada, including Nova Scotia, New Brunswick, eastern Newfoundland and Labrador, southern Quebec, and Ontario; suitable areas were also in western states, including Washington and Oregon and restricted areas of northern Idaho, northwestern Montana, and adjacent British Columbia, in Canada. This study produces the first maps of the potential geographic distribution of I. cookei. Documented POWV cases overlapped with suitable areas in the northeastern states; however, the presence of this disease in areas classified by our models as not suitable by our models but with POWV cases (Minnesota and North Dakota) requires more study.
How weather affects tick development and behavior and human Lyme disease remains poorly understood. We evaluated relations of temperature and humidity during critical periods for the tick lifecycle with human Lyme disease. We used electronic health records from 479,344 primary care patients in 38 Pennsylvania counties in 2006-2014. Lyme disease cases (n = 9657) were frequency-matched (5:1) by year, age, and sex. Using daily weather data at ~4 km(2) resolution, we created cumulative metrics hypothesized to promote (warm and humid) or inhibit (hot and dry) tick development or host-seeking during nymph development (March 1-May 31), nymph activity (May 1-July 30), and prior year larva activity (Aug 1-Sept 30). We estimated odds ratios (ORs) of Lyme disease by quartiles of each weather variable, adjusting for demographic, clinical, and other weather variables. Exposure-response patterns were observed for higher cumulative same-year temperature, humidity, and hot and dry days (nymph-relevant), and prior year hot and dry days (larva-relevant), with same-year hot and dry days showing the strongest association (4th vs. 1st quartile OR = 0.40; 95% confidence interval [CI] = 0.36, 0.43). Changing temperature and humidity could increase or decrease human Lyme disease risk.
Biting insects have a long-standing reputation for being an extreme presence in the Arctic, but it is unclear how they are responding to the rapid environmental changes currently taking place in the region. We review recent advances in our understanding of climate change responses by several key groups of biting insects, including mosquitoes, blackflies, and warble/botflies, and we highlight the significant knowledge gaps on this topic. We also discuss how changes in biting insect populations could impact humans and wildlife, including disease transmission and the disruption of culturally and economically important activities. Future work should integrate scientific with local and traditional ecological knowledge to better understand global change responses by biting insects in the Arctic and the associated consequences for the environmental security of Arctic communities.
BACKGROUND: Infections with nontyphoidal Salmonella cause an estimated 19,336 hospitalizations each year in the United States. Sources of infection can vary by state and include animal and plant-based foods, as well as environmental reservoirs. Several studies have recognized the importance of increased ambient temperature and precipitation in the spread and persistence of Salmonella in soil and food. However, the impact of extreme weather events on Salmonella infection rates among the most prevalent serovars, has not been fully evaluated across distinct U.S. regions. METHODS: To address this knowledge gap, we obtained Salmonella case data for S. Enteriditis, S. Typhimurium, S. Newport, and S. Javiana (2004-2014; n = 32,951) from the Foodborne Diseases Active Surveillance Network (FoodNet), and weather data from the National Climatic Data Center (1960-2014). Extreme heat and precipitation events for the study period (2004-2014) were identified using location and calendar day specific 95(th) percentile thresholds derived using a 30-year baseline (1960-1989). Negative binomial generalized estimating equations were used to evaluate the association between exposure to extreme events and salmonellosis rates. RESULTS: We observed that extreme heat exposure was associated with increased rates of infection with S. Newport in Maryland (Incidence Rate Ratio (IRR): 1.07, 95% Confidence Interval (CI): 1.01, 1.14), and Tennessee (IRR: 1.06, 95% CI: 1.04, 1.09), both FoodNet sites with high densities of animal feeding operations (e.g., broiler chickens and cattle). Extreme precipitation events were also associated with increased rates of S. Javiana infections, by 22% in Connecticut (IRR: 1.22, 95% CI: 1.10, 1.35) and by 5% in Georgia (IRR: 1.05, 95% CI: 1.01, 1.08), respectively. In addition, there was an 11% (IRR: 1.11, 95% CI: 1.04-1.18) increased rate of S. Newport infections in Maryland associated with extreme precipitation events. CONCLUSIONS: Overall, our study suggests a stronger association between extreme precipitation events, compared to extreme heat, and salmonellosis across multiple U.S. regions. In addition, the rates of infection with Salmonella serovars that persist in environmental or plant-based reservoirs, such as S. Javiana and S. Newport, appear to be of particular significance regarding increased heat and rainfall events.
Vibrio (V), a genus of marine bacteria, are common inhabitants of warm coastal waters and estuaries. Vibrio includes V. parahaemolyticus and V. vulnificus species that can cause human infections through the consumption of contaminated shellfish (as bivalve molluscs). The growth of pathogenic Vibrio is related to ambient water temperature and seems to increase at 15 degrees C and over. The expansion of Vibrio infection outbreak is increasing worldwide due to the increase of the sea surface temperature as a result of ocean warming. Canada’s coast is not an exception to this worldwide Vibrio spread. Faced with this issue, this study focuses on modelling the future potential Vibrio growth risk along the coasts of the St. Lawrence Gulf and Estuary, where the shellfish industry is well developed. This is done using the adequate machine learning model with explanatory variables that include air temperature and wind speed for predicting future water temperatures. Based on the predicted future water temperature scenarios and a threshold of 15 degrees C to determine the conditions favorable to the growth of Vibrio bacteria, we modelled the Vibrio growth risk indicator, i.e. the number of days exceeding the minimum temperature for Vibrio pathogenic growth (15 degrees C), in the horizon 2040-2100. Simulations show that the number of days, where the minimum temperature (15 degrees C) will be reached, will increase spatially and even seasonally and all the shellfish beds would meet the temperature condition for Vibrio growth regardless of the climate scenario (optimistic and pessimistic).
Coccidioidomycosis, or valley fever, is an infectious fungal disease currently endemic to the southwestern United States. Symptoms of valley fever range in severity from flu-like illness to severe morbidity and mortality. Warming temperatures and changes in precipitation patterns may cause the area of endemicity to expand northward throughout the western United States, putting more people at risk for contracting valley fever. This may increase the health and economic burdens from this disease. We developed an approach to describe the relationship between climate conditions and valley fever incidence using historical data and generated projections of future incidence in response to both climate change and population trends using the Climate Change Impacts and Risk Analysis (CIRA) framework developed by the U.S. Environmental Protection Agency. We also developed a method to estimate economic impacts of valley fever that is based on case counts. For our 2000-15 baseline time period, we estimated annual medical costs, lost income, and economic welfare losses for valley fever in the United States were $400,000 per case, and the annual average total cost was $3.9 billion per year. For a high greenhouse gas emission scenario and accounting for population growth, we found that total annual costs for valley fever may increase up to 164% by year 2050 and up to 380% by 2090. By the end of the twenty-first century, valley fever may cost $620,000 per case and the annual average total cost may reach $18.5 billion per year. This work contributes to the broader effort to monetize climate change-attributable damages in the United States.
BACKGROUND: Increasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE). METHODS: Fresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM(2.5) and ozone (O(3)) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0-3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days. RESULTS: From 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5217 deaths and 78,433 hospital admissions. A 10-unit increase in PM(2.5) concentration was associated with a 5% increase in ACM (rate ratio [RR(Lag0)(-)(3)]: 1.05, 95% CI: 1.00-1.10) and same-day O(3) (RR(Lag0): 1.02, 95% CI: 1.01-1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods. CONCLUSION: Our findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.
BACKGROUND/OBJECTIVE: Research suggests gestational exposure to particulate matter ≤2.5 μm (PM(2.5)) and extreme heat may independently increase risk of birth defects. We investigated whether duration of gestational extreme heat exposure modifies associations between PM(2.5) exposure and specific congenital heart defects (CHDs). We also explored nonlinear exposure-outcome relationships. METHODS: We identified CHD case children (n = 2824) and non-malformed live-birth control children (n = 4033) from pregnancies ending between 1999 and 2007 in the National Birth Defects Prevention Study, a U.S. population-based multicenter case-control study. We assigned mothers 6-week averages of PM(2.5) exposure during the cardiac critical period (postconceptional weeks 3-8) using the closest monitor within 50 km of maternal residence. We assigned a count of extreme heat days (EHDs, days above the 90th percentile of daily maximum temperature for year, season, and weather station) during this period using the closest weather station. Using generalized additive models, we explored logit-nonlinear exposure-outcome relationships, concluding logistic models were reasonable. We estimated joint effects of PM(2.5) and EHDs on six CHDs using logistic regression models adjusted for mean dewpoint and maternal age, education, and race/ethnicity. We assessed multiplicative and additive effect modification. RESULTS: Conditional on the highest observed EHD count (15) and at least one critical period day during spring/summer, each 5 μg/m(3) increase in average PM(2.5) exposure was significantly associated with perimembranous ventricular septal defects (VSDpm; OR: 1.54 [95% CI: 1.01, 2.41]). High EHD counts (8+) in the same population were positively, but non-significantly, associated with both overall septal defects and VSDpm. Null or inverse associations were observed for lower EHD counts. Multiplicative and additive effect modification estimates were consistently positive in all septal models. CONCLUSIONS: Results provide limited evidence that duration of extreme heat exposure modifies the PM(2.5)-septal defects relationship. Future research with enhanced exposure assessment and modeling techniques could clarify these relationships.
BACKGROUND: Individuals with respiratory conditions, such as asthma, are particularly susceptible to adverse health effects associated with higher levels of ambient air pollution and temperature. This study evaluates whether hourly levels of fine particulate matter (PM2.5) and dry bulb globe temperature (DBGT) are associated with the lung function of adult participants with asthma. METHODS AND FINDINGS: Global positioning system (GPS) location, respiratory function (measured as forced expiratory volume at 1 second (FEV1)), and self-reports of asthma medication usage and symptoms were collected as part of the Exposure, Location, and Lung Function (ELF) study. Hourly ambient PM2.5 and DBGT exposures were estimated by integrating air quality and temperature public records with time-activity patterns using GPS coordinates for each participant (n = 35). The relationships between acute PM2.5, DBGT, rescue bronchodilator use, and lung function collected in one week periods and over two seasons (summer/winter) were analyzed by multivariate regression, using different exposure time frames. In separate models, increasing levels in PM2.5, but not DBGT, were associated with rescue bronchodilator use. Conversely DBGT, but not PM2.5, had a significant association with FEV1. When DBGT and PM2.5 exposures were placed in the same model, the strongest association between cumulative PM2.5 exposures and the use of rescue bronchodilator was identified at the 0-24 hours (OR = 1.030; 95% CI = 1.012-1.049; p-value = 0.001) and 0-48 hours (OR = 1.030; 95% CI = 1.013-1.057; p-value = 0.001) prior to lung function measure. Conversely, DBGT exposure at 0 hours (β = 3.257; SE = 0.879; p-value>0.001) and 0-6 hours (β = 2.885; SE = 0.903; p-value = 0.001) hours before a reading were associated with FEV1. No significant interactions between DBGT and PM2.5 were observed for rescue bronchodilator use or FEV1. CONCLUSIONS: Short-term increases in PM2.5 were associated with increased rescue bronchodilator use, while DBGT was associated with higher lung function (i.e. FEV1). Further studies are needed to continue to elucidate the mechanisms of acute exposure to PM2.5 and DBGT on lung function in asthmatics.
Air pollution risk assessments typically estimate ozone-attributable mortality counts using concentration-response (C-R) parameters from epidemiologic studies that treat temperature as a potential confounder. However, some recent epidemiologic studies have indicated that temperature can modify the relationship between short-term ozone exposure and mortality, which has potentially important implications when considering the impacts of climate change on public health. This proof-of-concept analysis quantifies counts of temperature-modified ozone-attributable mortality using temperature-stratified C-R parameters from a multicity study in which the pooled ozone-mortality effect coefficients change in concert with daily temperature. Meteorology downscaled from two global climate models is used with a photochemical transport model to simulate ozone concentrations over the 21st century using two emission inventories: one holding air pollutant emissions constant at 2011 levels and another accounting for reduced emissions through the year 2040. The late century climate models project increased summer season temperatures, which in turn yields larger total counts of ozone-attributable deaths in analyses using temperature-stratified C-R parameters compared to the traditional temperature confounder approach. This analysis reveals substantial heterogeneity in the magnitude and distribution of the temperature-stratified ozone-attributable mortality results, which is a function of regional variability in both the C-R relationship and the model-predicted temperature and ozone.
The combined effects of heat events and poor air quality conditions can severely affect population health. A novel correlational method was developed to assess the impact of the short-term variations of environmental variables (air pollutants and ambient conditions) on community health responses (mortalities and emergency department visits). A multi-dimensional clustering approach was proposed by combining hierarchical and k-means clustering to promote flexibility and robustness to improve the correlation procedure. The study focused on the health records of the elderly population and people diagnosed with cardiorespiratory causes. The study investigated multiple health records on different levels of investigation: total, elderly, cause-based, and elderly cause-based records. The developed method was validated by investigating the short-term impact of ambient air temperature, relative humidity, ground-level ozone, and fine particulate matter on the health records during hot and warm seasons in the municipalities of Mississauga and Brampton, Peel Region, Ontario, Canada for 15 years. The analysis confirmed the association between moderate levels of environmental variables and increased short-term daily total deaths and emergency department visits, while the elderly sector showed higher vulnerability to environmental changes. Furthermore, the association with extreme heat conditions and poor air quality levels was affirmed with cause-based mortalities and emergency visits; the correlation was strongest with elderly cause-based health records. Findings confirm that cardiorespiratory patients, especially elderly people, were at the greatest risk of poor environmental conditions.
Major wildfires and heatwaves have begun to increase in frequency throughout much of the United States, particularly in western states such as California, causing increased risk to public health. Air pollution is exacerbated by both wildfires and warmer temperatures, thus adding to such risk. With climate change and the continued increase in global average temperatures, the frequency of major wildfires, heat days, and unhealthy air pollution episodes is projected to increase, resulting in the potential for compounding risks. Risks will likely vary by region and may disproportionately impact low-income communities and communities of color. In this study, we processed daily particulate matter (PM) data from over 18,000 low-cost PurpleAir sensors, along with gridMET daily maximum temperature data and government-compiled wildfire perimeter data from 2018-2020 in order to examine the occurrence of compound risk (CR) days (characterized by high temperature and high PM2.5) at the census tract level in California, and to understand how such days have been impacted by the occurrence of wildfires. Using American Community Survey data, we also examined the extent to which CR days were correlated with household income, race/ethnicity, education, and other socioeconomic factors at the census tract level. Results showed census tracts with a higher frequency of CR days to have statistically higher rates of poverty and unemployment, along with high proportions of child residents and households without computers. The frequency of CR days and elevated daily PM2.5 concentrations appeared to be strongly related to the occurrence of nearby wildfires, with over 20% of days with sensor-measured average PM2.5 > 35 mu g/m(3) showing a wildfire within a 100 km radius and over two-thirds of estimated CR days falling on such days with a nearby wildfire. Findings from this study are important to policymakers and government agencies who preside over the allocation of state resources as well as organizations seeking to empower residents and establish climate resilient communities.
California is one of the nation’s top agriculture producers and is vulnerable to extreme events such as droughts and heat waves. Concurrent extreme events may further stress water and energy resources, exerting greater adverse socioeconomic, environmental, and health impacts than individual events. Here we examine the features of compound drought, heat wave, and dust events in California during spring and summer. From 2003 to 2020, 16 compound events are found in warm seasons, with a mean duration of similar to 4 days. Compound events are characterized by enhanced surface temperature up to 4.5 degrees C over northern and western California, reduced soil moisture and vegetation density, and an increase in dust optical depth (DOD) by 0.05-0.1 over central and southern California. The enhanced DOD is largely associated with severe vegetation dieback that favors dust emissions and southeasterly wind anomalies that support northward transport of dust from source regions in southern California. Surface fine dust and PM2.5 concentrations also increase by more than 0.5 and 5 mu g m(-3), respectively, during compound events associated with both enhanced dust emissions and a relatively stable atmosphere that traps pollutants. The development of the compound events is related to an anomalous high over the west coast in the lower to middle troposphere, which is a pattern favoring sinking motion and dry conditions in California. The anomalous high is embedded in a wave train that develops up to 7 days before the events. In comparison with heat wave extremes alone, compound events show significantly higher DOD and lower vegetation density associated with droughts.
The negative synergistic effects of air pollution and sensible heat on public health have been noted in numerous studies. While separate, simplified, and public-facing indices have been developed to communicate the risks of unhealthful levels of air pollution and extreme heat, a combined index containing elements of both has rarely been investigated. Utilizing air quality, meteorology, and mortality data in Monterrey, Mexico, we investigated whether the association between the air quality index (AQI) and mortality was improved by considering elements of the heat index (HI). We created combined indices featuring additive, multiplicative, and either/or formulations and evaluated their relationship to mortality. Results showed increased associations with mortality for models employing indices that combined the AQI and the HI in an additive or multiplicative manner, with increases in the interquartile relative risk of 3-5% over that resulting from models employing the AQI alone.
Extreme heat and ozone are co-occurring exposures that independently and synergistically increase the risk of respiratory disease. To our knowledge, no joint warning systems consider both risks; understanding their interactive effect can warrant use of comprehensive warning systems to reduce their burden. We examined heterogeneity in joint effects (on the additive scale) between heat and ozone at small geographical scales. A within-community matched design with a Bayesian hierarchical model was applied to study this association at the zip code level. Spatially varying relative risks due to interaction (RERI) were quantified to consider joint effects. Determinants of the spatial variability of effects were assessed using a random effects metaregression to consider the role of demographic/neighborhood characteristics that are known effect modifiers. A total of 817,354 unscheduled respiratory hospitalizations occurred in California from 2004 to 2013 in the May to September period. RERIs revealed no additive interaction when considering overall joint effects. However, when considering the zip code level, certain areas observed strong joint effects. A lower median income, higher percentage of unemployed residents, and exposure to other air pollutants within a zip code drove stronger joint effects; a higher percentage of commuters who walk/bicycle, a marker for neighborhood wealth, showed decreased effects. Results indicate the importance of going beyond average measures to consider spatial variation in the health burden of these exposures and predictors of joint effects. This information can be used to inform early warning systems that consider both heat and ozone to protect populations from these deleterious effects in identified areas.
Evidence shows that climate change may have adverse effects on human health. The purpose of this study was to investigate the relation between Physiologically Equivalent Temperature (PET) and cardiovascular hospital admissions in Ahvaz. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression models were used to investigate the effect of PET on hospital admissions. Low PET values (6.4 °C, 9.9 °C and 16.9 °C) in all lags, except lag 0-30, significantly decreased the risk of hospital admissions for total cardiovascular diseases, hypertension, ischemic heart diseases, and cardiovascular admissions in men, women and ≤65 years. But, low PET (6.4 °C) in lags 0 and 0-2 significantly increased the risk of hospital admissions for cerebrovascular diseases; and high PET values increased the risk of ischemic heart diseases and in men. Both cold and hot stress are involved in cardiovascular hospital admissions.
Background: There are few epidemiological studies on the relation between temperature changes and adverse pregnancy outcomes. The purpose of this study was to determine the relation between Physiological Equivalent Temperature (PET) with adverse pregnancy outcomes including stillbirth, low birth weight (LBW), preterm labor (PTL), spontaneous abortion (SA), preeclampsia and hypertension in Ahvaz, Iran. Methods: Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on adverse pregnancy outcomes. In this study the effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted. Results: High PET (45.4 C°, lag = 0) caused a significant increase in risk of stillbirth. Also, high levels of PET (45.4, 43.6, 42.5 C°, lag = 0–6) and low levels of PET (9.9, 16.9 C°, lags = 0, 0–13, 0–21) significantly increased the risk of LBW. But, low levels of PET (6.4, 9.9, 16.9 C°, lags = 0–6, 0–13) reduced the risk of gestational hypertension. Conclusion: The results of this study showed that hot and cold thermal stress may be associated with increased risk of stillbirth, and LBW in Ahvaz.
Excessive ambient air temperature due to global warming and climate change is capable of imposing heat stress on outdoor workers. This study had a quantitative, secondary, and analytical design. The present study aimed at modelling the trend of climate change by Hadley atmosphere-ocean general circulation model (HadCM) and Long Ashton Climate Generator (LARS) to predict future climate change trends, and determining heat stress in exposed farmworkers with high working energy demand who work full time in the unsheltered farm area. In this study, the data of the three synoptic metrological monitoring stations (located at the cities of Dezful (32.3831 degrees N, 48.4236 degrees E), Ahvaz (31.3183 degrees N, 48.6706 degrees E), and Dehdez (31.7011 degrees N, 50.2946 degrees E)) in a 30 years duration (1986-2016) was used. To predict the future trend of air temperature, HadCM and LARS were applied. Also, the Wet-Bulb Globe Temperature (WBGT) index was used to determine heat stress. The results showed that the temperature will increase throughout the coming years in the 3 cities (Ahvaz, Dezful, and Dehdez). The determination coefficient (R-2) ranges from 0.91 to 0.96 for the results. The rise of temperature rate between the time duration of 2011-2040 and 2041-2070 will be about 5 degrees C, and the WBGT indexes in June, July, and August were obtained as very hot (danger; > 28 degrees C). And the rate of increase in air temperature in the city of Ahvaz will be higher than in the other two cities. According to the results, it was revealed that heat stress coincidence with global warming will increase and exposure to heat for farmworkers will be much more severe.
BACKGROUND: Ambient temperature is predicted to rise in Saudi Arabia, and how this will impact the health of its population has not been investigated. Saudi Arabia is one of the top ten countries with the highest prevalence of diabetes. The current study investigates the correlation between ambient temperature and HbA1c levels in a group of Saudis in Riyadh. METHODS: Age, gender, and HbA1c data for six years were obtained from patients’ records. The maximum daily temperature of Riyadh city for the same period was obtained. RESULTS: A total of 168,614 patient records were obtained. There was a statistically significant positive correlation between ambient temperature and HbA1c levels, where for each 1°C increase in average weekly temperature HbA1c increased by 0.007%. Patients were at higher risk of having HbA1c ≥ 7% in high and moderate temperature than in low temperature (P < 0.001, odds ratio (OR): 1.134, and P < 0.001, odds ratio (OR): 1.034; respectively). The mean of HbA1c in females (7.27±1.96) was significantly lower than in males (7.40±1.86), and the probability of males having HbA1c ≥ 7% was about 17.4% higher than females. However, the HbA1c levels in females were significantly more affected by rising temperature compared to males (B = 0.003, P = 0.008). CONCLUSION: Overall, rise in ambient temperature is associated with worsening HbA1c, which could be harmful to the health of Saudis suffering from diabetes. Possible reasons for the increase in HbA1c could include reduced physical activity, reduced sunlight exposure, and dehydration during hot weather. More research on the relationship between climate change and public health in Saudi Arabia is needed.
The Gaza Strip is one of the world’s most fragile states and faces substantial public health and development challenges. Climate change is intensifying existing environmental problems, including increased water stress. We provide the first published assessment of climate impacts on diarrhoeal disease in Gaza and project future health burdens under climate change scenarios. Over 1 million acute diarrhoea cases presenting to health facilities during 2009−2020 were linked to weekly temperature and rainfall data and associations assessed using time-series regression analysis employing distributed lag non-linear models (DLNMs). Models were applied to climate projections to estimate future burdens of diarrhoeal disease under 2 °C and 1.5 °C global warming scenarios. There was a significantly raised risk of diarrhoeal disease associated with both mean weekly temperature above 19 °C and total weekly rainfall below 6 mm in children 0−3 years. A heat effect was also present in subjects aged > 3 years. Annual diarrhoea cases attributable to heat and low rainfall was 2209.0 and 4070.3, respectively, in 0−3-year-olds. In both age-groups, heat-related cases could rise by over 10% under a 2 °C global warming level compared to baseline, but would be limited to below 2% under a 1.5 °C scenario. Mean rises of 0.9% and 2.7% in diarrhoea cases associated with reduced rainfall are projected for the 1.5 °C and 2 °C scenarios, respectively, in 0−3-year-olds. Climate change impacts will add to the considerable development challenges already faced by the people of Gaza. Substantial health gains could be achieved if global warming is limited to 1.5 °C.
BACKGROUND: In recent years, temperature fluctuations and adverse weather events have become major concerns, influencing overall mortality and morbidity. While the association between extreme temperatures and atrial fibrillation (AF) has been supported by research, there is limited evidence on the ability of AF patients to adapt to the changing temperatures. We explored this question among AF patients in Israel featured by extreme temperature conditions. METHODS: We examined the association between exposure to extreme temperatures and hospitalizations related to AF in a nationwide cohort in Israel. A case-crossover design with a distributed nonlinear model (DLNM) was applied to assess possible effects of temperature fluctuations during each season. We considered the 7 days prior to the event as the possible window period. RESULTS: During 2004-2018 we recorded a total of 54,909 hospitalizations for AF. Low temperatures in winter and high in summer adversely affected AF-related hospitalizations. The effect recorded for the first few weeks of each season was of higher magnitude and decreased or faded off completely as the seasons progressed (OR in winter: from 1.14, 95%CI 0.98, 1.32 to 0.90, 95%CI: 0.77, 1.06;OR in summer: from 1.95, 95%CI: 1.51, 2.52 to 1.22, 95%CI: 0.90, 1.65). Patients living in the south region and patients with low socioeconomic status were more susceptible to extreme temperatures. CONCLUSIONS: Although extreme hot and cold temperatures are associated with an increased risk of hospitalization for AF, the patients are likely to adapt to temperature change over the course of the first weeks of the season.
It is uncertain what climate change could bring to populations and countries in the hot desert environment of the Arabian Peninsula. Not only because they are already hot, countries in this region also have unique demographic profiles, with migrant populations potentially more vulnerable and constituting a large share of the population. In Kuwait, two-thirds of the population are migrant workers and record-high temperatures are already common. We quantified the temperature-related mortality burdens in Kuwait in the mid- (2050-2059) and end-century (2090-2099) decades under moderate (SSP2-4.5) and extreme (SSP5-8.5) climate change scenarios. We fitted time series distributed lag non-linear models to estimate the baseline temperature-mortality relationship which was then applied to future daily mean temperatures from the latest available climate models to estimate decadal temperature-mortality burdens under the two scenarios. By mid-century, the average temperature in Kuwait is predicted to increase by 1.80 degrees C (SSP2-4.5) to 2.57 degrees C (SSP5-8.5), compared to a 2000-2009 baseline. By the end of the century, we could see an increase of up to 5.54 degrees C. In a moderate scenario, climate change would increase heat-related mortality by 5.1% (95% empirical confidence intervals: 0.8, 9.3) by end-century, whereas an extreme scenario increases heat-related mortality by 11.7% (2.7, 19.0). Heat-related mortality for non-Kuwaiti migrant workers could increase by 15.1% (4.6, 22.8). For every 100 deaths in Kuwait, 13.6 (-3.6, 25.8) could be attributed to heat driven by climate change by the end of the century. Climate change induced warming, even under more optimistic mitigation scenarios, may markedly increase heat-related mortality in Kuwait. Those who are already vulnerable, like migrant workers, could borne a larger impact from climate change.
BACKGROUND: Exposure to heat during pregnancy has been associated with reduced fetal growth. Less is known about associations with cold and the potential for critical time windows of exposure. OBJECTIVES: We aimed to evaluate, in a national retrospective cohort, critical windows of susceptibility during pregnancy to extreme temperatures (low and high) and fetal growth, among 624,940 singleton term births in Israel during the period 2010-2014. METHODS: Temperature exposures were estimated using a spatially refined gridded climate data set with a 1-h and 1-km2 resolution. Percentiles of temperature were categorized by climatic zone for the entire pregnancy and by trimesters and weeks. Generalized additive models with the distributed lag nonlinear model framework were used to estimate unadjusted and adjusted associations between percentiles and categories of temperature and fetal growth markers: term [births after 36 weeks of gestational age (GA)] mean birth weight and term low birth weight (tLBW, term infants with birth weight below 2,500 g). RESULTS: After adjustment, extreme temperatures (percentiles) during the entire pregnancy were associated with a lower mean birth weight { ≤ 10th vs. 41st-50th percentile: – 56 g [95% confidence interval (CI): – 63 g, – 50 g)]; > 90th vs. 41st-50th percentile: – 65 g; 95% CI: – 72 g, – 58 g}. Similar inverse U-shaped patterns were observed for all trimesters, with stronger associations for heat than for cold and for exposures during the third trimester. For heat, results suggest critical windows between 3-9 and 19-34 GA-weeks, with the strongest association estimated at 3 GA-weeks (temperature > 90th vs. 41st-50th percentiles: – 3.8 g; 95% CI: – 7.1 g, – 0.4 g). For cold, there was a consistent trend of null associations early in pregnancy and stronger inverse associations over time, with the strongest association at 36 GA-week ( ≤ 10th vs. 41st-50th percentiles: – 2.9 g; 95% CI: – 6.5 g, 0.7g). For tLBW, U-shape patterns were estimated for the entire pregnancy and third trimester exposures, as well as nonsignificant associations with heat for 29-36 GA-weeks. Generally, the patterns of associations with temperatures during the entire pregnancy were consistent when stratified by urbanicity and geocoding hierarchy, when estimated for daily minimum and maximum temperatures, when exposures were classified based on temperature distributions in 49 natural regions, and when estimated for all live births. DISCUSSION: Findings from our study of term live births in Israel (2010-2014) suggest that exposure to extreme temperatures, especially heat, during specific time windows may result in reduced fetal growth. https://doi.org/10.1289/EHP8117.
Heat-related illnesses (HRIs), such as heatstroke (HS) and heat exhaustion (HE), are common complications during Hajj pilgrims. The Saudi Ministry of Health (MoH) developed guidelines on the management of HRIs to ensure the safety of all pilgrims. This study aimed to assess healthcare workers’ (HCWs) adherence to the updated national guidelines regarding pre-hospital and in-hospital management of HRIs. This was a cross-sectional study using a questionnaire based on the updated HRI management interim guidelines for the Hajj season. Overall, compliance with HE guidelines scored 5.5 out of 10 for basic management and 4.7 out of 10 for advanced management. Medical staff showed an average to above average adherence to pre-hospital HS management, including pre-hospital considerations (7.2), recognition of HS (8.1), case assessment (7.7), stabilizing airway, breathing, and circulation (8.7), and cooling (5). The overall compliance to in-hospital guidelines for HS management were all above average, except for special conditions (4.3). In conclusion, this survey may facilitate the evaluation of the adherence to Saudi HRIs guidelines by comparing annual levels of compliance. These survey results may serve as a tool for the Saudi MoH to develop further recommendations and actions.
In this study, the variability and trends of the outdoor thermal discomfort index (DI) in the Kingdom of Saudi Arabia (KSA) were analyzed over the 39-year period of 1980-2018. The hourly DI was estimated based on air temperature and relative humidity data obtained from the next-generation global reanalysis from the European Center for Medium-Range Weather Forecasts and in-house high-resolution regional reanalysis generated using an assimilative Weather Research Forecast (WRF) model. The DI exceeds 28°C, that is, the threshold for human discomfort, in all summer months (June to September) over most parts of the KSA due to a combination of consistently high temperatures and relative humidity. The DI is greater than 28°C for 8-16 h over the western parts of KSA and north of the central Red Sea. A DI of >28°C persistes for 7-9 h over the Red Sea and western KSA for 90% of summer days. The spatial extent and number of days with DI > 30°C, that is, the threshold for severe human discomfort, are significantly lower than those with DI > 28°C. Long-term trends in the number of days with DI > 28°C indicate a reduced rate of increase or even a decrease over some parts of the southwestern KSA in recent decades (1999-2018). Areas with DI > 30°C, in particular the northwestern regions of the Arabian Gulf and its adjoining regions, also showed improved comfort levels during recent decades. Significant increases in population and urbanization have been reported throughout the KSA during the study period. Analysis of five-years clinical data suggests a positive correlation between higher temperatures and humidity with heat-related deaths during the Hajj pilgrimage. The information provided herein is expected to aid national authorities and policymakers in developing necessary strategies to mitigate the exposure of humans to high levels of thermal discomfort in the KSA.
Background: Heat related illness can be avoided; it may also be present in a milder form to a life threatening condition. Objectives: To explore the pattern of KAP towards HRIs among the subjects in Jeddah city. Method: It was a cross-sectional study of 378 subjects, who gave their responses through an online Google form. Data were analyzed using SPSS software version 23. The level of significance was 0.05%. Results: 18.2% of the subjects suffered from HRls, and 49% never received health education about HRIs. Increased KAP score was associated with increased age (b= 0.177, p<0.000), more encountered in the females (b= -2.25, p <0.000), in those who owned air conditioning (b = 5.3, p < 0.024), in the smokers (b= 1.77, p<0.35), and in those who received health education about HRIs (b=2.327, p< 0.000). Conclusions: The subjects' awareness of the prevention of HRIs needs to be strengthened.
OBJECTIVES: The prevalence of kidney stones is increasing worldwide. Multiple risk factors are believed to contribute to the development of kidney stones such as lifestyle, diet, and global warming. In the United Arab Emirates (UAE), there has been limited research exploring the prevalence and risk factors of kidney stones. This study attempts to assess the understanding and prevalence of kidney stones among adults in the UAE. METHODS: In this cross-sectional study, data were collected using a self-administered questionnaire, distributed among 515 participants (20-49 years old) from Abu Dhabi, Dubai, Ajman, and Sharjah states. IBM SPSS version 25 was used for data analysis. RESULTS: The mean of knowledge score was 56.4% (n = 500). There was no correlation between the knowledge of those who had experienced kidney stones and those who did not. Furthermore, a family history of kidney stones increased the risk of developing stones by 2.27 times. Among participants reporting signs, symptoms, diagnosis, and the management of kidney stones, the knowledge and understanding about kidney stones was high. However, the perceptions of the same cohort about dietary precautions were limited. While analysing the sources of knowledge, the Internet and mass media were twice as important as physicians in educating the population. CONCLUSION: This study shows that the study cohort from the UAE population was aware of certain aspects of kidney stones but was quite naïve about its consequential risk factors. This highlights the importance of promoting education about kidney stones through health campaigns.
We have analyzed the long-term temperature trends and extreme temperature events in Saudi Arabia between 1979 and 2019. Our study relies on high-resolution, consistent, and complete ERA5 reanalysis data from the European Centre for Medium-Range Weather Forecasts (ECMWF). We evaluated linear trends in several climate descriptors, including temperature, dewpoint temperature, thermal comfort, and extreme event indices. Previous works on this topic used data from weather station observations over limited time intervals and did not include temperature data for recent years. The years 2010-19 have been the warmest decade ever observed by instrumental temperature monitoring and are the eight warmest years on record. Therefore, the earlier results may be incomplete, and their results may no longer be relevant. Our findings indicate that, over the past four decades, Saudi Arabia has warmed up at a rate that is 50% higher than the rest of the landmass in the Northern Hemisphere. Moreover, moisture content of the air has significantly increased in the region. The increases of temperature and humidity have resulted in the soaring of dewpoint temperature and thermal discomfort across the country. These increases are more substantial during summers, which are already very hot relative to winters. Such changes may be dangerous to people over vast areas of the country. If the current trend persists into the future, human survival in the region will be impossible without continuous access to air conditioning.
Recent work by Kephart et al.(1) updates estimates for mortality burden attributable to non-optimal ambient temperatures in Latin America, which helps to understand the climate-related health risks and burden in less-developed areas. Here, we discuss the main findings and focus on methodology that remains controversial in heat health field.
CONTEXT: Tropical areas and small islands are identified as highly vulnerable to climate change, and already experiencing shifts in their temperature distribution. However, the knowledge on the health impacts of temperatures under tropical marine climate is limited. We explored the influence of temperature on mortality in four French overseas regions located in French Guiana, French West Indies, and in the Indian Ocean, between 2000 and 2015. METHOD: Distributed lag non-linear generalized models linking temperature and mortality were developed in each area, and relative risks were combined through a meta-analysis. Models were used to estimate the fraction of mortality attributable to non-optimal temperatures. The role of humidity was also investigated. RESULTS: An increased risk of mortality was observed when the temperature deviated from median. Results were not modified when introducing humidity. Between 2000 and 2015, 979 deaths [confidence interval (CI) 95% 531:1359] were attributable to temperatures higher than the 90th percentile of the temperature distribution, and 442 [CI 95% 178:667] to temperature lower than the 10th percentile. DISCUSSION: Heat already has a large impact on mortality in the French overseas regions. Results suggest that adaptation to heat is relevant under tropical marine climate.
Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs.
OBJECTIVE: Increased temperature and humidity across the world and emergence of mosquito-borne diseases, notably dengue both continue to present public health problems, but their relationship is not clear as conflicting evidence abound on the association between climate conditions and risk of dengue fever. This characterization is important as mitigation of climate change-related variables will contribute toward efficient planning of health services. The purpose of this study was to determine whether humidity in addition to high temperatures increase the risk of dengue transmission. METHODS: We have assessed the joint association between temperature and humidity with the incidence of dengue fever at Jeddah City in Saudi Arabia. We obtained weekly data from Jeddah City on temperature and humidity between 2006 and 2009 for 200 weeks starting week 1/2006 and ending week 53/2009. We also collected incident case data on dengue fever in Jeddah City. RESULTS: The cross-tabulated analysis showed an association between temperature or humidity conditions and incident cases of dengue. Our data found that hot and dry conditions were associated with a high risk of dengue incidence in Jeddah City. CONCLUSION: Hot and dry conditions are risk factors for dengue fever.
Rift Valley Fever (RVF) and West Nile virus (WNV) are two important emerging Arboviruses transmitted by Aedes and Culex mosquitoes, typically Ae. caspius, Ae. detritus and Cx. pipiens in temperate regions. In Morocco, several outbreaks of WNV (1996, 2003 and 2010), affecting horses mostly, have been reported in north-western regions resulting in the death of 55 horses and one person cumulatively. Serological evidence of WNV local circulation, performed one year after the latest outbreak, revealed WNV neutralizing bodies in 59 out of 499 tested participants (El Rhaffouli et al., 2012). The country also shares common borders with northern Mauritania, where RVF is often documented. Human movement, livestock trade, climate changes and the availability of susceptible mosquito vectors are expected to increase the spread of these diseases in the country. Thus, in this study, we gathered a data set summarizing occurrences of Ae. caspius, Ae. detritus and Cx. pipiens in the country, and generated model prediction for their potential distribution under both current and future (2050) climate conditions, as a proxy to identify regions at-risk of RVF and WNV probable expansion. We found that the north-western regions (where the population is most concentrated), specifically along the Atlantic coastline, are highly suitable for Ae. caspius, Ae. detritus and Cx. pipiens, under present-day conditions. Future model scenarios anticipated possible range changes for the three mosquitoes under all climatic assumptions. All of the studied species are prospected to gain new areas that are currently not suitable, even under the most optimist scenario, thus placing additional human populations at risk. Our maps and predictions offer an opportunity to strategically target surveillance and control programmes. Public health officials, entomological surveillance and control delegation must augment efforts and continuously monitor these areas to reduce and minimize human infection risk.
The role of climate driving zoonotic diseases’ population dynamics has typically been addressed via retrospective analyses of national aggregated incidence records. A central question in epidemiology has been whether seasonal and interannual cycles are driven by climate variation or generated by socioeconomic factors. Here, we use compartmental models to quantify the role of rainfall and temperature in the dynamics of snakebite, which is one of the primary neglected tropical diseases. We took advantage of space-time datasets of snakebite incidence, rainfall, and temperature for Colombia and combined it with stochastic compartmental models and iterated filtering methods to show the role of rainfall-driven seasonality modulating the encounter frequency with venomous snakes. Then we identified six zones with different rainfall patterns to demonstrate that the relationship between rainfall and snakebite incidence was heterogeneous in space. We show that rainfall only drives snakebite incidence in regions with marked dry seasons, where rainfall becomes the limiting resource, while temperature does not modulate snakebite incidence. In addition, the encounter frequency differs between regions, and it is higher in regions where Bothrops atrox can be found. Our results show how the heterogeneous spatial distribution of snakebite risk seasonality in the country may be related to important traits of venomous snakes’ natural history.
Climate change is drastically altering the frequency, duration, and severity of compound drought-heatwave (CDHW) episodes, which present a new challenge in environmental and socioeconomic sectors. These threats are of particular importance in low-income regions with growing populations, fragile infrastructure, and threatened ecosystems. This review synthesizes emerging progress in the understanding of CDHW patterns in Brazil while providing insights about the impacts on fire occurrence and public health. Evidence is mounting that heatwaves are becoming increasingly linked with droughts in northeastern and southeastern Brazil, the Amazonia, and the Pantanal. In those regions, recent studies have begun to build a better understanding of the physical mechanisms behind CDHW events, such as the soil moisture-atmosphere coupling, promoted by exceptional atmospheric blocking conditions. Results hint at a synergy between CDHW events and high fire activity in the country over the last decades, with the most recent example being the catastrophic 2020 fires in the Pantanal. Moreover, we show that HWs were responsible for increasing mortality and preterm births during record-breaking droughts in southeastern Brazil. This work paves the way for a more in-depth understanding on CDHW events and their impacts, which is crucial to enhance the adaptive capacity of different Brazilian sectors.
The gradual increase in temperatures and changes in relative humidity, added to the aging and socioeconomic conditions of the population, may represent problems for public health, given that future projections predict even more noticeable changes in the climate and the age pyramid, which require analyses at an appropriate spatial scale. To our knowledge, an analysis of the synergic effects of several climatic and socioeconomic conditions on hospital admissions and deaths by cardiorespiratory and mental disorders has not yet been performed in Brazil. Statistical analyses were performed using public time series (1996-2015) of daily health and meteorological data from 16 metropolitan regions (in a subtropical climate zone in South America). Health data were stratified into six groups according to gender and age ranges (40-59; 60-79; and ≥80 years old) for each region. For the regression analysis, two distributions (Poisson and binomial negative) were tested with and without zero adjustments for the complete series and percentiles. Finally, the relative risks were calculated, and the effects based on exposure-response curves were evaluated and compared among regions. The negative binomial distribution fit the data best. High temperatures and low relative humidity were the most relevant risk factors for hospitalizations for cardiovascular diseases (lag = 0), while minimum temperatures were important for respiratory diseases (lag = 2 or 3 days). Temperature extremes, both high and low, were the most important risk factors for mental illnesses at lag 0. Groups with people over 60 years old presented higher risks for cardiovascular and respiratory diseases, while this was observed for the adult group (40-59 years old) in relation to mental disorders. In general, no major differences were found in the results between men and women. However, regions with higher urbanization levels presented risks, mainly for respiratory diseases, while the same was observed for cardiovascular diseases for regions with lower levels of urbanization. The Municipal Human Development Index is an important factor for the occurrence of diseases and deaths for all regions, depending on the evaluated group, representing high risks for health outcomes (the value for hospitalization for cardiovascular diseases was 1.6713 for the female adult group in the metropolitan region Palmas, and the value for hospitalization for respiratory diseases was 1.7274 for the female adult group in the metropolitan region Campo Mourão). In general, less developed regions have less access to adequate health care and better living conditions.
BACKGROUND: There is an urgent need for more information about the climate change impact on health in order to strengthen the commitment to tackle climate change. However, few studies have quantified the health impact of climate change in Brazil and in the Latin America region. In this paper, we projected the impacts of temperature on cardiovascular (CVD) mortality according to two climate change scenarios and two regionalized climate model simulations in Brazilian cities. METHODS: We estimated the temperature-CVD mortality relationship in 21 Brazilian cities, using distributed lag non-linear models in a two-stage time-series analysis. We combined the observed exposure-response functions with the daily temperature projected under two representative concentration pathways (RCP), RCP8.5 and RCP4.5, and two regionalized climate model simulations, Eta-HadGEM2-ES and Eta-MIROC5. RESULTS: We observed a trend of reduction in mortality related to low temperatures and a trend of increase in mortality related to high temperatures, according to all the investigated models and scenarios. In most places, the increase in mortality related to high temperatures outweighed the reduction in mortality related to low temperatures, causing a net increase in the excess temperature-related mortality. These trends were steeper according to the higher emission scenario, RCP8.5, and to the Eta-HadGEM2-ES model. According to RCP8.5, our projections suggested that the temperature-related mortality fractions in 2090-99 compared to 2010-2019 would increase by 8.6% and 1.7%, under Eta-HadGEM2-ES and Eta-MIROC5, respectively. According to RCP4.5, these values would be 0.7% and -0.6%. CONCLUSIONS: For the same climate model, we observed a greater increase trend in temperature-CVD mortality according to RCP8.5, highlighting a greater health impact associated with the higher emission scenario. Our results may be useful to support public policies and strategies for mitigation of and adaptation to climate change, particularly in the health sector.
BACKGROUND: Extreme temperatures may lead to adverse pregnancy and birth outcomes, including low birthweight. Studies on the impact of temperature on birthweight have been inconclusive due to methodological challenges related to operationalizing temperature exposure, the definitions of exposure windows, accounting for gestational age, and a limited geographic scope. METHODS: We combined data on individual-level term live births (N≈15 million births) from urban areas in Brazil, Chile, and Mexico from 2010 to 2015 from the SALURBAL study (Urban Health in Latin America) with high-resolution daily air temperature data and computed average ambient temperature for every month of gestation for each newborn. Associations between full-term birthweight and average temperature during gestation were analyzed using multi-level distributed lag non-linear models that adjusted for newborn’s sex, season of conception, and calendar year of child’s birth; controlled for maternal age, education, partnership status, presence of previous births, and climate zone; and included a random term for the sub-city of mother’s residence. FINDINGS: Higher temperatures during the entire gestation are associated with lower birthweight, particularly in Mexico and Brazil. The cumulative effect of temperature on birthweight is mostly driven by exposure to higher temperatures during months 7-9 of gestation. Higher maternal education can attenuate the temperature-birthweight associations. INTERPRETATION: Our work shows that climate-health impacts are likely to be context- and place-specific and warrants research on temperature and birthweight in diverse climates to adequately anticipate global climate change. Given the high societal cost of suboptimal birthweight, public health efforts should be aimed at diminishing the detrimental effect of higher temperatures on birthweight. FUNDING: The Wellcome Trust.
Climate change and urbanization are rapidly increasing human exposure to extreme ambient temperatures, yet few studies have examined temperature and mortality in Latin America. We conducted a nonlinear, distributed-lag, longitudinal analysis of daily ambient temperatures and mortality among 326 Latin American cities between 2002 and 2015. We observed 15,431,532 deaths among ≈2.9 billion person-years of risk. The excess death fraction of total deaths was 0.67% (95% confidence interval (CI) 0.58-0.74%) for heat-related deaths and 5.09% (95% CI 4.64-5.47%) for cold-related deaths. The relative risk of death was 1.057 (95% CI 1.046-1.067%) per 1 °C higher temperature during extreme heat and 1.034 (95% CI 1.028-1.040%) per 1 °C lower temperature during extreme cold. In Latin American cities, a substantial proportion of deaths is attributable to nonoptimal ambient temperatures. Marginal increases in observed hot temperatures are associated with steep increases in mortality risk. These risks were strongest among older adults and for cardiovascular and respiratory deaths.
BACKGROUND: In Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality. OBJECTIVES: Explore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities. METHODS: The dependent variables quantify city-specific associations between temperature and mortality: heat- and cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 °C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level. RESULTS: We find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality. DISCUSSION: Evidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.
Changes in climatic patterns are expected to have significant effects on health and wellbeing. However, the literature on the effect of climate on subjective wellbeing remains scant and existing studies focus mostly on developed countries or cross-country analyses. This paper aims to identify the relationship between climate conditions on happiness after controlling for individual and social characteristics. Ecuador, a geographically fragmented country with varying climate conditions across municipalities, constitutes an ideal case study to assess the effect of climate variables on happiness. We employ a cross-section analysis to identify the effect of temperature, precipitation and humidity on happiness. The paper shows that climate conditions constitute an important determinant of people’s subjective wellbeing. The results also suggest that income and education attenuate the effect of temperature on happiness and that substantial differences are observed depending on whether places are hot/humid or cold/dry.
Extreme heat events result in higher indoor temperatures in buildings, increased energy consumption, and more frequent health problems, mainly between the children, the elderly over 65, and vulnerable low-income people. The indoor environment plays a key role in reducing the effects of extreme heat events. While the benefits of passive cooling measures on thermal and environmental aspects are well known, their effects on resilience are less well explored. This paper aims at studying the indoor environment in low-income housing from the energy and heat resilience points of view, during extreme hot periods, together with possible passive cooling measures to be applied in the houses in order to improve both, heat resilience and energy efficiency. A low-income neighbourhood in La Pampa, central Argentina, was selected as a case study. Transient thermal simulation, electricity consumption bills obtained from the Energy Company, and health statistics from the data-base of the nearby hospital were used. We conclude that the houses are not capable to manage hot/heat wave periods in a resilient way because of their energy inefficient design. Moreover, the cooling equipment is sub-used due to economic reasons. Indoor temperatures exceeded 33 degrees C and Heat Index reached “Extreme caution” health risk level. Sudden changes in the meteorological conditions seems to increase the number of consultations of health disorders previous or after the hot periods. The best set of passive strategies is to favour night ventilation together with shading of the envelope (i.e., by trees, climbing plants, green walls, or by installing ventilated opaque facades) and an improved roof (light colour coating and addition of thermal insulation). These strategies could both, improve the heat resilience and the thermal behavior of the indoor environment while reducing the electricity consumption in the hottest months of summer. (C) 2020 Elsevier B.V. All rights reserved.
Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.
Complete savannization of the Amazon Basin would enhance the effects of climate change on local heat exposure and pose a risk to human health, according to climate model projections. Land use change and deforestation can influence local temperature and climate. Here we use a coupled ocean-atmosphere model to assess the impact of savannization of the Amazon Basin on the wet-bulb globe temperature heat stress index under two climate change scenarios (RCP4.5 and RCP8.5). We find that heat stress exposure due to deforestation was comparable to the effect of climate change under RCP8.5. Our findings suggest that heat stress index could exceed the human adaptation limit by 2100 under the combined effects of Amazon savannization and climate change. Moreover, we find that risk of heat stress exposure was highest in Northern Brazil and among the most socially vulnerable. We suggest that by 2100, savannization of the Amazon will lead to more than 11 million people will be exposed heat stress that poses an extreme risk to human health under a high emission scenario.
The aim of this study was to evaluate heat exposure, dehydration, and kidney function in rice workers over the course of three months, in Guanacaste, Costa Rica. We collected biological and questionnaire data across a three-month-period in male field (n = 27) and other (n = 45) workers from a rice company where chronic kidney disease of unknown origin (CKDu) is endemic. We used stepwise forward regression to determine variables associated with estimated glomerular filtration rate eGFR at enrollment and/or change in eGFR, and Poisson regression to assess associations with incident kidney injury (IKI) over the course of three months. Participants were 20−62 years old (median = 40 in both groups). Dehydration was common (≥37%) in both groups, particularly among other workers at enrollment, but field workers were more exposed to heat and had higher workloads. Low eGFR (<60 mL/min/1.73 m2) was more prevalent in field workers at enrollment (19% vs. 4%) and follow-up (26% vs. 7%). Field workers experienced incident kidney injury (IKI) more frequently than other workers: 26% versus 2%, respectively. Age (β = −0.71, 95%CI: −1.1, −0.4), current position as a field worker (β = −2.75, 95%CI: −6.49, 0.99) and past work in construction (β = 3.8, 95%CI: −0.1, 7.6) were included in the multivariate regression model to explain eGFR at enrollment. The multivariate regression model for decreased in eGFR over three month included current field worker (β = −3.9, 95%CI: −8.2, 0.4), current smoking (β= −6.2, 95%CI: −13.7−1.3), dehydration (USG ≥ 1.025) at both visits (β= −3.19, 95%CI: −7.6, 1.2) and pain medication at follow-up (β= −3.2, 95%CI: −8.2, 1.95). Current fieldwork [IR (incidence rate) = 2.2, 95%CI 1.1, 5.8) and being diabetic (IR = 1.8, 95%CI 0.9, 3.6) were associated with IKI. Low eGFR was common in field workers from a rice company in Guanacaste, and being a field worker was a risk factor for IKI, consistent with the hypothesis that occupational heat exposure is a critical risk factor for CKDu in Mesoamerica.
Extreme weather conditions, including intense heat stress due to higher temperatures, could trigger an increase in mortality risk. One way to evaluate the increase in mortality risk due to higher temperatures is the high risk warming (HRW) index, which evaluates the difference between the future and base period of a given percentile of daily maximum temperature (Tmax). Another is to calculate the future increase in the number of days over the temperature of such percentile, named high risk days (HRD) index. Previous studies point to the 84th percentile as the optimum temperature. Thus, this study aims to evaluate HRW and HRD indexes in Ecuador from 2011 to 2070 over the three natural climate zones, e.g., Coast, Andes, and Amazon. This climate analysis is based on historical data from meteorological stations and projections from CSIRO-MK36, GISS-E2, and IPSL-CM5A-MR, CMIP5 global climate models with dynamical scale reduction through weather research forecasting (WRF). The representative concentration pathways (RCPs), 8.5, were considered, which are related to the highest increases in future temperature. The results indicate that HRW and HRD will experience a larger increase in the period 2041-2070 compared with the period 1980-2005; in particular, these two indices will have a progressively increasing trend from 2011 onward. Specifically, the HRW calculated from the CMIP5 models for all stations is expected to grow from 0.6 degrees C to 1.4 degrees C and 1.8 degrees C to 4.6 degrees C for 2010-2040 and 2041-2070, respectively. Also, it is expected that the HRD for all stations will increase from 42 to 74 and 120 to 227 warming days for 2011-2040 and 2041-2070, respectively. The trends derived using Sen’s slope test show an increase in the HRW between 0.5 degrees C and 0.9 degrees C/decade and of the HRD between 2.88 and 4.9 days/decade since 1985. These results imply a high increase in heat-related mortality risks related to climate change in Ecuador. In terms of spatial distribution, three Ecuadorian regions experienced more critical temperature conditions with higher values of HRW and HRD for 2070. As a response to the increased frequency trends of warming periods in tropical areas, urgent measures should be taken to review public policies and legislation to mitigate the impacts of heat as a risk for human health in Ecuador.
An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. To explore this relationship, we assessed trends in maximum and minimum temperatures during harvest months between 1973 and 2014 as well as in the number of days during the harvest season for which the maximum temperature surpassed 35 °C. Data were collected at a weather station at a Nicaraguan sugar company where large numbers of workers have been affected by CKDu. Monthly averages of the daily maximum temperatures between 1996 and 2014 were also compared to concurrent weather data from eight Automated Surface Observing System Network weather stations across Nicaragua. Our objectives were to assess changes in temperature across harvest seasons, estimate the number of days that workers were at risk of heat-related illness and compare daily maximum temperatures across various sites in Nicaragua. The monthly average daily maximum temperature during the harvest season increased by 0.7 °C per decade between 1973 and 1990. The number of days per harvest season with a maximum temperature over 35 °C increased by approximately five days per year between 1974 and 1990, from 32 days to 114 days. Between 1991 and 2013, the number of harvest days with a maximum temperature over 35 °C decreased by two days per year, and the monthly average daily maximum temperature decreased by 0.3 °C per decade. Comparisons with weather stations across Nicaragua demonstrate that this company is located in one of the consistently hottest regions of the country.
Climate change has increased heat exposure in many parts of the tropics, negatively impacting outdoor worker productivity and health. Although it is known that tropical deforestation is associated with local warming, the extent to which this additional heat exposure affects people across the tropics is unknown. In this modeling study, we combine worker health guidelines with satellite, reanalysis, and population data to investigate how warming associated with recent deforestation (2003-2018) affects outdoor working conditions across low-latitude countries, and how future global climate change will magnify heat exposure for people in deforested areas. We find that the local warming from 15 years of deforestation was associated with losses in safe thermal working conditions for 2.8 million outdoor workers. We also show recent large-scale forest loss was associated with particularly large impacts on populations in locations such as the Brazilian states of Mato Grosso and Para ‘. Future global warming and additional forest loss will magnify these impacts.
BACKGROUND: Mesoamerica is severely affected by an epidemic of Chronic Kidney Disease of non-traditional origin (CKDnt), an epidemic with a marked variation within countries. We sought to describe the spatial distribution of CKDnt in Mesoamerica and examine area-level crop and climate risk factors. METHODS: CKD mortality or hospital admissions data was available for five countries: Mexico, Guatemala, El Salvador, Nicaragua and Costa Rica and linked to demographic, crop and climate data. Maps were developed using Bayesian spatial regression models. Regression models were used to analyze the association between area-level CKD burden and heat and cultivation of four crops: sugarcane, banana, rice and coffee. RESULTS: There are regions within each of the five countries with elevated CKD burden. Municipalities in hot areas and much sugarcane cultivation had higher CKD burden, both compared to equally hot municipalities with lower intensity of sugarcane cultivation and to less hot areas with equally intense sugarcane cultivation, but associations with other crops at different intensity and heat levels were not consistent across countries. CONCLUSION: Mapping routinely collected, already available data could be a first step to identify areas with high CKD burden. The finding of higher CKD burden in hot regions with intense sugarcane cultivation which was repeated in all five countries agree with individual-level studies identifying heavy physical labor in heat as a key CKDnt risk factor. In contrast, no associations between CKD burden and other crops were observed.
Recife is recognized as the 16th most vulnerable city to climate change in the world. In addition, the city has levels of air pollutants above the new limits proposed by the World Health Organization (WHO) in 2021. In this sense, the present study had two main objectives: (1) To evaluate the health (and economic) benefits related to the reduction in mean annual concentrations of PM(10) and PM(2.5) considering the new limits recommended by the WHO: 15 µg/m(3) (PM(10)) and 5 µg/m(3) (PM(2.5)) and (2) To simulate the behavior of these pollutants in scenarios with increased temperature (2 and 4 °C) using machine learning. The averages of PM(2.5) and PM(10) were above the limits recommended by the WHO. The scenario simulating the reduction in these pollutants below the new WHO limits would avoid more than 130 deaths and 84 hospital admissions for respiratory or cardiovascular problems. This represents a gain of 15.2 months in life expectancy and a cost of almost 160 million dollars. Regarding the simulated temperature increase, the most conservative (+ 2 °C) and most drastic (+ 4 °C) scenarios predict an increase of approximately 6.5 and 15%, respectively, in the concentrations of PM(2.5) and PM(10), with a progressive increase in deaths attributed to air pollution. The study shows that the increase in temperature will have impacts on air particulate matter and health outcomes. Climate change mitigation and pollution control policies must be implemented for meeting new WHO air quality standards which may have health benefits.
This research concerns the identification of a pattern between the occurrence of extreme weather conditions, such as cold waves and heat waves, and hospitalization for cardiovascular diseases (CVDs), in the University Hospital of Santa Maria (HUSM) in southern Brazil between 2012 and 2017. The research employed the field experiment method to measure the biometeorological parameters associated with hospital admissions in different seasons, such as during extreme weather conditions such as a cold wave (CW) or a heat wave (HW), using five thermal comfort indices: physiologically equivalent temperature (PET), new standard effective temperature (SET), predicted mean vote (PMV), effective temperatures (ET), and effective temperature with wind (ETW). The hospitalizations were recorded as 0.775 and 0.726 admissions per day for the winter and entire study periods, respectively. The records for extreme events showed higher admission rates than those on average days. The results also suggest that emergency hospitalizations for heart diseases during extreme weather events occurred predominantly on days with thermal discomfort. Furthermore, there was a particularly high risk of hospitalization for up to seven days after the end of the CW. Further analyses showed that cardiovascular hospitalizations were higher in winter than in summer, suggesting that CWs are more life threatening in wintertime.
A thermal comfort index for the Northeast of Brazil was analyzed for two scenarios of climatic changes, A1B and A2, for 2021-2080, and compared with the reference period 1961-1990. A technique of regionalization was applied to rainfall, maximum and minimum temperature data from meteorological stations, obtained by statistical downscaling of projections from four global climate models. The results pointed to a significant reduction of rainfall and an increase of temperature for three different climatically homogeneous subregions. Regarding the thermal comfort index, the results point to an increase in days with heat discomfort between 2021 and 2080. In the northern portion, the higher percentage of days with heat discomfort will be significant since the first half of the period under appreciation, i.e., from 2021 to 2050. Conversely, in the eastern of northeastern Brazil, the increase of days with heat discomfort should happen in the period from 2051 to 2080, whereas the central-western part of the region, which, in the reference period, had recorded less than 1% of days with heat discomfort, might see an elevation of that percentage to 7% between 2021 and 2050, potentially reaching 48% of its days made uncomfortable by heat between 2051 and 2080.
This work is taken up to evaluate the relationship between the thermal comfort of spectators and athletes and the prevailing meteorological conditions during Rio 2016 Olympic Games. Empirical and physiological thermal comfort indices are calculated from data collected from an automatic weather station installed near the Olympic Stadium and interviews with the spectators. The study period was marked by a gradual rise in air temperature and by the occurrence of two significant weather events associated with wind gusts, which caused disturbances in some areas of the competitions. ET and NET were below the air temperature, indicating that both humidity and wind contributed to the reduction of the human-biometeorological indices. Majority of the interviewed persons reported comfortable sensation and weather conditions. These perceptions corroborate results of the thermal comfort indices calculated for these resting spectators. The comfort indices calculated for the athletes with high level of physical activity showed that PET estimated hotter thermal sensation those for the individuals at rest, indicating that the physical type of a person may strongly influence the thermal sensation and comfort during intense physical activity. Increasing trend observed in all the indices of human thermal comfort during the period of study shows consistency among them.
Dengue fever is a serious and growing public health problem in Latin America and elsewhere, intensified by climate change and human mobility. This paper reviews the approaches to the epidemiological prediction of dengue fever using the One Health perspective, including an analysis of how Machine Learning techniques have been applied to it and focuses on the risk factors for dengue in Latin America to put the broader environmental considerations into a detailed understanding of the small-scale processes as they affect disease incidence. Determining that many factors can act as predictors for dengue outbreaks, a large-scale comparison of different predictors over larger geographic areas than those currently studied is lacking to determine which predictors are the most effective. In addition, it provides insight into techniques of Machine Learning used for future predictive models, as well as general workflow for Machine Learning projects of dengue fever.
Leishmaniasis is a public health problem worldwide. We aimed to predict ecological niche models (ENMs) for visceral (VL) and cutaneous (CL) leishmaniasis and the sand flies involved in the transmission of leishmaniasis in São Paulo, Brazil. Phlebotomine sand flies were collected between 1985 and 2015. ENMs were created for each sand fly species using Maximum Entropy Species Distribution Modeling software, and 20 climatic variables were determined. Nyssomyia intermedia (Lutz & Neiva, 1912) and Lutzomyia longipalpis (Lutz & Neiva, 1912), the primary vectors involved in CL and VL, displayed the highest suitability across the various regions, climates, and topographies. L. longipalpis was found in the border of Paraná an area currently free of VL. The variables with the greatest impact were temperature seasonality, precipitation, and altitude. Co-presence of multiple sand fly species was observed in the cuestas and coastal areas along the border of Paraná and in the western basalt areas along the border of Mato Grosso do Sul. Human CL and VL were found in 475 of 546 (86.7%) and 106 of 645 (16.4%) of municipalities, respectively. Niche overlap between N. intermedia and L. longipalpis was found with 9208 human cases of CL and 2952 cases of VL. ENMs demonstrated that each phlebotomine sand fly species has a unique geographic distribution pattern, and the occurrence of the primary vectors of CL and VL overlapped. These data can be used by public authorities to monitor the dispersion and expansion of CL and VL vectors in São Paulo state.
INTRODUCTION: Zika virus (ZIKV) is primarily transmitted byAedes aegypti and Aedes albopictus mosquitoes between humans and non-human primates. Climate change may enhance virus reproduction in Aedes spp. mosquito populations, resulting in intensified ZIKV outbreaks. The study objective was to explore how an outbreak similar to the 2016 ZIKV outbreak in Brazil might unfold with projected climate change. METHODS: A compartmental infectious disease model that included compartments for humans and mosquitoes was developed to fit the 2016 ZIKV outbreak data from Brazil using least squares optimization. To explore the impact of climate change, published polynomial relationships between temperature and temperature-sensitive mosquito population and virus transmission parameters (mosquito mortality, development rate, and ZIKV extrinsic incubation period) were used. Projections for future outbreaks were obtained by simulating transmission with effects of projected average monthly temperatures on temperature-sensitive model parameters at each of three future time periods: 2011-2040, 2041-2070, and 2071-2100. The projected future climate was obtained from an ensemble of regional climate models (RCMs) obtained from the Co-Ordinated Regional Downscaling Experiment (CORDEX) that used Representative Concentration Pathways (RCP) with two radiative forcing values, RCP4.5 and RCP8.5. A sensitivity analysis was performed to explore the impact of temperature-dependent parameters on the model outcomes. RESULTS: Climate change scenarios impacted the model outcomes, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the duration of the ZIKV outbreak. Comparing 2070-2100 to 2016, using RCP4.5, the peak incidence was 22,030 compared to 10,473; the time to epidemic peak was 12 compared to 9 weeks, and the outbreak duration was 52 compared to 41 weeks. Comparing 2070-2100 to 2016, using RCP8.5, the peak incidence was 21,786 compared to 10,473; the time to epidemic peak was 11 compared to 9 weeks, and the outbreak duration was 50 compared to 41weeks. The increases are due to optimal climate conditions for mosquitoes, with the mean temperature reaching 28 °C in the warmest months. Under a high emission scenario (RCP8.5), mean temperatures extend above optimal for mosquito survival in the warmest months. CONCLUSION: Outbreaks of ZIKV in locations similar to Brazil are expected to be more intense with a warming climate. As climate change impacts are becoming increasingly apparent on human health, it is important to quantify the effect and use this knowledge to inform decisions on prevention and control strategies.
The way newspapers frame infectious disease outbreaks and their connection to the environmental determinants of disease transmission matter because they shape how we understand and respond to these major events. In 2017, following an unexpected climatic event named “El Niño Costero,” a dengue epidemic in Peru affected over seventy-five thousand people. This paper examines how the Peruvian news media presented dengue, a climate-sensitive disease, as a public health problem by analyzing a sample of 265 news stories on dengue from two major newspapers published between January 1st and December 31st of 2017. In analyzing the construction of responsibility for the epidemic, I find frames that blamed El Niño Costero’s flooding and Peru’s poorly prepared cities and public health infrastructure as the causes of the dengue outbreak. However, when analyzing frames that offer solutions to the epidemic, I find that news articles call for government-led, short-term interventions (e.g., fogging) that fail to address the decaying public health infrastructure and lack of climate-resilient health systems. Overall, news media tended to over-emphasize dengue as requiring technical solutions that ignore the root causes of health inequality and environmental injustice that allow dengue to spread in the first place. This case speaks to the medicalization of public health and to a long history of disease-control programs in the Global South that prioritized top-down technical approaches, turning attention away from the social and environmental determinants of health, which are particularly important in an era of climate change.
The 2030 Agenda for Sustainable Development is a plan of action for people, planet and prosperity. Thousands of years and centuries of colonisation have passed the precarious housing conditions, food insecurity, lack of sanitation, the limitation of surveillance, health care programs and climate change. Chagas disease continues to be a public health problem. The control programs have been successful in many countries in reducing transmission by T. cruzi; but the results have been variable. WHO makes recommendations for prevention and control with the aim of eliminating Chagas disease as a public health problem. Climate change, deforestation, migration, urbanisation, sylvatic vectors and oral transmission require integrating the economic, social, and environmental dimensions of sustainable development, as well as the links within and between objectives and sectors. While the environment scenarios change around the world, native vector species pose a significant public health threat. The man-made atmosphere change is related to the increase of triatomines’ dispersal range, or an increase of the mobility of the vectors from their sylvatic environment to man-made constructions, or humans getting into sylvatic scenarios, leading to an increase of Chagas disease infection. Innovations with the communities and collaborations among municipalities, International cooperation agencies, local governmental agencies, academic partners, developmental agencies, or environmental institutions may present promising solutions, but sustained partnerships, long-term commitment, and strong regional leadership are required. A new world has just opened up for the renewal of surveillance practices, but the lessons learned in the past should be the basis for solutions in the future.
Amazonia and the Northeast region of Brazil exhibit the highest levels of climate vulnerability in the country. While Amazonia is characterized by an extremely hot and humid climate and hosts the world largest rainforest, the Northeast is home to sharp climatic contrasts, ranging from rainy areas along the coast to semiarid regions that are often affected by droughts. Both regions are subject to extremely high temperatures and are susceptible to many tropical diseases. This study develops a multidimensional Extreme Climate Vulnerability Index (ECVI) for Brazilian Amazonia and the Northeast region based on the Alkire-Foster method. Vulnerability is defined by three components, encompassing exposure (proxied by seven climate extreme indicators), susceptibility (proxied by sociodemographic indicators), and adaptive capacity (proxied by sanitation conditions, urbanization rate, and healthcare provision). In addition to the estimated vulnerability levels and intensity, we break down the ECVI by indicators, dimensions, and regions, in order to explore how the incidence levels of climate-sensitive infectious and parasitic diseases correlate with regional vulnerability. We use the Grade of Membership method to reclassify the mesoregions into homoclimatic zones based on extreme climatic events, so climate and population/health data can be analyzed at comparable resolutions. We find two homoclimatic zones: Extreme Rain (ER) and Extreme Drought and High Temperature (ED-HT). Vulnerability is higher in the ED-HT areas than in the ER. The contribution of each dimension to overall vulnerability levels varies by homoclimatic zone. In the ER zone, adaptive capacity (39%) prevails as the main driver of vulnerability among the three dimensions, in contrast with the approximately even dimensional contribution in the ED-HT. When we compare areas by disease incidence levels, exposure emerges as the most influential dimension. Our results suggest that climate can exacerbate existing infrastructure deficiencies and socioeconomic conditions that are correlated with tropical disease incidence in impoverished areas.
BACKGROUND: The burden of gastrointestinal infections related to hot ambient temperature remains largely unexplored in low-to-middle income countries which have most of the cases globally and are experiencing the greatest impact from climate change. The situation is particularly true in Brazil. OBJECTIVES: Using medical records covering over 78 % of population, we quantify the association between high temperature and risk of hospitalization for gastrointestinal infection in Brazil between 2000 and 2015. METHODS: Data on hospitalization for gastrointestinal infection and weather conditions were collected from 1814 Brazilian cities during the 2000-2015 hot seasons. A time-stratified case-crossover design was used to estimate the association. Stratified analyses were performed by region, sex, age-group, type of infection and early/late study period. RESULTS: For every 5 °C increase in mean daily temperature, the cumulative odds ratio (OR) of hospitalization over 0-9 days was 1.22 [95 % confidence interval (CI): 1.21, 1.23] at the national level, reaching its maximum in the south and its minimum in the north. The strength of association tended to decline across successive age-groups, with infants < 1 year most susceptible. The effect estimates were similar for men and women. Waterborne and foodborne infections were more associated with high temperature than the 'others' and 'idiopathic' groups. There was no substantial change in the association over the 16-year study period. DISCUSSION: Our findings indicate that exposure to high temperature is associated with increased risk of hospitalization for gastrointestinal infection in the hot season, with the strength varying by region, population subgroup and infection type. There was no evidence to indicate adaptation to heat over the study duration.
Compound dry and hot events (CDHEs) have increased significantly and caused agricultural losses and adverse impacts on human health. It is thus critical to investigate changes in CDHEs and population exposure in responding to climate change. Based on the simulations of the Coupled Model Intercomparison Project Phase 6 (CMIP6), future changes in CDHEs and population exposure are estimated under four Shared Socioeconomic Pathways climate scenarios (SSPs) at first. And then the driving forces behind these changes are analyzed and discussed. The results show that the occurrence of CDHEs is expected to increase by larger magnitudes by the end of the 21st century (the 2080s) than that by the mid-21st century (2050s). Correspondingly, population exposure to CDHEs is expected to increase significantly responding to higher global warming (SSP3-7.0 and SSP5-8.5) but is limited to a relatively low level under the modest emission scenarios (SSP1-2.6). Globally, compared to 1985-2014, the exposure is expected to increase by 8.5 and 7.7 times under SSP3-7.0 and SSP5-8.5 scenarios by the 2080s, respectively. Regionally, Sahara has the largest increase in population exposure to CDHEs, followed by the Mediterranean, Northeast America, Central America, Africa, and Central Asia. The contribution of climate change to the increase of exposure is about 75% by the 2080s under the SSP5-8.5 scenarios, while that of population change is much lower. The conclusion highlights the importance and urgency of implementing mitigation strategies to alleviate the influence of CDHEs on human society.
Previous studies seldom consider humidity when examining heat-related extremes, and none have explored the effects of humidity on concurrent extremes of high heat stress and low river streamflow. Here, we present the first global picture of projected changes in compound lethal heat stress (T-h)-drought hazards (CHD) across 11,637 catchments. Our observational datasets show that atmospheric conditions (e.g., energy and vapor flux) play an important role in constraining the heat extremes, and that T-h (32% +/- 11%) yields a higher coincidence rate of global CHD than wet-bulb temperature (28% +/- 11%), driven by lower relative humidity (RH) and thus air dryness in T-h extremes. Our large model ensemble projects a 10-fold intensification of bivariate CHD risks by 2071-2100, mainly driven by increases in heat extremes. Future declines in RH, wind, snow, and precipitation in many regions are likely to exacerbate such water and weather-related hazards (e.g., drought and CHD).
Outdoor thermal comfort is significantly affected by climate, including macroclimate, local climate, and microclimate. However, the combined impacts of macroclimate and microclimate factors are less understood in previous thermal comfort studies. This paper employed 43 previ-ously published studies to comprehensively explore the impacts of macro-and micro-climatic factors on the outdoor thermal comfort. The relative importance of these influencing factors was assessed via five verified artificial neural network (ANN) models. For studies employing subjec-tive thermal indices which collected participants’ thermal perceptions, the neutral temperature expressed by physiologically equivalent temperature (PET) was found to be significantly corre-lated with macroclimate factors, especially the latitude and season. In studies employing only objective thermal indices, it was found that macroclimate factors, such as the latitude, distance from the sea, and altitude, have similar contribution to the outdoor thermal comfort as micro-climate factors, such as height to width ratio (H/W) and sky view factor. Results resonated with previous findings that outdoor comfort can be improved by changing urban geometry, vegetation, surfaces, and waterbodies. Future design and planning works should consider both macroclimate and microclimate factors and carefully design urban geometry and morphology to improve out-door thermal comfort for regions with disadvantageous macroclimates.
Exposure to extreme environmental heat or cold during military activities can impose severe thermal strain, leading to impairments in task performance and increasing the risk of exertional heat (including heat stroke) and cold injuries that can be life-threatening. Substantial individual variability in physiological tolerance to thermal stress necessitates an individualized approach to mitigate the deleterious effects of thermal stress, such as physiological monitoring of individual thermal strain. During heat exposure, measurements of deep-body (T(c)) and skin temperatures and heart rate can provide some indication of thermal strain. Combining these physiological variables with biomechanical markers of gait (in)stability may provide further insight on central nervous system dysfunction – the key criterion of exertional heat stroke (EHS). Thermal strain in cold environments can be monitored with skin temperature (peripheral and proximal), shivering thermogenesis and T(c). Non-invasive methods for real-time estimation of T(c) have been developed and some appear to be promising but require further validation. Decision-support tools provide useful information for planning activities and biomarkers can be used to improve their predictions, thus maximizing safety and performance during hot- and cold-weather operations. With better understanding on the etiology and pathophysiology of EHS, the microbiome and markers of the inflammatory responses have been identified as novel biomarkers of heat intolerance. This review aims to (i) discuss selected physiological and biomechanical markers of heat or cold strain, (ii) how biomarkers may be used to ensure operational readiness in hot and cold environments, and (iii) present novel molecular biomarkers (e.g., microbiome, inflammatory cytokines) for preventing EHS.
BACKGROUND: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. METHODS: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. FINDINGS: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. INTERPRETATION: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. FUNDING: Australian Research Council and the Australian National Health and Medical Research Council.
Construction sites continue to operate despite inclement weather, exposing workers to unpleasant working circumstances that can lead to various physical and mental health challenges. A thorough literature review yielded 21 challenges for hot weather conditions such as heat stroke, kidney disease, heat cramps, anxiety and depression, and 20 challenges for cold weather conditions like asthma, frostbite, musculoskeletal disorders and hallucination. Workers vulnerable to hot and cold weather based on demographic characteristics were identified. The study also provides 27 strategies to address the challenges experienced in hot and cold weather conditions. Some of these include ensuring that workers stay hydrated, scheduling sufficient rest periods and allowing workers to self-pace. The results of this study will help construction decision-makers and project managers understand the difficulties faced by a field workforce who labors in extreme working conditions on construction sites and will facilitate adoption of strategies that can prevent weather-related physical and mental health problems.
Association between short-term exposure to ambient air pollution and respiratory health is well documented. At the same time, it is widely known that extreme weather events intrinsically exacerbate air pollution impact. Particularly, hot weather and extreme temperatures during heat waves (HW) significantly affect human health, increasing risks of respiratory mortality and morbidity. Concurrently, a synergistic effect of air pollution and high temperatures can be combined with weather–air pollution interaction during wildfires. The purpose of the current review is to summarize literature on interplay of hot weather, air pollution, and respiratory health consequences worldwide, with the ultimate goal of identifying the most dangerous pollution agents and vulnerable population groups. A literature search was conducted using electronic databases Web of Science, Pubmed, Science Direct, and Scopus, focusing only on peer-reviewed Researchs published in English from 2000 to 2021. The main findings demonstrate that the increased level of PM10 and O3 results in significantly higher rates of respiratory and cardiopulmonary mortality. Increments in PM2.5 and PM10, O3, CO, and NO2 concentrations during high temperature episodes are dramatically associated with higher admissions to hospital in patients with chronic obstructive pulmonary disease, daily hospital emergency transports for asthma, acute and chronic bronchitis, and premature mortality caused by respiratory disease. Excessive respiratory health risk is more pronounced in elderly cohorts and small children. Both heat waves and outdoor air pollution are synergistically linked and are expected to be more serious in the future due to greater climate instability, being a crucial threat to global public health that requires the responsible involvement of researchers at all levels. Sustainable urban planning and smart city design could significantly reduce both urban heat islands effect and air pollution.
Purpose. Noise and heat are the most important physical hazardous agents that can affect physiological parameters. This study investigated the independent and combined effects of noise and heat exposure on human saliva cortisol and blood pressure. Methods. In this experimental study, 72 students were exposed to noise (at sound pressure levels of 45, 75, 85 and 95 dB(A)) and heat (at wet bulb globe temperatures [WBGTs] of 22, 29 and 34 °C) for 30 min. Samples of saliva and blood pressure were taken before and after each independent and combined exposure. Results. The results revealed that the average saliva cortisol and blood pressure in male and female subjects increased significantly after independent exposure to noise at 95 dB(A) and a WBGT of 34 °C. The combined exposure to noise and heat increased saliva cortisol and blood pressure, which was statistically significant for three combinations of 95 dB(A) at 34 °C, 95 dB(A) at 29 °C and 85 dB(A) at 34 °C. Conclusions. Combined exposure to noise and heat could affect saliva cortisol and blood pressure in both male and female groups. Further studies are recommended to capture other combinations of physical hazardous agents, especially in the field.
EPIDEMIOLOGY: An increasing number of inhabitants of Central America have developed a form of chronic kidney disease of unknown cause, named Mesoamerican nephropathy (MeN). Because similar epidemics have been reported in other parts of the world, such as Sri Lanka, India, Egypt, and Tunisia, this condition is currently called chronic kidney disease of uncertain origin (CKDu). CLINICAL PRESENTATION: This disease is characterized by minimal proteinuria, leukocyturia, hyperuricemia, hypokalemia reduced glomerular filtration rate, and renal tubular dysfunctions. Pathology: The kidneys manifest tubulo-interstitial nephritis and glomerulosclerosis. Electron microscopy shows large dimorphic lysosomes with dark electron-dense aggregates. Potential causes: The cause(s) of this disease remain largely unknown. Several hypotheses have been proposed including infections, dehydration, global warming, hyperuricemia, exposure to agro-chemicals or heavy metals, and genetic susceptibility. This review addresses a mounting body of evidence suggesting that the disease may be the result of exposure to a variety of water contaminants combined with volume depletion. THERAPY: Absent a clear understanding of the causes of the disease, no specific therapeutic interventions can be recommended. Preliminary studies suggest that reduction of working hours, frequent rest in shaded area, and administration of purified water may reduce the risk of CKDu.
Environmental factors such as climate change are now underway, which have substantial impacts on health and well-being of human kind, but still imprecisely quantified, implications for human health. At present, one of the most significant discussions among scientists worldwide is interdependency of escalating environmental risk factors and the increasing rates of noncommunicable diseases (NCDs), which are the leading cause of death and disability worldwide. Climate change also triggers the occurrence of NCDs through a variety of direct and indirect pathways. Therefore, it is likely that the interdependence of climate change, environmental risk factors, and NCDs as a whole poses great threat to global health. Hence, this paper aims to review the latest evidence on impacts of environmental risk factors on NCDs and methods used in establishing the cause or correlation of environmental risk factors and NCDs. The literature review leveraged online databases such as PubMed and Google Scholar with articles that matched keywords “climate change”, “environmental risk factors,” and “noncommunicable diseases”. This review shows that the burden of NCDs is increasing globally and attribution of environmental risk factors such as climate change is significant. Understanding the nature of the relation between NCDs and the environment is complex and has relied on evidence generated from multiple study designs. This paper reviews eight types of study designs that can be used to identify and measure causal and correlational nature between environment and NCDs. Future projections suggest that increases in temperatures will continue and also increase the public health burden of NCDs.
BACKGROUND: The adverse effects of heat on workers’ health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. METHODS: Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. RESULTS: Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4-2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25-44 years. CONCLUSIONS: The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies.
BACKGROUND: Increased rates of exclusive breastfeeding could significantly improve infant survival in low- and middle-income countries. There is a concern that increased hot weather due to climate change may increase rates of supplemental feeding due to infants requiring fluids, or the perception that infants are dehydrated. OBJECTIVE: To understand how hot weather conditions may impact infant feeding practices by identifying and appraising evidence that exclusively breastfed infants can maintain hydration levels under hot weather conditions, and by examining available literature on infant feeding practices in hot weather. METHODS: Systematic review of published studies that met inclusion criteria in MEDLINE, EMBASE, Global Health and Web of Science databases. The quality of included studies was appraised against predetermined criteria and relevant data extracted to produce a narrative synthesis of results. RESULTS: Eighteen studies were identified. There is no evidence among studies of infant hydration that infants under the age of 6months require supplementary food or fluids in hot weather conditions. In some settings, healthcare providers and relatives continue to advise water supplementation in hot weather or during the warm seasons. Cultural practices, socio-economic status, and other locally specific factors also affect infant feeding practices and may be affected by weather and seasonal changes themselves. CONCLUSION: Interventions to discourage water/other fluid supplementation in breastfeeding infants below 6 months are needed, especially in low-middle income countries. Families and healthcare providers should be advised that exclusive breastfeeding (EBF) is recommended even in hot conditions.
Climate change should be of special concern for the nephrologist as the kidney has a critical role in protecting the host from dehydration, but is also a favorite target of heat stress and dehydration. Here we discuss how rising temperatures and extreme heat events may affect the kidney. The most severe presentation of heat stress is heat stroke, which can result in severe electrolyte disturbance and both acute and chronic kidney disease. However, lesser levels of heat stress also have multiple effects, including exacerbating kidney disease and precipitating cardiovascular events in subjects with established kidney disease. Heat stress can also increase the risk for kidney stones, cause multiple electrolyte abnormalities, and induce both acute and chronic kidney disease. Recently there have been multiple epidemics of chronic kidney disease of uncertain etiology in various regions of the world, including Mesoamerica, Sri Lanka, India and Thailand. There is increasing evidence that climate change and heat stress may have a contributory role in these conditions, although other causes including toxins could also be involved. As climate change worsens, the nephrologist should prepare for an increase in diseases associated with heat stress and dehydration.
The climate change induced global warming, and in particular the increased frequency and intensity of heat waves, have been linked to health problems. Among them, scientific works have been reporting an increased incidence of neurological diseases, encompassing also neurodegenerative ones, such as Dementia of Alzheimer’s type, Parkinson’s Disease, and Motor Neuron Diseases. Although the increase in prevalence of neurodegenerative diseases is well documented by literature reports, the link between global warming and the enhanced prevalence of such diseases remains elusive. This is the main theme of our work, which aims to examine the connection between high temperature exposure and neurodegenerative diseases. Firstly, we evaluate the influence of high temperatures exposure on the pathophysiology of these disorders. Secondly, we discuss its effects on the thermoregulation, already compromised in affected patients, and its interference with processes of excitotoxicity, oxidative stress and neuroinflammation, all of them related with neurodegeneration. Finally, we investigate chronic versus acute stressors on body warming, and put forward a possible interpretation of the beneficial or detrimental effects on the brain, which is responsible for the incidence or progression of neurological disorders.
The wet-bulb temperature (WBT; T-W) comprehensively characterizes the temperature and humidity of the thermal environment and is a relevant variable to describe the energy regulation of the human body. The daily maximum TW can be effectively used in monitoring humid heat waves and their effects on health. Because meteorological stations differ in temporal resolution and are susceptible to non-climatic influences, it is difficult to provide complete and homogeneous long-term series. In this study, based on the sub-daily station-based HadISD (Met Office Hadley Centre Integrated Surface Database) dataset and integrating the NCEP-DOE reanalysis dataset, the daily maximum T-W series of 1834 stations that have passed quality control were homogenized and reconstructed using the method of Climatol. These stations form a new dataset of global station-based daily maximum T-W (GSDM-WBT) from 1981 to 2020. Compared with other station-based and reanalysis-based datasets of TW, the average bias was -0.48 and 0.34 degrees C, respectively. The GSDM-WBT dataset handles stations with many missing values and possible inhomogeneities, and also avoids the underestimation of the TW calculated from reanalysis data. The GSDM-WBT dataset can effectively support the research on global or regional extreme heat events and humid heat waves. The dataset is available at (Dong et al., 2022).
The unbearable heat waves that we are experiencing these days around the world are the result of increasing global warming, leading to heat stress and a constant health issue for the existing population. The thermoregulatory dysfunction of the human body due to climatological changes might result in fluid and electrolyte imbalance and transforms the human body from a normal physiological condition to a distorted pathological state. Subsequently, at one point in time, the human body may fail to handle its normal thermoregulatory function in the form of sudden unconsciousness and health defects. There might be associated dehydration that imposes renal damage, even to the extent to cause acute kidney injury (AKI), followed by chronic kidney disease (CKD). Thus, we cannot deny CKD as a major cause of death, mainly in patients having long-standing medical issues such as cardiac dysfunction, hypertension, diabetes, and obesity, heat stress nephropathy (HSN) might therefore become a major health problem. There is always a hopeful way in our hands, fortunately, which is of course prevention, that comes through government policies and human awareness. The present review brings out light on the alarming resultant facts of heat stress, dehydration, its pathology, molecular derangements, and recommendations for the prevention of heat stress nephropathy.
BACKGROUND: Heat stroke (HS) is an acute physical disorder that is associated with a high risk of organ dysfunction and even death. HS patients are usually treated symptomatically and conservatively; however, there remains a lack of specific and effective drugs in clinical practice. An analysis of publication contributions from institutions, journals and authors in different countries/regions was used to study research progress and trends regarding HS. METHODS: We extracted all relevant publications on HS between 1989 and 2019 from Web of Science. Using the Statistical Package for Social Science (SPSS, version 24) and the software GraphPad Prism 8, graphs were generated and statistical analyses were performed, while VOSviewer software was employed to visualize the research trends in HS from the perspectives of co-occurring keywords. RESULTS: As of April 14, 2020, we identified 1443 publications with a citation frequency of 5216. The United States accounted for the largest number of publications (36.2%) and the highest number of citations (14,410), as well as the highest H-index at 74. Although the sum of publications from China ranked second, there was a contradiction between the quantity and quality of publications. Furthermore, Medicine & Science in Sports & Exercise published the most papers related to HS, with Lin MT publishing the most papers in this field (112), while the review by Knochel JP received the highest citation frequency at 969. The keyword heat-stress appeared most recently, with an average appearing year of 2015.5. In the clinical research cluster, exertional heat-stroke was determined to be the hotspot, while ambient-temperature and heat waves were the new trends in the epidemiological research cluster. CONCLUSIONS: Corresponding to this important field, while the contributions of the publications from the United States were significant, the mismatch between the quantity and quality of publications from China must be examined. Moreover, it is hypothesized that clinical and epidemiological studies may become hotspots in the near future.
Policy and technology responses to increased temperatures in urban heat islands (UHIs) are discussed in a variety of research; however, their interaction is overlooked and understudied. This is an important oversight because policy and technology are often developed in isolation of each other and not in conjunction. Therefore, they have limited synergistic effects when aimed at solving global issues. To examine this aspect, we conducted a systematic literature review and synthesised 97 articles to create a conceptual structuring of the topic. We identified the following categories: (a) evidence base for policymaking including timescale analysis, effective policymaking instruments as well as decision support and scenario planning; (b) policy responses including landscape and urban form, green and blue area ratio, albedo enhancement policies, transport modal split as well as public health and participation; (c) passive technologies including green building envelopes and development of cool surfaces; and (d) active technologies including sustainable transport as well as energy consumption, heating, ventilation and air conditioning, and waste heat. Based on the findings, we present a framework to guide future research in analysing UHI policy and technology responses more effectively in conjunction with each other.
Rationale: Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. Objectives: In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. Methods: Regionally resolved effect estimates of unit increases in temperature on net all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. Results: Effect estimates and associated uncertainties varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1% to 1.1% per 1°C) were estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel and included the following: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socioeconomic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. Conclusions: This work provides an example of how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates.
BACKGROUND: The link between heat exposure and adverse health outcomes in workers is well documented and a growing body of epidemiological evidence from various countries suggests that extreme heat may also contribute to increased risk of occupational injuries (OI). Previously, there have been no comparative reviews assessing the risk of OI due to extreme heat within a wide range of global climate zones. The present review therefore aims to summarise the existing epidemiological evidence on the impact of extreme heat (hot temperatures and heatwaves (HW)) on OI in different climate zones and to assess the individual risk factors associated with workers and workplace that contribute to heat-associated OI risks. METHODS: A systematic review of published peer-reviewed articles that assessed the effects of extreme heat on OI among non-military workers was undertaken using three databases (PubMed, Embase and Scopus) without temporal or geographical limits from database inception until July 2020. Extreme heat exposure was assessed in terms of hot temperatures and HW periods. For hot temperatures, the effect estimates were converted to relative risks (RR) associated with 1 °C increase in temperature above reference values, while for HW, effect estimates were RR comparing heatwave with non-heatwave periods. The patterns of heat associated OI risk were investigated in different climate zones (according to Köppen Geiger classification) based on the study locations and were estimated using random-effects meta-analysis models. Subgroup analyses according to workers’ characteristics (e.g. gender, age group, experience), nature of work (e.g. physical demands, location of work i.e. indoor/outdoor) and workplace characteristics (e.g. industries, business size) were also conducted. RESULTS: A total of 24 studies published between 2005 and 2020 were included in the review. Among these, 22 studies met the eligibility criteria, representing almost 22 million OI across six countries (Australia, Canada, China, Italy, Spain, and USA) and were included in the meta-analysis. The pooled results suggested that the overall risk of OI increased by 1% (RR 1.010, 95% CI: 1.009-1.011) for 1 °C increase in temperature above reference values and 17.4% (RR 1.174, 95% CI: 1.057-1.291) during HW. Among different climate zones, the highest risk of OI during hot temperatures was identified in Humid Subtropical Climates (RR 1.017, 95% CI: 1.014-1.020) followed by Oceanic (RR 1.010, 95% CI: 1.008-1.012) and Hot Mediterranean Climates (RR 1.009, 95% CI: 1.008-1.011). Similarly, Oceanic (RR 1.218, 95% CI: 1.093-1.343) and Humid Subtropical Climates (RR 1.213, 95% CI: 0.995-1.431) had the highest risk of OI during HW periods. No studies assessing the risk of OI in Tropical regions were found. The effects of hot temperatures on the risk of OI were acute with a lag effect of 1-2 days in all climate zones. Young workers (age < 35 years), male workers and workers in agriculture, forestry or fishing, construction and manufacturing industries were at high risk of OI during hot temperatures. Further young workers (age < 35 years), male workers and those working in electricity, gas and water and manufacturing industries were found to be at high risk of OI during HW. CONCLUSIONS: This review strengthens the evidence on the risk of heat-associated OI in different climate zones. The risk of OI associated with extreme heat is not evenly distributed and is dependent on underlying climatic conditions, workers' attributes, the nature of work and workplace characteristics. The differences in the risk of OI across different climate zones and worker subgroups warrant further investigation along with the development of climate and work-specific intervention strategies.
BACKGROUND: Respiratory diseases are a leading cause of mortality and morbidity, and are exacerbated by air pollution and temperature. AIM: To assess published literature on the effect of air pollution modified by temperature on respiratory mortality and hospital admissions. METHODS: We identified 26,656 papers in PubMed and Web of Science, up to March 2021, and selected for analysis; inclusion criteria included observational studies, short-term air pollution, and temperature exposure. Air pollutants considered were particulate matter with a diameter of 2.5 μg/m(3), and 10 μg/m(3) (PM(2.5), and PM(10)), ozone (O(3)), and nitrogen dioxide (NO(2)). A random-effects model was used for our meta-analysis. RESULTS: For respiratory mortality we found that when the effect PM(10) is modified by high temperatures there is an increased pooled Odds Ratio [OR, 95% Confidence Interval (CI)] of 1.021 (1.008 to 1.034) and for the effect of O(3) the pooled OR is 1.006 (1.001-1.012) during the warm season. For hospital admissions, the effects of PM(10) and O(3) respectively, during the warm season found an increased pooled OR of 1.011 (0.999-1.024), and 1.015 (0.995-1.036). In our analysis for low temperatures, results were inconsistent. CONCLUSIONS: Exposure to air pollution when modified by high temperature is likely to increase the odds of respiratory mortality and hospital admissions. Analysis on the interaction effect of air pollution and temperature on health outcomes is a relatively new research field and results are largely inconsistent; therefore, further research is encouraged to establish a more conclusive conclusion on the strength and direction of this effect.
With climate change increasing global temperatures, more workers are exposed to hotter ambient temperatures that exacerbate risk for heat injury and illness. Continuously monitoring core body temperature (T(C)) can help workers avoid reaching unsafe T(C). However, continuous T(C) measurements are currently cost-prohibitive or invasive for daily use. Here, we show that Kenzen’s wearable device can accurately predict T(C) compared to gold standard T(C) measurements (rectal probe or gastrointestinal pill). Data from four different studies (n = 52 trials; 27 unique subjects; >4000 min data) were used to develop and validate Kenzen’s machine learning T(C) algorithm, which uses subject’s real-time physiological data combined with baseline anthropometric data. We show Kenzen’s T(C) algorithm meets pre-established accuracy criteria compared to gold standard T(C): mean absolute error = 0.25 °C, root mean squared error = 0.30 °C, Pearson r correlation = 0.94, standard error of the measurement = 0.18 °C, and mean bias = 0.07 °C. Overall, the Kenzen T(C) algorithm is accurate for a wide range of T(C), environmental temperatures (13-43 °C), light to vigorous heart rate zones, and both biological sexes. To our knowledge, this is the first study demonstrating a wearable device can accurately predict T(C) in real-time, thus offering workers protection from heat injuries and illnesses.
Rising temperature especially in summer is currently a hot debate. Scientists around the world have raised concerns about Heat Stress Assessment (HSA). It depends on the urban geometry, building materials, greenery, environmental factor of the region, psychological and behavioral factors of the inhabitants. Effective and accurate heat stress forecasts are useful for managing thermal comfort in the area. A widely used technique is artificial intelligence (AI), especially neural networks, which can be trained on weather variables. In this study, the five most important meteorological parameters such as air temperature, global radiation, relative humidity, surface temperature and wind speed are considered for HSA. System dynamic approach and a new version of the Gated Recurrent Unit (GRU) method is used for the prediction of the mean radiant temperature, the mean predicted vote and the physiological equivalent temperature. GRU is a promising technology, the results with higher accuracy are obtained from this algorithm. The results obtained from the model are validated with the output of reference software named Rayman. Django’s graphical user interface was created which allows users to select the range of thermal comfort scales based on their perception which depends on the age factor, local weather adaptability, and habit of tolerating the heat events. It also gives a warning to the user by color code about the level of discomfort which helps them to schedule and manage their outdoor activities. Future work consists of coupling this model with urban greenery factors to analyze the impact on the estimation of heat stress. Copyright (C) 2022 The Authors.
Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days’ minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.
We examine the effect of short-run weather shocks and long-run climate change on a variety of national health outcomes for a sample of 170 countries between 1960 and 2016. We find that changing climate conditions – especially in the form of increasing temperatures – lead to health losses (e.g., increased infant mortality and lower life expectancy) both in the short and long run. The adverse effect of increasing temperatures is much more strongly felt in relatively poor countries, indicating that these countries are more vulnerable. Predicted health losses in poor countries due to weather shocks and climate change have already been substantial. Future health losses especially in less developed countries will likely also be considerable unless adequate adaptation and mitigation efforts are undertaken. (C) 2020 Elsevier Ltd. All rights reserved.
Health risks associated with heatwaves and ozone pollution are projected to rise significantly under the effects of climate change. Although the literature has considered the future health risks of heatwaves and ozone pollution separately, the compound effects remain unexplored, and this could potentially impair risk-prevention plans. Here, using a model from the Coupled Model Intercomparison Project Phase 6 (CMIP6) and four shared socioeconomic pathway (SSPs) scenarios, we explore the global tempo-spatial trend and country disparity of compound-event days and population-exposure person-days. We find that compared with the baseline of 1995-2014, by 2071-2090 under the high-emission scenario of SSP3-7.0, an increased annual mean of 34.6 compound-event days and mean population-exposure of 93.5 million person-days is expected. Furthermore, lower-income countries are facing dramatically higher exposure compared with higher-income countries. These projections could contribute to developing targeted mitigation and adaptation plans.
INTRODUCTION: There is an increasing interest in understanding whether air pollutants modify the quantitative relationships between temperature and health outcomes. The results of available studies were, however, inconsistent. This study aims to sum up the current evidence and provide a comprehensive understanding of this topic. METHODS: We conducted an electronic search in PubMed (MEDLINE), EMBASE, Web of Science Core Collection, and ProQuest Dissertations and Theses. The modified Navigation Guide was applied to evaluate the quality and strength of evidence. We calculated pooled temperature-related mortality at low and high pollutant levels respectively, using the random-effects model. RESULTS: We identified 22 eligible studies, eleven of which were included in the meta-analysis. Significant effect modification was observed on heat effects for all-cause and non-accidental mortality by particulate matter with an aerodynamic diameter of <10 μm (PM(10)) and ozone (O(3)) (p < 0.05). The excess risks (ERs) for all-cause and non-accidental mortality were 5.4% (4.4%, 6.4%) and 6.3% (4.8%, 7.8%) at the low PM(10) level, 8.8% (7.5%, 10.1%) and 11.4% (8.7%, 14.2%) at the high PM(10) level, respectively. As for O(3), the ERs for all-cause and non-accidental mortality were 5.1% (3.9%, 6.3%) and 3.6% (0.1%, 7.2%) at the low O(3) level, 7.6% (6.3%, 9.0%) and 12.5% (4.7%, 20.9%) at the high O(3) level, respectively. Surprisingly, the heat effects on cardiovascular mortality were found to be lower at high carbon monoxide (CO) levels [ERs = 5.4% (3.9%, 6.9%)] than that at low levels [ERs = 9.4% (7.0%, 11.9%)]. The heterogeneity varied, but the results of sensitivity analyses were generally robust. Significant effect modification by air pollutants was not observed for heatwave or cold effects. CONCLUSIONS: PM(10) and O(3) modify the heat-related all-cause and non-accidental mortality, indicating that policymakers should consider air pollutants when establishing heat-health warning systems. Future studies with comparable designs and settings are needed.
Invasive fungal diseases are rare in individuals with intact immunity. This, together with the fact that there are only a few species that account for most mycotic diseases, implies a remarkable natural resistance to pathogenic fungi. Mammalian immunity to fungi rests on two pillars, powerful immune mechanisms and elevated temperatures that create a thermal restriction zone for most fungal species. Conditions associated with increased susceptibility generally reflect major disturbances of immune function involving both the cellular and humoral innate and adaptive arms, which implies considerable redundancy in host defense mechanisms against fungi. In general, tissue fungal invasion is controlled through either neutrophil or granulomatous inflammation, depending on the fungal species. Neutrophils are critical against Candida spp. and Aspergillus spp. while macrophages are essential for controlling mycoses due to Cryptococcus spp., Histoplasma spp., and other fungi. The increasing number of immunocompromised patients together with climate change could significantly increase the prevalence of fungal diseases.
Climate change is a worsening global crisis that will continue negatively impacting population health and well-being unless adaptation and mitigation interventions are rapidly implemented. Climate change-related cardiovascular disease is mediated by air pollution, increased ambient temperatures, vector-borne disease and mental health disorders. Climate change-related cardiovascular disease can be modulated by climate change adaptation; however, this process could result in significant health inequity because persons and populations of lower socioeconomic status have fewer adaptation options. Clear scientific evidence for climate change and its impact on human health have not yet resulted in the national and international impetus and policies necessary to slow climate change. As respected members of society who regularly communicate scientific evidence to patients, clinicians are well-positioned to advocate on the importance of addressing climate change. This narrative review summarizes the links between climate change and cardiovascular health, proposes actionable items clinicians and other healthcare providers can execute both in their personal life and as an advocate of climate policies, and encourages communication of the health impacts of climate change when counseling patients. Our aim is to inspire the reader to invest more time in communicating the most crucial public health issue of the 21st century to their patients.
An investigation is made on the environmental factors that may determine the seasonal cycle of respiratory affections. The driving role of temperature is examined, for its inverse synergism with the dissolution of oxygen in human plasma. Two best-fit equations are discussed to interpolate the experimental data about the oxygen solubility and the saturation levels reached at various temperatures, referring to the value of the basic alveolar temperature. A vulnerable condition is when the airways temperature is lowered, e.g. breathing cold air, or increasing the breathing frequency. In winter, the upper airways reach lower temperatures and greater oxygen concentrations; the opposite occurs in summer. As low temperatures increase the dissolution of oxygen in plasma, and blood oxidation favours viral activity, an explanation is given to the seasonality of infections affecting the respiratory system.
BACKGROUND: A warming climate throughout the 21st century makes ambient high temperature exposure a major threat to population health worldwide. Mitigating the health impact of high temperature requires a timely, comprehensive and reliable assessment of disease burden globally, regionally and temporally. AIM: Based on Global Burden of Disease (GBD) Study 2019, this study aimed to evaluate the disease burden attributable to high temperature from various epidemiology perspectives. METHODS: A three-stage analysis was undertaken to investigate the number and age-standardized rates of death and disability-adjusted life years (DALY) attributable to high temperature from GBD Study 2019. First, we reported the high temperature-related disease burden for the whole world and for different groups by gender, age, region, country and disease. Second, we examined the temporal trend of the disease burden attributable to high temperature from 1990 to 2019. Finally, we explored if and how the high temperature-related disease burden was modified by a number of country-level indicators. RESULTS: Globally, high temperature accounted for 0.54% of death and 0.46% of DALY in 2019, equating to the age-standardized rates of death and DALY (per 100,000 population) of 3.99 (95% uncertainty interval (UI): 2.88, 5.93) and 156.81 (95% UI: 107.98, 261.98), respectively. In 2019, the high temperature-related DALY and death rates were the highest for lower respiratory infections, although they showed a downward trend. In contrast, during 1990-2019, high temperature-related non-communicable diseases burden exhibited an upward trend. Meanwhile, the disease burden attributable to high temperature varied spatially, with the heaviest burden in regions with low sociodemographic index (SDI) and the lightest burden in regions with high SDI. In addition, high temperature-related disease burden appeared to be higher in a country with a higher population density and PM(2.5) concentration background but lower in a country with a higher density of greenness. CONCLUSION: This study for the first time provided a comprehensive understanding of the global disease burden attributable to high temperature, underscoring the policy priority to protect human health worldwide in the context of global warming with particular attention to vulnerable countries or regions as well as susceptible population and diseases.
Many have claimed that climate change is an imminent threat to humanity, but there is no way to verify such claims. This is concerning, especially given the prominence of some of these claims and the fact that they are confused with other well verified and settled aspects of climate science. This paper seeks to build an analytical framework to help explore climate change’s contribution to Global Catastrophic Risk (GCR), including the role of its indirect and systemic impacts. In doing so it evaluates the current state of knowledge about catastrophic climate change and integrates this with a suite of conceptual and evaluative tools that have recently been developed by scholars of GCR and Existential Risk. These tools connect GCR to planetary boundaries, classify its key features, and place it in a global policy context. While the goal of this paper is limited to producing a framework for assessment; we argue that applying this framework can yield new insights into how climate change could cause global catastrophes and how to manage this risk. We illustrate this by using our framework to describe the novel concept of possible’ global systems death spirals,’ involving reinforcing feedback between collapsing sociotechnological and ecological systems.
Homo sapiens is currently living in serious disharmony with the rest of the natural world. For our species to survive, and for our well-being, we must gather knowledge from multiple perspectives and actively engage in studies of planetary health. The enormous diversity of species, one of the most striking aspects of life on our planet, provides a source of solutions that have been developed through evolution by natural selection by animals living in extreme environments. The food system is central to finding solutions; our current global eating patterns have a negative impact on human health, driven climate change and loss of biodiversity. We propose that the use of solutions derived from nature, an approach termed biomimetics, could mitigate the effects of a changing climate on planetary health as well as human health. For example, activation of the transcription factor Nrf2 may play a role in protecting animals living in extreme environments, or animals exposed to heat stress, pollution and pesticides. In order to meet these challenges, we call for the creation of novel interdisciplinary planetary health research teams.
(1) Background: Research on heart rate variability has increased in recent years and the temperature has not been controlled in some studies assessing repeated measurements. This study aimed to analyze how heart rate variability may change based on environmental temperature during measurement depending on parasympathetic and sympathetic activity variations. (2) Methods: A total of 22 volunteers participated in this study divided into an experimental (n = 12) and control group (n = 10). Each participant was assessed randomly under two different environmental conditions for the experimental group (19 °C and 35 °C) and two identical environmental conditions for the control group (19 °C). During the procedure, heart rate variability measurements were carried out for 10 min. (3) Results: Significantly changes were observed for time and frequency domains as well as Poincaré plot variables after heat exposure (p < 0.05). These findings were not observed in the control group, whose conditions between measurements did not change. (4) Conclusions: The reduction of heart rate variability due to exposure to hot conditions appears to be produced mostly by a parasympathetic withdrawal rather than a sympathetic activation. Therefore, if consecutive measurements have to be carried out, these should always be done under the same temperature conditions.
The steady increase in global temperatures, resulting from the combustion of fossil fuels and the accumulation of greenhouse gases (GHG), continues to destabilize all ecosystems worldwide. Although annual emissions must halve by 2030 and reach net-zero by 2050 to limit some of the most catastrophic impacts associated with a warming planet, the world’s efforts to curb GHG emissions fall short of the commitments made in the 2015 Paris Agreement (1). To this effect, July 2021 was recently declared the hottest month ever recorded in 142 years (2). The ramifications of these changes on global temperatures are complex and further promote outdoor air pollution, pollen exposure, and extreme weather events. Besides worsening respiratory health, air pollution, promotes atopy and susceptibility to infections. The GHG effects on pollen affect the frequency and severity of asthma and allergic rhinitis. Changes in temperature, air pollution, and extreme weather events exert adverse multisystemic health effects and disproportionally affect disadvantaged and vulnerable populations. This article is an update for allergists and immunologists about the health impacts of climate change, already evident in our daily practices. It is also a call to action and advocacy, including integrating climate change-related mitigation, education, and adaptation measures to protect our patients and avert further injury to our planet.
We develop a model of population dynamics accounting for the impact of climate change on mortality through five channels (heat, diarrhoeal disease, malaria, dengue, undernutrition). An age-dependent mortality, which depends on global temperature increase, is introduced and calibrated. We consider three climate scenarios (RCP 6.0, RCP 4.5 and RCP 2.6) and find that the five risks induce deaths in the range from 135,000 per annum (in the near term) to 280,000 per annum (at the end of the century) in the RCP 6.0 scenario. We examine the number of life-years lost due to the five selected risks and find figures ranging from 4 to 9 million annually. These numbers are too low to impact the aggregate dynamics but they have interesting evolution patterns. The number of life years lost is constant (RCP 6.0) or decreases over time (RCP 4.5 and RCP 2.6). For the RCP 4.5 and RCP 2.6 scenarios, we find that the number of life-years lost is higher today than in 2100, due to improvements in generic mortality conditions, the bias of those improvements towards the young, and an ageing population. From that perspective, the present generation is found to bear the brunt of the considered climate change impacts.
Exposure to global warming can be dangerous for health and can lead to an increase in the prevalence of neurological diseases worldwide. Such an effect is more evident in populations that are less prepared to cope with enhanced environmental temperatures. In this work, we extend our previous research on the link between climate change and Parkinson’s disease (PD) to also include Alzheimer’s Disease and other Dementias (AD/D) and Amyotrophic Lateral Sclerosis/Motor Neuron Diseases (ALS/MND). One hundred and eighty-four world countries were clustered into four groups according to their climate indices (warming and annual average temperature). Variations between 1990 and 2016 in the diseases’ indices (prevalence, deaths, and disability-adjusted life years) and climate indices for the four clusters were analyzed. Unlike our previous work on PD, we did not find any significant correlation between warming and epidemiological indices for AD/D and ALS/MND patients. A significantly lower increment in prevalence in countries with higher temperatures was found for ALS/MND patients. It can be argued that the discordant findings between AD/D or ALS/MND and PD might be related to the different features of the neuronal types involved and the pathophysiology of thermoregulation. The neurons of AD/D and ALS/MND patients are less vulnerable to heat-related degeneration effects than PD patients. PD patients’ substantia nigra pars compacta (SNpc), which are constitutively frailer due to their morphology and function, fall down under an overwhelming oxidative stress caused by climate warming.
BACKGROUND: Climate change, including global warming, will cause poorer global health and rising numbers of environmental refugees. As neurological disorders account for a major share of morbidity and mortality worldwide, global warming is also destined to alter neurological practice; however, to what extent and by which mechanisms is unknown. We aimed to collect information about the effects of ambient temperatures and human migration on the epidemiology and clinical manifestations of neurological disorders. METHODS: We searched PubMed and Scopus from 01/2000 to 12/2020 for human studies addressing the influence of ambient temperatures and human migration on Alzheimer’s and non-Alzheimer’s dementia, epilepsy, headache/migraine, multiple sclerosis, Parkinson’s disease, stroke, and tick-borne encephalitis (a model disease for neuroinfections). The protocol was pre-registered with PROSPERO (2020 CRD42020147543). RESULTS: Ninety-three studies met inclusion criteria, 84 of which reported on ambient temperatures and nine on migration. Overall, most temperature studies suggested a relationship between increasing temperatures and higher mortality and/or morbidity, whereas results were more ambiguous for migration studies. However, we were unable to identify a single adequately designed study addressing how global warming and human migration will change neurological practice. Still, extracted data indicated multiple ways by which these aspects might alter neurological morbidity and mortality soon. CONCLUSION: Significant heterogeneity exists across studies with respect to methodology, outcome measures, confounders and study design, including lack of data from low-income countries, but the evidence so far suggests that climate change will affect the practice of all major neurological disorders in the near future. Adequately designed studies to address this issue are urgently needed, requiring concerted efforts from the entire neurological community.
Environmental pollution, accounting for both chemical and physical factors, is a major matter of concern due to its health consequences in both humans and animals. The release of greenhouse gases with the consequent increase in environmental temperature is acknowledged to have a major impact on the health of both animals and humans, in current and future generations. A large amount of evidence reports detrimental effects of acute heat stress on testis function, particularly on the spermatogenetic and steroidogenetic process, in both animal and human models, wich is largely related to the testis placement within the scrotal sac and outside the abdomen, warranting an overall scrotal temperature of 2°C-4°C lower than the core body temperature. This review will provide a thorough evaluation of environmental temperature’s effect on testicular function. In particular, basic concepts of body thermoregulation will be discussed together with available data about the association between testis damage and heat stress exposure. In addition, the possible association between global warming and the secular decline of testis function will be critically evaluated in light of the available epidemiological studies.
High ambient temperature-induced heat stress (HS) during pregnancy may affect the placental function and fetal development. Late gestation is a critical period of the developing fetal brain and intestine. The study aimed to investigate the effects of HS during late pregnancy on the function of placenta, fetal brain and intestine in a mouse model. We found that the number of stillborn fetal mice were increased due to maternal HS. Transcriptome analysis revealed that the expression of genes enriched in nutrients transport and metabolism of HS group were up-regulated in the placenta, but down-regulated in the fetal duodenum and jejunum. Interestingly, the concentration of triglyceride (TG) in the HS group was raised in the placenta, but reduced both in the fetal duodenum and jejunum compared with the thermal-neutral (TN) group. Additionally, maternal HS also reduced total cholesterol (TC) contents in the fetal duodenum. The mRNA expression and protein levels of placental fatty acid binding protein 2 and 4 (fabp2 and fabp4) were not affected by maternal HS, but the mRNA expression and protein levels of cluster of differentiation 36 (CD36) and diacylglycerol acyltransferase-2 (Dgat2) were decreased in the fetal intestine. Furthermore, maternal HS reduced the mRNA expression and protein levels of the placental 11beta-hydroxysteroid dehydrogenase type 2 (Hsd11b2) and 5-hydroxytryptamine receptor 1D (Htr1d). The concentrations of corticosterone and the expression of heat shock protein 90 beta family member 1 (hsp90b1), hypoxia up-regulated 1 (hyou1) and corticotropin releasing hormone receptor 1 (crhr1) enriched in response to glucocorticoids in the fetal brain were increased by maternal HS. Taken together, our findings demonstrated that maternal HS disrupted the placental glucocorticoid barrier and serotonin system associated with the raised corticosterone levels in the fetal brain, which might contribute to the decreased capacity of nutrients transport and metabolism in the fetal intestine.
Background Worldwide rising trend in infertility has been observed in the past few years with male infertility arising as a major problem. One main reason for the rise in male infertility cases is declining semen quality. It was found that any factor that affects semen quality can affect male fertility. There are several modifiable factors affecting semen quality including air pollution, use of pesticides and harmful chemicals, exposure to excessive heat, and can lead to decreased male fertility. Main body The present review focuses on some of these environmental factors that affect semen quality and hence, can cause male infertility. The literature from 2000 till June 2021 was searched from various English peer-reviewed journals and WHO fact sheets using the USA National Library of Medicine (PubMed) database, the regional portal of Virtual Health Library, and Scientific Electronic Library Online. The search terms used were: “Air pollution and male fertility”, “Chemicals and male infertility”, “Heat exposure and infertility”, “heavy metals and male fertility”. Conclusion Adverse environmental factors have a significant impact on semen quality, leading to decreased sperm concentration, total sperm count, motility, viability, and increased abnormal sperm morphology, sperm DNA fragmentation, ultimately causing male infertility. However, all these factors are modifiable and reversible, and hence, by mere changing of lifestyle, many of these risk factors can be avoided.
OBJECTIVE: The deterioration in environmental quality has an economic and social cost. The aim of this study is to analyze the impact of environmental factors on health expenditures in developing countries. METHOD: To analyze the relationship between environmental quality (air pollution and temperature) and health expenditure in thirty-three developing countries, the study uses system generalized method of moments (GMM) using data from 2000 to 2017. RESULTS: The results suggest a positive effect of both air pollution and temperature on health expenditure. However, the effect is highest for government health expenditure, followed by private and total health expenditure in the studied countries. The results further suggest that the impact of environmental factors is greater in higher-income countries when we divide the studied countries into two groups, i.e., higher- and lower-income countries. CONCLUSION: Our results are interesting and informative for the policy makers to design such policies to attain better environmental quality and social well-being. The increased healthcare expenditures due to increased air pollution and climate change necessitate for an efficient, reliable, affordable and modern energy policy by emphasizing the use of clean and renewable energy in these countries that ensure better health for the masses. Furthermore, a smart and sustainable environmentally friendly economic growth policy is necessary to ensure better health for the masses.
Insects are highly successful animals. They have limited ability to regulate their temperature and therefore will expand range in response to warming temperatures. Climate change and associated rising global temperature is impacting the range and distribution of stinging insects. There is evidence that many species are expanding range toward the poles, primarily in response to warming. With expanded distribution of stinging insects, increased interaction with humans is anticipated with consequently increased rates of sting-related reactions and need for intervention. This article focuses on evidence that insects are expanding their range in response to warming temperature, increasing likelihood of human interaction.
This study investigated physiological, cognitive and neuromuscular performances in firefighters after a structural live-fire scenario. Changes in vital signs, environmental parameters and cognitive and neuromuscular performance were measured before and after a live-fire training session in a closed environment, in conditions similar to those one could encounter in a structural fire. Very high ambient temperature peaks were reached during the 30-min sessions. After the session, the forehead temperature was increased by 0.5 °C, mean water body loss was 639 ml and the mean heart rate increase was 7.5 bpm. Mental calculation speed did not vary significantly, however we observed a reduction in reaction time. These findings demonstrated that after 30 min of exposure, heat stress had little impact on firemen. Stress activation seems beneficial after firefighting operations. Normal vital parameters should allow re-engagement for a second firefighting task. This result must be compared with longer exposures.
As current action remains insufficient to meet the goals of the Paris agreement let alone to stabilize the climate, there is increasing hope that solutions related to demand, services and social aspects of climate change mitigation can close the gap. However, given these topics are not investigated by a single epistemic community, the literature base underpinning the associated research continues to be undefined. Here, we aim to delineate a plausible body of literature capturing a comprehensive spectrum of demand, services and social aspects of climate change mitigation. As method we use a novel double-stacked expert-machine learning research architecture and expert evaluation to develop a typology and map key messages relevant for climate change mitigation within this body of literature. First, relying on the official key words provided to the Intergovernmental Panel on Climate Change by governments (across 17 queries), and on specific investigations of domain experts (27 queries), we identify 121 165 non-unique and 99 065 unique academic publications covering issues relevant for demand-side mitigation. Second, we identify a literature typology with four key clusters: policy, housing, mobility, and food/consumption. Third, we systematically extract key content-based insights finding that the housing literature emphasizes social and collective action, whereas the food/consumption literatures highlight behavioral change, but insights also demonstrate the dynamic relationship between behavioral change and social norms. All clusters point to the possibility of improved public health as a result of demand-side solutions. The centrality of the policy cluster suggests that political actions are what bring the different specific approaches together. Fourth, by mapping the underlying epistemic communities we find that researchers are already highly interconnected, glued together by common interests in sustainability and energy demand. We conclude by outlining avenues for interdisciplinary collaboration, synthetic analysis, community building, and by suggesting next steps for evaluating this body of literature.
Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991-2018. Across all study countries, we find that 37.0% (range 20.5-76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.
PURPOSE OF REVIEW: Climate change has manifested itself in multiple environmental hazards to human health. Older adults and those living with cardiovascular diseases are particularly susceptible to poor outcomes due to unique social, economic, and physiologic vulnerabilities. This review aims to summarize those vulnerabilities and the resultant impacts of climate-mediated disasters on the heart health of the aging population. RECENT FINDINGS: Analyses incorporating a wide variety of environmental data sources have identified increases in cardiovascular risk factors, hospitalizations, and mortality from intensified air pollution, wildfires, heat waves, extreme weather events, rising sea levels, and pandemic disease. Older adults, especially those of low socioeconomic status or belonging to ethnic minority groups, bear a disproportionate health burden from these hazards. The worldwide trends responsible for global warming continue to worsen climate change-mediated natural disasters. As such, additional investigation will be necessary to develop personal and policy-level interventions to protect the cardiovascular wellbeing of our aging population.
In this paper, we present a narrative review of primary research on the health impacts of extreme weather events in urban informal settlements published between 1990 and June 2021. We include 54 studies and examine the health impacts of extreme weather events and how these were determined. We find that these events impact health directly by causing mortality, injury and disease and through indirect pathways by impacting livelihoods, access to healthcare, coping strategies and adaptive capacity. Drawing on the social determinants of health framework to frame our analysis, we find that health impacts are determined by multiple intersecting factors, relating to individual circumstances, material conditions, health status, and political and socio-economic context. Consequently, vulnerability varies between and within informal settlements. Overall, we show that responding to and minimising these health impacts requires an intersectional approach to understand and address these contextual root causes of vulnerability.
As climate change increases the frequency and intensity of extreme weather events, governments and civil society organizations are making large investments in early warning systems (EWS) with the aim to avoid death and destruction from hydro-meteorological events. Early warning systems have four components: (1) risk knowledge, (2) monitoring and warning, (3) warning dissemi-nation and communication, and (4) response capability. While there is room to improve all four of these components, we argue that the largest gaps in early warning systems fall in the latter two categories: warning dissemination/communication and response capability. We illustrate this by examining the four components of early warning systems for the deadliest and costliest meteo-rological disasters of this century, demonstrating that the lack of EWS protection is not a lack of forecasts or warnings, but rather a lack of adequate communication and lack of response capa-bility. Improving the accuracy of weather forecasts is unlikely to offer major benefits without resolving these gaps in communication and response capability. To protect vulnerable groups around the world, we provide recommendations for investments that would close such gaps, such as improved communication channels, impact forecasts, early action policies and infrastructure. It is our hope that further investment to close these gaps can better deliver on the goal of reducing deaths and damages with EWS.
BACKGROUND: Previous studies have shown that extreme heat likely increases the risk of road injuries. However, the global burden of road injuries due to high temperature and contributing factors remain unclear. This study aims to characterize the global, regional and national burden of road injuries due to high temperature from 1990 to 2019. METHODS: Based on the Global Burden of Disease (GBD) study 2019, we obtained the numbers and age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates (ASDR) of the road injury due to high temperature at global, regional, and national levels from 1990 to 2019. The world is divided into five climate zones according to the average annual temperature of each country: tropical, subtropical, warm temperate, cold temperate, and boreal. We used the generalized additive models (GAM) to model the trends of road injuries globally and by region. RESULTS: Globally, between 1990 and 2019, the deaths of road injury attributable to high temperature increased significantly from 20,270 (95% uncertainty interval [UI], 7836 to 42,716) to 28,396 (95% UI, 13,311 to 51,178), and the DALYs increased from 1,169,309 (95% UI, 450,834 to 2,491,075) to 1,414,527 (95% UI, 658,347 to 2,543,613). But the ASMR and the ASDR slightly decreased by 8.49% and 13.16%, respectively. The burden of road injury death attributable to high temperature remained high in low SDI and tropical regions. In addition, road transport infrastructure investment per inhabitant is associated with the burden of road injuries attributable to high temperature. CONCLUSIONS: Globally, the ASMR and ASDR for road injuries attributable to high temperature decreased from 1990 to 2019, but the absolute death and DALYs continued to increase. Thus, concerning global warming, implementation of prevention and interventions to reduce road injuries from heat exposure should be stressed globally.
Compound hot extremes (ChotEs) that refer to continuous heats throughout days and nights are projected to increase, causing more serious impacts on human health than daytime or nighttime heats alone. Previous studies have focused on daytime heats, but the timing of substantial increase in ChotEs relative to natural variability, which is defined as the time of emergence (ToE) for ChotEs, remains unknown. Here we examine ToE for duration of summertime ChotEs from coupled model intercomparison project phase 6 climate model projections under two shared socioeconomic pathway scenarios (i.e., SSP245 and SSP585). We further quantify the cumulative fraction of areal and population exposed to the emergence at global and continental scales. We find that, without implementation of climate mitigation policies (i.e., SSP585), global mean ToE is around 2062 (with 16%-84% uncertainty range of 2048-2072). On the basis of the ToE for each grid cell, 80.7% (with uncertainty range of 64.2%-96.7%) of global lands will expose to the emergence by 2080. Such substantial increases in ChotEs will lead to 75.2% (66.8%-93%) of global population exposed to the emergence by the end of 21st century. A moderate mitigation (i.e., SSP245) can delay the ToE by over 14 years and, more importantly, reduce the global land areal and population exposures by 50.3% and 39.7% respectively. Regionally, northern Europe, central America and western North America benefit the most. Therefore, early action towards moderate development socioeconomic pathways can remarkably cut back the possibility of large population exposure to ChotEs and relevant impacts.
It is generally believed that global warming drives an increase in heatwaves, but these changes vary regionally. Projected trends of heatwaves and comparisons between observed and projected heatwave trends are poorly understood. We selected multiple characteristics of global heatwave events, including indicators on heat-related health impacts under historical and future scenarios from the NASA Earth Exchange/Global Daily Downscaled Projections (NEX-GDDP) dataset. We quantified the trends in the frequency, intensity, duration and peak temperature of heatwave events and identified heatwave hotspots that respond dramatically to radiative forcing. Future simulations suggest a four-fold increase in the duration of heatwaves by 2050s, spatially concentrated in central Africa, northern South America and Southeast Asia, and the maximum duration of single heatwave event will be up to 44 days under a high emission scenario. Accelerated increasing trends are also detected in intensity, total duration and temperature of heatwaves with up to 2-fold, 8-fold and 9-fold larger than the trends of the baseline period under the high emission scenario. Considering socioeconomic exposure to extreme heatwaves, we identified some hotspot areas in western Europe, eastern North America and northern China that will face greater potential risks in the coming future and therefore need to urgently strengthen their adaptation capacity.
Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been understudied, although-given children’s physiologic susceptibility, with smaller body surface-to-mass ratios, and many years of increasing temperatures ahead-there is an urgent need for better information to inform public health policies and clinical approaches. In this review, we aim to (1) identify pediatric morbidity outcomes previously associated with extreme heat, (2) to identify predisposing co-morbidities which may make children more susceptible to heat-related outcomes, and (3) to map the current body of available literature. A scoping review of the current full-text literature was conducted using the Arksey and O’Malley framework Int J Soc Res Methodol 8:19-32, (2015). Search terms for (1) pediatric population, (2) heat exposures, (3) ambient conditions, and (4) adverse outcomes were combined into a comprehensive PubMed and Medline literature search. Of the 1753 publications identified, a total of 20 relevant studies were ultimately selected based on selection criteria of relevance to US urban populations. Most identified studies supported positive associations between high extreme temperature exposures and heat-related illness, dehydration/electrolyte imbalance, general symptoms, diarrhea and digestion disorders, infectious diseases/infections, asthma/wheeze, and injury. Most studies found no association with renal disease, cardiovascular diseases, or diabetes mellitus. Results were mixed for other respiratory diseases and mental health/psychological disorders. Very few of the identified studies examined susceptibility to pre-existing conditions; Cystic Fibrosis was the only co-morbidity for which we found significant evidence. Further research is needed to understand the nuances of associations between extreme heat and specific outcomes-particularly how associations may vary by child age, sex, race/ ethnicity, community characteristics, and other pre-existing conditions.
Climate change is upon us, and it will have a major effect on both kidney disease and the nephrology practice. But the converse is also true: our treatment of kidney disease has an effect on the climate. Much attention has focused on how rising temperatures can lead to acute and CKD and health exacerbations in patients with established kidney disease. Climate change is also associated with rising air pollution from wildfires and industrial wastes and infectious diseases associated with flooding and changing habitats, all of which heighten the risk of acute and CKD. Less well recognized or understood are the ways nephrology practices, in turn, contribute to still more climate change. Hemodialysis, although lifesaving, can be associated with marked water usage (up to 600 L per dialysis session), energy usage (with one 4-hour session averaging as much as one fifth of the total energy consumed by a household per day), and large clinical wastes (with hemodialysis accounting for one third of total clinical medicine-associated waste). Of note, >90% of dialysis occurs in highly affluent countries, whereas dialysis is much less available in the poorer countries where climate change is having the highest effect on kidney disease. We conclude that not only do nephrologists need to prepare for the rise in climate-associated kidney disease, they must also urgently develop more climate-friendly methods of managing patients with kidney disease.
Extreme humid heat events have seen rapid increases globally in recent decades, but regional changes and higher-order temporal characteristics, such as interannual and intra-annual clustering, have not been widely explored. Using ERA5 reanalysis data from 1979 to 2019, we find increasing trends of varying magnitudes in extreme wet-bulb temperatures at the Intergovernmental Panel on Climate Change Sixth Assessment Report (IPCC AR6) regional scale. In many locations, interannual variations in extremes show a strong relationship with the El Nino-Southern Oscillation. The temporal proximity of precipitation events to humid heat days in arid regions suggests that local moisture effects may lead to clustering. Knowledge of these spatial and temporal patterns aids in understanding how potential heat stress is increasing, as well as facilitates the development of regionally specific adaptation and mitigation strategies for combating the associated societal impacts. Plain Language Summary Extreme humid heat, or the combination of high temperature and humidity, poses a more severe threat to human health than does dry heat alone. Though extremes are particularly dangerous, even moderate levels of humid heat can lead to a variety of health and socioeconomic effects. Motivated by the growing demand for regional, decision-relevant climate information, we calculate historical changes in the intensity of humid heat extremes in the regions used in the Intergovernmental Panel on Climate Change Sixth Assessment Report. Humid heat extremes have intensified in most regions, though some areas have experienced greater increases than others. The timing of extremes also affects their impacts, and thus we additionally analyze how humid heat extremes are distributed, both within the year and across all years. In many locations across the world, extreme humid heat is more common during strong El Nino episodes. In some typically dry regions, extremes tend to occur near each other within a given year and around the same time as rainfall events. Our results help advance the understanding of potential heat stress and the development of regionally specific strategies for combating its impacts.
Natural and human-made disasters can cause tremendous physical damage, societal change, and suffering. In addition to their effects on people, disasters have been shown to alter the microbial population in the area affected. Alterations for microbial populations can lead to new ecological interactions, with additional potentially adverse consequences for many species, including humans. Disaster-related stressors can be powerful forces for microbial selection. Studying microbial adaptation in disaster sites can reveal new biological processes, including mechanisms by which some microbes could become pathogenic and others could become beneficial (e.g., used for bioremediation). Here we survey examples of how disasters have affected microbiology and suggest that the topic of “disaster microbiology” is itself a new field of study. Given the accelerating pace of human-caused climate change and the increasing encroachment of the natural word by human activities, it is likely that this area of research will become increasingly relevant to the broader field of microbiology. Since disaster microbiology is a broad term open to interpretation, we propose criteria for what phenomena fall under its scope. The basic premise is that there must be a disaster that causes a change in the environment, which then causes an alteration to microbes (either a physical or biological adaptation), and that this adaptation must have additional ramifications.
Drowning and climate change are both significant global health threats, yet little research links climate change to drowning risk. Research into the epidemiology, risk factors and preventive strategies for unintentional drowning in high-income and in low-income and middle-income countries has expanded understanding, but understanding of disaster and extreme weather-related drowning needs research focus. As nation states and researchers call for action on climate change, its impact on drowning has been largely ignored. This state-of-the-art review considers existing literature on climate change as a contributor to changes in drowning risks globally. Using selected climate change-related risks identified by the World Meteorological Organization and key risks to the Sustainable Development Goals as a framework, we consider the drowning risks associated with heat waves, hydrometeorological hazards, drought and water scarcity, damaged infrastructure, marine ecosystem collapse, displacement, and rising poverty and inequality. Although the degree of atmospheric warming remains uncertain, the impact of climate change on drowning risk is already taking place and can no longer be ignored. Greater evidence characterising the links between drowning and climate change across both high-income and low-income and middle-income contexts is required, and the implementation and evaluation of drowning interventions must reflect climate change risks at a local level, accounting for both geographical variation and the consequences of inequality. Furthermore, collaboration between the injury prevention, disaster risk reduction and climate change mitigation sectors is crucial to both prevent climate change from stalling progress on preventing drowning and further advocate for climate change mitigation as a drowning risk reduction mechanism.
This scoping review provides an overview of the published literature, identifies research gaps, and summarises the current evidence of the association between elevated ambient temperature exposure during pregnancy and adverse maternal, foetal, and neonatal outcomes. Following the PRISMA extension for scoping reviews reporting guidelines, a systematic search was conducted on CINAHL, PubMed, and Embase and included original articles published in the English language from 2015 to 2020 with no geographical limitations. A total of seventy-five studies were included, conducted across twenty-four countries, with a majority in the USA (n = 23) and China (n = 13). Study designs, temperature metrics, and exposure windows varied considerably across studies. Of the eighteen heat-associated adverse maternal, foetal, and neonatal outcomes identified, pre-term birth was the most common outcome (n = 30), followed by low birth weight (n = 11), stillbirth (n = 9), and gestational diabetes mellitus (n = 8). Overall, papers reported an increased risk with elevated temperature exposures. Less attention has been paid to relationships between heat and the diverse range of other adverse outcomes such as congenital anomalies and neonatal mortality. Further research on these less-reported outcomes is needed to improve understanding and the effect size of these relationships with elevated temperatures, which we know will be exacerbated by climate change.
Many actions to reduce greenhouse gases (GHGs) in cities have benefits for environmental quality, public health, and equity. These local and immediate “co-benefits” can include cleaner air, expanded green space, improved physical activity, and reduced noise. However, progress incorporating co-benefits assessments into climate mitigation planning has been limited. Here, we capitalized on the new availability of climate action plans (CAPs) from dozens of C40 cities to explore the stated role of environmental quality, health, and equity in urban GHG mitigation planning. Specifically, we qualitatively reviewed how four topics-equity, exposure to environmental risk factors, health effects of climate change, and health co-benefits of GHG mitigation-were addressed in CAPs from 27 C40 member cities. The cities span Africa, Asia, Australia, Europe, North America, and South America. We found that more references pertained to exposures (57% of all identified references across the four topics) than to equity (21%), health co-benefits of GHG mitigation (15%), or health effects of climate change (7%). On average across all cities, five exposure categories represented the majority of exposure references: green space (23% of total coded exposure references), disasters (20%), physical activity (24%), heat (16%), and air quality (12%). Approximately two-thirds of health effects and health co-benefits references noted a link with health generally, without specificity to disease or other health outcome. Our results indicate that while environmental quality is commonly considered in CAPs, health effects of climate change and health co-benefits of GHG mitigation are mentioned less frequently. Future work should further develop methods to qualitatively and quantitatively assess health consequences of action and inaction to reduce GHG emissions, using approaches that are appropriate for and accessible to multiple levels of governments.
As global temperatures continue to rise, extreme heat events are becoming more frequent and intense. Extreme heat affects cardiovascular health as it is associated with a greater risk of adverse cardiovascular events, especially for adults with preexisting cardiovascular diseases. Nonetheless, the pathophysiology underlying the association between extreme heat and cardiovascular risk remains understudied. Furthermore, specific recommendations to mitigate the effects of extreme heat on cardiovascular health remain limited to guide clinical practice within the context of a warming climate. The overall objective of this review article is to raise awareness that extreme heat poses a risk for cardiovascular health. Specifically, the review discusses why cardiovascular healthcare professionals should care about extreme heat, how extreme heat affects cardiovascular health, and recommendations to minimise the cardiovascular consequences of extreme heat. Future research directions are also provided to further our understating of the cardiovascular health consequences of extreme heat. A better awareness and understanding of the cardiovascular consequences of extreme heat will help cardiovascular health professionals assess the risk and optimise the care of their patients exposed to an increasingly warm climate.
BACKGROUND: Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a well-established teratogen in animal studies, with a growing body of literature suggesting human pregnancies are similarly at risk. Characterization of extreme heat as a pregnancy risk is problematic due to nonstandard definitions of heat waves, and variable study designs. To better focus future research in this area, we conducted a scoping review to assess the effects of extreme heat on pregnancy outcomes. METHODS: A scoping review of epidemiological studies investigating gestational heat-exposure and published 2010 and 2020, was conducted with an emphasis on study design, gestational windows of sensitivity, adverse pregnancy outcomes and characterization of environmental temperatures. RESULTS: A sample of 84 studies was identified, predominantly set in high-income countries. Preterm birth, birthweight, congenital anomalies and stillbirth were the most common pregnancy outcome variables. Studies reported race/ethnicity and/or socioeconomic variables, however these were not always emphasized in the analysis. CONCLUSION: Use of precise temperature data by most studies avoided pitfalls of imprecise, regional definitions of heat waves, however inconsistent study design, and exposure windows are a significant challenge to systematic evaluation of this literature. Despite the high risk of extreme heat events and limited mitigation strategies in the global south, there is a significant gap in the epidemiological literature from these regions. Greater consistency in study design and exposure windows would enhance the rigor of this field.
PURPOSE OF REVIEW: With cardiovascular disease (CVD) being the top cause of deaths worldwide, it is important to ensure healthy cardiovascular aging through enhanced understanding and prevention of adverse health effects exerted by external factors. This review aims to provide an updated understanding of environmental influences on cardiovascular aging, by summarizing epidemiological and mechanistic evidence for the cardiovascular health impact of major environmental stressors, including air pollution, endocrine-disrupting chemicals (EDCs), metals, and climate change. RECENT FINDINGS: Recent studies generally support positive associations of exposure to multiple chemical environmental stressors (air pollution, EDCs, toxic metals) and extreme temperatures with increased risks of cardiovascular mortality and morbidity in the population. Environmental stressors have also been associated with a number of cardiovascular aging-related subclinical changes including biomarkers in the population, which are supported by evidence from relevant experimental studies. The elderly and patients are the most vulnerable demographic groups to majority environmental stressors. Future studies should account for the totality of individuals’ exposome in addition to single chemical pollutants or environmental factors. Specific factors most responsible for the observed health effects related to cardiovascular aging remain to be elucidated.
BACKGROUND: Heat exposure is an important but underappreciated risk factor contributing to cardiovascular disease. Warming temperatures might therefore pose substantial challenges to population health, especially in a rapidly aging population. To address a potential increase in the burden of cardiovascular disease, a better understanding of the effects of ambient heat on different types of cardiovascular disease and factors contributing to vulnerability is required, especially in the context of climate change. This study reviews the current epidemiological evidence linking heat exposures (both high temperatures and heatwaves) with cardiovascular disease outcomes, including mortality and morbidity. METHODS: In this systematic review and meta-analysis, we searched PubMed, Embase, and Scopus for literature published between Jan 1, 1990, and March 10, 2022, and evaluated the quality of the evidence following the Navigation Guide Criteria. We included original research on independent study populations in which the exposure metric was high temperatures or heatwaves, and observational studies using ecological time series, case crossover, or case series study designs comparing risks over different exposures or time periods. Reviews, commentaries, grey literature, and studies that examined only seasonal effects without explicitly considering temperature were excluded. The risk estimates were derived from included articles and if insufficient data were available we contacted the authors to provide clarification. We did a random-effects meta-analysis to pool the relative risk (RR) of the association between high temperatures and heatwaves and cardiovascular disease outcomes. The study protocol was registered with PROSPERO (CRD42021232601). FINDINGS: In total, 7360 results were returned from our search of which we included 282 articles in the systematic review, and of which 266 were eligible for the meta-analysis. There was substantial heterogeneity for both mortality (high temperatures: I(2)=93·6%, p<0·0001; heatwaves: I(2)=98·9%, p<0·0001) and morbidity (high temperatures: I(2)=98·8%, p<0·0001; heatwaves: I(2)=83·5%, p<0·0001). Despite the heterogeneity in environmental conditions and population dynamics among the reviewed studies, results showed that a 1°C increase in temperature was positively associated with cardiovascular disease-related mortality across all considered diagnoses. The overall risk of cardiovascular disease-related mortality increased by 2·1% (RR 1·021 [95%CI 1·020-1·023]), with the highest specific disease risk being for stroke and coronary heart disease. A 1°C temperature rise was also associated with a significant increase in morbidity due to arrhythmias and cardiac arrest and coronary heart disease. Our findings suggest heat exposure leads to elevated risk of morbidity and mortality for women, people 65 years and older, individuals living in tropical climates, and those in countries of lower-middle income. Heatwaves were also significantly associated with a 17% increase in risk of mortality (RR 1·117 [95% CI 1·093-1·141]), and increasing heatwave intensity with an increasing risk (RR 1·067 [95% CI 1·056-1·078] for low intensity, 1·088 [1·058-1·119] for middle intensity, and 1·189 [1·109-1·269] for high intensity settings). INTERPRETATION: This review strengthens the evidence on the increase in cardiovascular disease risk due to ambient heat exposures in different climate zones. The widespread prevalence of exposure to hot temperatures, in conjunction with an increase in the proportion of older people in the population, might result in a rise in poor cardiovascular disease health outcomes associated with a warming climate. Evidence-based prevention measures are needed to attenuate peaks in cardiovascular events during hot spells, thereby lowering the worldwide total heat-related burden of cardiovascular disease-related morbidity and death. FUNDING: Australian Research Council Discovery Program.
Links between heat exposure and congenital anomalies have not been explored in detail despite animal data and other strands of evidence that indicate such links are likely. We reviewed articles on heat and congenital anomalies from PubMed and Web of Science, screening 14,880 titles and abstracts in duplicate for articles on environmental heat exposure during pregnancy and congenital anomalies. Thirteen studies were included. Most studies were in North America (8) or the Middle East (3). Methodological diversity was considerable, including in temperature measurement, gestational windows of exposure, and range of defects studied. Associations were detected between heat exposure and congenital cardiac anomalies in three of six studies, with point estimates highest for atrial septal defects. Two studies with null findings used self-reported temperature exposures. Hypospadias, congenital cataracts, renal agenesis/hypoplasia, spina bifida, and craniofacial defects were also linked with heat exposure. Effects generally increased with duration and intensity of heat exposure. However, some neural tube defects, gastroschisis, anopthalmia/microphthalmia and congenital hypothyroidism were less frequent at higher temperatures. While findings are heterogenous, the evidence raises important concerns about heat exposure and birth defects. Some heterogeneity may be explained by biases in reproductive epidemiology. Pooled analyses of heat impacts using registers of congenital anomalies are a high priority.
Although extreme weather events have played a constant role in human history, heatwaves (HWs) have become more frequent and intense in the past decades, causing concern especially in light of the increasing evidence on climate change. Despite the increasing number of reviews suggesting a relationship between heat and health, these reviews focus primarily on mortality, neglecting other important aspects. This systematic review of reviews gathered the available evidence from research syntheses conducted on HWs and health. Following the PRISMA guidelines, 2232 records were retrieved, and 283 reviews were ultimately included. Information was extracted from the papers and categorized by topics. Quantitative data were extracted from meta-analyses and, when not available, evidence was collected from systematic reviews. Overall, 187 reviews were non-systematic, while 96 were systematic, of which 27 performed a meta-analysis. The majority evaluated mortality, morbidity, or vulnerability, while the other topics were scarcely addressed. The following main knowledge gaps were identified: lack of a universally accepted definition of HW; scarce evidence on the HW-mental health relationship; no meta-analyses assessing the risk perception of HWs; scarcity of studies evaluating the efficacy of adaptation strategies and interventions. Future efforts should meet these priorities to provide high-quality evidence to stakeholders.
INTRODUCTION: From the perspective of public health, the climate crisis is also causing many health problems worldwide. In contrast with the cardiovascular, respiratory, and urinary system, the adverse effects of heatwaves on the endocrine system, particularly in people with diabetes mellitus (DM), are not well established to date. In this study, the author investigated the morbidity and mortality changes of DM patients during heatwave periods, using the meta-analysis method. METHODS: The author searched MEDLINE, EMBASE, and the Cochrane Library until March 12, 2020. The quality of each included study was assessed using the National Institutes of Health (NIH) Quality Assessment tools. The meta-analysis was conducted using the studies with a relative risk (RR) estimate and odds ratio (OR) estimate. The subgroup analysis and the meta-ANOVA analysis were conducted using various covariates, including lag days considered. RESULTS: Only 36 articles were included in the meta-analysis. The pooled RR of mortality and of morbidity for diabetics under the heatwave were 1.18 (95% CI 1.13-1.25) and 1.10 (95% CI 1.06-1.14). For mortality studies, whether or not the lag days considered were 10 days or more was only a significant covariate for the meta-ANOVA analysis (Q = 3.17, p = 0.075). For morbidity studies, the definition of the heatwave (Q = 65.94, p < 0.0001), whether or not the maximum temperature was 40 °C or more (Q = 4.78, p = 0.0288), and the type of morbidity (Q = 60.23, p < 0.0001) were significant covariates for the analysis. DISCUSSION: The mortality and morbidity risks of diabetes patients under the heatwave were mildly increased by about 18 percent for mortality and 10 percent for overall morbidity. The mortality risk of diabetics can increase more when lag days of 10 days or more are considered than when lag days of less than 10 days are considered. These valuable findings can be used in developing public health strategies to cope with heatwaves in the current era of aggravating global warming and climate crisis.
Background Heatstroke is associated with exposure to high ambient temperature (AT) and relative humidity (RH), and an increased risk of organ damage or death. Previously proposed animal models of heatstroke disregard the impact of RH. Therefore, we aimed to establish and validate an animal model of heatstroke considering RH. To validate our model, we also examined the effect of hydration and investigated gene expression of cotransporter proteins in the intestinal membranes after heat exposure. Methods Mildly dehydrated adult male C57/BL6J mice were subjected to three AT conditions (37 degrees C, 41 degrees C, or 43 degrees C) at RH > 99% and monitored with WetBulb globe temperature (WBGT) for 1 h. The survival rate, body weight, core body temperature, blood parameters, and histologically confirmed tissue damage were evaluated to establish a mouse heatstroke model. Then, the mice received no treatment, water, or oral rehydration solution (ORS) before and after heat exposure; subsequent organ damage was compared using our model. Thereafter, we investigated cotransporter protein gene expressions in the intestinal membranes of mice that received no treatment, water, or ORS. Results The survival rates of mice exposed to ATs of 37 degrees C, 41 degrees C, and 43 degrees C were 100%, 83.3%, and 0%, respectively. From this result, we excluded AT43. Mice in the AT 41 degrees C group appeared to be more dehydrated than those in the AT 37 degrees C group. WBGT in the AT 41 degrees C group was > 44 degrees C; core body temperature in this group reached 41.3 +/- 0.08 degrees C during heat exposure and decreased to 34.0 +/- 0.18 degrees C, returning to baseline after 8 h which showed a biphasic thermal dysregulation response. The AT 41 degrees C group presented with greater hepatic, renal, and musculoskeletal damage than did the other groups. The impact of ORS on recovery was greater than that of water or no treatment. The administration of ORS with heat exposure increased cotransporter gene expression in the intestines and reduced heatstroke-related damage. Conclusions We developed a novel mouse heatstroke model that considered AT and RH. We found that ORS administration improved inadequate circulation and reduced tissue injury by increasing cotransporter gene expression in the intestines.
Critical environmental limits are those combinations of ambient temperature and humidity above which heat balance cannot be maintained for a given metabolic heat production, limiting exposure time, and placing individuals at increased risk of heat-related illness. The aim of this study was to establish those limits in young (18-34 yr) healthy adults during low-intensity activity approximating the metabolic demand of activities of daily living. Twenty-five (12 men/13 women) subjects were exposed to progressive heat stress in an environmental chamber at two rates of metabolic heat production chosen to represent minimal activity (MinAct) or light ambulation (LightAmb). Progressive heat stress was performed with either 1) constant dry-bulb temperature (T(db)) and increasing ambient water vapor pressure (P(a)) (P(crit) trials; 36°C, 38°C, or 40°C) or 2) constant P(a) and increasing T(db) (T(crit) trials; 12, 16, or 20 mmHg). Each subject was tested during MinAct and LightAmb in two to three experimental conditions in random order, for a total of four to six trials per participant. Higher metabolic heat production (P < 0.001) during LightAmb compared with MinAct trials resulted in significantly lower critical environmental limits across all P(crit) and T(crit) conditions (all P < 0.001). These data, presented graphically herein on a psychrometric chart, are the first to define critical environmental limits for young adults during activity resembling those of light household tasks or other activities of daily living and can be used to develop guidelines, policy decisions, and evidence-based alert communications to minimize the deleterious impacts of extreme heat events.NEW & NOTEWORTHY Critical environmental limits are those combinations of temperature and humidity above which heat balance cannot be maintained, placing individuals at increased risk of heat-related illness. Those limits have been investigated in young adults during exercise at 30% V_(O2max), but not during metabolic rates that approximate those of light activities of daily living. Herein, we establish critical environmental limits for young adults at two metabolic rates that reflect activities of daily living and leisurely walking.
Thermal stress has a direct effect on various types of DNA damage, which depends on the stage of the cell cycle when the cell is exposed to different climate conditions. A literature review was conducted to systematically investigate and assess the overall effect of heat stress and DNA damage following heat exposure. In this study, electronic databases including PubMed, Scopus, and Web of Science were searched to find relevant literature on DNA damage in different ambient temperatures. Outcomes included (1) measurement of DNA damage in heat exposure, (2) three different quantification methods (comet assay, 8-hydroxy-2-deoxyguanosine (8-OHdG), and γ-H2AX), and (3) protocols used for moderate (31) and high temperatures (42). The evidence shows that long exposure and very high temperature can induce an increase in DNA damage through aggregate in natural proteins, ROS generation, cell death, and reproductive damage in hot-humid and hot-dry climate conditions. A substantial increase in DNA damage occurs following acute heat stress exposure, especially in tropical and subtropical climate conditions. The results of this systematic literature review showed a positive association between thermal stress exposure and inhibition of repair of DNA damage.
Hyperthermia is defined as a body temperature greater than 40 degrees C. Several conditions can cause hyperthermia. In sepsis, the immunologic reaction to the infection most often manifests as a fever. Some toxic ingestions and withdrawal states can cause elevated body temperature. Certain medications can cause a hyperthermic response, such as in neuroleptic malignant syndrome. The most common disease that can be treated by cooling alone is heat-related illness and heat stroke. Heat-related illness is a spectrum of disease that occurs when the body’s thermoregulatory system does not work properly. Heat exhaustion is characterized by elevated core body temperature associated with orthostatic hypotension, tachycardia, diaphoresis, and tachypnea. Heat stroke is defined as elevated core body temperature plus central nervous system involvement (delirium, decreased the level of consciousness, or ataxia). Heat-related illness most often affects athletes (exertional hyperthermia), but can also occur during the warm weather months or in locations with extreme temperatures. Patients with impaired thermoregulation (those at extremes of age, the obese or mentally ill) are at higher risk. The definitive treatment for heat-related illness is total body cooling. Conduction and evaporation are the two modes of cooling employed in the treatment of heat-related illness. Studies have shown ice water immersion to be the most effective and most rapid. However, there are obvious barriers to performing this in an emergency department. Marathons and other athletic events that have frequent heat-related illness sometimes have this capability. Evaporation (mist and fan) is the second most rapid way to cool a patient. Ice packs to the groin, axilla, neck, and areas near other great vessels have been shown to be less effective. Cooled intravenous fluids have been studied, but there is no clear consensus regarding their benefit (preservation of neurologic function) versus potential harm (induced shivering), but they may be considered. This article will discuss the procedure for performing evaporative cooling with other adjuncts in the field. The priority in heat-related illness is early recognition and intervention. Military and sports literature has identified 40 degrees C as the target, and the faster the target is achieved, the lower the patient mortality.
BACKGROUND: Although effects on labour is one of the most tangible and attributable climate impact, our quantification of these effects is insufficient and based on weak methodologies. Partly, this gap is due to the inability to resolve different impact channels, such as changes in time allocation (labour supply) and slowdown of work (labour productivity). Explicitly resolving those in a multi-model inter-comparison framework can help to improve estimates of the effects of climate change on labour effectiveness. METHODS: In this empirical, multi-model study, we used a large collection of micro-survey data aggregated to subnational regions across the world to estimate new, robust global and regional temperature and wet-bulb globe temperature exposure-response functions (ERFs) for labour supply. We then assessed the uncertainty in existing labour productivity response functions and derived an augmented mean function. Finally, we combined these two dimensions of labour into a single compound metric (effective labour effects). This combined measure allowed us to estimate the effect of future climate change on both the number of hours worked and on the productivity of workers during their working hours under 1·5°C, 2·0°C, and 3·0°C of global warming. We separately analysed low-exposure (indoors or outdoors in the shade) and high-exposure (outdoor in the sun) sectors. FINDINGS: We found differentiated empirical regional and sectoral ERF’s for labour supply. Current climate conditions already negatively affect labour effectiveness, particularly in tropical countries. Future climate change will reduce global total labour in the low-exposure sectors by 18 percentage points (range -48·8 to 5·3) under a scenario of 3·0°C warming (24·8 percentage points in the high-exposure sectors). The reductions will be 25·9 percentage points (-48·8 to 2·7) in Africa, 18·6 percentage points (-33·6 to 5·3) in Asia, and 10·4 percentage points (-35·0 to 2·6) in the Americas in the low-exposure sectors. These regional effects are projected to be substantially higher for labour outdoors in full sunlight compared with indoors (or outdoors in the shade) with the average reductions in total labour projected to be 32·8 percentage points (-66·3 to 1·6) in Africa, 25·0 percentage points (-66·3 to 7·0) in Asia, and 16·7 percentage points (-45·5 to 4·4) in the Americas. INTERPRETATION: Both labour supply and productivity are projected to decrease under future climate change in most parts of the world, and particularly in tropical regions. Parts of sub-Saharan Africa, south Asia, and southeast Asia are at highest risk under future warming scenarios. The heterogeneous regional response functions suggest that it is necessary to move away from one-size-fits-all response functions to investigate the climate effect on labour. Our findings imply income and distributional consequences in terms of increased inequality and poverty, especially in low-income countries, where the labour effects are projected to be high. FUNDING: COST (European Cooperation in Science and Technology).
Enhanced intestinal permeability is a pervasive issue in modern medicine, with implications demonstrably associated with significant health consequences such as sepsis, multiorgan failure, and death. Key issues involve the trigger mechanisms that could compromise intestinal integrity and increase local permeability allowing the passage of larger, potentially dangerous molecules. Heat stress, whether exertional or environmental, may modulate intestinal permeability and begs interesting questions in the context of global climate change, increasing population vulnerabilities, and public health. Emerging evidence indicates that intestinal leakage of digestive enzymes and associated cell dysfunctions–a process referred to as autodigestion–may play a critical role in systemic physiological damage within the body. This increased permeability is exacerbated in the presence of elevated core temperatures. We employed Latent Dirichlet Allocation (LDA) topic modeling methods to analyze the relationship between heat stress and the nascent theory of autodigestion in a systematic, quantifiable, and unbiased manner. From a corpus of 11,233 scientific articles across four relevant scientific journals (Gut, Shock, Temperature, Gastroenterology), it was found that over 1,000 documents expressed a relationship between intestine, enhanced permeability, core temperature, and heat stress. The association has grown stronger in recent years, as heat stress and potential autodigestion are investigated in tandem, yet still by a limited number of specific research studies. Such findings justify the design of future studies to critically test novel interventions against digestive enzymes permeating the intestinal tract, especially the small intestine.
Wet-bulb globe temperature (WBGT) is a widely applied heat stress index. However, most applications of WBGT within the heat stress impact literature that do not use WBGT at all, but use one of the ad hoc approximations, typically the simplified WBGT (sWBGT) or the environmental stress index (ESI). Surprisingly, little is known about how well these approximations work for the global climate and climate change settings that they are being applied to. Here, we assess the bias distribution as a function of temperature, humidity, wind speed, and radiative conditions of both sWBGT and ESI relative to a well-validated, explicit physical model for WBGT developed by Liljegren, within an idealized context and the more realistic setting of ERA5 reanalysis data. sWBGT greatly overestimates heat stress in hot-humid areas. ESI has much smaller biases in the range of standard climatological conditions. Over subtropical dry regions, both metrics can substantially underestimate extreme heat. We show systematic overestimation of labor loss by sWBGT over much of the world today. We recommend discontinuing the use of sWBGT. ESI may be acceptable for assessing average heat stress or integrated impact over a long period like a year, but less suitable for health applications, extreme heat stress analysis, or as an operational index for heat warning, heatwave forecasting, or guiding activity modification at the workplace. Nevertheless, Liljegren’s approach should be preferred over these ad hoc approximations and we provide a fast Python implementation to encourage its widespread use.
The heat index is a widely used measure of apparent temperature that accounts for the effects of humidity using Steadman’s model of human thermoregulation. Steadman’s model, however, gives unphysical results when the air is too hot and humid or too cold and dry, leading to an undefined heat index. For example, at a relative humidity of 80%, the heat index is only defined for temperatures in the range of 288-304 K (59 degrees-88 degrees F). Here, Steadman’s thermoregulation model is extended to define the heat index for all combinations of temperature and humidity, allowing for an assessment of Earth’s future habitability. The extended heat index can be mapped onto physiological responses of an idealized human, such as heat exhaustion, heat stroke, and even heat death, providing an indication of regional health outcomes for different degrees of global warming. Significance StatementThe existing heat index is well-defined for most combinations of high temperature and humidity experienced on Earth in the preindustrial climate, but global warming is increasingly generating conditions for which the heat index is undefined. Therefore, an extension of the original heat index is needed. When extending the heat index, we use the same physiological model as in the original work of Steadman to ensure backward compatibility. Following Steadman, each value of the heat index is mapped onto a measurable physiological variable, which can be useful for assessing the health impacts of various combinations of temperature and humidity, especially for outdoor workers.
Given health threat by global warming and increased energy consumption in regulating body temperature, it is an urgent need to construct smart temperature-regulating materials. Herein, a novel fiber-spinning asymmetric chemical assembly (FACA) method is proposed to construct nanofiber materials with asymmetric photothermal properties. The silver nanowires (AgNWs) and poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) with opposite thermal radiation are assembled on reduced graphene oxide (rGO) film, imparting AgNW/rGO/PVDF-HFP film with Janus structure that can realize the AgNWs side consistently keeps temperature of ca. 11 °C lower than the side of PVDF-HFP nanofiber regardless of the irradiation directions under 1 sun, suggesting the adjustable photothermal regulation. Such photothermally selective hybrid nanofiber film provides great potential as fabrics to achieve all-weather smart clothes, promoting controllable and comprehensive utilization of solar energy.
The direct impacts of climate change on crop yields and human health are individually well-studied, but the interaction between the two have received little attention. Here we analyze the consequences of global warming for agricultural workers and the crops they cultivate using a global economic model (GTAP) with explicit treatment of the physiological impacts of heat stress on humans’ ability to work. Based on two metrics of heat stress and two labor functions, combined with a meta-analysis of crop yields, we provide an analysis of climate, impacts both on agricultural labor force, as well as on staple crop yields, thereby accounting for the interacting effect of climate change on both land and labor. Here we analyze the two sets of impacts on staple crops, while also expanding the labor impacts to highlight the potential importance on non-staple crops. We find, worldwide, labor and yield impacts within staple grains are equally important at +3 C warming, relative to the 1986-2005 baseline. Furthermore, the widely overlooked labor impacts are dominant in two of the most vulnerable regions: sub-Saharan Africa and Southeast Asia. In those regions, heat stress with 3 C global warming could reduce labor capacity in agriculture by 30%-50%, increasing food prices and requiring much higher levels of employment in the farm sector. The global welfare loss at this level of warming could reach $136 billion, with crop prices rising by 5%, relative to baseline.
Climate change affects various fundamental human activities, and understanding the consequences of its impacts is essential. Among them, heat stress considerably affects economic conditions. Furthermore, when analyzing the socioeconomic impacts of climate change, both socioeconomic and climate systems must be considered simultaneously, though such studies are scarce. This study aimed to evaluate the socioeconomic impacts of changes in labor productivity due to heat stress (measured by wet bulb globe temperature) under various climate change scenarios through a new modeling framework that coupled a computable general equilibrium model and an Earth system model of intermediate complexity to realize the interactions between the two systems through the relationship between heat stress and labor productivity. Results indicated that labor productivity declined as climate change progressed (particularly in hot and humid regions), driving a gradual decline in total global gross domestic product (GDP). Although regional GDP largely decreased where labor productivity considerably declined, it slightly increased in some areas because of a comparative advantage brought about by the difference in the impact on labor productivity by region. Consequently, carbon dioxide (CO2) emissions and concentrations and the resulting temperature were slightly reduced when examining the impact of climate change on labor productivity. These tendencies were similar in both business-as-usual and climate change mitigation scenarios, but the overall impacts were smaller under the latter. There was a limited impact on CO2 emissions, CO2 concentrations, and temperature via integrated socioeconomic and climate systems. However, this study focused on only a single channel of the various interactions between the two systems. For a more complete evaluation of the impacts of climate change, further development of the integrated model is required.
The human body constantly exchanges heat with the environment. Temperature regulation is a homeostatic feedback control system that ensures deep body temperature is maintained within narrow limits despite wide variations in environmental conditions and activity-related elevations in metabolic heat production. Extensive research has been performed to study the physiological regulation of deep body temperature. This review focuses on healthy and disordered human temperature regulation during heat stress. Central to this discussion is the notion that various morphological features, intrinsic factors, diseases, and injuries independently and interactively influence deep body temperature during exercise and/or exposure to hot ambient temperatures. The first sections review fundamental aspects of the human heat stress response, including the biophysical principles governing heat balance and the autonomic control of heat loss thermoeffectors. Next, we discuss the effects of different intrinsic factors (morphology, heat adaptation, biological sex, and age), diseases (neurological, cardiovascular, metabolic, and genetic), and injuries (spinal cord injury, deep burns, and heat stroke), with emphasis on the mechanisms by which these factors enhance or disturb the regulation of deep body temperature during heat stress. We conclude with key unanswered questions in this field of research.
Due to the continuous rise of global temperatures and heatwaves worldwide as a result of climate change, concerns for the health and safety of working populations have increased. Workers in the food production chain, particularly farmworkers, are especially vulnerable to heat stress due to the strenuous nature of their work, which is performed primarily outdoors under poor working conditions. At the cross-section of climate change and farmworkers’ health, a scoping review was undertaken to summarize the existing knowledge regarding the health impacts associated with climate change and heat stress, guide future research toward better understanding current and future climate change risks, and inform policies to protect the health and safety of agricultural workers. A systematic search of 5 electronic databases and gray literature websites was conducted to identify relevant literature published up until December 2021. A total of 9045 records were retrieved from the searches, of which 92 articles were included in the final review. The majority of the reviewed articles focused on heat-related illnesses (n = 57) and kidney diseases (n = 28). The risk factors identified in the reviewed studies included gender, dehydration, heat strain, wearing inappropriate clothing, workload, piece-rate payment, job decision latitude, and hot environmental conditions. On the other hand, various protective and preventive factors were identified including drinking water, changing work hours and schedule of activities, wearing appropriate clothing, reducing soda consumption, taking breaks in shaded or air-conditioned areas, and increasing electrolyte consumption in addition to improving access to medical care. This review also identified various factors that are unique to vulnerable agricultural populations, including migrant and child farmworkers. Our findings call for an urgent need to expand future research on vulnerable agricultural communities including migrant workers so as to develop effective policies and interventions that can protect these communities from the effects of heat stress.
AIMS: Heat stroke is a life-threatening disorder triggered by thermoregulatory failure. Hyperthermia-induced splanchnic hypoperfusion has been reported to induce intestinal barrier dysfunction and systemic immune response that ultimately cause multiple-organ failure and death. Intestinal goblet cells contribute greatly to the formation of mucus barrier, which hinders translocation of gut microorganisms. Studies have reported that misoprostol can not only alleviate ischemic injury but also protect GI mucosal layer. Therefore, we evaluated the effects of misoprostol on intestinal goblet cells after heat stress and on multiple-organ dysfunction in heat stroke rats. MAIN METHODS: Heat stress was established in the heating chamber and followed by misoprostol treatment. Changes in hemodynamics, organ function indices, inflammation, oxidative stress, and survival rate were analyzed. Furthermore, ilea and LS174T cells were used to examine intestinal functions. KEY FINDINGS: Heat stress caused dysfunction of intestinal goblet cells and damage to ilea by increasing oxidative stress and apoptosis. Increased nitrosative stress and inflammation accompanied by hypotension, hypoperfusion, tachycardia, multiple-organ dysfunction, and death were observed in the heat stroke rat model. Treatment of LS174T cells with misoprostol not only decreased oxidative stress and apoptosis but also reduced cytotoxicity caused by heat stress. Moreover, misoprostol prevented disruption of the enteric barrier, multiple-organ injury, and death in rats with heat stroke. SIGNIFICANCE: This study indicates that misoprostol could alleviate intestinal damage and organ injury caused by heat stress and be a potential therapy for heat-related illnesses.
In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this first paper of the series, we conducted a systematic review (registration: INPLASY202090088) to identify all TSIs and provide reliable information regarding their use (funded by EU Horizon 2020; HEAT-SHIELD). Eight databases (PubMed, Agricultural and Environmental Science Collection, Web of Science, Scopus, Embase, Russian Science Citation Index, MEDLINE, and Google Scholar) were searched from database inception to 15 April 2020. No restrictions on language or study design were applied. Of the 879 publications identified, 232 records were considered for further analysis. This search identified 340 instruments and indicators developed between 200 BC and 2019 AD. Of these, 153 are nomograms, instruments, and/or require detailed non-meteorological information, while 187 can be mathematically calculated utilizing only meteorological data. Of these meteorology-based TSIs, 127 were developed for people who are physically active, and 61 of those are eligible for use in occupational settings. Information regarding the equation, operating range, interpretation categories, required input data, as well as a free software to calculate all 187 meteorology-based TSIs is provided. The information presented in this systematic review should be adopted by those interested in performing on-site monitoring and/or big data analytics for climate services to ensure appropriate use of the meteorology-based TSIs. Studies two and three in this series of companion papers present guidance on the application and validation of these TSIs, to guide end users of these indicators for more effective use.
Increasing air movement can alleviate or exacerbate occupational heat strain, but the impact is not well defined across a wide range of hot environments, with different clothing levels. Therefore, we combined a large empirical study with a physical model of human heat transfer to determine the climates where increased air movement (with electric fans) provides effective body cooling. The model allowed us to generate practical advice using a high-resolution matrix of temperature and humidity. The empirical study involved a total of 300 1-h work trials in a variety of environments (35, 40, 45, and 50 °C, with 20 up to 80% relative humidity) with and without simulated wind (3.5 vs 0.2 m(s^(-1)), and wearing either minimal clothing or a full body work coverall. Our data provides compelling evidence that the impact of fans is strongly determined by air temperature and humidity. When air temperature is ≥ 35 °C, fans are ineffective and potentially harmful when relative humidity is below 50%. Our simulated data also show the climates where high wind/fans are beneficial or harmful, considering heat acclimation, age, and wind speed. Using unified weather indices, the impact of air movement is well captured by the universal thermal climate index, but not by wet-bulb globe temperature and aspirated wet-bulb temperature. Overall, the data from this study can inform new guidance for major public and occupational health agencies, potentially maintaining health and productivity in a warming climate.
The PSU HEAT protocol has been used to determine critical environmental limits, i.e., those combinations of ambient temperature and humidity above which heat stress becomes uncompensable and core temperature rises continuously. However, no studies have rigorously investigated the reliability and validity of this experimental protocol. Here, we assessed the 1) between-visit reliability and 2) validity of the paradigm. Twelve subjects (5 M/7W; 25 ± 4 yr) completed a progressive heat stress protocol during which they walked on a treadmill (2.2 mph, 3% gradient) in a controllable environmental chamber. After an equilibration period, either dry-bulb temperature (T(db)) was increased every 5 min while ambient water vapor pressure (P(a)) was held constant (T(crit) experiments) or P(a) was increased every 5 min while T(db) was held constant (P(crit) experiments) until an upward inflection in gastrointestinal temperature (T(gi)) was observed. For reliability experiments, 11 subjects repeated the same protocol on a different day. For validity experiments, 10 subjects performed a T(crit) experiment at their previously determined P(crit) or vice versa. The between-visit reliability (intraclass correlation coefficient, ICC) for critical environmental limits was 0.98. Similarly, there was excellent agreement between original and validity trials for T(crit) (ICC = 0.95) and P(crit) (ICC = 0.96). Furthermore, the wet-bulb temperature at the T(gi) inflection point was not different during reliability (P = 0.78) or validity (P = 0.32) trials compared with original trials. These findings support the reliability and validity of this experimental paradigm for the determination of critical environmental limits for maintenance of human heat balance.NEW & NOTEWORTHY The PSU HEAT progressive heat stress protocol has been used to identify critical environmental limits for various populations, clothing ensembles, and metabolic intensities. However, no studies have rigorously investigated the reliability and validity of this experimental model. Here, we demonstrate excellent reliability and validity of the PSU HEAT protocol.
The objective of this study is to determine the impacts of low-intensity heat on human health in regions with hot, humid summers. Current literature has highlighted an increase in mortality and morbidity rates during significant heat events. While the impacts on high-intensity events are established, the impacts on low-intensity events, particularly in regions with hot, humid summers, are less clear. A scoping review was conducted searching three databases (PubMed, EMBASE, Web of Science) using key terms based on the inclusion criteria. We included papers that investigated the direct human health impacts of low-intensity heat events (single day or heatwaves) in regions with hot, humid summers in middle- and high-income countries. We excluded papers written in languages other than English. Of the 600 publications identified, 33 met the inclusion criteria. Findings suggest that low-intensity heatwaves can increase all-cause non-accidental, cardiovascular-, respiratory- and diabetes-related mortality, in regions experiencing hot, humid summers. Impacts of low-intensity heatwaves on morbidity are less clear, with research predominantly focusing on hospitalisation rates with a range of outcomes. Few studies investigating the impact of low-intensity heat events on emergency department presentations and ambulance dispatches were found. However, the data from a limited number of studies suggest that both of these outcome measures increase during low-intensity heat events. Low-intensity heat events may increase mortality. There is insufficient evidence of a causal effect of low-intensity heat events on increasing morbidity for a firm conclusion. Further research on the impact of low-intensity heat on morbidity and mortality using consistent parameters is warranted.
The concept of nature-based solutions (NBSs) has become increasingly popular among urban policymakers and planners to help them tackle the urban challenges arising from urban expansion and climate change. Stakeholders’ involvement is a fundamental step, and stakeholders’ perceptions and preferences can affect the development of NBS projects. This study aims to identify stakeholders’ perceptions of the most critical urban challenges, the priority interventions, the preferred NBSs and the benefits of the NBSs, and to identify the determinants of these perceptions. A survey was administered to assess stakeholders’ perceptions and views on implementing NBSs in two Portuguese cities with distinct urban, geographical, and socio-economic contexts. A binary logistic regression model was used to understand the determinants of the likelihood of the stakeholders’ answers. According to the stakeholders, climate change is one of the main concerns in the urban context. It is usually associated with the incidence of heatwaves and water scarcity. Additionally, stakeholders are concerned about the low quantity and poor management of green spaces (GSs). They believe that it will be necessary to increase the GS, to recover some degraded areas, and to increase mobility. The preferred NBSs were planting more urban trees, making green shaded areas, and rehabilitating riverbanks. The main expected benefits were benefits for leisure and relaxation, reductions in air temperature, purer air, and improvements in public health. The results showed mostly coherent connections between the main concerns/priorities of the stakeholders and the perceived NBS benefits; however, some stakeholders did not present coherent connections, indicating low awareness of the current policy for implementing NBSs to overcome existing and future urban challenges.
Climate change will have complex consequences for the environment, society, economy and people’s health. The issue of climate change has received comparatively little attention to date in the fields of sports science. Thus, sport-related health risks caused by climate change are discussed and summarized in a conceptual model presented here for the first time. Climate change is associated with the following increases of health-related risks for athletes in particular: Direct consequences caused by extreme temperature and other extreme weather events (e.g. increasing risks due to heatwaves, thunderstorms, floods, lightning, ultraviolet radiation) and indirect consequences as a result of climate-induced changes to our ecosystem (e.g. due to increased air pollution by ozone, higher exposures to allergens, increasing risks of infection by viruses and bacteria and the associated vectors and reservoir organisms). Each aspect is supplemented with advice on the prevention of health hazards. Not only individual athletes but also sports organizations and local clubs will have to respond to the changes in our climate, so that they can appropriately protect both athletes and spectators and ensure a plannable continuation of the sport in the future.
INTRODUCTION: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care. METHODS: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome. RESULTS: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies. CONCLUSION: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.
Heatwaves are one of the most dangerous natural hazards causing more than 166,000 deaths from 1998-2017. Their frequency is increasing, and they are becoming more intense. Electric fans are an efficient, and sustainable solution to cool people. They are, for most applications, the cheapest cooling technology available. However, many national and international health guidelines actively advise people not to use them when indoor air temperatures exceed the skin temperature, approximately 35 degrees C. We used a human energy balance model, to verify the validity of those recommendations and to determine under which environmental (air temperature, relative humidity, air speed and mean radiant temperature) and personal (metabolic rate, clothing) conditions the use of fans would be beneficial. We found that current guidelines are too restrictive. Electric fans can be used safely even if the indoor dry-bulb temperature exceeds 35 degrees C since they significantly increase the amount of sweat that evaporates from the skin. The use of elevated air speeds (0.8 m/s) increases the critical operative temperature at which heat strain is expected to occur by an average of 14 degrees C for relative humidity values above 22 %. We also analyzed the most extreme weather events from 1990 to 2014 recorded in the 115 most populous cities worldwide, and we determined that in 93 of them the use of fans would have been beneficial. We developed a free, open-source, and easy-to-use online tool to help researchers, building practitioners, and policymakers better understand under which conditions electric fans can be safely used to cool people.
Wet heatwaves can have more impact on human health than hot dry heatwaves. However, changes in these have received little scientific attention. Using the ECMWF Reanalysis v5 reanalysis dataset, wet-bulb temperatures (T (w)) were used to investigate the spatial-temporal variation of wet heatwaves in Eurasia for 1979-2017. Wet heatwaves were defined as three day or longer periods when T (w) was above the 90th percentile of the summer distribution and characterized by amplitude, duration and frequency. Maximum values of amplitude, close to 31 degrees C, occur in the Indus-Ganges plain, the lower Yangtze valley, and the coasts of the Persian Gulf and Red Sea. Significant positive trends in the frequency and amplitude of wet heatwaves have occurred over most of Eurasia though with regional variations. Changes in heatwave amplitude (HWA) are largely driven by changes in summer mean T (w). For Eurasia as a whole, increases in temperature contribute more than six times the impact of changes in relative humidity (RH) to changes in T (w) HWA. Changes in T (w) have a strong dependence on climatological RH with an increase in RH of 1% causing a T (w) increase of 0.2 degrees C in arid regions, and only increasing T (w) by 0.1 degrees C in humid regions. During T (w) heatwaves in Europe, parts of Tibet, India, East Asia and parts of the Arabian Peninsula both temperature and humidity contribute to the increase in T (w), with temperature the dominant driver. During wet heatwaves in part of Russia, changes in humidity are weak and the increase in T (w) is mainly caused by an increase in temperature. In the Mediterranean and Central Asia, RH has fallen reducing the increase in T (w) from general warming.
In the past two decades, record-breaking heatwaves have caused an increasing number of heat-related deaths, including heatstroke, globally. Heatstroke is a heat illness characterized by the rapid rise of core body temperature above 40 °C and central nervous system dysfunction. It is categorized as classic when it results from passive exposure to extreme environmental heat and as exertional when it develops during strenuous exercise. Classic heatstroke occurs in epidemic form and contributes to 9-37% of heat-related fatalities during heatwaves. Exertional heatstroke sporadically affects predominantly young and healthy individuals. Under intensive care, mortality reaches 26.5% and 63.2% in exertional and classic heatstroke, respectively. Pathological studies disclose endothelial cell injury, inflammation, widespread thrombosis and bleeding in most organs. Survivors of heatstroke may experience long-term neurological and cardiovascular complications with a persistent risk of death. No specific therapy other than rapid cooling is available. Physiological and morphological factors contribute to the susceptibility to heatstroke. Future research should identify genetic factors that further describe individual heat illness risk and form the basis of precision-based public health response. Prioritizing research towards fundamental mechanism and diagnostic biomarker discovery is crucial for the design of specific management approaches.
PURPOSE: We compared the accuracy and design of two thermoregulatory models, the US Army’s empirically designed Heat Strain Decision Aid (HSDA) and the rationally based Health Risk Prediction (HRP) for predicting human thermal responses during exercise in hot and humid conditions and wearing chemical protective clothing. METHODS: Accuracy of the HSDA and HRP model predictions of core body and skin temperature (Tc, Ts) were compared to each other and relative to measured outcomes from eight male volunteers (age 24 ± 6 years; height 178 ± 5 cm; body mass 76.6 ± 8.4 kg) during intermittent treadmill marching in an environmental chamber (air temperature 29.3 ± 0.1 °C; relative humidity 56 ± 1%; wind speed 0.4 ± 0.1 m∙s(-1)) wearing three separate chemical protective ensembles. Model accuracies and precisions were evaluated by the bias, mean absolute error (MAE), and root mean square error (RMSE) compared to observed data mean ± SD and the calculated limits of agreement (LoA). RESULTS: Average predictions of Tc were comparable and acceptable for each method, HSDA (Bias 0.02 °C; MAE 0.18 °C; RMSE 0.21 °C) and HRP (Bias 0.10 °C; MAE 0.25 °C; RMSE 0.34 °C). The HRP averaged predictions for Ts were within an acceptable agreement to observed values (Bias 1.01 °C; MAE 1.01 °C; RMSE 1.11 °C). CONCLUSION: Both HSDA and HRP acceptably predict Tc and HRP acceptably predicts Ts when wearing chemical protective clothing during exercise in hot and humid conditions.
The intensity and duration of hot weather and the number of extreme weather events, such as heatwaves, are increasing, leading to a growing need for space cooling energy demand. Together with the building stock’s low energy performance, this phenomenon may also increase households’ energy consumption. On the other hand, the low level of ownership of cooling equipment can cause low energy consumption, leading to a lack of indoor thermal comfort and several health-related problems, yet increasing the risk of energy poverty in summer. Understanding future temperature variations and the associated impacts on building cooling demand will allow mitigating future issues related to a warmer climate. In this respect, this paper analyses the effects of change in temperatures in the residential sector cooling demand in 2050 for a case study of nineteen cities across seven countries: Cyprus, Finland, Greece, Israel, Portugal, Slovakia, and Spain, by estimating cooling degree days and hours (CDD and CDH). CDD and CDH are calculated using both fixed and adaptive thermal comfort temperature thresholds for 2020 and 2050, understanding their strengths and weaknesses to assess the effects of warmer temperatures. Results suggest a noticeable average increase in CDD and CDH values, up to double, by using both thresholds for 2050, with a particular interest in northern countries where structural modifications in the building stock and occupants’ behavior should be anticipated. Furthermore, the use of the adaptive thermal comfort threshold shows that the projected temperature increases for 2050 might affect people’s capability to adapt their comfort band (i.e., indoor habitability) as temperatures would be higher than the maximum admissible values for people’s comfort and health.
HIGHLIGHTS: Cultural factors and acculturative stressors affect the health and safety behaviors of Hispanic/Latino farmworkers. Cultural factors and stressors also increase their risk of heat-related illnesses (HRIs). Interventions targeting HRIs in this population should account for cultural factors. ABSTRACT: Hispanic/Latino farmworkers have been widely recognized as a particularly vulnerable population in the U.S., with among the lowest levels of income and education in the country. Existing research has identified and explored factors, including cultural and demographic characteristics, that increase the vulnerability of these workers to adverse occupational health and safety outcomes. This review assesses Hispanic/Latino farmworkers’ vulnerability to increasing temperatures and intense heat events, focusing on the role of demographic and cultural factors in heat-related health outcomes. A systematic literature search was conducted using the search terms “heat” and “(Hispanic or Latino) farmworkers” and “health” over the years 2000 to 2020. A total of 348 articles were screened through a title review. The articles included in this review focused on heat-related illnesses (HRIs) and related symptoms among the population of interest. Hispanic/Latino workers were at heightened risk of HRI symptoms as a result of their work environments, working conditions, acculturative stressors, and other cultural factors.
BACKGROUND: With high temperature becoming an increasing health risk due to a changing climate, it is important to quantify the scale of the problem. However, estimating the burden of disease (BoD) attributable to high temperature can be challenging due to differences in risk patterns across geographical regions and data accessibility issues. METHODS: We present a methodological framework that uses Köppen-Geiger climate zones to refine exposure levels and quantifies the difference between the burden observed due to high temperatures and what would have been observed if the population had been exposed to the theoretical minimum risk exposure distribution (TMRED). Our proposed method aligned with the Australian Burden of Disease Study and included two parts: (i) estimation of the population attributable fractions (PAF); and then (ii) estimation of the BoD attributable to high temperature. We use suicide and self-inflicted injuries in Australia as an example, with most frequent temperatures (MFTs) as the minimum risk exposure threshold (TMRED). RESULTS: Our proposed framework to estimate the attributable BoD accounts for the importance of geographical variations of risk estimates between climate zones, and can be modified and adapted to other diseases and contexts that may be affected by high temperatures. CONCLUSIONS: As the heat-related BoD may continue to increase in the future, this method is useful in estimating burdens across climate zones. This work may have important implications for preventive health measures, by enhancing the reproducibility and transparency of BoD research.
Adaptation is key to minimizing heatwaves’ societal burden; however, our understanding of adaptation capacity across the socioeconomic spectrum is incomplete. We demonstrate that observed heatwave trends in the past four decades were most pronounced in the lowest-quartile income region of the world resulting in >40% higher exposure from 2010 to 2019 compared to the highest-quartile income region. Lower-income regions have reduced adaptative capacity to warming, which compounds the impacts of higher heatwave exposure. We also show that individual contiguous heatwaves engulfed up to 2.5-fold larger areas in the recent decade (2010-2019) as compared to the 1980s. Widespread heatwaves can overwhelm the power grid and nullify the electricity dependent adaptation efforts, with significant implications even in regions with higher adaption capacity. Furthermore, we compare projected global heatwave exposure using per-capita gross domestic product as an indicator of adaptation capacity. Hypothesized rapid adaptation in high-income regions yields limited changes in heatwave exposure through the 21st century. By contrast, lagged adaptation in the lower-income region translates to escalating heatwave exposure and increased heat-stress inequality. The lowest-quartile income region is expected to experience 1.8- to 5-fold higher heatwave exposure than each higher income region from 2060 to 2069. This inequality escalates by the end of the century, with the lowest-quartile income region experiencing almost as much heatwave exposure as the three higher income regions combined from 2090 to 2099. Our results highlight the need for global investments in adaptation capabilities of low-income countries to avoid major climate-driven human disasters in the 21st century.
Extreme heat research has largely focused on dry-heat, while humid-heat that poses a substantial threat to human-health remains relatively understudied. Using hourly high-resolution ERA5 reanalysis and HadISD station data, we provide the first spatially comprehensive, global-scale characterization of the magnitude, seasonal timing, and frequency of dry- and wet-bulb temperature extremes and their trends. While the peak dry- and humid-heat extreme occurrences often coincide, their timing differs in climatologically wet regions. Since 1979, dry- and humid-heat extremes have become more frequent over most land regions, with the greatest increases in the tropics and Arctic. Humid-heat extremes have increased disproportionately over populated regions (similar to 5.0 days per-person per-decade) relative to global land-areas (similar to 3.6 days per-unit-land-area per-decade) and population exposure to humid-heat has increased at a faster rate than to dry-heat. Our study highlights the need for a multivariate approach to understand and mitigate future harm from heat stress in a warming world.
The frequency and intensity of extreme events especially heat waves (HW) are growing all around the world which ultimately poses a serious threat to the health of individuals. To quantify the effects of extreme temperature, appropriate information, and the importance of HW and heat index (HI) are carefully discussed for different parts of the world. Varied definitions of the HW and HI formula proposed and used by different countries are carried out systematically continent-wise. Different studies highlighted the number of definitions of HW; however, mostly used Steadman’s formulae, which was developed in the late 1970s, for the calculation of HI that uses surface air temperature and relative humidity as climatic fields. Since then, dramatic changes in climatic conditions have been observed as evident from the ERA5 datasets which need to be addressed; likewise, the definition of HW, which is modified by the researchers as per the geographic conditions. It is evident from the ERA5 data that the temperature has increased by 1-2 ??C as compared to the 1980s. There is a threefold increase in the number of heatwave days over most of the continents in the last 40 years. This study will help the researcher community to understand the importance of HW and HI. Furthermore, it opens the scope to develop an equation based on the present scenario keeping in mind the basics of an index as considered by Steadman.
Prior research demonstrates a link between heat risk perception and population response to a heat warning. Communicating a precise and understandable definition of “heat” or “heatwaves” can affect how a population perceives and responds to extreme heat. Still, little is known about how heat perception affects behavior changes to heat and heat communication across diverse populations. This scoping review aims to identify and describe the main themes and findings of recent heat perception research globally and map critical research gaps and priorities for future studies. Results revealed risk perception influences a person’s exposure to and behavioral response to excessive heat. Risk perception varied geographically along the rural-urban continuum and was typically higher among vulnerable subgroups, including populations who were low-income, minority, and in poor health. A more integrated approach to refining risk communication strategies that result in a behavioral change and incorporates the individual, social, and cultural components of impactful group-based or community-wide interventions is needed. Research employing longitudinal or quasi-experimental designs and advanced statistical techniques are required to tease apart the independent and interacting factors that causally influence risk communication, heat perception, and adaptive behaviors. We advance a framework to conceptualize the structural, environmental, personal, and social drivers of population heat risk perception and how they interact to influence heat perception and adaptive behaviors. Our findings map future research priorities needed for heat perception and a framework to drive future research design.
Increases in the severity of heat stress extremes are potentially one of the most impactful consequences of climate change, affecting human comfort, productivity, health, and mortality in many places on Earth. Heat stress results from a combination of elevated temperature and humidity, but the relative contributions of each of these to heat stress changes have yet to be quantified. Here, conditions for the baseline specific humidity are derived for when specific humidity or temperature dominates heat stress changes, as measured using the equivalent potential temperature (theta(E)). Separate conditions are derived over ocean and over land, in addition to a condition for when relative humidity changes make a larger contribution than the Clausius-Clapeyron response at fixed relative humidity. These conditions are used to interpret the theta(E) responses in transient warming simulations with an ensemble of models participating in phase 6 of the Climate Model Intercomparison Project. The regional pattern of theta(E) changes is shown to be largely determined by the pattern of specific humidity changes, with the pattern of temperature changes playing a secondary role. This holds whether considering changes in seasonal-mean theta(E) or in extreme (98th-percentile) theta(E) events, and uncertainty in the response of specific humidity to warming is shown to be the leading source of uncertainty in the theta(E) response at most land locations. Finally, analysis of ERA5 data demonstrates that the pattern of observed theta(E) changes is also well explained by the pattern of specific humidity changes. These results demonstrate that understanding regional changes in specific humidity is largely sufficient for understanding regional changes in heat stress.
Purpose The purpose of this study is to analyze the question “In what order of magnitude does the comfort and performance improvement lie with the use of a cooling vest for construction workers?”. Design/methodology/approach The use of personal cooling systems, in the form of cooling vests, is not only intended to reduce the heat load, in order to prevent disruption of the thermoregulation system of the body, but also to improve work performance. A calculation study was carried out on the basis of four validated mathematical models, namely a cooling vest model, a thermophysiological human model, a dynamic thermal sensation model and a performance loss model for construction workers. Findings The use of a cooling vest has a significant beneficial effect on the thermal sensation and the loss of performance, depending on the thermal load on the body. Research limitations/implications Each cooling vest can be characterized on the basis of the maximum cooling power (Pmax; in W/m(2)), the cooling capacity (Auc; in Wh/m2) and the time (tc; in minutes) after which the cooling power is negligible. In order to objectively compare cooling vests, a (preferably International and/or European) standard/guideline must be compiled to determine the cooling power and the cooling capacity of cooling vests. Practical implications It is recommended to implement the use of cooling vests in the construction process so that employees can use them if necessary or desired. Social implications Climate change, resulting in global warming, is one of the biggest problems of present times. Rising outdoor temperatures will continue in the 21st century, with a greater frequency and duration of heat waves. Some regions of the world are more affected than others. Europe is one of the regions of the world where rising global temperatures will adversely affect public health, especially that of the labor force, resulting in a decline in labor productivity. It will be clear that in many situations air conditioning is not an option because it does not provide sufficient cooling or it is a very expensive investment; for example, in the situation of construction work. In such a situation, personal cooling systems, such as cooling vests, can be an efficient and financially attractive solution to the problem of discomfort and heat stress. Originality/value The value of the study lies in the link between four validated mathematical models, namely a cooling vest model, a thermophysiological human model, a dynamic thermal sensation model and a performance loss model for construction workers.
Heatstroke is increasingly becoming a significant concern due to global warming. Systemic inflammation and coagulopathy are the two major factors that provoke life-threatening organ dysfunction in heatstroke. Dysregulated thermo-control induces cellular injury, damage-associated molecular patterns release, hyperinflammation, and hypercoagulation with suppressed fibrinolysis to produce heatstroke-induced coagulopathy (HSIC). HSIC can progress to disseminated intravascular coagulation and multiorgan failure if severe enough. Platelet count, D-dimer, soluble thrombomodulin, and inflammation biomarkers such as interleukin-6 and histone H3 are promising markers for HSIC. In exertional heatstroke, the measurement of myoglobin is helpful to anticipate renal dysfunction. However, the optimal cutoff for each biomarker has not been determined. Except for initial cooling and hydration, effective therapy continues to be explored, and the use of antiinflammatory and anticoagulant therapies is under investigation. Despite the rapidly increasing risk, our knowledge is limited, and further study is warranted. In this review, we examine current information and what future efforts are needed to better understand and manage HSIC.
The combination of high humidity and ambient temperature of the 2021 Tokyo Summer Olympic Game will undoubtfully result in greater physiological strains and thereby downregulates the endurance performance of athletes. Although many research studies have highlighted that the thermoregulatory strain is greater when the environment is hot and humid, no review articles have addressed the thermoregulatory and performance differences between dry and humid heat and such lack of consensuses in this area will lead to increase the risk of heat-related injuries as well as suboptimal preparation. Furthermore, specific strategies to counteract this stressful environment has not been outlined in the current literature. Therefore, the purposes of this review are: 1) to provide a clear evidence that humid heat is more stressful than dry heat for both male and female athletes and therefore the preparation for the Tokyo Summer Olympic should be environmental specific instead of a one size fits all approach; 2) to highlight why female athletes may be facing a disadvantage when performing a prolonged endurance event under high humidity environment and 3) to highlight the potential interventional strategies to reduce thermal strain in hot-humid environment. The summaries of this review are: both male and female should be aware of the environmental condition in Tokyo as humid heat is more stressful than dry heat; Short-term heat acclimation may not elicit proper thermoregulatory adaptations in hot-humid environment; cold water immersion with proper hydration and some potential per-cooling modalities may be beneficial for both male and female athletes in hot-humid environment.
Clinical Background: Hydration status, which is influenced by environment and self-behavior is associated with kidney health and disease. Epidemiology: Lack of safe water, sanitation, and high temperatures are environmental issues that affect a significant part of the worldwide population. Occupational factors that discourage proper hydration, as well as low water intake in favorable environment conditions, are also highly prevalent. As a consequence, inadequate water intake can lead to several kidney problems ranging from uncomplicated urinary tract infections to kidney stones, acute kidney injury, and chronic disorders with high mortality rates. Challenges: Increasing water intake is an individual effort when self-behavior is the main reason for inadequate hydration status. When the environment is an obstacle, it might require complex changes in a concerted multidisciplinary effort from employers, health authorities, researchers, and governments. Prevention and Treatment: Strategies can be implemented at global, local, and individual levels. Global efforts include actions to decrease poverty and climate change consequences, while increasing access to safe water and sanitation. Local actions can improve working conditions and access to water and toilets to workers. At an individual level, self-monitoring through regular observation of thirst sensation, acute weight loss, urine frequency, and urine color are recommended tools to monitor hydration status.
Residential buildings instigate a vital role in creating a safe and comfortable indoor living environment. The phenomenon of overheating, an impact of climate change, can cause a negative effect on residents’ productiveness and heat-related illnesses and can even force high pressure on electricity generation by increasing the risk of power outages due to excessive peak cooling and heating requirements. Various issues on building thermal comfort are being evolved and discussed in review articles. However, there are few articles that review the current condition of adaptive thermal comfort studies and the potential for energy savings in residential buildings. Therefore, the aims for this paper are to: identify comfort temperature ranges in residential buildings, investigate the correlation of comfort temperature with indoor and outdoor temperatures with the aid of ‘comfort threads’, and clarify the effect of adaptive measures on residential energy saving potential. This study obtained a large variation of residential comfort temperatures, which mostly depend on the climate and operation modes of the building. ‘Comfort threads’ explains that people are adapting to a large variation of indoor and outdoor temperatures and the wide range of comfort temperature could provide significant energy savings in residential buildings. This review provides insight on and an overview of thermal comfort field studies in residential buildings.
High ambient temperature and humidity greatly increase the risk of hyperthermia and mortality, particularly in infants, who are especially prone to dehydration. World areas at high risk of heat stress include many of the low- and middle-income countries (LMICs) where most of their inhabitants have no access to air conditioning. This study aimed to design, evaluate, and test a novel low-cost and easy-to-assemble device aimed at preventing the risk of infant hyperthermia in LMICs. The device is based on optimizing negative heat transfer from a small amount of ice and transferring it directly to the infant by airflow of refrigerated air. As a proof of concept, a device was assembled mainly using recycled materials, and its performance was assessed under laboratory-controlled conditions in a climatic chamber mimicking realistic stress conditions of high temperature and humidity. The device, which can be assembled by any layperson using easily available materials, provided sufficient refrigerating capacity for several hours from just 1-2 kg of ice obtained from a domestic freezer. Thus, application of this novel device may serve to attenuate the adverse effects of heat stress in infants, particularly in the context of the evolving climatic change trends.
To fully address the multi-faceted challenges of urban heat, it is paramount that humans are placed at the center of the agenda. This is manifested in a recent shift in urban heat studies that aim to achieve a ‘human-centric’ approach, i.e. focusing on personalized characteristics of comfort, well-being, performance, and health, as opposed to the one-size-fits-all solutions and guidelines. The proposed article is focused on systematically reviewing personalized urban heat studies and detailing the objectives posed, methodologies utilized, and limitations yet to be addressed. We further summarize current knowledge and challenges in addressing the impact of personal heat exposure on human life by discussing the literature linked with urban heat studies at the human, building, and city scales. Lastly, this systematic review reveals the need for future evaluations focused on accuracy and standardization of human-centric data collection and analytics, and more importantly, addressing critical geographic and socio-economic knowledge gaps identified in the field.
BACKGROUND: Mental health is an important public health issue globally. A potential link between heat exposure and mental health outcomes has been recognised in the scientific literature; however, the associations between heat exposure (both high ambient temperatures and heatwaves) and mental health-related mortality and morbidity vary between studies and locations. OBJECTIVE: To fill gaps in knowledge, this systematic review aims to summarize the epidemiological evidence and investigate the quantitative effects of high ambient temperatures and heatwaves on mental health-related mortality and morbidity outcomes, while exploring sources of heterogeneity. METHODS: A systematic search of peer-reviewed epidemiological studies on heat exposure and mental health outcomes published between January 1990 and November 2020 was conducted using five databases (PubMed, Embase, Scopus, Web of Science and PsycINFO). We included studies that examined the association between high ambient temperatures and/or heatwaves and mental health-related mortality and morbidity (e.g. hospital admissions and emergency department visits) in the general population. A range of mental health conditions were defined using ICD-10 classifications. We performed random effects meta-analysis to summarize the relative risks (RRs) in mental health outcomes per 1 °C increase in temperature, and under different heatwaves definitions. We further evaluated whether variables such as age, sex, socioeconomic status, and climate zone may explain the observed heterogeneity. RESULTS: The keyword search yielded 4560 citations from which we identified 53 high temperatures/heatwaves studies that comprised over 1.7 million mental health-related mortality and 1.9 million morbidity cases in total. Our findings suggest associations between heat exposures and a range of mental health-related outcomes. Regarding high temperatures, our meta-analysis of study findings showed that for each 1 °C increase in temperature, the mental health-related mortality and morbidity increased with a RR of 1.022 (95%CI: 1.015-1.029) and 1.009 (95%CI: 1.007-1.015), respectively. The greatest mortality risk was attributed to substance-related mental disorders (RR, 1.046; 95%CI: 0.991-1.101), followed by organic mental disorders (RR, 1.033; 95%CI: 1.020-1.046). A 1 °C temperature rise was also associated with a significant increase in morbidity such as mood disorders, organic mental disorders, schizophrenia, neurotic and anxiety disorders. Findings suggest evidence of vulnerability for populations living in tropical and subtropical climate zones, and for people aged more than 65 years. There were significant moderate and high heterogeneities between effect estimates in overall mortality and morbidity categories, respectively. Lower heterogeneity was noted in some subgroups. The magnitude of the effect estimates for heatwaves varied depending on definitions used. The highest effect estimates for mental health-related morbidity was observed when heatwaves were defined as “mean temperature ≥90th percentile for ≥3 days” (RR, 1.753; 95%CI: 0.567-5.421), and a significant effect was also observed when the definition was “mean temperature ≥95th percentile for ≥3 days”, with a RR of 1.064 (95%CI: 1.006-1.123). CONCLUSIONS: Our findings support the hypothesis of a positive association between elevated ambient temperatures and/or heatwaves and adverse mental health outcomes. This problem will likely increase with a warming climate, especially in the context of climate change. Further high-quality studies are needed to identify modifying factors of heat impacts.
‘One World – One Health’ is a developing concept which aims to explicitly incorporate linkages between the environment and human society into wildlife and human health care. Past work in the field has concentrated on aspects of disease, particularly emerging zoonoses, and focused on terrestrial systems. Here, we argue that marine environments are crucial components of the ‘One World – One Health’ framework, and that coral reefs are the epitome of its underlying philosophy. That is, they provide vast contributions to a wide range of ecosystem services with strong and direct links to human well-being. Further, the sensitivity of corals to climate change, and the current emergence of a wide range of diseases, make coral reefs ideal study systems to assess links, impacts, and feedback mechanisms that can affect human and ecosystem health. There are well established protocols for monitoring corals, as well as global networks of coral researchers, but there remain substantial challenges to understanding these complex systems, their health and links to provisioning of ecosystem services. We explore these challenges and conclude with a look at how developing technology offers potential ways of addressing them. We argue that a greater integration of coral reef research into the ‘One World – One Health’ framework will enrich our understanding of the many links within, and between, ecosystems and human society. This will ultimately support the development of measures for improving the health of both humans and the environment.
The Warsaw International Mechanism for Loss and Damage has identified increasing temperatures as a key slow onset event. However, it is the resulting increases in short-term heat events – heatwaves – that have so far been the primary focus of risk assessment and policy, while gradual and sustained increases in temperature have received less attention. This is a global issue but particularly important in tropical and subtropical regions already chronically exposed to extreme heat. This paper reviews recent analyses of intensifying seasonal and year-round extreme heat exposures and how this affects daily life, including worker productivity, health and wellbeing, reduced GDP and economic viability. It frames this as a slow onset event and closes with a brief indication of tools available to assess and address these risks.
Prolonged and/or extreme heat has become a natural hazard that presents a significant risk to humans and the buildings, technologies, and infrastructure on which they have previously relied on to provide cooling. This paper presents a conceptual model of a resilient cooling system centred on people, the socio-cultural-technical contexts they inhabit, and the risks posed by the temperature hazard. An integrative literature review process was used to undertake a critical and comprehensive evaluation of published research and grey literature with the objective of adding clarity and detail to the model. Two databases were used to identify risk management and natural hazard literature in multiple disciplines that represent subcomponents of community resilience (social, economic, institutional, infrastructure and environment systems). This review enabled us to characterise in more detail the nature of the temperature hazard, the functionality characteristics of a resilient cooling system, and key elements of the four subsystems: people, buildings, cooling technologies and energy infrastructure. Six key messages can be surmised from this review, providing a guide for future work in policy and practice.
Increased exposure to extreme heat from both climate change and the urban heat island effect-total urban warming-threatens the sustainability of rapidly growing urban settlements worldwide. Extreme heat exposure is highly unequal and severely impacts the urban poor. While previous studies have quantified global exposure to extreme heat, the lack of a globally accurate, fine-resolution temporal analysis of urban exposure crucially limits our ability to deploy adaptations. Here, we estimate daily urban population exposure to extreme heat for 13,115 urban settlements from 1983 to 2016. We harmonize global, fine-resolution (0.05°), daily temperature maxima and relative humidity estimates with geolocated and longitudinal global urban population data. We measure the average annual rate of increase in exposure (person-days/year(-1)) at the global, regional, national, and municipality levels, separating the contribution to exposure trajectories from urban population growth versus total urban warming. Using a daily maximum wet bulb globe temperature threshold of 30 °C, global exposure increased nearly 200% from 1983 to 2016. Total urban warming elevated the annual increase in exposure by 52% compared to urban population growth alone. Exposure trajectories increased for 46% of urban settlements, which together in 2016 comprised 23% of the planet’s population (1.7 billion people). However, how total urban warming and population growth drove exposure trajectories is spatially heterogeneous. This study reinforces the importance of employing multiple extreme heat exposure metrics to identify local patterns and compare exposure trends across geographies. Our results suggest that previous research underestimates extreme heat exposure, highlighting the urgency for targeted adaptations and early warning systems to reduce harm from urban extreme heat exposure.
This article presents a customized system dynamics model to facilitate the informed development of policy for urban heat island mitigation within the context of future climate change, and with special emphasis on the reduction of heat-related mortality. The model incorporates a variety of components (incl.: the urban heat island effect; population dynamics; climate change impacts on temperature; and heat-related mortality) and is intended to provide urban planning and related professionals with: a facilitated means of understanding the risk of heat-related mortality within the urban heat island; and location-specific information to support the development of reasoned and targeted urban heat island mitigation policy.
BACKGROUND: The earth’s climate is warming and the frequency, duration, and severity of heat waves are increasing. Meanwhile, the world’s population is rapidly aging. Epidemiological data demonstrate exponentially greater increases in morbidity and mortality during heat waves in adults ≥65 years. Laboratory data substantiate the mechanistic underpinnings of age-associated differences in thermoregulatory function. However, the specific combinations of environmental conditions (i.e., ambient temperature and absolute/relative humidity) above which older adults are at increased risk of heat-related morbidity and mortality are less clear. METHODS: This review was conducted to (1) examine the recent (past 3 years) literature regarding heat-related morbidity and mortality in the elderly and discuss projections of future heat-related morbidity and mortality based on climate model data, and (2) detail the background and unique methodology of our ongoing laboratory-based projects aimed toward identifying the specific environmental conditions that result in elevated risk of heat illness in older adults, and the implications of using the data toward the development of evidence-based safety interventions in a continually-warming climate (PSU HEAT; Human Environmental Age Thresholds). RESULTS: The recent literature demonstrates that extreme heat continues to be increasingly detrimental to the health of the elderly and that this is apparent across the world, although the specific environmental conditions above which older adults are at increased risk of heat-related morbidity and mortality remain unclear. CONCLUSION: Characterizing the environmental conditions above which risk of heat-related illnesses increase remains critical to enact policy decisions and mitigation efforts to protect vulnerable people during extreme heat events.
Globally, extreme temperatures have severe impacts on the economy, human health, food and water security, and ecosystems. Mortality rates have been increased due to heatwaves in several regions. Specifically, megacities have high impacts with the increasing temperature and everexpanding urban areas; it is important to understand extreme temperature changes in terms of duration, magnitude, and frequency for future risk management and disaster mitigation. Here we framed a novel Semi-Parametric quantile mapping method to bias-correct the CMIP6 minimum and maximum temperature projections for 199 megacities worldwide. The changes in maximum and minimum temperature are quantified in terms of climate indices (ETCCDI and HDWI) for the four Shared Socioeconomic Pathways (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). Cities in northern Asia and northern North America (Kazan, Samara, Heihe, Montre ‘ al, Edmonton, and Moscow) are warming at a higher rate compared to the other regions. There is an increasing and decreasing trend for the warm and cold extremes respectively. Heatwaves increase exponentially in the future with the increase in warming, that is, from SSP1-2.6 to SSP5-8.5. Among the CMIP6 models, a huge variability is observed, and this further increases as the warming increases. All climate indices have steep slopes for the far future (2066-2100) compared to the near future (2031-2065). Yet the variability among CMIP6 models in near future is high compared to the far future for cold indices.
Surface temperatures are generally higher in cities than in rural surroundings. This phenomenon, known as Surface Urban Heat Island (SUHI), increases the risk of heat-related human illnesses and mortality. Past global studies analysed this phenomenon aggregated at city scale or over seasonal and annual time periods, while human impacts strongly depend on shorter term heat stress experienced locally. Here we develop a global longterm high-resolution dataset of daytime SUHI, offering an insight into the space-time variability of the urban-rural temperature differences which is unprecedented at global scale. Our results show that across urban areas worldwide over the period 2003-2020, 3-day SUHI extremes are on average more than twice as high as the warm-season median SUHI, with local exceedances up to 10 K. Over this period, SUHI extremes have increased more rapidly than warm-season medians, and averaged worldwide are now 1.04 K or 31% higher compared to 2003. This can be linked with increasing urbanisation, more frequent heatwaves, and greening of the earth, processes that are all expected to continue in the coming decades. Within many cities there are hotspots where extreme SUHI intensity is 10-15 K higher compared to relatively cooler city parts. Given the limited human adaptability to heat stress, our results advocate for mitigation strategies targeted at reducing SUHI extremes in the most vulnerable and exposed city neighbourhoods.
Over the past decades, the world has experienced increasing heatwave intensity, frequency, and duration. This trend is projected to increase into the future with climate change. At the same time, the global population is also projected to increase, largely in the world’s cities. This urban growth is associated with increased heat in the urban core, compared to surrounding areas, exposing residents to both higher temperatures and more intense heatwaves than their rural counterparts. Regional studies suggest that Asia and Africa will be significantly affected. How many people may be exposed to levels of extreme heat events in the future remains unclear. Identifying the range in number of potentially exposed populations and where the vulnerable are located can help planners prioritize adaption efforts. We project the ranges of population exposed to heatwaves at varying levels to 2,100 for three future periods of time (2010-2039, 2040-2069, 2070-2099) using the Shared Socio-Economic Pathways (SSPs) and the Representative Concentration Pathways (RCPs). We hypothesize that the largest populations that will be exposed to very warm heatwaves are located in Asia and Africa. Our projections represent the warmest heatwaves for 15 days during these three periods. By the 2070-2099 period, the exposure levels to extreme heatwaves (>42 degrees) exceed 3.5 billion, under the sustainability scenario (RCP2.6-SSP1). The number of those exposed in cities climbs with greater projected climate change. The largest shares of the exposed populations are located in Southern Asia and tropical countries Western and Central Africa. While this research demonstrates the importance of this type of climate change event, urban decision-makers are only recently developing policies to address heat. There is an urgent need for further research in this area.
Climate change lead to more intense, higher frequent and prolonged heat extremes. Under-standing the spatial pattern of heatwave is vital for providing the corresponding weather services, making climate change adaptation strategies and heat-health actions. In this study, we present an approach to estimate the heatwave spatial patterns by utilizing the WUDAPT Level 0 data and machine learning. The analysis is based on two years (2009 and 2016) of air temperature data from 86 meteorological monitoring stations in Guangdong province of China, a subtropical region with frequent hot and sultry weather in summer. First, heatwave conditions were quantified by calculating the number of hot days and frequency of heatwave events in each year and used as the response variables. Then, random forest models were built by using a geospatial dataset con-sisting of WUDAPT and urban canopy parameters (UCP) as predictor variables. Based on the resultant models, spatial patterns of heatwave were estimated and mapped at 100 m spatial -resolution. The results show that this approach is able to estimate heatwave spatial patterns using open data and inform urban policy and decision-making. The study is also a new perspective and a feasible pathway of utilizing WUDPAT Level 0 product to facilitate urban environment applications.
Urban overheating, driven by global climate change and urban development, is a major contemporary challenge that substantially impacts urban livability and sustainability. Overheating represents a multifaceted threat to the well-being, performance, and health of individuals as well as the energy efficiency and economy of cities, and it is influenced by complex interactions between building, city, and global scale climates. In recent decades, extensive discipline-specific research has characterized urban heat and assessed its implications on human life, including ongoing efforts to bridge neighboring disciplines. The research horizon now encompasses complex problems involving a wide range of disciplines, and therefore comprehensive and integrated assessments are needed that address such interdisciplinarity. Here, our objective is to go beyond a review of existing literature and instead provide a broad overview and integrated assessments of urban overheating, defining holistic pathways for addressing the impacts on human life. We (a) detail the characterization of heat hazards and exposure across different scales and in various disciplines, (b) identify individual sensitivities to urban overheating that increase vulnerability and cause adverse impacts in different populations, (c) elaborate on adaptive capacities that individuals and cities can adopt, (d) document the impacts of urban overheating on health and energy, and (e) discuss frontiers of theoretical and applied urban climatology, built environment design, and governance toward reduction of heat exposure and vulnerability at various scales. The most critical challenges in future research and application are identified, targeting both the gaps and the need for greater integration in overheating assessments.
Extreme heat, the deadliest summer weather-related hazard in the USA, is projected to increase in intensity, duration, frequency, and magnitude, especially in urban areas that account for 80% of the population. Spatial visualization and representation are crucial in establishing the hotspots of vulnerability to the heat hazard. However, despite the progress in the science of vulnerability, there lacks a systematic and consistent conceptual framework. The quantification of variables is unchecked, resulting in subjective decisions regarding the weighting of variables, selection of indicators, and the suitability of the proxies. Moreover, contradicting approaches generate disparate outputs such as; inductive versus deductive, area-based versus population-based, and raster versus vector designs. The qualitative approach, meant to provide supplementary data, is often ignored. This review provides a perspective of the lacunae in the existing literature and builds on these gaps to derive a conceptual framework towards harmonizing theoretical and statistical relationships. The framework is anchored on the longitudinal study approach as the socioeconomic, biophysical, and geodemographic dimensions have an inherent temporal variance. The review calls for a precise and accurate depiction of heat vulnerability in urban areas to inform targeted adaptation and mitigation measures and the long term projection of coupled systems behavior.
When inferring on the magnitude of future heat-related mortality due to climate change, human adaptation to heat should be accounted for. We model long-term changes in minimum mortality temperatures (MMT), a well-established metric denoting the lowest risk of heat-related mortality, as a function of climate change and socio-economic progress across 3820 cities. Depending on the combination of climate trajectories and socio-economic pathways evaluated, by 2100 the risk to human health is expected to decline in 60% to 80% of the cities against contemporary conditions. This is caused by an average global increase in MMTs driven by long-term human acclimatisation to future climatic conditions and economic development of countries. While our adaptation model suggests that negative effects on health from global warming can broadly be kept in check, the trade-offs are highly contingent to the scenario path and location-specific. For high-forcing climate scenarios (e.g. RCP8.5) the maintenance of uninterrupted high economic growth by 2100 is a hard requirement to increase MMTs and level-off the negative health effects from additional scenario-driven heat exposure. Choosing a 2 °C-compatible climate trajectory alleviates the dependence on fast growth, leaving room for a sustainable economy, and leads to higher reductions of mortality risk.
The absence of vegetation in urban areas contributes to the establishment of the urban heat island, markedly increasing thermal stress for residents, driving morbidity and mortality. Mitigation strategies are, therefore, needed to reduce urban heat, particularly against a background of urbanization, anthropogenic warming and increasing frequency and intensity of heatwaves. In this Review, we evaluate the potential of green infrastructure as a mitigation strategy, focusing on greenery on the ground (parks) and greenery on buildings (green roofs and green walls). Green infrastructure acts to cool the urban environment through shade provision and evapotranspiration. Typically, greenery on the ground reduces peak surface temperature by 2-9 degrees C, while green roofs and green walls reduce surface temperature by similar to 17 degrees C, also providing added thermal insulation for the building envelope. However, the cooling potential varies markedly, depending on the scale of interest (city or building level), greenery extent (park shape and size), plant selection and plant placement. Urban planners must, therefore, optimize design to maximize mitigation benefits, for example, by interspersing parks throughout a city, allocating more trees than lawn space and using multiple strategies in areas where most cooling is required. To do so, improved translation of scientific understanding to practical design guidelines is needed.
NEW FINDINGS: What is the topic of this review? The potential role of nutrition in exertional heat stroke. What advances does it highlight? Certain nutritional and dietary strategies used by athletes and workers may exert a protective effect the pathophysiological processes of exertional heat stroke, whereas others may be detrimental. While current evidence suggests that some of these practices may be leveraged as a potential countermeasure to exertional heat stroke, further research on injury-related outcomes in humans is required. ABSTRACT: Exertional heat stroke (EHS) is a life-threatening illness and an enduring problem among athletes, military servicemen and -women, and occupational labourers who regularly perform strenuous activity, often under hot and humid conditions or when wearing personal protective equipment. Risk factors for EHS and mitigation strategies have generally focused on the environment, health status, clothing, heat acclimatization and aerobic conditioning, but the potential role of nutrition is largely underexplored. Various nutritional and dietary strategies have shown beneficial effects on exercise performance and health and are widely used by athletes and other physically active populations. There is also evidence that some of these practices may dampen the pathophysiological features of EHS, suggesting possible protection or abatement of injury severity. Promising candidates include carbohydrate ingestion, appropriate fluid intake and glutamine supplementation. Conversely, some nutritional factors and low energy availability may facilitate the development of EHS, and individuals should be cognizant of these. Therefore, the aims of this review are to present an overview of EHS along with its mechanisms and pathophysiology, discuss how selected nutritional considerations may influence EHS risk focusing on their impact on the key pathophysiological processes of EHS, and provide recommendations for future research. With climate change expected to increase EHS risk and incidence in the coming years, further investigation on how diet and nutrition may be optimized to protect against EHS would be highly beneficial.
OBJECTIVES: To analyse 11 years of FIVB heat stress-monitoring data to determine the relative influence of the different environmental parameters in increasing the likelihood of a heat-related medical time-out (MTOheat). METHODS: A total of 8530 matches were recorded. The referee measured air temperature, black globe temperature, relative humidity and wet-bulb globe temperature (WBGT) before the matches, and registered the MTOheat. The absolute humidity was computed at posteriori. RESULTS: There were 20 MTOheat cases, but only 3 resulted in forfeiting the match. MTOheat incidence was not statistically impacted by sex (p=0.59). MTOheat cases were more prevalent during the games played in Asia during the 4th quarter of the year (p<0.001). Two cases of MTOheat experienced diarrhoea or gastroenteritis during the 5 preceding days; both of them forfeited the match. A principal component analysis showed a specific environmental profile for the matches with MTOheat. They occurred at higher WBGT, temperatures and absolute humidity (p<0.001), but with a lower relative humidity (p=0.027). CONCLUSIONS: The current data showed that an increase in ambient or black globe temperature, but not relative humidity, increased the risk of a MTOheat; but that the absolute risk remained low in elite beach volleyball players. However, suffering or recovering from a recent illness may represent a risk factor for a MTOheat to lead to player forfeit.
People exercising under high ambient temperature will cause changes in physiological indicators. In order to study the thermal physiological state of the human body, we randomly selected 18 volunteers into the thermal environment exercise group and the room temperature exercise group. Two groups of volunteers performed aerobic exercises in different thermal environments. In the case of exercise performed every 15 min, the volunteers’ hemorheology, physical performance rating (RPE) value and rectal temperature (Tre) were tested. At the same time, we recorded the physiological indicators of the volunteers and simulated the thermal physiology. The results showed that there was a difference in the thermal physiology of the two groups of volunteers, and the hemorheology and the self-strain rating scale were highly correlated in the thermal environment (r=0.839, P<0.01). For this reason, we can conclude that exercising in a hot environment will make people have a heavier heat stress response, and thus render them more likely to undergo muscle fatigue. It is advised that exercising at high temperatures may be avoided as much as possible.
The recent report of the Intergovernmental Panel on Climate Change is stark in its warnings about the changing climate, including future increases in the frequency and intensity of extremely hot weather. The well-established impacts of extreme heat on human health have led to widespread implementation of national and city-wide heat plans for mitigating such impacts. Evaluations of the effectiveness of some heat plans have been published, with previous reviews highlighting key methodological challenges. This article reviews methods used since and that address those challenges, so helping to set an agenda for improving evaluations of heat plans in terms of their effectiveness in reducing heat-health impacts. We examined the reviews that identified the methodological challenges and systematically searched the literature to find evaluations that had since been conducted. We found 11 evaluations. Their methods help address the key challenge of identifying study control groups and address other challenges to a limited extent. For future evaluations, we recommend: utilising recent evaluation methodologies, such as difference-in-differences quasi-experimental designs where appropriate; cross-agency working to utilise data on morbidity and confounders; adoption of a proposed universal heat index; and greater publication of evaluations. More evaluations should assess morbidity outcomes and be conducted in low- and middle-income countries. Evaluations of heat plans globally should employ robust methodologies, as demonstrated in existing studies and potentially transferrable from other fields. Publication of such evaluations will advance the field and thus help address some of the health challenges resulting from our changing climate.
Climate change causes global effects on multiple levels. The anthropogenic input of greenhouse gases increases the atmospheric mean temperature. It furthermore leads to a higher probability of extreme weather events (e.g., heat waves, floods) and thus strongly impacts the habitats of humans, animals, and plants. Against this background, research and innovation activities are increasingly focusing on potential health-related aspects and feasible adaptation and mitigation strategies. Progressing urbanization and demographic change paired with the climate change-induced heat island effect exposes humans living in urban habitats to increasing health risks. By employing scientometric methods, this scoping study provides a systematic bird’s eye view on the epistemic landscapes of climate change, its health-related effects, and possible technological and nature-based interventions and strategies in order to make urban areas climate proof. Based on a literature corpus consisting of 2614 research articles collected in SCOPUS, we applied network-based analysis and visualization techniques to map the different scientific communities, discourses and their interrelations. From a public health perspective, the results demonstrate the range of either direct or indirect health effects of climate change. Furthermore, the results indicate that a public health-related scientific discourse is converging with an urban planning and building science driven discourse oriented towards urban blue and green infrastructure. We conclude that this development might mirror the socio-political demand to tackle emerging climate change-induced challenges by transgressing disciplinary boundaries.
BACKGROUND: In hot weather, electric fans can potentially provide effective cooling for people, with lower greenhouse gas emissions and cost than air conditioning. However, international public health organisations regularly discourage fan use in temperatures higher than 35°C, despite little evidence. We aimed to determine humidity-dependent temperature thresholds at which electric fans would become detrimental in different age groups. METHODS: We used biophysical modelling to determine the upper humidity-dependent temperature thresholds at which fan use would become detrimental (ie, worsen heat stress) for healthy young adults (aged 18-40 years), healthy older adults (aged ≥65 years), and older adults taking anticholinergic medication. We also obtained hourly environmental data for the period Jan 1, 2007, to Dec 31, 2019, for 108 populous cities to determine the number of days fan use would be effective for cooling, standardised to a 31-day hot weather month. We established simplified temperature thresholds for future fan use recommendations on the basis of temperatures below which fan use would never have been detrimental between Jan 1, 2007, and Dec 31, 2019, across all prevailing levels of ambient humidity. FINDINGS: According to our model, fan use would have been beneficial on 30·0 (96·6%) of 31 hot weather days for healthy young adults and 29·4 (94·9%) of 31 hot weather days for both older adults and older adults taking anticholinergic medication between Jan 1, 2007, and Dec 31, 2019. Adherence to the current WHO recommendation of fan use below temperatures of 35°C only, fan use would have been recommended on 27·2 days (87·7%) of 31 hot weather days. According to our simplified thresholds for fan use (at temperatures <39·0°C for healthy young adults, <38·0°C for healthy older adults, and <37·0°C for older adults taking anticholinergic medication), fan use would have been recommended on 29·6 (95·5%) of 31 hot weather days in healthy young adults, 29·4 (94·8%) days in healthy older adults, and 28·8 (93·0%) days in older adults taking anticholinergic medication between Jan 1, 2007, and Dec 31, 2019. INTERPRETATION: Electric fan use, particularly for healthy young adults, would not have worsened heat stress on the majority of study days between 2007 and 2019. Our newly proposed thresholds for fan use provide simple guidelines that improve future heatwave fan use recommendations. FUNDING: None.
The ambition to develop sustainable and healthy cities requires city-specific policy and practice founded on a multidisciplinary evidence base, including projections of human-induced climate change. A cascade of climate models of increasing complexity and resolution is reviewed, which provides the basis for constructing climate projections-from global climate models with a typical horizontal resolution of a few hundred kilometres, through regional climate models at 12-50 km to convection-permitting models at 1 km resolution that permit the representation of urban induced climates. Different approaches to modelling the urban heat island (UHI) are also reviewed-focusing on how climate model outputs can be adjusted and coupled with urban canopy models to better represent UHI intensity, its impacts and variability. The latter can be due to changes induced by urbanisation or to climate change itself. City interventions such as greater use of green infrastructure also have an effect on the UHI and can help to reduce adverse health impacts such as heat stress and the mortality associated with increasing heat. Examples for the Complex Urban Systems for Sustainability and Health (CUSSH) partner cities of London, Rennes, Kisumu, Nairobi, Beijing and Ningbo illustrate how cities could potentially make use of more detailed models and projections to develop and evaluate policies and practices targeted at their specific environmental and health priorities. PRACTICE RELEVANCE: Large-scale climate projections for the coming decades show robust trends in rising air temperatures, including more warm days and nights, and longer/more intense warm spells and heatwaves. This paper describes how more complex and higher resolution regional climate and urban canopy models can be combined with the aim of better understanding and quantifying how these larger scale patterns of change may be modified at the city or finer scale. These modifications may arise due to urbanisation and effects such as the UHI, as well as city interventions such as the greater use of grey and green infrastructures.There is potential danger in generalising from one city to another-under certain conditions some cities may experience an urban cool island, or little future intensification of the UHI, for example. City-specific, tailored climate projections combined with tailored health impact models contribute to an evidence base that supports built environment professionals, urban planners and policymakers to ensure designs for buildings and urban areas are fit for future climates.
Urban heat island and regional climate change raise the ambient temperature in cities and increase the levels of heat related mortality. Higher albedo values lower the ambient temperature and reduce the impact of excess urban heat on health. The present work reviews and analyses fourteen detailed studies investigating the impact of increased urban albedo on the ambient temperature and heat related mortality. It is found that the real magnitude of the afternoon temperature drop caused by the albedo increase is close to 0.09C per 0.1 rise of the albedo, and it is highly determined by the specific climatic, landscape and layout characteristic of cities. A statistically significant association of the temperature drop with the albedo increase, the greenery and street ratio in cities is found. It is observed that the levels of heat related mortality increase significantly as a function of the population size of the cities and the local poverty levels, Increased urban albedo is found to reduce heat related mortality between 0.1 and 4 deaths per day, corresponding to an average decrease of deaths close to 19.8% per degree of temperature drop, or 1.8% per 0.1 increase of the albedo. Mortality drop is found to be in statistically significant association with the initial heat related mortality levels, albedo increase and socioeconomic parameters like the local poverty levels. Accurate parametric functions to predict the magnitude of the temperature drop and heat mortality reduction are developed.
The relationship between sport and the environment has been primarily examined to understand how sport impacts the natural environment. However, as the influence of climate change has become more apparent, there is a need to establish a systematic understanding of the impacts of climate change on the operations of sport. The aim of this review is to take stock of existing literature on climate change’s impacts on organized competitive sport entities, with further attention paid to their adaptation efforts. A scoping review was conducted to identify relevant studies published between 1995 and 2021. After evaluating more than 2100 publications, we retained 57 articles and analyzed them to answer the research questions: (1) What evidence is available regarding the impacts of climate change on the operation of organized competitive sport entities? (2) What is known from the literature about the measures taken by organized competitive sport entities to adapt to the impacts of climate change? Our analysis yielded five major themes: (1) Heat impacts on athlete and spectator health; (2) heat impacts on athlete performance; (3) adaptive measures taken in sport; (4) suitability of various cities for event hosting; and (5) benchmarking and boundary conditions. This review reveals that there is evidence of some climate change impacts on sport, but the literature reflects only a small share of the global sport sector. Equally, much remains to be understood about the nature of adaptation. This article is categorized under: Assessing Impacts of Climate Change > Evaluating Future Impacts of Climate Change
Projections show that Earth’s climate will continue to warm concurrent with increases in the percentage of the world’s elderly population. With an understanding that the body’s resilience to the heat degrades as it ages, these coupled phenomena point to serious concerns of heat-related mortality in growing elderly populations. As many of the people in this age cohort choose to live in managed long-term care facilities, it’s imperative that outdoor spaces of these communities be made thermally comfortable so that connections with nature and the promotion of non-sedentary activities are maintained. Studies have shown that simply being outside has a positive impact on a broad range of the psychosocial well-being of older adults. However, these spaces must be designed to afford accessibility, safety, and aesthetically pleasing experiences so that they are taken full advantage of. Here, we employ an integrative review to link ideas from the disciplines of climate science, health and physiology, and landscape architecture to explain the connections between heat, increased morbidity and mortality in aging adults, existing gaps in thermal comfort models, and key strategies in the development of useable, comfortable outdoor spaces for older adults. Integrative reviews allow for new frameworks or perspectives on a subject to be introduced. Uncovering the synergy of these three knowledge bases can contribute to guiding microclimatic research, design practitioners, and care providers as they seek safe, comfortable and inviting outdoor spaces for aging adults.
The Urban Heat Islands (UHI) effect is a microclimatic phenomenon that especially affects urban areas. It is associated with significant temperature increases in the local microclimate, and may amplify heat waves. Due to their intensity, UHI causes not only thermal discomfort, but also reductions in the levels of life quality. This paper reviews the important role of green infrastructure as a means through which the intensity of UHI may be reduced, along with their negative impact on human comfort and wellbeing. Apart from a comprehensive review of the available literature, the paper reports on an analysis of case studies in a set of 14 cities in 13 countries representing various geographical regions and climate zones. The results obtained suggest that whereas UHI is a common phenomenon, green infrastructure in urban areas may under some conditions ameliorate their impacts. In addition, the study revealed that the scope and impacts of UHI are not uniform: depending on peculiarities of urban morphologies, they pose different challenges linked to the microclimate peculiar to each city. The implications of this paper are threefold. Firstly, it reiterates the complex interrelations of UHIs, heat waves and climate change. Secondly, it outlines the fact that keeping and increasing urban green resources leads to additional various benefits that may directly or indirectly reduce the impacts of UHI. Finally, the paper reiterates the need for city planners to pay more attention to possible UHI effects when initiating new building projects or when adjusting current ones.
In buildings, energy is primarily consumed by mechanical air conditioning systems. Low energy alternatives, such as natural ventilation, are needed. However, they need to be able to cope with increasing heatwaves and pollution, particularly in warm climates. This review paper looked at the ability of natural ventilation to provide adequate thermal comfort, resilience against heatwaves, and good Indoor Air Quality in warm climates. Single sided ventilation demonstrates the poorest ability to provide thermal comfort, while cross ventilation highlights better performance in terms of reducing indoor air temperatures compared to outdoor. However, windcatchers and solar chimneys displayed even better performance by producing relatively high ventilation rates. During heatwaves and future climatic scenarios, natural ventilation, by cross-ventilation, was not able to meet internal thermal comfort standards. A potential low energy solution could be combining solar chimneys or windcatchers with water evaporation cooling. A critical synthesis of the literature suggests that these systems can generate high ventilation rates and keep indoor temperatures around 8 degrees C cooler than outdoor temperatures in warm weather (>35 degrees C). However, no studies were found testing these systems against future climate scenarios, and further studies are recommended. The literature supported natural ventilation being effective in removing pollution generated indoors due to adequate ventilation rates. However, using unfiltered natural ventilation for areas with high outdoor pollution can increase the indoor deposition of harmful particulate matter. With increasing air pollution, further studies are urgently required to investigate filter enabled natural ventilation, particularly with solar chimney/windcatcher incorporated.
Hot and humid working environments exist in civil engineering, exploration, shipping, and so on. Especially in mines and textile workplaces, the air humidity is usually close to saturation. Frontline workers perform physically demanding work, which will make the body sweat greatly and increase the occurrence of heat-related illnesses. The microenvironment under clothing can be improved by a ventilation cooling vest with pressurized air (denoted VCV), and the trunk skin temperature will be decreased. However, the amount of heat that a VCV removes from a working human body in hot and humid environments is unclear. In this study, human experiments were carried out, the ambient temperature was controlled at 30 degrees C, 32 degrees C or 34 degrees C, and the air humidity was 90%. The subjects wore a labor suit (denoted LS) or a VCV, running on a treadmill at 5 km/h or 7.5 km/h. The results showed that the total trunk heat loss was increased by 169-237%, and the cooling power of the VCV was between 79.5 and 97.6 W when wearing the VCV. However, the actual skin wettedness is often less than the calculated value, and the calculated cooling power should be considered the upper limit. The study indicated that the cooling capacity of the VCV increased as the ambient temperature and labor intensity increased, and the heat dissipation of the body also increased.
Working in hot and potentially humid conditions creates health and well-being risks that will increase as the planet warms. It has been proposed that workers could adapt to increasing temperatures by moving labor from midday to cooler hours. Here, we use reanalysis data to show that in the current climate approximately 30% of global heavy labor losses in the workday could be recovered by moving labor from the hottest hours of the day. However, we show that this particular workshift adaptation potential is lost at a rate of about 2% per degree of global warming as early morning heat exposure rises to unsafe levels for continuous work, with worker productivity losses accelerating under higher warming levels. These findings emphasize the importance of finding alternative adaptation mechanisms to keep workers safe, as well as the importance of limiting global warming.
BACKGROUND: Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting. METHODS: We collected daily ambient temperature and mortality data for 452 locations in 24 countries and used Enhanced Vegetation Index (EVI) as the greenspace measurement. We used distributed lag non-linear model to estimate the heat-mortality relationship in each city and the estimates were pooled adjusting for city-specific average temperature, city-specific temperature range, city-specific population density, and gross domestic product (GDP). The effect modification of greenspace was evaluated by comparing the heat-related mortality risk for different greenspace groups (low, medium, and high), which were divided into terciles among 452 locations. FINDINGS: Cities with high greenspace value had the lowest heat-mortality relative risk of 1·19 (95% CI: 1·13, 1·25), while the heat-related relative risk was 1·46 (95% CI: 1·31, 1·62) for cities with low greenspace when comparing the 99(th) temperature and the minimum mortality temperature. A 20% increase of greenspace is associated with a 9·02% (95% CI: 8·88, 9·16) decrease in the heat-related attributable fraction, and if this association is causal (which is not within the scope of this study to assess), such a reduction could save approximately 933 excess deaths per year in 24 countries. INTERPRETATION: Our findings can inform communities on the potential health benefits of greenspaces in the urban environment and mitigation measures regarding the impacts of climate change. FUNDING: This publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research Council-UK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/R009384/1), Academy of Finland (Grant ID: 310372), European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University’s NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033 The funders had no role in the design, data collection, analysis, interpretation of results, manuscript writing, or decision to publication.
The kidneys’ integrative responses to heat stress aid thermoregulation, cardiovascular control, and water and electrolyte regulation. Recent evidence suggests the kidneys are at increased risk of pathological events during heat stress, namely acute kidney injury (AKI), and that this risk is compounded by dehydration and exercise. This heat stress related AKI is believed to contribute to the epidemic of chronic kidney disease (CKD) occurring in occupational settings. It is estimated that AKI and CKD affect upwards of 45 million individuals in the global workforce. Water and electrolyte disturbances and AKI, both of which are representative of kidney-related pathology, are the two leading causes of hospitalizations during heat waves in older adults. Structural and physiological alterations in aging kidneys likely contribute to this increased risk. With this background, this comprehensive narrative review will provide the first aggregation of research into the integrative physiological response of the kidneys to heat stress. While the focus of this review is on the human kidneys, we will utilize both human and animal data to describe these responses to passive and exercise heat stress, and how they are altered with heat acclimation. Additionally, we will discuss recent studies that indicate an increased risk of AKI due to exercise in the heat. Lastly, we will introduce the emerging public health crisis of older adults during extreme heat events and how the aging kidneys may be more susceptible to injury during heat stress.
Climate change and rapid urbanization increase/amplify urban heat islands (UHIs). Green infrastructure (GI) is an effective and popularly strategy used to moderate UHIs. This paper aims to better understand the progress of different GI types (urban parks, urban forests, street trees, green roofs, green walls) in mitigating UHIs, and what benefits they provide. Firstly, this paper used CiteSpace to analyze 1243 publications on the Web of Science from 1990 to 2021, then analyzed the function/regulation of ecosystem services/benefits and values of GI types in reducing UHIs. The historical review results show that research on all GI types showed rapid growth since 2013, and their GR increased rapidly. The highest-ranking keywords were urban heat island/heat island, climate/climate change/microclimate, and temperature/land surface temperature/air temperature. “Design,” “vegetation,” “quality,” and “reduction” are the top four strongest keyword bursts. The most published countries are the People’s Republic of China, USA, Australia, Germany, and Italy, and the top three institutions are the Chinese Academy of Sciences, Arizona State University, and the National University of Singapore. Landscape and Urban Planning, Building and Environment, Energy and Building, and Urban Forestry and Urban Greening are the most published journals. In urban areas, different GI types as a form of ecosystem hardware provide multiple functions (reduced land surface temperatures, lower building energy usage, improved thermal comfort and enhanced human health, reduced morbidity and mortality, etc.). GI thus provides a regulated ecosystem service to ameliorate UHIs primarily through temperature regulation and shade. At the same time, GI provides benefits and values (ecological, economic, social, and cultural) to humans and urban sustainable development. GI types determine the functions they provide, afford corresponding regulated ecosystem services, and provide benefits and values in a logical/recycle system. Overall, this review highlights the development and importance of GI, as well as the relationship of GI types and functions of regulating the ecosystem service benefits and values to mitigate UHI, and advances the study of climate change adaptation in cities.
Urban areas are expanding due to rural-urban migration and due to population increases. Their resilience is being challenged due to socio-political consequences of increasingly frequent and severe storms, due to climate changes, influx of human and animal refugees and as a consequence of the COVID-19 pandemic. The authors prepared a systematic literature of ways cities can be transformed into more resilient, and sustainable regions by creatively enhancing the quality and quantity of blue and green areas in and around them. The literature review was conducted to provide holistic insights into selection, implementation monitoring, assessment, and valuation of Nature-based Solutions in diverse urban regions. The authors reviewed no fewer than 298 articles from 109 academic journals and related sources, published within 1997-2020. The focus of the articles was upon ‘nature-based’ changes that are being implemented in urban areas, globally to enhance their resilience and the ‘quality-of-life’ of humans and other species. By implementing nature-based solutions, and complimentary ‘urban wilding’ approaches, urban areas and their hinterlands are expanding their ‘blue’ and ‘green’ areas and are thereby decreasing the ‘heat-island’ effects, while improving human health by surrounding them with rich bio-diversities of locally adapted, aquatic and terrestrial plants and animals. Although, many NBS options have been documented to be beneficial, their environmental, economic and social/psychological dimensions have not been adequately quantified, especially in the context of climate changes, and with regard to COVID-19. It is essential that the benefits of NBS are quantified with easily measurable outcomes, that are readily understood by practitioners, city policy-makers and members of community organizations, based upon specific geographical and climatological contexts. This will help them accelerate implementation of NBS and wilding into their urban systems. The reviewers found that more research is needed on anticipatory learning, backcasting and community participation to help to effectively implement the appropriate NBS for improving the sustainability of urban systems. The reviewers provide guidance for urban leaders to incorporate NBS into their policies and strategies to improve urban resilience and equity and to more effectively reduce impacts of climate change, population growth and pandemics. (C) 2020 Elsevier Ltd. All rights reserved.
The present study aims to investigate the effects of co-exposure to heat and psychological stress on sperm DNA and semen parameters among male rats. The study was conducted on 40 healthy adult male Wistar rats. The rats were randomly categorized into four groups of same size consisting of a control group, a heat stress, psychological and co-exposure groups. The heat stress group was exposed to a temperature of 36 °C at 20% relative humidity. The psychological stress exposure group was subjected to three stressors including exposure to strobe light, noise and tilting cage. According the results,the co-exposure group had lower mean sperm parameters including sperm count (17.22 ± 4.22 10^6/ml), motility (42.63 ± 12.95 %), viability (48.50 ± 23.25 %), normal morphology (56 ± 7.5%), progressive motility (11.61 ± 7.81%), non-progressive motility (31.18 ± 7.77%), curvilinear velocity (24.11 ± 3.81 μm/s) and straight-line velocity (3.2 ± 1.4 μm/s) when compared with those of the other groups (P=0.001). Mean sperm immobility (57.36 ± 12.95%) and non-progressive motility (37.93 ± 11.15%) in the co-exposure group was higher compared to the other groups (P = 0.001 and P = 0.333, respectively). Assessment of damage to sperm DNA revealed that the heat exposure group had a higher percentage of sperm DNA damage (9.44 ± 6.80 %) compared to others (P=0.185). In case of all of exposure scenario, the chance that the semen quality decreased compared to the control group has been increased. In general the combined stress had a greater significant effect on sperm parameters compared to other exposure groups, except for DNA damage.
The intensity and frequency of extreme weather and climate events are expected to increase due to anthropogenic climate change. This systematic review explores extreme events and their effect on gender-based violence (GBV) experienced by women, girls, and sexual and gender minorities. We searched ten databases until February, 2022. Grey literature was searched using the websites of key organisations working on GBV and Google. Quantitative studies were described narratively, whereas qualitative studies underwent thematic analysis. We identified 26 381 manuscripts. 41 studies were included exploring several types of extreme events (ie, storms, floods, droughts, heatwaves, and wildfires) and GBV (eg, sexual violence and harassment, physical violence, witch killing, early or forced marriage, and emotional violence). Studies were predominantly cross-sectional. Although most qualitative studies were of reasonable quality, most quantitative studies were of poor quality. Only one study included sexual and gender minorities. Most studies showed an increase in one or several GBV forms during or after extreme events, often related to economic instability, food insecurity, mental stress, disrupted infrastructure, increased exposure to men, tradition, and exacerbated gender inequality. These findings could have important implications for sexual-transformative and gender-transformative interventions, policies, and implementation. High-quality evidence from large, ethnographically diverse cohorts is essential to explore the effects and driving factors of GBV during and after extreme events.
Climate change is a major global public-health challenge that will have wide-ranging impacts on human psychological health and well-being. Children and adolescents are at particular risk because of their rapidly developing brain, vulnerability to disease, and limited capacity to avoid or adapt to threats and impacts. They are also more likely to worry about climate change than any other age group. Drawing on a developmental life-course perspective, we show that climate-change-related threats can additively, interactively, and cumulatively increase psychopathology risk from conception onward; that these effects are already occurring; and that they constitute an important threat to healthy human development worldwide. We then argue that monitoring, measuring, and mitigating these risks is a matter of social justice and a crucial long-term investment in developmental and mental health sciences. We conclude with a discussion of conceptual and measurement challenges and outline research priorities going forward.
Empirical evidence suggests that the effects of anthropogenic climate change, and heat in particular, could have a significant impact on mental health. This article investigates the correlation between heatwaves and/or relative humidity and suicide (fatal intentional self-harm) on a global scale. The covariance between heat/humidity and suicide was modelled using a negative binomial Poisson regression with data from 60 countries between 1979-2016. Statistically significant increases and decreases in suicide were found, as well as many cases with no significant correlation. We found that relative humidity showed a more significant correlation with suicide compared to heatwaves and that both younger age groups and women seemed to be more significantly affected by changes in humidity and heatwave counts in comparison with the rest of the population. Further research is needed to provide a larger and more consistent basis for epidemiological studies; to understand better the connections among heat, humidity and mental health; and to explore in more detail which population groups are particularly impacted and why.
Extreme weather events (EWEs) are increasing in frequency and severity as the planet continues to become warmer. Resulting disasters have the potential to wreak havoc on the economy, infrastructure, family unit, and human health. Global estimates project that children will be disproportionately impacted by the changing climate – shouldering 88% of the related burdens. Exposure to EWEs in childhood is traumatic, with ramifications for mental health specifically. Symptoms of posttraumatic stress, depression, and anxiety have all been associated with childhood EWE exposure and have the potential to persist under certain circumstances. Conversely, many childhood survivors of EWE also demonstrate resilience and experience only transient symptoms. While the majority of studies are focused on the effects resulting from one specific type of disaster (hurricanes), we have synthesized the literature across the various types of EWEs. We describe psychological symptoms and behavior, the potential for long-term effects, and potential protective factors and risk factors. What this paper adds Climate change-related phenomena such as extreme weather events (EWEs) have the potential to impact mood and behavior in children. Posttraumatic stress (PTS) is the most common mental health consequence in child survivors of EWEs. PTS is often comorbid with depression and/or anxiety in this group.
AIMS: Explore the effects of heat stress and psychological stress combined exposure on the uterus and its underlying mechanisms. MAIN METHODS: Sixty female Sprague-Dawley rats were randomly assigned to four groups: control group, psychological stress group, high ambient temperature group, and high ambient temperature combined with psychological stress group. All treatments were administered for two weeks. During this period, the estrous cycle, body weights and rectal temperature were measured regularly. Then, ovarian weight coefficient, serum estradiol (E(2)) and progesterone (P) concentration, uterine histomorphological alterations, levels of tumor necrosis factor alpha (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD), and the expressions of ovarian hormone receptors, leukemia inhibitory factor (LIF) and its receptor, homeobox gene A10 (HoxA10), Wnt5a, Wnt7a, β-catenin, and P-β-catenin(Y142) in the uterus and endometrium were detected. KEY FINDINGS: High temperature combined with psychological stress lead to body weight, body temperature, ovarian hormones and estrus cycle disorder, uterine gland ducts expansion and endometrial thickness reduction, and the decreased expression of endometrial receptivity markers (LIF and HoxA10). Further, disturbed expression of E(2) and P receptors in endometrium, elevated MDA and TNF-α levels, and decreased Wnt5a, Wnt7a and P-β-catenin(Y142) content were found. Our data suggested that co-exposure to high temperature and psychological stress could aggravate uterine damage probably by inducing ovarian hormonal disorder and the subsequent oxidative stress and inflammation, and reduce the endometrial function through suppressing Wnt signaling. SIGNIFICANCE: This will provide the scientific basis for improving female reproductive health, and preventing and treating reproductive disorders.
BACKGROUND: Mortality due to enteric infections is projected to increase because of global warming; however, the different temperature sensitivities of major enteric pathogens have not yet been considered in projections on a global scale. We aimed to project global temperature-attributable enteric infection mortality under various future scenarios of sociodemographic development and climate change. METHODS: In this modelling study, we generated global projections in two stages. First, we forecasted baseline mortality from ten enteropathogens (non-typhoidal salmonella, Shigella, Campylobacter, cholera, enteropathogenic Escherichia coli, enterotoxigenic E coli, typhoid, rotavirus, norovirus, and Cryptosporidium) under several future sociodemographic development and health investment scenarios (ie, pessimistic, intermediate, and optimistic). We then estimated the mortality change from baseline attributable to global warming using the product of projected annual temperature anomalies and pathogen-specific temperature sensitivities. FINDINGS: We estimated that in the period 2080-95, the global mean number of temperature-attributable deaths due to enteric infections could be as low as 6599 (95% empirical CI 5441-7757) under the optimistic sociodemographic development and climate change scenario, or as high as 83 888 (67 760-100 015) under the pessimistic scenario. Most of the projected temperature-attributable deaths were from shigellosis, cryptosporidiosis, and typhoid fever in sub-Saharan Africa and South Asia. Considerable reductions in the number of attributable deaths were from viral infections, such as rotaviral and noroviral enteritis, which resulted in net reductions in attributable enteric infection mortality under optimistic scenarios for Latin America and the Caribbean and East Asia and the Pacific. INTERPRETATION: Temperature-attributable mortality could increase under warmer climate and unfavourable sociodemographic conditions. Mitigation policies for limiting global warming and sociodemographic development policies for low-income and middle-income countries might help reduce mortality from enteric infections in the future. FUNDING: Japan Society for the Promotion of Science, Japan Science and Technology Agency, and Spanish Ministry of Economy, Industry, and Competitiveness.
INTRODUCTION: This study quantitatively described the disease burden of diabetes and kidney disease attributable to non-optimal temperatures and explored the influencing factors. METHODS: We quantitatively described the mortality burden of diabetes and kidney disease attributable to non-optimal temperatures in six countries (China, USA, South Africa, Australia, Iraq, Portugal), and compare trends in mortality in six countries from 1990 to 2019. We used the APC model to analyse age, period, and cohort effects on mortality in six countries. We used restricted cubic splines and quantile regression to analyse the association of SDI with mortality and YLL using data from 21 regions in the world. RESULTS: The mortality rates of diabetes and kidney disease in the six countries in 2019 were 1.72% (Australia), 1.83% (China), 2.99% (USA), 3% (Portugal), 7.45% (South Africa) and 8.71% (Iraq) attributable to non-optimal temperatures. Cold was more harmful than heat. The mortality, YLLs of diabetes and kidney disease of male were higher than females. The mortality rate showed an upwards trend with age. The period effect had little changes or showed a slight upwards trend. The cohort effect showed a downwards trend. The regions with higher mortality or YLLs rates were mainly had SDI values of 0.45-0.80. CONCLUSIONS: Among the death burdens of diabetes and kidney disease attributed to non-optimal temperatures, cold had a greater burden than heat. The burden of death was affected by sex, age, period, cohort, and SDI.
Many studies project that climate change is expected to cause a significant number of excess deaths. Yet, in integrated assessment models that determine the social cost of carbon (SCC), human mortality impacts do not reflect the latest scientific understanding. We address this issue by estimating country-level mortality damage functions for temperature-related mortality with global spatial coverage. We rely on projections from the most comprehensive published study in the epidemiology literature of future temperature impacts on mortality (Gasparrini et al. in Lancet Planet Health 1:e360-e367, 2017), which estimated changes in heat- and cold-related mortality for 23 countries over the twenty-first century. We model variation in these mortality projections as a function of baseline climate, future temperature change, and income variables and then project future changes in mortality for every country. We find significant spatial heterogeneity in projected mortality impacts, with hotter and poorer places more adversely affected than colder and richer places. In the absence of income-based adaptation, the global mortality rate in 2080-2099 is expected to increase by 1.8% [95% CI 0.8-2.8%] under a lower-emissions RCP 4.5 scenario and by 6.2% [95% CI 2.5-10.0%] in the very high-emissions RCP 8.5 scenario relative to 2001-2020. When the reduced sensitivity to heat associated with rising incomes, such as greater ability to invest in air conditioning, is accounted for, the expected end-of-century increase in the global mortality rate is 1.1% [95% CI 0.4-1.9%] in RCP 4.5 and 4.2% [95% CI 1.8-6.7%] in RCP 8.5. In addition, we compare recent estimates of climate-change induced excess mortality from diarrheal disease, malaria and dengue fever in 2030 and 2050 with current estimates used in SCC calculations and show these are likely underestimated in current SCC estimates, but are also small compared to more direct temperature effects.
INTRODUCTION: Hot and cold weather events are increasingly becoming a global burden resulting in premature and preventable morbidity and mortality, particularly in vulnerable groups such as older people and people with chronic health conditions. However, risk perception regarding weather is generally poor among vulnerable groups which often acts as a barrier to the uptake of critical health-protective behaviours. A more cohesive understanding of determinants of risk perception is needed to inform public health risk communication and behaviour change interventions that promote protective health behaviours. This scoping literature review aimed to understand factors influencing perception of personal health risks in vulnerable groups as a result of exposure to hot and cold weather events. METHODS: A five-stage scoping review framework was followed. Searches were run across Medline, PsychInfo, Web of Science and EMBASE. Papers were included if they provided rationale for risk perceptions in vulnerable groups in indoor/domestic environments and focussed on samples from OECD countries. RESULTS: In total, 13 out of 15,554 papers met the full inclusion criteria. The majority of papers focused on hot weather events: one study exclusively examined cold weather events and one study addressed both cold and hot weather events. Included papers focused on older adults aged 65+ years. The papers identified eight factors that were associated with older adults’ personal health risk perception of hot and cold weather events: (1) Knowledge of the relationship between hot/cold weather and health risks, (2) presence of comorbidities, (3) age and self-identity, (4) perceived weather severity, (5) Beliefs associated with regional climate, (6) past experience with weather, (7) misconceptions of effectiveness of protective behaviours, and (8) external locus of control. CONCLUSIONS: Future research should explore risk communication methods by implementing the identified risk perception determinants from this review into health protection interventions targeting older adults. Further understanding is needed regarding risk perceptions in non-elderly vulnerable groups, for examples individuals with chronic diseases or disabilities.
BACKGROUND: Associations between ambient temperature exposure during pregnancy and stillbirth have been reviewed and described in the literature. However, there is no existing review of environmental and epidemiologic methods applied to measure stillbirths resulting from exposure to ambient temperatures during pregnancy. The objective of this study is to systematically review published methods, data sources, and data linkage practices to characterize associations between ambient temperature and stillbirth to inform stillbirth prevention and risk management strategies. METHODS: A systematic review of published studies that assess the association between ambient temperature exposure during pregnancy using any measures or approach and stillbirth was undertaken in Cochrane Library, PubMed, Medline, Scopus, Embase, and Web of Science of studies (2000-2020, inclusive). Selection of studies were assessed by pre-specified eligibility criteria and documented using PRISMA. Citations were managed using EndNote X8 whilst selection, reviewing, and data extraction were performed using Covidence. The screening, selection, and data extraction process consisted of two blind, independent reviews followed by a tertiary independent review. An adapted Critical Appraisal Skills Program (CASP) checklist was used to assess quality and bias. The main findings and characteristics of all studies was extracted and summarized. Where appropriate, a meta-analysis will be performed for measures of association. RESULTS: Among 538 original records, 12 eligible articles were identified that analysed associations between ambient temperature exposure and stillbirth for 42,848 stillbirths among 3.4 million births across seven countries. Varied definitions of stillbirth were reported based on gestational age, birthweight, both, or neither. The overall rate of stillbirth ranged from 1.9 to 38.4 per 1000 among six high-income countries and one low-middle-income country. All study designs were retrospective and included ten cohort studies, three case-crossover studies, and two additional case-control subgroup analysis. Exposure data for ambient temperature was mostly derived from standard municipal or country-level monitors based on weather stations (66.6%) or a forecasting model (16.7%); otherwise, not reported (16.7%). Results were not statistically pooled for a meta-analysis due to heterogeneity of methods and models among included studies. All studies reported associations of increased risk of stillbirth with ambient temperature exposures throughout pregnancy, particularly in late pregnancy. One study estimates 17-19% (PAR) of stillbirths are potentially attributable to chronic exposure to hot and cold ambient temperatures during pregnancy. Overall, risk of stillbirth was observed to increase below 15 °C and above 23.4 °C, where highest risk is above 29.4 °C. CONCLUSION: Exposure to hot and cold temperatures during pregnancy may increase the risk of stillbirth, although a clear causative mechanism remains unknown. Despite lack of causal evidence, existing evidence across diverse settings observed similar effects of increased risk of stillbirth using a variety of statistical and methodological approaches for exposure assessments, exposure windows, and data linkage. Managing exposure to ambient temperatures during pregnancy could potentially decrease risk of stillbirth, particularly among women in low-resource settings where access to safe antenatal and obstetric care is challenging. To fully understand the effects or dose-response relationship of maternal exposure to ambient temperatures and stillbirth, future studies should focus on biological mechanisms and contributing factors in addition to improving measurement of ambient temperature exposure.
To date, no review has focused specifically on the potential modulating role of environmental temperature on the effects of exercise on cognitive function. Despite this, a range of occupations and performance contexts exist (e.g., military personnel, emergency services, sport) where the maintenance of cognitive function in environmentally challenging environments is crucial. Therefore, this systematic review aimed to evaluate the experimental research investigating how manipulating environmental temperature influenced the effects of acute bouts exercise on cognitive functioning from pre-to-post exercise, or during exercise. Studies to be included were assessed by two authors reviewing title, abstract, and then full-text. From the searches conducted, twenty articles were identified which met the inclusion criteria. For the purpose of this review, exercise involved in each study was categorised into low, moderate, and vigorous dosages (dependent on intensity and duration). The results indicate that moderate dosages of exercise help stimulate improved cognitive performance from pre-to-post exercise in temperate conditions, where cold exposure appears to blunt these effects. In addition, hot environments led to cognitive decrements during and post exercise which were often identified in studies that implemented prolonged moderate or vigorous exercise protocols. Therefore, suggesting a combination of heightened physiological strain from increased dose of exercise, alongside heat exposure, can be detrimental to optimal cognitive functioning, whereby executive functioning tasks appeared to be most affected. The findings from this systematic review highlight the potential modulating role of environmental temperature on the effects of exercise on cognitive function. Thus, highlighting the importance of considering the role of environmental temperature for individuals either exercising to elicit desired cognitive benefits or for those involved in physically demanding occupations or performance domains.
BACKGROUND: We investigated adolescents’ feelings of thermal comfort during the educational process in various geographical locations far apart and present recommendations for the adjustment of the thermal environment in schools. METHODS: The prospective international multicenter study took place in 8 locations on different continents. The survey in the form of a questionnaire was carried out among 2800 healthy high school students. The study was divided into “cold season survey,” “warm-season survey,” and heat wave survey. RESULTS: The statistically significant difference between the “cold season survey” score of 4.04 (discomfort) and “warm-season survey” score of 3.47 (slight discomfort) (p = .04) indicates that students feel more thermal discomfort during winter months in all 8 locations. The heat wave survey score was 4.53 (discomfort). During the cold season, 29.24% of high school students felt themselves in full thermal comfort and 76.48% of the students felt themselves relatively comfortable (slightly cool-comfortable-slightly warm). CONCLUSIONS: Even during the ongoing process of climate change, the cold season discomfort remains the main problem for students in classes. This tendency is present in different continents as a universal problem. We recommend keeping an entrance hall and classroom temperatures at different levels and to advise students about proper clothing.
BACKGROUND: There is growing evidence in support of a short-term association between ambient temperature and cardiac arrest attacks that is a serious manifestation of cardiovascular disease and has a high incidence and low survival rate. However, it remains unrecognized about the hazardous temperature exposure types, exposure risk magnitude, and vulnerable populations. OBJECTIVES: We comprehensively summarize prior epidemiological studies looking at the short-term associations of out-of-hospital cardiac arrest (OHCA) with various temperature exposures among different populations. METHODS: We searched PubMed and Web of Science databases from inception to October 2021 for eligible English language. Temperature exposure was categorized into three types: heat (included high temperature, extreme heat, and heatwave), cold (included low temperature and extreme cold), and temperature variation (included diurnal temperature range and temperature change between two adjacent days). Meta-analysis weighted by inverse variance was used to pool effect estimates. RESULTS: This study included 15 studies from 8 countries, totaling around 1 million OHCA events. Extreme heat and extreme cold were significantly associated with an increased risk of OHCA, and the pooled relative risks (RRs) were 1.071 [95 % confidence interval (CI): 1.019-1.126] and 1.662 (95%CI: 1.138-2.427), respectively. The risk of OHCA was also elevated by heatwaves (RR = 1.248, 95%CI: 1.091-1.427) and more intensive heatwaves had a greater effect. Notably, the elderly and males seemed to be more vulnerable to the effects of heat and cold. However, we did not observe a significant association between temperature variation and the risk of OHCA (1.005, 95%CI: 0.999-1.012). CONCLUSION: Short-term exposure to heat and cold may be novel risk factors for OHCA. Considering available studies in limited regions, the temperature effect on OHCA should be urgently confirmed in different regions.
OBJECTIVES: Incidence and prognosis of ST-segment elevation myocardial infarction (STEMI) vary according to ambient temperature and season. We sought to assess whether season and temperature on the day of STEMI are associated with infarct size, microvascular obstruction (MVO), left ventricular ejection fraction (LVEF) and clinical outcomes after primary percutaneous coronary intervention (PCI). METHODS: Individual patient data from 1598 patients undergoing primary PCI in six randomized clinical trials were pooled. Infarct size was evaluated by cardiac magnetic resonance within 30 days in all trials. Patients were categorized either by whether they presented on a day of temperature extremes (minimum temperature <0 °C or maximum temperature >25 °C) or according to season. RESULTS: A total of 558/1598 (34.9%) patients presented with STEMI on a day of temperature extremes, and 395 (24.7%), 374 (23.4%), 481 (30.1%) and 348 (21.8%) presented in the spring, summer, fall and winter. After multivariable adjustment, temperature extremes were independently associated with larger infarct size (adjusted difference 2.8%; 95% CI, 1.3-4.3; P < 0.001) and smaller LVEF (adjusted difference -2.3%; 95% CI, -3.5 to -1.1; P = 0.0002) but not with MVO (adjusted P = 0.12). In contrast, infarct size, MVO and LVEF were unrelated to season (adjusted P = 0.67; P = 0.36 and P = 0.95, respectively). Neither temperature extremes nor season were independently associated with 1-year risk of death or heart failure hospitalization (adjusted P = 0.79 and P = 0.90, respectively). CONCLUSION: STEMI presentation during temperature extremes was independently associated with larger infarct size and lower LVEF but not with MVO after primary PCI, whereas season was unrelated to infarct severity.
BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. METHODS: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. RESULTS: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1-2.3) and 9.1 (95% eCI, 8.9-9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4-2.8) and 12.8 (95% eCI, 12.2-13.1) for every 1000 heart failure deaths, respectively. CONCLUSIONS: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day-and especially under a changing climate.
BACKGROUND: There is rapidly growing evidence indicating that extreme temperature is a crucial trigger and potential activator of asthma; however, the effects of extreme temperature on asthma are inconsistently reported and the its potential mechanisms remain undefined. OBJECTIVES: This review aims to estimate the impacts of extreme heat, extreme cold, and temperature variations on asthma by systematically summarizing the existing studies from epidemiological evidence to biological plausibility. METHODS: We conducted a systematic search in PubMed, Embase, and Web of Science from inception to June 30, 2022, and we retrieved articles of epidemiology and biological studies which assessed associations between extreme temperatures and asthma. This protocol was registered with PROSPERO (CRD42021273613). RESULTS: From 12,435 identified records, 111 eligible studies were included in the qualitative synthesis, and 37 articles were included in the meta-analysis (20 for extreme heat, 16 for extreme cold, and 15 for temperature variations). For epidemiological evidence, we found that the synergistic effects of extreme temperatures, indoor/outdoor environments, and individual vulnerabilities are important triggers for asthma attacks, especially when there is extreme heat or cold. Meta-analysis further confirmed the associations, and the pooled relative risks for asthma attacks in extreme heat and extreme cold were 1.07 (95%CI: 1.03-1.12) and 1.20 (95%CI: 1.12-1.29), respectively. Additionally, this review discussed the potential inflammatory mechanisms behind the associations between extreme temperatures and asthma exacerbation, and highlighted the regulatory role of immunological pathways and transient receptor potential ion channels in asthma triggered by extreme temperatures. CONCLUSIONS: We concluded that both extreme heat and cold could significantly increase the risk of asthma. Additionally, we proposed a potential mechanistic framework, which is important for understanding the disease pathogenesis that uncovers the complex mechanisms of asthma triggered by extreme temperatures and protects the sensitive individuals from impacts of extreme weather events and climate change.
INTRODUCTION: Defining extreme temperatures as the cause of death remains challenging. It is mostly based on circumstantial, macroscopic and microscopic features. METHODS: We retrospectively compared groups of cases of fatal hypothermia, fatal hyperthermia and non-extreme temperature-related deaths. We analysed specific histological findings, focusing on samples from the liver, pancreas and kidney. RESULTS: Between 1 January 2013 and 31 December 2016, 15 autopsies were performed for deaths related to extreme temperatures. They included 11 cases of fatal hypothermia (group A), four cases of fatal hyperthermia (group B) and eight controls (group C). Perinuclear hepatocyte vacuolisation was observed in seven cases of hypothermia, one case of hyperthermia and four controls. Pancreatic cytoarchitecture was well preserved in two cases of hypothermia, one case of hyperthermia and two controls. No particular microscopic feature was found in pancreatic samples. Renal epithelial tubular cell vacuolisation was observed in seven cases of hypothermia and one case of hyperthermia, while it was absent in all controls. Chromogranin A (CgA) was markedly positive in the pancreatic tissue of five cases of fatal hypothermia and one control, and mildly positive in one case of fatal hyperthermia. No significant p-values were observed for any comparisons (p > 0.05), except when hypothermia cases group were compared to the control group for the Armanni-Ebstein phenomenon test (p = 0.0078). CONCLUSIONS: Although our study did not find a specific microscopic marker, hepatocyte vacuolisation, the Armanni-Ebstein phenomenon and pancreatic CgA positivity, taken together, may be useful tools to confirm hypo- and hyperthermia-related deaths, in addition to circumstantial and macroscopic findings.
BACKGROUND: Associations between high and low temperatures and increases in mortality and morbidity have been previously reported, yet no comprehensive assessment of disease burden has been done. Therefore, we aimed to estimate the global and regional burden due to non-optimal temperature exposure. METHODS: In part 1 of this study, we linked deaths to daily temperature estimates from the ERA5 reanalysis dataset. We modelled the cause-specific relative risks for 176 individual causes of death along daily temperature and 23 mean temperature zones using a two-dimensional spline within a Bayesian meta-regression framework. We then calculated the cause-specific and total temperature-attributable burden for the countries for which daily mortality data were available. In part 2, we applied cause-specific relative risks from part 1 to all locations globally. We combined exposure-response curves with daily gridded temperature and calculated the cause-specific burden based on the underlying burden of disease from the Global Burden of Diseases, Injuries, and Risk Factors Study, for the years 1990-2019. Uncertainty from all components of the modelling chain, including risks, temperature exposure, and theoretical minimum risk exposure levels, defined as the temperature of minimum mortality across all included causes, was propagated using posterior simulation of 1000 draws. FINDINGS: We included 64·9 million individual International Classification of Diseases-coded deaths from nine different countries, occurring between Jan 1, 1980, and Dec 31, 2016. 17 causes of death met the inclusion criteria. Ischaemic heart disease, stroke, cardiomyopathy and myocarditis, hypertensive heart disease, diabetes, chronic kidney disease, lower respiratory infection, and chronic obstructive pulmonary disease showed J-shaped relationships with daily temperature, whereas the risk of external causes (eg, homicide, suicide, drowning, and related to disasters, mechanical, transport, and other unintentional injuries) increased monotonically with temperature. The theoretical minimum risk exposure levels varied by location and year as a function of the underlying cause of death composition. Estimates for non-optimal temperature ranged from 7·98 deaths (95% uncertainty interval 7·10-8·85) per 100 000 and a population attributable fraction (PAF) of 1·2% (1·1-1·4) in Brazil to 35·1 deaths (29·9-40·3) per 100 000 and a PAF of 4·7% (4·3-5·1) in China. In 2019, the average cold-attributable mortality exceeded heat-attributable mortality in all countries for which data were available. Cold effects were most pronounced in China with PAFs of 4·3% (3·9-4·7) and attributable rates of 32·0 deaths (27·2-36·8) per 100 000 and in New Zealand with 3·4% (2·9-3·9) and 26·4 deaths (22·1-30·2). Heat effects were most pronounced in China with PAFs of 0·4% (0·3-0·6) and attributable rates of 3·25 deaths (2·39-4·24) per 100 000 and in Brazil with 0·4% (0·3-0·5) and 2·71 deaths (2·15-3·37). When applying our framework to all countries globally, we estimated that 1·69 million (1·52-1·83) deaths were attributable to non-optimal temperature globally in 2019. The highest heat-attributable burdens were observed in south and southeast Asia, sub-Saharan Africa, and North Africa and the Middle East, and the highest cold-attributable burdens in eastern and central Europe, and central Asia. INTERPRETATION: Acute heat and cold exposure can increase or decrease the risk of mortality for a diverse set of causes of death. Although in most regions cold effects dominate, locations with high prevailing temperatures can exhibit substantial heat effects far exceeding cold-attributable burden. Particularly, a high burden of external causes of death contributed to strong heat impacts, but cardiorespiratory diseases and metabolic diseases could also be substantial contributors. Changes in both exposures and the composition of causes of death drove changes in risk over time. Steady increases in exposure to the r
Due to rising temperatures and CO(2) emissions, climate change has become one of the most important global issues. We described the relationship between extreme weather-related events and death, globally, from 1999 through 2018. We used data from the emergency events database of the Université Catholique de Louvain. We also categorized the countries’ income according to the World Bank GDP and we used the CO(2) emission levels data from the Carbon Dioxide Information Analysis Center to link the GDP and CO(2) emissions to years of extreme weather conditions in each country. We conducted descriptive and Poisson Regression analysis to analyze the data. A total of 77 countries reported 425 extreme weather-related events from1999 through 2018. Mortality related events were highest in middle-income countries due to severe winter conditions (N = 2,020) and cold-waves (N = 70,972). The total number of recorded deaths due to heat waves was highest in high-income countries (N = 84,344). Furthermore, the number of deaths in high-income countries, compared to low-income countries, was five-fold higher (IRR 5.18; 95%CI 4.58; 5.85, p < 0.001). The mortality rate in heat season was almost seven-fold higher than that in cold/severe winter (IRR 33.43; 95%CI 32.85; 34.02, p < 0.001). The number of deaths increased significantly with the repetition of extreme events (IRR 6.82; 95%CI 6.68; 6.96, p < 0.001). We found the number of deaths increased in high-income countries, and this was associated with an increase in the number of times extreme events occurred per year and with heat wave.
The frequency and duration of extreme temperature events continues to increase worldwide. However, the scale of population exposure and its quantitative relationship with health risks remains unknown on a global scale, limiting our ability to identify policy priorities in response to climate change. Based on data from 171 countries between 2010 and 2019, this study estimated the exposure of vulnerable populations to extreme temperatures, and their contemporary and lag associations with disease burden attributed to non-optimal temperatures. Fixed-effects models and dynamic panel models were applied. Increased vulnerable population exposure to extreme temperatures had adverse contemporary effects on the burden of disease attributed to non-optimal temperature. Health risks stemming from extreme cold could accumulate to a greater extent, exhibiting a larger lag effect. Population exposure to extreme cold was mainly distributed in high-income countries, while extreme heat occurred more in low-income and middle-income countries. However, the association between population exposure to extreme cold and burden of disease was much stronger in low-income and middle-income countries than in high-income countries, whereas the effect size of population exposure to extreme heat was similar. Our study highlighted that differential strategies should be determined and implemented according to the characteristics in different countries.
Workplace hazards and accidents occur more frequently in the construction industry than in any other industries. Occupational hazards cannot be completely eliminated but can be reduced to an extent where workers can perform activities in a safe environment. Health and safety of workers in construction site is of at most importance to employers, which when ignored can lead to fatal injuries and even death affecting the progress of work and project completion time. The goal of this study is to identify critical factors affecting workers health in extreme weather conditions and to identify the vulnerable workers based on age, gender, and ethnicity. Therefore, a questionnaire survey was developed and distributed to identify critical health challenges faced by construction workers while working in unfavorable weather conditions. The results revealed that workers with pre-existing medical condition like hyper-tension face higher unfavorable impacts on their health while working in extreme hot weather. Based on gender, female workers suffer from more heat related disorders compared to male workers. Based on age, workers above 50 years are more affected when working in extreme weather conditions compared to workers of other age groups. In addition, some workers reported increased irritation and distraction from work due to physical discomfort of working in unfavorable environment leading to more accidents at workplace. Moreover, some workers reported increased onset of muscle fatigue due to tight thermal clothing during cold weather conditions. Prolonged exposure to cold winds tends to distract the workers, leading to workers becoming more hallucinatory and disoriented. The results of this study will help employers and project managers to take proper actions against the unforeseen factors affecting the workers’ health and safety in the construction sites with extreme weather conditions.
BACKGROUND: Although a few studies have reported the relationship between high and low temperatures and chronic kidney disease (CKD), the global burden of CKD attributable to extreme heat and cold in recent decades remains unknown. METHODS: Based on the Global Burden of Disease Study (GBD) 2019, we obtained data on age-standardized mortality rates (ASMR) and age-standardized rates of disability-adjusted life years (ASDR) per 100 000 population of the CKD attributable to non-optimum temperatures from 1990 to 2019. The annual mean temperature of each country was used to divide each country into five climate zones (tropical, subtropical, warm-temperate, cool-temperate, and boreal). The locally weighted regression model was used to estimate the burden for different climate zones and Socio-demographic index (SDI) regions. RESULTS: In 1990, the ASMR and ASDR due to high temperature estimated -0.01 (95% UI, -0.74 to 0.44) and -0.32 (-21.66 to 12.66) per 100 000 population, respectively. In 2019, the ASMR and ASDR reached 0.10 (-0.28 to 0.38) and 2.71 (-8.07 to 10.46), respectively. The high-temperature burden increased most rapidly in tropical and low SDI regions. There were 0.99 (0.59 to 1.39) ASMR attributable to low-temperature in 1990, which increased to 1.05 (0.61-1.49) in 2019. While the ASDR due to low temperature declined from 22.03 (12.66 to 30.64) in 1990 to 20.43 (11.30 to 29.26) in 2019. Overall, the burden of CKD attributable to non-optimal temperatures has increased from 1990 to 2019. CKD due to hypertension and diabetes mellitus were the primary causes of CKD death attributable to non-optimum temperatures in 2019 with males and older adults being more susceptible to these temperatures. CONCLUSIONS: The CKD burden due to high, low, and non-optimum temperatures varies considerably by regions and countries. The burden of CKD attributable to high temperature has been increasing since 1990.
BACKGROUND AND OBJECTIVES: Although the international community collectively seeks to reduce global temperature rise to less than 1.5°C before 2100, irreversible environmental changes have already occurred, and as the planet warms, these changes will continue to occur. As we witness the effects of a warming planet on human health, it is imperative that neurologists anticipate how the epidemiology and incidence of neurologic disease may change. In this review, we organized our analysis around 3 key themes related to climate change and neurologic health: extreme weather events and temperature fluctuations, emerging neuroinfectious diseases, and pollutant impacts. Across each of these themes, we appraised and reviewed recent literature relevant to neurologic disease and practice. METHODS: Studies were identified using search terms relating to climate change, pollutants, and neurologic disease in PubMed, OVID MEDLINE, EMBASE, PsycInfo, and gray literature. Studies published between 1990 and 2022 were included if they pertained to human incidence or prevalence of disease, were in English, and were relevant to neurologic disease. RESULTS: We identified a total of 364 articles, grouped into the 3 key themes of our study: extreme weather events and temperature fluctuations (38 studies), emerging neuroinfectious diseases (37 studies), and pollutant impacts (289 studies). The included studies highlighted the relationships between neurologic symptom exacerbation and temperature variability, tick-borne infections and warming climates, and airborne pollutants and cerebrovascular disease incidence and severity. DISCUSSION: Temperature extremes and variability both associated with stroke incidence and severity, migraine headaches, hospitalization in patients with dementia, and multiple sclerosis exacerbations. Exposure to airborne pollutants, especially PM2.5 and nitrates, associated with stroke incidence and severity, headaches, dementia risk, Parkinson disease, and MS exacerbation. Climate change has demonstrably expanded favorable conditions for zoonotic diseases beyond traditional borders and poses the risk of disease in new, susceptible populations. Articles were biased toward resource-rich regions, suggesting a discordance between where research occurs and where changes are most acute. As such, 3 key priorities emerged for further study: neuroinfectious disease risk mitigation, understanding the pathophysiology of airborne pollutants on the nervous system, and methods to improve delivery of neurologic care in the face of climate-related disruptions.
Chronic obstructive pulmonary disease (COPD) is one of the greatest global public health challenges. Acute exacerbations of COPD lead to the accelerated deterioration of lung function, reduced quality of life, a higher number of hospitalizations, and increased mortality. The factor causing the exacerbation is usually an infectious agent, but the impact of environmental factors is being studied more thoroughly. Among them, meteorological factors are the least examined. Multiple studies have shown that lower temperatures during the cold season, as well as sudden temperature changes regardless of the season, have the most significant negative effect on patients with COPD. However, higher temperatures, especially during summer heatwaves, can also cause COPD exacerbation and it is expected that this will be an even more important health problem in the future considering climate changes. The effects of other meteorological factors on acute exacerbation of COPD, such as atmospheric pressure, solar radiation, rainfall, wind speed, and humidity are far less investigated and opposing results have been obtained in different studies. Thus, there is a need for further research in this area that would result in clinical recommendations and public health interventions that could decrease the global burden of COPD.
The present systematic review was conducted by gathering the impacts of climate change on occupational heat strain, gathering risk factors that may increase susceptibility to climate-related occupational hazards, and gathering measures for controlling the impacts of climate change on occupational heat strain in outdoor workers. Materials and methods: In this study, three main databases PubMed, Scopus, and Web of Science were searched to find relevant literature on climate change and its effects using subject headings, appropriate Mesh terms and experts’ opinion. Results: The evidence suggests an imprecise but positive relationship between climate change and occupational heat strain in outdoor workers, and the most likely mechanism involves dehydration, fatigue, dizziness, confusion, reduced brain function, loss of concentration and discomfort. Conclusion: With predictions of increasing temperatures, the baseline heat strain incidence data from this systematic review study in tropical and subtropical countries with low and middle income may be used to help stakeholders in policy-making, promotion campaigns, occupational health interventions, and choosing appropriate control methods. Strong evidence indicates that, to manage adverse effects of heat stress on outdoor workers, key factors include anticipating, recognizing, evaluating, controlling, researching, risk management, and applying suitable policy development may be useful tools.
Naegleria fowleri (N. fowleri) is a free-living, unicellular, opportunistic protist responsible for the fatal central nervous system infection, primary amoebic meningoencephalitis (PAM). Given the increase in temperatures due to global warming and climate change, it is estimated that the cases of PAM are on the rise. However, there is a current lack of awareness and effective drugs, meaning there is an urgent need to develop new therapeutic drugs. In this study, the target compounds were synthesized and tested for their anti-amoebic properties against N. fowleri. Most compounds exhibited significant amoebicidal effects against N. fowleri; for example, 1h, 1j, and 1q reduced N. fowleri’s viability to 15.14%, 17.45% and 28.78%, respectively. Furthermore, the majority of the compounds showed reductions in amoeba-mediated host death. Of interest are the compounds 1f, 1k, and 1v, as they were capable of reducing the amoeba-mediated host cell death to 52.3%, 51%, and 56.9% from 100%, respectively. Additionally, these compounds exhibit amoebicidal properties as well; they were found to decrease N. fowleri’s viability to 26.41%, 27.39%, and 24.13% from 100%, respectively. Moreover, the MIC(50) values for 1e, 1f, and 1h were determined to be 48.45 µM, 60.87 µM, and 50.96 µM, respectively. Additionally, the majority of compounds were found to exhibit limited cytotoxicity, except for 1l, 1o, 1p, 1m, 1c, 1b, 1zb, 1z, 1y, and 1x, which exhibited negligible toxicity. It is anticipated that these compounds may be developed further as effective treatments against these devastating infections due to brain-eating amoebae.
Harmful algal blooms (HABs) in freshwater lakes and oceans date back to as early as the 19th century, which can cause the death of aquatic and terrestrial organisms. However, it was not until the end of the 20th century that researchers had started to pay attention to the hazards and causes of HABs. In this study, we analyzed 5720 published literatures on HABs studies in the past 30 years. Our review presents the emerging trends in the past 30 years on HABs studies, the environmental and human health risks, prevention and control strategies and future developments. Therefore, this review provides a global perspective of HABs and calls for immediate responses.
Heat exposure is a well-known health hazard, which causes several problems ranging from thermal discomfort or productivity reduction to the aggravation of existing illnesses and death. Climate projections foresee an increase in the frequency and intensity of heat-related impacts on human health. To reduce these climate risks, governments need a better understanding of not only the scale and the factors affecting those risks, but also how to prepare and protect the city and citizens against these risks and prevent them through effective policy making. Therefore, climate adaptation decisions need to be made in complex systems with manifold uncertainties. In response to these deep uncertainties, different planning approaches have been developed to assist policymakers in decision making. This paper is focused on one of the dynamic adaptive policy planning approaches: the adaptation pathway. This approach allows designing alternative feasible plans that are flexible and can respond when new information appears or when conditions in the environment change. This paper presents a structured methodology for designing adaptation pathways. The work describes a high-level adaptation pathway covering heatwave impacts on productivity and health at city level in Antwerp to ensure the city adapts to future conditions. Lastly, a summary is provided of the lessons learned and the challenges of this approach are discussed.
The negative cardiorespiratory health outcomes due to extreme temperatures and air pollution are widely studied, but knowledge about the effectiveness of the implementation of adaptive mechanisms remains unclear. The objective of this paper is to explore the evidence of adaptive mechanisms for cardiorespiratory diseases regarding extreme temperatures and air pollution by comparing the results of two systematic literature review (SLR) processes sharing the same initial research question but led by two research groups with different academic backgrounds working in the same multidisciplinary team. We start by presenting the methodological procedures and the results of the SLR triggered by the research group mainly composed by researchers with a background in geography (named geographical strategy). We then compare these results with those achieved in the SLR led by the research group with a background in epidemiology (named epidemiological strategy). Both SLR were developed under the EU Horizon 2020 Project “EXHAUSTION “. The results showed: 1) the lack of evidence regarding the effectiveness of adaptation measures, namely due to the limited number of studies about the topic, the preponderance of studies dedicated to heat extremes or the unbalance between different adaptation measures; 2) that the choice of search terms in the geographical strategy, despite being more comprehensive at first sight, ended up retrieving less results, but it brought new studies that can complement the results of the epidemiological strategy. Therefore, it is suggested that to strengthen the empirical evidence of the effectiveness of adaptation measures, powerful multidisciplinary teams should work together in the preparation of SLR in topics of great complexity, such as the one presented in this paper.
OBJECTIVE: We conducted a systematic review of the published literature to test the hypothesis that maternal exposure to extremes of ambient temperatures during pregnancy is associated with the risk for psychiatric disorders or congenital malformations in offspring, both of which are indicative of perturbations of fetal neurodevelopment. METHOD: This study was conducted in accordance with the recommendations outlined in the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting proposal. Electronic databases (Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Ovid Global Health, Web of Science, and Cochrane Library) were searched. Four independent reviewers selected studies with the following criteria: (1) prenatal maternal ambient temperature exposure; (2) outcome of offspring psychiatric disorder or congenital defects; (3) empirical study; (4) full-length article, no conference presentations or abstracts. RESULTS: Twenty-two studies met criteria and one was added from a reference list (n = 23). Of these, schizophrenia (n = 5), anorexia nervosa (n = 3) and congenital cardiovascular malformations (n = 6) studies were the most common. Each of these categories showed some evidence of association with an early pregnancy maternal ambient heat exposure effect, with other evidence for a late pregnancy cold effect. CONCLUSION: Some evidence supports a role for early pregnancy maternal exposure to extreme ambient heat in the development of psychiatric disorders, but large-scale, prospective cohort data on individual births is essential. Optimal studies will be conducted in seasonally variable climates, accounting for actual maternal residence over the pregnancy and at parturition, local environmental temperature records, and appropriate covariates, similar to studies identified by this systematic review for congenital malformations.
West Nile virus (WNV, Flaviviridae, Flavivirus) is a mosquito-borne flavivirus introduced to North America in 1999. Since 1999, the Earth’s average temperature has increased by 0.6 °C. Mosquitoes are ectothermic organisms, reliant on environmental heat sources. Temperature impacts vector-virus interactions which directly influence arbovirus transmission. RNA viral replication is highly error-prone and increasing temperature could further increase replication rates, mutation frequencies, and evolutionary rates. The impact of temperature on arbovirus evolutionary trajectories and fitness landscapes has yet to be sufficiently studied. To investigate how temperature impacts the rate and extent of WNV evolution in mosquito cells, WNV was experimentally passaged 12 times in Culex tarsalis cells, at 25 °C and 30 °C. Full-genome deep sequencing was used to compare genetic signatures during passage, and replicative fitness was evaluated before and after passage at each temperature. Our results suggest adaptive potential at both temperatures, with unique temperature-dependent and lineage-specific genetic signatures. Further, higher temperature passage was associated with significantly increased replicative fitness at both temperatures and increases in nonsynonymous mutations. Together, these data indicate that if similar selective pressures exist in natural systems, increases in temperature could accelerate emergence of high-fitness strains with greater phenotypic plasticity.
BACKGROUND: Infections caused by non-cholera Vibrio species have undergone a global expansion over the past few decades reaching new areas of the world that were previously considered adverse for these organisms. The geographical extent of the expansion has not been uniform, and some areas have shown a rapid increase in infections. METHODS: We applied a new generation of models combining climate, population, and socioeconomic projections to map future scenarios of distribution and season suitability for pathogenic Vibrio. We used the Coupled Model Intercomparison Project 6 framework. Three datasets were used: Geophysical Fluid Dynamics Laboratory’s CM4.0 sea surface temperature and sea surface salinity; the coastline length dataset from the World Resources Institute; and Inter-Sectoral Impact Model Intercomparison Project 2b annual global population data. Future projections were used up to the year 2100 and historical simulations from 1850 to 2014. We also project human population at risk under different shared socioeconomic pathways worldwide. FINDINGS: Projections showed that coastal areas suitable for Vibrio could cover 38000 km of new coastal areas by 2100 under the most unfavourable scenario with an expansion rate of season suitability in these regions of around 1 month every 30 years. Population at risk in suitable regions almost doubled from 1980 to 2020 (from 610 million to 1100 million under the scenario of medium challenges to mitigation and adaptation, shared socioeconomic pathway 2-4.5), although the increment will be more moderate in the future and stabilises after 2050 at 1300 million. Finally, we provide the first global estimate for Vibrio infections, with values around half a million of cases worldwide in 2020. INTERPRETATION: Our projections anticipated an expansion of both the temporal and spatial disease burden for Vibrio infections, in particular at high latitudes of the northern hemisphere. However, the largest extent occurred from 1980 to 2020 and a more moderate increase is expected for the future. The most positive outcome is that the projections showed that Vibrio morbidity will remain relatively stable over the coming decades.
This review highlights two intersecting environmental phenomena that have significantly impacted the Tokyo Summer Olympic and Paralympic Games: infectious disease outbreaks and anthropogenic climate change. Following systematic searches of five databases and the gray literature, 15 studies were identified that addressed infectious disease and climate-related health risks associated with the Summer Games and similar sports mega-events. Over two decades, infectious disease surveillance at the Summer Games has identified low-level threats from vaccine-preventable illnesses and respiratory conditions. However, the COVID-19 pandemic and expansion of vector-borne diseases represent emerging and existential challenges for cities that host mass gathering sports competitions due to the absence of effective vaccines. Ongoing threats from heat injury among athletes and spectators have also been identified at international sports events from Asia to North America due to a confluence of rising Summer temperatures, urban heat island effects and venue crowding. Projections for the Tokyo Games and beyond suggest that heat injury risks are reaching a dangerous tipping point, which will necessitate relocation or mitigation with long-format and endurance events. Without systematic change to its format or staging location, the Summer Games have the potential to drive deleterious health outcomes for athletes, spectators and host communities.
Global climate change exposes workers to increased air temperature, polluted air, and ultraviolet radiation due to ozone depletion, increased extreme weather events, and evolving patterns of vector-borne diseases. These climate change hazards are causing acute and chronic health problems to workers. The occupational distribution of the population is the most vulnerable to the negative impacts of climate change worldwide. Climate change-related adverse health hazards to the general population is getting evident around the globe. A limited focus has been made on developing a relationship between climate change and related occupational health hazards. This policy paper aims to guide health officials and policymakers to develop a climate change mitigation policy for the occupational distribution of the population. Absolute magnitude determination of climate changerelated health risks is essential to developing projecting models and predicting future hazards and risks. These models will help us to estimate climate change and environmental exposure, susceptibility of the exposed population, and capacity of public health practice and services to reduce climate change impact. Adaptation policies in international, national, and local occupational settings are required to acclimatize the workers and mitigate climate change-related adverse effects.
BACKGROUND: Mosquito-borne diseases are expanding their range, and re-emerging in areas where they had subsided for decades. The extent to which climate change influences the transmission suitability and population at risk of mosquito-borne diseases across different altitudes and population densities has not been investigated. The aim of this study was to quantify the extent to which climate change will influence the length of the transmission season and estimate the population at risk of mosquito-borne diseases in the future, given different population densities across an altitudinal gradient. METHODS: Using a multi-model multi-scenario framework, we estimated changes in the length of the transmission season and global population at risk of malaria and dengue for different altitudes and population densities for the period 1951-99. We generated projections from six mosquito-borne disease models, driven by four global circulation models, using four representative concentration pathways, and three shared socioeconomic pathways. FINDINGS: We show that malaria suitability will increase by 1·6 additional months (mean 0·5, SE 0·03) in tropical highlands in the African region, the Eastern Mediterranean region, and the region of the Americas. Dengue suitability will increase in lowlands in the Western Pacific region and the Eastern Mediterranean region by 4·0 additional months (mean 1·7, SE 0·2). Increases in the climatic suitability of both diseases will be greater in rural areas than in urban areas. The epidemic belt for both diseases will expand towards temperate areas. The population at risk of both diseases might increase by up to 4·7 additional billion people by 2070 relative to 1970-99, particularly in lowlands and urban areas. INTERPRETATION: Rising global mean temperature will increase the climatic suitability of both diseases particularly in already endemic areas. The predicted expansion towards higher altitudes and temperate regions suggests that outbreaks can occur in areas where people might be immunologically naive and public health systems unprepared. The population at risk of malaria and dengue will be higher in densely populated urban areas in the WHO African region, South-East Asia region, and the region of the Americas, although we did not account for urban-heat island effects, which can further alter the risk of disease transmission. FUNDING: UK Space Agency, Royal Society, UK National Institute for Health Research, and Swedish Research Council.
The American Society for Reproductive Medicine compels centers providing reproductive medicine care to develop and implement an emergency preparedness plan in the event of a disaster. Reproductive care is vulnerable to disruptions in energy, transportation, and supply chains as well as may have potential destructive impacts on infrastructure. With the relentless progression of events related to climate change, centers can expect a growing number of such disruptive events and must prepare to deal with them. This article provides a case study of the impact of Hurricane Sandy on one center in New York City and proposes recommendations for future preparedness and mitigation.
Climate warming is occurring most rapidly in the Arctic, which is both a sentinel and a driver of further global change. Ecosystems and human societies are already affected by warming. Permafrost thaws and species are on the move, bringing pathogens and vectors to virgin areas. During a five-year project, the CLINF – a Nordic Center of Excellence, funded by the Nordic Council of Ministers, has worked with the One Health concept, integrating environmental data with human and animal disease data in predictive models and creating maps of dynamic processes affecting the spread of infectious diseases. It is shown that tularemia outbreaks can be predicted even at a regional level with a manageable level of uncertainty. To decrease uncertainty, rapid development of new and harmonised technologies and databases is needed from currently highly heterogeneous data sources. A major source of uncertainty for the future of contaminants and infectious diseases in the Arctic, however, is associated with which paths the majority of the globe chooses to follow in the future. Diplomacy is one of the most powerful tools Arctic nations have to influence these choices of other nations, supported by Arctic science and One Health approaches that recognise the interconnection between people, animals, plants and their shared environment at the local, regional, national and global levels as essential for achieving a sustainable development for both the Arctic and the globe.
Climate change affects ecological processes and interactions, including parasitism. Because parasites are natural components of ecological systems, as well as agents of outbreak and disease-induced mortality, it is important to summarize current knowledge of the sensitivity of parasites to climate and identify how to better predict their responses to it. This need is particularly great in marine systems, where the responses of parasites to climate variables are less well studied than those in other biomes. As examples of climate’s influence on parasitism increase, they enable generalizations of expected responses as well as insight into useful study approaches, such as thermal performance curves that compare the vital rates of hosts and parasites when exposed to several temperatures across a gradient. For parasites not killed by rising temperatures, some simple physiological rules, including the tendency of temperature to increase the metabolism of ectotherms and increase oxygen stress on hosts, suggest that parasites’ intensity and pathologies might increase. In addition to temperature, climate-induced changes in dissolved oxygen, ocean acidity, salinity, and host and parasite distributions also affect parasitism and disease, but these factors are much less studied. Finally, because parasites are constituents of ecological communities, we must consider indirect and secondary effects stemming from climate-induced changes in host-parasite interactions, which may not be evident if these interactions are studied in isolation.
Arthropod-borne viruses (Arboviruses) continue to generate significant health and economic burdens for people living in endemic regions. Of these viruses, some of the most important (e.g., dengue, Zika, chikungunya, and yellow fever virus), are transmitted mainly by Aedes mosquitoes. Over the years, viral infection control has targeted vector population reduction and inhibition of arboviral replication and transmission. This control includes the vector control methods which are classified into chemical, environmental, and biological methods. Some of these control methods may be largely experimental (both field and laboratory investigations) or widely practised. Perceptively, one of the biological methods of vector control, in particular, Wolbachia-based control, shows a promising control strategy for eradicating Aedes-borne arboviruses. This can either be through the artificial introduction of Wolbachia, a naturally present bacterium that impedes viral growth in mosquitoes into heterologous Aedes aegypti mosquito vectors (vectors that are not natural hosts of Wolbachia) thereby limiting arboviral transmission or via Aedes albopictus mosquitoes, which naturally harbour Wolbachia infection. These strategies are potentially undermined by the tendency of mosquitoes to lose Wolbachia infection in unfavourable weather conditions (e.g., high temperature) and the inhibitory competitive dynamics among co-circulating Wolbachia strains. The main objective of this review was to critically appraise published articles on vector control strategies and specifically highlight the use of Wolbachia-based control to suppress vector population growth or disrupt viral transmission. We retrieved studies on the control strategies for arboviral transmissions via arthropod vectors and discussed the use of Wolbachia control strategies for eradicating arboviral diseases to identify literature gaps that will be instrumental in developing models to estimate the impact of these control strategies and, in essence, the use of different Wolbachia strains and features.
Environmental factors play a crucial role in the population dynamics of arthropod endosymbionts, and therefore in the deployment of Wolbachia symbionts for the control of dengue arboviruses. The potential of Wolbachia to invade, persist, and block virus transmission depends in part on its intracellular density. Several recent studies have highlighted the importance of larval rearing temperature in modulating Wolbachia densities in adults, suggesting that elevated temperatures can severely impact some strains, while having little effect on others. The effect of a replicated tropical heat cycle on Wolbachia density and levels of virus blocking was assessed using Aedes aegypti lines carrying strains wMel and wAlbB, two Wolbachia strains currently used for dengue control. Impacts on intracellular density, maternal transmission fidelity, and dengue inhibition capacity were observed for wMel. In contrast, wAlbB-carrying Ae. aegypti maintained a relatively constant intracellular density at high temperatures and conserved its capacity to inhibit dengue. Following larval heat treatment, wMel showed a degree of density recovery in aging adults, although this was compromised by elevated air temperatures. IMPORTANCE In the past decades, dengue incidence has dramatically increased all over the world. An emerging dengue control strategy utilizes Aedes aegypti mosquitoes artificially transinfected with the bacterial symbiont Wolbachia, with the ultimate aim of replacing wild mosquito populations. However, the rearing temperature of mosquito larvae is known to impact on some Wolbachia strains. In this study, we compared the effects of a temperature cycle mimicking natural breeding sites in tropical climates on two Wolbachia strains, currently used for open field trials. When choosing the Wolbachia strain to be used in a dengue control program it is important to consider the effects of environmental temperatures on invasiveness and virus inhibition. These results underline the significance of understanding the impact of environmental factors on released mosquitoes, in order to ensure the most efficient strategy for dengue control.
The potential for adaptive evolution to enable species persistence under a changing climate is one of the most important questions for understanding impacts of future climate change. Climate adaptation may be particularly likely for short-lived ectotherms, including many pest, pathogen, and vector species. For these taxa, estimating climate adaptive potential is critical for accurate predictive modeling and public health preparedness. Here, we demonstrate how a simple theoretical framework used in conservation biology-evolutionary rescue models-can be used to investigate the potential for climate adaptation in these taxa, using mosquito thermal adaptation as a focal case. Synthesizing current evidence, we find that short mosquito generation times, high population growth rates, and strong temperature-imposed selection favor thermal adaptation. However, knowledge gaps about the extent of phenotypic and genotypic variation in thermal tolerance within mosquito populations, the environmental sensitivity of selection, and the role of phenotypic plasticity constrain our ability to make more precise estimates. We describe how common garden and selection experiments can be used to fill these data gaps. Lastly, we investigate the consequences of mosquito climate adaptation on disease transmission using Aedes aegypti-transmitted dengue virus in Northern Brazil as a case study. The approach outlined here can be applied to any disease vector or pest species and type of environmental change.
Wolbachia intracellular bacteria successfully reduce the transmissibility of arthropod-borne viruses (arboviruses) when introduced into virus-carrying vectors such as mosquitoes. Despite the progress made by introducing Wolbachia bacteria into the Aedes aegypti wild-type population to control arboviral infections, reports suggest that heat-induced loss-of-Wolbachia-infection as a result of climate change may reverse these gains. Novel, supplemental Wolbachia strains that are more resilient to increased temperatures may circumvent these concerns, and could potentially act synergistically with existing variants. In this article, we model the ecological dynamics among three distinct mosquito (sub)populations: a wild-type population free of any Wolbachia infection; an invading population infected with a particular Wolbachia strain; and a second invading population infected with a distinct Wolbachia strain from that of the first invader. We explore how the range of possible characteristics of each Wolbachia strain impacts mosquito prevalence. Further, we analyse the differential system governing the mosquito populations and the Wolbachia infection dynamics by computing the full set of basic and invasive reproduction numbers and use these to establish stability of identified equilibria. Our results show that releasing mosquitoes with two different strains of Wolbachia did not increase their prevalence, compared with a single-strain Wolbachia-infected mosquito introduction and only delayed Wolbachia dominance.
Evidence climate change is impacting ticks and tick-borne infections is generally lacking. This is primarily because, in most parts of the world, there are no long-term and replicated data on the distribution and abundance of tick populations, and the prevalence and incidence of tick-borne infections. Notable exceptions exist, as in Canada where the northeastern advance of Ixodes scapularis and Lyme borreliosis in the USA prompted the establishment of tick and associated disease surveillance. As a result, the past 30 years recorded the encroachment and spread of I. scapularis and Lyme borreliosis across much of Canada concomitant with a 2-3 degrees C increase in land surface temperature. A similar northerly advance of I. ricinus [and associated Lyme borreliosis and tick-borne encephalitis (TBE)] has been recorded in northern Europe together with expansion of this species’ range to higher altitudes in Central Europe and the Greater Alpine Region, again concomitant with rising temperatures. Changes in tick species composition are being recorded, with increases in more heat tolerant phenotypes (such as Rhipicephalus microplus in Africa), while exotic species, such as Haemaphysalis longicornis and Hyalomma marginatum, are becoming established in the USA and Southern Europe, respectively. In the next 50 years these trends are likely to continue, whereas, at the southern extremities of temperate species’ ranges, diseases such as Lyme borreliosis and TBE may become less prevalent. Where socioeconomic conditions link livestock with livelihoods, as in Pakistan and much of Africa, a One Health approach is needed to tackling ticks and tick-borne infections under the increasing challenges presented by climate change.
The effects of current and future global warming on the distribution and activity of the primary ixodid vectors of human babesiosis (caused by Babesia divergens, B. venatorum and B. microti) are discussed. There is clear evidence that the distributions of both Ixodes ricinus, the vector in Europe, and I. scapularis in North America have been impacted by the changing climate, with increasing temperatures resulting in the northwards expansion of tick populations and the occurrence of I. ricinus at higher altitudes. Ixodes persulcatus, which replaces I. ricinus in Eurasia and temperate Asia, is presumed to be the babesiosis vector in China and Japan, but this tick species has not yet been confirmed as the vector of either human or animal babesiosis. There is no definite evidence, as yet, of global warming having an effect on the occurrence of human babesiosis, but models suggest that it is only a matter of time before cases occur further north than they do at present.
The COVID-19 pandemic has shed light on the challenges we face as a global society in preventing and containing emerging and re-emerging pathogens. Multiple intersecting factors, including environmental changes, host immunological factors, and pathogen dynamics, are intimately connected to the emergence and re-emergence of communicable diseases. There is a large and expanding list of communicable diseases that can cause neurological damage, either through direct or indirect routes. Novel pathogens of neurotropic potential have been identified through advanced diagnostic techniques, including metagenomic next-generation sequencing, but there are also known pathogens which have expanded their geographic distribution to infect non-immune individuals. Factors including population growth, climate change, the increase in animal and human interface, and an increase in international travel and trade are contributing to the expansion of emerging and re-emerging pathogens. Challenges exist around antimicrobial misuse giving rise to antimicrobial-resistant infectious neurotropic organisms and increased susceptibility to infection related to the expanded use of immunomodulatory treatments. In this article, we will review key concepts around emerging and re-emerging pathogens and discuss factors associated with neurotropism and neuroinvasion. We highlight several neurotropic pathogens of interest, including West Nile virus (WNV), Zika Virus, Japanese Encephalitis Virus (JEV), and Tick-Borne Encephalitis Virus (TBEV). We emphasize neuroinfectious diseases which impact the central nervous system (CNS) and focus on flaviviruses, a group of vector-borne pathogens that have expanded globally in recent years and have proven capable of widespread outbreak.
Dengue virus (DENV) is the causative agent of dengue fever and severe dengue. Every year, millions of people are infected with this virus. There is no vaccine available for this disease. Dengue virus is present in four serologically varying strains, DENV 1, 2, 3, and 4, and each of these serotypes is further classified into various genotypes based on the geographic distribution and genetic variance. Mosquitoes play the role of vectors for this disease. Tropical countries and some temperate parts of the world witness outbreaks of dengue mainly during the monsoon (rainy) seasons. Several algorithms have been developed to predict the occurrence and prognosis of dengue disease. These algorithms are mainly based on epidemiological data, climate factors, and online search patterns in the infected area. Most of these algorithms are based on either machine learning or deep learning techniques. We summarize the different software tools available for predicting the outbreaks of dengue based on the aforementioned factors, briefly outline the methodology used in these algorithms, and provide a comprehensive list of programs available for the same in this article.
Climate change impacts represent one of the most important ecological and medical issues during this century. Several fungal species will change their distribution through space and time as a response to climate changes. This will rearrange many fungal diseases throughout the world. One of the most important and very common fungi is the black mold Aspergillus niger. The COVID-19 pandemic reforms the way in which mycologists think about this fungus as an emerging healthy issue. Through this work, about one thousand records of Aspergillus niger were used to model its current and future global distribution using 19 bioclimatic variables under several climate change scenarios. Maximum entropy implemented in Maxent was chosen as the modeling tool, especially with its accuracy and reliability over the other modeling techniques. The annual mean temperature (bio 1) forms the most contributed climatological parameter to black mold distribution. The produced current distribution model came compatible with the real distribution of the species with a cosmopolitan range. The rise of temperature due to global warming will form a limitation to Aspergillus niger through several parts of its range. The generated maps of the future status of this fungus under two different RCPs for 2050 and 2070, indicate several parts that become free from black mold due to temperature limitations. The present results need more intensive future evaluation using data science and GIS, especially on a local scale including more ecological parameters other than climatological data.
BACKGROUND: Numerous studies have quantified the associations between ambient temperature and enteric infections, particularly all-cause enteric infections. However, the temperature sensitivity of enteric infections might be pathogen dependent. Here, we sought to identify pathogen-specific associations between ambient temperature and enteric infections. METHODS: We did a systematic review and meta-analysis by searching PubMed, Web of Science, and Scopus for peer-reviewed research articles published from Jan 1, 2000, to Dec 31, 2019, and also hand searched reference lists of included articles and excluded reviews. We included studies that quantified the effects of ambient temperature increases on common pathogen-specific enteric infections in humans. We excluded studies that expressed ambient temperature as a categorical or diurnal range, or in a standardised format. Two authors screened the search results, one author extracted data from eligible studies, and four authors verified the data. We obtained the overall risks by pooling the relative risks of enteric infection by pathogen for each 1°C temperature rise using random-effects modelling and robust variance estimation for the correlated effect estimates. Between-study heterogeneity was measured using I(2), τ(2), and Q-statistic. Publication bias was determined using funnel plot asymmetry and the trim-and-fill method. Differences among pathogen-specific pooled estimates were determined using subgroup analysis of taxa-specific meta-analysis. The study protocol was not registered but followed the PRISMA guidelines. FINDINGS: We identified 2981 articles via database searches and 57 articles from scanning reference lists of excluded reviews and included articles, of which 40 were eligible for pathogen-specific meta-analyses. The overall increased risks of incidence per 1°C temperature rise, expressed as relative risks, were 1·05 (95% CI 1·04-1·07; I(2) 97%) for salmonellosis, 1·07 (1·04-1·10; I(2) 99%) for shigellosis, 1·02 (1·01-1·04; I(2) 98%) for campylobacteriosis, 1·05 (1·04-1·07; I(2) 36%) for cholera, 1·04 (1·01-1·07; I(2) 98%) for Escherichia coli enteritis, and 1·15 (1·07-1·24; I(2) 0%) for typhoid. Reduced risks per 1°C temperature increase were 0·96 (95% CI 0·90-1·02; I(2) 97%) for rotaviral enteritis and 0·89 (0·81-0·99; I(2) 96%) for noroviral enteritis. There was evidence of between-pathogen differences in risk for bacterial infections but not for viral infections. INTERPRETATION: Temperature sensitivity of enteric infections can vary according to the enteropathogen causing the infection, particularly for bacteria. Thus, we encourage a pathogen-specific health adaptation approach, such as vaccination, given the possibility of increasingly warm temperatures in the future. FUNDING: Japan Society for the Promotion of Science (Kakenhi) Grant-in-Aid for Scientific Research.
Why have some countries done significantly better than others in fighting the Covid-19 pandemic? Had some countries been better prepared than others? This paper attempts to shed light on these questions by examining the role of climate risk and culture in explaining the cross-country variation in the Covid-19 mortality, while controlling for other potential drivers. In our analysis, we consider climate risk, readiness to climate change and individualism as main indicators reflecting the climate and culture status of individual countries. Using data from 110 countries, we find that the greater the climate risk; the lower the readiness to climate change and the more individualistic the society, the higher the pandemic mortality rate. We also present a series of sensitivity checks and show that our findings are robust to different specifications, alternative definitions of the mortality rate; and different estimation methods. One policy implication arising from our results is that countries that were better prepared for the climate emergency were also better placed to fight the pandemic. Overall, countries in which individuals look after each other and the environment, creating sustainable societies, are better able to cope with climate and public health emergencies.
There is global evidence of a general increase in the incidence and prevalence of respiratory diseases including allergic rhinitis and associated asthma. This increase in turn, has been related, in part, to concurrent increases in carbon dioxide (CO(2)) and temperature on pollen production and allergic disease generated from plant-based sources of pollen. Such links to anthropogenic climate change has suggested three significant and interrelated consequences associated with respiratory allergies or disease. First, warmer temperatures and a longer frost-free growing season can influence pollen season length and temporal exposure to airborne aeroallergens. Second, both warmer temperatures and additional CO(2) can increase the amount of pollen, the seasonal intensity, from spring through fall. Thirdly, there is evidence from oak and ragweed that rising levels of CO(2) could increase the allergen concentration of the pollen and symptom severity. However, while these outcomes are of obvious consequence, they do not fully encompass all of the plant derived changes that could, directly or indirectly, influence aeroallergen production, exposure, and consequences for public health. In this overview, I will delve deeper into other plant-based links to climate/CO(2) that are consequential either directly or indirectly to allergic rhinitis and associated disease. Such interactions range from pollen morphology to fire occurrence, from volatile organic compounds to potential changes in pesticide usage. The goal in doing so is to provide a broader context and appreciation for the interactions between plant biology and climate that can also affect allergen production and human impact but which, to date, have received little recognition or research.
Climate change and air pollution can interact to amplify risks to human health and crop production. This has significant implications for our ability to reach the Sustainable Development Goals (e.g. SDGs 2, 3, 13, 15) and for the design of effective mitigation and adaptation policies and risk management. To be able to achieve the SDG targets, closer integration of climate change and air pollution both in terms of impact assessment for human health and agricultural productivity and respective policy development is needed. Currently, studies estimating the impacts of climate and air pollutants on human health and crops mostly treat these stressors separately, and the methods used by the health and agricultural science communities differ. Better insights into the methods applied in the different communities can help to improve existing and develop new methods to advance our knowledge about the combined impacts of climate change and air pollution on human health and crops. This topical review provides an overview of current methodologies applied in the two fields of human health and agricultural crop impact studies, ranging from empirical regression-based and experimental methods to more complex process-based models. The latter are reasonably well developed for estimating impacts on agricultural crops, but not for health impacts. We review available literature addressing the combined effects of climate and air pollution on human health or agricultural productivity to provide insights regarding state-of-the-art knowledge and currently available methods in the two fields. Challenges to assess the combined effect of climate and air pollution on human health and crops, and opportunities for both fields to learn from each other, are discussed.
Heatwaves are increasing in frequency, duration, and intensity due to climate change. They are associated with high mortality rates and cross-sectional impacts including a reduction in crop yield and power outages. Here we demonstrate that there are large deficiencies in reporting of heatwave impacts in international disasters databases, international organization reports, and climate bulletins. We characterize the distribution of heat stress across the world focusing on August in the Northern Hemisphere, when notably heatwaves have taken place (i.e., 2003, 2010, and 2020) for the last 20 years using the ERA5-HEAT reanalysis of the Universal Thermal Comfort Index and establish heat stress has grown larger in extent, more so during a heatwave. Comparison of heat stress against the emergency events impacts database and climate reports reveals underreporting of heatwave-related impacts. This work suggests an internationally agreed protocol should be put in place for impact reporting by organizations and national government, facilitating implementation of preparedness measures, and early warning systems.
In the middle of the twentieth century, the from North America sooty bark disease (SBD) of maples was first discovered in England and has spread in the last decades in Central Europe, in particular. The trigger of SBD is the mould fungus Cryptostroma (C.) corticale. The most common infested maple is the sycamore, Acer pseudoplatanus, a common tree in woods and parks. The disease is characterised by peeling of the outer layer of the bark and brownish-black spores under the peeled off bark. These spores can cause maple bark disease (MBD) in humans, a hypersensitivity pneumonitis (HP) with similar symptoms like COPD, allergic asthma, influenza or flu-like infections and interstitial pneumonia. Persons who have intensive respectively occupational contact with infested trees or wood, e.g., woodman, foresters, sawyers or paper mill workers, are at risk in particular. Since C. corticale favours hot summers and host trees weakened by drought, SBD will increasingly spread in the future due to ongoing climate change. Consequently, the risk of developing MBD will increase, too. As with all HPs, e.g., farmer’s lung and pigeon breeder’s disease, the diagnosis of MBD is intricate because it has no clear distinguishing characteristics compared to other interstitial lung diseases. Therefore, the establishment of consistent diagnosis guidelines is required. For correct diagnosis and successful therapy, multidisciplinary expertise including pulmonologists, radiologists, pathologists and occupational physicians is recommended. If MBD is diagnosed in time, the removal of the triggering fungus or the infested maple wood leads to complete recovery in most cases. Chronic HP can lead to lung fibrosis and a total loss of lung function culminating in death. HP and, thus, MBD, is a disease with a very high occupational amount. To avoid contact with spores of C. corticale, persons working on infested wood or trees have to wear personal protective equipment. To protect the public, areas with infested maples have to be cordoned off, and the trees should be removed. This is also for impeding further spreading of the spores.
Extreme and impactful weather events of the recent past provide a vital but under-utilised data source for understanding present and future climate risks. Extreme event attribution (EEA) enables us to quantify the influence of anthropogenic climate change (ACC) on a given event in a way that can be tailored to stakeholder needs, thereby enhancing the potential utility of studying past events. Here we set out a framework for systematically recording key details of high-impact events on a national scale (using the UK and Puerto Rico as examples), combining recent advances in event attribution with the risk framework. These `inventories’ inherently provide useful information depending on a user’s interest. For example, as a compilation of the impacts of ACC, we find that in the UK since 2000, at least 1500 excess deaths are directly attributable to human-induced climate change, while in Puerto Rico the increased intensity of Hurricane Maria alone led to the deaths of up to 3670 people. We also explore how inventories form a foundation for further analysis, learning from past events. This involves identifying the most damaging hazards and crucially also vulnerabilities and exposure characteristics over time. To build a risk assessment for heat-related mortality in the UK we focus on a vulnerable group, elderly urban populations, and project changes in the hazard and exposure within the same framework. Without improved preparedness, the risk to this group is likely to increase by similar to 50% by 2028 and similar to 150% by 2043. In addition, the framework allows the exploration of the likelihood of otherwise unprecedented events, or ‘Black Swans’. Finally, not only does it aid disaster preparedness and adaptation at local and national scales, such inventories also provide a new source of evidence for global stocktakes on adaptation and loss and damage such as mandated by the Paris Climate Agreement.
BACKGROUND: Itch is a cardinal feature of paediatric disorders and can impair quality of life. However, few studies have addressed symptoms and impacts of itch in paediatric patients. OBJECTIVES: We focused on understanding the child’s experience of itch and the impact of itch specifically on affected children, including comparison with the adult experience. METHODS: Semistructured interviews (nine parents, 15 children with itch) explored concerns related to paediatric itch experiences and effects. Themes were compared with those of previous adult interviews. Literature was reviewed to identify the need for a more comprehensive measure of paediatric itch. RESULTS: Itch quality, intensity, duration and environmental triggers (sweating, climate change, stress and certain fabrics) are important aspects of the child’s itch experience. Skin disruption, physical function, concentration, emotional reactions, stigma and relationships/social effects are itch impact themes that emerged. No paediatric-specific scale comprehensively captures the paediatric patient itch experience. However, differences between child and adult reports of itch-related pain, functional limitations, fatigue and restlessness, emotional reactions to itch, and treatment effects emphasize the need for a paediatric-specific measurement tool. CONCLUSIONS: Children and parents endorse the importance of capturing the paediatric-focused characteristics and impacts of itch in measuring disease severity and response to intervention.
The policies of response to and prevention of heat waves in France in 2003 and in South Korea in 2018 were compared and reviewed to see how public health policy orientation was being expanded in connection with urban and social policies. The statistics of the patients with heat illness and resulted death in France in 2003 and South Korea in 2018 were analyzed. The results and limitations of the French and Korean responses to heat waves were compared and discussed. The heat wave in France in 2003 caused an excess death of 14,802. The 2018 heat wave in South Korea resulted in 4,526 cases of heat illness and 48 deaths. France’s National Heat wave Plan established in 2004 introduced the warning system and strengthened support for the vulnerable. The heat wave in South Korea in 2018 revealed the success and limitations of the national measures that have been gradually implemented since the mid-2000s. Both France and South Korea are making efforts in preventing heat illness and managing health risk through the warning systems, providing public and social support for the vulnerable, and expanding urban infrastructure. Paris puts priority on the long-term prevention of heat wave, in the wider context of climate change response, while Seoul shows a relatively strong point in immediate infrastructural expansion. In order to respond to the climate crisis and the following health risk, public health policies need to be contrived with deeper connection with urban social policies for sustainable development.
The environmental conditions during the Tokyo Olympic and Paralympic Games are expected to be challenging, which increases the risk for participating athletes to develop heat-related illnesses and experience performance loss. To allow safe and optimal exercise performance of Dutch elite athletes, the Thermo Tokyo study aimed to determine thermoregulatory responses and performance loss among elite athletes during exercise in the heat, and to identify personal, sports-related, and environmental factors that contribute to the magnitude of these outcomes. For this purpose, Dutch Olympic and Paralympic athletes performed two personalized incremental exercise tests in simulated control (15°C, relative humidity (RH) 50%) and Tokyo (32°C, RH 75%) conditions, during which exercise performance and (thermo)physiological parameters were obtained. Thereafter, athletes were invited for an additional visit to conduct anthropometric, dual-energy X-ray absorptiometry (DXA), and 3D scan measurements. Collected data also served as input for a thermophysiological computer simulation model to estimate the impact of a wider range of environmental conditions on thermoregulatory responses. Findings of this study can be used to inform elite athletes and their coaches on how heat impacts their individual (thermo)physiological responses and, based on these data, advise which personalized countermeasures (i.e. heat acclimation, cooling interventions, rehydration plan) can be taken to allow safe and maximal performance in the challenging environmental conditions of the Tokyo 2020 Olympic and Paralympic Games.
Climate change is one of the biggest health threats facing humanity and can directly affect human health through heat waves. This study aims to evaluate excess deaths during heat waves between the summer months of 2004 and 2017 in Istanbul and to determine a definition of heat waves that can be used in the development of an early warning system, a part of prospective urban heat-health action plans. In this study, heat waves were determined using the Excess Heat Factor, an index based on a three-day-averaged daily mean temperature. The death rates during heat waves and non-heat wave days of the summer months were compared with a Z test of the difference of natural logarithms. Thirty heat waves were recorded in Istanbul during the summer months of 2004-2017. In 67% of the heat waves, the death rate was significantly higher than the reference period and 4281 excess deaths were recorded. The mortality risk was especially higher during heat waves of higher intensity. The study showed an excess risk of mortality during heat waves in Istanbul, and the findings suggest that the Excess Heat Factor could be an appropriate tool for an early warning system in Istanbul.
The present paper aims at verifying the awareness and preparedness of urban and local planners to cope with NaTech risk, together with the availability of dedicated tools. Since most of the natural events that can trigger technological hazards are influenced by climate change (i.e. flood, heavy rains, storms, etc.), NaTech risk is expected to be strongly increasing in the next years. However, dedicated NaTech planning actions and methods or tools to support them are still rarely available. The requirements of European Adaptation Strategy for Climate were examined considering the issues posed by the Seveso III Directive in terms of NaTech, focusing on the strategies adopted in the European countries, and in particular in Italy. Based on such analysis, a ‘NaTech tool’ dedicated to local planners was developed. Practical and easy to use methods and procedures were proposed in order to allow the use of the method by the local authorities, in the absence of sectorial experts.
In the recent years, the effects of extreme climate phenomena (mainly heat-related) on agricultural crops, infrastructure and human health have become increasingly severe as a result of their complex interactions with the particularities of the urban/rural habitat, as well as the social and economic factors. In Romania, heat-related phenomena (e.g. drought, heat waves) are affecting wide areas in the southern half of the territory where the study area (Bucharest Metropolitan Area) lies. The paper aims to develop a multi-criteria vulnerability assessment using both quantitative and qualitative methods. 23 indicators were selected and processed in order to assess various components of socio-economic and environmental vulnerability to heat-related phenomena using the statistical data available at local administrative units (LAU). The indicators were grouped into the three key components of vulnerability (potential exposure, sensitivity and adaptive capacity) on two dimensions (socio-economic and environmental) resulting two indexes: Socio-Economic Vulnerability Index (SEVI) and Environmental Vulnerability Index (EVI). Finally, an integrated Heat Vulnerability Index (HVI) (using Hull score, average 50 and standard deviation 14) was computed.
The study deals with an assessment and interpretation of the bioclimatic conditions in Vranje (southern Serbia). The study aims at temporal distributions of bioclimatic conditions focussing on extreme thermal stress based on the Universal Thermal Climate Index (UTCI). The meteorological data required for the calculation of UTCI concern hourly (7 and 14 CET) weather data collected for the period 2000-2017. The frequency of very strong heat stress (VSHS), very strong cold stress (VSCS) and extreme cold stress (ECS) for both morning and midday hours. Furthermore, the daily difference of the UTCI hourly values (diurnal UTCI change) are specified, giving the daily variance of heat and cold stress. The results revealed the frequency of days in which thermal stress prevails for the studied period. The obtained results show an increase in extreme heat biothermal conditions, while extreme cold biothermal conditions are in decline, especially in the last 10 years. However, the frequency (the number of days) of very strong heat stress (VSHS) increased since 2007. A spectacular increase in heat stress was observed in the month of September, particularly in 2015.
BACKGROUND: Because older adults are particularly vulnerable to nonoptimal temperatures, it is expected that the progressive population aging will amplify the health burden attributable to heat and cold due to climate change in future decades. However, limited evidence exists on the contribution of population aging on historical temperature-mortality trends. OBJECTIVES: We aimed to a) assess trends in heat- and cold-related mortality in Switzerland between 1969 and 2017 and b) to quantify the contribution of population aging to the observed patterns. METHODS: We collected daily time series of all-cause mortality by age group ( < 65, 65-79, and 80 y and older) and mean temperature for each Swiss municipality (1969-2017). We performed a two-stage time-series analysis with distributed lag nonlinear models and multivariate longitudinal meta-regression to obtain temperature-mortality associations by canton, decade, and age group. We then calculated the corresponding excess mortality attributable to nonoptimal temperatures and compared it to the estimates obtained in a hypothetical scenario of no population aging. RESULTS: Between 1969 and 2017, heat- and cold-related mortality represented 0.28% [95% confidence interval (CI): 0.18, 0.37] and 8.91% (95% CI: 7.46, 10.21) of total mortality, which corresponded to 2.4 and 77 deaths per 100,000 people annually, respectively. Although mortality rates for heat slightly increased over time, annual number of deaths substantially raised up from 74 (12;125) to 181 (39;307) between 1969-78 and 2009-17, mostly driven by the ≥ 80-y-old age group. Cold-related mortality rates decreased across all ages, but annual cold-related deaths still increased among the ≥ 80, due to the increase in the population at risk. We estimated that heat- and cold-related deaths would have been 52.7% and 44.6% lower, respectively, in the most recent decade in the absence of population aging. DISCUSSION: Our findings suggest that a substantial proportion of historical temperature-related impacts can be attributed to population aging. We found that population aging has attenuated the decrease in cold-related mortality and amplified heat-related mortality. https://doi.org/10.1289/EHP9835.
This study tries to solve some issues in the construction sector related to Sustainable Development Goals (SDG) numbers 3 (health and well-being) and 8 (decent work and economic growth) of the 2030 Agenda, improving the working conditions of workers in the construction sector, at certain latitudes, since they are constantly exposed to inclement weather conditions and their safety may be adversely affected. Therefore, a design of a new procedure for the installation of a panel-based facade is proposed, which allows the complete closing of the building during its execution and thus improves the comfort and safety of workers. In addition to the constructive definition of the proposed system, its implementation procedure and the energy consumption during the interior air conditioning phase are analyzed. In addition, a comparative study of execution times between the proposed procedure and a conventional solution is performed. The conclusions of the study highlight that the proposed system improves: the working conditions in extreme climates and prevents risks derived from work in extreme weather conditions; the precision in the formation of window and door openings and their coordination with the modular facades; the ease of execution and delays the placement of the exterior scaffolding. Overall, the proposed procedure reduces the weight of the facade and the thermal transmittance by 13.5% and reduces not only costs due to the modulation of the system, but also execution times in the facade and interior work phases (around 40%) and the structure phase (around 32%).
Climate change is producing more extremes and increasing the number and magnitude of risks that impact people’s lives, so identifying and understanding local climate risks is a long but essential process for defining adaptation strategies. The availability of technologies to sensitize and educate people about risks, and to assist people with becoming active observers and monitors of climatic elements has helped to promote permanent surveillance and proactive attitudes towards climatic phenomena that lead to undesirable risks. This paper proposes a methodological approach to guide citizens moving around the city when extreme temperatures occur, minimizing climatic risks and negative health comes, using a very simple method based on Landsat 8 temperature data images at a subsection spatial scale level. The results obtained indicate the places of higher extreme temperatures risks, as well as some of the potential places that people can use to protect themselves. This work demonstrates the value of mapping climatic factors at a local scale and deliver tailored and accurate maps with the places suitable for alleviating bioclimatic stresses and the places that should be avoided.
This paper describes the functional development of the ClimApp tool (available for free on iOS and Android devices), which combines current and 24 h weather forecasting with individual information to offer personalised guidance related to thermal exposure. Heat and cold stress assessments are based on ISO standards and thermal models where environmental settings and personal factors are integrated into the ClimApp index ranging from -4 (extremely cold) to +4 (extremely hot), while a range of -1 and +1 signifies low thermal stress. Advice for individuals or for groups is available, and the user can customise the model input according to their personal situation, including activity level, clothing, body characteristics, heat acclimatisation, indoor or outdoor situation, and geographical location. ClimApp output consists of a weather summary, a brief assessment of the thermal situation, and a thermal stress warning. Advice is provided via infographics and text depending on the user profile. ClimApp is available in 10 languages: English, Danish, Dutch, Swedish, Norwegian, Hellenic (Greek), Italian, German, Spanish and French. The tool also includes a research functionality providing a platform for worker and citizen science projects to collect individual data on physical thermal strain and the experienced thermal strain. The application may therefore improve the translation of heat and cold risk assessments and guidance for subpopulations. ClimApp provides the framework for personalising and downscaling weather reports, alerts and advice at the personal level, based on GPS location and adjustable input of individual factors.
BACKGROUND: Europe has emerged as a major climate change hotspot, both in terms of an increase in seasonal averages and climate extremes. Projections of temperature-attributable mortality, however, have not been comprehensively reported for an extensive part of the continent. Therefore, we aim to estimate the future effect of climate change on temperature-attributable mortality across Europe. METHODS: We did a time series analysis study. We derived temperature-mortality associations by collecting daily temperature and all-cause mortality records of both urban and rural areas for the observational period between 1998 and 2012 from 147 regions in 16 European countries. We estimated the location-specific temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model. These associations were used to transform the daily temperature simulations from the climate models in the historical period (1971-2005) and scenario period (2006-2099) into projections of temperature-attributable mortality. We combined the resulting risk functions with daily time series of future temperatures simulated by four climate models (ie, GFDL-ESM2M, HadGEM2-ES, IPSL-CM5A-LR, and MIROC5) under three greenhouse gas emission scenarios (ie, Representative Concentration Pathway [RCP]2.6, RCP6.0, and RCP8.5), providing projections of future mortality attributable fraction due to moderate and extreme cold and heat temperatures. FINDINGS: Overall, 7·17% (95% CI 5·81-8·50) of deaths registered in the observational period were attributed to non-optimal temperatures, cold being more harmful than heat by a factor of ten (6·51% [95% CI 5·14-7·80] vs 0·65% [0·40-0·89]), and with large regional differences across countries-eg, ranging from 4·85% (95% CI 3·75-6·00) in Germany to 9·87% (8·53-11·19) in Italy. The projection of temperature anomalies by RCP scenario depicts a progressive increase in temperatures, more exacerbated in the high-emission scenario RCP8.5 (4·54°C by 2070-2099) than in RCP6.0 (2·89°C) and RCP2.6 (1·67°C). This increase in temperatures was transformed into attributable fraction. Projections consistently indicated that the increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century, especially in the Mediterranean and in the higher emission scenarios. The comparison between scenarios highlighted the important role of mitigation, given that the total attributable fraction will only remain stable in RCP2.6, whereas the total attributable fraction will rapidly start to increase in RCP6.0 by the end of the century and in RCP8.5 already by the middle of the century. INTERPRETATION: The increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century. This finding highlights the importance of implementing mitigation policies. These measures would be especially beneficial in the Mediterranean, where the high vulnerability to heat will lead to an imbalance between the decreasing cold and increasing heat-attributable mortality. FUNDING: None.
This study was focused on the metropolitan area of Florence in Tuscany (Italy) with the aim to provide a functional spatial thermal anomaly indicator obtained throughout a thermal summer and winter hot-spot detection. The hot-spot analysis was performed by applying Getis-Ord Gi* spatial statistics to Land Surface Temperature (LST) layers, obtained from Landsat 8 remote sensing data during the 2015-2019 daytime summer and winter period, to delimitate summer hot- and cool-spots, and winter warm- and cold-spots. Further, these ones were spatially combined thus obtaining a comprehensive summer-winter Thermal Hot-Spot (THS(SW)) spatial indicator. Winter and summer mean daily thermal comfort profiles were provided for the study area assessing the Universal Thermal Climate Index (UTCI) by using meteorological data available from seven local weather stations, located at a maximum distance of 350 m from industrial sites. A specific focus on industrial sites was carried out by analyzing the industrial buildings characteristics and their surrounding areas (50 m buffer), through the following layers: industrial building area (BA), surface albedo of buildings (ALB), impervious area (IA), tree cover (TC), and grassland area (GA). The novel THS(SW) classification applied to industrial buildings has shown that about 50% of the buildings were located in areas characterized by summer hot-spots. Increases in BA and IA revealed warming effects on industrial buildings, whereas increases in ALB, TC, and GA disclosed cooling effects. A decrease of about 10% of IA replaced by TC and GA was associated with about 2 °C decrease of LST. Very strong outdoor heat stress conditions were observed during summer daytime, whereas moderate winter outdoor cold stress conditions were recorded during nighttime until the early morning. The thermal spatial hot-spot classification in industrial areas provides a very useful source of information for thermal mitigation strategies aimed to reduce the heat-related health risk for workers.
Bioclimatic comfort is the state of people in which they feel comfortable, happy, and fit in the atmospheric environment they are. The bioclimatic comfort conditions of cities have changed depending on anthropogenic factors. The aim of this study is to compare the bioclimatic comfort conditions of Usak city between 1990 and 2018. In the first stage, the bioclimatic comfort conditions of the city centre between 1990 and 2018 were determined according to the Physiological Equivalent Temperature (PET) index obtained from the RayMan model by using hourly data of the meteorological station in the city centre; air temperature (degrees C), relative humidity (%), wind velocity(m/s) and cloudiness (octa). By using Geographic Information Systems in the spatial distribution of bioclimatic comfort conditions, calculations were made with base maps of elevation, land use, solar radiation, mean radiant temperature (MRT), and wind speed. In the second stage, the land cover was classified according to the general appearance for the period covering 28 years (from 1990 to 2018), and the rates of change were calculated. As a result, it was determined that the most comfortable areas are the agricultural areas, followed by the forest and natural areas, and the most uncomfortable conditions are in the artificial areas. Intense urbanization and construction have increased the uncomfortable conditions in the city. It is thought that the plans to be made by prioritizing bioclimatic comfort conditions will contribute to decelerating the climate change caused by global warming, as well as improving the existing problems.
The thermal conditions that prevail in cities pose a number of challenges to urban residents and policy makers related to quality of life, health and welfare as well as to sustainable urban development. However, the changes in thermal stress due to climate change are probably not uniform among cities with different background climates. In this work, a comparative analysis of observed and projected thermal stress (cold stress, heat stress, no thermal stress) across four European cities (Helsinki, Rotterdam, Vienna, and Athens), which are representative of different geographical and climatic regions of the continent, for a recent period (1975 - 2004) and two future periods (2029 - 2058, 2069 - 2098) has been conducted. Applying a rational thermal index (Universal Thermal Climate Index) and considering two models of the EURO-CORDEX experiment (RCA4-MOHC, RCA4-MPI) under two Representative Concentration Pathways (RCP4.5, RCP8.5), the projected future changes in thermal conditions are inspected. The distribution of thermal stress in the current climate varies greatly between the cities, reflecting their climatic and urban heterogeneity. In the future climate, a reduction in the frequency of cold stress is expected across all cities, ranging between - 2.9% and - 16.2%. The projected increase in the frequency of optimal thermal conditions increases with increasing latitude, while the projected increase in the frequency of heat stress (ranging from + 0.2 to + 14.6%) decreases with increasing latitudes. Asymmetrical changes in cold- and heat-related stress between cities were found to affect the annual percentage of optimal (no thermal stress) conditions in future. Although future projections are expected to partly bridge the gap between the less-privileged cities (with respect to annual frequency of optimal thermal conditions) like Helsinki and Rotterdam and the more privileged ones like Athens, the former will still lag behind on an annual basis.
The aim of the article was to present the influence of the external environment on people working on scaffolding. For this purpose, the heat load of a man was determined using the universal thermal climate index. The research was carried out on 40 facade scaffolds located in four voivodeships in Poland: Lower Silesia, Lublin, Lodzkie, and Masovian. The conducted analysis showed that employees may experience strong or very strong heat stress, and also extreme heat stress in isolated cases. The highest probability at 0.30 level occurs on scaffolds located in the Lodzkie voivodeship. Environmental conditions are therefore unfavourable for people working outside. This can lead to reduced concentration, longer reaction time, and greater fatigue, contributing to an increase in situations that could lead to accidents. Hazard identification allows to take safety measures that improve the comfort of work on scaffolding.
BACKGROUND: There is emerging evidence suggesting a link between ambient heat exposure and chronic obstructive pulmonary disease (COPD) hospitalisations. Individual and contextual characteristics can affect population vulnerabilities to COPD hospitalisation due to heat exposure. This study quantifies the effect of ambient heat on COPD hospitalisations and examines population vulnerabilities by age, sex and contextual characteristics. METHODS: Individual data on COPD hospitalisation at high geographical resolution (postcodes) during 2007-2018 in England was retrieved from the small area health statistics unit. Maximum temperature at 1 km ×1 km resolution was available from the UK Met Office. We employed a case-crossover study design and fitted Bayesian conditional Poisson regression models. We adjusted for relative humidity and national holidays, and examined effect modification by age, sex, green space, average temperature, deprivation and urbanicity. RESULTS: After accounting for confounding, we found 1.47% (95% Credible Interval (CrI) 1.19% to 1.73%) increase in the hospitalisation risk for every 1°C increase in temperatures above 23.2°C (lags 0-2 days). We reported weak evidence of an effect modification by sex and age. We found a strong spatial determinant of the COPD hospitalisation risk due to heat exposure, which was alleviated when we accounted for contextual characteristics. 1851 (95% CrI 1 576 to 2 079) COPD hospitalisations were associated with temperatures above 23.2°C annually. CONCLUSION: Our study suggests that resources should be allocated to support the public health systems, for instance, through developing or expanding heat-health alerts, to challenge the increasing future heat-related COPD hospitalisation burden.
INTRODUCTION: The impacts of a changing climate on current and future dementia burdens have not been widely explored. METHODS: Time-series negative binomial regression analysis was used to assess acute associations between daily ambient temperature and counts of emergency admissions for dementia in each Government region of England, adjusting for season and day-of-week. Using the latest climate and dementia projections data, we then estimate future heat-related dementia burdens under a high emission scenario (Representative Concentration Pathway (RCP8.5), where global greenhouse gas (GHG) emissions continue to rise, and a low emissions scenario (RCP2.6), where GHG emissions are sizeably reduced under a strong global mitigation policy. RESULTS: A raised risk associated with high temperatures was observed in all regions. Nationally, a 4.5% (95% Confidence interval (CI) 2.9%-6.1%) increase in risk of dementia admission was observed for every 1 °C increase in temperature above 17 °C associated with current climate. Under a high emissions scenario, heat-related admissions are projected to increase by almost 300% by 2040 compared to baseline levels. CONCLUSIONS: People living with dementia should be considered a high-risk group during hot weather. Our results support arguments for more stringent climate change mitigation policies.
BACKGROUND: The impact of increasing temperatures on renal function in heart failure (HF) outpatients has never been specifically analyzed. METHODS: We retrieved creatinine and estimated glomerular filtration rate (eGFR) values of all HF outpatients followed at a HF clinic and temperature data from 2002 to 2021. For each patient and each year we averaged values of creatinine, eGFR and monthly temperatures during summer and the rest of the year. RESULTS: The study cohort included 2167 HF patients undergoing 25,865 elective visits, with a median of 14 visits for each patient (interquartile range 7-23). At the first visit, patients (70% men) had an age of 67 ± 13 years, and a left ventricular ejection fraction of 35 ± 14%. Creatinine was 1.25 ± 0.51 mg/dL, and eGFR was 65 ± 25 mL/min/1.73 m(2). When pooling together all average values of creatinine and eGFR measured during summer or in the rest of the year, creatinine was significantly higher in summer (difference 0.04, 95% confidence interval [CI] 0.04 to 0.05, p < 0.001), and eGFR was slightly lower (difference - 2.0, 95% CI -2.3 to -1.8, p < 0.001). Temperature rise during summer increased from 2002 to 2021. The absolute (Δ) and percent (Δ%) elevation in temperature during summer displayed independent associations with Δ and Δ% creatinine and eGFR after adjusting for age, sex, plasma creatinine, and HF therapies. CONCLUSIONS: The magnitude of temperature elevation during summer has increased over 20 years. This elevation correlates with the decline in renal function during summer. This might be an example of how global warming is affecting human health.
INTRODUCTION: The European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as exposure to urban natural environments, is unknown. Green CURe In Outdoor CITY spaces (Green CURIOCITY) will analyse how heat exposure during pregnancy affects birth outcomes and how long-term heat exposure may influence children’s neurodevelopment. We will also investigate if adverse effects can be mitigated by urban natural environments. A final goal is to visualise intraurban patterns of heat vulnerability and assist planning towards healthier cities. METHODS AND ANALYSIS: We will use existing data from the Human Early-Life Exposure cohort, which includes information on birth outcomes and neurodevelopment from six European birth cohorts. The cohort is linked to data on prenatal heat exposure and impact on birth outcomes will be analysed with logistic regression models, adjusting for air pollution and noise and sociobehavioural covariates. Similarly, impact of cumulative and immediate heat exposure on neurodevelopmental outcomes at age 5 will be assessed. For both analyses, the potentially moderating impact of natural environments will be quantified. For visualisation, Geographical information systems data will be combined to develop vulnerability maps, demonstrating urban ‘hot spots’ where the risk of negative impacts of heat is aggravated due to sociodemographic and land use patterns. Finally, geospatial and meteorological data will be used for informing GreenUr, an existing software prototype developed by the WHO Regional Office for Europe to quantify health impacts and augment policy tools for urban green space planning. ETHICS AND DISSEMINATION: The protocol was approved by the Comité Ético de Investigación Clínica Parc de Salut MAR, Spain. Findings will be published in peer-reviewed journals and presented at policy events. Through stakeholder engagement, the results will also reach user groups and practitioners.
OBJECTIVE: Surgical site infections (SSIs) occur more frequently during periods of warmer temperatures. We aimed to investigate for which pathogens this association is particularly strong. DESIGN: A retrospective observational study was conducted. METHODS: Data from the SSI-module of the German nosocomial infection surveillance system between 2000 and 2016 were linked with data from the German Meteorological Service. Patient- and procedure-related data were associated with monthly aggregated meteorological data. Due to high correlation with other meteorological parameters, we focused on the outside temperature. Adjusted odds ratios were calculated for SSI rates relating to temperature. SSIs were stratified by pathogen. A P value of <.05 was considered significant. RESULTS: Altogether, 2,004,793 procedures resulting in 32,118 SSIs were included. Generally, warmer temperatures were associated with a higher SSI risk, especially for SSIs with gram-negative pathogens. This association was particularly prominent for Acinetobacter spp, Pseudomonas aeruginosa, and certain Enterobacteriaceae. Per additional 1°C, we observed a 6% increase in the SSI risk for Acinetobacter spp and a 4% increase for Enterobacter spp. Superficial SSIs with Acinetobacter spp were 10 times more likely to occur when comparing surgeries in months with mean temperatures of ≥20°C to mean temperatures of <5°C. CONCLUSIONS: Higher temperatures were associated with increased SSI rates caused by gram-negative bacteria. Future SSI prevention measures should consider this aspect. Underlying shifts in microbiome composition due to climate factors should be included in further analyses. Given the expected rise of global temperatures until the end of the century, this topic has relevance from multiple perspectives.
Evidence of the relationship between temperature during pregnancy and human embryo mortality is limited. Most importantly, the literature lacks causal estimations and studies on early pregnancy losses. Here, we estimate the impact of early pregnancy temperature exposure on the clinically unobserved pregnancy loss rate. We use administrative data of clinically observed pregnancies from more than three decades for Hungary. We apply an empirical approach that allows us to infer the impact of temperature on the clinically unobserved pregnancy loss rate from the estimated effects on the clinically observed conception rate. The results show that exposure to hot temperatures during the first few weeks after the conception week increases the clinically unobserved pregnancy loss rate, whereas exposure to colder temperatures seems to decrease it. Importantly, the temperature-induced changes represent changes in the total number of pregnancy losses rather than a compositional change between clinically observed and clinically unobserved pregnancy losses.
The dynamics and likely associative link between global warming and the prevalence of preterm births in Ukraine over the years 2009-2018 was studied. to form modern ideas about the prognosis and prevention of this pathology. Data on medical care for pregnant women, mothers and parturients and adverse effects of pregnancy on preterm birth (form 21) for the period 2009-2018 were obtained from the municipal non-profit enterprise “Ternopil Regional Center of Public Health of Ternopil Regional Council”. The correlation between the number of premature births per 100 births according to the average annual air temperature according to the Global Historical Climatology Network from the US Department of Ocean and Atmospheric Research in the climatically homogeneous regions of Ukraine was estimated. Predictive analysis of time series was performed by the method of integrated autoregression of the moving average (ARIMA). The model error was estimated by calculating the absolute percentage error of the mean (MAPE). Statistical processing of materials was performed using programs Statistica 6.0 (StatSoft, USA) and open statistical package “R”. The study meets modern requirements of moral and ethical standards regarding the provisions of legislative acts of Ukraine. Analysis of these reports of women’s counseling shows an increase in the average number of preterm births from 2.88 per 100 births in the total number of births in Ukraine – 491445 in 2009 to 3.33, per 100 births in the total number of 309191 in 2018, which testifies to a significant increase in premature births in our country. Since 2009, there has been an annual, varying degree of increase in average annual air temperature in Ukraine. As a result of the correlation analysis, a significant strong direct correlation was established between the average level of premature birth and the average annual air temperature in Ukraine (r=0.84, p<0.05). Regression analysis revealed a significant increase in the number of premature births (per 100 births) in 1, 2, 5, 6, 7, 8 and 10 climatically homogeneous regions and a tendency to increase in, respectively, 3, 4, 9, 11 and 12 climatically homogeneous regions of Ukraine. Based on the analysis of data on the average annual air temperature in Ukraine for 20092018, the average annual air temperature in Ukraine is projected to increase by 0.3 degrees C in 3 years (MAPE <10%, p<0.05). The annual number of premature births is expected to increase (cases per 100 births) in 3 years by 0.4 cases per 100 births (MAPE <10%, p <0.05). In the context of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature infants. Strong correlations have been established between the annual number of premature births and the average annual air temperature in Ukraine. Regression models of preterm birth showed a significant increase in 1, 2, 5, 6, 7, 8, and 10 climatically homogeneous regions and a tendency to increase in 3, 4, 9, 11 and 12 climatically homogeneous regions. The annual number of premature births in Ukraine is projected to increase by 2023 by 20 cases per 100 births compared to 2018. The strategy for preventing premature births and related adverse effects of pregnancy should include the identification of global warming as a risk factor for increasing level of this pathology.
The association of fainting with specific situations and circumstances, such as the sight of blood, response to pain, prolonged standing position and fatigue, is well recognized and described in medical literature. Clinical experience also indicates that specific, local physical conditions, such as exposure to heat or remaining in a small, stuffy room may also trigger fainting. This paper verifies the hypothesis concerning the association between atmospheric conditions and the incidence of fainting. This is a retrospective cohort study of data relating to fainting collected in the city of Olsztyn (Poland). In total, 10,449 emergency service interventions in the period 2012-2019 that concluded with the R55 (syncope and collapse) diagnosis according to the ICD 10 were analyzed. The obtained data were matched with meteorological data, including basic parameters (temperature, humidity, atmospheric pressure) and complex parameters, with special attention given to the Universal Thermal Climate Index (UTCI). This index is derived from an analysis of human thermal balance and is particularly useful for describing the organism’s response to thermal stress. Statistically significant differences in the occurrences of fainting depending on the season were revealed (more in the summer), but only for women. Among the analyzed meteorological and biometeorological parameters, statistical significance was found for parameters relating to temperature, with the greatest usefulness revealed for the UTCI. Periods with heat stress were more conducive to fainting, whereas the result for the general population was influenced by women in two age groups: 25-45 and 46-60. To our best knowledge, this is the first attempt worldwide to utilize the UTCI as a predictor of fainting. Our results confirmed the applicability of the UTCI as a universal biometeorological tool for the assessment of relationships between atmospheric conditions and the incidence of fainting.
There is an increasing need to obtain climate projections for cities using an ensemble approach for uncertainty estimation. Yet, current-day computational resources are too limited to dynamically downscale GCM ensembles to urban scale. Here, a recently developed and validated statistical-dynamical computationally-cheap method is employed to downscale ten EURO-CORDEX climate projections over Brussels (Belgium) covering the period 1971-2100. Results show that, under the Paris agreement, summer mean projected temperature in Brussels will rise by 3.6 degrees C to 4.1 degrees C [+ – 0.7 degrees C] on average. The Urban Heat Island (UHI) intensity does not increase under future global warming with even a slight decrease under heatwave (HW) conditions by 0.1 degrees C (+/- 0.1 degrees C). However, the number of HW days is projected to be 30.6% and 158.9% higher for the 2 degrees C and 3 degrees C Global Warming Levels (GWL), respectively, as compared to 1.5 degrees C GWL. The heat stress during HW periods also follows the same trend: compared to a 1.5 degrees C GWL, the number of extreme heat stress days at 2 degrees C (3 degrees C) GWL will increase by 29% (91%) on average inside the city. The results can be used in support of adaptation measures, which should be considered for future resilience of the city of Brussels.
Global warming increases the risk of heat stress in Europe. Hence, heat stress must be considered as a health hazard for individuals working in outdoors and indoors conditions. Physiologically equivalent temperature (PET) is more related to the perceived temperature, but most of the current Local Climate Zone (LCZ) studies focus on measured temperature, instead of PET. Therefore, in this research, PET was applied to evaluate the thermal component of the outdoor microclimate for the f rst time in Berlin during a (1) hot spell, and (2) a normal period during July to August 2018. The aim of the present study is to explore the impacts of outdoor surroundings on human thermal comfort and its perception during the day and nighttime. Based on 32 micrometeorological stations located in different LCZs, the outdoor thermal sensation was investigated in order to f nd hourly thermal stress level conditions. Based on the mean hourly thermal sensation, the highest PET value was observed in, LCZ 4, “open high-rise” with 33.76 degrees C at 1400 CET, which represents a thermal stress level of “moderate heat stress”. The LCZ 2 showed “slight heat stress”, at the same time. High Sky View Factor (SVF) and relative humidity in “open high-rise” caused the highest PET. From the afternoon around 1800 CET to early morning 0600 CET, LCZ 2 is one thermal stress level warmer than all other existing LCZs in Berlin. During the hot spell, the hottest time period of the day was between 1600 CET to 1700 CET. In the morning from 0700 CET and midnight, the LCZ 2 was warmer than other local climate zones as the heat capacity of the buildings is high. Maximum hourly PET values illustrate that LCZ 4 was the warmest LCZ in which thermal sensation was ‘very hot’ between 0800 CET to 1700 CET. According to minimum hourly of PET, LCZ 4 was the coldest LCZs during the night and early in the morning.
OBJECTIVES: To investigate the efficacy of heat acclimation (HA) in the young (Y(EX)) and elderly (E(EX)) following exercise-HA, and the elderly utilising post-exercise hot water immersion HA (E(HWI)). DESIGN: Cross-sectional study. METHOD: Twenty-six participants (Y(EX): n = 11 aged 22 ± 2 years, E(EX:)n = 8 aged 68 ± 3 years, E(HWI): n = 7 aged 73 ± 3 years) completed two pre-/post-tests, separated by five intervention days. Y(EX) and E(EX) exercised in hot conditions to raise rectal temperature (T(rec)) ≥38.5 °C within 60 min, with this increase maintained for a further 60 min. E(HWI) completed 30 min of cycling in temperate conditions, then 30 min of HWI (40 °C), followed by 30 min seated blanket wrap. Pre- and post-testing comprised 30 min rest, followed by 30 min of cycling exercise (3.5 W·kg(-1) Ḣ(prod),) and a six-minute walk test (6MWT), all in 35 °C, 50% RH. RESULTS: The HA protocols did not elicit different mean heart rate (HR), T(rec), and duration T(rec) ≥ 38.5 °C (p > 0.05) between Y(EX), E(EX), and E(HWI) groups. Resting T(rec), peak skin temperature, systolic and mean arterial pressure, perceived exertion and thermal sensation decreased, and 6MWT distance increased pre- to post-HA (p < 0.05), with no difference between groups. Y(EX) also demonstrated a reduction in resting HR (p < 0.05). No change was observed in peak T(rec) or HR, vascular conductance, sweat rate, or thermal comfort in any group (p > 0.05). CONCLUSIONS: Irrespective of age or intervention, HA induced thermoregulatory, perceptual and exercise performance improvements. Both exercise-HA (E(EX)), and post-exercise HWI (E(HWI)) are considered viable interventions to prepare the elderly for heat stress.
OBJECTIVES: This study was conducted to examine modification in heat-related mortality in the Netherlands by sociodemographic and geographical factors including socioeconomic position and population density (PD). DESIGN: This observational study applied time series analysis on daily mortality counts according to mean daily temperature (°C). SETTING: Statistics Netherlands. PARTICIPANTS: Death registrations in 2006, 2018 and 2019 from residents registered at the Dutch Personal Records Database, restricted to deaths in the period between April and October. MAIN OUTCOME MEASURES: Assuming a V-like relation between temperature and mortality, a segmented linear model was used to estimate the temperature effects on mortality. In order to estimate the effects of severe heat, a second model including a heat threshold of 22°C was included in the model. We stratified by sociodemographic groups, calendar year and the five main causes of death (cardiovascular, respiratory, neoplasm, psychological and nervous system, and other) and controlled for time trend and seasonality. RESULTS: The effect of 1°C increase in temperature whereby the mean daily temperature exceeded 16°C was a 1.57% (95% CI 1.51% to 1.63%) increase in mortality among the total population. In temperature segments whereby the mean daily temperature exceeded 22°C, this effect was 2.84% (95% CI 2.73% to 2.93%). Low-income groups were at higher risk of heat-related mortality, compared with high-income groups. Areas with a high PD show relatively weak effects within both the warm and heat segments. CONCLUSION: Results of this study highlight the variation in terms of heat vulnerability among the Dutch population, whereby poor living conditions specifically may increase the effect on high temperature on mortality.
CONTEXT: A seasonal variation in hyponatremia, with higher incidence rates during hot summer days, has been demonstrated. Whether this applies to cool temperate regions is currently unknown. OBJECTIVE: The aim of this study was to investigate the influence of ambient temperature on hyponatremia in the Swedish population under current and future climate scenarios. METHODS: This nationwide cohort study identified all patients hospitalized with a first-ever principal diagnosis of hyponatremia between October 2005 and December 2014. Incidence rates for hyponatremia were calculated as number of hospitalizations divided by person-days at risk in the adult Swedish population at a given temperature, in increments of 1 °C. RESULTS: The incidence of hyponatremia was stable at 0.3 per million person-days from -10 to 10 °C, but increased rapidly at 24-hour mean temperatures above 15 °C, with 2.26 hospitalizations per million days at the highest recorded temperature of 25 °C. Women and elderly carried the greatest risk, with an incidence of 35 hospitalizations per million days in individuals ≥ 80 years of age on the hottest days, corresponding to a 15-fold increase in incidence compared with cool days. A future 1 or 2 °C increase in mean temperature is expected to increase the incidence of hyponatremia by 6.3% and 13.9%, respectively. CONCLUSION: The risk of hospitalization due to hyponatremia increases rapidly at temperatures above 15 °C, indicating a threshold effect. Over the next decades, rising global temperatures are expected to increase the inpatient burden of hyponatremia by approximately 10%. Strategies for protecting vulnerable groups are necessary to reduce this risk.
The IPCC 2021 report predicts rising global temperatures and more frequent extreme weather events in the future, which will have different effects on the regional climate and concentrations of ambient air pollutants. Consequently, changes in heat and mass transfer between the inside and outside of buildings will also have an increasing impact on indoor air quality. It is therefore surprising that indoor spaces and occupant well-being still play a subordinate role in the studies of climate change. To increase awareness for this topic, the Indoor Air Quality Climate Change (IAQCC) model system was developed, which allows short and long-term predictions of the indoor climate with respect to outdoor conditions. The IAQCC is a holistic model that combines different scenarios in the form of submodels: building physics, indoor emissions, chemical-physical reaction and transformation, mold growth, and indoor exposure. IAQCC allows simulation of indoor gas and particle concentrations with outdoor influences, indoor materials and activity emissions, particle deposition and coagulation, gas reactions, and SVOC partitioning. These key processes are fundamentally linked to temperature and relative humidity. With the aid of the building physics model, the indoor temperature and humidity, and pollutant transport in building zones can be simulated. The exposure model refers to the calculated concentrations and provides evaluations of indoor thermal comfort and exposure to gaseous, particulate, and microbial pollutants.
Recent evidence suggests a synergistic acute effect between temperature, ozone and particulate matter (PM) on premature mortality. Several studies reported higher air pollution-related mortality risks during warm days, and higher heat-related mortality risk during polluted days. We investigated if interactions between temperature and air pollution modified the mortality response to an extent that would support the need for joint heat and air pollution warning systems. We developed a multicentre time-series design for 17 French cities for the period 2000-2015, investigating the influence of season and temperature on the air pollution (PM10 and ozone)-mortality relationship, and the in-fluence of air pollution on the temperature-mortality relationship. Ozone and PM10 mortality risks exhibit an increasing gradient between spring, summer and heat waves. For instance, a 10 mu g/m(3) increase in PM10 was associated with a 3% [Confidence interval (CI) 95% 2.1:3.9] increase in mortality during summer, and with a 14.2% [CI 95% 5.6:23.4] increase in mortality during heat waves. The heat-mortality response was slightly influenced by air pollution, especially during the most extreme heat waves. Our results suggest that air pollution warnings should take season into account, using lower thresholds during summer and heat waves. Heat warning systems may not be improved by air pollution data, as its added value would be limited, compared to the complexity it would add to the warning systems. Efforts should be made to reduce ozone and PM10 concentrations during heat waves, even when they are already below regulatory thresholds.
Climate change can cause multiply potential health issues in urban areas, which is the most susceptible environment in terms of the presently increasing climate volatility. Urban greening strategies make an important part of the adaptation strategies which can ameliorate the negative impacts of climate change. It was aimed to study the potential impacts of different kinds of greenings against the adverse effects of climate change, including waterborne, vector-borne diseases, heat-related mortality, and surface ozone concentration in a medium-sized Hungarian city. As greening strategies, large and pocket parks were considered, based on our novel location identifier algorithm for climate risk minimization. A method based on publicly available data sources including satellite pictures, climate scenarios and urban macrostructure has been developed to evaluate the health-related indicator patterns in cities. The modelled future- and current patterns of the indicators have been compared. The results can help the understanding of the possible future state of the studied indicators and the development of adequate greening strategies. Another outcome of the study is that it is not the type of health indicator but its climate sensitivity that determines the extent to which it responds to temperature rises and how effective greening strategies are in addressing the expected problem posed by the factor.
Air pollution is responsible for many adverse effects on human beings. Thermal discomfort, on the other hand, is able to overload the human body and eventually provoke health implications due to the heat imbalance. Methods: The aim of the presented work is to study the behavior of two bio-climatic indices and statistical characteristics of the air quality index for Sofia city-the capital of Bulgaria for the period 2008-2014. The study is based on the WRF-CMAQ model system simulations with a spatial resolution of 1 km. The air quality is estimated by the air quality index, taking into account the influence of different pollutants and the thermal conditions by two indices, respectively, for hot and cold weather. It was found that the recurrence of both the heat and cold index categories and of the air quality categories have heterogeneous space distribution and well manifested diurnal and seasonal variability. For all of the situations, only O-3 and PM10 are the dominant pollutants-these which determine the AQI category. It was found that AQI1, AQI2, and AQI3, which fall in the “Low” band, have the highest recurrence during the different seasons, up to more than 70% in some places and situations. The recurrence of AQI10 (very high) is rather small-no more than 5% and concentrated in small areas, mostly in the city center. The Heat index of category “Danger” never appears, and the Heat index of category “Extreme caution” appears only in the spring and summer with the highest recurrence of less than 5% in the city center. For the Wind-chill index category, “Very High Risk” never appears, and the category “High Risk” appears with a frequency of about 1-2%. The above leads to the conclusion that both from a point of view of bioclimatic and air quality indices, the human health risks in the city of Sofia are not as high.
Urbanization, anthropogenic activities, and social determinants such as poverty and literacy rate greatly contribute to heat-related mortalities. The 2003 strong heat wave (Lucifer) in France resulted in catastrophic health consequences in the region that may be attributed to urbanization and other anthropogenic activities. Amiens is a medium-sized French city, where the average temperature has increased since the year 2000. In this study, we evaluated the Heat Vulnerability Index (HVI) in Amiens for extreme heat days recorded during three years (2018-2020). We used the principal component analysis (PCA) technique for fine-scale vulnerability mapping. The main types of considered data included (a) socioeconomic and demographic data, (b) air pollution, (c) land use and cover, (d) elderly heat illness, (e) social vulnerability, and (f) remote sensing data (land surface temperature (LST), mean elevation, normalized difference vegetation index (NDVI), and normalized difference water index (NDWI)). The output maps identified the hot zones through comprehensive GIS analysis. The resultant maps showed that high HVI exists in three typical areas: (1) areas with dense population and low vegetation, (2) areas with artificial surfaces (built-up areas), and (3) industrial zones. Low-HVI areas are in natural landscapes such as rivers and grasslands. Our analysis can be implemented in other cities to highlight areas at high risk of extreme heat and air pollution.
Cities are increasingly confronted with multiple environmental and climatic stressors. Especially during heatwaves, street canyons are both producers and sufferers of air pollution and urban heat island (UHI) effects, with severe risks on public health. To better design mitigation measures, it is important to consider both the microclimate behaviors as well as the perceptions of the local population. Therefore, this study examined pedestrian perceptions and microclimate modelings to understand outdoor thermal comfort conditions and air pollution dispersion in the case study neighborhood of Dortmund Marten, Germany. A field survey with measurement points at two street canyons for climatic variables and questionnaires on subjective thermal comfort and air pollution was conducted on a hot day during the heatwave period in August 2020. As a cost-effective method for modeling input generation, we extracted spatial and spectral data like albedo, roof materials and tree locations out of remote sensing imageries. Finally, we compared the modeling results of the physiological equivalent temperature (PET) index, particulate matter concentrations and air temperatures with empirical field measurement data and the questionnaire responses. Results indicate that during hot summer days with light winds from the east, the north-south orientated street canyon with tree arrangements tends to act as a tunnel for particulate matter accumulation. Coincidently, pedestrians show less thermal discomfort than calculated PET values in that particular area during morning and daytime, which underlines the dichotomy of such places. On the other hand, the low rise east-west orientated street canyon shows higher PET votes than predicted by the model. However, particulate matter concentrations were considerably underestimated by the model, while air temperature predictions provided meaningful results. The proposed workflow shows the potential to accelerate future preparations of input data for microclimate modelings, while the results can enhance wind-sensitive planning procedures and heat stress resilience in mid-latitude urban neighborhoods.
Monitoring microclimate variables within cities with high accuracy is an ongoing challenge for a better urban resilience to climate change. Assessing the intra-urban characteristics of a city is of vital importance for ensuring fine living standards for citizens. Here, a novel mobile microclimate station is applied for monitoring the main microclimatic variables regulating urban and intra-urban environment, as well as directionally monitoring shortwave radiation and illuminance and hence systematically map for the first time the effect of urban surfaces and anthropogenic heat. We performed day-time and night-time monitoring campaigns within a historical city in Italy, characterized by substantial urban structure differentiations. We found significant intra-urban variations concerning variables such as air temperature and shortwave radiation. Moreover, the proposed experimental framework may capture, for the very first time, significant directional variations with respect to shortwave radiation and illuminance across the city at microclimate scale. The presented mobile station represents therefore the key missing piece for exhaustively identifying urban environmental quality, anthropogenic actions, and data driven modelling toward risk and resilience planning. It can be therefore used in combination with satellite data, stable weather station or other mobile stations, e.g. wearable sensing techniques, through a citizens’ science approach in smart, livable, and sustainable cities in the near future.
Successful implementation of cooling strategies obviously depends on identifying effective interventions, but in industrial settings, it is equally important to consider feasibility and economic viability. Many cooling interventions are available, but the decision processes affecting adoption by end-users are not well elucidated. We therefore arranged two series of meetings with stakeholders to identify knowledge gaps, receive feedback on proposed cooling interventions, and discuss factors affecting implementation of heat-health interventions. This included four meetings attended by employers, employees, and health and safety officers (n = 41), and three meetings attended primarily by policy makers (n = 74), with feedback obtained via qualitative and quantitative questionnaires and focus group discussions. On a 10-point scale, both employers and employees valued worker safety (9.1 ± 1.8; mean±SD) and health (8.5 ± 1.9) as more important than protecting company profits (6.3 ± 2.3). Of the respondents, 41% were unaware of any cooling strategies at their company and of those who were aware, only 30% thought the interventions were effective. Following presentation of proposed interventions, the respondents rated “facilitated hydration”, “optimization of clothing/protective equipment”, and “rescheduling of work tasks” as the top-three preferred solutions. The main barriers for adopting cooling interventions were cost, feasibility, employer perceptions, and legislation. In conclusion, preventing negative health and safety effects was deemed to be more important than preventing productivity loss. Regardless of work sector or occupation, both health and wealth were emphasized as important parameters and considered as somewhat interrelated. However, a large fraction of the European worker force lacks information on effective measures to mitigate occupational heat stress. List of abbreviations: OH-Stress: Occupational heat stress; WBGT: Wet Bulb Globe Temperature.
Thermal models and indices integrated into a mobile application could provide relevant information regarding thermal stress and strain to the general public. The aim of the current paper is to validate such a mobile application, ClimApp, to the users needs in the heat. ClimApp combines weather data with personal user data, thermal models and indices to estimate the thermal strain of the user. The output of ClimApp ranges from -4 to +4, where values below 0 indicate cold strain and values above 0 indicate heat strain. 134 Participants filled in the required personal settings into the app, and indicated if the estimated thermal strain by ClimApp matched their thermal perception. 45 of the participants filled in a user satisfaction questionnaire. Results show that ClimApp is able to predict the heat strain of the user, but may underestimate perceived heat strain when ambient temperature increases. Furthermore, participants were positive about the user-friendliness of ClimApp, but did not think they would use ClimApp frequently and believed the information was irrelevant for them. This is quite remarkable as the number of heat illness cases are increasing and the negative effects of heat occur in all populations exposing themselves to the heat. There needs to be more focus on making people aware of the negative health risks of the heat. ClimApp could play a role as a tool to make heat warnings more accessible for everyone and make people aware of appropriate behavior during periods with high ambient temperatures.
OBJECTIVES: The elderly are the most at-risk population for heat-related illness and mortality during the periods of hot weather. However, evidence-based elderly-specific cooling strategies to prevent heat-illness are limited. The aim of this investigation was to quantify the elderly’s physiological and perceptual responses to cooling through cold water ingestion (COLD) or an L-menthol mouth rinse (MENT) during simulated activities of daily living in UK summer climatic conditions. STUDY DESIGN: Randomised, controlled repeated measures research design. METHODS: A total of ten participants (men n = 7, women n = 3: age; 69 ± 3 yrs, height; 168 ± 10 cm, body mass; 68.88 ± 13.72 kg) completed one preliminary and three experimental trials; control (CON), COLD and MENT. Experimental trials consisted of 40 min rest followed by 30 min of cycling exercise at 6 metabolic equivalents and a 6-min walk test (6MWT), within a 35 °C, 50% relative humidity environment. Experimental interventions (every 10 min); cold water (4 °C) ingestion (total of 1.5L) or menthol (5 ml mouth swill for 5 s, menthol concentration of 0.01%). RESULTS: Peak rectal temperature (T(re)) was significantly (P < 0.05) lower in COLD compared with CON (-0.34 ± 0.16 °C) and MENT (-0.36 ± 0.20 °C). End exercise heart rate (HR) decreased in COLD compared with CON (-7 ± 9 b min(-1)) and MENT (-6 ± 7 b min(-1)). There was no difference in end exercise thermal sensation (TS) (CON; 6.1 ± 0.4, COLD; 6.0 ± 0.4, MENT; 6.4 ± 0.6) or thermal comfort (TC) (CON; 4 ± 1, COLD; 4 ± 1, MENT; 4 ± 1) between trials. The participants walked significantly further during the COLD 6MWT compared with CON (40 m ± 40 m) and MENT (40 m ± 30 m). There was reduced physiological strain in the COLD 6MWT compared with CON (T(re); -0.21 ± 0.24 °C, HR; -7 ± 8 b min(-1)) and MENT (T(re); -0.23 ± 0.24 °C, HR; -4 ± 7 b min(-1)). CONCLUSION: The elderly have reduced physiological strain (T(re) and HR) during activities of daily living and a 6MWT in hot UK climatic conditions, when they drink cold water. Furthermore, the elderly's perception (TS and TC) of the hot environment did not differ from CON at the end of exercise with COLD or MENT interventions. Menthol provided neither perceptual benefit to exercise in the heat nor functional gain. The TS data indicate that elderly may be at increased risk of heat illness, due to not feeling hot and uncomfortable enough to implement physiological strain reducing strategies such as cold-water ingestion.
In this paper, we assess public attitudes on climate change in Europe over the last decade. Using aggregate figures from the Special Eurobarometer surveys on Climate Change, we find that environmental concern is directly re-lated to per capita income, social trust, secondary education, the physical distress associated with hot weather, media coverage, the share of young people in the total population, and monetary losses caused by extreme weather episodes. It is also inversely related to greenhouse gas emissions, relative power position of right-wing parties in government and tertiary education. Moreover, we find a significant, opposite impact for two dummies for years 2017 and 2019, which we respectively associate with the effects of Donald Trump’s denial campaigns and the U.S. Paris Agreement withdrawal announcement, and Greta Thunberg’s environmental activism. (c) 2021 Elsevier B.V. All rights reserved. In this paper, we assess public attitudes on climate change in Europe over the last decade. Using aggregate figures from the Special Eurobarometer surveys on Climate Change, we find that environmental concern is directly related to per capita income, social trust, secondary education, the physical distress associated with hot weather, media coverage, the share of young people in the total population, and monetary losses caused by extreme weather episodes. It is also inversely related to greenhouse gas emissions, relative power position of rightwing parties in government and tertiary education. Moreover, we find a significant, opposite impact for two dummies for years 2017 and 2019, which we respectively associate with the effects of Donald Trump?s denial campaigns and the U.S. Paris Agreement withdrawal announcement, and Greta Thunberg?s environmental activism.
Decarbonizing the building stock is a central component of global climate change mitigation efforts. In practice, this decarbonization can be achieved by a variety of different measures, including improvements in building energy efficiency, electrification of energy demand to reduce reliance on fossil fuels, and installation of distributed (renewable) generation in conjunction with flexible storage. However, these large-scale, often disruptive changes to the built environment also raise a number of concerns, such as loss of occupant comfort exacerbated by climate change, and introduction of additional stressors on the distribution grid. In this paper, we demonstrate several conclusions using detailed sub-hourly data of two years (2019-2020) collected from 40 homes in a recently refurbished net-zero energy neighborhood in the Netherlands. This paper shows that, in renovation projects like the case study, net-zero energy balances should be considered on a neighborhood, rather than building level to minimize worst case planning by accounting for occupant influences and seasonal effects. Furthermore, the energy flexibility and climate resilience in the buildings seems to be rather limited, as a result of energy efficiency improvements. While helpful in climate change mitigation efforts, the large seasonal differences in energy demand and generation imply that this evolution is perhaps sub-optimal from the grid perspective. The results illustrate that all homes in the study were net-zero energy over the two year period, sometimes net positive by up to a factor of three. This led to considerable excess generation especially during the summer months. In addition, it was found that indoor air temperature sensors in a number of buildings showed overheating beyond guideline thermal comfort temperature of 25 degrees C, showing potential thermal comfort and heat stress for vulnerable occupants. These results motivate energy storage or modifications of the installed heat pumps to leverage summer excess generation while reducing the impact of summer heat waves. These findings should enable the Netherlands and other countries aiming to fully decarbonize the building stock formulate better, future-proof policies.(c) 2022 Elsevier B.V. All rights reserved.
This paper brings together objective and subjective data on indoor temperature and thermal comfort to examine the magnitude and perception of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of indoor and outdoor temperature, relative humidity and CO2 levels was conducted in summer 2019 along with thermal comfort surveys and semi-structured interviews with older residents and staff of the care settings. Indoor temperatures were found to be high (>30 degrees C) with bedroom temperatures often higher at night than daytime across both care settings. Limited opening due to window restrictors constrained night-time ventilation. Overheating was prevalent with four out of the five monitored bedrooms failing all four overheating metrics investigated. While 35-42% of staff responses perceived indoor temperatures to be uncomfortably hot, only 13-19% of resident responses were found to do so, indicating that elderly residents tend to be relatively insensitive to heat, leaving them open to overheating without realising it. Residents and staff in the modern care setting were less satisfied with their thermal conditions. As hybrid buildings, care settings need to keep both residents and staff comfortable and healthy during hot weather through night-time ventilation, management of heating and supportive institutional practices.
Agricultural workers often produce considerable excess heat due to the physically demanding nature of their activities, increasing their risk of thermal stress in even moderately warm conditions. Few studies have examined the physiological responses to heat load in agriculture. We aimed to assess the heat strain experienced by vineyard workers during canopy management in dry field conditions, and to disentangle the effects of the heat produced by the body and the thermal environment. Thirty workers from five Bordeaux vineyards of southern France were monitored during vine-lifting and trellising (June 2012). The mean heart rate, net cardiac cost, relative cardiac cost, and cardiac workload score were assessed during field activity. As the workers were nested within vineyards, multilevel linear regression models were used for correct inference. Skin temperature increased by an average of 1.0°C. Cardiac indices showed marked differences between individuals. The workload was evaluated as ‘heavy’ or ‘very heavy’ for more than one-third of the workers, of whom one experienced heat exhaustion. Above some individual characteristics, we highlighted a contextual effect (air temperature) for the mean heart rate (P = 0.03), the relative cardiac cost (P = 0.01) and, to a lesser extent, a cardiac workload score (P = 0.07). Canopy management by hand in vineyards causes considerable cardiac and thermoregulatory strain. Appropriate instruments should be developed to simultaneously evaluate work intensity, work quality, and productivity at the vineyard level to raise the awareness of both managers and employees about taking preventive measures.
The analysis of susceptibility of construction workers to heat stress, the results of which are presented in this paper, was an important research module of the large research project focused on safety of workers on construction sites. The paper assesses the possibility of using different sets of data gathered in full scale on the scaffolding and on the meteorological station to estimate the heat stress of people working on scaffolding. The main purpose is to check if the use of public data from meteorological stations can provide reliable estimation. A simplified formula of Universal Thermal Climate Index (UTCI*) is used in analyses. The values of UTCI* calculated on the basis of two sets of input parameters are compared to each other and analysed. The measurements and UTCI* calculations are presented for 24 scaffolding structures located in Poland in L ‘ odz ‘ and Lower Silesian provinces. Test results based on construction sites and meteorological stations data are different, but statistical analysis shows their correlation. A stronger correlation occurs for scaffolding structures located in L ‘ odz ‘ province, while it is weaker for the results obtained in Lower Silesian province. The results show the possibility of simplified evaluation of comfort/discomfort of people working on scaffolding on the basis of publicly available environmental data measured at meteorological stations.
The objective of this study was to analyze and compare the effect of high temperatures on daily mortality in the urban and rural populations in Madrid. Data were analyzed from municipalities in Madrid with a population of over 10,000 inhabitants during the period from January 1, 2000 to December 31, 2020. Four groups were generated: Urban Metropolitan Center, Rural Northern Mountains, Rural Center, and Southern Rural. The dependent variable used was the rate of daily mortality due to natural causes per million inhabitants (CIE-X: A00-R99) between the months of June and September for the period. The primary independent variable was maximum daily temperature. Social and demographic “context variables” were included: population >64 years of age (%), deprivation index and housing indicators. The analysis was carried out in three phases: 1) determination of the threshold definition temperature of a heat wave (Tumbral) for each study group; 2) determination of relative risks (RR) attributable to heat for each group using Poisson linear regression (GLM), and 3) calculation of odds ratios (OR) using binomial family GLM for the frequency of the appearance of heat waves associated with context variables. The resulting percentiles (for the series of maximum daily temperatures for the summer months) corresponding to Tthreshold were: 74th percentile for Urban Metropolitan Center, 76th percentile for Southern Rural, 83rd for Rural Northern Mountains and 98th percentile for Center Rural (98). Greater vulnerability was found for the first two. In terms of context variables that explained the appearance of heat waves, deprivation index level, population >64 years of age and living in the metropolitan area were found to be risk factors. Rural and urban areas behaved differently, and socioeconomic inequality and the composition of the population over age 64 were found to best explain the vulnerability of the Rural Center and Southern Rural zones.
BACKGROUND: Heat waves are correlated with increased mortality in the aged population. Social isolation is known as a vulnerability factor. This study aims at evaluating the correlation between an intervention to reduce social isolation and the increase in mortality in the population over 80 during heat waves. METHODS: This study adopted a retrospective ecologic design. We compared the excess mortality rate (EMR) in the over-80 population during heat waves in urban areas of Rome (Italy) where a program to reduce social isolation was implemented, to others where it was not implemented. We measured the mortality of the summer periods from 2015 to 2019 compared with 2014 (a year without heat waves). Winter mortality, cadastral income, and the proportion of people over 90 were included in the multivariate Poisson regression. RESULTS: The EMR in the intervention and controls was 2.70% and 3.81%, respectively. The rate ratio was 0.70 (c.i. 0.54-0.92, p-value 0.01). The incidence rate ratio (IRR) of the interventions, with respect to the controls, was 0.76 (c.i. 0.59-0.98). After adjusting for other variables, the IRR was 0.44 (c.i. 0.32-0.60). CONCLUSIONS: Reducing social isolation could limit the impact of heat waves on the mortality of the elderly population.
Global warming is causing increasing Heat Waves that affect human health. High temperatures markedly increase morbidity and mortality. Urban Heat Islands increase the effects of Heat Waves and are a serious inconvenience to human health and comfort. Cities can substantially increase local temperatures and reduce temperature drop at night. During the night, the greater thermal inertia of the central areas reduces their cooling capacity. On the other hand, it is important to highlight that urban vegetation plays a key role in adapting cities to Global Warming and Urban Heat Island. Green areas have lower temperatures than the rest of land uses and generate a cooling effect that spreads to their surroundings creating a “cool island” effect. The main objective of this paper is to establish the nocturnal land surface temperature and land surface air temperature of Barcelona Metropolitan Area (35 municipalities, 636 km(2), 3.3 million inhabitants) in an episode of a nocturnal heatwave and to estimate its possible impact on health and mortality. Subsequently, nighttime temperatures are analysed in this extreme heat context to determine their spatial distribution and detect the urban landscapes that are most vulnerable to extreme night heat. Modelling of land surface temperature must reveal the elements that determine night Urban Heat Island and consequently identify actions that can be implemented at urban planning level to refresh the environment during the night and thus increase the resilience of the most vulnerable landscapes and improve residents’ health. This paper studies the effect of urban greenery and green infrastructures on Nighttime Urban Heat Island and propose climate adaptation measures and design for urban green areas to decrease high temperature in a Heat Wave context, which contributes to reducing the serious negative impacts on people’s health.
In Europe, regional climate change prospects indicate the urgency of adapting to extreme weather events. While increasing temperature trends have already been detected, in the last decades, the adoption of a European heatwave (HW) early-warning index is not yet consensual, partially due to the significant number of alternative algorithms, in some cases adjusted to the measurement of sector-specific impacts (as per the Expert Team on Climate Risk and Sector-specific Indices (ET-SCI)). In particular, the Excess Heat Factor (EHF) has been shown to accurately predict heat-related human health outcomes, in mid-latitude climates, provided that local summer exposure to excess heat is mostly driven by extreme air temperatures, with a lower contribution from relative humidity. Here, annual summaries of EHF-based HW detection were calculated for the European region, using daily maximum and minimum temperatures from the homogenised version of the E-OBS gridded dataset. Annual HW frequencies, duration, mean magnitude, maximum amplitude, and severity were subject to climatology and trend analysis across the European biogeographical regions, considering the 1961-1990 period as the baseline reference for anomaly detection in the more recent (1991-2018) decades. As HW-dependent morbidity/mortality affects mostly the elderly, an EHF-based HW Exposure Index was also calculated, by multiplying the recent probability of severe events per the number of people aged 65, or more, in the European Functional Urban Areas (FUAs). Results show that recent historical EHF-based patterns diverge across European Biogeographical regions, with a clear latitudinal gradient. Both the historical mean and recent trends point towards the greater exposure in the southern European Mediterranean region, driven by the significant increase of HW frequency, duration and maximum severity, especially in the last 3 decades; conversely, annual maximum EHF intensities (i.e., greatest deviations from the local 90th daily mean temperature) are mostly found in the northern and/or high altitude Boreal, Alpine and Continental regions, as a consequence of the latitudinal effect of local climatology on the HWM/HWA indices (this also translates into greater magnitudes of change, in this regions). Nonetheless, by simultaneously considering the probability of Severe HW occurrence in the last three decades, together with the log transformation of people aged 65 or more, results show that greater HW Exposure Indices affect FUAs across the whole Europe, irrespective of its regional climate, suggesting that more meaningful vulnerability assessments, early warning and adaptation measures should be prioritized accordingly.
This paper presents a new methodological approach for analysing the impacts of climate change on the urban habitat and improving the quality of life for citizens. The study falls within the diagnostic phase of the Climate Change and Urban Health Resilience (CCUHRE) research project applied to the rationalist neighbourhood of Monticelli, a suburb of Ascoli Piceno (Italy). The methodological approach tests innovative and multidisciplinary cognitive tools to quantify the impacts of climate change and create refined risk maps combining remote sensing, spatial data, satellite images, and thermal fluid dynamic (CFD) simulations. These tools created an atlas of green areas and surfaces using scientific indexes that describe the relationship between the urban form and heat and between the type of ground and materials. The information yielded by geoprocessing will allow critical aspects in the context to be addressed with site-specific strategies. In fact, through downscaling, it is possible to analyse the thermal fluid dynamics characteristics of the most significant urban areas and identify the related weather/climate characteristics, perceptual scenarios, and thermal stressed regions. The results have provided a dataset that defines the degree of vulnerability of the neighbourhood and identifies the areas exposed to thermal risk.
There is increasing evidence that rising temperatures and heatwaves in the United Kingdom are associated with an increase in heat-related mortality. However, the Public Health England (PHE) Heatwave mortality monitoring reports, which use provisional death registrations to estimate heat-related mortality in England during heatwaves, have not yet been evaluated. This study aims to retrospectively quantify the impact of heatwaves on mortality during the 2019 summer period using daily death occurrences. Second, using the same method, it quantifies the heat-related mortality for the 2018 and 2017 heatwave periods. Last, it compares the results to the estimated excess deaths for the same period in the PHE Heatwave mortality monitoring reports. The number of cumulative excess deaths during the summer 2019 heatwaves were minimal (161) and were substantially lower than during the summer 2018 heatwaves (1700 deaths) and summer 2017 heatwaves (1489 deaths). All findings were at variance with the PHE Heatwave mortality monitoring reports which estimated cumulative excess deaths to be 892, 863 and 778 during the heatwave periods of 2019, 2018 and 2017, respectively. Issues are identified in the use of provisional death registrations for mortality monitoring and the reduced reliability of the Office for National Statistics (ONS) daily death occurrences database before 2019. These findings may identify more reliable ways to monitor heat mortality during heatwaves in the future.
We investigate the effect of extreme heat on birth outcomes and how this effect may vary by family socioeconomic status (SES). We create a detailed data set by linking individual-level data on approximately 4 million newborns in Spanish provincial capitals between 1990 and 2016 with precise meteorological data on the temperatures children experienced throughout their gestation. The outcomes are preterm birth, low birth weight, and very low birth weight. Socioeconomic status is assessed using parents’ highest occupational level. We find that the incidence of negative birth outcomes increased for children exposed to extreme heat in early gestation. Further, the effect is concentrated mostly among children from a low socioeconomic background. Given the importance of birth outcomes for the next generation’s well-being, our results highlight the potential contributions of extreme temperatures to the widening of preexisting socioeconomic inequalities. The forecasted increase in extreme climatic events makes the results of this study concerning, especially for low-SES children.
NEW FINDINGS: What is the central question of this study? Fire service instructors are frequently exposed to live fire scenarios, representing the most extreme chronic occupational heat exposure. These individuals report a series of unique health issues. We sought to identify whether the number of exposures completed was associated with inflammatory and immunological markers and symptoms of ill health. What is the main finding and its importance? Fire service instructors exhibit greater levels of inflammatory markers in comparison to firefighters. The number of exposures to fire is positively related to the prevalence of ill health and inflammation. Implementation of a proposed limit of nine exposures per month might be appropriate to minimize health issues. ABSTRACT: Fire Service Instructors (FSIs) experience ∼10 times more fire exposures than firefighters (FFs), and the increased physiological stress from this potentially puts them at risk of ill health and future cardiac events. The aim of the study was to establish whether FSIs exhibit elevated biomarkers associated with cardiac event risk, identify whether FSIs experience systemic inflammation linked to the frequency of fire exposure and evaluate a proposed exposure limit of nine exposures per month. Blood samples were collected from 110 Fire Service personnel (mean ± SD, age,44 ± 7 years; height, 178.1 ± 7.1 cm; and body mass, 84.3 ± 12.0 kg; FSIs n = 53 and FFs n = 57) for biomarker analysis. Work history details were collected from all participants. Participants with biomarker concentrations above healthy reference ranges were classified as being ‘at risk’. The neutrophil-to-lymphocyte ratio, platelet count, cardiac troponin T, interleukin (IL)-6, IL-1β, C-reactive protein and immunoglobulin G were greater in FSIs than in FFs (P < 0.05). Multiple regression analysis revealed that 18.8% of IL-6, 24.9% of IL-1β, 29.2% of C-reactive protein and 10.9% of immunoglobulin G variance could be explained by the number of exposures to heat per month. Odds ratios revealed that those FSIs above the nine per month exposure limit were six to 12 times more likely to be classified as 'at risk' and were 16 times more likely to experience symptoms of ill health. Increased cytokine levels suggest that FSIs experience systemic inflammation, which is related to symptoms of ill health. We propose that an exposure limit could reduce the prevalence of these biomarker risk factors and ill health.
BACKGROUND: Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]∙insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used. MATERIALS AND METHODS: 68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]∙[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index. RESULTS: The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]∙[IGFBP7] (>0.3 [ng/mL]2/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]∙[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]∙[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)2/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]∙[IGFBP7] at the heat waves or the control visits. CONCLUSIONS: At heat waves, urinary [TIMP-2]∙[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.
In 2019, a heatwave – an unusual extended period of hot weather – broke the UK’s highest recorded temperature of 38.7 degrees C set in 2003. Of concern is that for summer 2019, this resulted in 892 excess deaths. With the intensity and frequency of UK heatwaves projected to increase, and summer temperatures predicted to be 5 degrees C hotter by 2070, urgent action is needed to prepare for, and adapt to, the changes now and to come. Yet it remains unclear what actions are needed and by whom. In response, a systematic literature review of UK heatwaves peer reviewed publications, inclusive of keyword criteria (total papers returned = 183), was conducted to understand what lessons have been learnt and what needs to happen next. Our research shows that heatwaves remain largely an invisible risk in the UK. Communication over what UK residents should do, the support needed to make changes, and their capacity to enact those changes, is often lacking. In turn, there is an inherent bias where research focuses too narrowly on the health and building sectors over other critical sectors, such as agriculture. An increased amount of action and leadership is therefore necessary from the UK government to address this.
During the last two decades, a number of countries or cities established heat-health warning systems in order to alert public health authorities when some heat indicator exceeds a predetermined threshold. Different methods were considered to establish thresholds all over the world, each with its own strengths and weaknesses. The common ground is that current methods are based on exposure-response function estimates that can fail in many situations. The present paper aims at proposing several data-driven methods to establish thresholds using historical data of health issues and environmental indicators. The proposed methods are model-based regression trees (MOB), multivariate adaptive regression splines (MARS), the patient rule-induction method (PRIM) and adaptive index models (AIM). These methods focus on finding relevant splits in the association between indicators and the health outcome but do it in different fashions. A simulation study and a real-world case study hereby compare the discussed methods. Results show that proposed methods are better at predicting adverse days than current thresholds and benchmark methods. The results nonetheless suggest that PRIM is overall the more reliable method with low variability of results according to the scenario or case.
BACKGROUND: Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0-4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave. METHODS: As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: ‘vulnerable’ (aged 75+), ‘potentially vulnerable’ (aged 18-74 in poor health) and ‘not vulnerable’ (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + . RESULTS: Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun’s ultra-violet radiation on the skin than on the effects of hot temperatures on health. CONCLUSIONS: Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures.
Rural areas cool off by night but built-up urban areas lack similar relief and may threaten vulnerable people’s health during heat waves. Temperature varies within a city due to the heterogenous nature of urban environments, but official measurement stations are unable to capture local variations, since they use few measurement stations typically set up outside of urban areas. Meteorological measurements may as such be at odds with citizen sensing, where absolute accuracy is sacrificed in pursuit of increased coverage. In this article, we use geographic information processing methodologies and generate 144 hourly apparent temperature surfaces for Rotterdam during a six-day heat wave that took place in July 2019 in The Netherlands. These surfaces are used to generate a humidex degree hours (HDH) composite map. The HDH metric integrates apparent temperature intensity with duration into one spatially explicit value and is used to identify geographical areas in Rotterdam where citizens may experience adverse health effects of prolonged heat exposure. Combining the HDH map with demographic data allows us to identify the most heat-exposed areas with the largest share of vulnerable population. These neighbourhoods may be the locations most in need of adaptation measures.
With global warming, heat waves are becoming more frequent and intense, particularly in northern latitudes, where the pace of warming is faster. Due to its northern location, Swedish society has been built primarily to manage a cold climate, and is less prepared to manage heat, which the 2018 heat wave demonstrated. While young children are recognized as vulnerable to heat, and are reliant on preschool care, few studies have examined how the young and vulnerable people are cared for during heat waves in the institutional preschool setting. This exploratory study demonstrates how children in preschool environments are vulnerable to heat, in order to identify management needs by assessing experienced impacts and responses to the 2018 heat wave in Sweden. Empirically, the study builds on a survey completed by 33 unit heads responsible for 77 preschools in the focused municipality, and qualitative interviews with five educators and five parents, as well as temperature measurements in three selected preschools. This study shows that: (i) children and educators are exposed to both high indoor and outdoor temperatures in the preschools; (ii) both children and educators were affected by the heat wave in the preschools, and their sensitivity is deeply intertwined due to their dependency relationship, rendering a form of double sensitivity to heat; and (iii) the preschool heads and educators were unprepared to sufficiently cope with the heat wave, and organizational strategies for managing heat were lacking, indicating weak adaptive capacity. The significant exposure to heat in preschool environments, the dual sensitivity of children and preschool educators, and the low organizational readiness resulting in uncoordinated responses to reduce heat stress suggest a pronounced vulnerability to heat waves in preschools.
Constant urban growth exacerbates the demand for residential, commercial and traffic areas, leading to progressive surface sealing and urban densification. With climate change altering precipitation and temperature patterns worldwide, cities are exposed to multiple risks, demanding holistic and anticipatory urban planning strategies and adaptive measures that are multi-beneficial. Sustainable urban planning requires comprehensive tools that account for different aspects and boundary conditions and are capable of mapping and assessing crucial processes of land-atmosphere interactions and the impacts of adaptation measures on the urban climate system. Here, we combine Computational Fluid Dynamics (CFD) and Geographic Information System (GIS) capabilities to refine an existing 2D urban micro- and bioclimatic modelling approach. In particular, we account for the vertical and horizontal variability in wind speed and air temperature patterns in the urban canopy layer. Our results highlight the importance of variability of these patterns in analysing urban heat development, intensity and thermal comfort at multiple heights from the ground surface. Neglecting vertical and horizontal variability, non-integrated CFD modelling underestimates mean land surface temperature by 7.8 °C and the Universal Thermal Climate Index by 6.9 °C compared to CFD-integrated modelling. Due to the strong implications of wind and air temperature patterns on the relationship between surface temperature and human thermal comfort, we urge caution when relying on studies solely based on surface temperatures for urban heat assessment and hot spot analysis as this could lead to misinterpretations of hot and cool spots in cities and, thus, mask the anticipated effects of adaptation measures. The integrated CFD-GIS modelling approach, which we demonstrate, improves urban climate studies and supports more comprehensive assessments of urban heat and human thermal comfort to sustainably develop resilient cities.
Our study plans to quantify the effect of higher temperatures on different critical Turkish health outcomes mainly to chart future developments and to identify locations in Turkey that may be potential vulnerable hotspots. The general structure of the temperature mortality function was estimated with different fixed-level effects, with a specific focus on the mortality effect of maximum apparent temperature. Regional models were fitted to pinpoint the thresholds where the temperature-mortality relation changes, thus investigating whether the thresholds are determined nationally or regionally. The future patterns were estimated by extrapolating from future temperature trends: analyzing possible future mortality trends under the restricting assumption of minimal acclimation. Using the fixed effect regression structure, social and developmental variables acting as heat effect modifiers were also identified. In the largest dataset, the initial fixed effect regression specification supports the hypothesis summarized by the U-shaped relationship between temperature and mortality. This is a first corroboration for Turkish climate and health research. In addition, intermediation effects were substantiated for the level of urbanization and population density, and the human development and health development within provinces. Regional heterogeneity is substantiated by the mortality-temperature relationship and the significant threshold deviations from the national average.
Over the last few decades, heat waves have intensified and have led to excess mortality. While the probability of being affected by heat stress has significantly increased, the risk of heat mortality is rarely quantified. This quantification of heat mortality risk is necessary for systematic adaptation measures. Furthermore, heat mortality records are sparse and short, which presents a challenge for assessing heat mortality risk for future climate projections. It is therefore crucial to derive indicators for a systematic heat mortality risk assessment. Here, risk indicators based on temperature and mortality data are developed and applied tomajor cities in Germany, France, and Spain using regional climatemodel simulations. Biascorrected dailymaximum, minimum, and wet-bulb temperatures show increasing trends in future climate projections for most considered cities. In addition, we derive a relationship between daily maximum temperatures and mortality for producing future projections of heatmortality risk fromextreme temperatures that is based on low(representative concentration pathway RCP2.6) and high (RCP8.5) emission scenario future climate projections. Our results illustrate that heatmortality increases by about 0.9% decade(-1) in Germany, 1.7% decade(-1) in France, and 7.9% decade(-1) in Spain for RCP8.5 by 2050. The future climate projections also show that wet-bulb temperatures above 30 degrees C will be reached regularly, withmaxima above 40 degrees C likely by 2050. Our results suggest a significant increase of heat mortality in the future, especially in Spain. On average, our results indicate that themortality risk trend is almost 2 times as high in all three countries for the RCP8.5 scenario relative to RCP2.6. SIGNIFICANCE STATEMENT: Anthropogenic greenhouse gas emissions have led to an increase in temperatures over the last century. This general warming leads to more intensive and more frequent heat waves that affect humans adversely. Extreme temperatures exert heat stress on the human body and can lead to reduced productivity, sickness, and death. Herewe derive a statistical relationship between extreme temperatures and the number of deaths inmajor cities in three European countries so as to be able to use future climate simulations to determine likely numbers of heat-related deaths. Our results show that the number of heat-related deaths will increase in major European cities by 2050 and will be 2 times as high for high greenhouse gas emissions simulations as for low greenhouse gas emissions simulations.
The 2018 Virgin Money London Marathon (2018 VMLM) was the hottest in the race’s 37-year history. The aims of this research were to (1) survey novice mass participation marathoners to examine the perceptual thermal demands of this extreme weather event and (2) investigate the effect of the air temperature on finish times. A mixed-methods design involving the collection of survey data (n = 364; male = 63, female = 294) and secondary analysis of environmental and marathon performance (676,456 finishers) between 2001 and 2019 was used. The 2018 VMLM mean finishing time was slower than the mean of all other London marathons; there were positive correlations between maximum race day temperature and finish time for mass-start participants, and the difference in maximum race day temperature and mean maximum daily temperature for the 60 days before the London Marathon (p < 0.05). Of the surveyed participants, 23% classified their thermal sensation as 'warm', 'hot' or 'very hot' and 68% 'thermally comfortable' during training, compared with a peak of 95% feeling 'warm', 'hot' or 'very hot' and 77% 'uncomfortable' or 'very uncomfortable' during the 2018VMLM. Organisers should use temperature forecasting and plan countermeasures such as adjusting the start time of the event to avoid high temperatures, help runners predict finish time and adjust pacing strategies accordingly and provide safety recommendations for participants at high-risk time points as well as cooling strategies.
A strong heat load in buildings and cities during the summer is not a new phenomenon. However, prolonged heat waves and increasing urbanization are intensifying the heat island effect in our cities; hence, the heat exposure in residential buildings. The thermophysiological load in the interior and exterior environments can be reduced in the medium and long term, through urban planning and building physics measures. In the short term, an increasingly vulnerable population must be effectively informed of an impending heat wave. Building simulation models can be favorably used to evaluate indoor heat stress. This study presents a generic simulation model, developed from monitoring data in urban multi-unit residential buildings during a summer period and using statistical methods. The model determines both the average room temperature and its deviations and, thus, consists of three sub-models: cool, average, and warm building types. The simulation model is based on the same mathematical algorithm, whereas each building type is described by a specific data set, concerning its building physical parameters and user behavior, respectively. The generic building model may be used in urban climate analyses with many individual buildings distributed across the city or in heat-health warning systems, with different building and user types distributed across a region. An urban climate analysis (with weather data from a database) may evaluate local differences in urban and indoor climate, whereas heat-health warning systems (driven by a weather forecast) obtain additional information on indoor heat stress and its expected deviations.
Hyperpyrexia syndrome in Parkinson’s disease (PD) is a medical emergency requiring prompt action. This can be precipitated by numerous provoking factors, in particular withdrawal of dopaminergic medication. We report a case of a patient with PD presenting with confusion, dramatic worsening of PD symptoms and pyrexia in the context of a heatwave, potentially mediating its effect through dehydration and impaired medication absorption. Precipitous cooling and conversion of dopaminergic medication to a rotigotine patch due to drowsiness led to her rapid improvement. The possibility of infection was covered however no source of infection or evidence of inflammatory response was found, but remained an important differential. This case highlights the importance of recognising and managing hyperpyrexia syndrome in PD and the possibility of uncharacteristically hot weather being a cause.
BACKGROUND: A large body of scientific evidence has established the impact of increased temperatures on human health. There is a relationship between extreme heat (either incremental temperature increase or heatwaves), and heat-related illnesses. This study aimed to collate the research findings on the effects of extreme heat on heat-related illness in a systematic review and meta-analysis, and to provide robust evidence for needed public health intervention. METHODS: We conducted a search of peer-reviewed articles in three electronic databases (PubMed, EMBASE, and SCOPUS), from database inception until January 2022. A random-effects meta-analysis model was used to calculate the pooled relative risks (RRs) of the association between high temperature and heat-related illness outcomes. A narrative synthesis was also performed for studies analysing heatwave effects. Assessment of evidence was performed in three parts: individual study risk of bias; quality of evidence across studies; and overall strength of evidence. RESULTS: A total of 62 studies meeting the eligibility criteria were included in the review, of which 30 were qualified to be included in the meta-analysis. The pooled results showed that for every 1 °C increase in temperature, when measured from study-specific baseline temperatures, direct heat illness morbidity and mortality increased by 18 % (RR 1.18, 95%CI: 1.16-1.19) and 35 % (RR 1.35, 95%CI: 1.29-1.41), respectively. For morbidity, the greatest increase was for direct heat illness (RR 1.45, 95%CI: 1.38-1.53), compared to dehydration (RR 1.02, 95%CI: 1.02-1.03). There was higher risk for people aged >65 years (RR 1.25; 95 % CI: 1.20-1.30), and those living in subtropical climates (RR 1.25; 95 % CI: 1.21-1.29). CONCLUSION: Increased temperature leads to higher burden of disease from heat-related illness. Preventative efforts should be made to reduce heat-related illness during hot weather, targeting on the most vulnerable populations. This is especially important in the context of climate change.
BACKGROUND: The aim of the study was to investigate the effect of a simulated heat-wave on the labour productivity and physiological strain experienced by workers. METHODS: Seven males were confined for ten days in controlled ambient conditions. A familiarisation day was followed by three (pre, during, and post-heat-wave) 3-day periods. During each day volunteers participated in a simulated work-shift incorporating two physical activity sessions each followed by a session of assembly line task. Conditions were hot (work: 35.4 °C; rest: 26.3 °C) during, and temperate (work: 25.4 °C; rest: 22.3 °C) pre and post the simulated heat-wave. Physiological, biological, behavioural, and subjective data were collected throughout the study. RESULTS: The simulated heat-wave undermined human capacity for work by increasing the number of mistakes committed, time spent on unplanned breaks, and the physiological strain experienced by the participants. Early adaptations were able to mitigate the observed implications on the second and third days of the heat-wave, as well as impacting positively on the post-heat-wave period. CONCLUSIONS: Here, we show for first time that a controlled simulated heat-wave increases workers’ physiological strain and reduces labour productivity on the first day, but it promotes adaptations mitigating the observed implications during the subsequent days.
BACKGROUND: There is strong evidence concerning the impact of heat stress on mortality, particularly from high temperatures. However, few studies to our knowledge emphasize the importance of hot nights, which may prevent necessary nocturnal rest. OBJECTIVES: In this study, we use hot-night duration and excess to predict daily cause-specific mortality in summer, using multiple cities across Southern Europe. METHODS: We fitted time series regression models to summer cause-specific mortality, including natural, respiratory, and cardiovascular causes, in 11 cities across four countries. We included a distributed lag nonlinear model with lags up to 7 days for hot night duration and excess adjusted by daily mean temperature. We summarized city-specific associations as overall-cumulative exposure-response curves at the country level using meta-analysis. RESULTS: We found positive but generally nonlinear associations between relative risk (RR) of cause-specific mortality and duration and excess of hot nights. RR of duration associated with nonaccidental mortality in Portugal was 1.29 (95% confidence interval [CI] = 1.07, 1.54); other associations were imprecise, but we also found positive city-specific estimates for Rome and Madrid. Risk of hot-night excess ranged from 1.12 (95% CI = 1.05, 1.20) for France to 1.37 (95% CI = 1.26, 1.48) for Portugal. Risk estimates for excess were consistently higher than for duration. CONCLUSIONS: This study provides new evidence that, over a wider range of locations, hot night indices are strongly associated with cause-specific deaths. Modeling the impact of thermal characteristics during summer nights on mortality could improve decisionmaking for preventive public health strategies.
OBJECTIVES: Heatwaves are having a disproportionate impact on the elderly population, as demonstrated by pronounced mortality and morbidity. The present study aimed to explore elders’ subjective experiences of heat impacts and adaptive strategies. METHODS: Semi-structured interviews with 19 elderly Swedes were conducted, focusing on their experiences of the extremely hot summer of 2018. RESULTS: Most informants suffered during the heatwave, although some found it pleasant. The readiness to implement adaptive measures was generally high among the healthiest, who were able to avoid excessive heat and adjust their daily routines. In contrast, those highly dependent on care from others had limited options for avoiding the heat, and little capacity to take up adaptive measures. DISCUSSION: With heat becoming an increasing problem, it is important to adjust elderly care so that the most vulnerable elderly people can avoid excessive heat exposure.
In recent years, UK summer heatwaves have resulted in thousands of excess deaths, with both extreme temperatures and high humidity increasing health risks. Here, the UK Climate Projections 2018 (UKCP18) are compared to observational (HadUK-Grid) and reanalysis data (ERA5) to quantify model performance at capturing mean, extremes (95th to 99.5th percentiles) and variability in the climate state and heat stress metrics (simplified wet bulb global temperature, sWBGT; Humidex; apparent temperature). Simulations carried out for UKCP18 generally perform as well as or better than CMIP5 models in reproducing observed spatial patterns of UK climate relating to extreme heat, with RMSE values on average similar to 30% less than for the CMIP5 models. Increasing spatial resolution in UKCP18 simulations is shown to yield a minor improvement in model performance (RMSE values on average similar to 5% less) compared to observations, however there is considerable variability between ensemble members within resolution classes. For both UKCP18 and CMIP5 models, model error in capturing characteristics of extreme heat generally reduces when using heat stress metrics with a larger vapour pressure component, such as sWBGT. Finally, the 95th percentile of observed UK summer temperature is shown to have similar to 60% greater interannual variability than the summer mean over the recent past (1981-2000). This effect is underestimated in UKCP18 models (similar to 33%) compared to HadUK-grid and ERA5. Compared to projected future changes in the global mean temperature, UK summer mean and 95th percentile temperatures are shown in increase at a faster rate than the global mean.
Current climate change aggravates human health hazards posed by heat stress. Forests can locally mitigate this by acting as strong thermal buffers, yet potential mediation by forest ecological characteristics remains underexplored. We report over 14 months of hourly microclimate data from 131 forest plots across four European countries and compare these to open-field controls using physiologically equivalent temperature (PET) to reflect human thermal perception. Forests slightly tempered cold extremes, but the strongest buffering occurred under very hot conditions (PET >35°C), where forests reduced strong to extreme heat stress day occurrence by 84.1%. Mature forests cooled the microclimate by 12.1 to 14.5°C PET under, respectively, strong and extreme heat stress conditions. Even young plantations reduced those conditions by 10°C PET. Forest structure strongly modulated the buffering capacity, which was enhanced by increasing stand density, canopy height and canopy closure. Tree species composition had a more modest yet significant influence: that is, strongly shade-casting, small-leaved evergreen species amplified cooling. Tree diversity had little direct influences, though indirect effects through stand structure remain possible. Forests in general, both young and mature, are thus strong thermal stress reducers, but their cooling potential can be even further amplified, given targeted (urban) forest management that considers these new insights.
Adverse health effects from extreme heat remain a major risk, especially in a changing climate. Several European countries have implemented heat health action plans (HHAPs) to prevent ill health and excess mortality from heat. This paper assesses the state of implementation of HHAPs in the WHO European Region and discusses barriers and successes since the early 2000s. The results are based on a web-based survey among 53 member states on the current national and federal HHAPs in place. Guided by the eight core elements of HHAPs as outlined by the WHO Regional Office for Europe guidance from 2008, we analyzed which elements were fully or partially implemented and which areas of improvement countries identified. HHAP adaptations to account for COVID-19 were sought via literature search and expert consultations. 27 member states provided information, of which 17 countries reported having a HHAP. Five out of eight core elements, namely agreement on a lead body, accurate and timely alert systems, heat-related health information plans, strategies to reduce health exposure, and care for vulnerable groups, were at least partially implemented in all 17 plans. Alert systems were implemented most often at 94%. The least often implemented items were real-time surveillance, long-term urban planning, and preparedness of health and social systems. Five countries had published COVID-19 guidance online. Our findings suggest a progressive improvement in the development and rollout of HHAPs overall and awareness of vulnerable population groups in WHO/Europe, while integration of HHAPs into long-term climate change and health planning remains a challenge.
Climate change leads to more days with extremely hot temperatures. Previous analyses of heat waves have documented a short-term rise in mortality. The results on the relationship between high temperatures and hospitalisations, especially in vulnerable patients admitted to nursing homes, are inconsistent. The objective of this research was to examine the discrepancy between heat-related mortality and morbidity in nursing homes. A time-stratified case-crossover study about the impact of heat waves on mortality and hospitalisations between 1 January 2013 and 31 December 2017 was conducted in 10 nursing homes over 5 years in Flanders, Belgium. In this study, the events were deaths and hospitalisations. We selected our control days during the same month as the events and matched them by day of the week. Heat waves were the exposure. Conditional logistic regression models were applied. The associations were reported as odds ratios at lag 0, 1, 2, and 3 and their 95% confidence intervals. In the investigated time period, 3048 hospitalisations took place and 1888 residents died. The conditional logistic regression showed that odds ratios of mortality and hospitalisations during heat waves were 1.61 (95% confidence interval 1.10-2.37) and 0.96 (95% confidence interval 0.67-1.36), respectively, at lag 0. Therefore, the increase in mortality during heat waves was statistically significant, but no significant changes in hospitalisations were obtained. Our result suggests that heat waves have an adverse effect on mortality in Flemish nursing homes but have no significant effect on the number of hospitalisations.
Heatwaves have been the deadliest weather extreme events in Europe in the last decades. People living in cities are especially prone to such events due to the urban heat island (UHI) effect which increases the heat stress in urban surroundings especially during calm, steady, and radiation intensive synoptic situations. Since official measurement stations in cities are scarce, studies on spatial patterns of UHIs often rely on satellite data, hobby meteorologists’ data, or on model outputs. Additionally, analyses of spatial UHI patterns using point-based measurements need adequate and cost-effective methods for spatial interpolation. In this study, air temperature data retrieved by 60 low cost measurement devices (LCD) are used to model the spatial pattern of the UHI with a land use regression (LUR) approach in Bern, Switzerland. For this purpose, 14 spatial variables with different buffer radii were calculated to evaluate their effect on the UHI and to interpolate the air temperature data. As a result, three models covering three different heatwaves at nighttime were developed. Given good model performance throughout the different scenarios, the here presented study demonstrates the successful interpolation of low cost temperature data by LUR modelling based on publicly accessible spatial information within a city.
Heat stress is one of the most critical factors affecting human life. In Central Europe, its influence is noticeable, especially in the Polish-Saxon region, which is a very popular tourist region also inhabited by a high number of elders. The main goal of this paper was to assess multi-annual changes in heat stress occurring in the region, considering the frequency of heat days, the UTCI (Universal Thermal Climate Index), and circulation conditions. The research showed that all the thermal and biothermal indices in this region significantly increased during 1971-2019 in the lowlands, the mountain foreland, and the lower mountain zone. In terms of the UTCI, a negative trend for cold stress frequency was noticed in the entire region in favor of an increase in a tendency toward thermoneutral conditions and heat stress. This concerns especially strong and very strong heat stress (UTCI > 32 degrees C), in which positive trends were observed for most of the stations located in the lower hypsometric zones. The results also showed that heat stress mainly occurs on days with anticyclonic circulation. Analysis of selected cases of heat waves in the 21st century indicated that the lower hypsometric zones are characterized by a very high UTCI, while the summit zone is free from heat stress occurrence.
OBJECTIVES: To provide perspectives from the HEAT-SHIELD project (www.heat-shield.eu): a multi-national, inter-sectoral, and cross-disciplinary initiative, incorporating twenty European research institutions, as well as occupational health and industrial partners, on solutions to combat negative health and productivity effects caused by working on a warmer world. METHODS: In this invited review, we focus on the theoretical and methodological advancements developed to combat occupational heat stress during the last five years of operation. RESULTS: We outline how we created climate forecast models to incorporate humidity, wind and solar radiation to the traditional temperature-based climate projections, providing the basis for timely, policy-relevant, industry-specific and individualized information. Further, we summarise the industry-specific guidelines we developed regarding technical and biophysical cooling solutions considering effectiveness, cost, sustainability, and the practical implementation potential in outdoor and indoor settings, in addition to field-testing of selected solutions with time-motion analyses and biophysical evaluations. All recommendations were adjusted following feedback from workshops with employers, employees, safety officers, and adjacent stakeholders such as local or national health policy makers. The cross-scientific approach was also used for providing policy-relevant information based on socioeconomic analyses and identification of vulnerable regions considered to be more relevant for political actions than average continental recommendations and interventions. DISCUSSION: From the HEAT-SHIELD experiences developed within European settings, we discuss how this inter-sectoral approach may be adopted or translated into actionable knowledge across continents where workers and societies are affected by escalating environmental temperatures.
BACKGROUND: Patients with respiratory diseases are vulnerable to the effects of heat. Therefore, it is important to develop adaptation strategies for heat exposure. One option is to optimise the indoor environment. To this end, we equipped hospital patient rooms with radiant cooling. We performed a prospective randomised clinical trial to investigate potentially beneficial effects of the hospitalisation in rooms with radiant cooling on patients with a respiratory disease exacerbation. METHODS: Recruitment took place in June, July and August 2014 to 2016 in the Charité – Universitätsmedizin Berlin, Germany. We included patients with COPD, asthma, pulmonary hypertension, interstitial lung disease and pneumonia. 62 patients were allocated to either a standard patient room without air conditioning or a room with radiant cooling set to 23°C (73°F). We analysed the patients’ length of stay with a Poisson regression. Physiological parameters, fluid intake and daily step counts were tested with mixed regression models. RESULTS: Patients hospitalised in a room with radiant cooling were discharged earlier than patients in standard rooms (p=0.003). The study participants in chambers with radiant cooling had a lower body temperature (p=0.002), lower daily fluid intake (p<0.001), higher systolic blood pressure (p<0.001) and an increased daily step count (p<0.001). CONCLUSION: The results indicate that a radiant cooling system in hospital patient rooms provides clinical benefits for patients with respiratory disease exacerbations during the warm summer months, which may contribute to an earlier mobilisation. Radiant cooling is commended as a suitable adaptation strategy to reduce the clinical impact of climate warming.
INTRODUCTION: There is currently little knowledge and few published works on the subject of vulnerability to heat in rural environments at the country level. Therefore, the objective of this study was to determine whether rural areas are more vulnerable to extreme heat than urban areas in Spain. This study aimed to analyze whether a pattern of vulnerability depends on contextual, environmental, demographic, economic and housing variables. METHODS: An ecological, longitudinal and retrospective study was carried out based on time series data between January 01, 2000 and December 31, 2013 in 42 geographic areas in 10 provinces in Spain. We first analyzed the functional relationship between the mortality rate per million inhabitants and maximum daily temperature (Tmax). We then determined the summer temperature threshold (Pthreshold) (June-September) at which increases in mortality are produced that are attributable to heat. In a second phase, based on Pthreshold, a vulnerability variable was calculated, and its distribution was analyzed using mixed linear models from the Poisson family (link = log). In these models, the dependent variable was vulnerability, and the independent variables were exposure to high temperatures, aridity of the climate, deprivation index, percentage of people over age 65, rurality index, percentage of housing built prior to 1980 and condition of dwellings. RESULTS: Rurality was a protective factor, and vulnerability in urban areas was six times greater. In contrast, risk factors included aridity (RR = 5.89 (2.26 15.36)), living in cool summer zones (2.69 (1.23, 5.91)), poverty (4.05 (1.91 8.59)) and the percentage of dysfunctional housing (1.13 (1.04 1.24)). CONCLUSIONS: Rural areas are less vulnerable to extreme heat than the urban areas analyzed. Also, population groups with worse working conditions and higher percentages of dwellings in poor conditions are more vulnerable.
Background An area of current study concerns analysis of the possible adaptation of the population to heat, based on the temporal evolution of the minimum mortality temperature (MMT). It is important to know how is the evolution of the threshold temperatures (Tthreshold) due to these temperatures provide the basis for the activation of public health prevention plans against high temperatures. The objective of this study was to analyze the temporal evolution of threshold temperatures (Tthreshold) produced in different Spanish regions during the 1983-2018 period and to compare this evolution with the evolution of MMT. The dependent variable used was the raw rate of daily mortality due to natural causes ICD X: (A00-R99) for the considered period. The independent variable was maximum daily temperature (Tmax) during the summer months registered in the reference observatory of each region. Threshold values were determined using dispersion diagrams (annual) of the prewhitened series of mortality temperatures and Tmax. Later, linear fit models were carried out between the different values of Tthreshold throughout the study period, which permitted detecting the annual rate of change in Tthreshold. Results The results obtained show that, on average, Tthreshold has increased at a rate of 0.57 oC/decade in Spain, while Tmax temperatures in the summer have increased at a rate of 0.41 oC/decade, suggesting adaptation to heat. This rate of evolution presents important geographic heterogeneity. Also, the rate of evolution of Tthreshold was similar to what was detected for MMT. Conclusions The temporal evolution of the series of both temperature measures can be used as indicators of population adaptation to heat. The temporal evolution of Tthreshold has important geographic variation, probably related to sociodemographic and economic factors, that should be studied at the local level.
In Spain the average temperature has increased by 1.7 °C since pre-industrial times. There has been an increase in heat waves both in terms of frequency and intensity, with a clear impact in terms of population health. The effect of heat waves on daily mortality presents important territorial differences. Gender also affects these impacts, as a determinant that conditions social inequalities in health. There is evidence that women may be more susceptible to extreme heat than men, although there are relatively few studies that analyze differences in the vulnerability and adaptation to heat by sex. This could be related to physiological causes. On the other hand, one of the indicators used to measure vulnerability to heat in a population and its adaptation is the minimum mortality temperature (MMT) and its temporal evolution. The aim of this study was to analyze the values of MMT in men and women and its temporal evolution during the 1983-2018 period in Spain’s provinces. An ecological, longitudinal retrospective study was carried out of time series data, based on maximum daily temperature and daily mortality data corresponding to the study period. Using cubic and quadratic fits between daily mortality rates and the temperature, the minimum values of these functions were determined, which allowed for determining MMT values. Furthermore, we used an improved methodology that provided for the estimation of missing MMT values when polynomial fits were inexistent. This analysis was carried out for each year. Later, based on the annual values of MMT, a linear fit was carried out to determine the rate of evolution of MMT for men and for women at the province level. Average MMT for all of Spain’s provinces was 29.4 °C in the case of men and 28.7 °C in the case of women. The MMT for men was greater than that of women in 86 percent of the total provinces analyzed, which indicates greater vulnerability among women. In terms of the rate of variation in MMT during the period analyzed, that of men was 0.39 °C/decade, compared to 0.53 °C/decade for women, indicating greater adaptation to heat among women, compared to men. The differences found between men and women were statistically significant. At the province level, the results show great heterogeneity. Studies carried out at the local level are needed to provide knowledge about those factors that can explain these differences at the province level, and to allow for incorporating a gender perspective in the implementation of measures for adaptation to high temperatures.
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.
The understanding of intra-urban air temperature variations is crucial to assess strategies for cities’ adaptation to impacts of present and future anthropogenic climate change. Depending on extensive measurement networks, high-resolution air temperature measurements in urban environments are challenging due to high instrumentation and maintenance costs. Here, we present a low-cost measurement device (LCD) consisting of a temperature logger and a custom-made, naturally ventilated radiation shield. Besides intercomparisons with automated weather stations (AWS) at three reference sites during record-dry summer 2018, we tested the potential of the devices using a network of 79 LCDs to assess the intra-urban variability of urban heat island (UHI) patterns in the city of Bern, Switzerland. We found positive mean measurement biases between LCDs and AWS of 0.61 to 0.93 K (RMSE: 0.78 to 1.17 K) during daytime, of which up to 82.8% of the variance could be explained statistically by solar irradiance (radiative heating) and wind speed (insufficient ventilation). During night, average measurement biases were markedly lower and eventually negative with -0.12 to 0.23 K (RMSE: 0.19 to 0.34 K). Our results highlight the importance of sensor intercomparisons being conducted at multiple locations with differing urban land-cover, structure, and metabolism given that biases varied considerably between the reference sites. Data retrieved by the city-wide measurement network showed that the LCD approach is well suited for the analysis of spatiotemporal UHI patterns during night and adds considerable value compared to the few existing AWS in detecting fine-scale air temperature variability. In conclusion, the current LCD measurement approach represents a valuable option for cost-effective analyses of urban air temperature variability across multiple scales, which may be of particular value for the development, appliance, and monitoring of adaptation strategies to climate change in cities with restricted financial resources.
Building energy codes have been implemented in Switzerland as well as across the world to reduce building energy consumption, however, due to the progressive effect of climate change phenomena and the precipitate change in occupancy patterns due to the global pandemic, their effectiveness and limitations must be constantly re-examined. This paper explores the effectiveness of natural ventilation as a passive cooling strategy, as well as the overheating patterns in dwellings across the Swiss territory. The work is based on a climate-based simulation model at a territorial scale, from which the building performance is further analysed considering the heating energy consumption and overheating risk hours above 26.5 degrees C. The effectiveness of natural ventilation through the operable window operable area in reducing overheating risk was also estimated. The results show the effectiveness across the whole territory of the current regulation (SIA 380/1:2016), which is focused on the performance of the building envelope to reduce heat losses. An unattended alarming overheating pattern was spotted in locations with altitudes below 1500 meters as a direct consequence of the climate change phenomena, hence a series of recommendations are proposed to update and improve the current legal requirements.
AIMS: Previous studies found increased cardiovascular mortality during hot days, while emergency hospital admissions were decreasing. We explored potential underlying reasons by analysing clinically similar cardiovascular disease groups taking into account primary, underlying and immediate causes of death. METHODS AND RESULTS: We assessed associations of daytime maximum temperature in relation to cardiovascular deaths and emergency hospital admissions between 1998 and 2016 in Switzerland. We applied conditional quasi-Poisson models with non-linear distributed lag functions to estimate relative risks (RRs) of daily cardiovascular mortality and morbidity for temperature increases from the median (22°C) to the 98th percentile (32°C) of the warm season temperature distribution with 10 days of lag. Cardiovascular mortality (n = 163,856) increased for total cardiovascular disease (RR 1.13, 95% confidence interval [CI] 1.08-1.19) and the disease groups hypertension (1.18, 1.02-1.38), arrhythmia (1.29, 1.08-1.55), heart failure (1.22, 1.05-1.43) and stroke of unknown origin (1.20, 1.02-1.4). In contrast, emergency hospital admissions (n = 447,577) decreased for total cardiovascular disease (0.91, 0.88-0.94), hypertension (0.72, 0.64-0.81), heart failure (0.83, 0.76-0.9) and myocardial infarction (0.88, 0.82-0.95). Opposing heat effects were most pronounced for disease groups associated with diuretic and antihypertensive drug use, with the age group ≥75 years at highest risk. CONCLUSIONS: Volume depletion and vasodilation from heat stress plausibly explain the risk reduction of heat-related emergency hospital admissions for hypertension and heart failure. Since primary cause of death mostly refers to the underlying chronic disease, the seemingly paradoxical heat-related mortality increase can plausibly be explained by an exacerbation of heat effects by antihypertensive and diuretic drugs. Clinical guidelines should consider recommending strict therapy monitoring of such medication during heatwaves, particularly in the elderly.
The human-biometeorological conditions in Ukraine during two mega-heat waves were analyzed. The evaluation is based on physiologically equivalent temperature (PET). The calculation of PET is performed utilizing the RayMan model. The results revealed these two mega-heat waves produced strenuous human-biometeorological conditions on the territory of Ukraine. During the summer 2010 mega-heat wave, strong and extreme heat stress prevailed at about midday at the stations where this atmospheric phenomenon was observed. The mega-heat wave of August 2015 was characterized by a lower heat load. The diurnal variation of PET values during the researched mega-HW was similar to that of the diurnal variation of air temperature with minimum values in the early morning and maximum values in the afternoon. On the territory where mega-heat waves were observed, the number of days during which heat stress occurred for 9 h amounted to 97.6% for the period from 31 July to 12 August 2010 and 77.1% for the mega-heat wave of August 2015.
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.
Global warming will lead to adverse consequences for human health and well-being. This research ought to determine whether passive low-cost strategies freely controlled by users (ventilation strategies, solar shadings or window operation) could be applied in low-income dwellings to meet acceptable thermal comfort to retrofit the Mediterranean social housing stock of southern Spain towards climate change. On-site measurements registered in some test cells (controlled environment with no users’ influence) were used to calibrate dynamic energy simulation models. The impact of several future periods, climate zones of southern Spain and orientations on thermal comfort was assessed. The results show that climate change triggers a more significant increase in outdoor temperatures in summer than in winter. Should ventilation be kept to minimum and blinds opened during daytime in winter, higher comfort would be achieved, with great differences between orientations and south reporting the best results. The higher the outdoor temperatures due to climate change, the higher the percentage of comfort hours (i.e. 23-68% in the present and 50-75% in 2080). In summer, natural night ventilation and blinds closed during daytime lead to the best comfort result, with negligible temperature differences between orientations. Future climate change scenarios worsen the percentage of comfort hours (i.e. 96-100% in the present, while up to 17% in 2080). Mechanical ventilation and blind aperture schedules were found to have the highest influence on overheating discomfort. Likewise, mechanical and natural ventilation schedules had the highest impact on undercooling discomfort.
In response to urbanization and global warming, which amplify heatwave effects and might lead to urban heat stress, this paper proposes a practical approach to characterize the local microclimate at the neigh-borhood scale. In this approach, the local urban climate is described using suitable indicators, to support the ecodistrict design process or refurbishment. Experimental and numerical results illustrate the approach in a case study of a French coastal city, La Rochelle. In the first step, we set up urban and rural weather stations to characterize the local urban climate over a summer period and to identify local tem-perature differences. The measurements highlighted a daytime urban cooling effect due to the local sea breeze. While the Urban Weather Generator (UWG) simulation tool used for this study does not capture coastal effects, the results were consistent with the urban heat island (UHI) measurements. We proposed two indicators to quantify the local climate modifications: local UHI and overheating intensity. The parameters of the adaptation strategies were assessed through a sensitivity analysis for these two indi-cators. For this case-study, we identified vegetation cover, building height and road albedo as key param-eters that can be used to mitigate local overheating. (c) 2021 Elsevier B.V. All rights reserved.
Effects of climate change are perceived in ever larger areas of the planet. Heat waves occur with increasing frequency, constituting a risk to the population, especially for the most sensitive subjects. Preventive information to the population on the characteristics of the phenomenon and on the behavior to be supported is the means to reduce the health risks. To monitor the intensity of heat and the physiological discomfort perceived by humans, there are indices based on the perception of meteorological parameters such as temperature and relative humidity. In this work, by applying the Thom Discomfort Index (TDI), the first bioclimatic characterization of the provinces that make up Sicily, a Mediterranean region defined as a hotspot for climate change, was performed by the authors. The nonparametric Mann-Kendall test was applied to the daily values of the TDI in all provinces in order to verify the presence of significant trends. The test results highlighted the existence of increasing trends, especially in the months of August and September, when the TDI value undergoes a significant increase due not only to high temperatures, as one might expect, but above all to a high humidity rate. When these two meteorological parameters reach certain values, the physiological discomfort from humid heat represents a risk to the population.
Environmental and technological design for climate adaptation in the urban built environment can no longer be separated from the generation, collection, or use of data (big data). ICT tools (Information and Communication Technologies), for the modelling and simulation of the built urban environment are identified as measuring devices and provide knowledge on the impacts of climate change in design practice based on an environmentally data-driven approach. This study aims to define a framework for the evaluation of environmental health and comfort parameters applicable to simulation tools, with a specific focus on thermal and environmental exchanges between indoor and outdoor spaces, to define those factors that affect the perception of user’s well-being in thermal stress conditions (e.g., heatwaves), both indoor and outdoor. Through the definition of two study cases in the city of Naples, Italy, special attention was paid to investigating the interaction between outdoor and indoor performance when urban temperatures rise. A comparison between a daily survey for occupants and simulations was conducted to confirm the validity of the data obtainable from the perceived thermal sensations. The obtained results show that the designed framework can reliably simulate real outdoor and indoor conditions according to comfort indices such as the predicted mean vote and adaptive comfort model. The methodological framework developed can guarantee the interoperability of data to simulate indoor and outdoor environments responding to real conditions and determine a favourable condition for the development of urban redevelopment interventions through the application of climate adaptive design strategies.
BACKGROUND: Heat waves can be considered as an emerging challenge among the potential health risks generated by urbanization and climate changes. Heat waves are becoming more frequent, long and intense, and can be defined as meteorological extreme events consisting in prolonged time of extremely high temperatures in a particular region. The following paper addresses health threats due to heat waves presenting the case study of Lecce, a city located in Southern Italy; the Mediterranean area is already recognized in international literature as a hot-spot for climate changes. This work assesses the potential impact of two different adaptation strategies. METHODS: We have tested the effectiveness of cool surfaces and urban forestry as adaptation approaches to cope with heat waves. The microclimate computer-based model “ENVI-met” was adopted to predict thermal scenarios arising from the two proposed interventions. The parameters analysed consisted in temperature and relative humidity. RESULTS: Urban forestry approach seem to lower temperature (that represents the major cause of urban overheating) better than cool surfaces strategy, but relative humidity produced by the evapotranspiration processes of urban forestry has also negative influences on temperature perceived by pedestrians (thermal discomfort). CONCLUSION: Vegetation represents both an adaptation and a mitigation strategy to climate changes that guarantees an improvement of air quality, with consequent psychological and physical benefits. Wide campaigns aimed at planting trees and increasing the urban green coverage should be systematically planned and fostered by national, regional and local institutions preferably with the involvement of research departments, schools and citizens’ associations.
Urban green infrastructure, especially trees, are widely regarded as one of the most effective ways to reduce urban temperatures in heatwaves and alleviate the adverse impacts of extreme heat events on human health and well-being. Nevertheless, urban planners and decision-makers are still lacking methods and tools to spatially evaluate the cooling effects of urban green spaces and exploit them to assess greening strategies at the urban agglomeration scale. This article introduces a novel spatially explicit approach to simulate urban greening scenarios by increasing the tree canopy cover in the existing urban fabric and evaluating their heat mitigation potential. The latter is achieved by applying the InVEST urban cooling model to the synthetic land use/land cover maps generated for the greening scenarios. A case study in the urban agglomeration of Lausanne, Switzerland, illustrates the development of tree canopy scenarios following distinct spatial distribution strategies. The spatial pattern of the tree canopy strongly influences the human exposure to the highest temperatures, and small increases in the abundance of tree canopy cover with the appropriate spatial configuration can have major impacts on human health and well-being. The proposed approach supports urban planning and the design of nature-based solutions to enhance climate resilience.
Temperatures in Mediterranean cities are rising due to the effects of climate change, with a consequent increase in the heat waves frequency. Recent research has shown the tempering potential of semi-outdoor spaces such as courtyards, which are semi-enclosed spaces that are widely used by the users of buildings in Mediterranean cities. International standards addressing thermal comfort parameters provide technical guidelines for indoor spaces only. Expanding this concept, this paper focuses on the potential to extend and interpret the existing calculation models for indoor thermal comfort, EN 16798 and ASHRAE 55, to determine thermal comfort, monitoring two different courtyards in Cordoba, Spain, during both typical summer and heat wave periods. The results show that during the typical summer, the monitored courtyards can reach temperatures up to 8.4 degrees C cooler than outside. Subsequently can be considered to be in thermal comfort on average for 88% of the time according to EN 16798, and 75% according to ASHRAE 55, which drop to 71% and 52% respectively during heat wave (HW) periods, in spite of increasing thermal gap (TG) up to 13.9 degrees C. The results are also compared with the PET indicator used for evaluation of outdoor thermal comfort, which provides comparable figures: 81% summer and 73% HW. Implications of implementing passive shading strategies to increase comfort in these transition spaces are also evaluated. The research highlights the thermal potential and usefulness of courtyards in warm climates, so they can ultimately be included in the building analysis as a potentially comfortable and habitable space.
Urban areas are characterised by the dominance of impervious surfaces and decreased presence of vegetation compared to their rural surroundings. The resultant increase in temperature is known to amplify global warming, with negative impacts on health and increased energy requirements for cooling. Intra-urban variations in temperature have received less attention than urban-rural variations, although the former can be even larger than the latter. Land cover composition is known to influence surface temperature, while the influence of heights, of buildings and vegetation, is less explored. There are also fewer studies in high-latitude cities although extreme heat events are increasing in frequency and severity in these cities, and high-resolution geospatial datasets are often available for detailed analysis. The aim of this study is therefore to assess the influence of selected land cover variables on the estimated surface temperature in the four largest cities in Denmark-Copenhagen, Aarhus, Odense and Aalborg. Land surface temperatures (LST) of the four cities were estimated using Band 10 (10.60-11.19 mu m) from Landsat 8 imagery. Vegetation cover, building cover, vegetation height and building height were estimated using 4-band aerial imagery, building footprints and LiDAR-based elevation models, and their correlations with LST were estimated. Moving average filters, with window sizes from 3 x 3 (90 m x 90 m) to 11 x 11 (330 m x 330 m), were used to understand the area of influence of surrounding land cover on the LST within 30-m cells. When vegetation cover and building cover increased from 0-5% to 95-100%, median values of LST decreased by 4.16 +/- 0.76 degrees C and increased by 4.31 +/- 0.69 degrees C, respectively. Land cover variables within 7 x 7 windows (210 m x 210 m) are shown to have strong correlations with the LST of 30-m cells. The area of influence of building heights on the LST of 30-m cells was the largest in Copenhagen, which also has the tallest buildings among the cities. LST reduced by 4.10 degrees C when the mean vegetation height within a 30-m cell increased from 0-2 m to 20-22 m, and by 5.75 degrees C for 210 m x 210 m patches with the same height range. A combination of increased vegetation cover and height could therefore be used to regulate temperature in or close to hot spots in cities depending on the availability of space.
Surface temperature is often used to examine heat exposure in multi-city studies and for informing urban heat mitigation efforts due to scarcity of urban air temperature measurements. Cities also have lower relative humidity, traditionally not accounted for in large-scale observational urban heat risk assessments. Here, using crowdsourced measurements from over 40,000 weather stations in approximate to 600 urban clusters in Europe, we show the moderating effect of this urbanization-induced humidity reduction on outdoor heat stress during the 2019 heatwave. We demonstrate that daytime differences in heat index between urban clusters and their surroundings are weak, and associations of this urban-rural difference with background climate, generally examined from the surface temperature perspective, are diminished due to moisture feedbacks. We also examine the spatial variability of surface temperature, air temperature, and heat index within these clusters-relevant for detecting hotspots and potential disparities in heat exposure-and find that surface temperature is a poor proxy for the intra-urban distribution of heat index during daytime. Finally, urban vegetation shows much weaker (similar to 1/6th as strong) associations with heat index than with surface temperature, which has broad implications for optimizing urban heat stress mitigation strategies. These findings are valid for operational metrics of heat stress for shaded conditions (apparent temperature and humidex), thermodynamic proxies (wet-bulb temperature), and empirical heat indices. Based on this large-scale empirical evidence, surface temperature, used due to the lack of better alternatives, may not be suitable for accurately informing heat mitigation strategies within and across cities, necessitating more urban-scale observations and better urban-resolving models.
Extreme Heat Events (EHE) are a major concern for many urban areas worldwide and are considered as one of the deadliest natural hazards globally. Climate change and socioeconomic trends (exposure and susceptibility) are expected to exacerbate the risk of urban heat stress. Several urban areas have recently declared a climate emergency and initiated the adaptation process, but progress is still patchy, uncoordinated, and of varied quality. The main constraint is the lack of mechanisms for monitoring and reporting adaptation strategies, not allowing the supervision and evaluation of the adaptation process. The EU-funded project U-ADAPT! (Urban-Adaptation) focuses on the concrete expression of adaptation to evaluate the current implementation and effectiveness of adaptation measures and strategies to reduce Heat Disaster Risk (HDR), moving the emphasis from the study of vulnerability, resilience, and potential adaptation (adaptation capacity) of communities to the actual depth and pace of the past and current adaptation process. In this article, we discuss the theoretical support and design of the project and set the base for next project stages, which ultimately aims to create a unique interdisciplinary framework and a replicable multidimensional indicator on adaptation to EHE that empower European Union citizens to demand a safe and sustainable environment and hold institutions accountable for the adaptation process to current and upcoming risks.
Urbanization and ongoing climate change increase the exposure of the populations to heat stress, and the urban heat island (UHI) effect may magnify heat-related mortality, especially during heatwaves. We studied temperature-related mortality in the city of Helsinki-with urban and suburban land uses-and in the surrounding Helsinki-Uusimaa hospital district (HUS-H, excluding Helsinki)-with more rural types of land uses-in southern Finland for two decades, 2000-2018. Dependence of the risk of daily all-cause deaths (all-age and 75+ years) on daily mean temperature was modelled using the distributed lag nonlinear model (DLNM). The modelled relationships were applied in assessing deaths attributable to four intensive heatwaves during the study period. The results showed that the heat-related mortality risk was substantially higher in Helsinki than in HUS-H, and the mortality rates attributable to four intensive heatwaves (2003, 2010, 2014 and 2018) were about 2.5 times higher in Helsinki than in HUS-H. Among the elderly, heat-related risks were also higher in Helsinki, while cold-related risks were higher in the surrounding region. The temperature ranges recorded in the fairly coarse resolution gridded datasets were not distinctly different in the two considered regions. It is therefore probable that the modelling underestimated the actual exposure to the heat stress in Helsinki. We also studied the modifying, short-term impact of air quality on the modelled temperature-mortality association in Helsinki; this effect was found to be small. We discuss a need for higher resolution data and modelling the UHI effect, and regional differences in vulnerability to thermal stress.
With climate change and socioeconomic trends expected to exacerbate the risk of urban heat stress, implementing adaptation measures is paramount to limit adverse impacts of heat on urban inhabitants. Identification of the best options needs to be based on sound, localised assessments of risk, understood as the interaction of hazard, exposure and vulnerability. Yet a review of the literature reveals that minimal research to date considers the perceived impacts of heat among urban residents. Based on a household survey in Bonn, Germany, this paper adopts an integrated approach to assess how different socioeconomic groups are affected by heat stress and explores the connections between perceived impacts of heat and indicators of exposure and vulnerability across groups. Results indicate that all socioeconomic groups are at risk of urban heat stress, though to differing extents and for different reasons. Exposure was found to be lowest in groups typically considered to be of higher risk, such as older respondents, who at the same time have the highest susceptibility. Students and other younger respondents, on the other hand, face comparably high exposure and have the lowest coping and adaptive capacities. At the same time, each group has its own capacities with the potential to mitigate risk. The study shows that urban inhabitants beyond “classic risk groups” usually addressed in literature and policy are affected by heat stress in ways that may not be accounted for in current urban policy.
Heat waves associated with global warming are a significant hazard to human health, and they particularly endanger low-income households. In this study, we systematically analyze how the different components of heat vulnerability are related to household income, and present empirical evidence on the determinants of heat adaptation, focusing on the role of income. We contribute the first empirical analysis of heat vulnerability using household-level data at the national level, based on a longitudinal survey, including data points for 10,226 households in Germany in the period 2012-2020. Our results indicate that low income households are significantly more heat sensitive and have lower adaptive capacity than high income households, measured inter alia by health status, household composition, and economic and psychological resources to implement adaptation measures. However, heat hazard and exposure levels are comparable between income groups, hence there is no sorting of richer households into less hazardous or exposed locations on a national scale. We also contribute robust empirical evidence on the factors influencing household decisions to implement technical adaptation measures (e.g. installation of air conditioning), ultimately showing that the adaptation behavior of the most vulnerable households (e.g. people with poor health conditions or the elderly) is not limited by financial constraints.
The juxtaposition of climate change and development changes is vital for understanding the future impacts of heat stress in urban areas. However, an approach that considers the relationship between climatic factors and socio-economic vulnerability in a forward-looking and stakeholder-involved manner is challenging. This article demonstrates the application of a future-oriented vulnerability scenarios approach to address human heat stress in Bonn, Germany, in 2035. The study highlights the interplays between climate trajectories and heat exposure associated with urban development scenario corridors. Moreover, this method allows for changing combinations of intersections and conditionalities of projected individual socio-economic vulnerability indicators in response to social and climate governance. However, this study found that a conventional structure within city departments might limit this integrative approach in practice. Thus, the theoretical background and the concept of alternative futures and uncertainties should be the focus of communication with practitioners to maximize the utilization of the results.
The transdisciplinary project “Heat-Health Action Plan for Elderly People in Cologne” addresses the most heat-vulnerable risk group, people over 65 years of age. A quantitative study aimed to better understand heat perception and coping strategies of elderly people during heat waves to inform heat-health action plans. We conducted a representative quantitative survey via structured interviews with 258 randomly chosen people over 65 years old, living in their own homes in four areas of Cologne, Germany. These areas varied, both in terms of social status and heat strain. Data regarding demographics, health status, coping strategies, and heat perception were collected in personal interviews from August to October 2019. The majority of the participants perceived heat strain as moderate to very challenging. Women, people with a lower monthly income, and those with a lower health status found the heat more challenging. We found that participants adapted to heat with a number of body-related, home-protective, and activity-related coping strategies. The number of coping strategies was associated with perceived personal heat strain. There is a definite underuse of water-related heat adaption strategies among the elderly. This is of increasing relevance, as rising heat impact will lead to more heat-related geriatric morbidity. Our results are seminal to inform elderly-specific, socio-adapted local heat-health action plans.
BACKGROUND: 2018-2020 were unusually warm years in Germany, and the summer of 2018 was the second warmest summer since record-keeping began in 1881. Higher temperatures regularly lead to increased mortality, particularly among the elderly. METHODS: We used weekly data on all-cause mortality and mean temperature from the period 1992-2021 and estimated the number of heat-related deaths in all of Germany, and in the northern, central, and southern regions of Germany, employing a generalized additive model (GAM). To characterize long-term trends, we compared the effect of heat on mortality over the decades. RESULTS: Our estimate reveals that the unusually high summer temperatures in Germany between 2018 and 2020 led to a statistically significant number of deaths in all three years. There were approximately 8700 heat-related deaths in 2018, 6900 in 2019, and 3700 in 2020. There was no statistically significant heat-related increase in deaths in 2021. A comparison of the past three decades reveals a slight overall decline in the effect of high temperatures on mortality. CONCLUSION: Although evidence suggests that there has been some adaptation to heat over the years, the data from 2018-2020 in particular show that heat events remain a significant threat to human health in Germany.
The Mediterranean area is one of the most visited tourist destinations of the world, but it has also been recognized as one of the most vulnerable to climate change areas worldwide with respect to increased thermal risk. The study focuses on a top worldwide tourist destination of the Mediterranean, Santorini Island in Greece, and aims to assess the past, present and future thermal environment in the island based on the advanced Universal Thermal Climate Index (UTCI). The study utilizes historical observations capturing past (late 19th to early 20th century) and more recent (1982-2019) time periods, while future projections are realized based on four regional climate models (RCMs) under the weak mitigation scenario (RCP4.5) and the non-mitigation scenario with high emissions (RCP8.5). The frequency of cold stress conditions at midday decreases during winter and early spring months by up to 19.8% (January) in the recent period compared to the historical one, while heat stress conditions increase in summer by up to 22.4% (August). Future projections suggest progressive shifts of the UTCI towards higher values in the future and an increase in the exposure time under heat stress depending on the RCM and adopted scenario. The increase in moderate and strong heat stress conditions is mainly expected during the summer months (June, July, August); nevertheless, a noticeable increase is also foreseen in September and May. The highest occurrences of favorable (no thermal stress) conditions are also projected to shift by one month, from June to May and from September to October, in the future.
To date, due to climate change, heatwaves are more frequent, with greater intensity and duration resulting in deleterious impacts on human health. To be able to manage heatwaves and quantify the impacts on human health, it is crucial to define them and implement policy preventive measures. However, heatwaves are relative to the climate of a location: The same meteorological conditions can constitute a heatwave in one place but not in another. Due to different climatic conditions, social characteristics, and adaptation, heatwaves should be defined on a local scale, which poses difficulties when it comes to comparison of different definitions. The aim of the present study is to define heatwaves, implementing robust statistical analysis for three different indicators (temperature, physiological equivalent temperature (PET), and universal thermal climate index (UTCI)) for three causes of mortality (i.e., cardiological and respiratory mortality and cardiorespiratory mortality) using Attica (Greece) as a case study. Our results define a heatwave for Attica as a period of at least 3 days when the mean temperature is higher than the 97.5th percentile. Afterwards, we encapsulate the harvesting effect by implementing robust statistical analysis, using the Superposed Epoch analysis. Consequently, quantifying heatwaves is crucial so as to create early warning systems and prevent avoidable mortality.
Populations in high-density urban areas are exposed to higher levels of heat stress in comparison to rural areas. New spatially explicit approaches that identify highly exposed and vulnerable areas are needed to inform current urban planning practices to cope with heat hazards. This study proposes an extreme heat stress risk index for Dublin city across multiple decades (2020s-2050s) and for two representative concentration pathways (RCPs). In order to consider the interactions between greenhouse gas emissions and urban expansion, a climate-based urban land cover classification and a simple climate model have been combined to compute air temperature values accounting for urban heat island effect. This allowed the derivation of an improved hazard indicator in terms of extreme heat stress which, when integrated with information on current levels of vulnerability (i.e., socioeconomic factors assessed using principal component analysis (PCA), provides a heat hazard risk index for Dublin city at a fine spatial scale. Between the 2020s and 2050s, urban areas considered at highest risk are expected to increase by about 70% and 96% under RCP 4.5 and 8.5 respectively. For the 2050s, enhanced levels of heat risk under the RCP 8.5 scenario are particularly visible in the core city centre and in the northern and western suburbs. This study provides a valuable reference for decision makers for urban planning and provides an approach to help prioritise management decisions for the development of heat resilient and sustainable cities.
The mitigation of urban heat islands (UHIs) is crucial for promoting the sustainable development of urban areas. Geographic information systems (GISs) together with satellite-derived data are powerful tools for investigating the spatiotemporal distribution of UHIs. Depending on the availability of data and the geographic scale of the analysis, different methodologies can be adopted. Here, we show a complete open source GIS-based methodology based on satellite-driven data for investigating and mapping the impact of the UHI on the heat-related elderly risk (HERI) in the Functional Urban Area of Padua. Thermal anomalies in the territory were mapped by modelling satellite data from Sentinel-3. After a socio-demographic analysis, the HERI was mapped according to five levels of risk. The highest vulnerability levels were localised within the urban area and in three municipalities near Padua, which represent about 20% of the entire territory investigated. In these municipalities, a percentage of elderly people over 20%, a thermal anomaly over 2.4 degrees C, and a HERI over 0.65 were found. Based on these outputs, it is possible to define nature-based solutions for reducing the UHI phenomenon and promote a sustainable development of cities. Stakeholders can use the results of these investigations to define climate and environmental policies.
Knowledge of bioclimatic comfort is paramount for improving people’s quality of life. To this purpose, several studies related to climatic comfort/discomfort have been recently published. These studies mainly focus on the analysis of temperature and relative humidity, i.e., the main variables influencing the environmental stress in the human body. In this context, the present work aims to analyze the number of visits to the hospital emergency department made by the inhabitants of the Crati River valley (Calabria region, southern Italy) during the heat waves that accompanied the African anticyclone in the summer of 2017. The analysis of the bioclimatic comfort was performed using the humidity index. Results showed that greater the index, the higher the number of accesses to the emergency department, in particular by the most vulnerable population groups, such as children and the elderly.
Remotely sensed Land Surface Temperature (LST) is widely used to characterize Surface Urban Heat Island (SUHI) intensity and spatial variability. SUHI may differ significantly from the Urban Heat Island (UHI), which is related to air temperature and is more representative of human wellbeing. The lack of information and results on UHI development is due to the difficulty in having measurements with high spatial density within the city and the uncertainties in finding relationships between air and surface temperatures. Characterizing UHI is fundamental when dealing with human thermal wellbeing especially when extreme events occur. A new index, named Urban Heatwave Thermal Index (UHTI), was presented here to quantify daytime air temperature variability patterns in an urban environment during a meteorological heatwave. UHTI integrates a) air temperature recorded by local sensors; b) structural microclimatic Envi-met fluidodynamic modeling simulations; and c) remotely sensed environmental indicators. UHTI is a reliable representation of thermal criticalities in the city for its inhabitants. A case study on Bologna (Italy) municipality is presented. Moreover, UHTI was calculated and compared with the Urban Thermal Field Variance Index (UTFVI), commonly used for urban climate character-ization. Results showed a high degree of correlation (R2 = 0.795) between the two indexes; re-sidual mapping and hot-spot detection indicated that their biggest differences are next to dense urban fabric areas like historical centers and water body areas.
The aim of the study is to evaluate the association between summer temperatures and emergency department visits (EDVs) in Bologna (Italy) and assess whether this association varies across areas with different socioeconomic and microclimatic characteristics. We included all EDVs within Bologna residences during the summers of 2010-2019. Each subject is attributed a deprivation and a microclimatic discomfort index according to the residence. A time-stratified case-crossover design was conducted to estimate the risk of EDV associated with temperature and the effect modification of deprivation and microclimatic characteristics. In addition, a spatial analysis of data aggregated at the census block level was conducted by applying a Poisson and a geographically weighted Poisson regression model. For each unit increase in temperature above 26 °C, the risk of EDV increases by 0.4% (95%CI: 0.05-0.8). The temperature-EDV relationship is not modified by the microclimatic discomfort index but rather by the deprivation index. The spatial analysis shows that the EDV rate increases with deprivation homogeneously, while it diminishes with increases in median income and microclimatic discomfort, with differences across areas. In conclusion, in Bologna, the EDV risk associated with high temperatures is not very relevant overall, but it tends to increase in areas with a low socioeconomic level.
Outdoor workers are particularly exposed to climate conditions, and in particular, the increase of environmental temperature directly affects their health and productivity. For these reasons, in recent years, heat-health warning systems have been developed for workers generally using heat stress indicators obtained by the combination of meteorological parameters to describe the thermal stress induced by the outdoor environment on the human body. There are several studies on the verification of the parameters predicted by meteorological models, but very few relating to the validation of heat stress indicators. This study aims to verify the performance of two limited area models, with different spatial resolution, potentially applicable in the occupational heat health warning system developed within the WORKLIMATE project for the Italian territory. A comparison between the Wet Bulb Globe Temperature predicted by the models and that obtained by data from 28 weather stations was carried out over about three summer seasons in different daily time slots, using the most common skill of performance. The two meteorological models were overall comparable for much of the Italian explored territory, while major limits have emerged in areas with complex topography. This study demonstrated the applicability of limited area models in occupational heat health warning systems.
The work describes diurnal meteorological and biometeorological conditions in June 2019 in the urban areas of Central Europe. UTCI, STI, Oh_H, WL, and OV indices were calculated based on 24-h data from Bydgoszcz (Poland) for hot days. The degree of risk connected with heat stress of different intensities, risk of hyperthermia, body water loss, and decreased oxygen volume was determined. The studies showed that June 2019 was an example of an extreme situation with a heatwave that generated high stress for the inhabitants of urban areas. The conditions were burdensome mostly due to “very strong” and “strong” heat stress and periodic risk of dehydration, situations that could quickly lead to overheating of the body and a decreased oxygen volume leading to stress.
The vast majority of studies on heat-related mortality are focused on large cities. The aim of this study is to fill this research gap and to estimate the impact of high temperatures on the risk of death in smaller towns and villages. The results show that increased mortality is not only a problem in large cities. The risk of death, although usually slightly lower than in highly populated areas, may be higher for the age-related risk group. At temperatures above 35 degrees C, it may exceed 1.3 in smaller towns and even 1.6 in villages. The increase in mortality during five selected heat waves of high intensity and long duration was also studied for two regions of Poland: Malopolska and Wielkopolska. Towns with a population of less than 10,000 in Malopolska region, during the 2006 heatwave, experienced an increase in the number of deaths by as much as 18%. At the same time in the largest city of Malopolska-Krakow, the death toll rose by 4%. This paper also presents some differences between regions in terms of the impact of heat waves: in the lowland region of Wielkopolska, the mortality rate is generally higher than in the upland region of Malopolska.
The study objective was to characterise human-biometeorological conditions in the summer season in the period 1966-2019 in Poland, with particular consideration of June 2019. The study was conducted based on data from the Institute of Meteorology and Water Management-National Research Institute (IMGW-PIB) for the years 1966-2019. The data provided the basis for the calculation of the Universal Thermal Climate Index (UTCI). The study revealed high spatial variability of human-biometeorological conditions in Poland, with strenuous character intensifying from the north to the south of the country. An increase in UTCI in the summer season was recorded in the studied multi-annual period. It was the most intensive in the north-eastern Poland. The consequence of the observed changes was an increase in the frequency of days with heat stress categories (days with UTCI > 26.0 degrees C), and a decrease in the frequency of days with cold stress categories (days with UTCI < 9.0 degrees C). Season 2019 stood out at the scale of the entire country in the context of the multi-annual period. This particularly concerns June, when mean monthly UTCI values were the highest in the analysed multi-annual period.
Although regulatory improvements for air quality in the European Union have been made, air pollution is still a pressing problem and, its impact on health, both mortality and morbidity, is a topic of intense research nowadays. The main goal of this work is to assess the impact of the exposure to air pollutants on the number of daily hospital admissions due to respiratory causes in 58 spatial locations of Portugal mainland, during the period 2005-2017. To this end, INteger Generalised AutoRegressive Conditional Heteroskedastic (INGARCH)-based models are extensively used. This family of models has proven to be very useful in the analysis of serially dependent count data. Such models include information on the past history of the time series, as well as the effect of external covariates. In particular, daily hospitalisation counts, air quality and temperature data are endowed within INGARCH models of optimal orders, where the automatic inclusion of the most significant covariates is carried out through a new block-forward procedure. The INGARCH approach is adequate to model the outcome variable (respiratory hospital admissions) and the covariates, which advocates for the use of count time series approaches in this setting. Results show that the past history of the count process carries very relevant information and that temperature is the most determinant covariate, among the analysed, for daily hospital respiratory admissions. It is important to stress that, despite the small variability explained by air quality, all models include on average, approximately two air pollutants covariates besides temperature. Further analysis shows that the one-step-ahead forecasts distributions are well separated into two clusters: one cluster includes locations exclusively in the Lisbon area (exhibiting higher number of one-step-ahead hospital admissions forecasts), while the other contains the remaining locations. This results highlights that special attention must be given to air quality in Lisbon metropolitan area in order to decrease the number of hospital admissions.
The urban microclimate is gradually changing due to climate change, extreme weather conditions, urbanization, and the heat island effect. In such an altered environment, outdoor thermal comfort can have a strong impact on public health and quality of life in urban areas. In this study, three main urban areas in Serbia were selected: Belgrade (Central Serbia), Novi Sad (Northern Serbia), and Nis (Southern Serbia). The focus was on the temporal assessment of OTC, using the UTCI over a period of 20 years (1999-2018) during different seasons. The main aim is the general estimation of the OTC of Belgrade, Novi Sad, and Nis, in order to gain better insight into the bioclimatic condition, current trends and anomalies that have occurred. The analysis was conducted based on an hourly (7 h, 14 h, and 21 h CET) and “day by day” meteorological data set. Findings show the presence of a growing trend in seasonal UTCI anomalies, especially during summer and spring. In addition, there is a notable increase in the number of days above the defined UTCI thresholds for each season. Average annual UTCIs values also show a positive, rising trend, ranging from 0.50 degrees C to 1.33 degrees C. The most significant deviations from the average UTCI values, both seasonal and annual, were recorded in 2000, 2007, 2012, 2015, 2017, and 2018.
The analysis of the bioclimatic conditions is becoming increasingly relevant in climate interpretations for human needs, particularly in spatial planning, tourism, public health, sports events, bio-prognosis, etc. In this context, our study presents general temporal bioclimatic conditions in Belgrade, defined based on the PET, mPET and UTCI heat budget indices. Monthly, seasonal and annual indices were analyzed for urban and suburban weather stations based on 43 annual sets of meteorological data obtained by hourly observations at 7 h and 14 h CET. This study aims to present the distribution of PET, mPET and UTCI indices to show the pattern of each index in a mild climate location and to examine annual and seasonal differences of each index in the Belgrade urban center and suburban part of the city. The study results indicate higher biothermal stress in the urban area compared to the suburban zone and that the indices are congruent during the summer. At the same time, during the winter, they are more difficult to compare due to their peculiarities becoming more noticeable. The results obtained of all mean monthly and mean annual values of all three indices clearly indicate the difference that follows the definition of the urban heat island (UHI), particularly those from morning observation and winter season. The UTCI index shows the most significant monthly, seasonal and annual difference between urban and suburban areas for both observations. The annual difference of ΔUTCI7h amounts to 1.5 °C is the same as the annual difference of minimum temperatures (Δtmin). In contrast, the annual differences of ΔPET7h ΔmPET7h are °smaller (0.8 °C and 0.7 °C) and closer to the annual differences of maximum temperatures Δtmax amounted of 0.6 °C.
BACKGROUND: In Spain, two synoptic-scale conditions influence heat wave formation. The first involves advection of warm and dry air masses carrying dust of Saharan origin (North African Dust (NAF) = 1). The second entails anticyclonic stagnation with high insolation and stability (NAF) = 0). Some studies show that the meteorological origin of these heat waves may affect their impact on morbidity and mortality. OBJECTIVE: To determine whether the impact of heat waves on health outcomes in Madrid (Spain) during 2013-2018 varied by synoptic-scale condition. METHODOLOGY: Outcome data consist of daily mortality and daily hospital emergency admissions (morbidity) for natural, circulatory, and respiratory causes. Predictors include daily maximum and minimum temperatures and daily mean concentrations of NO(2), PM(10), PM(2.5), NO(2), and O(3). Analyses adjust for insolation, relative humidity, and wind speed. Generalized linear models were performed with Poisson link between the variables controlling for trend, seasonality, and auto-regression in the series. Relative Risks (RR) and Attributable Risks (AR) were determined. The RRs for mortality attributable to high temperatures were similar regardless of NAF status. For hospital admissions, however, the RRs for hot days with NAF = 0 are higher than for days with NAF = 1. We also found that atmospheric pollutants worsen morbidity and mortality, especially PM(10) concentrations when NAF = 1 and O(3) concentrations when NAF = 0. RESULTS: The effect of heat waves on morbidity and mortality depends on the synoptic situation. The impact is greater under anticyclonic stagnation conditions than under Saharan dust advection. Further, the health impact of pollutants such as PM(10) and O(3) varies according to the synoptic situation. CONCLUSIONS: Based on these findings, we strongly recommend prevention plans to include data on the meteorological situation originating the heat wave, on a synoptic-scale, as well as comprehensive preventive measures against the compounding effect of high temperatures and pollution.
Greening and green regeneration have been developed as a major strategy for improving quality of life in cities and neighbourhoods. Greening policies and projects are being applied at both the citywide and the neigh-bourhood level for various reasons, such as adaptation to climate change and the improvement of housing and living conditions as well as wellbeing and health. Urban policies, plans, and programmes have increasingly employed greening strategies to make urban neighbourhoods more attractive, to improve quality of life, and to provide residents with recreational space. At the same time, greening is increasingly “exploited” by market -oriented regeneration and construction strategies. The new critical debates on eco-gentrification-or distribu-tional, procedural, and interactional injustices-are discussing emerging conflicts or trade-offs between green regeneration and the social or housing market impacts, as well as analysing the role of greening and green regeneration with respect to the (re)production of socio-spatial inequalities and injustices.Set against this background, our paper provides a comparative analysis of two cases-L acute accent odz acute accent Stare Polesie (Poland) and Leipzig’s inner east (Germany)-and has a threefold purpose: first, it seeks to analyse in-terconnections between greening policies and justice concerns. To operationalise the aforementioned in-terconnections, we will, second, develop an operational model that looks at interconnections as a process and applies a justice perspective that focuses on a multidimensional, intersectional, relational, and context-and policy-sensitive understanding of justice. Third, the paper seeks to detect how a contrasting comparison can help us to come to a better and more comprehensive understanding of the interconnections between green regen-eration and justice. The study itself builds on primary research about the two cases from earlier projects.
Heatwaves are occurring more frequently and are known to affect particularly night-time temperatures. We review here literature on how night-time ambient temperature changes affect body temperature and sleep quality. We then discuss how these temperature effects impact particularly vulnerable populations such as older adults, children, pregnant women, and those with psychiatric conditions. Several ways of dealing with sleep problems in the context of heatwaves are then suggested, adapted from elements of cognitive behavioural therapy for insomnia, with more specific advice for vulnerable populations. By better dealing with sleep problems during heatwaves, general health effects of heatwaves may be more limited. However, given the sparse literature, many links addressed in this review on sleep problems affected by temperature changes should be the focus of future research.
Suicide is one of the leading causes of death in young adults in many Western countries. We examined the short-term association of temperature with cause-specific mortality, comparing suicide with other causes of death and describing possible attenuation of associations with temperature across decades. We considered all deaths that occurred in France between 1968 and 2016. For each cause of death, we conducted a 2-stage meta-analysis of associations with daily temperature. We stratified the association across time periods. A total of 502,017 deaths by suicide were recorded over 49 years. Temperature was monotonically associated with suicide mortality. The strongest association was found at lag 0 days. The relative risk of suicide mortality at the 99th (compared with the 1st) temperature percentile was 1.54 (95% confidence interval, 1.46, 1.63). Among all causes of death, suicide was the only cause displaying a monotonic trend with temperature and ranked seventh for heat-related mortality; 2 other causes of death implying the nervous system ranked third and fourth. Associations with temperature attenuated between the 1968-1984 and 1985-2000 periods for all-cause mortality and suicide mortality, without clear further attenuation in the 2001-2016 period. The robust short-term monotonic association between temperature and suicide risk could be considered in heat effects- and suicide-related prevention campaigns.
Assessments of the impacts of climate change are typically made using climate scenarios based on assumptions about future emissions of greenhouse gases, but policymakers and climate risk communicators are increasingly asking for information on impacts at different levels of warming. This paper provides this information for a set of indicators of climate risks in the UK for levels of warming up to 4 degrees C above pre-industrial levels. The results show substantial increases in climate risks at 2 degrees C, which is often inferred in the media to be a ‘safe’ level of climate change. In a 2 degrees C world, the chance of a heatwave is doubled, and the frequency of heat stress affecting people, crops and animals can be increased by a factor of five. Cooling degree days more than double, wildfire danger can increase by 40%-70%, the frequency of agricultural and water resources droughts doubles in England, and flood frequency in Wales increases by 50%. At 4 degrees C the increases in risk are considerably greater: heatwaves occur in virtually every year. The frequency of cold weather extremes reduces, but is not eliminated, with increasing warming. The rate of change in an indicator with warming varies across the UK. For temperature-based indicators this reflects variability in current climate, but for rainfall-based indicators reflects variations in the change in climate. Most indicators show a generally linear increase in risk with level of warming (although the change in risk from now is around 2.4 times higher in a 4 degrees C world than a 2 degrees C world because of warming experienced so far). However, some indicators-particularly relating to heat extremes-show a highly non-linear increase with level of warming. The range in change in indicator at a given level of warming is primarily caused by uncertainty in the estimated regional response of to increasing forcing.
Psycholeptics, psychoanaleptics, and cardiovascular drugs alter individual tolerance to extreme heat. To explore the influence of heat waves on their toxicity in acute overdose, we retrospectively analyzed all human exposures to psycholeptics and psychoanaleptics (PLAexp) as well as cardiovascular drugs (CVDexp) registered by the Poisons Information Center (PIC) Erfurt between June to September of the years 2003 to 2018 for frequency, age groups, sex, circumstances of exposure, and symptom severity. The results of the non-heat years (NHY) 2004-2005 and 2007-2014 (average air temperature June-September 16.2 °C) were compared to the results of the heat years (HY) 2003, 2006 and 2015-2018 (average air temperature June-September 17.5 °C). In total, 13,191 cases (HY 5,117; NHY 8,074) of PLAexp and 2,960 cases (HY 1,168; NHY 1,792) of CVDexp were registered. During HY, accidental PLAexp (11.2% versus 9.7%) and CVDexp (40.6% versus 36.8%) were more often seen. Severe symptoms were less frequent in PLAexp (4.4% versus 6.3%) and CVDexp (3.3% versus 4.9%). Although in HY, no higher rates of moderate or severe PLAexp and CVDexp were detected than in NHY, patients with these medications should be observed carefully during heat waves because of affected body’s usual cooling mechanisms.
This study explores the relationship between temperature and the number of aggressive incidents and coercive interventions in the years 2007-2019 in six psychiatric hospitals in the south of the Germany with a total of 1007 beds. The number of aggressive incidents among 164 435 admissions was significantly higher on ‘heat days’ (≥30°C). Furthermore, there was a dose-response relationship between the number of aggressive incidents and increasing temperature. In contrast, the number of coercive interventions was not related to temperature. Considering the background of global warming, rising temperature could result in more frequent aggressive behaviour during in-patient treatment of psychiatric patients.
Background: Climate factors may offer a stronger explanation of the variations in suicide rates compared with economic variables, even in the case of patients admitted involuntarily. Aims: We assessed the role of temperature as a determinant of the increased prevalence of suicide attempts (SA). Method: The sample comprised all cases of hospitalization for SA at the Psychiatric Clinic of the IRCCS Ospedale Policlinico San Martino between August 2013 and July 2018. For ambient temperature, data were provided by the Meteorological Observatory of the University of Genoa. Results: We noted a peak in suicides that was typically found in late spring and early summer due to global warming. Limitations: Other environmental/psychological factors contributing to the onset of an acute clinical event were not considered. The cross-sectional design of the study is another limitation. Conclusion: Further studies are needed to clarify the impact of climatic factors on suicide behavior and implement early intervention and preventive strategies for mental health.
Previous research has found higher levels of heatwave mortality and morbidity among urban residents with a migration background because of their social, health and environmental conditions. The purpose of the study was to investigate and compare heat induced changes in the outdoor recreation behaviours of Turkish migrants with those of non-migrants on hot days in Vienna. Specifically, the study compared coping behaviours due to heat such as inter-area, intra-area, temporal and activity displacement between migrants and non-migrants. The study interviewed 400 migrants and non-migrants in four public green spaces of different area sizes and asked about their outdoor recreation motives and activities, as well as behavioural changes, due to summer heat. Results show that migrants have different motives for visiting urban green spaces on hot days, and that they visit these less frequently on hot days compared to non-migrants. While both groups shift their outdoor uses more to shady areas and the cooler times of the day, more migrants visit green spaces in the afternoon, perform more energetic recreational activities, and use sunnier sites more frequently than non-migrants on hot days. Few migrants and non-migrants stated that they would visit alternative green spaces when it is hot. The results indicate that migrants’ behaviours result in higher heat exposure, while making less use of the opportunities larger green spaces such as forests can provide for heat relief. Recommendations on how green and city planners could reduce heat related health risks for both study groups are presented.
Cities experience temperature differences during heat events, in part modulated by green spaces. In the face of climate change, vegetation and green infrastructure are increasingly important for residents’ thermal comfort. Generally, socio-economically marginalised communities are more likely to live in neighbourhoods with less access to green spaces, which can lead to the experience of hotter temperatures and higher incidences of poor health during heat-waves. Building on three bodies of literature – thermal inequity and green space planning, risk and vulnerability, and critical urban theory – an interdisciplinary approach was employed to understand residents’ perceptions of heat and vulnerability, and disparities in distribution of green space arising due to urban planning in Antwerp, Belgium. Using census data, a high and low-vulnerability district – Borgerhout and Wilrijk – were selected as case studies. Park audits and interviews were carried out to provide insights into parks’ cooling ability and residents’ potential responses to extreme heat. Results demonstrated an unequal distribution, access and quality of green spaces between inner-city Borgerhout and suburban Wilrijk, suggesting that lower-income, vulnerable residents are systematically disadvantaged by municipal green space planning. All Borgerhout interviewees described feeling too hot in summer, whilst the opposite held true for interviewees in Wilrijk. Results were situated within Antwerp planning documents to understand how neoliberalism and social exclusion drive and reproduce patterns of injustice, introducing the term heat injustice to describe entrenched injustice in green space distribution and corresponding resident perceptions, experiences of and vulnerabilities to heat within the city.
BACKGROUND: There is strong evidence of mortality being associated to extreme temperatures but the extent to which individual or residential factors modulate this temperature vulnerability is less clear. METHODS: We conducted a multi-city study with a time-stratified case-crossover design and used conditional logistic regression to examine the association between extreme temperatures and overall natural and cause-specific mortality. City-specific estimates were pooled using a random-effect meta-analysis to describe the global association. Cold and heat effects were assessed by comparing the mortality risks corresponding to the 2.5(th) and 97.5(th) percentiles of the daily temperature, respectively, with the minimum mortality temperature. For cold, we cumulated the risk over lags of 0 to 28 days before death and 0 to 7 days for heat. We carried out stratified analyses and assessed effect modification by individual characteristics, preexisting chronic health conditions and residential environment (population density, built-up area and air pollutants: PM(2.5), NO(2), O(3) and black carbon) to identify more vulnerable population subgroups. RESULTS: Based on 307,859 deaths from natural causes, we found significant cold effect (OR = 1.42, 95%CI: 1.30-1.57) and heat effect (OR = 1.17, 95%CI: 1.12-1.21) for overall natural mortality and for respiratory causes in particular. There were significant effects modifications for some health conditions: people with asthma were at higher risk for cold, and people with psychoses for heat. In addition, people with long or frequent hospital admissions in the year preceding death were at lower risk. Despite large uncertainties, there was suggestion of effect modification by air pollutants: the effect of heat was higher on more polluted days of O(3) and black carbon, and a higher cold effect was observed on more polluted days of PM(2.5) and NO(2) while for O(3), the effect was lower. CONCLUSIONS: These findings allow for targeted planning of public-health measures aiming to prevent the effects of extreme temperatures.
Intensive urbanization and global warming are impacting the health and well-being of urban population. Nevertheless, urban environments with different designs will have different micro and local climate conditions. This study used data from micrometeorological measurements performed in different urban spaces (downtown, urban park, riverside) in Banja Luka, Bosnia and Herzegovina, on hot summer days in June 2021. Air temperature, relative humidity, wind speed, and globe temperature were measured and Mean Radiant Temperature (Tmrt), Psychologically Equivalent Temperature (PET), and modified Psychologically Equivalent Temperature (mPET) were calculated for each location. Results show that the downtown is the most uncomfortable area in terms of the highest Ta, Tg, Tmrt, PET, and mPET values registered at this location. The urban park is the most comfortable area with the lowest values of Tg, Tmrt, PET, and mPET. Relative humidity is the highest at the riverside and the lowest in downtown. Furthermore, riverside had lower average Ta during summer daytime compared to urban park and downtown likely due to the synergy between river cooling effect (evaporation and sensible heat transfer) and tree shade.
Climate change at the regional and local levels is forcing strong implementation of urban adaptation strategies related to climate-conscious urbanization and public health. Accordingly, the application of parameters that assess thermal stress in urban areas, such as outdoor thermal comfort (OTC) indices, is of paramount importance. As a contribution to this statement, long-term (1961-2020) datasets of daily OTC indices for the city of Banja Luka (Bosnia and Hercegovina) were used. Detailed temporal analysis using Physiologically Equivalent Temperature (PET), Universal Thermal Climate Index (UTCI), and Mean Radiant Temperature (Tmrt) was performed for (a) the entire research period, (b) the decadal level, and (c) defined heat/cold stress subcategories. The results show an intensive increase in extreme/strong heat days in the last 20 years, and the number of these days is five times higher than in the’70 s and’80 s. Decreasing tendencies are noticed in extreme/strong cold days towards the last two decades.
The state of the thermal environment can affect human health and well-being. Heat stress is associated with a wide range of health outcomes increasing morbidity and mortality and is recognized as an important health risk posed by climate change. This study aims at examining the effect of thermal conditions on the daily number of hospital admissions in Cyprus. Data from eight public hospitals located in five districts of Cyprus were analyzed from 2009 to 2018. Meteorological hourly gridded data were extracted by the ERA-5 Land reanalysis database with a spatial horizontal resolution of 0.1° × 0.1°. The Physiologically Equivalent Temperature (PET) and the Universal Thermal Climate Index (UTCI) were calculated as measures of the integrated effect of meteorological variables. Negative binomial regression was fitted to examine associations between the daily number of hospital admissions and meteorological variables, PET, and UTCI. The results showed that the mean daily temperature (Tair) was positively associated with hospital admissions from any cause. Hospital admissions increased by 0.6% (p < 0.001) for each 1 °C increase of Tair and by 0.4% (p < 0.001) for each 1 °C increase of PET and UTCI. Ozone and nitrogen oxides act as confounding factors. An effect of particulate matter (less than 10 μm in diameter) was observed when the analysis focused on April to August. Thresholds above which hospital admissions are likely to increase include daily mean Tair = 26.1 °C, PET = 29 °C, and UTCI = 26 °C. Studies on heat-related health effects are necessary to monitor health patterns, raise awareness, and design adaptation and mitigation measures.
BACKGROUND: Heatwaves are known to increase mortality. However, there is a need for more quantitative information on factors affecting sensitivity to the adverse health effects, particularly in countries with cool summer temperatures. OBJECTIVES: We evaluated mortality risk related to heatwave days in Finland. Risk was examined by age, sex, cause of death, and place of death, including health and social care facilities and homes. Mortality was also analysed for different patient subgroups in healthcare facilities. METHODS: Heatwaves were defined as periods when the daily average temperature exceeded the 90th percentile of that from May to August in 2000-2014 for ≥4 days. In addition to all heatwave days, risk was analysed for short (4-5 days) and long (≥10 days) heatwaves. Mortality analyses were based on linking registry data on i) daily non-accidental and cause-specific mortality and ii) admissions to a health or social care facility. Statistical analyses were conducted using generalised estimating equations for longitudinal data analysis, assuming a Poisson distribution for the daily mortality count. RESULTS: During all heatwave days, mortality increased among those aged 65-74 years (6.7%, 95% confidence interval 2.9-10.8%) and ≥75 years (12.8%, 95% CI 9.8-15.9%). Mortality increased in both sexes, but the risk was higher in women. Positive associations were observed for deaths due to respiratory diseases, renal diseases, mental and behavioural disorders, diseases of the nervous system, and cardiovascular diseases. Overall, effects were stronger for long than short heatwaves. During all heatwave days, mortality increased in healthcare facilities in outpatients (26.9%, 95% CI 17.3-37.2%) and inpatients. Among inpatients, the risk was higher in long-term inpatients (stay in ward > 30 days, 13.1%, 95% CI 8.6-17.7%) than others (5.8%, 95% CI 2.7-9.0%). At homes, mortality increased by 8.1% (95% CI 1.9-14.6%). Elevated risk estimates were also detected for social care facilities. CONCLUSIONS: In Finland, a cold-climate Northern country, heatwaves increase mortality risk significantly among the elderly. Women are more susceptible than men, and many chronic diseases are important risk factors. To reduce heatwave-related deaths, preparedness should be improved particularly in hospital and healthcare centre wards, where the most vulnerable are long-term inpatients. However, measures are also needed to protect the elderly at home and in social care facilities, especially during prolonged hot periods.
In this article, we examine the effects of high temperatures on hospital visits and mortality in Finland. This provides new information of the topic in a context of predominantly cool temperatures. Unique, individual-level data are used to examine the relationship at the municipality-month level over a span of 20 years. Linear regression methods alongside high-dimensional fixed effects are used to minimize confounding variation. Analysis is conducted with special emphasis on the elderly population, as well as on specific elderly risk groups identified in previous literature. We show that for an additional day per month above 25°C, monthly all-cause mortality increases by 1.5 percent (95% CI: 0.4%-2.6%) and acute hospital visits increase by 1.1 percent (95% CI: 0.7%-1.6%). We also find some evidence that these effects are elevated in selected population subgroups, the low-income elderly, and people with dementia. Hospital visits also increase among younger age groups, illustrating the importance of using multiple health indicators. Such detailed evidence is important for identifying vulnerable groups as extreme heat waves are expected to become more frequent and intense in northern countries.
INTRODUCTION: In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France. METHODS: Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015. RESULTS: The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval “CI”: [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types. CONCLUSION: Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.
OBJECTIVES: Between 2015 and 2019, 5700 excess deaths were observed during heatwaves in France. The summer of 2020 combined exceptionally high temperatures with the COVID-19 pandemic. The associated health impacts of this unique situation are described in this study. STUDY DESIGN: This is an observational study based on indicators of the French heat prevention plan. METHODS: Mortality and morbidity data during heatwaves were compared between 2020 and previous years, alongside COVID-19 in-hospital mortality. RESULTS: In total, 1921 additional deaths (+18.2%) were observed during the 2020 heatwaves, which is the largest number of deaths observed since 2003. Less than 100 deaths were attributed to COVID-19 during the heatwaves of 2020. CONCLUSIONS: Exceptionally high temperatures driven by climate change, combined with health inequities exacerbated by the COVID-19 outbreak, may have increased vulnerability to heat in 2020.
Heatwaves affect human health and should be more and more frequent because of global warming and could lead to increase mortality in general population, especially regarding cardiovascular mortality. During the summer 2019, Europe experienced a strong episode of heatwave. Telemonitoring of patients with heart failure (HF) provide an elegant tool to monitor closely the weights, and we assumed to be able to assess our hypothesis through a nationwide telemonitoring system. Here, we hypothesize that (i) there will be a change in patients’ weight during the heatwave and (ii) that the telemonitoring would enable us to follow these changes. The change in weight would be a surrogate for clinical worsening (with or without decompensated HF). Briefly, 1420 patients with a median age of 73.0 years and mean weight of 78.1 kg have been included in this analysis. The relationship between temperature and weight is very strong (P < 10(-7) ). The magnitude of the effect seems clinically relevant with a variation of 1.5 kg during a short period. This could expose patients to increased symptoms, HF decompensations, and poor outcomes. These results suggest a new way to implement weight telemonitoring in HF. This suggests also a direct impact of global warming on Human health, with acute episodes that are expected to occur more often, threatening patients with chronic diseases, especially patients with heart failure. In clinical practice, this urges to take into consideration the episodes of extreme heatwave and suggest that we have already useful tools including telemonitoring available in frail patients.
Background The frequency and intensity of heatwaves are expected to increase in the coming years. To promote resilient cities, it is key to have insights in populations with low preparedness levels. This study investigated personal characteristics associated with heatwave-protective knowledge, and preferred information channels and sources on this topic in cities in Georgia. Methods We undertook a street survey among three large cities in Georgia, including the capital Tbilisi. We collected demographic, socio-economic, medical and behavioural characteristics as potential risk factors for reduced heatwave-protective knowledge. Furthermore, we asked respondents about information channels and sources they use and prefer to obtain information on heatwave-protective measures. Results Being male, parent of children under the age of 12 and having a lower educational level are risk factors for lower knowledge levels on heatwave protection. Being homemakers, retiree, having fasted and using medication are protective factors. Television and internet are the channels more often used for obtaining information on heatwave-protective measures, and people prefer to receive information on this topic from health authorities. Conclusion Our findings identified characteristics that make people more vulnerable to heatwaves, due to a reduced knowledge level on heatwave protection. Targeted communication towards these groups, using information sources and media specifically aimed at this target audience, could improve this.
As climate change progresses, it is causing more frequent and severe heat waves, resulting in higher indoor temperatures. Various temperature thresholds for indicating indoor overheating have been proposed in different contexts, extending from reduced comfort in buildings to subjective heat stress and onset of first or serious health problems. This study reviews these thresholds and identifies threshold values for subjective heat stress of occupants in the city of Augsburg, Germany, distinguishing between vulnerable and non-vulnerable households. Survey data from 427 private households are analysed using unpaired analysis of variances (ANOVA), t-tests and regression analysis to identify factors related to subjective heat stress at home during night-time. The findings imply that health implications during heat waves, age, local climate zones favouring the urban heat island effect and higher indoor temperature represent significant factors for subjective heat stress. A significant difference in subjective heat stress among different groups related to temperature could be identified for thresholds of 24.8 degrees C (people living alone) and 26.7 degrees C (people with chronic disease). As WHO threshold for health risk from overheating is 24 degrees C, people are apparently at heat-related risk without feeling that they are at risk, especially when they have chronic diseases; thus they may not see the urgency of taking adaptation measures.
Exposure to heat has a range of potential negative impacts on human health; hot weather may exacerbate cardiovascular and respiratory illness or lead to heat stroke and death. Urban populations are at increased risk due to the Urban Heat Island (UHI) effect (higher urban temperatures compared with rural ones). This has led to extensive investigation of the summertime UHI and its effects, whereas far less research focuses on the wintertime UHI. Exposure to low temperature also leads to a range of illnesses, and in fact, in the UK, annual cold-related mortality outweighs heat-related mortality. It is not clearly understood to what extent the wintertime UHI may protect against cold related mortality. In this study we quantify the UHI intensity in wintertime for a heavily urbanized UK region (West Midlands, including Birmingham) using a regional weather model, and for the first time, use a health impact assessment (HIA) to estimate the associated impact on cold-related mortality. We show that the population-weighted mean winter UHI intensity was +2.3 °C in Birmingham city center, and comparable with that of summer. Our results suggest a potential protective effect of the wintertime UHI, equivalent to 266 cold-related deaths avoided (~15% of total cold-related mortality over ~11 weeks). When including the impacts of climate change, our results suggest that the number of heat-related deaths associated with the summer UHI will increase from 96 (in 2006) to 221 in the 2080s, based on the RCP8.5 emissions pathway. The protective effect of the wintertime UHI is projected to increase only slightly from 266 cold-related deaths avoided in 2009 to 280 avoided in the 2080s. The different effects of the UHI in winter and summer should be considered when assessing interventions in the built environment for reducing summer urban heat, and our results suggest that the future burden of temperature-related mortality associated with the UHI is likely to increase in summer relative to winter.
Air temperature has been the most commonly used exposure metric in assessing relationships between thermal stress and mortality. Lack of the high-quality meteorological station data necessary to adequately characterize the thermal environment has been one of the main limitations for the use of more complex thermal indices. Global climate reanalyses may provide an ideal platform to overcome this limitation and define complex heat and cold stress conditions anywhere in the world. In this study, we explored the potential of the Universal Thermal Climate Index (UTCI) based on ERA5 – the latest global climate reanalysis from the European Centre for Medium-Range Weather Forecasts (ECMWF) – as a health-related tool. Employing a novel ERA5-based thermal comfort dataset ERA5-HEAT, we investigated the relationships between the UTCI and daily mortality data in 21 cities across 9 European countries. We used distributed lag nonlinear models to assess exposure-response relationships between mortality and thermal conditions in individual cities. We then employed meta-regression models to pool the results for each city into four groups according to climate zone. To evaluate the performance of ERA5-based UTCI, we compared its effects on mortality with those for the station-based UTCI data. In order to assess the additional effect of the UTCI, the performance of ERA5-and station-based air temperature (T) was evaluated. Whilst generally similar heat- and cold-effects were observed for the ERA5-and station-based data in most locations, the important role of wind in the UTCI appeared in the results. The largest difference between any two datasets was found in the Southern European group of cities, where the relative risk of mortality at the 1st percentile of daily mean temperature distribution (1.29 and 1.30 according to the ERA5 vs station data, respectively) considerably exceeded the one for the daily mean UTCI (1.19 vs 1.22). These differences were mainly due to the effect of wind in the cold tail of the UTCI distribution. The comparison of exposure-response relationships between ERA5-and station-based data shows that ERA5-based UTCI may be a useful tool for definition of life-threatening thermal conditions in locations where high-quality station data are not available.
Few studies have used empirical evidence of past adaptation to project temperature-related excess mortality under climate change. Here, we assess adaptation in future projections of temperature-related excess mortality by employing evidence of shifting minimum mortality temperatures (MMTs) concurrent with climate warming of recent decades. The study is based on daily non-external mortality and daily mean temperature time-series from 11 Spanish cities covering four decades (1978-2017). It employs distributed lag non-linear models (DLNMs) to describe temperature-mortality associations, and multivariate mixed-effect meta-regression models to derive city- and subperiod-specific MMTs, and subsequently MMT associations with climatic indicators. We use temperature projections for one low- and one high-emission scenario (ssp126, ssp370) derived from five global climate models. Our results show that MMTs have closely tracked mean summer temperatures (MSTs) over time and space, with meta-regression models suggesting that the MMTs increased by 0.73 degrees C (95%CI: 0.65, 0.80) per 1 degrees C rise in MST over time, and by 0.84 degrees C (95%CI: 0.76, 0.92) per 1 degrees C rise in MST across cities. Future projections, which include adaptation by shifting MMTs according to observed temporal changes, result in 63.5% (95%CI: 50.0, 81.2) lower heat-related excess mortality, 63.7% (95%CI: 30.2, 166.7) higher cold-related excess mortality, and 11.2% (95%CI: -5.5, 39.5) lower total temperature-related excess mortality in the 2090s for ssp370 compared to estimates that do not account for adaptation. For ssp126, assumptions on adaptation have a comparatively small impact on excess mortality estimates. Elucidating the adaptive capacities of societies can motivate strengthened efforts to implement specific adaptation measures directed at reducing heat stress under climate change.
Aim To determine the relationship between seasonal changes in ambient temperature, humidity and general and specific mortality rates in the area of Zenica-Doboj Canton. Methods Changes in the average monthly mortality in the period from 2008 to 2019 were analysed (linear regression) in relation to the average temperatures and humidity in those months in the same time period in Zenica-Doboj Canton. Results Overall mortality increased from 7.9 ‰ in 2008 to 10.2 ‰ in 2019. Overall and specific mortality rates for cardiovascular, malignant, respiratory and metabolic diseases followed seasonal change of ambient temperature and humidity. The monitoring trend showed strong determination degree for overall mortality and mortality for cardiovascular, malignant and respiratory diseases, while for metabolic diseases it was somewhat lower. The highest mortality rates were found in January (cold month), and in August (warm month); the lowest one was in May, September and October. There was a strong significant negative correlation between temperature and mortality rates, while the correlation between humidity and mortality rates was not significant. Conclusion As we have proven that mortality rates followed seasonal changes in ambient temperature and determined months with the least mortality rate, the community must take measures to ensure microclimatic conditions for the survival of patients with cardiovascular, malignant, respiratory and metabolic diseases.
Climate change means the UK will experience warmer winters and hotter summers in the future. Concurrent energy efficiency improvements to housing may modify indoor exposures to heat or cold, while population aging may increase susceptibility to temperature-related mortality. We estimate heat and cold mortality and energy consumption in London for typical (non-extreme) future climates, given projected changes in population and housing. Building physics models are used to simulate summertime and wintertime indoor temperatures and space heating energy consumption of London dwellings for ‘baseline’ (2005-2014) and future (2030s, 2050s) periods using data from the English Housing Survey, historical weather data, and projected future weather data with temperatures representative of ‘typical’ years. Linking to population projections, we calculate future heat and cold attributable mortality and energy consumption with demolition, construction, and alternative scenarios of energy efficiency retrofit. At current retrofit rates, around 168-174 annual cold-related deaths per million population would typ-ically be avoided by the 2050s, or 261-269 deaths per million under ambitious retrofit rates. Annual heat deaths would typically increase by 1 per million per year under the current retrofit rate, and 12-13 per million under ambitious rates without population adaptation to heat. During typical future summers, an estimated 38-73% of heat-related deaths can be avoided using external shutters on windows, with their effectiveness lower during hotter weather. Despite warmer winters, ambitious retrofit rates are nec-essary to reduce typical annual energy consumption for heating below baseline levels, assuming no improvement in heating system efficiencies. Concerns over future overheating in energy efficient housing are valid but increases in heat attributable mortality during typical and hot (but not extreme) summers are more than offset by significant reductions in cold mortality and easily mitigated using passive mea-sures. More ambitious retrofit rates are critical to reduce energy consumption and offer co-benefits for reducing cold-related mortality. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
Periods of extremely hot and cold weather can cause significant mortality and morbidity in both temperate and more extreme climates. In the UK, their occurrence prompts the issuing of number and colour coded warnings providing an assessment of the level of risk. These are designed to minimize health impact by prompting timely and appropriate mitigating actions by the public. Drawing upon the interdisciplinary notion of framing, I report on a study that identified a central role for language in mediating how these warnings are interpreted and evaluated. I use an innovative approach that combines the quantitative tools of corpus linguistics to identify the language used to represent warnings and the risks of extreme temperature in the mass media, with qualitative analysis of focus group discussions of typical texts. A comparison of both datasets indicates a multi-layered interactivity between the myriad ways in which language can give salience to aspects of a risk scenario and an interpreter’s knowledge and perception of a threat, and that underlying such interactions, is the conceptualization of risk as scalar property.
During the last decades the effects of thermal stress on public health have been a great concern worldwide. Thermal stress is determined by air temperature in combination with other meteorological parameters, such as relative humidity and wind speed. The present study is focused on the Mediterranean city of Thessaloniki, Greece and it aims to explore the association between thermal stress and mortality from cardiovascular diseases, using both air temperature and other thermal indices as indicators. For that, an over-dispersed Poisson regression function was used, in combination with distributed lag non-linear models, in order to capture the delayed and nonlinear effects of temperature. Our results revealed a reverse J-shaped exposure-response curve for the total population and females and a U-shaped association for males. In all cases examined, the minimum mortality temperature was identified around the 80th percentile of each distribution. It is noteworthy that despite the fact that the highest risks of cardiovascular mortality were estimated for exposure to extreme temperatures, moderate temperatures were found to cause the highest burden of mortality. On the whole, our estimations demonstrated that the population in Thessaloniki is more susceptible to cold effects and in regard with gender, females seem to be more vulnerable to ambient thermal conditions.
Climate change poses an unprecedented challenge to population health and health systems’ resilience, with increasing fluctuations in extreme temperatures through pressures on hospital capacity. While earlier studies have estimated morbidity attributable to hot or cold weather across cities, we provide the first large-scale, population-wide assessment of extreme temperatures on inequalities in excess emergency hospital admissions in England. We used the universe of emergency hospital admissions between 2001 and 2012 combined with meteorological data to exploit daily variation in temperature experienced by hospitals (N = 29,371,084). We used a distributed lag model with multiple fixed-effects, controlling for seasonal factors, to examine hospitalisation effects across temperature-sensitive diseases, and further heterogeneous impacts across age and deprivation. We identified larger hospitalisation impacts associated with extreme cold temperatures than with extreme hot temperatures. The less extreme temperatures produce admission patterns like their extreme counterparts, but at lower magnitudes. Results also showed an increase in admissions with extreme temperatures that were more prominent among older and socioeconomically-deprived populations – particularly across admissions for metabolic diseases and injuries.
BACKGROUND: Ambient temperature, particularly heat, is increasingly acknowledged as a trigger for preterm delivery but study designs have been limited and results mixed. We aimed to comprehensively evaluate the association between ambient temperature throughout pregnancy and preterm delivery. METHODS: We estimated daily temperature throughout pregnancy using a cutting-edge spatiotemporal model for 5347 live singleton births from three prospective cohorts in France, 2002-2018. We performed Cox regression (survival analysis) with distributed lags to evaluate time-varying associations with preterm birth simultaneously controlling for exposure during the first 26 weeks and last 30 days of pregnancy. We examined weekly mean, daytime, night-time and variability of temperature, and heatwaves accounting for adaptation to location and season. RESULTS: Preterm birth risk was higher following cold (5th vs 50th percentile of mean temperature) 7-9 weeks after conception [relative risk (RR): 1.3, 95% CI: 1.0-1.6 for 2°C vs 11.6°C] and 10-4 days before delivery (RR: 1.6, 95% CI: 1.1-2.1 for 1.2°C vs 12.1°C). Night-time heat (95th vs 50th percentile of minimum temperature; 15.7°C vs 7.4°C) increased risk when exposure occurred within 5 weeks of conception (RR: 2.0, 95% CI: 1.05-3.8) or 20-26 weeks after conception (RR: 2.9, 95% CI: 1.2-6.8). Overall and daytime heat (high mean and maximum temperature) showed consistent effects. We found no clear associations with temperature variability or heatwave indicators, suggesting they may be less relevant for preterm birth. CONCLUSIONS: In a temperate climate, night-time heat and chronic and acute cold exposures were associated with increased risk of preterm birth. These results suggest night-time heat as a relevant indicator. In the context of rising temperatures and more frequent weather hazards, these results should inform public health policies to reduce the growing burden of preterm births.
Climate change is expected to increase heat-related mortality across the world. Health Impact Assessment (HIA) studies are used to quantify the impact of higher temperatures, taking into account the effect of population adaptation. Although air-conditioning (AC) is one of the main drivers of technological adaptation to heat, the health impacts associated with AC-induced air pollution have not been examined in detail. This study uses the city of Thessaloniki, Greece as a case study and aims to estimate the future heat-related mortality, the residential cooling demand, and the adaptation trade-off between averted heat-related and increased air pollution cardiorespiratory mortality. Using temperature and population projections under different Coupled Model Intercomparison Project Phase 6 (CIMP6) Shared Socioeconomic Pathways scenarios (SSPs), a HIA model was developed for the future heat and air pollution cardiorespiratory mortality. Counterfactual scenarios of either black carbon (BC) or natural gas (NG) being the fuel source for electricity generation were included in the HIA. The results indicate that the heat-related cardiorespiratory mortality in Thessaloniki will increase and the excess of annual heat-related deaths in 2080-2099 will range from 2.4 (95% CI: 0.0-20.9) under SSP1-2.6 to 433.7 (95% CI: 66.9-1070) under SSP5-8.5. Population adaptation will attenuate the heat-related mortality, although the latter may be counterbalanced by the higher air pollution-related mortality due to increased AC, especially under moderate SSP scenarios and coal-fired power plants. Future studies examining the health effects of warmer temperatures need to account for the impact of both adaptation and increased penetration and use of AC.
The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed.
The objective of this study was to analyze at the level of Spain’s 52 provinces province level the temporal evolution of minimum mortality temperatures (MMT) from 1983 to 2018, in order to determine whether the increase in MMT would be sufficient to compensate for the increase in environmental temperatures in Spain for the period. It also aimed to analyze whether the rate of evolution of MMT would be sufficient, were it to remain constant, to compensate for the predicted increase in temperatures in an unfavorable (RCP 8.5) emissions scenario for the time horizon 2051-2100. The independent variable was made up of maximum daily temperature data (Tmax) for the summer months in the reference observatories of each province for the 1983-2018 period. The dependent variable was daily mortality rate due to natural causes (ICD 10: A00-R99). For each year and province, MMT was determined using a quadratic or cubic fit (p < 0.05). Based on the annual MMT values, a linear fit was carried out that allowed for determining the time evolution of MMT. These values were compared with the evolution of Tmax registered in each observatory during the 1983-2018 analyzed period and with the predicted values of Tmax obtained for an RCP8.5 scenario for the period 2051-2100. The rate of global variance in Tmax in the summer months in Spain during the 1983-2018 period was 0.41 °C/decade, while MMT across the whole country increased at a rate of 0.64 °C/decade. Variations in the provinces were heterogeneous. For the 2051-2100 time horizon, there was predicted increase in Tmax values of 0.66 °C/decade, with marked geographical differences. Although at the global level it is possible to speak of adaptation, the heterogeneities among the provinces suggest that the local level measures are needed in order to facilitate adaptation in those areas where it is not occurring.
In the context of dense urban environments and climate change, pedestrians’ thermal experience plays an increasingly significant role in people’s health and well-being. In this research, the authors combine the fields of architecture, climate-responsive design, and robotic fabrication with the goal of investigating strategies to improve outdoor thermal comfort for pedestrians in cities with frequent extreme heat events. Based on a case study in the city of Munich, this paper presents findings into the technological approaches and methods for location-specific climate-resilient brick facades using robotic assembly. To achieve this goal, different bricklaying patterns were investigated to create a self-shading effect and thus reduce solar radiation and ultimately achieve an improved thermal condition for pedestrians moving along urban facades at street level. Using computer-aided microclimate simulation, generic self-shading brick pattern designs were tailored to highly location-specific microclimate requirements. Robotic assembly technology was used to produce such tailored, non-standard brickwork facades. The results of this research led to a data-informed design process with a demonstrator object being realized at 1:1 scale with a height of 2 m and a length of 3 m using a collaborative robot on site. Thermal measurements on the built demonstrator provided indications of reduced surface temperatures despite high solar radiation and thus validated the location-specific self-shading effects according to solar radiation simulation.
BACKGROUND: Adapting the urban environment to heat is a public health priority in the context of climate change. Cities are now considering interventions on specific urban characteristics known to contribute to the urban heat island (UHI) such as vegetation and imperviousness. OBJECTIVES: To explore how these urban characteristics influence the temperature-mortality relationship in the Paris region. METHODS: We modeled the temperature-mortality relationship for the 1300 municipalities of the region from 1990 to 2015, while including an interaction with indicators that summarize the municipalities’ main urban characteristics. Four indicators were tested: lack of green spaces, lack of trees, proportion of impervious surface, and overexposed population to a potential night UHI. RESULTS: The shape of the temperature-mortality relationship was similar across all municipalities, but with a higher slope at the highest temperatures in municipalities with less green spaces, less trees, and more impervious soil. For instance, in Paris and its close suburbs, the relative risk associated with a temperature in the 99th percentile of the temperature distribution (compared to the 50th percentile) was 2.17 [IC95% 1.98:2.38] in municipalities with 40% of their surface covered by trees compared to 2.57 [IC 95% 2.47:2.68] in municipalities with only 3% of their surface covered by trees. DISCUSSION: A lack of vegetation and a high degree of imperviousness were associated with a higher risk of heat-related mortality in the Paris region. Therefore, we can assume that interventions targeting these characteristics could reduce the health impacts of extreme heat. Such interventions should be coupled with other initiatives such as protecting the most vulnerable and promoting appropriate behaviors.
Extreme heatwaves will occur more frequently and with higher intensity in future. Their consequences for human health can be fatal if adaptation measures will not be taken. This study analyses factors related to heat adaptation measures in private households in Germany. During the summer months of 2019, indoor temperatures were measured in over 500 private households in the City of Augsburg, Germany, accompanied by a survey to find out about heat perception and adaptation measures. Hypotheses deducted from the Protective Action Decision Model were tested using one-way ANOVAs, regression analysis and in the end a multiple hierarchical regression model. The results of the hypotheses tested imply an influence of knowledge and heat risk perception of heat adaptation behaviour and an influence of age on heat risk perception. The results of the regression model show an influence of the efficacy-related attribute, of age, indoor temperature, subjective heat stress and health implications to heat adaptation behaviour. In the end, this study proposes adjustments to the PADM according to the results of the hierarchical regression analysis.
Urbanization, environmental change and ageing are putting urban health at risk. In many cities, heat stress is projected to increase. Urban green spaces are considered as an important resource to strengthen the resilience of city dwellers. We conducted a questionnaire survey in two structurally distinct parks in Leipzig, Germany, on hot summer days in 2019. We assessed the respondents? activity patterns, satisfaction with the existing infrastructure, heat-related health impairment, changes in park use during heat waves and evaluation of the role of parks in coping with heat stress. We found that the old-grown, tree-rich park was used significantly more frequently for experiencing nature, while the newer, less tree-rich park developed on a former railway-brownfield site was used more often for socializing and having BBQs and picnics. Satisfaction with available drinking fountains and public toilets was generally low and satisfaction with lighting was assessed less satisfactory in the old-grown park. Safety was assessed as satisfactory in general but significantly less satisfactory by female respondents. The heat stress summary score indicating heat-related health impairment was significantly higher for participants in the newer park. A high share of respondents stated that they used parks during heat waves as frequently as usual in the summer (46 %), while some respondents stated that they adapted their park use behaviour (18 %), e.g., by coming later in the evening. Regarding the participants? responses about the role of parks under summer heat conditions, we matched 138 statements to several regulating and cultural ecosystem services, and we found cooling and recreation to be mentioned most often. We concluded that green space planning should diminish usage barriers, such as insufficient lighting and insufficient sanitary infrastructure, to ensure equal park use opportunities for all city dwellers. Specific local environmental and sociocultural conditions, changing environments and climate adaptation must be considered. To maintain ecological processes and functions and to cope with climate change, urban planning should preserve older parks with a large amount of tree coverage while respecting demands for particular built infrastructure.
For both tree-lined sidewalks of a shallow and deep E-W street canyon located in the city of Freiburg (Southwest Germany), the solar elevation impact on the magnitude of the daytime human heat stress mitigation (hhsm) is analysed in dependence of different tree scenarios. Identic ENVI-met simulations are carried out on the summer solstice day 21 June 2003 and heat wave day 4 August 2003. All simulation scenarios indicate an almost negligible solar elevation impact on hhsm in terms of spatiotemporal averaged air temperature. The results achieved on both simulation days for the spatiotemporal averaged mean radiation temperature (T-mrt) and physiologically equivalent temperature (PET) as well as spatially high-resolution PET reflect that the north-facing sidewalk in both street canyons is entirely shaded by the south-bounding building. Secondarily it is influenced by lower radiant flux densities from the trees near the curb edges of both sidewalks. On both simulation days, the south-facing sidewalk in the shallow street canyon is only shaded by the tree crowns. In the deep street canyon, however, the south-facing sidewalk is completely shaded on 4 August by the south-bounding building, while on 21 June this shade is limited to its southern half, i.e. its northern half is directly influenced by the shade of trees. Due to these shading conditions, the results focused on pedestrians on both sidewalks show different patterns of the solar elevation impact on T-mrt and PET as well as hhsm in terms of T-mrt and PET. While increasing tree crown projection areas lead to a lower solar elevation impact on T-mrt and PET, they cause a more distinct hhsm in terms of T-mrt and PET for higher solar elevations. The non-negligible magnitude of the solar elevation impact in all scenarios leads to the recommendation to carry out ensemble simulations in order to achieve T-mrt, PET, hhsm-T-mrt and hhsm-PET results, which are reliable for planning applications.
This paper analyses the probabilistic future behaviour of heat-waves (HWs) in the city of Madrid in the twenty-first century, using maximum daily temperatures from twenty-one climate circulation models under two representative concentration pathways (RCP 8.5 & RCP 4.5). HWs are modelled considering three factors: number per annum, duration and intensity, characterised by three stochastic processes: Poisson, Gamma and truncated Gaussian, respectively. Potential correlations between these processes are also considered. The probabilistic temperature behaviour is combined with an epidemiological model with stochastic mortality risk following a generalized extreme value distribution (gev). The objective of this study is to obtain probability distributions of mortality and risk measures such as the mean value of the 5% of worst cases in the 21st century, in particular from 2025 to 2100. Estimates from stochastic models for characterising HWs and epidemiological impacts on human health can vary from one climate model to another, so relying on a single climate model can be problematic. For this reason, the calculations are carried out for 21 models and the average of the results is obtained. A sensitivity adaptation analysis is also performed. Under RCP 8.5 for 2100 for Madrid city a mean excess of 3.6 °C over the 38 °C temperature threshold is expected as the average of all models, with an expected attributable mortality of 1614 people, but these figures may be substantially exceeded in some cases if the highest-risk cases occur.
Due to phenomena such as urban heat islands, outdoor thermal comfort of the cities’ residents emerges as a growing concern. A major challenge for mega-cities in changing climate is the design of urban spaces that ensure and promote pedestrian thermal comfort. Understanding pedestrian behavioural adaptation to urban thermal environments is critically important to attain this goal. Current research in pedestrian behaviour lacks controlled experimentation, which limits the quantitative modelling of such complex behaviour. Combining well-controlled experiments with human participants and computational methods inspired by behavioural ecology and decision theory, we examine the effect of sun exposure on route choice in a tropical city. We find that the distance walked in the shade is discounted by a factor of 0.86 compared to the distance walked in the sun, and that shadows cast by buildings have a stronger effect than trees. The discounting effect is mathematically formalised and thus allows quantification of the behaviour that can be used in understanding pedestrian behaviour in changing urban climates. The results highlight the importance of assessment of climate through human responses to it and point the way forward to explore scenarios to mitigate pedestrian heat stress.
In recent years, the increasing occurrence of heatwaves raises the cooling need of residential buildings in Scandinavian countries, which are traditionally not equipped with active cooling systems. Indoor overheating caused by such heatwaves leads to severe consequences for occupants, especially kids and seniors. Efficient and economical cooling solutions are urgently needed to cope with frequent heatwaves. The present study investigated the novel usage of the geothermal-assisted mechanical ventilation with heat recovery (GEO-MVHR) system for cooling purposes in typical Swedish multi-family dwellings. The cooling potential of the system and its contributions to thermal comfort were evaluated. Dynamic simulations were conducted to assess the system’s cooling performance under two climate scenarios: the climate of 2018 representing an extreme year with excessively hot summer and the climate of a typical meteorological year. The GEO-MVHR system shows great potential in mitigating indoor overheating with improved thermal comfort. A ventilation airflow rate of 0.50-0.70 l/s/m(2) is suggested for multi-family dwellings to maximize the cooling potential of the GEO-MVHR system. The indoor operative temperature could be reduced by up to 3 degrees C with the GEO-MVHR system operating for cooling. Modulating the supply air temperature of the GEO-MVHR system based on indoor thermal conditions is recommended, as it shows the advantage of avoiding unnecessary overcooling and energy saving.
Adaptation to climate change is often understood as a top-down decision-making and policy-implementing process, as well as application of expert knowledge, to prevent or reduce its (locally specific) negative consequences. In high-income societies, adaptation at the household level then frequently refers to adopting technological fixes distributed through the market, sometimes at a considerable cost. Informed by a study in the context of Central Europe, this article aims to discuss different practices of households and individuals that do not require increased consumption of energy or materials, but still help adapting to climate change in some of its local expressions, such as heatwaves and drought. They were described by participants in focus groups in six cities in the Czech Republic. I argue that such ‘inconspicuous adaptations’ emerge without connection to the climate change debate, or without deeper knowledge about the issue. Yet, they should not be overlooked as unimportant and short-term ‘coping responses’ and underestimated in this debate. They are part and parcel of the ongoing process of societal adaptation to climate change.
Increases in the magnitude and frequency of climate and other disruptive factors are placing environmental, economic, and social stresses on coastal systems. This is further exacerbated by land use transformations, urbanization, over-tourism, sociopolitical tensions, technological innovations, among others. A scenario-informed multicriteria decision analysis (MCDA) was applied in the Metropolitan City of Venice integrating qualitative (i.e., local stakeholder preferences) and quantitative information (i.e., climate-change projections) with the aim of enhancing system resilience to multiple climate-related threats. As part of this analysis, different groups of local stakeholders (e.g., local authorities, civil protection agencies, SMEs, NGOs) were asked to identify critical functions that needs to be sustained. Various policy initiatives were considered to support these critical functions. The MCDA was used to rank the initiatives across several scenarios describing main climate threats (e.g., storm surges, floods, heatwaves, drought). We found that many climate change scenarios were considered to be disruptive to stakeholders and influence alternative ranking. The management alternatives acting on physical domain generally enhance resilience across just a few scenarios while cognitive and informative initiatives provided resilience enhancement across most scenarios considered. With uncertainty of multiple stressors along with projected climate variability, a portfolio of cognitive and physical initiatives is recommended to enhance resilience.
Human health can be negatively impacted by hot or cold weather, which often exacerbates respiratory or cardiovascular conditions and increases the risk of mortality. Urban populations are at particular increased risk of effects from heat due to the Urban Heat Island (UHI) effect (higher urban temperatures compared with rural ones). This has led to extensive investigation of the summertime UHI, its impacts on health, and also the consideration of interventions such as reflective ‘cool’ roofs to help reduce summertime overheating effects. However, interventions aimed at limiting summer heat are rarely evaluated for their effects in wintertime, and thus their overall annual net impact on temperature-related health effects are poorly understood. In this study we use a regional weather model to simulate the winter 2009/10 period for an urbanized region of the UK (Birmingham and the West Midlands), and use a health impact assessment to estimate the impact of reflective ‘cool’ roofs (an intervention usually aimed at reducing the UHI in summer) on cold-related mortality in winter. Cool roofs have been shown to be effective at reducing maximum temperatures during summertime. In contrast to the summer, we find that cool roofs have a minimal effect on ambient air temperatures in winter. Although the UHI in summertime can increase heat-related mortality, the wintertime UHI can have benefits to health, through avoided cold-related mortality. Our results highlight the potential annual net health benefits of implementing cool roofs to reduce temperature-related mortality in summer, without reducing the protective UHI effect in winter. Further, we suggest that benefits of cool roofs may increase in future, with a doubling of the number of heat-related deaths avoided by the 2080s (RCP8.5) compared to summer 2006, and with insignificant changes in the impact of cool-roofs on cold-related mortality. These results further support reflective ‘cool’ roof implementation strategies as effective interventions to protect health, both today and in future.
In light of climate change, health risks are expected to be exacerbated by more frequent high temperatures and reduced by less frequent cold extremes. To assess the impact of different climate change scenarios, it is necessary to describe the current effects of temperature on health. A time-stratified case-crossover design fitted with conditional quasi-Poisson regressions and distributed lag non-linear models was applied to estimate specific temperature-mortality associations in nine urban agglomerations in Belgium, and a random-effect meta-analysis was conducted to pool the estimates. Based on 307,859 all-cause natural deaths, the mortality risk associated to low temperature was 1.32 (95% CI: 1.21-1.44) and 1.21 (95% CI: 1.08-1.36) for high temperature relative to the minimum mortality temperature (23.1 °C). Both cold and heat were associated with an increased risk of cardiovascular and respiratory mortality. We observed differences in risk by age category, and women were more vulnerable to heat than men. People living in the most built-up municipalities were at higher risk for heat. Air pollutants did not have a confounding effect. Evidence from this study helps to identify specific populations at risk and is important for current and future public health interventions and prevention strategies.
Ambient temperature can affect the survival rate of humans. Studies have shown a relationship between ambient temperature and mortality rate in hot and cold environments. This effect of ambient temperature on mortality seems to be more pronounced in older people. The aim of this study is to examine the effects of thermal stress on cardiovascular mortality and the associated relative risk per degree Celsius in Greek individuals ≥70 years old. Mortality data 1999-2012 were matched with the midday temperature. The present study found a higher circulatory mortality when ambient temperature is below or above the temperature range 6 to 39 °C.
OBJECTIVES: To identify the associations of temperature with non-COVID-19 mortality and all-cause mortality in the pandemic 2020 in comparison with the non-COVID-19 period in Italy. METHODS: The data on 3,189,790 all-cause deaths (including 3,134,137 non-COVID-19 deaths) and meteorological conditions in 107 Italian provinces between February 1st and November 30th in each year of 2015-2020 were collected. We employed a time-stratified case-crossover study design combined with the distributed lag non-linear model to investigate the relationships of temperature with all-cause and non-COVID-19 mortality in the pandemic and non-pandemic periods. RESULTS: Cold temperature exposure contributed higher risks for both all-cause and non-COVID-19 mortality in the pandemic period in 2020 than in 2015-2019. However, no different change was found for the impacts of heat. The relative risk (RR) of non-COVID-19 deaths and all-cause mortality at extremely cold (2 °C) in comparison with the estimated minimum mortality temperature (19 °C) in 2020 were 1.63 (95% CI: 1.55-1.72) and 1.45 (95%CI: 1.31-1.61) respectively, which were higher than all-cause mortality risk in 2015-2019 with RR of 1.19 (95%CI: 1.17-1.21). CONCLUSION: Cold exposure indicated stronger impacts than high temperatures on all-cause and non-COVID-19 mortality in the pandemic year 2020 compared to its counterpart period in 2015-2019 in Italy.
BACKGROUND/AIM: Extreme temperatures have impact on the health and occupational injuries. The construction sector is particularly exposed. This study aims to investigate the association between extreme temperatures and occupation injuries in this sector, getting an insight in the main accidents-related parameters. METHODS: Occupational injuries in the construction sector, with characteristic of accidents, were retrieved from Italian compensation data during years 2014-2019. Air temperatures were derived from ERA5-land Copernicus dataset. A region based time-series analysis, in which an over-dispersed Poisson generalized linear regression model, accounting for potential non-linearity of the exposure- response curve and delayed effect, was applied, and followed by a meta-analysis of region-specific estimates to obtain a national estimate. The relative risk (RR) and attributable cases of work-related injuries for an increase in mean temperature above the 75th percentile (hot) and for a decrease below the 25th percentile (cold) were estimated, with effect modifications by different accidents-related parameters. RESULTS: The study identified 184,936 construction occupational injuries. There was an overall significant effect for high temperatures (relative risk (RR) 1.216 (95% CI: (1.095-1.350))) and a protective one for low temperatures (RR 0.901 (95% CI: 0.843-0.963)). For high temperatures we estimated 3,142 (95% CI: 1,772-4,482) attributable cases during the studied period. RRs from 1.11 to 1.30 were found during heat waves days. Unqualified workers, as well as masons and plumbers, were found to be at risk at high temperatures. Construction, quarry and industrial sites were the risky working environments, as well as specific physical activities like working with hand-held tools, operating with machine and handling of objects. Contact with sharp, pointed, rough, coarse ‘Material Agent’ were the more risky mode of injury in hot conditions. CONCLUSIONS: Prevention policies are needed to reduce the exposure to high temperatures of construction workers. Such policies will become a critical issue considering climate change.
BACKGROUND: Human beings and society are experiencing substantial consequences caused by non-optimum temperatures. However, limited studies have assessed the economic burden of premature deaths attributable to non-optimum temperatures. OBJECTIVES: To characterize the association between daily mean temperature and the economic burden of premature deaths. METHODS: A total of 3 228 098 deaths were identified from a national mortality dataset in Italy during 2015 and 2019. We used the value of statistical life to quantify the economic losses of premature death. A two-stage time-series analysis was performed to evaluate the economic losses of premature deaths associated with non-optimum temperatures. Attributable burden for non-optimum temperatures compared with minimum risk temperature were estimated. Potential effect modifiers were further explored. RESULTS: From 2015 to 2019, the economic loss of premature deaths due to non-optimum temperatures was $525.52 billion (95% CI: $461.84-$580.80 billion), with the attributable fraction of 5.74% (95% CI: 5.04%-6.34%). Attributable economic burden was largely due to moderate cold temperatures ($309.54 billion, 95% CI: $249.49-$357.34 billion). A higher economic burden was observed for people above the age of 65, accounting for 75.97% ($452.42, 95%CI: $406.97-$488.76 billion) of the total economic burden. In particular, higher fractions attributable to heat temperatures were observed for provinces with the lowest level of GDP per capita but the highest level of urbanization. DISCUSSION: This study shows a considerable economic burden of premature deaths attributed to non-optimum temperatures. These figures can help inform tailored prevention to tackle the large economic burden imposed by non-optimum temperatures.
Climate change and climate-sensitive disasters caused by climatic hazards have a significant and increasing direct and indirect impact on human health. Due to its vast area, complex geographical environment and various climatic conditions, Russia is one of the countries that suffers significantly from frequent climate hazards. This paper provides information about temperature extremes in Russia in the beginning of the 21st century, and their impact on human health. A literature search was conducted using the electronic databases Web of Science, Science Direct, Scopus, and e-Library, focusing on peer-reviewed Researchs published in English and in Russian from 2000 to 2021. The results are summarized in 16 studies, which are divided into location-based groups, including Moscow, Saint Petersburg and other large cities located in various climatic zones: in the Arctic, in Siberia and in the southern regions, in ultra-continental and monsoon climate. Heat waves in cities with a temperate continental climate lead to a significant increase in all-cause mortality than cold waves, compared with cities in other climatic zones. At the same time, in northern cities, in contrast to the southern regions and central Siberia, the influence of cold waves is more pronounced on mortality than heat waves. To adequately protect the population from the effects of temperature waves and to carry out preventive measures, it is necessary to know specific threshold values of air temperature in each city.
BACKGROUND: The increased risk of mortality during periods of high and low temperatures has been well established. However, most of the studies used daily counts of deaths or hospitalisations as health outcomes, although they are the ones at the top of the health impact pyramid reflecting only a limited proportion of patients with the most severe cases. OBJECTIVES: This study evaluates the relationship between short-term exposure to the daily mean temperature and medication prescribed for the respiratory system in five Spanish cities. METHODS: We fitted time series regression models to cause-specific medical prescriptions, including different respiratory subgroups and age groups. We included a distributed lag non-linear model with lags up to 14 days for daily mean temperature. City-specific associations were summarised as overall-cumulative exposure-response curves. RESULTS: We found a positive association between cause-specific medical prescriptions and daily mean temperature with a non-linear inverted J- or V-shaped relationship in most cities. Between 0.3% and 0.6% of all respiratory prescriptions were attributed to cold for Madrid, Zaragoza and Pamplona, while in cities with only cold effects the attributable fractions were estimated as 19.2% for Murcia and 13.5% for Santander. Heat effects in Madrid, Zaragoza and Pamplona showed higher fractions between 8.7% and 17.2%. The estimated costs are in general higher for heat effects, showing annual values ranging between €191,905 and €311,076 for heat per 100,000 persons. CONCLUSIONS: This study provides novel evidence of the effects of the thermal environment on the prescription of medication for respiratory disorders in Spain, showing that low and high temperatures lead to an increase in the number of such prescriptions. The consumption of medication can reflect exposure to the environment with a lesser degree of severity in terms of morbidity.
Extreme temperatures are a threat to public health, increasing mortality in the affected population. Moreover, there is substantial research showing how age and gender shape vulnerabilities to this environmental risk. However, there is only limited knowledge on how socioeconomic status (SES), operationalized using educational attainment, stratifies the effect of extreme temperatures on mortality. Here, we address this link using Poisson regression and administrative data from 2012 to 2018 for 50 Spanish Provinces on individuals aged above 65 matched with meteorological data provided by the E-OBS dataset. In line with previous studies, results show that hot and cold days increase mortality. Results on the interaction between SES and extreme temperatures show a positive and significant effect of exposure to heat and cold for individuals with medium and low SES level. Conversely, for high SES individuals we do not find evidence of a robust association with heat or cold. We further investigate how the local climate moderates these associations. A warmer climate increases risks with exposures to low temperatures and vice versa for hot temperatures in the pooled sample. Moreover, we observe that results are mostly driven by low SES individuals being particularly vulnerable to heat in colder climates and cold in warmer climates. In conclusion, results highlight how educational attainment stratifies the effect of extreme temperatures and the relevance of the local climate in shaping risks of low SES individuals aged above 65.
New gridded climate datasets (GCDs) on spatially resolved modeled weather data have recently been released to explore the impacts of climate change. GCDs have been suggested as potential alternatives to weather station data in epidemiological assessments on health impacts of temperature and climate change. These can be particularly useful for assessment in regions that have remained understudied due to limited or low quality weather station data. However to date, no study has critically evaluated the application of GCDs of variable spatial resolution in temperature-mortality assessments across regions of different orography, climate, and size. Here we explored the performance of population-weighted daily mean temperature data from the global ERA5 reanalysis dataset in the 10 regions in the United Kingdom and the 26 cantons in Switzerland, combined with two local high-resolution GCDs (HadUK-grid UKPOC-9 and MeteoSwiss-grid-product, respectively) and compared these to weather station data and unweighted homologous series. We applied quasi-Poisson time series regression with distributed lag nonlinear models to obtain the GCD- and region-specific temperature-mortality associations and calculated the corresponding cold- and heat-related excess mortality. Although the five exposure datasets yielded different average area-level temperature estimates, these deviations did not result in substantial variations in the temperature-mortality association or impacts. Moreover, local population-weighted GCDs showed better overall performance, suggesting that they could be excellent alternatives to help advance knowledge on climate change impacts in remote regions with large climate and population distribution variability, which has remained largely unexplored in present literature due to the lack of reliable exposure data.
BACKGROUND: To date, little is known about the temporal variation of the temperature-mortality association among different demographic and socio-economic groups. The aim of this work is to investigate trends in cold- and heat- attributable mortality risk and burden by sex, age, education, marital status, and number of household occupants in the city of Turin, Italy. METHODS: We collected daily time-series of temperature and mortality counts by demographic and socio-economic groups for the period 1982-2018 in Turin. We applied standard quasi-Poisson regression models to data subsets of 25-year moving subperiods, and we estimated the temperature-mortality associations with distributed lag non-linear models (DLNM). We provided cross-linkages between the evolution of minimum mortality temperatures, relative risks of mortality and temperature-attributable deaths under cold and hot conditions. RESULTS: Our findings highlighted an overall increase in risk trends under cold and heat conditions. All-cause mortality at the 1st percentile increased from 1.15 (95% CI: 1.04; 1.28) in 1982-2006 to 1.24 (95% CI: 1.11; 1.38) in 1994-2018, while at the 99th percentile the risk shifted from 1.51 (95% CI: 1.41; 1.61) to 1.59 (95% CI: 1.49; 1.71). In relation to social differences, women were characterized by greater values in respect to men, and similar estimates were observed among the elderly in respect to the youngest subgroup. Risk trends by educational subgroups were mixed, according to the reference temperature condition. Finally, individuals living in conditions of isolation were characterized by higher risks, with an increasing vulnerability throughout time. CONCLUSIONS: The overall increase in cold- and heat- related mortality risk suggests a maladaptation to ambient temperatures in Turin. Despite alert systems in place increase public awareness and improve the efficiency of existing health services at the local level, they do not necessarily prevent risks in a homogeneous way. Targeted public health responses to cold and heat in Turin are urgently needed to adapt to extreme temperatures due to climate change.
Using novel weekly mortality data for London spanning 1866-1965, we analyze the changing relationship between temperature and mortality as the city developed. Our main results show that warm weeks led to elevated mortality in the late nineteenth century, mainly due to infant deaths from digestive diseases. However, this pattern largely disappeared after WWI as infant digestive diseases became less prevalent. The resulting change in the temperature-mortality relationship meant that thousands of heat-related deaths-equal to 0.9-1.4 percent of all deaths- were averted. These findings show that improving the disease environment can dramatically alter the impact of high temperature on mortality.
PURPOSE: This report describes a rare autochthonous case of human D. repens infection in Austria. Dirofilariosis is a mosquito-borne parasitic infection that predominantly affects dogs. Human D. repens infections have primarily been reported in Mediterranean countries, but are emerging throughout Central and Northern Europe. METHODS: The worm was removed surgically and identified using PCR and DNA sequencing. The consensus sequences were compared against reference sequences of Dirofilaria repens from GenBank. RESULTS: The 56-year-old woman acquired the infection, which presented as a subcutaneous nodule, in Vienna, Austria. This is the second autochthonous case of human D. repens infection in Austria. CONCLUSION: The reasons for the emergence of D. repens and other parasitic infections in Central and Northern Europe are manifold, including climate change and globalization. This case demonstrates that with the growing number of D. repens infections, health care professionals must place further emphasis on emerging infectious diseases to ensure appropriate diagnostics and treatment in the future.
Background: Tickborne-encephalitis (TBE) is a potentially life-threating neurological disease that is mainly transmitted by ticks. The goal of the present study is to analyze the potential uniform environmental patterns of the identified TBEV microfoci in Germany. The results are used to calculate probabilities for the present distribution of TBEV microfoci in Germany based on a geostatistical model. Methods: We aim to consider the specification of environmental characteristics of locations of TBEV microfoci detected in Germany using open access epidemiological, geographical and climatological data sources. We use a two-step geostatistical approach, where in a first step, the characteristics of a broad set of environmental variables between the 56 TBEV microfoci and a control or comparator set of 3575 sampling points covering Germany are compared using Fisher’s Exact Test. In the second step, we select the most important variables, which are then used in a MaxEnt distribution model to calculate a high resolution (400 × 400 m) probability map for the presence of TBEV covering the entire area of Germany. Results: The findings from the MaxEnt prediction model indicate that multi annual actual evapotranspiration (27.0%) and multi annual hot days (22.5%) have the highest contribution to our model. These two variables are followed by four additional variables with a lower, but still important, explanatory influence: Land cover classes (19.6%), multi annual minimum air temperature (14.9%), multi annual sunshine duration (9.0%), and distance to coniferous and mixed forest border (7.0%). Conclusions: Our findings are based on defined TBEV microfoci with known histories of infection and the repeated confirmation of the virus in the last years, resulting in an in-depth high-resolution model/map of TBEV microfoci in Germany. Multi annual actual evapotranspiration (27%) and multi annual hot days (22.5%) have the most explanatory power in our model. The results may be used to tailor specific regional preventive measures and investigations.
Mosquitoes are the major vectors that can transmit many diseases agents to humans and animals. This study was conducted in Edirne central district between July 2017 and July 2018 to identify important mosquito vector species, to determine their seasonality and distribution pattern in general terms. Larvae, pupae, and adults were collected from areas assessed as being particularly suitable for medically important species of the genus Aedes Meigen, Culex Linnaeus, and Anopheles Meigen. In addition to the foci naturally found in the areas, ovitraps placed in suitable places for ovipositing were also used. As a result, a total of 3155 females and 353 males belonging to 11 species of 5 genera were obtained. Among these species, Anopheles sacharovi Favre (the primary vector of malaria in Turkey) and Culex pipiens s.l. Linnaeus (the primary vector of West Nile Fever) has been recognized as a public health threat to the province. Anopheles sacharovi was present at a very low population level, while Cx. pipiens s.l. was determined as the most common and numerous species in the study area. Known to have a high preference for warmer climate compared to members of the Anopheles maculipennis s.l. Meigen, An. sacharovi has the risk of increasing its population in the region with possible global warming in the future. The importance of this risk increases even more since rice production is widespread especially in Edirne and this species can use the paddy fields as an effective breeding place. While Aedes caspius Pallas was commonly encountered, Aedes albopictus Skuse was not found during the field observation and ovitrap controls.
Vector-borne diseases (VBDs), such as dengue, Zika, West Nile virus (WNV) and tick-borne encephalitis, account for substantial human morbidity worldwide and have expanded their range into temperate regions in recent decades. Climate change has been proposed as a likely driver of past and future expansion, however, the complex ecology of host and vector populations and their interactions with each other, environmental variables and land-use changes makes understanding the likely impacts of climate change on VBDs challenging. We present an environmentally driven, stage-structured, host-vector mathematical modelling framework to address this challenge. We apply our framework to predict the risk of WNV outbreaks in current and future UK climates. WNV is a mosquito-borne arbovirus which has expanded its range in mainland Europe in recent years. We predict that, while risks will remain low in the coming two to three decades, the risk of WNV outbreaks in the UK will increase with projected temperature rises and outbreaks appear plausible in the latter half of this century. This risk will increase substantially if increased temperatures lead to increases in the length of the mosquito biting season or if European strains show higher replication at lower temperatures than North American strains.
Climate change has influenced the transmission of a wide range of vector-borne diseases in Europe, which is a pressing public health challenge for the coming decades. Numerous theories have been developed in order to explain how tick-borne diseases are associated with climate change. These theories include higher proliferation rates, extended transmission season, changes in ecological balances, and climate-related migration of vectors, reservoir hosts, or human populations. Changes of the epidemiological pattern have potentially catastrophic consequences, resulting in increasing prevalence of tick-borne diseases. Thus, investigation of the relationship between climate change and tick-borne diseases is critical. In this regard, climate models that predict the ticks’ geographical distribution changes can be used as a predicting tool. The aim of this review is to provide the current evidence regarding the contribution of the climatic changes to Lyme borreliosis (LB) disease and tick-borne encephalitis (TBE) and to present how computational models will advance our understanding of the relationship between climate change and tick-borne diseases in Europe.
BACKGROUND: Understanding of the impacts of climatic variability on human health remains poor despite a possibly increasing burden of vector-borne diseases under global warming. Numerous socioeconomic variables make such studies challenging during the modern period while studies of climate-disease relationships in historical times are constrained by a lack of long datasets. Previous studies have identified the occurrence of malaria vectors, and their dependence on climate variables, during historical times in northern Europe. Yet, malaria in Sweden in relation to climate variables is understudied and relationships have never been rigorously statistically established. This study seeks to examine the relationship between malaria and climate fluctuations, and to characterise the spatio-temporal variations at parish level during severe malaria years in Sweden 1749-1859. METHODS: Symptom-based annual malaria case/death data were obtained from nationwide parish records and military hospital records in Stockholm. Pearson (r(p)) and Spearman’s rank (r(s)) correlation analyses were conducted to evaluate inter-annual relationship between malaria data and long meteorological series. The climate response to larger malaria events was further explored by Superposed Epoch Analysis, and through Geographic Information Systems analysis to map spatial variations of malaria deaths. RESULTS: The number of malaria deaths showed the most significant positive relationship with warm-season temperature of the preceding year. The strongest correlation was found between malaria deaths and the mean temperature of the preceding June-August (r(s) = 0.57, p < 0.01) during the 1756-1820 period. Only non-linear patterns can be found in response to precipitation variations. Most malaria hot-spots, during severe malaria years, concentrated in areas around big inland lakes and southern-most Sweden. CONCLUSIONS: Unusually warm and/or dry summers appear to have contributed to malaria epidemics due to both indoor winter transmission and the evidenced long incubation and relapse time of P. vivax, but the results also highlight the difficulties in modelling climate-malaria associations. The inter-annual spatial variation of malaria hot-spots further shows that malaria outbreaks were more pronounced in the southern-most region of Sweden in the first half of the nineteenth century compared to the second half of the eighteenth century.
BackgroundVibrio spp. are aquatic bacteria that prefer warm seawater with moderate salinity. In humans, they can cause gastroenteritis, wound infections, and ear infections. During the summers of 2018 and 2019, unprecedented high sea surface temperatures were recorded in the German Baltic Sea.AimWe aimed to describe the clinical course and microbiological characteristics of Vibrio infections in Germany in 2018 and 2019.MethodsWe performed an observational retrospective multi-centre cohort study of patients diagnosed with domestically-acquired Vibrio infections in Germany in 2018 and 2019. Demographic, clinical, and microbiological data were assessed, and isolates were subjected to whole genome sequencing and antimicrobial susceptibility testing.ResultsOf the 63 patients with Vibrio infections, most contracted the virus between June and September, primarily in the Baltic Sea: 44 (70%) were male and the median age was 65 years (range: 2-93 years). Thirty-eight patients presented with wound infections, 16 with ear infections, six with gastroenteritis, two with pneumonia (after seawater aspiration) and one with primary septicaemia. The majority of infections were attributed to V. cholerae (non-O1/non-O139) (n = 30; 48%) or V. vulnificus (n = 22; 38%). Phylogenetic analyses of 12 available isolates showed clusters of three identical strains of V. vulnificus, which caused wound infections, suggesting that some clonal lines can spread across the Baltic Sea.ConclusionsDuring the summers of 2018 and 2019, severe heatwaves facilitated increased numbers of Vibrio infections in Germany. Since climate change is likely to favour the proliferation of these bacteria, a further increase in Vibrio-associated diseases is expected.
Climate change will lead to more extreme weather events in Europe. In Norway, little is known about how this will affect drinking water quality and population’s health due to waterborne diseases. The aim of our work was to generate new knowledge on the effect of extreme weather conditions and climate change on drinking water and waterborne disease. In this respect we studied the relationship between temperature, precipitation and runoff events, raw and treated water quality, and gastroenteritis consultations in Norway in 2006-2014 to anticipate the risk with changing climate conditions. The main findings are positive associations between extreme weather events and raw water quality, but only few with treated drinking water. Increase in maximum temperature was associated with an increase in risk of disease among all ages and 15-64 years olds for the whole year. Heavy rain and high runoff were associated with a decrease in risk of gastroenteritis for different age groups and time periods throughout the year. No evidence was found that increase in precipitation and runoff trigger increased gastroenteritis outbreaks. Large waterworks in Norway currently seem to manage extreme weather events in preventing waterborne disease. However, with more extreme weather in the future, this may change. Therefore, modelling future climate scenarios is necessary to assess the need for improved water treatment capacity in a future climate.
This paper provides a summary of the knowledge of drinking-water temperature increases and present daily, seasonal, and yearly temperature data of drinking-water distribution systems (DWDS). The increasing water temperatures lead to challenges in DWDS management, and we must assume a promotion of invertebrates as pipe inhabitants. Macro-, meio-, and microinvertebrates were found in nearly all DWDS. Data in relation to diversity and abundance clearly point out a high probability of mass development, and invertebrate monitoring must be the focus of any DWDS management. The water temperature of DWDS is increasing due to climate change effects, and as a consequence, the growth and reproduction of invertebrates is increasing. The seasonal development of a chironomid (Paratanytarus grimmii) and longtime development of water lice (Asellus aquaticus) are given. Due to increased water temperatures, a third generation of water lice per year has been observed, which is one reason for the observed mass development. This leads to an impact on drinking-water quality and an increased health risk, as invertebrates can serve as a host or vehicle for potential harmful microbes. More research is needed especially on (i) water temperature monitoring in drinking-water distribution systems, (ii) invertebrate development, and (iii) health risks.
BACKGROUND: Vibrio infections are becoming more frequent in the Baltic Sea region, which is caused by an increase in the sea surface temperature. Climate change creates the conditions for the emergence of new environmental niches that are beneficial for Vibrio spp., especially in the summer months. Vibrio vulnificus, which causes wound infections and septicaemia, represents a particularly dangerous species of Vibrio spp. There are numerous publications on the prevalence of V. vulnificus in various regions of the Baltic Sea, but there is a lack of such data for the Polish coast. This prompted us to conduct a pilot study into the prevalence of the bacteria in the Gulf of Gdansk. The study aimed to detect Vibrio spp. in the coastal waters and the wet sand at the beaches and bathing areas in the Gulf of Gdansk. MATERIALS AND METHODS: During the period from June 16th to September 23rd 2020, 112 samples of seawater and 105 samples of wet sand were collected at 16 locations along the coast of the Gulf of Gdansk and Hel peninsula. Isolation of Vibrio spp. was conducted by filtering method and the isolated bacteria was cultured on CHROM agar Vibrio and TCBS agar. Final genus identification was performed by the MALDI TOF technique. RESULTS: In the present study, 10 isolates of Vibrio spp. were obtained from seawater and wet sand samples collected in the Gulf of Gdansk and Hel peninsula coast. Three of the isolates were identified as V. vulnificus; the presence of the species was confirmed in the seawater samples which had been collected in Hel (1 isolate), Jastarnia (1 isolate), and Chalupy (1 isolate). One strain of Vibrio alginolyticus was isolated from the seawater sample collected in Hel. Moreover, identification was incomplete for 6 of the isolated strains, these were identified as Vibrio cholerae/mimicus These strains were collected in Jastarnia (1 isolate), Kuznica (1 isolate), Gdansk-Brzezno (1 isolate), Puck (2 isolates), Chalupy (1 isolate). CONCLUSIONS: Our preliminary research study confirmed the presence of potentially pathogenic V. vulnificus in the Gulf of Gdansk in the summer months. Therefore, further monitoring of the presence of Vibrio spp. in the Baltic coast area is necessary.
BACKGROUND: The aim of our study was to analyse the influence of air temperature and implemented veterinary measures on salmonellosis incidence in the Czech Republic (CZ). METHODS: We conducted a descriptive analysis of salmonellosis as reported to the Czech national surveillance system during 1998-2017 and evaluated the influence of applied veterinary measures (started in January 2008) on salmonellosis incidence by comparing two 9-year periods (1998-2006, 2009-2017). Using a generalized additive model, we analysed association between monthly mean air temperature and log-transformed salmonellosis incidence over the entire twenty-year period. RESULTS: A total of 410,533 salmonellosis cases were reported during the study period in the CZ. Annual mean incidences of salmonellosis were 313.0/100,000 inhabitants before and 99.0/100,000 inhabitants after implementation of the veterinary measures. The time course of incidence was non-linear, with a sharp decline during 2006-2010. Significant association was found between disease incidence and air temperature. On average, the data indicated that within a common temperature range every 1 °C rise in air temperature contributed to a significant 6.2% increase in salmonellosis cases. CONCLUSIONS: Significant non-linear effects of annual trend, within-year seasonality, and air temperature on the incidence of salmonellosis during 1998-2017 were found. Our study also demonstrates significant direct effect of preventive veterinary measures taken in poultry in reducing incidence of human salmonellosis in the CZ. The annual mean number of salmonellosis cases in the period after introducing the veterinary measures was only 32.5% of what it had been in the previous period.
This study aimed to estimate dynamic changes in seroprevalence of Toxoplasma gondii within the general population living in the northern part of the Republic of Serbia (Province of Vojvodina) during a 14-year period. The differences in prevalence of anti-toxoplasma antibodies were analyzed in correlation with age, gender, residential area (rural/urban) and meteorological factors. In this cohort retrospective study, 24,440 subjects between 1 and 88 years old were enrolled. To determine the presence of T. gondii-specific IgM and IgG antibodies in serum samples, commercially available ELISA kits were used (Euroimmun, Luebeck, Germany). During the study period, the overall T. gondii seroprevalence was 23.5%. The seroprevalence continuously decreased over time from 31.7% in 2008 to 20.4% in 2021 (0.81% per year, p < 0.001). Approximately 2% of patients had a serologic profile positive for both anti-Toxoplasma IgG and IgM antibodies. The seroprevalence was higher (28.87%) among men compared to women (24.28%), while urban residents (24.94%) had lower seroprevalence than the rural population (28.17%). A statistically significant negative correlation (r = -0.559) was found between serologic profile of patients positive for both T. gondii IgG and IgM antibodies and the annual mean air temperature. No significant association was observed between seropositivity to T. gondii infection and examined meteorological factors. These data could be useful to national and regional health authorities to create an optimal health policy to reduce rate of T. gondii infections.
Excess mortality not directly related to the virus has been shown to have increased during the COVID-19 pandemic. However, changes in heat-related mortality during the pandemic have not been addressed in detail. Here, we performed an observational study crossing daily mortality data collected in Portugal (SICO/DGS) with high-resolution temperature series (ERA5/ECMWF), characterizing their relation in the pre-pandemic, and how it aggravated during 2020. The combined result of COVID-19 and extreme temperatures caused the largest annual mortality burden in recent decades (~ 12 000 excess deaths [~ 11% above baseline]). COVID-19 caused the largest fraction of excess mortality during March to May (62%) and from October onwards (85%). During summer, its direct impact was residual, and deaths not reported as COVID-19 dominated excess mortality (553 versus 3 968). A prolonged hot spell led mortality to the upper tertile, reaching its peak in mid-July (+ 45% deaths/day). The lethality ratio (+ 14 deaths per cumulated ºC) was higher than that observed in recent heatwaves. We used a statistical model to estimate expected deaths due to cold/heat, indicating an amplification of at least 50% in heat-related deaths during 2020 compared to pre-pandemic years. Our findings suggest mortality during 2020 has been indirectly amplified by the COVID-19 pandemic, due to the disruption of healthcare systems and fear of population in attending healthcare facilities (expressed in emergency room admissions decreases). While lockdown measures and healthcare systems reorganization prevented deaths directly related to the virus, a significant burden due to other causes represents a strong secondary impact. This was particularly relevant during summer hot spells, when the lethality ratio reached magnitudes not experienced since the 2003 heatwaves. This severe amplification of heat-related mortality during 2020 stresses the need to resume normal healthcare services and public health awareness.
High ambient temperatures pose a significant risk to health. This study investigates the heatwave mortality in the summer of 2020 during the SARS-CoV-2 coronavirus (COVID-19) pandemic and related countermeasures. The heatwaves in 2020 caused more deaths than have been reported since the Heatwave Plan for England was introduced in 2004. The total and cause-specific mortality in 2020 was compared to previous heatwave events in England. The findings will help inform summer preparedness and planning in future years as society learns to live with COVID-19. Heatwave excess mortality in 2020 was similar to deaths occurring at home, in hospitals, and in care homes in the 65+ years group, and was comparable to the increases in previous years (2016-2018). The third heatwave in 2020 caused significant mortality in the younger age group (0-64) which has not been observed in previous years. Significant excess mortality was observed for cardiovascular disease, respiratory disease, and Alzheimer’s and Dementia across all three heatwaves in persons aged 65+ years. There was no evidence that the heatwaves affected the proportional increase of people dying at home and not seeking heat-related health care. The most significant spike in daily mortality in August 2020 was associated with a period of high night-time temperatures. The results provide additional evidence that contextual factors are important for managing heatwave risks, particularly the importance of overheating in dwellings. The findings also suggest more action is also needed to address the vulnerability in the community and in health care settings during the acute response phase of a heatwave.
Climate extremes affected cities and their populations during the last decades. Future climate projections indicate climate extremes will increasingly impact urban areas during the 21st century. Humidity related fluctuations and extremes directly underpin convective processes, as well as can influence human health conditions. Regional climate models are a powerful tool to understand regional-to-local climate change processes for cities and their surroundings. Convection-permitting regional climate models, operating on very high resolutions, indicate improved simulation of convective extremes, particularly on sub-daily timescales and in regions with complex terrain such as cities. This research aims to understand how crossing spatial resolutions from similar to 12.5 km to similar to 3 km grid size affect humidity extremes and related variables under future climate change for urban areas and its surroundings. Taking Berlin and its surroundings as the case study area, the research identifies two categories of unprecedented future extreme atmospheric humidity conditions happening under 1.5 degrees C and 2.0 degrees C mean warming based on statistical distributions, respectively near surface specific humidity >0.02 kg/kg and near surface relative humidity <30%. Two example cases for each future extreme condition are dynamically downscaled for a two months period from the 0.44 degrees horizontal resolution following a double-nesting approach: first to the 0.11 degrees (similar to 12.5 km) horizontal resolution with the regional climate model REMO and thereafter to the 0.0275 degrees (similar to 3 km) horizontal resolution with the non-hydrostatic version of REMO. The findings show that crossing spatial resolutions from similar to 12.5 km to similar to 3 km grid size affects humidity extremes and related variables under climate change. Generally, a stronger decrease in moisture (up to 0.0007-0.005 kg/kg SH and 10-20% RH) and an increase in temperature (1-2 degrees C) is found on the 0.0275 degrees compared to the 0.11 degrees horizontal resolution, which is more profound in Berlin than in the surroundings. The convection-permitting scale mitigates the specific humidity moist extreme and intensifies the relative humidity dry extreme in Berlin, posing challenges with respect to health for urban dwellers.
Heat and cold temperatures associated with exposure to poor air quality lead to increased mortality. Using a generalized linear model with Poisson regression for overdispersion, this study quantifies the natural-caused mortality burden attributable to heat/cold temperatures and PM(10) and O(3) air pollutants in Rome and Milan, the two most populated Italian cities. We calculate local-specific mortality relative risks (RRs) for the period 2004-2015 considering the overall population and the most vulnerable age category (≥85 years). Combining a regional climate model with a chemistry-transport model under future climate and air pollution scenarios (RCP2.6 and RCP8.5), we then project mortality to 2050. Results show that for historical mortality the burden is much larger for cold than for warm temperatures. RR peaks during wintertime in Milan and summertime in Rome, highlighting the relevance of accounting for the effects of air pollution besides that of climate, in particular PM(10) for Milan and O(3) for Rome. Overall, Milan reports higher RRs while, in both cities, the elderly appear more susceptible to heat/cold and air pollution events than the average population. Two counterbalancing effects shape mortality in the future: an increase associated with higher and more frequent warmer daily temperatures – especially in the case of climate inaction – and a decrease due to declining cold-mortality burden. The outcomes highlight the urgent need to adopt more stringent and integrated climate and air quality policies to reduce the temperature and air pollution combined effects on health.
Urban Built Environments (UBE) are increasingly prone to SLow-Onset Disasters (SLODs) such as air pollution and heatwaves. The effectiveness of sustainable risk-mitigation solutions for the exposed individuals’ health should be defined by considering the effective scenarios in which emergency conditions can appear. Combining environmental (including climatic) conditions and exposed users’ presence and behaviors is a paramount task to support decision-makers in risk assessment. A clear definition of input scenarios and related critical conditions to be analyzed is needed, especially while applying simulation-based approaches. This work provides a methodology to fill this gap, based on hazard and exposure peaks identification. Quick and remote data-collection is adopted to speed up the process and promote the method application by low-trained specialists. Results firstly trace critical conditions by overlapping air pollution and heatwaves occurrence in the UBE. Exposure peaks (identified by remote analyses on the intended use of UBEs) are then merged to retrieve critical conditions due to the presence of the individuals over time and UBE spaces. The application to a significant case study (UBE in Milan, Italy) demonstrates the approach capabilities to identify key input scenarios for future human behavior simulation activities from a user-centered approach.
Longitudinal shifts in pollen onset, duration, and intensity are public health concerns for the growing number of individuals with pollen sensitization. National analyses of long-term pollen changes are influenced by how a plant’s main pollen season (MPS) is defined. Prior Swiss studies have inconsistently applied MPS definitions, leading to heterogeneous conclusions regarding the magnitude, directionality, and significance of multi-decade pollen trends. We examined national pollen data in Switzerland between 1990 and 2020, applying six MPS definitions (2 percentage-based and 4 threshold-based) to twelve relevant allergenic plants. We analyzed changes in pollen season using both linear regression and locally estimated scatterplot smoothing (LOESS). For 4 of the 12 plant species, there is unanimity between definitions regarding earlier onset of pollen season (p < 0.05), with magnitude of 31-year change dependent on specific MPS definition (hazel: 9-18 days; oak: 5-13 days; grasses: 8-25 days; and nettle/hemp: 6-25 days). There is also consensus (p < 0.05) for modified MPS duration among hazel (21-104% longer), nettle/hemp (8-52% longer), and ash (18-38% shorter). Between-definition agreement is highest for MPS intensity analysis, with consensus for significant increases in seasonal pollen quantity (p < 0.05) among hazel, birch, oak, beech, and nettle/hemp. The largest relative intensification is noted for hazel (110-146%) and beech (162-237%). LOESS analysis indicates that these multi-decade pollen changes are typically nonlinear. The robustness of MPS definitions is highly dependent on annual pollen accumulation, with definition choice particularly influential for long-term analysis of low-pollen plants such as ragweed. We identify systematic differences between MPS definitions and suggest future aerobiologic studies apply multiple definitions to minimize bias. In summary, national pollen onset, duration, and intensity have shifted for some plants in Switzerland, with MPS definition choice affecting magnitude and significance of these variations. Future public health research can determine whether these temporal and quantitative pollen changes correlate with longitudinal differences in population pollen sensitization.
The depletion of air quality is a major problem that is faced around the globe. In Australia, the pollutants emitted by bushfires play an important role in making the air polluted. These pollutants in the air result in many adverse impacts on the environment. This paper analysed the air pollution from the bushfires from November 2019 to July 2020 and identified how it affects the human respiratory system. The bush fires burnt over 13 million hectares, destroying over 2400 buildings. While these immediate effects were devastating, the long-term effects were just as devastating, with air pollution causing thousands of people to be admitted to hospitals and emergency departments because of respiratory complications. The pollutant that caused most of the health effects throughout Australia was Particulate Matter (PM) PM(2.5) and PM(10). Data collection and analysis were covered in this paper to illustrate where and when PM(2.5) and PM(10,) and other pollutants were at their most concerning levels. Susceptible areas were identified by analysing environmental factors such as temperature and wind speed. The study identified how these pollutants in the air vary from region to region in the same time interval. This study also focused on how these pollutant distributions vary according to the temperature, which helps to determine the relationship between the heatwave and air quality. A computational model for PM(2.5) aerosol transport to the realistic airways was also developed to understand the bushfire exhaust aerosol transport and deposition in airways. This study would improve the knowledge of the heat wave and bushfire meteorology and corresponding respiratory health impacts.
Australia often experiences natural disasters and extreme weather conditions such as: flooding, sandstorms, heatwaves, and bushfires (also known as wildfires or forest fires). The proportion of the Australian population aged 65 years and over is increasing, alongside the severity and frequency of extreme weather conditions and natural disasters. Extreme heat can affect the entire population but particularly at the extremes of life, and patients with morbidities. Frequently identified as a vulnerable demographic in natural disasters, there is limited research on older adults and their capacity to deal with extreme heat and bushfires. There is a considerable amount of literature that suggests a significant association between mental disorders such as dementia, and increased vulnerability to extreme heat. The prevalence rate for dementia is estimated at 30%by age 85 years, but there has been limited research on the effects extreme heat and bushfires have on individuals living with dementia. This review explores the differential diagnosis of dementia, the Australian climate, and the potential impact Australia’s extreme heat and bushfires have on individuals from vulnerable communities including low socioeconomic status Indigenous and Non-Indigenous populations living with dementia, in both metropolitan and rural communities. Furthermore, we investigate possible prevention strategies and provide suggestions for future research on the topic of Australian bushfires and heatwaves and their impact on people living with dementia. This paper includes recommendations to ensure rural communities have access to appropriate support services, medical treatment, awareness, and information surrounding dementia.
Air pollution and extreme heat have been responsible for more than a million deaths in China every year, especially in densely urbanized regions. While previous studies intensively evaluated air pollution episodes and extreme heat events, a limited number of studies comprehensively assessed atmospheric hot-and-polluted-episodes (HPE) – an episode with simultaneously high levels of air pollution and temperature – which have potential adverse synergic impacts on human health. This study focused on the Pearl River Delta (PRD) region of China due to its high temperature in summer and poor air quality throughout a year. We employed geostatistical downscaling to model meteorology at a spatial resolution of 1 km, and applied a machine learning algorithm (XGBoost) to estimate a high-resolution (1 km) daily concentration of particulate matter with an aerodynamic diameter ≤2.5 μm (PM(2.5)) and ozone (O(3)) for June to October over 20 years (2000-2019). Our results indicate an increasing trend (∼50%) in the frequency of HPE occurrence in the first decade (2000-2010). Conversely, the annual frequency of HPE occurrence reduced (16.7%), but its intensity increased during the second decade (2010-2019). The northern cities in the PRD region had higher levels of PM(2.5) and O(3) than their southern counterparts. During HPEs, regional daily PM(2.5) exceeded the World Health Organization (WHO) and Chinese guideline levels by 75% and 25%, respectively, while the O(3) exceeded the WHO O(3) standard by up to 69%. Overall, 567,063 (95% confidence interval (CI): 510,357-623,770) and 52,231 (95%CI: 26,116-78,346) excessive deaths were respectively attributable to exposure to PM(2.5) and O(3) in the PRD region. Our findings imply the necessity and urgency to formulate co-benefit policies to mitigate the region’s air pollution and heat problems.
INTRODUCTION: There is a large body of epidemiological evidence showing significantly increased mortality risks from air pollution and temperature. However, findings on the modification of the association between air pollution and mortality by temperature are mixed. METHODS: We used a varying coefficient distributed lag model to assess the complex interplay between air temperature and PM(2.5) on daily mortality in Guangzhou City from 2013 to 2020, with the aim of establishing the PM(2.5)-mortality association at different temperatures and exploring synergetic mortality risks from PM(2.5) and temperature on vulnerable populations. RESULTS: We observed near-linear concentration-response associations between PM(2.5) and mortality across different temperature levels. Each 10 μg/m³ increase of PM(2.5) in low, medium, and high temperature strata was associated with increments of 0.73% [95% confidence interval (CI): 0.38%, 1.09%], 0.12% (95% CI: -0.27%, 0.52%), and 0.46% (95% CI: 0.11%, 0.81%) in non-accidental mortality, with a statistically significant difference between low and medium temperatures (P=0.02). There were significant modification effects of PM(2.5) by low temperature for cardiovascular mortality and among individuals 75 years or older. CONCLUSIONS: Low temperatures may exacerbate physiological responses to short-term PM(2.5) exposure in Guangzhou, China.
Background: Preterm birth contributes to the morbidity and mortality of newborns and infants. Recent studies have shown that maternal exposure to particulate matter and extreme temperatures results in immune dysfunction, which can induce preterm birth. This study aimed to evaluate the association between fine particulate matter (PM(2.5)) exposure, temperature, and preterm birth in Seoul, Republic of Korea. Methods: We used 2010-2016 birth data from Seoul, obtained from the Korea National Statistical Office Microdata. PM(2.5) concentration data from Seoul were generated through the Community Multiscale Air Quality (CMAQ) model. Seoul temperature data were collected from the Korea Meteorological Administration (KMA). The exposure period of PM(2.5) and temperature were divided into the first (TR1), second (TR2), and third (TR3) trimesters of pregnancy. The mean PM(2.5) concentration was used in units of ×10 µg/m(3) and the mean temperature was divided into four categories based on quartiles. Logistic regression analyses were performed to evaluate the association between PM(2.5) exposure and preterm birth, as well as the combined effects of PM(2.5) exposure and temperature on preterm birth. Result: In a model that includes three trimesters of PM(2.5) and temperature data as exposures, which assumes an interaction between PM(2.5) and temperature in each trimester, the risk of preterm birth was positively associated with TR1 PM(2.5) exposure among pregnant women exposed to relatively low mean temperatures (<3.4 °C) during TR1 (OR 1.134, 95% CI 1.061-1.213, p < 0.001). Conclusions: When we assumed the interaction between PM(2.5) exposure and temperature exposure, PM(2.5) exposure during TR1 increased the risk of preterm birth among pregnant women exposed to low temperatures during TR1. Pregnant women should be aware of the risk associated with combined exposure to particulate matter and low temperatures during TR1 to prevent preterm birth.
This study aims to quantitatively identify the economic value of the comprehensive improvement of environmental degradations caused by climate change. The research method applied to that is the choice experiment. Fine particulate matter, algae bloom, and heat waves were selected as individual attributes constituting environmental problems. It was found that the willingness to pay could not be induced for any level of improvement in algal bloom. It was concluded that if heat waves improved to the medium level where the number of heat-related illnesses and estimated deaths decreased by 50% compared to the current level, there would be a loss in value by USD 13.33. The value of improving environmental problems is USD 7.69 per household per year, and the improvement of fine particulate matter was the highest value attributed by consumers. This study is significant in that it comprehensively evaluates severe environmental problems, reflects their priorities and importance, and assesses the value for each level. It provides important foundational data for establishing effective budget input strategies to maximize consumer benefits and aids in the preparation of effective policies by establishing more detailed goals to achieve net-zero carbon emissions and the Sustainable Development Goals.
Mounting studies have associated asthma with environmental and climatic factors, but their interaction during pregnancy on childhood asthma are unclear. This study aims to investigate the interaction of in utero air pollution and environmental temperature exposure on childhood asthma, to identify key timing windows for exposure. A retrospective cohort study with 2,598 pre-schoolers was conducted during 2011-2012 in Changsha, China. Maternal exposure to three critical ambient air pollutants (PM10, SO2 and NO2, as proxies of industrial and vehicular air pollution) and temperature (T), was assessed for the 40 gestational weeks, three trimesters of gestation, and entire pregnancy by an inverse distance weighted (IDW) method. Logistic regression analysis was used to examine the association of childhood asthma with air pollution and temperature exposure. Our results showed that pre-schooler’s asthma was significantly associated with SO2 and NO2 exposure in utero, ORs = 1.46 (95% CI: 1.12-1.89) and 1.67 (95% CI: 1.24-2.26) by inter quartile range (IQR) increase of their exposure respectively. Significant risk was observed for exposure of SO2 and NO2 particularly during the 1st and 2nd trimesters and their specific gestational weeks. Pre-schooler’s asthma was related with high temperature expo-sure during 1st trimester, OR = 2.33 (95% CI: 1.11-4.90) by IQR increase of T exposure. Low T and high T respectively increased the asthma risk of NO2 exposure in the 1st and 3rd trimester. Boys were more susceptible to the temperature-pollution interaction on asthma development. Our study indicates that low and high tem-perature respectively during early and late pregnancy significantly increased the impact of air pollution exposure in utero on pre-schooler’s asthma.
BACKGROUND: Although low temperature and air pollution exposures have been associated with the risk of anxiety, their combined effects remain unclear. OBJECTIVE: To investigate the independent and interactive effects of low temperature and air pollution exposures on anxiety. METHOD: Using a case-crossover study design, the authors collected data from 101,636 outpatient visits due to anxiety in three subtropical Chinese cities during the cold season (November to April in 2013 through 2018), and then built conditional logistic regression models based on individual exposure assessments [temperature, relative humidity, particulate matter (PM(2.5), PM(10)), sulfur dioxide (SO(2)), and nitrogen dioxide (NO(2))] and twelve cold spell definitions. Additive-scale interactions were assessed using the relative excess risk due to interaction (RERI). RESULTS: Both cold spell and air pollution were significantly associated with outpatients for anxiety. The effects of cold spell increased with its intensity, ranging from 8.98% (95% CI: 2.02%, 16.41%) to 15.24% (95% CI: 6.75%, 24.39%) in Huizhou. Additionally, each 10 μg/m(3) increase of PM(2.5), PM(10), NO(2) and SO(2) was associated with a 1.51% (95% CI: 0.61%, 2.43%), 1.58% (95% CI: 0.89%, 2.28%), 13.95% (9.98%, 18.05%) and 11.84% (95% CI: 8.25%, 15.55%) increase in outpatient visits for anxiety. Synergistic interactions (RERI >0) of cold spell with all four air pollutants on anxiety were observed, especially for more intense cold spells. For particulate matters, these interactions were found even under mild cold spell definitions [RERI: 0.11 (95% CI: 0.02, 0.21) for PM(2.5), and 0.24 (95% CI: 0.14, 0.33) for PM(10)]. Stratified analyses yielded a pronounced results in people aged 18-65 years. CONCLUSIONS: These findings indicate that both cold spell and air pollution are important drivers of the occurrence of anxiety, and simultaneous exposure to these two factors might have synergistic effects on anxiety. These findings highlight the importance of controlling air pollution and improving cold-warning systems.
BACKGROUND: The extreme thermal environment driven by climate change disrupts thermoregulation in pregnant women and may threaten the survival of the developing fetus. OBJECTIVES: To investigate the acute effect of maternal exposure to thermophysiological stress (measured with Universal Thermal Climate Index, UTCI) on the risk of stillbirth and modification of this effect by sociodemographic disparities. METHODS: We conducted a space-time-stratified case-crossover analysis of daily UTCI and 2835 singleton stillbirths between 1st January 2000 and 31st December 2015 across multiple small areas in Western Australia. Distributed lag non-linear models were combined with conditional quasi-Poisson regression to investigate the effects of the UTCI exposure from the preceding 6 days to the day of stillbirth. We also explored effect modification by fetal and maternal sociodemographic factors. RESULTS: The median UTCI was 13.9 °C (representing no thermal stress) while the 1st and 99th percentiles were 0.7 °C (slight cold stress) and 31.7 °C (moderate heat stress), respectively. Relative to median UTCI, we found positive associations between acute maternal cold and heat stresses and higher risks of stillbirth, increasing with the intensity and duration of the thermal stress episodes. The cumulative risk from the preceding 6 days to the day of stillbirth was stronger in the 99th percentile (RR = 1.19, 95% CI: 1.17, 1.21) than the 1st percentile (RR = 1.14, 95% CI: 1.12, 1.15), relative to the median UTCI. The risks were disproportionately higher in term and male stillborn fetuses, smoking, unmarried, ≤19 years old, non-Caucasian, and low socioeconomic status mothers. DISCUSSION: Acute maternal exposure to both cold and heat stresses may contribute to the risk of stillbirth and be exacerbated by sociodemographic disparities. The findings suggest public health attention, especially for the identified higher-risk groups. Future studies should consider the use of a human thermophysiological index, rather than surrogates such as ambient temperature.
Qinghai-Tibet Plateau (QTP) is one of the most sensitive regions to climate change in the world. As a result, people in the QTP are more likely to be sensitively affected by climate change than those in other regions, particularly in the poverty area. Using the Universal Thermal Climate Index (UTCI) derived from ERA5 and population data, changes in annual thermal comfort condition and population under such condition in the QTP are systematically analyzed. The results reveal that there is considerable regional heterogeneity in the distribution of UTCI and the number of comfortable days (CDs), mainly due to the complex geographic features. In most areas of the QTP, the increase in UTCI leads to an increased number of comfortable days. Spatial distribution and temporal change in the number of comfortable days are found to be principally related to altitude. In areas within altitudes of 3000-4500 m, the number of comfortable days increases by up to 6 d per decade, which is faster than that in higher elevation areas above 4500 m. Results also indicate that thermal comfortable condition has improved in areas of 2500-5000 m (medium to high altitude), particularly in spring and autumn. Further research indicates that population distribution also shows a regional clustering feature, with the majority of residents residing in cities and their vicinities, where a higher number of comfortable days were observed. Most areas with a greater number of comfortable days have experienced a more significant increase in population under thermal comfortable conditions. It implies that climate change more likely has a large influence on population in the QTP. These findings are expected to enhance tourism development and the assessment of the impact on the living environment. The findings can be helpful for optimizing of tourism development and better understanding how climate change affects population distribution.
Thermal comfort and environmental health in scenic open spaces, a communication bridge between tourists and their environment, are prerequisites for tourism activities. In this study, scenic open spaces in an urban area of Xi’an, China were selected. Thermal perception (thermal sensation, comfort and acceptability) of residents and tourists were investigated through meteorological measurement and questionnaire survey. Physiological equivalent temperature (PET) was used to determine thermal benchmarks of all visitors to the site. Variables that influence individual thermal perception assessment (physical, individual, society and psychology) were measured and compared. Finally, a series of strategies and suggestions were proposed based on meteorological characteristics and influencing factors of thermal perception from perspectives of designers and scenic spot managers. Results show that: 1) Neutral PET (NPET) of respondents were 17.3 °C (residents) and 15.5 °C (tourists). Neutral PET ranges (NPETR) were 8.9-25.8 °C (residents) and 7.2-23.8 °C (tourists). Preferred PET values were 20.1 °C (residents) and 19.7 °C (tourists). Thermal acceptability ranges (TAR) were 6.3-37.8 °C (residents) and 0.5-39.9 °C (tourists). 2) In winter, physical factors were primary influencers of residents’ thermal perception, followed by social factors, while tourists’ thermal perception was mainly influenced by physical factors. In spring, physical factors were still the primary influencers for residents, followed by individual factors. Physical factors were also dominant for tourists, followed by psychological. In summer, physical factors were the major influencing factors for residents and tourists’ thermal perceptions.
The study aims to investigate the thermal comfort requirements in residential buildings and to establish an adaptive thermal comfort model in the cold zone of China. A year-long field study was conducted in residential buildings in Xi’an, China. A total of 2069 valid questionnaires, along with indoor environmental parameters were obtained. The results indicated occupants’ thermal comfort requirements varied with seasons. The neutral temperatures were 17.9, 26.1 (highest), 25.2, and 17.4 degrees C (lowest), and preferred temperatures were 23.2, 25.6 (highest), 24.8, and 22.4 degrees C (lowest), respectively for spring, summer, autumn, and winter. The neutral temperature and preferred temperature in autumn are close to the neutral temperature in summer, while the neutral temperature and preferred temperature in spring are close to that in winter. Besides, the 80% and 90% acceptable temperature ranges, adaptive thermal comfort models, and thermal comfort zones for each season were established. Human’s adaptability is related to his/her thermal experience of the current season and the previous season. Therefore, compared with the traditional year-round adaptive thermal comfort model, seasonal models can better reflect seasonal variations of human adaptation. This study provides fundamental knowledge of the thermal comfort demand for people in this region.
BACKGROUND: Given that low income worsens health outcomes, income differences may affect health disparities in weather-related illnesses. The aim of this study was to investigate the association between income levels and prevalence of heat- and cold-related illnesses among Korean adults. METHODS: The current study comprised 535,186 participants with all variables on income and health behaviors. Patients with temperature-related illnesses were defined as individuals with outpatient medical code of heat- and cold-related illnesses. We categorized individual income into three levels: “low” for the fourth quartile (0-25%), “middle” for the second and the third quartiles (25-75%), and “high” for the first quartile (75-100%). To examine income-related health disparities, Cox proportional hazard regression was performed. Hazard ratios (HRs) and 95% CI (confidence interval) for heat- and cold-related illnesses were provided. The model adjusted for age, sex, smoking status, alcohol drinking, exercise, body mass index, hypertension, hyperglycemia, and local income per capita. RESULTS: A total of 5066 (0.95%) and 3302 (0.62%) cases identified patients with heat- and cold-related illnesses, respectively. Compared with high income patients, the adjusted HR for heat-related illnesses was significantly increased in the low income (adjusted HR = 1.103; 95% CI: 1.022-1.191). For cold-related illnesses, participants with low income were likely to have 1.217 times greater likelihood than those with high income (95% CI: 1.107-1.338), after adjusting for other covariates. In the stratified analysis of age (20-64 years and over 65 years) and sex, there was no difference in the likelihood of heat-related illnesses according to income levels. On the other hand, an HR for cold-related illnesses was higher in patients aged 20 to 64 years than in those aged over 65 years. Male with low income had also a higher HR for cold-related illnesses than female with low income. CONCLUSIONS: Our results showed that heat- or cold-related illnesses were more prevalent in Koreans with low income than those with high income. Strategies for low-income subgroups were needed to reduce greater damage due to the influence of extreme temperature events and to implement effective adaptation.
Changes of thermal environment can lead to unfavorable impacts such as a decrease of thermal stratification, increase of energy consumption, and increase of thermal health risk. Investigating changes in outdoor thermal environments can provide meaningful information for addressing economic and social issues and related challenges. In this study, thermal environment changes in South Korea were investigated using a nonstationary two-component Gaussian mixture model (NSGMM) for air temperature and two thermal comfort indices. For this, the perceived temperature (PT) and universal thermal climate index (UTCI) were employed as the thermal comfort index. Thermal comfort indices were computed using observed meteorological data at 26 weather stations for 37 years in South Korea. Meanwhile, trends of thermal comforts in the warm and cool seasons were simultaneously modeled by the NSGMM. The results indicate significant increasing trends in thermal comfort indices for South Korea. The increasing trends in thermal comfort indices both the warm and cool seasons were detected while the magnitudes of the trends are significantly different. This difference between the magnitude of trends led to an increase in mean and inter-annual variability of thermal comfort indices based on PT, while an increase of mean and decrease of inter-annual variability were observed based on the UTCI. Moreover, the annual proportion of the category referring to days in comfort based on the results of PT has decreased due to the different trends of thermal comfort indices in the warm and cool seasons. This decrease may lead to an increase of thermal health risk that is larger than what would be expected from the results considering the increasing trend of the annual mean temperature in South Korea. From this result, it can be inferred that the thermal health risk in South Korea may be more adverse than what we originally expected from the current temperature trend.
Determining the thresholds for risk assessment is critical for the successful implementation of thermal health warning systems. A risk assessment methodology with multiple thresholds must be developed to provide detailed warning information to the public and decision makers. This study developed a new methodology to identify multiple thresholds for different risk levels for heat or cold wave events by considering simultaneously impact on public health. A new objective function was designed to optimize segmented Poisson regression, which relates public health to temperature indicators. Thresholds were identified based on the values of the objective functions for all threshold candidates. A case study in identifying thresholds for cold and heat wave events in Seoul, South Korea, from 2014 to 2018, was conducted to evaluate the appropriateness of the proposed methodology. Daily minimum or maximum air temperature, mortality, and morbidity data were used for threshold identification and evaluation. The proposed methodology can successfully identify multiple thresholds to simultaneously represent different risk levels. These thresholds show comparable performance to those using the relative frequency approach.
Individual and meteorological factors are associated with cognitive function in older adults. However, how these two factors interact with each other to affect cognitive function in older adults is still unclear. We used mixed effects models to assess the association of individual and meteorological factors with cognitive function among older adults. Individual data in this study were from the database of China Family Panel Studies. A total of 3448 older adults from 25 provinces were included in our analysis. Cognitive functions were measured using a memory test and a logical sequence test. We used the meteorological data in the daily climate dataset of China’s surface international exchange stations, and two meteorological factors (i.e., average temperature and relative humidity) were assessed. The empty model showed significant differences in the cognitive scores of the older adults across different provinces. The results showed a main impact of residence (i.e., urban or rural) and a significant humidity-residence interaction on memory performance in older adults. Specifically, the negative association between humidity and memory performance was more pronounced in urban areas. This study suggested that meteorological factors may, in concert with individual factors, be associated with differences in memory function in older adults.
Accumulating studies have been focused on the independent effects of air pollutants and ambient heat exposure on congenital heart defects (CHDs) but with inconsistent results, and their interactive effect remains unclear. A case-control study including 921 cases and 9210 controls was conducted in Changsha, China in warm season in 2015-2018. The gravidas were assigned monthly averages of daily air pollutants and daily maximum temperature using the nearest monitoring station method and city-wide average method, respectively, during the first trimester of pregnancy. Multivariate logistic regression models were used to estimate the independent effects of each air pollutant and different ambient heat exposure indicators. Their additive joint effects were quantified using attribute proportions of interaction (API). Increasing SO(2) consistently increased the risk of CHDs in the first trimester of pregnancy, with aORs ranging from 1.78 to 2.04. CO, NO(2) and PM(2.5) exposure in the first month of pregnancy, and O(3) exposure in the second and third month of pregnancy were also associated with elevated risks of CHDs, with aORs ranging from 1.04 to 1.15. Depending on the ambient heat exposure indicator used, air pollutants showed more apparent synergistic effects (API > 0) with less and moderately intense heat exposure. Maternal exposure to CO, NO(2), SO(2), PM(2.5) and O(3) during early pregnancy increased risk of CHDs, and ambient heat exposure may enhance these effects. Our findings help to understand the interactive effect of air pollution with ambient heat exposure on CHDs, which is of vital public health significance.
Air pollution and high temperatures can increase kidney disease rate, especially under climate change. A well-designed urban environment has mediating effects on atmospheric environmental threats and promoting human health, but previous studies have overlooked these effects. This study used partial least squares modeling and urban-scale data from Taiwan to identify the crucial effects (i.e., direct, indirect, and total effects) and pathways of urban form (i.e., urban development intensity, land-use mix, and urban sprawl), urban greening (i.e., green coverage), urban industrial status (e.g., industrial level), atmospheric environment (i.e., high temperature and air pollution), and socioeconomic status (i.e., elderly ratio, medical resources, and economic status) on kidney disease rate. Maximizing land-use mix and green coverage and minimizing urban development intensity, urban sprawl, and industrial levels could help reduce kidney disease rate. Air pollution and high temperature had a mediation effect of built environment on kidney disease rate; with the mediation effect of air pollution was greater than that of high temperature. Furthermore, air pollution, high temperature, and elderly ratio increased kidney disease rate, whereas medical resources decreased kidney disease rate. This study is the first to consider the impact (i.e., direct, indirect, and total effects) and pathways of built environment characteristics on kidney disease rate. The findings revealed that an appropriate urban policy might be a practical strategy and lower kidney disease rate for a healthy city development. Moreover, this study provides a new approach for clarifying complex relationships and identifying crucial factors.
The Yellow River, with a developmental and historical significance to China, is now facing several emerging pressures, which are degrading the river status and creating challenges for high-quality development in the basin. Numerous studies on such emerging pressures, present scattered outcomes, and trigger uncertainties and deficient assumptions on the river’s problems. This review integrated such scattered information and investigated the emerging pressures, their drivers and integrated impacts at the basin level. The study intended to prioritize those pressures needing expeditious consideration, and carried a discussion on the alternative pathways to the solution. To determine the critical emerging pressures, a literature review was conducted and experts’ opinion was sought. The outcome further led to a comprehensive review, data collection, and analysis of three groups of emerging pressures. The review recognized ‘Water Stress’ in the lower reach, primarily caused by an abated flow, as the most distressing emerging pressure inflicting social, ecological, and economic consequences. Such decline in flow was mostly induced by a recent increase in ‘Anthropogenic activities’, such as intensive water withdrawal for irrigation (≥27 BCM), and construction of check dams in the Loess Plateau region (trapping~5 BCM water). The increasing ‘Pollution’ in the river, besides threatening public health and ecology, also contributed to the water stress by rendering certain stretches of the river biologically dead and unsuitable for any use. The ‘Climate Change’, with its key negative effect on precipitation in the middle sub-basin, overall contributed small (8-11 %) to the observed reduction in river flow. With increasing challenges for the adopted engineering solutions tackling the water stress, the study suggested the use of a demand management approach, employing adaptive policy measures, as an alternative or supplementary solution to the current approach. In addition, the study highlights that regular reviewing and reforming the key decisions based on evidence and updated information, and taking a participatory approach, may offer a sustainable pathway to the environment as well as socio-economic goals.
Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has historically been associated with HRIs. Hajj attracts over two million Muslim pilgrims from more than 180 countries to the holy city of Makkah, Kingdom of Saudi Arabia. Several modifiable and non-modifiable factors render Hajj pilgrims at increased risk of developing HRIs during Hajj. These include characteristics of the Hajj, its location, population, and rituals, as well as pilgrims’ knowledge of HRIs and their attitude and behavior. Makkah is characterized by a hot desert climate and fluctuating levels of relative humidity. Pilgrims are very diverse ethnically and geographically, with different adaptations to heat. Significant proportions of the Hajj population are elderly, obese, and with low levels of fitness. In addition, many have underlying health conditions and are on multiple medications that can interfere with thermoregulation. Other factors are inherent in the Hajj and its activities, including crowding, physically demanding outdoor rituals, and a high frequency of infection and febrile illness. Pilgrims generally lack awareness of HRIs, and their uptake of preventive measures is variable. In addition, many engage in hazardous behaviors that increase their risk of HRIs. These include performing rituals during the peak sunshine hours with no sun protection and with suboptimal sleep, nutrition, and hydration, while neglecting treatment for their chronic conditions. HRIs preventive plans for Hajj should incorporate measures to address the aforementioned factors to reduce the burden of these illnesses in future Hajj seasons. Lessons from the Hajj can be used to inform policy making and HRIs preventive measures in the general population worldwide.
Most heat-health studies identified thresholds just outside human comfort zones, which are often too low to be used in heat-warning systems for reducing climate-related health risks. We refined a generalized additive model for selecting thresholds with substantial health risk enhancement, based on Taiwan population records of 2000-2017, considering lag effects and different spatial scales. Reference-adjusted risk ratio (RaRR) is proposed, defined as the ratio between the relative risk of an essential health outcome for a threshold candidate against that for a reference; the threshold with the highest RaRR is potentially the optimal one. It was found that the wet-bulb globe temperature (WBGT) is a more sensitive heat-health indicator than temperature. At lag 0, the highest RaRR (1.66) with WBGT occurred in emergency visits of children, while that in hospital visits occurred for the working-age group (1.19), presumably due to high exposure while engaging in outdoor activities. For most sex, age, and sub-region categories, the RaRRs of emergency visits were higher than those of hospital visits and all-cause mortality; thus, emergency visits should be employed (if available) to select heat-warning thresholds. This work demonstrates the applicability of this method to facilitate the establishment of heat-warning systems at city or country scales by authorities worldwide.
This study was conducted as a planning stage for development of wearable devices capable of managing the thermal diseases by applying the ICT (Information Communication Technology) in an endeavor to meet the urgent needs for countermeasures amid rapid increase in the number of patients with the thermal diseases caused as a result of global warming. The purpose of this study was to provide the basic data for development of wearable devices allowing the patients to be transported expeditiously to hospitals based on synchronization with medical institutions or enabling the prevention of diseases through the response system for each stage according to the reference values based on the data reflecting physical characteristics of individuals by applying the ICT, so that the thermal diseases can be managed effectively. For that, basic study will be conducted on expanding the role of the devices capable of protecting human lives from various thermal diseases caused by the scorching heat waves, which are affecting countries worldwide and expected to persist in the period ahead, by setting the goals of each stage for the thermal disease management platform and collecting necessary information. Based on the accumulated data, the functions of precise diagnosis and treatment can be expected through more accurate evidences pertaining to the thermal diseases.
Previous studies have suggested an association between air pollution and lung disease. However, few studies have explored the relationship between chronic lung diseases classified by lung function and environmental parameters. This study aimed to comprehensively investigate the relationship between chronic lung diseases, air pollution, meteorological factors, and anthropometric indices. We conducted a cross-sectional study using the Taiwan Biobank and the Taiwan Air Quality Monitoring Database. A total of 2889 participants were included. We found a V/U-shaped relationship between temperature and air pollutants, with significant effects at both high and low temperatures. In addition, at lower temperatures (<24.6 °C), air pollutants including carbon monoxide (CO) (adjusted OR (aOR):1.78/Log 1 ppb, 95% CI 0.98-3.25; aOR:5.35/Log 1 ppb, 95% CI 2.88-9.94), nitrogen monoxide (NO) (aOR:1.05/ppm, 95% CI 1.01-1.09; aOR:1.11/ppm, 95% CI 1.07-1.15), nitrogen oxides (NO(x)) (aOR:1.02/ppm, 95% CI 1.00-1.05; aOR:1.06/ppm, 95% CI 1.04-1.08), and sulfur dioxide (SO(2)) (aOR:1.29/ppm, 95% CI 1.01-1.65; aOR:1.77/ppm, 95% CI 1.36-2.30) were associated with restrictive and mixed lung diseases, respectively. Exposure to CO, NO, NO(2), NO(x) and SO(2) significantly affected obstructive and mixed lung disease in southern Taiwan. In conclusion, temperature and air pollution should be considered together when evaluating the impact on chronic lung diseases.
The Asia-Pacific contains over half of the world’s population, 21 countries have a Gross Domestic Product <25% of the world's largest economy, many countries have tropical climates and all suffer the impact of global warming. That 'perfect storm' exacerbates the risk of occupational heat illness, yet first responders must perform physically demanding work wearing personal-protective clothing and equipment. Unfortunately, the Eurocentric emphasis of past research has sometimes reduced its applicability to other ethnic groups. To redress that imbalance, relevant contemporary research has been reviewed, to which has been added information applicable to people of Asian, Melanesian and Polynesian ancestry. An epidemiological triad is used to identify the causal agents and host factors of work intolerance within hot-humid climates, commencing with the size dependency of resting metabolism and heat production accompanying load carriage, followed by a progression from the impact of single-layered clothing through to encapsulating ensembles. A morphological hypothesis is presented to account for inter-individual differences in heat production and heat loss, which seems to explain apparent ethnic- and gender-related differences in thermoregulation, at least within thermally compensable states. The mechanisms underlying work intolerance, cardiovascular insufficiency and heat illness are reviewed, along with epidemiological data from the Asia-Pacific. Finally, evidence-based preventative and treatment strategies are presented and updated concerning moisture-management fabrics and barriers, dehydration, pre- and post-exercise cooling, and heat adaptation. An extensive reference list is provided, with >25 recommendations enabling physiologists, occupational health specialists, policy makers, purchasing officers and manufacturers to rapidly extract interpretative outcomes pertinent to the Asia-Pacific.
Tasks performed by search and rescue (SAR) teams can be physically demanding. SAR organizations are faced with mounting challenges due to increased participation in recreation in remote locations and more frequent extreme weather. We sought to describe the physiological response and the methods for data collection during helicopter emergency medical service (HEMS) winch rescue from remote wilderness in extreme heat. A flight paramedic sustained 81% of maximum heart rate (VO₂ ~44.8 mL/kg/min) for ~10 minutes at a rate of perceived exertion of 19/20, and a relative heart rate of 77.5% in 37.1°C. Maximal acceptable work time for this task was calculated at 37.7 minutes. Our data collection methods were feasible, and the data captured demonstrated the level of physiological strain that may be encountered during HEMS SAR operations in austere environments and hot climate. It is essential that SAR teams that perform physically demanding tasks use a scientific approach to adapt and evolve. This is necessary to ensure personnel are appropriately selected, trained, and equipped to respond in an era of increasing demand and extreme environments.
INTRODUCTION: It is well-established that heatwaves increase demand for emergency transport in metropolitan areas; however, little is known about the impact of heat events on demand for prehospital retrieval services in rural and remote areas, or how heatwaves are defined in this context. INCLUSION CRITERIA: Papers were eligible for inclusion if they reported on the impact of a heat event on the activity of a prehospital and retrieval service in a rural or remote area. METHODS: A search of PubMed, Cochrane, Science Direct, CINAHL, and Google Scholar databases was undertaken on August 18, 2020 using search terms related to emergency medical transport, extreme heat, and rural or remote. Data relevant to the impact of heat on retrieval service activity were extracted, as well as definitions of extreme heat. RESULTS: Two papers were identified, both from Australia. Both found that heat events increased the number of road ambulance call-outs. Both studies used the Excess Heat Factor (EHF) to define heatwave periods of interest. CONCLUSIONS: This review found almost no primary literature on demand for prehospital retrieval services in rural and remote areas, and no data specifically related to aeromedical transport. The research did recognize the disproportionate impact of heat-related increase in service demand on Australian rural and regional health services. With the effects of climate change already being felt, there is an urgent need for more research and action in this area.
An innovative bioclimatic metric based on the Universal Thermal Climate Index (UTCI) is developed to quantify human thermal physiological heat stress. The Heat Stress Exposure (HSE) metric includes both duration and intensity dimensions of heat exposure, and in this paper it is applied to the Sydney Australia climatology. Geographic Information Systems (GIS) were used to spatially represent and visualize Sydney’s HSE. The first stage of the analysis collated observed meteorological data from 10 weather stations across the Sydney metropolitan region, extending from coastal Sydney to approximately 50 km inland in 2017. The second stage of the analysis integrated the radiative meteorological data into estimates of hourly Mean Radiant Temperature which were then applied to UTCI. In the final stage, a threshold UTCI value of 26 degrees C was selected for the calculation of HSE, which was then cumulated to represent the duration of heat exposure throughout the year. The difference between each UTCI hourly reading and the 26 degrees C threshold defined a UTCI exceedance (Delta UTCI; degrees C). The cumulative total of all Delta UTCI throughout the year defined n-ary sumation Delta UTCI in units of degree hours (degrees C.hr), thereby capturing both intensity and duration of exposure to heat stress. Weather systems driving westerly winds from the Australian continent’s central deserts brought the highest HSE to Sydney’s inland western suburbs, with values ranging between 4,000-6,000 n-ary sumation Delta UTCI (degrees C.hr). Coastal eastern Sydney experienced considerably lower HSE values ranging from 1,600-3,000 n-ary sumation Delta UTCI (degrees C.hr), reflecting the moderating influences of sea breezes and evaporative cooling.
Extreme heat and hot weather has a negative impact on human health and society. Global warming has resulted in an increase in the frequency and duration of heatwaves. Heat-related illnesses are a significant negative consequence of high temperatures and can be life-threatening medical emergencies. The severity of the symptoms can depend on the pre-existing medical conditions and vary from mild headaches to severe cases that can lead to coma and death. The risk of heat-related illness may be higher for people experiencing homelessness due to a lack of access to cool places and water, and the complex interactions between mental illness, medications and substance use disorder. This paper presents two cases of people experiencing homelessness who were admitted to the emergency department of a hospital in Sydney, Australia during a heatwave in November 2020. Both cases were adult males with known risk factors for heat-related illness including hypertension and schizophrenia (Case One) and hepatitis C, cirrhosis, and alcohol use disorder (Case Two). These cases show that severe weather can not only be detrimental to homeless people’s health but can also cause a significant economic toll, evident by the $70,184 AUD expenditure on the care for these two cases. This case report highlights the requirement to determine the risk of heat-related illness to people experiencing homelessness and need to protect this vulnerable population from weather-related illness and death.
Public health risks resulting from urban heat in cities are increasing due to rapid urbanisation and climate change, motivating closer attention to urban heat mitigation and adaptation strategies that enable climate-sensitive urban design and development. These strategies incorporate four key factors influencing heat stress in cities: the urban form (morphology of vegetated and built surfaces), urban fabric, urban function (including human activities), and background climate and regional geographic settings (e.g. topography and distance to water bodies). The first two factors can be modified and redesigned as urban heat mitigation strategies (e.g. changing the albedo of surfaces, replacing hard surfaces with pervious vegetated surfaces, or increasing canopy cover). Regional geographical settings of cities, on the other hand, cannot be modified and while human activities can be modified, it often requires holistic behavioural and policy modifications and the impacts of these can be difficult to quantify. When evaluating the effectiveness of urban heat mitigation strategies in observational or traditional modelling studies, it can be difficult to separate the impacts of modifications to the built and natural forms from the interactions of the geographic influences, limiting the universality of results. To address this, we introduce a new methodology to determine the influence of urban form and fabric on thermal comfort, by utilising a comprehensive combination of possible urban forms, an urban morphology data source, and micro-climate modelling. We perform 9814 simulations covering a wide range of realistic built and natural forms (building, roads, grass, and tree densities as well as building and tree heights) to determine their importance and influence on thermal environments in urban canyons without geographical influences. We show that higher daytime air temperatures and thermal comfort indices are strongly driven by increased street fractions, with maximum air temperatures increases of up to 10 and 15 ? as street fractions increase from 10% (very narrow street canyons and/or extensive vegetation cover) to 80 and 90% (wide street canyons). Up to 5 ? reductions in daytime air temperatures are seen with increasing grass and tree fractions from zero (fully urban) to complete (fully natural) coverage. Similar patterns are seen with the Universal Thermal Climate Index (UTCI), with increasing street fractions of 80% and 90% driving increases of 6 and 12 ?, respectively. We then apply the results at a city-wide scale, generating heat maps of several Australian cities showing the impacts of present day urban form and fabric. The resulting method allows mitigation strategies to be tested on modifiable urban form factors isolated from geography, topography, and local weather conditions, factors that cannot easily be modified.
Historically, heat waves have resulted in more Australian deaths than any other natural hazard and continue to present challenges to the health and emergency management sectors. While people experiencing homelessness are particularly vulnerable to adverse effects of heat waves, little research has been reported about their hot weather experiences. This paper reports findings from interviews with 48 homeless people sleeping rough in Adelaide CBD on very hot days. While the majority reported drinking a litre or more of water in the previous 24 hours, 79% reported experiencing one or more heat stress symptoms. The research highlights that the protective actions people sleeping rough can take during hot weather are limited by their circumstances and may not be sufficient to prevent dehydration and heat stress. The levels of dehydration and heat stress symptoms suggest that immediate responses could include making drinking water more readily available. It may be helpful to provide information which highlights heat stress symptoms including indicators of dehydration. The role of outreach in providing connections, support and advice is most likely to ameliorate the risk of heat stress. However, the long-term response to protect people from heat stress is access to housing.
OBJECTIVES: To conduct a document analysis of sports and leisure activity heat-related injury prevention resources in Australia and develop an understanding of the content within those resources. DESIGN & METHODS: Heat resources were included if they dealt specifically with, or could be extrapolated to, prevention of heat-related injuries. Collating strategies for the catalogue included: (1) a detailed search of the organisation’s website and (2) an online search for sport specific heat resources. A content analysis of each resource was first performed, and descriptive codes were assigned to the data using qualitative data analysis software. Every coded text was recorded as an individual data point (n). Common sub-categories were identified by thematic analysis and collated under three broader categories. RESULTS: A total of 468 data points were identified within the 64 heat resources found. Guidelines (n = 20) and policies (n = 18) were the most common type of resources followed by factsheets (n = 9), webpages (n = 8), laws and by-laws (n = 2). Three overarching categories emerged through the data analysis process: preventive strategies (n = 299, 63.9%), risk factors (n = 94, 20.1%), treatment (n = 75, 16.0%). Activity modification, which included information on rescheduling games and extra breaks, was the most common intervention. Cricket, soccer, swimming and triathlon had the most complete set of heat resources. CONCLUSIONS: The findings of this study provide an insight into the composition of heat-related sports injury prevention resources within Australia and identify areas for development. As the resources were incomplete for many sports, the development of more comprehensive heat safety resources is required to ensure the safety of participants.
Anthropogenic climate change and related sea level rise will have a range of impacts on populations, particularly in the low lying Pacific island countries (PICs). One of these impacts will be on the health and well-being of people in these nations. In such cases, access to medical facilities is important. This research looks at the medical facilities currently located on 14 PICs and how climate change related impacts such as sea level rise may affect these facilities. The medical infrastructure in each country were located using information from a range of sources such as Ministry of Health (MoH) websites, World Health Organization, Doctors Assisting in South Pacific Islands (DAISI), Commonwealth Health Online, and Google Maps. A spatial analysis was undertaken to identify medical infrastructure located within 4 zones from the coastline of each country: 0 to 50 m, 50 to 100 m, 100 to 200 m, and 200 to 500 m. The findings indicate that 62% of all assessed medical facilities in the 14 PICs are located within 500 m of the coast. The low-lying coral atoll countries of Kiribati, Marshall Islands, Nauru, Palau, Tokelau, and Tuvalu will be highly affected as all medical facilities in these countries fall within 500 m of the coast. The results provide a baseline analysis of the threats posed by sea-level rise to existing critical medical infrastructure in the 14 PICs and could be useful for adaptive planning. These countries have limited financial and technical resources which will make adaptation challenging.
In recent years, climate changeability, hydrologic regime conditions, and human interventions have become crucial issues to be assessed. In this research, two annually recorded datasets were collected to analyse the change in the trend. The first set is comprised of precipitation, streamflow, and water quality variables including Total Dissolved Solids (TDS), pH, cation, and anion and the second one contains the mean groundwater level and agricultural water demand of four main stations of Shahpour River basin in the south of Iran. To recognize the fluctuating patterns, the Mann-Kendall Trend Test (MKTT), KPSS Stationary Test, and Pettit Homogeneity Test (PHT) of statistical methods were utilized at a 5% significance level. The Standardized Precipitation Index (SPI) and Streamflow Drought Index (SDI) were subsequently employed to detect the hydrological drought patterns. According to the statistical analysis, the streamflow and water quality depicted intensive varying trends, while there were slight decreasing trends for the precipitation series. Afterward, the abrupt changing points were identified in the first and second datasets between the years 2004 to 2007. The results of this study clarified that human activity effects (as a major factor) and climate variability (as a minor factor) have been affecting the Shahpour River basin. These effects disrupt the water chemical balance (the relationship between cations and anions) and hydrological regimes (increasing drought drivers) and consequently menace the health of the watershed.
Urban overheating (UO) may interact with synoptic-scale weather conditions. The association between meteorological parameters and UO has already been a subject of considerable research, however, the impact of synoptic-scale weather conditions on UO magnitude, particularly in a coastal city that is also near the desert landmass (Sydney) has never been investigated before. The present research examines the influence of synoptic-scale weather conditions on UO magnitude in Sydney by utilizing the newly developed gridded weather typing classification (GWTC). The diurnal, and seasonal variations in suburban-urban temperature contrast (ΔT) in association with synoptic-scale weather conditions, and ΔT response to synoptic air-masses during extreme heat events are investigated in three zones of Sydney. Generally, an exacerbation in UO magnitude was reported at daytime over the years, whereas the nocturnal UO magnitude was alleviated over time. The humid warm (HW), and warm (W) air-masses were found primarily responsible for exacerbated daytime UO during extreme heat events and in all other seasons, raising the mean daily maximum ΔT to 8-10.5 °C in Western Sydney, and 5-6.5 °C in inner Sydney. The dry warm (DW), and W conditions were mainly responsible for urban cooling (UC) at nighttime, bringing down the mean daily minimum ΔT to – 7.5 to – 10 °C in Western Sydney, and – 6 to – 7.5 °C in inner Sydney. The appropriate mitigation technologies can be planned based on this study to alleviate the higher daytime temperatures in the Sydney suburbs.
BACKGROUND: Though inconsistent, acute effects of ambient nitrogen oxides on cardiovascular mortality have been reported. Whereas, interactive roles of temperature on their relationships and joint effects of different indicators of nitrogen oxides were less studied. This study aimed to extrapolate the independent roles of ambient nitrogen oxides and temperature interactions on cardiovascular mortality. METHODS: Data on mortality, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were collected. Three indicators including nitric oxide (NO), nitrogen dioxide (NO(2)), and nitrogen oxides (NO(X)) were studied. Adjusted generalized additive models (GAMs) were applied to analyse their associations with cardiovascular mortality in different groups. RESULTS: The average daily concentrations of NO, NO(2), and NO(X) were 11.7 μg/m^3, 30.7 μg/m^3, and 53.2 μg/m3, respectively. Significant associations were shown with each indicator. Cumulative effects of nitrogen oxides were more obvious than distributed lag effects. Males, population under 65 years old, and population with stroke-related condition were more susceptible to nitrogen oxides. Adverse effects of nitrogen oxides were more significant at low temperature. Impacts of NO(2) on cardiovascular mortality, and NO on stroke mortality were the most robust in the multi-pollutant models, whereas variations were shown in the other relationships. CONCLUSIONS: Low levels of nitrogen oxides showed acute and adverse impacts and the interactive roles of temperature on cardiovascular mortality. Cumulative effects were most significant and joint effects of nitrogen oxides required more attention. Population under 65 years old and population with stroke-related health condition were susceptible, especially days at lower temperature.
BACKGROUND: The concentration of air pollutants is affected by changes in climatic conditions. Air temperature is a main factor affecting the concentration of air pollutants. This study sought to examine the relationship between air temperature, air pollutants, and their interactions in elderly patients with coronary heart disease (CHD) in Liaoning Province, China. METHODS: The population data primarily comprised data on daily hospitalizations due to CHD between January 1, 2015 and December 31, 2019 at the Shengjing Hospital of China Medical University. A total of 25,461 patients, who were permanent residents of Liaoning Province, were included in the study. The meteorological data included data on the average daily temperature and air pollutant data of the average daily concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) over the hospitalization period. A multiple linear regression model was constructed to analyze the relationship between meteorological factors and CHD. RESULTS: The interaction between air temperature and SO2, NO2, and O3 concentrations was related to the number of daily CHD-related hospitalizations in elderly patients aged ≥65 years (P=0.0023); however, this correlation was lower than that of the interaction between SO2 and NO2 concentrations (P=0.0026). Additionally, age exerted a greater effect than air temperature and air pollutants. CONCLUSIONS: The incidence of CHD in elderly patients aged ≥65 years was found to be related to the interaction of SO2 and NO2 concentrations, and the interaction of air temperature and the concentrations of SO2, NO2, and O3.
Hot extremes are anticipated to be more frequent and more intense under climate change, making the Indo-Gangetic Plain of India, with a 400 million population, vulnerable to heat stress. Recent studies suggest that irrigation has significant cooling and moistening effects over this region. While large-scale irrigation is prevalent in the Indo-Gangetic Plain during the two major cropping seasons, Kharif (Jun-Sep) and Rabi (Nov-Feb), hot extremes are reported in the pre-monsoon months (Apr-May) when irrigation activities are minimal. Here, using observed irrigation data and regional climate model simulations, we show that irrigation effects on heat stress during pre-monsoon are 4.9 times overestimated with model-simulated irrigation as prescribed in previous studies. We find that irrigation increases relative humidity by only 2.5%, indicating that irrigation is a non-crucial factor enhancing the moist heat stress. On the other hand, we detect causal effects of aerosol abundance on the daytime land surface temperature. Our study highlights the need to consider actual irrigation data in testing model-driven hypotheses related to the land-atmosphere feedback driven by human water management.
BACKGROUND: Improving the level of knowledge, attitude and practices of workers exposed to heat stress using a suitable tool can be a cheap and effective method. This requires the consideration of personal, environmental and social factors, which, the PRECEDE model is highly applicable for. Thus, the aim of the present study is the development of a tool assessment for measuring the knowledge, attitude and practices of workers in outdoor occupations regarding heat stress exposure using the PRECEDE model. METHODS: In the present study, a tool was designed and constructed using the PRECEDE model by analyzing the relevant literature and expert opinion. The face validity of the tool was determined based on the opinion of ten experts with experience in the field of occupational weather conditions. The content validity of the tool was determined using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). Cronbach’s alpha reliability coefficient was used to determine the reliability of the tool’s internal consistency. SPSS version 23 was used for statistical analysis. RESULTS: A PRECEDE based questionnaire was designed with a total of 55 questions consisting of predisposing factors (28 questions for knowledge and 14 questions for attitude), enabling factors (5 questions), reinforcing factors (3 questions) and preventive behaviors (5 questions). The Content Validity Index (CVI) of all questions was above 0.79. The Content Validity Ratio (CVR) of all questions was above 0.62 (Lawshe method). The Cronbach’s alpha reliability coefficient of all PRECEDE domains were above the 0.7 acceptable value. Based on the results obtained, all 55 questions were approved and thus the content validity and reliability of this tool was deemed acceptable. CONCLUSION: Considering the reliability and validity of this tool, its application is recommended in all health and safety inspections within various industries for measuring the heat stress knowledge, attitude and practices of workers engaged in outdoor occupations and also for presenting suitable solutions or preventive measures.
OBJECTIVE: The purpose of this study is to evaluate the factors involved in the early stage of exertional heat stroke (EHS) that are associated with mortality. METHODS: In this retrospective, case-control study, patients from 11 tertiary medical centers in China were enrolled from January 1, 2012, to December 31, 2019. Demographic information, underlying diseases, ambient temperature, and relative humidity, clinical manifestations, initial body temperature, time from onset to diagnosis of EHS (including suspected), and the duration of body temperature > 38°C of all enrolled patients were recorded. The occurrence of organ dysfunction within 72 h was evaluated, and in-hospital deaths were recorded. The patients were subsequently divided into a survival group and a non-survival group. The “case” refers to patients in the non-survival group, while the “control” refers to patients without death. RESULTS: Of the 214 hospitalized patients with EHS, 183 survived and 31 died, and the overall mortality was 14.49% (31/214). A binary logistic regression showed that only the duration of body temperature > 38°C (OR 1.80, 95% CI 1.34-2.42) and the number of organs damaged within 72 h of onset (OR 6.54, 95% CI 2.31-18.56) were statistically significant in terms of risk of death in hospital (p < 0.05). A goodness of fit test produced a p-value of 0.76. According to receiver operating characteristic curve (ROC) analysis, the areas under the curve (AUC) were 0.989 (95% CI 0.978-1.000; p < 0.05) and 0.936 (95% CI 0.896-0.976; p < 0.05). CONCLUSION: Of the various factors involved in the early stage of the disease, the duration of high body temperature and the number of organs damaged within 72 h of onset were independent risk factors and predictors associated with death.
The net effective temperature (NET), an index that includes the combined effects of temperature, humidity, and wind, was used along with temperature to assess the impacts of climate change on the heat stress perception in East Asia, one of the regions considered most vulnerable to heat stress. The need for dynamic downscaling has been emphasized because the regional effects of climate change do not follow the global levels linearly. In this study, daily maximums calculated from the 3-hourly data downscaled by five different regional climate models from four coupled general circulation models participating in Coordinated Regional Climate Downscaling Experiment-East Asia phase 2 were utilized. To account for the fact human beings acclimate to their environments, 95th percentile of the maximum temperature and maximum NET was used along with the average boreal summer maximum temperatures/NETs. The performance of the models was assessed first, which showed that the models reproduced the current climate well. Future projections revealed an increase in both average and 95th percentile of the maximum temperature and NET over the entire domain for both the RCP8.5 and SSP5-8.5 scenarios. The increase in heat stress (NET) was slightly larger than the temperature itself, with an increase of up to 7/10 degrees C for temperature and 8/11 degrees C for NET in RCP8.5/SSP5-8.5, respectively. The overall increases in temperature and NET were projected to be higher in the higher latitudes, while the increase in the frequency of the temperature and NET extremes was predicted to be higher in the already vulnerable regions in the southern part of the domain.
Background: One of the biggest global occupational threats, especially in the outdoor workplace, is climate change and global warming, as workers are exposed to the heat stress leading to reduced performance. The aim of this study was to investigate the effect of workplace climate on labor productivity index in the agricultural sector. Methods: In this study, data related to environmental variables of 215 synoptic meteorological stations in Khuzestan province were collected from three climatic regions (hot, mild, and cold). Using MATLAB R 2018b mathematical software based on ASHRAE/ISO7730 standard values by designing some scenarios, predicted mean vote (PMV) index, and then, labor productivity index (P) were estimated. The data were analyzed using SPSS version 25 software. Results: The results showed that in the hot regions, there is a significant inverse relationship between P index and the main environmental variables (ta, tr, pa). In the cold regions, increasing the amount of ta and tr in light and medium workload improved the P index, but for heavy workload, it reduced productivity, and the most effective factor was increasing air vapor pressure. In the mild regions, the most effective factor in productivity was air vapor pressure. In addition, the results of Spearman’s correlation coefficient showed that PMV index has a direct and significant relationship with P index. Conclusion: Regarding the increasing trend of climate change and its effect on the desired thermal comfort and productivity, well structure and planning is needed to manage farm workers health.
The number of patients experiencing heat-related illnesses has gradually increased due to global warming. Owing to an aging society, 50% of patients with heat-related illnesses in Japan are elderly. Core temperature is one key parameter for health care; however, its monitoring is virtually impossible. Internet of Things (IoT) devices for healthcare have been proposed; however, the vital parameters to be monitored remain controversial. Here, we assessed the core temperature of elderly patients who were transported to hospitals by ambulance from their homes. The patients’ core temperatures were recorded by the Fire Department of Nagoya City in the summers of 2019 and 2020. The time course of the core temperature of each patient was then replicated using the integrated computational techniques through multiphysics analysis and thermoregulation under ambient condition data. According to the statistics, most elderly patients who were transported from their homes had a high core temperature. The measured core temperature in 31.4% of the patients was higher than the computed core temperature even assuming that there was no sweating. Assuming that the sweating function works well, the total amount of water loss was insufficient to have caused dehydration in a single day. These results suggest that successive heat stress during the preceding days should be considered to recreate the computed core temperature to match the measurement. These results were consistent with the previous finding that some elderly suffered from heatstroke successively over a few days. In the IoT-based monitoring system development, it would be informative for monitoring core temperature during the preceding days.
Objective: This study explored the effect of multiple-nutrient supplementation on muscle damage and liver and kidney function after vigorous exercise under heat. Methods: After an initial pilot trial comprising 89 male participants, 85 participants were recruited and assigned into three groups: a multiple-nutrient (M) group, a glucose (G) group, and a water (W) group. Multiple-nutrient supplements contain glucose, fructose, maltose, sodium, potassium, vitamin B(1), vitamin B(2), vitamin C, vitamin K, and taurine. Participants were organised to take a 3-km running test (wet-bulb globe temperature 32??C) after a short-term (7 days) supplement. Blood samples were obtained to detect biochemical parameters [glucose (GLU), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), uric acid (UA), creatinine (Cr), creatine kinase (CK), lactate dehydrogenase (LDH), and lactic acid], inflammation factors [interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α)], and oxidative stress biomarkers [superoxide dismutase (SOD) and 8-iso-prostaglandin F (2alpha) (8-iso-PGF2α)]. Results: In the pilot trial, BUN decreased significantly in the M and G groups immediately after the running test. AST, Cr, and UA were significantly reduced 24 h after the running test with single-shot multiple-nutrient supplementation. In the short-term trial, multiple nutrients further prevented the elevation of CK (p = 0.045) and LDH (p = 0.033) levels 24 h after strenuous exercise. Moreover, we found that multiple nutrients significantly reduced IL-6 (p = 0.001) and TNF-α (p = 0.015) elevation immediately after exercise. Simultaneously, SOD elevation was significantly higher in the M group immediately after exercising than in the other two groups (p = 0.033). 8-iso-PGF2α was reduced in the M group 24 h after exercise (p = 0.036). Conclusions: This study found that multiple-nutrient supplementation promoted the recovery of muscle damage and decreased liver and kidney function caused by strenuous exercise in a hot environment, probably through the inhibition of secondary damage induced by increased inflammatory reactions and oxidative stress. In this respect, the current study has important implications for the strategy of nutritional support to accelerate recovery and potentially prevent heat-related illness. This study was prospectively registered on clinicaltrials.gov on June 21, 2019 (ID: ChiCTR1900023988).
Energy efficiency in the housing sector is important for achieving carbon neutrality; to achieve this, more net-zero energy houses (ZEHs) are required. ZEHs are considered resilient to power outages. However, the type of living that can be achieved during a power outage is unclear. The purpose of this study was to examine the feasibility of staying in a ZEH with thermal comfort without a risk of heat stroke dur-ing summer power outages. We created daily schedules and conducted experiments using an actual ZEH assuming a power outage in summer. The experimental house was constructed in the suburbs of Shizuoka (about 110 km west of Tokyo), Japan, which has a humid subtropical climate. The house was equipped with a photovoltaic system of 4.62 kW and a storage battery capacity of 5.6 kWh, which can output up to 2.0 kVA. The results showed that ZEH can provide air conditioning (AC), ventilation, lighting, refrigerator, cell phone charging, televisions, and hot water supply for a 72-hour power outage. However, the use of high-load appliances and the use of bedroom AC during sleeping time caused disruption in the power supply. The use of AC on an independent circuit resulted in a predicted mean vote (PMV) of-0.5 ti 0.8, and a wet-bulb globe temperature of approximately 23 degrees C was achieved. Thus, thermal com-fort with a low risk of heat stroke was maintained. Solar shading and window openings were however not considered and further research is needed to evaluate more varied architectural design and behaviors, and to assess the potential for staying at home in a ZEH. Different weather conditions and different occu-pant assumptions (e.g., elderly) also need to be further studied.(c) 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
In the past, thermal comfort in naturally ventilated hospital wards was not a major issue to discuss, but now this matter needs to be revisited following the effects of climate change. A Hybrid Photovoltaic Thermal (PVT) and Heat Pump System (HPVTHPS) was proposed in this field study to enhance the thermal comfort of naturally ventilated hospital wards. The heat pump was used for heating water and producing cold air to reduce the air temperature in the ward, besides being an active cooling agent to improve the performance of the PVT system. Thus, the main purpose of this article is to evaluate an on-site performance of a HPVTHPS in providing hot water and space cooling for naturally ventilated hospital wards in tropical climates. Overall, the proposed HPVTHPS installation has reduced the room temperature of the hospital ward compared to the baseline temperature with an average temperature drop ranging from 0.5 degrees C to 3.9 degrees C. The PVT system also shows high efficiency values between 51.0% and 69.0% which include thermal and electrical energy performance. The findings in this study are very useful for hospital management in improving thermal comfort in hospital wards using efficient and low energy systems.
Power grid outdoor workers are usually exposed to hot environments and could suffer the threats to occupational health and safety like heat strain and injury. In order to predict and assess the thermophysiological responses of grid workers in the heat, the clothing thermal insulation of grid worker ensembles was measured by a thermal manikin and a multi-segment human bioheat model was employed to evaluate the thermophysiological response parameters of grid workers such as core temperature, skin temperature and sweat loss. The results show that working in a hot environment can cause a obvious increase in core temperature and skin temperature of grid workers, and the acceptable maximum working time of grid workers varies greatly in different hot environments. A reasonable work organization strategy can effectively decrease the core temperature and sweat loss, increasing the duration of acceptable maximum working time for grid workers. This study is helpful to assess heat-related risks of grid workers and support power grid companies to rationalize work organization strategies and personal protection guidelines.
Occupational heat stress is a crucial risk factor for a range of Heat-Related Illnesses (HRI). Outdoor workers in unorganized work sectors exposed to high ambient temperatures are at increased risk in developing countries. We aim to compare HRI, Productivity Loss (PL), and reduced renal health risk between workers from outdoor unorganized (N = 1053) and indoor organized (N = 1051) work sectors. Using descriptive methods and a large epidemiological cross-sectional study using mixed methods, we compared risk patterns between the two groups. We analyzed the risk of self-reported HRI symptoms, Heat Strain Indicators (HSIs), PL, and reduced kidney function using Multivariate Logistic Regression (MLR) models. Although Wet Bulb Globe Temperature (WBGT) exposures were high in both the outdoor and indoor sectors, significantly more Outdoor Unorganized Workers (OUWs) reported heat stress symptoms (45.2% vs 39.1%) among 2104 workers. OUWs had a significantly higher share of the heavy workload (86.7%) and long years of heat exposures (41.9%), the key drivers of HRIs, than the workers in indoor sectors. MLR models comparing the indoor vs outdoor workers showed significantly increased risk of HRI symptoms (Adjusted Odds Ratio) (AOR(outdoor) = 2.1; 95% C.I:1.60-2.77), HSI (AOR(outdoor) = 1.7; 95% C.I:1.00-2.93), PL (AOR(outdoor) = 11.4; 95% C.I:7.39-17.6), and reduced kidney function (Crude Odds Ratio) (CORoutdoor = 1.4; 95% C.I:1.10-1.84) for the OUWs. Among the heat-exposed workers, OUW had a higher risk of HRI, HSI, and PL even after adjusting for potential confounders. The risk of reduced kidney function was significantly higher among OUWs, particularly for those with heat exposures and heavy workload (AOR(outdoor) = 1.5; 95% C.I: 0.96-2.44, p = 0.073) compared to the indoor workers. Further, in-depth studies, protective policies, feasible interventions, adaptive strategies, and proactive mitigation efforts are urgently needed to avert health and productivity risks for a few million vulnerable workers in developing nations as climate change proceeds.
BACKGROUND: Although age and regional climate are considered to have effects on the incidence ratio of heat-related illness, quantitative estimation of age or region on the effect of occurring temperature for heat stroke is limited. METHODS: By utilizing data on the number of daily heat-related ambulance transport (HAT) in each of three age groups (7-17, 18-64, 65 years old, or older) and 47 prefectures in Japan, and daily maximum temperature (DMT) or Wet Bulb Globe Temperature (DMW) of each prefecture for the summer season, the effects of age and region on heat-related illness were studied. Two-way ANOVA was used to analyze the significance of the effect of age and 10 regions in Japan on HAT. The population-weighted average of DMT or DMW measured at weather stations in each prefecture was used as DMT or DMW for each prefecture. DMT or DMW when HAT is one in 100,000 people (T(1) and W(1), respectively) was calculated for each age category and prefecture as an indicator of heat acclimatization. The relation between T(1) or W(1) and average DMT or DMW of each age category and prefecture were also analyzed. RESULTS: HAT of each age category and prefecture was plotted nearly on the exponential function of corresponding DMT or DMW. Average R(2) of the regression function in 47 prefectures in terms of DMW was 0.86, 0.93, and 0.94 for juveniles, adults, and elderly, respectively. The largest regional difference of W(1) in 47 prefectures was 4.5 and 4.8 °C for juveniles and adults, respectively between Hokkaido and Tokyo, 3.9 °C for elderly between Hokkaido and Okinawa. Estimated W(1) and average DMT or DMW during the summer season for 47 prefectures was linearly related. Regarding age difference, the regression line showed that W(1) of the prefecture for DMW at 30 °C of WBGT was 31.1 °C, 32.4 °C, and 29.8 °C for juveniles, adults, and elderly, respectively. CONCLUSIONS: Age and regional differences affected the incidence of HAT. Thus, it is recommended that public prevention measures for heat-related disorders take into consideration age and regional variability.
The last century has seen a gradual increase in global average temperatures-a phenomenon that has come to be known as global warming. The World Meteorological Organization (WMO) has reported that 2020 was one of the three warmest years on record and that the global average temperature was ~1.2°C above preindustrial (1850-1900) levels [1]. Adverse effects on health resulting from global warming are important issues to consider, as health risks associated with such extreme heat are anticipated [2]. In fact, this warming has been shown to severely limit human activity in tropical and mid-latitude regions [3], and in particular, outdoor and manual workers who are exposed to ambient heat during working hours are susceptible to increased health risks. Thus, workers should pay attention to their own physical conditions and proactively keep out of the heat to rest when uncomfortable. Additionally, supervisors must manage worker’s physical conditions and schedule regular breaks. Therefore, in this trial a new integrated system was developed to notify individuals at risk based on their thermal physiology. This method uses biological and environmental information obtained directly via wearable sensors and the estimated body core temperature collected on-ground cannot be measured wirelessly and noninvasively [4].
Introduction: A wide variety of diseases alter the perceptions of different sensations, often evaluated in a subjective manner. Assessment of temperature perception and tolerance is a useful screening tool to evaluate the Degenerative and neuropathic changes of an individual. Therefore the current study was intended to design and develop an inexpensive device to quantify the heat threshold and tolerance in healthy participants. Materials and methods: The study was carried out in 30 apparent healthy participants for heat threshold, and tolerance was recorded on both hands’ thenar and dorsal sites on two occasions. The minimum temperature when the subject was perceived is threshold and maximum until the subject withstood tolerance. The data was collected using the electronically controlled device for these two extremes. The entire study was carried out at a controlled room temperature precisely.Results: The heat threshold was 39.84 ± 2.33 °C, and the tolerance was perceived at 46.84 ± 3.36 °C. There were no intraindividual differences (p > 0.05) in the heat threshold measured on two different periods as well as between the two hands (p > 0.05). As expected, there were significantly higher threshold values on the palm’s thenar aspect than dorsum (p < 0.05). The tolerance was significantly higher in the thenar aspect than the dorsum of both hands. (p < 0.01, p-0.03). There were no significant inter-hand differences of both surfaces of the hand. Conclusion: Our study showed that the results of threshold and tolerance using the indigenously built device were consistent and reproducible proves the robustness of the methodology. It is a cost-effective and user-friendly device that provides quantitative results of temperature extremes.
Heat stress provokes thermal discomfort to people living in semiarid and arid climates. This study evaluates thermal discomfort levels, building design concepts, and some heat mitigation strategies in low-income neighborhoods of Faisalabad, Pakistan. The outdoor and indoor weather data are collected from April to August 2016 using a weather station installed ad hoc in urban settings, and the 52 houses of the five low-income participating communities living in congested and less environment-friendly areas of Faisalabad. The discomfort index values, related to the building design concepts, including (i) house orientation to sunlight and (ii) house ventilation, are calculated from outdoor and indoor dry-bulb and wet-bulb temperatures. Our results show that although June was the hottest month of summer 2016, based on the monthly mean temperature of the Faisalabad region, the month of May produced the highest discomfort levels, which were higher in houses exposed to sunlight and without ventilation. The study also identifies some popular heat mitigation strategies adopted by the five participating low-income communities during various heat-related health complaints. The strategies are gender-biased and have medical, cultural/customary backgrounds. For example, about 52% of the males and 28% of the females drank more water during dehydration, diarrhea, and eye infection. Over 11% and 19% of the males and females, respectively, moved to cooler places during fever. About 43% of the males and 51% of the females took water showers and rested to combat flu (runny nose), headache, and nosebleed. The people did not know how to cure muscular fatigue, skin allergy (from a type of Milia), and mild temperature. Planting trees in an area and developing open parks with greenery and thick canopy trees can be beneficial for neighborhoods resembling those evaluated in this study.
The heat increase caused by climate change has worsened the urban heat environment and damaged human health, which has led to heat-related mortality. One of the most important ways to respond to heat-related damage is to develop effective forecasting tools. However, accurately predicting heatwave damage is difficult in regions in a city with different conditions. Damage due to extreme heat can be evaluated differently in each region, as climatic, demographic and socioeconomic sectors are diversely distributed across local areas. In this study, we develop a random forest-based model for estimating the occurrence of heat-related mortality in a detailed spatial unit within a city. Through hyperparameter optimization, the model yielded accuracy, F1-score and AUC values of 90.3%, 94.75%, and 86%, respectively. The estimation results of the model were interpreted from the global and local perspectives by introducing the latest SHAP method. As a result of interpretation, demographic, socioeconomic and climatic sectors were determined to contribute the most to the estimation process. This is the first study of partial scenarios through the development and interpretation of a spatial unit machine learning-based occurrence estimation model for heat-related mortality.
The frequency and intensity of compound hot extremes will be likely to increase in the context of global warming. Epidemiological studies have demonstrated the adverse effect of simple hot extreme events on mortality, but little is known about the effects of compound hot extremes on mortality. Daily meteorological, demographic, and mortality data during 2011-2017 were collected from 160 streets in Guangzhou City, China. We used distributed lag non-linear model (DLNM) to analyze the associations of different hot extremes with mortality risk in each street. Street-specific associations were then combined using a meta-analysis approach. To assess the spatial distribution of vulnerability to compound hot extremes, vulnerable characteristics at street level were selected using random forest model, and then we calculated and mapped spatial vulnerability index (SVI) at each street in Guangzhou. At street level, compared with normal day, compound hot extreme significantly increased mortality risk (relative risk(RR)=1.43, 95%CI:1.28-1.59) with higher risk for female (RR=1.54 [1.35-1.76]) and the elderly(RR for aged 65-74=1.41 [1.14-1.74]; RR for ≥75years=1.63 [1.45-1.84]) than male (RR=1.32 [1.15-1.52]) and population <65 years (RR=1.01 [0.83-1.22]). Areas with high vulnerability were in the urban center and the edge of suburban. High proportion of population over 64 years old in urban center, and high proportions of outdoor workers and population with illiteracy in suburban areas were the determinants of spatial vulnerability. We found that compound hot extreme significantly increased mortality risk at street level, which is modified by socio-economic and demographic factors. Our findings help allocate resources targeting vulnerable areas at fine-spatial scale.°.
BACKGROUND: Previous studies have reported numerous environmental factors for atopic dermatitis (AD), such as allergens and chemical stimulants. However, few studies have addressed the relationship between ambient air pollution and AD at a population level. OBJECTIVE: To evaluate the effect of air pollutants on medical care visits for AD and to identify susceptible populations. METHODS: In this time-series study conducted on 513,870 medical care visits for AD from 2012 to 2015 identified by reviewing national health insurance claim data in Incheon, Republic of Korea. Treating daily number of medical care visits for AD as a dependent variable, generalized additive models with Poisson distributions were constructed, which included air pollutant levels, ambient temperature, relative humidity, day of the week, national holiday, and season. Risks were expressed as relative risks (RR) with 95% confidence intervals (95% CIs) per interquartile range increase of each air pollutant. RESULTS: Higher levels of particulate matter of diameter ≤10 μm (PM(10)) (RR, 1.009; 95% CI, 1.007-1.012), ozone (1.028; 1.023-1.033), and sulfur dioxide (1.033; 1.030-1.037) were significantly associated with increased risk of medical care visits for AD on same days. In all age and sex groups, ozone was associated with a significantly higher risk of medical care visits, with the greatest risk among 13- to 18-year-old males (RR, 1.127; 95% CI, 1.095-1.159). CONCLUSION: This study suggests relationships of ambient PM(10), ozone, and sulfur dioxide levels with medical care visits for AD.
Several air pollution episodes occurred in Beijing before and after the 2014 Asia-Pacific Economic Cooperation (APEC) summit, during which air-pollution control measures were implemented. Within this autumn-winter transit season, domestic heating started. Such interesting period merits comprehensive chemical characterization, particularly the organic species, to look into the influence of additional heating sources and the control measures on air pollution. Therefore, this study performed daily and 6h time resolved PM2.5 sampling from the 24th October to 7th December, 2014, followed by comprehensive chemical analyses including water-soluble ions, elements and organic source-markers. Apparent alterations of chemical profiles were observed with the initiation of domestic heating. Through positive matrix factorization (PMF) source apportionment modeling, six PM2.5 sources including secondary inorganic aerosol (SIA), traffic emission, coal combustion, industry emission, biomass burning and dust were separated and identified. Coal combustion was successfully distinguished from traffic emission by hopane diagnostic ratio. The result of this study reveals a gradual shift of dominating sources for PM pollution episodes from SIA to primary sources after starting heating. BaPeq toxicity from coal combustion increased on average by several to dozens of times in the heating period, causing both long-term and short-term health risk. Air mass trajectory analysis highlights the regional influence of the industry emissions from the area south to Beijing. Control measures taken during APEC were found to be effective for reducing industry source, but less effective in reducing the overall PM2.5 level. These results provide implications for policy making regarding appropriate air pollution control measures. (c) 2021 Elsevier Ltd. All rights reserved.
The seasonal and meteorological factors in predicting infections after urological interventions have not been systematically evaluated. This study aimed to determine the seasonality and the effects of the weather on the risk and severity of infectious complications (IC) after a transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Using retrospectively collected data at the tertiary care hospital in Taiwan, we investigated the seasonal and meteorological differences in IC after TRUS-Bx. The IC included urinary tract infection (UTI), sepsis, and a positive culture finding (PCF). The severity was assessed on the basis of the Common Terminology Criteria for Adverse Events grading system. The prevalences of the infectious complications (UTI, sepsis, PCF and grade ≥ 3 IC) were significantly higher in the summer than in the winter. Monthly temperature and average humidity were significant factors for IC. After adjusting the demographic factors, multivariate regression revealed that UTI, sepsis, PCF, and grade ≥ 3 IC increased by 12.1%, 16.2%, 21.3%, and 18.6% for every 1 °C increase in the monthly average temperature, respectively (UTI: p = 0.010; sepsis: p = 0.046; PCF: p = 0.037; grade ≥ 3 IC: p = 0.021). In conclusion, the development and severity of IC after TRUS-Bx had significant seasonality. These were dose-dependently associated with warmer weather. Infectious signs after TRUS-Bx should be monitored more closely and actively during warm weather.
The urban heat island (UHI) phenomenon has become a major concern for city sustainability in the wake of global warming and rapid urbanization. This has resulted in increased heat stress and worsened outdoor thermal comfort in urban microclimates. The study demonstrated that outdoor thermal stress pedestrians can be reduced in single streets by adopting mitigation strategies, that is, cool materials, vegetation, and water bodies. In this article, computational fluid dynamics (CFD) simulations using URANS modeling for four different scenarios have been performed to investigate the effectiveness of different mitigation measures in hot, humid urban climates conditions. The reduction of ambient air temperature and surface temperature characterizing the mitigation (cooling) intensity is examined at pedestrian height and diverse vertical levels. The analysis shows that on its own, water provides the largest reduction in air temperature at pedestrian height (2 degrees C), and cool materials provide a larger reduction in surface temperature (6 degrees C). When applied individually, cool materials are the more effective in the vertical direction with a UHI mitigation intensity of 1.5 degrees C, followed by vegetation, with a mitigation intensity of 1.0 degrees C. Furthermore, the impact (temperature reduction) is more significant when all three measures are combined, with a large reduction of 2 degrees C in air temperature and 9 degrees C in surface temperature observed compared to the reference case.
This study aims to develop and validate prediction models for the number of all heatstroke cases, and heatstrokes of hospital admission and death cases per city per 12 h, using multiple weather information and a population-based database for heatstroke patients in 16 Japanese cities (corresponding to around a 10,000,000 population size). In the testing dataset, mean absolute percentage error of generalized linear models with wet bulb globe temperature as the only predictor and the optimal models, respectively, are 43.0% and 14.8% for spikes in the number of all heatstroke cases, and 37.7% and 10.6% for spikes in the number of heatstrokes of hospital admission and death cases. The optimal models predict the spikes in the number of heatstrokes well by machine learning methods including non-linear multivariable predictors and/or under-sampling and bagging. Here, we develop prediction models whose predictive performances are high enough to be implemented in public health settings.
Urban heat islands (UHI) are a widely documented phenomenon that adversely increases urban overheating and, among other effects, contributes to heat-related mortalities and morbidities in urban areas. Consequently, comprehensive UHI-mitigating measures are essential for improving urban microclimate environments and contributing to salutogenic urban design practices. This study proposed urban cooling strategies involving different tree percentages and leaf area densities in a dense urban area during the summertime in Korea. The cooling effects of sixteen various combinations of proposed scenarios based on common urban tree types were studied via in-situ field measurements and numerical modeling, considering both vegetated and exposed areas. It was observed that by changing the characteristics of the leaf area density (LAD) per plant of our vegetated base area—for instance, from 4% trees to 60% trees, from a low LAD to a high LAD—the daily average and daily maximum temperatures were reduced by approximately 3 °C and 5.23 °C, respectively. The obtained results demonstrate the usefulness of urban trees to mitigate urban heating, and they are particularly useful to urban designers and policymakers in their efforts to minimize UHI effects.
A few studies on outdoor human thermal comfort (HTC) have been conducted in the tropical region in a hot and humid climate; however, there is a paucity of discussions on how exactly different spatial settings influence HTC. Thus, this paper aims to examine how land use land cover (LULC) affects HTC on the basis of the simulation of Predicted Mean Vote (PMV) and Physiologically Equivalent Temperature (PET) indices via ENVI-met and Rayman. The results reveal that people living in the urban area have a higher tendency to experience strong heat stress (25% of the areas with PMV ranging from 3.4 to 3.9 and 2% of the areas, where PMV reached 4.1), followed by the rural area (43% of the areas with PMV ranging from 2.1 to 2.4), and the suburban area (more than 50% of the areas with PMV values less than 2.4). Surprisingly, a concrete LULC in the suburb area exhibits a higher air temperature than an asphalt surface at 4 p.m., due to the large area of high albedo that increases the reflection of solar radiation, subsequently contributing to warming up the airmass. Similarly, sandy, and loamy LULC tend to emit more heat during nighttime, while the heat is absorbed slowly during daytime, and it is then slowly released during nighttime after 6 p.m. Spatial settings that promote heat stress in the urban area are mainly contributed by an LULC of asphalt, concrete, sandy, and loamy areas. Meanwhile, people in the suburban and rural areas are less likely to experience heat stress, due to agricultural plantations and lowland forest that provide shade, except for the barren lands-loamy areas. The result also indicates that tree-covered areas near the river in the suburban area afforded the best thermal experience with PMV of 2.1 and PET of 30.7. From the LULC comparison, it is pivotal to consider tree species (canopy density), surface material (albedo), sky-view factor, wind direction, and speed toward designing a more comfortable and sustainable environment.
In this study, we aimed to develop and validate a machine learning-based mortality prediction model for hospitalized heat-related illness patients. After 2393 hospitalized patients were extracted from a multicentered heat-related illness registry in Japan, subjects were divided into the training set for development (n = 1516, data from 2014, 2017-2019) and the test set (n = 877, data from 2020) for validation. Twenty-four variables including characteristics of patients, vital signs, and laboratory test data at hospital arrival were trained as predictor features for machine learning. The outcome was death during hospital stay. In validation, the developed machine learning models (logistic regression, support vector machine, random forest, XGBoost) demonstrated favorable performance for outcome prediction with significantly increased values of the area under the precision-recall curve (AUPR) of 0.415 [95% confidence interval (CI) 0.336-0.494], 0.395 [CI 0.318-0.472], 0.426 [CI 0.346-0.506], and 0.528 [CI 0.442-0.614], respectively, compared to that of the conventional acute physiology and chronic health evaluation (APACHE)-II score of 0.287 [CI 0.222-0.351] as a reference standard. The area under the receiver operating characteristic curve (AUROC) values were also high over 0.92 in all models, although there were no statistical differences compared to APACHE-II. This is the first demonstration of the potential of machine learning-based mortality prediction models for heat-related illnesses.
The changing climate has introduced new and unique challenges and threats to humans and their environment. Urban dwellers in particular have suffered from increased levels of heat stress, and the situation is predicted to continue to worsen in the future. Attention toward urban climate change adaptation has increased more than ever before, but previous studies have focused on indoor and outdoor temperature patterns separately. The objective of this research is to assess the indoor and outdoor temperature patterns of different urban settlements. Remote sensing data, together with air temperature data collected with temperature data loggers, were used to analyze land surface temperature (outdoor temperature) and air temperature (indoor temperature). A hot and cold spot analysis was performed to identify the statistically significant clusters of high and low temperature data. The results showed a distinct temperature pattern across different residential units. Districts with dense urban settlements show a warmer outdoor temperature than do more sparsely developed districts. Dense urban settlements show cooler indoor temperatures during the day and night, while newly built districts show cooler outdoor temperatures during the warm season. Understanding indoor and outdoor temperature patterns simultaneously could help to better identify districts that are vulnerable to heat stress in each city. Recognizing vulnerable districts could minimize the impact of heat stress on inhabitants.
Global climate is changing as a result of anthropogenic warming, leading to higher daily excursions of temperature in cities. Such elevated temperatures have great implications on human thermal comfort and heat stress, which should be closely monitored. Current methods for heat exposure assessments (surveys, microclimate measurements, and laboratory experiments), however, present several limitations: measurements are scattered in time and space and data gathered on outdoor thermal stress and comfort often does not include physiological and behavioral parameters. To address these shortcomings, Project Coolbit aims to introduce a human-centric approach to thermal comfort assessments. In this study, we propose and evaluate the use of wrist-mounted wearable devices to monitor environmental and physiological responses that span a wide range of spatial and temporal distributions. We introduce an integrated wearable weather station that records (a) microclimate parameters (such as air temperature and humidity), (b) physiological parameters (heart rate, skin temperature and humidity), and (c) subjective feedback. The feasibility of this methodology to assess thermal comfort and heat stress is then evaluated using two sets of experiments: controlled-environment physiological data collection, and outdoor environmental data collection. We find that using the data obtained through the wrist-mounted wearables, core temperature can be predicted non-invasively with 95 percent of target attainment within +/- 0.27 degrees C. Additionally, a direct connection between the air temperature at the wrist (T-a,T-w) and the perceived activity level (PAV) of individuals was drawn. We observe that with increased T-a,T-w, the desire for physical activity is significantly reduced, reaching ‘Transition only’ PAV level at 36 degrees C. These assessments reveal that the wearable methodology provides a comprehensive and accurate representation of human heat exposure, which can be extended in real-time to cover a large spatial distribution in a given city and quantify the impact of heat exposure on human life.
Extreme heat is a leading cause of weather-related human mortality throughout much of the world, posing a significantly heavy burden on the development of healthy and sustainable cities. To effectively reduce heat health risk, a better understanding of where and what risk factors should be targeted for intervention is necessary. However, little research has examined how different risk factors for heat-related mortality operate at varying spatial scales. Here, we present a novel application of the multiscale geographically weighted regression (GWR) approach to explore the scale of effect of each underlying risk factor using Hong Kong as a case study. We find that a hybrid of global and local processes via multiscale GWR yields a better fit of heat-related mortality risk than models using GWR and ordinary least squares (OLS) approaches. Predictor variables are categorized by the scale of effect into global variables (i.e., age and education attainment, socioeconomic status), intermediate variables (i.e., work place, birth place and language), and local variables (i.e., thermal environment, low in-come). These findings enrich our understanding of the spatial scale-dependent risk factors for heat-related mortality and shed light on the importance of hierarchical policy-making and site-specific planning processes in effective heat hazard mitigation and climate adaptation strategies.
The purpose of this study was to compare the efficacy of four cooling interventions used for reducing physiological and perceptual strain and improving exercise performance during outdoor match-play tennis in the heat. Eight competitive tennis players played four counter-balanced simulated outdoor matches in the heat (WBGT: 28.4-32.5°C) at 24- or 48-h intervals. Each match comprised 3 sets for which the “no-ad” rule was applied to limit duration variability. Players underwent the following cooling interventions: ad libitum fluid ingestion (CON), ad libitum fluid ingestion and ice vest (VEST), total ingestion of approximately 1000 g ice slurry and ice vest (Combined: BINE), or total ingestion of approximately 400 g ice slurry and ice vest (Low-combined: L-BINE). Gastrointestinal temperature was lower in the BINE and the L-BINE trials than in the CON trial at the set-break of set 1, and these differences in gastrointestinal temperature persisted throughout the remainder of the match (p < 0.05). The ratio of moderate-high intensity activity (≥10 km/h) in set 3 was significantly higher in the L-BINE trial than that in the BINE trial (p < 0.05). In the CON and BINE trials, high intensity activity was significantly lower in set 3 compared with set 1 and 2, respectively. Cooling by optimal ice slurry ingestion and ice vest may be a more effective strategy in mitigating the development of heat strain during outdoor match-play tennis in the heat.
Heat strain impairs performance across a broad spectrum of sport disciplines. The impeding effects of hyperthermia and dehydration are often ascribed to compromised cardiovascular and muscular functioning, but expert performance also depends on appropriately tuned sensory, motor and cognitive processes. Considering that hyperthermia has implications for central nervous system (CNS) function and fatigue, it is highly relevant to analyze how heat stress forecasted for the upcoming Olympics may influence athletes. This paper proposes and demonstrates the use of a framework combining expected weather conditions with a heat strain and motor-cognitive model to analyze the impact of heat and associated factors on discipline- and scenario-specific performances during the Tokyo 2021 games. We pinpoint that hyperthermia-induced central fatigue may affect prolonged performances and analyze how hyperthermia may impair complex motor-cognitive performance, especially when accompanied by either moderate dehydration or exposure to severe solar radiation. Interestingly, several short explosive performances may benefit from faster cross-bridge contraction velocities at higher muscle temperatures in sport disciplines with little or no negative heat-effect on CNS fatigue or motor-cognitive performance. In the analyses of scenarios and Olympic sport disciplines, we consider thermal impacts on “motor-cognitive factors” such as decision-making, maximal and fine motor-activation as well as the influence on central fatigue and pacing. From this platform, we also provide perspectives on how athletes and coaches can identify risks for their event and potentially mitigate negative motor-cognitive effects for and optimize performance in the environmental settings projected.
The pilgrimages of Muslims to Makkah (Hajj and Umrah) is one of the largest religious gatherings in the world which draws millions of people from around 180 countries each year. Heat stress during summer has led to health impacts including morbidity and mortality in the past, which is likely to worsen due to global warming. Here we investigate the impacts of increasing heat stress during the peak summer months over Makkah at present levels of warming as well as under Paris Agreement’s targets of 1.5 degrees C and 2 degrees C global mean temperature increase above pre-industrial levels. This is achieved by using multi member ensemble projections from the half a degree additional warming, prognosis and projected impacts project. We find a substantial increase in the exceedance probabilities of dangerous thresholds (wet-bulb temperature >24.6 degrees C) in 1.5 degrees C and 2 degrees C warmer worlds over the summer months. For the 3 hottest months, August, September and October, even thresholds of extremely dangerous (wet-bulb temperature >29.1 degrees C) health risks may be surpassed. An increase in exceedance probability of dangerous threshold is projected by two and three times in 1.5 degrees C and 2 degrees C warmer worlds respectively for May as compared to the reference climate. September shows the highest increase in the exceedance probability of extremely dangerous threshold which is increased to 4 and 13 times in 1.5 degrees C and 2 degrees C warmer worlds respectively. Based on the indicators of hazard, exposure and vulnerability, we carried out probabilistic risk analysis of life-threatening heat stroke over Makkah. A ten time increase in the heat stroke risk at higher wet-bulb temperatures for each month is projected in 2 degrees C warmer world. If warming was limited to 1.5 degrees C world, the risk would only increase by about five times, or half the risk of 2 degrees C. Our results indicate that substantial heat related risks during Hajj and Umrah happening over peak summer months, as it is the case for Hajj during this decade, will require substantial adaptation measures and would negatively affect the performance of the rite. Stringent mitigation actions to keep the global temperature to 1.5 degrees C can reduce the risks of heat related illnesses and thereby reduce the non-economic loss and damage related to one of the central pillars of a world religion.
This study aims to provide an in-depth understanding of what motivates older adults to take their adaptive behaviors during extreme heat events. Elaborating the mediating role of emotion in human behaviors, we empirically explore an interrelationship between individuals’ cognition, emotion, and heat-protective action in response to heat warning system alarms. Through face-to-face surveys and structural equation modeling, this study reveals that an increased level of cognition about climate change, heat waves, and local policy measures leads to emotional responses such as concern and worry, and consequently encourages people to comply with heat-related public guidelines. Furthermore, we also consider individuals’ pre-existing health conditions and their previous experiences of heat-related illnesses together with the emotional factors. The role of emotion in mediating between cognition and heat-protective action is much greater than in mediating between pre-existing health conditions and heat-protective action. We conclude that policy interventions to educate older adults can effectively increase the likelihood of individual compliance with the relevant preventive measures beyond their individual health and experiences.
How to maximize the cooling effect of urban parks in hot extremes has been closely linked to well-beings of citizens. Few studies have quantified urban parks’ cooling effect in hot extremes from both maximum and accumulative perspectives. Here, we explored 65 urban parks’ cooling effect based on spatially continuous cooling curves using multiple satellite images of Greater Xi’an (34 degrees 06′ similar to 34 degrees 34′ N, 108 degrees 33′ similar to 109 degrees 15′ E), one of China’s metropolises with frequent hot extremes during July and August in 2019 summer. From maximum perspective, the urban parks cool down as far as 151.4 m, and covering 63.62 ha area, circa five times their own area in hot extremes; from accumulative perspective, the average cooling intensity is 0.78 degrees C along the whole continuous cooling distance spectrum, accumulated as 153.87 degrees C.m. And the urban parks show stronger accumulative cooling effect in hot extremes than the relative moderate temperatures. The cooling range could be maximized in large parks with dense trees, also in complex-shaped parks with strong interaction with surrounding environment. Small parks such as neighborhood parks located in the densely populated area are with maximum efficiency, cooling down about nine times their own area, which could serve as highly efficient cooling networks. Enhancing vegetation growth and coupling both blue and green infrastructures are always effective to increase accumulative cooling intensity in hot extremes. Our findings provide nature-based solutions (NBS) to counteracting heat stresses from the intense and frequent hot extremes in the future, also helpful for energy saving in the continuing climate change scenario.
As the frequency, duration, and intensity of heat waves have been increasing in recent decades, the effective and efficient allocation of cooling shelters has become a significant issue in many cities. This study presents an integer programming model for allocating cooling shelters with the two conflicting objectives of maximizing coverage for the heat-vulnerable population and minimizing total operating cost of the cooling shelters. The temperature-humidity index is included in the model to reflect the weather conditions that affect heat waves. We also introduce data analysis procedures using real-time floating population data so as to track the hourly number and locations of individuals in the heat-vulnerable population. The proposed model is then validated with an application to Ulsan Metropolitan City in the Republic of Korea in which heat-vulnerable people are assigned to existing and potential cooling shelters. Given the condition of restricted budgets, we categorize and prioritize heat-vulnerable people into several groups using a clustering method and heat vulnerability index, and we suggest effective policy recommendations, so the most vulnerable people are provided cooling services first. In addition, we perform a sensitivity analysis on weather conditions, travel distance, electricity cost, and percentage of heatvulnerable population served by cooling shelters, so policy makers can be prepared to respond quickly to the various factors that can change during a heat wave and ultimately reduce heatrelated morbidity and mortality.
The rising episodes of deadly heat waves have intensified the need for a heat protection strategy. The Unani system of medicine offers ways to stay healthy in different climatic conditions. Hence, this article aims to discuss the applicability of health protection measures suggested by Unani scholars for hot weather conditions in the light of current researches. The manual literature survey of classical Unani texts was conducted to collect information on health safety measures for hot weather. A substantial search of scientific databases such as “Google Scholar” and “Medline” for proposed measures in combination with “heat-stroke”, “heat exhaustion” and “heat rash” was also conducted to identify their possible activity in heat-related illnesses. The guidelines for summer seasons in the classical Unani literature are described under the title tadābīr-i-mavsam. Unani scholars have discussed in detail the pathophysiological effects of heat and the measures to stay healthy by regulating the body system through lifestyle, diet and herbs. Most of the measures proposed by them are backed up by evidences. However, some measures have not yet been evaluated for their therapeutic or prophylactic efficacy in heat-related illnesses. On the basis of findings, the authors advocate the adoption of evidence-based measures and propose further investigation of those measures that are not well supported by the evidence or have not yet been evaluated.
Using the China Health and Retirement Longitudinal Study, this paper studies the impact of abnormal hot temperature on residents’ demand for commercial health insurance. The results show that for every 1°F rise in abnormal temperature, the probability of people buying commercial health insurance increased by 6%. Furthermore, the abnormal hot temperature has a more significant impact on the commercial health insurance demand of women, residents in the South and residents in the East. Channel analysis shows that abnormal hot temperature affects the demand for commercial health insurance through two channels: increasing residents’ concern about climate risk and affecting health. This paper provides evidence for actively promoting sustainable development and improving the construction of medical security system.
Arba’een, a Muslim pilgrimage, is one of the largest annual mass gatherings in the world, with a date fixed according to the lunar calendar. Most pilgrims start their long walking journey from Basra/Najaf toward Karbala (about 70-500 km) and are significantly affected by outdoor weather conditions during this period. Here, based on simulations performed using carefully-selected climate models, we project that heat stress during the pilgrimage is likely to reach a “dangerous” level, defined according to the US National Weather Service criteria, by the end of this century. Moreover, a significant increase in consecutive occurrence of hot days and hot nights is expected within the coming decades, which may cause a high incidence of heat-related disorders as the human body may not recover from the daytime heat loads. Our study suggests that sound adaptation measures and stringent mitigation actions must be established to ensure a safe pilgrimage in the future.
Heat-related illness (HRI) is a common occupational injury, especially in construction workers. To explore the factors related to HRI risk in construction workers under hot outdoor working conditions, we surveyed vital and environmental data of construction workers in the summer season. Sixty-one workers joined the study and the total number of days when their vital data during working hours and environmental data were recorded was 1165. Heart rate with high-risk HRI was determined using the following formula: 180 - 0.65 × age. As a result of the logistic regression analysis, age, working area, maximum skin temperature, and heart rate immediately after warming up were significantly positively related, and experience of construction was significantly negatively related to heart rate with high-risk HRI. Heart rate immediately after warming up may indicate morning fatigue due to reasons such as insufficient sleep, too much alcohol intake the night before, and sickness. Asking morning conditions may lead to the prevention of HRI. For occupational risk management, monitoring of environmental and personal conditions is required.
Heat waves are increasing in frequency and exhibit high spatial variability in their distribution over India. There are limited studies focused on thermal indices over India due to the nonavailability of high-resolution (HR) climate data. Here we develop dynamically downscaled HR (4 x 4 km) daily climate information for the months of April to June during 2001-2016 using a regional climate model called Weather Research and Forecasting (WRF) Model, which are validated with station observations. The thermal comfort, heat stress, and its spatiotemporal variability and change over India are quantified in terms of indices like excessive heat factor (EHF), the heat index (HI), humidex, apparent temperature (AT), and wet bulb globe temperature (WBGT). The results show that there is an increasing trend in annual heat waves coverage (22,240 km(2)/year), annual frequency (0.07 days/year), and average intensity (0.04 degrees C/year) during 2001-2016. The spatial distribution of indices exhibits high spatial and temporal variability. The days with the severe threshold of indices are significantly increasing over north India at the rate of EHF (15.9%), HI (14.9%), humidex (15.9%), AT (13.4%), and WBGT (13.8%). The heat waves’ most vulnerable hotspots are on the parts of Rajasthan, Uttar Pradesh, Madhya Pradesh, and the coastal regions of Andhra Pradesh and Odisha. During heat waves, prolonged exposure under the sun will lead to adverse health impacts, and it is mostly observed over severe heat wave zone. These findings stress the need for developing suitable mitigation strategies for a sustainable ecosystem with minimum impact.
Severe high-temperature leads significant risks of human health under the highly population concentration and climate change. The thermal sensitivity to high temperature is needed to be quantified associated with different population characteristics. Thermal condition was quantified by universal thermal climate index (UTCI) and thermal sensitivity was identified by thermal sensation votes (TSV), thermal comfort votes, and thermal unacceptability votes based on 667 questionnaires in Beijing, China. This study designated four indicators, i.e., neutral temperature, neutral temperature range, tolerance temperature, and tolerance temperature range to analyze the effects of individual characteristics on thermal sensitivity. A one-way ANOVA was used to identify the effects of long-term adaptation and psychological factors. Results showed that: (1) Older residents had a higher neutral temperature, narrow tolerance temperature range, and lower tolerance temperature of 1.2 degrees C UTCI than younger residents. (2) People with chronic disease had a narrow tolerance temperature range and lower tolerance temperature of 1.3 degrees C UTCI than healthy ones; (3) The proportion of people who voted strong thermal sensation (TSV >= 2) rated the highest in building areas, while the proportion decreased 31.6% in spaces with dense trees; (4) Residential history and city attractiveness had significant impacts on mean thermal sensation votes and mean thermal comfort votes, excluding the effect of thermal stress level. This study provided useful implications of specific adaption for summer extreme heat according to different population characteristics.
BACKGROUND: Occupational factors have previously been mentioned as contributing to decreased kidney function and the development of chronic kidney disease of unknown cause. Sea salt workers are one of the occupations facing high outdoor temperatures and a highly, intensive workload. OBJECTIVES: The purpose of the study was to examine whether the kidney function of sea salt workers at the beginning of the harvest season differs from kidney function at the end of the harvest season and to identify factors that can predict the change of kidney function. MATERIAL AND METHODS: Data were collected from salt workers (n=50) who were between 18–60 years of age without hypertension, diabetes, and kidney disease in Samut Sakhon province, Thailand. Urine specific gravity (USG) was used for hydration status and the estimated glomerular filter rate (eGFR) was used to measure kidney function. The mixed model was used to find differences over the harvest season and prediction of factors. RESULTS: On average, the eGFR was estimated to decrease by 15.2 ml/min/1.73 m2 over the harvest season. The decline in eGFR of sea salt workers with moderate and heavy workloads were significantly faster than their light workload counterparts after controlling for other covariates. Similarly, dehydration (USG ≥ 1.030) significantly accelerated the rate of kidney function loss. CONCLUSION: Our study confirmed exposure to heat over the harvest season leads to decreased eGFR in sea salt workers. The rate of change of eGFR could be predicted by workload and hydration status. Workers with dehydration who performed medium to heavy workloads in farms showed faster kidney function decline than those who performed light workload.
An outbreak of powerful tornadoes tore through multiple states in the central and southern United States from 10 to 11 December 2021. It is claimed the deadliest tornado outbreak that has taken place on December days. The National Oceanic and Atmospheric Administration had confirmed 66 tornadoes as of 21 December, producing at least 90 fatalities. Most tornadoes occurred at night and thus they were difficult to be visually located, which directly increases the risk for local residents. Two violent nighttime tornadoes were rated category 4 on the enhanced Fujita scale (EF4). Although a high death toll was caused during this event, the operational service actually presented an excellent performance. This tornado outbreak has aroused extensive discussion from both the public and the research community in China. This paper presents a brief discussion on the formation environment and warning services of the tornado outbreak. Recall the deadliest violent tornado in the past 45 years in China, the radar-based tornadic vortex signatures at the locations with EF4 damages show a comparable strength with those in the current cases. Some views on the tornado warning issuance and receiving and damage surveys in China are also presented.
Air temperature and humidity have a great impact on public health, leads to heat stress. The US National Weather Service uses temperature and relative humidity to build a heat index (HI) as a metric to identify the thresholds for heat stress as felt by the public. Under climate change conditions and especially in hot humid weather during summer, the number of hot days in Hanoi has increased in recent times. Subsequently, the heat index is rising in both number of occurrences and level of intensity leading to increasing temperature stress on people’s health. The daily heat index for the future was simulated using maximum daily temperature and minimum daily relative humidity based on climate change scenarios. Maximum daily temperature was provided by the climate change model, while minimum daily relative humidity was estimated from the following: maximum daily temperature, mean daily temperature and daily rainfall. Results show that in the future, the heat index will increase by 0.0777 degrees C/year in the RCP 4.5 scenario and 0.08 degrees C/year in the RCP 8.5 scenario. Number of weeks with heat at danger tends to increase to 5.5 weeks/5 year for scenario RCP 4.5, and it is 6 weeks/5 years under RCP 8.5 scenario. In particular, the number of days of heatstroke over a 30-year period (from 1991 to 2020) amounted to only 4, that is an average of 0.13 days of the year, which represents a very rare weather phenomenon in the past. In contrast, under an RCP 4.5 scenario in the future over a 30-year period, the average number of days per year will be 2, 57 days; while the average number of days per year under an RCP 8.5 scenario would be 3, 87 days. This phenomenon will be mainly concentrated in the months of June, July, and August. Projections of this type are a key tool for communities working out how they will adapt to heat stress in the context of climate change.
The frequency and intensity of high-temperature events continue to increase, resulting in a surge of pathogenicity and mortality. People with low levels of risk perception and adaptability, such as the elderly, suffer more from high temperatures. Effective intervention measures may lead to reduced levels of high temperature-related risk. The purpose of this study was to compare changes in temperature exposure, risk perception and coping behaviors under different intervention methods. Herein we conducted three different interventions including education, subsidies for electricity and uses of spray-cooling appliances as well as collected data about temperature exposure, risk perception, and coping behaviors. Before and after the experiment, we evaluated the intervention effectiveness with a number of variables related to alerting human responses under high temperatures. We conducted nonparametric tests for paired samples and generalized linear mixed effect models. Compared with subsidy support and outdoor spray-cooling methods, education is more effective as it leads to lower levels of temperature exposure, higher levels of risk perception, and more behavioral responses. The subsidy support intervention is useful in increasing risk perception and promoting home cooling practices as well. In comparison, spray cooling barely contributes to the reduction of personal temperature exposure. The encouragement of risk-related education and continued government subsidy may prevent elderly individuals from experiencing high-temperature exposure.
Rising temperatures are causing distress across the world, and for those most vulnerable, it is a silent killer. Information about indoor air temperature in residential dwellings is of interest for a range of reasons, such as health, thermal comfort and coping practices. However, there have been only few studies that measure indoor heat exposure, and contrast these to outdoor temperatures in rural-urban areas, of which none are in South Asia. We aim to close this knowledge gap with our indoor and outdoor heat measurement dataset, covering five low-income sites in South Asia. Two sites are in rural areas (Maharashtra, India), while three sites focus on urban areas (Dhaka, Delhi and Faisalabad). Data are based on 206 indoor temperature data loggers and complemented by data from five outdoor automated weather stations. The data-set can be used to examine temperature and humidity variation in low-socioeconomic status households in rural and urban areas and to better understand factors aggravating heat stress. This is important to plan and implement actions for combating heat stress.
Public health is threatened by climate change and extreme temperature events worldwide. Differences in health predispositions, access to cooling infrastructure and occupation raises an issue of heat-related health inequality in those vulnerable and disadvantaged demographic groups. To address these issues, a comprehensive understanding of the effect of elevated body temperatures on human biological systems and overall health is urgently needed. In this paper we look at the inner workings of the human innate immunity under exposure to heat stress induced through exposure to environment and physical exertion. We couple two experimentally validated computational models: the innate immune system and thermal regulation of the human body. We first study the dynamics of critical indicators of innate immunity as a function of human core temperature. Next, we identify environmental and physical activity regimes that lead to core temperature levels that can potentially compromise the performance of the human innate immunity. Finally, to take into account the response of innate immunity to various intensities of physical activities, we utilise the dynamic core temperatures generated by a thermal regulation model. We compare the dynamics of all key players of the innate immunity for a variety of stresses like running a marathon, doing construction work, and leisure walking at speed of 4 km/h, all in the setting of a hot and humid tropical climate such as present in Singapore. We find that exposure to moderate heat stress leading to core temperatures within the mild febrile range (37, 38][Formula: see text], nudges the innate immune system into activation and improves the efficiency of its response. Overheating corresponding to core temperatures beyond 38[Formula: see text], however, has detrimental effects on the performance of the innate immune system, as it further induces inflammation, which causes a series of reactions that may lead to the non-resolution of the ongoing inflammation. Among the three physical activities considered in our simulated scenarios (marathon, construction work, and walking), marathon induces the highest level of inflammation that challenges the innate immune response with its resolution. Our study advances the current state of research towards understanding the implications of heat exposure for such an essential physiological system as the innate immunity. Although we find that among considered physical activities, a marathon of 2 h and 46 min induces the highest level of inflammation, it must be noted that construction work done on a daily basis under the hot and humid tropical climate, can produce a continuous level of inflammation triggering moieties stretched at a longer timeline beating the negative effects of running a marathon. Our study demonstrates that the performance of the innate immune system can be severely compromised by the exposure to heat stress and physical exertion. This poses significant risks to health especially to those with limited access to cooling infrastructures. This is due in part to having low income, or having to work on outdoor settings, which is the case for construction workers. These risks to public health should be addressed through individual and population-level measures via behavioural adaptation and provision of the cooling infrastructure in outdoor environments.
This study investigates the varies in human physiological response, subjective sensation and acute subclinical health symptoms with increasing activity levels at different high temperatures. Thirty-two healthy subjects were recruited to walk on a treadmill in a climate chamber at a speed of 4 km/h. They experienced four temperature conditions (26 degrees C, 30 degrees C, 33 degrees C and 37 degrees C), each exposure lasting 85 min. Eardrum temperature, heart rate, skin temperature, systolic blood pressure, respiratory flow, and respiration rate changed significantly with increasing temperatures. At temperature of 37 degrees C, the SpO2 decreased significantly compared with at 33 degrees C. Subjects perceived the environment unacceptable at 37 degrees C. The perceived air quality and air freshness correlated linearly with the enthalpy of air. The intensity of headache, dizziness, fatigue and sleepiness increased with increasing temperatures, while only aggravated significantly at 37 degrees C. Additionally, compared with the results at light activity level, heart rate and other key physiological parameters increased significantly with increasing activity levels. The subjects felt “very hot” at 37 degrees C, and the change trend in symptoms reported by subjects increased significantly at 37 degrees C with the increased exposure time, while no significant change was observed in 26-33 degrees C. It indicates that exposure to 37 degrees C impairs the health and safety of heat acclimatized subjects. Using linear fitting curve to predict human physiological tolerance time suggested by ISO 9986. The result shows that eardrum temperature exceeded 38.5 degrees C for 97min continuously walk at 37 degrees C. This provides valuable information involved physiological and psychological responses when human exposed to high temperatures in daily life or industrial production.
Purpose Weather is one of the main factors affecting labour productivity. Existing weather-productivity models focussed on hot and cold climates paying less attention to the tropics. Many tropical countries are expected to be the most areas affected by accelerated climate change and global warming, which may have a severe impact on labour health and productivity. The purpose of this paper is to assess whether the existing models can be used to predict labour productivity based on weather conditions in the tropics. Design/methodology/approach Five models are identified from the literature for evaluation. Using real labour productivity data of a high-rise building project in Malaysia, the actual productivity rate was compared with predicted productivity rates generated using the five models. The predicted productivity rates were generated using weather variables collected from an adjusting weather station to the project. Findings Compared with other models evaluated in this paper, the United States Army Corps of Engineers (USACE) was found to be the best model to predict productivity based on the case study data. However, the result shows only a 57% accuracy level of the USACE model indicating the need to develop a new model for the tropics for more accurate prediction. Originality/value The result of this study is perhaps the first to apply meteorological variables to predict productivity rates and validate them using actual productivity data in the tropics. This study is the first step to developing a more accurate productivity model, which will be useful for project planning and more accurate productivity rate estimation.
Introduction: In a tropical country like India, heat-related illnesses are a common occurrence in the unforgiving summer months. Our study aimed to study the profile and outcome of patients with heat-related illnesses presenting to the emergency department (ED).Materials and Methods: This retrospective, cross-sectional study included all patients with heat-related illnesses to the ED during the months of April, May, and June of 2016. Baseline demographic characteristics, computed tomography (CT) brain findings, and hospital outcome were noted.Results: During the 3-month study period, 72 patients presented with heat-related illnesses. Two-thirds (46/72: 63.8%) suffered from heat stroke, whereas one-third (26/72: 36.2%) had heat exhaustion. Classical and exertional types were seen in 46% and 54% of heat strokes, respectively. The mean age (standard deviation) of the patients was 59.7 (13.3) years with a male preponderance (56.9%). Homemakers (37.5%) and manual laborers (20.8%) were most commonly affected. Hypotension at ED arrival was noticed in 20.8% (15/72), whereas tachycardia and tachypnea were noted in 80.5% (58/72) each. The findings on CT of the brain included acute infarcts (5/26: 19.6%) and an intra-cranial bleed (1/26: 3.8%). The mortality rate was 19.5% (14/72).Conclusion: Heat-related illnesses cause significant mortality during the relentless hot summers of a tropical country like India. Homemakers and manual labors were the most affected group. Acute changes were seen in CT brain of a quarter of patients with heat stroke.The following core competencies are addressed in this article: Patient care, Systems-based practice, Medical knowledge, Practice-based learning and improvement.
The health and economic impacts of extreme heat on humans are especially pronounced in populations without the means to adapt. We deployed a sensor network across 12 informal settlements in Makassar, Indonesia to measure the thermal environment that people experience inside and outside their homes. We calculated two metrics to assess the magnitude and frequency of heat stress conditions, wet bulb temperature and wet bulb globe temperature, and compared our in situ data to that collected by weather stations. We found that informal settlement residents experience chronic heat stress conditions, which are underestimated by weather stations. Wet bulb temperatures approached the uppermost limits of human survivability, and wet bulb globe temperatures regularly exceeded recommended physical activity thresholds, both in houses and outdoors. Under a warming climate, a growing number of people living informally will face potentially severe impacts from heat stress that have likely been previously overlooked or underestimated.
The Intergovernmental Panel on Climate Change (IPCC) projects that the frequency of heat waves (HWs) is likely to increase over most land areas in the twenty-first century. Recurrent HWs are an emerging environmental and health concern and already distress in rapidly growing and fast urbanizing South Asia. A review of original research publications of the past five decades from peer-reviewed journals and conference proceedings, covering South Asia, revealed that the region is constantly experiencing the warmest temperatures. The review attempts to comprehend HWs in different contexts, geographic locations, and on previous studies. The paper presents a compre-hensive review of existing plans/policies/guidelines in South Asia at the national/regional/city level to counter extreme heat risk. The study is extended to identify the issues and gaps in the current policies and frameworks in the larger setting of urban planning measures for adaptation and mitigation efforts. A specific set of long-term actions and vulnerability assessment concen-trated on cities must be developed and integrated into a defined heat action plan coupled with improvements in urban and regional planning. Policies and actions must address the issues of the built environment in land use/planning and address the existing institutional and implementation gaps.
Heat risk assessment is important due to serious health problems caused by heat waves. The complexity and diversity of socio-ecological characteristics in urban areas that lead to heat risk are more serious in heat-exposed areas, while risk assessments and determinant based on individuals in heat-exposed areas have been neglected in previous studies. This study pursues a new idea of combining questionnaire surveys and remote sensing analysis to identify urban heat-exposed areas and assess heat risk in heat-exposed areas of Beijing, China. Morphological spatial pattern analysis (MSPA) was used to identify large and continuous hotspot regions as urban heat-exposed areas based on summer surface temperature from 2011 to 2017. A total of 1484 valid questionnaires were completed by residents of heat-exposed areas. The majority of respondents (96.4%) indicated that they perceived heat risk. Moreover, the residents without a local “hukou” were a potentially vulnerable group (note: hukou refers to the population registration management system.). This study further analysed the diversity of community types within the heat-exposed areas. There were significant differences in heat risk among the different community types of multi-story residential districts, Hutong (a traditional architectural form) residential districts and city villages. In particular, the degree of heat risk perceived by residents living in these the community types was determined by whether they had pre-existing medical conditions; however, age only played a decisive role in city villages. This study not only enriches the current understanding of health risks affected by heat waves but also explores the determinants contributing to the severity of heat risk. The output provides important information for future development of heat mitigation and adaptation strategies.
In recent years, the phenomenon of urban warming has become increasingly serious, and with the number of urban residents increasing, the risk of heatstroke in extreme weather has become higher than ever. In order to mitigate urban warming and adapt to it, many researchers have been paying increasing attention to outdoor thermal comfort. The mean radiant temperature (MRT) is one of the most important variables affecting human thermal comfort in outdoor urban spaces. The purpose of this paper is to predict the distribution of MRT around buildings based on a commonly used multilayer neural network (MLNN) that is optimized by genetic algorithms (GA) and backpropagation (BP) algorithms. Weather data from 2014 to 2018 together with the related indexes of the grid were selected as the input parameters for neural network training, and the distribution of the MRT around buildings in 2019 was predicted. This study obtained very high prediction accuracy, which can be combined with sensitivity analysis methods to analyze the important input parameters affecting the MRT on hot summer days (the days with the highest air temperature over 30 degrees C). This has significant implications for the optimization strategies for future building and urban designers to improve the thermal conditions around buildings.
Urban heat challenges are increasingly severe, along with climate change and urbanisation. Despite significant environmental, economic, and social consequences, limited actions have been conducted to address urban heat challenges. To support the formulation of heat-health plans and guidelines at the city and community scale, this study presented results, through a questionnaire survey among 584 respondents in Shanghai, China, on heat-induced physiological and psychological impacts and analysed the variability of them with demographic characteristics. The results indicate that psychological impacts were more severe than physiological impacts in severity and susceptible people. Skin heat damage and digestive system diseases were ignored in previous studies, compared with fatal cardiovascular and respiratory diseases. Emotional irritability and difficulty in controlling temper were the two most prominent psychological symptoms. The elderly and health-vulnerable groups were more susceptible to heat-induced physiological and psychological impacts than other groups. Among different demographic groups, the most critical physiological and psychological symptoms could vary significantly. Afterwards, suggestions for heat-health plans or guidelines have been proposed. Overall, this study provides a reference for the understanding of heat-induced impacts and enhancing the capacity to cope with urban heat challenges.
This study proposes the methodology to identify heatwave hotspots in Seoul, the metropolis of Korea, using high-resolution data. Resident credit data, population mobility data, and temperature observation data are analyzed to determine vulnerable regions to heatwaves. Potentially vulnerable regions are derived in two ways: static vulnerable regions (SVRs) and dynamic vulnerable regions (DVRs), depending on their characteristics. SVRs are determined by lowincome (lower 20% income quantile) residential areas fixed on time. In contrast, DVRs vary with the time and day of the week. DVRs are defined by the place less responsive to heatwaves, where are with low population variability and low correlation with temperature. The final vulnerable regions, so-called hotspots, are determined by the high temperature predicted area where the SVRs and DVRs intersect. We examine how to remove commuting-related displacement signals, which are represented as noise when analyzing population mobility. An example of the hotspots identification result is also shown using temperature hindcast data generated by the Korean Meteorological Administration short-range forecast system. Applying the vulnerability information can improve the quality of disaster planning and decision-making by highlighting the time and area of need for resources in the implementation of short-and long-term disaster response.
Heat stress events in urban areas are increasing as a result of global warming and urban heat islands. In response to heat stress, outdoor activators naturally often move themselves to a less hot place. An understanding of human physiological responses in dynamic outdoor thermal environments is desired. This study aims to reveal the dynamic physiological adjustment and thermal perception response characteristics under varying outdoor heat stress conditions. A robust model for predicting dynamic thermal sensation outdoors has been developed. Experiments involving heat stress changes in a hot summer were conducted with 25 subjects. Three categories of data were collected including meteorological data, physiological parameters, and thermal perception. The results showed that lower-arm skin temperature (T-lowerarm) is more sensitive to changes in the outdoor thermal environment, and correlates closely with the thermal sensation vote (TSV). For a better practical application, based on the strong linear relationship between T-lowerarm and T-ty, the new dynamic outdoor thermal sensation model has been developed involving two parameters: T-lowerarm and delta T-lowerarm/delta t (the change rate of T-lowerarm). The validity of the model in transient outdoor conditions was verified. The algorithm can be integrated into a wearable armband to predict practical thermal sensation responses. This contribution will advance technologies based on the scientific findings to provide alert services to support human health and wellbeing, consequently increasing urban resilience and sustainability.
Climate change (CC) and urban heat island (UHI) are important environmental forces that have serious consequences for the existing buildings, such as increased resource consumption and environmental footprint, adverse human health effects and reduced occupant comfort. In this context, educational buildings represent a critical category amongst other building typologies, due to their high energy use, high occupant density, atypical daily/annual occupancy patterns, and their occupants’ high vulnerability to heat. Poor indoor conditions can reduce the health and productivity of students and teachers, worsen learning performance and reduce attendance. Retrofitting educational buildings is an effective solution to tackle this challenge. This study investigates the impact of CC&UHI on educational building performance and demonstrates the effectiveness of passive retrofit scenarios targeting CC&UHI mitigation and adaptation. These investigations are based on a systematic approach that consists of (i) the generation and analyses of CC&UHI-modified weather datasets, and (ii) simulation-based comparative analyses of the as-is building and various retrofit scenarios. An existing secondary school building in Ankara, Turkey is selected as a case study for evaluations of the selected performance indicators including energy use, global warming potential (GWP) and thermal comfort. Obtained results indicate that total energy consumption can be reduced up to 50% with retrofit, whereas possible reductions in indoor discomfort are even more pronounced, underlining the significance of selecting the optimal combination of passive measures for maximum impact towards the adaptation of the existing educational buildings to the changes in climatic conditions.
Elderly residents are prominent users of urban parks and comfortable open spaces in parks have been shown to improve their physical health and mental well-being. In this study, the thermal perceptions (thermal sensation, thermal comfort and thermal acceptability) of elderly visitors to an urban park in Xi’an, China was investigated using meteorological measurements, questionnaire surveys and activity records. Physiological equivalent temperature (PET) was used to determine thermal benchmarks. Spatial-temporal distributions of the elderly in open spaces were recorded and relationships among elderly residents’ thermal perceptions, their age and chronic disease were analyzed. Finally, optimal design strategies for open spaces suitable for the elderly were proposed based on meteorological characteristics, elderly residents’ attendance patterns and their thermal perceptions. Results showed that: 1) globe temperature (T(g)) and air temperature (T(a)) were the primary meteorological factors that influenced elderly residents’ thermal sensation while clothing insulation and activity intensity were negatively correlated with their thermal sensation. 2) Attendance was significantly affected by the outdoor microclimate, space functionality and facilities in spaces. The elderly mainly participated in dynamic activities and social interaction. 3) The neutral PET (NPET) was 13.2 °C, with NPET range (NPETR) of 3.1-23.2 °C. The 90% thermal acceptable PET ranged between 10.9 and 25.9 °C, and the preferred PET was 14.4 °C. Compared with the ISO7730 standard, the predicted percentage of dissatisfied (PPD) elderly park users was lower than users of indoor spaces when -1 ≤ MTSV ≤ + 1, indicating that the elderly preferred to conduct activities outside when the environment was comfortable. Additionally, NPET for the elderly with respiratory disease was higher than those with cardiovascular diseases and diabetes. 4) Optimal design strategies for open spaces were proposed for elderly residents based on their physical, physiological and psychological preferences.
Actively addressing urban heat challenges is an urgent task for numerous cities. Existing studies have primarily developed heat mitigation strategies and analyzed their cooling performance, while the adaptation strategies are far from comprehensive to protect citizens from heat-related illnesses and deaths. To address this research gap, this paper aims to enhance people’s adaptation capacity by investigating walkability within fifteen-minute cities (FMC). Taking cognizance of thermal comfort, health, and safety, this paper developed a dynamic attenuation model (DAM) of heat stress, along with heat stress aggravation, continuance, and alleviation. An indicator of remaining tolerant heat discomfort (R (t) ) was proposed with the integration of the Universal Thermal Climate Index (UTCI) to assess heat-related walkability. Following an empirical study among 128 residents in Mianyang, China, and assessing four levels of heat stress, the maximum tolerant heat discomfort was determined to be 60 min. Furthermore, the DAM was applied to an FMC with 12 neighborhoods in Fucheng, Mianyang, China. The results indicate that for each neighborhood, the street was generally walkable with an R (t) ranging between 15 and 30 min, after walking for 900 m. A population-based FMC walkability was further determined, finding that the core area of the FMC was favorable for walking with an R (t) of 45-46 min, and the perpetual areas were also walkable with an R (t) of 15-30 min. Based on these results, suggestions on the frequency of public services (frequently used, often used, and occasionally used) planning were presented. Overall, this paper provides a theoretical model for analyzing walkability and outlines meaningful implications for planning heat adaptation in resilient, safe, comfortable, and livable FMCs.
Due to direct exposure to high temperatures in summer, sanitation workers can easily experience heat-related illness and even mortality. This paper aims to determine the thresholds of the environmental parameters for sanitation workers in summer. Firstly, a field test of sanitation workers was conducted, the environmental parameters (solar radiation intensity, dry bulb temperature, wind speed and relative humidity) and mean skin temperature were measured, and the thermal comfort and work willingness were investigated via a questionnaire. Then, the mathematical programming method was adopted to obtain the safety limits and danger limits of the environmental parameters. Finally, the thresholds of the outdoor heat stress indexes, namely, the environmental stress index (ESI), discomfort index (DI), heat index (HI) and relative strain index (RSI) were obtained. The results indicate that a high solar radiation intensity, high dry bulb temperature, high wind speed and low humidity will cause more adverse effects on sanitation workers in summer. The safety limits of the solar radiation intensity, dry bulb temperature, wind speed and relative humidity are 182.42 W/m(2), 28.42 degrees C, 0.15 m/s and 71.35%, respectively, and the danger limit value are 876.86 W/m(2), 34.98 degrees C, 1.27 m/s and 36.59%, respectively. In addition, the safety limit values of the ESI, DI, HI and RSI are 27.08 degrees C, 26.23 degrees C, 31.71 degrees C and 0.13, respectively; and the danger limit values are 29.60 degrees C, 27.84 degrees C, 36.21 degrees C and 0.24, respectively. This paper can provide a study method and reference data for the work arrangement and health protection of sanitation workers in summer.
The estimation of heat-related illness cases is a key factor in proposing and implementing suitable intervention strategies and healthcare resource management. This paper proposes new frameworks to estimate the number of patients with heat-related illnesses by administrative wards in Nagoya City using 2014-2019 data. The proposed frameworks are based on the derivation of estimation formulae and machine learning. The daily residual estimation error in the 16 wards was less than one person with both the frameworks. The daily working time average ambient temperature may yield a better correlation than the daily average temperature or daily highest temperature with the number of patients transported by an ambulance from outdoor sites. The results also indicate that patients transported from indoor sites are influenced by earlier ambient conditions over approximately 50 days. In contrast, those transported from outdoor sites are influenced by a relatively short period (20 days), which may correspond to heat adaptation. The frameworks provide a better understanding of the different factors that would lead to an accurate prediction of the number of cases of heat-related patients from weather forecasts. These findings would lead to efficient ambulance allocation as well as public awareness on hot days to suppress heat-related morbidity.
With an increase in the aging population in many countries worldwide, much attention is being paid to the study of thermal comfort for the elderly. Because the elderly spend most of their time indoors, the demand for air conditioning is expected to increase, and it is important to study the thermal comfort of the elderly and appropriate operation plans for air conditioning. In this study, we conducted a field survey of thermal comfort and building energy simulation for an air-conditioned nursing home in Nagano, Japan. The field survey was conducted between June 2020 and June 2021. Over 80% of the subjects were satisfied with the indoor thermal environment. The thermal neutral temperature of the elderly was 25.9 degrees C in summer and 23.8 degrees C in winter. Future weather data was used to predict the future heating and cooling loads of the nursing home. The results showed that the total heat load may not change significantly, as the decrease in heating load compensates for the increase in cooling load. This study will serve as a useful reference for a wide range of stakeholders, including managers and designers of nursing homes.
BACKGROUND: Predictive scenarios of heatstroke over the long-term future have yet to be formulated. The purpose of the present study was to generate baseline scenarios of heat-related ambulance transportations using climate change scenario datasets in Tokyo, Japan. METHODS: Data on the number of heat-related ambulance transportations in Tokyo from 2015 to 2019 were examined, and the relationship between the risk of heat-related ambulance transportations and the daily maximum wet-bulb globe temperature (WBGT) was modeled using three simple dose-response models. To quantify the risk of heatstroke, future climatological variables were then retrieved to compute the WBGT up to the year 2100 from climate change scenarios (i.e., RCP2.6, RCP4.5, and RCP8.5) using two scenario models. The predicted risk of heat-related ambulance transportations was embedded onto the future age-specific projected population. RESULTS: The proportion of the number of days with a WBGT above 28°C is predicted to increase every five years by 0.16% for RCP2.6, 0.31% for RCP4.5, and 0.68% for RCP8.5. In 2100, compared with 2000, the number of heat-related ambulance transportations is predicted to be more than three times greater among people aged 0-64 years and six times greater among people aged 65 years or older. The variance of the heatstroke risk becomes greater as the WBGT increases. CONCLUSIONS: The increased risk of heatstroke for the long-term future was demonstrated using a simple statistical approach. Even with the RCP2.6 scenario, with the mildest impact of global warming, the risk of heatstroke is expected to increase. The future course of heatstroke predicted by our approach acts as a baseline for future studies.
The purpose of this study was to quantify the sleep disturbances caused by climate change using disability-adjusted life years (DALY). The revised sleep quality index for daily sleep (SQIDS2), a self-administered questionnaire for daily sleep quality, was developed to assess daily sleep disturbances. This questionnaire referenced and simplified the Pittsburgh Sleep Quality Index (PSQI). This study was conducted in Nagoya City in August 2011 and 2012. Sleep quality was measured using SQIDS2 and PSQI. A total of 574 participants in 2011 and 710 in 2012 responded to the survey. The sleep disturbance prevalence calculated from the SQIDS2 score was correlated with the daily minimum temperature (p = 0.0067). This score increased when the daily minimum temperature was above 24.8 degrees C. When correcting for the PSQI score, DALY loss due to heat-related sleep disturbances in Nagoya City (population: 2,266,851) was estimated to be 81.8 years in 2012. This value was comparable to the DALY loss due to heatstroke. Sleep disturbance due to climate change was quantified using the DALY based on the PSQI. Legislators must recognize the critical impact of the damage caused by sleep disturbances due to high temperatures at night. Additionally, a daily minimum temperature of 25 degrees C should be the starting point when establishing a goal or guideline for nighttime temperature.
An increase in the global surface temperature and changes in urban morphologies are associated with increased heat stress especially in urban areas. This can be one of the contributing factors underlying an increase in heat strokes. We examined the impact of summer minimum air temperatures, which often represent nighttime temperatures, as well as a maximum temperature on a heat stroke. We collected data from the records of daily ambulance transports for heat strokes and meteorological data for July and August of 2017-2019 in the Tottori Prefecture, Japan. A time-stratified case-crossover design was used to determine the association of maximum/minimum air temperatures and the incidence of heat strokes. We used a logistic regression to identify factors associated with the severity of heat strokes. A total of 1108 cases were identified with 373 (33.7%) calls originating in the home (of these, 59.8% were the age of ≥ 75). A total of 65.8% of cases under the age of 18 were related to exercise. Days with a minimum temperature ≥ 25 °C had an odds ratio (95% confidence interval) of 3.77 (2.19, 6.51) for the incidence of an exercise-related heat stroke (reference: days with a minimum temperature < 23 °C). The odds ratio for a heat stroke occurring at home or for calls for an ambulance to the home was 6.75 (4.47, 10.20). The severity of the heat stroke was associated with older age but not with air temperature. Minimum and maximum air temperatures may be associated with the incidence of heat strokes and in particular the former with non-exertional heat strokes.
BACKGROUND: An increase in extreme heat events has been reported along with global warming. Heat exposure in ambient temperature is associated with all-cause diabetes mortality and all-cause hospitalization in diabetic patients. However, the association between heat exposure and hospitalization for hyperglycemic emergencies, such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and hypoglycemia is unclear. The objective of our study is to clarify the impact of heat exposure on the hospitalization for DKA, HHS, and hypoglycemia. METHODS: Data of daily hospitalizations for hyperglycemic emergencies (i.e., DKA or HHS) and hypoglycemia was extracted from a nationwide administrative database in Japan and linked with temperature in each prefecture in Japan during 2012-2019. We applied distributed lag non-linear model to evaluate the non-linear and lagged effects of heat exposure on hospitalization for hyperglycemic emergencies. RESULTS: The pooled relative risk for hyperglycemic emergencies of heat effect (the 90th percentile of temperature with reference to the 75th percentile of temperature) and extreme heat effect (the 99th percentile of temperature with reference to the 75th percentile of temperature) over 0-3 lag days was 1.27 (95 %CI: 1.16-1.39) and 1.64 (95 %CI: 1.38-1.93), respectively. The pooled relative risk for heat effect on hospitalization for hypoglycemia and extreme heat effect over 0-3 lag days was 1.33 (95 %CI: 1.17-1.52) and 1.65 (95 %CI: 1.29-2.10), respectively. These associations were consistent by type of hyperglycemic emergencies and type of diabetes and were generally consistent by regions. DISCUSSION: Heat exposure was associated with hospitalizations for DKA, HHS and hypoglycemia. These results may be useful to guide preventive actions for the risk of fatal hyperglycemic emergencies and hypoglycemia.
Extreme heat exposure has severe negative impacts on humans, and the issue is exacerbated by climate change. Estimating spatial heat stress such as mean radiant temperature (MRT) is currently difficult to apply at city scale. This study constructed a method for estimating the MRT of street canyons using Google Street View (GSV) images and investigated its large-scale spatial patterns at street level. We used image segmentation using deep learning to calculate the view factor (VF) and project panorama into fisheye images. We calculated sun paths to estimate MRT using panorama images from Google Street View. This paper shows that regression analysis can be used to validate between estimated short-wave, long-wave radiation and the measurement data at seven field measurements in the clear-sky (0.97 and 0.77, respectively). Additionally, we compared the calculated MRT and land surface temperature (LST) from Landsat 8 on a city scale. As a result of investigating spatial patterns of MRT in Seoul, South Korea, we found that a high MRT of street canyons (>59.4 degrees C) is mainly distributed in open space areas and compact low-rise density buildings where the sky view factor is 0.6-1.0 and the building view factor (BVF) is 0.35-0.5, or west-east oriented street canyons with an SVF of 0.3-0.55. However, high-density buildings (BVF: 0.4-0.6) or high-density tree areas (Tree View Factor, TVF: 0.6-0.99) showed low MRT (<47.6). The mapped MRT results had a similar spatial distribution to the LST; however, the MRT was lower than the LST in low tree density or low-rise high-density building areas. The method proposed in this study is suitable for a complex urban environment consisting of buildings, trees, and streets. This will help decision makers understand spatial patterns of heat stress at the street level.
BACKGROUND: Although urbanization is often an important topic in climate change studies, the complex effect of urbanization on heat vulnerability in urban and rural areas has rarely been studied. We investigated the disparate effects of urbanization on heat vulnerability in urban and rural areas, using nationwide data. METHODS: We collected daily weather data for all 229 administrative districts in South Korea (2011-17). Population density was applied as an urbanization indicator. We calculated the heat-mortality risk using a distributed lag nonlinear model and analysed the relationship with population density. We also examined district characteristics that can be related to the spatial heterogeneity in heat-mortality risk. RESULTS: We found a U-shaped association between population density and heat-mortality risk, with the highest risk for rural populations; in urban areas, risk increases with increasing population density. Higher heat-mortality risk was associated with a lower number of hospital beds per person and higher percentage of people requiring recuperation. The association between hospital beds and heat-mortality risk was prominent in high-density urban areas, whereas the association between the percentage of people requiring recuperation and heat-mortality risk was pronounced in rural areas. CONCLUSIONS: Our findings indicate that the association between population density and heat-mortality risk is different in urban and rural areas, and that district characteristics related to heat-mortality risk also differ by urbanicity. These results can contribute to understanding the complex role of urbanization on heat vulnerability and can provide evidence to policy makers for prioritizing resources.
Access to urban greenspace has many benefits such as improved health and social cohesion. If access differs by population, these benefits make access to greenspace an environmental justice issue, but little is known regarding accessibility of parks among different sub-groups in Seoul, South Korea. We explored potential socioeconomic inequities for access to parks in Seoul measuring two park provision metrics: total park area per capita (TPPC), and park accessibility index determined by size and proximity of parks. We assessed correlations between a deprivation index for the 25 Gus (administrative unit equivalent to the US borough) and each park provision metric. Regression analyses were applied for the associations between eight socioeconomic indicators of the 424 Dongs (equivalent to the US neighborhood) and each park provision metric. An interquartile range (IQR) increase in percent elderly (> 65 years) (3.2%) was significantly associated with larger TPPC (1.6 m(2)/person, 95% CI: 0.8, 2.4). Park accessibility index was associated with more socioeconomic variables than was TPPC. An IQR increase in percent elderly and divorce rates (1.2/1000 population) was associated with increased park accessibility by 3571 km (95% CI: 1103, 6040) and decreased park accessibility by 1387 (95% CI: -2706, -67), respectively. An IQR increase in percentage of the population receiving social low-income support aid (2.2%) was associated with increased park accessibility (reflecting park size and proximity of parks) of residential parks near residential areas by 1568 (95% CI: 15, 3120). Results suggest higher park access for socioeconomically disadvantaged regions. Findings indicate that measures of detailed park access considering spatial proximity and park size may more accurately measure park inequity compared to more basic metrics (e.g. TPPC), which may bias estimation of park inequity by capturing only one characteristic of parks. Detailed park measures should be considered in urban planning and health studies of greenspace.
We analyzed the relationship between the temperature and traffic accidents in Seoul-Incheon, Busan, Daegu, Daejeon, and Gwangju by the time-of-day (06:00 to 22:00, divided into segments of 4 h) and age of casualties between 2012 and 2017 for the summer season (June to August). A generalized additive model and meta-analysis were employed to analyze this relationship. We found that the threshold temperatures was observed to be approximately 30 degrees C. Above this temperature, traffic accidents increased in four urban areas, except Busan, which is a popular tourist location. In total, traffic accidents increased by approximately 0.59% (95% confidence interval of 0.41-0.75) per 1 degrees C increase in the daily maximum temperature, with substantial differences between the different areas, ranging from 0.12% (CI = – 0.26-0.50) in Busan to 1.08% (CI = 0.45-1.71) in Gwangju. The morning and evening hours showed a greater increase in traffic accidents than other timeframes. The increase in traffic accidents for young casualties was statistically significant at all times, and that for elderly casualties was observed at 10:00-14:00 and 18:00-22:00. The results of this study could provide information for developing customized traffic accident reduction policies considering time-of-day, age of casualties, and type of city.
Many countries are operating a heatwave warning system (HWWS) to mitigate the impact of heatwaves on human health. The level of heatwave warning is normally determined by using the threshold temperature of heat-related morbidity or mortality. However, morbidity and mortality threshold temperatures have not been used together to account for the severity of health impacts. In this study, we developed a heatwave warning system with two different warning levels: Level-1 and Level-2, by analyzing the severity and likelihood of heat-related morbidity and mortality using the generalized additive model. The study particularly focuses on the cases in Seoul, South Korea, between 2011 and 2018. The study found that the threshold temperature for heat-related morbidity and mortality are 30 °C and 33 °C, respectively. Approximately 73.1% of heat-related patients visited hospitals when temperature was between 30 °C and 33 °C. We validated the developed HWWS by using both the threshold temperatures of morbidity and mortality. The area under curves (AUCs) of the proposed model were 0.74 and 0.86 at Level-1 and Level-2, respectively. On the other hand, the AUCs of the model using only the mortality threshold were 0.60 and 0.86 at Level-1 and Level-2, respectively. The AUCs of the model using only the morbidity threshold were 0.73 and 0.78 at Level-1 and Level-2, respectively. The results suggest that the updated HWWS can help to reduce the impact of heatwaves, particularly on vulnerable groups, by providing the customized information. This also indicates that the HWWS could effectively mitigate the risk of morbidity and mortality.
BACKGROUND: Due to climate change, days with high temperatures are becoming more frequent. Although the effect of high temperature on the kidneys has been reported in research from Central and South America, Oceania, North America and Europe, evidence from Asia is still lacking. This study aimed to examine the association between short-term exposure to high temperatures and acute kidney injury (AKI) in a nationwide study in South Korea. METHODS: We used representative sampling data from the 2002-2015 National Health Insurance Service-National Sample Cohort in South Korea to link the daily mean temperatures and AKI cases that occurred in the summer. We used a bidirectional case-crossover study design with 0-7 lag days before the emergency room visit for AKI. In addition, we stratified the data into six income levels to identify the susceptible population. RESULTS: A total of 1706 participants were included in this study. The odds ratio (OR) per 1°C increase at 0 lag days was 1.051, and the ORs per 1°C increase at a lag of 2 days were both 1.076. The association between exposure to high temperatures and AKI was slightly greater in the low-income group (OR = 1.088; 95% CI: 1.049-1.128) than in the high-income group (OR = 1.065; 95% CI: 1.026-1.105). CONCLUSIONS: In our study, a relationship between exposure to high temperatures and AKI was observed. Precautions should be taken at elevated temperatures to minimize the risk of negative health effects.
Many studies have shown that heat waves can cause both death and disease. Considering the adverse health effects of heat waves on vulnerable groups, this study highlights their impact on workers. The present study thus investigated the association between heat exposure and the likelihood of hospitalization and death, and further identified the risk of heat-related diseases or death according to types of heat and dose-response modeling with heat threshold. Workers were selected from the Korean National Health Insurance Service-National Sample Cohort 2002-2015, and regional data measured by the Korea Meteorological Administration were used for weather information. The relationship between hospitalization attributable to disease and weather variables was analyzed by applying a generalized additional model. Using the Akaike information criterion, we selected a model that presented the optimal threshold. Maximum daily temperature (MaxT) was associated with an increased risk of death and outdoor mortality. The association between death outdoors and MaxT had a threshold of 31.2 °C with a day zero lag effect. History of medical facility visits due to the health effects of heat waves was evident in certain infectious and parasitic diseases (A and B), cardio and cerebrovascular diseases (I20-25 and I60-69), injury, poisoning, and other consequences of external causes (S, T). The study demonstrated that heat exposure is a risk factor for death and infectious, cardio-cerebrovascular, and genitourinary diseases, as well as injuries or accidents among workers. The finding that heat exposure affects workers’ health has future implications for decision makers and researchers.
OBJECTIVE: This study aimed to determine the association between maximum daily temperature and work-related injuries according to employment status in South Korea. METHODS: Data on workers’ compensation claims and daily maximum temperature between May 20 and September 10, 2017-2018, were collected and analyzed. The absolute temperature risk effect (ATR) was evaluated by comparing the risk effect at 2 temperatures (30°C vs 33°C) across all communities using 2-stage time-series analysis. RESULTS: The association between high temperatures and work-related injuries was statistically significant in the construction sector (ATR, 1.129; 95% confidence interval [CI], 1.010-1.261). In addition, the findings of this study also demonstrated a higher risk effect among nonpermanent workers (ATR, 1.109; 95% CI, 1.013-1.214) at 33°C versus 30°C when compared with permanent workers (ATR, 0.963; 95% CI, 0.891-1.041). CONCLUSIONS: This study found a significant association between high temperatures and work-related injuries among nonpermanent workers in South Korea.
BACKGROUND: Environmental factors have been associated with adverse health effects in epidemiological studies. The main exposure variable is usually determined via prior knowledge or statistical methods. It may be challenging when evidence is scarce to support prior knowledge, or to address collinearity issues using statistical methods. This study aimed to investigate the importance level of environmental variables for the under-five mortality in Malaysia via random forest approach. METHOD: We applied a conditional permutation importance via a random forest (CPI-RF) approach to evaluate the relative importance of the weather- and air pollution-related environmental factors on daily under-five mortality in Malaysia. This study spanned from January 1, 2014 to December 31, 2016. In data preparation, deviation mortality counts were derived through a generalized additive model, adjusting for long-term trend and seasonality. Analyses were conducted considering mortality causes (all-cause, natural-cause, or external-cause) and data structures (continuous, categorical, or all types [i.e., include all variables of continuous type and all variables of categorical type]). The main analysis comprised of two stages. In Stage 1, Boruta selection was applied for preliminary screening to remove highly unimportant variables. In Stage 2, the retained variables from Boruta were used in the CPI-RF analysis. The final importance value was obtained as an average value from a 10-fold cross-validation. RESULT: Some heat-related variables (maximum temperature, heat wave), temperature variability, and haze-related variables (PM10, PM10-derived haze index, PM10- and fire-derived haze index, fire hotspot) were among the prominent variables associated with under-five mortality in Malaysia. The important variables were consistent for all- and natural-cause mortality and sensitivity analyses. However, different most important variables were observed between natural- and external-cause under-five mortality. CONCLUSION: Heat-related variables, temperature variability, and haze-related variables were consistently prominent for all- and natural-cause under-five mortalities, but not for external-cause.
The impacts of climate change and degradation are increasingly felt in Malaysia. While everyone is vulnerable to these impacts, the health and wellbeing of children are disproportionately affected. We carried out a study composed of two major components. The first component is an environmental epidemiology study comprised of three sub-studies: (i) a global climate model (GCM) simulating specific health-sector climate indices; (ii) a time-series study to estimate the risk of childhood respiratory disease attributable to ambient air pollution; and (iii) a case-crossover study to identify the association between haze and under-five mortality in Malaysia. The GCM found that Malaysia has been experiencing increasing rainfall intensity over the years, leading to increased incidences of other weather-related events. The time-series study revealed that air quality has worsened, while air pollution and haze have been linked to an increased risk of hospitalization for respiratory diseases among children. Although no clear association between haze and under-five mortality was found in the case-crossover study, the lag patterns suggested that health effects could be more acute if haze occurred over a longer duration and at a higher intensity. The second component consists of three community surveys on marginalized children conducted (i) among the island community of Pulau Gaya, Sabah; (ii) among the indigenous Temiar tribe in Pos Kuala Mu, Perak; and (iii) among an urban poor community (B40) in PPR Sg. Bonus, Kuala Lumpur. The community surveys are cross-sectional studies employing a socio-ecological approach using a standardized questionnaire. The community surveys revealed how children adapt to climate change and environmental degradation. An integrated model was established that consolidates our overall research processes and demonstrates the crucial interconnections between environmental challenges exacerbated by climate change. It is recommended that Malaysian schools adopt a climate-smart approach to education to instill awareness of the impending climate change and its cascading impact on children’s health from early school age.
It is recognized that as humans age, their ability to withstand high or low temperatures reduces. Temperature extremes can also worsen chronic conditions, including cardiovascular, respiratory and other health issues. This study analyses 40 apartments in a single building in Auckland, New Zealand to determine whether the newly designed and constructed apartment, specifically for retirees, is delivering a suitable thermal interior environment during the warmest months of the year. Despite holding this green certification and meeting specific requirements to achieve cooling points that are meant to reduce the likelihood of overheating, the building exhibits significant signs of overheating in the two warmest months of the year (January and February) with two-thirds of apartments failing the CIBSE TM59 overheating criteria. The summertime performance of this green-rated building crucial insights for design professionals policymakers and developers of green building rating tools.
Heat waves are unusually high temperature events over consecutive days and may cause adverse impacts such as morbidity and mortality. The interaction between heat waves and urban heat island (UHI) effects has remained a subject of debate, as some studies prove heat wave-UHI synergy while others do not. Furthermore, heat waves affect tropical cities more severely than mid-latitude cities, but there is a disproportionate lack of heat wave studies focusing on tropical cities. We attempt to narrow this gap by studying the heat wave in Singapore in April 2016 using ground observations and the Weather Research and Forecasting (WRF) model. Compared to non-heat wave days, the ground observations show that daytime temperatures can be 3 degrees C higher during the heat wave. Despite the temperature spike, the UHI intensity is not amplified during the heat wave, maintaining its peak near 2.5 degrees C during both heat wave and non-heat wave periods. WRF simulation results also agree well with measurements and predict UHI peaks near 2.5 degrees C during both periods, showing no heat wave-UHI synergy. The spatially averaged UHI intensity also shows no such synergy. There is no significant change of wind speed, soil moisture availability or heat storage flux during the heat wave. Therefore, the lack of heat wave-UHI synergy in our study is consistent with current understanding of factors contributing to UHI. This study shows that the heat wave-UHI interaction in a tropical city can be different from that in cities in the temperate climate zone and more studies should be conducted in tropical cities, which are projected to suffer larger impacts of increasing heat stress.
BACKGROUND: Excessive heat exposure and dehydration among agricultural workers have been reported to reduce kidney function and lead to chronic kidney disease of unknown etiology (CKDu). OBJECTIVE: This cross-sectional study aimed to assess heat exposure, factors related to dehydration and the relationship between dehydration and biomarkers of kidney function among sea salt workers in Thailand. MATERIAL AND METHODS: Wet bulb globe temperature (WBGT) was used at the time workers started work outdoors on salt farms. Urine-specific gravity, urine osmolarity, and serum creatinine were collected from 50 workers after work. RESULTS: The results showed that more than 50% of the participants were dehydrated after work. The maximum hours spent working per day was 10. The average water intake was 1.51 L. Urine specific gravity was highly significant correlated with urine osmolality (rs = 0.400, p<0.01), and urine osmolality was significantly correlated with the estimated glomerular filtration rate (eGFR) (rs = 0.349, p<0.05). In bivariate analysis adjusted for age, sex, and current alcohol consumption, we found that a WBGTTWA ≥ 30°C (OR = 0.08, 95% CI = 0.01-0.44, p = 0.003) and hours spent working (OR=2.22, 95% CI = 1.42-3.47, p <0.001) were independently associated with dehydration. This suggests that workers should increase their time spent on breaks and increase water consumption. CONCLUSIONS: Educational program on heat exposure and heat-related illness prevention strategies should be provided.
Increased heat stress affects well-being, comfort, and economic activities across the world. It also causes a significant decrease in work performance, as well as heat-related mortality. This study aims to investigate the impacts of the projected climate change scenario under RCP8.5 on heat stress and associated work performance in Thailand during the years 2020-2029. The model evaluation shows exceptional performance in the present-day simulation (1990-1999) of temperature and relative humidity, with R-2 values ranging from 0.79 to 0.87; however, the modeled temperature and relative humidity are all underestimated when compared to observation data by -0.9 degrees C and -27%, respectively. The model results show that the temperature change will tend to increase by 0.62 degrees C per decade in the future. This could lead to an increase in the heat index by 2.57 degrees C if the temperature increases by up to 1.5 degrees C in Thailand. The effect of climate change is predicted to increase heat stress by 0.1 degrees C to 4 degrees C and to reduce work performance in the range of 4% to >10% across Thailand during the years 2020 and 2029.
No abstract available.
BACKGROUND: Exposure to non-optimum ambient temperature has been linked to increased risk of total cardiovascular disease (CVD) mortality; however, the adverse effects on mortality from specific types of CVD remain less understood. OBJECTIVES: To comprehensively investigate the association of ambient temperature with cause-specific CVD mortality, and to estimate and compare the corresponding mortality burden. METHODS: We conducted a time-stratified case-crossover study of 1000,014 CVD deaths in Jiangsu province, China during 2015-2019 using data from the China National Mortality Surveillance System. Residential daily 24-hour average temperature for each subject was extracted from a validated grid data at a spatial resolution of 0.0625° × 0.0625°. We fitted distributed lag non-linear models (DLNM) based on conditional logistic regression to quantitatively investigate the association of ambient temperature with total and cause-specific CVD mortality, which was used to further estimate mortality burden attributable to non-optimum ambient temperatures. RESULTS: With adjustment for relative humidity, we observed reverse J-shaped exposure-response associations of ambient temperature with total and cause-specific CVD mortality, with minimum mortality temperatures ranging from 19.5 °C to 23.0 °C. An estimated 20.3% of the total CVD deaths were attributable to non-optimum temperatures, while the attributable fraction (AF) of mortality from chronic rheumatic heart diseases, hypertensive diseases, ischemic heart diseases (IHD), pulmonary heart disease, stroke, and sequelae of stroke was 22.4%, 23.2%, 23.3%, 20.9%, 17.6% and 21.3%, respectively. For total and cause-specific CVDs, most deaths were attributable to moderate cold temperature. We observed significantly higher mortality burden from total and certain cause-specific CVDs in adults 80 years or older and those who were widowed. CONCLUSION: Exposure to ambient temperature was significantly associated with increased risk of cause-specific CVD mortality. The burden of CVD mortality attributable to non-optimum temperature was substantial especially in older and widowed adults, and significantly varied across specific types of CVD.
BACKGROUND: The effect of ambient temperature on allergic rhinitis (AR) remains unclear. Accordingly, this study aimed to explore the relationship between ambient temperature and the risk of AR outpatients in Xinxiang, China. METHOD: Daily data of outpatients for AR, meteorological conditions, and ambient air pollution in Xinxiang, China were collected from 2015 to 2018. The lag-exposure-response relationship between daily mean temperature and the number of hospital outpatient visits for AR was analyzed by distributed lag non-linear model (DLNM). Humidity, long-time trends, day of the week, public holidays, and air pollutants including sulfur dioxide (SO(2)), and nitrogen dioxide (NO(2)) were controlled as covariates simultaneously. RESULTS: A total of 14,965 AR outpatient records were collected. The relationship between ambient temperature and AR outpatients was generally M-shaped. There was a higher risk of AR outpatient when the temperature was 1.6-9.3 °C, at a lag of 0-7 days. Additionally, the positive association became significant when the temperature rose to 23.5-28.5 °C, at lag 0-3 days. The effects were strongest at the 25th (7 °C) percentile, at lag of 0-7 days (RR: 1.32, 95% confidence intervals (CI): 1.05-1.67), and at the 75th (25 °C) percentile at a lag of 0-3 days (RR: 1.15, 95% CI: 1.02-1.29), respectively. Furthermore, men were more sensitive to temperature changes than women, and the younger groups appeared to be more influenced. CONCLUSIONS: Both mild cold and mild hot temperatures may significantly increase the risk of AR outpatients in Xinxiang, China. These findings could have important public health implications for the occurrence and prevention of AR.
Under the background of global warming, it has been confirmed that heat exposure has a huge impact on human health. The current study aimed to evaluate the effects of daily mean ambient temperature on hospital admissions for obstructive nephropathy (ON) at the population level. A total of 19,494 hospitalization cases for ON in Wuhan, China from January 1, 2015 to December 31, 2018 were extracted from a nationwide inpatient database in tertiary hospitals according to the International Classification of Diseases (ICD)- 10 codes. Daily ambient meteorological and pollution data during the same period were also collected. A quasi-Poisson Generalized Linear Model (GLM) combined with a distributed lag non-linear model (DLNM) was applied to analyze the lag-exposure-response relationship between daily mean temperature and daily hospital admissions for ON. Results showed that there were significantly positive associations between the daily mean temperature and ON hospital admissions. Relative to the minimum-risk temperature (-3.4 ℃), the risk of hospital admissions for ON at moderate hot temperature (25 ℃, 75th percentile) occurred from lag day 4 and stayed to lag day 12 (cumulative relative risk [RR] was 1.846, 95 % confidence interval [CI]: 1.135-3.005, over lag 0-12 days). Moreover, the risk of extreme hot temperature (32 ℃, 99th percentile) appeared immediately and lasted for 8 days (RR = 2.019, 95 % CI: 1.308-3.118, over lag 0-8 days). Subgroup analyses indicated that the middle-aged and elderly (≥45 years) patients might be more susceptible to the negative effects of high temperature, especially at moderate hot conditions. Our findings suggest that temperature may have a significant impact on the acute progression and onset of ON. Higher temperature is associated with increased risks of hospital admissions for ON, which indicates that early interventions should be taken in geographical settings with relatively high temperatures, particularly for the middle-aged and elderly.
OBJECTIVE: The relationship between outdoor temperature and blood pressure (BP) has been inconclusive. We analyzed data from a prospective cohort study in northwestern China to investigate the effect of outdoor temperature on BP and effect modification by season. METHODS: A total of 32,710 individuals who participated in both the baseline survey and the first follow-up in 2011-2015 were included in the study. A linear mixed-effect model and generalized additive mixed model (GAMM) were applied to estimate the association between outdoor temperature and BP after adjusting for confounding variables. RESULTS: The mean differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between summer and winter were 3.5 mmHg and 2.75 mmHg, respectively. After adjusting for individual characteristics, meteorological factors and air pollutants, a significant increase in SBP and DBP was observed for lag 06 day and lag 04 day, a 0.28 mmHg (95% CI: 0.27-0.30) per 1 °C decrease in average temperature for SBP and a 0.16 mmHg (95% CI: 0.15-0.17) per 1 °C decrease in average temperature for DBP, respectively. The effects of the average temperature on both SBP and DBP were stronger in summer than in other seasons. The effects of the average temperature on BP were also greater if individuals were older, male, overweight or obese, a smoker or drinker, or had cardiovascular diseases (CVDs), hypertension, and diabetes. CONCLUSIONS: This study demonstrated a significant negative association between outdoor temperature and BP in a high-altitude environment of northwest China. Moreover, BP showed a significant seasonal variation. The association between BP and temperature differed by season and individuals’ demographic characteristics (age, gender, BMI), unhealthy behaviors (smoking and alcohol consumption), and chronic disease status (CVDs, hypertension, and diabetes).
BACKGROUND: Composite temperature-related indices have been utilized to comprehensively reflect the impact of multiple meteorological factors on health. We aimed to evaluate the predictive ability of temperature-related indices, choose the best predictor of stroke morbidity, and explore the association between them. METHODS: We built distributed lag nonlinear models to estimate the associations between temperature-related indices and stroke morbidity and then applied two types of cross-validation (CV) methods to choose the best predictor. The effects of this index on overall stroke, intracerebral hemorrhage (ICH), and ischemic stroke (IS) morbidity were explored and we explained how this index worked using heatmaps. Stratified analyses were conducted to identify vulnerable populations. RESULTS: Among 12 temperature-related indices, the alternative temperature-humidity index (THIa) had the best overall performance in terms of root mean square error when combining the results from two CVs. With the median value of THIa (25.70 °C) as the reference, the relative risks (RRs) of low THIa (10th percentile) reached a maximum at lag 0-10, with RRs of 1.20 (95%CI:1.10-1.31), 1.49 (95%CI:1.29-1.73) and 1.12 (95%CI:1.03-1.23) for total stroke, ICH and IS, respectively. According to the THIa formula, we matched the effects of THIa on stroke under various combinations of temperature and relative humidity. We found that, although the low temperature (<20 °C) had the greatest adverse effect, the modification effect of humidity on it was not evident. In contrast, lower humidity could reverse the protective effect of temperature into a harmful effect at the moderate-high temperature (24 °C-27 °C). Stratification analyses showed that the female was more vulnerable to low THIa in IS. CONCLUSIONS: THIa is the best temperature-related predictor of stroke morbidity. In addition to the most dangerous cold weather, the government should pay more attention to days with moderate-high temperature and low humidity, which have been overlooked in the past.
This paper investigates the relationship between temperature and hospitalization in China. Using inpatient visit claims of two major public insurance schemes covering 47 cities in 28 provinces for three years, we see a 7.3% increase in hospital admissions on days on which the average temperature is above 27 degrees C, and a 2% increase in 31-day cumulative hospital admissions relative to a benchmark-temperature day in the subsequent weeks. Such an effect is much larger than evidence from developed economies. Using detailed information on medical bills, we calculate that an additional hot day nationwide is associated with approximately 2 billion yuan (roughly equivalent to 0.3 billion US dollars) increase in medical expenses that are related to inpatient services, 1.9 billion yuan (roughly equivalent to 0.29 billion US dollars) of which is borne by the public insurance system, and 0.2 billion yuan (roughly equivalent to 0.01 billion US dollars) of which is borne by the insured.
Association between acute myocardial infarction (AMI) morbidity and ambient temperature has been examined with generalized linear model (GLM) or generalized additive model (GAM). However, the effect size by these two methods might be biased due to the autocorrelation of time series data and arbitrary selection of degree of freedom of natural cubic splines. The present study analyzed how the climatic factors affected AMI morbidity for older adults in Shanghai with Mixed generalized additive model (MGAM) that addressed these shortcomings mentioned. Autoregressive random effect was used to model the relationship between AMI and temperature, PM10, week days and time. The degree of freedom of time was chosen based on the seasonal pattern of temperature. The performance of MGAM was compared with GAM on autocorrelation function (ACF), partial autocorrelation function (PACF) and goodness of fit. One-year predictions of AMI counts in 2011 were conducted using MGAM with the moving average. Between 2007 and 2011, MGAM adjusted the autocorrelation of AMI time series and captured the seasonal pattern after choosing the degree of freedom of time at 5. Using MGAM, results were well fitted with data in terms of both internal (R2 = 0.86) and external validity (correlation coefficient = 0.85). The risk of AMI was relatively high in low temperature (Risk ratio = 0.988 (95% CI 0.984, 0.993) for under 12°C) and decreased as temperature increased and speeded up within the temperature zone from 12°C to 26°C (Risk ratio = 0.975 (95% CI 0.971, 0.979), but it become increasing again when it is 26°C although not significantly (Risk ratio = 0.999 (95% CI 0.986, 1.012). MGAM is more appropriate than GAM in the scenario of response variable with autocorrelation and predictors with seasonal variation. The risk of AMI was comparatively higher when temperature was lower than 12°C in Shanghai as a typical representative location of subtropical climate.
BACKGROUND: Extreme ambient temperature has an adverse effect on pregnancy outcomes, but the conclusions have been inconsistent. The influence of ambient temperature and diurnal temperature variation on the premature rupture of membranes (PROM) needs further study. METHODS AND FINDINGS: The daily data of PROMs, daily meteorological and air pollutant were obtained. After controlling for potential confounding factors, the quasi-Poisson generalized additive model (GAM) combined with the distributed lag nonlinear model (DLNM) was used to analyze the association between temperature or diurnal temperature variation and PROM, including preterm premature rupture of membranes (PPROM) and term premature rupture of membranes (term PROM). Compared with the median temperature(18.7 °C), the mean temperature of 5-7 days lagging beyond 31.5 °C and below -1.5 °C was positively correlated with PROM; the mean temperature had more sensitive effect on the term PROM. Exposure to extremely high temperatures (97.5th percentile, 32 °C) had a 6-day lagging relative risk (RR) (95% CI: 1.005-1.160) of 1.08 for PROM and a 6-day lagging RR of 1.079 (95% CI: 1.005-1.159) for term PROM; Exposure to a high diurnal temperature variation (diurnal temperature variation greater than 16 °C) was positively correlated with the term PROM. Compared with the 2.5th percentile diurnal temperature variation (2 °C), exposure to the 95th percentile diurnal temperature variation (17 °C) significantly increased the risk of term PROM (RR: 1.229, 95% CI: 1.029-1.467). CONCLUSIONS: Exposure to a high-temperature and a high diurnal temperature variation environment will increase the relative risks of PROM. For pregnant women in the 3rd trimester, it is important to reduce exposure to extremely high-temperatures and greater diurnal temperature changes.
BACKGROUND: The burden of cardiovascular disease (CVD) on the current aging society in China is substantial. Climate change, including extreme temperatures and humidity, has a detrimental influence on health. However, epidemiological studies have been unable to fully identify the association between climate change and CVD among older adults. Therefore, we investigated the associations between temperature and relative humidity and CVD among older adults in China. METHODS: We used cohort data from the China Longitudinal Health and Longevity Survey (CLHLS) conducted in 2002, 2005, 2008, 2011, 2014, and 2018. A total of 39,278 Chinese adults 65 years and older participated in the analyses. The average annual temperatures and relative humidity during 2001 and 2017 (before the survey year) at the city level in China were used as the exposure measures. We selected patients with hypertension, heart disease, and stroke to create a sample of CVD patients. The associations between temperature and relative humidity and CVD were analyzed using the generalized estimation equation (GEE) model. Covariates included sociodemographic factors, health status, lifestyle, and cognitive function. RESULTS: The average annual temperature was negatively correlated with the prevalence of CVD. Every 1°C increase in the average annual temperature reduced the rates of hypertension by 3% [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96-0.97], heart disease by 6% (OR: 0.94; 95% CI: 0.92-0.95), and stroke by 5% (OR: 0.95; 95% CI: 0.94-0.97). The results of the analyses stratified by sex, urban/rural residence, and educational level were robust. The average annual relative humidity was inversely associated with the likelihood of CVD among older adults. Every 1% increase in the average annual relative humidity reduced the rates of hypertension by 0.4% (OR: 0.996; 95% CI: 0.99-1.00), heart disease by 0.6% (OR: 0.994; 95% CI: 0.99-1.00), and stroke by 0.08% (OR: 0.992; 95% CI: 0.98-1.00). However, the effects were more obvious with higher humidity levels (>70). CONCLUSION: Our findings suggest that higher temperatures and relative humidity may reduce the risk of CVD among older adults.
Existing studies suggested that ambient temperature may affect the attack of acute appendicitis. However, the identification of the quantitative effect and vulnerable populations are still unknown. The purposes of this study were to quantify the impact of daily mean temperature on the hospitalization of acute appendicitis and clarify vulnerable groups, further guide targeted prevention of acute appendicitis in Tongling. Daily data of cases and meteorological factors were collected in Tongling, China, during 2015-2019. Time stratified case-crossover design and conditional logistic regression model were used to evaluate the odds ratio (OR) of ambient temperature on hospitalizations for acute appendicitis. Stratified analyses were performed by sex, age, and marital status. The odds ratio (OR) of hospitalizations for acute appendicitis increased by 1.6% for per 1 ℃ rise in mean temperature at lag3[OR = 1.016, 95% confidence interval (CI): 1.004-1.028]. In addition, our results suggest it is in the women that increased ambient temperature is more likely to contribute to acute appendicitis hospitalizations; we also found that the married are more susceptible to acute appendicitis hospitalizations due to increased ambient temperature than the unmarried; people in the 21-40 years old are more sensitive to ambient temperature than other age groups. The significant results of the differences between the subgroups indicate that the differences between the groups are all statistically significant. The elevated ambient temperatures increased the risk of hospitalizations for acute appendicitis. The females, married people, and patients aged 21-40 years old were more susceptible to ambient temperature. These findings suggest that more attention should be paid to the impact of high ambient temperature on acute appendicitis in the future.
BACKGROUND: Evidence is limited regarding the association between temperatures and health costs. OBJECTIVES: We tried to investigate the association between temperatures and emergency department visits (EDVs) costs in China. METHODS: Daily data on EDVs costs, weather, air pollution were collected from 17 sites in China during 2014-2018. A quasi-Poisson generalized additive regression with distributed lag nonlinear model was applied to assess the temperature-EDVs cost association. Random-effect meta-analysis was used to pool the estimates from each site. Attributable fractions and national attributable EDVs costs due to heat and cold were calculated. RESULTS: Relative risk (RR) due to extreme heat over 0-7 lag days was 1.14 [95% confidence intervals (CI): 1.08-1.19] and 1.11 (95% CI: 1.07-1.16) for EDVs examination (including treatment) and medicine cost, respectively. People aged 18-44 and those with genitourinary diseases were at higher risk from heat. 0.72% of examination cost and 0.57% of medicine cost were attributed to extreme heat, costing 274 million Chinese Yuan annually. Moderate heat had lower RR but higher attributable fraction of EDVs costs. Exposure to extreme cold over 0-21 lag days increased the risk of medicine cost for people aged 18-44 [RR: 1.30 (95% CI: 1.10-1.55)] and those with respiratory diseases [RR: 1.56 (95% CI: 1.14-2.14)], but had non-statistically significant attributable fraction of the total EDVs cost. CONCLUSIONS: Exposure to heat and cold resulted in remarkable health costs. More resources and preparedness are needed to tackle such a challenge as our climate is rapidly changing.
BACKGROUND: For the reason that many studies have been inconclusive on the effect of humidity on respiratory disease, we examined the association between absolute humidity and respiratory disease mortality and quantified the mortality burden due to non-optimal absolute humidity in Guangzhou, China. METHODS: Daily respiratory disease mortality including total 42,440 deaths from 1 February 2013 to 31 December 2018 and meteorological data of the same period in Guangzhou City were collected. The distributed lag non-linear model was used to determine the optimal absolute humidity of death and discuss their non-linear lagged effects. Attributable fraction and population attributable mortality were calculated based on the optimal absolute humidity, defined as the minimum mortality absolute humidity. RESULTS: The association between absolute humidity and total respiratory disease mortality showed an M-shaped non-linear curve. In total, 21.57% (95% CI 14.20 ~ 27.75%) of respiratory disease mortality (9154 deaths) was attributable to non-optimum absolute humidity. The attributable fractions due to high absolute humidity were 13.49% (95% CI 9.56 ~ 16.98%), while mortality burden of low absolute humidity were 8.08% (95% CI 0.89 ~ 13.93%), respectively. Extreme dry and moist absolute humidity accounted for total respiratory disease mortality fraction of 0.87% (95% CI – 0.09 ~ 1.58%) and 0.91% (95% CI 0.25 ~ 1.39%), respectively. There was no significant gender and age difference in the burden of attributable risk due to absolute humidity. CONCLUSIONS: Our study showed that both high and low absolute humidity are responsible for considerable respiratory disease mortality burden, the component attributed to the high absolute humidity effect is greater. Our results may have important implications for the development of public health measures to reduce respiratory disease mortality.
Climate-related disasters are increasing across the globe, but their adverse health impacts are unevenly distributed. The people most severely affected tend to be from socio-economically disadvantaged, vulnerable populations, who have high exposure to risk conditions and insufficient adaptive capacity. Despite the increasing health impacts of climate change and disaster risks felt in Asian countries such as China, Indonesia and Vietnam, there are few attempts to access and translate literature and evidence on climate-related disasters and adaptation activities from non-English speaking countries. Conducted by a multi-country project team, this review aims to better understand the current literature and to study gaps in these three countries through an extensive search of literature, in English, Chinese, Indonesian and Vietnamese. Through a systematic review process a total of 298 studies out of 10,139 were included in this study. Key findings confirm that all three countries have experienced increasing climate-related disasters with their associated health impacts, and that adaptation strategies are urgently needed to reduce the risk and vulnerability of the most affected populations. Future studies should consider conducting vulnerability assessments to inform translational research on developing effective adaptation strategies. Authors commented that a common challenge they found was the shortterm nature of disaster response mechanisms, and the lack of long-term investment and policy support for capacity building and multisectoral collaborative research that address the needs of populations vulnerable to climate-related disasters. Thus, to better prepare for future disasters, it is vital that governments and international agencies prioritize funding policies to fill this gap.
Climate change causing an increase of frequency and magnitude of heat waves has a huge impact on the urban population worldwide. In Indonesia, the Southeast Asian country in the tropical climate zone, the increasing heat wave duration due to climate change will be also magnified by projected rapid urbanization. Therefore, not only climate change mitigation measures but also adaptation solutions to more frequent extreme weather events are necessary. Adaptation is essential at local levels. The projected increase of the heat wave duration will trigger greater health-related risks. It will also drive higher energy demands, particularly in urban areas, for cooling. New smart solutions for growing urbanization for reducing urban heat island phenomenon are critical, but in order to identify them, analyzing the changing magnitude and spatial distribution of urban heat is essential. We projected the current and future spatial variability of heat stress index in three cities in Indonesia, namely, Medan, Surabaya, and Denpasar, under climate change and land-cover change scenarios, and quantified it with the Universal Thermal Climate Index (UTCI) for two periods, baseline (1981-2005) and future (2018-2042). Our results demonstrated that currently the higher level of the UTCI was identified in the urban centers of all three cities, indicating the contribution of urban heat island phenomenon to the higher UTCI. Under climate change scenarios, all three cities will experience increase of the heat, whereas applying the land-cover scenario demonstrated that in only Medan and Denpasar, the UTCI is likely to experience a higher increase by 3.1 degrees C; however, in Surabaya, the UTCI will experience 0.84 degrees C decrease in the period 2018-2042 due to urban greening. This study advanced the UTCI methodology by demonstrating its applicability for urban heat warning systems and for monitoring of the urban green cooling effect, as well as it provides a base for adaptation measures’ planning.
As a highly important meteorological hazard, heat waves notably impact human health and socioeconomics, and accurate heat wave risk identification and assessment are effective ways to address this issue. The current spatial scale of heat wave risk assessment is relatively coarse, hardly meeting fine-scale heat wave risk assessment requirements. Therefore, based on multi-source fine-scale remote sensing data and socioeconomic data, this paper evaluates the heat wave risk along the Jakarta-Bandung high-speed railway, obtains the spatial distribution of heat wave risk in 2005, 2014 and 2019, and analyzes spatiotemporal risk variations over the past 15 years. The results show that most high-risk areas were affected by high-temperature hazards. Over time, the hazard, exposure, vulnerability and risk levels increased by 25.82%, 3.31%, 14.82% and 6.97%, respectively, from 2005-2019. Spatially, the higher risk in the northwest is mainly distributed in Jakarta. Additionally, a comparative analysis was conducted on the risk results, and the results showed that the 100-m scale showed more spatial differences than the kilometer scale. The research results in this paper can provide scientific advice on heat wave risk prevention considering the Jakarta-Bandung high-speed railway construction and regional economic and social development.
BACKGROUND: Previous studies focusing on urban, industrialised regions have found that excess heat exposure can increase all-cause mortality, heat-related illnesses, and occupational injuries. However, little research has examined how deforestation and climate change can adversely affect work conditions and population health in low latitude, industrialising countries. METHODS: For this modelling study we used data at 1 km^(2) resolution to compare forest cover and temperature conditions in the Berau regency, Indonesia, between 2002 and 2018. We used spatially explicit satellite, climate model, and population data to estimate the effects of global warming, between 2002 and 2018 and after applying 1·0°C, 1·5°C, and 2·0°C of global warming to 2018 temperatures, on all-cause mortality and unsafe work conditions in the Berau regency, Indonesia. FINDINGS: Between 2002 and 2018, 4375 km(2) of forested land in Berau was cleared, corresponding to approximately 17% of the entire regency. Deforestation increased mean daily maximum temperatures by 0·95°C (95% CI 0·97–0·92; p<0·0001). Mean daily temperatures increased by a population-weighted 0·86°C, accounting for an estimated 7·3–8·5% of all-cause mortality (or 101-118 additional deaths per year) in 2018. Unsafe work time increased by 0·31 h per day (95% CI 0·30–0·32; p<0·0001) in deforested areas compared to 0·03 h per day (0·03–0·04; p<0·0001) in areas that maintained forest cover. With 2·0°C of additional future global warming, relative to 2018, deforested areas could experience an estimated 17-20% increase in all-cause mortality (corresponding to an additional 236-282 deaths per year) and up to 5 h of unsafe work per day. INTERPRETATION: Heat exposure from deforestation and climate change has already started affecting populations in low latitude, industrialising countries, and future global warming indicates substantial health impacts in these regions. Further research should examine how deforestation is currently affecting the health and wellbeing of local communities. FUNDING: University of Washington Population Health Initiative. TRANSLATION: For the Bahasa translation of the abstract see Supplementary Materials section.
BACKGROUND: Climate change, as a defining issue of the current time, is causing severe heat-related illness in the context of extremely hot weather conditions. In Japan, the remarkable temperature increase in summer caused by an urban heat island and climate change has become a threat to public health in recent years. METHODS: This study aimed to determine the potential risk factors for heatstroke by analysing data extracted from the records of emergency transport to the hospital due to heatstroke in Fukuoka City, Japan. In this regard, a negative binomial regression model was used to account for overdispersion in the data. Age-structure analyses of heatstroke patients were also embodied to identify the sub-population of Fukuoka City with the highest susceptibility. RESULTS: The daily maximum temperature and wet-bulb globe temperature (WBGT), along with differences in both the mean temperature and time-weighted temperature from those of the consecutive past days were detected as significant risk factors for heatstroke. Results indicated that there was a positive association between the resulting risk factors and the probability of heatstroke occurrence. The elderly of Fukuoka City aged 70 years or older were found to be the most vulnerable to heatstroke. Most of the aforementioned risk factors also encountered significant and positive associations with the risk of heatstroke occurrence for the group with highest susceptibility. CONCLUSION: These results can provide insights for health professionals and stakeholders in designing their strategies to reduce heatstroke patients and to secure the emergency transport systems in summer.
BACKGROUND: The complex role of urbanisation in heat-mortality risk has not been fully studied. Japan has experienced a rapid population increase and densification in metropolitan areas since the 2000s; we investigated the effects of population concentration in metropolitan areas on heat-mortality risk using nationwide data. METHODS: We collected time-series data for mortality and weather variables for all 47 prefectures in Japan (1980-2015). The prefectures were classified into three sub-areas based on population size: lowest (<1 500 000), intermediate (1 500 000 to 3 000 000), and highest (>3 000 000; i.e. metropolitan areas). Regional indicators associated with the population concentration of metropolitan areas were obtained. RESULTS: Since the 2000s, the population concentration intensified in the metropolitan areas, with the highest heat-mortality risk in prefectures with the highest population. Higher population density and apartment % as well as lower forest area and medical services were associated with higher heat-mortality risk; these associations have generally become stronger since the 2000s. CONCLUSIONS: Population concentration in metropolitan areas intensified interregional disparities in demography, living environments, and medical services in Japan; these disparities were associated with higher heat-mortality risk. Our results can contribute to policies to reduce vulnerability to high temperatures.
This study assesses heatstroke risk in the near future (2031-2050) under RCP8.5 scenario. The developed model is based on a generalized linear model with the number of ambulance transport due to heatstroke (hereafter the patients with heatstroke) as the explained variable and the daily maximum temperature or wet bulb globe temperature (WBGT) as the explanatory variable. With the model based on the daily maximum temperature, we performed the projection of the patients with heatstroke in case of considering only climate change (Case 1); climate change and population dynamics (Case 2); and climate change, population dynamics, and long-term heat acclimatization (Case 3). In Case 2, the number of patients with heatstroke in the near future will be 2.3 times higher than that in the baseline period (1981 – 2000) on average nationwide. The number of future patients with heatstroke in Case 2 is about 10 % larger than that in Case 1 on average nationwide despite population decline. This is due to the increase in the number of elderly people from the baseline period to the near future. However, in 20 prefectures, the number of patients in Case 2 is smaller compared to Case 1. Comparing the results from Cases 1 and 3 reveals that the number of patients with heatstroke could be reduced by about 60 % nationwide by acquiring heat tolerance and changing lifestyles. Notably, given the lifestyle changes represented by the widespread use of air conditioners, the number of patients with heatstroke in the near future will be lower than that of the baseline period in some areas. In other words, lifestyle changes can be an important adaptation to the risk of heatstroke emergency. All of the above results were also confirmed in the prediction model with WBGT as the explanatory variable.
In the context of climate change, most of the global regions are facing the threat of high temperature. Influenced by tropical cyclones in the western North Pacific Ocean, high temperatures are more likely to occur in central China, and the economic losses caused by heat are in urgent need of quantification to form the basis for health decisions. In order to study the economic burden of high temperature on the health of Wuhan residents between 2013 and 2019, we employed meta-analysis and the value of statistical life (VSL) approach to calculate the relative risk of high temperature health endpoints, the number of premature deaths, and the corresponding economic losses in Wuhan City, China. The results suggested that the pooled estimates of relative risk of death from high temperature health endpoints was 1.26 [95% confidence interval (CI): 1.15, 1.39]. The average number of premature deaths caused by high temperature was estimated to be 77,369 (95% CI: 48,906-105,198) during 2013-2019, and the induced economic losses were 156.1 billion RMB (95% CI: 92.28-211.40 billion RMB), accounting for 1.81% (95% CI: 1.14-2.45%) of Wuhan’s annual GDP in the seven-year period. It can be seen that high temperature drives an increase in the premature deaths, and the influence of high temperature on human health results in an economic burden on the health system and population in Wuhan City. It is necessary for the decision-makers to take measures to reduce the risk of premature death and the proportion of economic loss of residents under the impacts of climate change.
BACKGROUND: As climate change, compound hot extremes (CHEs), daytime and nighttime persistent hot extremes, are projected to become much more frequent and intense, which may pose a serious threat to human health. However, evidence on the impact of CHEs on injury is rare. METHODS: We collected injury death data and daily meteorological data from six Chinese provinces during 2013-2018. A time-stratified case-crossover design with two-stage analytic approach was applied to assess the associations of CHEs with injury mortality by intention, mechanism, age and gender. Using the projected daily temperatures of five General Circulation Models (GCMs), we projected the frequency of CHEs and CHEs-attributable mortality burden of injury under three Representative Concentration Pathway (RCP) scenarios. RESULTS: CHEs were significantly associated with increased injury mortality risk (RR = 1.14, 95%CI: 1.09-1.19), with strong effects on unintentional injuries (RR = 1.16, 95%CI:1.11,1.22) and intentional injuries (RR = 1.11, 95%CI:0.99,1.25). Female (RR = 1.21,95%CI: 1.13-1.29) and the elderly (RR = 1.30, 95%CI: 1.22-1.39) were more susceptible to CHEs. Both the frequency and injury mortality burden of CHEs showed a steep rising trend under RCP8.5 scenario, with a 7.37-fold and 8.22-fold increase respectively, by the end of the century, especially in southern, eastern, central and northwestern China. CONCLUSION: CHEs were associated with increased injury mortality risk, and the CHEs-attributable injury mortality burden was projected to aggravate substantially in the future as global warming. It is urgent to develop targeted adaptation policies to alleviate the health burden of CHEs.
BACKGROUND: Many studies have shown that heatwaves are associated with an increased prevalence of urinary diseases. However, few national studies have been undertaken in China, and none have considered the associated economic losses. Such information would be useful for health authorities and medical service providers to improve their policy-making and medical resource allocation decisions. OBJECTIVES: To explore the association between heatwaves and hospital admissions for urinary diseases and assess the related medical costs and indirect economic losses in China from 2014 to 2019. METHODS: Daily meteorological and hospital admission data from 2014 to 2019 were collected from 23 study sites with different climatic characteristics in China. We assessed the heatwave-hospitalization associations and evaluated the location-specific attributable fractions (AFs) of urinary-related hospital admissions due to heatwaves by using a time-stratified case-crossover method with a distributed lag nonlinear model. We then pooled the AFs in a meta-analysis and estimated the national excess disease burden and associated economic losses. We also performed stratified analyses by sex, age, climate zone, and urinary disease subtype. RESULTS: A significant association between heatwaves and urinary-related hospital admissions was found with a relative risk of 1.090 (95 % confidence interval (CI): 1.050, 1.132). The pooled AF was 8.27 % (95%CI: 4.77 %, 11.63 %), indicating that heatwaves during the warm season (May to September) caused 248,364 urinary-related hospital admissions per year, with 2.42 (95%CI: 1.35, 3.45) billion CNY in economic losses, including 2.23 (95%CI: 1.29, 3.14) billion in direct losses and 0.19 (95%CI, 0.06, 0.31) billion in indirect losses, males, people aged 15-64 years, residents of temperate continental climate zones, and patients with urolithiasis were at higher risk. CONCLUSION: Tailored community health campaigns should be developed and implemented to reduce the adverse health effects and economic losses of heatwave-related urinary diseases, especially in the context of climate change.
Heatwaves with unprecedented conditions have devastating health impacts. The summer of 2017 saw unusual heat in China and other regions on earth. Although epidemiologic evidence is clear for elevated mortality risks of heatwaves, the economic impacts due to heatwave-associated mortality remain poorly characterized. Hence, this study systematically assessed the mortality and economic impacts of the 2017 exceptional heatwaves in China. We first used the generalized linear mixed-effect model with Poisson distribution to examine the mortality risks of the 2017 heatwaves in 91 Chinese counties. Further, we calculated the excess deaths attributable to heatwaves in 2852 counties. Finally, we evaluated the city- and province-level death-related economic burden of the 2017 heatwaves based on the value of statistical life (VSL). We found that the 2017 exceptional heatwaves had a statistically significant association (relative risk was 1.23, 95% confidence interval 1.14-1.32) with all-cause mortality across 91 Chinese counties. Nationwide, a total of 16,299 all-cause deaths that occurred in 2017 were attributable to the exceptional heatwaves, resulting in an overall death-related economic loss of 61,304 million RMB as valued by VSL. Given that extraordinary heatwaves are projected to be more frequent under global climate change, our findings could enhance the current understanding of heatwaves’ health and economic impacts and add valuable insights in projection studies of estimating the future health burden of heatwaves.
Objectives: To assess the relationship between regional climatic factors and child drowning in China. Methods: Provincial age-specific drowning rate, climatic and income data were collected. We conducted a geographically weighted regression to evaluate the association between drowning and climatic factors. A generalized additive model was used to comprise a bivariate term with which to investigate the interaction of environmental risk factors and whether such interactions influence drowning mortality. Results: In southern China, an abundance of water systems and increased precipitation, as well as hotter and longer summers, lead to significantly higher drowning compared with that in northern China. Long summers and low economic performance in parts of Xinjiang were key factors for its high drowning mortality rate. Linear and nonlinear joint effects were observed between the risk factors of drowning. Conclusion: Different regions should use adaptive measures to reduce drowning risks, for example, communication campaigns during the summer period or when the weather changes.
BACKGROUND: Antibiotic resistance leads to longer hospital stays, higher medical costs, and increased mortality. However, research into the relationship between climate change and antibiotic resistance remains inconclusive. This study aims to address the gap in the literature by exploring the association of antibiotic resistance with regional ambient temperature and its changes over time. METHODS: Data were obtained from the China Antimicrobial Surveillance Network (CHINET), monitoring the prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB), Klebsiella pneumoniae (CRKP) and Pseudomonas aeruginosa (CRPA) in 28 provinces/regions over the period from 2005 to 2019. Log-linear regression models were established to determine the association between ambient temperature and antibiotic resistance after adjustment for variations in socioeconomic, health service, and environmental factors. FINDINGS: A 1 °C increase in average ambient temperature was associated with 1.14-fold increase (95%-CI [1.07-1.23]) in CRKP prevalence and 1.06-fold increase (95%-CI [1.03-1.08]) in CRPA prevalence. There was an accumulative effect of year-by-year changes in ambient temperature, with the four-year sum showing the greatest effect on antibiotic resistance. Higher prevalence of antibiotic resistance was also associated with higher antibiotic consumption, lower density of health facilities, higher density of hospital beds and higher level of corruption. INTERPRETATION: Higher prevalence of antibiotic resistance is associated with increased regional ambient temperature. The development of antibiotic resistance under rising ambient temperature differs across various strains of bacteria. FUNDING: The National Key R&D Program of China (grant number: 2018YFA0606200), National Natural Science Foundation of China (grant number: 72074234), Fundamental Scientific Research Funds for Central Universities, P.R. China (grant number: 22qntd4201), China Medical Board (grant number: CMB-OC-19-337).
Urolithiasis was a global disease and it was more common in southern China. This study looked into the association between daily temperature and urolithiasis hospital admissions in Ganzhou, a large prefecture-level city in southern China. In Ganzhou City from 2016 to 2019, a total of 60,881 hospitalized cases for urolithiasis from 69 hospitals and meteorological data were gathered. The effect of high ambient temperature on urolithiasis hospital admissions was estimated using a distributed lag nonlinear model. Stratified analysis was done to examine sex differences. The study found that in Ganzhou of China, the exposure-response curves approximated a “J” shape which across genders were basically similar. The maximum lag effect occurred on the second day after high temperatures for males but on the third day for females. Compared to the 10 °C reference temperature and considering the cumulative lag effect of 10 days, the relative risks of the daily mean temperature at the 95th percentile on the total, male, and female hospital admissions for urolithiasis were 2.026 (95% CI: 1.628, 2.521), 2.041 (95% CI: 1.603, 2.598), and 2.030 (95% CI: 1.552, 2.655), respectively, but the relative risks between sex were not statistically significant (p = 0.977). Urolithiasis morbidity risk in China could be exacerbated by high temperatures. The effect of high temperature on urolithiasis was similar across genders.
Ambient high temperature is a worldwide trigger for hypertension events. However, the effects of heat exposure on hypertension and years of life lost (YLL) due to heat remain largely unknown. We conducted a multicenter study in 13 cities in Jiangsu Province, China, to investigate 9727 individuals who died from hypertension during the summer months (May to September) between 2016 and 2017. Meteorological observation data (temperature and rainfall) and air pollutants (fine particulate matter and ozone) were obtained for each decedent by geocoding the residential addresses. A time-stratified case-crossover design was used to quantify the association between heat and different types of hypertension and further explore the modification effect of individual and hospital characteristics. Meanwhile, the YLL associated with heat exposure was estimated. Our results show that summer heat exposure shortens the YLL of hypertensive patients by a total of 14,74 years per month. Of these, 77.9% of YLL was mainly due to hypertensive heart disease. YLL due to heat was pronounced for essential hypertension (5.1 years (95% empirical confidence intervals (eCI): 4.1-5.8)), hypertensive heart and renal disease with heart failure (4.4 years (95% eCI: 0.9-5.9)), and hypertensive heart and renal disease (unspecified, 3.5 years (95% eCI: 1.8-4.5)). Moderate heat was associated with a larger YLL than extreme heat. The distance between hospitals and patients and the number of local first-class hospitals can significantly mitigate the adverse effect of heat exposure on longevity. Besides, unmarried people and those under 65 years of age were potentially susceptible groups, with average reduced YLL of 3.5 and 3.9 years, respectively. Our study reveals that heat exposure increases the mortality risk from many types of hypertension and YLL. In the context of climate change, if effective measures are not taken, hot weather may bring a greater burden of disease to hypertension due to premature death.
The aim of this study was to evaluate the short-term effect of temperature on the risk of acute pancreatitis (AP) in southern China. We performed a time-series study of 2822 patients admitted with a first episode of AP in Nanchang between May 2014 and June 2017. A generalized additive model combined with a distributed lag non-linear model was applied to assess the association of temperature and AP. In subgroup analysis, according to different etiologies of pancreatitis, significant associations were found between daily average temperature and non-biliary pancreatitis hospitalization at lags of 0-7 days, but not for biliary pancreatitis or total AP. Higher daily average temperature tended to increase the occurrence of non-biliary pancreatitis at lags of 0-7 days. These findings suggest that high temperature is associated with higher non-biliary pancreatitis risk in Nanchang, China. In the context of global warming, the morbidity of non-biliary pancreatitis may increase.
BACKGROUND: Many studies have shown that various kinds of diseases were associated with the variation of ambient temperature. However, there’s only a scrap of evidence paying attention to the link between temperature and skin diseases, and no relevant national research was performed in China. OBJECTIVE: This study aimed to quantify the effect of heat on skin diseases and identify the vulnerable populations and areas in China. METHODS: Daily meteorological data, air pollutant data and outpatient data were collected from in 18 sites of China during 2014-2018. A time-series study with distributed lag nonlinear model and multivariate meta-analysis was applied to analyze the site-specific and pooled associations between daily mean temperature and daily outpatient visits of skin diseases by using the data of warm season (from June to September). Stratified analysis by age, sex and climate zones and subtypes of skin diseases were also conducted. RESULTS: We found a positive linear relationship between the ambient temperature and risk of skin diseases, with a 1.25% (95%CI: 0.34%, 2.16%) increase of risk of outpatient visits for each 1 °C increase in daily mean temperature during the warm season. In general, groups aged 18-44 years, males and people living in temperate climate regions were more susceptible to high temperature. Immune dysfunction including dermatitis and eczema were heat-sensitive skin diseases. CONCLUSIONS: Our findings suggested that people should take notice of heat-related skin diseases and also provided some references about related health burden for strategy-makers. Targeted measures for vulnerable populations need to be taken to reduce disease burden, including monitoring and early warning systems, and sun-protection measures.
As one of the most common complications of early pregnancy, spontaneous abortion is associated with environmental factors, but reports estimating the effect of ambient temperature on spontaneous abortion are still inconclusive. Herein, a case-control study (1002 cases and 2004 controls) in Nanjing, China, from 2017 to 2021 was conducted to evaluate the association between temperature exposure and the risk of spontaneous abortion by using distributed lag nonlinear model (DLNM). As a result, daily mean temperature exposure and early spontaneous abortion showed a nonlinear relationship in 14-day lag periods. Moreover, taking the median temperature (17 °C) as a reference, gradually increased positive effects of high temperature on spontaneous abortion could be found during the 4 days prior to hospitalization, and the highest odds ratio (OR) of 2.07 (95% confidence interval (CI): 1.36, 3.16) at extremely hot temperature (33 °C) was observed at 1 lag day. The results suggested that high-temperature exposure in short times during early pregnancy might increase the risk of SAB. Thus, our findings highlight the potential risk of short-term high-temperature exposure during early pregnancy, and more evidence was given for the effects of climate change on maternal health.
BACKGROUND: The health impact of short-term heat exposure is well documented. However, limited studies explored the association between life-time summer heat exposure and lung function. OBJECTIVE: To examine the association between life-time summer heat exposure and lung function among young adults. METHODS: We conducted a retrospective cohort study among 1928 college students in Shandong, China from September 4, 2020 to November 15, 2020. Life-time summer heat exposure for participants were estimated based on the nearest station meteorological data after the participant’s birth date and divided by their learning phases. Lung function indicators included forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). A multiple linear regression model was conducted to examine the associations between summer heat exposure and lung function. Stratificationanalysis by cooling facilities and respiratory diseases history were also conducted. RESULTS: The study subjects had a slight majority of women (58.8%), age 19.2 ± 0.6 years. Each 1 °C increase in life-time summer mean temperature was associated with 1.07% [95% confidence interval (CI): -1.95-0.18%] decrease in FVC and 0.88% (95 %CI: -1.71, -0.05%) decrease in FEV1. Participants with respiratory diseases and non-cooling facility users were more susceptible to summer heat exposure. The usage of fan and air condition could effectively reduce the deleterious heat effects on lung function. CONCLUSION: Life-time summer heat exposure is significantly associated with the reduction of lung function in young adults. Cooling facilities are necessary for pre-school children to reduce heat effects. Fan and air-condition are effective cooling facilities, especially for people with respiratory diseases.
A heat danger day is defined as an extreme when the heat stress index (a combined temperature and humidity measure) exceeding 41 degrees C, warranting public heat alerts. This study assesses future heat risk (i.e. heat danger days times the population at risk) based on the latest Coupled Model Intercomparison Project phase 6 projections. In recent decades (1995-2014) China’s urban agglomerations (Beijing-Tianjin-Hebei, Yangtze River Delta, Middle Yangtze River, Chongqing-Chengdu, and Pearl River Delta (PRD)) experienced no more than three heat danger days per year, but this number is projected to increase to 3-13 days during the population explosion period (2041-2060) under the high-emission shared socioeconomic pathways (SSP3-7.0 and SSP5-8.5). This increase will result in approximately 260 million people in these agglomerations facing more than three heat danger days annually, accounting for 19% of the total population of China, and will double the current level of overall heat risk. During the period 2081-2100, there will be 8-67 heat danger days per year, 60%-90% of the urban agglomerations will exceed the current baseline number, and nearly 310 million people (39% of the total China population) will be exposed to the danger, with the overall heat risk exceeding 18 times the present level. The greatest risk is projected in the PRD region with 67 heat danger days to occur annually under SSP5-8.5. With 65 million people (68% of the total population) experiencing increased heat danger days, the overall heat risk in the region will swell by a factor of 50. Conversely, under the low-emission pathways (SSP1-2.6 and SSP2-4.5), the annual heat danger days will remain similar to the present level or increase slightly. The result indicates the need to develop strategic plans to avoid the increased heat risk of urban agglomerations under high emission-population pathways.
As a combination of temperature and humidity, wet-bulb temperature (WBT) is useful for assessing heat stress and its societal and economic impacts. However, spatial and temporal behaviors of summer WBT in China remain poorly understood. In this study, we investigate the dominant spatiotemporal modes of summer (June-July-August) WBT in the mainland of China during 1960-2017 by using empirical orthogonal function (EOF) analysis and reveal their corresponding underlying mechanisms. The leading mode (EOF1) of summer WBT in China shows a nationwide increasing WBT with a stronger magnitude in northern and western than southeastern China. The second mode (EOF2) displays a zonal pattern with anomalously increased WBT in the west and decreased WBT in the east. The third mode (EOF3) shows a meridional feature with the largest WBT trends appearing in the Yangtze River valley. Further examinations suggest that EOF1 exhibits remarkable interdecadal/long-term variations and is likely connected with global warming and the Atlantic Multidecadal Oscillation (AMO), which induce an anomalous anticyclone centering over northern China and covering nearly the whole country. This anticyclone not only plays a key role in the nationwide WBT increases, but also dominates the spatial pattern of EOF1 by modulating relative humidity. EOF2 and EOF3 reflect interannual variations and show significant correlations with the El Nino-Southern Oscillation (ENSO) and North Atlantic Oscillation (NAO), respectively. A zonal wavelike pattern with troughs over Balkhash and northeastern China, and Mongolia high substantially modulates the water vapor transport in China, thus playing a key role in EOF2. In the case of EOF3, an anomalous anticyclone in the middle-upper troposphere and a shallow intensified cyclone in the lower troposphere collectively format the spatial pattern of EOF3 by inducing significant increases in temperature in central-eastern China and transporting a large amount of water vapor to northeastern China, respectively. These findings are critical to improve our understanding of summer WBT in China and to mitigate the negative effects of heat stress.
With the acceleration of urbanization throughout the world, climate problems related to climate change including urban heat islands and global warming have become challenges to urban human settlements. Numerous studies have shown that greenways are beneficial to urban climate improvement and can provide leisure places for people. Taking the coastal greenway in Qingdao as the research object, mobile measurements of the microclimate of the greenway were conducted in order to put forward an evaluation method for the research of outdoor thermal comfort. The results showed that different vegetation coverage affected the PET (physiologically equivalent temperature), UTCI (Universal Thermal Climate Index) as well as thermal comfort voting. We found no significant correlation between activities, age, gender, and thermal comfort voting. Air temperature sensation and solar radiation sensation were the primary factors affecting the thermal comfort voting of all sections. Otherwise, within some sections, wind sensation and humidity sensation were correlated with thermal sensation voting and thermal comfort voting, respectively. Both PET and UTCI were found to have a negative correlation with the vegetation coverage on both sides of the greenway. However, the vegetation coverage had positive correlation (R = 0.072) for thermal sensation and significant positive correlation (R = 0.077*) for thermal comfort. The paved area cover was found to have a positive correlation with PET and UTCI, while having a negative correlation with thermal sensation (R = -0.049) and thermal comfort (R = -0.041). This study can provide scientific recommendations for the planning and design of greenway landscapes to improve thermal comfort.
With the effects of climate change, people are increasingly facing human-perceived heat stress (HPHS), which describes the combined effects of high temperature, high humidity, and low surface wind speed. HPHS has a significant impact on industrial and agricultural production, people’s lifestyles, and public health. However, the characteristics of HPHS with respect to changes and influencing factors have not been fully investigated using dynamic classification of urban, suburban, and rural stations based on absolute and relative thresholds of seven HPHS indices in Southwest China. The results of this study revealed that, first, during the period 1961-2019, the normal annual and seasonal HPHS values and extreme HPHS days increased significantly, while the extreme HPHS values for the seven HPHS indices decreased. Second, based on the absolute and relative thresholds, the frequency and intensity of the impact of urbanization differed in four regions, and in Yunnan and Guizhou in particular. Different HPHS indices and different dynamic station classification methods result in different esti -mations of the effects of urbanization on annual and seasonal changes in the regional climate. Therefore, choosing an appropriate dynamic station classification method and considering the applicability of different indices in different seasons in different regions is very important. Third, the Granger causality test shows that the percentage of stations with Granger causality between landscape composition indices and seven extreme HPHS is the highest among all influencing factors. At the same time, boosted regression tree detection also showed that the landscape composition indices had the highest contribution percentage to the seven extreme HPHS. There-fore, rational planning of land-use patterns, especially in relation to urban forest land, grassland, wetland, and water bodies (including vertical landscape composition, configuration planning, and building density and layout) has implications for the realization of the United Nations Sustainable Development Goals (SDGs), in particular SDG 11, Sustainable Cities and Communities.
Cardiovascular disease (CVD) has become a severe public health and social issue in China. However, in northwest China, evidence on the association between ambient temperature and CVD hospitalisations in suburban farmers is somewhat limited. We collected CVD hospitalisations and meteorological data (2012-2015) in Zhangye suburbs and assessed the temperature-related risk and burden of admission by fitting a distributed lag nonlinear model to probe the relationship between ambient temperature and CVD hospitalisations among farmers in suburban northwest China. The results show that 23,921 cases of CVD admissions were recorded from 2012 to 2015. There was a “U-shaped” association between temperature and hospitalisations. Compared with the minimum admissions temperature (MAT) at 15.3 °C, the cumulative relative risk (RR) over lag 0-21 days was 1.369 (95% CI 0.980-1.911) for extreme cold temperature (1st percentile, -15 °C), 1.353 (95% CI 1.063-1.720) for moderate cold (5th percentile, -11 °C), 1.415 (95% CI 1.117-1.792) for extreme heat (99th percentile, 26 °C), and 1.241 (95% CI 1.053-1.464) for moderate heat (95th percentile, 24 °C). Female farmers were more susceptible to low and high temperatures than male farmers. Farmers aged ≥ 65 years old were more sensitive to low temperatures, while farmers aged < 65 years old were more sensitive to high temperatures. A total of 13.4% (3,208 cases) of the hospitalisation burden for CVD were attributed to temperature exposure, with the moderate range of temperatures accounting for the most significant proportion (12.2%). Ambient temperature, primarily moderate temperatures, might be an essential factor for cardiovascular-related hospitalisations among farmers in suburban northwest China.
What is already known about this topic? Previous studies have mainly focused on the relationship between temperature and mortality from stroke, but analysis on the effects on years of life lost (YLL) is limited. What is added by this report? YLLs were used as the health outcome, and cold and hot weather were found to be significantly associated with an increase in YLLs from stroke and for different groups, with a stronger effect found to be associated with low temperature. What are the implications for public health practice? These findings could help identify vulnerable regions and populations that have a more serious temperature-related burden and to guide the practical and effective measures for stroke control from a YLL perspective.
BACKGROUND: Whether ambient temperature exposure contributes to death from asthma remains unknown to date. We therefore conducted a case-crossover study in China to quantitatively evaluate the association and burden of ambient temperature exposure on asthma mortality. METHODS: Using data from the National Mortality Surveillance System in China, we conducted a time-stratified case-crossover study of 15 888 individuals who lived in Hubei and Jiangsu province, China and died from asthma as the underlying cause in 2015-2019. Individual-level exposures to air temperature and apparent temperature on the date of death and 21 days prior were assessed based on each subject’s residential address. Distributed lag nonlinear models based on conditional logistic regression were used to quantify exposure-response associations and calculate fraction and number of deaths attributable to non-optimum ambient temperatures. RESULTS: We observed a reverse J-shaped association between air temperature and risk of asthma mortality, with a minimum mortality temperature of 21.3 °C. Non-optimum ambient temperature is responsible for substantial excess mortality from asthma. In total, 26.3% of asthma mortality were attributable to non-optimum temperatures, with moderate cold, moderate hot, extreme cold and extreme hot responsible for 21.7%, 2.4%, 2.1% and 0.9% of asthma mortality, respectively. The total attributable fraction and number was significantly higher among adults aged less than 80 years in hot temperature. CONCLUSIONS: Exposure to non-optimum ambient temperature, especially moderate cold temperature, was responsible for substantial excess mortality from asthma. These findings have important implications for planning of public-health interventions to minimize the adverse respiratory damage from non-optimum ambient temperature.
Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.
Previous studies demonstrate a significant correlation between the vertical elevation of urban morphology and UHI, however, topological parameters are barely considered.
Urban heat island (UHI), referring to higher temperatures in urban extents than its surrounding rural regions, is widely reported in terms of negative effects to both the ecological environment and human health. To propose effective mitigation measurements, spatiotemporal variations and control machines of surface UHI (SUHI) have been widely investigated, in particular based on the indicator of SUHI intensity (SUHII). However, studies on SUHI frequency (SUHIF), an important temporal indicator, are challenged by a large number of missing data in daily land surface temperature (LST). Whether there is any city with strong SUHII and low SUHIF remains unclear. Thanks to the publication of daily seamless all-weather LST, this paper is proposed to investigate spatiotemporal variations of SUHIF, to compare SUHII and SUHIF, to conduct a pattern classification, and to further explore their driving factors across 305 Chinese cities. Four main findings are summarized below: (1) SUHIF is found to be higher in the south during the day, while it is higher in the north at night. Cities within the latitude from 20 degrees N and 40 degrees N indicate strong intensity and high frequency at day. Climate zone-based variations of SUHII and SUHIF are different, in particular at nighttime. (2) SUHIF are observed in great diurnal and seasonal variations. Summer daytime with 3.01 K of SUHII and 80 of SUHIF, possibly coupling with heat waves, increases the risk of heat-related diseases. (3) K-means clustering is employed to conduct pattern classification of the selected cities. SUHIF is found possibly to be consistent to its SUHII in the same city, while they provide quantitative and temporal characters respectively. (4) Controls for SUHIF and SUHII are found in significant variations among temporal scales and different patterns. This paper first conducts a comparison between SUHII and SUHIF, and provides pattern classification for further research and practice on mitigation measurements.
Due to global warming and human activities, heat stress (HS) has become a frequent extreme weather event around the world, especially in megacities. This study aims to quantify the responses of urban HS (UHS) to anthropogenic heat (AH) emission and its antrophogenic sensible heat (ASH)/anthropogenic latent heat (ALH) components and increase in the size of cities in the south and north China for the 2019 summer based on observations and numerical simulations. AH release could aggravate UHS drastically, producing maximal increment in moist entropy (an effective HS metric) above 1 and 2 K over the south and north high-density urban regions mainly through ALH. In contrast, future urban expansion leads to an increase in HS coverage, and it has a larger impact on UHS intensity change (6 and 2 K in south and north China) relative to AH. The city radius of 60 km is a possible threshold to plan to city sprawl. Above that city size, the HS intensity change due to urban expansion tends to slow down in the north and inhibit in the south, and about one-third of the urban regions might be hit by extreme heat stress (EHS), reaching maximal hit ratio. Furthermore, changes in warmest EHS events are more associated with high humidity change responses, irrespective of cities being in the north or south of China, which support the idea that humidity change is the primary driving factor of EHS occurrence. The results of this study serve for effective urban planning and future decision making.
Rapid urbanization greatly alters land surface vegetation cover and heat distribution, leading to the development of the urban heat island (UHI) effect and seriously affecting the healthy development of cities and the comfort of living. As an indicator of urban health and livability, monitoring the distribution of land surface temperature (LST) and discovering its main impacting factors are receiving increasing attention in the effort to develop cities more sustainably. In this study, we analyzed the spatial distribution patterns of LST of the city of Wuhan, China, from 2013 to 2019. We detected hot and cold poles in four seasons through clustering and outlier analysis (based on Anselin local Moran’s I) of LST. Furthermore, we introduced the geographical detector model to quantify the impact of six physical and socio-economic factors, including the digital elevation model (DEM), index-based built-up index (IBI), modified normalized difference water index (MNDWI), normalized difference vegetation index (NDVI), population, and Gross Domestic Product (GDP) on the LST distribution of Wuhan. Finally, to identify the influence of land cover on temperature, the LST of croplands, woodlands, grasslands, and built-up areas was analyzed. The results showed that low temperatures are mainly distributed over water and woodland areas, followed by grasslands; high temperatures are mainly concentrated over built-up areas. The maximum temperature difference between land covers occurs in spring and summer, while this difference can be ignored in winter. MNDWI, IBI, and NDVI are the key driving factors of the thermal values change in Wuhan, especially of their interaction. We found that the temperature of water area and urban green space (woodlands and grasslands) tends to be 5.4 degrees C and 2.6 degrees C lower than that of built-up areas. Our research results can contribute to the urban planning and urban greening of Wuhan and promote the healthy and sustainable development of the city.
Internal migration from rural to urban areas is prevalent in China. Past studies demonstrated that thermal adaptation differed among people from various climate regions. However, the outdoor thermal comfort of exercising people with a diverse climatic background remains largely unexplored. This study examines the relationship between short-term physiological and psychological thermal adaptation and outdoor thermal comfort of exercising people from different climate zones in China. We recruited first-year students (n = 145) who engaged in outdoor training between 3 and September 14, 2018 in Guangzhou, China. Physiological parameters include heart rate (HR) from fitness trackers and skin temperature (Tskin) from iButtons. These students were surveyed regarding their thermal comfort and psychological state over the study period (n = 968). Physiological Equivalent Temperature (PET) was calculated from weather station data at the training sites. T-tests reveal differences in HR and thermal perception between local and non-local students, but not Tskin. Under similar PET conditions, non-local students reported a higher thermal sensation and greater thermal discomfort than local students during the first week of training. Logistic regression indicates that HR and metabolic rate predict the thermal sensation of non-local students, but not local students. Wind sensation, pleasantness level, fatigue, and perceived suitability for outdoor activities are significant predictors of local and non-local students’ thermal comfort. Our research highlights both physiological and psychological factors (including emotion and fatigue) are necessary to understand acclimatized and non-acclimatized people’s thermal perception. Addressing thermal discomfort at an early stage can prevent more severe heat-related illnesses.
BACKGROUND: Evidence of the effectiveness of intervention against extreme heat remains unclear, especially among children, one of the vulnerable populations. This study aimed to evaluate the effectiveness of a primary school-based intervention program against heatwave and climate change in China to provide evidence for development of policies for adaptation to climate change. METHODS: Two primary schools in Dongtai City, Jiangsu Province, China, were randomly selected as intervention and control schools (CTR registration number: ChiCTR2200056005). Health education was conducted at the intervention school to raise students’ awareness and capability to respond to extreme heat during May to September in 2017. Knowledge, attitude, and practice (KAP) of students and their parents at both schools were investigated by questionnaire surveys before and after intervention. The changes in KAP scores after intervention were evaluated using multivariable difference-in-difference (DID) analysis, controlling for age, sex, etc. Results: The scores of knowledge, attitude, and practice of students and their parents increased by 19.9% (95%CI: 16.3%, 23.6%) and 22.5% (95%CI: 17.8%, 27.1%); 9.60% (95%CI: 5.35%, 13.9%) and 7.22% (95%CI: 0.96%, 13.5%); and 9.94% (95%CI: 8.26%, 18.3%) and 5.22% (95%CI: 0.73%, 9.71%), respectively, after intervention. The KAP score changes of boys were slightly higher than those of girls. Older students had higher score changes than younger students. For parents, the higher the education level, the greater the score change, and change in scores was greater in females than in males. All the health education activities in the program were significantly correlated with the changes in KAP scores of primary school students after intervention, especially those curricula with interesting activities and experiential learning approaches. CONCLUSIONS: Heat and health education program in primary school was an effective approach to improve cognition and behavior for both students and their parents to better adapt to heatwaves and climate change. The successful experience can be generalized to respond to the increasing extreme weather/climate events in the context of climate change, such as heatwaves, and other emergent occasions or public health education, such as the control and prevention of COVID-19.
Heatwaves can produce catastrophic effects on public health and natural systems, especially under global warming. There are two methods to measure heatwaves, computed by relative and absolute thresholds, namely relative and absolute heatwaves (RHWs and AHWs). Generally, AHWs mostly occur in hot areas because of fixed thresholds, while RHWs represent anomalous events for the local climate, making them possible everywhere in the warm season. Based on observations and CMIP6 outputs, this study compared AHWs and RHWs in Eastern China (EC) with five sub-regions [Northeast China (NEC), North China (NC), Lower Yangtze River (LYR), Middle Yangtze River (MYR) and South China (SC)]. Similarities among RHWs and AHWs were found in present-day trends (1995-2014) and spatial distributions. The heatwave intensity/days for RHWs and AHWs both displayed highest future increases in northern/southern EC, and the increases for 2081-2100 would be 1.5 times as high as 2041-2060. All these similarities illustrate that applying either relative or absolute thresholds in EC, historical temporal variations, changing future spatial patterns, and increasing ratio from 2081-2100 to 2041-2060, would show reliable results. As far as differences are concerned, RHWs were observed across the entire EC, while AHWs did not show up in parts of NC and NEC. Considering model performance, RHWs would perform better than AHWs in most areas of EC. The annual heatwave intensity/days were higher for RHWs than for AHWs during present-day and future periods, which might overestimate heat-related risks. Overall, this study recommended RHWs for heatwave analyses, particularly for future projections, but for risk assessment, the choice of thresholds is crucial. The results reinforced the necessity to further improve model performance to address various needs.
Background: The morbidity and mortality rates from heat illness have increased due to a higher number of heatwaves. Effective urgent care of heat illness is crucial for optimizing patient outcomes. However, few studies have examined the emergency preparedness measures required for treating such patients. Methods: From December 23, 2019, to January 23, 2020, a content-validated instrument containing the Perceived Emergency Preparedness Scale for heat illness (heatPEPS) was administered to emergency nurses in China through WeChat. Some of these nurses were retested two weeks later. SPSS 26, IRTPRO 4.2, and NVivo 12 Plus were used for data analysis. Results: In total, 46.4% (200/431) of the participants returned valid responses. With dichotomous scoring, a high score for heatPEPS (mean 7.29; SD 1.667) was elicited. The reduced 9-item heatPEPS had a perfect fit with the 2PL model (M-2 = 27.24, p > 0.05; RMSEA = 0.01) and acceptable internal (alpha = 0.68) and test-rest reliability (intraclass correlation = 0.56). Many participants (74%) were dissatisfied with their heat illness-related knowledge and skills, suggesting an area that could be improved for better emergency preparedness. Conclusion: Emergency departments appear to be well-prepared; however, this is subject to social desirability bias. The 9-item heatPEPS is a reliable and valid tool to measure emergency preparedness for heat illness.
Extreme heatwaves are among the most important climate-related disasters affecting public health. Assessing heatwave-related population exposures under different warming scenarios is critical for climate change adaptation. Here, the Coupled Model Intercomparison Project phase 6 (CMIP6) multi-model ensemble output results are applied over several warming periods in the Intergovernmental Panel on Climate Change AR6 report, to estimate China’s future heatwave population exposure under 1.5 degrees C and 2.0 degrees C warming scenarios. Our results show a significant increase in projected future annual heatwave days (HD) under both scenarios. With an additional temperature increase of 0.5 degrees C to 2.0 degrees C of warming, by mid-century an additional 20.15 percent increase in annual HD would occur, over 1.5 degrees C warming. If the climate warmed from 1.5 degrees C to 2.0 degrees C by mid-century, population exposure would increase by an additional 40.6 percent. Among the three influencing elements that cause the changes in population exposure related to heatwaves in China-climate, population, and interaction (e.g., as urbanization affects population redistribution)-climate plays the dominant role in different warming scenarios (relative contribution exceeds 70 percent). Therefore, considering the future heat risks, humanity benefits from a 0.5 degrees C reduction in warming, particularly in eastern China. This conclusion may provide helpful insights for developing mitigation strategies for climate change.
Heatwaves have afflicted human health, ecosystem, and socioeconomy and are expected to intensify under warming climate. However, few efforts have been directed to moist heat stress (MHS) considering relative humidity and wind speed, and moist heat stress risk (MHSR) considering exposure and vulnerability. Here we showed MHS and MHSR variations across China during 1998-2100 using China Meteorological Administration Land Data Assimilation System datasets, the 6th Coupled Model Intercomparison Project (CMIP6) merged datasets, Gross Domestic Product, population and leaf area index. We detected increased MHS across China under different Shared Socioeconomic Pathways (SSPs). Specifically, the historical MHS occurred mostly during mid-July to mid-August. We found increasing trends of 0.08%/year, 0.249%/year, and 0.669%/year in the MHS-affected areas under SSP126, SSP245, and SSP585, respectively. Furthermore, we observed the highest increasing rate of MHSR in Northwest and Southwest China, while the MHSR across Northeast and North China under SSP126 shifted from increasing to decreasing trends. Noteworthy is that the increasing trend of MHSR under SSP585 is 1.5-2.6 times larger than that under SSP245, especially in North and South China. This study highlights spatiotemporal evolutions of MHS and MHSR and mitigation to moisture heat stress in a warming climate.
Understanding the spatiotemporal trends of temperature in the context of global warming is significant for public health. Although many studies have examined changes in temperature and the impacts on human health over the past few decades in many regions, they have often been carried out in data-rich regions and have rarely considered acclimatization explicitly. The most frequent temperature (MFT) indicator provides us with the ability to solve this problem. MFT is defined as the longest period of temperature throughout the year to which a human is exposed and therefore acclimates. In this study, we propose a new method to estimate the number of heat exposure days from the perspective of temperature distribution and MFT, based on the daily mean temperature readings of 2142 weather stations in eight major climate zones in China over the past 20 years. This method can be used to calculate the number of heat exposure days in terms of heat-related mortality risk without the need for mortality data. We estimated the distribution and changes of annual mean temperature (AMT), minimum mortality temperature (MMT), and the number of heat exposure days in different climate zones in China. The AMT, MMT, and number of heat exposure days vary considerably across China. They all tend to decrease gradually from low to high latitudes. Heat exposure days are closely related to the risk of heat-related mortality. In addition, we utilized multiple linear regression (MLR) to analyze the association between the risk of heat-related mortality and the city and its climatic characteristics. Results showed that the number of heat exposure days, GDP per capita, urban population ratio, proportion of elderly population, and climate zone were found to modify the estimate on heat effect, with an R-2 of 0.71. These findings will be helpful for the creation of public policies protecting against high-temperature-induced mortalities.
Climate change leads to heat-related changes in labor productivity, which have additional economic impacts. Based on a framework that considers the impacts evolving from climate change to labor productivity to economic impact, we estimate the changes in labor productivity for indoor and outdoor activities and different work intensities at the grid level in China under a wide range of climatic and socioeconomic conditions and then evaluate the economic impacts in seven regions and eight sectors. The results show that (a) the negative impacts of labor productivity are concentrated in outdoor sectors, and the labor productivity of indoor sectors will decrease slightly or even increase due to high air-conditioning device penetration rates under relatively optimistic scenarios. (b) The national results show that total economic impacts increase by 0.28%-0.61% of the GDP for each 1 degrees C rise in the temperature, and the total economic impacts of labor productivity reductions in the most pessimistic scenario reach 1.15%-2.67% of the GDP in 2100. (c) The regional results indicate that the regions with lower labor productivity impacts (Northwest and Northeast China) still suffer large economic impacts, highlighting the importance of economic impact assessments across the regions. (b) The sectors in the seven regions of China that are most sensitive to climate change are agriculture and construction. The economic impacts in the manufacturing and service sectors, which contribute 22%-35% and 11%-15% of regional GDP losses, respectively, cannot be ignored, and should receive more attention in climate mitigation policies. Plain Language Summary Climate change will increase the heat stress in working environment, which limits the labor productivity of workers. Reductions in labor productivity will also lead to economic impacts. The consequences of this impact chain within China have been evaluated for the first time. Outdoor workers will be seriously affected by heat stress, while indoor workers’ productivity may benefit from the popularity of air-conditioning devices. However, all regions of China will face the negative economic impacts of increased heat stress under climate change. Even if the heat-related labor productivity of a region is not severely affected, the economic impacts cannot be ignored due to the economic links between regions and sectors. The agriculture and construction suffer from the most serious economic impact. Although labor productivity in the indoor sectors will benefit from the popularity of air-conditioning devices, the economic impact of the manufacturing and service sectors cannot be underestimated.
With the continued global warming, quantifying the risks of human and social-economic exposure to extremely high temperatures is very essential. The simulated extreme high-temperature days (EHTDs) with a maximum temperature higher than 35 degrees C (38 degrees C, 40 degrees C) in Southern China during 1980-1999 and 2080-2099 are analyzed using the NEX-GDDP dataset. By comparing the climatology of the two scenario periods, the multi-model ensemble mean patterns show that EHTDs will greatly increase at the end of the 21st century, and its center at 35 degrees C is projected to shift to Guangxi from Jiangxi. Model diversities are fairly small, and the spread increases with T-level rises. EOF analysis shows that the 100-years warming will impact the southern part greater than the northern part. Trend patterns exhibit comparable results to models, but with a relatively large spread. The population and economy exposure to extremely high temperatures are calculated, showing that they both will experience a large increase in future projected decades. In historical decades, the growth of population and Gross Domestic Product have dominated the increasing exposure risks, but these effects weaken with the T-level increases. In future decades, climate change plays a leading role in affecting the exposure, and its effect strengthens with the T-level increases. For historical to future changes, the dominant contributor to population exposure changes is the climate factor (74%), while substantially 90% contribution to economy exposure changes is dominated by the combined effects of climate and economy growth.
Exposure to extreme heat is a significant public health problem and the primary cause of weather-related mortality, which can be anticipated by accurately predicting outdoor thermal sensation. Empirical models have shown better accuracy in predicting thermal sensation than the most frequently used theoretical thermal indices, which have ignored adaptability to local climate and resulted in underestimating or overestimating the neutral levels of residents. This study proposes a scheme to build an empirical model by considering the multiple linear regression of thermal sensation and microclimatic parameters during summer in Chongqing, China. Thermal environment parameters (air temperature, relative humidity, wind speed, and surface temperature) were recorded and analyzed, together with 375 questionnaire survey responses referring to different underlying surfaces. The results found that the proposed model predicted neutral sensations as warm and 19.4% of warm sensations as hot, indicating that local residents adapted to warm or even hot sensations. In addition, the empirical model could provide references for local pedestrians’ daytime path choices. Residents might feel more comfortable staying beside a pond from 8:00 to 11:00 or sheltering under trees from 08:00 to 14:00 and 17:00 to 19:00. Masonry offered a comfortable microclimate between 10:15 and 11:00, and residents on the lawns were comfortable from 17:30 to 19:00. However, asphalt should be equipped with cooling infrastructures in order to cool thermal sensation.
Cardiovascular disease (CVD) is a leading threat to global public health. Although associations between temperature and CVD hospitalization have been suggested for developed countries, limited evidence is available for developing countries or rural residents. Moreover, the effect of apparent temperature (AT) on the spectrum of cause-specific CVDs remains unknown. Based on 2,024,147 CVD hospitalizations for rural residents from eight regions in Fujian Province, China, during 2010-2016, a quasi-Poisson regression with distributed lag non-linear model was fitted to estimate the AT effect on daily CVD hospitalization for each region, and then pooled in a meta-regression that included regional indicators related to rural residents. Stratified analyses were performed according to the cause of hospitalization, sex and age groups. Finally, we calculated the fraction of CVD hospitalizations attributable to AT, as a reflection of the burden associated with AT. The heat effect appeared at lag 0-1 days, with 19% (95% CI, 11-26%) increased risk of CVD hospitalization, which was worse for ischemic heart disease, heart failure, arrhythmias and ischemic stroke. The decreased AT was associated with increase of hemorrhagic stroke at lag 0-28 days. People aged 65 and above suffered more from the heat effect on cardiovascular and cerebrovascular diseases. Regions with a lower gross value of agricultural production, rural residents’ per capita net income, number of air conditioners and water heaters were more susceptible. A large number of hospitalizations were attributable to heat for most subcategories. High AT level increased CVD hospitalization, and the subcategories had different susceptibilities. The effects were modified by individual and regional characteristics. These findings have important implications for the development of targeted interventions and for hospital service planning.
The purpose of this work was to assess population vulnerability to heat-related health risks and its relationship with urbanization levels to provide essential information for the future development and policy-making for climate change adaptation. We constructed a heat vulnerability index (HVI), quantified the population heat vulnerability in each county across China by a principal component analysis (PCA) of multiple factors, and assessed urbanization levels in each county using multisource data. Then, the HVI was validated using the heat-attributable fraction (heat-AF) of nonaccidental mortality based on death monitoring data and meteorological data from 95 counties across China. The results showed that our HVI was significantly positively associated with the heat AF of nonaccidental mortality. A negative correlation was observed between the urbanization level and the HVI. The HVI was generally higher in less urbanized western China and lower in the more urbanized eastern regions. The baseline mortality occupies the top position in the importance ranking of the heat-vulnerability indicators at all three urbanization levels, but the other indicators, including the aging rate, agricultural population rate, education, ethnic structure, economic status, air conditioner ownership rate, and number of hospitals, ranked differently among different urbanization levels. This finding indicates that to reduce population heat vulnerability, the most important approach is to improve the health status of the whole population and reduce baseline mortality; additionally, regional-specific measures and emphasis should be adjusted reasonably along with the process of urbanization according to the characteristics and key factors of local heat vulnerability.
Global warming, high temperatures, and heatwave weather are some of the factors affecting human settlement environment health. In high-temperature weather, human production and life are seriously threatened, as long-term exposure to high temperatures causes a variety of diseases, and children and elderly, who have poor tolerance, require strengthened protection. From a human perspective, this study calculated the thermal duration distribution of high temperatures based on maximum temperature data in a central urban area of Beijing combined with the results of the sixth population census of Beijing, investigated the population distribution of individuals under 15 years old and over 65 years old, and analyzed the spatial distribution of a thermal exposure space in a central urban area of Beijing with the help of the ArcGIS platform. Based on 130 district districts, streets with high-risk heat exposure spaces in the central urban area of Beijing were reddened to determine the distribution of high-risk grades. Using the semantic segmentation method and a street view map, the high-risk thermal exposure space environment from the humanistic perspective was restored, and the typical characteristics were summarized and analyzed. Finally, the environmental characteristics of the high-risk thermal exposure space were analyzed from the humanistic perspective, and an improvement strategy for thermal exposure spaces was proposed based on the perspective of emotional relief.
The surface urban heat island (SUHI) effect poses a significant threat to the urban environment and public health. This paper utilized the Local Climate Zone (LCZ) classification and land surface temperature (LST) data to analyze the seasonal dynamics of SUHI in Wuhan based on the Google Earth Engine platform. In addition, the SUHI intensity derived from the traditional urban-rural dichotomy was also calculated for comparison. Seasonal SUHI analysis showed that (1) both LCZ classification and the urban-rural dichotomy confirmed that Wuhan’s SHUI effect was the strongest in summer, followed by spring, autumn and winter; (2) the maximum SUHI intensity derived from LCZ classification reached 6.53 °C, which indicated that the SUHI effect was very significant in Wuhan; (3) LCZ 8 (i.e., large low-rise) had the maximum LST value and LCZ G (i.e., water) had the minimum LST value in all seasons; (4) the LST values of compact high-rise/midrise/low-rise (i.e., LCZ 1-3) were higher than those of open high-rise/midrise/low-rise (i.e., LCZ 4-6) in all seasons, which indicated that building density had a positive correlation with LST; (5) the LST values of dense trees (i.e., LCZ A) were less than those of scattered trees (i.e., LCZ B) in all seasons, which indicated that vegetation density had a negative correlation with LST. This paper provides some useful information for urban planning and contributes to the healthy and sustainable development of Wuhan.
BACKGROUND: Although the existing studies have suggested a significant association between high temperatures and urolithiasis, no nationwide studies have quantified the burden attributable to environmental heat stress and explored how the urolithiasis burden would vary in a warming climate. METHODS: We collected data on urolithiasis attacks from 137 hospitals in 59 main cities from 20 provincial regions of China from 2000 to 2020. An individual-level case-crossover analysis was conducted to estimate the effect of daily wet-bulb globe temperature (WBGT), a heat stress index combining temperature and humidity, on urolithiasis attacks. Stratified analyses were performed by region, age, and sex. We further quantified the future WBGT-related burden of urolithiasis from the Coupled Model Intercomparison Project Phase 6 under three Shared Socioeconomic Pathway (SSP) scenarios. RESULTS: In total, 118,180 urolithiasis patients were evaluated. The exposure-response curve for the association between WBGT and urolithiasis attacks was J-shaped, with a significantly increased risk for WBGT higher than 14.8 °C. The middle-aged and elderly group (≥45 years old) had a higher risk of WBGT-related urolithiasis attacks than in the younger group, while no significant sex difference was observed. The attributable fraction (AF) due to high WBGT would increase from 10.1% in the 2010s to 16.1% in the 2090s under the SSP585 scenario. Warm regions were projected to experience disproportionately higher AFs and larger increments in the future. CONCLUSIONS: This nationwide investigation provides novel evidence on the acute effect of high WBGT on urolithiasis attacks and demonstrates the increasing disease burden in a warming climate.
The peak summer (July-August; JA) muggy hot weather over Northeast China (NEC) negatively impacts local socioeconomic development and human health. This study investigates the physical connection between sea surface temperature (SST) and year-to-year variations in the number of peak summer muggy hot days (MHDs) in NEC (PSMHDNEC) for the period 1979-2018. We found that on the interannual timescale, SST anomalies (SSTAs) over the tropical North Australia (TNA) sector have a stable and significant negative correlation with PSMHDNEC since the early summer of June; however, the strongest negative correlation occurs in the JA. Our further analyses indicate that the SST cooling over the TNA sector could form a large-scale atmospheric teleconnection emanating northwest of the TNA through the profound in situ diabatic cooling anomalies tied to the SST cooling, which propagates poleward from the northeastern Pacific Ocean. This teleconnection might remotely strengthen the local-scale anticyclonic anomaly centered near NEC, a critical system responsible for a higher PSMHDNEC. Under such circumstances, the NEC region is dominated by high-pressure anomalies, facilitating the establishment of localized MHD-favorable environmental conditions (e.g., increased surface air temperature and enhanced downward solar radiation flux with suppressed convection activities). During years of negative SSTAs over TNA, local SSTAs can persist from early summer until JA via the wind-evaporation-SST feedback. Therefore, it appears that SSTAs over the TNA sector may be a significant remote tropical forcing factor for the interannual variability of PSMHDNEC, and the corresponding June SST cooling may act as a potential predictability source physically contributing to a higher PSMHDNEC.
During the COVID-19 pandemic, wearing protective facemasks (PFMs) can effectively reduce infection risk, but the use of PFMs can amplify heat-related health risks. We studied the amplified PFM-induced human thermal stress via both field measurements and model simulations over a typical subtropical mountainous city, Hong Kong. First, a hot and humid PFM microenvironment has been observed with high temperature (34-35 °C) and high humidity (80-95%), resulting in an aggravated facial thermal stress with a maximal PFM-covered facial heat flux of 500 W/m(2) under high-intensity activities. Second, to predict the overall PFM-inclusive human thermal stress, we developed a new facial thermal load model, S (PFM) and a new human-environment adaptive thermal stress (HEATS) model by coupling S (PFM) with an enhanced thermal comfort model to resolve modified human-environment interactions with the intervention of PFM under realistic climatic and topographical conditions. The model was then applied to predict spatiotemporal variations of PFM-inclusive physiological subjective temperature (PST) and corresponding heat stress levels during a typical heat wave event. It was found wearing PFM can significantly aggravate human thermal stress over Hong Kong with a spatially averaged PST increment of 5.0 °C and an additional spatial area of 158.4% exposed to the severest heat risks. Besides, PFM-inclusive PST was found to increase nonlinearly with terrain slopes at a rate of 1.3-3.9 °C/10°(slope), owing to elevated metabolic heat production. Furthermore, urban residents were found to have higher PFM-aggravated heat risks than rural residents, especially at night due to synergistic urban heat and moisture island effects.
Extreme heat events are gaining ever more policy and societal attention under a warming climate. Although a breadth of expertises are required to understand drivers of vulnerability to hazards such as extreme heat, it is also acknowledged that expert assessments in group settings may be subject to biases and uneven power relations. In this Technical Note, we outline a structured deliberative process for supporting experts to work collaboratively to assess social vulnerability to a climate-related hazard, in this case extreme heat in Taiwanese cities. We argue that adapting elicitation approaches such as Q-Methodology for use in collaborative settings can help to organise expert discussion and enable dialogue and mutual learning, in a way that supports consensus-building on vulnerability assessment. Outcomes from our collaborative assessments suggest elderly people living alone, elderly people over 75, pre-existing circulatory diseases and level of participation in community decision-making may all be notable drivers of heat vulnerability in the Taiwanese context. Methodologically, we argue that collaborative sorting exercises offer a way to embed local and experiential knowledges into assessments of available evidence, but that strong facilitation and additional checks are necessary to ensure an inclusive process that reflects the diversity of perspectives involved. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11069-022-05280-4.
BACKGROUND: Despite emerging recognition of the benefits of green and blue spaces on human health, evidence for their effect modifications on heat-mortality associations is limited. We aimed to investigate the effect modifications of green and blue spaces on heat-mortality associations among different age and sex groups and at different heat levels. METHODS: Daily mortality and meteorological data from 2008 to 2017 in Hong Kong, China were collected. The Normalized Difference Vegetation Index and distance to coast were used as proxies for green and blue space exposure, respectively. Time-series analyses was performed using fitting generalized linear mixed models with an interaction term between heat and levels of exposure to either green or blue space. Age-, sex-, and heat level-stratified analyses were also conducted. RESULTS: With a 1 °C increase in temperature above the 90th percentile (29.61 °C), mortality increased by 5.7% (95% confidence interval [CI]: 1.6, 10.1%), 5.4% (1.4, 9.5%), and 4.6% (0.8, 8.9%) for low, medium and high levels of green space exposure, respectively, and by 7.5% (3.9, 11.2%) and 3.5% (0.3, 6.8%) for low and high levels of blue space exposure, respectively. Significant effect modifications of green and blue spaces were not observed for the whole population or any specific age and sex group, either at a moderate heat level or a heat level (Ps > 0.05). CONCLUSIONS: No significant effect modifications of green and blue spaces on heat-related mortality risk were observed in Hong Kong. These findings challenge the existing evidence on the prominent protective role of green and blue spaces in mitigating heat-related mortality risks.
Due to climate change, the heatwave has become a more serious public health threat with aging as an aggravating factor in recent years. There is a pressing need to detect the most effective prevention and response measures. However, the specific health effects of interventions have not been characterized on an individual scale. In this study, an intervention experiment was designed to explore the health effects of heat exposure at the individual level and assess the effects of different interventions based on a comprehensive health sensitivity index (CHSI) in Xinyi, China. Forty-one subjects were recruited randomly, and divided into one control group and three intervention groups. Interventions included education (Educate by lecturing, offering relative materials, and communication), subsidy support (offer subsidy to offset the cost of running air conditioning), and cooling-spray (install a piece of cooling-spray equipment in the yard). Results showed that systolic blood pressure (SBP) and deep sleep duration (DSD) were significantly affected by short-term heat exposure, and the effects could be alleviated by three types of interventions. The estimated CHSI indicated that the effective days of the education group were longer than other groups, while the lower CHSI of the subsidy group showed lower sensitivity than the control group. These findings provide feasible implementation strategies to optimize Heat-health action plans and evaluate the intervention performance. ELECTRONIC SUPPLEMENTARY MATERIAL: Supplementary material is available in the online version of this article at 10.1007/s11783-022-1545-4 and is accessible for authorized users.
Few studies have examined individual socioeconomic status (SES) as a potential modifier of ambient temperature-health associations, especially for temperature-related hospitalizations. We fit penalized distributed lag non-linear models within generalized additive models to study the short-term associations (0-3 days) between temperature and hospital admissions stratified by common causes, age, and individual SES, as determined by whether patients received public assistance (PA) to cover their medical fee at the time of hospitalizations, during the hot season (May 15 to October 15) in Hong Kong for the years 2010-2019. We calculated the ratio of relative risk (RRR) and corresponding 95% confidence interval (CI) to statistically test the difference of the associations between PA groups. For 75 + patients, the PA group had significantly increased risks of hospitalizations at higher temperature for most causes, with relative risks (RR, 99th %ile vs. 25%ile) and 95% CIs of 1.138 (1.099, 1.179), 1.057 (1.008, 1.109), and 1.163 (1.094, 1.236) estimated for all non-cancer non-external, circulatory, and respiratory admissions, respectively. There were slight decreases of RRs with higher temperature for 75 + patients without PA. The strengths of temperature-hospitalization associations were strongly and significantly different between PA groups for all examined causes for 75 + patients, with the most considerable discrepancy found for ischemic heart disease (RRR = 1.266; 95% CI, 1.137, 1.410). Hospitalizations for patients aged 15-74 were less affected by heat, and the difference of the associations between groups was small. Individual SES is a significant modifier of high temperature-hospitalization associations in Hong Kong among the elderly. Public health interventions are needed to better protect this subpopulation from adverse health impacts of high temperature.
Anthropogenic modification of the natural environment has caused significant impacts on the local atmosphere and far-reaching changes to the global climate. Taking Hong Kong as a case study, high-resolution (250 m) mesoscale simulations are conducted using Meso-NH coupled with the multi-layer Town Energy Balance to investigate the effects of past (early 1960s), present (2018), and future (late 2040s) urban developments on the city’s surface energy balance, heat island, boundary layer structure, and heat stress during a prolonged heatwave event. Overall, horizontal and vertical urban expansion has caused the urban areas to become warmer, drier, less ventilated, and more susceptible to hot nights. The dense built-up urban core in the Kowloon peninsula is also found to deepen the urban boundary layer and enhance the coastal urban heat island circulation. Reclaimed land exhibits the largest differences in 2-m air temperature relative to a no urban scenario due to the drastic change in surface thermal properties. Areas downwind of the planned artificial islands in East Lantau are expected to experience warmer and calmer conditions due to the altered wind field. Study findings raise awareness regarding the increasingly long durations of strong heat stress in urban areas and the need for heat stress mitigation.
Thermal comfort analogs can be used to quantify the similarity of thermal comfort between current and future climates and are critical for raising awareness of future climate change. However, the similarity of thermal comfort analogs in consecutive future periods and under different emission scenarios remains unclear. This knowledge gap has significantly limited our understanding of future climate change and its effects on the living environment, especially from a human perception perspective. In this study, we identified the universal thermal climate index (UTCI) analogs of 352 cities in China under four specific emission scenarios for future periods (2021-2080). The results show that the UTCI analogs show significant spatial differentiation between cities. The analogs of northern cities primarily shift to cities with a neighboring latitude (-5 degrees to 5 degrees), whereas most central and southern cities mainly shift their analogs to lower-latitude cities. The shift to lower-latitude cities with latitude differences exceeding 5 degrees is enhanced with time and increased anthropogenic emissions. In addition, compared with the temperature analogs, the shift of UTCI analogs is more intense and the shift direction is more complex. The results of this study provide insights into future climate change and heat-related health risks.
With the increases in hot weather frequency and intensity induced by observed and predicted climate change, heat exposure is an evolving challenge. We estimated a fixed effect econometric model to data on 5,404 individuals drawn from the China Health and Retirement Longitudinal Study database. These observations were used to examine the effect of heat stress on cognitive performance for those above 40 years of age who are often household decision-makers. We found today’s heat stress decreases performance on verbal and math test scores, and that cumulative heat exposure over the last 3 days adversely affects verbal test scores. We also found that middle-aged women and people in rural areas exhibit substantial heat stress-induced reductions on cognitive test scores. This finding implies that continuing climate change may well diminish decision-making capacity and effectiveness.
Extreme thermal environment harms the health of outdoor workers and poses a potential threat to workplace safety. A field survey, including thermal parameter measurements, was conducted at construction sites in South China during the summer of 2019. The relationship between health risk and thermal parameters was obtained. The thermal sensation and satisfaction rate of the workers at different outdoor environmental conditions were analyzed, and recommendations were made based on the comparison of thermal indices. The thermal stress categories of the thermal indices were also investigated. The results suggest that the intensity of working conditions should be reduced when the air temperature is higher than 34 degrees C; the satisfaction rate of workers was found to be relatively high when the outdoor temperature is lower than 34 degrees C and the wind speed is greater than 1.3 m/s. Thermal indicators used to evaluate the comfort level of outdoor workers need to be modified according to the local climate and working environment to avoid excessive exposure to high-temperature work environments.
Long-lasting heatwaves have seriously threatened human health. Exploring the distribution of heat vulnerability is important for urban risk management. A model of heat vulnerability coupled with physical and social conditions based on exposure, sensitivity, and adaptation was established in Chongqing, a mountainous megacity in China, and 11 indicators were adopted to assess heat vulnerability. Heat perception evaluated by social media data is used to validate heat vulnerability. Four primary outcomes emerged. First, integration of high physical and low social heat vulnerabilities was found in central areas, while low physical and high social heat vulnerabilities were concentrated in suburban areas. Second, the spatial distribution of heat vulnerability is consistent with that of heat perception. Third, high social exposure, high physical and social sensitivity, and low physical adaptation led to high heat vulnerability in central areas, while high heat vulnerability in suburban areas was primarily caused by high physical exposure and low social adaptation. Finally, due to the barriers of mountains and rivers, both physical and social heat vulnerabilities form unique decentralized patterns following urbanization. According to the finding of heat vulnerability, mitigative and adaptive strategies (e.g. hierarchical layouts, green measures, and vulnerable health databases) are proposed to improve climate resilience.
This study investigates public participation in heat impact reduction by analysing adaptive behaviours, familiarity with urban heat island (UHI) and cooling strategies, the perceived urgency of heat impact actions and citizen’s willingness to pay through a questionnaire survey in Chongqing, China. The results indicate that airconditioning systems are the dominant cooling facility in both work and living environments. Respondents had a moderately familiar understanding of several cooling strategies such as urban vegetation, shading devices, water-based artificial facilities, urban design for shading and ventilation and water bodies. Familiarity with innovative materials and techniques for pavements, roofs and facades was less than moderate. Urban planning and design for heat resilient cities was thought to be the most urgent intervention, followed by the establishment of temporary cooling facilities. Most respondents indicated that cost-sharing mechanisms for urban heat prevention and control systems should at least include the government, whilst 50% of the respondents preferred collaborative payment among government, developers, and owners. Only 41.6% of the interviewees expressed their willingness to pay, with a share varying between 20 and 80 RMB. A conservative estimate indicated that there could be an average payment of 45.95 RMB and 19.10 RMB among the 234 respondents who were willing to pay and all 562 respondents regardless of willingness, respectively. Respondents’ heat-related responses and actions towards urban heat challenges were dependent on a wide range of factors like gender, age, education, economic status, health, exposure, habit formation and behavior change, social acceptance, etc. Moreover, such factors could interact with each other affecting public behavior with different weights. Overall, this study increases our understanding of people’s perceptions and proactiveness in reducing urban heat and provides guidance for decision-makers towards a novel user-aware approach to the implementation of urban heat prevention, adaptation, and mitigation strategies.
High temperatures pose great threats to the health of urban populations. The use of air conditioners (AC) is an important adaptive means to reduce the morbidity and mortality of heat-related diseases. However, it remains unclear how exposure and sensitivity factors affect residents’ AC use. This study aimed to answer this question through a case study in 78 residential areas in Beijing, China. We conducted over 7,000 structured interviews during June 20-August 5, 2017 to learn respondents’ AC use, health conditions and socioeconomic status. We also used remote sensing data to obtain land surface temperature (LST) and proportion of greenspace in residential areas. We applied a multilevel logistic regression to assess the influences of these factors on probability of frequent AC use. The results showed mixed impacts from sensitivity factors on AC use. While respondents with chronic diseases were 14.7% more likely to use AC every day, probability of AC use decreased by 29.2% with the increase of age groups. Instead of economic cost, the main reason preventing respondents from using AC was “feeling uncomfortable” or consider it as “unhealthy”. At the scale of residential area, results did not find significant impact of LST on AC use, while proportion of greenspace posed a negative impact on probability of using AC every day even when LST was considered.
More than half of the total population in China are living in cities. Especially, the people in highly developed and spatially integrated city clusters, i.e., urban agglomerations (UAs), are facing increasing human-perceived heat stress that describes the combined effects of hot temperature, high humidity, and lowered surface wind speed. By analyzing multiple indicators over 20 major UAs across China, we demonstrate that summer heat stress has been significantly intensifying in nearly all UAs during 1971–2014. This intensification is more profound in northern than southern regions and is especially stronger in more urbanized and densely populated areas (e.g., Beijing-Tianjin-Hebei and the Yangtze River Delta). Based on a dynamic classification of weather stations using time-varying land use/land cover maps, we find that urban core areas exhibit distinctly stronger increasing heat stress trends than their surrounding rural areas. On average, urbanization contributes to approximately one-quarter of the total increase in mean heat stress over urban core areas of UAs and nearly half of the total increase in extreme heat stress events. The urbanization effect is also dependent on the geographical region within China. Urbanization tends to have stronger intensifying effects on heat stress in UAs with higher population density in low-altitude areas, while it has a relatively weaker intensifying and even weakening effect in some arid and high-altitude regions. Moreover, as various heat stress metrics may yield different estimations of long-term trend and urbanization contribution, the particular choice of heat stress indicator is of critical importance for investigations on this subject matter.
Due to the progress in global warming, the frequency, duration and intensity of climate extremes are increasing. As one of these extremes, heat waves influence the well-being of human beings and increase societies’ energy consumption. The Water-Cooling Island (WCI) effect of urban water bodies (UWBs) is important in urban heat wave mitigation. In this paper, the impact of WCI, especially the landscape pattern of the surrounding area, was explored. The results indicate that water bodies with a larger total area and simpler shape have a longer cooling effect. In the areas surrounding UWBs, a lower percentage or discrete distribution of impervious surfaces or green land provide a longer cooling effect. The amplitude of WCI is mainly decided by the impervious surface in the surrounding areas. A lower percentage or discrete distribution of impervious surfaces or green land leads to a smaller-amplitude WCI. The gradient is impacted by the shape of the UWB and surrounding green land. A complex shape and discrete distribution of green land lead to a higher gradient of WCI. The linear regress model was significant in terms of WCI range and gradient, while the model of WCI amplitude was not significant. This indicates that WCI is directly decided by impact factors through gradient and range. The conclusions provide a methodology for WCI prediction and optimization, which is important when mitigating summer heat waves.
Urban heatwaves increase residential health risks. Identifying urban residential sensitivity to heatwave risks is an important prerequisite for mitigating the risks through urban planning practices. This research proposes a new paradigm for urban residential sensitivity to heatwave risks based on social media Big Data, and describes empirical research in five megacities in China, namely, Beijing, Nanjing, Wuhan, Xi’an and Guangzhou, which explores the application of this paradigm to real-world environments. Specifically, a method to identify urban residential sensitive to heatwave risks was developed by using natural language processing (NLP) technology. Then, based on remote sensing images and Weibo data, from the perspective of the relationship between people (group perception) and the ground (meteorological temperature), the relationship between high temperature and crowd sensitivity in geographic space was studied. Spatial patterns of the residential sensitivity to heatwaves over the study area were characterized at fine scales, using the information extracted from remote sensing information, spatial analysis, and time series analysis. The results showed that the observed residential sensitivity to urban heatwave events (HWEs), extracted from Weibo data (Chinese Twitter), best matched the temporal trends of HWEs in geographic space. At the same time, the spatial distribution of observed residential sensitivity to HWEs in the cities had similar characteristics, with low sensitivity in the urban center but higher sensitivity in the countryside. This research illustrates the benefits of applying multi-source Big Data and intelligent analysis technologies to the understand of impacts of heatwave events on residential life, and provide decision-making data for urban planning and management.
High-density cities are faced with growing extreme hot weather driven by climate change and local urbanization, but localized heat risk detection is still at an early stage for most cities (Watts et al., 2019). This study developed a spatiotemporal hazard-exposure-vulnerability assessment of the extreme heat risk in Hong Kong for 2006, 2011, and 2016 integrating cumulative very hot day hours and hot night hours in summer, population density and a principal component analysis (PCA) of demo-socioeconomic characteristics. The risk was found spatially variant, and high-risk spots were identified at the community scale for both daytime and nighttime with underlying determinants behind. In both the daytime and the nighttime, high risk mainly occurred in the core urban areas. Nearly 10 more hot-spots were found in the nighttime than those in the daytime. Several old communities in Kowloon stayed at high risk from 2006 to 2016. Some new towns in the New Territories turned to be at higher risk in 2016 compared to 2006 and 2011, and this result showed signs to be emerging hot-spots in the near future. This study would be a useful reference for community-scale heat risk assessment and mitigation for the development of healthy and sustainable high-density cities.
Large-scale modifications to urban underlying surfaces owing to rapid urbanization have led to stronger urban heat island (UHI) effects and more frequent urban heat wave (HW) events. Based on observations of automatic weather stations in Beijing during the summers of 2014–2020, we studied the interaction between HW events and the UHI effect. Results showed that the UHI intensity (UHII) was significantly aggravated (by 0.55°C) during HW periods compared to non-heat wave (NHW) periods. Considering the strong impact of unfavorable weather conditions and altered land use on the urban thermal environment, we evaluated the modulation of HW events and the UHI effect by wind speed and local climatic zones (LCZs). Wind speeds in urban areas were weakened due to the obstruction of dense high-rise buildings, which favored the occurrence of HW events. In detail, 35 HW events occurred over the LCZ1 of a dense high-rise building area under low wind speed conditions, which was much higher than that in other LCZ types and under high wind speed conditions (< 30 HW events). The latent heat flux in rural areas has increased more due to the presence of sufficient water availability and more vegetation, while the increase in heat flux in urban areas is mainly in the form of sensible heat flux, resulting in stronger UHI effect during HW periods. Compared to NHW periods, lower boundary layer and wind speed in the HW events weakened the convective mixing of air, further expanding the temperature gap between urban and rural areas. Note that LCZP type with its high-density vegetation and water bodies in the urban park area generally exhibited, was found to have a mitigating effect on the UHI, whilst at the same time increasing the frequency and duration of HW events during HW periods. Synergies between HWs and the UHI amplify both the spatial and temporal coverage of high-temperature events, which in turn exposes urban residents to additional heat stress and seriously threatens their health. The findings have important implications for HWs and UHII forecasts, as well as for scientific guidance on decision-making to improve the thermal environment and to adjust the energy structure.
Nighttime heat waves have greater impacts on human society than daytime because nighttime heat waves deprive humans to recover from daytime heat and increase energy consumption for cooling. In this study, we found increased occurrence and severity of nighttime heat waves across China during 1980-2017 based on measurements from more than 2,000 meteorological stations. The nighttime heat waves have been longer lasting and occurred more often in spring and fall. Compared to rural areas, urban areas have shown enhanced frequency, intensity, and duration of nighttime heat waves. Urbanization accounted for nearly 50% of the extended duration and nearly 40% of the enhanced intensity and frequency of nighttime heat waves in urban areas relative to rural areas. Urban expansion, causing reduced evapotranspiration and weakened wind speed that normally cools the lower atmosphere by turbulent heat loss and cooled air advection, led to nighttime urban heat island, thus magnifying nighttime heat extremes. Plain Language Summary Extreme temperature events will likely increase and cause severe damage to human society and natural ecosystem under climate change and urbanization. Compared to daytime, nighttime heat waves reduce people’s ability to cool off and prevent the human body recovering from daytime heat exposure, and therefore increase the risks of heat illnesses and deaths. Here, we show that nighttime heat waves have been more frequent, longer lasting, and severer, and occurred increasingly in spring and fall in China. These changes have been more intensive in urban areas than their surrounding rural areas. Urbanization accounted for nearly 50% of the extended duration, and nearly 40% of the enhanced intensity and frequency of nighttime heat waves in urban areas relative to rural areas. Nighttime urban heat island due to rapid urban expansion magnified nighttime heat extremes.
Global climate change results in an increased risk of high urban temperatures, making it crucial to conduct a comprehensive assessment of the high-temperature risk of urban areas. Based on the data of 194 meteorological stations in China from 1986 to 2015 and statistical yearbooks and statistical bulletins from 2015, we used GIS technology and mathematical statistics to evaluate high-temperature spatial and temporal characteristics, high-temperature risk, and high-temperature vulnerability of 31 cities across China. Over the past 30 years, most Chinese cities experienced 5-8 significant oscillation cycles of high-temperature days. A 15-year interval analysis of high-temperature characteristics found that 87% of the cities had an average of 5.44 more high-temperature days in the 15-year period from 2001 to 2015 compared to the period from 1986 to 2000. We developed five high-temperature risk levels and six vulnerability levels. Against the background of a warming climate, we discuss risk mitigation strategies and the importance of early warning systems.
In the context of climate change, the outdoor thermal environment is essential for urban health, particularly in hot and humid climate zones. In most cities in southern China, traditional shophouse neighbourhoods are regarded as a reference for climate-responsive urban morphology because multiple shading strategies are integrated, including deep canyons, semi-open arcades, and vegetation. In total, four shading strategies, namely, the height-to-width ratio of canyons and arcades, tree coverage area, and orientation, are employed in this study to compare their cooling efficiency in street canyons during summer daytime. The ENVI-met is employed for the microclimatic simulations and validated by site measurement data. The impact of varying sky view factor on the physiologically equivalent temperature was quantified to assess the cooling efficiency of each shading strategy. Our results demonstrate that the cooling efficiency of orientations varies significantly with sky view factor and is negatively associated with pedestrian thermal comfort in alleys, but positive in street canyons with arcades and trees. Varying the height-to-width ratio of canyons in arcade streets presents the best cooling efficiency, except in the east-west orientation. Shading by arcades shows a slightly higher cooling efficiency than tree coverage.
OBJECTIVES: Heat injuries have become a considerable health risk for sport and exercise participants in Australia. This study seeks to update the Australian sports case numbers by considering data from hospital admission and emergency department (ED) presentations (collectively referred to as total hospitalisations). Specifically, this study aimed to report epidemiological features (incidence and case characteristics) for sport related heat injury (SRHI) cases treated in hospital, over an 11-year period in Victoria, Australia. DESIGN: Analysis of administrative health data. METHODS: Data were extracted from the Victorian Injury Surveillance Unit for hospital admissions and ED presentations separately using diagnosis and activity codes (focused on subgroups of T67 – effects of heat and light and U5000-U7100). Descriptive data were reported by age, sex, financial year and activity, and population trends reported for SRHI incidence rate. RESULTS: A total of 323 SRHI cases (ED=142, 44%; admissions=181, 56%) were identified, representing 10.2% of all heat injury cases (non-sport cases=2834). The highest number of SRHI cases were in golf (n=43, 13.3%) and lawn bowls (n=38, 11.8%). The age groups >65 and 15-34years reported a total of 114 cases (35.3%) and 106 cases (32.8%), respectively. CONCLUSIONS: Findings were consistent with previous Australian studies with SRHI comprising 10% of all heat injury cases. Strategies for SRHI awareness can be aimed at the age and sport groups with greater representation in the cases identified. We had expected several-times more ED presentations than admissions, suggesting fewer of the mild-moderate cases of SRHI attend for emergency care and that alternative data are needed to capture these.
Extreme high-temperature events pose a threat to human beings on Earth. In coastal cities, the sea breeze is widely known as a prevailing wind that can cool the near-surface air. However, the cumulative cooling effect and its attenuation process during the sea breeze penetration have not been well investigated. In this study, we analyze sea breeze cooling capacity (SBCC) and propose a new method in estimating the penetration distance of sea breeze cooling in metropolitan Adelaide during summer using data from the Adelaide urban heat island monitoring network. The results show that during a sea breeze day, wind direction rapidly changes from southeast to southwest in the morning, and it gradually returns to southeast in the afternoon. It takes 67 min on average for the sea breeze cooling fronts to penetrate inside metropolitan Adelaide. The SBCC value is 21.3 degrees C h per event averaged spatially in Adelaide summer. During the penetration process, the SBCC values decrease at a rate of 0.7 and 0.9 degrees C h per kilometer from coast to inland on an average sea breeze day and a hot sea breeze day, respectively. Correspondingly, the mean cooling penetration distances are 42 and 29 km along the prevailing wind path. A multiple linear regression analysis indicates that the distance from the coast and elevation at the onshore point together explain 88% of the spatial variability of the temporally average SBCC in the study area. The spatial pattern and penetration distance of the cumulative sea breeze cooling effect contribute to a better understanding of this common cooling source for heat mitigation in coastal cities where a large number of people reside.
The warming trend over recent decades has already contributed to the increased prevalence of heat-vulnerable chronic diseases in many regions of the world. However, understanding the relationship between heat-vulnerable chronic diseases and heatwaves remains incomplete due to the complexity of such a relationship mingling with human society, urban and natural environments. Our study extends the Social Ecological Theory by constructing a tri-environmental conceptual framework (i.e., across social, built, and natural environments) and contributes to the first nationwide study of the relationship between heat-vulnerable chronic diseases and heatwaves in Australia. We utilize the random forest regression model to explore the importance of heatwaves and 48 tri-environmental variables that contribute to the prevalence of six types of heat-vulnerable diseases. We further apply the local interpretable model-agnostic explanations and the accumulated local effects analysis to interpret how the heat-disease nexus is mediated through tri-environments and varied across urban and rural space. The overall effect of heatwaves on diseases varies across disease types and geographical contexts (latitudes; inland versus coast). The local heat-disease nexus follows a J-shape function-becoming sharply positive after a certain threshold of heatwaves-reflecting that people with the onset of different diseases have various sensitivity and tolerance to heatwaves. However, such effects are relatively marginal compared to tri-environmental variables. We propose a number of policy implications on reducing urban-rural disparity in Healthcare and service distribution, delineating areas, and identifying the variations of sensitivity to heatwaves across urban/rural space and disease types. Our conceptual framework can be further applied to examine the relationship between other environmental problems and health outcomes.
BACKGROUND: Exposure to high ambient temperatures has been shown to increase the risk of spontaneous preterm birth. Determining which maternal factors increase or decrease this risk will inform climate adaptation strategies. OBJECTIVES: This study aims to assess the risk of spontaneous preterm birth associated with exposure to ambient temperature and differences in this relationship between mothers with different health and demographic characteristics. METHODS: We used quasi-Poisson distributed lag non-linear models to estimate the effect of high temperature-measured as the 95th percentile of daily minimum, mean and maximum compared with the median-on risk of spontaneous preterm birth (23-36 weeks of gestation) in pregnant women in New South Wales, Australia. We estimated the cumulative lagged effects of daily temperature and analyses on population subgroups to assess increased or decreased vulnerability to this effect. RESULTS: Pregnant women (n = 916,678) exposed at the 95th percentile of daily mean temperatures (25°C) had an increased risk of preterm birth (relative risk 1.14, 95% confidence interval 1.07, 1.21) compared with the median daily mean temperature (17°C). Similar effect sizes were seen for the 95th percentile of minimum and maximum daily temperatures compared with the median. This risk was slightly higher among women with diabetes, hypertension, chronic illness and women who smoked during pregnancy. CONCLUSIONS: Higher temperatures increase the risk of preterm birth and women with pre-existing health conditions and who smoke during pregnancy are potentially more vulnerable to these effects.
BACKGROUND: Heat exposure is a risk factor for urologic diseases. However, there are limited existing studies that have examined the relationship between high temperatures and urologic disease. The aim of this study was to examine the associations between heat exposure and hospitalizations for urologic diseases in Queensland, Australia, during the hot seasons of 1995-2016 and to quantify the attributable risks. METHODS: We obtained 238 427 hospitalized cases with urologic diseases from Queensland Health between 1 December 1995 and 31 December 2016. Meteorological data were collected from the Scientific Information for Land Owners-a publicly accessible database of Australian climate data that provides daily data sets for a range of climate variables. A time-stratified, case-crossover design fitted with the conditional quasi-Poisson regression model was used to estimate the associations between temperature and hospitalizations for urologic diseases at the postcode level during each hot season (December-March). Attributable rates of hospitalizations for urologic disease due to heat exposure were calculated. Stratified analyses were performed by age, sex, climate zone, socio-economic factors and cause-specific urologic diseases. RESULTS: We found that a 1°C increase in temperature was associated with a 3.3% [95% confidence interval (CI): 2.9%, 3.7%] increase in hospitalization for the selected urologic diseases during the hot season. Hospitalizations for renal failure showed the strongest increase 5.88% (95% CI: 5.25%, 6.51%) among the specific causes of hospital admissions considered. Males and the elderly (≥60 years old) showed stronger associations with heat exposure than females and younger groups. The sex- and age-specific associations with heat exposure were similar across specific causes of urologic diseases. Overall, nearly one-fifth of hospitalizations for urologic diseases were attributable to heat exposure in Queensland. CONCLUSIONS: Heat exposure is associated with increased hospitalizations for urologic disease in Queensland during the hot season. This finding reinforces the pressing need for dedicated public health-promotion campaigns that target susceptible populations, especially for those more predisposed to renal failure. Given that short-term climate projections identify an increase in the frequency, duration and intensity of heatwaves, this public health advisory will be of increasing urgency in coming years.
Heatwaves are associated with increased mortality and are exacerbated by the urban heat island (UHI) effect. Thus, to inform climate change mitigation and adaptation, we quantified the mortality burden of historical heatwave days in Sydney, Australia, assessed the contribution of the UHI effect and used climate change projection data to estimate future health impacts. We also assessed the potential for tree cover to mitigate against the UHI effect. Mortality (2006-2018) records were linked with census population data, weather observations (1997-2016) and climate change projections to 2100. Heatwave-attributable excess deaths were calculated based on risk estimates from a published heatwave study of Sydney. High resolution satellite observations of UHI air temperature excesses and green cover were used to determine associated effects on heat-related mortality. These data show that >90% of heatwave days would not breach heatwave thresholds in Sydney if there were no UHI effect and that numbers of heatwave days could increase fourfold under the most extreme climate change scenario. We found that tree canopy reduces urban heat, and that widespread tree planting could offset the increases in heat-attributable deaths as climate warming progresses.
Heatwaves are an accustomed extreme event of the Australian climate, which can cause catastrophic impacts on human health, agriculture, and urban and natural systems. We have analyzed the trends in Australia-wide heatwave metrics (frequency, duration, intensity, number, cumulative magnitude, timing, and season duration) across 69 extended summer seasons (i.e., from November-1951 to March-2020). Our findings not only emphasize that heatwaves are becoming hotter, longer, and more frequent, but also signify that they are occurring with excess heat, commencing much earlier, and expanding their season over many parts of Australia in recent decades. The Australian heatwave trends have strengthened since last observed Australian study was conducted. We also investigated the heatwave and severe heatwave trends at a local city-scale using three different observational products (AWAP and SILO gridded datasets and ACORN_SATV2 station data) over selected time periods (1911-2019, 1911-1964, and 1965-2019). Results suggest that heatwave trends are noticeably different amongst the three datasets. However, the results highlight that the severe heatwave cumulative magnitude and their season duration have been increasing significantly in recent decades over Australia’s southern coastal cities (like Melbourne and Adelaide). The climatological mean of the most heatwave and severe heatwave metrics is substantially higher in recent decades compared to earlier periods across all the cities considered. The findings of our study have significant implications for the development of advanced heatwave planning and adaptation strategies.
Most studies evaluating future changes in climate extremes over Australia have examined events that occur once or more each year. However, it is extremes that occur less frequently than this that generally have the largest impacts on sectors such as infrastructure, health and finance. Here we use an ensemble of high resolution (similar to 10 km) climate projections from the NSW and ACT Regional Climate Modelling (NARCliM) project to provide insight into how such rare events may change over southeast Australia in the future. We examine changes in the frequency of extremes of heat, rainfall, bushfire weather, meteorological drought and thunderstorm energy by the late 21st century, focusing on events that currently occur once every 20 years (those with a 5% Annual Exceedance Probability). Overall the ensemble suggests increases in the frequency of all five extremes. Heat extremes exhibit the largest change in frequency and the greatest ensemble agreement, with current 1-in-20 year events projected to occur every year in central Australia and at least every 5 years across most of southeast Australia, by the late 21st century. The five capital cities included in our model domain are projected to experience multiple climate extremes more than twice as frequently in the late 21st century, with some cities projected to experience 1-in-20 year events more than six times as frequently. Although individual simulations show decreases in some extremes in some locations, there is no strong ensemble agreement for a decrease in any of the climate extremes over any part of southeast Australia. These results can support adaptation planning and should motivate further research into how extremely rare events will change over Australia in the future.
BACKGROUND: Climate change is causing an increase in the frequency and severity of heatwave events, with a corresponding negative impact on human health. Health service utilisation during a heatwave is increased, with a greater risk of poor health outcomes identified for specific population groups. In this study, we examined the impact of heatwave events on ambulance dispatches in Tasmania, Australia from 2008 to 2019 to explore health service utilisation and identify the most vulnerable populations at a local level. METHODS: We used a time-stratified case-crossover analysis with conditional logistic regression to examine the association between ambulance dispatches and three levels of heatwave events (extreme, severe, and low-intensity). We examined the relationship for the whole study population, and by age, gender, socio-economic advantage and clinical diagnostic group. RESULTS: We found that ambulance dispatches increase by 34% (OR 1.34, 95% CI 1.18-1.52) during extreme heatwaves, by 10% (OR 1.10, 95% CI 1.05-1.15) during severe heatwaves and by 4% (OR 1.04, 95% CI 1.02-1.06) during low-intensity heatwaves. We found significant associations for the elderly (over 65), the young (5 and under) and for regions with the greatest socio-economic disadvantage. CONCLUSION: Heatwaves were associated with increased demands on ambulance services in Tasmania. In subgroups of people aged over 65 or under 5 years of age, and those from areas of higher disadvantage, we generally observed greater effect sizes than for the population as a whole.
Historically, heatwaves are Australia’s most destructive natural hazard in terms of loss of life. This study analyses statistics of fatalities associated with heatwaves in Australia from 2001 to 2018 as noted by a Coroner. At least 473 heat-related deaths were reported to a Coroner during the period of research, of which 354 occurred during heatwave conditions and, of these, 244 within buildings. Most indoor heatwave fatalities occurred in older housing stock. There was no overall trend in the number or rate of fatalities but, rather, a record of generally low numbers with periodic excursions into very high numbers. Almost two-thirds (63%) of heatwave fatalities occurred during two severe heatwave years: 2009 and 2014. The record was dominated by male fatalities. The risk of dying in a heatwave increased with age, socio-economic disadvantage, social isolation, geographical remoteness, the presence of disabilities (physical or mental) and some prescribed medications and the absence or non-use of air conditioning or other building heat protection. Other risk factors and behaviours were examined and recommendations to decrease future heatwave deaths suggested.
OBJECTIVE: To determine if global warming has changed the balance of summer and winter deaths in Australia. METHODS: Counts of summer and winter cause-specific deaths of subjects aged 55 and over for the years 1968-2018 were entered into a Poisson time-series regression. Analysis was stratified by states and territories of Australia, by sex, age and cause of death (respiratory, cardiovascular, and renal diseases). The warmest and coldest subsets of seasons were compared. RESULTS: Warming over 51 years was associated with a long-term increase in the ratio of summer to winter mortality from 0.73 in the summer of 1969 to 0.83 in the summer of 2018. The increase occurred faster in years that were warmer than average. CONCLUSIONS: Mortality in the warmest and coldest times of the year is converging as annual average temperatures rise. Implications for public health: If climate change continues, deaths in the hottest months will come to dominate the burden of mortality in Australia.
Heat kills more Australians than any other natural disaster. Previous Australian research has identified increases in Emergency Department presentations in capital cities; however, little research has examined the effects of heat in rural/regional locations. This retrospective cohort study aimed to determine if Emergency Department (ED) presentations across the south-west region of Victoria, Australia, increased on high-heat days (1 February 2017 to 31 January 2020) using the Rural Acute Hospital Data Register (RAHDaR). The study also explored differences in presentations between farming towns and non-farming towns. High-heat days were defined as days over the 95th temperature percentile. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes associated with heat-related illness were identified from previous studies. As the region has a large agricultural sector, a framework was developed to identify towns estimated to have 70% or more of the population involved in farming. Overall, there were 61,631 presentations from individuals residing in the nine Local Government Areas. Of these presentations, 3064 (5.0%) were on days of high-heat, and 58,567 (95.0%) were of days of non-high-heat. Unlike previous metropolitan studies, ED presentations in rural south-west Victoria decrease on high-heat days. This decrease was more prominent in the farming cohort; a potential explanation for this may be behavioural adaption.
OBJECTIVE: To examine the cost benefits of a heat health warning system (HHWS) in South Australia. METHODS: Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS-attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts. RESULTS: The estimated cost for a one-week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS-attributable reductions in hospital admissions and ambulance callouts with an estimated benefit-cost ratio of 2.0-3.3. CONCLUSIONS: On the basis of estimated cost benefit, the South Australian HHWS is a no-regret public health response to heatwaves. IMPLICATIONS FOR PUBLIC HEALTH: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost-effective public health interventions.
Increasing temperature and its impact on population health is an emerging significant public health issue in the context of climate change in Australia. While previous studies have primarily focused on risk assessment, very few studies have evaluated heat-attributable emergency department (ED) visits and associated healthcare costs, or projected future health and economic burdens. This study used a distributed lag non-linear model to estimate heat attributable ED visits and associated healthcare costs from 13 hospitals in Perth, Western Australia, and to project the future healthcare costs in 2030s and 2050s under three climate change scenarios-Representative Concentration Pathways (RCPs)2.6, RCP4.5 and RCP8.5. There were 3697 ED visits attributable to heat (temperatures above 20.5 degrees C) over the study period 2012-2019, accounting for 4.6% of the total ED visits. This resulted in AU$ 2.9 million in heat-attributable healthcare costs. The number of ED visits projected to occur in the 2030s and 2050s ranges from 5707 to 9421 under different climate change scenarios, which would equate to AU$ 4.6-7.6 million in heat associated healthcare costs. The heat attributable fraction for ED visits and associated healthcare costs would increase from 4.6% and 4.1% in 2010s to 5.0%-6.3% and 4.4%-5.6% in 2030s and 2050s, respectively. Future heat attributable ED visits and associated costs will increase in Perth due to climate change. Excess heat will generate a substantial population health challenge and economic burdens on the healthcare system if there is insufficient heat adaptation. It is vital to reduce greenhouse gas emissions, develop heat-related health interventions and optimize healthcare resources to mitigate the negative impact on the healthcare system and population health in the face of climate change.
Extreme heat events are a leading natural hazard risk to human health. Under all future climate change models, extreme heat events will continue to increase in frequency, duration, and intensity. Evidence from previous extreme heat events across the globe demonstrates that adverse cardiovascular events are the leading cause of morbidity and mortality, particularly amongst the elderly and those with pre-existing cardiovascular disease. However, less is understood about the adverse effects of extreme heat amongst specific cardiovascular diseases (i.e., heart failure, dysrhythmias) and demographics (sex, ethnicity, age) within Australia and New Zealand. Furthermore, although Australia has implemented regional and state heat warning systems, most personal heat-health protective advice available in public health policy documents is either insufficient, not grounded in scientific evidence, and/or does not consider clinical factors such as age or co-morbidities. Dissemination of evidence-based recommendations and enhancing community resilience to extreme heat disasters within Australia and New Zealand should be an area of critical focus to reduce the burden and negative health effects associated with extreme heat. This narrative review will focus on five key areas in relation to extreme heat events within Australia and New Zealand: 1) the potential physiological mechanisms that cause adverse cardiovascular outcomes during extreme heat events; 2) how big is the problem within Australia and New Zealand?; 3) what the heat-health response plans are; 4) research knowledge and translation; and, 5) knowledge gaps and areas for future research.
Information on the spatiotemporal characteristics of Beijing’s urban-rural near-surface air temperature difference, known as the canopy layer urban heat island (UHI), is important for future urban climate management strategies. This paper investigates the variation of near-surface air temperatures within Beijing at a neighbourhood-scale resolution (similar to 100 m) during winter 2016 and summer 2017. We perform simulations using the urban climate component of the ADMS-Urban model with land surface parameters derived from both local climate zone classifications and OpenStreetMap land use information. Through sensitivity simulations, the relative impacts of surface properties and anthropogenic heat emissions on the temporal variation of Beijing’s UHI are quantified. Measured UHI intensities between central Beijing (Institute of Atmospheric Physics) and a rural site (Pinggu) during the Atmospheric Pollution and Human Health in a Chinese Megacity (APHH-China) campaigns, peak during the evening at similar to 4.5 degrees C in both seasons. In winter, the nocturnal UHI is dominated by anthropogenic heat emissions but is underestimated by the model. Higher-resolution anthropogenic heat emissions may capture the effects of local sources (e.g. residential buildings and adjacent major roads). In summer, evening UHI intensities are underestimated, especially during heatwaves. The inability to fully replicate the prolonged release of heat stored in the urban fabric may explain this. Observed negative daytime UHI intensities in summer are more successfully captured when surface moisture levels in central Beijing are increased. However, the spatial correlation between simulated air temperatures and satellite-derived land surface temperatures is stronger with a lower urban moisture scenario. This result suggests that near-surface air temperatures at the urban meteorological site are likely influenced by fine-scale green spaces that are unresolved by the available land cover data and demonstrates the expected differences between surface and air temperatures related to canopy layer advection. This study lays the foundations for future studies of heat-related health risks and UHI mitigation strategies across Beijing and other megacities.
The urbanization process leads to the enhancement of the urban heat island (UHI) effect, and the high temperature brought by it exacerbates the risk of heat exposure and seriously endangers human health. Analyzing the spatiotemporal characteristics and levels of heat exposure risk is important for formulating heat risk prevention and control measures. Therefore, this study analyzes the spatiotemporal characteristics of heat exposure risk based on the UHI footprint (FP) and explores the relationship between it and urbanization factors in the Beijing-Tianjin-Hebei (BTH) region from 2000 to 2020, and obtains the following conclusions: (1) The BTH region suffers from severe UHI problems, with FP ranging from 6.05 km (Chengde) to 32.51 km (Beijing), and the majority of cities show significant trends of FP increase. (2) With the increase in FP, massive populations are exposed within the heat risk areas, with the average annual population at risk across cities ranging from 269,826 (Chengde) to 166,020,390 (Beijing), with a predominance of people exposed to high risk (more than 65% of the total) and generally showing increasing trends. (3) The population at risk of heat exposure is significantly correlated with urbanization factors, indicating that urbanization is an important reason for the increase in the risk population and the enhancement of the risk level. These results suggest that with the continuous urbanization process, the heat exposure risk problem faced by cities in the BTH region will persist and gradually worsen, which must be paid attention to and effective mitigation measures must be taken.
Both extreme heat and heavy air pollution can cause adverse health impacts on urban inhabitants. To understand heat stress and its relationship with boundary layer structure and air pollution in Beijing, this study analyzed surface meteorological observations, radiosonde measurements, and ground-level PM2.5 and O3 concentrations in summer from 2015 to 2019, in conjunction with simulated air quality and MERRA-2 data. We measured the heat stress using a heat index that combines temperature and humidity to quantify the sensible temperature as perceived by humans, and found that high heat risk in Beijing was often associated with a low boundary layer height and poor air quality. To reveal the underlying physical mechanism involved, we objectively classified the synoptic conditions in North China. The typical synoptic pattern associated with the coupling of heat and pollution in Beijing was found to feature a southeast-to-north pressure gradient at the 700-hPa level, leading to westward warm advection above planetary boundary layer (PBL) and southward movement of warm, humid, and polluted air masses within the PBL towards Beijing. The elevated warm advection can enhance the capping of thermal inversion over the PBL and suppress the PBL’s development and the vertical dispersion of pollutants. With mountains to the north and west, pollutants and heat can be trapped in a limited volume in Beijing, increasing the health risk from heat and pollution. These findings on the meteorological mechanisms of the coupling between heat and pollution in Beijing may have important implications for limiting the current health risk and preparing for any projected changes in it in the future.
The growing elderly population living in high density cities undergoing mass urbanization raises concerns over age-friendliness of neighborhood open space, an essential component for healthy aging-in-place as elderly tend to spend most of their time at home and immediate home environment. This study discusses factors that influence age-friendly open space design pertaining to outdoor thermal environment and physical design element for highdensity high-rise housing in hot weather, using the case of public housing developments in Hong Kong. Field measurements, observations and linear regression data analyses are used to understand dynamic thermal condition, adaptive elderly user behavior and response to planned open space. It is demonstrated that four influential factors are important to correlate with elderly residents’ use of open space: 1) mean radiant temperature (MRT); 2) air temperature; 3) greenery; and 4) outdoor seating. Moreover, it is found that MRT, specifically longwave MRT, is the most influential and impacts the effectiveness of greenery and outdoor seating. In addition, the study proposes guide points to reflect the effect of each factor and shed more insight into improving age-friendly neighborhood open space design against climate-change induced heat-related health issues.
Against the background of global climate change, the increasing heat health risk from the combined effect of changes in high temperature, exposure, vulnerability, and other factors has become a growing concern. Yet the low number of temperature observation stations is insufficient to represent the complex changes in urban heatwaves, and subdistrict-scale (town, township, neighborhood committee, and equivalent) heat health risk and adaptability assessments are still limited. In this study, we built daytime and nighttime high-temperature interpolation models supported by data from 225 meteorological stations in Beijing. The models performed well at interpolating the cumulative hours of high temperature and the interpolation quality at night was better than that during the day. We further established a methodological framework for heat health risk and adaptability assessments based on heat hazard, population exposure, social vulnerability, and adaptability at the subdistrict scale in Beijing. Our results show that the heat health risk hotspots were mainly located in the central urban area, with 81 hotspots during the day and 76 at night. The average value of the heat health risk index of urban areas was 5.60 times higher than that of suburban areas in the daytime, and 6.70 times higher than that of suburban areas in the night. Greater population density and higher intensity of heat hazards were the main reasons for the high risk in most heat health risk hotspots. Combined with a heat-adaptive-capacity evaluation for hotspot areas, this study suggests that 11 high-risk and low-adaptation subdistricts are priority areas for government action to reduce heat health risk in policy formulation and urban development.
Heatstroke is defined as severe symptoms of heat-related illness, which could lead to death. Sugarcane farmers are at high risk of heatstroke under extremely hot outdoor working conditions. We explored the prevalence of heat-related illness symptoms and risk factors related to heat-related illness among sugarcane farmers working in the summer. We conducted a cross-sectional study using questionnaire interviews among 200 sugarcane farmers in Kamphaeng Phet Province, Thailand. The questionnaire addressed demographics, heat-related symptoms experienced during summer at work, and occupational factors. Bioelectrical impedance analysis was used to assess body mass index and body fat percentage. Watson formula equations were used to estimate total body water. The prevalence of heat-related illness symptoms was 48%; symptoms included heavy sweating, weakness/fatigue, dizziness, muscle cramps, headache, and vertigo. Factors associated with heat-related illness included women and clothing. Sugarcane farmers wearing two-layer shirts had a higher risk of heat-related illness. Farmers with fluid intake 3.1-5.0 liters per day had a 79% lower risk of heat-related illness. Our findings demonstrated that sugarcane farmers are at risk of heat-related illness. We confirmed that working conditions, including wearing proper clothing and water-drinking habits, can reduce this risk.C
Extreme urban heat alongside higher ambient temperatures in urban areas causes serious energy, comfort, health and environmental problems. The implementation of urban heat mitigation techniques can significantly reduce urban temperatures and counterbalance the impact of extreme urban heat. This study assesses the potential cooling ability of modified urban albedo strategies through the implementation of reflective and super reflective materials, as well as the global climatic impacts on a subtropical desert urban environment in Dubai, UAE. Three scenarios using low, average and high albedo modifications are designed and evaluated in parallel to a reference scenario. A physically-based mesoscale urban modeling system is used to assess the thermal and meteorological impacts of the albedo modifications during both the summer and winter seasons at a city scale. The reduction of ambient temperature during the peak of a summer day (14:00 LT) is shown to be 0.6 degrees C, 1.4 degrees C and 2.6 degrees C when urban albedo is increased by 0.20, 0.45 and 0.60 respectively. The winter cooling penalty ranges between 0.6 degrees C and 1.1 degrees C for the different albedo scenarios. The increase of the urban albedo also significantly reduces the planetary boundary layer (PBL) depth due to the loss of sensible heat and decreases the intensity of the convective mixing and advection flows from the desert to the city, improving the mitigation potential of the reflective materials; however this increases the risk of a higher pollutants concentration. A much higher mitigation potential is observed for the high-density parts of the city when compared to that of the low-density parts of the city. Irrespective of linear function in the drop of ambient temperature and changing fraction of global albedo, our results reported that the cooling potential of reflective materials is highly influenced by the climate, landscape, and urban characteristics of the cities.
Mapping the elderly population exposure to heat hazard in urban areas is important to inform adaptation strategies for increasingly-deadly urban heat under climate change. However, fine-scale mapping is lacking, because global climate change projections have not previously been integrated with urban heat island effects especially with urban three-dimensional characteristics for within-city heat risk analyses. This study compared the spatial patterns of deadly heat exposure for elderly populations in two East Asian megacities, Seoul and Tokyo, using current climate (2006-2015) and two future periods (2040s and 2090s). We integrated global warming projections (the Shared Socioeconomic Pathway 5 based on Representative Concentration Pathway 8.5) with local urban characteristics and demographics. We found that, for the historical period, the overall hotspots of elderly population exposure to urban heat was larger in Tokyo because of relatively higher maximum air temperatures and lack of green spaces, whereas in the future periods, Seoul will have larger hotspots because the elderly population density will have increased. About 20% of the area in Seoul and 0.3-1% of Tokyo will be hotpots in the 2040s, and the size of these hotspots increases to 25-26% and 2-3%, respectively, in the 2090s. The spatial patterns of hotspots identify different types of priority areas and suggest that alternative adaptation strategies for two cities are appropriate. The approach introduced here will be useful for identifying sustainable thermal environments in other cities with high density elderly population and severe heat hazard. (c) 2021 Elsevier B.V. All rights reserved.
Urban heat islands (UHI) exacerbates the heat-related risk associated with global warming, increasing morbidity and mortality of urban residents. While the impacts of the spatial pattern of urban greenspace (UG) and its change on urban heat have been widely examined, there is less understanding of the aggregate effect of the change of UG-considering the loss and gain of UG simultaneously -on urban temperature. This study aims to fill this gap by using Beijing, China as a case study. Using a newly developed index -dynamic index of UG (UGDI) that simultaneously measures the loss and gain of UG in a certain unit of analysis, we investigated how changes in UG affect the daytime and nighttime land surface temperature (LST). We found: (1) A substantial proportion (49.90%) of grids with increased UG cover had increased LST during the daytime, with a magnitude ranging from 0.02 to 1.82 ?, indicating that the increase in UG does not always result in reduction of LST. (2) UGDI had a significantly positive correlation with LST change, suggesting that increase in UG does not necessarily result in decrease of LST, which can be affected by the degree of dynamics of UG. (3) The evapotranspiration (ET) rate of vegetation for lost greenspace was higher than that of new greenspace, indicating that adding the same amount of UG might not able to provide the same amount of cooling effects provided by lost ones. Results can enhance our understanding on how (landscape) process affects ecological effect. Future research and practical manage-ment strategies shall move beyond net increase of UG and focus more on its change process. This finding provides new evidence for explaining the effect of the change of UG on LST, and offers new insights for planning and managing urban natural resource to enhance resilience of cities to climate warming.
Rapid urbanization has led to altered thermal circulations in major cities that are responsible for the increasing occurrence of urban heat islands (UHIs) and events such as tropical nights and heat waves. To effectively mitigate such events, low-impact development (LID) and green infrastructure strategies have been developed. In Korea, LID techniques focus mainly on road pavement materials; however, issues regarding the reliability of measurements due to differences in the measurement equipment and studied specimens persist. This study presents the design of a green infrastructure surface temperature measurement (GSTM) instrument and a reliable methodology developed to evaluate the performance of pavement materials under controlled climate conditions. The developed GSTM instrument and methodology were tested by monitoring the surface temperature of materials based on LID practices and dense-graded asphalt and evaluating their ability to mitigate UHI and tropical night phenomena. The experiments were conducted under controlled climate conditions, using summer climate conditions of Seoul’s typical meteorological year data. The UHI and tropical night phenomena mitigation performance of the pavement materials was evaluated by analyzing the correlation between the pavement materials’ albedo and surface temperature using porous block specimens of different colors and LID-based pavement materials. The greening block recorded the most significant reduction in surface temperature, showing a difference of 22.6 °C, 185 min to the dense-graded asphalt. The white and yellow porous blocks showed surface temperature differences of 10.2 °C and 8.2 °C respectively compared to the dense-graded asphalt. The results revealed that pavement materials with higher albedo, more evaporation, and lower heat capacity have superior performance in mitigating UHI and tropical night events.
Urban areas generally have higher near-surface air temperature and lower air humidity than rural areas. Little is known about how heat stress, the combined effect of high air temperature and high humidity on human physiology, will be affected by future urban land expansion. Here we use a mesoscale numerical weather prediction model to examine the effects of urban land expansion from 2000 to 2050 on heat stress (measured as wet-bulb globe temperature, WBGT) in the urban areas of China, India, and Nigeria, which are projected to account for one-third of global urban population growth through 2050. Our results show that urban expansion slightly reduces heat stress during the day (similar to 0.2 degrees C) but substantially intensifies it at night, by similar to 1 degrees C on average and by up to 2-3 degrees C in five mega-urban regions (MURs). These effects exist with or without climate change induced by rising concentrations of greenhouse gases (GHGs). Installing cool roofs-an urban heat island mitigation measures-can reduce the daytime WBGT by 0.5-1 degrees C, partially offsetting the heat stress conditions caused by GHG-induced climate change. However, even with cool roofs, the nighttime WBGTs are higher by 0.3-0.9 degrees C over the whole countries studied, and by 1-2 degrees C in the MURs under the urban expansion scenario, compared to the situation in which urban areas remain unchanged. These results show that future urban expansion and heat island mitigation can result in potential daytime benefits but also persistent nighttime risks.
The intensification of heat stress reduces the labor capacity and hence poses a threat to socio-economic development. The reliable projection of the changing climate and the development of sound adaptation strategies are thus desired for adapting to the decreasing labor productivity under climate change. In this study, an optimization modeling approach coupled with dynamical downscaling is proposed to design the optimal adaptation strategies for improving labor productivity under heat stress in China. The future changes in heat stress represented by the wet-bulb globe temperature (WBGT) are projected with a spatial resolution of 25 × 25 km by a regional climate model (RCM) through the dynamical downscaling of its driving global climate model (GCM). Uncertain information such as system costs, environmental costs, and subsidies are also incorporated into the optimization process to provide reliable decision alternatives for improving labor productivity. Results indicate that the intensification of WBGT is overestimated by the GCM compared to the RCM. Such an overestimation can lead to more losses in working hours derived from the GCM than those from the RCM regardless of climate scenarios. Nevertheless, the overestimated heat stress does not alter the regional measures taken to adapt to decreasing labor productivity. Compared to inland regions, the monsoon-affected regions tend to improve labor productivity by applying air conditioning rather than working overtime due to the cost differences. Consequently, decision-makers need to optimally make a balance between working overtime and air conditioning measures to meet sustainable development goals.
The intensification of heat stress in a changing climate poses great threats to both human health and labor productivity. It is of great practical importance to assess the impacts of climate-induced heat stress on labor productivity and to develop effective adaptation strategies. In this paper, an integrated optimization-based productivity restoration modeling framework is proposed for the first time to develop the optimal policies for adaptation to climate change. To address underlying uncertainties associated with climate and labor management systems, we take into account ensemble projections from five global climate models (GCMs) under two Representative Concentration Pathways (RCP2.6 and RCP8.5) and inexact system costs. The system costs, including direct and indirect costs such as management costs, energy costs, and labor costs, are presented as interval numbers due to inherent uncertainty caused by population growth, technology development, and other social-economic factors. Uncertain information can be effectively communicated into the optimization processes in this study to generate optimal and reliable decision alternatives. We find that the increased Wet-Bulb Globe Temperature (WBGT) will lead to a large reduction in labor capacities over China except for the Tibetan Plateau under both RCPs by the end of the 21st century. The less developed regions tend to achieve the minimum system cost by having labor productivity recovered through working overtime due to the relatively low cost of overtime. This could result in more heat-related work injuries in the less developed regions. Since the less developed regions are not heat-prone areas in China, the changing climate would be a more dangerous threat and cause more damages to these regions where the residents are less acclimatized to heat stress. Moreover, we obtain a range of minimum system costs from 1.86 to 8.97 billion dollars under RCP2.6 and from 9.42 to 32.31 billion dollars under RCP8.5 (about 0.2% of China’s GDP in 2019, 0.01% of China’s GDP projected in 2100 under a sustainable socio-economic development scenario) for the restoration of labor productivity in a warming climate. We argue that urgent actions are needed to mitigate global warming impacts on labor productivity.
Several heat records have been broken in recent years and decades. Extreme high temperature not only damages human health, but also increases the risk of wildfires. As a common urban infrastructure, urban green space has been proved to have a cooling effect. In this study, the physical indicators and temperature data of 36 green spaces in Xi’an were collected, and the influence of different physical indicators of green spaces on their thermal environment was explored through correlation analysis. The results suggest that the area of green space should be between 0.6-0.7 square kilometers or the perimeter should range from 4000 to 4500 m in order to obtain the lowest internal temperature. When the area of water body in the green space is between 0.3-0.4 square kilometers or the perimeter is about 5000 m, its internal temperature is the lowest. Indicators of green space in the conclusion can be directly understood and referred by urban planners and policy makers. Results of this study thus have implications for improving urban thermal comfort by controlling the physical indicators of green space.
Global endeavors to respond to the problems caused by climate change and are leading to higher temperatures inside homes, which can cause skin conditions (such as eczema), lethargy, and poor concentration; disturbed sleep and fatigue are also rising. The energy performance of buildings is influenced by interactions and associations of numerous different variables, such as the envelope specifications as well as the design, technologies, apparatuses, and occupant behaviours. This paper introduces simple and sustainable strategies that are not dependent on expensive or sophisticated technologies, as they rely only on the actions practiced by the building’s occupants (movable window shading, and nighttime natural ventilation) instead of completely relying on high-cost mechanical cooling systems in buildings located in the main Eastern Mediterranean climates represented in the country of Jordan. These low-energy solutions could be applied to low-income houses in hot areas to avoid health problems, such as dermatological diseases, and save a significant amount of energy. The final results indicate that window shading has significant potential in reducing the cooling load in different climate zones. Natural ventilation exhibits high energy-saving abilities in climates that have cool nights, whereas its abilities in hot climates where nights are moderate is limited.
Average global temperatures and frequencies of heat waves are increasing with detrimental effects on health and wellbeing. This study presents a case study from two cities in the Northern Territory with the aim of exploring if and how people make deliberate adaptations to cope with increasing heat. Results show that 37% of all respondents made adjustments, with the most common being increased use of air-conditioning (65% of those responding to heat), followed by staying inside more often (22%) and passive cooling through modifications of house and garden (17%). Young people increasingly refrain from outside activities as temperatures increase. We also found that adaptive capacity was a function of education, long-term residency, home ownership and people’s self-rated wellbeing. Homeowners were more likely to adjust their living environment to the heat and renters less so. Being a property owner was commonly associated with the installation of solar panels to pay for high energy bills needed to run air-conditioning. Those who had solar panels at home were about ten times more likely to use air-conditioning more frequently in response to increasing heat. Our results confirm a growing dependence on artificially controlled environments to cope with heat in cities.
BACKGROUND: Previous studies have reported that high ambient temperature is associated with increased risk of suicide; however, the association has not been extensively investigated with drug overdose which is the most common method of unsuccessful suicidal behavior in Japan. Therefore, this study aims to examine the short-term association between daily mean temperature and the incidence of self-harm attempts by drug overdose in Tokyo, Japan. METHODS: We collected the emergency ambulance dispatch data and daily meteorological data in Tokyo from 2010 to 2014. A quasi-Poisson regression model incorporating a distributed lag non-linear function was applied to estimate the non-linear and delayed association between temperature and drug overdose, adjusting for relative humidity, seasonal and long-term trends, and days of the week. Sex, age and location-specific associations of ambient temperature with drug overdose was also estimated. RESULTS: 12,937 drug overdose cases were recorded during the study period, 73.9% of which were female. We observed a non-linear association between temperature and drug overdose, with the highest risk observed at 21 °C. The highest relative risk (RR) was 1.30 (95% Confidence Interval (CI): 1.10-1.67) compared with the risk at the first percentile of daily mean temperature (2.9 °C) over 0-4 days lag period. In subgroup analyses, the RR of a drug overdose at 21 °C was 1.36 (95% CI: 1.02-1.81) for females and 1.07 (95% CI: 0.66-1.75) for males. Also, we observed that the risk was highest among those aged ≥65 years (RR = 2.54; 95% CI: 0.94-6.90), followed by those aged 15-34 years (RR = 1.25; 95% CI: 0.89-1.77) and those aged 35-64 years (RR = 1.15; 95% CI: 0.78-1.68). There was no evidence for the difference in RRs between urban (23 special wards) and sub-urban areas in Tokyo. CONCLUSIONS: An increase in daily mean temperature was associated with increased drug overdose risk. This study indicated the positive non-linear association between temperature and incomplete attempts by drug overdose. The findings of this study may add further evidence of the association of temperature on suicidal behavior and suggests increasing more research and investigation of other modifying factors.
BACKGROUND: Epidemiological studies based on mortality and crime data have indicated that short-term exposure to higher temperature increases the risk of suicide and violent crimes. However, there are few studies on non-fatal intentional injury, especially on non-fatal self-harm which is much more common than suicide. OBJECTIVES: We aimed to clarify how short-term exposure to temperature is associated with emergency ambulance transport caused by intentional injuries including acts of self-harm and assault. METHOD: We applied a time-stratified case-crossover design using a conditional quasi-Poisson regression model for each of the 46 prefectures. All temperatures were converted to percentile value for each prefecture, to account for the varied climate across Japan. A Distributed Lag Non-Linear Model was used to explore the temperature percentile and lag pattern. The prefecture-specific results were combined using a meta-analysis with the random effects model. RESULT: Between 2012 and 2015, the number of acts of self-harm and assault across all 46 prefectures totaled 151,801 and 95,861, respectively. We found that as the temperature increased, the relative risk (RRs) for both self-harm and assault behaviors increased in a nearly linear manner. The pooled relative risk at the 99th percentile temperature for self-harm behavior was 1.11 (95% CI: 1.07, 1.15) compared with the risk at the 1st percentile temperature, and that for assault was 1.12 (95% CI: 1.08, 1.16) at lag 0. The RRs were highest at lag0 and less than 1 at lag7-20. CONCLUSION: The present study found that short-term exposure to higher temperature promotes the risk of emergency ambulance transport due to acts of self-harm and assault. The lag pattern indicates a possible “displacement” effect. These results suggest that exposure to high temperatures may potentially function as a trigger for intentional injuries.
Vietnam is highly vulnerable to climate change-related extreme weather events such as heatwaves. This study assesses the association between heatwaves and hospitalizations due to mental and behavioral disorders (MBDs) in Ho Chi Minh City (HCMC). We collected daily MBD hospital admissions data at the HCMC Mental Health Hospital from 2017 to 2019. Heatwaves effects were characterized into the main effect (i.e., the intensity of temperature during heatwaves) and the added effect (i.e., the duration of heatwaves). Time series Poisson regression coupled with a distributed lag linear model (DLM) was used to quantify the 14-day lags effect of heatwaves. Confounders including long-term trend, seasonality, days of the week, holidays, and relative humidity were included in the model. Heatwaves increased all-cause MBD hospitalization by 62% (95%Cl, 36-93%) for the main effect and by 8% (95% Cl, - 3% to 19%) for the added effect. Noticeably, the group aged 18-60 years old was affected by the main effect of the heatwave, while the group aged 61 years and older was affected by the added effect of the heatwave. The effects of heatwaves differed among groups of MBD hospitalizations. The mental and behavioral disorder group due to psychoactive substance use was significantly affected by the main effect of heatwaves (RR:2.21; 95%Cl:1.55-3.15). The group of schizophrenia, schizotypal and delusional disorders were highly vulnerable towards both the main and the added effect of heatwaves with RR = 1.50 (95%CI, 1.20-1.86) and RR = 1.14 (95%CI, 1.01-1.30), respectively.
The effect of thermal discomfort on human well-being and performance was studied in the field office, and an attempt was made to elucidate its psychological mechanism. Thirty participants were recruited to perform subjective evaluations and performance tests under 5 different conditions (25 degrees C, 27 degrees C, 29 degrees C, 31 degrees C, 33 degrees C). During the experiment, the air temperature was considered as an independent variable and other parameters were kept at the same level. The results show that thermal discomfort can lead to poor comfort and reduced performance, and people report that many sick building syndrome symptoms are intensified, showing more negative emotions and reducing their motivation. When people’s thermal sensation vote is -0.13, the best performance can be obtained. But the changes in human performance are not only caused by objective environmental factors, but also by psychological factors such as emotion and motivation. When people’s negative emotions decrease or their motivations increase, performance will also increase.
The combined effect of global warming and the heat island effect keeps the temperature of cities rising in the summer, seriously threatening the physical and mental health of urban residents. Taking the area within the Sixth Ring Road of Beijing as an example, based on Landsat remote sensing images, meteorological stations, and questionnaires, this study established a relational model between temperature and hostility and then analyzed the changes in the emotional health risk (hostility) in the study area and the mechanism of how outdoor activity duration influences hostility. Results show that: (1) the area within the Sixth Ring Road of Beijing had a higher and higher temperature from 1991 to 2020. Low-temperature areas gradually shrank, and medium- and high-temperature areas extended outwards from the center. (2) The threat of high temperature to residents’ hostility gradually intensified-the sphere of influence expanded, low-risk areas quickly turned into medium-high-risk areas, and the level of hostility risk increased. Level 1 risk areas of hostility had the most obvious reduction-a 74.33% reduction in area proportion; meanwhile, Level 3 risk areas had the most significant growth-a 50.41% increase in area proportion. (3) In the first 120 min of outdoor activities under high temperature, residents’ hostility was negatively correlated with outdoor activity duration; after more than 120 min, hostility became positively correlated with duration. Therefore, figuring out how temperature changes influence human emotions is of great significance to improving the living environment and health level of residents. This study attempts to (1) explore the impact of temperature changes and outdoor activity duration on hostility, (2) evaluate residents’ emotional health risk levels affected by high temperature, and (3) provide a theoretical basis for the early warning mechanism of emotional health risk and the planning of healthy cities.
The emotional health of urban residents has been seriously threatened by frequent and normalized heat waves. This study constructed the VI-level assessment standard for emotional health risk using data from satellite images, meteorological sites, questionnaire surveys, and statistical yearbooks to assess the effect of high temperatures on negative emotions in Hangzhou. The results showed that the morphological changes of urban high-temperature areas were aggregated from a cross-shape to a large patch shape, then dispersed into cracked patch shapes. Additionally, the health risk of daytime negative emotions peaked at the VI-level from 1984 to 2020, and the influence level of the typical period risk increased by 1-2 levels compared with the daytime. Additionally, driven by urban spatial structure policies, the risk pattern of emotional health expanded outward from a single center into multiple centers. The emotional health risk level rose and then descended in urban centers, and the innovation industries drove the variation tendency of hot spots. Furthermore, high educational background, employment, and couples living together were critical variables that could alleviate the emotional health risk to the middle-aged and elderly population. This study aimed to optimize the urban spatial structure and alleviate residents’ emotional health hazards for healthy urban planning.
OBJECTIVES: In the context of frequent global extreme weather events, there are few studies on the effects of sequential extreme precipitation (EP) and heatwaves (HW) events on schizophrenia. We aimed to quantify the effects of the events on hospitalizations for schizophrenia and compare them with EP and HW alone to explore the amplification effect of successive extremes on health loss. METHODS: A time-series Poisson regression model combined with a distributed lag non-linear model was applied to estimate the association between sequential EP and HW events (EP-HW) and schizophrenia hospitalizations. The effects of EP-HW with different intervals and intensities on the admission of schizophrenia were compared. In addition, we calculated the mean attributable fraction (AF) and attributable numbers (AN) per exposure of extreme events to reflect the amplification effect of sequential extreme events on health hazards compared with individual extreme events. RESULTS: EP-HW increased the risk of hospitalization for schizophrenia, with significant effects lasting from lag0 (RR and 95% CI: 1.150 (1.041-1.271)) to lag11 (1.046 (1.000-1.094)). Significant associations were found in the subgroups of male, female, married people, and those aged≥ 40 years old. Shorter-interval (0-3days) or higher-intensity EP-HW (both precipitation ≥ P97.5 and mean temperature ≥ P97.5) had a longer lag effect compared to EP-HW with longer intervals or lower intensity. We found that the mean AF and AN caused by each exposure to EP-HW (AF: 0.074% (0.015%-0.123%); AN: 4.284 (0.862-7.118)) were higher than those induced by each exposure to HW occurring alone (AF:0.032% (0.004%-0.058%); AN:1.845 (0.220-3.329)). CONCLUSIONS: Sequential extreme precipitation-heatwaves events significantly increase the risk of hospitalizations for schizophrenia, with greater impact and disease burden than independently occurring extremes. The impact of consecutive extremes is supposed to be considered in local sector early warning systems for comprehensive public health decision-making.
The association between heat and diseases has been extensively reported. However, its associated healthcare costs and attributable fraction due to heat were scarcely explored. The aim of this study was to estimate hospitalisation costs attributable to heat in Sydney, and to project future costs under climate change scenarios. Using a distributed lag nonlinear model, this study estimated heat-attributable hospitalisation costs in Sydney; and using 2010-2016 data as baseline, future costs for 2030s and 2050s were estimated under three climate change scenarios depending on greenhouse gas emissions – Representative Concentration Pathway (RCP)2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospitalisation costs. About 8-9% of the total hospitalisation costs were attributable to heat. The total costs attributable to heat over the baseline period 2010-2016 were estimated to be AU$252 million, with mental health hospitalisation making the largest contribution. Hospitalisation costs are estimated to increase substantially to AU$387-399 million in the 2030s, and AU$506-570 million by midcentury under different climate change scenarios. Urgent action is required to reduce heatattributable illness in our communities, particularly for mental health conditions. Relevant preparations including healthcare workforce capacity building and resource allocation are needed to deal with these challenges in the context of climate change.
OBJECTIVES: To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives. DESIGN: Descriptive, population-based, retrospective cohort study. METHODS: Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased’s socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations. RESULTS: Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8-77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training. CONCLUSIONS: Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15-45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.
Background: The negative impacts of environmental factors on allergic respiratory diseases (ARD) in children have gotten a lot of attention recently. However, the influence of climatic conditions, especially extreme temperatures, on childhood ARD induced by house dust mites (HDM-ARD) is uncertain. Objective: We aimed to quantify the associations between outpatient visits for HDM-ARD and extreme temperatures in Shanghai, China. Methods: A distributed lag nonlinear model combined with Quasi-Poisson generalized linear model was used to analyze data. Results: Daily mean temperature was significantly associated with outpatient visits for childhood ARD and HDM-ARD. Exposure to extreme temperatures increased the cumulative relative risks of outpatient visits for ARD and HDM-ARD in children (RRlag0-28 for the 5th percentile of Tmean: 2.97, 95% confidence interval (CI): 1.25, 7.06; RRlag0-28 for the 95th percentile of Tmean: 2.85, 95% CI: 1.03, 7.86). Boys were vulnerable to extreme lower temperature, while girls were more sensitive to extreme higher temperature in both ARD and HDM-ARD. The effect seemed to be most pronounced among 6-11 years of age school children. Conclusion: Our study presents quantitative evidence that extreme temperatures prompted outpatient visits for children with ARD, especially HDM-ARD, in Shanghai, China. These findings might have significant consequences for developing appropriate preventive measures for vulnerable populations.
BACKGROUND: Ambient temperature change is a risk factor for urolithiasis that cannot be ignored. The association between temperature and urolithiasis varies from region to region. Our study aimed to analyze the impact of extremely high and low temperatures on the number of inpatients for urolithiasis and their lag effect in Ganzhou City, China. METHODS: We collected the daily number of inpatients with urolithiasis in Ganzhou from 2018 to 2019 and the meteorological data for the same period. The exposure-response relationship between the daily mean temperature and the number of inpatients with urolithiasis was studied by the distributed lag non-linear model (DLNM). The effect of extreme temperatures was also analyzed. A stratification analysis was performed for different gender and age groups. RESULTS: There were 38,184 hospitalizations for urolithiasis from 2018 to 2019 in Ganzhou. The exposure-response curve between the daily mean temperature and the number of inpatients with urolithiasis in Ganzhou was non-linear and had an observed lag effect. The warm effects (30.4°C) were presented at lag 2 and lag 5-lag 9 days, and the cold effects (2.9°C) were presented at lag 8 and lag 3-lag 4 days. The maximum cumulative warm effects were at lag 0-10 days (cumulative relative risk, CRR = 2.379, 95% CI: 1.771, 3.196), and the maximum cumulative cold effects were at lag 0-5 (CRR = 1.182, 95% CI: 1.054, 1.326). Men and people between the ages of 21 and 40 were more susceptible to the extreme temperatures that cause urolithiasis. CONCLUSION: Extreme temperature was correlated with a high risk of urolithiasis hospitalizations, and the warm effects had a longer duration than the cold effects. Preventing urolithiasis and protecting vulnerable people is critical in extreme temperature environments.
Epidemiological studies have proven that extreme temperatures have a significant threat to public health. This study aimed to investigate the association between extreme temperatures and circulatory mortality from January 1, 2014, to December 31, 2016, in Harbin, a city with a cold climate in Northeast China. We set a maximum lag of 27 days to evaluate the hysteresis effects of different temperatures on circulatory mortality using a distributed lag nonlinear model (DLNM). Results indicated that daily mean temperature and circulatory mortality presented approximately an L-shaped, and the cumulative relative risks (RRs) decreased continuously as the temperature increased in both low and high temperatures. Extremely low temperature showed a hysteresis and durability on circulatory mortality, with the largest RR of 1.023 (95%CI: 1.001-1.046) at lag 26, and RR of the cumulative cold effect of 0-27 days was 1.302 (95%CI: 1.160-1.462). The effect of extremely high temperatures presented more acute and intense, with the largest RR of 1.033 (95%CI: 1.004-1.063) at lag 0. RR of the cumulative hot effect of 0-3 days was 1.056 (1.008-1.106). In addition, females were more susceptible to extremely low temperatures, while males were more vulnerable to extremely high temperatures. This study demonstrated that extremely low temperatures have a stronger effect on circulatory mortality than extremely high temperatures in Harbin.
With the rapid increase in global warming, the impact of extreme temperatures on morbidity and mortality related to respiratory diseases has attracted considerable attention. In the current study, we quantified the relative risks (RRs) of mortality for respiratory diseases in three capital cities in Northeast China. We used a distributed lag nonlinear model (DLNM) based on a generalized additive model (GAM) to estimate the impact of extreme temperatures on respiratory mortality in Shenyang, Changchun, and Harbin from 2014 to 2016. The results revealed that the maximum cumulative RRs and 95% confidence intervals (CIs) were 1.52 (1.28-1.80), 1.42 (1.07-1.89), and 1.38 (1.21-1.58) in Shenyang, Changchun, and Harbin respectively when the median temperature was used as reference. The effect of extremely high temperature (99th percentile relative to 90th percentile) on respiratory mortality was found to be strongest in Shenyang (at the lowest latitude), while the effect of extreme low temperature (1st percentile relative to 10th percentile) on respiratory mortality was strongest in Harbin (at the highest latitude). In Shenyang and Changchun, the effects of high temperatures were much more intense and pronounced in females. Furthermore, the effect of high temperatures was more acute, whereas the effect of low temperatures was longer lasting.
Global climate change increased air temperature variability and enhanced the frequency and intensity of extreme weather events, such as heat waves and cold spells with adverse impacts on public health. In this study, we examined the relationships of the daily air temperature with mortality in Shanghai in 2003, a record hot year. We found V-shaped associations between causespecific mortality and daily air temperature. The temperature-mortality relationship well manifests in three temperature measures, but with varied temperature thresholds for different age groups and mortality categories. Two heat waves and one cold spell were identified in 2003 and brought out excess mortality. The first heat wave lasting for 19 days had a significant impact on total non-accidental, cardiovascular and respiratory deaths compared to the corresponding reference period. The second heat wave lasting for 14 days have resulted in excess mortality in three categories of mortality but without statistical significance. The cold spell lasting for 7 days only had a significant impact on total non-accidental and cardiovascular mortality. We also found the elderly are more sensitive to temperature variation. Our results suggest that air temperature is a significant factor influencing human mortality, particularly for the elderly.
Out-of-hospital cardiac arrest (OHCA) is a notable public health issue with negative outcomes, such as high mortality and aftereffects. Additionally, the adverse effects of extreme temperatures on health have become more important under climate change; however, few studies have investigated the relationship between temperature and OHCA. In this study, we examined the association between temperature and OHCA and its underlying risk factors. We conducted a two-stage time-series analysis using a Poisson regression model with a distributed lag non-linear model (DLNM) and meta-analysis, based on a nationwide dataset from South Korea (2008-2018). We found that 17.4% of excess OHCA was attributed to cold, while 0.9% was attributed to heat. Based on central estimates, excess OHCA attributed to cold were more prominent in the population with hypertension comorbidity (31.0%) than the populations with diabetes (24.3%) and heart disease (17.4%). Excess OHCA attributed to heat were larger in the populations with diabetes (2.7%) and heart disease comorbidity (2.7%) than the population with hypertension (1.2%) based on central estimates. Furthermore, the time-varying excess OHCA attributed to cold have decreased over time, and although those of heat did not show a certain pattern during the study period, there was a weak increasing tendency since 2011. In conclusion, we found that OHCAs were associated with temperature, and cold temperatures showed a greater impact than that of hot temperatures. The effects of cold and hot temperatures on OHCA were more evident in the populations with hypertension, diabetes, and heart diseases, compared to the general population. In addition, the impacts of heat on OHCA increased in recent years, while those of cold temperatures decreased. Our results provide scientific evidence for policymakers to mitigate the OHCA burden attributed to temperature.
Understanding extreme temperature variations is important for countries to manage risks associated with climate change. Yet, the characteristics of temperature extremes and possible climate change impacts have not been adequately investigated in Singapore. In this study, we attempted to do so by defining 14 extreme temperature indices (ETIs) for the period of 1982-2018 in Singapore, and investigating the trends of those ETIs using a pre-whitening Man-Kendall test coupled with the Sen’s slope estimator method. The linear and nonlinear relationships between ETIs and El Nino Southern Oscillation (ENSO) were also examined using correlation, composite and wavelet analysis. Our results indicate that trends of temperature extremes varied according to station locations, ETIs and time scales. In all stations, ETIs such as the monthly mean value of the diurnal range between maximum and minimum temperatures (DTR), cool nights (TN10p) and cool days (TX10p) presented decreasing trends, while the rest of them exhibited increasing trends. The composite values varied for different ETIs-meaning that while eight no-threshold ETIs reflected smaller values, other ETIs reflected relatively larger composite values, indicating that ENSO may have affected those ETIs more. The ETIs were mainly statistically and significantly coherent with ENSO at a 2-8 year cycle. We hope that our findings would be beneficial for climate action planning and temperature-related disaster prevention in Singapore.
BACKGROUND: Previous studies have found that exposed to low and high outdoor temperature was associated with cardiovascular diseases morbidity and mortality. The risk factors for cardiovascular disease include high blood lipid, high uric acid (UA) and high fasting plasma glucose (FPG). However, few studies have explored the effects of low and high temperature on these metabolic indicators. OBJECTIVE: To explore the effect of low and high temperature on metabolic indicators in adults from northwest of China. METHODS: Based on a prospective cohort study, a total of 30,759 individuals who participated in both baseline and first follow-up from 2011 to 2015 were selected in this study. The meteorological observation data and environmental monitoring data were collected in the same period. Associations between cold and hot temperature and blood lipid (total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C)), UA and FPG were conducted with mixed effect models after adjusting for confounding factors. RESULTS: A nonlinear relationship between outdoor temperature and metabolic indicators was found. For the cold effects, each 5 °C decrease of mean temperature was associated with an increase of 5.07% (95% CI: 3.52%, 6.63%) in TG and 2.85% (95% CI: 2.18%, 3.53%) in UA, While a decrease of 3.38% (95% CI: 2.67%, 4.09%) in HDL-C and 1.26% (95% CI: 0.48%, 2.04%) in LDL-C. For the heat effects, each 5 °C increase in mean temperature was associated with 1.82% (95% CI: 0.89%, 2.76%), 0.56% (95% CI: 0.11%, 1.00%), 5.82% (95% CI: 4.58%, 7.06%), 9.02% (95% CI: 7.17%, 10.87%), 0.20% (95% CI: 0.01%, 0.40%), and 1.22% (95% CI: 0.19%, 2.24%) decrease in TC, TG, HDL-C, LDL-C, UA and FPG. Age, smoking, drinking, high-oil diet and hyperlipidemia might modify the association between mean temperature and metabolic indicators. CONCLUSION: There was a significant effect of cold and hot temperature on metabolic indicators in a high altitude area of northwestern China. These results provide a basis for understanding the underlying mechanism of the influence of temperature on metabolic diseases.
BACKGROUND: The influences of air pollution exposure and temperature on respiratory diseases have become major global health concerns. This study investigated the relationship between ambient air pollutant concentrations and temperature in cold industrial cities that have the risk of hospitalization for respiratory diseases. METHODS: A time-series study was conducted in Changchun, China, from 2015 to 2019 to analyse the number of daily admissions for respiratory diseases, air pollutant concentrations, and meteorological factors. Time-series decomposition was applied to analyse the trend and characteristics of the number of admissions. Generalized additive models and distributed lag nonlinear models were constructed to explore the effects of air pollutant concentrations and temperature on the number of admissions. RESULTS: The number of daily admissions showed an increasing trend, and the seasonal fluctuation was obvious, with more daily admissions in winter and spring than in summer and autumn. There were positive and gradually decreasing lag effects of PM10, PM2.5, NO(2), and CO concentrations on the number of admissions, whereas O(3) showed a J-shaped trend. The results showed that within the 7-day lag period, 0.5°C was the temperature associated with the lowest relative risk of admission due to respiratory disease, and extremely low and high temperatures (<-18°C, >27°C, respectively) increased the risk of hospitalization for respiratory diseases by 8.3% and 12.1%, respectively. CONCLUSIONS: From 2015 to 2019, respiratory diseases in Changchun showed an increasing trend with obvious seasonality. The increased concentrations of SO(2), NO(2), CO, PM2.5, O(3) and PM10 lead to an increased risk of hospitalization for respiratory diseases, with a significant lag effect. Both extreme heat and cold could lead to increases in the risk of admission due to respiratory disease.
Extreme temperature could affect traffic crashes by influencing road safety, vehicle performance, and drivers’ behavior and abilities. Studies evaluating the impacts of extreme temperatures on the risk of traffic crashes have mainly overlooked the potential role of vehicle air conditioners. The aim of this study, therefore, was to evaluate the effect of exposure to extreme cold and hot temperatures on seeking medical attention due to motorcycle crashes. The study was conducted in Iran by using medical attendance for motorcycle crashes from March 2011 to June 2017. Data on daily minimum, mean and maximum temperature (°C), relative humidity (%), wind velocity (km/h), and precipitation (mm/day) were collected. We developed semi-parametric generalized additive models following a quasi-Poisson distribution with the distributed nonlinear lag model to estimate the immediate and lagged associations (reported as relative risk [RR], and 95% confidence interval [CI]). Between March 2011 and June 2017, 36,079 medical attendances due to motorcycle road traffic crashes were recorded (15.8 ± 5.92 victims per day). In this time period, the recorded temperature ranged from -11.2 to 45.4 °C (average: 25.5 ± 11.0 °C). We found an increased risk of medical attendance for motorcycle crashes (based on maximum daily temperature) at both extremely cold (1st percentile) and hot (99th percentile) temperatures and also hot (75th percentile) temperatures, mainly during lags 0 to 3 days (e.g., RR: 1.12 [95% CI: 1.05: 1.20]; RR: 1.08 [95% CI: 1.01: 1.16]; RR: 1.20 [95% CI: 1.09: 1.32] at lag0 for extremely cold, hot, and extremely hot conditions, respectively). The risk estimates for extremely hot temperatures were larger than hot and extremely cold temperatures. We estimated that 11.01% (95% CI: 7.77:14.06) of the medical attendance for motorcycle crashes is estimated to be attributable to non-optimal temperature (using mean temperature as exposure variable). Our findings have important public health messaging, given the considerable burden associated with road traffic injury, particularly in low- and middle-income countries.
BACKGROUND: Out-of-hospital-cardiac arrest (OHCA) is frequently linked to environmental exposures. Climate change and global warming phenomenon have been found related to cardiovascular morbidity, however there is no agreement on their impact on OHCA occurrence. In this nationwide analysis, we aimed to assess the incidence of the OHCA events attended by emergency medical services (EMS), in relation to meteorological conditions: temperature, humidity, heat index and solar radiation. METHODS: We analyzed all adult cases of OHCA in Israel attended by EMS during 2016-2017. In the case-crossover design, we compared ambient exposure within 72 h prior to the OHCA event with exposure prior to the four control times using conditional logistic regression in a lag-distributed non-linear model. RESULTS: There were 12,401 OHCA cases (68.3% were pronounced dead-on-scene). The patients were on average 75.5 ± 16.2 years old and 55.8% of them were males. Exposure to 90th and 10th percentile of temperature adjusted to humidity were positively associated with the OHCA with borderline significance (Odds Ratio (OR) =1.20, 95%CI 0.97; 1.49 and OR 1.16, 95%CI 0.95; 1.41, respectively). Relative humidity below the 10th percentile was a risk factor for OHCA, independent of temperature, with borderline significance (OR = 1.16, 95%CI 0.96; 1.38). Analysis stratified by seasons revealed an adverse effect of exposure to 90th percentile of temperature when estimated in summer (OR = 3.34, 95%CI 1.90; 3.5.86) and exposure to temperatures below 10th percentile in winter (OR = 1.75, 95%CI 1.23; 2.49). Low temperatures during a warm season and high temperatures during a cold season had a protective effect on OHCA. The heat index followed a similar pattern, where an adverse effect was demonstrated for extreme levels of exposure. CONCLUSIONS: Evolving climate conditions characterized by excessive heat and low humidity represent risk factors for OHCA. As these conditions are easily avoided, by air conditioning and behavioral restrictions, necessary prevention measures are warranted.
Epidemiological studies have reported the association between extreme temperatures and adverse reproductive effects. However, the susceptible period of exposure during pregnancy remains unclear. This study aimed to assess the impact of extreme temperature on the stillbirth rate. We performed a time-series analysis to explore the associations between temperature and stillbirth with a distributed lag nonlinear model. A total of 22,769 stillbirths in Taiwan between 2009 and 2018 were enrolled. The mean stillbirth rate was 11.3 ± 1.4 per 1000 births. The relative risk of stillbirth due to exposure to extreme heat temperature (> 29 °C) was 1.18 (95% CI 1.11, 1.25). Pregnant women in the third trimester were most susceptible to the effects of extreme cold and heat temperatures. At lag of 0-3 months, the cumulative relative risk (CRR) of stillbirth for exposure to extreme heat temperature (29.8 °C, 97.5th percentile of temperature) relative to the optimal temperature (21 °C) was 2.49 (95% CI: 1.24, 5.03), and the CRR of stillbirth for exposure to extreme low temperature (16.5 °C, 1st percentile) was 1.29 (95% CI: 0.93, 1.80). The stillbirth rate in Taiwan is on the rise. Our findings inform public health interventions to manage the health impacts of climate change.
BACKGROUND: This study aimed to explore the effects of heatwaves and cold spells on blood pressure, thrombus formation, and systemic inflammation at admission in patients with ischemic stroke. METHODS: Data of patients with ischemic stroke who were admitted to the Second Hospital of Tianjin Medical University between May 2014 and March 2019 were reviewed, along with meteorological data from the same time period. A total of 806 clinically confirmed patients with ischemic stroke (34-97 years old) were included in the final analysis. Heatwaves and cold spells were defined as ≥2 consecutive days with average temperature >95(th) percentile (May-August) and <5(th) percentile (November-March), respectively. Coagulation parameters, inflammation indices, blood pressure, and neurological impairment were evaluated within 24 hours of admission. General linear and logistic regression models were created to investigate the relationships of heatwaves and cold spells with the examination results of patients with ischemic stroke at admission. RESULTS: After adjustment for potential environmental confounders, heatwaves were positively associated with high systolic blood pressure (SBP) (β=8.693, P=0.019), diastolic blood pressure (DBP) (β=3.665, P=0.040), reduced thrombin time (TT) (β=-0.642, P=0.027), and activated partial thromboplastin time (APTT) (β=-1.572, P=0.027) in ischemic stroke patients at admission. Cold spells were positively associated with high SBP (β=5.277, P=0.028), DBP (β=4.672, P=0.012), fibrinogen (β=0.315, P=0.011), globulin (β=1.523, P=0.011), and reduced TT (β=-0.784, P<0.001) and APTT (β=-1.062, P=0.024). Cold spells were also associated with a higher risk of respiratory infection [odds ratio (OR) =2.677, P=0.001]. CONCLUSIONS: Exposure to heatwaves or cold spells was associated with blood pressure and coagulation at admission in patients with ischemic stroke. Cold spells also resulted in higher levels of inflammation. These findings suggest that changes in coagulation, blood pressure, and inflammation may be the potential biological mechanisms underlying the cerebrovascular effects of exposure to extreme temperatures.
Day-to-day change in ambient temperature is associated with acute myocardial infarction (AMI) attacks, but evidence is scarce about the effects of extreme temperatures on the risk of AMI within hours of exposure. This study investigated the hour-level associations between extreme temperatures and AMI occurrence. State-wide data on AMI patients and temperature during winter and summer of 2013-2015 were obtained for Queensland state of Australia. We employed a fixed time-stratified case-crossover analysis to quantify the risk of AMI associated with temperature within 24 h after exposure. Subgroups analyses by age, gender and disease history were also conducted. We observed a very acute effect of cold on men (occurred 9-10 h after exposure), women (19-22 h after exposure), and the elderly (4-20 h after exposure). Cold was associated with elevated AMI risk for men within 9 h (OR = 2.1, 95 % CI: 1.2-3.6), women within 19 h (OR = 2.5, 95 % CI: 1.0-6.0), and the elderly within 4 h (OR: 2.0, 95 % CI: 1.0-4.0). However, elevated risk of AMI associated with heat occurred 15 h later for men (OR: 3.9; 95 % CI: 1.1-13.9) and 23 h later for adults (OR: 4.1, 95 % CI: 1.1-15.4). People never suffered AMI and the elderly with diabetes or hyperlipidaemia were particularly vulnerable to cold. Those that were particularly vulnerable to heat were men never experienced AMI or having hypertension or having hyperlipidaemia as well as women ever suffered AMI. Effects of temperature on AMI risk at sub-daily timescales should be considered to prevent cardiac events.
BACKGROUND: A growing number of studies have investigated the effect of increasing temperatures on morbidity and health service use. However, there is a lack of studies investigating the temperature-attributable cost burden. OBJECTIVES: This study examines the relationship of daily mean temperature with hospital admissions, length of hospital stay (LoS), and costs; and estimates the baseline temperature-attributable hospital admissions, and costs and in relation to warmer climate scenarios in Adelaide, South Australia. METHOD: A daily time series analysis using distributed lag non-linear models (DLNM) was used to explore exposure-response relationships and to estimate the aggregated burden of hospital admissions for conditions associated with temperatures (i.e. renal diseases, mental health, diabetes, ischaemic heart diseases and heat-related illnesses) as well as the associated LoS and costs, for the baseline period (2010-2015) and different future climate scenarios in Adelaide, South Australia. RESULTS: During the six-year baseline period, the overall temperature-attributable hospital admissions, LoS, and associated costs were estimated to be 3915 cases (95% empirical confidence interval (eCI): 235, 7295), 99,766 days (95% eCI: 14,484, 168,457), and AU$159 million (95% eCI: 18.8, 269.0), respectively. A climate scenario consistent with RCP8.5 emissions, and including projected demographic change, is estimated to lead to increases in heat-attributable hospital admissions, LoS, and costs of 2.2% (95% eCI: 0.5, 3.9), 8.4% (95% eCI: 1.1, 14.3), and 7.7% (95% eCI: 0.3, 13.3), respectively by mid-century. CONCLUSIONS: There is already a substantial temperature-attributable impact on hospital admissions, LoS, and costs which are estimated to increase due to climate change and an increasing aged population. Unless effective climate and public health interventions are put into action, the costs of treating temperature-related admissions will be high.
Urban heat island can exacerbate the harmful influence on human health and urban environment in historical and cultural block within Beijing Old City, China. To improve urban resilience and human well-being, protect historical and cultural heritage, nature-based solutions for urban heat mitigation are being the hotspot of research. However, only few studies focused on the comprehensive thermal environment of historical and cultural block from the social, ecological and technical aspects. Thus, we set-up scenarios combining with the three domains, to explore the cooling effect and thermal comfort improvement of Dashilar Block through ENVI-met. The results showed that 1) The areas with highest air temperature (Ta) and physiological equivalent temperature (PET) were mainly distributed in Peizhi Hutong and Zongshu Toutiao. 2) Five mitigation scenarios adapting to historical protection requirements and public preferences were vertical greening, traditional greening, quality improvement greening, high-albedo paving, and comprehensive. 3) The comprehensive and vertical greening scenarios could reduce the mean Ta of whole block by 1.01 degrees C or 0.38 degrees C, decrease the percentage of Ta hotter zone by 13.87% or 19.63%, and reduce the local Ta inside the block by 0.65 degrees C-1.80 degrees C or 0.33 degrees C-1.05 degrees C, respectively, which turned out the cooling effect and thermal comfort improvement of abovementioned two scenarios could significantly alleviate the heat stress. The comprehensive and vertical greening can act as the preferred nature-based solution for heat mitigation in Dashilar Block. We believed that this study would provide novel insights into the balance between urban heat mitigation and heritage protection during the renewal of Beijing Old City.
Extreme heat events caused by climate change have serious adverse effects on residents’ health in many coastal metropolises in southeast China. Adaptive capacity (AC) is crucial to reduce heat vulnerability in the human-environment system. However, it is unclear whether changes in individual characteristics and socioeconomic conditions likely amplify or attenuate the impacts of residents’ heat adaptive capacity (HAC) changes. Moreover, which public policies can be implemented by the authorities to improve the HAC of vulnerable groups remains unknown. We conducted a questionnaire survey of 630 residents of Xiamen, a typical coastal metropolis, in 2018. The effects of individual and household characteristics, and government actions on the residents’ HAC were examined by using ordinal logistic regression analysis. Results show that the majority (48.10%) of Xiamen residents had a “medium” HAC level, followed by a “high” level (37.14%). On Xiamen Island, residents who settled locally for one-three years and spent less than one hour outdoors might report weaker HAC, and their HAC would not improve with increased air conditioning units in household. In other areas of Xiamen, residents with more rooms in their households, no educational experience, and building areas <50 m(2) might report better HAC. Further, vulnerable groups, such as local residents and outdoor workers on Xiamen Island, people lacking educational experience and renters in other areas of Xiamen, showed better AC to hot weather than those in previous studies. Low-income groups should be given more attention by local governments and community groups as monthly household income played a positive role in improving Xiamen residents' HAC. Rational green spaces planning and cooling services, such as street sprinkling operations, provided by municipal departments can effectively bring benefits to Xiamen residents. Identification of basic conditions of AC has significant implications for practical promoting targeted measures or policies to reduce health damages and livelihood losses of urban residents during extreme heat events.
BACKGROUND: Workplace heat exposure can cause a series of heat-related illnesses and injuries. Protecting workers especially those undertake work outdoors from the risk of heat strain is a great challenge for many workplaces in China under the context of climate change. The aim of this study is to investigate the perceptions and adaptation behaviors of heat exposure among construction workers and to provide evidence for the development of targeted heat adaptation strategies nationally and internationally. METHODS: In 2020, we conducted a cross-sectional online questionnaire survey via WeChat Survey Star in China, using a purposive snowball sampling approach. A total of 326 construction workers submitted completed questionnaires. The perceptions of workplace heat exposure were measured using seven indicators: concerns over high temperature, perception of high temperature injury, attitudes towards both heat-related training and regulations, adjustment of working habits during heat, heat prevention measures in the workplace, and reduction of work efficiency. Bivariate and multivariate regression analyses were used to identify the factors significantly associated with workers’ heat perceptions and behavioral responses. RESULTS: 33.3% of the respondents were moderately or very concerned about heat exposure in the workplace. Less than half of the workers (43.8%) were worried about heat-related injuries. Workers who have either experienced work-related injuries (OR=1.30, 95% CI 1.03-1.62) or witnessed injuries to others during high temperatures (OR=1.12, 95% CI 1.02-1.27) were more concerned about heat exposure compared to other workers. Most respondents (63.5%) stated that their work efficiency declined during extremely hot weather. The factors significantly associated with a reduction of work efficiency included undertaking physically demanding jobs (OR=1.28, 95% CI 1.07-1.54) and witnessing other workers’ injuries during high temperatures (OR=1.26, 95% CI 1.11-1.43). More than half of the workers were willing to adjust their work habits to adapt to the impact of high temperatures (81.6%). The internet was the most common method to obtain heat prevention information (44.7%), and the most frequently used heat prevention measure was the provision of cool drinking water (64.8%). CONCLUSIONS: Chinese construction workers lack heat risk awareness and are not well prepared for the likely increasing heat exposure in the workplace due to global warming. Therefore, there is a need to improve their awareness of heat-related injuries, strengthen high temperature related education and training, and update the current heat prevention policies to ensure compliance and implementation.
Older people are more vulnerable to climate change and with its increasing elderly population, inadequate research on the health impacts of climate change has focused on this particular population in China. This study evaluates climate change and health-related knowledge, attitudes and practices (KAP) of elderly residents in three cities Suzhou, Hefei and Xiamen. This cross-sectional study included 3466 participants. Data analysis was undertaken using descriptive methods (Chi-square test). Results showed that the elderly were most concerned about heatwaves, flooding and drought and the main perceived health risks included heatstroke and respiratory diseases. Finally, over half of the participants from Suzhou city reported that they did not receive enough government assistance in extreme events (56%). Findings from this work provide important insights for new adaptation strategies targeting the elderly population. It is recommended that the government should focus on creating awareness of the necessary adaptations the elderly will need to take to alleviate the impact of climate change on their physical health.
Background: Short-term heat exposure might induce stroke morbidity and mortality, and there were several studies explored the possible vulnerable populations. At present, the research on the modification effect of intra-urban landscape characteristics on the association between heat and stroke morbidity is limited, especially in China. Methods: We collected data on 22,424 first-ever strokes between 2010 and 2016 in Shenzhen, from June to August of each year. We adopted the case-only study combined with logistic regression models to examine the modification effects of 5 urban landscape characteristics. We studied the characteristics of relevant vulnerable populations through stratification analyses. Results: High values (refer to the median values) of nighttime land surface temperature (LST) and the proportion of impervious surface may aggravate the harmful effects of heat on stroke morbidity, with the OR values (95% CI) of 1.205 (1.053, 1.357) and 1.115 (1.010, 1.220); while, high values of NDVI and the proportion of water bodies may alleviate the harmful effects of heat, with the OR values (95% CI) of 0.772 (0.699, 0.845) and 0.821 (0.741, 0.901). The OR value of daytime LST was 1.004 (0.861, 1.147). Statistically significant modification effects were located in the population without Shenzhen’s household registration; as for nighttime LST, statistically significant modification effects were located in females and the elderly. Conclusions: High values of nighttime LST and the proportion of impervious surface might aggravate the harmful effects of heat on stroke morbidity, while high green space and water cover might alleviate its effects. Immigrants were the related vulnerable populations. The government should take measures to cope with climate warming and pay attention to the health effects of heat on immigrants. (c) 2021 Published by Elsevier B.V.
Playgrounds in urban parks are important for children’s physical and mental health, but global warming has led to a worsening outdoor environment and children’s outdoor activities have been affected. Improving the outdoor thermal comfort (OTC) of playgrounds can encourage children to engage in more and safer outdoor activities. However, there are a limited number of studies focusing on preschoolers’ outdoor thermal comfort (OTC) and most of them have substituted children’s thermal comfort with caregivers’ evaluations. To investigate the differences between children’s and caregivers’ evaluations of thermal sensation, thermal benchmarks and thermal adaptive behavior for children, we conducted meteorological measurements on representative playgrounds in three parks in Wuhan, China, and administered thermal perception questionnaires to preschool children and their caregivers. In addition, the Physiological Equivalent Temperature (PET) was used to establish evaluation criteria for children’s OTC and to make recommendations for the improvement of the playground environment. We draw five conclusions by analyzing 719 valid questionnaires: (1) Children were less sensitive to changes in meteorological factors than caregivers and had better tolerance of cold environments. (2) The NPET for preschoolers was evaluated by children and by caregivers, respectively, as 22.9 degrees C and 22.3 degrees C in summer and 10.6 degrees C and 11.2 degrees C in winter. (3) Playgrounds in Wuhan’s parks are uncomfortable for a long time in summer and a short time in winter. (4) Both children and caregivers want to improve summer comfort by lowering the temperature and winter comfort by increasing solar radiation. At the same time, children and caregivers show different preferences in adaptive behavior choices. (5) Adding deciduous trees and water play facilities can improve the site thermal environment. Furthermore, the OTC of humans can be improved by adding more service facilities on playgrounds.
Due to limits to standard methods for surveying outdoor thermal comfort (OTC), it is difficult to compare thermal benchmarks and thermal index calibrations among studies and climatic regions. Using uniform standard meteorological measurements and questionnaire surveys, our study conducted an OTC study in urban parks in Beijing, Xi’an and Hami; representative of cities in China’s cold regions. The Universal Thermal Climate Index (UTCI) was used as the thermal comfort index, and differences in residents’ thermal perceptions and outdoor thermal benchmarks among these cities were compared. Results showed that: 1) air temperature (T(a)) and globe temperature (T(g)) were two primary factors affecting residents’ thermal sensations in the three cities during winter. Residents’ thermal sensation in Beijing and Hami was negatively correlated with wind speed (V(a)). Residents in Xi’an and Hami preferred a higher relative humidity (RH). Residents in Beijing and Hami preferred a lower V(a) to improve OTC related to local climatic characteristics. 2) Xi’an residents had the highest neutral UTCI (NUTCI) (17.3 °C), followed by Beijing (17.0 °C) and Hami (6.4 °C). Xi’an residents had slightly wider neutral UTCI range (NUTCIR) (7.9-26.7 °C) compared to Beijing (8.7-25.4 °C), while Hami residents had the narrowest NUTCIR (1.5-11.3 °C). The “no thermal stress” range in the three cities was 6.1-26.0 °C in Beijing, 6.7-25.5 °C in Xi’an, and -2.2-12.2 °C in Hami. 3) Calibrated thermal indices, based on the ASHRAE 7-point scale, were gained to judge the thermal qualities of an environment for all three cities.
BACKGROUND: The existing evidence suggests that pre-existing diabetes may modify the association between heat and hospitalizations for acute myocardial infarction (AMI). METHODS: This study included patients who were hospitalized for AMI from 1 January 2005 to 31 December 2013 in Brisbane, Australia, and also included those who died within 2 months after discharge. A time-stratified case-crossover design with conditional logistic regression was used to quantify the associations of heat and cold with hospitalizations and post-discharge deaths due to AMI in patients with and without pre-existing diabetes. Stratified analyses were conducted to explore whether age, sex and suburb-level green space and suburb-level socio-economic status modified the temperature-AMI relationship. Heat and cold were defined as the temperature above/below which the odds of hospitalizations/deaths due to AMI started to increase significantly. RESULTS: There were 14 991 hospitalizations for AMI and 1811 died from AMI within 2 months after discharge during the study period. Significant association between heat and hospitalizations for AMI was observed only in those with pre-existing diabetes (odds ratio: 1.19, 95% confidence interval: 1.00-1.41) [heat (26.3°C) vs minimum morbidity temperature (22.2°C)]. Cold was associated with increased odds of hospitalizations for AMI in both diabetes and non-diabetes groups. Significant association between cold and post-discharge deaths from AMI was observed in both diabetes and non-diabetes groups. CONCLUSIONS: Individuals with diabetes are more susceptible to hospitalizations due to AMI caused by heat and cold.
Climate may significantly affect human society. Few studies have focused on the temperature impact on residents’ health, especially mental health status. This paper uses 98 423 observations in China to study the relationship between temperature and health, based on the China Family Panel Studies survey during 2010-16. We analyze the health effects of extreme hot and cold weather and compare the effects under different social demographic factors including gender, age, and income. We find that temperature and health status exhibit a nonlinear relationship. Women and low-income households are more likely to be impacted by extreme cold, whereas men, the elderly, and high-income households are more sensitive to extreme heat. Our results highlight the potential effects of extreme temperatures on physical and mental health and provide implications for future policy decisions to protect human health under a changing climate.
OBJECTIVE: We aimed to examine the temporal trends of the association between extreme temperature and schizophrenia (SCZ) hospitalisations in Hefei, China. METHODS: We collected time-series data on SCZ hospitalisations for 10 years (2005-2014), with a total of 36 607 cases registered. We used quasi-Poisson regression and distributed lag non-linear model (DLNM) to assess the association between extreme temperature (cold and heat) and SCZ hospitalisations. A time-varying DLNM was then used to explore the temporal trends of the association between extreme temperature and SCZ hospitalisations in different periods. Subgroup analyses were conducted by age (0-39 and 40+ years) and gender, respectively. RESULTS: We found that extreme cold and heat significantly increased the risk of SCZ hospitalisations (cold: 1st percentile of temperature 1.19 (95% CI 1.04 to 1.37) and 2.5th percentile of temperature 1.16 (95% CI 1.03 to 1.31); heat: 97.5th percentile of temperature 1.37 (95% CI 1.13 to 1.66) and 99th percentile of temperature 1.38 (95% CI 1.13 to 1.69)). We found a slightly decreasing trend in heat-related SCZ hospitalisations and a sharp increasing trend in cold effects from 2005 to 2014. However, the risk of heat-related hospitalisation has been rising since 2008. Stratified analyses showed that age and gender had different modification effects on temporal trends. CONCLUSIONS: The findings highlight that as temperatures rise the body’s adaptability to high temperatures may be accompanied by more threats from extreme cold. The burden of cold-related SCZ hospitalisations may increase in the future.
To examine the associations between ambient temperature and hospitalizations for acute kidney injury (AKI) in Queensland, Australia, 1995-2016. Data were collected on a total of 34 379 hospitalizations for AKI from Queensland between 1 January 1995 and 31 December 2016. Meteorological data were downloaded from the Queensland Government’s Department of Environment and Science. We assessed the temperature-AKI relationship using a time-stratified case-crossover design fitted with conditional quasi-Poisson regression model and time-varying distributed lag non-linear model. Stratified analyses were performed by age, sex, climate zone and socioeconomic group. Both cold and hot temperatures were associated with hospitalizations for AKI. There were stronger temperature-AKI associations among women than men. Cold effects were only positive in the > 70 years age group. Hot effects were stronger in the <= 59 years age group than in the >60 years age group. In different climate zone areas, cold effects decreased with increasing local mean temperatures, while hot effects increased. In different socio-economic status groups, hot effects were stronger in the poor areas than the affluent areas. From 1995 to 2016, the magnitude of associations between cold temperature and hospitalizations for AKI decreased, while the hot effect increased. The associations between hot temperature and hospitalizations for AKI become stronger, while the magnitude of cold effect decreased from 1995 to 2016. This trend may accelerate over the coming decades, which warrants further research. More attention is needed toward susceptible population including women, people > 70 years, and the people living in hot climate zones and in low socioeconomic status areas.
This study aimed to estimate respiratory disease hospitalization costs attributable to ambient temperatures and to estimate the future hospitalization costs in Australia. The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010-2016 were analyzed using distributed non-linear lag models. Future hospitalization costs were estimated based on three predicted climate change scenarios-RCP2.6, RCP4.5 and RCP8.5. The estimated respiratory disease hospitalization costs attributable to ambient temperatures increased from 493.2 million Australian dollars (AUD) in the 2010s to more than AUD 700 million in 2050s in Sydney and from AUD 98.0 million to about AUD 150 million in Perth. The current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1-20.1%) and (5.1-6.6%), respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Limitations of this study should be noted, such as lacking information on individual-level exposures, local air pollution levels, and other behavioral risks, which is common in such ecological studies. Nonetheless, this study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change may result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location.
BACKGROUND: Extreme temperatures are associated with the risk of preterm birth (PTB), but evidence on the effects of different clinical subtypes and across different regions is limited. We aimed to evaluate the effects of maternal exposure to extreme temperature on PTB and its clinical subtypes in China, and to identify effect modification of regional factors in dimensions of population, economy, medical resources and environmental factors. METHODS: This was a prospective population-based cohort of 210,798 singleton live births from 16 counties in eight provinces across China during 2014-2018. We used an extended Cox regression with time-varying variables to evaluate the effects of extreme heat and cold on PTB and its subtypes in the entire pregnancy, each trimester, the last gestational month and week. Meta-analysis and meta-regression were conducted to estimate the pooled effects of each city and effect modification by regional characteristics. FINDINGS: Exposure to heat and cold during the entire pregnancy significantly increased the risk of PTB. The effects varied with subtypes, for medically indicated and spontaneous PTB, hazard ratios were 1·84 (95% CI: 1·29, 2·61) and 1·50 (95% CI: 1·11, 2·02) for heat, 2·18 (95% CI: 1·83, 2·60) and 2·15 (95% CI: 1·92, 2·41) for cold. The associations were stronger for PTB less than 35 weeks than those during weeks 35-36. The effects varied across locations, and GDP per capita (β=-0·16) and hospital beds per 1000 persons (β=-0·25) were protective factors for the effects. INTERPRETATION: Extreme temperature can increase the risk of medically indicated and spontaneous PTB, and higher regional socio-economic status may moderate such effects. In the context of climate change, such findings may have important implications for protecting the health of vulnerable groups, especially newborns. FUNDING: National Key R&D Program of China (2018YFA0606200), National Natural Science Foundation of China (42175183), Strategic Priority Research Program of the Chinese Academy of Sciences (XDA20030302), National Natural Science Foundation of China (42071377).
Extreme temperatures were considered natural hazards because they could increase morbidity and mortality. Understanding the extreme temperature changes at different warming levels is crucial to climate change mitigation and adoption for human health. This study projected climate change effects on the intensity, occurrence, and duration of extreme temperatures in Taiwan with 2 and 4 degrees C global warming scenarios using the Weather Research and Forecasting model. The future climate simulations were conducted with the pseudo-global warming approach, and the future climate changes were obtained from the ensemble mean of simulations in the Coupled Model Intercomparison Project 5. The simulated daily mean temperature increased by 1.40 and 3.09 degrees C under 2 and 4 degrees C global warmings. In a warming world, the daily maximum temperature was projected to increase by 1.35-3.00 degrees C, whereas the daily minimum temperature was even higher, leading to weaker diurnal temperature variation in most regions. The simulation results show that intensified heatwaves with frequent and prolonged durations become par for the course, whereas extremely cold days disappear gradually. The occurrence of heatwaves in the future is projected to be five times that in the current climate. Comparing the global warming impacts over different land-use types, the heatwave occurrence over urban areas rose more quickly than over other land-use types; forests are less vulnerable to global warming. On the contrary, the changes in extremely cold days over urban areas were weaker than over other land-use types. Overall, the effects of global warming on temperature revealed that extreme events were more severe with increased temperature than with the mean state of air temperature. Nonlinear behaviours indicated that global warming should be limited to 2 degrees C, and the additional 2 degrees C warming (from 2 to 4 degrees C) should be addressed carefully.
Although numerous studies have investigated premature deaths attributable to temperature, effects of temperature on years of life lost (YLL) remain unclear. We estimated the relationship between temperatures and YLL, and quantified the YLL per death caused by temperature in China. We collected daily meteorological and mortality data, and calculated the daily YLL values for 364 locations (2013-2017 in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces, and 2006-2011 in other locations) in China. A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates (YLL/100,000 population), and a multivariate meta-analysis model was used to pool location-specific associations. Then, YLL per death caused by temperatures was calculated. The temperature and YLL rates consistently showed U-shaped associations. A mean of 1.02 (95% confidence interval: 0.67, 1.37) YLL per death was attributable to temperature. Cold temperature caused 0.98 YLL per death with most from moderate cold (0.84). The mean YLL per death was higher in those with cardiovascular diseases (1.14), males (1.15), younger age categories (1.31 in people aged 65-74 years), and in central China (1.34) than in those with respiratory diseases (0.47), females (0.87), older people (0.85 in people ≥75 years old), and northern China (0.64) or southern China (1.19). The mortality burden was modified by annual temperature and temperature variability, relative humidity, latitude, longitude, altitude, education attainment, and central heating use. Temperatures caused substantial YLL per death in China, which was modified by demographic and regional characteristics.
People in urban agglomerations (UAs) are increasingly exposed to elevated extreme temperature events under global warming and local human activities such as urbanization. While the urbanization effects on local temperature changes have been well studied, possibly different effects on human perceived temperature (HPT), which measures the compound influences of multiple indicators (e.g., temperature, humidity, and wind), remain much less understood. Here, we examine the long-term changes in mean and extreme HPT in 20 major UAs across the mainland of China since the 1970s, and evaluate the effect of urbanization based on a dynamic classification of urban and rural stations using time-varying land use/land cover maps. The results show that mean HPT and actual near-surface air temperature (T) in both summer and winter seasons display significant trends in most portions of China, while the frequency of extreme HPT and T events in summer (winter) exhibits increasing (decreasing) tendency. These trends are particularly stronger in more populated and urbanized UAs. It is estimated that urbanization averagely accounts for around 1/6 of the total increasing trend in mean HPT and T in the urban core areas of 20 UAs. In both seasons, the effects of urbanization on mean HPT are more profound than T. Moreover, urbanization significantly increases the occurrence frequency of summertime hot extremes and decreases the occurrence of wintertime cold events. Regionally, northern UAs in general exhibit more remarkable trends than the south. The urbanization process exerts more prominent effects in HPT than T in nearly three-quarters of all UAs, except several regions with a complex topography and lower urbanization level. These findings reported here can provide suggestions and support for urban planning of decision-maker and human perceived thermal comfort choices of humans living in UAs.
BACKGROUND: Non-optimal temperatures are associated with mortality risk, yet the heterogeneity of temperature-attributable mortality burden across subnational regions in a country was rarely investigated. We estimated the mortality burden related to non-optimal temperatures across all provinces in China in 2019. METHODS: The global daily temperature data were obtained from the ERA5 reanalysis dataset. The daily mortality data and exposure-response curves between daily temperature and mortality for 176 individual causes of death were obtained from the Global Burden of Disease Study 2019 (GBD 2019). We estimated the population attributable fraction (PAF) based on the exposure-response curves, daily gridded temperature, and population. We calculated the cause- and province-specific mortality burden based on PAF and disease burden data from the GBD 2019. FINDINGS: We estimated that 593·9 (95% UI:498·8, 704·6) thousand deaths were attributable to non-optimal temperatures in China in 2019 (PAF=5·58% [4·93%, 6·28%]), with 580·8 (485·7, 690·1) thousand cold-related deaths and 13·9 (7·7, 23·2) thousand heat-related deaths. The majority of temperature-related deaths were from cardiovascular diseases (399·7 [322·8, 490·4] thousand) and chronic respiratory diseases (177·4 [141·4, 222·3] thousand). The mortality burdens were observed significantly spatial heterogeneity for both high and low temperatures. For instance, the age-standardized death rates (per 100 000) attributable to low temperature were higher in Western China, with the highest in Tibet (113·7 [82·0, 155·5]), while for high temperature, they were greater in Xinjiang (1·8 [0·7, 3·3]) and Central-Southern China such as Hainan (2·5 [0·9, 5·4]). We also observed considerable geographical variation in the temperature-related mortality burden by causes of death at provincial level. INTERPRETATION: A substantial mortality burden was attributable to non-optimal temperatures across China, and cold effects dominated the total mortality burden in all provinces. Both cold- and heat-related mortality burden showed significantly spatial variations across China. FUNDING: National Key Research and Development Program.
Little is known about the association between air temperature and causes-specific respiratory diseases (RD), especially in northwest China. A time-stratified case crossover design with a distributed lag nonlinear model (DLNM) was conducted to assess the nonlinear and delayed ef-fects of temperature on total and cause-specific outpatient visits, with analyses stratified by gender and age. The cumulative effects of temperature were irregular M-shaped curves for total and upper respiratory tract infection (URTI), with inverted U-shaped curve for pneumonia, bronchitis and chronic obstructive pulmonary disease (COPD). Positive cold and heat effects were observed for URTI, pneumonia, bronchitis and COPD, bronchitis was most vulnerable to cold but pneumonia was more affected to heat. Heat effects were immediate whereas cold effects were delayed and lasted longer. The magnitude of temperature effects varies greatly by age, gender, and disease. Notably, the cold effect was greater for children aged 0-14 than that of other age groups. This study suggested that both cold and hot temperatures exposure could increase all-cause and cause-specific respiratory outpatient visits in Lanzhou, China. The harmful effect and duration of cold were greater than that of heat, and children aged 0-14 were more sensitive to cold. Protection against extreme temperatures should be strengthened.
BACKGROUND: Evidence is scant on the relative and attributable contributions of ambient temperature on stroke subtypes mortality. Few studies have examined modification effects of multiple greenness indicators on such contributions, especially in China. We quantified the associations between ambient temperature and overall, ischemic, and hemorrhagic stroke mortality; further examined whether the associations were modified by greenness. METHODS: We conducted a multicenter time-series analysis from January 1, 2013 to December 31, 2019. we adopted a distributed lag non-linear model to evaluate county-specific temperature-stroke mortality associations. We then applied a random-effects meta-analysis to pool county-specific effects. Attributable mortality was calculated for cold and heat, defined as temperatures below and above the minimum mortality temperature (MMT). Finally, We conducted a multivariate meta-regression to determine associations between greenness and stroke mortality risks for cold and heat, using normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) as quantitative indicators of greenness exposure. RESULTS: In the study period, 138,749 deaths from total stroke were reported: 86,873 ischemic and 51,876 hemorrhagic stroke. We observed significant W-shaped relationships between temperature and stroke mortality, with substantial differences among counties and regions. With MMT as the temperature threshold, 17.16 % (95 % empirical CI, 13.38 %-19.75 %) of overall, 20.05 % (95 % eCI, 16.46 %-22.70 %) of ischemic, and 12.55 % (95 % eCI, 5.59 %-16.24 %) of hemorrhagic stroke mortality were attributable to non-optimum temperature (combining cold and heat), more mortality was caused by cold (14.94 %; 95 % eCI, 11.57 %-17.34 %) than by heat (2.22 %; 95 % eCI, 1.54 %-2.72 %). Higher levels of NDVI, SAVI and EVI were related to mitigated effects of non-optimum temperatures-especially heat. CONCLUSIONS: Exposure to non-optimum temperatures aggravated stroke mortality risks; increasing greenness could alleviate that risks. This evidence has important implications for local communities in developing adaptive strategies to minimize the health consequences of adverse temperatures.
Limited evidence is available on apparent temperature (AT) and hospital admissions for acute cardiac events. We examined the associations of AT with admissions for acute cardiac events and acute coronary syndrome (ACS), and explored the effect difference between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction ACS (NSTE-ACS). Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-admission associations. Stratified analyses were performed by gender and age-groups for acute cardiac events. A total of 11,657 acute cardiac events admissions were collected from hospital-based chest pain centers in Beijing, during 2017-2019. The single day effect of low AT (-11 degrees C, 2.5th percentile) appeared on the 2nd day and persisted until the 11th day, with estimated relative risk (RR) ranging from 1.44 (95% CI: 1.159, 1.790) to 1.084 (95% CI: 1.022, 1.150) for acute cardiac events and from 1.034 (95% CI: 1.010, 1.059) to 1.006 (95% CI: 1.000, 1.011) for ACS. The single day effect of high AT (34 degrees C, 97.5th percentile) was only observed on the current day. The cold effect on acute cardiac events was more pronounced among female and older patients. The cumulative effect of high AT on STEMI admissions and low AT on NSTE-ACS reached a peak RR peak of 2.545 (95% CI: 1.016, 6.375) and 3.71 (95% CI: 1.315, 10.469) on lag 0-6 days, respectively. Both high and low ATs were associated with increased risk of acute cardiac events and ACS admissions. STEMI admissions may be more sensitive to high AT while NSTE-ACS to low AT.
BACKGROUND: Most studies have focused on the relationship between ambient temperature and stroke mortality, but studies on the relationship between ambient temperature and stroke occurrence are still limited and inconsistent. OBJECTIVE: This study aimed to analyze the effect of ambient temperature and other environmental factors on emergency stroke visits in Beijing. METHODS: Our study utilized stroke visit data from the Beijing Red Cross Emergency Medical Center during 2017-2018, and applied a generalized additive model (GAM) as well as a distributed lag non-linear model (DLNM), respectively, regarding the direct, lagged, and cumulative effects of ambient temperature alone and with correction for other environmental factors on stroke occurrence. RESULTS: With a total of 26,984 emergency stroke patients in 2017-2018, both cold and hot effects were observed and weakened after correction for other environmental factors. Compared to the reference temperature, in the multi-factor model, extreme cold (-10°C) reached a maximum relative risk (RR) of 1.20 [95% Confidence Interval (CI): 1.09, 1.32] at lag 14 days, and extreme hot (30°C) had a maximum RR of 1.07 (95% CI: 1.04, 1.11) at lag 6 days. The cumulative effect of extreme cold reached a maximum of 2.02 (95% CI: 1.11, 3.67) at lag 0-14 days, whereas the cumulative effect of extreme hot temperature is greatest at lag 0-10 days, but no statistically significant effect was found. In addition, ischemic stroke patients, the elderly, and males were more susceptible to the effects of cold temperature. CONCLUSIONS: There is a non-linear relationship between ambient temperature and stroke occurrence, with cold temperature having a greater and longer-lasting impact than hot temperature.
By using 64,270 daily observations from a large hospital in Guangzhou between 2017 and 2019, we analyzed the impact of extreme temperature on the health of newborns via OLS regression with time fixed effect. Given that the short-term temperature change can be regarded as exogenous and random, solving the potential endogenous problem is critical. We find that extreme temperature negatively affects the health of newborns. The Apgar score, an index for evaluating neonatal health, decreases by 0.008 (0.029%) when the duration of extreme temperature events increases by a day. A series of robustness checks verify the reliability of this negative effect. Extreme temperature also has a particularly serious effect on the health of newborns whose mothers have poor education. By gradually extending the observation period, we find that the effect of extreme temperature on neonatal health is mainly concentrated 1-6 weeks before delivery, whereas the effect of extreme temperature on hospitalization cost is mainly concentrated 4-8 weeks before delivery. This paper provides a valuable reference for evaluating the health and social costs of extreme weather, and our findings are conducive to the construction of climate resilient health systems, especially in Guangzhou.
BACKGROUND: Despite concerns regarding increasingly frequent and intense heat waves due to global warming, there is still a lack of information on the effects of extremely high temperatures on the adult abundance of mosquito species that are known to transmit vector-borne diseases. This study aimed to evaluate the effects of extremely high temperatures on the abundance of mosquitoes by analyzing time series data for temperature and mosquito abundance in Incheon Metropolitan City (IMC), Republic of Korea, for the period from 2015 to 2020. METHODS: A generalized linear model with Poisson distribution and overdispersion was used to model the nonlinear association between temperature and mosquito count for the whole study area and for its constituent urban and rural regions. The association parameters were pooled using multivariate meta-regression. The temperature-mosquito abundance curve was estimated from the pooled estimates, and the ambient temperature at which mosquito populations reached maximum abundance (TMA) was estimated using a Monte Carlo simulation method. To quantify the effect of extremely high temperatures on mosquito abundance, we estimated the mosquito abundance ratio (AR) at the 99th temperature percentile (AR(99th)) against the TMA. RESULTS: Culex pipiens was the most common mosquito species (51.7%) in the urban region of the IMC, while mosquitoes of the genus Aedes (Ochlerotatus) were the most common in the rural region (47.8%). Mosquito abundance reached a maximum at 23.5 °C for Cx. pipiens and 26.4 °C for Aedes vexans. Exposure to extremely high temperatures reduced the abundance of Cx. pipiens mosquitoes {AR(99th) 0.34 [95% confidence interval (CI) 0.21-0.54]} to a greater extent than that of Anopheles spp. [AR(99th) 0.64 (95% CI 0.40-1.03)]. When stratified by region, Ae. vexans and Ochlerotatus koreicus mosquitoes showed higher TMA and a smaller reduction in abundance at extreme heat in urban Incheon than in Ganghwa, suggesting that urban mosquitoes can thrive at extremely high temperatures as they adapt to urban thermal environments. CONCLUSIONS: We confirmed that the temperature-related abundance of the adult mosquitoes was species and location specific. Tailoring measures for mosquito prevention and control according to mosquito species and anticipated extreme temperature conditions would help to improve the effectiveness of mosquito-borne disease control programs.
The rapid spread of dengue fever (DF) infection has posed severe threats to global health. Environmental factors, such as weather conditions, are believed to regulate DF spread. While previous research reported inconsistent change of DF risk with varying weather conditions, few of them evaluated the impact of extreme weather conditions on DF infection risk. This study aims to examine the short-term associations between extreme temperatures, extreme rainfall, and DF infection risk in South and Southeast Asia. A total of 35 locations in Singapore, Malaysia, Sri Lanka, and Thailand were included, and weekly DF data, as well as the daily meteorological data from 2012 to 2020 were collected. A two-stage meta-analysis was used to estimate the overall effect of extreme weather conditions on the DF infection risk. Location-specific associations were obtained by the distributed lag nonlinear models. The DF infection risk appeared to increase within 1-3 weeks after extremely high temperature (e.g. lag week 2: RR = 1.074, 95 % CI: 1.022-1.129, p = 0.005). Compared with no rainfall, extreme rainfall was associated with a declined DF risk (RR = 0.748, 95 % CI: 0.620-0.903, p = 0.003), and most of the impact was across 0-3 weeks lag. In addition, the DF risk was found to be associated with more intensive extreme weathers (e.g. seven extreme rainfall days per week: RR = 0.338, 95 % CI: 0.120-0.947, p = 0.039). This study provides more evidence in support of the impact of extreme weather conditions on DF infection and suggests better preparation of DF control measures according to climate change.
BACKGROUND: Global incidence of dengue has surged rapidly over the past decade. Each year, an estimated 390 million infections occur worldwide, with Asia-Pacific countries bearing about three-quarters of the global dengue disease burden. Global warming may influence the pattern of dengue transmission. While previous studies have shown that extremely high temperatures can impede the development of the Aedes mosquito, the effect of such extreme heat over a sustained period, also known as heatwaves, has not been investigated in a tropical climate setting. AIM: We examined the short-term relationships between maximum ambient temperature and heatwaves and reported dengue infections in Singapore, via ecological time series analysis, using data from 2009 to 2018. METHODS: We studied the effect of two measures of extreme heat – (i) heatwaves and (ii) maximum ambient temperature. We used a negative binomial regression, coupled with a distributed lag nonlinear model, to examine the immediate and lagged associations of extreme temperature on dengue infections, on a weekly timescale. We adjusted for long-term trend, seasonality, rainfall and absolute humidity, public holidays and autocorrelation. RESULTS: We observed an overall inhibitive effect of heatwaves on the risk of dengue infections, and a parabolic relationship between maximum temperature and dengue infections. A 1 °C increase in maximum temperature from 31 °C was associated with a 13.1% (Relative Risk (RR): 0.868, 95% CI: 0.798, 0.946) reduction in the cumulative risk of dengue infections over six weeks. Weeks with 3 heatwave days were associated with a 28.3% (RR: 0.717, 95% CI: 0.608, 0.845) overall reduction compared to weeks with no heatwave days. Adopting different heatwaves specifications did not substantially alter our estimates. CONCLUSION: Extreme heat was associated with decreased dengue incidence. Findings from this study highlight the importance of understanding the temperature dependency of vector-borne diseases in resource planning for an anticipated climate change scenario.
BACKGROUND: Dengue dynamics result from the complex interactions between the virus, the host and the vector, all being under the influence of the environment. Several studies explored the link between weather and dengue dynamics and some investigated the impact of climate change on these dynamics. Most attempted to predict incidence rate at a country scale or assess the environmental suitability at a global or regional scale. Here, we propose a new approach which consists in modeling the risk of dengue outbreak at a local scale according to climate conditions and study the evolution of this risk taking climate change into account. We apply this approach in New Caledonia, where high quality data are available. METHODS: We used a statistical estimation of the effective reproduction number (R(t)) based on case counts to create a categorical target variable : epidemic week/non-epidemic week. A machine learning classifier has been trained using relevant climate indicators in order to estimate the probability for a week to be epidemic under current climate data and this probability was then estimated under climate change scenarios. RESULTS: Weekly probability of dengue outbreak was best predicted with the number of days when maximal temperature exceeded 30.8°C and the mean of daily precipitation over 80 and 60 days prior to the predicted week respectively. According to scenario RCP8.5, climate will allow dengue outbreak every year in New Caledonia if the epidemiological and entomological contexts remain the same. CONCLUSION: We identified locally relevant climatic factor driving dengue outbreaks in New Caledonia and assessed the inter-annual and seasonal risk of dengue outbreak under different climate change scenarios up to the year 2100. We introduced a new modeling approach to estimate the risk of dengue outbreak depending on climate conditions. This approach is easily reproducible in other countries provided that reliable epidemiological and climate data are available.
Japanese encephalitis (JE) is an important mosquito-borne infectious disease in rural areas of Asia that is caused by Japanese encephalitis virus (JEV). Culex tritaeniorhynchus is the major vector of JEV, nevertheless there are other mosquitoes that may be able to transmit JEV. This study confirms that the midgut, head tissue, salivary glands, and reproductive tissue of Aedes albopictus, Armigeres subalbatus, and Culex quinquefasciatus are all able to be infected with JEV after a virus-containing blood meal was ingested by female mosquitoes. Even though the susceptibility to JEV of the different tissues varies, the virus-positive rate increased with the number of days after JEV infection. Moreover, once JEV escapes the midgut barrier, the oral transmission rates of JEV were 16%, 2%, and 21% for Ae. albopictus, Ar. subalbatus, and Cx. quinquefasciatus at 14 days after infection at 30 °C, respectively. There is no supporting evidence to suggest vertical transmission of JEV by the tested mosquitoes. Collectively, raising the temperature enhances JEV replication in the salivary gland of the three mosquito species, suggesting that global warming will enhance mosquito vector competence and that this is likely to lead to an increase in the probability of JEV transmission.
Vibrio infection was rarely reported in Tasmania prior to 2016, when a multistate outbreak of Vibrio parahaemolyticus associated with Tasmanian oysters was identified and 11 people reported ill. Since then, sporadic foodborne cases have been identified following consumption of commercially- and recreationally-harvested oysters. The increases in both foodborne and non-foodborne Vibrio infections in Tasmania are likely associated with increased sea water temperatures. As oyster production increases and climate change raises the sea surface temperature of our coastline, Tasmania expects to see more vibriosis cases. Vibriosis due to oyster consumption has been reported in other Australian states, but the variability in notification requirements between jurisdictions makes case and outbreak detection difficult and potentially hampers any public health response to prevent further illness.
BACKGROUND: High atmospheric temperature has been associated with the occurrence of bacillary dysentery (BD). Recent studies have suggested that hot extremes may influence health outcomes, however, none have examined the association between hot extremes and BD risk, especially at the national level. OBJECTIVES: To assess the effect and attributable burden of hot extremes on BD cases and to identify populations at high risk of BD. METHODS: Daily incident BD data of 31 provincial capital cities from 2010 to 2018 were collected from the Chinese Center for Disease Control and Prevention, weather data was obtained from the fifth generation of the European Re-Analysis Dataset. Three types of hot extremes, including hot day, hot night, and hot day and night, were defined according to single or sequential occurrence of daytime hot and nighttime hot within 24 h. A two-stage analytical strategy combined with distributed lag non-linear models (DLNM) was used to evaluate city-specific associations and national pooled estimates. RESULTS: Hot extremes were significantly associated with the risk of BD on lagged 1-6 days. The overall cumulative relative risk (RR) was 1.136 [95% confidence interval (CI): 1.022, 1.263] for hot day, 1.181 (95% CI: 1.019, 1.369) for hot night, and 1.154 (95% CI: 1.038, 1.283) for hot day and night. Northern residents, females, and children younger than or equal to 14 years old were vulnerable under hot night, southern residents were vulnerable under hot day, and males were vulnerable under hot day and night. 1.854% (95% CI: 1.294%, 2.205%) of BD cases can be attributable to hot extremes, among which, hot night accounted for a large proportion. CONCLUSIONS: Hot extremes may significantly increase the incidence risk and disease burden of BD. Type-specific protective measures should be taken to reduce the risk of BD, especially in those we found to be particularly vulnerable.
The COVID-19 pandemic continues to expand, while the relationship between weather conditions and the spread of the virus remains largely debatable. In this paper, we attempt to examine this question by employing a flexible econometric model coupled with fine-scaled hourly temperature variations and a rich set of covariates for 291 cities in the Chinese mainland. More importantly, we combine the baseline estimates with climate-change projections from 21 global climate models to understand the pandemic in different scenarios. We found a significant negative relationship between temperatures and caseload. A one-hour increase in temperatures from 25 degrees C to 28 degrees C tends to reduce daily cases by 15.1%, relative to such an increase from -2 degrees C to 1 degrees C. Our results also suggest an inverted U-shaped nonlinear relationship between relative humidity and confirmed cases. Despite the negative effects of heat, we found that rising temperatures induced by climate change are unlikely to contain a hypothesized pandemic in the future. In contrast, cases would tend to increase by 10.9% from 2040 to 2059 with a representative concentration pathway (RCP) of 4.5 and by 7.5% at an RCP of 8.5, relative to 2020, though reductions of 1.8% and 18.9% were projected for 2080-2099 for the same RCPs, respectively. These findings raise concerns that the pandemic could worsen under the climate-change framework.
BACKGROUND: The effects of extreme temperature on infectious diseases are complex and far-reaching. There are few studies to access the relationship of pulmonary tuberculosis (PTB) with extreme temperature. The study aimed to identify whether there was association between extreme temperature and the reported morbidity of PTB in Shandong Province, China, from 2005 to 2016. METHODS: A generalized additive model (GAM) was firstly conducted to evaluate the relationship between daily reported incidence rate of PTB and extreme temperature events in the prefecture-level cities. Then, the effect estimates were pooled using meta-analysis at the provincial level. The fixed-effect model or random-effect model was selected based on the result of heterogeneity test. RESULTS: Among the 446,016 PTB reported cases, the majority of reported cases occurred in spring. The higher reported incidence rate areas were located in Liaocheng, Taian, Linyi and Heze. Extreme low temperature had an impact on the reported incidence of PTB in only one prefecture-level city, i.e., Binzhou (RR = 0.903, 95% CI: 0.817-0.999). While, extreme high temperature was found to have a positive effect on reported morbidity of PTB in Binzhou (RR = 0.924, 95% CI: 0.856-0.997) and Weihai (RR = 0.910, 95% CI: 0.843-0.982). Meta-analysis showed that extreme high temperature was associated with a decreased risk of PTB (RR = 0.982, 95% CI: 0.966-0.998). However, extreme low temperature was no relationship with the reported incidence of PTB. CONCLUSION: Our findings are suggested that extreme high temperature has significantly decreased the risk of PTB at the provincial levels. The findings have implications for developing strategies to response to climate change.
The aim of this study was to explore the effect of temperature on tuberculosis (TB) incidence using the distributed lag non-linear model (DLNM) from 2017 to 2021 in Kashgar city, the region with higher TB incidence than national levels, and assist public health prevention and control measures. From January 2017 to December 2021, a total of 8730 cases of TB were reported, with the higher incidence of male than that of female. When temperature was below 1 °C, it was significantly correlated with TB incidence compared to the median observed temperature (15 °C) at lag 7, 14, and 21, and lower temperatures showed larger RR (relative risk) values. High temperature produced a protective effect on TB transmission, and higher temperature from 16 to 31 °C has lower RR. In discussion stratified by gender, the maximum RRs were achieved for both male group and female group at - 15 °C with lag 21, reporting 4.28 and 2.02, respectively. At high temperature (higher than 20 °C), the RR value of developing TB for female group was significantly larger than 1. In discussion stratified by age, the maximum RRs were achieved for all age groups (≤ 35, 36-64, ≥ 65) at - 15 °C with lag 21, reporting 3.20, 2.07, and 3.45, respectively. When the temperature was higher than 20 °C, the RR of the 36-64-year-old group and the ≥ 65-year-old group was significantly larger than 1 at lag 21, while significantly smaller than 1 for cumulative RR at lag 21, reporting 0.11, 95% confidence interval (CI) (0.01, 0.83) and 0.06, 95% CI (0.01, 0.44), respectively. In conclusion, low temperature, especially in extreme level, acts as a high-risk factor inducing TB transmission in Kashgar city. Males exhibit a significantly higher RR of developing TB at low temperature than female, as well as the elderly group in contrast to the young or middle-aged groups. High temperature has a protective effect on TB transmission in the total population, but female and middle-aged and elderly groups are also required to be alert to the delayed RR induced by it.
BACKGROUND: The association between the incidence of hand, foot, and mouth disease (HFMD) and ambient temperature has been well documented. Although the severity of symptoms is an important indicator of disease burden and varies significantly across cases, it usually was ignored in previous studies, potentially leading to biased estimates of the health impact of temperature. METHODS: We estimated the disability-adjusted life year (DALY) by considering the severity of symptoms for each HFMD case reported during 2010-2012 in Guangdong and used distributed lag-nonlinear models to estimate the association between the daily average temperature and daily DALY of HFMD cases at the city-level. We investigated the potential effect modifiers on the pathway between temperature and DALY and pooled city-specific estimates to a provincial association using a meta-regression. The overall impact of temperature was further evaluated by estimates of DALYs that could be attributed to HFMD. RESULTS: The overall cumulative effect of daily mean temperature on the DALY of HFMD showed an inverse-U shape, with the maximum effect estimated to be β = 0.0331 (95%CI: 0.0199-0.0463) DALY at 23.8°C. Overall, a total of 6.432 (95%CI: 3.942-8.885) DALYs (attributable fraction = 2.721%, 95%CI: 1.660-3.759%) could be attributed to temperature exposure. All the demographic subgroups had a similar trend as the main analysis, while the magnitude of the peak of the temperature impact tended to be higher among the males, those aged ≥3yrs or from the Pear-River Delta region. Additionally, the impact of temperature on DALY elevated significantly with the increasing population density, per capita GDP, and per capita green space in parks. CONCLUSIONS: Temperature exposure was associated with increased burden of HFMD nonlinearly, with certain groups such as boys and those from areas with greater population density being more vulnerable.
The burden of disease caused by ambient high temperature has become a public health concern, but the associations between high temperature and hand, foot, and mouth disease (HFMD) remain indistinct. We used distributed lag non-linear model (DLNM) to estimate the burden of disease attribute to high temperature, adjusting for long-term trend and weather confounders. Total 18,167,455 cases were reported in 31 Chinese provinces, the incidence of HFMD showed a gradually increasing trend from 2008 to 2017 in China. Minimum morbidity temperature (MMT) was mainly concentrated at 17 to 23 °C in ≤ 5 years old group, 18 to 25 °C in 6 ~ 10 years old group and 19 to 27 °C in > 10 years old group. The greatest relative risk (RR) in age group ≤ 5 years old was 2.06 (95% CI: 1.85 ~ 2.30) in Heilongjiang, and the lowest RR was 1.02 (95% CI: 1.00 ~ 1.05) in Guangdong; the greatest RR in age group 6 ~ 10 years old was 2.24 (95% CI: 1.72 ~ 2.91) in Guizhou, and the lowest RR was 1.01 (95% CI: 0.97 ~ 1.12) in Tianjin; the greatest RR in the age group > 10 years old was 2.53 (95% CI: 1.66 ~ 3.87) in Heilongjiang, and the lowest RR was 1.02 (95% CI: 0.71 ~ 1.46) in Henan. We found the positive association between high temperature and HFMD in China.
BACKGROUND: Hand, foot and mouth disease (HFMD) is one of the common intestinal infectious diseases worldwide and has caused huge economic and disease burdens in many countries. The average annual incidence rate of HFMD was 11.66% in Shaanxi during the time span from 2009 to 2018. There are distinct differences within Shaanxi, as it is a special region that crosses three temperature zones. Hence, in this study, a spatiotemporal analysis of Shaanxi was performed to reveal the characteristics of the distribution of HFMD and to explore the meteorological determinants of HFMD. METHODS: The county-level and municipal data from Shaanxi Province from 2009 to 2018 were applied to research the spatiotemporal characteristics of HFMD and its meteorological determinants. Time series and spatial autocorrelation analyses were applied to assess the spatiotemporal characteristics of HFMD. This study used spatial econometric panel models to explore the relationship between HFMD and meteorological factors based on the data of 107 counties and 10 municipalities. RESULTS: The incidence rate of HFMD displayed no variable trend throughout the whole research period. A high incidence rate of HFMD was observed from June to September, corresponding to a time when the climate is characterized by heavy rain, high temperature, and high humidity. The high-incidence areas were mainly located in the central region in Shaanxi, whereas the low-incidence spots were mainly found in Northern Shaanxi. Regarding the meteorological factors analysed in this study, in general, the incidence rate of HFMD in specific regions was positively associated with the rainfall, temperature and humidity. CONCLUSION: These results could be applied by the government and the general public to take effective measures to prevent disease. Region-targeted policies could be enacted and implemented in the future according to specific situations in different areas and the relevant meteorological determinants. Additionally, meteorological conditions normally extend to a wide-ranging region; thus, cooperation among surrounding regions is necessary.
BACKGROUND: Although exposure to air pollution has been linked to many health issues, few studies have quantified the modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo, China. METHODS: The data of daily incidence of influenza and the relevant meteorological data and air pollution data in Ningbo from 2014 to 2017 were retrieved. Low, medium and high temperature layers were stratified by the daily mean temperature with 25th and 75th percentiles. The potential modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo was investigated through analyzing the effects of air pollutants stratified by temperature stratum using distributed lag non-linear model (DLNM). Stratified analysis by sex and age were also conducted. RESULTS: Overall, a 10 μg/m(3) increment of O(3), PM(2.5), PM(10) and NO(2) could increase the incidence risk of influenza with the cumulative relative risk of 1.028 (95% CI 1.007, 1.050), 1.061 (95% CI 1.004, 1.122), 1.043 (95% CI 1.003, 1.085), and 1.118 (95% CI 1.028, 1.216), respectively. Male and aged 7-17 years were more sensitive to air pollutants. Through the temperature stratification analysis, we found that temperature could modify the impacts of air pollution on daily incidence of influenza with high temperature exacerbating the impact of air pollutants. At high temperature layer, male and the groups aged 0-6 years and 18-64 years were more sensitive to air pollution. CONCLUSION: Temperature modified the relationship between air pollution and daily incidence of influenza and high temperature would exacerbate the effects of air pollutants in Ningbo.
Extreme heat and poor air quality arising from landscape fires are an increasing global concern driven by anthropogenic climate change. Previous studies have shown these environmental conditions are associated with negative health outcomes for vulnerable people. Managing and adapting to these conditions in a warming climate can present substantial difficulties, especially in climates already challenging for human habitation. This study was set in the tropical city of Darwin, Australia. We recruited individuals from population groups vulnerable to outdoor hazards: outdoor workers, teachers and carers, and sportspeople, to participate in focus group discussions. We aimed to gain an understanding of the impacts of extreme heat and poor air quality and how individuals perceived and managed these environmental conditions. We identified a number of key themes relating to impacts on health, work and activity, and adaptive behaviors, while identifying gaps in policy and infrastructure that could improve the lives and protect the health of vulnerable people living, working, and playing in this region. In addition, these outcomes potentially provide direction for other regions with similar environmental challenges. Extreme heat and poor air quality place an additional burden on the lives of people in high-risk settings, such as outdoor workers, teachers and carers, and sportspeople.
Anxiety and depression are severe public health problems worldwide. The effects of ozone exposure on anxious and depressive symptoms remain largely unknown, especially in China. We evaluated the associations between ozone exposure and depression and anxiety among middle-aged and older adults across China. A multi-center community-based repeated measurement study among middle-aged and older adults was conducted from 2017 to 2018 in 11 provinces in China. The status of depression and anxiety was measured using Patient Health Questionnaire-9 (PHQ-9) and the generalized anxiety disorder seven-item (GAD-7) scale at the cut-off point of five, respectively. Concentrations of multiple ozone metrics were collected from real-time monitoring stations. The multilevel logistic regression model with random intercept was used to evaluate the effects of ambient ozone on anxiety and depression over different exposure windows. After adjusting for potential confounders, a 10 mu g /m(3) increase in the three months moving average of ozone was associated with the risk of anxiety [odds ratio (OR) = 1.25; 95% confidence interval (CI): 1.15; 1.37] and depression (OR = 1.17; 95% CI: 1.08; 1.27). A significantly positive modification effect of temperature on associations between ozone and anxiety was also found, while there is no interaction for depression. Exposure-response curves showed that there may be a threshold for the effect of ozone exposure on anxiety and depression over the three months moving average concentrations, with similar patterns observed at different temperature levels. People over 65 years old were at significantly higher risks of ozone-associated depression, while anxiety was more strongly associated with ozone in hypertensive patients. Our study supports the theory that anxiety and depression is associated with mid-term ozone exposure in China, and temperatures significantly enhanced their associations. These findings may have significant implications for promoting prevention activities regarding mental disorders and approaches in reducing the disease burden by simultaneously controlling air pollution and mitigating climate change.
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? Ozone (O(3)) is a weather-driven photochemical ambient pollutant, and its harm to human health may be affected by meteorological factors such as temperature. However, there is conflicting evidence regarding whether temperature can modify the effects of ozone on health. WHAT IS ADDED BY THIS REPORT? Short-term exposure to O(3) in the Beijing Municipality, Tianjin Municipality, Hebei Province, and surrounding areas was associated with an increased risk of human mortality and that association was positive modified by relatively higher (>75th 24 h-average temperature) or extreme cold temperature (<10th 24 h-average temperature). Under extreme temperatures (>90th 24 h-average temperature) modification, the associations were further increased. Cardiopulmonary diseases, as vulnerable diseases of air pollution, their mortality risks associated with O(3) were markedly strengthened by uncomfortable temperatures. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? This study suggests that policymakers should pay attention to the synergistic effect between ozone and heat or extreme cold on human health, as well as provide evidence for establishing an integrated early-warning system to protect the public against both uncomfortable temperature and air pollution.
Heatwaves (HWs) paired with higher ozone (O-3) concentration at the surface level pose a serious threat to human health. Their combined modulation of synoptic patterns and urbanization remains unclear. Using 5 years of summertime temperature and O-3 concentration observation in Beijing, this study explored potential drivers of compound HWs and O-3 pollution events and their public health effects. Three favorable synoptic weather patterns were identified to dominate the compound HWs and O-3 pollution events. These weather patterns contributing to enhance those conditions are characterized by sinking air motion, low boundary layer height, and high temperatures. Under the synergy of HWs and O-3 pollution, the mortality risk from all non-accidental causes increased by approximately 12.31 % (95 % confidence interval: 4.66 %, 20.81 %). Urbanization caused a higher risk of HWs and O-3 in urban areas than at rural stations. Particularly, due to O(3 )depletion caused by NO titration at traffic and urban stations, the health risks related to O(3 )pollution in different regions are characterized as follows: suburban stations > urban stations > rural stations > traffic stations. In general, favorable synoptic patterns and urbanization enhanced the health risk of these compound events in Beijing by 33.09 % and 18.95 %, respectively. Our findings provide robust evidence and implications for forecasting compound HWs and O-3 pollution events and their health risks in Beijing or in other urban areas all over the world that have high concentrations of O-3 and high-density populations.
The 1.5 °C pathways initially promoted by the challenges presented by climate change could bring substantial air quality-related benefits. However, since there is a lack of comprehensive assessment on emissions of air pollutants, meteorology, air quality, and heatwave occurrences under different climate goals, how significant the clean air cobenefits compared with the direct climate-related impact is uncertain. In this study, we assess the cobenefits of 1.5 °C pathways for air quality in China by linking multiple shared socioeconomic pathways, ensembling simulations of regional climate-air quality dynamic downscaling and an air pollution and climate-related health assessment model, and compare different kinds of benefits: the health benefits from direct slowing climate (reduced heatwaves) versus the health cobenefits from air quality improvement (the improved air quality from reduced air pollutants versus meteorological changes). The benefit of reduced air pollution emissions associated with sustainable development under 1.5 °C pathways dominated the overall impact, which could avoid 1 589 000 PM(2.5)-related and 526 000 O(3)-related deaths in 2050. Correspondingly, the impact of changed meteorology on air quality would avoid additional 8000 PM(2.5)-related deaths in 2050 under 1.5 °C pathways yet would lead to 22 000 O(3)-related deaths. Also, the heatwave-related deaths could be avoided by 7000. The substantial anthropogenic emission reduction cobenefits of 1.5 °C pathways in improving air quality significantly exceed the direct climate (heatwave-related) benefits and completely offset the impact of meteorological changes’ impact on air pollution under climate change.
A multitude of epidemiological studies have demonstrated that both ambient temperatures and air pollution are closely related to health outcomes. However, whether temperature has modification effects on the association between ozone and health outcomes is still debated. In this study, three parallel time-series Poisson generalized additive models (GAMs) were used to examine the effects of modifying ambient temperatures on the association between ozone and mortality (including non-accidental, respiratory, and cardiovascular mortality) in Chengdu, China, from 2014 to 2016. The results confirmed that the ambient high temperatures strongly amplified the adverse effects of ozone on human mortality; specifically, the ozone effects were most pronounced at > 28 °C. Without temperature stratification conditions, a 10-μg/m(3) increase in the maximum 8-h average ozone (O(3-8hmax)) level at lag01 was associated with increases of 0.40% (95% confidence interval [CI] 0.15%, 0.65%), 0.61% (95% CI 0.27%, 0.95%), and 0.69% (95% CI 0.34%, 1.04%) in non-accidental, respiratory, and cardiovascular mortality, respectively. On days during which the temperature exceeded 28 °C, a 10-μg/m(3) increase in O(3-8hmax) led to increases of 2.22% (95% CI 1.21%, 3.23%), 2.67% (95% CI 0.57%, 4.76%), and 4.13% (95% CI 2.34%, 5.92%) in non-accidental, respiratory, and cardiovascular mortality, respectively. Our findings validated that high temperature could further aggravate the health risks of O(3-8hmax); thus, mitigating ozone exposure will be brought into the limelight especially under the context of changing climate.
Numerous epidemiological studies have reported that ozone (O(3)) and temperature are independently associated with health outcomes, but modification of the effects of O(3) on health outcomes by temperature, and vice versa, has not been fully described. This study aimed to investigate effect modification by temperature on the association between O(3) and emergency ambulance dispatches (EADs) in Japan. Data on daily air pollutants, ambient temperature, and EADs were obtained from eight Japanese cities from 2007 to 2015. A distributed lag non-linear model combined with Poisson regression was performed with temperature as a confounding factor and effect modifier to estimate the effects of O(3) on EADs at low (<25th percentile), moderate (25th-75th percentile), and high (>75th percentile) temperature for each city. The estimates obtained from each city were pooled by random-effects meta-analysis. When temperature was entered as a confounder, the estimated effects of O(3) on EADs for all acute, cardiovascular, and respiratory illnesses were largest at lag 0 (current-day lag). Therefore, this lag was used to further estimate the effects of O(3) on EADs in each temperature category. The estimated effects of O(3) on EADs for all acute, cardiovascular, and respiratory illnesses in all eight Japanese cities increased with increasing temperature. Specifically, a 10 ppb increase in O(3) was associated with 0.80 % (95 % CI: 0.25 to 1.35), 0.19 % (95 % CI: -0.85 to 1.25), and 1.14 % (95 % CI: -0.01 to 2.31) increases in the risk of EADs for all acute, cardiovascular, and respiratory illnesses, respectively, when city-specific daily temperature exceeded the 75th percentile. Our findings suggest that the association between O(3) and EADs for all acute, cardiovascular, and respiratory illnesses is the highest during high temperature. Finding of this study can be used to develop potential mitigation measures against O(3) exposure in high temperature environment to reduce its associated adverse health effects.
BACKGROUND: Numerous studies have confirmed the association of ambient temperature and air pollution with a higher risk of morbidities, yet few have addressed their effect on the ocular system. The purpose of this study was to assess the association between temperature, air pollution, and emergency room visits for conjunctivitis. METHODS: In this case-crossover study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Daily exposure to fine and coarse particulate matter and temperature were determined by a hybrid model involving satellite sensors. Mean relative humidity was obtained from the Ministry of Environmental Protection meteorological monitoring station located in Beer-Sheva. RESULTS: Six hundred one patients were diagnosed with conjunctivitis in the SUMC emergency room. We discovered a positive association between temperature increments and incidence of conjunctivitis. The strongest effect was found during summer and autumn, with an immediate (lag0) incidence increase of 8.1% for each 1 °C increase in temperature (OR = 1.088, 95%CI: 1.046-1.132) between 24 and 28 °C in the summer and 7.2% for each 1 °C increase in temperature (OR = 1.072, 95%CI: 1.036-1.108) between 13 and 23 °C in the autumn. There was no statistically significant association between fine and coarse particulate matter and conjunctivitis incidence. CONCLUSION: Temperature increases during summer and autumn are significantly associated with an increased risk of conjunctivitis. Conjunctivitis is not associated with non-anthropogenic air pollution. These findings may help community clinics and hospital emergency rooms better predict conjunctivitis cases and will hopefully lead to improved prevention efforts that will lower the financial burden on both the individual and the public.
BACKGROUND: Climate change has resulted in an increase in ambient temperatures during the summer months as well as an increase in risk of associated air pollution and of potentially disastrous bushfires throughout much of the world. The increasingly frequent combination of elevated summer temperatures and bushfires may be associated with acute increases in risks of cardiovascular events, but this relationship remains unstudied. We evaluated the individual and cumulative impacts of daily fluctuations in temperature, fine particulate matter of less than 2.5 µm (PM(2.5)) pollution and presence of bushfires on incidence of acute coronary syndromes and Takotsubo syndrome. METHODS: From November 1, 2019, to February 28, 2020, all admissions with acute coronary syndromes or Takotsubo syndrome to South Australian tertiary public hospitals were evaluated. Univariate and combined associations were sought among each of 1) maximal daily temperature, 2) PM(2.5) concentrations, and 3) presence of active bushfires within 200 km of the hospitals concerned. RESULTS: A total of 504 patients with acute coronary syndromes and 35 with Takotsubo syndrome were studied. In isolation, increasing temperature was associated (r(s) = 0.26, P = .005) with increased incidence of acute coronary syndromes, while there were similar, but nonsignificant correlations for PM(2.5) and presence of bushfires. Combinations of all these risk factors were also associated with a doubling of risk of acute coronary syndromes. No significant associations were found for Takotsubo syndrome. CONCLUSION: The combination of high temperatures, presence of bushfires and associated elevation of atmospheric PM(2.5) concentrations represents a substantially increased risk for precipitation of acute coronary syndromes; this risk should be factored into health care planning including public education and acute hospital preparedness.
Australia is home to one of the highest rates of allergic rhinitis worldwide. Commonly known as ‘hay fever’, this chronic condition affects up to 30% of the population and is characterised by sensitisation to pollen and fungal spores. Exposure to these aeroallergens has been strongly associated with causing allergic reactions and worsening asthma symptoms. Over the last few decades, incidences of respiratory admissions have risen due to the increased atmospheric concentration of airborne allergens. The fragmentation and dispersion of these allergens is aided by environmental factors like rainfall, temperature and interactions with atmospheric aerosols. Extreme weather parameters, which continue to become more frequent due to the impacts of climate change, have greatly fluctuated allergen concentrations and led to epidemic thunderstorm asthma (ETSA) events that have left hundreds, if not thousands, struggling to breathe. While a link exists between airborne allergens, weather and respiratory admissions, the underlying factors that influence these epidemics remain unknown. It is important we understand the potential threat these events pose on our susceptible populations and ensure our health infrastructure is prepared for the next epidemic.
Severe volatile organic compound (VOC) pollution has become an urgent problem during the heating season in the North China Plain (NCP), as exposure to hazardous VOCs can lead to chronic or acute diseases. A campaign with online VOC measurements was conducted at a rural site in Wangdu, NCP during the 2018 heating season to characterize the compositions and associated sources of VOCs and to assess their potential health risks. The total concentration of VOCs with 94 identified species was 77.21 +/- 54.39 ppb. Seven source factors were identified by non-negative matrix factorization, including coal combustion (36.1%), LPG usage (21.1%), solvent usage (13.9%), biomass burning and secondary formation (142%), background (7.0%), industrial emissions (4.5%), and vehicle emissions (3.3%). The point estimate approach and Monte Carlo simulation were used to estimate the carcinogenic and non-carcinogenic risks of harzadous VOCs. The results showed that the cumulative health risk of VOCs was above the safety level. Acrolein, 1.2-dichlorprothane, 12-dichloropropane, chloroform, 1,3-butadiene, and benzene were identified as the key hazardous VOCs in Wangdu. Benzene had the highest average carcinogenic risk. Solvent usage and secondary formation were the dominant sources of adverse health effects. During the Spring Festival, most sources were sharply reduced; and VOC concentration declined by 49%. However, coal and biomass consumptions remained relatively large, probably due to heating demand. This study provides important references for the control strategies of VOCs during the heating season in heavily polluted rural areas in the NCP. (C) 2021 Elsevier B.V. All rights reserved.
El Plan Nacional de Predicción y Vigilancia de Fenómenos Meteorológicos Adversos (Meteoalerta) pretende facilitar la mejor y más actualizada información posible sobre los fenómenos atmosféricos adversos que se prevean, con un adelanto de hasta 72 horas. En ese sentido, uno de los avisos se corresponde con temperaturas mínimas y máximas extremas, con cuatro niveles básicos (de menor a mayor riesgo en modo semafórico) a partir del posible alcance de determinados umbrales: verde, amarillo, naranja y rojo. Estos umbrales se han establecido con criterios climatológicos cercanos al concepto de “poco o muy poco frecuente” y de adversidad, en función de la amenaza que puedan suponer para la población.
The purpose of the warnings on extreme temperatures is to prevent health problems resulting from cold and hot weather. The warnings are mainly intended for risk groups and people who work outdoors.
A heat wave warning is issued if stifling hot weather has been forecasted for some area in Finland. Criteria for cold weather warnings are based on wind chill index, which describes the combined effect of cold and wind. Warnings for hot and cold weather are for the next 5 days.
A large majority of climate change studies carried out to date are on changes in mean climate, which have comparatively downplayed variability. In terms of trend analysis or forecast, the scientific output and common knowledge for global warming are much more robust than for changes in temperature variability. Quantification of temperature variability adds another dimension of temporal scale, requiring immense labor and presenting great uncertainty. Regardless, this endeavor is necessary since changes in ambient temperature variabilities could also contribute to current and future human health burden besides changes in mean quantities. Here, we review the current literature on trends of surface air temperature variability defined at a range of timescales, aiming to tease out the welter of evidence and thus improving the scientific recognition of changes in air temperature variability in the context of climate change. The findings of reviewed studies from numerous regions differ substantially over various temporal scales. In general, the ambient temperature variability on short time scales (e.g., diurnal or inter-day) shows a downward trend, while it is increasing on longer time scales (e.g., inter-annual). We then move beyond the review and deliver an extended discussion of potential implications for future research related to ambient temperature variability. We highlight the need to consider the methodological choices, especially timescales of interest, in the trend analysis as well as health impact studies. Continued research focusing on temperature variability at multiple timescales, with concerted efforts from scientists of all relevant stripes, is meaningful in synthesizing knowledge and reducing uncertainties surrounding air temperature variability.
Pollens are a major cause of seasonal allergic diseases. Weather may alter the production of pollens. Increased atmospheric temperatures lead to earlier pollination of many plants and longer duration of pollination, resulting in extended pollen seasons, with early spring or late winter. Longer pollen seasons increase duration of exposure, resulting in more sensitization, and higher pollen concentrations may lead to more severe symptoms. Climate changes in contact to pollens may affect both allergic sensitization and symptom prevalence with severity. The future consequences of climate change, however, are speculative, because the influence on humans, is complex.
BACKGROUND: Climate change is broadly affecting human health, with grave concern that continued warming of the earth’s atmosphere will result is serious harm. Since the mid-20th century, skin cancer incidence rates have risen at an alarming rate worldwide. OBJECTIVE: This review examines the relationship between climate change and cutaneous carcinogenesis. METHODS: A literature review used the National Institutes of Health databases (PubMed and Medline), the Surveillance, Epidemiology, and End Results and International Agency for Research on Cancer registries, and published reports by federal and international agencies and consortia, including the Australian Institute of Health and Welfare, Climate and Clean Air Coalition, U.S. Environmental Protection Agency, Intergovernmental Panel on Climate Change, National Aeronautics and Space Administration, National Oceanic and Atmospheric Administration, United Nations Environment Programme, World Health Organization, and World Meteorological Organization. RESULTS: Skin cancer risk is determined by multiple factors, with exposure to ultraviolet radiation being the most important. Strong circumstantial evidence supports the hypothesis that factors related to climate change, including stratospheric ozone depletion, global warming, and ambient air pollution, have likely contributed to the increasing incidence of cutaneous malignancy globally and will continue to impose a negative on influence skin cancer incidence for many decades to come. CONCLUSION: Because much of the data are based on animal studies and computer simulations, establishing a direct and definitive link remains challenging. More epidemiologic studies are needed to prove causality in skin cancer, but the evidence for overall harm to human health as a direct result of climate change is clear. Global action to mitigate these negative impacts to humans and the environment is imperative.
INTRODUCTION: Type 2 diabetes and climate change are forefront global challenges of the 21st century. Both are on a progressive incline with intergenerational effects on the wellbeing, health and security of the population. The aim of this review was to explore the interconnection relationship between type 2 diabetes and climate change. METHODS: A literature review search of MEDLINE publications from 2010 to March 2020 was performed. English-language articles using terms “diabetes” AND “climate change” OR “temperature change” OR “temperature rise” OR “hot temperature” OR “extreme heat” were reviewed. RESULTS: Climate change and diabetes are interconnected through a direct and indirect pathway. Temperature changes can trigger a person’s susceptibility to develop diabetes as well as impose adverse effects on those diagnosed with diabetes (such as increased incidence of hospitalization, dehydration and mortality). Both temperature extremes have been reported to lead to negative effects on diabetes. Concurrently, both phenomena have shared predisposing vectors (such as sedentary lifestyle, urbanisation, unhealthy diets) that lead to their progressive development. CONCLUSION: A bidirectional relationship exists between type 2 diabetes and climate change. This relationship originates through a multifactorial pathway involving biological, social, environmental, geophysical and economic factors. An integrated action plan targeting the common predisposing vectors should be set up. This should support a low environmental impact while promoting equity and wellbeing.
For the Chinese, French, German, and Spanish translations of the abstract see Supplementary Materials section.
Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.
Global food insecurity concerns due to climate change, emphasizes the need to focus on the sensitivity of sorghum to climate change and potential crop improvement strategies available, which is discussed in the current review to promote climate-smart agriculture. Climate change effects immensely disturb the global agricultural systems by reducing crop production. Changes in extreme weather and climate events such as high-temperature episodes and extreme rainfalls events, droughts, flooding adversely affect the production of staple food crops, posing threat to ecosystem resilience. The resulting crop losses lead to food insecurity and poverty and question the sustainable livelihoods of small farmer communities, particularly in developing countries. In view of this, it is essential to focus and adapt climate-resilient food crops which need lower inputs and produce sustainable yields through various biotic and abiotic stress-tolerant traits. Sorghum, “the camel of cereals”, is one such climate-resilient food crop that is less sensitive to climate change vulnerabilities and also an important staple food in many parts of Asia and Africa. It is a rainfed crop and provides many essential nutrients. Understanding sorghum’s sensitivity to climate change provides scope for improvement of the crop both in terms of quantity and quality and alleviates food and feed security in future climate change scenarios. Thus, the current review focused on understanding the sensitivity of sorghum crop to various stress events due to climate change and throws light on different crop improvement strategies available to pave the way for climate-smart agriculture.
Recently, there is growing evidence that ambient temperature and seasonal changes are related to the incidence of gestational diabetes mellitus (GDM). Thereby, this study was conducted to evaluate the association between seasonal changes and ambient temperature and GDM. We conducted a systematic search in PubMed, ISI Web of Science, Scopus, Google Scholar, and Cochrane Collaboration for human studies available until the end of 2020. We used the following keywords to identify relevant articles: “Diabetes, Gestational” (MeSH), “Glucose Tolerance Test” (MeSH), “Glucose intolerance” (MeSH), “Pregnancy outcome” (MeSH), “Birth outcome”, “Seasons” (MeSH), “Weather” (MeSH), “Ambient Temperature,” “Climate Change” (MeSH). Meta-analyses by using STATA software were conducted for analyzing data. Due to the high heterogeneity between included studies, a random-effects model was used. Subgroup analysis, meta-regression, and sensitivity analysis were used to define a source of heterogeneity. We found 13 studies related to the association between ambient temperature and season changes and GDM, which 11 of them were included in meta-analyses. Despite inconsistencies in outcome assessment across studies, we found a significant positive association between seasons of GDM screening and risk of GDM (pooled OR=1.12; 95% CI (1.03, 1.21)). The funnel plot and Egger’s test showed that there was no significant publication bias among these studies (p=0.51). In general, season changes showed a significant positive relationship with prevalence of GDM. However, due to the unknown exact mechanism on this association, further studies should be conducted.
Sensing and measuring meteorological and physiological parameters of humans, animals, and plants are necessary to understand the complex interactions that occur between atmospheric processes and the health of the living organisms. Advanced sensing technologies have provided both meteorological and biological data across increasingly vast spatial, spectral, temporal, and thematic scales. Information and communication technologies have reduced barriers to data dissemination, enabling the circulation of information across different jurisdictions and disciplines. Due to the advancement and rapid dissemination of these technologies, a review of the opportunities for sensing the health effects of weather and climate change is necessary. This paper provides such an overview by focusing on existing and emerging technologies and their opportunities and challenges for studying the health effects of weather and climate change on humans, animals, and plants.
Infectious diarrhea (ID) is an intestinal infectious disease including cholera, typhoid and paratyphoid fever, bacterial and amebic dysentery, and other infectious diarrhea. There are many studies that have explored the relationship between ambient temperature and the spread of infectious diarrhea, but the results are inconsistent. It is necessary to systematically evaluate the impact of temperature on the incidence of ID. This study was based on the PRISMA statement to report this systematic review. We conducted literature searches from CNKI, VIP databases, CBM, PubMed, Web of Science, Cochrane Library, and other databases. The number registered in PROSPERO is CRD42021225472. After searching a total of 4915 articles in the database and references, 27 studies were included. The number of people involved exceeded 7.07 million. The overall result demonstrated when the temperature rises, the risk of infectious diarrhea increases significantly (RR(cumulative)=1.42, 95%CI: 1.07-1.88, RR(single-day)=1.08, 95%CI: 1.03-1.14). Subgroup analysis found the effect of temperature on the bacillary dysentery group (RR(cumulative)=1.85, 95%CI: 1.48-2.30) and unclassified diarrhea groups (RR(cumulative)=1.18, 95%CI: 0.59-2.34). The result of the single-day effect subgroup analysis was similar to the result of the cumulative effect. And the sensitivity analysis proved that the results were robust. This systematic review and meta-analysis support that temperature will increase the risk of ID, which is helpful for ID prediction and early warning in the future.
This review seeks to explain three features of viral respiratory illnesses that have perplexed generations of virologists: (1) the seasonal timing of respiratory illness and the rapid response of outbreaks to weather, specifically temperature; (2) the common viruses causing respiratory illness worldwide, including year-round disease in the Tropics; (3) the rapid arrival and termination of epidemics caused by influenza and other viruses. The inadequacy of the popular explanations of seasonality is discussed, and a simple hypothesis is proposed, called temperature dependent viral tropism (TDVT), that is compatible with the above features of respiratory illness. TDVT notes that viruses can spread more effectively if they moderate their pathogenicity (thereby maintaining host mobility) and suggests that endemic respiratory viruses accomplish this by developing thermal sensitivity within a range that supports organ-specific viral tropism within the human body, whereby they replicate most rapidly at temperatures below body temperature. This can confine them to the upper respiratory tract and allow them to avoid infecting the lungs, heart, gut etc. Biochemical and tissue-culture studies show that ‘wild’ respiratory viruses show such natural thermal sensitivity. The typical early autumn surge of colds and the occurrence of respiratory illness in the Tropics year-round at intermediate levels are explained by the tendency for strains to adapt their thermal sensitivity to their local climate and season. TDVT has important practical implications for preventing and treating respiratory illness including Covid-19. It is testable with many options for experiments to increase our understanding of viral seasonality and pathogenicity.
Climate change acts as a risk multiplier, meaning vulnerable populations bear a disproportionate burden of its effects. Improving climate resiliency is a key strategy to help the Rhode Island Department of Health meet its overarching goals of addressing the socio-economic and environmental determinants of health for all Rhode Islanders. The Climate Change and Health Program focuses on both the immediate health impacts of climate change and building resiliency. Part of the US Centers for Disease Control and Prevention’s Climate Ready States and Cities Initiative, the Program has partnered with community groups and other state and local agencies to bring technical assistance, educational resources, and funding to support community resilience to the challenges presented by the already changing climate. Specific projects discussed include the extreme heat communications plan and outdoor worker campaign; community-driven resiliency projects in response to flooding and natural hazards, and improving resilience in senior citizen housing.
Climate change is one of the biggest challenges humanity is facing in the 21st century. Two recognized sequelae of climate change are global warming and air pollution. The gradual increase in ambient temperature, coupled with elevated pollution levels have a devastating effect on our health, potentially contributing to the increased rate and severity of numerous neurological disorders. The main aim of this review paper is to shed some light on the association between the phenomena of global warming and air pollution, and two of the most common and debilitating neurological conditions: stroke and neurodegenerative disorders. Extreme ambient temperatures induce neurological impairment and increase stroke incidence and mortality. Global warming does not participate in the etiology of neurodegenerative disorders, but it exacerbates symptoms of dementia, Alzheimer’s disease (AD) and Parkinson’s Disease (PD). A very close link exists between accumulated levels of air pollutants (principally particulate matter), and the incidence of ischemic rather than hemorrhagic strokes. People exposed to air pollutants have a higher risk of developing dementia and AD, but not PD. Oxidative stress, changes in cardiovascular and cerebrovascular haemodynamics, excitotoxicity, microglial activation, and cellular apoptosis, all play a central role in the overlap of the effect of climate change on neurological disorders. The complex interactions between global warming and air pollution, and their intricate effect on the nervous system, imply that future policies aimed to mitigate climate change must address these two challenges in unison.
The combined effect of global warming and insecticide exposure on the spread of mosquito-borne diseases is poorly studied. In our opinion, more resources should be diverted to this topic to further research efforts and deal with this increasing threat. It is particularly important to determine how Aedes, Anopheles, and Culex vector species cope with insecticide exposure under warming temperatures, as well as how both stressors may impact the activity of mosquito biocontrol agents. Herein, we promote a discussion on the topic, fostering a research agenda with insights for the longer-term implementation of mosquito control strategies under the Integrated Vector Management framework.
PURPOSE OF REVIEW: Climate change remains a major threat to the health and well-being of children globally. This article reviews the myriad health effects of climate change on children throughout their lives and discusses ways in which the general pediatrician can be an advocate for climate solutions. RECENT FINDINGS: Rising atmospheric temperatures, increased air pollution, and destabilized weather patterns all lead to adverse health outcomes for children and adverse obstetric outcomes. However, the impact of climate change is not evenly distributed. Children living in poverty are more likely to be adversely impacted by the changing climate. SUMMARY: Ongoing and emerging research suggests that children are particularly vulnerable to the effects of climate change. The primary care pediatrician is encouraged to see this irrefutable evidence as a call to action for advocacy on behalf of our patients and the planet.
OBJECTIVES: Increasing obesity rates and accelerating climate change represent two global health challenges shaped by lifestyle change and human environmental modifications. Yet, few studies have considered how these issues may interact to exacerbate disease risk. METHODS: In this theory article, we explore evidence that obesity-related disease and climatic changes share socio-ecological drivers and may interact to increase human morbidity and mortality risks. Additionally, we consider how obesity-climate change interactions may disproportionately affect vulnerable populations and how anthropological research can be applied to address this concern. RESULTS: Interactions between heat stress and cardiometabolic disease represent an important pathway through which climate change and obesity-related morbidities may jointly impair health. For example, individuals with higher body fatness and obesity-related metabolic conditions (eg, type 2 diabetes) exhibit a reduced ability to dissipate heat. The risk of poor health resulting from these interactions is expected to be heterogeneous, with low- and middle-income countries, individuals of lower socioeconomic status, and minority populations facing a greater disease burden due to relative lack of resource access (eg, air conditioning). Moreover, older adults are at higher risk due to aging-associated changes in body composition and loss of thermoregulation capabilities. CONCLUSIONS: Few policy makers appear to be considering how interventions can be designed to simultaneously address the medical burden posed by increasing obesity rates and climate change. Anthropological research is well situated to address this need in a nuanced and culturally-sensitive way; producing research that can be used to support community resilience, promote holistic well-being, and improve health outcomes.
Climatic change will have an impact on production and release of pollen, with consequences for the duration and magnitude of aeroallergen seasonal exposure and allergic diseases. Evaluations of pollen aerobiology in the southern hemisphere have been limited by resourcing and the density of monitoring sites. This review emphasizes inconsistencies in pollen monitoring methods and metrics used globally. Research should consider unique southern hemisphere biodiversity, climate, plant distributions, standardization of pollen aerobiology, automation, and environmental integration. For both hemispheres, there is a clear need for better understanding of likely influences of climate change and comprehending their impact on pollen-related health outcomes.
Global warming, provoked by the greenhouse effect of high levels of atmospheric gases (most notably carbon dioxide and methane), directly threatens human health and survival. Individuals vary in their capacity to tolerate episodes of extreme heat. Because skin is the organ tasked with heat dissipation, it is important for dermatologists to be versed in the physiology of cutaneous heat dissipation and cognizant of clinical settings in which the skin’s thermoregulatory responses may be impaired. When the external temperature is lower than that of the skin, the skin releases internal heat through direct thermal exchange with the environment, a process that is aided by an expansion of cutaneous blood flow and eccrine sweating. Cooling through the evaporation of sweat is effective even when the external temperature exceeds that of skin. Many factors, including environmental and physiological (e.g., age and sex), and pathological (e.g., preexisting illnesses, disorders of eccrine function, and medications) considerations, affect the skin’s capacity to thermoregulate. Identification of individuals at increased risk for heat-related morbidity and mortality will become increasingly important in the care of patients.
Increasingly severe extreme weather events (EWEs) threaten population health in Asia-Pacific. Resilient health systems can minimize health risks by improving EWE preparedness, response, and recovery. However, how health systems demonstrate resilience is less understood in the emerging resilience literature. The objective of this scoping review was to describe how peer-reviewed and grey literature has operationalized health system resilience to EWEs in Asia-Pacific. Included sources were available in English, published from 2000 to 2019, and focused on health system activity in Asia-Pacific for EWE risk management. The World Health Organization’s climate-resilient health system framework and building block model guided analysis of 49 sources. Health system activity was categorized by system building blocks. Assets and/or gaps to resilience were identified based on whether building blocks facilitated or impeded EWE risk management. Sources mostly focused on the Philippines (29%), India (16%) and Thailand (14%), with lower income economies and Pacific Island countries underrepresented. Floods (47%), typhoons (27%), and cyclones (16%) were frequently discussed while no sources mentioned droughts. Financing was the least mentioned building block (27%) and often described as a gap to resilience (24%). Overall, this review highlights opportunities for future research to develop EWE resilient health systems in Asia-Pacific and beyond.
OBJECTIVES: Several studies on the health effects of heat exposure on workers have been reported; however, only few studies have summarized the overall and systematic health effects of heat exposure on workers. This study aims to review the scientific reports on the health status of workers exposed to high temperatures in the workplace. METHODS: We reviewed literature from databases such as PubMed and Google Scholar, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to identify studies that address health effects of heat exposure among workers. RESULTS: In total, 459 articles were identified, and finally, 47 articles were selected. Various health effects of heat exposure on workers have been reported, such as heat-related diseases, deaths, accidents or injuries, effects on the urinary system, reproductive system, and on the psychological system. CONCLUSIONS: Our review suggests that many workers are vulnerable to heat exposure, and this has a health effect on workers.
Research on heat waves (periods of excessively hot weather, which may be accompanied by high humidity) is a newly emerging research topic within the field of climate change research with high relevance for the whole of society. In this study, we analyzed the rapidly growing scientific literature dealing with heat waves. No summarizing overview has been published on this literature hitherto. We developed a suitable search query to retrieve the relevant literature covered by the Web of Science (WoS) as complete as possible and to exclude irrelevant literature (n?=?8,011 papers). The time evolution of the publications shows that research dealing with heat waves is a highly dynamic research topic, doubling within about 5 years. An analysis of the thematic content reveals the most severe heat wave events within the recent decades (1995 and 2003), the cities and countries/regions affected (USA, Europe, and Australia), and the ecological and medical impacts (drought, urban heat islands, excess hospital admissions, and mortality). An alarming finding is that the limit for survivability may be reached at the end of the twenty-first century in many regions of the world due to the fatal combination of rising temperatures and humidity levels measured as “wet-bulb temperature” (WBT). Risk estimation and future strategies for adaptation to hot weather are major political issues. We identified 104 citation classics, which include fundamental early works of research on heat waves and more recent works (which are characterized by a relatively strong connection to climate change).
BACKGROUND: The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. METHODS: Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. RESULTS: Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009-1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ?64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018-1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. CONCLUSIONS: High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
The relationship between diabetes mellitus and short-term exposure to extreme temperatures remains controversial. A systematic review and meta-analysis were performed to assess the association between extreme temperatures and diabetes mellitus morbidity and mortality. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched since inception to January 1, 2019, and updated on November 17, 2020. The results were combined using random effects model and reported as relative risk (RR) with 95% confidence interval (CI). In total, 32 studies met the inclusion criteria. (1) Both heat and cold exposures have impact on diabetes. (2) For heat exposure, the subgroup analysis revealed that the effect on diabetes mortality (RR=1.139, 95% CI: 1.089-1.192) was higher than morbidity (RR=1.012, 95% CI: 1.004-1.019). (3) With the increase of definition threshold, the impact of heat exposure on diabetes rose. (4) A stronger association between heat exposure and diabetes was observed in the elderly (? 60 years old) (RR=1.040, 95% CI: 1.017-1.064). In conclusion, short-term exposure to both heat and cold temperatures has impact on diabetes. The elderly is the vulnerable population of diabetes exposure to heat temperature. Developing definitions of heatwaves at the regional level are suggested.
The cold and arid mountains and plateaus of High Asia, inhabited by a relatively sparse human population, a high density of livestock, and wildlife such as the iconic snow leopard Panthera uncia, are usually considered low risk for disease outbreaks. However, based on current knowledge about drivers of disease emergence, we show that High Asia is rapidly developing conditions that favor increased emergence of infectious diseases and zoonoses. This is because of the existing prevalence of potentially serious pathogens in the system; intensifying environmental degradation; rapid changes in local ecological, socio-ecological, and socio-economic factors; and global risk intensifiers such as climate change and globalization. To better understand and manage the risks posed by diseases to humans, livestock, and wildlife, there is an urgent need for establishing a disease surveillance system and improving human and animal health care. Public health must be integrated with conservation programs, more ecologically sustainable development efforts and long-term disease surveillance.
Studies have shown that climatic factors can significantly influence transmission of many waterborne diseases. However, knowledge of the impact of climate variability on cryptosporidiosis is much less certain. Associations between the incidence of cryptosporidiosis and climatic variables have been reported in several countries. Given that the identified relationships were not consistently reported across studies, it is not known whether these were country-specific observations or can be considered more globally. Variation in the disease risk in both low- and middle-income countries and high-income countries presents new challenges and opportunities to enact responsive changes in research and public health policies. Available epidemiological evidence of the influence of weather and climate on cryptosporidiosis is reviewed. Fourteen studies met the inclusion criteria, and most studies showed that the incidence of cryptosporidiosis is highly sensitive to climatic conditions, especially temperature, rainfall and relative humidity. The identified associations varied across studies, with different conditions of importance and lag times across different locations. Therefore, there is a need for countries at risk to assess Cryptosporidium transmission routes based on the spatiotemporal patterns of the disease and what role climate and other socio-ecological changes play in the transmission. Information gathering will then allow us to provide information for evidence-based control strategies and mitigation of transmission. This review offers new perspectives on the role of climate variability on Cryptosporidium transmission. It highlights different epidemiological approaches adopted and provides the potential for future research and surveillance to reduce the disease burden. By evaluating the epidemiological transmission of this organism in high-income countries, all mitigation strategies, for example filtration and water catchment management, can be used as exemplars of preventing infection in low- to middle-income countries.
BACKGROUND: Extreme temperatures have negative consequences on the environment, ecosystem, and human health. With recent increases in global temperatures, there has been a rise in the burden of heat-related illnesses, with a disproportionate impact on low- and middle-income countries. Effective population-level interventions are critical to a successful public health response. OBJECTIVE: This scoping review aims to summarize the evidence on the effectiveness of population-level heat-related interventions and serve as a potential guide to the implementation of these interventions. METHODS: Studies that evaluated the effectiveness of community-based interventions to mitigate or reduce the impact of extreme heat on heat-related mortality and morbidity were sought by searching four electronic databases. Studies published in the English language and those that had quantifiable, measurable mortality, morbidity or knowledge score outcomes were included. RESULTS: The initial electronic search yielded 2324 articles, and 17 studies were included. Fourteen studies were based in high-income countries (HICs) (Europe, US, Canada) and discussed multiple versions of (1) heat action plans, which included but were not limited to establishing a heat monitoring system, informative campaigns, the mobilization of health care professionals, volunteers, social workers and trained caregivers in the surveillance and management of individuals with known vulnerabilities, or stand-alone (2) education and awareness campaigns. Multi-pronged heat action plans were highly effective in reducing heat-related mortality and morbidity, especially among vulnerable populations such as the elderly and those with chronic conditions. CONCLUSIONS: The heat action plans covered in these studies have shown promising results in reducing heat-related mortality and morbidity and have included instituting early warning systems, building local capacity to identify, prevent or treat and manage heat-related illnesses, and disseminating information. Nevertheless, they need to be cost-effective, easy to maintain, ideally should not rely on a mass effort from people and should be specifically structured to meet the local needs and resources of the community.
In Italy, human cases of West Nile virus (WNV) infection have been recorded since 2008, and seasonal outbreaks have occurred almost annually. In this study, we summarize available evidences on the epidemiology of WNV and West Nile neuro-invasive disease (WNND) in humans reported between 2012 and 2020. In total, 1145 WNV infection cases were diagnosed; of them 487 (42.5%) had WNND. A significant circulation of the pathogen was suggested by studies on blood donors, with annual incidence rates ranging from 1.353 (95% confidence intervals (95% CI) 0.279-3.953) to 19.069 cases per 100,000 specimens (95% CI 13.494-26.174). The annual incidence rates of WNND increased during the study period from 0.047 cases per 100,000 (95% CI 0.031-0.068) in 2012, to 0.074 cases per 100,000 (95% CI 0.054-0.099) in 2020, peaking to 0.377 cases per 100,000 (95% CI 0.330-0.429) in 2018. There were 60 deaths. Cases of WNND were clustered in Northern Italy, particularly in the Po River Valley, during the months of August (56.7%) and September (27.5%). Higher risk for WNND was reported in subjects of male sex (risk ratio (RR) 1.545, 95% CI 1.392-1.673 compared to females), and in older age groups (RR 24.46, 95% CI 15.61-38.32 for 65-74 y.o.; RR 43.7, 95% CI 28.33-67.41 for subjects older than 75 years), while main effectors were identified in average air temperatures (incidence rate ratio (IRR) 1.3219, 95% CI 1.0053-1.7383), population density (IRR 1.0004, 95% CI 1.0001-1.0008), and occurrence of cases in the nearby provinces (IRR 1.0442, 95% CI 1.0340-1.0545). In summary, an enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.
Background: Environmental health is a growing area of knowledge, continually increasing and updating the body of evidence linking the environment to human health. Aim: This study summarizes the epidemiological evidence on environmental risk factors from meta-analyses through an umbrella review. Methods: An umbrella review was conducted on meta-analyses of cohort, case-control, case-crossover, and time-series studies that evaluated the associations between environmental risk factors and health outcomes defined as incidence, prevalence, and mortality. The specific search strategy was designed in PubMed using free text and Medical Subject Headings (MeSH) terms related to risk factors, environment, health outcomes, observational studies, and meta-analysis. The search was limited to English, Spanish, and French published articles and studies on humans. The search was conducted on September 20, 2020. Risk factors were defined as any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or death. The environment was defined as the external elements and conditions that surround, influence, and affect a human organism or population’s life and development. The environment definition included the physical environment such as nature, built environment, or pollution, but not the social environment. We excluded occupational exposures, microorganisms, water, sanitation and hygiene (WASH), behavioral risk factors, and no-natural disasters. Results: This umbrella review found 197 associations among 69 environmental exposures and 83 diseases and death causes reported in 103 publications. The environmental factors found in this review were air pollution, environmental tobacco smoke, heavy metals, chemicals, ambient temperature, noise, radiation, and urban residential surroundings. Among these, we identified 65 environmental exposures defined as risk factors and 4 environmental protective factors. In terms of study design, 57 included cohort and/or case-control studies, and 46 included time-series and/or case-crossover studies. In terms of the study population, 21 included children, and the rest included adult population and both sexes. In this review, the largest body of evidence was found in air pollution (91 associations among 14 air pollution definitions and 34 diseases and mortality diagnoses), followed by environmental tobacco smoke with 24 associations. Chemicals (including pesticides) were the third larger group of environmental exposures found among the meta-analyses included, with 19 associations. Conclusion: Environmental exposures are an important health determinant. This review provides an overview of an evolving research area and should be used as a complementary tool to understand the connections between the environment and human health. The evidence presented by this review should help to design public health interventions and the implementation of health in all policies approach aiming to improve populational health.
Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm’s way could alter this trend. Long-term changes to Earth’s energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.
BACKGROUND: Due to climate change, the frequency, intensity and severity of extreme weather events, such as heat waves, cold waves, storms, heavy precipitation causing wildfires, floods, and droughts are increasing, which could adversely affect human health. The purpose of this systematic review is therefore to assess the current literature about the association between these extreme weather events and their impact on the health of the European population. METHODS: Observational studies published from January 1, 2007 to May 17, 2020 on health effects of extreme weather events in Europe were searched systematically in Medline, Embase and Cochrane Central Register of Controlled Trials. The exposures of interest included extreme temperature, heat waves, cold waves, droughts, floods, storms and wildfires. The health impacts included total mortality, cardiovascular mortality and morbidity, respiratory mortality and morbidity, and mental health. We conducted the systematic review following PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis). The quality of the included studies was assessed using the NICE quality appraisal checklist (National Institute for Health and Care Excellence). RESULTS: The search yielded 1472 articles, of which 35 met the inclusion criteria and were included in our review. Studies regarding five extreme weather events (extreme heat events, extreme cold events, wildfires, floods, droughts) were found. A positive association between extreme heat/cold events and overall, cardiovascular and respiratory mortality was reported from most studies. Wildfires are likely to increase the overall and cardiovascular mortality. Floods might be associated with the deterioration of mental health instead of mortality. Depending on their length, droughts could have an influence on both respiratory and cardiovascular mortality. Contradictory evidence was found in heat-associated morbidity and wildfire-associated respiratory mortality. The associations are inconclusive due to the heterogeneous study designs, study quality, exposure and outcome assessment. CONCLUSIONS: Evidence from most of the included studies showed that extreme heat and cold events, droughts, wildfires and floods in Europe have negative impacts on human health including mental health, although some of the associations are not conclusive. Additional high-quality studies are needed to confirm our results and further studies regarding the effects of other extreme weather events in Europe are to be expected.
Gestational diabetes (GDM) is a common metabolic complication of pregnancy that is generally asymptomatic in its clinical course, although it is potentially associated with a wide range of both maternal and foetal complications. The population prevalence of GDM varies widely, depending on the clinical diagnostic criteria, ethnicity, demographics and background prevalence of type 2 diabetes. Climate variability and environmental temperature have recently come to the forefront as potential direct or indirect determinants of human health. The association between GDM and environmental temperature is complex, and studies have often reported conflicting findings. Epidemiologic studies have shown a direct relation between rising environmental temperature and the risk of both GDM and impaired beta cell function. Seasonal trends in the prevalence of GDM have been reported in several populations, with a higher prevalence in summer months. Multiple mechanisms have been proposed to explain the GDM-temperature correlation. A growing body of evidence supports a link between temperature, energy expenditure and adipose tissue metabolism. Brown adipose tissue thermogenesis, induced by cold temperatures, improves insulin sensitivity. Further biological explanations for the GDM-temperature correlation lie in potential association with low vitamin D levels, which varies according to sunshine exposure. Observational studies are also complicated by lifestyle factors, such as diet and physical activity, that could exhibit seasonal variation. In this review article, we provide a systematic overview of available epidemiological evidence linking environmental temperature and gestational diabetes. Furthermore, the physiological mechanisms that give biological plausibility to association between GDM and temperature are explored. As future climate patterns could drive global changes in GDM prevalence, this knowledge has important implications for both clinicians and researchers.
BACKGROUND: Although the frequency and magnitude of climate change-related health hazards (CCRHHs) are likely to increase, the population vulnerabilities and corresponding health impacts are dependent on a community’s exposures, pre-existing sensitivities, and adaptive capacities in response to a hazard’s impact. To evaluate spatial variability in relative vulnerability, we: 1) identified climate change-related risk factors at the dissemination area level; 2) created actionable health vulnerability index scores to map community risks to extreme heat, flooding, wildfire smoke, and ground-level ozone; and 3) spatially evaluated vulnerability patterns and priority areas of action to address inequity. METHODS: A systematic literature review was conducted to identify the determinants of health hazards among populations impacted by CCRHHs. Identified determinants were then grouped into categories of exposure, sensitivity, and adaptive capacity and aligned with available data. Data were aggregated to 4188 Census dissemination areas within two health authorities in British Columbia, Canada. A two-step principal component analysis (PCA) was then used to select and weight variables for each relative vulnerability score. In addition to an overall vulnerability score, exposure, adaptive capacity, and sensitivity sub-scores were computed for each hazard. Scores were then categorised into quintiles and mapped. RESULTS: Two hundred eighty-one epidemiological papers met the study criteria and were used to identify 36 determinant indicators that were operationalized across all hazards. For each hazard, 3 to 5 principal components explaining 72 to 94% of the total variance were retained. Sensitivity was weighted much higher for extreme heat, wildfire smoke and ground-level ozone, and adaptive capacity was highly weighted for flooding vulnerability. There was overall varied contribution of adaptive capacity (16-49%) across all hazards. Distinct spatial patterns were observed – for example, although patterns varied by hazard, vulnerability was generally higher in more deprived and more outlying neighbourhoods of the study region. CONCLUSIONS: The creation of hazard and category-specific vulnerability indices (exposure, adaptive capacity and sensitivity sub-scores) supports evidence-based approaches to prioritize public health responses to climate-related hazards and to reduce inequity by assessing relative differences in vulnerability along with absolute impacts. Future studies can build upon this methodology to further understand the spatial variation in vulnerability and to identify and prioritise actionable areas for adaptation.
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.
Climate change is one of the major global health threats to the world’s population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth’s atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women’s sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women’s reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.
Under the climate change scenario, the negative impacts of urban heat island (UHI) will exacerbate due to unsustainable urban planning and human activities. Thermal comfort has close relationships with UHI in urban areas. This paper is based on the studies of urban heat island, thermal comfort, microclimate, and urban planning in cities in the recent decade, combined with a method of research into design. The key topics include vegetation and water conditions, the albedo of materials, and urban morphology. By the comparative case studies in landscape projects, the results further reveal that the density of tree canopies, the natural structure and density of ground cover, the form of water features, the color and texture of materials, and the scale of shading structures have different cooling effect and performance in outdoor thermal comfort improvement with specific features in the landscape design. It is also found that there are some external conditions that can influence design determinations in real practices. The purpose of this study is to provide theoretical research methods and evaluation of thermal comfort landscape design elements and to provide guidance for future sustainable city research and landscape design.
The United States has approximately 5 percent of the world’s population but incarcerates nearly 25 percent of the world’s incarcerated population and produces nearly 25 percent of global carbon dioxide emissions to date. Climate change and hyperincarceration are causes and consequences of structural racism and economic deprivation, which disproportionately affect structurally disenfranchised citizens, including lower-income communities, communities of color, and people with disabilities. Empirical evidence exists regarding the adverse health effects of climate change and mass incarceration, which occur in cascading and overlapping categories and include preventable death, illness, and injury. Researchers underscore the medical vulnerability of incarcerated populations, who are increasingly susceptible to climate-driven exposure pathways and mental and physical health outcomes involving extreme temperatures, natural disasters, infectious diseases, and displacement. Intersectional structural drivers, such as anthropogenic climate change and hyperincarceration, undermine social and political determinants of health equity. Policymakers and health professionals can advance understanding and mitigate present and anticipated public health threats by increasing transparency, accountability, and human rights protections with an emphasis on decarceration and decarbonization.
It is generally accepted that older adults display an impaired cardiovascular response to heat stress, and it has been suggested that this impaired response contributes to their increased risk of mortality during extreme heat events. Seminal studies have shown that cutaneous vasodilation, the redistribution of blood flow from visceral organs, and the increase in cardiac output are blunted in older adults during passive heating. The blunted rise of cardiac output was initially attributed to an inability to maintain stroke volume, suggesting that cardiac systolic and/or diastolic function does not adequately respond to the constraints of heat stress in older adults. Recent studies evaluated potential mechanisms underlying these seminal findings and their results challenge some of these initial observations. Notably, stroke volume is maintained during heat exposure in older adults and studies have provided evidence for preserved cardiac systolic and diastolic functions in this population. Nonetheless, a blunted increase in cardiac output during heat exposure remains a consistent observation in older adults, although it is now attributed to a blunted increase in heart rate. Recent studies have also evaluated the possibility that the attenuated capacity of aged skin to vasodilate contributes to a blunted increase in cardiac output during heat stress. The objective of this Mini-Review is to highlight these recent advances and challenge the long-standing view that the control of stroke volume during heat exposure is compromised in older adults. By doing so, our intent is to stimulate future studies to evaluate several unanswered questions in this area of research.
Anthropogenic emissions of greenhouse gases are warming the Earth. It is likely that the greatest impacts of climate change on human and natural systems will come from increasingly frequent and severe extreme weather and climate events. Some increases in such extremes are already being detected, and this trend is projected to continue as Earth warms. Here we review the overarching climate drivers of increases in extreme weather and address the context in which extremes occur and the challenges of projecting future changes. The observational evidence for climate-driven increases in extremes and the implications of model projections are reviewed for heat and drought and several types of storms: tropical cyclones, midlatitude storms, and severe local weather, focusing on those changes most relevant to the continental United States. We emphasize the overall observed and modeled trends in extreme weather in which we have the greatest confidence, because they are consistent with our fundamental understanding of weather and climate. Despite remaining uncertainty about many details, especially in model-based projections, the signal of increasing extremes is sufficiently clear that it demands a robust human response, in limiting future emissions of greenhouse gases and in making our human systems more resilient to further changes that are inevitable as Earth continues to warm.Implications: By placing observed and projected changes in extreme weather in the context of our fundamental understanding of physics and statistics, this review makes it clear that these are significant and impactful changes that demand a robust human response.
Europeans are not only exposed to direct effects from climate change, but also vulnerable to indirect effects from infectious disease, many of which are climate sensitive, which is of concern because of their epidemic potential. Climatic conditions have facilitated vector-borne disease outbreaks like chikungunya, dengue, and West Nile fever and have contributed to a geographic range expansion of tick vectors that transmit Lyme disease and tick-borne encephalitis. Extreme precipitation events have caused waterborne outbreaks and longer summer seasons have contributed to increases in foodborne diseases. Under the Green Deal, The European Union aims to support climate change health policy, in order to be better prepared for the next health security threat, particularly in the aftermath of the traumatic COVID-19 experience. To bolster this policy process we discuss climate change-related hazards, exposures and vulnerabilities to infectious disease and describe observed impacts, projected risks, with policy entry points for adaptation to reduce these risks or avoid them altogether.
Observed weather and projected climate change suggest an increase in the transmission of vector-borne diseases (VBDs) in the Hindu Kush Himalayan (HKH) region. In this study, we systematically explore the literature for empiric associations between the climate variables and specific VBDs and their vectors in the HKH region. We conducted a systematic synthesis of the published literature on climate variables, VBDs and vectors in the HKH region until the 8th of December 2020. The majority of studies show significant positive associations of VBDs with climatic factors, such as temperature, precipitation, relative humidity, etc. This systematic review allowed us to identify the most significant variables to be considered for evidence-based trend estimates of the effects of climate change on VBDs and their vectors in the HKH region. This evidence-based trend was set into the context of climate change as well as the observed expansion of VBDs and disease vectors in the HKH region. The geographic range of VBDs expanded into previously considered non-endemic areas of highlands (mountains) in the HKH region. Based on scarce, but clear evidence of a positive relationship of most climate variables and VBDs and the observed climatic changes, we strongly recommend an expansion of vector control and surveillance programmes in areas of the HKH region that were previously considered to be non-endemic.
Purpose of review This review aims to identify the key factors, methods, and spatial units used in the development and validation of the heat vulnerability index (HVI) and discuss the underlying limitations of the data and methods by evaluating the performance of the HVI. Recent findings Thirteen studies characterizing the factors of the HVI development and relating the index with validation data were identified. Five types of factors (i.e., hazard exposure, demographic characteristics, socioeconomic conditions, built environment, and underlying health) of the HVI development were identified, and the top five were social cohesion, race, and/or ethnicity, landscape, age, and economic status. The principal component analysis/factor analysis (PCA/FA) was often used in index development, and four types of spatial units (i.e., census tracts, administrative area, postal code, grid) were used for establishing the relationship between factors and the HVI. Moreover, although most studies showed that a higher HVI was often associated with the increase in health risk, the strength of the relationship was weak. This review provides a retrospect of the major factors, methods, and spatial units used in development and validation of the HVI and helps to define the framework for future studies. In the future, more information on the hazard exposure, underlying health, governance, and protection awareness should be considered in the HVI development, and the duration and location of validation data should be strengthened to verify the reliability of HVI.
Climate and weather directly impact plant phenology, affecting airborne pollen. The objective of this systematic review is to examine the impacts of meteorological variables on airborne pollen concentrations and pollen season timing. Using PRISMA methodology, we reviewed literature that assessed whether there was a relationship between local temperature and precipitation and measured airborne pollen. The search strategy included terms related to pollen, trends or measurements, and season timing. For inclusion, studies must have conducted a correlation analysis of at least 5 years of airborne pollen data to local meteorological data and report quantitative results. Data from peer-reviewed articles were extracted on the correlations between seven pollen indicators (main pollen season start date, end date, peak date, and length, annual pollen integral, average daily pollen concentration, and peak pollen concentration), and two meteorological variables (temperature and precipitation). Ninety-three articles were included in the analysis out of 9,679 articles screened. Overall, warmer temperatures correlated with earlier and longer pollen seasons and higher pollen concentrations. Precipitation had varying effects on pollen concentration and pollen season timing indicators. Increased precipitation may have a short-term effect causing low pollen concentrations potentially due to “wash out” effect. Long-term effects of precipitation varied for trees and weeds and had a positive correlation with grass pollen levels. With increases in temperature due to climate change, pollen seasons for some taxa in some regions may start earlier, last longer, and be more intense, which may be associated with adverse health impacts, as pollen exposure has well-known health effects in sensitized individuals.
The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.
Heat related morbidity and mortality, especially during extreme heat events, are increasing due to climate change. More Americans die from heat than from all other natural disasters combined. Identifying the populations and locations that are under high risk of heat vulnerability is important for urban planning and design policy making as well as health interventions. An increasing number of heat vulnerability/risk models and indices (HV/R) have been developed based on indicators related to population heat susceptibility such as sociodemographic and environmental factors. The objectives of this study are to summarize and analyze current HV/R’s construction, calculation, and validation, evaluate the limitation of these methods, and provide directions for future HV/R and related studies. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and used 5 datasets for the literature search. Journal articles that developed indices or models to assess population level heat-related vulnerability or risks in the past 50?years were included. A total of 52 papers were included for analysis on model construction, data sources, weighting schemes and model validation. By synthesizing the findings, we suggested: (1) include relevant and accurately measured indicators; (2) select rational weighting methods and; (3) conduct model validation. We also concluded that it is important for future heat vulnerability models and indices studies to: (1) be conducted in more tropical areas; (2) include a comprehensive understanding of energy exchanges between landscape elements and humans; and (3) be applied in urban planning and policy making practice.
Heat stress caused by climate change and heat-related labor productivity losses have become global concerns. Estimating the economic impacts of heat stress is of great significance for employers, as well as sectoral and national policy makers who are searching for solutions to reduce productivity losses. As the value of economic impacts are sensitive to the research methodologies, we conducted a systematic review of published literature on the methodologies and results of economic impacts of heat on labor productivity. Four methods were summarized: the human capital (HC) method, the econometric method (EM), the input–output (IO) method, and the computable general equilibrium (CGE) model. Considering adaptation measures, global economic losses due to heat-related labor productivity losses are projected to range from 0.31% (0.14–0.5%, RCP2.6) to 2.6% (1.4–4%, RCP8.5) of global GDP in 2100. The published studies found that large economic losses occurred mainly in South and Southeast Asia, Sub-Saharan Africa, and Central America. Owing to different methodologies and considerations of adaptation measures, the disparities of results within the same area at a given time can be as high as 7.4-fold. We summarized the knowledge gaps in existing studies and proposed new directions to provide more targeted and reliable results for policy makers.
BACKGROUND: South Asia is highly vulnerable to climate change and is projected to experience some of the highest increases in average annual temperatures throughout the century. Although the adverse impacts of ambient temperature on human health have been extensively documented in the literature, only a limited number of studies have focused on populations in this region. OBJECTIVES: Our aim was to systematically review the current state and quality of available evidence on the direct relationship between ambient temperature and heat waves and all-cause mortality in South Asia. METHODS: The databases Pubmed, Web of Science, Scopus and Embase were searched from 1990 to 2020 for relevant observational quantitative studies. We applied the Navigation Guide methodology to assess the strength of the evidence and performed a meta-analysis based on a novel approach that allows for combining nonlinear exposure-response associations without access to data from individual studies. RESULTS: From the 6,759 screened papers, 27 were included in the qualitative synthesis and five in a meta-analysis. Studies reported an association of all-cause mortality with heat wave episodes and both high and low daily temperatures. The meta-analysis showed a U-shaped pattern, with increasing mortality for both high and low temperatures, but a statistically significant association was found only at higher temperatures – above 31° C for lag 0-1 days and above 34° C for lag 0-13 days. Effects were found to vary with cause of death, age, sex, location (urban vs. rural), level of education and socio-economic status, but the profile of vulnerabilities was somewhat inconsistent and based on a limited number of studies. Overall, the strength of the evidence for ambient temperature as a risk factor for all-cause mortality was judged as limited and for heat wave episodes as inadequate. CONCLUSIONS: The evidence base on temperature impacts on mortality in South Asia is limited due to the small number of studies, their skewed geographical distribution and methodological weaknesses. Understanding the main determinants of the temperature-mortality association as well as how these may evolve in the future in a dynamic region such as South Asia will be an important area for future research. Studies on viable adaptation options to high temperatures for a region that is a hotspot for climate vulnerability, urbanisation and population growth are also needed.
Almost half of the Brazilian population has no access to sewage collection and treatment. Untreated effluents discharged in waters of reservoirs for human supply favor the flowering of cyanobacteria – and these microorganisms produce toxins, such as saxitoxin, which is a very potent neurotoxin present in reservoirs in the Northeast region. A recent study confirmed that chronic ingestion of neurotoxin-infected water associated with Zika virus infection could lead to a microcephaly-like outcome in pregnant mice. Cyanobacteria benefit from hot weather and organic matter in water, a condition that has been intensified by climate change, according to our previous studies. Considering the new findings, we emphasize that zika arbovirus is widespread and worsened when associated with climate change, especially in middle- or low-income countries with low levels of sanitation coverage.
A large-ensemble climate simulation database, which is known as the database for policy decision-making for future climate changes (d4PDF), was designed for climate change risk assessments. Since the completion of the first set of climate simulations in 2015, the database has been growing continuously. It contains the results of ensemble simulations conducted over a total of thousands years respectively for past and future climates using high-resolution global (60 km horizontal mesh) and regional (20 km mesh) atmospheric models. Several sets of future climate simulations are available, in which global mean surface air temperatures are forced to be higher by 4 K, 2 K, and 1.5 K relative to preindustrial levels. Nonwarming past climate simulations are incorporated in d4PDF along with the past climate simulations. The total data volume is approximately 2 petabytes. The atmospheric models satisfactorily simulate the past climate in terms of climatology, natural variations, and extreme events such as heavy precipitation and tropical cyclones. In addition, data users can obtain statistically significant changes in mean states or weather and climate extremes of interest between the past and future climates via a simple arithmetic computation without any statistical assumptions. The database is helpful in understanding future changes in climate states and in attributing past climate events to global warming. Impact assessment studies for climate changes have concurrently been performed in various research areas such as natural hazard, hydrology, civil engineering, agriculture, health, and insurance. The database has now become essential for promoting climate and risk assessment studies and for devising climate adaptation policies. Moreover, it has helped in establishing an interdisciplinary research community on global warming across Japan.
PURPOSE OF REVIEW: The purpose of this review is to summarize researchs that provide risk estimates for the historical and future impact that climate change has had upon dengue published from 2007 through 2019. RECENT FINDINGS: Findings from 30 studies on historical health estimates, with the majority of the studies conducted in Asia, emphasized the importance of temperature, precipitation, and relative humidity, as well as lag effects, when trying to understand how climate change can impact the risk of contracting dengue. Furthermore, 35 studies presented findings on future health risk based upon climate projection scenarios, with a third of them showcasing global level estimates and findings across the articles emphasizing the need to understand risk at a localized level as the impacts from climate change will be experienced inequitably across different geographies in the future. Dengue is one of the most rapidly spreading viral diseases in the world, with ~390 million people infected worldwide annually. Several factors have contributed towards its proliferation, including climate change. Multiple studies have previously been conducted examining the relationship between dengue and climate change, both from a historical and a future risk perspective. We searched the U.S. National Institute of Environmental Health (NIEHS) Climate Change and Health Portal for literature (spanning January 2007 to September 2019) providing historical and future health risk estimates of contracting dengue infection in relation to climate variables worldwide. With an overview of the evidence of the historical and future health risk posed by dengue from climate change across different regions of the world, this review article enables the research and policy community to understand where the knowledge gaps are and what areas need to be addressed in order to implement localized adaptation measures to mitigate the health risks posed by future dengue infection.
Urban outdoor thermal conditions, and its impacts on the health and well-being for the city inhabitants have reached increased attention among biometeorological studies during the last two decades. Children are considered more sensitive and vulnerable to hot ambient conditions compared to adults, and are affected strongly by their thermal environment. One of the urban outdoor environments that children spend almost one third of their school time is the schoolyard. The aims of the present manuscript were to review studies conducted worldwide, in order to present the biophysical characteristics of the typical design of the urban schoolyard. This was done to assess, in terms of bioclimatology, the interactions between the thermal environment and the children’s body, to discuss the adverse effects of thermal environment on children, especially the case of heat stress, and to propose measures that could be applied to improve the thermal environment of schoolyards, focusing on vegetation. Human thermal comfort monitoring tools are mainly developed for adults, thus, further research is needed to adapt them to children. The schemes that are usually followed to design urban schoolyards create conditions that favour the exposure of children to excessive heat, inducing high health risks to them. The literature survey showed that typical urban schoolyard design (i.e., dense surface materials, absence of trees) triggered high surface temperatures (that may exceed 58 degrees C) and increased absorption of radiative heat load (that may exceed 64 degrees C in terms of Mean Radiant Temperature) during a clear day with intense solar radiation. Furthermore, vegetation cover has a positive impact on schoolyard’s microclimate, by improving thermal comfort and reducing heat stress perception of children. Design options for urban schoolyards and strategies that can mitigate the adverse effects of heat stress are proposed with focus on vegetation cover that affect positively their thermal environment and improve their aesthetic and functionality.
Climate change is expected to have complex effects on infectious diseases, causing some to increase, others to decrease, and many to shift their distributions. There have been several important advances in understanding the role of climate and climate change on wildlife and human infectious disease dynamics over the past several years. This essay examines 3 major areas of advancement, which include improvements to mechanistic disease models, investigations into the importance of climate variability to disease dynamics, and understanding the consequences of thermal mismatches between host and parasites. Applying the new information derived from these advances to climate-disease models and addressing the pressing knowledge gaps that we identify should improve the capacity to predict how climate change will affect disease risk for both wildlife and humans.
INTRODUCTION: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant health burden both for patients and healthcare systems. Exposure to various environmental factors increases the risk of exacerbations. AREAS COVERED: We searched PubMed and assessed literature published within the last 10 years to include epidemiological evidence on the relationships between air pollution, temperature and COPD exacerbation risk as well as the implications of extreme weather events on exacerbations. EXPERT OPINION: Ongoing climate change is expected to increase air pollution levels, global temperature and the frequency and severity of extreme weather events, all of which are associated with COPD exacerbations. Further research is needed using patient-focused methodological approaches to better understand and quantify these relationships, so that effective mitigation strategies that decrease the risk of exacerbations can be developed.
According to United Nations, cities situated in the tropical belt occupy only 36% of the Earth’s surface yet account for 1/3 of the entire global population. The increasing number of compact dense cities and the rapid population growth in the tropics have also been accompanied by increased urban air temperature. Increased air temperature is often associated with heat waves, and increased energy consumption. Therefore, the urban heat island (UHI) phenomenon and thermal stress have received much research attention and, as a result, the establishment of heat mitigation technologies has become critical. Although studies on urban climate in the tropics have shown progress, the situation in these areas remains complex and warrants further investigation. Accordingly, this paper examines the available heat mitigation techniques and their effectiveness in tropical areas from five perspectives, namely, shading (modifications in urban geometry), urban ventilation (street orientation, sun, and wind), urban greening (green roofs, trees, parks, and walls), albedo, and water bodies. This review paper showed that adopting a combination of mitigation approaches is the most effective method in reducing temperature in tropical cities. The use of shading and/or urban ventilation has also been proven to be more promising than the extensive use of vegetation, water bodies, or albedo modifications in reducing air temperature in tropical cities, where there is already a high level of humidity exists. Some key planning actions to combat UHI and thermal discomfort in tropical areas are eventually provided that can help urban planners integrate urban climatic knowledge into their practices.
Cities in Australia are experiencing unprecedented levels of urban overheating, which has caused a significant impact on the country’s socioeconomic environment. This article provides a comprehensive review on urban overheating, its impact on health, energy, economy, and the heat mitigation potential of a series of strategies in Australia. Existing studies show that the average urban heat island (UHI) intensity ranges from 1.0 degrees C to 13.0 degrees C. The magnitude of urban overheating phenomenon in Australia is determined by a combination of UHI effects and dualistic atmospheric circulation systems (cool sea breeze and hot desert winds). The strong relation between multiple characteristics contribute to dramatic fluctuations and high spatiotemporal variabilities in urban overheating. In addition, urban overheating contributes to serious impacts on human health, energy costs, thermal comfort, labour productivity, and social behaviour. Evidence suggest that cool materials, green roofs, vertical gardens, urban greenery, and water-based technologies can significantly alleviate the UHI effect, cool the ambient air, and create thermally balanced cities. Urban greenery, especially trees, has a high potential for mitigation. Trees and hedges can reduce the average maximum UHI by 1.0 degrees C. The average maximum mitigation performance values of green roofs and green walls are 0.2 degrees C and 0.1 degrees C, respectively. Reflective roofs and pavements can reduce the average maximum UHI by 0.3 degrees C. In dry areas, water has a high cooling potential. The average maximum cooling potential using only one technology is 0.4 degrees C. When two or more technologies are used at the same time, the average maximum UHI drop is 1.5 degrees C. The mitigation strategies identified in this article can help the governments and other stakeholders manage urban heating in the natural and built environment, and save health, energy, and economic costs.
Background Air-pollution and weather exposure beyond certain thresholds have serious effects on public health. Yet, there is lack of information on wider aspects including the role of some effect modifiers and the interaction between air-pollution and weather. This article aims at a comprehensive review and narrative summary of literature on the association of air-pollution and weather with mortality and hospital admissions; and to highlight literature gaps that require further research. Methods We conducted a scoping literature review. The search on two databases (PubMed and Web-of-Science) from 2012 to 2020 using three conceptual categories of “environmental factors”, “health outcomes”, and “Geographical region” revealed a total of 951 records. The narrative synthesis included all original studies with time-series, cohort, or case cross-over design; with ambient air-pollution and/or weather exposure; and mortality and/or hospital admission outcomes. Results The final review included 112 articles from which 70 involved mortality, 30 hospital admission, and 12 studies included both outcomes. Air-pollution was shown to act consistently as risk factor for all-causes, cardiovascular, respiratory, cerebrovascular and cancer mortality and hospital admissions. Hot and cold temperature was a risk factor for wide range of cardiovascular, respiratory, and psychiatric illness; yet, in few studies, the increase in temperature reduced the risk of hospital admissions for pulmonary embolism, angina pectoris, chest, and ischemic heart diseases. The role of effect modification in the included studies was investigated in terms of gender, age, and season but not in terms of ethnicity. Conclusion Air-pollution and weather exposure beyond certain thresholds affect human health negatively. Effect modification of important socio-demographics such as ethnicity and the interaction between air-pollution and weather is often missed in the literature. Our findings highlight the need of further research in the area of health behaviour and mortality in relation to air-pollution and weather, to guide effective environmental health precautionary measures planning.
In the next century, global warming, due to changes in climatic factors, is expected to have an enormous influence on the interactions between pathogens and their hosts. Over the years, the rate at which vector-borne diseases and their transmission dynamics modify and develop has been shown to be highly dependent to a certain extent on changes in temperature and geographical distribution. Schistosomiasis has been recognized as a tropical and neglected vector-borne disease whose rate of infection has been predicted to be elevated worldwide, especially in sub-Saharan Africa; the region currently with the highest proportion of people at risk, due to changes in climate. This review not only suggests the need to develop an efficient and effective model that will predict Schistosoma spp. population dynamics but seeks to evaluate the effectiveness of several current control strategies. The design of a framework model to predict and accommodate the future incidence of schistosomiasis in human population dynamics in sub-Saharan Africa is proposed. The impact of climate change on schistosomiasis transmission as well as the distribution of several freshwater snails responsible for the transmission of Schistosoma parasites in the region is also reviewed. Lastly, this article advocates for modelling several control mechanisms for schistosomiasis in sub-Saharan Africa so as to tackle the re-infection of the disease, even after treating infected people with praziquantel, the first-line treatment drug for schistosomiasis.
There is a significant relationship between ambient temperature and mortality. In healthy individuals with no underlying co-morbid conditions, there is an efficient heat regulation system which enables the body to effectively handle thermal stress. However, in vulnerable groups, especially in elderly over the age of 65 years, infants and individuals with co-morbid cardiovascular and/or respiratory conditions, there is a deficiency in thermoregulation. When temperatures exceed a certain limit, being cold winter spells or heat waves, there is an increase in the number of deaths. In particular, it has been shown that at temperatures above 27 °C, the daily mortality rate increases more rapidly per degree rise compared to when it drops below 27 °C. This is especially of relevance with the current emergency of global warming. Besides the direct effect of temperature rises on human health, global warming will have a negative impact on primary producers and livestock, leading to malnutrition, which will in turn lead to a myriad of health related issues. This is further exacerbated by environmental pollution. Public health measures that countries should follow should include not only health-related information strategies aiming to reduce the exposure to heat for vulnerable individuals and the community, but improved urban planning and reduction in energy consumption, among many others. This will reduce the carbon footprint and help avert global warming, thus reducing mortality.
Throughout much of the African continent, healthcare systems are already strained in their efforts to meet the needs of a growing population using limited resources. Climate change threatens to undermine many of the public health gains that have been made in this region in the last several decades via multiple mechanisms, including malnutrition secondary to drought-induced food insecurity, mass human displacement from newly uninhabitable areas, exacerbation of environmentally sensitive chronic diseases, and enhanced viability of pathogenic microbes and their vectors. We reviewed the literature describing the various direct and indirect effects of climate change on diseases with cutaneous manifestations in Africa. We included non-communicable diseases such as malignancies (non-melanoma skin cancers), inflammatory dermatoses (i.e. photosensitive dermatoses, atopic dermatitis), and trauma (skin injury), as well as communicable diseases and neglected tropical diseases. Physicians should be aware of the ways in which climate change threatens human health in low- and middle-income countries in general, and particularly in countries throughout Africa, the world’s lowest-income and second most populous continent.
Introduction: This study aimed to identify climatic and environmental factors influencing the occurrence of heatstroke. Methods: A systematic review was conducted in February 2020 and 428 potentially relevant records were searched among PubMed, Scopus, Science Direct, and Web of Science and Google scholar databases in English language. After quality assessment and cross-checking by two independent researchers, finally, 14 articles included in this systematic review. Results: Solar radiant heat, ambient temperature, humidity, maximum and minimum daily temperature and humidity, water vapor pressure, wet bulb globe temperature (WBGT) index, Heat index (HI), sub-tropical climate, heatwaves, Urban Heat Island (UHI) effect, urbanization, daytime population density, surface temperature, high activity level in indoor/outdoor settings and local ambient temperatures were positive correlated factors of exertional heat illnesses (EHI) and exertional heat stroke (EHS) incidence and mortality. Seasonal acclimation, vegetative cover, cool roofs, tree canopy cover, cloud cover, wind speed and shading were inversely related factors of EHI and EHS. Conclusion: According to the results of the study, in order to prevent the increase of heat-related illnesses, it is necessary to consider and strengthen the factors affecting the reduction of the incidence of EHI and EHS, which were identified as negative correlated factors in this study.
Of all-natural disasters, extreme high temperatures events are the main cause of weather-related mortality. The compact urban settings of cities, the dependency on infrastructural systems as well as the larger concentration of people and economic activities make urban areas particularly vulnerable to health risks due to heat. To investigate vulnerabilities to heat, the study illustrates how vulnerability factors together with the hazard and the urban parameters determine the nexus between the heat and the health outcome, here called heat-health nexus. Peer-reviewed articles with no language limitations were searched from the first available record subjected to the imposed selection criteria. First, the information related to the study area were analysed, taking into consideration the level of resolution to investigate the scale of analysis. Then, the specific hazard parameters, divided in simple or combined weather indices, were evaluated. For sensitivity and adaptive capacity aspects, the study considered four distinct categories of determinants: mental and physical health, demographics, social and economic status. Finally, when looking at enhanced exposure, groups of determinants of vulnerability, divided between those describing indoor and outdoor environment conditions were analysed. Results demonstrated a heterogeneous spatial distribution of the identified case studies about heat and health in the urban context and highlighted different characteristics related to climate hazard, exposure, vulnerability and enhanced exposure factors in relation to the health of the population. This literature review demonstrate that a detailed identification of sensitivity, adaptive capacity and enhanced exposure elements is crucial in the implementation of effective adaptation measures in the health context.
BACKGROUND: Climate change is one of the great challenges of our time. The consequences of climate change on exposed biological subjects, as well as on vulnerable societies, are a concern for the entire scientific community. Rising temperatures, heat waves, floods, tornadoes, hurricanes, droughts, fires, loss of forest, and glaciers, along with disappearance of rivers and desertification, can directly and indirectly cause human pathologies that are physical and mental. However, there is a clear lack in psychiatric studies on mental disorders linked to climate change. METHODS: Literature available on PubMed, EMBASE, and Cochrane library until end of June 2019 were reviewed. The total number of articles and association reports was 445. From these, 163 were selected. We looked for the association between classical psychiatric disorders such as anxiety schizophrenia, mood disorder and depression, suicide, aggressive behaviors, despair for the loss of usual landscape, and phenomena related to climate change and extreme weather. Review of literature was then divided into specific areas: the course of change in mental health, temperature, water, air pollution, drought, as well as the exposure of certain groups and critical psychological adaptations. RESULTS: Climate change has an impact on a large part of the population, in different geographical areas and with different types of threats to public health. However, the delay in studies on climate change and mental health consequences is an important aspect. Lack of literature is perhaps due to the complexity and novelty of this issue. It has been shown that climate change acts on mental health with different timing. The phenomenology of the effects of climate change differs greatly-some mental disorders are common and others more specific in relation to atypical climatic conditions. Moreover, climate change also affects different population groups who are directly exposed and more vulnerable in their geographical conditions, as well as a lack of access to resources, information, and protection. Perhaps it is also worth underlining that in some papers the connection between climatic events and mental disorders was described through the introduction of new terms, coined only recently: ecoanxiety, ecoguilt, ecopsychology, ecological grief, solastalgia, biospheric concern, etc. CONCLUSIONS: The effects of climate change can be direct or indirect, short-term or long-term. Acute events can act through mechanisms similar to that of traumatic stress, leading to well-understood psychopathological patterns. In addition, the consequences of exposure to extreme or prolonged weather-related events can also be delayed, encompassing disorders such as posttraumatic stress, or even transmitted to later generations.
Despite being one of the continents with the least greenhouse gas emissions, no continent is being struck as severely by climate change (CC) as Africa. Mosquito-borne diseases (MBD) cause major human diseases in this continent. Current knowledge suggests that MBD range could expand dramatically in response to CC. This study aimed at assessing the relationship between CC and MBD in Africa. Methods For this purpose, a systematic peer review was carried out, considering all articles indexed in PubMed, Scopus, Embase and CENTRAL. Search terms referring to MBD, CC and environmental factors were screened in title, abstract and keywords.Results A total of twenty-nine studies were included, most of them on malaria (61%), being Anopheles spp. (61%) the most commonly analyzed vector, mainly in Eastern Africa (48%). Seventy-nine percent of these studies were based on predictive models. Seventy-two percent of the reviewed studies considered that CC impacts on MBD epidemiology. MBD prevalence will increase according to 69% of the studies while 17% predicted a decrease. MBD expansion throughout the continent was also predicted. Most studies showed a positive relationship between observed or predicted results and CC. However, there was a great heterogeneity in methodologies and a tendency to reductionism, not integrating other variables that interact with both the environment and MBD. In addition, most results have not yet been tested. A global health approach is desirable in this kind of research. Nevertheless, we cannot wait for science to approve something that needs to be addressed now to avoid greater effects in the future.
PURPOSE OF REVIEW: Vaccine-preventable diseases remain a major public health concern globally. Climate is a key driver of the dynamics of many infectious diseases, including those that are vaccine preventable. Understanding the impact of climate change on vaccine-preventable diseases is, thus, an important public health research priority. Here, we summarize the recent literature and highlight promising directions for future research. RECENT FINDINGS: Vaccine-preventable enteric diseases, such as cholera, exhibit sensitivity to precipitation and flooding events. The predicted increase in extreme weather events as a result of climate change could exacerbate outbreaks of these pathogens. For airborne pathogens, temperature and specific humidity have been shown to be the most important environmental drivers, although the impact of climate change on disease burden and dynamics remains unclear. Finally, the transmission dynamics of vector-borne diseases are dependent on both temperature and precipitation, and climate change is expected to alter the burden and geographic range of these diseases. However, understanding the interacting effects of multiple factors, including socioeconomic and ecological factors, on the vector-borne disease ecosystem will be a crucial step towards forecasting disease burden under climate change. Recent work has demonstrated associations between climate and transmission of vaccine-preventable diseases. Translating these findings into forecasts under various climate change scenarios will require mechanistic frameworks that account for both intrinsic and extrinsic drivers of transmission, and the non-linear effects on disease burden. Future research should also pay greater attention to uncertainty in both the climate modeling processes as well as disease outcomes in the context of vaccine-preventable diseases.
Climate change is considered to have great impact on human health. The heat waves have been associated with excess morbidity and mortality of cardiovascular diseases (CVD) across various populations and geographic locations. Important role in the heat-induced cardiovascular damage has endothelial dysfunction. It has been noticed that hot weather can impair tone and structure of the blood vessels via interfering with variety of biological factors such as nitric oxide synthesize, cytokine production and systemic inflammation. Also, due to dehydration and increased blood viscosity, by promoting thrombogenesis, heat has important impact on patients with atherosclerosis. During chronic exposure to the cold or hot weather cardiovascular function can be decreased, leading to a higher risk of developing heart attack, malignant cardiac arrhythmias, thromboembolic diseases and heat-induced sepsis like shock. It has been shown that changes in the ambient temperature through increasing blood pressure, blood viscosity, and heart rate, contribute to the cardiovascular mortality. The majority of deaths due to heat waves especially affect individuals with preexisting chronic CVD. This population can experience a decline in the health status, since extreme ambient temperature affects pharmacokinetic parameters of many cardiovascular drugs. Increased mortality from ischemic or hemorrhagic stroke can also be related to extreme temperature variations. On a cellular level, higher ambient temperature can limit storage of ATP and O(2) increase amount of free radicals and toxic substances and induce neuronal apoptotic signal transduction, which all can lead to a stroke. Preserving cardiovascular function in context of extreme climate changing tends to be particularly challenging.
BACKGROUND: Malaria is one of the most life-threatening vector-borne diseases globally. Recent autochthonous cases registered in several European countries have raised awareness regarding the threat of malaria reintroduction to Europe. An increasing number of imported malaria cases today occur due to international travel and migrant flows from malaria-endemic countries. The cumulative factors of the presence of competent vectors, favourable climatic conditions and evidence of increasing temperatures might lead to the re-emergence of malaria in countries where the infection was previously eliminated. METHODS: We performed a systematic literature review following PRISMA guidelines. We searched for original articles focusing on rising temperature and the receptivity to malaria transmission in Europe. We evaluated the quality of the selected studies using a standardised tool. RESULTS: The search resulted in 1’999 articles of possible relevance and after screening we included 10 original research papers in the quantitative analysis for the systematic review. With further increasing temperatures studies predicted a northward spread of the occurrence of Anopheles mosquitoes and an extension of seasonality, enabling malaria transmission for annual periods up to 6 months in the years 2051-2080. Highest vector stability and receptivity were predicted in Southern and South-Eastern European areas. Anopheles atroparvus, the main potential malaria vector in Europe, might play an important role under changing conditions favouring malaria transmission. CONCLUSION: The receptivity of Europe for malaria transmission will increase as a result of rising temperature unless socioeconomic factors remain favourable and appropriate public health measures are implemented. Our systematic review serves as an evidence base for future preventive measures.
Seasonal blood pressure (BP) variation is mostly found between the summer and winter months. Guidelines for diagnosis and treatment of hypertension in children have not considered this variation until recently. This review aims to present an overview of seasonal BP variation in childhood along with potential underlying pathophysiological mechanisms and long-term implications as well as conclusions for future studies. In pediatric cohorts, seven studies investigated seasonal changes in BP. These changes amount to 3.4-5.9 mmHg (or 0.5-1.5 mmHg per -?1 °C difference in environmental temperature) in systolic BP with a peak in fall or winter. Potential mechanisms and mediators of seasonal BP variation include sympathetic activation of the nervous system with an increase of urinary and plasma norepinephrine levels in the winter season. Additionally, the physical activity among children and adolescents was inversely correlated with BP levels. Temperature sensitivity of BP and pediatric BP levels predict future systolic BP and target-organ damage. Therefore, cardiovascular events may even be long-term complications of seasonal BP variation in pediatric hypertensive patients. Overall, these data strongly suggest an important effect of ambient temperature on BP in children. Additional studies in pediatric cohorts are needed to define how best to incorporate such variation into clinical practice.
BACKGROUND: Exposure to heat, air pollution, and pollen are associated with health outcomes, including cardiovascular and respiratory disease. Studies assessing the health impacts of climate change have considered increased exposure to these risk factors separately, though they may be increasing simultaneously for some populations and may act synergistically on health. Our objective is to systematically review epidemiological evidence for interactive effects of multiple exposures to heat, air pollution, and pollen on human health. METHODS: We systematically searched electronic literature databases (last search, April 29, 2019) for studies reporting quantitative measurements of associations between at least two of the exposures and mortality from any cause and cardiovascular and respiratory morbidity and mortality specifically. Following the Navigation Guide systematic review methodology, we evaluated the risk of bias of individual studies and the overall quality and strength of evidence. RESULTS: We found 56 studies that met the inclusion criteria. Of these, six measured air pollution, heat, and pollen; 39 measured air pollution and heat; 10 measured air pollution and pollen; and one measured heat and pollen. Nearly all studies were at risk of bias from exposure assessment error. However, consistent exposure-response across studies led us to conclude that there is overall moderate quality and sufficient evidence for synergistic effects of heat and air pollution. We concluded that there is overall low quality and limited evidence for synergistic effects from simultaneous exposure to (1) air pollution, pollen, and heat; and (2) air pollution and pollen. With only one study, we were unable to assess the evidence for synergistic effects of heat and pollen. CONCLUSIONS: If synergistic effects between heat and air pollution are confirmed with additional research, the health impacts from climate change-driven increases in air pollution and heat exposure may be larger than previously estimated in studies that consider these risk factors individually.
OBJECTIVE: The purpose of this review is to evaluate the currently-available literature regarding the impact of both primary aging and age-related fitness on thermoregulatory function during exercise in the heat. In so doing, we aim to (1) characterize the influence of fitness in mitigating age-related declines in thermoregulation, (2) address the limitations of prior experimental approaches for investigating age-related thermoregulatory impairments, (3) examine to what extent aerobic fitness can be maintained in the aging athlete, and (4) begin to address the specific environmental conditions in which age-related impairments in thermoregulatory function may place highly active older adults at increased risk for heat-related illness and injury and/or limited performance. DESIGN: Mini-review. METHODS: Review and synthesis of available information. RESULTS: The earth’s climate is warming, accompanied by a consequently greater frequency and severity of extreme heat events. At the same time, lifespan is increasing and people of all ages are staying increasingly active. Age-related impairments in thermoregulatory function are well-documented, leading to increased heat-related health risks and reduced exercise/athletic performance for older adults in hot environmental conditions. High aerobic fitness improves body temperature regulation during exercise via augmented sweating and improved cardiovascular function, including cardiac output and skin blood flow, in humans of all ages. CONCLUSIONS: The masters athlete is better suited for exercise/heat-stress compared to his or her less fit peers. However, while age and thermoregulation in general has been studied extensively, research on the most fit older adults, including highly competitive athletes, is generally lacking.
More frequent and intense periods of extreme heat (heatwaves) represent the most direct challenge to human health posed by climate change. Older adults are particularly vulnerable, especially those with common age-associated chronic health conditions (e.g., cardiovascular disease, hypertension, obesity, type 2 diabetes, chronic kidney disease). In parallel, the global population is aging and age-associated disease rates are on the rise. Impairments in the physiological responses tasked with maintaining homeostasis during heat exposure have long been thought to contribute to increased risk of health disorders in older adults during heatwaves. As such, a comprehensive overview of the provisional links between age-related physiological dysfunction and elevated risk of heat-related injury in older adults would be of great value to healthcare officials and policy makers concerned with protecting heat-vulnerable sectors of the population from the adverse health impacts of heatwaves. In this narrative review, we therefore summarize our current understanding of the physiological mechanisms by which aging impairs the regulation of body temperature, hemodynamic stability and hydration status. We then examine how these impairments may contribute to acute pathophysiological events common during heatwaves (e.g., heatstroke, major adverse cardiovascular events, acute kidney injury) and discuss how age-associated chronic health conditions may exacerbate those impairments. Finally, we briefly consider the importance of physiological research in the development of climate-health programs aimed at protecting heat-vulnerable individuals.
The global climate has been changing over the last century due to greenhouse gas emissions and will continue to change over this century, accelerating without effective global efforts to reduce emissions. Ticks and tick-borne diseases (TTBDs) are inherently climate-sensitive due to the sensitivity of tick lifecycles to climate. Key direct climate and weather sensitivities include survival of individual ticks, and the duration of development and host-seeking activity of ticks. These sensitivities mean that in some regions a warming climate may increase tick survival, shorten life-cycles and lengthen the duration of tick activity seasons. Indirect effects of climate change on host communities may, with changes in tick abundance, facilitate enhanced transmission of tick-borne pathogens. High temperatures, and extreme weather events (heat, cold, and flooding) are anticipated with climate change, and these may reduce tick survival and pathogen transmission in some locations. Studies of the possible effects of climate change on TTBDs to date generally project poleward range expansion of geographical ranges (with possible contraction of ranges away from the increasingly hot tropics), upslope elevational range spread in mountainous regions, and increased abundance of ticks in many current endemic regions. However, relatively few studies, using long-term (multi-decade) observations, provide evidence of recent range changes of tick populations that could be attributed to recent climate change. Further integrated ‘One Health’ observational and modeling studies are needed to detect changes in TTBD occurrence, attribute them to climate change, and to develop predictive models of public- and animal-health needs to plan for TTBD emergence.
PURPOSE OF REVIEW: Climate change will affect mortality associated with both ambient temperature and air pollution. Because older adults have elevated vulnerability to both non-optimal ambient temperature (heat and cold) and air pollution, population aging can amplify future population vulnerability to these stressors through increasing the number of vulnerable older adults. We aimed to review recent evidence on projections of temperature- or air pollution-related mortality burden (i.e., number of deaths) under combined climate change and population aging scenarios, with a focus on evaluating the role of population aging in assessing these health impacts of climate change. We included studies published between 2014 and 2019 with age-specific population projections. RECENT FINDINGS: We reviewed 16 temperature projection studies and 15 air pollution projection studies. Nine of the temperature studies and four of the air pollution studies took population aging into account by performing age-stratified analyses that utilized age-specific relationships between temperature or air pollution exposures and mortality (i.e., age-specific exposure-response functions (ERFs)). Population aging amplifies the projected mortality burden of temperature and air pollution under a warming climate. Compared with a constant population scenario, population aging scenarios lead to less reduction or even increases in cold-related mortality burden, resulting in substantial net increases in future overall (heat and cold) temperature-related mortality burden. There is strong evidence suggesting that to accurately assess the future temperature- and air pollution-related mortality burden of climate change, investigators need to account for the amplifying effect of population aging. Thus, all future studies should incorporate age-specific population size projections and age-specific ERFs into their analyses. These studies would benefit from refinement of age-specific ERF estimates.
Urban overheating is documented for more than 400 major cities in the world. Numerous experimental data show that the magnitude of the average temperature increase may exceed 4-5 C, while at the peak may exceed 10 C. Increased ambient temperatures cause a serious impact on the cooling energy consumption, peak electricity demand, heat related mortality and morbidity, urban environmental quality, local vulnerability and comfort. Synergies between urban heat island and heat waves increase further the amplitude of urban overheating The present paper reviews and reports the recent progress and knowledge on the specific impact of current and projected urban overheating in energy, peak electricity demand, air quality, mortality and morbidity and urban vulnerability. In parallel, it discusses new findings related to the characteristics and the magnitude of urban overheating, and reports and analyse the recent knowledge on the synergies between urban heat island and heat waves. (C) 2019 Elsevier B.V. All rights reserved.
Climate change is a worldwide challenge. Its consequences do encompass severe threats not only for the existence and somatic health, but also for the mental health of children and adolescents. Mental health can be impaired by three types of consequences. Direct consequences of climate change, such as natural disasters and indirect consequences, such as loss of land, flight and migration, exposure to violence, change of social, ecological, economic or cultural environment. Moreover, the increasing awareness of the existential dimension of climate change in children and adolescents can influence their well-being or challenge their mental health. Consequences of climate change for somatic health may interact with mental health or have psychological sequelae in children and adolescents. Based on the estimates by the United Nations Intergovernmental Panel on Climate Change, we have summarized current data on these differential pathways as to how climate change affects the mental health of children worldwide through selective literature research on Pubmed. Mental health sequelae of direct and indirect consequences of climate change, increased awareness and physical health problems caused by climate change are presented. We give insights into special vulnerabilities of children and adolescents and identify high-risk groups. As the “Fridays for Future” movement has been initiated in northern Europe, we will discuss these results with a focus on children and adolescents in Europe. The results indicate that climate change is a serious threat to children and adolescent mental health. Children´s rights, mental health and climate change should not continue to be seen as separate points; instead, they need to be brought together to address this major challenge determining the future of our children and their descendants.
Many studies have been conducted to assess the health effects of climate change in Korea. However, there has been a lack of consideration regarding how the results of these studies can be applied to relevant policies. The current study aims to examine research trends at the agenda-setting stage and to review future ways in which health-related adaptation to climate change can be addressed within national public health policy. A systematic review of previous studies of the health effects of climate change in Korea was conducted. Many studies have evaluated the effect of ambient temperature on health. A large number of studies have examined the effects on deaths and cardio-cerebrovascular diseases, but a limitation of these studies is that it is difficult to apply their findings to climate change adaptation policy in the health sector. Many infectious disease studies were also identified, but these mainly focused on malaria. Regarding climate change-related factors other than ambient temperature, studies of the health effects of these factors (with the exception of air pollution) are limited. In Korea, it can be concluded that studies conducted as part of the agenda-setting stage are insufficient, both because studies on the health effects of climate change have not ventured beyond defining the problem and because health adaptation to climate change has not been set as an important agenda item. In the future, the sharing and development of relevant databases is necessary. In addition, the priority of agenda items should be determined as part of a government initiative.
Numerous extreme heatwaves producing large impacts on human health, agriculture, water resources, energy demand, regional economies, and forest ecosystems occurred during the first twenty years of the 21st century. The present study strives to provide a systematic review of recent studies of warm biometeorological extremes in Europe. The main aim of this paper is to provide a methodical summary of the observed changes in warm extremes, duration, and variability in different parts of Europe. During the last decade, much attention has been paid to the negative impacts of heat and humidity on human health. Therefore, the human biometeorology is required to appraise the human thermal environment in a way that human thermoregulation is taken into account. In many European countries and regions, future heat exposure will indeed exceed critical levels, and a steep increase in biometeorological heatwaves and warm extremes are expected. The indices that take into account human energy balance along with weather conditions should be used to examine the impacts of extreme heatwaves on human health and should be used as a basis for the determination of acclimatization to high-heat-stress conditions. A detailed description of recent studies that have used biometeorological indices such as Physiological Equivalent Temperature (PET) and Universal Thermal Climate Index (UTCI) for the estimation of warm extremes and their influence on human health is provided. Additionally, a short overview of the existence of the heat-health warning systems (HHWS), their conceptualization, and implementation across the European continent is considered, as well as the possibilities for further investigations and implementation of effective measures and programs that could reduce the adverse health impacts.
To protect public health, heat-related policies are increasingly being adopted by city authorities to address the unequal impact of heatwaves. Ahmedabad’s Heat Action Plan (HAP) is an acclaimed and successful policy response in India and beyond. While the pilot evaluation of the initiative suggests that almost a thousand deaths were avoided annually after its implementation, it is not yet clear whose lives were saved, and to what extent this statistic was due to the HAP, rather than other factors. By reviewing the published and grey literature centering on the HAP target groups, outreach strategies, and impacts on urban services, this paper points out major knowledge gaps concerning the potentials and impacts of the HAP, which may lead to the systematical exclusion of vulnerable and disadvantaged groups from the intended benefits. In this paper, it is argued that the effectiveness and inclusiveness of the HAP predominantly depend on its integration into urban development projects, which is a challenging task given the existing horizontal and vertical fragmentation in the planning of city projects. Moreover, urban plans and policies, including the HAP, are shown to be overly focused on technology, and as a consequence, they do not realize their limited scope in addressing the associated issues, which are fundamentally social, deep, and structural, such as spatial inequality in Indian cities.
As the world overheats-potentially to conditions warmer than during the three million years over which modern humans evolved-suffering from heat stress will become widespread. Fundamental questions about humans’ thermal tolerance limits are pressing. Understanding heat stress as a process requires linking a network of disciplines, from human health and evolutionary theory to planetary atmospheres and economic modeling. The practical implications of heat stress are equally transdisciplinary, requiring technological, engineering, social, and political decisions to be made in the coming century. Yet relative to the importance of the issue, many of heat stress’s crucial aspects, including the relationship between its underlying atmospheric drivers-temperature, moisture, and radiation-remain poorly understood. This review focuses on moist heat stress, describing a theoretical and modeling framework that enables robust prediction of the averaged properties of moist heat stress extremes and their spatial distribution in the future, and draws some implications for human and natural systems from this framework. Moist heat stress affects society; we summarize drivers of moist heat stress and assess future impacts on societal and global scales. Moist heat stress pattern scaling of climate models allows research on future heat waves, infrastructure planning, and economic productivity.
Climate change is expanding the global at-risk population for vector-borne diseases (VBDs). The World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework emphasises the importance of primary prevention of biological hazards and its value in protecting against VBDs. The framework encourages stakeholder coordination and information sharing, though there is still a need to reinforce prevention and recovery within disaster management. This keyword-search based narrative literature review searched databases PubMed, Google Scholar, Embase and Medline between January 2000 and May 2020, and identified 134 publications. In total, 10 health-EDRM primary prevention measures are summarised at three levels (personal, environmental and household). Enabling factor, limiting factors, co-benefits and strength of evidence were identified. Current studies on primary prevention measures for VBDs focus on health risk-reduction, with minimal evaluation of actual disease reduction. Although prevention against mosquito-borne diseases, notably malaria, has been well-studied, research on other vectors and VBDs remains limited. Other gaps included the limited evidence pertaining to prevention in resource-poor settings and the efficacy of alternatives, discrepancies amongst agencies’ recommendations, and limited studies on the impact of technological advancements and habitat change on VBD prevalence. Health-EDRM primary prevention measures for VBDs require high-priority research to facilitate multifaceted, multi-sectoral, coordinated responses that will enable effective risk mitigation.
The associations between built and food environments and childhood obesity have been studied extensively. However, the association between the natural environment and childhood obesity has received too little scholarly attention. This study reviewed the literature published before 1 January 2019, which described associations between a full range of natural environmental factors (e.g., rainfall, temperature, sunlight, natural disasters, flood and drought) and weight-related behaviours and childhood obesity. Five cross-sectional studies and one longitudinal study were identified. Measures of natural environmental factors varied across six included studies, falling into five broad categories: weather conditions, altitude, natural disaster risk, air quality and day length. It was found that temperature was a significant weather indicator in most included studies and was associated with a reduction of daily physical activity. Children living in high-altitude areas were more likely to be shorter and heavier than their counterparts in low-altitude areas. Findings of this study will contribute to helping multiple stakeholders, including policy makers and urban planners, and formulate health policies and interventions to mitigate the detrimental impact of the natural environment on childhood obesity. More longitudinal studies should be designed to confirm these effects and explore the potential health effects of more natural environmental factors.
East Africa is highly affected by neglected tropical diseases (NTDs), which are projected to be exacerbated by climate change. Consequently, understanding what research has been conducted and what knowledge gaps remain regarding NTDs and climate change is crucial to informing public health interventions and climate change adaptation. We conducted a systematic scoping review to describe the extent, range, and nature of publications examining relationships between NTDs and climatic factors in East Africa. We collated all relevant English and French publications indexed in PubMed(®), Web of Science™ Core Collection, and CAB Direct(©) databases published prior to 2019. Ninety-six publications were included for review. Kenya, Tanzania, and Ethiopia had high rates of publication, whereas countries in the Western Indian Ocean region were underrepresented. Most publications focused on schistosomiasis (n = 28, 29.2%), soil-transmitted helminthiases (n = 16, 16.7%), or human African trypanosomiasis (n = 14, 14.6%). Precipitation (n = 91, 94.8%) and temperature (n = 54, 56.3%) were frequently investigated climatic factors, whereas consideration of droughts (n = 10, 10.4%) and floods (n = 4, 4.2%) was not prominent. Publications reporting on associations between NTDs and changing climate were increasing over time. There was a decrease in the reporting of Indigenous identity and age factors over time. Overall, there were substantial knowledge gaps for several countries and for many NTDs. To better understand NTDs in the context of a changing climate, it would be helpful to increase research on underrepresented diseases and regions, consider demographic and social factors in research, and characterize how these factors modify the effects of climatic variables on NTDs in East Africa.
Changes to Australia’s climate and land-use patterns could result in expanded spatial and temporal distributions of endemic mosquito vectors including Aedes and Culex species that transmit medically important arboviruses. Climate and land-use changes greatly influence the suitability of habitats for mosquitoes and their behaviors such as mating, feeding and oviposition. Changes in these behaviors in turn determine future species-specific mosquito diversity, distribution and abundance. In this review, we discuss climate and land-use change factors that influence shifts in mosquito distribution ranges. We also discuss the predictive and epidemiological merits of incorporating these factors into a novel integrated statistical (SSDM) and mechanistic species distribution modelling (MSDM) framework. One potentially significant merit of integrated modelling is an improvement in the future surveillance and control of medically relevant endemic mosquito vectors such as Aedes vigilax and Culex annulirostris, implicated in the transmission of many arboviruses such as Ross River virus and Barmah Forest virus, and exotic mosquito vectors such as Aedes aegypti and Aedes albopictus. We conducted a focused literature search to explore the merits of integrating SSDMs and MSDMs with biotic and environmental variables to better predict the future range of endemic mosquito vectors. We show that an integrated framework utilising both SSDMs and MSDMs can improve future mosquito-vector species distribution projections in Australia. We recommend consideration of climate and environmental change projections in the process of developing land-use plans as this directly impacts mosquito-vector distribution and larvae abundance. We also urge laboratory, field-based researchers and modellers to combine these modelling approaches. Having many different variations of integrated (SDM) modelling frameworks could help to enhance the management of endemic mosquitoes in Australia. Enhanced mosquito management measures could in turn lead to lower arbovirus spread and disease notification rates.
India is urbanizing at an alarming rate and the impact of climate change is becoming more visible each passing day. The rapid urbanization and climate change have severe direct and indirect consequences, such as increasing poverty, inequality, massive displacement, public health concerns, and challenges of urban governance, among others. This paper identifies some of the most pressing issues faced by urban India in the context of climate change. It also details the interventions undertaken at the local, national, and international levels to counter the effect of the climate change. In addition, it critically evaluates the role of government organizations, especially in terms of undertaking regulatory and planning functions. The paper argues that the implementation of institutional reforms would enable the government to reach out to the private sector to improve urban service delivery. It also provides examples of best practices from India and the world in combating climate change through adaptation and mitigation approaches.
PURPOSE OF REVIEW: To describe a collection of recent work published on thermal suitability for vector-borne diseases, in which mapping approaches illustrated the geographic shifts, and spatial approaches describe the demographic impact anticipated with a changing climate. RECENT FINDINGS: While climate change predictions of warming indicate an expansion in VBD suitability risk in some parts of the globe, while in others, optimal temperatures for transmission may be exceeded, as seen for malaria in Western Africa, resulting in declining risk. The thermal suitability of specific vector-pathogen pairs can have large impacts on geographic range of risk, and changes in human demography itself will intersect with this risk to create different vulnerability profiles over the coming century. Using a physiological approach to describe the thermal suitability of transmission for vector-borne diseases allows us to illustrate the future risk as mapped information. This in turn can be coupled with demographic projections to anticipate changing risk, and even changing vulnerability within that population change.
The recognition and documentation of climatic change effects on human health remains one of the most important challenges of the 21st century. While myriad in scope, one of the most recognised impacts is related to pollen, specifically its production, release and duration, and the consequences for allergic diseases, including asthma and allergic rhinitis. At present, the bulk of efforts to understand and document these links have been conducted by scientists in the Northern Hemisphere. However, the link between climate change and aeroallergenic pollen is global and international in scope. For this reason, more recent efforts to provide similar evaluations have been initiated by scientists in the Southern Hemisphere. The current review acknowledges northern enquiries, but also emphasises research gaps and inconsistencies which should be avoided by southern investigators. To remedy these deficiencies, some suggestions are offered, including a greater emphasis on plant demographics, the standardisation of pollen metrics, automation and environmental integration. It is hoped that this perspective will be able to provide support to efforts of scientists in the Southern Hemisphere to evaluate better climate shifts and aeroallergen consequences. Overall, there is a clear and pressing need to understand these likely changes while simultaneously comprehending their impact on pollen-related health outcomes – for both hemispheres.
Heat waves represent a public health risk to elderly people, and typically result in an increased rate of hospital admissions and deaths. Studies of thermoregulation in this cohort have generally focused on single elements such as sweating capacity. Sweating capacity and skin blood flow reduce with age, reducing ability to dissipate heat. Perception of effort during heat exposure is emerging as an area that needs further investigation as the elderly appear to lack the ability to adequately perceive increased physiological strain during heat exposure. The role of the gut and endotoxemia in heat stress has received attention in young adults, while the elderly population has been neglected. This shortcoming offers another potential avenue for identifying effective integrated health interventions to reduce heat illnesses. Increasing numbers of elderly individuals in populations worldwide are likely to increase the incidence of heat wave-induced deaths if adequate interventions are not developed, evaluated, and implemented. In this narrative-style review we identify and discuss health-related interventions for reducing the impact of heat illnesses in the elderly.
Cities are prone to excess heat, manifesting as urban heat islands (UHIs). UHIs impose a heat penalty upon urban inhabitants that jeopardizes human health and amplifies the escalating effects of background temperature rises and heatwaves, presenting barriers to participation in city life that diminish interaction and activity. This review paper investigates how green infrastructure, passive design and urban planning strategies-herein termed as green infrastructure and design solutions (GIDS)-can be used to cool the urban environment and improve city vitality. A systematic literature review has been undertaken connecting UHIs, city vitality and GIDS to find evidence of how qualities and conditions fundamental to the vitality of the city are diminished by heat, and ways in which these qualities and conditions may be improved through GIDS. This review reveals that comfortable thermal conditions underpin public health and foster activity-a prerequisite for a vital city-and that reducing environmental barriers to participation in urban life enhances physical and mental health as well as activity. This review finds that GIDS manage urban energy flows to reduce the development of excess urban heat and thus improve the environmental quality of urban spaces. Furthermore, it finds that the most equitable approach to urban cooling is one that reduces the intensity of the meso-scale UHI that affects all urban inhabitants. Subsequently, a cooler urban fabric based on GIDS is proposed. A cohesive approach to the widespread adoption of GIDS shows potential to produce a cooler urban fabric that is human-centered in its function and aesthetic to enhance participation in public life and stimulate life on the streets. Four spatial scales are presented in which a combination of GIDS may be collectively implemented to reduce the meso-scale UHI, including the urban, intra-urban, building and body scales. This approach considers the interacting nature of GIDS applied within contrasting urban landscapes, and aims to produce cooler urban conditions, better walking environments, and ecosystem co-benefits to stimulate participation in physical activity and public life to underpin public health, productivity and livelihoods, thereby inducing city vitality.
Sea level rise and the anthropogenic warming of the world’s oceans is not only an environmental tragedy, but these changes also result in a significant threat to public health. Along with coastal flooding and the encroachment of saltwater farther inland comes an increased risk of human interaction with pathogenic Vibrio species, such as Vibrio cholerae, V. vulnificus and V. parahaemolyticus. This minireview examines the current literature for updates on the climatic changes and practices that impact the location and duration of the presence of Vibrio spp., as well as the infection routes, trends and virulence factors of these highly successful pathogens. Finally, an overview of current treatments and methods for the mitigation of both oral and cutaneous exposures are presented.
Urban vegetation provides undeniable benefits to urban climate, health, thermal comfort and environmental quality of cities and represents one of the most considered urban heat mitigation measures. Despite the plethora of available scientific information, very little is known about the holistic and global impact of a potential increase of urban green infrastructure (GI) on urban climate, environmental quality and health, and their synergies and trade-offs. There is a need to evaluate globally the extent to which additional GI provides benefits and quantify the problems arising from the deployment of additional greenery in cities which are usually overlooked or neglected. The present paper has reviewed and analysed 55 fully evaluated scenarios and case studies investigating the impact of additional GI on urban temperature, air pollution and health for 39 cities. Statistically significant correlations between the percentage increase of the urban GI and the peak daily and night ambient temperatures are obtained. The average maximum peak daily and night-time temperature drop may not exceed 1.8 and 2.3 degrees C respectively, even for a maximum GI fraction. In parallel, a statistically significant correlation between the peak daily temperature decrease caused by higher GI fractions and heat-related mortality is found. When the peak daily temperature drops by 0.1 degrees C, then the percentage of heat-related mortality decreases on average by 3.0% The impact of additional urban GI on the concentration of urban pollutants is analysed, and the main parameters contributing to decrease or increase of the pollutants’ concentration are presented.
The international community has recognized global warming as an impending catastrophe that poses significant threat to life on earth. In response, the signatories of the Paris Agreement (2015) have committed to limit the increase in global mean temperature to < 1.5 °C from pre-industry period, which is defined as 1950-1890. Considering that the protection of human life is a central focus in the Paris Agreement, the naturally endowed properties of the human body to protect itself from environmental extremes should form the core of an integrated and multifaceted solution against global warming. Scholars believe that heat and thermoregulation played important roles in the evolution of life and continue to be a central mechanism that allows humans to explore, labor and live in extreme conditions. However, the international effort against global warming has focused primarily on protecting the environment and on the reduction of greenhouse gases by changing human behavior, industrial practices and government policies, with limited consideration given to the nature and design of the human thermoregulatory system. Global warming is projected to challenge the limits of human thermoregulation, which can be enhanced by complementing innate human thermo-plasticity with the appropriate behavioral changes and technological innovations. Therefore, the primary aim of this review is to discuss the fundamental concepts and physiology of human thermoregulation as the underlying bases for human adaptation to global warming. Potential strategies to extend human tolerance against environmental heat through behavioral adaptations and technological innovations will also be discussed. An important behavioral adaptation postulated by this review is that sleep/wake cycles would gravitate towards a sub-nocturnal pattern, especially for outdoor activities, to avoid the heat in the day. Technologically, the current concept of air conditioning the space in the room would likely steer towards the concept of targeted body surface cooling. The current review was conducted using materials that were derived from PubMed search engine and the personal library of the author. The PubMed search was conducted using combinations of keywords that are related to the theme and topics in the respective sections of the review. The final set of articles selected were considered “state of the art,” based on their contributions to the strength of scientific evidence and novelty in the domain knowledge on human thermoregulation and global warming.
In 2010, the American Heart Association published a statement concluding that the existing scientific evidence was consistent with a causal relationship between exposure to fine particulate matter and cardiovascular morbidity and mortality, and that fine particulate matter exposure is a modifiable cardiovascular risk factor. Since the publication of that statement, evidence linking air pollution exposure to cardiovascular health has continued to accumulate and the biological processes underlying these effects have become better understood. This increasingly persuasive evidence necessitates policies to reduce harmful exposures and the need to act even as the scientific evidence base continues to evolve. Policy options to mitigate the adverse health impacts of air pollutants must include the reduction of emissions through action on air quality, vehicle emissions, and renewable portfolio standards, taking into account racial, ethnic, and economic inequality in air pollutant exposure. Policy interventions to improve air quality can also be in alignment with policies that benefit community and transportation infrastructure, sustainable food systems, reduction in climate forcing agents, and reduction in wildfires. The health care sector has a leadership role in adopting policies to contribute to improved environmental air quality as well. There is also potentially significant private sector leadership and industry innovation occurring in the absence of and in addition to public policy action, demonstrating the important role of public-private partnerships. In addition to supporting education and research in this area, the American Heart Association has an important leadership role to encourage and support public policies, private sector innovation, and public-private partnerships to reduce the adverse impact of air pollution on current and future cardiovascular health in the United States.
BACKGROUND: In the face of climate change, the protection of vulnerable patients from extreme climatic conditions is of growing interest to the healthcare sector and governments. Inpatients are especially susceptible to heat due to acute illness and/or chronic diseases. Their condition can be aggravated by adverse environmental factors. Installing air conditioning can be seen as an element of public health adaptation because it was shown to improve mortality rates of hospital patients experiencing hot temperatures. Still, the mediating factors and resulting health effects are largely unknown. METHOD: The PRISMA-ScR guideline was followed for this scoping review. Available evidence on the health effects of Heating, Ventilation, Air Conditioning (HVAC) and fans was searched in Medline, Embase and the Cochrane Library. The focus of the search strategy was on inpatients of the hospital. Grey literature was screened on 14 relevant websites. English and German publications were eligible without restrictions on publication date. Results were charted according to the categories population, intervention, control and outcome together with a qualitative description. RESULTS: The review process yielded eleven publications of which seven were issued after 2003. Seven were clinical trials, three cross-sectional studies and one was a case report. The publications described the installation of HVAC on general wards and in intensive care units. Main topics were heat stress protection and support of thermoregulation, but also the rewarming of hypothermic patients. HVAC use resulted in a recovery effect shown by improved vital signs, reduced cardiac stress, accelerated recuperation and greater physical activity. This protective effect was demonstrated by a shorter hospital stay for patients with respiratory disease and a reduction of mortality for heat illness patients. CONCLUSION: This scoping review summarises the fragmented evidence on health effects of HVAC and fan utilisation for inpatients. Installing HVAC has the potential to improve patients’ outcomes and to make hospital treatment more efficient during heat waves. The application of HVAC could be a promising adaptation measure to mitigate the adverse effects of climate change on health and healthcare systems.
The humanity is currently facing the COVID-19 pandemic challenge, the largest global health emergency after the Second World War. During summer months, many countries in the northern hemisphere will also have to counteract an imminent seasonal phenomenon, the management of extreme heat events. The novelty this year concerns that the world population will have to deal with a new situation that foresees the application of specific measures, including adjunctive personal protective equipment (i.e. facemasks and gloves), in order to reduce the potential transmission of the SARS-CoV-2 virus. These measures should help to decrease the risk of the infection transmission but will also represent an aggravating factor to counteract the heat effects on the population health both at occupational and environmental level. The use of a specific heat health warning system with personalized information based on individual, behavioural and environmental characteristics represents a necessary strategy to help a fast adaptation of the population at a time where the priority is to live avoiding SARS-CoV-2 infection.
BACKGROUND: In Ireland, rising temperatures remains the climate projection that national climate scientists associate with the highest degree of confidence. However, the health challenge of heat has been largely absent from Ireland’s public health sector. This is epitomised by the lack of a comprehensive public health-focused heat-health action plan or country-specific codes of practice for heat-health when working outdoors. Our objective is to highlight the anticipated heat-health challenges in Ireland, and other temperate regions, through analysing vulnerable groups and systems, reinforcing the need to respond. METHODS: A scoping literature review was conducted to determine how heat affects health of the vulnerable in temperate climatic regions, with a focus on Ireland. Additionally, national Google Trends data was coarsely analysed to determine whether heat is a growing societal concern. RESULTS AND DISCUSSION: The heat-vulnerable include: older people; chronically ill; infants, pregnant women, children; outdoor workers; socio-economically disadvantaged; urban dwellers; food systems and the health sector. Google Trends data suggest an increase in heat-related health searches over time, demonstrating rising levels of concern to temperature increases, reinforcing a gap in national policy associated with communication of, and response to, the heat-health challenge. Specific, actionable recommendations for adaptation and mitigation strategies are proposed. CONCLUSION: Heat poses a public and occupational health challenge, receiving limited attention in Ireland. Lack of a co-ordinated effort, places vulnerable populations at risk. Our recommendations, with reference to vulnerable groups and acknowledging the multi-sectoral nature of heat-health and climate change, advocate for the adoption of a “health and climate change in all policies” approach and the development of a public health-focused heat-health action plan.
Climate extremes threaten human health, economic stability, and the wellbeing of natural and built environments (e.g., 2003 European heat wave). As the world continues to warm, climate hazards are expected to increase in frequency and intensity. The impacts of extreme events will also be more severe due to the increased exposure (growing population and development) and vulnerability (aging infrastructure) of human settlements. Climate models attribute part of the projected increases in the intensity and frequency of natural disasters to anthropogenic emissions and changes in land use and land cover. Here, we review the impacts, historical and projected changes, and theoretical research gaps of key extreme events (heat waves, droughts, wildfires, precipitation, and flooding). We also highlight the need to improve our understanding of the dependence between individual and interrelated climate extremes because anthropogenic-induced warming increases the risk of not only individual climate extremes but also compound (co-occurring) and cascading hazards. Climate hazards are expected to increase in frequency and intensity in a warming world. Anthropogenic-induced warming increases the risk of compound and cascading hazards. We need to improve our understanding of causes and drivers of compound and cascading hazards.
BACKGROUND: Current and projected increases in global temperatures and extreme climate events have led to heightened interest in the impact of climate factors (i.e. ambient temperature, season/seasonality, and humidity) on human health. There is growing evidence that climate factors may impact metabolic function, including insulin sensitivity. Gestational diabetes mellitus (GDM) is a common pregnancy complication, with an estimated global prevalence of up to 14%. While lifestyle and genetic risk factors for GDM are well established, environmental factors may also contribute to GDM risk. Previous reviews have summarized the growing evidence of environmental risk factors for GDM including endocrine disrupting chemicals and ambient air pollution. However, studies of the effects of climate factors on GDM risk have not been systematically evaluated. Therefore, we conducted a systematic review to summarize and evaluate the current literature on the associations of climate factors with GDM risk. METHODS: We conducted systematic searches in PubMed and EMBASE databases for original researchs on associations of climate factors (i.e. ambient temperature, season/seasonality, and humidity) with GDM and/or related glycemic outcomes for all publication dates through September 20th, 2020. RESULTS: Our search identified 16 articles on the associations of ambient temperature and/or season with GDM and maternal glycemic outcomes during pregnancy, which were included in this review. Despite inconsistencies in exposure and outcome assessment, we found consistent evidence of a seasonal effect on GDM risk, with higher prevalence of GDM and higher pregnancy glucose levels in summer months. We found suggestive evidence of an association between higher ambient temperature and elevated glucose levels from GDM screening tests. CONCLUSION: Climate factors may be associated with GDM risk. However, further research is needed to evaluate these associations and to elucidate the specific mechanisms involved.
Worldwide, diabetes mellitus (DM) represents a major public-health problem due to its increasing prevalence in tandem with the rising trend of obesity. However, climate change, with its associated negative health effects, also constitutes a worrisome problem. Patients with DM are experiencing more visits to emergency departments, hospitalizations, morbidity and mortality during heat waves at ever-increasing numbers. Such patients are particularly vulnerable to heat waves due to impaired thermoregulatory mechanisms in conjunction with impaired autonomous nervous system responses at high temperatures, electrolyte imbalances and rapid deterioration of kidney function, particularly among those aged > 80 years and with preexisting chronic kidney disease (CKD). Moreover, exposure to cold temperatures is associated with increased rates of acute myocardial infarction as well as poor glycaemic control, although results are conflicting regarding cold-related mortality among patients with DM. In addition to extremes of temperature, air pollution as a consequence of the climate crisis may also be implicated in the increased prevalence and incidence of DM, particularly gestational DM (GDM), and lead to deleterious effects in patients with DM. Thus, more large-scale studies are now required to elucidate the association between specific air pollutants and risk of DM. This review presents the currently available evidence for the detrimental effects of climate change, particularly those related to weather variables, on patients with DM (both type 1 and type 2) and GDM. Specifically, the effects of heat waves and extreme cold, and pharmaceutical and therapeutic issues and their implications, as well as the impact of air pollution on the risk for DM are synthesized and discussed here.
The preliminary determination of the article is to investigate the effects of pollution and climate change. In this regard, the authors want to highlight that this real and critical issue must take seriously because each of us contributes to pollution and climate change, which is very real, and which will be aggravated by not taking action. Global warming currently involves two major problems for humanity: on the one hand, the need to dramatically diminish greenhouse gas emissions to stabilize the concentration of these gases in the atmosphere to prevent anthropogenic influence on the climate system and enable ecosystems, contrastingly the need to accommodate to the consequence of climate change, given that these effects are already visible and inevitable due to the activity of the climate system, regardless of the outcome of emission reduction actions. The main problem with pollution is air quality, which has fallen considerably, especially in urban areas. The” World Health Organization” approximates, more than seven million people die each year from air pollution. The authors also conducted a case study on the local effects of climate change – Timisoara and its peri-urban area. Therefore, we concluded that if Timisoara is successful in reducing greenhouse gas emissions, this will create a test market for Romania’s ecological technologies and help the environmental industries to locate in Timisoara.
Crops contaminated by aflatoxins (AFs), the toxic and carcinogenic mycotoxins produced namely by Aspergillus flavus and Aspergillus parasiticus, have severe impacts on human health. Changes in temperature and water availability related to actual climate changes (increased temperature, heavy rainfalls, and droughts) are modulating factors of mould growth and production of mycotoxins. To protect human and animal health from the harmful effects caused by AFs, the development of a safe and effective multifaceted approach in combating food and feed contamination with AFs is necessary. This review aims to collect and analyze the available information regarding AF presence in food and feed to reinforce AF management and to prevent health issues related to the AF exposure in the light of actual climate changes.
Naegleria fowleri is a free-living protozoan that resides in soil and freshwater. Human intranasal amoebae exposure through water or potentially dust particles can culminate in primary amoebic meningoencephalitis, which generally causes death. While many questions remain regarding pathogenesis, the microbial ecology of N. fowleri is even less understood. This review outlines current knowledge of the environmental abiotic and biotic factors that affect the distribution and abundance of N. fowleri. Although the impacts of some abiotic factors remain poorly investigated or inconclusive, N. fowleri appears to have a wide pH range, low salinity tolerance and thermophilic preference. From what is known about biotic factors, the amoebae preferentially feed upon bacteria and are preyed upon by other free-living amoebae. Additional laboratory and environmental studies are needed to fill in knowledge gaps, which are crucial for surveillance and management of N. fowleri in freshwaters. As surface water temperatures increase with climate change, it is likely that this amoeba will pose a greater threat to human health, suggesting that identifying its abiotic and biotic preferences is critical to mitigating this risk.
INTRODUCTION: Yellow fever (YF) is primarily transmitted by Haemagogus species of mosquitoes. Under climate change, mosquitoes and the pathogens that they carry are expected to develop faster, potentially impacting the case count and duration of YF outbreaks. The aim of this study was to determine how YF virus outbreaks in Brazil may change under future climate, using ensemble simulations from regional climate models under RCP4.5 and RCP8.5 scenarios for three time periods: 2011-2040 (short-term), 2041-2070 (mid-term), and 2071-2100 (long-term). METHODS: A compartmental model was developed to fit the 2017/18 YF outbreak data in Brazil using least squares optimization. To explore the impact of climate change, temperature-sensitive mosquito parameters were set to change over projected time periods using polynomial equations fitted to their relationship with temperature according to the average temperature for years 2011-2040, 2041-2070, and 2071-2100 for climate change scenarios using RCP4.5 and RCP8.5, where RCP4.5/RCP8.5 corresponds to intermediate/high radiative forcing values and to moderate/higher warming trends. A sensitivity analysis was conducted to determine how the temperature-sensitive parameters impacted model results, and to determine how vaccination could play a role in reducing YF in Brazil. RESULTS: Yellow fever case projections for Brazil from the models varied when climate change scenarios were applied, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the outbreak duration. Overall, a decrease in YF cases and outbreak duration was observed. Comparing the observed incidence in 2017/18 to the projected incidence in 2070-2100, for RCP4.5, the cumulative case incidence decreased from 184 to 161, and the outbreak duration decreased from 21 to 20 weeks. For RCP8.5, the peak case incidence decreased from 184 to 147, and the outbreak duration decreased from 21 to 17 weeks. The observed decrease was primarily due to temperature increasing beyond that suitable for Haemagogus mosquito survival. CONCLUSIONS: Climate change is anticipated to have an impact on mosquito-borne diseases. We found outbreaks of YF may reduce in intensity as temperatures increase in Brazil; however, temperature is not the only factor involved with disease transmission. Other factors must be explored to determine the attributable impact of climate change on mosquito-borne diseases.
Heat-related mortality is one of the leading causes of weather-related deaths in the United States. With changing climates and an aging population, effective adaptive strategies to address public health and environmental justice issues associated with extreme heat will be increasingly important. One effective adaptive strategy for reducing heat-related mortality is increasing tree cover. Designing such a strategy requires decision-support tools that provide spatial and temporal information about impacts. We apply such a tool to estimate spatially and temporally explicit reductions in temperature and mortality associated with a 10% increase in tree cover in 10 U.S. cities with varying climatic, demographic, and land cover conditions. Two heat metrics were applied to represent tree impacts on moderately and extremely hot days (relative to historical conditions). Increasing tree cover by 10% reduced estimated heat-related mortality in cities significantly, with total impacts generally greatest in the most populated cities. Mortality reductions vary widely across cities, ranging from approximately 50 fewer deaths in Salt Lake City to about 3800 fewer deaths in New York City. This variation is due to differences in demographics, land cover, and local climatic conditions. In terms of per capita estimated impacts, hotter and drier cities experience higher percentage reductions in mortality due to increased tree cover across the season. Phoenix potentially benefits the most from increased tree cover, with an estimated 22% reduction in mortality from baseline levels. In cooler cities such as Minneapolis, trees can reduce mortality significantly on days that are extremely hot relative to historical conditions and therefore help mitigate impacts during heat wave conditions. Recent studies project highest increases in heat-related mortality in the cooler cities, so our findings have important implications for adaptation planning. Our estimated spatial and temporal distributions of mortality reductions for each city provide crucial information needed for promoting environmental justice and equity. More broadly, the methods and model can be applied by both urban planners and the public health community for designing targeted, effective policies to reduce heat-related mortality. Additionally, land use managers can use this information to optimize tree plantings. Public stakeholders can also use these impact estimates for advocacy.
BACKGROUND: Both the World Health Organization and the Intergovernmental Panel on Climate Change project that malnutrition will be the greatest contributor to climate change-associated morbidity and mortality. Although there have been several studies that have examined the potential effects of climate change on human health broadly, the effects on malnutrition are still not well understood. We conducted a systematic review investigating the role of three climate change proxies (droughts, floods, and climate variability) on malnutrition in children and adults. METHODS AND FINDINGS: We identified 22 studies examining the effects of droughts, floods, and climate variability on at least one malnutrition metric. We found that 17 out of 22 studies reported a significant relationship between climate change proxies and at least one malnutrition metric. In meta-analysis, drought conditions were significantly associated with both wasting (Odds Ratio [OR] 1.46, 95% Confidence Interval [CI] 1.05-2.04) and underweight prevalence (OR 1.46, 95% CI 1.01-2.11). CONCLUSIONS: Given the long-term consequences of malnutrition on individuals and society, adoption of climate change adaptation strategies such as sustainable agriculture and water irrigation practices, as well as improving nutritional interventions aimed at children aged 1-2 years and older adults, should be prioritised on global policy agendas in the coming years.
Climate change is increasing weather unpredictability, causing more intense, frequent and longer extreme events including droughts, precipitation, and both heat and cold waves. The performance of parasites, and host-parasite interactions, under these unpredictable conditions, are directly influenced by the ability of parasites to cope with extremes and their capacity to adapt to the new conditions. Here, we review some of the structural, behavioural, life history and ecological characteristics of parasitic nematodes that allow them to persist and adapt to extreme and changing environmental conditions. We focus primarily, but not exclusively, on parasitic nematodes in the Arctic, where temperature extremes are pronounced, climate change is happening most rapidly, and changes in host-parasite interactions are already documented. We discuss how life-history traits, phenotypic plasticity, local adaptation and evolutionary history can influence the short and long term response of parasites to new conditions. A detailed understanding of the complex ecological processes involved in the survival of parasites in extreme and changing conditions is a fundamental step to anticipate the impact of climate change in parasite dynamics.
OBJECTIVE: To assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth. DESIGN: Systematic review and random effects meta-analysis. DATA SOURCES: Medline and Web of Science searched up to September 2018, updated in August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Clinical studies on associations between high environmental temperatures, and preterm birth, birth weight, and stillbirths. RESULTS: 14?880 records and 175 full text articles were screened. 70 studies were included, set in 27 countries, seven of which were countries with low or middle income. In 40 of 47 studies, preterm births were more common at higher than lower temperatures. Exposures were classified as heatwaves, 1°C increments, and temperature threshold cutoff points. In random effects meta-analysis, odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. Higher temperature was associated with reduced birth weight in 18 of 28 studies, with considerable statistical heterogeneity. Eight studies on stillbirths all showed associations between temperature and stillbirth, with stillbirths increasing 1.05-fold (1.01 to 1.08) per 1°C rise in temperature. Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings. CONCLUSIONS: Although summary effect sizes are relatively small, heat exposures are common and the outcomes are important determinants of population health. Linkages between socioeconomic status and study outcomes suggest that risks might be largest in low and middle income countries. Temperature rises with global warming could have major implications for child health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD 42019140136 and CRD 42018118113.
One of the particularly vulnerable groups for adverse weather conditions is people with heart disease. Most of the studies analyzed the association between certain weather conditions and increased mortality, morbidity, hospital admissions, calls, or visits to the emergency department and used as statistical data. This study evaluated associations between daily weather conditions and daily weather-related well-being in patients with coronary artery disease (CAD). From June 2008 to October 2012, a total of 865 consecutive patients with CAD (mean age 60 years; 30% of women) were recruited from the cardiac rehabilitation program at the Hospital Palanga Clinic, Lithuania. To evaluate the well-being, all patients filled in Palanga self-assessment diary for weather sensitivity every day from 8 to 21 days (average 15 ± 3 days) about their well-being (psychological, cardiac, and physical symptoms) on the last day. The weather data was recorded in the database eight times every day with a 3-hour interval using the weather station “Vantage Pro2 Plus” which was located in the same Clinic. The daily averages of the eight time records for weather parameters were calculated and were linked to the same-day diary data. We found that the well-being of patients with CAD was associated with weather parameters; specifically, general well-being was better within the temperature range 9-15 °C and worse on both sides of this range. Worsened general well-being was also associated with higher relative humidity and lower atmospheric pressure. Weather parameters can explain from 3 to 8% of the variance of well-being in patients with CAD.
A city’s climate is affected both by global warming and the local factors such as built form and the landscape. The temperature related impacts of climate change make urban areas more vulnerable particularly due to higher population concentration as well as heat island effect. Cities in India are already experiencing enhanced temperature and precipitation related impacts of climate change and extreme events, e.g., >2 degrees C warming in some places. This study describes a case of Ahmedabad a city of around 5 million people (Census, 2011) and currently almost 7.8 million, located in the hot and humid western part of India to understand the current temperature-related mortality impacts and the role of land use. Satellite images (MODIS from NASA), temperature data from India Meteorological Department (IMD) and daily all-cause mortality from Ahmedabad Municipal Corporation between 2001 and 2015 have been used to create a distributed lag non-linear model. Using land surface temperature for mortality risk assessment gives significantly different results as compared to using air temperature for mortality risk assessment. This indicates impacts of localized temperature variations on mortality risks. Thus, the microclimate in a city as represented by land surface temperatures is a better indicator for estimating relative risk of temperature related mortality as compared to air temperature. The study also infers that with increase in built-up spaces by 1% in the land use mix, the relative risk of heat related mortality increases by 0.59 points at 40 degrees C and by 0.78 points at 45 degrees C.
Efforts have been made to quantify the spatio-temporal malaria transmission intensity over India using the dynamical malaria model, namely, Vector-borne Disease Community Model of International Centre for Theoretical Physics Trieste (VECTRI). The likely effect of climate change in the variability of malaria transmission intensity over different parts of India is also investigated. The Historical data and future projection scenarios of the rainfall and temperature derived from the Coupled Model Intercomparison Project Phase 5 (CMIP5) model output are used for this purpose. The Entomological Inoculation Rate (EIR) and Vector are taken as quantifiers of malaria transmission intensity. It is shown that the maximum number of malaria cases over India occur during the Sept-Oct months, whereas the minimum during the Feb-Apr months. The malaria transmission intensity as well as length of transmission season over India is likely to increase in the future climate as a result of global warming.
Environmental variables related to vegetation and weather are some of the most influential factors that impacting Aedes (Stegomya) aegypti, a mosquito vector of dengue, chikungunya and Zika viruses. In this paper, we aim to develop temporal predictive models for Ae. aegypti oviposition activity utilizing vegetation and meteorological variables as predictors in Córdoba city (Argentina). Eggs were collected using ovitraps placed throughout the city from 2009 to 2012 that were replaced weekly. Temporal generalized linear mixed models were developed with negative binomial distributions of errors that model average number of eggs collected weekly as a function of vegetation and meteorological variables with time lags. The best model included a vegetation index, vapor pressure of water, precipitation and photoperiod. With each unit of increment in vegetation index per week the average number of eggs increased by 1.71 in the third week. Furthermore, each millimeter increase of accumulated rain during 4 weeks was associated with a decrease of 0.668 in the average number of eggs found in the following week. This negative effect of precipitation could occur during abundant rainfalls that fill containers completely, thereby depriving females of oviposition sites and leading them to search for other suitable breeding sites. Furthermore, the average number of eggs increased with the photoperiod at low values of mean vapor pressure; however the average number of eggs decreased at high values of mean vapor pressure, and the positive relationship between the response variable and mean vapor pressure was stronger at low values of photoperiod. Additionally, minimum temperature was associated positively with oviposition activity and that low minimum temperatures could be a limiting factor in Ae. aegypti oviposition activity. Our results emphasize the important role that climatic variables such as temperature, precipitation, and vapor pressure play in Ae. aegypti oviposition activity and how these variables along with vegetation indices can be used to inform predictive temporal models of Ae. aegypti population dynamics that can be used for informing mosquito population control and arbovirus mitigation strategies.
The urban heat island is a representative urban climate characteristic, which can affect heat-stress conditions and extreme precipitation that are closely connected with human life. Better understanding of urban-climate interactions, therefore, is crucial to ultimately support better planning and adaptation in various application fields. This study assesses urban-climate interactions during summer for eastern North America using regional climate model simulations at 0.22° resolution. Two regional climate model experiments, with and without realistic representation of urban regions, are performed for the 1981–2010 period. Comparison of the two experiments shows higher mean temperatures and reduced mean precipitation in the simulation with realistic urban representation, which can be attributed primarily to reduced albedo and soil moisture for the urban regions in this simulation. Furthermore, the mean temperature and precipitation in the simulation with improved urban representation is also closer to that observed. Analysis of short-duration precipitation extremes for climatologically different sub-regions, however, suggests that, for higher temperatures, the magnitudes of precipitation extremes are generally higher in the simulation with realistic urban representation, particularly for coastal urban regions, and are collocated with higher values of convective available potential energy and cloud fraction. Enhanced sea and lake breezes associated with lower sea level pressure found around these regions, contribute additional water vapor and further enhance dynamic convective development, leading to higher precipitation intensities. Analysis of temperature extremes clearly demonstrates that urban regions experience aggravated heat-stress conditions due to relatively higher temperatures despite reduced relative humidity. Double the number of extreme heat spells lasting six or more days are noted for the coastal urban regions in the study domain. This study, in addition to demonstrating the differences in urban-climate interactions for climatologically different regions, also demonstrates the need for better representation of urban regions in climate models to generate realistic climate information.
OBJECTIVES: Climate variables are implied in the pathogenesis of certain otologic diseases, including benign paroxysmal positional vertigo (BPPV). Using internet search data obtained through Google Trends (GT), we explored the relationship between climate patterns and symptom search frequencies for BPPV. We hypothesized that increased latitude, as a proxy for decreased sunlight exposure, would lead to increase in BPPV symptom searches. METHODS: GT searches for symptoms related to BPPV were obtained for five U.S. cities of different latitudes via the Google Trends online interface. Comparisons were made using SPSS via ANOVA analysis. Figures were made using Microsoft Excel. RESULTS: Searches for BPPV-related symptoms increased with increasing latitude. BPPV-related symptoms did show seasonal variations, but not in predictable manners. CONCLUSIONS: GT may be a viable research tool when comparing geographical differences in searches, but may be less sensitive in detecting time dependent changes. We offer suggestions as to how big data tools may be altered for research purposes. LEVEL OF EVIDENCE: NA.
BACKGROUND: Ross River virus (RRV) disease is Australia’s most widespread vector-borne disease causing significant public health concern. The aim of this study was to identify the ecological covariates of RRV risk and to develop epidemic forecasting models in a disease hotspot region of South Australia. METHODS: Seasonal autoregressive integrated moving average models were used to predict the incidence of RRV disease in the Riverland region of South Australia, an area known to have a high incidence of the disease. The model was developed using data from January 2000 to December 2012 then validated using disease notification data on reported cases for the following year. RESULTS: Monthly numbers of the mosquito Culex annulirostris (?=0.033, p<0.001) and total rainfall (?=0.263, p=0.002) were significant predictors of RRV transmission in the study region. The forecasted RRV incidence in the predictive model was generally consistent with the actual number of cases in the study area. CONCLUSIONS: A predictive model has been shown to be useful in forecasting the occurrence of RRV disease, with increased vector populations and rainfall being important factors associated with transmission. This approach may be useful in a public health context by providing early warning of vector-borne diseases in other settings.
PURPOSE: The incidence of urinary tract infections is seasonal, peaking in summer months. One possible mechanism for the observed seasonality of urinary tract infections is warmer weather. MATERIALS AND METHODS: We identified all urinary tract infection cases located in approximately 400 metropolitan statistical areas in the contiguous United States between 2001 and 2015 using the Truven Health MarketScan® databases. A total of 167,078,882 person-years were included in this data set and a total of 15,876,030 urinary tract infection events were identified by ICD-9 code 599.0. Weather data for each metropolitan statistical area and date were obtained from the National Centers for Environmental Information. We computed the mean temperature during the period 0 to 7 days prior to the urinary tract infection diagnosis. We used a quasi-Poisson generalized linear model. The primary outcome was the number of urinary tract infections each day in a metropolitan statistical area in each age group. Covariates considered included age group, day of week, year and the temperature during the previous 7 days. RESULTS: Warmer weather increases the risk of urinary tract infections among women treated in outpatient settings in a dose-response fashion. On days when the prior week’s average temperature was between 25 and 30C, the incidence of urinary tract infections was increased by 20% to 30% relative to when the prior week’s temperature was 5 to 7.5C. CONCLUSIONS: The incidence of urinary tract infections increases with the prior week’s temperature. Our results indicate that warmer weather is a risk factor for urinary tract infections. Furthermore, as temperatures rise, the morbidity attributable to urinary tract infections may increase.
BACKGROUNDS: Studies on the association between ambient temperature and human mortality have been widely reported, focusing on common diseases such as cardiopulmonary diseases. However, multi-city studies on the association between both high and low temperatures and mortality of nervous system diseases were scarce, especially on the evidence of vulnerable populations. METHODS: Weekly meteorological data, air pollution data and mortality data of nervous system were collected in 5 cities in China. A quasi-Poisson regression with distributed lag non-linear model (DLNM) was applied to quantify the association between extreme temperatures and mortality of nervous system diseases. Multivariate meta-analysis was applied to estimate the pooled effects at the overall levels. The attributable fractions (AFs) were calculated to assess the mortality burden attributable to both high and low temperatures. Stratified analyses were also performed by gender and age-groups through the above steps. RESULTS: A total of 12,132 deaths of nervous system diseases were collected in our study. The overall minimum mortality temperature was 23.9 °C (61.9th), the cumulative relative risks of extreme heat and cold for nervous system diseases were 1.33(95%CI: 1.10, 1.61) and 1.47(95%CI: 1.27, 1.71). The mortality burden attributed to non-optimal temperatures accounted for 29.54% (95%eCI: 13.45%, 40.52%), of which the mortality burden caused by low temperature and high temperature accounted for 25.89% (95%eCI: 13.03%, 34.36%) and 3.65% (95%eCI: 0.42%, 6.17%), respectively. The mortality burden attributable to ambient temperature was higher in both males and the elderly (>74 years old), with the AF of 31.85% (95%eCI: 20.68%, 39.88%) and 31.14% (95%eCI: -6.83%, 49.51%), respectively. CONCLUSIONS: The non-optimal temperature can increase the mortality of nervous system diseases and the males and the elderly over 74 years have the highest attributable burden. The findings add the evidence of vulnerable populations of nervous system diseases against ambient temperatures.
(1) Background: The health effect of temperature has become a rising public health topic. The objective of this study is to assess the association between apparent temperature and non-accidental deaths, and the mortality burden attributed to cold and heat temperature; (2) Methods: The daily data on temperature and deaths were collected from 10 cities in Thailand, Korea and China. We fitted a time-series regression with a distributed lag nonlinear model (DLNM) to derive the health risk of temperature for each city and then pooled them to get the overall cumulative risk by multivariate meta-analysis. Additionally, we calculated the attributable fraction of deaths for heat and cold, which was defined as temperatures above and below minimum-mortality temperature (MMT); (3) Results: There are regional heterogeneities in the minimum mortality percentiles (MMP) and attributable fractions for different countries. The MMP varied from about the 5-10th percentile in Thailand to 63-93rd percentile in China and Korea. The attributable fractions of the total deaths due to short-term exposure to temperature in Asia is 7.62%, of which the cold effect (6.44%) is much higher than the heat effect (1.18%); (4) Conclusions: Our study suggested that apparent temperature was associated with an increase in non-accidental mortality. Most of the temperature-related mortality burden was attributable to cold, except for Thailand.
Since the 2003 heatwave in Europe, evidence has been rapidly increasing on the association between extreme temperature and all-cause mortality. Little is known, however, about cause-specific cardiovascular mortality, effect modification by air pollution and aircraft noise, and which population groups are the most vulnerable to extreme temperature. We conducted a time-stratified case-crossover study in Zurich, Switzerland, including all adult cardiovascular deaths between 2000 and 2015 with precise individual exposure estimates at home location. We estimated the risk of 24,884 cardiovascular deaths associated with heat and cold using distributed non-linear lag models. We investigated potential effect modification of temperature-related mortality by fine particles, nitrogen dioxide, and night-time aircraft noise and performed stratified analyses across individual and social characteristics. We found increased risk of mortality for heat (odds ratio OR = 1.28 [95% confidence interval: 1.11-1.49] for 99th percentile of daily Tmean (24 °C) versus optimum temperature at 20 °C) and cold (OR = 1.15 [0.95-1.39], 5th percentile of daily Tmean (-3 °C) versus optimum temperature at 20 °C). Heat-related mortality was particularly strong for myocardial infarctions and hypertension related deaths, and among older women (>75 years). Analysis of effect modification also indicated that older women with lower socio-economic position and education are at higher risk for heat-related mortality. PM(2.5) increased the risk of heat-related mortality for heart failure, but not all-cause cardiovascular mortality. This study provides useful information for preventing cause-specific cardiovascular temperature-related mortality in moderate climate zones comparable to Switzerland.
The association between meteorological factors and infectious diarrhea has been widely studied in many countries. However, investigation among children under 5 years old in Jiangsu, China remains quite limited. Data including infectious diarrhea cases among children under five years old and daily meteorological indexes in Jiangsu, China from 2015 to 2019 were collected. The lag-effects up to 21 days of daily maximum temperature (Tmax) on infectious diarrhea were explored using a quasi-Poisson regression with a distributed lag non-linear model (DLNM) approach. The cases number of infectious diarrhea was significantly associated with seasonal variation of meteorological factors, and the burden of disease mainly occurred among children aged 0-2 years old. Moreover, when the reference value was set at 16.7°C, Tmax had a significant lag-effect on cases of infectious diarrhea among children under 5 years old in Jiangsu Province, which was increased remarkably in cold weather with the highest risk at 8°C. The results of DLNM analysis implicated that the lag-effect of Tmax varied among the 13 cities in Jiangsu and had significant differences in 8 cities. The highest risk of Tmax was presented at 5 lag days in Huaian with a maximum RR of 1.18 (95% CI: 1.09, 1.29). Suzhou which had the highest number of diarrhea cases (15830 cases), had a maximum RR of 1.04 (95% CI:1.03, 1.05) on lag 15 days. Tmax is a considerable indicator to predict the epidemic of infectious diarrhea among 13 cities in Jiangsu, which reminds us that in cold seasons, more preventive strategies and measures should be done to prevent infectious diarrhea.
OBJECTIVES: Despite the well-established benefits of exercise, pregnant women are discouraged from physical activity in hot/humid conditions to avoid hyperthermia (core temperature (T(core))???39.0 °C). Recent epidemiological evidence also demonstrates greater risk of negative birth outcomes following heat exposure during pregnancy, possibly due to thermoregulatory impairments. We aimed to determine (1) the risk of pregnant women exceeding a T(core) of 39.0 °C during moderate-intensity exercise in the heat; and (2) if any thermoregulatory impairments are evident in pregnant (P) versus non-pregnant (NP) women. METHODS: Thirty participants (15 pregnant in their second trimester or third trimester) completed two separate exercise-heat exposures in a climate chamber (32 °C, 45%RH). On separate occasions, each participant cycled on a semi-recumbent cycle ergometer for 45 min at a workload representative of a moderate-intensity (1) non-weight-bearing (NON-WB), or (2) weight-bearing (WB) activity. Thermoregulatory responses were monitored throughout. RESULTS: The highest rectal temperature observed in a pregnant individual was 37.93 °C. Mean end-exercise rectal temperature did not differ between groups (P:37.53?±?0.22 °C, NP:37.52?±?0.34 °C, P?=?0.954) in the WB trial, but was lower in the P group (P:37.48?±?0.25 °C, vs NP:37.73?±?0.38 °C, P?=?0.041) in the NON-WB trial. Whole-body sweat loss was unaltered by pregnancy during WB (P:266?±?62 g, NP:264?±?77 g; P?=?0.953) and NON-WB P:265?±?51 g, NP:300?±?75 g; P?=?0.145) exercise. Pregnant participants reported higher ratings of thermal sensation (felt hotter) than their non-pregnant counterparts in the WB trial (P?=?0.002) but not in the NON-WB trial, (P?=?0.079). CONCLUSION: Pregnant women can perform 45 min of moderate-intensity exercise at 32 °C, 45%RH with very low apparent risk of excessive maternal hyperthermia. No thermoregulatory impairments with pregnancy were observed.
BACKGROUND: Ambient temperature observations from single monitoring stations (usually located at the major international airport serving a city) are routinely used to estimate heat exposures in epidemiologic studies. This method of exposure assessment does not account for potential spatial variability in ambient temperature. In environmental health research, there is increasing interest in utilizing spatially-resolved exposure estimates to minimize exposure measurement error. METHODS: We conducted time-series analyses to investigate short-term associations between daily temperature metrics and emergency department (ED) visits for well-established heat-related morbidities in five US cities that represent different climatic regions: Atlanta, Los Angeles, Phoenix, Salt Lake City, and San Francisco. In addition to airport monitoring stations, we derived several exposure estimates for each city using a national meteorology data product (Daymet) available at 1?km spatial resolution. RESULTS: Across cities, we found positive associations between same-day temperature (maximum or minimum) and ED visits for heat-sensitive outcomes, including acute renal injury and fluid and electrolyte imbalance. We also found that exposure assessment methods accounting for spatial variability in temperature and at-risk population size often resulted in stronger relative risk estimates compared to the use of observations at airports. This pattern was most apparent when examining daily minimum temperature and in cities where the major airport is located further away from the urban center. CONCLUSION: Epidemiologic studies based on single monitoring stations may underestimate the effect of temperature on morbidity when the station is less representative of the exposure of the at-risk population.
Risk to health from extreme heat is gaining attention in scholarship and policy. Demographic and socio-economic factors affect the extent to which a person is at risk from extreme heat, whilst empirical research of social vulnerability to heat outside a ‘Western’ context is relatively limited. Many countries still rely on expert judgements to draw locally specific context for heat vulnerability assessment. Yet, their view might not be evidence-informed and the result is influenced by who are involved. This paper reflects this point by eliciting expert views of social heat vulnerability in Taiwan through an expert questionnaire survey using the Analytic Hierarchy Process method, and the result was compared to existing empirical research. Our study finds that experts consider factors related to adaptive capacity, especially societal support, as the most important; but rate gender and ethnicity as the least important. Although experts point to the importance of adaptive capacity, there are relatively few empirical studies to date in societal support, and the low priority given to gender and ethnicity also contradicts prior empirical research. For heat risk assessment, our findings show that whilst systematic elicitation of expert judgement may help to fill gaps in empirical evidence specific to the local context, caution should be paid to the significant divergence with existing empirical data and expert opinions depending on who are selected to involve.
PURPOSE: Millions of workers exposed to the outdoor environment are extremely susceptible to extreme heat. Although several articles analyzed heat-related illnesses, injuries, fatalities at the country level, few investigated regional and state statistics especially for OSHA Region 4 and the state of Alabama, U.S, which we explored in this study. METHODS: We studied the number of heat-days over 90 °F (32.2 °C) heat-index within our study area, analyzed heat-related injury and illnesses to calculate their incidence rate during 2015 to 2019, observed the nature of such incidents, their monthly occurrence, and incidence trend over average air temperature. We conducted a comparative analysis of heat-related fatalities between construction and all industries. The existing heat regulations by OSHA and some state agencies have also been summarized. RESULTS: We observed the highest mean, maximum heat-days and injury-illness rate in the south and southeast part of Region 4; increase in incidence rate from 0.03 in 2017 to 0.28 per 10,000 employees in 2018 for the contiguous U.S; highest injury-illness rate (HIR) in OSHA Region 1, 4 and 6; highest HIR in Lee, Montgomery, Mobile and Madison counties of Alabama; 34.7% (construction) and 31.3% (all industries) of all cases experiencing nonclassifiable heat-light effects; high fatalities in construction industry with a trend of 1 death/5 years; increased mortality in all occupations with 1 death/2.4 years. We also proposed a Heat-Stress Index (HSI) as a routine heat-stress measure on jobsite. CONCLUSION: The findings from this research and the proposed index can help in understanding heat-related risk at a regional level and implementing workplace interventions.
PURPOSE: Salmonella is one of the main causes of gastroenteritis, and its incidence may be affected by meteorological variables. This is the first study about the effect of climatic factors on salmonella incidence in Kermanshah, Iran. METHODS: Data about salmonellosis cases in Kermanshah were inquired from Center for Communicable Disease Control, at the Ministry of Health and Medical Education of Iran, for the 2008 to 2018 time-frame. Meteorological variables including maximum, minimum and mean of temperature and humidity, sunshine hours and rainfall were inquired for the same time frame. Negative binomial generalized linear models (GLM) were used to assess the effect of meteorological variables on the weekly incidence of salmonellosis. RESULTS: During the years under study, 569 confirmed cases were registered in Kermanshah province. Study results showed a 3?% increase in salmonellosis incidence, after 1?% increase in minimum humidity in the week before (incidence rate ratio (IRR): 1.03; 95?% confidence interval (CI):1.02-1.05) and also a 4?% increase in incidence for 1 °C increase in mean temperature in the same week (IRR: 1.04; 95?% CI:1.02-1.06). CONCLUSIONS: Increase in minimum humidity and mean temperature may have a role in increasing the incidence of salmonellosis in Iran.
Spontaneous pneumothorax (SP) is defined as the presence of free air inside the pleural space. Many studies have reported that meteorological variables may trigger SP, but the mechanism is unknown. The aim of this study was to compare the effects of meteorological variables on the development of SP in two regions with different altitudes. The study was conducted in the Çanakkale (2 m above sea level) and the Erzurum region (1758 m). A total of 494 patients with SP who presented to the hospitals of the two regions between January 2011 and December 2016 were included in the study. The meteorological variables used included ambient temperature, atmospheric pressure, relative humidity, precipitation amount, wind speed, and wind direction (as north and south). The total 2192 days were divided into two as days with and without an SP case presentation. A 4-day period prior to the day a case presented was compared with the other days without any cases to investigate the presence of any lagged effect. Statistical significance was accepted at p?<?0.05. Comparison of these two regions showed a significant difference between them. The meteorological variables of the regions that affect SP development were found to be low mean minimum temperature, high daily temperature change, low precipitation, low wind speed and north winds for Erzurum, and only rainy days for Çanakkale. The results have demonstrated that cold weather, sudden temperature changes, north winds, and low wind speed are risk factors for the development of SP at high altitudes.
Increasing urban heat island and global warming have aroused serious thermal environmental problems and even harm people’s thermal health. Because of the importance in people’s daily life, a commercial pedestrianized block represents a symbol of a city or metropolis; therefore, focusing the attention on the thermal environment in such regions is very necessary. Most of the researches on the urban thermal environment are calculated by remote sensing data; limited by the low spatial resolution of remote sensing image, it may not obviously reflect the true thermal environment of the research site, especially in some microscale regions. Based on this, the new software ENVI-met is developed to research the thermal environment and forecast people’s thermal sensation in a microscale region. Therefore, the objective of this study aims at conducting field measurement and numerical simulation to assess the thermal environment of a typical commercial pedestrianized space in southern China and assess the different urban design parameters in ameliorating the urban heat island effect. Our final results demonstrate a quantitative evidence for establishing a comprehensive standard for improving the thermal environment in a microscale region, and this study also can be a supplementary in the research field about improving thermal health.
OBJECTIVE: The objective of the study was to explore the influences of seasonality, meteorological conditions, and air pollution exposure on the number of patients who visit the hospital due to seizures. METHODS: Outpatient and inpatient data from the National Health Insurance Database of Taiwan from 2009 to 2013, meteorological data from the Meteorological Bureau, and air pollution exposure data from the Taiwan Air Quality Monitoring Stations were collected and integrated into daily time series data. The following data processing and analysis results are based on the mean of the 7?days’ lag data of the 18 meteorological condition/air pollution exploratory factors to identify the critical meteorological conditions and air pollution exposure factors by executing univariate analysis. The average hospital visits for seizure per day by month were used as an index of observation. The effect of seasonality has also been examined. RESULTS: The average visits per day by month had a significant association with 10 variables. Overall, the number of visits due to these factors has been estimated to be 71.529 (13.7%). The most obvious factors affecting the estimated number of visits include ambient temperature, CH(4), and NO. Six air pollutants, namely CH(4), NO, CO, NO(2), PM2.5, and NMHC had a significantly positive correlation with hospital visits due to seizures. Moreover, the average daily number of hospital visits was significantly high in January and February (winter season in Taiwan) than in other months (R(2)?=?0.422). CONCLUSION: The prediction model obtained in this study indicates the necessity of rigorous monitoring and early warning of these air pollutants and climate changes by governments. Additionally, the study provided a firm basis for establishing prediction models to be used by other countries or for other diseases.
Epidemiological studies have suggested an association between particulate air pollution, increased temperatures, and morbidity related to pregnancy outcomes. However, the roles of desert dust storms and climatological factors have not been fully addressed. The objectives of the present study were to investigate the association between desert dust storms, particulate matter with a diameter ?10 ?m (PM(10)), daily temperatures, and toxemia of pregnancy and spontaneous abortion in Gaziantep, South East Turkey. The study was conducted retrospectively at emergency department of two hospitals in Gaziantep city. Data from January 1, 2009, to March 31, 2014, were collected. Patients, who were diagnosed with toxemia of pregnancy and spontaneous abortion by radiological imaging modalities, were included in the study. Daily temperature ranges, mean temperature values, humidity, pressure, wind speed, daily PM10 levels, and records of dust storms were collected. A generalized additive regression model was designed to assess variable effects on toxemia of pregnancy and spontaneous abortion, while adjusting for possible confounding factors. Our findings demonstrated that presence of dust storms was positively associated with the toxemia of pregnancy both in outpatient admissions (OR=1.543 95% CI=1.186-2.009) and inpatient hospitalizations (OR=1.534; 95% CI=1.162-2.027). However, neither PM(10) nor maximum temperature showed a marked association with spontaneous abortion or toxemia of pregnancy in our study population. Our findings suggest that desert dust storms may have an impact on the risk for adverse pregnancy outcomes such as toxemia of pregnancy. Health authorities should take necessary measures to protect pregnant women against detrimental effects of these storms.
This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan’s metropolitan city from 2000 to 2014. The distributed lag non-linear model was adopted to examine the association between ambient temperature and area-age-sex-disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area-age-sex-disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40-64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40-64 years. All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40-64 years.
This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan’s metropolitan city from 2000 to 2014. The distributed lag non-linear model was adopted to examine the association between ambient temperature and area-age-sex-disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area-age-sex-disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40-64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40-64 years. All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40-64 years.
This study investigated the effects of heat exposure on physical and cognitive performance during an intermittent exercise protocol so as to reflect the incremental fatigue experienced during team sports. Twelve well-trained male team sport players completed an 80-minute cycling intermittent sprint protocol (CISP), alongside computerized vigilance and congruent (i.e., simple) and incongruent (i.e., complex) Stroop tasks of cognitive functioning, in two counterbalanced temperature conditions; hot (32°C[50%rh]) and control (18°C[50%rh]). Incongruent Stroop accuracy declined over time (p?=?.002), specifically in the second (M(diff)?=?-3.75, SD?=?0.90%, p?=?.009) and third (M(diff)?=?-4.58, SD?=?1.22%, p?=?.019) quarters compared to the first quarter of the CISP; but there were no differences between temperature conditions. Congruent Stroop reaction time (RT) was quicker in the second quarter of exercise in the hot condition (M?=?561.99, SD?=?112.93?ms) compared to the control condition (M=617.80, SD?=?139.71?ms; p?=?.022), but no differences were found for congruent Stroop accuracy nor vigilance measures. Additionally, peak power output was lower during the third quarter of the CISP in the hot condition (M?=?861.31, SD?=?105.20?W) compared to the control condition (M?=?900.68, SD?=?114.84?W; p?<?.001). Plasma normetanephrine and metanephrine concentrations increased from pre- to post-CISP (M(diff)?=?+616.90, SD?=?306.99, p?<?.001; and M(diff)?= +151.23, SD?=?130.32, p?=?.002, respectively), with a marginal interaction suggesting a higher normetanephrine increase from pre- to post-CISP in the hot versus the control condition (p?=?.070). Our findings suggest that accuracy for more complex decisions suffered during prolonged high-intensity intermittent exercise, perhaps due to exercise-induced catecholamine increases. Athletes may have also reduced physical effort under increased heat exposure, indicating how cognitive performance may be sustained in physically demanding environments.
The Paris Agreement has prompted much interest in the societal and health impacts of limiting global warming to 1.5 degrees C and 2 degrees C. Previous assessments of differential impacts of two targets indicate that 1.5 degrees C warming target would substantially reduce the impact on human health compared to 2 degrees C, but they mainly focused on the magnitude of temperature changes under future climate change scenarios without any consideration of greater frequency of cumulative heat exposures within a day. Here we quantified the health risks of compound daytime and night-time hot extremes using morbidity data in a megacity of China, and also identified the time-period of heat exposure with higher risks. Then we projected future morbidity burden attributable to compound hot extremes due to the half-degree warming. We estimated that the 2 degrees C warming scenario by 2100 as opposed to 1.5 degrees C would increase annual heat-related ambulance dispatches by 31% in Shenzhen city. Substantial additional impacts were associated with occurrence of consecutive hot days and nights, with ambulance dispatches increased by 82%. Our results suggested that compound hot extremes should be considered in assessment of heat-related health impacts, particularly in the context of climate change. Minimizing the warming of climate in a more ambitious target can significantly reduce the health damage.
The human population is increasing. The ongoing urbanization process, in conjunction with climate change, is causing larger environmental footprints. Consequently, quality of life in urban systems worldwide is under immense pressure. Here, the seasonal characteristics of Maribor’s urban thermal environment were studied from the perspectives of surface urban heat island (SUHI) and urban heat island (UHI) A remote sensing thermal imagery time series and in-situ measurements (stationary and mobile) were combined with select geospatial predictor variables to model this atmospheric phenomenon in its most intensive season (summer). Finally, CMIP6 climate change scenarios and models were considered, to predict future UHI intensity. Results indicate that Maribor’s UHI intensity maximum shifted from winter to spring and summer. The implemented generalized additive model (GAM) underestimates UHI intensity in some built-up parts of the study area and overestimates UHI intensity in green vegetated areas. However, by the end of the century, UHI magnitude could increase by more than 60% in the southern industrial part of the city. Such studies are of particular concern, in regards to the increasing frequency of heat waves due to climate change, which further increases the (already present) heat stress in cities across the globe.
Cold spells have been associated with mortality from a few broad categories of diseases or specific diseases. However, there is a lack of data about the health effects of cold spells on mortality from a wide spectrum of plausible diseases which can reveal a more comprehensive contour of the mortality burden of cold spells. We collected daily mortality data in Guangzhou during 2010-2018 from the Guangzhou Center for Disease Control and Prevention. The quasi-Poisson generalized linear regression model mixed with the distributed lag non-linear model (DLNM) was conducted to examine the health impacts of cold spells for 11 broad causes of death groupings and from 35 subcategories in Guangzhou. Then, we examined the effect modification by age group (0-64 and 65+ years) and sex. Effects of cold spells on mortality generally delayed for 3-5 d and persisted up to 27 d. Cold spells were significantly responsible for increased mortality risk for most categories of deaths, with cumulative relative risk (RR) over 0-27 lagged days of 1.57 [95% confidence interval (CI): 1.48-1.67], 1.95 (1.49-2.55), 1.58 (1.39-1.79), 1.54 (1.26-1.88), 1.92 (1.15-3.22), 1.75, (1.14-2.68), 2.02 (0.78-5.22), 1.92 (1.49-2.48), 1.48 (1.18-1.85), and 1.18 (1.06-1.30) for non-accidental causes, cardiovascular diseases, respiratory diseases, digestive diseases, nervous system diseases, genitourinary diseases, mental diseases, endocrine diseases, external cause and neoplasms, respectively. The magnitudes of the effects of cold spells on mortality varied remarkably among the 35 subcategories, with the largest cumulative RR of 2.87 (1.72-4.79) estimated for pulmonary heart diseases. The elderly and females were at a higher risk of mortality for most diseases after being exposed to cold spells. Increased mortality from a wide range of diseases was significantly linked with cold spells. Our findings may have important implications for formulating effective preventive strategies and early warning response plans that mitigate the health burden of cold spells.
The impact of extreme weather conditions on humans is one of the most important topics in biometeorology studies. The main objective of this study is to analyze the relationship between temperature-related weather conditions and natural mortality in the five most populated cities of Romania, namely, Bucharest, Cluj-Napoca, Constan?a, Ia?i, and Timi?oara. The results of this study aim to bridge a gap in national research. In the present paper, we used daily natural mortality data and daily minimum and maximum air temperatures. The distributed lag nonlinear model (DLNM) allowed us to identify weather conditions associated with natural mortality. The most important results are as follows: (i) a higher daily mortality is related to a high frequency of heat stress conditions; (ii) a higher maximum temperature increases the relative risk (RR) of natural mortality; (iii) the maximum number of fatalities is recorded on the first day of high-temperature events; and (iv) individuals much more easily adapt to cold stress conditions. The main conclusion in this study is that the inhabitants of the most populated cities in Romania are more sensitive to high-temperature stress than to low-temperature stress.
The aim of the study was to examine the relationship between ambient temperature, ultraviolet radiation, and the development of herpes zoster in Taiwan. An ecological study was conducted to analyse the database of the Taiwan National Health Insurance Programme. Participants aged ?20 years with newly diagnosed herpes zoster between 2003 and 2012 were selected for analysis. The monthly incidence rate of herpes zoster was measured between 2003 and 2012. Monthly average ambient temperature in Celsius (°C) between 2003 and 2012 was measured according to the official database of the Central Weather Bureau in Taiwan. Monthly accumulated ultraviolet radiation (MJ m(-2) ) between 2003 and 2012 was measured according to the official database of the Environmental Protection Administration in Taiwan. The overall incidence rates of herpes zoster ranged from 2.54 to 5.67 per 10 000 persons per month from 2003 to 2012.The monthly average ambient temperature was higher and the monthly accumulated ultraviolet radiation was stronger from May to October. The incidence rates of herpes zoster seemed to be high during the period of high ambient temperature and strong ultraviolet radiation (from May to October).Whenever ambient temperature increased 1°C per month, the incidence rate of herpes zoster increased by 0.072 per 10,000 persons per month. Whenever ultraviolet radiation increased 1 MJ m(-2) per month, the incidence rate of herpes zoster increased by 0.313 per 10 000 persons per month. There is a significant association between ambient temperature, ultraviolet radiation, and the development of herpes zoster in Taiwan. The incidence rate of herpes zoster is high during the period of high ambient temperature and strong ultraviolet radiation. Low ambient temperature and weak ultraviolet radiation might be beneficial for the prevention of herpes zoster.
Urban Heat Island (UHI) is posing a significant challenge due to growing urbanisations across the world. Green infrastructure (GI) is popularly used for mitigating the impact of UHI, but knowledge on their optimal use is yet evolving. The UHI effect for large cities have received substantial attention previously. However, the corresponding effect is mostly unknown for towns, where appreciable parts of the population live, in Europe and elsewhere. Therefore, we analysed the possible impact of three vegetation types on UHI under numerous scenarios: baseline/current GI cover (BGI); hypothetical scenario without GI cover (HGI-No); three alternative hypothetical scenarios considering maximum green roofs (HGR-Max), grasslands (HG-Max) and trees (HT-Max) using a dispersion model ADMS-Temperature and Humidity model (ADMS-TH), taking a UK town (Guildford) as a case study area. Differences in an ambient temperature between three different landforms (central urban area, an urban park, and suburban residential area) were also explored. Under all scenarios, the night-time (0200 h; local time) showed a higher temperature increase, up to 1.315 °C due to the lowest atmospheric temperature. The highest average temperature perturbation (change in ambient temperature) was 0.563 °C under HGI-No scenario, followed by HG-Max (0.400 °C), BGI (0.343 °C), HGR-Max (0.326 °C) and HT-Max (0.277 °C). Furthermore, the central urban area experienced a 0.371 °C and 0.401 °C higher ambient temperature compared with its nearby suburban residential area and urban park, respectively. The results allow to conclude that temperature perturbations in urban environments are highly dependent on the type of GI, anthropogenic heat sources (buildings and vehicles) and the percentage of land covered by GI. Among all other forms of GI, trees were the best-suited GI which can play a viable role in reducing the UHI. Green roofs can act as an additional mitigation measure for the reduction of UHI at city scale if large areas are covered.
The study was conducted to determine thermal stress and its trend in Iran. The atmospheric variables of 304 synoptic stations, including mean temperature, relative humidity, wind speed and cloudiness, for the period 1961-2010, were used to identify the thermal stress conditions in Iran. These data were prepared on a daily basis from the Iran Meteorological Organization. Physiologically equivalent temperature (PET) and standard effective temperature (SET*) were used to identify thermal stress. Also, thermal stress was studied with a simple linear regression method and at a 95% confidence level. The results of the study revealed that in Iran each location can experience different types of environmental conditions throughout the year. At a specified time, thermal stresses of different intensities can be seen. The other results showed that the mountainous regions, especially the highlands of the northwest, along with the Zagros and Alborz mountains, had the highest co-efficient of variability (> 50%). Also, the southern regions of Iran have both monthly and annual scales with the least co-efficient of variability (< 20%) in bioclimatic conditions. In general, a diversity of bioclimatic conditions is evident in Iran both temporally and spatially. The other part of the study determined that heat and cold stress and heat comfort had a positive trend (fewer than 60 stations) in parts of Iran, a negative trend in some other parts (more than 50 stations), and no specific trend in the remaining parts (more than 250 stations). Most of the northern stations, especially on the Caspian coast, have been shown to have a positive trend in the event of cold stress. Indeed, extreme bioclimatic conditions (very cold and hot conditions) have been rising in both the southern and northern latitudes of the country. Even in southern parts, a positive trend of cold and very cold conditions can be observed at some stations.
Aim. To examine the temporal variations of the association between ambient temperature and mortality for cardiovascular diseases in Queensland, Australia between 1997 and 2013. Methods. We obtained 147 238 cardiovascular deaths data from Queensland Health between 1 January 1997 and 31 December 2013. Time-stratified case-crossover design was fitted via the conditional quasi-Poisson regression with time-varying distributed lag non-linear model to estimate the associations between temperature and cardiovascular mortality. Stratified analyses were performed by age, sex, climate zone, and socioeconomic status. Results. We found a substantial decrease in the cold effect, while there was no significant change in the heat effect. Results of subgroup analyses showed an increasing trend for heat effects in men, people 84 years old, those living in low and middle socioeconomic areas and those living in hot climate areas. There was a decreasing trend for the magnitude of associations between temperature (both cold and hot temperatures) and cardiovascular mortality in people 85 years old and in areas of high socioeconomic status. Conclusions. The associations between cold temperature and cardiovascular mortality decreased in Queensland, Australia between 1997 and 2013, but no declines were observed for hot temperatures. Men, people 84 years old, people living in low and middle socioeconomic score areas and people living in hot climate areas demonstrated increased susceptibility to hot temperatures. Our findings suggest a need for heat awareness health promotion campaigns to enhance adaptation to a warming climate among vulnerable population.
Along with climate change, unstable weather patterns are becoming more frequent. However, the temporal trend associated with the effect of temperature variation on schizophrenia (SCZ) is not clear. Daily time-series data on SCZ and meteorological factors for 15-year between January 1, 2005 and December 31, 2019 were collected. And we used the Poisson regression model combined with the time-varying distribution lag nonlinear model (DLNM) to explore the temporal trend of the association between three temperature variation indicators (diurnal temperature range, DTR; temperature variability, TV; temperature change between neighboring days, TCN) and SCZ hospitalizations, respectively. Meanwhile, we also explore the temporal trend of the interaction between temperature and temperature variation. Stratified analyses were performed in different gender, age, and season. Across the whole population, we found a decreasing trend in the risk of SCZ hospitalizations associated with high DTR (from 1.721 to 1.029), TCN (from 1.642 to 1.066), and TV (TV0-1, from 1.034 to 0.994; TV0-2, from 1.041 to 0.994, TV0-3, from 1.044 to 0.992, TV0-4, from 1.049 to 0.992, TV0-5, from 1.055 to 0.993, TV0-6, from 1.059 to 0.991, TV0-7, from 1.059 to 0.990), but an increasing trend in low DTR (from 0.589 to 0.752). Subgroup analysis results further revealed different susceptible groups. Besides, the interactive effect suggests that temperature variation may cause greater harm under low-temperature conditions. There was a synergy between TCN and temperature on the addition and multiplication scales, which were 1.068 (1.007, 1.133) and 0.067 (0.009, 0.122), respectively. Our findings highlight public health interventions to mitigate temperature variation effects needed to focus not only on high temperature variations but also moderately low temperature variations. Future hospitalizations for SCZ associated with temperature variation may be more severely affected by temperature variability from low temperature environments. The temporal trend is associated with the effect of temperature variation on schizophrenia (SCZ).
Urban air pollution can have negative short- and long-term impacts on health, including cardiovascular, neurological, immune system and developmental damage. The irritant qualities of pollutants such as ozone (O(3)), nitrogen dioxide (NO(2)) and particulate matter (PM) can cause respiratory and cardiovascular distress, which can be heightened during physical activity and particularly so for those with respiratory conditions such as asthma. Previously, research has only examined marathon run outcomes or running under laboratory settings. This study focuses on elite 5-km athletes performing in international events at nine locations. Local meteorological and air quality data are used in conjunction with race performance metrics from the Diamond League Athletics series to determine the extent to which elite competitors are influenced during maximal sustained efforts in real-world conditions. The findings from this study suggest that local meteorological variables (temperature, wind speed and relative humidity) and air quality (ozone and particulate matter) have an impact on athletic performance. Variation between finishing times at different race locations can also be explained by the local meteorology and air quality conditions seen during races.
Culex mosquitoes are important vectors of West Nile Virus (WNV), St. Louis Encephalitis Virus (SLEV) and Japanese Encephalitis Virus (JEV). Climate change is expected to alter their ability to spread diseases in human populations. Studies examining the influence of climate variability on Culex mosquitoes in South East Asia are scarce. We examined the influence of climate variability on reported Culex mosquito larval habitats from 2009 to 2018 in Singapore. We analysed the non-linear immediate and lagged weather dependence of Culex habitats over 5 weeks in negative binomial regression models using nationally representative data. We adjusted for the effects of long-term trend, seasonality, public holidays and autocorrelation. There were 41,170 reported Culex larval habitats over the study period. Non-residential premises were associated with more reports of habitats compared to residential premises [Rate Ratio (RR): 113.9, 95% CI: 110.9, 116.9]. Larvae in more than 90% of these habitats were entomologically identified as Culex quinquefasciatus. In residences, every 10 mm increase in rainfall above a 90 mm threshold was associated with a 10.1% [Incidence Rate Ratio (IRR): 0.899, 95% CI: 0.836, 0.968] cumulative decline in larval habitats. Public holidays were not significantly included in the model analysing larval habitats in residences. In non-residences, a 1 °C increase in the ambient air temperature with respect to the mean was associated with a 36.0% (IRR: 1.360, 95% CI: 1.057, 1.749) cumulative increase in Culex larval habitats. Public holidays were associated with a decline in Culex larval habitats in the same week. Our study provides evidence of how ambient air temperature and rainfall variability influences the abundance of Culex mosquito larval habitats. Our findings support the utility of using weather data in predictive models to inform the timing of vector control measures aimed at reducing the risk of WNV and other Culex-borne flavivirus transmission in urban areas.
The effects of daily mean temperature on health outcomes have been discussed in many previous studies, but few have considered the adverse impacts on upper respiratory tract infection (URTI) due to variance of temperature in one day. Diurnal temperature range (DTR) was a novel indicator calculated as maximum temperature minus minimum temperature on the same day. In this study, generalized additive model (GAM) with quasi-Poisson distribution was used to investigate the association between DTR and the number of daily outpatient visits for URTI among college students. Data about meteorological factors and air pollutants were provided by Hubei Meteorological Bureau and Wuhan Environmental Protection Bureau, respectively. Outpatient visits data were collected from the Hospital of Wuhan University from January 1, 2016, to December 31, 2018. Short-term exposure to DTR was associated with the increased risk of outpatient for URTI among all college students. Per 1 °C increased in DTR was associated with 0.73% (95%CI: 0.24, 1.21) increased in outpatient visits of all college students for URTI at lag 0 day. The greatest effect values were observed in males [1.35% (95%CI: 0.33,2.39)] at lag 0-6 days, and in females [0.86% (95%CI: 0.24, 1.49)] at lag 0-1 days. DTR had more adverse health impact in autumn and winter. Public health departments should consider the negative effect of DTR to formulate more effective prevention and control measures for protecting vulnerable people.
This study aims to examine the relationship between daily temperature and mortality in the Klang Valley, Malaysia, over the period 2006-2015. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM) was used to estimate the association between the mean temperature and mortality categories (natural n=69,542, cardiovascular n= 15,581, and respiratory disease n=10,119). Particulate matter with an aerodynamic diameter below 10 ?m (PM(10)) and surface ozone (O(3)) was adjusted as a potential confounding factor. The relative risk (RR) of natural mortality associated with extreme cold temperature (1st percentile of temperature, 25.2 °C) over lags 0-28 days was 1.26 (95% confidence interval (CI): 1.00, 1.60), compared with the minimum mortality temperature (28.2 °C). The relative risk associated with extremely hot temperature (99th percentile of temperature, 30.2 °C) over lags 0-3 days was 1.09 (95% CI: 1.02, 1.17). Heat effects were immediate whereas cold effects were delayed and lasted longer. People with respiratory diseases, the elderly, and women were the most vulnerable groups when it came to the effects of extremely high temperatures. Extreme temperatures did not dramatically change the temperature-mortality risk estimates made before and after adjustments for air pollutant (PM(10) and O(3)) levels.
INTRODUCTION: Extremely preterm births (EPT), require complex decision making and significant medical interventions. While environmental factors such as ambient temperature extremes have been associated with preterm births, little is known of the environmental associations with EPT births. The objective of this study is to explore whether ambient temperature is associated with increased risk of EPT birth. METHODS: Birth records for 315,226 infants born in Queensland Australia (2007-2015) were matched to average maximum and minimum temperature for the last month of pregnancy. Odds ratios and 95% confidence intervals were calculated using a generalised linear model. Population attributable risk was calculated for a 5% reduction in maximum temperature. RESULTS: Each one degree increase in maximum [aOR 1.03 (95% CI 1.01, 1.05)] and minimum temperature [aOR 1.02 (95% CI 1.01, 1.04)] was associated with an increase in odds for EPT birth. Increased odds for EPT births was found for maternal smoking [aOR 1.46 (95% CI 1.23, 1.72)], increasing plurality [OR 6.38 (95% CI 5.48, 7.42)] and stillbirth [aOR 342.99 (95% CI 295.53, 398.06)]. When stratified by birth status, the association was only found for live births. DISCUSSION: Higher temperatures are associated with small increases in the odds of delivering an infant in the EPT period. The risk may be enhanced for women who smoke during pregnancy. Women at an increased risk of preterm births should be counselled around methods to reduce their exposure to excessive heat.
People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018-June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months-Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments.
PURPOSE: Diurnal temperature range (DTR) is a meteorological indicator closely associated with global climate change. Thus, we aim to explore the effects of DTR on the outpatient and emergency room (O&ER) admissions for cardiovascular diseases (CVDs), and related predictive research. METHODS: The O&ER admissions data for CVDs from three general hospitals in Jinchang of Gansu Province were collected from 2013 to 2016. A generalized additive model (GAM) with Poisson regression was employed to analyze the effect of DTR on the O&ER admissions for all cardiovascular diseases, hypertension, ischemic heart disease (IHD) and stoke. GAM was also used to preform predictive research of the effect of DTR on the O&ER admissions for CVDs. RESULTS: There were similar positive linear relationships between DTR and the O&ER visits with the four cardiovascular diseases. And the cumulative lag effects were higher than the single lag effects. A 1 °C increase in DTR corresponded to a 1.30% (0.99-1.62%) increase in O&ER admissions for all cardiovascular diseases. Males and elderly were more sensitivity to DTR. The estimates in non-heating season were higher than in heating season. The trial prediction accuracy rate of CVDs based on DTR was between 59.32 and 74.40%. CONCLUSIONS: DTR has significantly positive association with O&ER admissions for CVDs, which can be used as a prediction index of the admissions of O&ER with CVDs.
In recent years, there have been considerable changes in the distribution of diseases that are potentially tied to ongoing climate variability. The aim of this study was to investigate the association between the incidence of cutaneous leishmaniasis (CL) and climatic factors in an Iranian city (Isfahan), which had the highest incidence of CL in the country. CL incidence and meteorological data were acquired from April 2010 to March 2017 (108 months) for Isfahan City. Univariate and multivariate seasonal autoregressive integrated moving average (SARIMA), generalized additive models (GAM), and generalized additive mixed models (GAMM) were used to identify the association between CL cases and meteorological variables, and forecast CL incidence. AIC, BIC, and residual tests were used to test the goodness of fit of SARIMA models; and R(2) was used for GAM/GAMM. 6798 CL cases were recorded during this time. The incidence had a seasonal pattern and the highest number of cases was recorded from August to October. In univariate SARIMA, (1,0,1) (0,1,1)(12) was the best fit for predicting CL incidence (AIC=8.09, BIC=8.32). Time series regression (1,0,1) (0,1,1)(12) showed that monthly mean humidity after 4-month lag was inversely related to CL incidence (AIC=8.53, BIC=8.66). GAMM results showed that average temperature with 2-month lag, average relative humidity with 3-month lag, monthly cumulative rainfall with 1-month lag, and monthly sunshine hours with 1-month lag were related to CL incidence (R(2)=0.94). The impact of meteorological variables on the incidence of CL is not linear and GAM models that include non-linear structures are a better fit for prediction. In Isfahan, Iran, meteorological variables can greatly predict the incidence of CL, and these variables can be used for predicting outbreaks.
Urbanization models that do not comply with the planning criteria are affecting human lives. In urban areas, street trees have positive contributions to the ecosystem and human thermal comfort. In this study, the thermal comfort of the main streets that connect people to each other and provide access and transportation has been thermally explored. Cumhuriyet Street, which is one of the vibrant streets in Erzurum, was selected as a case study scenario in the winter and summer periods in 2018 by using the ENVI-met V. 4.4.2 winter model. A different green scenario is proposed, and the best thermal comfort scenario in both seasons is determined. The results show that, in the summer period, the air temperature of the greener street scenario is about 1.0 °C cooler than the existing condition and about 2.0 °C warmer in the winter period. Physiological equivalent temperature (PET) value was better in narrow canyon streets in winter months, but in wide canyon streets in summer months. The green scenarios of wide canyon streets positively affect the outdoor thermal comfort in both seasons. These results clearly imply that green streets are an appropriate strategy for city streets that suffer from discomfort levels in cold winter and hot summer periods. It has been concluded that it is possible to increase thermal comfort through improvement in the open space in street and more suitable plant preferences for livable urbanization. Planning streets in a new city characterized by summer and winter seasons should take into consideration an accurate decision for providing a thermal comfort level and healthy urbanization.
The paper analyses the temporal and spatial variability of the Universal Thermal Climate Index (UTCI) in Poland in summer. Summer is the season with the highest intensity of tourism traffic that is why it is important to determine biometeorological conditions, especially in popular tourist destinations such as coastal, mountain and urban areas, in the times of climate changes. The analysis was based on data from 18 stations of IMGW-PIB (Institute of Meteorology and Water Management-National Research Institute), distributed evenly in the territory of the country, and representing all eight bioclimatic regions. The data include air temperature, relative humidity, wind velocity and cloudiness at 12 UTC from summer months: June, July and August from the years 2001-2018. Thermoneutral zone was the most frequently occurring UTCI class in Poland. It was recorded during 56-75% of summer days (with the exception of mountain stations, where it occurred on 30-35% of days). Moderate heat stress is the second most frequently occurring category with a frequency from 18 to 29% with the exception of mountain and coastal areas. Extreme and very strong cold stress occurred particularly in high mountain stations, and was sporadically observed at the coast of the Baltic Sea; however, the occurrence of such conditions decreases, which if favourable for beach tourism. No cases of extreme heat stress were recorded in any of the stations. The most unfavourable bioclimatic conditions were characteristic of the Upland Region (IV), represented by Kraków and Sandomierz, where very strong heat stress occurred with a 10% frequency. This is a limitation for urban tourism in those regions. The highest UTCI values were recorded in Kraków on 17 July 2007 and 29 July 2005. The highest number of cases with strong and very strong heat stress was recorded in 2015 as a consequence of the heat wave observed in Poland in the first half of August. In the majority of the analysed stations, in the second half of the analysed period (2010-2018), an increase in the number of days with strong and very strong heat stress was observed in comparison with the first half of period (2001-2009). The highest frequency of such days was observed in July. Based on the data, there are 4 potential periods of occurrence of such days, with two most intense being 26. July-13 August and 14-22 July.
Few evidences are available about the impact of temperature variation on childhood asthma in different seasons. This study aimed to assess the influence of temperature changes between neighboring days (TCN) on the exacerbation of asthma among children. Daily outpatient visits for childhood asthma (DOVCA) were collected from 17 main hospitals in Shanghai, China, from 2016 to 2018. A quasi-Poisson regression combined with distributed lagged nonlinear models was employed to estimate the association between TCN and asthma visits in cool or warm seasons, after controlling for short- and long-term trends, day of week, holidays, daily mean temperature, daily mean relative humidity, and air pollutants. The TCN varied from -?9.6 to 6.7 °C. The relationship between TCN and DOVCA greatly varied by season. In warm seasons, positive TCN (temperature rise) was associated with higher risks of asthma outpatient visits and negative TCN (temperature drop) was associated with lower risks; the associations were present on lag 1 day and lasted for 2 weeks; the cumulative relative risk of childhood asthma over 0 to 14 days was 1.98 (95% confidence interval: 1.42, 2.76) and 0.31 (95% confidence intervals: 0.21, 0.44) comparing a TCN of 2.5 °C (5th percentile) and -?3.2 °C (95th percentile) with 0 °C, respectively. In cool seasons, neither negative nor positive TCN showed significant risks. In conclusion, temperature rise might increase the risk of childhood asthma exacerbation and temperature drop might decrease the risks in warm seasons. There were no statistically significant influences in cool seasons.
West Nile Virus (WNV) is now endemic in many European countries, causing hundreds of human cases every year, with a high spatial and temporal heterogeneity. Previous studies have suggested that spring temperature might play a key role at shaping WNV transmission. Specifically, warmer temperatures in April-May might amplify WNV circulation, thus increasing the risk for human transmission later in the year. To test this hypothesis, we collated publicly available data on the number of human infections recorded in Europe between 2011 and 2019. We then applied generalized linear models to quantify the relationship between human cases and spring temperature, considering both average conditions (over years 2003-2010) and deviations from the average for subsequent years (2011-2019). We found a significant positive association both spatial (average conditions) and temporal (deviations). The former indicates that WNV circulation is higher in usually warmer regions while the latter implies a predictive value of spring conditions over the coming season. We also found a positive association with WNV detection during the previous year, which can be interpreted as an indication of the reliability of the surveillance system but also of WNV overwintering capacity. Weather anomalies at the beginning of the mosquito breeding season might act as an early warning signal for public health authorities, enabling them to strengthen in advance ongoing surveillance and prevention strategies.
Higher temperatures are associated with morbidity and mortality. Most epidemiological studies use outdoor temperature data, however, people spend most of their time indoors. Indoor temperatures and determinants of indoor temperatures have rarely been studied on a large scale. We measured living room and bedroom temperature in 113 homes of elderly subjects, as well as outdoor temperatures, in two cities in the Netherlands. Linear regression was used to determine the influence of building characteristics on indoor living room and bedroom temperatures in the warm episode. During the warm episode, indoor temperatures were higher during the night and lower during the day than outdoor temperatures. Indoor temperatures on average exceeded outdoor temperatures. The weekly average indoor temperature in living rooms varied between 23.1 and 30.2 °C. Dwellings that warmed up easily, also cooled down more easily. Outdoor and indoor temperatures were moderately correlated (R(2) = 0.36 and 0.34 for living rooms and bedrooms, respectively). Building year before 1930 and rooms being located on the top floor were associated with higher indoor temperatures. Green in the vicinity was associated with lower temperatures in bedrooms. This study shows that indoor temperatures vary widely between dwellings, and are determined by outdoor temperatures and building characteristics. As most people, especially the elderly, spend most of the time indoor, indoor temperature is a more exact predictor of heat exposure than outdoor temperature. The importance of mitigating high indoor temperatures will be more important in the future because of higher temperatures due to climate change.
SARS-CoV-2 is a novel coronavirus which has caused the COVID-19 pandemic. Other known coronaviruses show a strong pattern of seasonality, with the infection cases in humans being more prominent in winter. Although several plausible origins of such seasonal variability have been proposed, its mechanism is unclear. SARS-CoV-2 is transmitted via airborne droplets ejected from the upper respiratory tract of the infected individuals. It has been reported that SARS-CoV-2 can remain infectious for hours on surfaces. As such, the stability of viral particles both in liquid droplets as well as dried on surfaces is essential for infectivity. Here we have used atomic force microscopy to examine the structural stability of individual SARS-CoV-2 virus like particles at different temperatures. We demonstrate that even a mild temperature increase, commensurate with what is common for summer warming, leads to dramatic disruption of viral structural stability, especially when the heat is applied in the dry state. This is consistent with other existing non-mechanistic studies of viral infectivity, provides a single particle perspective on viral seasonality, and strengthens the case for a resurgence of COVID-19 in winter.
Natural air ventilation in the hot-dry regions plays a key role to decrease indoor air temperature in hot season, also to improve thermal comfort during the cold season. One of the most common ways to take advantage of natural ventilation is using wind catcher with an underground tunnel. In this method, the tower catches the airflow and directs it to the underground tunnel to decrease the air temperature by transferring heat to the ground, which is cooler in the summer and warmer in the winter. Earth-to-air heat exchanger (EAHE) is a modern form of wind catcher with underground tunnel. In this method, air after passing through buried pipes exchanges heat with the ground, and its temperature increases in the winter and decreases during the summer. This study analyzes the energy performance and cost-effectiveness of earth-to-air heat exchanger to be utilized in a residential building in climate condition of the province of Kermanin Iran. In this regard, 9 different configurations of the EAHE are investigated to find the optimized EAHE. The system performance and cost-effectiveness are studied in 3 different depths including 1, 2, and 3 m with 3 different pipe lengths including 25, 50, and 75 m. The results show that the EAHE is capable of reducing the inlet air temperature by 0.5-9.9celcius in the summer and increasing it by 0.9-11.2celcius in the winter. Furthermore, by integrating the EAHEs in a building design, one can reduce the total annual cooling load by 1.25%-3.97% and for heating by 1.34%-3.96%. The payback period of the system with a pipe length of 25 m is 16 years, but for the systems with pipe lengths of 50 and 75 m, this period reduces to almost 3 years.
Aedes albopictus (Diptera: Culicidae) distribution is bounded to a subtropical area in Argentina, while Aedes aegypti (Diptera: Culicidae) covers both temperate and subtropical regions. We assessed thermal and photoperiod conditions on dormancy status, development time and mortality for these species from subtropical Argentina. Short days (8 light : 16 dark) significantly increased larval development time for both species, an effect previously linked to diapause incidence. Aedes albopictus showed higher mortality than Ae. aegypti at 16?°C under long day treatments (16 light : 8 dark), which could indicate a lower tolerance to a sudden temperature decrease during the summer season. Aedes albopictus showed a slightly higher percentage of dormant eggs from females exposed to a short day, relative to previous research in Brazilian populations. Since we employed more hours of darkness, this could suggest a relationship between day-length and dormancy intensity. Interestingly, local Ae. aegypti presented dormancy similar to Ae. albopictus, in accordance with temperate populations. The minimum dormancy in Ae. albopictus would not be sufficient to extend its bounded distribution. We believe that these findings represent a novel contribution to current knowledge about the ecophysiology of Ae. albopictus and Ae. aegypti, two species with great epidemiological relevance in this subtropical region.
Temperature has been studied in relation to many health outcomes. However, few studies have explored its effect on the risk of hospital admission for rheumatoid arthritis (RA). A distributed lag non-linear model (DLNM) was used to analyze associations between mean temperature, diurnal temperature range (DTR), temperature change between neighboring days (TCN), and daily admissions for RA from 2015 to 2019 in Anqing, China. Subgroup analyses based on age, gender, rheumatoid factors, and admission route were performed. In total, 1456 patients with RA were hospitalized. Regarding the cumulative-lag effects of extreme cold temperature (5th percentile?=?3?), the risks of admissions for RA were increased and highest at lag 0-11 (RR?=?2.68, 95% CI: 1.23-5.86). Exposing to low (5th percentile?=?1.9?) and high (95th percentile?=?14.2?) DTRs both had increased risks of RA admission, with highest RRs of 1.40 (95% CI: 1.03-1.91) and 1.24 (95% CI: 1.0-1.53) at lag 0 day, respectively. As for TCN, the marginal risk of admission in RA patients was found when exposed to high TCN (95th percentile?=?2.9?) with the largest single-day effect at lag 10 (RR?=?1.11, 95% CI: 1.01-1.23). In subgroup analyses, females were more susceptible to extreme cold temperature, low and high DTRs, and high TCN. In regard to extreme cold temperature, significant risk of hospital admission in females only appeared at lag 2 (RR?=?1.48, 95% CI: 1.02-2.15) and lag 0-2 (RR?=?2.35, 95% CI: 1.11-4.95). It is clear that RA patients exposed to changing temperature may increase risks of admission.
We analyze the impact of in utero temperature exposure on the birth weight and an indicator for low birth weight using administrative data on singleton live births conceived between 2000 and 2016 in Hungary. We find that exposure to high temperatures during pregnancy decreases birth weight, but its impact on the probability of low birth weight is weaker. Exposure to one additional hot day (mean temperature > 25 degrees C) during the gestation period reduces birth weight by 0.46 g, relative to a 15-20 degrees C day. The second and third trimesters appear to be slightly more sensitive to temperature exposure than the first trimester. We project that climate change will decrease birth weight and increase the prevalence of low birth weight by the mid-twenty-first century. The projected impacts are the strongest for newborns conceived during the winter and spring months.
In this paper, we examine the relationship between temperature and human conception rates and project the impacts of climate change by the mid-twenty-first century. Using complete administrative data on 6.8 million pregnancies between 1980 and 2015 in Hungary, we show that exposure to hot temperatures reduces the conception rate in the first few weeks following exposure, but a partial rebound is observed after that. We project that with absent adaptation, climate change will increase seasonal differences in conception rates and annual conception rates will decline. A change in the number of induced abortions and spontaneous fetal losses drives the decline in conception rates. The number of live births is unaffected. However, some newborns will experience a shift in the timing of conception that leads to changes in in utero temperature exposure and therefore might have further consequences.
Current development of temperature-related health early warning systems mainly arises from knowledge of temperature-related mortality or hospital-based morbidity. However, due to the delay in data reporting and limits in hospital capacity, these indicators cannot be used in health risk assessments timely. In this study, we examine temperature impacts on emergency ambulance and discuss the benefits of using this near real-time indicator for risk assessment and early warning. We collected ambulance dispatch data recording individual characteristics and preliminary diagnoses between 2015 and 2016 in Shenzhen, China. Distributed lag nonlinear model was used to examine the effects of high and low temperatures on ambulance dispatches during warm and cold seasons. Lag effects were also assessed to evaluate the sensitivity of ambulance dispatches in reflecting immediate health reactions. Stratified analyses by gender, age, and a wide range of diagnoses were performed to identify vulnerable subgroups. Disease-specific numbers of ambulance dispatches attributable to non-optimal temperature were calculated to determine the related medical burdens. Effects of temperature on ambulance dispatches appeared to be acute on the current day. Males, people aged 18-44 years, were more susceptible to non-optimal temperatures. Highest RR during heat exposure by far was for urinary disease, alcohol intoxication, and traumatic injury, while alcohol intoxication and cardiovascular disease were especially sensitive to cold exposure, causing the main part of health burden. The development of local health surveillance systems by utilizing ambulance dispatch data are important for temperature impact assessments and medical resource reallocation.
To date, research evidence suggests that extreme ambient temperatures may lead to preterm birth. Since the results of studies in subtropical humid monsoon climate are inconclusive, we investigated the association between extreme ambient temperatures and the risk of preterm birth in Xuzhou, China. We analyzed the association between the birth data of 103,876 singleton deliveries (from July 1, 2016 to June 30, 2019) and ambient temperature. We used a quasi-Poisson model with distributed lag nonlinear models (DLNM) to investigate the delay and nonlinear effects of temperature, taking into account the effects of air pollutants and relative humidity. During the study period, the number of hospitalizations for preterm birth was 4623. Taking the median temperature (16.8 °C) as a reference, the highest risk estimate at extreme cold temperature (- 2.8 °C, 1st percentile) was found at lag 0-1 days. Exposure to extreme cold (- 2.8 °C, 1st percentile), or moderate cold (6.8 °C, 25th percentile) were associated with 1.659 (95% confidence interval [CI] 1.177-2.338) and 1.456 (95% CI 1.183-1.790) increased risks of preterm birth, respectively. In the further stratified analysis of the age of pregnant women, we found that there were significant associations between cold temperatures and preterm birth in both groups (older group ? 35; younger group < 35). In a subtropical humid monsoon climate, low ambient temperatures may lead to preterm birth, suggesting that women should stay away from low temperatures during pregnancy.
Exposure to heat stress (HS) has adverse effects on brain function, leading to anxiety-like behavior and memory impairment. Sericin is a silk derived protein with various neurobiological activities. The present study has investigated the effects of sericin on anxiety and cognitive impairments, in HS-received mice. The adult male mice were exposed to HS (43 ºC, 15 min once a day for 14 days) and simultaneously treated with 100, 150, and 200 mg/kg/day of sericin through oral gavage. Elevated plus-maze and Lashley III Maze tests were used to evaluate anxiety and learning and memory, respectively. The hippocampal BAX, BCL-2, caspase3, caspase9 and heat-shock protein-70 (HSP-70) were evaluated by western blotting and oxidative stress markers including malondialdehyde (MDA), total antioxidant capacity (TAC), super oxide dismutase (SOD) as well as glutathione peroxidase (GPx) were evaluated by spectroscopy method. The serum was collected for the analysis of the corticosterone levels. Treatment with sericin in higher doses reversed anxiety-like behavior and cognitive deficit induced by HS. Moreover, heat exposure increased serum corticosterone, hippocampal MDA, apoptotic proteins and HSP-70 levels. Sericin administration decreased serum corticosterone and enhanced hippocampal antioxidant defense and attenuated apoptosis and HSP-70 levels. The results show that the protective effects of sericin against HS-mediated cognitive dysfunction and anxiety-like behavior is possibly through suppressing HSP-70, oxidative stress and apoptosis.
PURPOSE: Over the last few decades, a global increase in both cold and heat extremes has been observed with significant impacts on human mortality. Although it is well-identified that older individuals (>?65 years) are most prone to temperature-related mortality, there is no consensus on the effect of sex. The current study investigated if sex differences in temperature-related mortality exist in the Netherlands. METHODS: Twenty-three-year ambient temperature data of the Netherlands were combined with daily mortality data which were subdivided into sex and three age classes (
Temperature change is an important meteorological indicator reflecting weather stability. This study aimed to examine the effects of ambient temperature change on non-accidental mortality using diurnal temperature change (DTR) and temperature change between neighboring days (TCN) from two perspectives, intra-day and inter-day temperature change, and further, to explore seasonal variations of mortality, identify the susceptible population and investigate the interaction between temperature change and apparent temperature (AT). We collected daily data on cause-specific mortality, air pollutants and meteorological indicators in Shenzhen, China, from 1 January 2013 to 29 December 2017. A Quasi-Poisson generalized linear regression combined with distributed lag non-linear models (DLNMs) were conducted to estimate the effects of season on temperature change-related mortality. In addition, a non-parametric bivariate response surface model was used to explore the interaction between temperature change and AT. The cumulative effect of DTR was a U-shaped curve for non-accidental mortality, whereas the curve for TCN was nearly monotonic. The overall relative risks (RRs) of non-accidental, cardiovascular and respiratory mortality were 1.407 (95% CI: 1.233-1.606), 1.470 (95% CI: 1.220-1.771) and 1.741 (95% CI: 1.157-2.620) from exposure to extreme large DTR (99th) in cold seasons. However, no statistically significant effects were observed in warm seasons. As for TCN, the effects were higher in cold seasons than warm seasons, with the largest RR of 1.611 (95% CI: 1.384-1.876). The elderly and females were more sensitive, and low apparent temperature had a higher effect on temperature change-related non-accidental mortality. Temperature change was positively correlated with an increased risk of non-accidental mortality in Shenzhen. Both female and elderly people are more vulnerable to the potential adverse effects, especially in cold seasons. Low AT may enhance the effects of temperature change.
Considering the increasing rate of hospitalization due to the symptoms intensification, and the increasing trend of air pollution, this study aimed to determine the relationship between the amount of air pollutants and the incidence of cardiovascular disease leading to hospitalization. This case-crossover study was carried out on the data of admitted patients with cardiovascular disease such as hypertension, ischemic heart disease, and cerebrovascular disease in Urmia during 2011-2016. Weather data about air pollutants (NO2, PM10, SO2, and CO) were obtained from the meteorological department of Urmia. The data were coded for each patient and matched with the meteorological data for statistical modeling. The data were analyzed through STATA version 14. Conditional logistic regression was used to estimate the effects of air pollutants on cardiovascular disease adjusted to air temperature, relative humidity, and air pollutants. The final analysis was performed on 43,424 patients with cardiovascular disease using code I10-I99 including ischemic heart disease, hypertension, and cerebrovascular disease adjusted to air temperature and relative humidity. Of all pollutants, CO with each increase 10 ?g/m(3) had a meaningful relationship with the incidence of cardiovascular hospitalization. By selecting the window of exposure, 1, 2, and 6 days before admission, lag 6 (6 days) was the best estimation for exposure time in the patients with cardiovascular patients (OR 1.0056, CI 1.0041-1.007), and in the patients with ischemic heart disease (OR 1.000055, CI 1.000036-1.000075) and in the patients with hypertension (OR 1.000076, CI 1.00002-1.000132). Regarding cerebrovascular disease, no statistically significant association was observed. The results showed that only CO was associated with an increased risk of admission in patients with cardiovascular disease, ischemic heart disease, and hypertension, and there was no clear evidence for pollution effects on cerebrovascular diseases.
OBJECTIVES/HYPOTHESIS: This study investigated the impacts of air pollution and meteorological factors on the occurrence of epiglottitis. STUDY DESIGN: A nested case-control study. METHODS: Participants ?40?years old in the Korean National Health Insurance Service-Health Screening Cohort were analyzed. A total of 2,615 epiglottitis patients and 10,460 matched control participants were analyzed. The odds ratios (ORs) for epiglottitis associated with meteorological and air pollution factors, including sulfur dioxide (SO(2) , ppb), nitrogen dioxide (NO(2) , ppb), ozone (O(3) , ppb), and carbon monoxide (CO, ppm), after 3, 7, 15, and 30?days of exposure were analyzed using conditional logistic regression adjusted for total cholesterol, blood pressure, fasting blood glucose, obesity, smoking, alcohol consumption, prior upper respiratory infection, tonsillectomy, immunocompromise, autoimmune disease, and the Charlson comorbidity index. RESULTS: The daily temperature range and NO(2) exposure after 3?days were associated with increased rates of epiglottitis (OR = 1.03, 95% confidence interval [CI] = 1.02-1.05 for temperature range and OR = 1.78, 95% CI = 1.14-2.77 for NO(2) , respectively). These results were generally consistent at 7, 15, and 30?days. CONCLUSIONS: The temperature range and NO(2) exposure for 3, 7, 15, and 30?days were positively related to the occurrence of adult epiglottitis. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2483-2489, 2021.
Objective: Numerous epidemiological studies have reported relevance of morbidity and mortality from cardiovascular diseases with short-term exposure to environmental temperature. In this study, we examined the hypothesis between temperature indices and hospital admission because of cardiovascular diseases. Methods: The daily number of CVDs was obtained from all hospitals of the Sabzevar city. A semi-parametric generalized additive model (GAM) following a quasi-Poisson distribution with distributed lag non-linear model (dlnm) was selected as a modeling framework for time-series analysis. Results: The overall CVD risk comparing the 1st percentile and the 99th percentile relative to the mean temperature (at lag 0) was 1.33 (95% CI, 1.11: 1.61), and 1.34 (95% CI, 1.10: 1.64), respectively. For all indicators, the extremely cold effects persisted for the initial 7 days. Conclusions: Our results suggest that extremely cold and extremely hot temperatures increase the relative risk of cardiovascular diseases.
Brazil is the country with the highest social inequality in South America. This socioeconomic disparity reflects not only on the families’ income but also on their spatial localization in the city, as well as on the urban design. These urban environments can alter the urban microclimate, and consequently, interfere in dwellers’ thermal comfort. This research investigated the relationship between socio-spatial inequalities and thermal comfort in two different Local Climate Zones (LCZ) using a combination of measurement and modeling. Air temperature (Tair) was obtained by on-site measurements in compact high-rise (LCZ1) and compact low-rise buildings (LCZ3) and Mean radiant temperature (Tmrt) was simulated using SOlar and LongWave Environmental Irradiance Geometry (SOLWEIG). The results indicated that in LCZ1 seafront-localized buildings, in which residents have a higher income, the temperature remains in a range classified as comfortable, mainly due to shading and sea breeze. On the other hand, LCZ3, located in the periphery of the city, in which the low-income population is concentrated and is marked by a precariousness urban environment, presented a higher air temperature and Tmrt values, exposing the dwellers to heat stress throughout the year, especially during the summer season. These observations suggested that public and private actions tend to promote better urban designs in areas with a higher concentration of income. Public reforms aimed at improving the urban environment and promoting thermal comfort should be a priority for the warmest LCZ, where the poorest residents live. Public agents should rethink the distribution of environmental resources to promote equitable urban spaces.
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.
This study attempts to measure the spatial correlation length (SCL) of summer extreme heat stress in any location by using a characterized scale identification method. Daily datasets of multiple meteorological variables from 2,134 observation stations over eastern China during 1961-2010 were used. Three types of heat indexes (a total of seven indexes) were applied to characterize the heat stress. The first type used a single variable, that is, daily maximum temperature (T-max) or daily minimum temperature (T-min), while the second used mean temperature (T) and relative humidity, and the third used T, vapour pressure, and 10-m wind speed. A 90th percentile of the climatology of local heat stress was applied to identify hot days. The SCLs of heat stress were analysed in three regions: North China (NC), the Yangtze River Valley (YRV), and South China (SC). Results showed that the trend changes in heat stress had obvious temporal and geographical characteristics, especially in NC and YRV. Generally, the SCLs of heat stress in NC were the largest, reaching more than 440 km for T-max, with YRV second, about 350 km, and SC the smallest, only about 185 km. This phenomenon could be found for almost all indexes. Moreover, the SCLs of the first two types of heat indexes (except T-min) for the three regions were greater than that of the third one, particularly in NC and YRV, which was related to inconsistent changes in the variables used and the primary role of which one characterized the heat stress. The spatial distributions of high SCLs for all indexes were in line with that of the major urban agglomeration in eastern China. The SCL of heat stress for a location was related not only to the changes themselves, but also to the surroundings, involving the number and spatial distribution of hot days.
Previous studies indicate that the incidence of bacillary dysentery is closely related to meteorological factors. However, the impact of temperature and the spatial heterogeneity of the disease in regions of unbalanced socioeconomic development remains unclear. Therefore, this research collected data for 29,639 daily bacillary dysentery cases in children under 5 years of age, as well as the meteorological variables from China’s Beijing-Tianjin-Hebei region, to analyze the spatial pattern of bacillary dysentery and reveal its nonlinear association with temperature. The SatScan method was employed first, to detect the spatial heterogeneity of the disease risk, and then the distributed lag nonlinear model (DLNM) was used to analyze the relationships between the daily minimum, mean, and maximum temperatures and bacillary dysentery in the stratified heterogeneous regions. The results indicated that bacillary dysentery incidence presented statistically significant spatial heterogeneity. The area of highest risk was found to be Beijing and its neighboring regions, which have high population densities. There was also a positive association between bacillary dysentery and temperature. Hotter temperatures were accompanied by higher relative risks. In the most likely spatial cluster region, the excess risk (ER) values for a 1°C rise in minimum, mean, and maximum temperatures above the median were 4.65%, 11.30%, and 19.21%, respectively. The effect of temperature on bacillary dysentery peaked at a lag of 3 to 4 days. The findings of this study will aid risk assessments and early warning systems for bacillary dysentery.
The Urban Heat Island effect has been the focus of several studies concerned with the effects of urbanisation on human and ecosystem health. Humidity, however, remains much less studied, although it is useful for characterising human thermal comfort, the Urban Dryness Island effect and vegetation development. Furthermore, variability in microscale climate due to differences in land cover is increasingly crucial for understanding urbanisation effects on the health and wellbeing of living organisms. We used regression analysis to investigate the spatial and temporal dynamics of temperature, humidity and heat index in the tropical African city of Kampala, Uganda. We gathered data during the wet to dry season transition from 22 locations that represent the wide range of urban morphological differences in Kampala. Our analysis showed that the advancement of the dry season increased variability of climate in Kampala and that the most built-up locations experienced the most profound seasonal changes in climate. This work stresses the need to account for water availability and humidity to improve our understanding of human and ecosystem health in cities.
PURPOSE: The aim of the present study was to investigate the effect of short-term exposure to ambient black carbon (BC) on daily cause-specific mortality, including mortality due to respiratory, cardiovascular, ischemic heart and cerebrovascular diseases in Tehran, Iran. MATERIALS AND METHODS: Daily non-accidental death counts, meteorological data and hourly concentrations of air pollutants from 2014 to 2017 were collected in Tehran. A distributed lag non-linear model was used to assess the association between exposure to BC and daily mortality. RESULTS: The mean daily BC concentration during the study period was 3.96?±?1.19 µg/m(3). The results indicated that BC was significantly associated with cardiovascular, ischemic heart disease, and cerebrovascular mortality, but not with respiratory mortality. In first model, each 10 µg/m(3) increase in at lag 3, lag 4 and lag 5 were associated with cardiovascular mortality in 16-65 year age group with the relative risks (RRs) of 1.17 (95?% CI: 1.02-1.33), 1.17 (95?% CI: 1.04-1.31) and 1.12 (95?% CI: 1.02-1.24), respectively. The highest mortality rate per 10 µg/m(3) increase in exposure was found for ischemic heart diseases with RR of 3.98 (95?% CI: 1.04-1.81, lag 01) for 16-65 age group. Cerebrovascular mortality was associated with 10 µg/m(3) increases in non-cumulative exposure with RR of 1.17 (95?% 1.009-1.35, lag 5) in the age group ? 65 years. In the second model for a 10 µg/m(3) increase in BC, cardiovascular mortality at specific lag days (5 and 6 days) in the age group ? 16 years were associated with RR of 1.34 (95?% CI 1.08-1.66) and 1.35(95?% CI 1.02-1.77), respectively. CONCLUSIONS: This study in Tehran found significant effects of BC exposure on daily mortality for cardiovascular, ischemic heart disease, cerebrovascular disease. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-021-00659-0.
Ischemic stroke is one of the most common causes of death worldwide, and uncomfortable meteorological and built environments may increase its risk. Residents in different built environments are exposed to different risks of ischemic stroke in cold and hot weather. By using the data from 3547 patients hospitalized, a distributed lag non-linear model was established to compare the differences in the risk of ischemic stroke in urban areas with respect to different Building Height, Building Density, Normalized Differential Vegetation Index, and Distance to Water under the meteorological condition. The results showed that lower Building Height is related to the negative cold effects in winter, and higher Building Height is related to increased risks at high temperatures. Built environments with Building Heights of 10-15 m in hot weather and above 15 m in cold weather have low risks. Higher Building Density was found to be associated with reduced negative cold effects; however, the negative hot effects increased in summer. Built environments with a Building Density of more than 0.3 showed low risks, regardless of the weather conditions. Increasing NDVI seemed to mitigate negative effects in uncomfortable weather, and built environments with higher NDVI were found to be associated with lower risks of ischemic stroke. Built environments with shorter Distance to Water seemed to pose higher risks in summer, and longer Distance to Water was correlated with higher risks in winter. Built environments with Distance to Water in the range of 0.65-2.30 km showed low risks. The research results could have some implications for urban planners to form reasonable built environments under certain meteorological factors which can be beneficial for the mitigation of incidence of ischemic stroke. (C) 2020 Elsevier B.V. All rights reserved.
AIM: As the COVID-19 pandemic has been spreading rapidly all over the world, there are plenty of ongoing works to shed on light to unknown factors related to disease. One of the factors questioned is also to be the factors affecting the disease course. In this study, our aim is to determine the factors that affect the course of the disease in the hospitalised patients because of COVID-19 infection and to reveal whether the seasonal change has an effect on the disease course. METHODS: Our study was conducted on 1950 PCR test positive patients who were hospitalised for COVID-19 disease between March 16 and July 15. RESULTS: As the seasonal temperature increases, decrease in WBC, PLT and albumin levels and increase in LDH and AST levels were observed. Risk of need for ICU has been found statistically significant (P < .05) with the increase in the age, LDH levels and CRP levels and with the decrease in the Ca and Albumin levels. CONCLUSIONS: It is predicted with these results that, seasonal change might have affects on the clinical course of the disease, although it has no affect on the spread of the disease. And it might beneficial to check biochemical parameters such as LDH, CRP, Ca and Albumin to predict the course of the disease.
Previous studies demonstrated that global warming can lead to deteriorated air quality even when anthropogenic emissions were kept constant, which has been called a climate change penalty on air quality. It is expected that anthropogenic emissions will decrease significantly in the future considering the aggressive emission control actions in China. However, the dependence of climate change penalty on the choice of emission scenario is still uncertain. To fill this gap, we conducted multiple independent model simulations to investigate the response of PM(2.5) to future (2050) climate warming (RCP8.5) in China but with different emission scenarios, including the constant 2015 emissions, the 2050 CLE emissions (based on Current Legislation), and the 2050 MTFR emissions (based on Maximum Technically Feasible Reduction). For each set of emissions, we estimate climate change penalty as the difference in PM(2.5) between a pair of simulations with either 2015 or 2050 meteorology. Under 2015 emissions, we find a PM(2.5) climate change penalty of 1.43 ?g m(-3) in Eastern China, leading to an additional 35,000 PM(2.5)-related premature deaths [95% confidence interval (CI), 21,000-40,000] by 2050. However, the PM(2.5) climate change penalty weakens to 0.24 ?g m(-3) with strict anthropogenic emission controls under the 2050 MTFR emissions, which decreases the associated PM(2.5)-related deaths to 17,000. The smaller MTFR climate change penalty contributes 14% of the total PM(2.5) decrease when both emissions and meteorology are changed from 2015 to 2050, and 24% of total health benefits associated with this PM(2.5) decrease in Eastern China. This finding suggests that controlling anthropogenic emissions can effectively reduce the climate change penalty on PM(2.5) and its associated premature deaths, even though a climate change penalty still occurs even under MTFR. Strengthened controls on anthropogenic emissions are key to attaining air quality targets and protecting human health in the context of future global climate change.
Leishmaniasis is a vector-borne disease transmitted by sand flies. A dozen species have been involved in the transmission of Leishmania infantum in the Mediterranean region. Climate change may alter sand fly distribution at particular altitudes and latitudes. The objective of this study was to interrogate the existence of stable populations of sand flies in high-altitude ecosystems and evaluate if these populations are enough to support autochthonous transmission of leishmaniasis. These altitudinal conditions can be found in Sierra Nevada (southern Spain). Therefore, we have determined the sand fly population dynamics in different biotopes located at elevations above 1,300 m a.s.l. and searched for evidence of leishmaniasis transmission. Five collecting sites above 1,300 m a.s.l. containing large livestock concentrations were selected. Sand flies were caught using CDC light traps from May to November, annually from 2008 to 2013, and these were morphologically identified. Association between sand fly density or presence and temperature/humidity was estimated by linear and logistic regression, respectively. Leishmania infantum detection in female sand flies was performed by PCR. Diagnosis of canine leishmaniasis (CanL) was carried out by indirect immunofluorescence and PCR. A total of 2,973 specimens of 5 sand fly species were collected from June to October. Phlebotomus perniciosus was the most frequent (100%), abundant (80.1%) and densest species (9.8 sand flies/trap). The minimum temperature on the day of capture was the most important variable factor for sand fly presence and P. perniciosus density. An increase in altitude showed a negative effect over the sand fly diversity and activity period, driving changes in seasonal dynamics similar to those reported by latitudinal changes. CanL prevalence was 23%, a similar rate to previous surveys carried out on randomly selected dogs from towns in southern Spain. A successful host-vector-pathogen network was found at this altitude characterised by 9.9% L. infantum infection rate in non-blood fed P. perniciosus and Phlebotomus ariasi females and high CanL prevalence that entails an increase in the leishmaniasis risk area driven by sand fly colonization.
Under the influence of global warming, heatwaves are becoming a major threat in many parts of the world, affecting human health and mortality, food security, forest fires, biodiversity, energy consumption, as well as the production and transportation networks. Seasonal forecasting is a promising tool to help mitigate these impacts on society. Previous studies have highlighted some predictive capacity of seasonal forecast systems for specific strong heatwaves such as those of 2003 and 2010. To our knowledge, this study is thus the first of its kind to systematically assess the prediction skill of heatwaves over Europe in a state-of-the-art seasonal forecast system. One major prerequisite to do so is to appropriately define heatwaves. Existing heatwave indices, built to measure heatwave duration and severity, are often designed for specific impacts and thus have limited robustness for an analysis of heatwave variability. In this study, we investigate the seasonal prediction skill of European summer heatwaves in the ECMWF System 5 operational forecast system by means of several dedicated metrics, as well as its added-value compared to a simple statistical model based on the linear trend. We are able to show, for the first time, that seasonal forecasts initialized in early May can provide potentially useful information of summer heatwave propensity, which is the tendency of a season to be predisposed to the occurrence of heatwaves.
PURPOSE: To investigate whether previously reported seasonal variation and winter-dominant prevalence of acute massive submacular hemorrhages (SMHs) caused by age-related macular degeneration (AMD) disappeared, and those caused by retinal microaneurysms (RMAs) emerged. METHOD: The medical charts of 95 patients (95 eyes) with SMH caused by AMD and 76 patients (76 eyes) with SMH caused by RMAs in 2012-2019 were retrospectively reviewed. For each subject, the month of onset, the mean ambient temperature of that month were recorded. RESULTS: The monthly numbers of cases of SMHs caused by AMD from January to December were 6, 8, 4, 9, 7, 10, 9, 11, 7, 11, 3, and 10. No significant seasonal variation in the monthly incidence was identified (Roger’s R?=?1.89, p?=?0.39). The monthly numbers of SMHs caused by RMAs from January to December were 3, 11, 11, 8, 7, 8, 5, 5, 2, 4, 7, and 5. There was significant seasonal variation in the monthly incidence (Roger’s R?=?7.67, p?=?0.02). There was no significant correlation between the monthly incidence of SMHs caused by RMAs and mean ambient temperature. CONCLUSION: Our previous study conducted for cases obtained in 1998-2005 showed seasonal cyclic trend in the number of SMHs caused by AMD, with the peak in winter. However, that significant seasonal variation disappeared in 2012-2019 in the present study. Common usage of OCT devices and anti-VEGF drugs might be the reason for the lack of seasonal variation in the cases of SMH caused by AMD.
BACKGROUND: The aim of our study was to describe seasonal trends of acute kidney injury (AKI) and its relationship with weather conditions in a hospitalized population. METHODS: We retrospectively collected demographic (age, sex), clinical (ICD-9-CM codes of diagnosis discharge) and laboratory data (creatinine values) from the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of all patients ?18?years with at least two values available for creatinine. The outcome of interest was AKI development, defined according to creatinine kinetics criteria. The exposures of interest were the months and seasons of the year; air temperature and humidity level were also evaluated. Log-binomial regression models adjusted for age, sex, eGFR, comorbidities, Charlson/Deyo index score, year of hospitalization were used to estimate risk ratios (RR) and 95% confidential intervals (CI). RESULTS: A total of 64,610 patients met the inclusion criteria. AKI occurred in 2864 (4.4%) hospital admissions. After full adjustment, winter period was associated with increased risk of AKI (RR 1.16, 95% CI 1.05, 1.29, p=0.003). Lower air temperature and higher humidity level were associated with risk of AKI, however in multivariable-adjusted models only higher humidity level showed a significant and independent association. CONCLUSIONS: AKI is one of the most common complications of hospitalized populations with a defined seasonal pattern and a significant increase in incidence during wintertime; weather conditions, particularly higher humidity level, are independent predictors of AKI and could partially justify the observed seasonal variations.
BACKGROUND: Ambient temperature may contribute to seasonality of mortality; in particular, a warming climate is likely to influence the seasonality of mortality. However, few studies have investigated seasonality of mortality under a warming climate. METHODS: Daily mean temperature, daily counts for all-cause, circulatory, and respiratory mortality, and annual data on prefecture-specific characteristics were collected for 47 prefectures in Japan between 1972 and 2015. A quasi-Poisson regression model was used to assess the seasonal variation of mortality with a focus on its amplitude, which was quantified as the ratio of mortality estimates between the peak and trough days (peak-to-trough ratio (PTR)). We quantified the contribution of temperature to seasonality by comparing PTR before and after temperature adjustment. Associations between annual mean temperature and annual estimates of the temperature-unadjusted PTR were examined using multilevel multivariate meta-regression models controlling for prefecture-specific characteristics. RESULTS: The temperature-unadjusted PTRs for all-cause, circulatory, and respiratory mortality were 1.28 (95% confidence interval (CI): 1.27-1.30), 1.53 (95% CI: 1.50-1.55), and 1.46 (95% CI: 1.44-1.48), respectively; adjusting for temperature reduced these PTRs to 1.08 (95% CI: 1.08-1.10), 1.10 (95% CI: 1.08-1.11), and 1.35 (95% CI: 1.32-1.39), respectively. During the period of rising temperature (1.3?°C on average), decreases in the temperature-unadjusted PTRs were observed for all mortality causes except circulatory mortality. For each 1?°C increase in annual mean temperature, the temperature-unadjusted PTR for all-cause, circulatory, and respiratory mortality decreased by 0.98% (95% CI: 0.54-1.42), 1.39% (95% CI: 0.82-1.97), and 0.13% (95% CI: – 1.24 to 1.48), respectively. CONCLUSION: Seasonality of mortality is driven partly by temperature, and its amplitude may be decreasing under a warming climate.
INTRODUCTION: Patients with knee osteoarthritis (KOA) often complain about clinical symptoms affected by weather-related factors. The purpose of the present study was to use cross-sectional analysis to determine whether weather sensitivity was associated with clinical symptoms, as well as structure abnormalities, in KOA patients. METHODS: Data from 80 participants were obtained from the Feng Hans Shi Effects on OA (FHS) study, an OA cohort study initiated in China in 2015. The weather sensitivity of each participant was determined by a self-reported questionnaire. The following measurements were used to assess clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for symptoms, and semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) for cartilage defects and marrow abnormalities of magnetic resonance imaging (MRI). Chi-square with Cochran-Armitage test for trend and regression analysis were used to evaluate the associations between weather sensitivity and WOMAC and WORMS of KOA patients. RESULTS: Most of the KOA participants (57.5%) perceived the weather as affecting their knee-joint clinical symptoms. After adjusting for age, gender, and body mass index (BMI), weather sensitivity was not only associated with knee pain [OR?=?3.3 (95% CI 1.1, 9.9), P?=?0.032], dysfunction [OR?=?5.5 (95% CI 1.8, 16.8), P?=?0.003], and overall clinical symptoms [OR?=?3.3 (95% CI 1.1, 10.2), P?=?0.034], but also associated with cartilage defect [OR?=?3.1 (95% CI 1.1, 8.5), P?=?0.027] and marrow abnormality [OR?=?3.0 (95% CI 1.1, 8.1), P?=?0.029]. CONCLUSIONS: In KOA patients, weather sensitivity was associated with clinical symptoms and structural abnormalities. Future longitudinal study is warranted for the causal relationship. INFOGRAPHIC.
The present study analyses changes in the timing and duration of the hot days season over the Middle East and North Africa region from 1970 to 2099 using model simulations of 11 regional models from the Coordinated Regional Climate Downscaling Experiment under the RCP8.5 scenario. In general, a non-symmetrical lengthening of the hot days season is projected, with a tendency to extend more into spring than into autumn. By the end of the century and the RCP8.5 scenario, Western Africa and the Persian Gulf display a hot days season starting 60 days earlier than in the historical period (1970-1999) (May vs. July, respectively). Southernmost latitudes are the most affected by a later retreat of the hot days season, of up to 60 days with respect to the historical period (October vs. August). The length of the extreme season is projected to increase between 100 and 120 days for the southernmost latitudes and the Persian Gulf resulting in nearly four more months with hot days conditions.
Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030?s and 5.5% (0.5-9.9%) in the 2090?s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.
Background: Extreme temperature events have been observed to appear more frequently and with greater intensity in Taiwan in recent decades due to climate change, following the global trend. Projections of temperature extremes across different climate zones and their impacts on related mortality and adaptation have not been well studied. Methods: We projected site-specific future temperature extremes by statistical downscaling of 8 global climate models followed by Bayesian model averaging from 2021 to 2060 across Taiwan under the representative concentration pathway (RCP) scenarios RCP2.6, RCP4.5, and RCP8.5. We then calculated the attributable mortality (AM) in 6 municipalities and in the eastern area by multiplying the city/county- and degree-specific relative risk of mortality according to the future population projections. We estimated the degree of adaptation to heat by slope reduction of the projected AM to be comparable with that in 2018. Results: The annual number of hot dayswithmean temperatures over 30 degrees C was predicted to have a substantial 2-to 5-fold increase throughout the residential areas of Taiwan by the end of 2060 under RCP8.5, whereas the decrease in cold days was less substantial. The decrease in cold-related mortality below 15 degrees C was projected to outweigh heat-related mortality for the next two decades, and then heat-related mortality was predicted to drastically increase and cross over cold-related mortality, surpassing it from 2045 to 2055. Adjusting for future population size, the percentage increase in heat-related deaths per 100,000 people could increase by more than 10-fold under the worst scenario (RCP8.5), especially for those over 65 years old. The heat-related impacts will be most severe in southern Taiwan, which has a tropical climate. There is a very high demand for heat-adaptation prior to 2050 under all RCP scenarios. Conclusions: Spatiotemporal variations in AM in cities in different climate zones are projected in Taiwan and are expected to have a net negative effect in the near future before shifting to a net positive effect from 2045 to 2055. However, there is an overall positive and increasing trend of net effect for elderly individuals under all the emission scenarios. Active adaptation plans need to bewell developed to face future challenges due to climate change, especially for the elderly population in central and southern Taiwan. (C) 2020 Elsevier B.V. All rights reserved.
INTRODUCTION: A decline in semen quality caused by global warming and torrid working conditions is a major cause of human male infertility, and heat stress-induced decreases in male reproductive ability results in economic losses in livestock husbandry. Increasing evidence suggests that melatonin exerts protective effects on stress-induced DNA damage and apoptosis in germ cells. However, few studies have assessed the effects of melatonin on testicular recovery during post-heat stress and the underlying mechanisms. METHODS AND RESULTS: In vivo studies using 8-week-old male CD-1 mice revealed that melatonin pretreatment (50 mg/kg for 5 days) did not alleviate heat stress-induced germ cell loss and disrupted testicular histomorphology, however, long-term melatonin administration after heat stress accelerated germ cell apoptosis, spermatogenic cell regeneration, and testicular weight recovery. In vitro studies demonstrated that melatonin enhanced RAC1 activity, resulting in increased phagocytosis of apoptotic germ cells by Sertoli cells. In addition, melatonin restored gap junctions and tight junctions after heat stress, thereby promoting hollow seminiferous tubule filling. DISCUSSION: Long-term melatonin administration accelerated testicular recovery after heat stress by enhancing the phagocytotic activity of Sertoli cells and the regeneration of spermatogenic cells. This finding suggests that melatonin is a potential therapeutic for heat stress-induced male infertility.
OBJECTIVES: The primary objective was to evaluate the association between weather variables and joint pain in patients with chronic rheumatic diseases (CRD: rheumatoid arthritis (RA), osteoarthritis (OA), and spondyloarthritis (SpA)). A secondary objective was to study the impact of air pollution indicators on CRD pain. METHOD: The study is prospective, correlational, with time-series analysis. Patients with CRD, living in a predefined catchment area, filled their level of pain daily using a 0-10 numerical scale (NS), for 1 year. Weather (temperature, relative humidity (H), atmospheric pressure (P)) and air pollution indicators (particulate matters (PM(10), PM(2.5)), nitrogen dioxide (NO(2)), and ozone (O(3))) were recorded daily using monitoring systems positioned in the same area. Association between pain and weather and air pollution indicators was studied using Pearson’s correlation. Time-series analysis methodology was applied to determine the temporal relationship between pain and indicators. RESULTS: The study included 94 patients, 82% reported they were weather-sensitive. Pain variation was similar across diseases over a year. Pain was associated negatively with temperature, H, and O(3,) and positively with P and NO(2). However, the strength of correlation was moderate; temperature explained 22% of pain variance. A drop of 10°C in temperature corresponded to an increase of 0.5 points in pain NS. Also, there was a significant interaction among environmental factors. In time-series analysis, temperature and NO(2) remained independently associated with pain. CONCLUSIONS: The perception of joint pain in patients with CRD was correlated with weather and air pollution. The strength of association was moderate and independent of underlying disease. Key Points •Weather variation was moderately correlated with joint pain in chronic rheumatic diseases, with an inverse association with temperature, humidity, and O(3). • Air pollution indicators, mainly nitrogen dioxide and ozone, were correlated with joint pain; particulate matters were also correlated but to a lesser extent. • The influence of these environmental factors was independent of the type of rheumatic disease, thus raising the hypothesis of their impact on pain perception mechanisms.
Climate change is an urgent challenge in urban planning. Weather extremes and resulting impacts such as heat waves and flash floods are already influencing the quality of life in cities and impact on infrastructure, human health and city life. In this study, we investigated perception of and economic preferences for adaptation to climate change in one of Europe’s capital cities to inform its planning policy. Through a choice experiment, we elicit the preferences of a sample (n = 550) from Prague, Czech Republic, for a citywide policy which would increase the use of six commonly used nature-based solutions (NBS) in public spaces and on public buildings across the city. Three attributes were used to describe this policy: (i) the locations where NBS would predominantly be implemented, (ii) the species diversity of these measures, and (iii) their implied costs for households. Our results showed that the NBS policy is widely supported by the public over the status quo and that this preference is mirrored in citizens’ concerns about climate change and the risks posed by heatwaves particularly. Species diversity matters in the portrayed scenarios, suggesting that (bio)diverse NBS generate additional public value over single species measures and that policy which targets biodiversity may gain support. Implementation of NBS in public spaces (e.g., street trees, rain gardens) is preferred over measures implemented on public buildings (green roofs and facades). Furthermore, adverse experiences with heatwaves has increased support for the policy. The presented results provide evidence that adaptation planning through NBS is likely to generate significant public value which is expected to increase with the intensifying effects of climate change.
Many cities aim to progress toward their sustainability and public health goals by increasing use of their public transit systems. However, without adequate protective infrastructure that provides thermally comfortable conditions for public transit riders, it can be challenging to reach these goals in hot climates. We took micrometeorological measurements and surveyed riders about their perceptions of heat and heat-coping behaviors at bus stops with a variety of design attributes in Phoenix, AZ, USA, during the summer of 2018. We identified the design attributes and coping behaviors that made riders feel cooler. We observed that current infrastructure standards and material choices for bus stops in Phoenix are insufficient to provide thermal comfort, and can even expose riders to health risks. Almost half of the study participants felt hot or very hot at the time they were surveyed, and more than half reported feeling thermally uncomfortable. On average, shade reduced the physiological equivalent temperature (PET) by 19 °C. Moreover, we found significant diurnal differences in PET reductions from the shade provided by various design attributes. For instance, all design attributes were effective in reducing PET in the morning; however, a vegetated awning did not provide statistically significant shade reductions in the afternoon. Temperatures of sun-exposed surfaces of man-made materials exceeded skin burn thresholds in the afternoon, but shade was effective in bringing the same surfaces to safe levels. Aesthetically pleasing stops were rated as cooler than stops rated as less beautiful. We conclude that cities striving to increase public transit use should prioritize thermal comfort when designing public transit stops in hot climates.
Urban green spaces (UGS) are known for providing a cooling effect by evapotranspiration, shade, and by altering the albedo. Heat mitigation by UGS reduces the space cooling demand, provides comfort, and enhances productivity. Rapid urbanization in developing countries has resulted in dwindling green spaces and their protective role is often neglected. We have quantified the heat mitigation by UGS using the InVEST model (Integrated Valuation of Ecosystem Services and Trade-offs) for present and future scenarios of Nagpur City which is situated in a heatwave-affected zone. Four future plausible scenarios were generated with a combination of drivers-economic development and commitment to promoting UGS, using the two-axis scenario analysis method. The simulated UGS in each future scenario (by allowing 10% variation in the land use) is utilized for quantification of heat mitigation and energy conserved. In comparison with the present situation, 21-29% less space cooling energy is conserved in scenarios driven by economic development (least commitment to UGS), whereas 17% more energy is conserved when UGS are promoted. In similar lines, the average temperature is increased by 0.5-0.7 degrees C when UGS are neglected, while the temperature dropped by 0.5 degrees C when UGS are promoted in Nagpur City. The methodology presents an integration of scenario analysis with heat mitigation modeling which can enable urban planners and researchers to improve their understanding of the ecological structure of urban centers and can aid in appreciating the potential of UGS in heat mitigation for human wellbeing.
Heat stress decreases human physical work capacity (PWC), but the extent to which solar radiation (SOLAR) compounds this response is not well understood. This study empirically quantified how SOLAR impacts PWC in the heat, considering wide, but controlled, variations in air temperature, humidity, and clothing coverage. We also provide correction equations so PWC can be quantified outdoors using heat stress indices that do not ordinarily account for SOLAR (including the Heat Stress Index, Humidex, and Wet-Bulb Temperature). Fourteen young adult males (7 donning a work coverall, 7 with shorts and trainers) walked for 1 h at a fixed heart rate of 130 beats?min(-)1, in seven combinations of air temperature (25 to 45°C) and relative humidity (20 or 80%), with and without SOLAR (800 W/m(2) from solar lamps). Cumulative energy expenditure in the heat, relative to the work achieved in a cool reference condition, was used to determine PWC%. Skin temperature was the primary determinant of PWC in the heat. In dry climates with exposed skin (0.3 Clo), SOLAR caused PWC to decrease exponentially with rising air temperature, whereas work coveralls (0.9 Clo) negated this effect. In humid conditions, the SOLAR-induced reduction in PWC was consistent and linear across all levels of air temperature and clothing conditions. Wet-Bulb Globe Temperature and the Universal Thermal Climate Index represented SOLAR correctly and did not require a correction factor. For the Heat Stress Index, Humidex, and Wet-Bulb Temperature, correction factors are provided enabling forecasting of heat effects on work productivity.
BACKGROUND: Accurate and timely forecasts of bacillary dysentery (BD) incidence can be used to inform public health decision-making and response preparedness. However, our ability to detect BD dynamics and outbreaks remains limited in China. OBJECTIVES: This study aims to explore the impacts of meteorological factors on BD transmission in four representative regions in China and to forecast weekly number of BD cases and outbreaks. METHODS: Weekly BD and meteorological data from 2014 to 2016 were collected for Beijing (Northern China), Shenyang (Northeast China), Chongqing (Southwest China) and Shenzhen (Southern China). A boosted regression tree (BRT) model was conducted to assess the impacts of meteorological factors on BD transmission. Then a real-time forecast and early warning model based on BRT was developed to track the dynamics of BD and detect the outbreaks. The forecasting methodology was compared with generalized additive model (GAM) and seasonal autoregressive integrated moving average model (SARIMA) that have been used to model the BD case data previously. RESULTS: Ambient temperature was the most important meteorological factor contributing to the transmission of BD (80.81%-92.60%). A positive effect of temperature was observed when weekly mean temperature exceeded 4 °C, -3 °C, 9 °C and 16 °C in Beijing (Northern China), Shenyang (Northeast China), Chongqing (Southwest China) and Shenzhen (Southern China), respectively. BD incidence (Beijing and Shenyang) in temperate cities was more sensitive to high temperature than that in subtropical cities (Chongqing and Shenzhen). The dynamics and outbreaks of BD can be accurately forecasted and detected by the BRT model. Compared to GAM and SARIMA, BRT model showed more accurate forecasting for 1-, 2-, 3-weeks ahead forecasts in Beijing, Shenyang and Shenzhen. CONCLUSIONS: Temperature plays the most important role in weather-attributable BD transmission. The BRT model achieved a better performance in comparison with GAM and SARIMA in most study cities, which could be used as a more accurate tool for forecasting and outbreak alert of BD in China.
BACKGROUND: Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. METHODS: We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. RESULTS: We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. CONCLUSION: Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.
We analyzed two historical extreme heat events in Los Angeles to explore the potential of increasing vegetative cover and surface solar reflectance (albedo) to reduce total exposure (indoor and outdoor) to dangerously hot conditions. We focus on three population subgroups, the elderly, office workers, and outdoor workers, and explore the extreme case where each subgroup does not have functioning air conditioning in their residences. For each heat event, we conducted atmospheric model simulations for a control case and four mitigation cases with varying levels of increased albedo and vegetation cover. Simultaneously, we conducted building simulations of representative residential buildings that lacked mechanical air conditioning. These simulations factored in both the indirect cooling effects associated with neighborhood implementation of mitigation strategies and the direct effects of high albedo roofing on the individual buildings. From both the atmospheric and building models, we exported hourly values of air temperature and dew point temperature, and used this information in combination with various scenarios of occupant behavior to create profiles of individual heat exposure. We also gathered heat-mortality data for the two heat events and developed a synoptic climatology-based relationship between exposure and excess mortality. This relationship was then applied to the scenarios in which albedo and canopy cover were increased. The results suggest that improvements in indoor thermal conditions are responsible for a sizable portion of the health benefit of large-scale implementation of heat mitigation strategies.
Climate risks and vulnerability continue to disproportionately affect the urban poor given their constrained adaptive capacity. This paper examines the urban poor’s perceptions and vulnerability to climate change in Kampala. Data was collected from a proportionate sample of 534 respondents drawn from households that were randomly selected from the city’s informal settlements and interviewed using a structured questionnaire. Six focus group discussions and 15 key informant interviews were conducted whose participants were purposively selected because of their knowledge and experiences. Quantitative data was analyzed using chi-square tests while content analysis was used to analyze qualitative data from key informant interviews and focus group discussions. A total of 96.6% of the households were aware of climate change, mainly perceived as rising temperatures and reduction in rainfall. Floods (53.4%) and droughts (27%) were the most commonly experienced climate risks, with the former considered more frequent and severe. Perceptions and vulnerability to climate risk varied with incomes, education level, marital status, main occupation, housing conditions and length of stay. Individuals with less wealth and education, employed in informal business and having insecure housing tenure were most vulnerable to flooding than they are to drought. The sensitivity of the urban poor communities is heightened by ecosystem degradation, poor access to urban infrastructure, utilities and services. With socio-economic attributes highly associated to climate change vulnerabilities, incorporating social dimensions and exchange of information between the vulnerable communities, planners and decision makers is necessary to inform the city’s adaptation policy and building long-term urban resilience. Partnerships are necessary between the urban authorities, communities, civil society and donors/financiers to improve housing and livelihoods in slums settlements. At the same time, strengthening co-production of climate information services, building climate change awareness, restoration of critical ecosystems and a broader inclusive adaptation planning are avenues for building resilient urban poor communities.
Extreme heat is an increasing climate threat, most pronounced in urban areas where poor populations are at particular risk. We analyzed heat impacts and vulnerabilities of 1027 outdoor workers who participated in a KAP survey in Hanoi, Vietnam in 2018, and the influence of their mitigation actions, their knowledge of heat-risks, and access to early warnings. We grouped respondents by their main income (vendors, builders, shippers, others, multiple jobs, and non-working) and analyzed their reported heat-health impacts, taking into consideration socioeconomics, knowledge of heat impacts and preventive measures, actions taken, access to air-conditioning, drinking amounts and use of weather forecasts. We applied linear and logistic regression analyses using R. Construction workers were younger and had less knowledge of heat-health impacts, but also reported fewer symptoms. Older females were more likely to report symptoms and visit a doctor. Access to air-conditioning in the bedroom depended on age and house ownership, but did not influence heat impacts as cooling was too expensive. Respondents who knew more heat exhaustion symptoms were more likely to report impacts (p < 0.01) or consult a doctor (p < 0.05). Similarly, those who checked weather updates were more likely to report heat impacts (p < 0.01) and experienced about 0.6 more symptoms (p < 0.01). Even though occupation type did not explain heat illness, builders knew considerably less (40%; p < 0.05) about heat than other groups but were twice as likely to consult a doctor than street vendors (p < 0.01). Knowledge of preventive actions and taking these actions both correlated positively with reporting of heat-health symptoms, while drinking water did not reduce these symptoms (p < 0.01). Child carers and homeowners experienced income losses in heatwaves (p < 0.01). The differences support directed actions, such as dissemination of educational materials and weather forecasts for construction workers. The Red Cross assisted all groups with cooling tents, provision of drinks and health advice.
Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO(2), SO(2) and PM(10)), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0-2, 0-6 and 0-13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0-2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.
Although Ahvaz is considered as one of the warmest cities around the world, few epidemiological studies have been conducted on the adverse effects of temperature on human health using thermal indices in this city. This study investigates the relation between physiologically equivalent temperature (PET) and respiratory hospital admissions in Ahvaz. Distributed lag non-linear models (DLNMs) combined with quasi-Poisson regression models were used to investigate the relation between PET and respiratory disease hospital admissions, adjusted for the effect of time trend, air pollutants (NO(2), SO(2), and PM(10)), and weekdays. The analysis was performed by utilizing R software. Low PET values significantly decreased the risk of hospital admissions for total respiratory diseases, respiratory diseases in men and women, chronic obstructive pulmonary diseases (COPD), and bronchiectasis. However, low PET (16.9°C) in all lags except lag 0-30 significantly increased the risk of hospital admissions for asthma. The results indicate that in Ahvaz, which has a warm climate, cold weather decreased overall respiratory hospital admissions, except for asthma.
Both droughts and hot extremes may exert critical impacts on human society, and their concurrence is no exception. Global warming is expected to increase the frequency and intensity of compound dry and hot events widely, the impacts of which will be particularly severe for sensitive and vulnerable sectors. However, projected risk and impact of compound dry and hot events in China are less assessed, especially in the context of the goals specified by the Paris Agreement in 2015. Here, we show an overall increased risk of compound dry and hot events on human health in China, particularly in eastern regions, for the two warming levels (1.5 and 2 degrees C) based on Coupled Model Intercomparison Project Phase 5 climate models. The population exposure to extreme compound dry and hot events is projected to increase by about 165.46% for the 1.5 degrees C warming and about 200.49% for the 2 degrees C warming compared with the exposure in the present period 1986-2005. These potential variations are driven by climate change and population change with climate effect being the dominantly positive contributor. These findings highlight the urgent need for more efforts to limit warming within 1.5 degrees C to reduce the risk of compound dry and hot events and associated impacts on human society.
Changes in the preconception ambient temperature (PAT) can affect the gametogenesis, disturbing the development of the embryo, but the health risks of PAT on the developing fetus are still unclear. Here, based on the National Free Preconception Health Examination Project in the rural areas of Henan Province, we evaluate the effects of PAT on preterm birth (PTB). Data of 1,231,715 records from self-reported interviews, preconception physical examination, early gestation follow-up, and postpartum follow-up were collected from 1 January 2013 to 31 December 2016. Generalized additive models were used to assess the cumulative and lag effects of PAT upon PTB. The significant cumulative effects of mean temperature within 2 weeks and 3 weeks on the risk of PTB, especially upon late PTB (34-36 weeks) (P < 0.05), were observed. Exposure to extreme heat (> 90th percentile) within 2 weeks (RR = 1.470) and 3 weeks (RR = 1.375) before conception could increase the risk of PTB. After stratifying PTB, exposure to extreme heat within 2 weeks before conception can increase the risks of early (< 34 weeks) and late PTB (P < 0.05). Besides, exposure to extreme cold (< 10th percentile) within 3 weeks or longer before conception can elevate the risk of PTB, especially late PTB. The significant lag effects of temperature changes on the risk of early PTB (lag-8 days or earlier) were observed. In conclusion, the risk of PTB was susceptible to PAT changes within 2 weeks or longer before conception. Our findings provide (i) guidance for rural couples to make pregnancy plans and (ii) scientific evidence for the government to formulate policies to prevent PTB.
Air pollution in large cities produces numerous diseases and even millions of deaths annually according to the World Health Organization. Pollen exposure is related to allergic diseases, which makes its prediction a valuable tool to assess the risk level to aeroallergens. However, airborne pollen concentrations are difficult to predict due to the inherent complexity of the relationships among both biotic and environmental variables. In this work, a stochastic approach based on supervised machine learning algorithms was performed to forecast the daily Olea pollen concentrations in the Community of Madrid, central Spain, from 1993 to 2018. Firstly, individual Light Gradient Boosting Machine (LightGBM) and artificial neural network (ANN) models were applied to predict the day of the year (DOY) when the peak of the pollen season occurs, resulting the estimated average peak date 149.1?±?9.3 and 150.1?±?10.8 DOY for LightGBM and ANN, respectively, close to the observed value (148.8?±?9.8). Secondly, the daily pollen concentrations during the entire pollen season have been calculated using an ensemble of two-step GAM followed by LightGBM and ANN. The results of the prediction of daily pollen concentrations showed a coefficient of determination (r(2)) above 0.75 (goodness of the model following cross-validation). The predictors included in the ensemble models were meteorological variables, phenological metrics, specific site-characteristics, and preceding pollen concentrations. The models are state-of-the-art in machine learning and their potential has been shown to be used and deployed to understand and to predict the pollen risk levels during the main olive pollen season.
Global warming leads to increased exposure of humankind to meteorological variation, including short-term weather changes. Weather conditions involve changes in temperature, heat and cold, in air pressure and in air humidity. Every single condition influences the incidence and mortality of different diseases such as myocardial infarction and stroke. This study investigated the impact of weather conditions on short- and long-term mortality of 4321 critically ill patients (66?±?14 years, 2638 men) admitted to an intensive care unit (ICU) over a period of 5 years. Meteorological information (air temperature, air pressure and humidity) for the same period was retrieved. The influence of absolute weather parameters, different seasons, sudden weather changes including “warm” and “cold” spells on ICU and long-term mortality was analyzed. After correction for Simplified Acute Physiology Score (SAPS-2), no impact of meteorological conditions on mortality was found. Different seasons, sudden weather changes, “warm spells” or “cold spells” did not affect the outcome of critically ill patients.
Although vaccination is available, mumps remains a public health concern in many countries including China. Previous studies have indicated the impact of meteorological factors and mumps, but findings vary across different regions with limited evidence to inform local public health responses. We aim to examine the impacts of meteorological variables on mumps in Jinan, a temperate city of China, and explore the interactions of temperature with humidity or wind speed. Weekly meteorological data and notified cases of mumps in Jinan were collected for 2014-2018. Regression analyses using the generalized additive model were performed with considerations of multicollinearity, lag effects, school holidays, long-term trend, and seasonality. A stratification model was applied to investigate the interaction. We found a non-linear relationship between weekly mean temperature and the number of cases. Between 1.2 and 24.5 °C, the excess risk (ER) of mumps for a 1 °C increase in weekly mean temperature was 3.08% (95% CI 1.32 to 4.87%) at 0-week lag. The lagged effects could last for 3 weeks. There were interactions between mean temperature and relative humidity or wind speed. The effect of mean temperature was enhanced in days with low relative humidity or high wind speed. This study suggests that temperature is positively associated with mumps cases with thresholds in the temperate city of China, and the effect can be modified by relative humidity and wind speed and is independent of vaccine coverage. Findings could be integrated into current early warning systems of mumps in order to protect people’s health from the risk of changing climate.
Under the dual effects of climate change and urban heat islands (UHI), non-optimum temperature-related mortality burdens are complex and uncertain, and are rarely discussed in China. In this study, by applying city-specific exposure-response functions to multiple temperature and population projections under different climate and urbanization scenarios, we comprehensively assessed the non-optimum temperature-related mortality burdens in China from 2000 to 2050. Our results showed that temperature-related deaths will decrease from 1.19 million in 2010 to 1.08-1.17 million in 2050, with the exception of the most populous scenario. Excess deaths attributable to non-optimal temperatures under representative concentration pathway 8.5 (RCP8.5) were 2.35% greater than those under RCP4.5. This indicates that the surge in heat-related deaths caused by climate change will be offset by the reduction in cold-related deaths. As the climate changes, high-risk areas will be confronted with more severe health challenges, which requires health protection resource relocation strategies. Simultaneously, the net effects of UHIs are beneficial in the historical periods, preventing 3493 (95% CI: 22-6964) deaths in 2000. But UHIs will cause an additional 6951 (95% CI: -17,637-31,539, SSP4-RCP4.5) to 17,041 (95% CI: -10,516-44,598, SSP5-RCP8.5) deaths in 2050. The heavier health burden in RCP8.5 than RCP4.5 indicates that a warmer climate aggravates the negative effects of UHIs. Considering the synergistic behavior of climate change and UHIs, UHI mitigation strategies should not be developed without considering climate change. Moreover, the mortality burden exhibited strong spatial variations, with heavy burdens concentrated in the hotspots including Beijing-Tianjin Metropolitan Region, Yangtze River Delta, Chengdu-Chongqing City Group, Guangzhou, Wuhan, Xi’an, Shandong, and Henan. These hotspots should be priority areas for the allocation of the national medical resources to provide effective public health interventions.
A more precise understanding of individual-level heat exposure may be helpful to advance knowledge about heat-health impacts and effective intervention strategies, especially in light of projected increases in the severity and frequency of extreme heat events. We developed and interrogated different metrics for quantifying personal heat exposure and explored their association with social risk factors. To do so, we collected simultaneous personal heat exposure data from 64 residents of metropolitan Phoenix, Arizona. From these data, we derived five exposure metrics: Mean Individually Experienced Temperature (IET), Maximum IET, Longest Exposure Period (LEP), Percentage Minutes Above Threshold (PMAT), and Degree Minutes Above Threshold (DMAT), and calculated each for Day Hours, Night Hours, and All Hours of the study period. We then calculated effect sizes for the associations between those metrics and four social risk factors: neighborhood vulnerability, income, home cooling type, and time spent outside. We also investigated exposure misclassification by constructing linear regression models of observations from a regional weather station and hourly IET for each participant. Our analysis revealed that metric choice and timeframe added depth and nuance to our understanding of differences in exposure within and between populations. We found that time spent outside and income were the two risk factors most strongly associated with personal heat exposure. We also found evidence that Mean IET is a good, but perhaps not optimal, measure for assessing group differences in exposure. Most participants’ IETs were poorly correlated with regional weather station observations and the slope and correlation coefficient for linear regression models between regional weather station data and IETs varied widely among participants. We recommend continued efforts to investigate personal heat exposure, especially in combination with physiological indicators, to improve our understanding of links between ambient temperatures, social risk factors, and health outcomes.
BACKGROUND: Mechanisms linking occupational heat exposure with chronic diseases have been proposed. However, evidence on occupational heat exposure and cancer risk is limited. METHODS: We evaluated occupational heat exposure and female breast cancer risk in a large Spanish case-control study. We enrolled 1,738 breast cancer cases and 1,910 frequency-matched population controls. A Spanish job-exposure matrix, MatEmEsp, was used to assign estimates of the proportion of workers exposed (P ? 25% for at least 1 year) and work time with heat stress (wet bulb globe temperature ISO 7243) for each occupation. We used three exposure indices: ever versus never exposed, lifetime cumulative exposure, and duration of exposure (years). We estimated ORs and 95% confidence intervals (CI), applying a lag period of 5 years and adjusting for potential confounders. RESULTS: Ever occupational heat exposure was associated with a moderate but statistically significant higher risk of breast cancer (OR 1.22; 95% CI, 1.01-1.46), with significant trends across categories of lifetime cumulative exposure and duration (P (trend) = 0.01 and 0.03, respectively). Stronger associations were found for hormone receptor-positive disease (OR ever exposure = 1.38; 95% CI, 1.12-1.67). We found no confounding effects from multiple other common occupational exposures; however, results attenuated with adjustment for occupational detergent exposure. CONCLUSIONS: This study provides some evidence of an association between occupational heat exposure and female breast cancer risk. IMPACT: Our results contribute substantially to the scientific literature. Further investigations are needed considering multiple occupational exposures.
According to the European Environment Agency, the year 2015 was the warmest on record to that point, with a series of heat waves from May to September resulted in high levels of tropospheric ozone. The implications of such a year on the human well-being and health are therefore of multiple nature and can be quantified referring to the exceedances of the corresponding thresholds. This work focused on the analysis of the May-September period of 2015 in the city of Milan (Italy) in terms of Mediterranean Outdoor Comfort Index (MOCI) and ozone concentrations, recorded by monitoring stations and modeled through the Weather Research and Forecasting model. Main findings show that thermo-hygrometric stress events (periods of at least six consecutive days characterized by daily maximum values of the MOCI higher than 0.5) are characterized by daily ozone higher than the guideline level of the World Health Organization (equal to 100 ?gm(-3)). This means that thermo-hygrometric stress conditions are added up to poor air quality conditions, with severe risks for human health. Moreover, a daily MOCI-daily ozone correlation coefficient equal to 0.6 was found for the whole period. The degree of correspondence between ozone events (defined according to the European Air Quality Directive) and MOCI events was also investigated pointing out that 86% and 95% of days during ozone events are correctly predicted by events of recorded and modeled MOCI respectively, with a corresponding false alarm rate of 3% and 9%.
Schizophrenia (SCZ) hospital re-admissions constitute a serious disease burden worldwide. Some studies have reported an association between air pollutants and hospital admissions for SCZ. However, evidence is scarce regarding the effects of ambient particulate matter (PM) on SCZ hospital re-admissions, especially in coastal cities in China. The purpose of this study was to examine whether PM affects the risk of SCZ hospital re-admission in the coastal Chinese city of Qingdao. Daily SCZ hospital re-admissions, daily air pollutants, and meteorological factors from 2015 to 2019 were collected. A quasi-Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was applied to model the exposure-lag-response relationship between PM and SCZ hospital re-admissions. The relative risks (RRs) were estimated for an inter-quartile range (IQR) increase in PM concentrations. Subgroup analyses by age and gender were conducted to identify the vulnerable subgroups. There were 6220 SCZ hospital re-admissions during 2015-2019. The results revealed that PM, including PM(10) (particles with an aerodynamic diameter ?10 ?m), PM(c) (particles >2.5 ?m but <10 ?m), and PM(2.5) (particles ?2.5 ?m), was positively correlated with SCZ hospital re-admissions. The strongest single-day effects all occurred on lag3 day, and the corresponding RRs were 1.07 (95% CI: 1.02-1.11) for PM(10), 1.03 (95% CI: 1.00-1.07) for PM(c), and 1.05 (95% CI: 1.01-1.09) for PM(2.5) per IQR increase. Stronger associations were observed in males and younger individuals (<45 years). Our findings suggest that PM exposure is associated with increased risk of SCZ hospital re-admission. Active intervention measures against PM exposure should be taken to reduce the risk of SCZ hospital re-admission, especially for males and younger individuals.
OBJECTIVE: To investigate reported extreme temperature-related catastrophic events and associated mortality on the European continent including the Russian Federation. DESIGN: Cross-sectional respecting Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. SETTINGS: Data source: Emergency Events Database (EM-DAT). PARTICIPANTS: Search criteria: location-European continent including Russian Federation, time-years 1988 until 2019 (close of database 12 July 2019), catastrophic events-extreme temperatures. PRIMARY OUTCOME MEASURES: Numbers of heat waves, cold waves, severe winter conditions and associated number of deaths, overall, and per country and year, respecting STROBE criteria. RESULTS: The most frequent type of the 243 events recorded in EM-DAT were cold waves (54.7%). However, cold waves and severe winter conditions only accounted for 6460 deaths (4.5%), while heat waves were associated with 137?533 deaths (95.5%). The five most severe heat waves in 2003, 2006, 2010, 2013 and 2015 were associated with a total of 135?089 deaths. The most severe heat waves were geographically distributed over the Russian Federation (2010), as well as France, Italy, Spain and Germany, each in 2003. CONCLUSION: Although cold waves are more frequently reported in EM-DAT, heat waves are the major cause for temperature-related deaths. In order to better protect the public, it is important to address resiliency and vulnerability of populations at risk and age groups.
The aim of the study was to establish to what extent extreme thermal conditions have changed and how they affected mortality, and what conditions favor lower mortality rates or conversely, higher mortality rates. Heat/cold exposure was measured with the Universal Thermal Climate Index (UTCI). Daily mortality and meteorological data for 8 large Polish cities (Bia?ystok, Gda?sk, Kraków, Lublin, ?ód?, Pozna?, Warszawa, and Wroc?aw) in the period 1975-2014 were analyzed. Generalized additive models were used to investigate the relationship between UTCI and mortality, and TBATS models were used for the evaluation of time series UTCI data. Most of the cities experienced a clear and statistically significant at p???0.05 decrease in cold stress days of 0.8-3.3 days/year and an increase in the frequency of thermal heat stress days of 0.3-0.6 days/year until 1992-1994. There was a clear difference as regards the dependence of mortality on UTCI between cities located in the “cooler” eastern part of Poland and the “warmer” central and western parts. “Cool” cities were characterized by a clear thermal optimum, approx. in the range of 5-30 °C UTCI, changing slightly depending on cause of death, age, or sex. For UTCI over 32 °C, in most of the cities except Gda?sk and Lublin, the relative risk of death (RR) rose by 10 to 20%; for UTCI over 38 °C, RR rose to 25-30% in central Poland. An increase in mortality on cold stress days was noted mainly in the “cool” cities: RR of total mortality increased even by 9-19% under extreme cold stress.
Statistical models for measuring the impact of adverse weather conditions on pedestrian injuries are of great importance for enhancing road safety measures. The development of these models in the presence of high collinearity among the weather conditions poses a real challenge in practice. The collinearity among these conditions may result in underestimation of the regression coefficients of the regression model, and hence inconsistency regarding the impact of the weather conditions on the pedestrian injuries counts. This paper presents a methodology through which the penalization-based regression is applied to model the impact of weather conditions on pedestrian injury in the presence of a high level of collinearity among these conditions. More specifically, the methodology integrates both the least absolute shrinkage squared operator (Lasso) with the cross-validation approach. The statistical performance of the proposed methodology is assessed through an analytical comparison involving the standard Poisson regression, Poisson generalized linear model (Poisson-GzLM), and Ridge penalized regression model. The mean squared error (MSE) was used as a criterion of comparison. In terms of the MSE, the Lasso-based Poisson generalized linear model (Lasso-GzLM) revealed an advantage over the other regression models. Moreover, the study revealed that weather conditions involved in this study are of insignificant impact on pedestrian injury counts.
Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperature-attributable mortality among age groups (0-64 years; 65-74 years; 75-84 years; and 85+ years) in Lisbon Metropolitan Area, from 1986-2015. Non-linear and delayed exposure-lag-response relationships between temperature and mortality were fitted with a distributed lag non-linear model (DLNM). In general, the adverse effects of cold and hot temperatures on mortality were greater in the older age groups, presenting a higher risk during the winter season. We found that, for all ages, 10.7% (95% CI: 9.3-12.1%) deaths were attributed to cold temperatures in the winter, and mostly due to moderately cold temperatures, 7.0% (95% CI: 6.2-7.8%), against extremely cold temperatures, 1.4% (95% CI: 0.9-1.8%). When stratified by age, people aged 85+ years were more burdened by cold temperatures (13.8%, 95% CI: 11.5-16.0%). However, for all ages, 5.6% of deaths (95% CI: 2.7-8.4%) can be attributed to hot temperatures. It was observed that the proportion of deaths attributed to exposure to extreme heat is higher than moderate heat. As with cold temperatures, people aged 85+ years are the most vulnerable age group to heat, 8.4% (95% CI: 3.9%, 2.7%), and mostly due to extreme heat, 1.3% (95% CI: 0.8-1.8%). These results provide new evidence on the health burdens associated with alert thresholds, and they can be used in early warning systems and adaptation plans.
A common problem that arises in extreme value theory when dealing with several variables (such as weather or meteorological) is to find an appropriate method to assess their joint or conditional multivariate extremal dependence behaviour. The method for choosing an appropriate threshold in peaks-over threshold approach is also another problem of endless debate. In this era of climate change and global warming, extreme temperatures accompanied by heat waves and cold waves pose serious economic and health challenges particularly in small economies or developing countries like South Africa. The present study attempts to address these problems, in particular, to deal with and capture dependencies in extreme values of two variables, by applying bivariate conditional extremes modelling with a time-varying threshold to Limpopo province’s monthly maximum temperature series. Limpopo and North West provinces are the two hottest provinces in South Africa characterised by heat waves and the present study is carried out in the Limpopo province at Mara, Messina, Polokwane and Thabazimbi meteorological stations for the period 1994-2009. With the aim to model extremal dependence of maximum temperature at these four meteorological stations, two modelling approaches are applied: bivariate conditional extremes model and time-varying threshold. The latter approach was used to capture the climate change effects in the data. The main contribution of this paper is in combining these two approaches in bivariate extremal dependence modelling of maximum temperature extremes in the Limpopo province of South Africa. The findings of the study revealed both significant positive and negative extremal dependence in some pairs of meteorological stations. Among the major findings were the significant strong positive extremal dependence of Thabazimbi on high-temperature values at Mara and the strong negative extremal dependence of Polokwane on high-temperature values at Messina. The findings of this study play an important role in revealing information useful to meteorologists, climatologists, agriculturalists, and planners in the energy sector among others.
Climate change is expected to increase the prevalence of water-borne diseases especially in developing countries. Climate-resilient drinking water supplies are critical to protect communities from faecal contamination and thus against increasing disease risks. However, no quantitative assessment exists for the impacts of short-term climate variability on faecal contamination at different drinking water sources in developing countries, while existing understanding remains largely conceptual. This critical gap limits the ability to predict drinking water quality under climate change or to recommend climate-resilient water sources for vulnerable communities. This study aims to provide such quantitative understanding by investigating the relationships between faecal contamination and short-term climate variability across different types of water sources. We collected a novel dataset with over 20 months’ monitoring of weather, Escherichia coli (E. coli) and total coliforms, at 233 different water sources in three climatically different regions in Tanzania. We then took a rigorous statistical analysis with Bayesian hierarchical models, to relate both contamination occurrence and amount to climate variability. The model results explained the temporal variability in drinking water faecal contamination using climate predictors, and also revealed the climate sensitivity of faecal contamination for individual water sources. We found that: a) short-term climate variability and baseline contamination levels can explain about half the observed variability in faecal contamination (R(2) ? 0.44); b) increased contamination was most consistently related to recent heavy rainfall and high temperature across different water sources; c) unimproved water sources such as the unprotected dug wells have substantially higher climate sensitivity. Based on these results, we can expect substantial increases in drinking water contamination risks across tropical Sub-Saharan Africa and South-East Asian developing countries under a warmer climate, which highlight the urgent need of protecting vulnerable communities from the severe climate impacts.
Rivers are important for drinking water supply worldwide. However, they are often impacted by pathogen discharges via wastewater treatment plants (WWTP) and combined sewer overflows (CSO). To date, accurate predictions of the effects of future changes and pollution control measures on the microbiological water quality of rivers considering safe drinking water production are hindered due to the uncertainty of the pathogen source and transport variables. The aim of this study was to test an integrative approach for an improved understanding of these effects, i.e. climate change and population growth as well as enhanced treatment at WWTPs and/or prevention of CSOs. We applied a significantly extended version of QMRAcatch (v1.0 Python), a probabilistic-deterministic model that combines fate and transport modelling with quantitative microbial infection risk assessment. The impact of climatic changes until the period 2035-2049 was investigated by a conceptual semi-distributed hydrological model, based on regional climate model outputs. QMRAcatch was calibrated and validated using site- and source-specific data (human-associated genetic microbial source tracking marker and enterovirus). The study showed that the degree to which future changes affect drinking water safety strongly depends on the type and magnitude of faecal pollution sources and are thus highly site- and scenario-specific. For example, if the load of pathogens from WWTPs is reduced through enhanced treatment, climate-change driven increases in CSOs had a considerable impact. Preventing CSOs and installing enhanced treatment at the WWTPs together had the most significant positive effect. The simultaneous consideration of source apportionment and concentrations of reference pathogens, focusing on human-specific viruses (enterovirus, norovirus) and cross-comparison with bacterial and protozoan pathogens (Campylobacter, Cryptosporidium), was found crucial to quantify these effects. While demonstrated here for a large, wastewater-impacted river, the approach is applicable at other catchments and pollution sources. It allows assessing future changes and selecting suitable pollution control measures for long-term water safety planning.
The Middle Paranapanema region in the state of São Paulo, Brazil, is an area with high diversity for Biomphalaria species, with municipalities historically marked by cases of schistosomiasis transmission. The objectives of the study were to evaluate the current distribuition and predict the future distribution of habitats of Biomphalaria species at a high spatial resolution along 114 freshwater sites in the Middle Paranapanema watershed. The modelling encompassed 55 municipalities of the Middle Paranapanema region, which were analyzed through the maximum entropy algorithm. All geographic coordinates of the Biomphalaria species collected from 2015-2018 and environmental data were obtained through WorldClim, HydroSHEDS, TOPODATA and Secretaria do Meio Ambiente for the 1970-2017 period. For the 2041-2060 period we used the HadGEM2-ES climate model. Due to climate change, MaxEnt showed that there was a high probability for the maintenance of B. glabrata habitats near Ourinhos and Assis, an expansion of scattered spots, and a 50% probability that the species will spread throughout new suitable areas. The results showed that the geographical range of B. straminea will most likely expand in the future along the Middle Paranapanema hydrographic basin, especially in the municipalities near Ourinhos. For B. glabrata and B. straminea, the geographic expansion was related to the predicted increase in the annual temperature range. The habitats suitable for B. tenagophila and B. peregrina seemed to slightly expand around the west border of the Middle Paranapanema region. Biomphalaria occidentalis may have a small reduction in its distribution due to climate change. The variables that contributed the most to the future modelling for these three species were precipitation and temperature. Identifying the sites with intermediate hosts for schistosomiasis may guide public health measures to avoid or reduce future transmissions in this region.
FluMOMO is a universal formula to forecast mortality in 27 European countries and was developed on EuroMOMO context, http://www.euromomo.eu. The model has a trigonometric baseline and considers any upwards deviation from that to come from flu or extreme temperatures. To measure it, the model considers two variables: influenza activity and extreme temperatures. With the former, the model gives the number of deaths because of flu and with the latter the number of deaths because of extreme temperatures. In this article, we show that FluMOMO lacks important variables to be an accurate measure of all-cause mortality and flu mortality. Indeed, we found, as expected, that population ageing and exposure to the risk of death cannot be excluded from the linear predictor. We model weekly deaths as an autoregressive process (lag of one together with a lead of one week). This step allowed us to avoid FluMOMO trigonometric baseline and have a fit to weekly deaths through demographic variables. Our model uses data from Portugal between 2009 and 2020, on ISO-week basis. We use negative binomial-generalized linear models to estimate the weekly number of deaths as an alternative to traditional overdispersion Poisson. As explanatory variables were found to be statistically significant, we registered the number of deaths from the previous week, the influenza activity index, the population average age, the heat waves, the flu season, the number of deaths with COVID-19, and the population exposed to the risk of dying. Considering as excess mortality the number of deaths above the best estimate of deaths from our model, we conclude that excess mortality in 2020 (net of COVID-19 deaths, heat wave of July, and ageing) is low or inexistent. The model also allows us to have the number of deaths arising from flu and we conclude that FluMOMO is overestimating deaths from flu by 78%. Averages from the probability of dying are obtained as well as the probability of dying from flu. The latter is shown to be decreasing over time, probably due to the increase of flu vaccination. Higher mortality detected with the start of COVID-19, in March-April 2020, was probably due to COVID-19 deaths not recognized as COVID-19 deaths.
Although a number of epidemiological studies have examined the effects of non-optimal temperatures on mortality in Europe, evidence about the mortality risks associated with exposures to hot and cold temperatures in Bulgaria is scarce. This study provides evidence about mortality attributable to non-optimal temperatures in adults aged 65 and over in Sofia, Bulgaria, between 2000 and 2017. We quantified the relationship between the daily mean temperature and mortality in the total elderly adult population aged 65 and over, among males and females aged 65 and over, as well as individuals aged 65-84 and 85 years or older. We used a distributed lag non-linear model with a 25-day lag to fully capture the effects of both cold and hot temperatures and calculated the fractions of mortality attributable to mild and extreme hot and cold temperatures. Cold temperatures had a greater impact on mortality than hot temperatures during the studied period. Most of the temperature-attributable mortality was due to moderate cold, followed by moderate heat, extreme cold, and extreme heat. The total mortality attributable to non-optimal temperatures was greater among females compared to males and among individuals aged 85 and over compared to those aged 65 to 84. The findings of this study can serve as a foundation for future research and policy development aimed at characterizing and reducing the risks from temperature exposures among vulnerable populations in the country, climate adaptation planning and improved public health preparedness, and response to non-optimal temperatures.
Several studies have investigated the associations between diurnal temperature rage (DTR) and mortality, but little evidence has been available regarding the association of DTR with years of life lost (YLL). The aim of this study was to examine the association of DTR with YLL rate, and quantify life loss per death caused by DTR in China. Daily meteorological and death data were collected from 364 locations in China during 2006-2017. First, we calculated daily YLL rate. Then, the distributed lag nonlinear model was applied to estimate the associations of DTR with YLL rate in each location, and multivariable meta-analysis was conducted to pool the location-specific estimates. Finally, we calculated the attributable fractions of DTR on YLL rate and average life loss per death to estimate the mortality burden caused by DTR. Subgroups analyses were conducted by region, age, sex and cause of death. A J-shaped association of DTR with YLL rate was identified in China. The minimum YLL-rate DTR (MYDTR) was 3.7 degrees C nationwide. The overall AF of DTR in China was 6.40% [95% confidence interval (CI) 3.95-8.86%], and AFs caused by DTR were higher in females, the elderly and south China. An average of 0.96 years (95%CI 0.57-1.35) life loss per death was attributable to DTR nationwide, and life losses per death attributed to DTR were higher in female, young population, and south China. AF and life loss per death caused by DTR were much higher in cold season than that in warm season. Both high DTR and low DTR increased YLL rate in China. Mortality burdens of DTR were much higher in cold season than warm season. The effects of DTR were modified by region, demography and cause of death. Our findings suggest that vulnerable population should be protected when daily temperature change rapidly, especially in cold season.
Over the past decade, Brazil has experienced and continues to be impacted by extreme climate events. This study aims to evaluate the association between daily average temperature and mortality from respiratory disease among Brazilian elderlies. A daily time-series study between 2000 and 2017 in 27 Brazilian cities was conducted. Data outcomes were daily counts of deaths due to respiratory diseases in the elderly aged 60 or more. The exposure variable was the daily mean temperature from Copernicus ERA5-Land reanalysis. The association was estimated from a two-stage time series analysis method. We also calculated deaths attributable to heat and cold. The pooled exposure-response curve presented a J-shaped format. The exposure to extreme heat increased the risk of mortality by 27% (95% CI: 15-39%), while the exposure to extreme cold increased the risk of mortality by 16% (95% CI: 8-24%). The heterogeneity between cities was explained by city-specific mean temperature and temperature range. The fractions of deaths attributable to cold and heat were 4.7% (95% CI: 2.94-6.17%) and 2.8% (95% CI: 1.45-3.95%), respectively. Our results show a significant impact of non-optimal temperature on the respiratory health of elderlies living in Brazil. It may support proactive action implementation in cities that have critical temperature variations.
Climate risk is a consequence of climate hazards, exposure, and the vulnerability (IPCC 2014). Here, we assess future (2040-2049) climate risk for the entire contiguous US at the county level with a novel climate risk index integrating multiple hazards, exposures and vulnerabilities. Future, weather and climate hazards are characterized as frequency of heat wave, cold spells, dryer, and heavy precipitation events along with anomalies of temperature and precipitation using high resolution (4 km) downscaled climate projections. Exposure is characterized by projections of population, infrastructure, and built surfaces prone to multiple hazards including sea level rise and storm surges. Vulnerability is characterized by projections of demographic groups most sensitive to climate hazards. We found Florida, California, the central Gulf Coast, and North Atlantic at high climate risk in the future. However, the contributions to this risk vary regionally. Florida is projected to be equally hard hit by the three components of climate risk. The coastal counties in the Gulf states of Louisiana, Texas, Mississippi and Alabama are at high climate risk due to high exposure and hazard. High exposure and vulnerability drive high climate risk in California counties. This approach can guide planners in targeting counties at most risk and where adaptation strategies to reduce exposure or protect vulnerable populations might be best applied.
The application of green infrastructure presents an opportunity to mitigate rising temperatures using a multi-faceted ecosystems-based approach. A controlled field study in Toronto, Ontario, Canada, evaluates the impact of nature-based solutions on near surface air temperature regulation focusing on different applications of green infrastructure. A field campaign was undertaken over the course of two summers to measure the impact of green roofs, green walls, urban vegetation and forestry systems, and urban agriculture systems on near surface air temperature. This study demonstrates that multiple types of green infrastructure applications are beneficial in regulating near surface air temperature and are not limited to specific treatments. Widespread usage of green infrastructure could be a viable strategy to cool cities and improve urban climate.
Bangladesh stands out as a climate change hot spot due to its unique geography, climate, high population density, and limited adaptation capacity. Mounting evidence suggests that the country is already suffering from the effects of climate change which may get worse without aggressive action. Here, we use an ensemble of high-resolution (10 km) regional climate model simulations to project near-term change in climate extremes, mainly heat waves and intense rainfall, for the period (2021–2050). Near-term climate projections represent a valuable input for designing sound adaptation policies. Our climate projections suggest that heatwaves will become more frequent and severe in Bangladesh under the business-as-usual scenario (RCP8.5). In particular, extremes of wet-bulb temperature (a temperature and humidity metric important in evaluating humid heat stress) in the western part of Bangladesh including Bogra, Ishurdi, and Jessore are likely to exceed the extreme danger threshold (according to U.S. National Weather Service criterion), which has rarely been observed in the current climate. The return periods of extreme heat waves are also significantly shortened across the country. In addition, country-averaged rainfall is projected to increase by about 6% during the summer months, with the largest increases (above 10%) in the eastern mountainous areas, such as Sylhet and Chittagong. Meanwhile, insignificant changes in extreme rainfall are simulated. Our results suggest that Bangladesh is particularly susceptible to climate extremes in the near future, in the form of extreme heat waves over the western part of the country.
Currently, the correlation between ambient temperature and systemic lupus erythematosus (SLE) hospital admissions remains not determined. The aim of this study was to explore the correlation between ambient temperature and SLE hospital admissions in Hefei City, China. An ecological study design was adopted. Daily data on SLE hospital admissions in Hefei City, from January 1, 2007, to December 31, 2017, were obtained from the two largest tertiary hospitals in Hefei, and the daily meteorological data at the same period were retrieved from China Meteorological Data Network. The generalized additive model (GAM) combined with distributed lag nonlinear model (DLNM) with Poisson link was applied to evaluate the influence of ambient temperature on SLE hospital admissions after controlling for potential confounding factors, including seasonality, relative humidity, day of week, and long-term trend. There were 1658 SLE hospital admissions from 2007 to 2017, including 370 first admissions and 1192 re-admissions (there were 96 admissions with admission status not stated). No correlation was observed between ambient temperature and SLE first admissions, but a correlation was found between low ambient temperature and SLE re-admissions (RR: 2.53, 95% CI: 1.11, 5.77) (3.5 °C vs 21 °C). The effect of ambient temperature on SLE re-admissions remained for 2 weeks but disappeared in 3 weeks. Exposure to low ambient temperature may increase hospital re-admissions for SLE, and thus it is important for SLE patients to maintain a warm living environment and avoid exposure to lower ambient temperature.
Heat waves (HWs) and urban heat islands (UHIs) can potentially interact. The mechanisms behind their synergy are not fully disclosed. Starting from the localized UHI phenomenon, this study aims i) to reveal their associated impacts on human thermal comfort through three different definitions of HW events, based on air temperature (airT), wet-bulb globe temperature (WBGT) and human-perceived temperature (AppT) respectively, and ii) to understand the role of air moisture and wind. The analysis was conducted in four districts (NH, JD, MH and XJH) with different urban development patterns and geographic conditions, in the megacity of Shanghai with a subtropical humid climate. Results evidenced the localized interplay between HWs and UHIs. The results indicate that less urbanized districts were generally more sensitive to the synergies. JD district recorded the highest urban heat island intensity (UHII) amplification, regardless of the specific HW definition. Notably, during AppT-HWs, the increment was observed in terms of maximum (1.3 °C), daily average (0.8 °C), diurnal (0.4 °C) and nocturnal UHII (1.0 °C). Nevertheless, localized synergies between HWs and UHIs at different stations also exhibited some commonalities. Under airT-HW, the UHII was amplified throughout the day at all stations. Under WBGT-HW, diurnal UHII (especially at 11:00-17:00 LST) was consistently amplified at all stations. Under AppT-HW conditions, the nocturnal UHII was slightly amplified at all stations. Air moisture and wind alleviated the synergistic heat exacerbation to the benefit of thermal comfort. The extent depended on geographic condition, diurnal and nocturnal scenarios, temperature type and HW/normal conditions. Stronger HW-UHI synergies indicate the necessity to develop specific urban heat emergency response plans, able to capture and intervene on the underlying mechanisms. This study paves to way to their identification.
Significant changes in climate variables in the last decades resulted in changes of perceived climate conditions. However, there are only few studies discussing long-lasting changes in bioclimatic conditions. Thus, the purpose of this paper is to present the temporal and spatial distribution of hazardous heat and cold stress conditions in different regions of Poland. Its focus is on long-lasting changes in such conditions in the period 1951-2018. To assess changes in hazardous thermal stress conditions, the Universal Thermal Climate Index (UTCI) was used. UTCI values at 12 UTC hour (respectively 1 pm winter time, 2 pm summer time) were calculated daily based on air temperature, relative humidity, total cloud cover and wind speed at 24 stations representing the whole area of Poland. We found that the greatest changes were observed in minimum (1.33 °C/10 years) and average (0.52 °C/10 years) UTCI values as well as in cold stress frequency (- 4.00 days per 10 years). The changes vary seasonally and regionally. The greatest increase in UTCImin and decrease in cold stress days were noted from November to March and had the highest values in north-east and east Poland, and also in the foothills of the Carpathian Mountains. The trends in maximum UTCI are much smaller and not always positive. The spatially averaged trend in UTCImax for Poland as a whole was 0.35 °C/10 years and the increase in heat stress days was 0.80 days/10 years. The highest increases in UTCImax and heat stress days were noted in eastern and south-eastern Poland.
The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006-2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), -0.53 % (95 % CI: -0.89 %, -0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure.
In the context of global climate change, far less is known about the impact of long-term temperature variability (TV), especially in developing countries. The current study aimed to estimate the effect of long-term TV on the incidence of cardiovascular disease (CVD) in China. A total of 23,721 individuals with a mean age of 56.15 years were enrolled at baseline from 2012 to 2016 and followed up during 2017-2019. TV was defined as the standard deviation of daily temperatures during survey years and was categorized into tertiles (lowest? 8.78 °C, middle = 8.78-10.07 °C, highest ? 10.07 °C). The Cox proportional hazards regression was used to estimate the multivariable-adjusted hazard ratio (HR) between TV and CVD. During the median follow-up of 4.65 years, we ascertained 836 cases of incident CVD. For per 1 °C increase in TV, there was a 6% increase of CVD (HR = 1.06 [95% confidence interval (CI): 1.01-1.11]). A significant positive trend was observed between CVD risk and increasing levels of TV compared to the lowest tertile [HR = 1.34 (95% CI: 1.13-1.59) for the medium tertile, HR = 1.72 (95% CI: 1.35-2.19) for the highest tertile, P(trend) < 0.001]. Exposure to high TV would lose 2.11 disease-free years for the population aged 35-65 years and 66 CVD cases (or 7.95% cases) could been attributable to TV higher than 8.11 °C in the current study. The current findings suggested that long-term TV was associated with a higher risk of CVD incidence, it is needed to reduce the TV-related adverse health effect.
Livability, resilience, and justice in cities are challenged by climate change and the historical legacies that together create disproportionate impacts on human communities. Urban green infrastructure has emerged as an important tool for climate change adaptation and resilience given their capacity to provide ecosystem services such as local temperature regulation, stormwater mitigation, and air purification. However, realizing the benefits of ecosystem services for climate adaptation depend on where they are locally supplied. Few studies have examined the potential spatial mismatches in supply and demand of urban ecosystem services, and even fewer have examined supply-demand mismatches as a potential environmental justice issue, such as when supply-demand mismatches disproportionately overlap with certain socio-demographic groups. We spatially analyzed demand for ecosystem services relevant for climate change adaptation and combined results with recent analysis of the supply of ecosystem services in New York City (NYC). By quantifying the relative mismatch between supply and demand of ecosystem services across the city we were able to identify spatial hot- and coldspots of supply-demand mismatch. Hotspots are spatial clusters of census blocks with a higher mismatch and coldspots are clusters with lower mismatch values than their surrounding blocks. The distribution of mismatch hot- and coldspots was then compared to the spatial distribution of socio-demographic groups. Results reveal distributional environmental injustice of access to the climate-regulating benefits of ecosystem services provided by urban green infrastructure in NYC. Analyses show that areas with lower supply-demand mismatch tend to be populated by a larger proportion of white residents with higher median incomes, and areas with high mismatch values have lower incomes and a higher proportion of people of color. We suggest that urban policy and planning should ensure that investments in “nature-based” solutions such as through urban green infrastructure for climate change adaptation do not reinforce or exacerbate potentially existing environmental injustices.
The rising temperature makes the weather becoming more extreme. Understanding how extreme hot temperature-heat wave events (HWEs)-are likely to alter individual heat exposure and sensitivity is crucial for developing climate change mitigation and adaptation strategies. Despite the importance, little is known about the real-time impacts of HWEs on individual daily life in developing nations, like China. To fill this gap, we adopt over 1544 thousand Weibo (Chinese Twitter) social media data, coupled with meteorological conditions people face when posting, to assess the heat exposure and people’s sensitivity to HWEs across 31 mega-cities in China. The results show the hotspot of Weibo heat is coincident with the extremely hot temperature, with a correlation of 0.7 (p < 0.05). The intensities, frequencies, and durations of HWEs in both geographical and social media space have high spatial heterogeneity. Its spatial variation can be explained by the type of climate zone and the unique geographical environment. The cities with extreme hot weather are more likely to adapt to the heatwave and less sensitivity to HWEs. The proposed framework, which integrates the real-time social media semantic analysis, statistical method, and spatial techniques, provides a new paradigm to assess the HWEs exposure and sensitivity analysis in China.
BACKGROUND: Global temperatures are projected to rise by ?2?°C by the end of the century, with expected impacts on infectious disease incidence. Establishing the historic relationship between temperature and childhood diarrhea is important to inform future vulnerability under projected climate change scenarios. METHODS: We compiled a national dataset from Peruvian government data sources, including weekly diarrhea surveillance records, annual administered doses of rotavirus vaccination, annual piped water access estimates, and daily temperature estimates. We used generalized estimating equations to quantify the association between ambient temperature and childhood (
The present work investigates the increase of confirmed cases of West Nile virus and the relationship between weather-related patterns and the geographical expansion of West Nile virus in Greece, with a special focus on West Attica, Central Greece, a semi-arid, ecologically fragile Mediterranean area. Using data from the European Environment Agency, European Drought Observatory of Joint Research Centre, the pairwise relationship between surface air temperature anomalies, precipitation anomalies, soil moisture index anomalies, and the fraction of absorbed photosynthetically active radiation anomalies (fAPAR) was evaluated during summer time of 2018, a particularly intense virus outbreak. The empirical results of this study indicate that total precipitation during 2018 was extremely high, nearly 500% above the average. These conditions contributed to the increase of soil moisture index anomaly and fAPAR, creating an ideal microenvironment (wet soils and green pastures) for mosquito breeding. This phenomenon was directly associated with a drastic outbreak of West Nile virus cases in the area, compared with earlier years. Our results indicate how unusually high values of summer precipitation may have contributed (both through direct and indirect ecological channels) to the rapid spread of the West Nile virus in West Attica, causing a significant number of confirmed cases and fatalities. Climate change may bring forth other issues aside from natural disasters, including-but not limited to-virus expansion.
The mosquito Aedes aegypti is the primary vector of many disease-causing viruses, including dengue (DENV), Zika, chikungunya, and yellow fever. As consequences of climate change, we expect an increase in both global mean temperatures and extreme climatic events. When temperatures fluctuate, mosquito vectors will be increasingly exposed to temperatures beyond their upper thermal limits. Here, we examine how DENV infection alters Ae. aegypti thermotolerance by using a high-throughput physiological ‘knockdown’ assay modeled on studies in Drosophila. Such laboratory measures of thermal tolerance have previously been shown to accurately predict an insect’s distribution in the field. We show that DENV infection increases thermal sensitivity, an effect that may ultimately limit the geographic range of the virus. We also show that the endosymbiotic bacterium Wolbachia pipientis, which is currently being released globally as a biological control agent, has a similar impact on thermal sensitivity in Ae. aegypti. Surprisingly, in the coinfected state, Wolbachia did not provide protection against DENV-associated effects on thermal tolerance, nor were the effects of the two infections additive. The latter suggests that the microbes may act by similar means, potentially through activation of shared immune pathways or energetic tradeoffs. Models predicting future ranges of both virus transmission and Wolbachia’s efficacy following field release may wish to consider the effects these microbes have on host survival.
Statistical models to evaluate the relationships between large-scale meteorological conditions, prevailing air pollution levels and combined ozone and temperature events, were developed during the 1993-2012 period with Central Europe as regional focus. Combined ozone and temperature events were defined based on the high frequency of coinciding, health-relevant elevated levels of daily maximum tropospheric ozone concentrations (based on running 8-h means) and daily maximum temperature values in the peak ozone and temperature season from April to September. By applying two different modeling approaches based on lasso, logistic regression, and multiple linear regression mean air temperatures at 850 hPa, ozone persistence, surface thermal radiation, geopotential heights at 850 hPa, meridional winds at 500 hPa, and relative humidity at 500 hPa were identified as main drivers of combined ozone and temperature events. Statistical downscaling projections until the end of the twenty-first century were assessed by using the output of seven models of the Coupled Model Intercomparison Project Phase 5 (CMIP5). Potential frequency shifts were evaluated by comparing the mid- (2031-2050) and late-century (2081-2100) time windows to the base period (1993-2012). A sharp increase of ozone-temperature events was projected under RCP4.5 and RCP8.5 scenario assumptions with respective multi-model mean changes of 8.94% and 16.84% as well as 13.33% and 37.52% for mid- and late-century European climate.
Background This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilisation of hospitalisation for heatstroke in the United States. Additionally, this study aimed to explore factors associated with in-hospital mortalities of heatstroke. Methods The 2003-2014 National Inpatient Sample database was used to identify hospitalised patients with a principal diagnosis of heatstroke. The inpatient prevalence, clinical characteristics, in-hospital treatments, outcomes, length of hospital stay, and hospitalisation cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results A total of 3372 patients were primarily admitted for heatstroke, accounting for an overall inpatient prevalence of heatstroke amongst hospitalised patients of 36.3 cases per 1 000 000 admissions in the United States with an increasing trend during the study period (P < .001). Age 40-59 was the most prevalent age group. During the hospital stay, 20% required mechanical ventilation, and 2% received renal replacement therapy. Rhabdomyolysis was the most common complication. Renal failure was the most common end-organ failure, followed by neurological, respiratory, metabolic, hematologic, circulatory, and liver systems. The in-hospital mortality rate of heatstroke hospitalisation was 5% with a decreasing trend during the study period (P < .001). The presence of end-organ failure was associated with increased in-hospital mortality, whereas more recent years of hospitalisation was associated with decreased in-hospital mortality. The median length of hospital stay was 2 days. The median hospitalisation cost was $17 372. Conclusion The inpatient prevalence of heatstroke in the United States increased, while the in-hospital mortality of heatstroke decreased.
Home health care (HHC) services are of vital importance for the health care system of many countries. Further increases in their demand must be expected and with it grows the need to sustain these services in times of disasters. Existing risk assessment tools and guides support HHC service providers to secure their services. However, they do not provide insights on interdependencies of complex systems like HHC. Causal-Loop-Diagrams (CLDs) are generated to visualize the impacts of epidemics, blackouts, heatwaves, and floods on the HHC system. CLDs help to understand the system design as well as cascading effects. Additionally, they simplify the process of identifying points of action in order to mitigate the impacts of disasters. In a case study, the course of the COVID-19 pandemic and its effects on HHC in Austria in spring 2020 are shown. A decision support system (DSS) to support the daily scheduling of HHC nurses is presented and applied to numerically analyze the impacts of the COVID-19 pandemic, using real-world data from a HHC service provider in Vienna. The DSS is based on a Tabu Search metaheuristic that specifically aims to deal with the peculiarities of urban regions. Various transport modes are considered, including time-dependent public transport.
Foodborne diseases (FBDs) remain a global public health concern. Climatic factors such as wind-chill temperature, rainfall, and relative humidity affect the incidence of several FBDs. This study was performed to analyze how the various factors of the climate influence the incidence and severity of FBDs. This study retrospectively analyzed the results of multiplex polymerase chain reaction (mPCR) tests for diarrhea-causing bacteria performed on 2300 fecal samples obtained from patients at Dankook University Hospital, Cheonan, from June 2010 to December 2019. The Clostridioides difficile toxin B infection rate positively correlated with the intensity of sunshine, and the content of particulate matter. The Campylobacter spp. infection rate positively correlated with wind-chill temperature and the content of particulate matter. The Escherichia coli O157:H7 infection rate positively correlated with relative humidity. These findings may explain the dynamics and risks of Clostridioides difficile toxin B, Clostridium perfringens, Campylobacter spp., and Escherichia coli O157:H7 infection. They may help predict interrelationships among climatic factors and standardize national environmental health policies. However, in-depth research with large-scale data, molecular biology, and epidemiology would be required going forward. Future research would also require objective indicators of the changes in the prevalence of FBD-causing microbial pathogens for the effective prevention and management of these bacterial infections.
Cities are experiencing more and more frequent extreme heat events in hot summers in the context of rising global temperatures. A precise understanding of the spatial distribution of the human outdoor heat exposure across neighborhoods in cities is of great importance for urban heat management. Different from remote sensing based the land surface temperature, this study calculated the mean radiant temperature, which is more objective to indicate human heat stress, to study the spatial distribution of human outdoor heat exposure in Philadelphia, Pennsylvania. The SOLWEIG (SOlar and LongWave Environmental Irradiance Geometry) model was applied to estimate the mean radiant temperature based on the high-resolution urban 3D model and meteorological data. This study further examined the spatial distributions of heat exposure levels across neighborhoods of different groups in Philadelphia. Results show that there is no significant disparity in terms of outdoor heat exposure levels for different racial/ethnic groups in Philadelphia. Generally, the elderly, who usually are more vulnerable to extreme heat, tend to live in neighborhoods with less outdoor heat exposure in summer (p<0.001). The higherincome people tend to live in thermally more comfortable neighborhoods (p<0.001). The study provides a precise understanding of the heat distribution across neighborhoods, which would further help to develop strategies to allocate resources to the most needed neighborhoods to maximumly mitigate the negative impact of urban heat.
Urban heat island (UHI) and cool island (UCI) effects are well-known and prevalent in cities worldwide. An increasing trend of extreme heat events has been observed over the last few decades and is expected to continue in the foreseeable future. In this study, warm periods (May to September) of 2000-2018 were examined to acquire a comprehensive understanding of the UHI and UCI characteristics for the case study of Hong Kong, China. Twenty-two weather stations in Hong Kong were classified into four categories, namely urban, urban oasis, suburban, and rural, with reference to the local climate zone (LCZ) scheme, to analyze UHI and UCI phenomena during extreme heat and non-extreme heat situations. One representative type of extreme heat events was considered in this study: three consecutive hot nights with two very hot days in between (2D3N). Results show that both the UHI and UCI effects are exacerbated during extreme heat events. Using the concept of the UHI degree hours (UHIdh) and UCI degree hours (UCIdh), their spatial patterns in Hong Kong during extreme heat and non-extreme heat situations were mapped based on multiple linear regression models. It is found that the predictor variable – windward/leeward index is a significant influential factor of both UHIdh and UCIdh during extreme heat events. The resulting UHIdh and UCIdh maps not only enhance our understanding on the spatial pattern and characteristics of the UHI and UCI during extreme heat events, but could also serve as a useful reference in climate change adaptation, heat-health risk detection, cooling-energy estimation and policy making.
Increasing resilience to natural hazards and climate change is critical for achieving many Sustainable Development Goals (SDGs). In recent decades, China has experienced rapid economic development and became the second-largest economy in the world. This rapid economic expansion has led to large-scale changes in terrestrial (e.g., land use and land cover changes), aquatic (e.g., construction of reservoirs and artificial wetlands) and marine (e.g., land reclamation) environments across the country. Together with climate change, these changes may significantly influence flood risk and, in turn, compromise SDG achievements. The Luanhe River Basin (LRB) is one of the most afforested basins in North China and has undergone significant urbanisation and land use change since the 1950s. However, basin-wide flood risk assessment under different development scenarios has not been considered, although this is critically important to inform policy-making to manage the synergies and trade-offs between the SDGs and support long-term sustainable development. Using mainly open data, this paper introduces a new framework for systematically assessing flood risk under different social and economic development scenarios. A series of model simulations are performed to investigate the flood risk under different land use change scenarios projected to 2030 to reflect different development strategies. The results are systematically analysed and compared with the baseline simulation based on the current land use and climate conditions. Further investigations are also provided to consider the impact of climate change and the construction of dams and reservoirs. The results potentially provide important guidance to inform future development strategies to maximise the synergies and minimise the trade-offs between various SDGs in LRB.
Many studies have linked temperature with respiratory deaths, but epidemiological evidence of temperature-attributable years of life lost (YLL) from respiratory diseases is limited. Daily respiratory YLL rates were calculated using mortality data from 364 locations of China during 2006-2017, and meteorological data were collected for the same period. First, the distributed lag non-linear model (DLNM) was applied to estimate specific temperature-respiratory YLL rate associations in each location. Then multivariable meta-analysis was conducted to pool the location-specific estimates. Finally, we calculated the average life loss per death (LLD) to quantify the respiratory mortality burden of non-optimal temperature. Subgroup analyses were conducted by gender, age, region and cause of death. Inversely J-shaped association was observed between non-optimal temperature and respiratory YLL rate in China. The minimum YLL-rate temperature was 26.9 degrees C nationwide. An average of 1.37 years (95% CI: 1.06-1.65) LLD was attributable to non-optimal temperatures with 2.06 years (95% CI: 1.57-2.60) for pneumonia, 2.03 years (95% CI: 1.76-2.31) for chronic lower respiratory infections (LRTI), 0.88 years (95% CI: 0.65-1.09) for chronic obstructive pulmonary disease (COPD), most of which was attributed to moderate cold (0.73 years, 95% CI: 0.65-0.80). LLD caused by non-optimal temperature was higher in males, the young, and north China. Exposure to non-optimal temperature increases respiratory YLL rate in China, most of which were attributed to moderate cold. People with respiratory diseases including pneumonia, chronic LRTI and COPD are vulnerable to non-optimal temperature exposure. The result of this study provides useful information to reduce temperature-related respiratory disease burden.
PM(2.5) pollution has adverse health effects on humans. Urbanization and long-term meteorological variations play important roles in influencing the PM(2.5) concentration and its associated health effects. Our results indicate that the urbanization process can enhance the PM(2.5) concentration globally. The PM(2.5)-caused mortality density (deaths/100 km(2)) is also positively correlated with the urbanization degree in both developed and developing countries. The results from machine learning technique revealed that the meteorology-driven variation in PM(2.5)-caused health burden has increased with the increase in the urbanization degree from 1980 to 2018, suggesting that residents living in urban areas are more vulnerable to experiencing unfavorable meteorological conditions (e.g. low wind speed and planetary boundary layer height). The maximum difference in PM(2.5)-caused mortality due to the variation in annual meteorological conditions (between 2013 and 1986) was 270 600 (196 800-317 900). Our findings indicate an urgent need to understand the driving force behind the appearance of unfavorable meteorological situations and propose suitable climate mitigation measures.
With the increasing threat of climate change and the accompanying rise in the frequency and severity of extreme heat events, there are growing health concerns for heat-vulnerable elderly adults. Elderly adults are at increased risk of developing heat-related injuries, in part due to age-related declines in thermoregulatory and cellular function. Regarding the latter, the process of autophagy is activated as a cellular protective mechanism to counter heat-induced stress, but the extent that heat stress activates autophagy in elderly adults is not known. Further, the interplay between autophagy, the heat shock response (HSR), the acute inflammatory response, and apoptosis remains poorly understood in elderly adults. Therefore, the purpose of this study was to examine changes in autophagy, the HSR, inflammation, and apoptosis following increasing levels of ex vivo heat stress representative of physiologically relevant increases in body core temperatures (37-41 °C). Whole blood from 20 elderly adults (72 ± 4 years; 14 men, 6 women) was heated (via water immersion) to temperatures representative of normal resting conditions (normothermia; 37 °C), in addition to moderate and severe heat stress conditions (39, and 41 °C, respectively) for 90 min. Peripheral blood mononuclear cells (PBMC) were isolated and protein markers of autophagy, the HSR, acute inflammation, and apoptosis were examined. No significant increases in markers of autophagy or the HSR were observed following any temperature condition. However, an increase in acute inflammation was observed above baseline following moderate heat stress (39 °C), with further increases in inflammation and apoptosis observed during severe heat stress (41 °C). Our findings indicate that PBMCs from elderly adults do not exhibit increases in autophagy or the HSR following severe heat stress, potentially contributing to the elevated risk of cellular dysfunction seen in elderly adults during heat stress.
Most studies focused on the temporal trend of mortality risk associated with temperature exposure. The relative role of heat, cold, and temperature variation (TV) on morbidity and its temporal trends are explored insufficiently. This study aims to investigate the temporal trends of emergency ambulance dispatch (EAD) risk and the attributable burden of heat, cold, and hourly temperature variation (HTV). We collected time-series data of daily EAD and ambient temperature in Shenzhen from 2010 to 2017. HTV was calculated as the standard deviation of the hourly temperatures between 2 consecutive days. Quasi-Poisson generalized additive models (GAM) with a time-varying distributed lag nonlinear model (DLNM) were applied to examine temporal trends of the HTV-, heat-, and cold-EAD association. The temporal variation of the attributable fraction (AF%) and attributable number (AN) for different temperature exposures was also calculated. The largest RR was observed in extreme cold [1.30 (95% CI: 1.18, 1.43)] and moderate cold [1.25 (95% CI: 1.17, 1.34)]. Significant increasing trends in HTV-related effects and burden were observed, especially for the extreme HTV effects (P for interaction < 0.05). Decreasing trends were observed in the heat-related effect and burden, though it showed no significance (P for interaction = 0.46). There was no clear change pattern of cold-related effects and burdens. Overall, the three temperature exposure caused 13.7% of EAD, of which 4.1%, 4.3%, and 5.3% were attributed to HTV, heat, and cold, respectively. All the temperature indexes in this study, especially the cold effect, are responsible for the increased risk of EAD. People have become more susceptible to HTV over the recent decade. However, there is no clear evidence to support the temporal change of the population's susceptibility to heat and cold. Thus, in addition to heat and cold, the emergency ambulance service department should pay more attention to HTV under climate change.
Heat exposure of a population is often estimated by applying temperatures from outdoor monitoring stations. However, this can lead to exposure misclassification if residents do not live close to the monitoring station and temperature varies over small spatial scales due to land use/built environment variability, or if residents generally spend more time indoors than outdoors. Here, we compare summertime temperatures measured inside 145 homes in low-income households in Baltimore city with temperatures from the National Weather Service weather station in Baltimore. There is a large variation in indoor temperatures, with daily-mean indoor temperatures varying from 10 °C lower to 10 °C higher than outdoor temperatures. Furthermore, there is only a weak association between the indoor and outdoor temperatures across all houses, indicating that the outdoor temperature is not a good predictor of the indoor temperature for the residences sampled. It is shown that much of the variation is due to differences in the availability of air conditioning (AC). Houses with central AC are generally cooler than outdoors (median difference of -?3.4 °C) while those with no AC are generally warmer (median difference of 1.4 °C). For the collection of houses with central or room AC, there is essentially no relationship between indoor and outdoor temperatures, but for the subset of houses with no AC, there is a weak relationship (correlation coefficient of 0.36). The results presented here suggest future epidemiological studies of indoor exposure to heat would benefit from information on the availability of AC within the population.
Very little research has documented the exposure of populations in Africa to extreme heat. We measured indoor air temperature and humidity hourly for 13 months in seven houses of contrasted architecture and construction materials all in the northern neighbourhoods of Ouagadougou, Burkina Faso. These measurements are compared to air temperatures recorded at the synoptic weather station of Ouagadougou airport and to land surface temperature estimates from Landsat satellite images at seven dates with clear-sky conditions. The results reveal huge temperature differences (exceeding 10 degrees C) between houses, especially in the afternoon hours of the warmest season. Indoor temperature is also much more variable than land surface (outdoor) temperature in the same locations, as estimated by satellite imagery. Houses with greater thermal inertia smooth the afternoon temperature peak, reducing heat exposure. Heat stress bioindicators reveal that danger thresholds, while rarely reached in some houses, are frequently exceeded in others year round except for the core of the cold winter season (December and January). In spring, the hottest season, the danger threshold is almost permanently exceeded in these dwellings, exposing their inhabitants to significant heat stress. This pilot study shows the primary role of housing in modulating indoor temperature, raising questions of public health and habitability of Sahelian regions in a warming world. This issue will be of increasing importance with ongoing climate change, hence the need for further, more detailed instrumented campaigns in African settlements.
While general features of mountain climate are well recognised, there is not many research regarded their bioclimatic differentiation. The aim of the present study is to answer the question how different geographical factors: elevation above sea level, physiographical type of area, climate continentality and location of area in relation to the main mountain ridge influence thermal stress in northern Carpathians. To analyse thermal stress in the region, daily meteorological data from 21 stations of national weather networks of Poland, Ukraine and Slovakia for the period 1986-2015 were used. Daily data of air temperature, relative humidity, total cloud cover and wind speed at 10 m above ground for 12 UTC were used because they represent midday hours which are mostly used for any human activity. The Universal Thermal Climate Index (UTCI) was applied as a measure of thermal stress. The results show that (1) cold stress significantly increases and heat stress decreases due to rise of altitude, (2) due to climate continentality and physiographical differences between western and eastern parts of northern Carpathians in their eastern edge, the cold stress is more evident than in western one, (3) at southward slopes of Carpathian, heat stress is significantly more frequent then at northward areas.
The present study aimed to determine the effect of hyperthermia on both electrochemical and mechanical components of the electromechanical delay (EMD), using very-high-frame-rate ultrasound. Electrically evoked peak twitch force, EMD, electrochemical (D(m); i.e., delay between stimulation and muscle fascicle motion), and mechanical (T(m); i.e., delay between fascicle motion and force production onset) components of EMD were assessed in 16 participants. Assessments were conducted in a control ambient environment (CON; 26°C, 34% relative humidity) and in a hot ambient environment (HOT; 46-50°C, 18% relative humidity, after ?127?min of heat exposure). Following heat exposure, gastrocnemius medialis temperature was 37.0?±?0.6°C in HOT vs. 34.0?±?0.8°C in CON (P < 0.001). EMD was shorter (9.4?±?0.8?ms) in HOT than in CON (10.8?±?0.6?ms, P < 0.001). Electrochemical processes were shorter in HOT than in CON (4.0?±?0.8?ms vs. 5.5?±?0.9?ms, respectively, P < 0.001), whereas mechanical processes were unchanged (P = 0.622). These results demonstrate that hyperthermia reduces electromechanical delay via accelerated electrochemical processes, whereas force transmission along the active and passive parts of the series elastic component is not affected following heat exposure. The present study demonstrates that heat exposure accelerates muscle contraction thanks to faster electrochemical processes. Further investigations during voluntary contractions would contribute to better understand how these findings translate into motor performance.NEW & NOTEWORTHY Hyperthermia (targeted core temperature: 38.5°C) reduces the time between gastrocnemius medialis stimulation and the onset of plantar flexor force production in vivo. This reduction in electromechanical delay is concomitant to an earlier motion of muscle fascicle compared with thermoneutral environment. However, hyperthermia has no impact on the duration of force transmission along aponeurosis and tendon, thereby reflecting different effects of heat exposure on contractile and elastic properties of the muscle-tendon unit.
Achieving environmental sustainability by improving the urban microclimate is a key principle in mitigating the urban heat island (UHI) effect. This study aimed to (a) investigate the outdoor thermal comfort by establishing Heat Index (HI) values to identify thermal hot spots and (b) model green infrastructure possibilities to alleviate UHI in Colombo urban metropolitan in Sri Lanka using ENVImet climate model. Daytime temperature and humidity values of 14 urban locations were collected to determine HI to recognize thermal urban hotspots in Colombo area. A pretested comprehensive random-stratified questionnaire survey has been conducted to appraise the thermal discernment of the general public. ENVImet microclimate model was accompanied to test the temperature reduction levels in different bioclimatic green infrastructure scenarios [Two belts (R-1), three belts (R-2), four belts (R-3), five belts (R-4)] in the selected study site. Five sites (Borella, Colombo Fort, Maradana, Wellawaththa, Liberty junction) were identified as thermal hotspots in Colombo metropolitan. HI values were fluctuated within 33.82-40.35 degrees C range and the highest average day time HI value was observed at Maradana (40.35 degrees C) and the lowest HI was observed at Thummulla (33.82 degrees C). Survey results revealed that 89.3% people are affected with thermal uncomfortability and 5% were affected with heat-related skin diseases. Inserting trees into curbsides (R-4) reduced temperature remarkably by 2.07 degrees C in the urban metropolitan. Therefore, the proposed green infrastructure scenario has proved to be the most suitable way to improve the thermal comfort conditions of urban environment, as it can reduce the UHI effects.
In the context of global climate change, research efforts were focused on the association of ambient temperatures on maternal and neonatal health condition, but few have examined associations with low Apgar scores. From January 1, 2017, to December 31, 2018, all singleton deliveries of Ningxia Hui Autonomous Region were extracted from the Hospital Information System (N = 182,322). Daily temperature data were obtained from the official website of China Meteorological Administration. Low Apgar scores were defined as Apgar score ? 3 at 5 min in the present study. Logistic regression models were used to estimate the adjusted association between prenatal temperature exposure and low Apgar scores. Restricted cubic spline models were used to explore the dose-response relationship between temperature and low Apgar scores. The study population included 182,322 live singleton births, with 1575 (0.86%) cases of low Apgar scores. The elevated ambient temperature in different exposure timing windows in late pregnancy was associated with increased risk of low Apgar scores. As compared to moderate (10th-90th) temperature exposure, prenatal exposure to extreme hot (>90th) was associated with 13.9-47.0% increased risk of low Apgar scores, while non-significant relationship was found between extreme cold (<10th) exposure and low Apgar scores. The restricted cubic spline models showed a U-shaped relationship between prenatal temperature exposure and low Apgar scores (P for non-linearity < 0.05). Exposure to high ambient temperature during late pregnancy is associated with an increased risk of low Apgar scores in northwest China.
Cardiovascular disease (CVD) has been a major threat to global public health. The association between temperature and CVD has been widely studied and reported in cities in developed countries. However, information from developing countries, especially from suburbs and countryside, is quite limited. In this study, the daily time series data on CVD hospital admissions in farmers in the suburbs of Tianshui, China, and the meteorological data from 2012 to 2015, were collected; besides, a quasi-Poisson regression with a distributed-lag non-linear model (DLNM) was used to explore the impact of local daily mean temperature on CVD hospital admissions in suburban farmers. This study found that, first, from 2011 to 2015, a total of 30,611 person-times of CVD hospital admissions in farmers were recorded; second, there was a “J-shaped” relation between temperature and CVD hospital admissions, and both low and high temperature increased the risk of hospital admission, but the impact of high temperature was greater; third, compared with the minimum hospitalization temperature (MHT) at 0.3 °C, during 0 to 21 lag days, the cumulative relative risk (RR) for extreme cold and heat (1st and 99th percentile of temperature, respectively) was 1.117 (95% CI 0.941-1.325) and 1.740 (95% CI 1.302-2.327), respectively, and that of moderate cold and heat (5st and 95th percentile of temperature, respectively) was 1.029 (95% CI 0.958-1.106) and 1.572 (95% CI 1.210-2.042), respectively; fourth, compared with male and ? 65 years groups, the risk for low temperature was greater for female and < 65 years groups, the risk for high temperature was just the opposite; last, about 21.04% of CVD hospital admissions burden were attributed to the ambient temperature, and most of (about 19.26%) were caused by moderate heat. In Tianshui, alongside with extreme temperature, the moderate temperature might be an important risk factor for CVD hospital admissions in suburban farmers.
In order to assess the influence of atmospheric conditions and particulate matter (PM) on the seasonally varying incidence of influenza-like illnesses (ILI) in the capital of Poland-Warsaw, we analysed time series of ILI reported for the about 1.75 million residents in total and for different age groups in 288 approximately weekly periods, covering 6 years 2013-2018. Using Poisson regression, we predicted ILI by the Universal Thermal Climate Index (UTCI) as biometeorological indicator, and by PM2.5 and PM10, respectively, as air quality measures accounting for lagged effects spanning up to 3 weeks. Excess ILI incidence after adjusting for seasonal and annual trends was calculated by fitting generalized additive models. ILI morbidity increased with rising PM concentrations, for both PM2.5 and PM10, and with cooler atmospheric conditions as indicated by decreasing UTCI. While the PM effect focused on the actual reporting period, the atmospheric influence exhibited a more evenly distributed lagged effect pattern over the considered 3-week period. Though ILI incidence adjusted for population size significantly declined with age, age did not significantly modify the effect sizes of both PM and UTCI. These findings contribute to better understanding environmental conditionings of influenza seasonality in a temperate climate. This will be beneficial to forecasting future dynamics of ILI and to planning clinical and public health resources under climate change scenarios.
Attributing the changes in the population exposure to global compound hot extremes, which combine daytime-nighttime hot extremes with more severe impacts, is essential for climate change adaptation. Based on daily temperature data from the Coupled Model Intercomparison Project phase 6 (CMIP6) and population data, we estimate the changes in population exposure for two future periods under three scenarios of emission and socio-economic development at global and continental scales, and assess the contributions from climate and population changes. We find that the spatial patterns of exposure to compound hot extremes are similar for different periods and scenarios, and regions with high exposure are mainly located over East Asia, South Asia, Europe, and parts of eastern USA and Africa. The exposure shows an increase from baseline (1980-2014) to mid- and late 21st century periods (2021-2055 and 2056-2090) in most regions worldwide. Under the business-as-usual scenario (SSP2-4.5), the global exposure increases by ~19-fold during the late 21st century, and Africa shows the largest increase while Europe shows the smallest. Early (SSP1-2.6) and no (SSP5-8.5) actions of mitigation would relieve and aggravate the increase rate, respectively. For about 78%-87% of the global land areas, the changes in exposure are mainly caused by climate change (accounting for >69%), followed by the interaction effect (accounting for ~29%) that refers to synergistic changes in climate and population. In parts of mid- to high-latitude regions, the exposure is smaller than expected due to opposite effects of climate change and population change.
OBJECTIVE: The aim of this study is to find the most suitable heat wave definition among 15 different ones and to evaluate its impact on total, age-, and gender-specific mortality for Bandafassi, Senegal. METHODS: Daily weather station data were obtained from Kedougou situated at 17 km from Bandafassi from 1973 to 2012. Poisson generalized additive model (GAM) and distributed lag non-linear model (DLNM) are used to investigate the effect of heat wave on mortality and to evaluate the nonlinear association of heat wave definitions at different lag days, respectively. RESULTS: Heat wave definitions, based on three or more consecutive days with both daily minimum and maximum temperatures greater than the 90th percentile, provided the best model fit. A statistically significant increase in the relative risk (RRs 1.4 (95% Confidence Interval (CI): 1.2-1.6), 1.7 (95% CI: 1.5-1.9), 1.21 (95% CI: 1.08-1.3), 1.2 (95% CI: 1.04-1.5), 1.5 (95% CI: 1.3-1.8), 1.4 (95% CI: 1.2-1.5), 1.5 (95% CI: 1.07-1.6), and 1.5 (95% CI: 1.3-1.8)) of total mortality was observed for eight definitions. By using the definition based on the 90th percentile of minimum and maximum temperature with a 3-day duration, we also found that females and people aged ? 55 years old were at higher risks than males and other different age groups to heat wave related mortality. CONCLUSION: The impact of heat waves was associated with total-, age-, gender-mortality. These results are expected to be useful for decision makers who conceive of public health policies in Senegal and elsewhere. Climate parameters, including temperatures and humidity, could be used to forecast heat wave risks as an early warning system in the area where we conduct this research. More broadly, our findings should be highly beneficial to climate services, researchers, clinicians, end-users and decision-makers.
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects 20% of children worldwide. Environmental factors including weather and air pollutants have been shown to be associated with AD symptoms. However, the time-dependent nature of such a relationship has not been adequately investigated. This paper aims to assess whether real-time data on weather and air pollutants can make short-term prediction of AD severity scores. METHODS: Using longitudinal data from a published panel study of 177 paediatric patients followed up daily for 17 months, we developed a statistical machine learning model to predict daily AD severity scores for individual study participants. Exposures consisted of daily meteorological variables and concentrations of air pollutants, and outcomes were daily recordings of scores for six AD signs. We developed a mixed-effect autoregressive ordinal logistic regression model, validated it in a forward-chaining setting and evaluated the effects of the environmental factors on the predictive performance. RESULTS: Our model successfully made daily prediction of the AD severity scores, and the predictive performance was not improved by the addition of measured environmental factors. Potential short-term influence of environmental exposures on daily AD severity scores was outweighed by the underlying persistence of preceding scores. CONCLUSIONS: Our data does not offer enough evidence to support a claim that weather or air pollutants can make short-term prediction of AD signs. Inferences about the magnitude of the effect of environmental factors on AD severity scores require consideration of their time-dependent dynamic nature.
Understanding the regional impact of future climate change is one of the major global challenges of this century. This study investigated possible effects of climate change on malaria in West Africa in the near future (2006-2035) and the far future (2036-2065) under two representative concentration pathway (RCP) scenarios (RCP4.5 and RCP8.5), compared to an observed evaluation period (1981-2010). Projected rainfall and temperature were obtained from the coordinated regional downscaling experiment (CORDEX) simulations of the Rossby Centre Regional Atmospheric regional climate model (RCA4). The malaria model used is the Liverpool malaria model (LMM), a dynamical malaria model driven by daily time series of rainfall and temperature obtained from the CORDEX data. Our results highlight the unimodal shape of the malaria prevalence distribution, and the seasonal malaria transmission contrast is closely linked to the latitudinal variation of the rainfall. Projections showed that the mean annual malaria prevalence would decrease in both climatological periods under both RCPs but with a larger magnitude of decreasing under the RCP8.5. We found that the mean malaria prevalence for the reference period is greater than the projected prevalence for 6 of the 8 downscaled GCMs. The study enhances understanding of how malaria is impacted under RCP4.5 and RCP8.5 emission scenarios. These results indicate that the southern area of West Africa is at most risk of epidemics, and the malaria control programs need extra effort and help to make the best use of available resources by stakeholders.
The impact of heat waves and cold spells on mortality has become a major public health problem worldwide, especially among older adults living in low-to middle-income countries. This study aimed to investigate the effects of heat waves and cold spells under different definitions on cause-specific mortality among people aged ?65 years in São Paulo from 2006 to 2015. A quasi-Poisson generalized linear model with a distributed lag model was used to investigate the association between cause-specific mortality and extreme air temperature events. To evaluate the effects of the intensity under different durations, we considered twelve heat wave and nine cold spell definitions. Our results showed an increase in cause-specific deaths related to heat waves and cold spells under several definitions. The highest risk of death related to heat waves was identified mostly at higher temperature thresholds with longer events. We verified that men were more vulnerable to die from cerebrovascular diseases and ischemic stroke on cold spells and heat waves days than women, while women presented a higher risk of dying from ischemic heart diseases during cold spells and tended to have a higher risk of chronic obstructive pulmonary disease than men during heat waves. Identification of heat wave- and cold spell-related mortality is important for the development and promotion of public health measures.
Background: The health impacts of heatwaves are a growing public health concern with the frequency, intensity, and duration of heatwaves increasing with global climate change. However, little is known about the healthcare costs and the attributable morbidity associated with heatwaves Objective This study aims to examine the relationship between heatwaves and costs of emergency department (ED) presentations, and to quantify heat-attributable burden during the warm seasons of 2014-2017, in Adelaide, South Australia. Methods: Daily data on ED presentations and associated costs for the period 2014-2017 were obtained from the South Australian Department of Health and Wellbeing. Heatwave intensity was determined using the excess heat factor (EHF) index, obtained from the Australian Bureau of Meteorology. A distributed lag non-linear model (DLNM) was used to quantify the cumulative risk of heatwave-intensity over a lag of 0-7 days on ED presentations and costs. Effects of heatwaves were estimated relative to no heatwave. The number of ED presentations and costs attributable to heatwaves was calculated separately for two EHF severity categories (low-intensity and severe/extreme heatwaves). Subgroup analyses by disease-diagnosis groups and age categories were performed. Results: For most disease diagnosis and age categories, low-intensity and severe heatwaves were associated with higher rates of ED presentations and costs. We estimated a total of 1161 (95% empirical confidence interval (eCI): 342, 1944) heatwave-attributable all-cause ED presentations and associated healthcare costs (thousands) of AU $1020.3 (95% eCI: 224.9, 1804.7) during the warm seasons of 2014-2017. The heat-related illness was the disease category contributing most to ED presentations and costs. Age groups 0-14 and >= 65 years were most susceptible to heat. Conclusions: Heatwaves produced a statistically significant case-load and cost burden to the ED. Developing tailored interventions for the most vulnerable populations may help reduce the health impacts of heatwaves and to minimise the cost burden to the healthcare system. (C) 2021 Elsevier B.V. All rights reserved.
Tropospheric ozone is known to have adverse effects on human health. Ozone pollution events are often associated with specific atmospheric circulation conditions. Therefore, studying the relationship between atmospheric circulation and ozone is particularly important for early warning and forecasting of ozone pollution events. Focusing on the Yangtze River Delta region, particularly in four important large industrial cities (Xuzhou, Nanjing, Shanghai, and Hangzhou) in the Yangtze River Delta, the T-mode objective classification method was applied to classify the weather circulation that mainly affects the Yangtze River Delta region into nine types. Local wind fields for the four industrial cities were classified according to their propensity for ventilation, stagnation, and recirculation based on the Allwine and Whiteman method. Based on the analysis of large-scale atmospheric circulation, we concluded that certain circulation patterns correspond to excessive ozone concentrations, while other circulation patterns correspond to good air quality. Moreover, ozone pollution was not closely related to local regional transmission. The importance of high temperatures in potentiating ozone pollution was also identified in the study area, whereas the effect of relative humidity was negligible. Finally, the importance of the different scale atmospheric motions was analyzed by studying two specific ozone pollution events in Xuzhou area (March, 2019) and Nanjing area (July-August, 2017). This analysis was complemented by HYSPLIT model’s outputs to simulate the pollutant diffusion path. Regarding the first episode, ozone concentration is often closely related to the slowly approaching thermal high-pressure system. In the second episode, local transmission had little effect on the generation and spread of ozone pollution. Furthermore, and comparing the circulation conditions with local meteorological factors, it was found that the increase in ozone concentration was often accompanied by higher temperature, and the response to humidity was not clear.
Lyme disease is the most common vector-borne disease in temperate zones and a growing public health threat in the United States (US). The life cycles of the tick vectors and spirochete pathogen are highly sensitive to climate, but determining the impact of climate change on Lyme disease burden has been challenging due to the complex ecology of the disease and the presence of multiple, interacting drivers of transmission. Here we incorporated 18 years of annual, county-level Lyme disease case data in a panel data statistical model to investigate prior effects of climate variation on disease incidence while controlling for other putative drivers. We then used these climate-disease relationships to project Lyme disease cases using CMIP5 global climate models and two potential climate scenarios (RCP4.5 and RCP8.5). We find that interannual variation in Lyme disease incidence is associated with climate variation in all US regions encompassing the range of the primary vector species. In all regions, the climate predictors explained less of the variation in Lyme disease incidence than unobserved county-level heterogeneity, but the strongest climate-disease association detected was between warming annual temperatures and increasing incidence in the Northeast. Lyme disease projections indicate that cases in the Northeast will increase significantly by 2050 (23,619 ± 21,607 additional cases), but only under RCP8.5, and with large uncertainty around this projected increase. Significant case changes are not projected for any other region under either climate scenario. The results demonstrate a regionally variable and nuanced relationship between climate change and Lyme disease, indicating possible nonlinear responses of vector ticks and transmission dynamics to projected climate change. Moreover, our results highlight the need for improved preparedness and public health interventions in endemic regions to minimize the impact of further climate change-induced increases in Lyme disease burden.
Climate change and variability influence temperature and rainfall, which impact vector abundance and the dynamics of vector-borne disease transmission. Climate change is projected to increase the frequency and intensity of extreme climate events. Mosquito-borne diseases, such as dengue fever, are primarily transmitted by Aedes aegypti mosquitoes. Freshwater availability and temperature affect dengue vector populations via a variety of biological processes and thus influence the ability of mosquitoes to effectively transmit disease. However, the effect of droughts, floods, heat waves, and cold waves is not well understood. Using vector, climate, and dengue disease data collected between 2013 and 2019 in Kenya, this retrospective cohort study aims to elucidate the impact of extreme rainfall and temperature on mosquito abundance and the risk of arboviral infections. To define extreme periods of rainfall and land surface temperature (LST), we calculated monthly anomalies as deviations from long-term means (1983-2019 for rainfall, 2000-2019 for LST) across four study locations in Kenya. We classified extreme climate events as the upper and lower 10% of these calculated LST or rainfall deviations. Monthly Ae. aegypti abundance was recorded in Kenya using four trapping methods. Blood samples were also collected from children with febrile illness presenting to four field sites and tested for dengue virus using an IgG enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). We found that mosquito eggs and adults were significantly more abundant one month following an abnormally wet month. The relationship between mosquito abundance and dengue risk follows a non-linear association. Our findings suggest that early warnings and targeted interventions during periods of abnormal rainfall and temperature, especially flooding, can potentially contribute to reductions in risk of viral transmission.
Changes in ambient temperature have been reported as an important risk factor for respiratory diseases among pre-school children. However, there have been few studies so far on the effects of temperature on children respiratory health in developing countries including Vietnam. This study examined the impact of short-term changes in ambient temperature on hospital admissions for acute lower respiratory infection (ALRI) among children aged less than 5 years old in Ho Chi Minh City (HCMC), Vietnam. Data on daily hospital admissions from 2013 to 2017 were collected from two large paediatric hospitals of the city. Daily meteorological data of the same period were also collected. Time series analysis was performed to evaluate the association between risk of hospitalisations and temperatures categorised by seasons, age, and causes. We found that a 1 °C increase in maximum temperature was associated with 4.2 and 3.4% increase in hospital admission for ALRI among children 3-5 years old during the dry season and the rainy season, respectively. Surprisingly, in the rainy season, a rise of 1°C diurnal temperature range (DTR) was significantly associated with a decrease from 2.0 to 2.5% risk of hospitalisation for ALRI among children <3 years old. These findings suggested that although high temperature is a risk factor for hospital admissions among children in general, other modifiable factors such as age, exposure time, air conditioning usage, wearing protective clothing, socioeconomic status, and behaviour may influence the overall effect of high temperature on hospital admissions of children <5 years old in HCMC. The findings of this study have provided evidence for building public health policies aimed at preventing and minimizing the adverse health effects of temperature on children in HCMC.
BACKGROUND: Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019. METHODS: Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs. RESULTS: Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion). CONCLUSION: The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.
This study aimed to estimate morbidity risk/number attributed to air extreme temperatures using time-stratified case crossover study and distributed lag non-linear model in a region of Iran during 2015-2019. A time-stratified case crossover design based on aggregated exposure data was used in this study. In order to have no overlap bias in the estimations, a fixed and disjointed window by using 1-month strata was used in the design. A conditional Poisson regression model allowing for over dispersion (Quasi-Poisson) was applied into Distributed Lag Non-linear Model (DLNM). Different approaches were applied to estimate Optimum Temperature (OT). In the model, the interaction effect between temperature and humidity was assessed to see if the impact of heat or cold on Hospital Admissions (HAs) are different between different levels of humidity. The cumulative effect of heat during 21 days was not significant and it was the cold that had significant cumulative adverse effect on all groups. While the number of HAs attributed to any ranges of heat, including medium, high, extreme, and even all values were negligible, but a large number was attributable to cold values; about 10000 HAs were attributable to all values of cold temperature, of which about 9000 were attributed to medium range and about 1000 and less than 500 were attributed to high and extreme values of cold, respectively. This study highlights the need for interventions in cold seasons by policymakers. The results inform researchers as well as policy makers to address both men and women and elderly when any plan or preventive program is developed in the area under study.
The lack of empirical evidence on the effect of heat exposure on the health and safety, productivity, psychological behaviour and social well-being outcomes of small- and large-scale mining workers in Africa has derailed concrete policy directions and interventions. An explanatory cross-sectional survey involving 320 small- and large-scale mining workers was used to assess this research gap. A path analysis was used to model health and safety, productivity, psychological behaviour and social well-being as a function of heat exposure, mediated and moderated by adaptation strategies and barriers, while controlling for age, gender, level of education, years of working experience and workplace environment. Significant direct adverse effects of heat exposure on mining workers’ health and safety, productivity and psychological behaviour outcomes were found. Using a pick-a-point approach, significant difference was found in simple slopes (SS) for heat exposure on adaptation strategies at medium level of barriers and a trend toward significance at the high level of barriers. Except for health and safety outcomes, there were significant conditional indirect effects of heat exposure on the performance outcomes at the medium and high levels of barriers to adaptation strategies. However, there was no evidence of mediated-moderation for heat exposure and health and safety, productivity, psychological behaviour and social well-being outcomes. We have provided empirical evidence to establish heat exposure effect on key performance outcomes of mining workers to initiate and guide the formulation of heat exposure management policies.
The aim of this interdisciplinary study is to assess the heat risk for Bratislava. The following layers were created to compute the risk index: the hazard layer of air temperature, a mitigation layer of tree vegetation, an exposure layer of population and a vulnerability layer of individuals over 65 years of age. The MUKLIMO_3 model was used to evaluate the field of mean surface air temperature at 9 PM during selected days of the summer heat wave in August 2018. The tree vegetation layer, in the form of percentage per grid cell, was derived from Sentinel-2 satellite data. Population density data are based on mobile positioning data, and elderly population data are based on a gridded database from the statistical census. Input layers were unified into a resolution of 500 × 500 m, and the heat risk index was calculated by summation of the weighted input layers. The results reflect the variability of the population and the elderly population within the city, as well as the variability of the temperature field, which is caused by the joint effect of an urban heat island and topography. The highest values of risk index occur within the broader city centre, with specific hot spots at several places.
The occurrence of long-lasting severe heat stress, such as in July-August 2003, July 2010, or in April-May 2018 has been one of the biggest meteorological threats in Europe in recent years. The paper focuses on the biometeorological and mortality effects of the hot June that was observed in Central Europe in 2019. The basis of the study was hourly and daily Universal Thermal Climate Index (UTCI) values at meteorological stations in Poland for June 2019. The average monthly air temperature and UTCI values from 1951 to 2018 were analysed as background. Grosswetterlagen calendar of atmospheric circulation was used to assess synoptic conditions of heat wave. Several heat strain measures were applied : net heat storage (S), modelled heart rate (HR), sultriness (HSI), and UTCI index. Actual total mortality (TM) and modelled strong heat-related mortality (SHRM) were taken as indicators of biometeorological consequences of the hot June in 2019. The results indicate that prolonged persistence of unusually warm weather in June 2019 was determined by the synoptic conditions occurring over the European region and causing advection of tropical air. They led to the emergence of heat waves causing 10% increase in TM and 5 times bigger SHRM then in preceding 10 years. Such increase in SHRM was an effect of overheating and overload of circulatory system of human organism.
Soaring temperatures cause deaths in large numbers in various parts of India. The number of deaths vary with region and are influenced by the demographics and socioeconomic characteristics of the region. This study tried to estimate the number of deaths associated with exposure to heat in the different states of India. Secondary data was used, which was collected from the website data.gov.in, an Open Government Data (OGD) Platform of the Indian government. Descriptive statistics were applied using Microsoft Excel-10. It was found that there 3014 men died from heat-related causes in 2001-05, which increased to 5157 in the period 2011-15. For women the number of deaths in the corresponding periods were 849 and 1254 respectively. Deaths caused by heatwaves were found to be higher than those resulting from avalanches, exposure to cold, cyclone, tornado, starvation due to natural calamity, earthquake, epidemic, flood, landslide, torrential rain and forest fire. The study revealed that there are regional variations in the number deaths due to heatstroke. From the perspective of disaster preparedness, it is important to note that deaths from heat strokes occur every year. With rising temperatures, the numbers are likely to increase. The findings of the study highlight this concern. Therefore, there is a need for targeted region-specific interventions for reducing the number of deaths due to heatwaves.
The present study aimed to investigate the differential response of oxidative (soleus) and glycolytic (gastrocnemius) muscles to heat-induced endoplasmic reticulum (ER) stress. It was hypothesized that due to compositional and functional differences, both muscles respond differently to acute heat stress. To address this, male Sprague Dawley rats (12/group) were subjected to thermoneutral (25 °C) or heat stress (42 °C) conditions for 1 h. Soleus and gastrocnemius muscles were removed for analysis post-exposure. A significant increase in body temperature and free radical generation was observed in both the muscles following heat exposure. This further caused a significant increase in protein carbonyl content, AOPP, and lipid peroxidation in heat-stressed muscles. These changes were more pronounced in heat-stressed soleus compared to the gastrocnemius muscle. Accumulation of unfolded, denatured proteins results in ER stress, causing activation of unfolded protein response (UPR) pathway. The expressions of UPR transducers were significantly higher in soleus as compared to the gastrocnemius muscle. A significant elevation in resting intracellular calcium ion was also observed in heat-stressed soleus muscle. Overloading of cells with misfolded proteins in soleus muscle activated ER-induced apoptosis as indicated by significant upregulation of C/EBP homologous protein and Caspase12. The study provides a detailed mechanistic representation of the differential response of muscles toward UPR under heat stress. Data suggests that soleus majorly being an oxidative muscle is more prone to heat stress-induced insult indicated by enhanced apoptosis. This study may aid in devising mitigation strategies to improve muscle performance under heat stress.
Heat-related illnesses (HRIs), mainly heat exhaustion (HE) and heat stroke (HS), are characterized by an elevation of core body temperature. In this study, we aimed to explore the HRIs’ types and patient characteristics among a sample taken from various representative in-field points in the Hajj season. A cross-sectional study was conducted in 2018 at 80 data collection points distributed in the field. Data related to demographics, features and risk factors were collected and analyzed from all encountered cases with suspected HRIs. Moreover, we developed a diagnostic tree for HRIs by using the XGBoost model. Out of the 1200 persons encountered during the study period, 231 fulfilled the criteria of HRIs spectrum and were included in this study. Around 6% had HS and 20% had HE. All HS cases (100%) were from outside of Saudi Arabia as compared with 72.5% diagnosed with HE (27.5% were from Saudi Arabia). In addition, 16% were considered as heat-induced muscle spasms, and 7% had limb heat edema. Additionally, most of HRIs cases were reported between 11 am and 1 pm. The HRIs diagnostic tree model gave a diagnostic accuracy of 93.6%. This study highlights the magnitude of HRIs among pilgrims in Hajj and provides a diagnostic tree that can aid in the risk stratification and diagnosis of these patients. We advise the implementation of more educational campaigns to pilgrims regarding preventable measures especially for the vulnerable groups (e.g. from outside Saudi Arabia, those with comorbidities and light-skinned people).
As the world’s population is expected to be over 2/3rd urban by 2050, climate action in cities is a growing area of interest in the inter-disciplines of development policy, disaster mitigation and environmental governance. The climate impacts are expected to be quite severe in the developing world, given its urban societies are densely packed, vastly exposed to natural elements while possessing limited capabilities. There is a notable ambiguity and complexity that inhibits a methodical approach in identifying urban resilience measures. The complexity is due to intersection of large number of distinct variables in climate geoscience (precipitation and temperature anomalies at different locations, RCPs, timeline), adaptation alternatives (approach, priority, intervention level) and urban governance (functional mandate, institutional capacity, and plans & policies). This research examines how disparate and complex knowledge and information in these inter-disciplines can be processed for systematic ‘negotiation’ to situate, ground and operationalize resilience in cities. With India as a case, we test this by simulating mid-term and long-run climate scenarios (2050 & 2080) to map regional climate impacts that shows escalation in the intensity of climate events like heat waves, urban flooding, landslides and sea level rise. We draw on suitable adaptation measures for five key urban sectors- water, infrastructure (including energy), building, urban planning, health and conclude a sleuth of climate resilience building measures for policy application through national/ state policies, local urban plans and preparation of city resilience strategy, as well as advance the research on ‘negotiated resilience’ in urban areas.
The excessively warm weather, especially in cities, can lead to several adverse impacts, including heat-related mortality, becoming an increasingly important public health issue. Previous studies on heat-related mortality have assessed risk factors at the municipal scale, missing the intra-urban variability in heat risk and vulnerability. The knowledge of the spatial intra-variability can help to design spatially targeted measures to better protect citizens’ health. Through hot spot analysis, we identified the neighbourhood-scale spatial pattern of heat-related cardiorespiratory mortality in the elderly, during the yearly warmest five months of a three years period. Potential associations between spatial variability in heat-related mortality and several independent factors in each neighbourhood were investigated and their predictions. Two approaches were adopted: one is eminently statistical, using Generalized Linear Models (GLM) and another using Geographically Weighted Regression (GWR). This new recent regression technique is increasing in international attention on spatial modelling. The spatial model explains about 60% of the spatial variations in elderly’s heat-related cardiorespiratory mortality. The two-analyses produced an overlapping set of predictor variables, with emphasis on the elderly, vegetation cover and employment. The results also show that the areas where heat-related mortality is high, are also the areas where the number of deaths is higher than expected. These neighbourhoods should be considered as the most vulnerable to heat-related mortality. We concluded that studying human health outcomes at neighbourhood-scale is relevant for public health heat-related plans. Essential suggestions are provided to decision-making support and city planners designing strategies to reduce heat-related mortality.
Human health vulnerability (HHV) to different climate change-related phenomena, that is, summer heat extremes, is related to the exposure, sensitivity, and adaptive capacity of the affected entities. The current research is an empirical regional assessment of the human health effects of summer heat extremes in the Romania-Bulgarian Danube floodplain Calafat-Vidin-Turnu Magurele-Nikopol (CV-TMN) sector. The external biophysical and socioeconomic factors that shape the vulnerability are supported by the climate approach. The research relies on processing meteorological data from the most representative climate stations in the study area based on which some indicators-significant for measuring the impact on human health-were computed (e.g., number of extremely hot days, number of tropical days, number of tropical nights) and integrated into a composite summer heat extremes index (SHEI). To assess HHV to summer heat extremes, the vulnerability framework was completed by the internal socioeconomic factors revealed by the characteristics of the population living in urban and rural settlements in terms of demographic, health provisions, and quality of indoor living spaces. Finally, the authors computed the index of human health vulnerability to summer heat extremes (HHVI) as the Hull Score at the level of territorial local administrative units.
In this study, 30 subjects were exposed to different combinations of air temperature (T(a) : 24, 27, and 30°C) and CO(2) level (8000, 10 000, and 12 000 ppm) in a high-humidity (RH: 85%) underground climate chamber. Subjective assessments, physiological responses, and cognitive performance were investigated. The results showed that as compared with exposure to T(a) = 24°C, exposure to 30°C at all CO(2) levels caused subjects to feel uncomfortably warm and experience stronger odor intensity, while increased mental effort and greater intensity of acute health symptoms were reported. However, no significant effects of T(a) on task performance or physiological responses were found. This indicated that subjects had to exert more effort to maintain their performance in an uncomfortably warm environment. Increasing CO(2) from 8000 to 12 000 ppm at all T(a) caused subjects to report higher rates of headache, fatigue, agitation, and feeling depressed, although the results were statistically significant only at 24 and 27°C. The text typing performance and systolic blood pressure (SBP) decreased significantly at this exposure, whereas diastolic blood pressure (DBP) and thermal discomfort increased significantly. These effects suggest higher arousal/stress. No significant interaction effect of T(a) and CO(2) concentration on human responses was identified.
Elevated temperatures negatively affect human reproduction through several processes that regulate nutrient uptake and resource allocation in pregnant women. These can interfere with foetal development, resulting in low birth weight neonates with altered development trajectories. Temperatures that affect the current generation could, therefore, also have an impact on the following generation. We asked whether heat stress affected offspring fertility by asking if current and past ambient temperatures influenced total fertility rates (TFR) in human populations distributed across the world. We analysed time series data in 65 countries using simple regression analyses based on maximum temperatures and temperature amplitudes over 55 years. Supplemental longer time series (up to 100 years) provided information on response patterns in Northern Europe and Greenland’s colder climates. There were clear and strong effects of temperatures on the TFR in the concurrent and the previous generation. Our temperature-based models account for 71-95% of the variation in TRF in European countries and Greenland, and 56-99% of the variation in 65 countries worldwide. Our findings are consistent with studies of seasonal variation in fertility and suggest that increased temperatures will negatively influence populations subjected to monthly maximum temperatures above 15-20 °C, while fertility in colder climates benefits from elevated temperatures. Our results provide strong evidence that ambient temperatures have important effects on human fertility, and that these effects persist into the following generation.
OBJECTIVES: This study compared the prevalence of concentrated urine (urine specific gravity ?1.021), an indicator of hypohydration, across Tsimane’ hunter-forager-horticulturalists living in hot-humid lowland Bolivia and Daasanach agropastoralists living in hot-arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. METHODS: This study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane’ households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). RESULTS: The prevalence of hypohydration among Tsimane’ men (50.0%) and women (54.0%) was substantially higher (P?
BACKGROUND: People working in agriculture, fishing, and forestry have elevated risks of suicide. The suicide rates for the occupations of “agriculture, fishing, and forestry” are significantly higher than any other occupation. AIMS OF STUDY: This study evaluates whether the variability in socioeconomic and demographic factors and in climate as well as the support from mental health providers and social associations affected the suicide rates of farmers in the US. METHODS: We estimate Poisson count data regression and county level-fixed effects regressions using data from the National Center for Health Statistics complemented with relevant socio-economic, climate data and data on mental health providers from a variety of sources. RESULTS: The results show more suicides in counties with more farms and with higher share of population without health insurance, lower agricultural wages and, in non-rural counties higher poverty rate. Surprisingly, we find more suicides in counties with more social associations, while the availability of mental health providers is associated with fewer suicides in non-rural counties, and lower suicide rate in southern counties. DISCUSSION: These results highlight the need for innovative targeted policy interventions instead of relying on one-size-fits-all approach. Farmers and farm workers are yet to be reached with modern and effective tools to improve mental health and prevent suicide. At the same time, factors such as the weather and climate as well as some more traditional factors such as social associations or religious participation play a limited role. IMPLICATIONS FOR HEALTH POLICIES: Support mechanisms have a differential effect in rural and urban areas. It is important to identify the specific demographic, climate, and policy changes that serve as external stressors and affect farm workers’ suicide and accidental death from on-farm injury. IMPLICATION FOR FURTHER RESEARCH: Ideally, individual level data on farmers would be best in a study that evaluates what factors cause suicides.
Difficulties in controlling the effects of outdoor thermal environment on the human body are attracting considerable research attention. This study investigated the outdoor thermal comfort of urban pedestrians by assessing their perceptions of the tropical, micrometeorological, and physical conditions via a questionnaire survey. Evaluation of the outdoor thermal comfort involved pedestrians performing various physical activities (sitting, walking, and standing) in outdoor and semi-outdoor spaces where the data collection of air temperature, globe temperature, relative humidity, wind speed, solar radiation, metabolic activity, and clothing insulation data was done simultaneously. A total of 1011 participants were interviewed, and the micrometeorological data were recorded under outdoor and semi-outdoor conditions at two Malaysian university campuses. The neutral temperatures obtained which were 28.1 °C and 30.8 °C were within the biothermal acceptable ranges of 24-34 °C and 26-33 °C of the PET thermal sensation ranges for the outdoor and semi-outdoor conditions, respectively. Additionally, the participants’ thermal sensation and preference votes were highly correlated with the PET and strongly related to air and mean radiant temperatures. The findings demonstrated the influence of individuals’ thermal adaptation on the outdoor thermal comfort levels. This knowledge could be useful in the planning and designing of outdoor environments in hot and humid regions to create better thermal environments.
This study investigates the impact of future changes in climatic variables on dengue incidence in the region of the Tucurui dam in the Amazon. Tucurui dam is the one of the largest hydroelectric power stations in the Amazon. Correlations and regression analysis through least squares fitting between dengue cases and temperature, precipitation, and humidity are obtained. Positive correlations between dengue incidence and temperature are found for lags from 4 to 5 months (higher correlation for lag 5), dengue and precipitation for lags 0 up to 1, and dengue and humidity for lag 0. The positive correlations between dengue and precipitation and between dengue and humidity are higher for the simultaneous correlation. To investigate the impact of the future changes in these climatic variables in the region, projections of RegCM4 model simulations under the RCP 8.5 scenario are obtained. The model projections indicate a warming and moisture increase in the region near the dam at the end of the twenty-first century. Regression analysis using the model projections indicates that the dengue incidence may increase substantially in future climate scenarios in this region (more than fivefold compared with the present climate). This increase is between two and three times higher than the global estimates of dengue incidence in the future. It is suggested that the incidence of dengue cases is more sensitive to changes in temperature. Vector parameters increase with temperature in the future, indicating that the temperature conditions are highly favorable for the spread of the disease in the region. The results indicate that cities in the area surrounding the Tucurui hydroelectric dam are areas of potential dengue incidence in the future. These findings may be applied to hydroelectric dams in other areas of the world. However, future studies involving additional dams are necessary. The results suggest an increase in climate-driven risk of transmission from Aedes aegypti throughout the entire Amazon, and especially the eastern and southern parts.
Longevity research is a hot topic in the health field. Considerable research focuses on longevity phenomenon in Bama Yao Autonomous County, which has a typical karst landform and is located in Southwest China. This study aims to illustrate the spatial feature of longevity indicators in other Yao areas, to analyze the correlation between climatic factors and longevity indicators, and to provide new clues and targets for further longevity studies. We collect and integrate population, climate, and terrain data into a spatial database. The main analysis methods include spatial autocorrelation, high/low clustering, and multiscale geographically weighted regression (MGWR). Two longevity clusters are identified in Guijiang River Basin (longevity index (LI%): 2.49?±?0.63) and Liujiang River Basin (LI%: 2.13?±?0.60). The spatial distribution of longevity indicators is autocorrelative (Moran’s I?=?0.652, p?
Global warming is likely to cause a progressive drought increase in some regions, but how population and natural resources will be affected is still underexplored. This study focuses on global population and land-use (forests, croplands, pastures) exposure to meteorological drought hazard in the 21st century, expressed as frequency and severity of drought events. As input, we use a large ensemble of climate simulations from the Coordinated Regional Climate Downscaling Experiment, population projections from the NASA-SEDAC dataset, and land-use projections from the Land-Use Harmonization 2 project for 1981-2100. The exposure to drought hazard is presented for five SSPs (SSP1-SSP5) at four Global Warming Levels (GWLs, from 1.5 to 4 degrees C). Results show that considering only Standardized Precipitation Index (SPI; based on precipitation), the combination SSP3-GWL4 projects the largest fraction of the global population (14%) to experience an increase in drought frequency and severity (vs. 1981-2010), with this value increasing to 60% if temperature is considered (indirectly included in the Standardized Precipitation-Evapotranspiration Index, SPEI). With SPEI, considering the highest GWL for each SSP, 8 (for SSP2, SSP4, and SSP5) and 11 (SSP3) billion people, that is, more than 90%, will be affected by at least one unprecedented drought. For SSP5 (fossil-fuelled development) at GWL 4 degrees C, approximately 2 center dot 10(6) km(2) of forests and croplands (respectively, 6 and 11%) and 1.5 center dot 10(6) km(2) of pastures (19%) will be exposed to increased drought frequency and severity according to SPI, but for SPEI, this extent will rise to 17 center dot 10(6) km(2) of forests (49%), 6 center dot 10(6) km(2) of pastures (78%), and 12 center dot 10(6) km(2) of croplands (67%), with mid-latitudes being the most affected areas. The projected likely increase of drought frequency and severity significantly increases population and land-use exposure to drought, even at low GWLs, thus extensive mitigation and adaptation efforts are needed to avoid the most severe impacts of climate change.
The world’s most important mosquito vector of viruses, Aedes aegypti, is found around the world in tropical, subtropical and even some temperate locations. While climate change may limit populations of Ae. aegypti in some regions, increasing temperatures will likely expand its territory thus increasing risk of human exposure to arboviruses in places like Europe, Northern Australia and North America, among many others. Most studies of Ae. aegypti biology and virus transmission focus on locations with high endemicity or severe outbreaks of human amplified urban arboviruses, such as dengue, Zika, and chikungunya viruses, but rarely on areas at the margins of endemicity. The objective in this study is to explore previously published global patterns in the environmental suitability for Ae. aegypti and dengue virus to reveal deviations in the probability of the vector and human disease occurring. We developed a map showing one end of the gradient being higher suitability of Ae. aegypti with low suitability of dengue and the other end of the spectrum being equal and higher environmental suitability for both Ae. aegypti and dengue. The regions of the world with Ae. aegypti environmental suitability and no endemic dengue transmission exhibits a phenomenon we term ‘aegyptism without arbovirus’. We then tested what environmental and socioeconomic variables influence this deviation map revealing a significant association with human population density, suggesting that locations with lower human population density were more likely to have a higher probability of aegyptism without arbovirus. Characterizing regions of the world with established populations of Ae. aegypti but little to no autochthonous transmission of human-amplified arboviruses is an important step in understanding and achieving aegyptism without arbovirus.
Climate change driven increases in the frequency of extreme heat events (EHE) and extreme precipitation events (EPE) are contributing to both infectious and non-infectious disease burden, particularly in urban city centers. While the share of urban populations continues to grow, a comprehensive assessment of populations impacted by these threats is lacking. Using data from weather stations, climate models, and urban population growth during 1980-2017, here, we show that the concurrent rise in the frequency of EHE, EPE, and urban populations has resulted in over 500% increases in individuals exposed to EHE and EPE in the 150 most populated cities of the world. Since most of the population increases over the next several decades are projected to take place in city centers within low- and middle-income countries, skillful early warnings and community specific response strategies are urgently needed to minimize public health impacts and associated costs to the global economy.
INTRODUCTION/AIMS: Exertional rhabdomyolysis (ER) often occurs during prolonged intense exercise in hot environments, posing a threat to the health of military personnel. In this study we aimed to investigate possible risk factors for ER and provide further empirical data for prevention and clinical treatment strategies. METHODS: A retrospective investigation of 116 concurrent ER cases was conducted. Conditional logistic regression analyses were performed to assess the association between each potential risk (or protective) factor and ER. The clinical characteristics of the 71 hospitalized patients were analyzed descriptively. RESULTS: After screening, the following variables significantly increased the risk of ER: shorter length of service (recruits; odds ratios [OR], 7.49; 95% confidence interval [CI], 2.58-21.75); higher body mass index (BMI; OR, 1.14, 95% CI, 1.03-1.26); lack of physical exercise in the last half year (less than once per month; OR, 3.20; 95% CI, 1.08-9.44); and previous heat injury (OR, 2.94; 95% CI, 1.26-6.89). Frequent fruit consumption (OR, 0.57; 95% CI, 0.33-0.99), active hydration habit (OR, 0.37; 95% CI, 0.20-0.67), water replenishment of more than 2 L on the training day (OR, 0.15; 95% CI, 0.05-0.45), and water replenishment of at least 500?mL within 1 hour before training (OR, 0.33; 95% CI, 0.12-0.88) significantly decreased the risk of ER. Of the 71 hospitalized patients, 41 (57.7%) were diagnosed with hypokalemia on admission. DISCUSSION: In military training, emphasis should be placed on incremental adaptation training before more intense training, and close attention should be given to overweight and previously sedentary recruits. Fluid replenishment before exercise, increased fruit intake, and proper potassium supplementation may help prevent ER.
Proposed ways of improving adaptation to climate change have most often been supported by narrowly framed and separate analysis. This article investigates how different levels of vulnerability and resilience interplay with adaptation to extreme temperatures, what is the nature of these relationships and whether lower vulnerability and higher resilience contribute to increased adaptation. This article explores the governance implications of a project that, unlike other, brings together vulnerability, resilience and adaptation assessments. The project has made significant advances in addressing the current deficit integrated assessments for shaping governance propositions. Such propositions argue that the diverse levels of vulnerability and resilience convey important bases for (1) targeting at-risk older individuals; (2) developing vulnerability reduction actions; (3) resilience building actions; and (4) understanding ‘success cases’ and learn from them for developing appropriate policy measures. Taken together, these propositions offer a social, psychological and health framework not simply for governing extreme temperatures but for governing responses to climate change at large.
INTRODUCTION: Patients with primary Sjögren’s syndrome (pSS) reportedly believe that their symptoms worsen on extreme weather days due to variations in environmental conditions. However, few studies have assessed the acute effects of environmental exposure on the onset of pSS. This study aimed to evaluate the exposure-response relationship between extreme environmental conditions and pSS outpatient visits. METHOD: We obtained data on pSS outpatient visits from two provincial general hospitals in Hefei, China, during 2014-2019. A distributed lag non-linear model was used to estimate the exposure-lag-response relationship between environmental variables and pSS. RESULTS: We detected significant and non-linear associations between extreme environments and pSS. The estimated relative risk (RR) for a lag of 3 days was 1.11 (95% CI: 1.03 to 1.19) for extreme cold and for a lag of 21 days was 1.07 (95% CI: 1.01 to 1.12) for extreme dampness. Long sunshine duration was positively correlated with pSS (lag 11, 1.05, 95% CI: 1.01 to 1.08). Moreover, female patients were more susceptible to these effects. Patients older than 65 years old were more vulnerable to frigid environments (lag 3, RR?=?1.30, 95% CI: 1.09 to 1.54), while younger patients were more vulnerable to extreme dampness (lag 21, RR?=?1.10, 95% CI: 1.03 to 1.16). Extreme cold and high humidity were negatively correlated with the same-day outpatient visits. CONCLUSIONS: Our findings suggest a potential relationship between exposure to extreme environmental conditions and increased risk of pSS outpatient visits. We therefore suggest that policymakers and doctors aim to further our understanding of environmental effects on pSS and adopt adequate measures to alleviate pSS symptoms. Key Points • Extreme cold, extreme dampness, and long sunshine duration increased the risk of pSS outpatient visits, especially for females. • Young pSS patients are more susceptible to a rise in humidity. • Elderly pSS patients are more sensitive to extreme cold weather.
The effects of meteorological factors on health outcomes have gained popularity due to climate change, resulting in a general rise in temperature and abnormal climatic extremes. Instead of the conventional cross-sectional analysis that focuses on the association between a predictor and the single dependent variable, the distributed lag non-linear model (DLNM) has been widely adopted to examine the effect of multiple lag environmental factors health outcome. We propose several novel strategies to model mortality with the effects of distributed lag temperature measures and the delayed effect of mortality. Several attempts are derived by various statistical concepts, such as summation, autoregressive, principal component analysis, baseline adjustment, and modeling the offset in the DLNM. Five strategies are evaluated by simulation studies based on permutation techniques. The longitudinal climate and daily mortality data in Taipei, Taiwan, from 2012 to 2016 were implemented to generate the null distribution. According to simulation results, only one strategy, named MV(DLNM), could yield valid type I errors, while the other four strategies demonstrated much more inflated type I errors. With a real-life application, the MV(DLNM) that incorporates both the current and lag mortalities revealed a more significant association than the conventional model that only fits the current mortality. The results suggest that, in public health or environmental research, not only the exposure may post a delayed effect but also the outcome of interest could provide the lag association signals. The joint modeling of the lag exposure and the delayed outcome enhances the power to discover such a complex association structure. The new approach MV(DLNM) models lag outcomes within 10 days and lag exposures up to 1 month and provide valid results.
OBJECTIVES: The impact of extreme diurnal temperature range (DTR) on cardiovascular morbidity in Mediterranean regions remains uncertain. We aimed to analyse the impact of extreme low DTR (stable temperature) or high DTR (changeable temperature) on cardiovascular hospitalisations in Catalonia (Southern Europe). METHODS: We conducted a self-controlled case series study using whole-year data from the System for the Development of Research in Primary Care database and 153 weather stations from the Catalan Meteorological Service. The outcome was first emergency hospitalisation. Monthly DTR percentiles were used to define extreme DTR as low (DTR 95th percentile). We assessed two effects: same-day (1-day exposure, coinciding with the extreme DTR episode) and cumulative (3-day exposure, adding two subsequent days). Incidence rate ratios (IRR) were calculated adjusted by age, season and air pollution. Stratified analyses by gender, age or cardiovascular type and regions are provided. RESULTS: We computed 121 206 cardiovascular hospitalisations from 2006 to 2013. The IRR was 1.032 (95% CI 1.005 to 1.061) for same day and 1.024 (95% CI 1.006 to 1.042) for cumulative effects of extreme high DTR. The impact was significant for stroke and heart failure, but not for coronary heart disease. Conversely, extreme low DTR did not increase cardiovascular hospitalisations. CONCLUSIONS: Extreme high DTR increased the incidence of cardiovascular hospitalisations, but not extreme low DTR. Same-day effects of extreme high DTR were stronger than cumulative effects. These findings contribute to better understand the impact of outdoor temperature on health, and to help defining public health strategies to mitigate such impact.
OBJECTIVE: The risk of adverse health events is expected to increase with hotter temperatures, particularly among the most vulnerable groups such as elderly persons and children. The objective of this study was to assess the association between extreme heat and daily emergency department visits among children (0 to 17 years) in Southwestern Ontario. METHODS: We examined the average maximum temperature, relative humidity, and daily paediatric emergency department visits in June through August of 2002 to 2019. We reviewed emergency department visits from two academic hospitals. Daily meteorological data from the local weather station were obtained from Environment and Climate Change Canada. RESULTS: Extreme heat, defined as the 99th percentile of the maximum temperature distribution, occurred at 33.1°C and was associated with an overall 22% increase in emergency department visits, compared to the reference temperature of 21°C. This association was mostly found between the second and fifth day after the exposure, suggesting a slightly delayed effect. The results of the sub-group analysis indicate that the risk of an emergency department visit due to infectious disease increases by 35% and the most pronounced association was noted in children aged 1 to 12 years. CONCLUSIONS: Extreme heat is associated with an increased incidence of emergency department visits in children. As temperatures continue to increase, strategies to mitigate heat-related health risks among children should be developed.
Extreme heat has been responsible for more deaths in the United States than any other weather-related phenomenon over the past decade. The frequency and intensity of extreme heat events are projected to increase over the course of this century. In this work, we examine historical patterns of extreme heat exposure and mortality in the continental United States. We examine spatial variation in the mortality response to exposure, consider the contribution of key demographic and socio-economic factors in driving heat-related mortality, and test three different extreme heat thresholds using a national-level spatial autoregressive model and a geographically weighted regression approach. We find that the mortality response to exposure is higher in areas that do not routinely experience heat extremes, and that exposure itself is a stronger driver of heat-related mortality across the larger urban areas of the Midwest and Northeast. The importance of demographic/socio-economic factors varies substantially over space, and results are robust across alternative measures of heat extremes, suggesting that no single definition is necessarily superior. The baseline relationships established here are potentially useful for future predictions of exposure and heat-related mortality under alternative population and climate change scenarios, and may aid policy makers and planners in implementing effective adaptation and mitigation strategies.
BACKGROUND: Many people die from cardiovascular diseases each year, and extreme temperatures are regarded as a risk factor for cardiovascular deaths. However, the relationship between temperature and cardiovascular deaths varies in different regions because of population density, demographic inequality, and economic situation, and the evidence in Ganzhou, China is limited and inconclusive. OBJECTIVE: This study aimed to assess extreme temperature-related cardiovascular mortality and identify the potential vulnerable people. METHODS: After controlling other meteorological measures, air pollution, seasonality, relative humidity, day of the week, and public holidays, we examined temperature-related cardiovascular mortality along 21 lag days by Poisson in Ganzhou, China. RESULTS: A J-shaped relationship was observed between mean temperature and cardiovascular mortality. Extremely low temperatures substantially increased the relative risks (RR) of cardiovascular mortality. The effect of cold temperature was delayed by 2-6 days and persisted for 4-10 days. However, the risk of cardiovascular mortality related to extremely high temperatures was not significant (p > 0.05). Subgroup analysis indicated that extremely low temperatures had a stronger association with cardiovascular mortality in people with cerebrovascular diseases (RR: 1.282, 95% confidence interval [CI]: 1.020-1.611), males (RR: 1.492, 95% CI: 1.175-1.896), married people (RR: 1.590, 95% CI: 1.224-2.064), and people above the age of 65 years (RR: 1.641, 95% CI: 1.106-2.434) than in people with ischemic heart disease, females, unmarried people, and the elderly (?65 years old), respectively. CONCLUSIONS: The type of cardiovascular disease, sex, age, and marital status modified the effects of extremely low temperatures on the risk of cardiovascular mortality. These findings may help local governments to establish warning systems and precautionary measures to reduce temperature-related cardiovascular mortality.
Modern technology empowers human beings to cope with various extreme weather events. Using Chinese historical data, we examine the impact of extreme weather on long-term human mortality in an environment where individuals had no access to modern technology. By combining life-course data on 5000 Chinese elites with historical weather data over the period 1-1840 AD, we find a significant and robust negative impact of droughts in childhood on the longevity of elites. Quantitatively, encountering three years of droughts in childhood reduces an elite’s life span by about two years.
BACKGROUND: Acute coronary syndrome is a disease with high prevalence and high mortality. Exposure to heat or cold increases the risks of myocardial infarction significantly. Gender-specific effects of this have not yet been examined. Our goal was to determine whether extreme weather conditions, which become more and more frequent, are gender-specific risk factors for myocardial infarction, in order to help provide faster diagnosis and revascularization therapy for patients. METHODS: We analysed the incidence of ST-elevation myocardial infarction (STEMI) in a large urban area over a 65-months period in a cohort study. A day was the unit of analysis. Incidence rate ratios (IRR) with Poisson regression models were calculated. All patients with STEMI on Saturdays and Sundays were included. Gender, high or low perceived temperatures (PT), a function of temperature, wind speed and humidity, and meteorological cold and heat warnings by the Austrian Central Institute for Meteorology and Geodynamics (ZAMG) were considered as risk factors. RESULTS: During the 562 days of the study period, a total of 1109 patients with STEMI (803; 72% men, mean age 61;14 years) were included. The gender difference between men and women was much more pronounced on cold (0 °C) days (85% of patients male; 1.8 per day) than on hot (20 °C) days (71% male; 1.4 per day) or days without extreme temperatures (72% male; 1.4 per day). We found significant interaction between gender and cold days (IRR of the interaction term 2.3 (95% CI 1.2-4.6), p = 0.02). No gender-specific effect was observed on warm days (IRR for interaction 0.9 (95% CI 0.6-1.3), p = 0.3). CONCLUSION: Low perceived temperature pronouncedly increases the already elevated risk for STEMI in males. Whether this effect is based on gender alone, or on one of the cardiovascular risk factors which are more common in men, is up to further study.
Dengue transmission is climate-sensitive and permissive conditions regularly cause large outbreaks in Asia-Pacific area. As climate change progresses, extreme weather events such as heatwaves and unusually high rainfall are predicted more intense and frequent, but their impacts on dengue outbreaks remain unclear so far. This paper aimed to investigate the relationship between extreme weather events (i.e., heatwaves, extremely high rainfall and extremely high humidity) and dengue outbreaks in China. We obtained daily number of locally acquired dengue cases and weather factors for Guangzhou, China, for the period 2006-2015. The definition of dengue outbreaks was based on daily number of locally acquired cases above the threshold (i.e., mean + 2SD of daily distribution of dengue cases during peaking period). Heatwave was defined as ?2 days with temperature ? 95th percentile, and extreme rainfall and humidity defined as daily values ?95th percentile during 2006-2015. A generalized additive model was used to examine the associations between extreme weather events and dengue outbreaks. Results showed that all three extreme weather events were associated with increased risk of dengue outbreaks, with a risk increase of 115-251% around 6 weeks after heatwaves, 173-258% around 6-13 weeks after extremely high rainfall, and 572-587% around 6-13 weeks after extremely high humidity. Each extreme weather event also had good capacity in predicting dengue outbreaks, with the model’s sensitivity, specificity, accuracy, and area under the receiver operating characteristics curve all exceeding 86%. This study found that heatwaves, extremely high rainfall, and extremely high humidity could act as potential drivers of dengue outbreaks.
Severe fever with thrombocytopenia syndrome (SFTS) was firstly identified in mainland China in 2009 and the geographic distribution has expanded in recent years. In this study, we constructed ecological niche models (ENM) of SFTS with meteorological factors, environmental factor, and density of domestic animals using MaxEnt. We found four significant associated factors including altitude, yearly average temperature, yearly accumulated precipitation, and yearly average relative humidity which accounted for 94.1% percent contribution. SFTS occurrence probability was high when altitude was between -100 m and 100 m, and the probability was nearly 0 when altitude was beyond 3000 m. Response curves of SFTS to the yearly average temperature, yearly accumulated precipitation, and yearly average relative humidity were all reversed V-shape. SFTS occurrence probability was high where the yearly average temperature, yearly accumulated precipitation, and yearly relative humidity were 12.5-17.5 °C, 700-2250 mm and 63-82%, respectively. ENMs predicted that the potential high-risk areas were mainly distributed in eastern areas and central areas of China. But there were some predicted potential high-risk areas where no SFTS case was reported up to date. More researches should be done to make clear whether SFTS case had occurred in these areas.
Under the global climate warming, extreme weather events occur more and more frequently. Epidemiological studies have proved that extreme temperature is strongly correlated with respiratory diseases. We evaluated extreme-temperature effect on respiratory emergency room (ER) visits for 5 years in Lanzhou, a northwest temperate climate city of China from January 1st, 2013, to August 31st, 2017. We built a distributed lag non-linear model (DLNM) to evaluate the lag effect up to 30 days. Results showed the relative risk (RR) of respiratory disease always reached the maximum at lag 0 day and decreased to 1.0 at lag 5 days. Extremely low temperature showed the lag effect of 22 days and the maximum RR was 1.415 (95% CI 1.295-1.546) at lag 0 day. Extremely high temperature showed the lag effect of 7 days and the maximum RR was 1.091 (95% CI 1.069-1.114) at lag 0 day. The elders (age > 65 years) were at the greatest risk to extreme temperatures and the response were very acute. Children (age ? 15 years) were at the lowest risk but the lag effect lasted the longest lag days than other subgroups. Males showed longer-term lag effect and higher RR than females. Our study indicated that the extremely low temperature has a significantly greater effect on respiratory diseases than extremely high temperature.
Leptospirosis is a disease usually acquired by humans through water contaminated with the urine of rodents that comes into direct contact with the cutaneous lesions, eyes, or mucous membranes. The disease has an important environmental component associated with climatic conditions and natural disasters, such as floods. We analyzed the relationship between rainfall and temperature and the incidence of leptospirosis in the top 30 municipalities with the highest numbers of cases of the disease in the period of 2007 to 2016. It was an ecological study of the time series of cases of leptospirosis, rainfall, and temperature with lags of 0, 1, 2, 3, and 4 weeks. A multilevel negative binomial regression model was implemented to evaluate the relationship between leptospirosis and both meteorological factors. In the 30 evaluated municipalities during the study period, a total of 5136 cases of leptospirosis were reported. According to the implemented statistical model, there was a positive association between the incidence of leptospirosis and rainfall with a lag of 1 week and a negative association with temperature with a lag of 4 weeks. Our results show the importance of short-term lags in rainfall and temperature for the occurrence of new cases of leptospirosis in Colombia.
BACKGROUND: Excessive heat is a leading weather-related cause of fatalities in the USA. Vulnerable populations can face greater exposure to health risks during extreme heat events. The aim of this study is to examine the effects of excessive heat and community-level social vulnerability on morbidity in San Antonio, Texas, in 2018. METHODS: Heat Index (HI) data are from the National Oceanic and Atmospheric Administration. Social vulnerability is measured using the Centres for Disease Control and Prevention’s Social Vulnerability Index (SVI). Morbidity is measured as the number of emergency medical service (EMS) incidents. Sixty-one zip codes were analysed for the 153 constrained calendar days from 1 May to 30 September 2018. Negative binomial regression analysis with the time-stratified case-crossover design was conducted to predict the effects of HI and SVI on the rate of EMS incidents. RESULTS: HI is significantly and positively associated with the rate of EMS incidents. Social vulnerability has a statistically significant association with EMS incidents, with higher levels of community-level social vulnerability associated with higher rates of EMS incidents. The effect of the HI on the rate of EMS incidents is significantly and positively moderated by the SVI. CONCLUSIONS: Social vulnerability and excessive heat increase the rate of EMS incidents. As the number of excessive heat days increases and San Antonio continues to have extreme disparities by location, there will be an effect on health systems, including EMSs.
BACKGROUND: Climate change and increasing risks of extreme weather events affect human health and lead to changes in the emergency department (ED) admissions and the emergency medical services (EMS) operations. For a better allocation of resources in the healthcare system, it is essential to predict ED numbers based on environmental variables. This publication aims to quantify weather, air pollution and calendar-related effects on daily ED admissions. METHODS: Analyses were based on 575,725 admissions from the web-based IVENA system recording all patients in the greater Munich area with pre-hospital emergency care in ambulance operations during 2014-2018. Linear models were used to identify statistically significant associations between daily ED admissions and calendar, meteorological and pollution factors, allowing for lag effects of one to three days. Separate analyses were performed for seasons, with additional subset analyses by sex, age and surgical versus internal department. RESULTS: ED admissions were exceptionally high during the three-week Oktoberfest, particularly for males and on the weekends, as well as during the New Year holiday. Admissions significantly increased during the years of study, decreased in spring and summer holidays, and were lower on Sundays while higher on Mondays. In the warmer seasons, admissions were significantly associated with higher temperature, adjusting for the effects of sunshine and humidity in all age groups except for the elderly. Adverse weather conditions in non-summer seasons were either linked to increasing ED admissions (from storms, gust) or decreasing them from rain. Mostly, but not exclusively, in winter, increasing ED admissions were associated with colder minimum temperatures as well as with higher NO and PM(10) concentrations. CONCLUSIONS: In addition to standard calendar-related factors, incorporating seasonal weather, air pollutant and interactions with patient demographics into resource planning models can improve the daily allocation of resources and staff of EMS operations at hospital and city levels.
Climate change can cause property damage and deaths in cities. City-scale climate projections are essential for making informed decisions towards climate change mitigation and adaptation at city levels. This study aims at developing ensemble projections of temperature extremes at the city-level and quantifying the contributions of various factors to the resulting uncertainty of the ensemble projections. The city of Toronto will be used here as an example to demonstrate the effectiveness of the proposed research framework. In particular, the stepwise cluster analysis (SCA) model will be used to perform climate downscaling to three GCM datasets (GFDL, IPSL, and MPI) under three emission scenarios (RCP2.6, RCP4.5, and RCP8.5) in order to generate city-level climate projections for the city of Toronto. The SCA model is demonstrated to be capable of capturing the inter- and intra-annual variations of the daily maximum, mean, and minimum temperatures in the studied city. The results suggest that mean temperatures in Toronto are projected to increase at the rate of 0.15 and 0.5 degrees C/decade under RCP4.5 and RCP8.5, respectively, while no significant warming trend is detected for RCP2.6. In terms of temperature extremes, extreme warm events are projected to increase while extreme cold events decrease under all emission scenarios. The decrease in the heating demand is two to four times larger than the increase in the cooling demand, indicating a decrease in the city’s total energy use. The projected warming might be beneficial for the urban growers because of the significant increases in the growing season length and growing degree days; however, the residents of the city of Toronto are likely to experience simultaneous increases in the intensity, duration, and frequency of heatwave events in future summers. Because of the warming, coldwave events in winters are likely to become less frequent and be shorter in duration, but their intensity is expected to increase significantly. Through decomposition of the resulting uncertainty of the ensemble projections, emission scenario is found to be the dominant factor for the uncertainty associated with urban climate projection.
BACKGROUND: Tuberculosis (TB) is a serious public health problem in China. There is evidence to prove that meteorological factors and exposure to air pollutants have a certain impact on TB. But the evidence of this relationship is insufficient, and the conclusions are inconsistent. METHODS: Descriptive epidemiological methods were used to describe the distribution characteristics of TB in Shijiazhuang in the past five years. Through the generalized linear regression model (GLM) and the generalized additive model (GAM), the risk factors that affect the incidence of TB are screened. A combination of GLM and distribution lag nonlinear model (DLNM) was used to evaluate the lag effect of environmental factors on the TB. Results were tested for robustness by sensitivity analysis. RESULTS: The incidence of TB in Shijiazhuang showed a downward trend year by year, with seasonality and periodicity. Every 10 ?g/m(3) of PM(10) changes, the RR distribution is bimodal. The first peak of RR occurs on the second day of lag (RR = 1.00166, 95% CI: 1.00023, 1.00390); the second risk period starts from 13th day of lag and peaks on15th day (RR = 1.00209, 95% CI: 1.00076, 1.00341), both of which are statistically significant. The cumulative effect of increasing 10 ?g/m(3) showed a similar bimodal distribution. Time zones where the RR makes sense are days 4-6 and 13-20. RR peaked on the 18th day (RR = 1.02239, 95% CI: 1.00623, 1.03882). The RR has a linear relationship with the concentration. Under the same concentration, the RR peaks within 15-20 days. CONCLUSION: TB in Shijiazhuang City showed a downward trend year by year, with obvious seasonal fluctuations. The air pollutant PM(10) increases the risk of TB. The development of TB has a short-term lag and cumulative lag effects. We should focus on protecting susceptible people from TB in spring and autumn, and strengthen the monitoring and emission management of PM(10) in the atmosphere.
Many occupational settings located outdoors in direct sun, such as open cut mining, pose a health, safety, and productivity risk to workers because of their increased exposure to heat. This issue is exacerbated by climate change effects, the physical nature of the work, the requirement to work extended shifts and the need to wear protective clothing which restricts evaporative cooling. Though Ghana has a rapidly expanding mining sector with a large workforce, there appears to be no study that has assessed the magnitude and risk of heat exposure on mining workers and its potential impact on this workforce. Questionnaires and temperature data loggers were used to assess the risk and extent of heat exposure in the working and living environments of Ghanaian miners. The variation in heat exposure risk factors across workers’ gender, education level, workload, work hours, physical work exertion and proximity to heat sources is significant (p<0.05). Mining workers are vulnerable to the hazards of heat exposure which can endanger their health and safety, productive capacity, social well-being, adaptive capacity and resilience. An evaluation of indoor and outdoor Wet Bulb Globe Temperature (WBGT) in the working and living environment showed that mining workers can be exposed to relatively high thermal load, thus raising their heat stress risk. Adequate adaptation policies and heat exposure management for workers are imperative to reduce heat stress risk, and improve productive capacity and the social health of mining workers.
OBJECTIVES: Evolutionary theorists have debated the adaptive significance of developmental plasticity in organisms with long lifespans such as humans. This debate in part stems from uncertainty regarding the timing of sensitive periods. Does sensitivity to environmental signals fluctuate across development or does it steadily decline? We investigated developmental plasticity in brown adipose tissue (BAT) among indigenous Siberians in order to explore the timing of phenotypic sensitivity to cold stress. METHODS: BAT thermogenesis was quantified using infrared thermal imaging in 78 adults (25 men; 33 women). Cold exposure during gestation, infancy, early childhood, middle childhood, and adolescence was quantified using: (1) the average ambient temperature across each period; (2) the number of times daily temperature dropped below -40°F during each period. We also assessed past cold exposure with a retrospective survey of participation in outdoor activities. RESULTS: Adult BAT thermogenesis was significantly associated with the average temperature (p = 0.021), the number of times it was below -40°F (p = 0.026), and participation in winter outdoor activities (p = 0.037) during early childhood. CONCLUSIONS: Our results suggest that early childhood represents an important stage for developmental plasticity, and that culture may play a critical role in shaping the timing of environmental signals. The findings highlight a new pathway through which the local consequences of global climate change may influence human biology, and they suggest that ambient temperature may represent an understudied component of the developmental origins of health and disease.
This paper analyses how recent trends in heat waves impact heat warning systems. We performed a retrospective analysis of the challenges faced by the French heat prevention plan since 2004. We described trends based on the environmental and health data collected each summer by the French heat warning system and prevention plan. Major evolutions of the system were tracked based on the evaluations organized each autumn with the stakeholders of the prevention plan. Excess deaths numbering 8000 were observed during heat waves between 2004 and 2019, 71% of these between 2015 and 2019. We observed major changes in the characteristics, frequency and the geographical spread of heat waves since 2015. Feedbacks led to several updates of the warning system such as the extension of the surveillance period. They also revealed that risk perception remained limited among the population and the stakeholders. The sharp increase in the number of heat warnings issued per year since 2015 challenges the acceptability of the heat warnings. Recent heat waves without historical equivalent interfere with the development of evidence-based prevention strategies. The growing public health impacts heat waves emphasize the urgent need to act to adapt the population, at different levels of intervention, from individual comportments to structural modifications. A specific attention should be given to increase the resources allocated to the evaluation and the management of heat-related risks, especially considering the needs to catch with the rapid rhythm of the changing climate.
Marching band (MB) artists frequently spend many hours engaged in outdoor physical activity. Anecdotal evidence and small studies have indicated that MB artists do experience heat-related health problems. Yet, unlike athletes, military personnel, or workers, there is very little research on heat-related hazards among this unique population. Here, we seek to understand the incidence and circumstances under which exertional heat illnesses (EHIs) occur among MB artists over a 31-year period (1990-2020) across the USA. Using an on-line news dataset, we identified 34 separate events and at least 393 total EHIs. Heat syncope (~?55%) and heat exhaustion (~?44%) comprised the majority of EHIs, although a small number of exertional heat stroke cases were also reported. EHIs were reported in all types of MB activities with?~?32% during rehearsal,?~?29% during parades,?~?21% during competition, and?~?15% during a performance. Also, the vast majority of events occurred with high school (~?88%) marching bands. Finally, EHIs overwhelmingly occurred when the weather was unusually hot by local conditions. In light of these findings, we emphasize the need for MB specific heat polices that incorporate weather-based activity modification, acclimatization, education about EHIs, and access to on-site medical professionals.
Temperature change between neighboring days (TCN) is an important trigger for cardiovascular diseases, but the modulated effects by seasonal temperature trends have been barely taken into account. A quantified comparison between impacts of positive TCNs (temperature rise) and negative situations (temperature drop) is also needed. We evaluated the associations of TCNs with emergency room (ER) visits for coronary heart disease (CHD) and cerebral infarction (CI) in Beijing, China, from 2008 to 2012. A year was divided into two segments dominated by opposite temperature trends, quasi-Poisson regression with distributed lag nonlinear models estimating TCN-morbidity relations were employed, separately for each period. High morbidities of CHD and CI both occurred in transitional seasons accompanied by large TCNs. Under warming backgrounds, positive TCNs increased CHD risk in patients younger than 65 years, and old people showed limited sensitivity. In the cooling periods, negative TCNs induced CHD risk in females and the elderly; the highest RR showed on lag 6 d. In particular, a same diurnal temperature decrease (e.g., – 2°C) induced greater RR (RR = 1.113, 95% CIs: 1.033-1.198) on old people during warming periods than cooling counterparts (RR = 1.055, 95% CIs: 1.011-1.100). Moreover, positive TCNs elevated CI risk regardless of background temperatures, and males were particularly vulnerable. Seasonal temperature trends modify TCN-cardiovascular morbidity associations significantly, which may provide new insights into the health impact of unstable weathers.
BACKGROUND: An acute upper respiratory tract infection (URI) is the most common disease worldwide, irrespective of age or sex. This study aimed to evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) visits for URI in Seoul, Korea, between 2009 and 2013. METHODS: Daily ER visits for URI were selected from the National Emergency Department Information System, which is a nationwide daily reporting system for ER visits in Korea. URI cases were defined according to International Classification of Diseases, 10(th) Revision codes J00-J06. The search for DTR effects associated with URI was performed using a semi-parametric generalized additive model approach with log link. RESULTS: There were 529,527 ER visits for URI during the study period, with a daily mean of 290 visits (range, 74-1942 visits). The mean daily DTR was 8.05 °C (range, 1.1-17.6 °C). The cumulative day (lag 02) effect of DTR above 6.57 °C per 1 °C increment was associated with a 1.42% (95% confidence interval [CI] 0.04-2.82) increase in total URI. Children (? 5 years of age) were affected by DTR above 6.57 °C per 1 °C, with 1.45% (95% CI 0.32-2.60) at lag 02, adults (19-64 years) with 2.77% (95% CI 0.39-5.20) at lag 07. When the DTR (lag02) was 6.57 °C to 11.03 °C, the relative risk was significant at 6.01% (95% CI 2.45-9.69) for every 1 °C increase in youth subjects aged for 6 to 18 years. CONCLUSIONS: DTR was associated with a higher risk for ER visits for URI. In addition, the results suggested that the lag effects and relative risks of DTR on URI were quite different according to age.
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.
Relatively few studies investigated the effects of extreme temperatures (both heat and cold) on mental health (ICD-9: 290-319; ICD-10: F00-F99) and the potential effect modifications by individuals’ age, sex, and race. We aimed to explore the effect of extreme temperatures of both heat and cold on the emergency room (ER) visits for mental health disorders, and conducted a stratified analysis to identify possible susceptible population in Erie and Niagara counties, NY, USA. To assess the short-term impacts of daily maximum temperature on ER visits related to mental disorders (2009-2015), we applied a quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM). The model was adjusted for day of the week, precipitation, long-term time trend, and seasonality. We found that there were positive associations between short-term exposure to extreme ambient temperatures and increased ER visits for mental disorders, and the effects can vary by individual factors. We found heat effect (relative risk (RR) =?1.16; 95% confidence intervals (CI), 1.06-1.27) on exacerbated mental disorders became intense in the study region and subgroup of population (the elderly) being more susceptible to extreme heat than any other age group. For extreme cold, we found that there is a substantial delay effect of 14 days (RR =?1.25; 95% CI =?1.08-1.45), which is particularly burdensome to the age group of 50-64 years old and African-Americans. Our findings suggest that there is a positive association between short-term exposure to extreme ambient temperature (heat and cold) and increased ER visits for mental disorders, and the effects vary as a function of individual factors, such as age and race.
BACKGROUND: Previous studies have reported that fine particulate matter (PM(2.5)) affects the incidence of premature births. In addition, recent studies have suggested that heat waves have a negative impact on birth outcomes. However, the combined effect of PM(2.5) and heat waves on the incidence of premature birth is controversial. This study investigated the independent and combined effects of PM(2.5) and heat wave exposures during the 1st and 2nd trimesters on premature birth. METHODS: The National Statistical Office of Korea provided birth data from 2010 to 2016. Preterm birth was defined as birth between 22 and 36 weeks. To assess the exposure to PM(2.5) and heat waves, we used PM(2.5) data estimated by the Community Multiscale Air Quality Modeling System (CMAQ) and heat wave warning data provided by the Korea Meteorological Administration. A multivariate logistic regression was used to investigate the risk of preterm birth according to the exposure to PM(2.5) and heat waves during the 1st and 2nd trimesters, and it was adjusted for residential area, year of birth, season of birth, parity, education level of the mother, age of the mother, and sex of the baby. RESULTS: In the 2nd trimester, compared with the 0 h of heat wave exposure (?67 percentile), 62.50-314.00 h (79-88 percentile) and>315.00 h of heat wave exposure (>88 percentile) were both significantly associated with preterm birth (OR for 79-88 percentile, 1.037, 95% CI, 1.003-1.073; OR for > 88 percentile, 1.174, 95% CI, 1.134-1.215). However, PM(2.5) exposure was not significantly associated with preterm birth. On the other hand, in the analysis to evaluate the combined effect of PM(2.5) and heat wave exposures of the 2nd trimester, compared with 0 h of heat wave exposure (?67 percentile) and<11.64 ?g/m(3) (?25 percentile) of PM(2.5), 11.64-22.74 ?g/m(3) (?25 percentile), 22.74-27.58 ?g/m(3) (26-50 percentile), and 27.57-32.39 ?g/m(3) (51-75 percentile) of PM(2.5) exposure combined with>315.00 h of heat wave exposure (>88 percentile) were all significantly associated with preterm birth. In addition, the effect size was increased with an increase of PM(2.5) exposure (OR for ? 25 percentile, 1.148, 95% CI, 1.095-1.203; OR for 26-50 percentile, 1.248, 95% CI, 1.178-1.323; OR for 51-75 percentile, 1.370, 95% CI, 1.245-1.507). CONCLUSION: Our findings suggest that the combined effect of heat wave and PM(2.5) exposure during the 2nd trimester on the risk of preterm birth was greater than that of each exposure alone. In other words, exposure to PM(2.5) increases the impact of heat waves on the risk of preterm birth. These results indicate that control of prenatal exposure to fine particular matter and extreme temperatures is important for the prevention of preterm birth.
Heatwaves and greenness have been shown to affect health, but the evidence on their joint effects is limited. We aim to assess the associations of the combined exposure to greenness and heatwaves. We utilized five waves (February 2000-October 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a prospective cohort of older adults aged 65. We defined heatwaves as the daily maximum temperature ?92.5th percentile with duration ?3 days. We calculated the number of heatwave days in one year before death to and cumulative Normalized Difference Vegetation Index (NDVI) during follow-up to assess individual long-term exposure to heatwaves and greenness. Cox proportional hazards models were used to assess the effects of greenness, heatwaves, and their interaction on mortality, adjusted for covariates. We conducted subgroup analyses by residence, gender, and age. There were 20,758 participants in our study, totaling 67,312 person-years of follow-up. The mean NDVI was 0·41 (SD 0.13), and the mean number of heatwave days was 8.92 (2.04). In the adjusted model, the mortality hazard ratio (HR) for each 3-day increase in heatwave days was 1.04 (95% CI 1.04, 1.05), each 0.1-unit decrease in cumulative NDVI was 1.06 (1.05, 1.07). In the adjusted model with an interaction term, the HR for the interaction term was 1.01 (1.01, 1.02) with a p-value less than 0.001. In our subgroup analyses, the HR for each 3-day increase in heatwave days was higher in urban areas than in rural areas (1.06 vs. 1.03), and the HR for 0.1-unit decrease in NDVI was higher in urban areas than in rural areas (1.08 vs. 1.04). Greenness can protect against the effect of heatwaves on mortality, and heatwaves affect the health effects of greenness. Urban dwellers have a higher response to the detrimental effect of heatwaves and a higher marginal benefit from greenness exposure.
Non-optimum ambient temperature has been associated with a variety of health outcomes in the elderly population. However, few studies have examined its adverse effects on neurocognitive function. In this study, we explored the temperature-cognition association in elderly women. We investigated 777 elderly women from the German SALIA cohort during the 2007-2010 follow-up. Cognitive function was evaluated using the CERAD-Plus test battery. Modelled data on daily weather conditions were assigned to the residential addresses. The temperature-cognition association over lag 0-10 days was estimated using multivariable regression with distributed lag non-linear model. The daily mean temperature ranged between -6.7 and 26.0 °C during the study period for the 777 participants. We observed an inverse U-shaped association in elderly women, with the optimum temperature (15.3 °C) located at the 68th percentile of the temperature range. The average z-score of global cognitive function declined by -0.31 (95%CI: 0.73, 0.11) for extreme cold (the 2.5th percentile of temperature range) and -0.92 (95%CI: 1.50, -0.33) for extreme heat (the 97.5th percentile of temperature range), in comparison to the optimum temperature. Episodic memory was more sensitive to heat exposure, while semantic memory and executive function were the two cognitive domains sensitive to cold exposure. Individuals living in an urban area and those with a low educational level were particularly sensitive to extreme heat. In summary, non-optimum temperature was inversely associated with cognitive function in elderly women, with the effect size for heat exposure particularly substantial. The strength of association varied by cognitive domains and individual characteristics.
BACKGROUND/AIM: Previous studies have suggested that the short-term ambient air pollution and temperature are associated with myocardial infarction. In this study, we aimed to conduct a time-series analysis to assess the impact of fine particulate matter (PM2.5) and temperature on acute myocardial infarction (AMI) among adults over 20 years of age in Korea by using the data from the Korean National Health Information Database (KNHID). METHODS: The daily data of 192,567 AMI cases in Seoul were collected from the nationwide, population-based KNHID from 2005 to 2014. The monitoring data of ambient PM2.5 from the Seoul Research Institute of Public Health and Environment were also collected. A generalized additive model (GAM) that allowed for a quasi-Poisson distribution was used to analyze the effects of PM2.5 and temperature on the incidence of AMI. RESULTS: The models with PM2.5 lag structures of lag 0 and 2-day averages of lag 0 and 1 (lag 01) showed significant associations with AMI (Relative risk [RR]: 1.011, CI: 1.003-1.020 for lag 0, RR: 1.010, CI: 1.000-1.020 for lag 01) after adjusting the covariates. Stratification analysis conducted in the cold season (October-April) and the warm season (May-September) showed a significant lag 0 effect for AMI cases in the cold season only. CONCLUSIONS: In conclusion, acute exposure to PM2.5 was significantly associated with AMI morbidity at lag 0 in Seoul, Korea. This increased risk was also observed at low temperatures.
Malaria is a climate-sensitive infectious disease. Many ecological studies have investigated the independent impacts of ambient temperature on malaria. However, the optimal temperature measures of malaria and its interaction with other meteorological factors on malaria transmission are less understood. This study aims to investigate the effect of ambient temperature and its interactions with relative humidity and rainfall on malaria in Suzhou, a temperate climate city in Anhui Province, China. Weekly malaria and meteorological data from 2005 to 2012 were obtained for Suzhou. A distributed lag nonlinear model was conducted to quantify the effect of different temperature measures on malaria. The best measure was defined as that with the minimum quasi-Akaike information criterion. GeoDetector and Poisson regression models were employed to quantify the interactions of temperature, relative humidity, and rainfall on malaria transmission. A total of 13,382 malaria cases were notified in Suzhou from 2005 to 2012. Each 5 °C rise in average temperature over 10 °C resulted in a 22% (95% CI: 17%, 28%) increase in malaria cases at lag of 4 weeks. In terms of cumulative effects from lag 1 to 8 weeks, each 5 °C increase over 10 °C caused a 175% growth in malaria cases (95% CI: 139%, 216%). Average temperature achieved the best performance in terms of model fitting, followed by minimum temperature, most frequent temperature, and maximum temperature. Temperature had an interactive effect on malaria with relative humidity and rainfall. High temperature together with high relative humidity and high rainfall could accelerate the transmission of malaria. Meteorological factors may affect malaria transmission interactively. The research findings could be helpful in the development of weather-based malaria early warning system, especially in the context of climate change for the prevention of possible malaria resurgence.
Meteorological factors, which are periodic and regular in a long run, have an unignorable impact on human health. Accurate health risk prediction based on meteorological factors is essential for optimal allocation of resource in healthcare units. However, due to the non-stationary and non-linear nature of the original hospitalization sequence, traditional methods are less robust in predicting it. This study aims to investigate hospital admission prediction models using time series pre-processing algorithms and deep learning approach based on meteorological factors. Using the electronic medical record data from Panyu Central Hospital and meteorological data of Panyu district from 2003 to 2019, 46,089 eligible patients with lower respiratory tract infections (LRTIs) and four meteorological factors were identified to build and evaluate the prediction models. A novel hybrid model, Cascade GAM-CEEMDAN-LSTM Model (CGCLM), was established in combination with generalized additive model (GAM), complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN), and long-short term memory (LSTM) networks for predicting daily admissions of patients with LRTIs. The experimental results show that CGCLM multistep method proposed in this paper outperforms single LSTM model in the prediction of health risk time series at different time window sizes. Moreover, our results also indicate that CGCLM has the best prediction performance when the time window is set to 61 days (RMSE = 1.12, MAE = 0.87, R(2) = 0.93). Adequate extraction of exposure-response relationships between meteorological factors and diseases and suitable handling of sequence pre-processing have an important role in time series prediction. This hybrid climate-based model for predicting LRTIs disease can also be extended to time series prediction of other epidemic disease.
Despite the significant economic cost of falls and injuries to individuals and communities, little is known about the impact of meteorological factors on the incidence of fall-related injuries (FRIs). Therefore, a time-series study was conducted to explore the effects of meteorological factors on FRIs in Ma’anshan City, East China. Injury data from 2011 to 2017 were collected from the National Injury Monitoring Station in Ma’anshan City. A distributed lag nonlinear model was used in this study to evaluate the correlation between ambient temperature and fall injuries. The results showed a significant exposure-response relationship between temperature and FRIs in Ma’anshan City. The high temperatures increased the risk of FRIs (RR = 1.110; 95% CI, 1.005-1.225; lag 0). The lag effect appeared at lag 10 (RR = 1.032; 95% CI, 1.003-1.063), and then gradually remained stable after lag 25 (RR = 1.077; 95% CI, 1.045-1.110). The effect of ambient temperature varied with age and gender. The lag effect of high temperature appeared in the male group after lag 15 (RR = 1.042; 95% CI, 1.006-1.079). In contrast, the effect of the female group appeared for the first time at lag 0 (RR = 1.187; 95% CI, 1.042-1.352). And the ? 60 years subgroup seemed to be more sensitive in low temperature (RR = 1.017; 95% CI, 1.004-1.031; lag 0; RR = 1.003; 95% CI, 1.000-1.007; lag 25). The cumulative result is similar to the single-day effect. From the results, this study would help the establishment of fall-related injury prediction and provide evidence for the formulation and implementation of preventive strategies and measures in the future.
In this study, we use a statistical approach based on generalized additive models, linking atmospheric circulation and the number of influenza-related hospital admissions in the Spanish Iberian Peninsula during 2003-2013. The relative risks are estimated for administrative units in the Spanish territory, which is politically structured into 15 regions called autonomous communities. A catalog of atmospheric circulation types is defined for this purpose. The relationship between the exposure and response variables is modeled using a distributed lag nonlinear model (DLNM). Types from southwest and anticyclonic are significant in terms of the probability of having more influenza-related hospital admissions for all of Spain. The heterogeneity of the results is very high. The relative risk is also estimated for each autonomous community and weather type, with the maximum number of influenza-related hospital admissions associated with circulation types from the southwest and the south. We identify six specific situations where relative risk is considered extreme and twelve with a high risk of increasing influenza-related hospital admissions. The rest of the situations present a moderate risk. Atmospheric local conditions become a key factor for understanding influenza spread in each spatial unit of the Peninsula. Further research is needed to understand how different weather variables (temperature, humidity, and sun radiation) interact and promote the spread of influenza.
Eczema resulting from external and internal factors accounts for the biggest global burden of disability owing to skin disease. This study aimed to determine an association between environmental factors and outpatient clinic visits for eczema. We collected data on dermatology clinic outpatient visits for eczema between January 2013 and July 2019. Data concerning environmental factors during this period were collated using national air quality network and air monitoring measurement parameters, namely barometric pressure, relative humidity, air temperature, and air pollutant concentrations, such as sulfur dioxide (SO(2)) and particulate matter (PM(10)). A distributed lag nonlinear model was used to investigate the relationship among eczema, environmental factors, and lagged effects. In total, 27,549 outpatient visits for eczema were recorded. In both single-factor and multiple-factor lag models, the effects of a 10-µg/m(3) increase in PM(10) and SO(2) values had significantly positive effects on the number of daily outpatient visits over a total 5 days of lag after adjusting for temperature, the number of daily outpatient visits increased with 0.87%, 7.65% and 0.69%, 5.34%, respectively. Relative humidity (RR?=?1.3870, 95% CI 1.3117-1.4665) and pressure (RR?=?1.0394, 95% CI 1.0071-1.0727) had significantly positive effects on the number of daily outpatients in single-factor lag models. However temperature had a significantly negative effect on them in the number of daily outpatients (RR?=?0.9686, 95% CI 0.9556-0.9819). Exposure to air pollution exacerbated eczema. Outpatient visits for eczema were found to have strong positive associations with changes in PM(10) levels.
Rotavirus A is the most common cause of infectious diarrhea worldwide. This study aimed to retrospectively study and analyze 4009 stool samples that were tested for viruses causing diarrhea, using multiplex reverse transcription PCR at Dankook University Hospital between 2010 and 2019. Furthermore, we determined the correlation between these factors and various climatic factors, including wind-chill temperature, relative humidity, rate of sunshine, and particulate matter. Rotavirus A infections occurred frequently in February, March, and April on an annual basis. Furthermore, during the study, the detection rate was highest at 17.0% (n=61/359) in 2011. Based on an analysis of weather big data, patient age, and period-specific infection during the summer, when the wind-chill temperature and relative humidity were high, the Rotavirus A infection rate was very low. Relative humidity (p=0.020) and particulate matter (p=0.049) were associated with the average number of monthly cases of Rotavirus A infection. However, wind chill temperature (p=0.074) and rate of sunshine (p=0.993) were not associated with the average monthly distribution of Rotavirus A cases. These results indicate that Rotavirus A infection was correlated with relative humidity and particulate matter during the study period and further the current understanding of the distribution of Rotavirus A infections resulting from climatic factors and particulate matter. This could help establish climate-related health policies to reduce the incidence of diarrhea and guide the development of vaccines against Rotavirus A.
Studying relationships between meteorological conditions and respiratory virus infections may help interpret the causality of disease outbreaks and provide a better understanding of the seasonal distribution of viruses. Therefore, in this study, we analyzed the correlations between meteorological data and the trends of infection by human parainfluenza virus-1 (HPIV-1; also known as human respirovirus 1), human parainfluenza virus-2 (human orthorubulavirus 2), and human parainfluenza virus-3 (human respirovirus 3) using 9010 viral samples collected at Dankook University Hospital from January 1, 2012, to December 31, 2018. Infection frequency data were used to detect the seasonal patterns of HPIV-1, HPIV-2, and HPIV-3 infections, and these patterns were compared with local weather data over the same period. We performed descriptive statistical analysis, frequency analysis, t test, and binomial logistic regression analysis to examine the relationships of weather and particulate matter conditions with the incidence of HPIV-1, HPIV-2, and HPIV-3 infections. The highest average infection rate with one of these three viruses (88.17%) was found in children aged 1-9 years. Specifically, the infection rate of HPIV-1 was 91.9% in children aged 1-9 years, whereas that of HPIV-2 and HPIV-3 was 86.3%. HPIV infection exhibited a meaningful relationship with climatic factors, such as temperature, wind-chill temperature, and atmospheric pressure. Our results suggest that climate changes might affect the rate of infection by HPIV. These findings may help in predicting the effectiveness of preventive strategies of HPIV infection.
Growing studies have shown that high temperature is a potential risk factor of schizophrenia occurrence. Therefore, elaborate analysis of different temperature exposure patterns, such as cumulative heat exposure within a time period and transient exposure at a particular time point, is of important public health significance. This study aims to utilize hourly temperature data to better capture the effects of cumulative and transient heat exposures on schizophrenia during the warm season in Hefei, China. We included the daily mean temperature and daily schizophrenia hospitalizations into the distributed lag non-linear model (DLNM) to simulate the exposure-response curve and determine the heat threshold (19.4 °C). We calculated and applied a novel indicator-daily excess hourly heat (DEHH)-to examine the effects of cumulative heat exposure over a day on schizophrenia hospitalizations. Temperature measurements at each time point were also incorporated in the DLNM as independent exposure indicators to analyze the impact of transient heat exposure on schizophrenia. Each increment of interquartile range (IQR) in DEHH was associated with elevated risk of schizophrenia hospitalizations from lag 1 (RR = 1.036, 95% confidence interval (CI): 1.016, 1.057) to lag 4 (RR = 1.025, 95% CI: 1.005, 1.046). Men and people over 40 years old were more susceptible to DEHH. Besides, we found a greater risk of heat-related schizophrenia hospitalizations between 0 a.m. and 6 a.m. This study revealed the adverse effects of accumulated and transient heat exposures on schizophrenia hospitalizations. Our findings need to be further tested in other regions with distinct regional features.
Cardiovascular disease (CVD), reported to relate with climate change, is the leading cause of global mortality and morbidity. Since the relevant information is quite limited from suburbs and countryside in developing and underdeveloped countries, there are no studies that focused on morbidity through diurnal temperature range (DTR) for these regions. This is the first study to evaluate the short-term effect of DTR on CVD hospital admission in suburban farmers, as well as to identify vulnerable subpopulations. Daily time series data of CVD hospital admissions on suburban farmers of Qingyang, China, and meteorological data from 2011 to 2015 were collected, and a distributed lag non-linear model (DLNM) combined with a quasi-Poisson generalized additive regression model (GAM) was used to examine the exposure-response relationship and delayed effect between DTR and CVD hospital admissions. Stratified analyses by age and gender were performed and extreme DTR effects were examined. Non-linear relation between DTR and CVD hospital admissions was observed, and whether DTR lower or higher than the reference (13 °C, 50(th) percentile) had adverse effect while lower DTR have slightly higher impact. Also, both extreme low and extreme high DTR had adverse effect. Besides, adults (age < 65) and males were more vulnerable to the effects of DTR compared with the old (age ? 65) and females, respectively. This study provides evidence that not only high DTR but also low DTR had adverse effects on CVD which should be paid attention to. Adults and males were more vulnerable among suburban farmers. The results are inconsistent with the studies from urban and indicate differences between urban and suburban residents. Multiple factors such as occupations, risk awareness, and lifestyles could have a significant influence on CVD morbidity, and further study is needed to explore more evidence.
OBJECTIVE: To examine autonomic regulation of core body temperature, heart rate (HR), and breathing rate (BR) in response to moderately elevated ambient temperature or moderate physical exercise in a mouse model of Dravet syndrome (DS). METHODS: We studied video-EEG, ECG, respiration, and temperature in mice with global heterozygous Scn1a knockout (KO) (DS mice), interneuron specific Scn1a KO, and wildtype (WT) mice during exposure to increased environmental temperature and moderate treadmill exercise. RESULTS: Core body temperatures of WT and DS mice were similar during baseline. After 15 mins of heat exposure, the peak value was lower in DS than WT mice. In the following mins of heat exposure, the temperature slowly returned close to baseline level in WT, whereas it remained elevated in DS mice. KO of Scn1a in GABAergic neurons caused similar thermoregulatory deficits in mice. During exercise, the HR increase was less prominent in DS than WT mice. After exercise, the HR was significantly more suppressed in DS. The heart rate variability (HRV) was lower in DS than WT mice during baseline and higher in DS during exercise-recovery periods. SIGNIFICANCE: We found novel abnormalities that expand the spectrum of interictal, ictal, and postictal autonomic dysregulation in DS mice. During mild heat stress, there was a significantly blunted correction of body temperature, and a less suppression of both HR and respiration rate in DS than WT mice. These effects were seen in mice with selective KO of Scn1A in GABAergic neurons. During exercise stress, there was diminished increase in HR, followed by an exaggerated HR suppression and HRV elevation during recovery in DS mice compared to controls. These findings suggest that different environmental stressors can uncover distinct autonomic disturbances in DS mice. Interneurons play an important role in thermoregulation. Understanding the spectrum and mechanisms of autonomic disorders in DS may help develop more effective strategies to prevent seizures and SUDEP.
Industrialization and urbanization have aggravated the contradiction between environmental protection and economic growth, leading to health issues. While there are considerable interests in understanding the health effects of carbon emissions in the context of climate change, little is observed at regional scale and by econometric methods. Applying regression analysis on 2002-2017 Chinese provincial-level panel data, this study explores the intermediary mechanisms and regional differences of carbon emissions on residents’ health. The results indicate that: (1) Carbon emissions have a long-term adverse impact on residents’ health-a 1% rise in carbon emission adds 0.298% more outpatients and 0.162% more inpatients; (2) The rise in carbon emissions impairs residents’ health mainly by raising the temperature; (3) In areas with high levels of industrialization and urbanization, increased carbon emissions bring greater health risks; and (4) In terms of China’s unique “leading industrialization and lagging urbanization” situation, only by upgrading industrial structure, improving urbanization quality, and promoting coordinated industrialization and urbanization can the harm of carbon emissions to residents’ health be reduced. Therefore, the “one-size-fits-all” policy model is not suitable for China’s current situation. To address global “climate change” issues, China must act according to local conditions by applying mitigating (adaptive) measures in economically developed (less developed) regions. Simultaneously, the authorities must focus on the interaction and synergy between industrialization and urbanization.
Hazard mitigation plans (HMP) inform residents and policymakers of the risks a community is vulnerable to, as well as prioritize measures implemented to minimize hazard damage. HMP development emphasizes the importance of creating plans with a strong fact base and analysis of risk exposure, while also facilitating participatory planning with residents. This paper discusses the intersection of citizen perception of extreme heat risk, policy implementation concerning extreme heat risk and actual extreme heat risk exposure in four coastal counties in Texas, Brazoria, Cameron, Galveston and Nueces Counties. Through surveying county residents and analyzing the counties’ HMPs, it was observed that residents perceive extreme heat risk as very high but HMPs have very little information on extreme heat mitigation. By examining three major components of hazard mitigation planning (actual/projected risk exposure, policy implementation and citizen perception), planners can better understand possible disconnects and fallacies that decrease the efficacy of mitigation plans. As HMPs are updated, officials should ensure that resident perceptions, which may change over time and as the result of specific events, are reflected.
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.
Since the early twentieth century, the intensity of malaria transmission has decreased sharply worldwide, although it is still an infectious disease with a yearly estimate of 228 million cases. The aim of this study was to expand our knowledge on the main drivers of malaria in Spain. In the case of autochthonous malaria, these drivers were linked to socioeconomic and hygienic and sanitary conditions, especially in rural areas due to their close proximity to the wetlands that provide an important habitat for anopheline reproduction. In the case of imported malaria, the main drivers were associated with urban areas, a high population density and international communication nodes (e.g. airports). Another relevant aspect is that the major epidemic episodes of the twentieth century were strongly influenced by war and military conflicts and overcrowding of the healthcare system due to the temporal overlap with the pandemic flu of 1918. Therefore, military conflicts and overlap with other epidemics or pandemics are considered to be drivers of malaria that can-in a temporary manner-exponentially intensify transmission of the disease. Climatic factors did not play a relevant role as drivers of malaria in Spain (at least directly). However, they did influence the seasonality of the disease and, during the epidemic outbreak of 1940-1944, the climate conditions favored or coadjuvated its spread. The results of this study provide additional knowledge on the seasonal and interannual variability of malaria that can help to develop and implement health risk control measures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41207-021-00245-8.
Many methods have been developed to verify the correlation between meteorological conditions and air pollutants; however, all have limitations that lead to biased or incomplete conclusions. Hence, improved methods are urgently required to describe this correlation comprehensively and accurately. In this study, we demonstrated the ability of the Copula function to apply time-varying correlations between meteorological factors and atmospheric pollutants. A mixed Copula model was constructed using meteorological monitoring data for Beijing and Guangzhou from 2014 to 2019 to dynamically analyse the correlation characteristics and tail dependence between these factors. We then performed a correlation analysis for the data from the average, lower, and upper tails to obtain a more accurate and comprehensive correlation description. Dynamic analysis results demonstrated significant seasonal fluctuations between meteorological conditions and pollutants relationships. Moreover, the correlation coefficient variations differ according to their average and tail values. High humidity is more likely to be accompanied by increased NO2 compared with average summer humidity. Our proposed model represents a novel application of the Copula function for determining the factors influencing air pollution. This model emphasizes the tail dependence between meteorological conditions and air pollutant concentrations and can be used to guide more targeted prevention and control strategies.
Air pollution has been a rising concern of the 21st due to its effects to public health. Air Monitoring Stations are state-of-the-art equipment used to measure airborne pollutants concentration i.e. carbon monoxide, nitrogen oxide, sulphur dioxide, particulate matter (PM10) and ozone (O-3), as well as the meteorological parameters (i.e. ambient air temperature, relative humidity, wind speed and wind direction). Effects of climate change will affect the ambient temperature and humidity, which may induce a direct effect on air quality. In light of this, feed forward artificial neural network was employed to simulate the dynamic variations of PM10 and O-3 with relative humidity, temperature, and windspeed data being the inputs under 12 different training algorithms. Based on the results obtained, Bayesian regularization with 12 hidden neurons is the optimized network structure, with mean absolute percentage error in testing dataset of O-3 and PM10 at 51.31% and 36.49%, respectively. The models performed better in O-3 prediction as it is a photochemical reaction where ozone concentration varies according to temperature, the effect of meteorological parameters is significant. On the other hand, PM10 is not heavily dependent on meteorological parameters as the diversity of particulate matter components where most of its sources are dormant to changes in climate.
Aedes aegypti is the main vector of dengue globally. The variables that influence the abundance of dengue vectors are numerous and complex. This has generated a need to focus on areas at risk of disease transmission, the spatial-temporal distribution of vectors, and the factors that modulate vector abundance. To help guide and improve vector-control efforts, this study identified the ecological, social, and other environmental risk factors that affect the abundance of adult female and immature Ae. aegypti in households in urban and rural areas of northeastern Thailand. A one-year entomological study was conducted in four villages of northeastern Thailand between January and December 2019. Socio-demographic; self-reported prior dengue infections; housing conditions; durable asset ownership; water management; characteristics of water containers; knowledge, attitudes, and practices (KAP) regarding climate change and dengue; and climate data were collected. Household crowding index (HCI), premise condition index (PCI), socio-economic status (SES), and entomological indices (HI, CI, BI, and PI) were calculated. Negative binomial generalized linear models (GLMs) were fitted to identify the risk factors associated with the abundance of adult females and immature Ae. aegypti. Urban sites had higher entomological indices and numbers of adult Ae. aegypti mosquitoes than rural sites. Overall, participants’ KAP about climate change and dengue were low in both settings. The fitted GLM showed that a higher abundance of adult female Ae. aegypti was significantly (p < 0.05) associated with many factors, such as a low education level of household respondents, crowded households, poor premise conditions, surrounding house density, bathrooms located indoors, unscreened windows, high numbers of wet containers, a lack of adult control, prior dengue infections, poor climate change adaptation, dengue, and vector-related practices. Many of the above were also significantly associated with a high abundance of immature mosquito stages. The GLM model also showed that maximum and mean temperature with four-and one-to-two weeks of lag were significant predictors (p < 0.05) of the abundance of adult and immature mosquitoes, respectively, in northeastern Thailand. The low KAP regarding climate change and dengue highlights the engagement needs for vector-borne disease prevention in this region. The identified risk factors are important for the critical first step toward developing routine Aedes surveillance and reliable early warning systems for effective dengue and other mosquito-borne disease prevention and control strategies at the household and community levels in this region and similar settings elsewhere.
OBJECTIVE: Evidence on the relationship between ambient temperature and morbidity of different stroke subtypes in China is limited. This study aimed to assess the influence of ambient temperature on stroke risk in Shenzhen, China. METHODS: From 1 January 2003 to 31 December 2014, 114 552 stroke cases in Shenzhen were collected. A generalised additive model with quasi-Poisson regression combined with a distributed lag non-linear model was applied to evaluate the temperature effects on stroke subtypes. Furthermore, this study explored the variability of the effects across sex, age and education. RESULTS: The immediate heat effects on ischaemic stroke (IS) and the persistent effects of ambient temperature on intracerebral haemorrhage (ICH) were significant. Overall, the cold-related relative risks (RRs) of IS, ICH and subarachnoid haemorrhage (SAH) were 1.02 (0.97-1.07), 1.16 (1.04-1.30) and 1.12 (0.61-2.04), whereas the heat-related RRs were 1.00 (0.97-1.04), 0.80 (0.73-0.88) and 1.05 (0.63-1.78), respectively. For IS, a weakly beneficial cold effect was found among men while a detrimental heat effect among both men and women, the elderly and higher-educated population at lag0. However, regarding ICH, the temperature effects in men, the young and higher-educated population are stronger at lag0-4, lag0-7 as cold reveals threat and heat reveals protection. CONCLUSION: Responses of diverse stroke subtypes to ambient temperature varied. Effective measures should be taken to increase public awareness about the effects of ambient temperature on stroke attack and to educate the public about self-protection.
BACKGROUND: Many studies have explored the association between meteorological factors and infectious diarrhea (ID) transmission but with inconsistent results, in particular the roles from temperatures. We aimed to explore the effects of temperatures on the transmission of category C ID, to identify its potential heterogeneity in different climate zones of China, and to provide scientific evidence to health authorities and local communities for necessary public health actions. METHODS: Daily category C ID counts and meteorological variables were collected from 270 cities in China over the period of 2014-16. Distributed lag non-linear models (DLNMs) were applied in each city to obtain the city-specific temperature-disease associations, then a multivariate meta-analysis was implemented to pool the city-specific effects. Multivariate meta-regression was conducted to explore the potential effect modifiers. Attributable fraction was calculated for both low and high temperatures, defined as temperatures below the 5th percentile of temperature or above the 95th percentile of temperature. RESULTS: A total of 2,715,544 category C ID cases were reported during the study period. Overall, a M-shaped curve relationship was observed between temperature and category C ID, with a peak at the 81st percentile of temperatures (RR = 1.723, 95% CI: 1.579-1.881) compared to 50th percentile of temperatures. The pooled associations were generally stronger at high temperatures compared to low ambient temperatures, and the attributable fraction due to heat was higher than cold. Latitude was identified as a possible effect modifier. CONCLUSIONS: The overall positive pooled associations between temperature and category C ID in China suggest the increasing temperature could bring about more category C infectious diarrhea cases, which warrants further public health measurements.
In this study the authors examined how maternal health workers (MHWs) perceive the health risks of extreme heat exposure to pregnant women and fetuses. The authors conducted interviews with 12 MHWs (including midwives and doulas) in El Paso, Texas. Using qualitative analysis, the researchers identified numerous themes. Although heat was not communicated as a major health risk, participants expressed some concern with growing heat exposure and communicated standard protective measures. While all participants were familiar with some heat illness symptoms, they were generally unaware of their clients’ vulnerability. MHWs’ minimal heat-risk knowledge leaves pregnant women and developing fetuses at risk of preventable harm.
Climate change affects the reproductive life cycles of plants, including pollen production, which has consequences for allergic respiratory diseases. We examined climatic trends at eight locations in Bavaria, Southern Germany, with pollen time series of at least 10 years (up to 30 years in Munich). Climate change in Bavaria was characterized by a rise in temperature, but not during the winter. There is also a trend towards a more continental climate in Bavaria, which is significant in the Alps in the south of the territory. The influence of climate change depended on pollen type. Wind-pollinated arboreal species (e.g. Alnus, Betula and Cupressaceae/Taxaceae) showed advances in the start and end dates of pollen seasons and an increase in pollen load. These changes correlated negatively with late-winter (February) and spring temperatures (April). For herbaceous species, like Poaceae and Urticaceae, an earlier season was observed. Although precipitation is not a limiting factor in Southern Germany, water availability in the spring did influence the magnitude of grass pollen seasons. The effect of climatic change on the characteristics of pollen seasons was also more pronounced at higher altitudes, significant at > 800 m above sea level. Our results show that trends for start, end dates and intensity were similar at all locations, but only statistically significant at some. If we assume that earlier and more intense pollen seasons result in increases in prevalence and severity of allergic diseases, then the effect of climate change on public health in Bavaria may be significant.
The purpose of this study was to explore the application of serum amyloid A (SAA) in the outcome of upper respiratory tract infection in children by analyzing the correlation between the change of mean air temperature and the positive rate of SAA detection in children. Daily data on upper respiratory tract infection diseases and weather conditions were collected in 2016-2019. A quasi-Poisson regression with a distributed lag non-linear model was used to examine the association between temperature and SAA-positive rate. The positive rate of SAA had a moderate correlation with the temperature and a weak correlation with relative humidity. Low ambient temperature (7 °C, P(1)) was related to the increase in the positive rate of SAA, with the effect lag for 0-7 days (RR 1.34 (1.19~1.74)). The increase in the SAA-positive case induced by 27 °C (P(75)) could last for 0-14 days (RR 1.07 (1.01-1.08)), and high temperature (30 °C, P(99)) could reduce the positive rate of SAA. Our findings add additional evidence to the adverse effects of sub-optimal ambient temperature and provide useful information for public health programs targeting pediatric patients.
BACKGROUND: In recent years, many previous studies have examined the association between ambient temperature and mortality in different parts of the world. However, very few studies have explored the mortality burden attributable to temperature, especially those in developing countries. This study aimed to quantify the burden of mortality attributable to non-optimum temperature in Thailand and explore whether greenness, using normalized difference vegetation index (NDVI) as indicator, alleviates the mortality contributed by non-optimum ambient temperature. METHODS: Daily number of mortality (i.e., all-cause, cardiovascular and respiratory diseases) and daily meteorological data were obtained over 65 provinces in Thailand during 2010 to 2017. The two-stage statistical approach was applied to estimate the association between temperature and mortality. First, the time-stratified case-crossover analysis was performed to examine province-specific temperature-mortality association. Second, province-specific association was pooled to derive national estimates using multivariate meta-regression. Mortality burden attributable to temperature was then estimated, and the association between attributed mortality and NDVI was explored using multivariate meta-regression models. RESULTS: A total of 2,891,407 all-cause of death was included over the study period, in which 403,450 and 264,672 deaths were accounted for cardiovascular and respiratory diseases, respectively. The temperature-mortality association at cumulative lag 0-7 days was non-linear with J-shaped curve for all-cause and respiratory mortality, whereas V-shaped curve was observed for cardiovascular mortality. Using minimum mortality temperature (MMT) as optimum temperature, 3.72% (95% empirical CI: 2.18, 5.21) of all-cause, 2.92% (0.55, 5.10) of cardiovascular and 3.00% (0.27, 5.49) of respiratory mortality were attributable to non-optimum temperature (both hot and cold effects). Higher level of NDVI was associated with alleviated impacts of non-optimum temperature, especially hot temperature. CONCLUSION: Exposure to non-optimum temperature was associated with increased risks of mortality in Thailand. This finding is useful for planning the public health interventions to reduce health effects of non-optimum ambient temperature.
The objective of research involved the comparison of daily and seasonal courses of thermal stress occurring in Central Europe depending on the inflowing air mass. The analysis used data from Warsaw (1991-2000), including air temperature (°C), water vapour pressure (hPa), wind speed (m s(-1)) and cloud cover (%). Universal thermal climate index was calculated and subsequently averaged for the individual months and four types of atmospheric air masses: polar maritime (mP), arctic(A), polar continental (cP) and tropical (T). The studies analysed differences in daily patterns of the averaged values of universal thermal climate index between air masses and determined the frequency of days with various types of thermal stress in individual air masses. The analyses indicated that under the conditions of Central Europe, the highest daily variance of biothermal conditions occurs between the masses of cP and T in the spring and autumn. Considerably greater diversity of biothermal conditions was observed between the masses during daytime compared with nighttime, especially in the warm half of the year. The thermal stress, which can be encountered in Central Europe, ranges from an “extreme cold stress” in winter at night and early morning hours to “very strong heat stress” in summer at noon. Extreme thermal stress is related primarily to the masses of cP, A and T. The most optimal biothermal conditions occur during the advection of mP air.
In this study, we examined the cognitive performance of subtropically acclimatized subjects at an extreme high indoor temperature and the effect of decreased humidity on the cognitive performance at the high temperature. Forty-eight healthy subjects experienced the three exposure conditions: 26 degrees C/relative humidity (RH) 70%, 39 degrees C/RH50%, and 39 degrees C/RH70% in a climate chamber. During 140-minute-long exposures to each thermal condition, they were required to perform cognitive tests that assess the perception, spatial orientation, concentration, memory, and thinking abilities. Meanwhile, their heart rate, core temperature, skin temperature, blood pressure, and body weight were measured and subjective responses, that is, thermal comfort, perceived air quality, and acute health symptoms were investigated. At the relative humidity of 70%, increasing indoor temperature from 26 degrees C to 39 degrees C caused a significant decrease in the accuracy of these cognitive tests. However, when the relative humidity decreased from 70% to 50% at 39 degrees C, the accuracy of the cognitive tests increased significantly. Accordingly, the physiological and subjective responses of the subjects changed significantly with the changes in indoor temperature and humidity, which provided a basis to the variation in the cognitive performance. These results indicated that decreasing indoor humidity at extreme high temperature could improve the impaired cognitive performance.
The distribution of temperature and temperature-health association varied largely across different regions in China, a region-specific definition for heatwave was therefore needed. We collected the data on daily mortality, meteorological factors and air pollution in 84 Chinese cities during 2013-2016, which was divided into seven regions. Based on the association between daily maximum temperature and mortality in each city in a threshold distributed lag non-linear model, where the threshold was defined as the temperature corresponding to the lowest mortality risk, we calculated the number of deaths that could be avoided for 1 degrees C decrease in maximum temperature under different thresholds, then a random-effect meta-analysis was used to generate regional results, in which the temperature with the highest avoidable mortality number for 1 degrees C decrease was considered as the most appropriate heatwave definition. We observed an immediate detrimental effect of high temperature within three lag days. Our analysis suggested to use 29.5 degrees C, 31.5 degrees C, 29.0 degrees C, 31.5 degrees C, 30.0 degrees C, and 28.5 degrees C as the heatwave standard for east, north, northeast, central, south, and southwest region, with the avoidable mortality number of 1.54 (95 % Confidence interval (CD: 0.88, 2.19), 0.55 (95 % CI: 0.16, 0.94), 0.59 (95 % CI: 0.32, 0.86), 1.14 (95 % CI: 0.68, 1.59), 1.22 (95 % CI: 0.54, 1.90), and 0.78 (95 % CI: 0.01, 1.55), respectively, while the estimated number 0.19 (95 % CI: -0.02, 0.40) in northwest region was not statistically significant. The concept of ‘avoidable mortality for 1 degrees C decrease’ was proposed to define the heatwave event, and varied maximum temperature between 28.5 and 31.5 degrees C was suggested for region-specific heatwave definition in China.
Climate change has triggered health hazards that need to be identified and recognized in Jalisco state. A confirmed threat is the extreme maximum temperatures that lead to a necessary diagnosis of vulnerability and risk as a basis for the design and implementation of adaptation measures to current and future manifestations. The demands of attention of the health sector have increased since the period of time where there is the probability of presenting extreme temperatures and heat waves has increased from two months considered as normal to four months at present with an increase in mortality due to cardiovascular diseases and morbidity due to gastrointestinal infections, likewise, the temperature has increased by two months which promotes the increase of the population of mosquitoes that transmit dengue fever. The above requires a response from the health sector, not only in hospital care, but also in the prevention of exposure through an early warning system in the presence of danger with an evaluation of such communication strategies to break and reverse the increase in damage to the health of the Jalisco state inhabitants, particularly the Tlaquepaque, Zapopan, Tonala, Guadalajara and Puerto Vallarta urban areas which turned out to be the most vulnerable to climate change in Jalisco.
Food poisoning is caused by pathogenic bacteria in water and aquatic products, especially bivalves (e.g., oysters, clams), which can bioaccumulate pathogenic bacteria. Polluted water and aquatic products thus pose a serious threat to human health and safety. In this study, the types of pathogenic bacteria in water samples and shellfish collected from the Dadeng offshore area in Xiamen were examined. We also analyzed the relationships between dominant pathogens and major climate and water quality parameters. Our objective was to provide reference data that may be used to help prevent bacterial infections and to improve aquatic food hygiene in Xiamen and its surrounding areas to safe levels, thus ensuring the health of Xiamen residents. We found that the main pathogenic bacteria were Vibrio and Bacillus, with the dominant pathogen being Vibrio parahaemolyticus. Physical and chemical indexes (water temperature, salinity, pH, dissolved oxygen, and turbidity) of water bodies and the 3-day accumulated rainfall were found to be important factors affecting the occurrence and abundance of V. parahaemolyticus.
ISSUE ADDRESSED: Across Australia there are inconsistent and varying guidelines or ‘recommendations’ across a number of jurisdictions for the protection of school children from heat-related consequences, yet there is no national policy for heat protection in school settings. The aim of this study was to determine public perceptions of the efficacy of implementing a heat protection policy for Australian schools. METHODS: A sample of public perceptions was drawn upon from public comments posted on a national Australian Broadcasting Corporation (ABC) news article on the proposed heat protection policy. Public comments were analysed using a social-ecological model thematic content analysis. RESULTS: Themes that emerged to support a national heat protection policy for schools included: protection from the consequences of extreme heat, reliance of children on adult/school decisions and utilising modern knowledge/technology advancements. In contrast, criticism emerged relating to the importance of having resilient children, air conditioning costs, perceived over-regulation and heat exposure being a lifestyle choice in some contexts. CONCLUSIONS: Overall, this study provides support for the introduction of a national heat protection policy with a number of key considerations identified for implementation to benefit and protect Australian school children. SO WHAT?: As a number of the heat guidelines are developed by individual organisations with differing messages, determining the public efficacy of comprehensive heat protection strategies can help lead to the development of policy for a widespread and consistent heat protection program across Australian schools.
Extreme heat is one of the most pressing climate risks in the United States and is exacerbated by a warming climate and aging population. Much work in heat health has focused only on temperature-based metrics, which do not fully measure the physiological impact of heat stress on the human body. The U.S. Climate Reference Network (USCRN) consists of 139 sites across the United States and includes meteorological parameters that fully encompass human tolerance to heat, including relative humidity, wind, and solar radiation. Hourly and 5-min observations from USCRN are used to develop heat exposure products, including heat index (HI), apparent temperature (AT), and wet-bulb globe temperature (WBGT). Validation of this product is conducted with nearby airport and mesonet stations, with reanalysis data used to fill in data gaps. Using these derived heat products, two separate analyses are conducted. The first is based on standardized anomalies, which place current heat state in the context of a long-term climate record. In the second study, heat events are classified by time spent at various levels of severity of conditions. There is no consensus as to what defines a heat event, so a comparison of absolute thresholds (i.e., >= 30.0 degrees, 35.0 degrees, and 40.0 degrees C) and relative thresholds (>= 90th, 95th, and 98th percentile) will be examined. The efficacy of the product set will be studied using an extreme heat case study in the southeastern United States. While no heat exposure metric is deemed superior, each has their own advantages and caveats, especially in the context of public communication.
Air Quality assessment and forecasting are the essentials today and they attracted many researchers. Environmental organizations regularly monitor and predict the air contaminants to make the public awareness, provide a better environment, and suitable for human health. Physical factors like climate changes, Industrialization, Fires and Urbanization are some of the factors which directly affect and reduce the air quality. All these data are time-series and real-time data. The primary pollutant is PMx that affect the respiratory systems and cardiac activity of humans. The secondary pollutants are SO2, CO, NOx, and O-3. Each has allowable range of concentration levels. In this work, meteorological elements are collected in different locations in last 5 years, with time window of 24 h and mapped to the concentration level of pollutants. The Machine Learning(ML) Methods such as Non-Linear Artificial Neural Network(ANN), Statistical Multilevel Regression, Neuro- Fuzzy and Deep Learning Long-Short-Term Memory (DL-LSTM) are used; to find the current concentration level of pollutants and will be useful for Real Time Correction (RTC) to give a feedback that can be used to reduce the contaminants in air for further days. The results are compared with the parameters such as R-2, RMSE and MAPE. Using these methods, the concentration level of contaminants is predicted with the deviation of R-2 in the range of 0.71-0.89. The results proved that DL-LSTM suits well when comparing to the ANN, Neuro-fuzzy and regression algorithms.
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.
Extreme climate change is posing an increasing threat to human welfare across countries. Specifically, the devastating floods coupled with the looming spectre of drought are argued to explain cross-country differences in food security. While the debate continues and uncertainties about the precise influence of climate change on food security linger, the question of whether climate change plays a pivotal role in increased hunger and food insecurity across countries remains unanswered. This study presented new evidence of the role of climate change in Africa’s food security. We utilised the Mann-Kendall test and Sen’s slope estimator to analyse climate change trends. We also employed the pooled mean group technique and the Dumitrescu-Hurlin panel causality test to investigate the effect of climate change on food security in 15 African countries between 1970 and 2016. Our empirical findings revealed three things. First, rainfall plays a decisive role in Africa’s food security when examined broadly. However, the significance of the effect of rainfall varied substantially across the 15 countries. Second, we find no robust impact of temperature on food security in the long run. However, the short-run results showed that extreme temperatures impede food security, with varying magnitudes across countries. Third, except for rainfall, a bidirectional causality exists between food security and temperature in Africa. Given the risks associated with rain-fed agriculture, we argue that African countries need to limit their dependence on rain-fed agriculture to boost food production.
Climate drives population dynamics through multiple mechanisms, which can lead to seemingly context-dependent effects of climate on natural populations. For climate-sensitive diseases, such as dengue, chikungunya, and Zika, climate appears to have opposing effects in different contexts. Here we show that a model, parameterized with laboratory measured climate-driven mosquito physiology, captures three key epidemic characteristics across ecologically and culturally distinct settings in Ecuador and Kenya: the number, timing, and duration of outbreaks. The model generates a range of disease dynamics consistent with observed Aedes aegypti abundances and laboratory-confirmed arboviral incidence with variable accuracy (28-85% for vectors, 44-88% for incidence). The model predicted vector dynamics better in sites with a smaller proportion of young children in the population, lower mean temperature, and homes with piped water and made of cement. Models with limited calibration that robustly capture climate-virus relationships can help guide intervention efforts and climate change disease projections.
BACKGROUND: In resource-poor societies, neonatal mortality (death in the first 28 days of life) is usually very high. Young infants are particularly vulnerable to environmental health risks, which are modified by socioeconomic factors that change over time. We investigated the association between ambient temperature and neonatal mortality in northern Sweden during the demographic transition. METHODS: Parish register data and temperature data in coastal Västerbotten, Sweden, between 1880 and 1950 were used. Total and sex-specific neonatal mortality was modelled as a function of mean temperature, adjusting for age, seasonality and calendar time, using discrete-time survival analysis. A linear threshold function was applied with a cut point at 14.5 °C (the minimum mortality temperature). Odds ratios (ORs) with 95% confidence intervals (CIs) were computed. Further analyses were stratified by study period (1800-1899, 1900-1929, and 1930-1950). RESULTS: Neonatal mortality was 32.1 deaths/1000 live births, higher in boys than in girls, and decreased between 1880 and 1950, with high inter-annual variability. Mean daily temperature was +2.5 °C, ranging from -40.9 °C to +28.8 °C. At -20 °C, the OR of neonatal death was 1.56 (CI 1.30-1.87) compared to the reference at +14.5 °C. Among girls, the OR of mortality at -20 °C was 1.17 (0.88-1.54), and among boys, it was 1.94 (1.53-2.45). A temperature increase from +14.5 to +20 °C was associated with a 25% increase of neonatal mortality (OR 1.25, CI 1.04-1.50). Heat- and cold-related risks were lowest between 1900 and 1929. CONCLUSIONS: In this remote sub-Arctic region undergoing socio-economic changes, we found an increased mortality risk in neonates related to low but also to high temperature. Climate vulnerability varied across time and was particularly high among boys. This demonstrates that environmental impacts on human health are complex and highly dependent on the specific local context, with many, often unknown, contributing determinants of vulnerability.
BACKGROUND: During the period 2001 to 2016, the maximum temperatures in Thailand rose from 38-41(o)C to 42-44(o)C. The current occupational heat exposure standard of Thailand issued in 2006 is based on wet bulb globe temperature (WBGT) defined for three workload levels without a work-rest regimen. This study examined whether the present standard still protects most workers. METHODS: The sample comprised 168 heat acclimatized workers (90 in construction sites, 78 in foundries). Heart rate and auditory canal temperature were recorded continuously for 2 hours. Workplace WBGT, relative humidity, and wind velocity were monitored, and the participants’ workloads were estimated. Heat-related symptoms and signs were collected by a questionnaire. RESULTS: Only 55% of the participants worked in workplaces complying with the heat standard. Of them, 79% had auditory canal temperature ? 38.5(o)C, compared with only 58% in noncompliant workplaces. 18% and 43% of the workers in compliant and noncompliant workplaces, respectively, had symptoms from heat stress, the trend being similar across all workload levels. An increase of one degree (C) in WBGT was associated with a 1.85-fold increase (95% confidence interval: 1.44-2.48) in odds for having symptoms. CONCLUSION: Compliance with the current occupational heat standard protects 4/5 of the workers, whereas noncompliance reduces this proportion to one half. The reasons for noncompliance include the gaps and ambiguities in the law. The law should specify work/rest schedules; outdoor work should be identified as an occupational heat hazard; and the staff should include occupational personnel to manage heat stress in establishments involving heat exposure.
BACKGROUND: Dengue is one of the most rapidly spreading vector-borne diseases, which is considered to be a major health concern in tropical and sub-tropical countries. It is strongly believed that the spread and abundance of vectors are related to climate. Construction of climate-based mathematical model that integrates meteorological factors into disease infection model becomes compelling challenge since the climate is positively associated with both incidence and vector existence. METHODS: A host-vector model is constructed to simulate the dynamic of transmission. The infection rate parameter is replaced with the time-dependent coefficient obtained by optimization to approximate the daily dengue data. Further, the optimized infection rate is denoted as a function of climate variables using the Autoregressive Distributed Lag (ARDL) model. RESULTS: The infection parameter can be extended when updated daily climates are known, and it can be useful to forecast dengue incidence. This approach provides proper prediction, even when tested in increasing or decreasing prediction windows. In addition, associations between climate and dengue are presented as a reversed slide-shaped curve for dengue-humidity and a reversed U-shaped curves for dengue-temperature and dengue-precipitation. The range of optimal temperature for infection is 24.3-30.5 °C. Humidity and precipitation are positively associated with dengue upper the threshold 70% at lag 38 days and below 50 mm at lag 50 days, respectively. CONCLUSION: Identification of association between climate and dengue is potentially useful to counter the high risk of dengue and strengthen the public health system and reduce the increase of the dengue burden.
In 2016, an outbreak of anthrax killing thousands of reindeer and affecting dozens of humans occurred on the Yamal peninsula, Northwest Siberia, after 70 years of epidemiological situation without outbreaks. The trigger of the outbreak has been ascribed to the activation of spores due to permafrost thaw that was accelerated during the summer heat wave. The focus of our study is on the dynamics of local environmental factors in connection with the observed anthrax revival. We show that permafrost was thawing rapidly for already 6 years before the outbreak. During 2011-2016, relatively warm years were followed by cold years with a thick snow cover, preventing freezing of the soil. Furthermore, the spread of anthrax was likely intensified by an extremely dry summer of 2016. Concurrent with the long-term decreasing trend in the regional annual precipitation, the rainfall in July 2016 was less than 10% of its 30-year mean value. We conclude that epidemiological situation of anthrax in the previously contaminated Arctic regions requires monitoring of climatic factors such as warming and precipitation extremes.
The persistence of high values of relative humidity for several hours to a few days has wide-ranging implications for natural and human systems. Among its many impacts, persistent high relative humidity contributes to reduced atmospheric visibility, fog frequency and duration, road and powerline icing, the occurrence of foliar plant disease and the temperature at which heat-related morbidity and mortality can occur. Despite this, the characteristics of humidity spells-including shifts with climate change-are rarely investigated and consequently poorly understood. Hourly relative humidity, precipitation and temperature for 35 locations in the Lower Peninsula (LP) of Michigan during 2003-2017, and for seven locations during 1973-2017, were used to assess, by biweekly periods, spatial, intra-annual and inter-annual variations in the characteristics of relative humidity spells. Two humidity thresholds that accommodate a wide range of applications were used: (1) high relative humidity (HRH), defined as hourly values >= 60%, and extremely high relative humidity (EHRH), defined as hourly values >= 85%. Extended HRH and EHRH spells are frequent across the LP, with HRH spells often spanning 36 hr or longer and EHRH spells commonly persisting more than 12 hr. The probability of HRH and EHRH spells generally decreased with time during 1973-2017, particularly later in the period. Although most spells initiate in the late afternoon and early evening hours, this diurnal preference is less evident as spell length increases, especially for EHRH spells. Furthermore, precipitation is more likely to occur with EHRH spells compared to HRH spells. The orientation and strength of spatial gradients in average annual spell frequency are highly dependent on the choice of humidity and duration thresholds and the temperatures accompanying the spells. This study represents the first comprehensive analysis of the persistence of humidity spells and illustrates the potential usefulness of temporally-flexible climatological summaries relevant for a wide range of applications.
BACKGROUND: The impact of simultaneous adverse climate conditions in the risk of myocardial infarction (MI) was not tested before. The aim of the present study was to investigate the impact of the combination of climate and air pollution features in the number of admissions and mortality due to acute myocardial infarction in 39 municipalities of São Paulo from 2012 to 2015. METHODS: Data about MI admissions were obtained from the Brazilian public health system (DataSUS). Daily information on weather were accessed from the Meteorological Database for Teaching and Research. Additionally, daily information on air pollution were obtained from the Environmental Company of the State of São Paulo. A hierarchical cluster analysis was applied for temperature, rainfall patterns, relative air humidity, nitrogen dioxide, particulate matter 2.5 and particulate matter 10. MI admissions and in-hospital mortality were compared among the clusters. RESULTS: Data analysis produced 3 clusters: High temperature variation-Low humidity-high pollution (n=218 days); Intermediate temperature variation/high humidity/intermediate pollution (n=751 days) and low temperature variation/intermediate humidity-low pollution (n=123 days). All environmental variables were significantly different among clusters. The combination of high temperature variation, dry weather and high pollution resulted in a significant 9% increase in hospital admissions for MI [30.5 (IQR 25.0-36.0)]; patients/day; P<0.01). The differences in weather and pollution did not have impact on in-hospital mortality (P=0.88). CONCLUSION: The combination of atmospheric conditions with high temperature variation, lower temperature, dryer weather and increased inhalable particles was associated with a marked increase of hospital admissions due to MI.
The assessments of future climate risks are common; however, usually, they focus on climate projections without considering social changes. We project heat risks for Finland to evaluate (1) what kind of differences there are in heat vulnerability projections with different scenarios and scales, and (2) how the use of socio-economic scenarios influences heat risk assessments. We project a vulnerability index with seven indicators downscaled to the postal code area scale for 2050. Three different scenario sets for vulnerability are tested: one with five global Shared Socioeconomic Pathways (SSPs) scenarios; the second with three European SSPs (EUSSPs) with data at the sub-national scale (NUTS2); and the last with the EUSSPs but aggregated data at the national scale. We construct projections of heat risk utilizing climatic heat hazard data for three different Representative Concentration Pathways (RCPs) and vulnerability and exposure data for five global SSPs up to 2100. In the vulnerability projections, each scenario in each dataset shows a decrease in vulnerability compared to current values, and the differences between the three scenario sets are small. There are evident differences both in the spatial patterns and in the temporal trends when comparing the risk projections with constant vulnerability to the projections with dynamic vulnerability. Heat hazard increases notably in RCP4.5 and RCP8.5, but a decrease of vulnerability especially in SSP1 and SSP5 alleviates risks. We show that projections of vulnerability have a considerable impact on future heat-related risk and emphasize that future risk assessments should include the combination of long-term climatic and socio-economic projections.
Global warming is already having a negative impact on vital sectors on which human development depends, such as water resource availability. In this study, the changes and abrupt change timing of climatic extreme indices, aridity and drought over the Region of South Aegean are captured using the Mann-Kendall and Pettitt tests, while the latter variables are correlated with the water volume transported by ships to the region as well as the relevant costs. The region’s climate is shifting to warmer conditions with less precipitation, since significantly positive trends were noted with regard to the number of tropical nights, warm nights, warm days, the warm spell duration index and the diurnal temperature range; significant negative trends were observed in relation to the number of cool nights, cool days and the cold spell duration index, with the change-point year for the latter variables being 2006. Inaddition, 7/11 precipitation related indices exhibited a downward trend, while significantly negative trends were observed with regard to the number of consecutive dry days, with the timing of the abrupt change being 2001. The Aridity Index (AI) reveals that the region’s climate characterization is changing from dry and sub-humid to semi-arid conditions, whilst the Reconnaissance Drought Index standardized (RDI(st)) and the Standardized Precipitation Index (SPI) indices suggests an amplification of drought phenomena over the Region. The tourism variables illustrated a significant positive trend, with the timing of the abrupt change being registered during 2006-2009, whilst the correlation analysis between tourism variables and water transfers implies that the surge on water transfer by ships to the Region occurred between 1998 and 2008. This can be mainly attributed to the changes in climate patterns. The correlation analysis documents a strong positive correlation between the water transfer dataset and the diurnal temperature range, and a moderately negative association with the precipitation related indices, annual precipitation, drought phenomena and aridity with 7/11.
This paper describes spatial distribution of Visceral Leishmaniasis (VL) and determines its correlation with climatic factors in an endemic focus in northern and central Tunisia. Data on VL cases in children under five years of age were obtained by consulting medical reports from all Tunisian Pediatric Departments (TPD) during 2006-2016. Three key climatic factors, namely precipitation, continentality index and pluviometric coefficient of Emberger were used as predictor variables to model the VL geographical distribution. Data handling and statistical analysis were performed using R and Arcview GIS software systems. Bayesian local spatial model was employed to analyse the data. The results show a progressive increase in the VL incidence rates in regions with high levels of precipitation, but with low values of both continentality index and pluviometric coefficient of Emberger. A likely explanation of these findings arises from the opposite local effects of climatic factors which tend to cancel each other out in the calculation of the mean parameter estimate over the whole study area. We conclude that using non-local spatial analysis approach leads to misleading epidemiological interpretations, which in turn are of relevance for more efficient and cost-effective resource allocation for control and well manage the spread of VL in the study region and elsewhere in Tunisia.
Epidemiological studies have reported significant associations between weather situations and health. Cardiovascular disease is a serious chronic non-communicable disease which causes mortality and morbidity, bringing large economic burden to patients’ families. This study explored the relationship between cardiovascular disease (CVD) and weather conditions in Changchun, northeast China. The frequency distributions of 13 main circulation weather types (CWTs) were analyzed, and a comparison between air mass classification and hospital admissions was performed for various groups using an admission index (AI). The results indicated that women had a lower risk of CVD than men did. The risk of CVD for older people (aged???65 years) was lower than that for young people (aged?
Climate change has been linked to poor childhood growth and development through maternal stress, nutritional insults related to lean harvests, and exposure to infectious diseases. Vulnerable populations are often most susceptible to these stressors. This study tested whether susceptibility to linear growth faltering is higher among Peruvian children from indigenous, rural, low-education, and low-income households. High-resolution weather and household survey data from Demographic and Health Survey 1996-2012 were used to explore height-for-age z-scores (HAZ) at each year of life from 0 to 5. Rural, indigenous children at age 0-1 experience a HAZ reduction of 0.35 units associated with prenatal excess rainfall which is also observed at age 4-5. Urban, non-indigenous children at age 4-5 experience a HAZ increase of 0.07 units associated with postnatal excess rainfall, but this advantage is not seen among rural, indigenous children. These findings highlight the need to consider developmental stage and social predictors as key components in public health interventions targeting increased climate change resilience.
Many zoonotic diseases are weather sensitive, raising concern how their distribution and outbreaks will be affected by climate change. At northern high latitudes, the effect of global warming on especially winter conditions is strong. By using long term monitoring data (1980-1986 and 2003-2013) from Northern Europe on temperature, precipitation, an endemic zoonotic pathogen (Puumala orthohantavirus, PUUV) and its reservoir host (the bank vole, Myodes glareolus), we show that early winters have become increasingly wet, with a knock-on effect on pathogen transmission in its reservoir host population. Further, our study is the first to show a climate change effect on an endemic northern zoonosis, that is not induced by increased host abundance or distribution, demonstrating that climate change can also alter transmission intensity within host populations. Our results suggest that rainy early winters accelerate PUUV transmission in bank voles in winter, likely increasing the human zoonotic risk in the North.
Arboviral diseases are a theme of high interest in the field of public and collective health worldwide. Dengue, Zika, and Chikungunya, in particular, have shown significant expansion in terms of morbidity and mortality in different portions of the ecumene. These diseases are of great interest in geographic studies due to the characteristics of their vector (Aedes aegypti), adapted to the environmental and unequal context of the urbanization process. Given this background, this study assesses the relationship between global climate change and the risk of arboviral diseases for the state of Rio de Janeiro. To this end, the characteristics of future climate susceptibility to vector proliferation in the scenarios RCP 4.5 and 8.5 (2011-2040 and 2041-2070) were assessed using two models: Eta HadGEM2-ES and Eta MIROC5, as well as the vulnerability conditions that favor the spread of arboviruses. The results indicate that the tendency of thermal and hygrometric elevation, in association with vulnerability, may have repercussions on the intensification and spatial expansion of the risk of arboviral diseases in the state of Rio de Janeiro, since there is a spatial and temporal expansion of the optimal environmental conditions for the development of the vector.
Climate change is predicted to adversely affect agricultural yields, particularly in African countries such as Ethiopia, where crop production relies heavily on environmental factors such as rainfall and temperature. However, there have only been a limited number of studies on the effects of climate change dynamics on food security in Africa, particularly at the household level. We therefore analyzed local climatic changes, the status of household food security, climate-related causes of food insecurity, food security determinants, and the adaptation strategies of local farmers. Three decades meteorological data were analyzed. A total of 185 farmers were selected using simple random sampling and interviewed, together with focus groups. Data were analyzed using the descriptive and inferential statistics were used together with the logit regression model. Climate change over the last three decades was found to have a negative impact the food security status of households. Crop production was constrained by poor rainfall, severe erosion, and increases in temperature. The unpredictability of rainfall, pests, and diseases were also contributing factors. Using the calorie intake approach, 60.5% of sampled respondents were found to be food insecure. Analysis using the logistic regression model showed that age and family size, as well as the amount of cultivated land and rainfall, were the significant (p < .05) factors influencing household food security status. A large proportion (69.8%) of farmers were incorporating adapting strategies into farm management including improved use of crop varieties and livestock production, in addition to income diversification. Taken together, these findings show that improving climate change awareness, facilitating the participation of female-led households in income generation, and strengthening existing adaptation measures have positive impacts on food security.
Pakistan is home to a wide range of geographical landscapes, each of which faces different climate change impacts and challenges. This article presents findings from a National Geographic Society funded project, which employed a people-centered, narratives-based approach to study climate impacts and adaptation strategies of people in 19 rural study sites in four provinces of Pakistan (N = 108). The study looked at six climate-related stressors-changes in weather patterns, floods, Glacial Lake Outburst Floods, drought, heat waves, and sea-level rise-in the coastal areas of Sindh, the desert of Thar, the plains of Punjab, and the mountains of Hunza, Gilgit, and Chitral. Speaking to people at these frontlines of climate change revealed much about climate suffering and trauma. Not only is the suffering induced by losses and damages to property and livelihood, but climate impacts also take a heavy toll on people’s psycho-social wellbeing, particularly when they are displaced from their homes. The findings further demonstrate that people try to adapt in various ways, for instance by altering their agricultural practices, but they face severe barriers to effective adaptation action. Understanding people’s perceptions of climate change and incorporating their recommendations in adaptation planning can help policy-makers develop a more participatory, inclusive, and holistic climate resilience framework for the future.
Some epidemiological studies have confirmed the association between environmental factors and congenital heart defects (CHD). While the possibility that maternal ambient heat exposures are related to CHD has received little attention. Our study aims to investigate the association between maternal ambient extreme heat exposure early in pregnancy and the risk of CHD in offspring in China. We conducted a retrospective cohort study of 1,918,105 fetuses between 2 and 8 weeks after gestation from May to October in Guangdong, China, 2015-2019. The main heat exposure was defined as extreme heat events (EHE) by using the 90th (EHE90) or 95th (EHE95) percentile of the daily maximum temperature. For each EHE definition, we further defined four indicators: having EHE or not, frequency, duration, and cumulative days. We used the log-binomial regression models to calculate the prevalence ratios (PR) of CHD with 95% confidence intervals (CI) for the associations between CHD and EHE, adjusted for potentially confounding covariates. There are 1,918,105 infants included in the study, of which 9588 had CHD, with a prevalence rate of 499.9 per 100,000 (95% CI: 489.9, 509.8). We found that all EHE indicators were positively associated with the increased risks of overall CHD, some CHD classes (congenital malformations of cardiac septa, congenital malformations of great arteries, and congenital malformations of great arteries), and some CHD subtypes (atrial septal defect and patent ductus arteriosus). In addition, the PR yielded higher estimates when exposing to EHE95. For instance, the risk of suffering congenital malformations of great arteries was 1.548 (95% CI: 1.401, 1.712) for EHE90 exposure and 1.723 (95% CI: 1.565, 1.898) for EHE95 exposure, respectively. Our study demonstrated that EHE during 2-8 weeks postconception was associated with overall CHD in offspring, particularly atrial septal defects and patent ductus arteriosus. The associations strengthened with the extent and cumulative days of maternal exposure to EHE.
IMPORTANCE: Future changes in climate are likely to adversely affect human health by affecting concentrations of particulate matter sized less than 2.5 ?m (PM2.5) and ozone (O3) in many areas. However, the degree to which these outcomes may be mitigated by reducing air pollutant emissions is not well understood. OBJECTIVE: To model the associations between future changes in climate, air quality, and human health for 2 climate models and under 2 air pollutant emission scenarios. DESIGN, SETTING, AND PARTICIPANTS: This modeling study simulated meteorological conditions over the coterminous continental US during a 1995 to 2005 baseline and over the 21st century (2025-2100) by dynamically downscaling representations of a high warming scenario from the Community Earth System Model (CESM) and the Coupled Model version 3 (CM3) global climate models. Using a chemical transport model, PM2.5 and O3 concentrations were simulated under a 2011 air pollutant emission data set and a 2040 projection. The changes in PM2.5 and O3-attributable deaths associated with climate change among the US census-projected population were estimated for 2030, 2050, 2075, and 2095 for each of 2 emission inventories and climate models. Data were analyzed from June 2018 to June 2020. MAIN OUTCOMES AND MEASURES: The main outcomes were simulated change in summer season means of the maximum daily 8-hour mean O3, annual mean PM2.5, population-weighted exposure, and the number of avoided or incurred deaths associated with these pollutants. Results are reported for 2030, 2050, 2075, and 2095, compared with 2000, for 2 climate models and 2 air pollutant emissions data sets. RESULTS: The projected increased maximum daily temperatures through 2095 were up to 7.6 °C for the CESM model and 11.8 °C for the CM3 model. Under each climate model scenario by 2095, compared with 2000, an estimated additional 21?000 (95% CI, 14?000-28?000) PM2.5-attributable deaths and 4100 (95% CI, 2200-6000) O3-attributable deaths were projected to occur. These projections decreased to an estimated 15?000 (95% CI, 10?000-20?000) PM2.5-attributable deaths and 640 (95% CI, 340-940) O3-attributable deaths when simulated using a future emission inventory that accounted for reduced anthropogenic emissions. CONCLUSIONS AND RELEVANCE: These findings suggest that reducing future air pollutant emissions could also reduce the climate-driven increase in deaths associated with air pollution by hundreds to thousands.
BACKGROUND: Existing evidence has suggested that heat exposure was associated with increase of low-density lipoprotein (LDL) and decrease of high-density lipoprotein (HDL). This study aimed to assess the effects of extreme temperatures (i.e., heat and cold) on hospitalizations and post-discharge deaths for stroke amongst individuals with and without pre-existing hyperlipidemia, and examine whether individual- and community-level characteristics modified the temperature-stroke relationship. METHODS: People who were hospitalized for stroke from 1(st) January 2005 to 31(st) December 2013 in Brisbane, Australia, and died from stroke within two months after discharge were included in this cohort study. The effects of extreme temperatures on hospitalizations and post-discharge deaths for stroke in patients with and without pre-existing hyperlipidemia were quantified using a time-stratified case-crossover design with conditional logistic regression. Suburb-level temperature data were used to minimize exposure measurement bias. Relative humidity, NO(2) and PM(10) were adjusted as potential confounders in the regression. Subgroup analyses were conducted to examine if age, sex, and suburb-level greenspace (measured as normalized difference vegetation index (NDVI)) and socioeconomic status (measured as Socio-Economic Indexes for Areas (SEIFA)) modified the temperature-stroke relationship in the hyperlipidemia group and the non-hyperlipidemia group. RESULTS: There were 11,469 hospitalizations for stroke during the study period, and 2270 (19.79%) of them died within two months after discharge. Significant effect of heat on hospitalizations for stroke was observed only in individuals with pre-existing hyperlipidemia (odds ratio (OR): 1.85; 95% confidence interval (CI): 1.07-3.19), and significant effect of cold on hospitalizations was found in individuals without pre-existing hyperlipidemia (OR: 1.60; 95% CI: 1.03-2.47). Males appeared to be more vulnerable to the effects of heat and cold on hospitalizations for stroke than females. People living in suburbs with low-level greenspace (OR: 4.23; 95% CI: 1.08-16.61) were more vulnerable to heat effect on stroke hospitalizations than those living in suburbs with high-level greenspace (OR: 1.41; 95% CI: 0.32-6.16). People living in suburbs with the lowest socioeconomic advantage level or the lowest economic resources level were most vulnerable the effects of heat and cold on hospitalizations for stroke. No significant effect of heat or cold on post-discharge deaths from stroke was observed. CONCLUSIONS: This study provides suggestive evidence that heat adaptation strategies aiming to reduce stroke attacks may need to target those individuals with pre-existing hyperlipidemia.
Heatwaves pose a serious threat to human health worldwide but remain poorly documented over Africa. This study uses mainly the ERA5 dataset to investigate their large-scale drivers over the Sahel region during boreal spring, with a focus on the role of tropical modes of variability including the Madden-Julian Oscillation (MJO) and the equatorial Rossby and Kelvin waves. Heatwaves were defined from daily minimum and maximum temperatures using a methodology that retains only intraseasonal scale events of large spatial extent. The results show that tropical modes have a large influence on the occurrence of Sahelian heatwaves, and, to a lesser extent, on their intensity. Depending on their convective phase, they can either increase or inhibit heatwave occurrence, with the MJO being the most important of the investigated drivers. A certain sensitivity to the geographic location and the diurnal cycle is observed, with nighttime heatwaves more impacted by the modes over the eastern Sahel and daytime heatwaves more affected over the western Sahel. The examination of the physical mechanisms shows that the modulation is made possible through the perturbation of regional circulation. Tropical modes thus exert a control on moisture and the subsequent longwave radiation, as well as on the advection of hot air. A detailed case study of a major event, which took place in April 2003, further supports these findings. Given the potential predictability offered by tropical modes at the intraseasonal scale, this study has key implications for heatwave risk management in the Sahel.
In addition to several negative environmental effects, climate change, which reduces bioclimatic comfort levels especially in urban areas, also has economic implications, especially in cities where the economic structure is tourism-oriented. Considering most of the tourism practices are based on outdoor activities in cities such as Antalya, it is of great importance to determine bioclimatic comfort level as well as the attitudes of people toward climate change who live in those conditions to be able to take proper precautions in terms of tourism and urban planning. Therefore, the purpose of this study was to reveal the bioclimatic comfort conditions of Antalya city center, and a comprehensive questionnaire was conducted with the people living in the area questioning the opinions on reasons and consequences of climate change, perceivable effects of climate change in Antalya, and suggestions to prevent or reduce the adverse effects. The areas with appropriate bioclimatic comfort conditions were determined and mapped via geographical information systems using temperature and relative humidity data of the years between 1960 and 2018. The data gathered via questionnaires were analyzed using confirmatory factor analysis, regression, correlation, and structural equation modelling via SPSS and AMOS software. According to the results, it was determined that in some parts of city center the bioclimatic comfort conditions decreased to levels that could reach harmful dimensions for human health and the analysis of the questionnaires revealed that people living in that area state that the effects of climate change are perceivable as the precipitation seasons have become irregular. According to the participants, it was determined that a 1-unit increase in environmental measures causes a decrease of 0.136 units in disasters (R(2)?=?1.1%). In comparison, 1-unit increase of Administrative Precautions will cause 0.030 units decrease in effects of climate change on vital needs (R(2)?=?1.4%). These analysis results show that the respondents expect the disaster scenarios to decrease when environmental measures are increased.
This work analyses the temporal and spatial characteristics of bioclimatic conditions in the Lower Silesia region. The daily time values (12UTC) of meteorological variables in the period 1966-2017 from seven synoptic stations of the Institute of Meteorology and Water Management (IMGW) (Jelenia Góra, K?odzko, Legnica, Leszno, Wroc?aw, Opole, ?nie?ka) were used as the basic data to assess the thermal stress index UTCI (Universal Thermal Climate Index). The UTCI can be interpreted by ten different thermal classes, representing the bulk of these bioclimatic conditions. Stochastic autoregressive moving-average modelling (ARMA) was used for the statistical analysis and modelling of the UTCI as well as separately for all meteorological components. This made it possible to test differences in predicting UTCI as a full index or reconstructing it from single meteorological variables. The results show an annual and seasonal variability of UTCI for the Lower Silesia region. Strong significant spatial correlations in UTCI were also found in all stations of the region. “No thermal stress” is the most commonly occurring thermal class in this region (about 38%). Thermal conditions related to cold stress classes occurred more frequently (all cold classes at about 47%) than those of heat stress classes (all heat classes at about 15%). Over the available 52-year period, the occurrence of “extreme heat stress” conditions was not detected. Autoregressive analysis, although successful in predicting UTCI, was nonetheless unsuccessful in reconstructing the wind speed, which showed a persistent temporal correlation possibly due to its vectorial origin. We conclude thereby that reconstructing UTCI using linear autoregressive methods is more suitable when working directly on the UTCI as a whole rather than reconstructing it from single variables.
INTRODUCTION: Climate change is heightening both long-term adverse risks to human health and the immediate-term risk of injuries and illness following climate-related disaster events that are becoming more frequent and severe. In addition to its direct health effects, climate change poses new threats to the nation’s health care infrastructure – with potential to negatively impact healthcare capacity amidst increasing demand – through risks of flooding, wind damage, heat stress, power outages, and other physical harm to facilities. The typical Hazard Vulnerability Analyses conducted annually by hospitals use historical data to assess risks; these analyses are likely now inadequate for future preparation due to the impact of climate change. This article describes one approach to how healthcare leaders can better assess both near-term and long-term risks due to climate change, to mitigate against unprecedented but foreseeable threats. METHODS: In our large health system in the US Northeast, a process was undertaken to gather updated data and expert projections to forecast threats faced by each of our facilities in different climate-related disaster scenarios. Hazards examined in our setting included precipitation-based and coastal flooding events, heat waves, and high wind events, in addition to seismic events. Probabilities of occurrence and extents of different hazards were projected for the near term (2030) and the long term (2070). We then performed detailed vulnerability analyses for each facility with the predicted amount of rainfall, storm surge, heat stress, and windspeed, in collaboration with leaders at each facility. This was followed by a process to understand what would be needed to mitigate each vulnerability along with the associated costs. Ultimately, a cost/benefit analysis was performed – incorporating the relative likelihood and impact of different scenarios – to decide which improvement projects to embark on immediately, and what to defer and/or incorporate into future building plans. RESULTS: In our system, all facilities were vulnerable to the effects of increased temperatures, and multiple hospitals were noted to be vulnerable to extreme precipitation, storm surge, and high winds. Specific damaging scenarios identified included flooding of basements and building infrastructure spaces, water entry through windows during high winds, and overheating of power systems during heat waves. Potential solutions included improved power redundancy for cooling systems, enhancements to roof and window systems, and the acquisition of deployable flood barriers. We identified four categories for prioritization of action based on projected impact: 1) priorities in need of urgent mitigation, 2) priorities in need of investigative study for medium-term mitigation, 3) priorities for planned capital improvement projects, and 4) priorities to integrate into new facility construction. DISCUSSION: While the specific risks and vulnerabilities for each facility will differ according to its location and structural features, the approach we describe is broadly applicable. By forecasting specific risks, diagnosing vulnerabilities, developing potential solutions, and using a risk/benefit approach to decision making, hospitals can work toward protecting facilities and patients in the face of potential climate related natural disasters in an economically sound manner.
PURPOSE: Given the pressing impact of global warming and its detrimental effect on the health of older populations, understanding age-related changes in thermoregulatory function is essential. Age differences in regional sweat distribution have been observed previously, but given the typically small measurement areas assessed, the development of whole body sweat maps for older individuals is required. Therefore, this study investigated age-related differences in regional sweat distribution in a hot environment (32 °C/50%RH) in young and older adults, using a body mapping approach. METHODS: Technical absorbent pads were applied to the skin of 14 young (age 24?±?2 years) and 14 older (68?±?5 years) males to measure regional sweat rate (RSR) at rest (30 min) and during exercise (30 min), at a fixed heat production (200 W m(-2)). Gastrointestinal (T(gi)) and skin temperature (T(sk)), heart rate, thermal sensation, and thermal comfort were also measured. RESULTS: Whole body sweat maps showed that despite equal heat production, healthy older males had significantly lower gross sweat loss (GSL) than the young and significantly lower RSR at almost all body regions at rest and at the hands, legs, ankles, and feet during exercise. The lower sweat loss in the older group coincided with a greater increase in T(gi) and a consistently higher T(sk) at the legs, despite subjectively feeling slightly cooler than younger individuals. CONCLUSION: These findings support the evidence of age-related deterioration in both autonomic and subjective responses in the heat and highlight the lower extremities as the most affected body region.
Since 2001, a synthesizing element in Intergovernmental Panel on Climate Change assessment reports has been a summary of how risks in a particular system could change with additional warming above pre-industrial levels, generally accompanied by a figure called the burning embers. We present a first effort to develop burning embers for climate change risks for heat-related morbidity and mortality, ozone-related mortality, malaria, diseases carried by Aedes sp., Lyme disease, and West Nile fever. We used an evidence-based approach to construct the embers based on a comprehensive global literature review. Projected risks for these health outcomes under 1.5 degrees C, 2 degrees C, and >2 degrees C of warming were used to estimate at what temperatures risk levels increased from undetectable to medium, high, and very high, from the pre-industrial baseline, under three adaptation scenarios. Recent climate change has likely increased risks from undetectable to moderate for heat-related morbidity and mortality, ozone-related mortality, dengue, and Lyme disease. Recent climate change also was assessed as likely beginning to affect the burden of West Nile fever. A detectable impact of climate change on malaria is not yet apparent but is expected to occur with additional warming. The risk for each climate-sensitive health outcome is projected to increase as global mean surface temperature increases above pre-industrial levels, with the extent and pace of adaptation expected to affect the timing and magnitude of risks. The embers may be an effective tool for informing efforts to build climate-resilient health systems including through vulnerability, capacity, and adaptation assessments and the development of national adaptation plans. The embers also can be used to raise awareness of future threats from climate change and advocate for mitigation actions to reduce the overall magnitude of health risks later this century and to expand current adaptation efforts to protect populations now.
The 2020 summer Olympic and Paralympic Games in Tokyo were postponed to July-September 2021 due to the coronavirus disease 2019 (COVID-19) pandemic. While COVID-19 has emerged as a monumental health threat for mass gathering events, heat illness must be acknowledged as a potentially large health threat for maintaining health services. We examined the number of COVID-19 admissions and the Tokyo rule for emergency medical care, in Tokyo, from March to September 2020, and investigated the weekly number of emergency transportations due to heat illness and weekly averages of the daily maximum Wet Bulb Globe Temperature (WBGT) in Tokyo in the summer (2016-2020). The peak of emergency transportations due to heat illness overlapped the resurgence of COVID-19 in 2020, and an increase of heat illness patients and WBGT has been observed. Respect for robust science is critical for the decision-making process of mass gathering events during the pandemic, and science-based countermeasures and implementations for COVID-19 will be warranted. Without urgent reconsiderations and sufficient countermeasures, the double burden of COVID-19 and heat-related illnesses in Tokyo will overwhelm the healthcare provision system, and maintaining essential health services will be challenging during the 2021 summer Olympic and Paralympic Games.
Both global climate change and urbanization trends will demand adaptation measures in cities. Large agglomerations and impacts on landscape and natural environments due to city growth will require guided densification schemes in urban areas, particularly in developing countries. Human biometeorological indices such as the Universal Thermal Climate Index (UTCI) could guide this process, as they provide a clear account of expected effects on thermal sensation from a given change in outdoor settings. However, an earlier step should optimally include an adequacy test of suggested comfort and thermal stress ranges with calibration procedures based on surveys with the target population. This paper compares obtained thermal comfort ranges for three different locations in Brazil: Belo Horizonte, 20° S, Aw climate type; Curitiba, 25.5° S, Cfb subtropical climate, both locations in elevation (above 900 m a.s.l.); and Pelotas, at sea level, latitude 32° S, with a Cfa climate type. In each city, a set of outdoor comfort field campaigns has been carried out according to similar procedures, covering a wide range of climatic conditions over different seasons of the year. Obtained results indicate a variation of neutral temperatures up to 3 °C (UTCI units) as a possible latitude and local climate effect between the southern locations relative to the northernmost location. Low UTCI values were found in the two subtropical locations for the lower threshold of the thermal comfort band as compared with the original threshold. A possible explanation for that is a longer exposure to cold conditions as buildings are seldom provided with heating systems.
Individuals living in every region of the world are increasingly vulnerable to negative health outcomes due to extreme heat exposure. Children, in particular, may face long-term consequences associated with heat stress that affect their educational attainment and later life health and well-being. Retrospective individual-level analyses are useful for determining the effects of extreme heat exposure on health outcomes. Typically, future risk is inferred by extrapolating these effects using future warming scenarios that are applied uniformly over space and time without consideration of topographical or climatological gradients. We propose an alternative approach using a stochastic weather generator. This approach employs a 1 degrees C warming scenario to produce an ensemble of plausible future weather scenarios, and subsequently a distribution of future health risks. We focus on the effect of global warming on fetal development as measured by birth weight in Ethiopia. We demonstrate that predicted changes in birth weight are sensitive to the evolution of temperatures not quantified in a uniform warming scenario. Distributions of predicted changes in birth weight vary in magnitude and variability depending on geographic and socioeconomic region. We present these distributions alongside results from the uniform warming scenario and discuss the spatiotemporal variability of these predicted changes.
Urban areas are increasingly affected by extreme heat in the face of climate change, while the size and vulnerability of exposed populations are shifting due to economic development, demographic change, and urbanization. In addition to the need to assess future urban heat-related health risks, there is also an increasing need to design adaptation strategies that will be effective under varying levels of socioeconomic development and climate change. We use the case study of Houston, Texas, to develop and demonstrate a scenario-based approach to explore the effectiveness of both autonomous and planned heat-related adaptations under multiple plausible futures. We couple a heat risk model with urban climate projections (under the Representative Concentration Pathways) and vulnerability projections (under locally extended Shared Socioeconomic Pathways) to investigate the impact of different adaptation strategies under multiple scenario combinations. We demonstrate that, in the context of Houston, community-based adaptation strategies aiming to reduce social isolation are the most effective and the least challenging to implement across all plausible futures. Scenario-based approaches can provide local policymakers with context-specific assessments of possible adaptation strategies that account for uncertain futures.
What is already known on this topic? The health risk caused by high-temperatures depends on the interaction between high temperature exposure and the sensitivity and adaptability of the affected populations. What is added by this report? A comprehensive assessment model was established by principal component analysis using the data of 19 cities, 15 provincial-level administrative divisions and used to identify regional characteristics and major influencing factors of health vulnerability to extreme heat in China. What are the implications for public health practice? The results of the health vulnerability assessment could effectively identify the regions highly vulnerable to extreme heat in China and provide scientific evidence for the development of adaptive measures and resource allocation plans.
Student morbidity during adaptation to the weather and climate conditions of the Baltic Sea is evaluated from 2012 to 2017 in this study. The research used the Steadman apparent temperature method to analyse the health impact of physical factors and investigated student morbidity in three Kaliningrad universities that had different percentage responses to the local climate change. Apparent temperatures (T) with different combinations of meteorological parameters significantly deviated from monthly average temperatures. For the average temperature and maximum wind speed, apparent temperatures were found to be negative from September to March. In January and February, they were 7.8-16.8 times lower than the average T. With humidity (e.g., RH) unchanged, different combinations of physical factor posed no danger to a person dressed for the weather conditions. In January, at the minimum T and maximum wind speed (Uh), frostbite was possible after 20-30 of exposure. Apparent T close to the threshold value was observed in December and February. The climate of the Kaliningrad enclave is not the best for human health conditions. In the winter, there are serious risks of frostbite in uncovered parts of the body when threshold conditions were not met. Results suggested that disease susceptibility in non-local students representing all the universities was 1.2-1.7 times higher than these of locals students. Also, a relationship between morbidity and percentage of non-local students is obtained, suggesting that the weather and climate conditions will likely adversely affect human health during climate change adaptation that can likely increase the morbidity rate, particularly among the students.
The present study aims to assess the recent changes and trends in the extreme climate indices in the Kashmir basin using the observational records from 1980 to 2016. The extreme climate indices were computed using the ClimPACT2 software and a total of 39 indices were selected for the analysis having particular utility to various sectors like agriculture, water resources, energy consumption, and human health. Besides adopting the station scale analysis, regional averages were computed for each index. In terms of the mean climatology, an increase has been observed in the annual mean temperature with a magnitude of 0.024 °C/year. Further, differential warming patterns have been observed in the mean maximum and minimum temperatures with mean maximum temperature revealing higher increases than mean minimum temperature. On the other hand, the annual precipitation shows a decrease over most of the region, and the decreases are more pronouncing in the higher altitudes. The trend analysis of the extreme indices reveals that in consonance with the rising temperature there has been an increase in the warm temperatures and decrease in the cold temperatures across the Kashmir basin. Furthermore, our analysis suggests a decrease in the extreme precipitation events. The drought indices viz., Standardised Precipitation Index (SPI), and Standardised Precipitation Evapotranspiration Index (SPEI) manifest decreasing trends with the tendency towards drier regimes implying the need for better water resource management in the region under changing climate.
Many studies have explored the association between temperature and atopic dermatitis (AD); however, the results are inconsistent. We used a quasi-Poisson function fitted to a distributed lag nonlinear model (DLNM) to evaluate the association between daily average temperature and AD outpatient visits from January 1, 2013, to December 31, 2019, in Lanzhou, China. We found that the exposure-response association curve was inversely “s-shaped,” low-temperature effects occurred at a lag of 11 days and then lasted for 10 days, and high-temperature effects occurred on the current day and then significantly decreased. Both low and high ambient temperatures can increase the risk of outpatient visits. Compared with median temperature (12.89°C), the cumulative relative risk (RR) of extreme high temperature and moderate-high temperature were 1.847 (95% confidence interval [CI]: 1.613, 2.114) and 1.447 (95% CI: 1.298, 1.614), respectively, at lag0-7 days, and the cumulative RRs of extremely low temperature and moderate-low temperature were 1.004 (95% CI: 0.904, 1.115) and 1.056 (95% CI: 0.925, 1.205), respectively, at lag0-21 days. Females were more sensitive to high temperatures than males, and high or low temperatures had significant effects on children ?14 years of age. Graphical abstract.
Despite the relevance of road crashes and their impact on social and health care costs, the effects of extreme temperatures on road crashes risk have been scarcely investigated, particularly for those occurring in occupational activities. A nationwide epidemiological study was carried out to estimate the risk of general indistinct and work-related road crashes related with extreme temperatures and to identify crash and occupation parameters mostly involved. Data about road crashes, resulting in death or injury, occurring during years 2013-2015 in Italy, were collected from the National Institute of Statistics, for general indistinct road crashes, and from the compensation claim applications registered by the national workers’ compensation authority, for work-related ones. Time series of hourly temperature were derived from the results provided by the meteorological model WRF applied at a national domain with 5 km resolution. To consider the different spatial-temporal characteristics of the two road crashes archives, the association with extreme temperatures was estimated by means of a case-crossover time-stratified approach using conditional logistic regression analysis, and a time-series analysis, using over-dispersed Poisson generalized linear regression model, for general indistinct and work-related datasets respectively. The analyses were controlled for other covariates and confounding variables (including precipitation). Non-linearity and lag effects were considered by using a distributed lag non-linear model. Relative risks were calculated for increment from 75th to 99th percentiles (hot) and from 25 to first percentile (cold) of temperature. Results for general indistinct crashes show a positive association with hot temperature (RR = 1.12, 95 % CI: 1.09-1.16) and a negative one for cold (RR = 0.93, 95 % CI: 0.91-0.96), while for work-related crashes a positive association was found for both hot and cold (RR = 1.06 (95 % CI: 1.01-1.11) and RR = 1.10 (95 % CI: 1.05-1.16). The use of motorcycles, the location of accident (urban vs out of town), presence of crossroads, as well as occupational factors like the use of a vehicle on duty were all found to produce higher risks of road crashes during extreme temperatures. Mitigation and prevention measures are needed to limit social and health care costs.
BACKGROUND: There is growing evidence suggesting that extreme temperatures have an impact on mental disorders. We aimed to explore the effect of extreme temperatures on emergency room (ER) visits for mental health disorders using 2.8 million records from New York State, USA (2009-2016), and to examine potential effect modifications by individuals’ age, sex, and race/ethnicity through a stratified analysis to determine if certain populations are more susceptible. METHOD: To assess the short-term impact of daily average temperature on ER visits related to mental disorders, we applied a quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM). The model was adjusted for day of the week, precipitation, as well as long-term and seasonal time trends. We also conducted a meta-analysis to pool the region-specific risk estimates and construct the overall cumulative exposure-response curves for all regions. RESULTS: We found positive associations between short-term exposure to extreme heat (27.07 (?)C) and increased ER visits for total mental disorders, as well as substance abuse, mood and anxiety disorders, schizophrenia, and dementia. We did not find any statistically significant difference among any subgroups of the population being more susceptible to extreme heat than any other. CONCLUSIONS: Our findings suggest that there is a positive association between short-term exposure to extreme heat and increased ER visits for total mental disorders. This extreme effect was also found across all sub-categories of mental disease, although further research is needed to confirm our finding for specific mental disorders, such as dementia, which accounted for less than 1% of the total mental disorders in this sample.
Spermatogenesis is a temperature-dependent process, and high summer temperatures have been linked to lower sperm concentration and count. However, reports describing the association between other meteorological variables and semen quality are scarce. This study evaluated the association between semen quality and temperature, humidity, pressure, apparent temperature (AT), temperature-humidity index (THI), simplified wet-bulb global temperature (sWBGT), and sunshine duration. Semen samples were obtained at the Laboratorio de Andrología y Reproducción (LAR, Argentina), from men undergoing routine andrology examination (n=11657) and computer-assisted sperm analysis (n=4705) following WHO 2010 criteria. Meteorological variables readings were obtained from the Sistema Meteorológico Nacional. Sperm quality parameters were negatively affected in summer when compared to winter. Additionally, there was a significant decrease in sperm kinematics between winter and spring. Branch and bound variable selection followed by multiple regression analysis revealed a significant association between semen quality and meteorological variables. Specifically, changes in sunshine duration and humidity reinforced the prognosis of semen quality. Highest/lowest sunshine duration and humidity quantiles resulted in decreased sperm concentration, count, motility, vitality and membrane competence, nuclear maturity, and sperm kinematics associated to highest sunshine duration and lowest humidity. Findings from this report highlight the relevance of environmental studies for predicting alterations in male reproductive health associated to variations in meteorological variables, especially considering the current climate changes around the planet due to global warming and its consequences for human health.
OBJECTIVE: The aim of this study was to determine whether an association existed between intussusception and air temperature. METHODS: A retrospective study was performed between March 2006 and February 2016 to determine the relationship between pediatric primary intussusception (PPI) and air temperature. Information from hospital records of 5922 cases of PPI and Mean daily temperatures of Shenyang were obtained. Pearson correlation analysis was used to examine the association between monthly PPI cases and monthly mean temperature. Factorial analysis-of-variance was used to examine differences in the numbers of seasonal PPI cases during different seasons. RESULTS: Monthly PPI cases fluctuated throughout the year, with a peak in June, and a trough in February. Pearson correlation analysis showed that monthly PPI cases was associated with the monthly mean temperature (p < 0.01). Factorial analysis-of-variance showed there was significant difference in the numbers of seasonal PPI cases during different seasons. Multiple comparison showed a significant difference in seasonal PPI cases between spring and summer, spring and winter, summer and autumn, summer and winter, autumn and winter (p < 0.01). CONCLUSIONS: Monthly PPI cases were positively associated with monthly mean temperature in Shenyang. The incidence of intussusception shows a seasonal trend, with a peak in summer (May to July).
Evidence of the impact of ambient temperatures on emergency ambulance calls (EACs) in developing countries contributes to the improvement and complete understanding of the acute health effects of temperatures. This study aimed to examine the impacts and burden of heat on EACs in China, quantify the contributions of regional modifiers, and identify the vulnerable populations. A semi-parametric generalized additive model with a Poisson distribution was used to analyze the city-specific impacts of the daily maximum temperature (T-ma(x)) on EACs in June-August in 2014-2017. Stratified analyses by sex and age were performed to identify the vulnerable sub-populations. Meta-analysis was undertaken to illustrate the pooled associations. Further subgroup analysis, stratified by climate, latitude, and per capita disposable income (PCDI), and meta-regression analysis were conducted to explore the regional heterogeneity and quantify the contributions of possible modifiers. The city- and region-specific attributable fractions of EACs attributable to heat were calculated. Strong associations were observed between the daily T-max and total EACs in all cities. A total of 11.7% (95% confidence interval (CI): 11.2%-12.3%) of EACs were attributed to high temperatures in ten Chinese cities, and the central region with a low level of PCDI had the highest attributable fraction of 17.8% (95% CI: 17.2%-18.4%). People living in the central region with lower PCDI, and those aged 18-44 and 0-6 years were more vulnerable to heat than the others. The combined effects of PCDI, temperature, and latitude contributed 88.6% of the regional heterogeneity. The results complemented the understanding of the burden of EACs attributable to heat in developing countries and the quantitative contribution of regional modifiers.
BACKGROUND: Ozone pollution keeps deteriorating in the context of climate change. Maternal ozone exposure may be associated with low birth weight (LBW), but the results are still inconsistent. The identification of the critical exposure windows, a specific period of particular susceptibility during pregnancy, remains unresolved. We aimed to evaluate whether ozone exposure was associated with term LBW and further identify the susceptible exposure windows. METHODS: A retrospective cohort study was conducted in Guangzhou, a megacity in the most populous and economically developed city clusters in China. We included 444,096 singleton live births between January 2015 and July 2017. From 11 fixed stations, we collected daily 1-h maximum and 8-h maximum moving average ozone level (O(3)-1 h and O(3)-8 h) and calculated exposures for each participant based on their district of residence during pregnancy. We used traditional Logistic regression to estimate the trimester-specific association between ozone exposure and term LBW, and further estimated monthly- and weekly association by distributed lag models (DLMs) with Logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) of term LBW were calculated for an interquartile range (IQR) increase in ozone exposure. Stratified analyses and heterogeneity tests were conducted by maternal age and infant sex. RESULTS: The incidence of term LBW was 1.9%. During the study period, the mean O(3)-1 h and O(3)-8 h levels were 112.6 µg/m(3) and 84.5 µg/m(3), respectively. Increased O(3)-1 h (IQR: 90 µg/m(3)) and O(3)-8 h (73 µg/m(3)) exposure during the second trimester were associated with increased risk of term LBW. At a monthly level, the term LBW risk was associated with O(3)-1 h exposure during the 4th-6th month and O(3)-8 h exposure during the 6th month. By estimating the weekly-specific association, we observed that critical exposure windows were the 15th- 26th gestational weeks for O(3)-1 h, and the 20th-26th weeks for O(3)-8 h, respectively. Estimated ORs and 95% CIs ranged from 1.012 (1.000, 1.024) to 1.023 (1.007, 1.039). When examined by subgroups, the effects were present among women ? 35 years or < 25 years old and those with female babies. CONCLUSIONS: This study provides compelling evidence that exposure to O(3) was associated with increased risk of term LBW, and gestational weeks 15th- 26th was found to be particularly susceptible. These findings provide a research basis for further mechanism examination, public health interventions, and targeted environmental policy-making.
Prevalence of allergic diseases has been increasing due to multiple factors, among which climate change has had the most impact. Climate factors increase production of pollen, which also exhibits increased allergenicity. Also, as a result of climate change, there has been a shift in flowering phenology and pollen initiation causing prolonged pollen exposure. Various numerical models have been developed to understand the effect of climate change on pollen emission and transport and the impact on allergic airway diseases.
Most studies of short-term exposure to ambient air pollution and cerebrovascular diseases focused on specific stroke-related outcomes, and results were inconsistent due to data unavailability and limited sample size. It is unclear yet how ambient air pollution contributes to the total cardiovascular mortality in central China. Daily deaths from cerebrovascular diseases were obtained from the Disease Surveillance Point System (DSPs) of Wuhan Center for Disease Control and Prevention during the period from 2013 to 2019. Air pollution data were obtained from Wuhan Ecology and Environment Institute from 10 national air quality monitoring stations, including average daily PM(2.5), PM(10), SO(2), NO(2), and O(3). Average daily temperature and relative humidity were obtained from Wuhan Meteorological Bureau. We performed a Poisson regression in generalized additive models (GAM) to examine the association between ambient air pollution and cerebrovascular disease mortality. We observed a total of 84,811 deaths from cerebrovascular diseases from 1 January 2013 to 31 December 2019 in Wuhan. Short-term exposure to PM(2.5), PM(10), SO(2), and NO(2) was positively associated with daily deaths from cerebrovascular diseases, and no significant association was found for O(3). The largest effect on cerebrovascular disease mortality was found at lag0 for PM(2.5) (ERR: 0.927, 95% CI: 0.749-1.105 per 10 ?g/m3) and lag1 for PM(10) (ERR: 0.627, 95% CI: 0.493-0.761 per 10 ?g/m(3)), SO(2) (ERR: 2.518, 95% CI: 1.914, 3.122 per 10 ?g/m(3)), and NO(2) (ERR: 1.090, 95% CI: 0.822-1.358 per 10 ?g/m(3)). The trends across lags were statistically significant. The stratified analysis demonstrated that females were more susceptible to SO(2) and NO(2), while elder individuals aged above 65 years old, compared with younger people, suffered more from air pollution, especially from SO(2). Short-term exposure to PM(2.5), PM(10), SO(2), and NO(2) were significantly associated with a higher risk of cerebrovascular disease mortality, and elder females seemed to suffer more from air pollution. Further research is required to reveal the underlying mechanisms.
Little is known about the association between ambient temperature and DNA methylation, which is a potential biological process through which ambient temperature affects health. This study aimed to evaluate the association between ambient temperature and DNA methylation across human genome. We included 479 Australian women, including 132 twin pairs and 215 sisters of these twins. Blood-derived DNA methylation was measured using the HumanMethylation450 BeadChip array. Data on average ambient temperature during eight different exposure windows [lag0d (the blood draw day), lag0-7d (the current day and previous seven days prior to blood draw), lag0-14d, lag0-21d, lag0-28d, lag0-90d, lag0-180d, and lag0-365d)] was linked to each participant’s home address. For each cytosine-guanine dinucleotide (CpG), we evaluated the association between its methylation level and temperature using generalized estimating equations (GEE), adjusting for important covariates. We used comb-p and DMRcate to identify differentially methylated regions (DMRs). We identified 31 CpGs at which blood DNA methylation were significantly associated with ambient temperature with false discovery rate [FDR] < 0.05. There were 82 significant DMRs identified by both comb-p (Sidak p-value < 0.01) and DMRcate (FDR < 0.01). Most of these CpGs and DMRs only showed association with temperature during one specific exposure window. These CpGs and DMRs were mapped to 85 genes. These related genes have been related to many human chronic diseases or phenotypes (e.g., diabetes, arthritis, breast cancer, depression, asthma, body height) in previous studies. The signals of short-term windows (lag0d and lag0-21d) showed enrichment in biological processes related to cell adhesion. In conclusion, short-, medium-, and long-term exposures to ambient temperature were all associated with blood DNA methylation, but the target genomic loci varied by exposure window. These differential methylation signals may serve as potential biomarkers to understand the health impacts of temperature.
BACKGROUND: Psychiatric disorders constitute a major public health concern that are associated with substantial health and socioeconomic burden. Psychiatric patients may be more vulnerable to high temperatures, which under current climate change projections will most likely increase the burden of this public health concern. OBJECTIVE: This study investigated the short-term association between ambient temperature and mental health hospitalizations in Bern, Switzerland. METHODS: Daily hospitalizations for mental disorders between 1973 and 2017 were collected from the University Hospital of Psychiatry and Psychotherapy in Bern. Population-weighted daily mean ambient temperatures were derived for the catchment area of the hospital from 2.3-km gridded weather maps. Conditional quasi-Poisson regression with distributed lag linear models were applied to assess the association up to three days after the exposure. Stratified analyses were conducted by age, sex, and subdiagnosis, and by subperiods (1973-1989 and 1990-2017). Additional subanalyses were performed to assess whether larger risks were found during the warm season or were due to heatwaves. RESULTS: The study included a total number of 88,996 hospitalizations. Overall, the hospitalization risk increased linearly by 4.0% (95% CI 2.0%, 7.0%) for every 10°C increase in mean daily temperature. No evidence of a nonlinear association or larger risks during the warm season or heatwaves was found. Similar estimates were found across for all sex and age categories, and larger risks were found for hospitalizations related to developmental disorders (29.0%; 95% CI 9.0%, 54.0%), schizophrenia (10.0%; 95% CI 4.0%, 15.0%), and for the later rather than the earlier period (5.0%; 95% CI 2.0%, 8.0% vs. 2.0%; 95% CI -3.0%, 8.0%). CONCLUSIONS: Our findings suggest that increasing temperatures could negatively affect mental status in psychiatric patients. Specific public health policies are urgently needed to protect this vulnerable population from the effects of climate change.
BACKGROUND: The health impacts of temperatures are gaining attention in Australia and worldwide. While a number of studies have investigated the association of temperatures with the risk of cardiovascular diseases, few examined out-of-hospital cardiac arrest (OHCA) and none have done so in Australia. This study examined the exposure-response relationship between temperatures, including heatwaves and OHCA in Brisbane, Australia. METHODS: A quasi-Poisson regression model coupled with a distributed lag non-linear model was employed, using OHCA and meteorological data between 1 January 2007 and 31 December 2019. Reference temperature was chosen to be the temperature of minimum risk (21.4°C). Heatwaves were defined as daily average temperatures at or above a heat threshold (90th, 95th, 98th, 99th percentile of the yearly temperature distribution) for at least two consecutive days. RESULTS: The effect of any temperature above the reference temperature was not statistically significant; whereas low temperatures (below reference temperature) increased OHCA risk. The effect of low temperatures was delayed for 1 day, sustained up to 3 days, peaking at 2 days following exposures. Heatwaves significantly increased OHCA risk across the operational definitions. When a threshold of 95th percentile of yearly temperature distribution was used to define heatwaves, OHCA risk increased 1.25 (95% CI 1.04 to 1.50) times. When the heat threshold for defining heatwaves increased to 99th percentile, the relative risk increased to 1.48 (1.11 to 1.96). CONCLUSIONS: Low temperatures and defined heatwaves increase OHCA risk. The findings of this study have important public health implications for mitigating strategies aimed at minimising temperature-related OHCA.
Occupational heat stress directly hampers physical work capacity (PWC), with large economic consequences for industries and regions vulnerable to global warming. Accurately quantifying PWC is essential for forecasting impacts of different climate change scenarios, but the current state of knowledge is limited, leading to potential underestimations in mild heat, and overestimations in extreme heat. We therefore developed advanced empirical equations for PWC based on 338 work sessions in climatic chambers (low air movement, no solar radiation) spanning mild to extreme heat stress. Equations for PWC are available based on air temperature and humidity, for a suite of heat stress assessment metrics, and mean skin temperature. Our models are highly sensitive to mild heat and to our knowledge are the first to include empirical data across the full range of warm and hot environments possible with future climate change across the world. Using wet bulb globe temperature (WBGT) as an example, we noted 10% reductions in PWC at mild heat stress (WBGT = 18°C) and reductions of 78% in the most extreme conditions (WBGT = 40°C). Of the different heat stress indices available, the heat index was the best predictor of group level PWC (R(2) = 0.96) but can only be applied in shaded conditions. The skin temperature, but not internal/core temperature, was a strong predictor of PWC (R(2) = 0.88), thermal sensation (R(2) = 0.84), and thermal comfort (R(2) = 0.73). The models presented apply to occupational workloads and can be used in climate projection models to predict economic and social consequences of climate change.
The indoor human thermal comfort (HTC) was investigated in residences located in the Pelotas City, southern Brazil, by the effective temperature index (ETI). In this study, temperature and relative humidity were measured inside 429 houses, located in different regions of Pelotas city, from January 11 to August 27, 2019. Samples were obtained using HOBO data loggers, indoor sensors, installed in different regions of the municipality, in the context of a cohort study of children between 2 and 4 years old and their respective mothers, led by Epidemiological Research Center of the Federal University of Pelotas (UFPEL). In general, all regions had average hourly values of effective temperature index above the comfort zone in summer and below the comfort zone in the winter. In terms of spatial variability, the indoor HTC was dependent on environmental factors such as lake breeze and indoor behavior factors, such as the use of air conditioning system in the downtown buildings.
With the rising trends in elderly populations around the world, there is a growing interest in understanding how climate variability is related to the health of this population group. Therefore, we analyzed the associations between mortality in the elderly due to cardiovascular (CVD) and respiratory diseases (RD) and meteorological variables, for three cities in the State of Sao Paulo, Brazil: Campos do Jordao, Ribeirao Preto, and Santos, all in different subtropical regions, from 1996 to 2017. The main objective was to verify how these distinct subtropical climates impact elderly mortality differently. We applied the autoregressive model integrated with moving average (ARIMA) and the principal component analysis (PCA), in order to evaluate statistical associations. Results showed CVD as a major cause of mortality, particularly in the cold period, when a high mortality rate is also observed due to RD. The mortality rate was higher in Campos do Jordao and lower in Santos. In Campos do Jordao, results indicate an increased probability of mortality from CVD and RD due to lower temperatures. In Ribeirao Preto, the lower relative humidity may be related to the increase in CVD and RD deaths. This study emphasizes that, even among subtropical climates, there are significant differences on how climate impacts human health, which can assist decision-makers in the implementation of mitigating and adaptive measures.
BACKGROUND: As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. METHODS AND FINDINGS: We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ?1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms. CONCLUSIONS: Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.
The disclosed study undertook a ‘human centred-approach’ that ascertained and categorised environmental human thermophysiological risk factors by relating them to the human biometeorological system through the use of three widely utilised energy balance model (EBM) indices, the physiologically equivalent temperature (PET), the modified PET, and the universal thermal climate index (UTCI). The disclosed assessment was carried out over the past decade (i.e., 2010-2019) with a 3-h temporal resolution for the case of Ankara through two WMO meteorological stations to compare both local urban and peri-urban environmental conditions. The study recognised extreme annual variability of human physiological stress (PS) during the different seasons as a result of the biometeorological processing of the singular variables, which in the case of average PET for both stations, varied by up to 75 °C between the winter and summer for the same annual dataset (2012). In addition, all EBMs indicated higher heat stress within the city centre that were conducive of both urban extreme heatwaves and very hot days during the summer months, with extreme heat stress levels lasting for longer than a week with PET values reaching a maximum of 48 °C. Similar cold extremes were found for the winter months, with PET values reaching -?30 °C, and average PS levels varying lower in the case of the peri-urban station. Graphical abstract.
Hot weather not only impacts upon human physical comfort and health, but also impacts the way that people access and experience active travel options such as walking and cycling. By evaluating the street thermal environment of a city alongside an assessment of those communities that are the most vulnerable to the effects of heat, we can prioritise areas in which heat mitigation interventions are most needed. In this paper, we propose a new approach for policy makers to determine where to delegate limited resources for heat mitigation with most effective outcomes for the communities. We use eye-level street panorama images and community profiles to provide a bottom-up, human-centred perspective of the city scale assessment, highlighting the situation of urban tree shade provision throughout the streets in comparison with environmental and social-economic status. The approach leverages multiple sources of spatial data including satellite thermal images, Google street view (GSV) images, land use and demographic census data. A deep learning model was developed to automate the classification of streetscape types and percentages at the street- and eye-view level. The methodology is metrics based and scalable which provides a data driven assessment of heat-related vulnerability. The findings of this study first contribute to sustainable development by developing a method to identify geographical areas or neighbourhoods that require heat mitigation; and enforce policies improving tree shade on routes, as a heat adaptation strategy, which will lead to increasing active travel and produce significant health benefits for residents. The approach can be also used to guide post COVID-19 city planning and design.
INTRODUCTION: In 2016-18, the Democratic Republic of São Tomé and Príncipe suffered a necrotic skin infection epidemic. METHODS: A surveillance system was established after increased hospitalisations for this infection. Microbiology results were available for samples analysed in December 2016 and March 2017 using whole genome sequencing and metagenomics. Negative binomial regression was used to study the association of weather conditions with monthly case counts in a time-series analysis. RESULTS: From October 2016 to October 2018, the epidemic cumulative attack rate was 1.5%. The first peak lasted 5 months, accounting for one-third of total cases. We could not conclusively identify the aetiological agent(s) due to the country’s lack of microbiology capacity. Increased relative humidity was associated with increased monthly cases (incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.09), and higher precipitation in the previous month with a higher number of cases in the following month (months with 0-49 mm rainfall compared with months with 50-149 mm and ?150 mm: IRR 1.44, 95 % CI 1.13-1.78 and 1.50, 95% CI 1.12-1.99, respectively). DISCUSSION: This epidemic was favoured by increased relative humidity and precipitation, potentially contributing to community-based transmission of ubiquitous bacterial strains superinfecting skin wounds. FUNDING: World Health Organization Regional Office for Africa, Ministry of Health.
BACKGROUND: As global temperatures rise, increasing numbers of individuals will work in hot environments. Interventions to protect their health are critical, as are reliable methods to measure the physiological strain experienced from heat exposure. The physiological strain index (PSI) is a measure of heat strain that relies on heart rate and core temperature but is challenging to calculate in a real-world occupational setting. METHODS: We modified the PSI for use in field settings where resting temperature and heart rate are not available and used the modified physiological strain index (mPSI) to describe risk factors for high heat strain (mPSI???7) experienced by agricultural workers in Florida during the summers of 2015 through 2017. mPSI was calculated for 221 workers, yielding 465 days of data. RESULTS: A higher heat index (??=?0.185; 95% CI: 0.064, 0.307) and higher levels of physical activity at work (0.033; 95% CI: 0.017, 0.050) were associated with a higher maximum mPSI. More years worked in US agriculture (-0.041; 95% CI: -0.061, -0.020) were protective against a higher maximum mPSI. Out of 23 workdays that a participant experienced a maximum mPSI???7,?22 were also classified as strained by at least one other measure of high heat strain (core temperature [Tc] >38.5°C, sustained heart rate >(180?-?age), and mean heart rate?>?115?bpm). CONCLUSIONS: This study provides critical information on risk factors for elevated heat strain for agricultural workers and suggests a practical approach for using PSI in field-based settings.
Surface characteristics play a vital role in simulations for urban bioclimatic conditions. Changing relationships and distribution patterns of sealed and vegetated surfaces as well as building geometry across different scales in urban environments influence surface temperatures. Cities comprise different urban forms, which, depending on their surface characteristics, enhance the heating process, increasing the emergence of urban heat islands (UHIs). Detecting priority areas to introduce multi-beneficial climate change adaptation measures is set to be a key task for the cities long-term strategies to improve climatic conditions across different urban structures and scales. We introduce a simple and fast spatial modelling approach to carry out fine-scale simulations for land surface temperature (LST), mean radiant temperature (MRT) and Universal Thermal Climate Index (UTCI) in a 2D environment. Capabilities of our modelling approach are demonstrated in evaluating urban thermal comfort in the alpine city of Innsbruck, the capital of Tyrol in western Austria. Results show a major contrast between sealed and vegetated surfaces reflected in the distributional patterns and values of LST, MRT and UTCI, correlating with the appearance and frequency of specific surface classes. We found the Sky View Factor to have a substantial impact on calculations for bioclimatic conditions and see high-albedo surfaces decrease LST but increase the apparent temperature (MRT and UTCI values) effecting human thermal comfort. Furthermore, MRT and UTCI are more sensitive to changes in emissivity values, whereas LST is more sensitive to changes in Bowen Ratio values. Application of our modelling approach can be used to identify priority areas and maximise multi-functionality of climate change adaptation measures, to support urban planning processes for heat mitigation and the implementation of policy suggestions to achieve sustainable development goals and other political objectives.
The mean radiant temperature (T(mrt)) is the most important meteorological factor influencing human thermal comfort in urban areas. Numerous methods have been implemented for estimating T(mrt) using measured radiometer or thermometer data, and exhibit different levels of accuracy. This study presents a simple technique based on the traditional method (T(mrt_TM)) to estimate T(mrt) by utilizing measured radiation data from the radiometers. The estimated T(mrt) values from the six-directional method (T(mrt_SM)) and two black globe thermometer methods (T(mrt_BG) and T(mrt_BGv)) at two stations (sky view factor 0.69 and 0.94) in Jeju, Republic of Korea, for 8 days (5 sunny days, 3 (semi-) cloudy days) in spring and summer were used to validate the T(mrt_TM). The results showed that the mean differences between T(mrt_TM) and T(mrt_SM) were within the required accuracy for comfort in ISO 7726 (±?2 ?) on sunny days and were reduced to 0.1-0.3 ? in high T(mrt) conditions such as clear summer days. The T(mrt_BG) in most sunny and semi-cloudy days and T(mrt_BGv) on all days resulted in large mean differences from the T(mrt_TM) that exceeded the required accuracy for thermal stress in ISO 7726 (±?5 ?). Therefore, both black globe thermometer methods should be used carefully when estimating T(mrt), especially during sunny days. The correlations between T(mrt_TM) and T(mrt_SM) were highly significant, 0.93 on all days (p?=?0.01). The newly developed regression equations between T(mrt_TM) and T(mrt_SM) could reduce mean differences within 0.5 ? for all days, and their r(2) values exceeded 0.87. Therefore, the simple T(mrt_TM) technique can be used for T(mrt) estimation in human thermal comfort studies.
While weather stations generally capture near-surface ambient air temperature (Ta) at a high temporal resolution to calculate daily values (i.e., daily minimum, mean, and maximum Ta), their fixed locations can limit their spatial coverage and resolution even in densely populated urban areas. As a result, data from weather stations alone may be inadequate for Ta-related epidemiology particularly when the stations are not located in the areas of interest for human exposure assessment. To address this limitation in the Megalopolis of Central Mexico (MCM), we developed the first spatiotemporally resolved hybrid satellite-based land use regression Ta model for the region, home to nearly 30 million people and includes Mexico City and seven more metropolitan areas. Our model predicted daily minimum, mean, and maximum Ta for the years 2003-2019. We used data from 120 weather stations and Land Surface Temperature (LST) data from NASA’s MODIS instruments on the Aqua and Terra satellites on a 1?×?1 km grid. We generated a satellite-hybrid mixed-effects model for each year, regressing Ta measurements against land use terms, day-specific random intercepts, and fixed and random LST slopes. We assessed model performance using 10-fold cross-validation at withheld stations. Across all years, the root-mean-square error ranged from 0.92 to 1.92?K and the R (2) ranged from .78 to .95. To demonstrate the utility of our model for health research, we evaluated the total number of days in the year 2010 when residents ?65?years old were exposed to Ta extremes (above 30°C or below 5°C). Our model provides much needed high-quality Ta estimates for epidemiology studies in the MCM region.
Characterizing the future risks of climate change is a key goal of climate impacts analysis. Temperature binning provides a framework for analyzing sector-specific impacts by degree of warming as an alternative or complement to traditional scenario-based approaches in order to improve communication of results, comparability between studies, and flexibility to facilitate scenario analysis. In this study, we estimate damages for nine climate impact sectors within the contiguous United States (US) using downscaled climate projections from six global climate models, at integer degrees of US national warming. Each sector is analyzed based on socioeconomic conditions for both the beginning and the end of the century. The potential for adaptive measures to decrease damages is also demonstrated for select sectors; differences in damages across adaptation response scenarios within some sectors can be as much as an order of magnitude. Estimated national damages from these sectors based on a reactive adaptation assumption and 2010 socioeconomic conditions range from $600 million annually per degree of national warming for winter recreation to $8 billion annually per degree of national warming for labor impacts. Results are also estimated per degree of global temperature change and for 2090 socioeconomic conditions.
Over the 21st century, human-caused climate change is projected to vastly increase the occurrence of severe heat, which has deleterious health, economic, and societal impacts. Over the same period, global human population is expected to increase from 7.8 to 10.9 billion, placing more people in harm’s way. Here, we combine projections of sustained heat from climate models with spatially explicit population projection scenarios. We find that: (1) by 2090, high climate change and population growth scenarios show a -5-, -10-, and -100-1000-fold increase in the population exposed to a mean hottest monthly temperature of 30 degrees C, 35 degrees C, and 40 degrees C, respectively; (2) globally, population growth, warming, and their interaction, are the major drivers for the increase in exposure at milder, harsher, and extreme, temperatures, respectively; and (3) differences between population growth scenarios show that policy can potentially reduce the level of increase in exposure by up to 70%. Based on our analyses, the major driver for the increased heat exposure is the dangerous combination between global warming and population growth in already-warm cities in regions like Africa, India, and the Middle East.
The purpose of this study was to assess autonomic and hemodynamic recovery in women who performed moderate-intensity exercise in heat. Seven women (31.7 ± 7.6 years, 67.5 ± 4.4 kg, 25.7 ± 5.6% Fat, 43.9 ± 5.1 mL/kg/min) completed two identical bouts of graded treadmill walking (~60% VO(2)peak). One bout was hot (37.5 ± 1.4°C, 46.5 ± 4.6% relative humidity (RH)), and the other was moderate (20.7 ± 1.1°C, 29.9 ± 4.1% RH). For 24 h before and one h after each bout, participants had heart rate variability monitored. After each exercise bout HR and BP were measured during 30 min of supine recovery and 10 min of orthostatic challenge. HF power and RMSSD were lower and LF power and LF:HF ratio greater following exercise in the heat and remained different from the moderate condition for 30 min (p < 0.05). During supine recovery, heat exposure led to higher HR (p = 0.002) and lower DBP (p = 0.016). SBP (p = 0.037) and DBP (p = 0.008) were both lower after 10 min of supine recovery following hot exercise than after moderate temperature. Average response did not reveal orthostatic hypotension despite heat causing a higher HR (p = 0.011) and lower SBP (p = 0.026) after 10 min of orthostatic exposure. Trained women exhibit an autonomic shift toward sympathetic dominance for at least 30 min after exercise in heat. Women who exercise in heat should be wary of an exacerbated HR response after exercise and low recovery blood pressures.
Air pollution has become a threat to human health in urban settlements, ultimately leading to negative impacts on overall economic system as well. Already developed nations and still developing countries both are at the risk of air pollution globally. In this scenario, this work aims to investigate the associations of asthma (AS) and acute upper respiratory infection (ARI) patients with satellite-based aerosol optical depth (AOD) and meteorological factors, i.e., relative humidity (RH), temperature (TEMP), and wind speed (WS). We applied second-generation unit root tests to provide empirical evidence. Two sets of unit root tests confirmed mix order of integration, and the other Westerlund co-integration test further showed strong linkages between estimated variables. Fully modified ordinary least square (FMOLS) and dynamic ordinary least square (DOLS) tests were applied, only to explore that TEMP and WS lower the number of AS and ARI patients, but RH and AOD increase the number of patients. Therefore, in accordance with these findings, our study provides some important policy instruments to improve the health status in megacities of Pakistan.
Ambient air pollutants have been linked to adverse health outcomes, but evidence is still relatively rare in college students. Upper respiratory tract infection (URTI) is a common disease of respiratory system among college students. In this study, we assess the acute effect of air pollution on clinic visits of college students for URTI in Wuhan, China. Data on clinic visits due to URTI were collected from Wuhan University Hospital, meteorological factors (including daily temperature and relative humidity) provided by Wuhan Meteorological Bureau, and air pollutants by Wuhan Environmental Protection Bureau. In the present study, generalized additive model with a quasi-Poisson distribution link function was used to examine the association between ambient air pollutants (fine particulate matter (PM(2.5)), particulate matter (PM(10)), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)), and ozone (O(3))) and the daily number of clinic visits of college students for URTI at Wuhan University Hospital in Wuhan, China. In the meantime, the model was adjusted for the confounding effects of long-term trends, seasonality, day of the week, public holidays, vacation, and meteorological factors. The best degrees of free in model were selected based on AIC (Akaike Information Criteria). The effect modification by gender was also examined. A total of 44,499 cases with principal diagnosis of URTI were included from January 1, 2016, to December 31, 2018. In single-pollutant models, the largest increment of URTI visits were found at lag 0 day in single-day lags, and the effect values in cumulative lags were greater than those in single-day lags. PM(2.5) (0.74% (95%CI: 0.05, 1.44)) at lag 0 day, PM(10) (0.61% (95%CI: 0.12, 1.11)) and O(3) (1.01% (95%CI: 0.24, 1.79)) at lag 0-1 days, and SO(2) (9.18% (95%CI: 3.27, 15.42)) and NO(2) (3.40% (95% CI:1.64, 5.19)) at lag 0-3 days were observed to be strongly and significantly associated with clinic visits for URTI. PM(10) and NO(2) were almost still significantly associated with URTI after controlling for the other pollutants in our two-pollutant models, where the effect value of SO(2) after inclusion of O(3) appeared to be the largest and the effects of NO(2) were also obvious compared with the other pollutants. Subgroups analysis demonstrated that males were more vulnerable to PM(10) and O(3), while females seemed more vulnerable to exposure to SO(2) and NO(2). This study implied that short-term exposure to ambient air pollution was associated with increased risk of URTI among college students at Wuhan University Hospital in Wuhan, China. And gaseous pollutants had more negative health impact than solid pollutants. SO(2) and NO(2) were the major air pollutants affecting the daily number of clinic visits on URTI, to which females seemed more vulnerable than males.
Heatwaves-excessively hot ambient conditions that are considered a serious threat to human health-are often associated with poor air quality. The aim of this study was to examine the impact of an early heatwave episode in an industrialized plain in the eastern Mediterranean region (Thriasio, Greece) on human thermal discomfort and urban air quality. The heatwave occurred in mid (15-20) May 2020, shortly after some of the restrictions that were improsed to halt the spread of coronavirus disease 2019 (COVID-19) in Greece were lifted (on 4 May). The discomfort index (DI) and the daily air quality index (DAQI) were calculated on an hourly basis throughout spring 2020 (March, April, May) using data from two stations that measure meteorological parameters and air pollutant concentrations in the Thriasio Plain. The analysis showed that the air temperature increased during 7-17 May to levels that were more than 10 °C above the monthly average value (25.8 °C). The maximum measured air temperature was 38 °C (on 17 May). The results showed a high level of thermal discomfort. The DI exceeded the threshold of 24 °C for several hours during 13-20 May. Increased air pollution levels were also identified. The average DAQI was estimated as 0.83?±?0.1 and 1.14?±?0.2 at two monitoring stations in the region of interest during the heatwave. Particulate matter (diameter < 10 ?m) appeared to contribute significantly to the poor air quality. Significant correlations between the air temperature, DI, and AQSI were also identified.
The over one million agricultural workers in the United States (U.S.) are amongst the populations most vulnerable to the health impacts of extreme heat. Climate change will further increase this vulnerability. Here we estimate the magnitude and spatial patterns of the growing heat exposure and health risk faced by U.S. crop workers and assess the effect of workplace adaptations on mitigating that risk. We find that the average number of days spent working in unsafe conditions will double by mid-century, and, without mitigation, triple by the end of it. Increases in rest time and the availability of climate-controlled recovery areas can eliminate this risk but could affect farm productivity, farm worker earnings, and/or labor costs much more than alternative measures. Safeguarding the health and well-being of U.S. crop workers will therefore require systemic change beyond the worker and workplace level.
There is a well-established relationship between temperature and mortality, with older individuals being most at risk in high-income settings. This raises the question of the degree to which lives are being shortened by exposure to heat or cold. Years of life lost (YLL) take into account population life expectancy and age at which mortality occurs. However, YLL are rarely used as an outcome-metric in studies of temperature-related mortality. This represents an important gap in knowledge; to better comprehend potential impacts of temperature in the context of climate change and an ageing population, it is important to understand the relationship between temperature and YLL, and also whether the risks of temperature related mortality and YLL have changed over recent years. Gridded temperature data derived from observations, and mortality data were provided by the UK Met Office and the Office for National Statistics (ONS), respectively. We derived YLL for each death using sex-specific yearly life expectancy from ONS English-national lifetables. We undertook an ecological time-series regression analysis, using a distributed-lag double-threshold model, to estimate the relationship between daily mean temperature and daily YLL and mortality between 1996 and 2013 in Greater London, the West Midlands including Birmingham, and Greater Manchester. Temperature-thresholds, as determined by model best fit, were set at the 91st (for heat-effects) and 35th (for cold-effects) percentiles of the mean temperature distribution. Secondly, we analysed whether there had been any changes in heat and cold related risk of YLL and mortality over time. Heat-effects (lag 0-2 days) were greatest in London, where for each 1 °C above the heat-threshold the risk of mortality increased by 3.9% (CI 3.5%, 4.3%) and YLL increased by 3.0% (2.5%, 3.5%). Between 1996 and 2013, the proportion of total deaths and YLL attributable to heat in London were 0.50% and 0.40% respectively. Cold-effects (lag 0-27 days) were greatest in the West Midlands, where for each 1 °C below the cold-threshold, risk of mortality increased by 3.1% (2.4%, 3.7%) and YLL also increased by 3.1% (2.2%, 3.9%). The proportion of deaths and YLL attributable to cold in the West Midlands were 3.3% and 3.2% respectively. We found no evidence of decreasing susceptibility to heat and cold over time. The addition of life expectancy information into calculations of temperature-related risk and mortality burdens for English cities is novel. We demonstrate that although older individuals are at greatest risk of temperature-related mortality, heat and cold still make a significant contribution to the YLL due to premature death.
To assess YLL and mortality burden attributable to non-optimum ambient temperature, we collected mortality and environmental data from June 1, 2012 to December 30, 2017 in Shenzhen. We applied distributed lag nonlinear models with 21 days of lag to examine temperature-YLL and temperature-mortality associations, and calculated the attributable fractions of YLL and deaths for non-optimum temperature, including four subranges, mild cold, mild heat, extreme cold, and extreme heat. Cold and heat were distinguished by the optimum temperature, and each was separated into extreme and mild by cutoffs at 2.5th (12.2?°C) and 97.5th (30.4?°C) temperature percentile further. The optimum temperature was defined as the temperature that had minimum effect on YLL or mortality risk. The optimum temperature for non-accidental YLL was 24.5?°C, and for mortality it was 25.4?°C. Except for the population older than 65 years, the optimum temperature was generally lower in the YLL model than the mortality model. Of the total 61,576 non-accidental deaths and 1,350,835.7 YLL within the study period, 17.28% (95% empirical CI 9.42-25.14%) of YLL and 17.27% (12.70-21.34%) of mortality were attributable to non-optimum temperature. More YLL was caused by cold (10.14%, 3.94-16.36%) than by heat (7.14%, 0.47-13.88%). Mild cold (12.2-24.5?°C) was responsible for far more YLL (8.78%, 3.00-14.61%) than extreme cold (3.5-12.2?°C). As for cardiovascular deaths, only the fractions attributable to overall and cold temperature were significant, with mild cold contributing the largest fraction to YLL (16.31%, 6.85-25.82%) and mortality (16.08%, 9.77-21.22%). Most of the temperature-related YLL and mortality was attributable to mild but non-optimum weather, especially mild cold, while the YLL model implied a more prominent heat effect on premature death. Our findings can supply additional evidence from multiperspectives for health planners to define priorities and make targeted policies for mitigating the burden of adverse temperatures.
We aimed to explore whether there were cold and heat temperature adverse effects on years of life lost (YLL) for non-accidental mortality in Yuxi, a southwest plateau region of China. From data for 89,467 non-accidental deaths over an 8-year study period, we used a general linear regression model combined with a distributed lag non-linear model to assess the burden of disease non-accidental mortality due to ambient temperature with the YLL indicator. We estimated the mean YLL change per 1 °C decrease from the 25th to 1st percentile mean temperature as the cold effect and per 1 °C increase from the 75th to 99th percentile as the heat effect. The 95% empirical confidence intervals (eCIs) were calculated by using a bootstrap simulation method. The exposure-response curve between average temperature and YLL was U-shaped. The cold effect peaked at the first day after exposure and disappeared at 2 weeks, and the heat effect only lasted for the first 3 days. A per 1 °C decrease from the 25th to 1st mean temperature percentile was associated with an increase of 15.6 (95% eCI: 2.4, 22.9) in YLL for non-accidental diseases, and the cumulative effects due to cold were stronger in contrast to that attributed by heat. Cold temperature had a significant impact on YLL among the subgroups, with higher YLL in cardiovascular disease, stroke, males, Han nationality, married, and those engaged in agriculture than their corresponding categories. An increasing death burden of non-accidental in Yuxi of China due to cold temperature was demonstrated, and the association was also modified by specific disease causes and individual features.
BACKGROUND: Zika virus (ZIKV) emerged in the Pacific Ocean and subsequently caused a dramatic Pan-American epidemic after its first appearance in the Northeast region of Brazil in 2015. The virus is transmitted by Aedes mosquitoes. We evaluated the role of temperature and infectious doses of ZIKV in vector competence of Brazilian populations of Ae. aegypti and Ae. albopictus. METHODOLOGY/PRINCIPAL FINDINGS: Two Ae. aegypti (Rio de Janeiro and Natal) and two Ae. albopictus (Rio de Janeiro and Manaus) populations were orally challenged with five viral doses (102 to 106 PFU / ml) of a ZIKV strain (Asian genotype) isolated in Northeastern Brazil, and incubated for 14 and 21 days in temperatures mimicking the spring-summer (28°C) and winter-autumn (22°C) mean values in Brazil. Detection of viral particles in the body, head and saliva samples was done by plaque assays in cell culture for determining the infection, dissemination and transmission rates, respectively. Compared with 28°C, at 22°C, transmission rates were significantly lower for both Ae. aegypti populations, and Ae. albopictus were not able to transmit the virus. Ae. albopictus showed low transmission rates even when challenged with the highest viral dose, while both Ae. aegypti populations presented higher of infection, dissemination and transmission rates than Ae. albopictus. Ae. aegypti showed higher transmission efficiency when taking virus doses of 105 and 106 PFU/mL following incubation at 28°C; both Ae. aegypti and Ae. albopictus were unable to transmit ZIKV with virus doses of 102 and 103 PFU/mL, regardless the incubation temperature. CONCLUSIONS/SIGNIFICANCE: The ingested viral dose and incubation temperature were significant predictors of the proportion of mosquito’s biting becoming infectious. Ae. aegypti and Ae. albopictus have the ability to transmit ZIKV when incubated at 28°C. However Brazilian populations of Ae. aegypti exhibit a much higher transmission potential for ZIKV than Ae. albopictus regardless the combination of infection dose and incubation temperature.
BACKGROUND: Extreme weather events happen more frequently along with global warming and they constitute a challenge for public health preparedness. For example, many investigations showed heavy rainfall was associated with an increased risk of acute gastroenteritis. In this study, we examined the associations between different meteorological factors and paediatric acute gastroenteritis in an affluent setting in China controlling for pollutant effects. METHODS: Aggregated total weekly number of intestinal infection-related hospital admissions, and meteorological and air pollution data during 1998-2018 in Hong Kong were collected and analysed by a combination of quasi-Poisson generalized additive model and distributed lag nonlinear model. Study population was restricted to children under 5 years of age at the time of admission. RESULTS: While heavy rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to intestinal infections, low temperature and humidity extremes (both relative humidity and vapour pressure) did. Compared with the temperature at which the lowest risk was detected (i.e. 22.5 °C), the risk was 6.4% higher (95% confidence interval: 0.0% to 13.0% at 15.1 °C (i.e. the 5th percentile)). We also found the risk of paediatric admission was statistically significantly associated with an increase in the number of extreme cold days in a week over the study period. CONCLUSION: Cold condition may have greater impact on disease transmission through increased stability and infectivity of enteric viruses in affluent settings like Hong Kong and thus resulted in an increased risk for paediatric acute gastroenteritis. On the contrary, an insignificant impact from heavy rainfall and high temperature may indicate a minor effect on disease transmission through bacterial growth in contaminated food and water. With the identified impacts of weather factors, extreme weather events are likely to distort the prevalence and seasonal pattern of diarrhoeal diseases in the future.
Gender-sensitive and gender-responsive approaches are important to increase adaptive capacity in a changing climate given the gendered nature of exposure levels to climate shocks. Nonetheless, knowledge and perception of the public to climate change influence behavioural intention to adapt. While literature is replete with public perception and adaptation strategies to climate change, there is a dearth of information exploring the influence of gender on climate change knowledge. This paper employs quantitative and qualitative data to examine the influence of gender on knowledge in climate trends in Beitbridge Rural District, Zimbabwe, using questionnaire surveys. This survey tool consisted of demographic questions on gender and other variables. Our results indicate that compared to women, actual knowledge of trends in selected variables of climate change was higher among men. Furthermore, male respondents had higher self-evaluated knowledge on climate trends compared to female participants. We recommend gender disaggregated data in the vulnerability and adaptation assessments and the education, training and awareness sections of the National Communications to the United Nations Convention on Climate Change.
Background: The number of meteoropaths, or people negatively affected by weather conditions, is rising dramatically. Meteoropathy is developing rapidly due to ever poorer adaptations of people to changes in weather conditions. Strong weather stimuli may not only exacerbate symptoms in people with diseases of the cardiovascular and respiratory systems but may also induce aggressive behavior. Researchers have shown that patients suffering from mental illnesses are most vulnerable to changes in the weather and postulate a connection between the seasons and aggressive behavior. Methods: The goal of the study was to analyze the relationship between coercive measures and weather factors. The researchers identified what meteorological conditions prevailed on days with an increased number of incidents of aggressive behavior leading to the use of physical coercion towards patients in a psychiatric hospital in Poland. In order to determine the impact of weather conditions on the frequency at which physical coercion measures were used, the hospital’s “coercion sheets” from 1 January 2015 to 31 March 2017 were analyzed. The data were correlated with meteorological data. In order to determine the relationship between the occurrence of specific weather conditions and the number of coercive interventions (N), researchers utilized Spearman’s rank correlation analysis together with two-dimensional scatter diagrams (dependency models), multiple regression, stepwise regression, frequencies, and conditional probability (%). Results: Lower barometric pressure and foehn wind increased aggressive behavior in patients that led to coercive measures. For temperature (positive correlation) and humidity (negative correlation), there was a poor but statistically significant correlation. Conclusions: Monitoring weather conditions might be useful in predicting and preventing aggression by patients who are susceptible to weather changes.
BACKGROUND: Stroke has been found to have a seasonally varying incidence; blood pressure, one of its risk factors, is influenced by humidity and temperature. The relationship between the incidence of stroke and meteorological parameters remains controversial. OBJECTIVE: We investigated whether meteorological conditions are significant risk factors for stroke, focusing on the fluctuation of weather elements that triggers the onset of stroke. METHODS: We collected ambulance transportation data recorded by emergency personnel from Gifu Prefecture. We included cases where the cause of the transportation was stroke and excluded cases of trauma. We combined these data with meteorological data as well as data on average temperature, average air pressure, and humidity provided publicly by the Japan Meteorological Agency. Our target period was from January 2012 to December 2016. RESULTS: In the 5-year target period, there were 5,501 occurrences of ambulance transportation due to stroke. A seasonal tendency was confirmed, since ambulance transportation for stroke occurred more frequently at low temperatures (p < 0.001). Temperature (odds ratio: 0.91; p < 0.001) and humidity change (odds ratio: 1.50; p = 0.016) were identified as risk factors for ambulance transportation due to stroke. An increase in temperature incurs a lower risk than a decrease (odds ratio: 0.58; p = 0.09), although there is no statistically significant difference. CONCLUSIONS: Meteorological effects on the frequency of ambulance transportation due to stroke were studied. A lower temperature and radical humidity change were identified as risk factors for ambulance transportation due to stroke, and a decrease in temperature was also associated. We speculate on the possibilities of using meteorological data to optimize the assignment of limited medical resources in medical economics.
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.
As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.
To prevent the risk associated with heat-related health, several countries and institutions have built heat-health warning systems (HHWS). An HHWS is designed to alert the general public and decision-makers about the danger of high temperature by triggering a series of actions that avoid adverse health outcomes. The comparison of the various HHWS is complicated because there is no universal quantitative definition to predict and define a heatwave. The slightest variability at the threshold of definition the heatwave can trigger considerable differences in the action plan, health service demand and the time the population at risk must prepare. The choice of the index influences the number of days of heatwaves and its characteristics, such as severity. Estimating the risk of mortality associated with heatwave is variable according to the indexes, and the selection of the threshold is essential to prevent the burdens of heat on public health. The aim is the comparison between two metrics to know, which has higher predictive power to prevent health risks related to heat. On the one hand, a new way of defining heatwaves that have generated high consensus worldwide – the Excess Heat Factor (EHF); on the other hand, the Generalized Accumulated Thermal Overload (GATO IV) – an opportunity to improve the existing Lisbon heatwaves surveillance system. Daily mortalities and air temperatures from 1980 to 2016 in Lisbon with both indexes are modelled using Generalized Linear Models, with the calculation of the predictive power of the models using ROC curves for two levels of mortality severity. It is concluded that for total mortality, both indexes were statistically significant. Though, for daily mortality in individuals with 65 years or older with all diseases of the circulatory and respiratory system, when considering both indexes together, GATO IV was the only index significantly predicting the impact of heatwaves on mortality. GATO IV metric seems to have the best statistical properties. Nevertheless, EHF also stands out as a good indicator to predict heat-related mortality in Lisbon.
Urban Heat Island (UHI) effect has become one of the most significant hazards for cities, presenting a challenge for dense anthropic areas affected by climate change with enormous consequences for health and human wellbeing. Ecosystem Services (ES) are increasingly attracting attention for their use in setting urban design parameters and criteria which can be deployed in planning and projects, also considering the Cooling Capacity (CC) useful to mitigate heatwaves effect and high temperatures. The paper investigates how ES assessment could support the definition of urban design parameters influencing the CC of cities. We modelled CC in the city of Milan using InVEST software identifying the urban design criteria that most influence temperature and associated urban comfort. This empirical test was conducted by selecting different urban districts built during four main historical periods which correspond to four urban planning approaches, namely: 1) Cited Berutiana; 2) Clan Moderna; 3) Gina anni ’60-’70 and 4) Cited Contemporanea. Results demonstrate how different urban planning approaches have shaped the design of the city in terms of green areas, permeability, built-up footprint, and tree density and cover while influencing the CC of the system.
Mitigation and adaption measures must be designed strategically by urban planners, designers, and decision-makers to reduce urban heat island (UHI) related risks. We employed the Weather Research and Forecasting (WRF) model to assess UHI mitigation scenarios for the tropical city of Singapore during April 2016, including two heat wave periods. The local climate zones for Singapore were used as the land use/land cover data to account for the intra-urban variability. The simulations show that the canopy layer UHI intensity in Singapore can reach up to 5 degrees C in compact areas during nighttime. The results reveal that city-scale deployment of cool roofs can provide an overall reduction of 1.3 degrees C in the near-surface daytime air temperature in large lowrise areas. Increasing the thermostat set temperature to 25 degrees C from 21 degrees C in city-wide buildings can potentially reduce the air temperature due to less (similar to 20%) waste heat discharge from airconditioning units. A densification scenario considering an increase from approximately 7 841 people/km(2) (2016) to 9040-9,600 people/km(2) (2030) under the current climate leads to air temperature increase of 1.4 degrees C, which demonstrates the importance of limiting the densification of less compact areas in maintaining thermal comfort in the future.
Objectives. To examine the relationships among environmental characteristics, temperature, and health outcomes during heat advisories at the geographic scale of street segments.Methods. We combined multiple data sets from Boston, Massachusetts, including remotely sensed measures of temperature and associated environmental characteristics (e.g., canopy cover), 911 dispatches for medical emergencies, daily weather conditions, and demographic and physical context from the American Community Survey and City of Boston Property Assessments. We used multilevel models to analyze the distribution of land surface temperature and elevated vulnerability during heat advisories across streets and neighborhoods.Results. A substantial proportion of variation in land surface temperature existed between streets within census tracts (38%), explained by canopy, impervious surface, and albedo. Streets with higher land surface temperature had a greater likelihood of medical emergencies during heat advisories relative to the frequency of medical emergencies during non-heat advisory periods. There was no independent effect of the average land surface temperature of the census tract.Conclusions. The relationships among environmental characteristics, temperature, and health outcomes operate at the spatial scale of the street segment, calling for more geographically precise analysis and intervention. (Am J Public Health. Published online ahead of print May 21, 2020: e1-e8. doi:10.2105/AJPH.2020.305636).
Heat stress has been recognized as one of the consequences of climate change in urban areas. Its adverse effects on the urban population range from economy, social, environment, and human health. With the increasing urbanization and economic development in cities, heat stress is expected to worsen. This particular study aims to achieve two objectives: (1) to understand the determinants of heat stress, especially the roles of the urban environment in exacerbating the heat stress, and (2) to explore the effects of heat stress to human health using self-reported health assessment. We employed a cross-sectional study using a survey questionnaire from 505 respondents living in the urban area of Bangkok, Thailand. We found that socioeconomic conditions of the individual and urban environment were significant determinants of urban heat stress. Low-income urban populations living in high-density areas with less green open space were more likely to experience heat stress. We also found that heat stress significantly affects human health. Those who reported a higher level of heat stress were more likely to have adverse health and well-being outcomes. The findings suggest that the increased risk of heat stress represents a major problem in the Bangkok, Thailand. It is necessary to address heat stress in adaptation policy and measures at the city levels amid the continued increase of global temperature and climate change.
The scarlet fever incidence has increased drastically in recent years in China. However, the long-term relationship between climate variation and scarlet fever remains contradictory, and an early detection system is lacking. In this study, we aim to explore the potential long-term effects of variations in monthly climatic parameters on scarlet fever and to develop an early scarlet-fever detection tool. Data comprising monthly scarlet fever cases and monthly average climatic variables from 2004 to 2017 were retrieved from the Notifiable Infectious Disease Surveillance System and National Meteorological Science Center, respectively. We used a negative binomial multivariable regression to assess the long-term impacts of weather parameters on scarlet fever and then built a novel forecasting technique by integrating an autoregressive distributed lag (ARDL) method with a nonlinear autoregressive neural network (NARNN) based on the significant meteorological drivers. Scarlet fever was a seasonal disease that predominantly peaked in spring and winter. The regression results indicated that a 1 °C increment in the monthly average temperature and a 1-h increment in the monthly aggregate sunshine hours were associated with 17.578% (95% CI 7.674 to 28.393%) and 0.529% (95% CI 0.035 to 1.025%) increases in scarlet fever cases, respectively; a 1-hPa increase in the average atmospheric pressure at a 1-month lag was associated with 12.996% (95% CI 9.972 to 15.919%) decrements in scarlet fever cases. Based on the model evaluation criteria, the best-performing basic and combined approaches were ARDL(1,0,0,1) and ARDL(1,0,0,1)-NARNN(5, 22), respectively, and this hybrid approach comprised smaller performance measures in both the training and testing stages than those of the basic model. Climate variability has a significant long-term influence on scarlet fever. The ARDL-NARNN technique with the incorporation of meteorological drivers can be used to forecast the future epidemic trends of scarlet fever. These findings may be of great help for the prevention and control of scarlet fever.
Epidemiological evidence has shown an association between exposure to high temperatures and occupational injuries, an issue gaining importance with environmental change. The aim of this study was to better understand contributing risk factors and preventive actions based on personal experiences. Interviews were conducted with 21 workers from five Australian states using a critical phenomenological approach to capture the lived experiences of participants, whilst exploring contextual factors that surround these experiences. Two case studies are presented: a cerebrovascular injury and injuries among seasonal horticulture workers. Other accounts of heat-related injuries and heat stress are also presented. Risk factors were classified as individual, interpersonal and organizational. In terms of prevention, participants recommended greater awareness of heat risks and peer-support for co-workers. Adding value to current evidence, we have provided new insights into the etiology of the health consequences of workplace heat exposure with workers identifying a range of influencing factors, prevention measures and adaptation strategies. Underpinning the importance of these are future climate change scenarios, suggesting that extended hot seasons will lead to increasing numbers of workers at risk of heat-stress and associated occupational injuries.
We used monthly precipitation and temperature data to give early warning of years with higher West Nile Virus (WNV) risk in Nebraska. We used generalized additive models with a negative binomial distribution and smoothing curves to identify combinations of extremes and timing that had the most influence, experimenting with all combinations of temperature and drought data, lagged by 12, 18, 24, 30, and 36 months. We fit models on data from 2002 through 2011, used Akaike’s Information Criterion (AIC) to select the best-fitting model, and used 2012 as out-of-sample data for prediction, and repeated this process for each successive year, ending with fitting models on 2002-2017 data and using 2018 for out-of-sample prediction. We found that warm temperatures and a dry year preceded by a wet year were the strongest predictors of cases of WNV. Our models did significantly better than random chance and better than an annual persistence naïve model at predicting which counties would have cases. Exploring different scenarios, the model predicted that without drought, there would have been 26% fewer cases of WNV in Nebraska through 2018; without warm temperatures, 29% fewer; and with neither drought nor warmth, 45% fewer. This method for assessing the influence of different combinations of extremes at different time intervals is likely applicable to diseases other than West Nile, and to other annual outcome variables such as crop yield.
The question of whether, how, and to what extent climate change is affecting health is central to many climate and health studies. We describe a set of formal methods, termed detection and attribution, used by climatologists to determine whether a climate trend or extreme event has changed and to estimate the extent to which climate change influenced that change. We discuss events where changing weather patterns were attributed to climate change and extend these analyses to include health impacts from heat waves in 2018 and 2019 in Europe and Japan, and we show how such impact attribution could be applied to melting ice roads in the Arctic. Documenting the causal chain from emissions of greenhouse gases to observed human health outcomes is important input into risk assessments that prioritize health system preparedness and response interventions and into financial investments and communication about potential risk to policy makers and to the public.
The urban heat island effect creates warmer and drier conditions in urban areas than in their surrounding rural areas. This effect is predicted to be exacerbated in the future, under a climate change scenario. One way to mitigate this effect is to use the urban green infrastructure as a way to promote the cooling island effect. In this study we aimed to model, with a high spatial resolution, how Mediterranean urban parks can be maximized to be used as cooling islands, by answering the following questions: i) which factors influence the cooling effect and when?; ii) what type of green spaces contributes the most to the cooling effect?; iii) what is the cooling distance of influence? To answer these questions we established a sampling design where temperature and relative humidity were measured in different seasons, in locations with contrasting characteristics of green and grey cover. We were able to model the effect of green and grey spaces in the cooling island effect and build high spatial resolution predicting maps for temperature and relative humidity. Our study showed that even green spaces with reduced areas can regulate microclimate, alleviating temperature by 1-3 °C and increasing moisture by 2-8%, on average. Green spaces with a higher density of trees were more efficient in delivering the cooling effect. The morphology, aspect and level of exposure of grey surfaces to the solar radiation were also important features included in the models. Green spaces influenced temperature and relative humidity up to 60 m away from the parks’ limits, whereas grey areas influenced in a much lesser range, from 5 m up to 10 m. These models can now be used by citizens and stakeholders for green spaces management and human well-being impact assessment.
As the literature on heat tolerance suggests that the elderly are generally more heat-intolerant and suffer more from the substantial impacts of excessive heat on human health, exacerbated by their higher rate of chronic diseases, it is important to learn how to better protect this vulnerable population. Moreover, many studies have shown that, despite their vulnerability, the elderly do not necessarily perceive themselves as being at risk or see heat waves as a danger to their health. This lower risk perception could hinder their adoption of adaptive behavior. Thus, using the theory of planned behavior and the health belief model, this study aimed at developing a more thorough understanding of what motivates older people from the province of Quebec, Canada, to adopt pro-adaptive behaviors to protect themselves from the heat, to better predict and explain their self-reported heat adaptation behaviors, and to identify their most important beliefs. In this quantitative study, a telephone sample of 1002 persons was used to explore the decision-making process of seniors in a way that led us to illustrate specific variables that could be targeted for awareness raising. All three variables of the theory of planned behavior (i.e., attitude, perceived social pressure, and perceived behavioral control) had a statistically significant impact on intention to adapt, while intention itself was linked to adoption of adaptive behaviors. This shows that increasing elderly people’s intention to adapt can have a positive impact on their adaptation to heat, which could help prevent this at-risk population from suffering the dangerous effects of heat waves.
Cities are particularly sensitive to the effects of climate change, causing an increasing incidence of heat waves. Extreme temperatures can impair the use of public spaces in cities, as heat stress endangers human well-being and health. Identifying suitable adaptation measures to maintain the full functionality of public spaces requires a multidimensional approach, accounting for interrelated scientific, social, and practical aspects. As one result we introduce an inter- and transdisciplinary concept that addresses the challenge of adapting public spaces to climate change. Additionally we present a pilot study from Heidelberg, Germany, where a new, sustainable urban quarter experienced more pronounced heat stress than the historic city centre in the hot and dry summer of 2018. The study shows the suitability of our approach to identify appropriate heat adaptation measures. Solar potential modelling and mental map surveys proved to be particularly effective methods. We find that adaptation measures generate synergy effects by improving both climatic and social conditions.
BACKGROUND: Although visceral leishmaniasis (VL), a disease caused by parasites, is controlled in most provinces in China, it is still a serious public health problem and remains fundamentally uncontrolled in some northwest provinces and autonomous regions. The objective of this study is to explore the spatial and temporal characteristics of VL in Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region in China from 2004 to 2018 and to identify the risk areas for VL transmission. METHODS: Spatiotemporal models were applied to explore the spatio-temporal distribution characteristics of VL and the association between VL and meteorological factors in western China from 2004 to 2018. Geographic information of patients from the National Diseases Reporting Information System operated by the Chinese Center for Disease Control and Prevention was defined according to the address code from the surveillance data. RESULTS: During our study period, nearly 90% of cases occurred in some counties in three western regions (Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region), and a significant spatial clustering pattern was observed. With our spatiotemporal model, the transmission risk, autoregressive risk and epidemic risk of these counties during our study period were also well predicted. The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. CONCLUSIONS: The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. Our findings will strengthen the VL control programme in China.
In the aftermath of the 2015 pandemic of Zika virus, concerns over links between climate change and emerging arboviruses have become more pressing. Given the potential that much of the world might remain at risk from the virus, we used a previously established temperature-dependent transmission model for Zika virus (ZIKV) to project climate change impacts on transmission suitability risk by mid-century (a generation into the future). Based on these model predictions, in the worst-case scenario, over 1.3 billion new people could face suitable transmission temperatures for ZIKV by 2050. The next generation will face substantially increased ZIKV transmission temperature suitability in North America and Europe, where naïve populations might be particularly vulnerable. Mitigating climate change even to moderate emissions scenarios could significantly reduce global expansion of climates suitable for ZIKV transmission, potentially protecting around 200 million people. Given these suitability risk projections, we suggest an increased priority on research establishing the immune history of vulnerable populations, modeling when and where the next ZIKV outbreak might occur, evaluating the efficacy of conventional and novel intervention measures, and increasing surveillance efforts to prevent further expansion of ZIKV.
BACKGROUND: An increase of the frequency of uric acid urinary stones compared to calcium-containing ones has been recently described. This study was aimed at assessing the frequency of different types of urinary stones in the population of northern Italy in the period 2016-18 compared to 2001-2003. METHODS: Analyses by infrared spectroscopy of 1007 stones endoscopically removed at two institutions in the area of Milan (Northern Italy) were retrospectively considered. Stones were classified as calcium oxalate monohydrate (COM) and dihydrate (COD), mixed uric acid/calcium oxalate (UC); uric acid (UA), struvite (ST); apatite (CAP); mixed calcium oxalate / apatite (CAPOX); others. The patients were divided into two groups: 2001-2003 and 2016-2018. The average temperature values of the region over the two time periods were obtained by the national statistical institute. RESULTS: The average age of the 2001-2003 group (45.8+/-?15.4?years) was significantly lower than the average age of the 2016-18 group (57.9+/-?14.8) (0.000). M / F ratio was similar in the two groups: 119 / 69 (1,0.58) in 2001-2003 and 527 / 292 (1,0.55) in 2016-18 (p =?0.862). COM stones tended to more frequent in 2016-18 group than in 2001-03. COD stones were significantly more frequent in 2001-03 than in 2016-18. ST stone frequency was increased from 2001 to 03 to 2016-18. No increase of uric acid containing stones was observed in 2016-18. Results were confirmed after adjustment by age. Averages annual regional temperatures increased from 14?°C to 15.4?°C during the two observation periods. CONCLUSIONS: No increase of UA stones was observed, probably due to the limited impact of the global warming in our temperate climate.
BACKGROUND: We assessed the association between multiple meteorological factors and air pollutants and the number of acute myocardial infarction (AMI) cases using a multi-step process. METHODS: Daily AMI hospitalizations matched with 16 meteorological factors and air pollutants in 7 metropolitan provinces of the Republic of Korea from 2002 to 2017 were analyzed. We chose the best fit model after conducting the Granger causality (GC) test and examined the daily lag time effect on the orthogonalized impulse response functions. To define dose-response relationships, we performed a time series analysis using multiple generalized additive lag models based on seasons. RESULTS: A total of 196,762 cases of AMI in patients older than 20 years admitted for hospitalization were identified. The distribution of meteorological factors and air pollutants showed characteristics of a temperate climate. The GC test revealed a complex interaction between meteorological factors, including air pollutants, and AMI. The final selected factors were NO(2) and temperature; these increased the incidence of AMI on lag day 4 during summer (NO(2): population-attributable fraction [PAF], 3.9%; 95% confidence interval [CI], 3.6-4.0; mean temperature: PAF, 3.3%; 95% CI, 2.7-3.9). CONCLUSIONS: This multi-step time series analysis found that average temperature and NO(2) are the most important factors impacting AMI hospitalizations, specifically during summer. Based on the model, we were able to visualize the effect-time association of meteorological factors and air pollutants and AMI.
OBJECTIVES: Preterm births (PTBs) represent significant health risks, and several studies have found associations between high outdoor temperatures and PTB. We estimated both the total and natural direct effects (independent of particulate matter, ozone and nitrogen dioxide air pollutants) of the prior 2-day mean apparent temperature (AT) on PTB. We evaluated effect modification by maternal age, race, education, smoking status and prenatal care. DESIGN AND SETTING: We obtained birth records and meteorological data for the Detroit, Michigan, USA area, for the warm months (May to September), 1991 to 2001. We used a time series Poisson regression with splines of AT, wind speed, solar radiation and citywide average precipitation to estimate total effects. To accommodate multiple mediators and exposure-mediator interactions, AT inverse odds weights, predicted by meteorological and air pollutant covariates, were added in a subsequent model to estimate direct effects. RESULTS: At 24.9°C relative to 18.6°C, 10.6% (95% CI: 3.8% to 17.2%) of PTBs were attributable to the total effects of AT, and 10.4% (95% CI: 2.2% to 17.5%) to direct effects. Relative excess risks of interaction indicated that the risk of PTB with increasing temperature above 18.6°C was significantly lower among black mothers and higher among mothers less than 19, older than 30, with late or no prenatal care and who smoked. CONCLUSION: This additional evidence of a direct association between high temperature and PTB may motivate public health interventions to reduce extreme heat exposures among pregnant women, particularly among those who may have enhanced vulnerability.
It is well known that sudden variations of air temperature have the potential to cause severe impacts on human health. Therefore, it becomes necessary to provide information capable of quantifying the severity of the problem, considering that the continuous increase of temperature due to global warming and urban development will cause more intense effects in heavily populated areas. Due to its geographical location and local characteristics, Ecuador, a country located on the western coast of South America, is characterized by a high vulnerability to climatic extremes. The present research develops an evaluation of urban climate change effects through the analysis of extreme temperature indices using four meteorological stations situated in the city of Guayaquil (southwest Ecuador). Since the available data are not adequate for extreme temperature indices criteria, it was necessary to employ an infilling method for times series in an innovative way that can be applicable at the small scale. Thus, a cross-correlation-enhanced inverse distance weighting (CC-IDW) method was proposed. The method entails a spatial interpolation based on data of urban stations situated outside of Guayaquil by taking into account cross-correlation among times series at precise lags that leads to an improvement in the way of estimating the missing values. Subsequently, a homogeneity test, data quality control and the calculation of extreme temperature indices chosen from those proposed by the World Meteorological Organization (WMO) were implemented. The results show that there is a general tendency of warming with quite homogenous temperatures for all considered stations. However, it should be recognized that the climate pattern of this region is strongly modulated by the El Nino Southern Oscillation (ENSO) cycle. Only for two extreme indices: the highest maximum temperature (TXx) and the warm days (TX90p), are the resulting trend co-efficients statistically significant. The study suggests a deteriorated climatic condition due to heat stress that warrants further study using the available database for the city of Guayaquil.
Disaster risk is a complex, uncertain and evolving threat to society which changes based on broad drivers of hazard, exposure and vulnerability such as population, economic and climatic change, along with new technologies and social preferences. It also evolves as a function of decisions of public policy and public/private investment which alters future risk profiles. These factors however are often not captured within disaster risk assessments and explicitly excluded from the UN General Assembly definition of a disaster risk assessment which focuses on the current state of risk. This means that 1) we cannot adequately capture changes in risk and risk assessments are out of date as soon as published but also 2) we cannot show the benefit of proactive risk treatments in our risk assessments. This paper therefore outlines a generic, scale-neutral, framework for integrating foresight – thinking about the future – into risk assessment methodologies. This is demonstrated by its application to a disaster risk assessment of heatwave risk in Tasmania, Australia, and shows how risk changes across three future scenarios and what proactive treatments could be possible mitigating the identified drivers of future risk.
The temperature-dependence of many important mosquito-borne diseases has never been quantified. These relationships are critical for understanding current distributions and predicting future shifts from climate change. We used trait-based models to characterize temperature-dependent transmission of 10 vector-pathogen pairs of mosquitoes (Culex pipiens, Cx. quinquefascsiatus, Cx. tarsalis, and others) and viruses (West Nile, Eastern and Western Equine Encephalitis, St. Louis Encephalitis, Sindbis, and Rift Valley Fever viruses), most with substantial transmission in temperate regions. Transmission is optimized at intermediate temperatures (23-26°C) and often has wider thermal breadths (due to cooler lower thermal limits) compared to pathogens with predominately tropical distributions (in previous studies). The incidence of human West Nile virus cases across US counties responded unimodally to average summer temperature and peaked at 24°C, matching model-predicted optima (24-25°C). Climate warming will likely shift transmission of these diseases, increasing it in cooler locations while decreasing it in warmer locations.
Ticks may transmit a variety of human and animal pathogens. Prevalence of Borrelia spp., Rickettsia spp. and Anaplasma phagocytophilum in ticks has been monitored in the city of Hanover, Germany, since 2005. However, to determine the infection risk for humans and animals, not only pathogen prevalence, but also tick abundance and seasonality need to be taken into account. Therefore, the aim of this study was to investigate tick abundance at ten different collection sites in the city of Hanover, Germany. Collection of questing ticks was performed by the flagging method in the first and second half of each month during the tick season (April-October) in 2017 and 2018. At each 200 m² collection site, one of four 50 m² fields was sampled per visit on a rotational basis, resulting in 100 m² sampled per month. In addition, data on weather conditions, near-ground temperature, relative humidity and vegetation composition were noted at each collection event. In 2017, a total of 1770 ticks were collected, while 1866 ticks were collected in 2018. Ixodes ricinus was the most prevalent species (97.0 % of all ticks, 98.0 % of nymphs, 91.6 % of adults) followed by I. inopinatus (2.3 % of all ticks, 1.1 % of nymphs, 8.0 % of adults), I. frontalis (0.6 % of all ticks, 0.6 % of nymphs, 0.3 % of adults) and I. hexagonus (0.03 % of all ticks, 0.03 % of nymphs, 0.0 % of adults). Using generalized linear mixed modeling, density of I. ricinus and I. inopinatus in 2017 was significantly higher than in 2018. Regarding different landscape types, ticks were significantly more abundant in mixed forests than in parks, with more than 50 ticks/100 m² on average in both years. In urban parks, average tick density amounted to 15 ticks/100 m² in 2017 and 11 ticks/100 m² in 2018 and in broad-leaved forests average tick density was 13 and 18 ticks/100 m² in 2017 and 2018, respectively. Tick density showed a marked peak in June 2017 and in May 2018 at most sites, whereas a less pronounced peak was recognizable in September. Tick density varied considerably between collection sites. However, no statistically significant effect of (micro-)climatic variables, including near-ground temperature, relative humidity and saturation deficit, was found. Thus, further factors, such as the abundance of wildlife hosts, need to be considered in future studies to explain the differences between collection sites.
Major heat waves are occurring over India during the hottest months of May and June. Since the temperature extremes have major impact on human health and agriculture, better understanding the dynamics behind its evolution and propagation will help us to develop effective mitigation strategies. Understanding the spatio-temporal distribution, evolution and dynamics associated with heat waves is lacking over this region, due to the lack of high-resolution weather information. Here, we developed a high-resolution (4 x 4 km) dynamically downscaled hourly climate data for April to June during period of 2001-2016. The downscaled daily surface temperature is in good agreement with station observations, which is also in agreement with the observed features of temperature distribution during this period. Based on the Indian meteorological department definition, intensity of the heat waves is identified and re-classified into minor and severe category. The spatio-temporal distribution of each heat wave shows variation in its spatial coverage and also in its intensity. The distributions of heat waves are mainly over central India, North-West India and states such as Odisha, Andhra Pradesh and Telangana during pre-monsoon season. Results show that the increase in meridional heat transport is higher than the zonal advection component, and intensification of heat waves is linked with heat accumulation over a particular region associated with weakening of heat transport. The further amplification associated with depletion of soil moisture will result in the reduction in evaporative cooling, and it will further amplify the surface air temperature.
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.
Extreme temperature events (ETEs) pose a significant risk to society, especially vulnerable populations with limited access to shelter and water and those with pre-existing respiratory and cardiovascular ailments. This research examines the relationship of atmospheric circulation with a myriad of metrics related to ETEs to better understand which synoptic-scale circulations are likely to have negative health/thermal comfort outcomes. Daily sea-level pressure (SLP) and 500-hPa geopotential height (z500) data from the North American Regional Reanalysis (NARR) were used to identify circulation patterns over North America. Self-organizing maps were used to partition the variability in circulation patterns over five distinct domains covering North America for both variables. Daily 2-m temperature, 2-m dewpoint temperature, and 10-m wind data from the NARR were used to derive five major categories of ETEs based on 95th percentiles: temperature events, apparent temperature events, dew point events, and excess heat and excess cold temperature events. The relationship of circulation pattern frequencies (SOM nodes) leading up to ETEs were assessed using point biserial correlations, accounting for spatial and temporal autocorrelation. The results show that z500 has a stronger association with ETEs than does SLP. A great deal of spatial variability exists in the strength of relationship for many ETE variables with circulation patterns likely due to the local geographical influence (e.g., leeside mountain adiabatic warming and low-level maritime flow). Generally, high extremes are associated with broad ridging and anticyclonic flow and cold extremes are associated with high amplitude trough patterns with low-level flow originating from the continental interior. The use of self-organizing maps presents a unique way of examining the potential for human health risks related ETEs and may be an effective method for statistically downscaling climate model data to assess the potential for ETEs in the future.
INTRODUCTION: Predicting when fracture incidence will rise assists in healthcare planning and delivery of preventative strategies. The aim of this study was to investigate the relationship between temperature and the incidence of hip and wrist fractures. METHODS: Data for adults presenting to our unit with a hip or wrist fracture over a seven and eight-year period respectively were analysed. Incidence rates were calculated and compared with meteorological records. A Poisson regression model was used to quantify the relationship between temperature and fracture rate. RESULTS: During the respective study periods, 8,380 patients presented with wrist fractures and 5,279 patients were admitted with hip fractures. All women (?50 years: p<0.001; <50 years: p<0.001) and men aged ?50 years (p=0.046) demonstrated an increased wrist fracture rate with reduced temperature. Men aged <50 years also had an increased wrist fracture rate with increased temperature (p<0.001).The hip fracture rate was highest in women aged ?50 years but was not associated with temperature (p=0.22). In men aged ?50 years, there was a significant relationship between reduced temperature and increased fracture rate (p<0.001). CONCLUSIONS: Fragility fracture of the wrist is associated with temperature. Compared with an average summer, an additional 840 procedures are performed for wrist fractures during an average winter in our trust with an additional 798 bed days taken up at a cost of £3.2 million. The winter increase seen in male hip fracture incidence requires approximately 888 surgical procedures, with 18,026 bed days, and costs £7.1 million. Hip fracture incidence in older women is not related to temperature.
Malaria is a vector-borne disease of significant public health concern. Despite widespread success of many elimination initiatives, elimination efforts in some regions of the world have stalled. Barriers to malaria elimination include climate and land use changes, such as warming temperatures and urbanization, which can alter mosquito habitats. Socioeconomic factors, such as political instability and regional migration, also threaten elimination goals. This is particularly relevant in areas where local elimination has been achieved and consequently surveillance and control efforts are dwindling and are no longer a priority. Understanding how environmental change, impacts malaria elimination has important practical implications for vector control and disease surveillance strategies. It is important to consider climate change when monitoring the threat of malaria resurgence due to socioeconomic influences. However, there is limited assessment of how the combination of climate variation, interventions and socioeconomic pressures influence long-term trends in malaria transmission and elimination efforts. In this study, we used Bayesian hierarchical mixed models and malaria case data for a 29-year period to disentangle the impacts of climate variation and malaria control efforts on malaria risk in the Ecuadorian province of El Oro, which achieved local elimination in 2011. We found shifting patterns of malaria between rural and urban areas, with a relative increase ofPlasmodium vivaxin urbanized areas. Minimum temperature was an important driver of malaria seasonality and the association between warmer minimum temperatures and malaria incidence was greater forPlasmodium falciparumcompared toP. vivaxmalaria. There was considerable heterogeneity in the impact of three chemical vector control measures on bothP. falciparumandP. vivaxmalaria. We found statistically significant associations between two of the three measures [indoor residual spraying (IRS) and space spraying] and a reduction in malaria incidence, which varied between malaria type. We also found environmental suitability for malaria transmission is increasing in El Oro, which could limit future elimination efforts if malaria is allowed to re-establish. Our findings have important implications for understanding environmental obstacles to malaria elimination and highlights the importance of designing and sustaining elimination efforts in areas that remain vulnerable to resurgence.
Climate change is resulting in heatwaves that are more frequent, severe, and longer lasting, which is projected to double-to-triple the heat-related mortality in Boston, MA if adequate climate change mitigation and adaptation strategies are not implemented. A case-only analysis was used to examine subject and small-area neighborhood characteristics that modified the association between hot days and mortality. Deaths of Boston, Massachusetts residents that occurred from 2000-2015 were analyzed in relation to the daily temperature and heat index during the warm season as part of the case-only analysis. The modification by small-area (census tract, CT) social, and environmental (natural and built) factors was assessed. At-home mortality on hot days was driven by both social and environmental factors, differentially across the City of Boston census tracts, with a greater proportion of low-to-no income individuals or those with limited English proficiency being more highly represented among those who died during the study period; but small-area built environment features, like street trees and enhanced energy efficiency, were able to reduce the relative odds of death within and outside the home. At temperatures below current local thresholds used for heat warnings and advisories, there was increased relative odds of death from substance abuse and assault-related altercations. Geographic weighted regression analyses were used to examine these relationships spatially within a subset of at-home deaths with high-resolution temperature and humidity data. This revealed spatially heterogeneous associations between at-home mortality and social and environmental vulnerability factors.
Meteorological conditions during pregnancy can affect birth outcome, which has been linked to the H19/H19-differentially methylated region (DMR). However, the detailed mechanisms underlying this association are unclear. This was investigated in the present study to provide epidemiological evidence for elucidating the pathogenesis of adverse birth outcomes. A total of 550 mother-newborn pairs were recruited in Zhengzhou, China from January 2010 to January 2012. Meteorological data including temperature (T), relative humidity (RH), and sunshine duration (SSD) were obtained from the China Meteorological Data Sharing Service System. Bisulfite sequencing PCR was performed to determine the methylation levels of H19/H19-DMR using genomic DNA extracted from maternal peripheral and umbilical cord blood. The results showed that H19-DMR methylation status in cord blood was positively associated with that in maternal blood. Neonatal H19-DMR methylation was negatively associated with T and RH during the first trimester and positively associated with these variables during the third trimester. There was a positive correlation between neonatal H19-DMR methylation and SSD during the second trimester and a negative correlation during the third trimester. Similar associations were observed between maternal H19-DMR methylation and prenatal meteorological conditions. We also observed significant interaction effects of maternal H19/H19-DMR methylation and most prenatal meteorological factors on neonatal methylation, and found that changes in the methylation status of maternal H19-DMR were responsible for the effects of prenatal meteorological conditions on neonatal methylation. In summary, neonatal H19-DMR methylation was significantly associated with prenatal meteorological conditions, which was modified and mediated by maternal H19-DMR methylation changes. These findings provide insights into the relationship between meteorological factors during pregnancy and adverse birth outcomes or disease susceptibility in offspring, and can serve as a reference for environmental policy-making.
PURPOSE: Global warming and air pollution are among the most important problems all over the world. Considering the key role of traffic officers who saliently deal with traffic management and are in full, constant and direct exposure to thermal stress and air pollution index, this study aims to investigate the simultaneous effects of these factors on the body temperature of traffic officers in the main squares of Tehran. METHODS: This study was conducted among 119 traffic officers who were working in 29 squares of Tehran, located near the active pollutant’s stations during 2017. Samples were selected by the census method. Environmental parameters such as air temperature (dry and wet), radiation temperature, the level of air pollution in the main squares and characteristics of officers such as body temperature and the Wet-Bulb-Globe-Temperature (WBGT) index were evaluated. Data were analyzed through independent samples t-test and factorial ANOVA with a p value of p???0.05 in SPSS software. RESULTS: There was no significant relationship between air pollution and ear temperature, but there was a statistically significant difference between the wet-bulb temperature and the ear temperature (t?=?26.4, P?
BACKGROUND: Previous studies have thoroughly elucidated the exposure-response relationship between ambient temperature and hand, foot, and mouth disease (HFMD), whereas very little concern has been to the lag-response relationship and related key time points. OBJECTIVES: We aimed to clarify the temporal characteristics of the lag-response relationship between ambient temperature and HFMD and how they may vary spatially. METHODS: We retrieved the daily time series of meteorological variables and HFMD counts for 143 cities in mainland China between 2009 and 2014. We estimated the city-specific lag-response curve between ambient temperature and HFMD and related key time points by applying common distributed lag nonlinear models (DLNM) and Monte Carlo simulation methods. Then, we pooled the city-specific estimates by performing a meta-regression with the city-specific characteristics as meta-predictors to explain the potential spatial heterogeneity. RESULTS: We found a robust lag pattern between temperature and HFMD for different levels of temperatures. The temporal change of risk obtained its maximum value on the current day but dropped sharply thereafter and then rebounded to a secondary peak, which implied the presence of a harvesting effect. By contrast, the estimation of key time points showed substantial heterogeneity, especially at high temperature (the I(2) statistics ranged from 47% to 80%). With one unit increase in the geographic index, the secondary peak would arrive 0.37 (0.02, 0.71) days later. With one unit increase in the economic index and climatic index, the duration time of the lag-response curve would be lengthened by 0.36 (0.1, 0.62) and 0.92 (0.54, 1.29) days, respectively. CONCLUSION: Our study examined the lag pattern and spatial heterogeneity of the lag-response relationship between temperature and HFMD. Those findings gave us new insights into the complex association and the related mechanisms between weather and HFMD and important information for weather-based disease early warning systems.
Low-cost houses make up the majority of the homes in townships (racially segregated areas which are usually underdeveloped) in South Africa and there has been limited research on the indoor temperatures experienced by residents of these homes. As a developing nation the price and availability of construction materials, often takes precedence over the potential thermal efficiency of the house. Occupants of low-cost houses are particularly vulnerable to climatic changes which may increase the likelihood of exposure to extreme temperatures in South Africa. This study focused on the relationship between indoor and ambient temperature in two study areas namely; Kathorus in Gauteng and Wakkerstroom in Mpumalanga. Three housing types were included in the study (government funded apartheid era houses, government funded post-apartheid houses and informal houses (shacks)). Temperature data loggers were installed in each home, in each area, from June 2017 to July 2018. Ambient temperature data were collected for the period June 2017 to July 2018. The houses studied were built with different materials which affect their thermal efficiency. The study also included semi-structured interviews where occupant’s perspectives on housing could be surveyed. Household temperatures in Kathorus and Wakkerstroom, both in the warmer and colder months fluctuated substantially throughout the day. There was an 8 °C, 9 °C and 14 °C fluctuations in daily indoor temperatures of apartheid-era, post-apartheid and shacks houses, and daily outdoor fluctuations of 5-15 °C, with higher fluctuations measured in Wakkerstroom. Generally, ambient and indoor temperatures were correlated but showed high variability. Indoor data for the winter months were less well correlated. Data showed that residents are subjected to extreme temperatures and these are expected to increase. The householder’s perceptions of thermal comfort were often not related to indoor temperature readings but to behavioural changes including the use of warm clothes and wood burning stoves. The study’s findings suggest that a majority of low-cost houses are thermally inefficient especially for those built in the post-apartheid era and shacks. With these houses showing a clear link between ambient and indoor temperature fluctuations. The occupants of these homes are poor and vulnerable to health risks which could be exacerbated by temperature fluctuations. Small changes such as installation of ceilings and use of insulation could make a large difference in these houses.
BACKGROUND: In Thailand, dengue fever is one of the most well-known public health problems. The objective of this study was to examine the epidemiology of dengue and determine the seasonal pattern of dengue and its associate to climate factors in Bangkok, Thailand, from 2003 to 2017. METHODS: The dengue cases in Bangkok were collected monthly during the study period. The time-series data were extracted into the trend, seasonal, and random components using the seasonal decomposition procedure based on loess. The Spearman correlation analysis and artificial neuron network (ANN) were used to determine the association between climate variables (humidity, temperature, and rainfall) and dengue cases in Bangkok. RESULTS: The seasonal-decomposition procedure showed that the seasonal component was weaker than the trend component for dengue cases during the study period. The Spearman correlation analysis showed that rainfall and humidity played a role in dengue transmission with correlation efficiency equal to 0.396 and 0.388, respectively. ANN showed that precipitation was the most crucial factor. The time series multivariate Poisson regression model revealed that increasing 1% of rainfall corresponded to an increase of 3.3% in the dengue cases in Bangkok. There were three models employed to forecast the dengue case, multivariate Poisson regression, ANN, and ARIMA. Each model displayed different accuracy, and multivariate Poisson regression was the most accurate approach in this study. CONCLUSION: This work demonstrates the significance of weather in dengue transmission in Bangkok and compares the accuracy of the different mathematical approaches to predict the dengue case. A single model may insufficient to forecast precisely a dengue outbreak, and climate factor may not only indicator of dengue transmissibility.
INTRODUCTION: Human dirofilariasis is a disease historically linked to the Mediterranean area. For the last few decades, however, Dirofilaria nematodes have been spreading, both in terms of prevalence and the geographical expansion in non-endemic areas. Currently, cases of human dirofilariasis are recorded in more than 40 countries worldwide. Croatia is considered an endemic area of the Adriatic basin. METHODS: In a nationwide investigation, new and previously published cases of human dirofilariasis in Croatia were analyzed. RESULTS: Since 1996, 30 cases of human dirofilariosis were reported in Croatia. A total of 14 (46,67%) cases were from the coastal and 16 (53,33%) from continental regions of the country. Based on anatomical location, 13 (43,33%) cases were subcutaneous, 12 (40%) were ocular and five (16,67%) occurred in the reproductive organs. In all 30 cases, Dirofilaria repens was identified as the causative agent. CONCLUSIONS: An increase in air temperature as climate change, changes in mosquito fauna, high prevalence of D. repens in dogs and limited use of chemoprophylaxis are possible risk factors for Dirofilaria infection in the Croatian population. Since reporting to epidemiological services is not mandatory in this country, the real number of human dirofilariasis cases is probably significantly higher than published. This emphasizes the need for mandatory reporting of human cases and surveillance of Dirofilaria infection in dogs and mosquitoes in Croatia, following the “One Health” concept.
High air temperatures are a public health threat, causing 1300 deaths annually in the United States (US) along with heat-related morbidity and increased electricity consumption for air-conditioning (AC). Increasing tree canopy cover has been proposed as one way to reduce urban air temperatures. Here, we assemble tree cover and developed land-cover information for 97 US cities, housing 59 million people, and use regression relationships to analyze how much current urban tree cover reduces summer (JJA) air temperatures and associated heat-related mortality, morbidity, and electricity consumption. We find that 78% of urban dwellers are in neighborhoods with less than 20% tree cover. Some 15.0 million people (25% of total) experience a reduction of 0.5-1.0 degrees C from tree cover, with another 7.9 million (13% of total) experiencing a reduction of greater than 1.0 degrees C. Current relationships between temperature and health outcomes imply that urban tree cover helps avoid 245-346 deaths annually. Heat-mortality relationships in the 1980s, when a smaller fraction of US households had AC, imply a greater role in the past for urban tree cover in avoiding heat-related mortality. As AC availability has increased, the value of tree cover for avoiding heat-related mortality has decreased, while the value of tree cover for reducing electricity consumption likely has increased. Currently, for the 97 cities studied, the total annual economic value of avoided mortality, morbidity, and electricity consumption is an estimated $1.3-2.9 billion, or $21-49 annually per capita. Applying our results to the entire US urban population, we estimate urban tree cover annually supplies heat-reduction services worth $5.3-12.1 billion.
Fuel poverty has increasingly been associated with thermal discomfort, health related issues and winter deaths in the Global North because it can force families to choose between food and a warmer environment. Juxtaposing the concept of fuel poverty in rural tropical areas of the Global South, it is likely that a similar pattern between fuel poverty and heat related illnesses can be found. A recent study shows that between 1.8 and 4.1 billion people, especially in India, Southeast Asia and Sub-Saharan Africa will need indoor cooling to avoid heat related health issues. This paper aims to address a blind spot in the literature on the links between fuel poverty, thermal comfort and cooling strategies in the Brazilian Amazon. This study draws from current definitions and indicators of fuel poverty in the Global North and juxtaposes it in the context of tropical areas to understand how fuel poverty affects human health, livelihood strategies and social justice in rural communities that live in hot climates. To do so, this paper uses qualitative methods and a conceptual framework to guide the analysis. I call the intersection between vernacular architecture and sustainable cooling practices ‘energy relief.
This study was conducted in order to explore the effect of thermal comfort on all-cause mortality using three indices in different lag times, in a semi-arid to dry region of Iran. Three thermal comfort indices based on the energy balance of the human body including physiologically equivalent temperature (PET), predicted mean vote (PMV), and standard effective temperature (SET) were used to assess the effects of thermal comfort on mortality. Distributed lag non-linear models were used to assess the relation. The natural cubic spline was chosen as the basis function for the space of predictors and lags, with 4 degrees of freedom. All three indices showed the same pattern in general, but the relative risk for PMV values were more than the other indices in different lags. For all three indices, lag 0 had the highest relative risk of mortality in warm and hot indices. The relative risk for warm and hot values was more than cool and cold values in lag 0, and for the PMV index, it was larger than the two other indices. These results were different in lags 5 to 8, and the relative risks for cool and cold values were more than warm and hot values. This study showed that heat stress has a stronger and more immediate adverse effect on mortality than cold stress. Also, the elderly and females are more vulnerable than others. The most apparent effect was seen in lags 0-12.
Temperature is widely known to influence the spatio-temporal dynamics of vector-borne disease transmission, particularly as temperatures vary across critical thermal thresholds. When temperature conditions exhibit such ‘transcritical variation’, abrupt spatial or temporal discontinuities may result, generating sharp geographical or seasonal boundaries in transmission. Here, we develop a spatio-temporal machine learning algorithm to examine the implications of transcritical variation for West Nile virus (WNV) transmission in the Los Angeles metropolitan area (LA). Analysing a large vector and WNV surveillance dataset spanning 2006-2016, we found that mean temperatures in the previous month strongly predicted the probability of WNV presence in pools of Culex quinquefasciatus mosquitoes, forming distinctive inhibitory (10.0-21.0°C) and favourable (22.7-30.2°C) mean temperature ranges that bound a narrow 1.7°C transitional zone (21-22.7°C). Temperatures during the most intense months of WNV transmission (August/September) were more strongly associated with infection probability in Cx. quinquefasciatus pools in coastal LA, where temperature variation more frequently traversed the narrow transitional temperature range compared to warmer inland locations. This contributed to a pronounced expansion in the geographical distribution of human cases near the coast during warmer-than-average periods. Our findings suggest that transcritical variation may influence the sensitivity of transmission to climate warming, and that especially vulnerable locations may occur where present climatic fluctuations traverse critical temperature thresholds.
Limited research exists on the influence of climatic conditions on the risk of hospital admission for asthma in Minas Gerais, Brazil. The objectives of this article are: a) to evaluate the influence of climatic conditions on hospital admissions for asthma and lower respiratory tract infections (LRTIs) among children and adolescents living in Belo Horizonte during the period 2002 to 2012 and identify epidemic peaks of admissions for asthma; b) to compare local seasonal patterns of admissions for asthma and LRTIs. Using hospital admission data stratified by aged group, regression analysis was performed to determine the relationship between the variables. Epidemic peaks were identified using an ARIMA model. There was an increase in admissions for asthma with an increase in relative humidity after rainy periods; admissions for bronchiolitis were associated with low levels of maximum temperature and rainfall. Rainy periods can lead to an increase in indoor and outdoor humidity, facilitating fungal proliferation, while cold periods can lead to an increase in the spread of viruses.
Objectives. To examine the impact of extreme heat on emergency services in Boston, MA.Methods. We conducted relative risk and time series analyses of 911 dispatches of the Boston Police Department (BPD), Boston Emergency Medical Services (BEMS), and Boston Fire Department (BFD) from November 2010 to April 2014 to assess the impact of extreme heat on emergency services.Results. During the warm season, there were 2% (95% confidence interval [CI]?=?0%, 5%) more BPD dispatches, 9% (95% CI?=?7%, 12%) more BEMS dispatches, and 10% (95% CI?=?5%, 15%) more BFD dispatches on days when the maximum temperature was 90°F or higher, which remained consistent when we considered multiple days of heat. A 10°F increase in daily maximum temperature, from 80° to 90°F, resulted in 1.016, 1.017, and 1.002 times the expected number of daily BPD, BEMS, and BFD dispatch calls, on average, after adjustment for other predictors.Conclusions. The burden of extreme heat on local emergency medical and police services may be agency-wide, and impacts on fire departments have not been previously documented.Public Health Implications. It is important to account for the societal burden of extreme heat impacts to most effectively inform climate change adaptation strategies and planning.
A yellow fever epidemic occurred in Cadiz and other areas of southern Spain during the last months of 1800. An anonymous author attributed this disease to the contrast between the cold and rainy winter and spring, and the subsequent very hot summer. However, the physician J.M. Arejula published a report in 1806 where he refuted this conclusion after a detailed analysis of the meteorological conditions in the area. This controversy is a good example of the discussion about the relationships between meteorological conditions and public health. In this work, this “scientific” controversy is studied. Although the arguments of both authors were inspired by the neo-Hippocratic medical paradigm, the anonymous author put forth a simple cause effect hypothesis, while Arejula recognized the complexity of the problem, introducing the concept of “concause” to explain the confluence of environmental and contagious effects.
The aim of the present study was to analyse the effect of weather conditions on Ambrosia artemisiifolia air pollen concentrations in the highly invaded area of western Romania. The investigation of Ambrosia pollen concentrations was carried out for a period of ten years by means of the volumetric method. Ambrosia pollen concentrations had increasing trend over study period. The results of cluster analysis show that two main groups were identified: group A, with lower SPI and group B, with much higher SPI. The statistical correlation between pollen concentrations and meteorological factors was determined by Pearson’s test. The relationships between Ambrosia pollen concentrations and meteorological parameters, were further assessed using multiple linear regression techniques. The pollen emissions are affected by meteorological factors in the main pollen season. Our results suggest that the abundance of Ambrosia artemisiifolia in western Romania is massive. The Ambrosia pollen load of Timisoara is most important between 15 August – 15 September. Consequently, this is the most dangerous period of the year for allergic reactions. The investigation of Ambrosia pollen behaviour in the atmosphere is a compulsory step for measures to stop the spread and establishing control. Ambrosia pollen represents a major health problem and can be considered the main aero allergenic plant pollen in our region.
OBJECTIVES: To investigate the effects of climatic variables on peritoneal dialysis-associated peritonitis (PDAP) among patients receiving PD, such as seasonal variations in temperature and humidity. METHODS: A retrospective analysis was performed on PD patients, from 1 January 2011, to 31 December 2019. We evaluated the influence of seasonal factors on peritonitis rates and outcomes. RESULTS: Over the 9-year study period, 667 peritonitis episodes occurred, in 401 PD patients. Diarrhea-associated peritonitis occurred more frequently in summer compared with other seasons. Eating raw and cold food was identified as the primary cause of peritonitis in the summer. More peritonitis episodes occurred during summer. The peritonitis rate associated with gram-negative bacteria (p?=?0.050) during summer was higher than those in all other seasons. The gram-negative bacterial peritonitis rate was positively correlated with monthly mean temperature (r?=?0.504, p?<?0.01) and humidity (r?=?0.561, p?<?0.01). A similar trend was observed for Enterobacterial peritonitis (temperature: r?=?0.518, p?<?0.01; humidity: r?=?0.456, p?=?0.001). Logistic regression analysis showed that summer was a risk factor for peritonitis (p?=?0.041). Peritonitis prognosis during summer was significantly worse than those for all other seasons (p?=?0.037). CONCLUSIONS: Seasonal variations exist in the incidence of dialysis-associated peritonitis, with peak incidents caused by gram-negative bacteria in the summer. High average temperature and humidity are associated with significant increases in the gram-negative bacteria and Enterobacterial peritonitis rates. Peritonitis prognosis during summer is worse.
The physical nature of the built urban environment gives rise to urban heat islands (UHI), making many cities frequently thermally uncomfortable in the summer, with potentially serious effects on human health. When climate change effects of higher summer temperatures and prolonged heatwaves are factored in, it is clear that adaptive measures are needed to ensure the liveability of cities. The shade provided by planting trees is one such adaptation measure. This study, in Bolzano, Italy, used a thermal camera to record the surface temperatures of three common urban surfaces – asphalt, porphyry, and grass – in the shade of 332 single tree crowns, of 85 different species, during the peak temperature period of summer days. By comparing with the temperature of adjacent unshaded ground, estimates of the degree of surface cooling were made. Measurements at three locations within the shadow revealed higher cooling in the centre and at the western edge. The cooling was related to a multitude of tree traits, of which Leaf Area Index estimate (LAIcept) and crown width were the most important. Median average cooling of 16.4, 12.9 and 8.5 degrees C was seen in the western edge of the tree shade for asphalt, porphyry and grass, respectively. Maximum temperatures were reduced by roughly 19 degrees C for all surface types. Coniferous trees were capable of providing high cooling, however, crown dimensions may limit the receiving surface area. Descriptive and predictive multiple linear regression models were able to predict cooling with some success from several of the predictor variables (LAIcept and gap fraction). Strategic planting of single trees in cities can have significant impacts on the absorption of solar radiation by ground surface materials thus reducing the heat storage that contributes to UHIs.
The interactive effects between particulate matter (PM) and heat waves on circulatory mortality are under-researched in the context of global climate change. We aimed to investigate the interaction between heat waves and PM on circulatory mortality in Fuzhou, a city characterized by a humid subtropical climate and low level of air pollution in China. We collected data on deaths, pollutants, and meteorology in Fuzhou between January 2016 and December 2019. Generalized additive models were used to examine the effect of PM on circulatory mortality during the heat waves, and to explore the interaction between different PM levels and heat waves on the circulatory mortality. During heat waves, circulatory mortality was estimated to increase by 8.21% (95% confidence intervals (CI): 0.32-16.72) and 3.84% (95% CI: 0.28-7.54) per 10 ?g/m(3) increase of PM(2.5) and PM(10), respectively, compared to non-heat waves. Compared with low-level PM(2.5) concentration on non-heat waves layer, the high level of PM(2.5) concentration on heat waves layer has a significant effect on the cardiovascular mortality, and the effect value was 48.35% (95% CI: 6.37-106.89). Overall, we found some evidence to suggest that heat waves can significantly enhance the impact of PM on circulatory mortality.
Evidence on the long-term influence of climatic variables on pertussis is limited. This study aims to explore the long-term quantitative relationship between weather variability and pertussis. Data on the monthly number of pertussis cases and weather parameters in Chongqing in the period of 2004-2018 were collected. Then, we used a negative binomial multivariable regression model and cointegration testing to examine the association of variations in monthly meteorological parameters and pertussis. Descriptive statistics exhibited that the pertussis incidence rose from 0.251 per 100,000 people in 2004 to 3.661 per 100,000 persons in 2018, and pertussis was a seasonal illness, peaked in spring and summer. The results from the regression model that allowed for the long-term trends, seasonality, autoregression, and delayed effects after correcting for overdispersion showed that a 1 hPa increment in the delayed one-month air pressure contributed to a 3.559% (95% CI 0.746-6.293%) reduction in the monthly number of pertussis cases; a 10 mm increment in the monthly aggregate precipitation, a 1 °C increment in the monthly average temperature, and a 1 m/s increment in the monthly average wind velocity resulted in 3.641% (95% CI 0.960-6.330%), 19.496% (95% CI 2.368-39.490%), and 3.812 (95% CI 1.243-11.690)-fold increases in the monthly number of pertussis cases, respectively. The roles of the mentioned weather parameters in the transmission of pertussis were also evidenced by a sensitivity analysis. The cointegration testing suggested a significant value among variables. Climatic factors, particularly monthly temperature, precipitation, air pressure, and wind velocity, play a role in the transmission of pertussis. This finding will be of great help in understanding the epidemic trends of pertussis in the future, and weather variability should be taken into account in the prevention and control of pertussis.
BACKGROUND: Growing evidence suggests that the diurnal temperature range (DTR) could modify the temperature-disease relationship for those environmentally-related infectious diseases. However, there is a lack of evidence on the hand, foot and mouth disease (HFMD). In this study, we thoroughly examined this hypothesis via a nationwide study. METHOD: We collected the daily time series of HFMD cases and meteorological factors of 143 cities in mainland China from 2009 to 2014. For each city, we calculated the arithmetic average of the meteorological factors as a proxy for the climatic differences. We then performed two-stage time series analyses for four different climatic regions. Specifically, a distributed lag nonlinear model was applied to estimate the temperature-HFMD relationship for each city, and then a multivariate meta-regression was implemented to examine whether the DTR could explain the potential heterogeneity as an effect modifier. In addition, we compared the modification effect of the DTR with those of other climatic factors. RESULT: We found a significant modification effect of DTR on the temperature-HFMD relationship in the moderate-temperature region. Besides, the modification effect was only observed at hot temperatures. Comparing the maximum temperature (32.2 °C) to the median temperature (11.9 °C), the risk ratio was 1.60 (1.33, 1.92) when DTR was in the 10th percentile (6.8 °C) and 0.81 (0.69, 0.96) when the DTR was in the 90th percentile (11.8 °C). By comparing DTR with other climatic variables, we found that the DTR had the best performance in improving the model fit (?QAIC= 10.1) and reducing the heterogeneity (?I(2) = 3.1%) in the multivariate meta-regression. CONCLUSION: Our findings verified that DTR can modify the temperature-HFMD relationship. Besides, our findings also implied that DTR could be used as a proxy variable to comprehensively reflect the modification effects of multiple climatic factors.
Cardiovascular disease is the most common cause of death globally. Examining the relationship between the extreme temperature events (e.g. heat and cold waves) and cardiovascular mortality has profound public significance. However, this evidence is scarce, particularly those from China. We collected daily data on cardiovascular mortality and meteorological conditions from 31 major Chinese cities during the maximum period of 2007-2013. A two-stage analysis was used to estimate the effects of heat and cold waves, and the potential effect modification of their characteristics (intensity, duration, and timing in season) on cardiovascular mortality. Firstly, a generalized quasi-Poisson regression combined with distributed lag nonlinear model was used to evaluate city-specific effects. Then, the meta-analysis was performed to pool effect estimates at the national scale. Overall, cardiovascular mortality risk increased by 19.03% (95%CI: 11.92%, 26.59%) during heat waves and 54.72% (95%CI: 21.20%, 97.51%) during cold waves. The effect estimates varied by the wave’s characteristics. In heat wave days, the cardiovascular mortality risks increased by 3.28% (95%CI: -0.06%, 6.73%) for every 1 degrees C increase in intensity, 2.84% (95%CI: 0.92%, 4.80%) for every 1-d more in duration and -0.07% (95%CI: -0.38%, 0.24%) for every 1-d late in the staring of heat wave; the corresponding estimates for cold wave were 1.82% (95%CI: -0.04%, 3.72%), 1.52% (95%CI: 0.60%, 2.44%) and -0.26% (95%CI: -0.67%, 0.16%). Increased susceptibility to heat and cold waves was observed among patients with ischemic heart disease, females, the elderly, and those with lower education level. And consistent vulnerable populations were found for the effects of changes in cold and heat wave’s characteristics. The findings have important implications for the development of early warning systems and plans in response to heat and cold waves, which may contribute to mitigating health threat to vulnerable populations.
(1) Background: The adverse health effect associated with extreme temperature has been extensively reported in the current literature. Some also found that temperature effect may vary among the population with different socioeconomic status (SES), but found inconsistent results. Previous studies on the socioeconomic vulnerability of temperature effect were mainly achieved by multi-city or country analysis, but the large heterogeneity between cities may introduce additional bias to the estimation. The linkage between death registry and census in Hong Kong allows us to perform a city-wide analysis in which the study population shares virtually the same cultural, lifestyle and policy environment. This study aims to examine and compare the high and low temperature on morality in Hong Kong, a city with a subtropical climate and address a key research question of whether the extreme high and low temperature disproportionally affects population with lower SES. (2) Methods: Poisson-generalized additive models and distributed-lagged nonlinear models were used to examine the association between daily mortality and daily mean temperature between 2007-2015 with other meteorological and confounding factors controlled. Death registry was linked with small area census and area-level median household income was used as the proxy for socioeconomic status. (3) Results: 362,957 deaths during the study period were included in the analysis. The minimum mortality temperature was found to be 28.9 °C (82nd percentile). With a subtropical climate, the low temperature has a stronger effect than the high temperature on non-accidental, cardiovascular, respiratory and cancer deaths in Hong Kong. The hot effect was more pronounced in the first few days, while cold effect tended to last up to three weeks. Significant heat effect was only observed in the lower SES groups, whilst the extreme low temperature was associated with significantly higher mortality risk across all SES groups. The older population were susceptible to extreme temperature, especially for cold. (4) Conclusions: This study raised the concern of cold-related health impact in the subtropical region. Compared with high temperature, low temperature may be considered a universal hazard to the entire population in Hong Kong rather than only disproportionally affecting people with lower SES. Future public health policy should reconsider the strategy at both individual and community levels to reduce temperature-related mortality.
The 2018 outbreak of dengue in the French overseas department of Réunion was unprecedented in size and spread across the island. This research focuses on the cause of the outbreak, asserting that climate played a large role in the proliferation of the Aedes albopictus mosquitoes, which transmitted the disease, and led to the dengue outbreak in early 2018. A stage-structured model was run using observed temperature and rainfall data to simulate the life cycle and abundance of the Ae. albopictus mosquito. Further, the model was forced with bias-corrected subseasonal forecasts to determine if the event could have been forecast up to 4 weeks in advance. With unseasonably warm temperatures remaining above 25°C, along with large tropical-cyclone-related rainfall events accumulating 10-15 mm per event, the modeled Ae. albopictus mosquito abundance did not decrease during the second half of 2017, contrary to the normal behavior, likely contributing to the large dengue outbreak in early 2018. Although subseasonal forecasts of rainfall for the December-January period in Réunion are skillful up to 4 weeks in advance, the outbreak could only have been forecast 2 weeks in advance, which along with seasonal forecast information could have provided enough time to enhance preparedness measures. Our research demonstrates the potential of using state-of-the-art subseasonal climate forecasts to produce actionable subseasonal dengue predictions. To the best of the authors’ knowledge, this is the first time subseasonal forecasts have been used this way.
BACKGROUND: Intense studies have been carried out on the effects of climate change on vector-borne diseases and vectors. Culex pipiens pallens and Culex pipiens quinquefasciatus are two medically concerned mosquito species in temperate and tropical areas, which serve as important disease-transmitting pests of a variety of diseases. The ongoing geographical expansion of these mosquitoes has brought an increasing threat to public health. RESULTS: Based on mosquito occurrence records and high-resolution environmental layers, an ecological niche model was established to model their current and future potential distribution in China. Our model showed that the current suitable area for Cx. p. pallens is distributed in the central, eastern and northern parts of China, while Cx. p. quinquefasciatus is distributed in vast areas in southern China. Under future climate change scenarios, both species are predicted to expand their range to varying degrees and RCP 8.5 provides the largest expansion. Northward core shifts will occur in ranges of both species. Environmental variables which have significant impact on the distribution of mosquitoes were also revealed by our model. CONCLUSION: Severe habitat expansion of vectors is likely to occur in the future 21st century. Our models mapped the high-risk areas and risk factors which needs to be paid attention. The results of our study can be referenced in further ecological surveys and will guide the development of strategies for the prevention and control of vector-borne diseases. © 2020 Society of Chemical Industry.
BACKGROUND: Impact of climate change on tick-borne encephalitis (TBE) prevalence in the tick-host enzootic cycle in a given region depends on how the region-specific climate change patterns influence tick population development processes and tick-borne encephalitis virus (TBEV) transmission dynamics involving both systemic and co-feeding transmission routes. Predicting the transmission risk of TBEV in the enzootic cycle with projected climate conditions is essential for planning public health interventions including vaccination programs to mitigate the TBE incidence in the inhabitants and travelers. We have previously developed and validated a mathematical model for retroactive analysis of weather fluctuation on TBE prevalence in Hungary, and we aim to show in this research that this model provides an effective tool for projecting TBEV transmission risk in the enzootic cycle. METHODS: Using the established model of TBEV transmission and the climate predictions of the Vas county in western Hungary in 2021-2050 and 2071-2100, we quantify the risk of TBEV transmission using a series of summative indices – the basic reproduction number, the duration of infestation, the stage-specific tick densities, and the accumulated (tick) infections due to co-feeding transmission. We also measure the significance of co-feeding transmission by observing the cumulative number of new transmissions through the non-systemic transmission route. RESULTS: The transmission potential and the risk in the study site are expected to increase along with the increase of the temperature in 2021-2050 and 2071-2100. This increase will be facilitated by the expected extension of the tick questing season and the increase of the numbers of susceptible ticks (larval and nymphal) and the number of infected nymphal ticks co-feeding on the same hosts, leading to compounded increase of infections through the non-systemic transmission. CONCLUSIONS: The developed mathematical model provides an effective tool for predicting TBE prevalence in the tick-host enzootic cycle, by integrating climate projection with emerging knowledge about the region-specific tick ecological and pathogen enzootic processes (through model parametrization fitting to historical data). Model projects increasing co-feeding transmission and prevalence of TBEV in a recognized TBE endemic region, so human risk of TBEV infection is likely increasing unless public health interventions are enhanced.
Previous studies that observed the fact that Middle Palaeolithic sites mainly were concentrated in arid and semi-arid areas in Africa and Southwest Asia, concluded that climate factors determined the distribution patterns. We argue that biological factors could have been equally important. In present-day sub-Saharan Africa, mosquito borne diseases and especially falciparum malaria have a serious impact on human populations. This study was aimed to investigate the possible former effect of falciparum malaria on Middle Palaeolithic site distribution patterns and explain why ancient humans avoided the humid areas in the tropical and subtropical regions. It was found that the early human settlements situated in those regions of Africa and Southwest Asia where the potential annual development period of falciparum parasites was short in the mosquitoes, the area was not too humid, and the potential falciparum malaria incidence values were low or moderate. In the Indian Peninsula, precipitation played a less significant role in determining human settlements. The number of the months when the extrinsic development of Plasmodium falciparum parasites was possible showed the strongest structural overlap with the modelled malaria incidences according to the spatial occurrence of the Middle Paleolithic archaeological sites in the case of Africa and in Southwest Asia. In the Indian Peninsula, climatic factors showed the strongest structural overlap with the modelled malaria incidences according to the occurrence patterns of the Middle Palaeolithic archaeological sites.
The impacts of heat waves in a warming climate depend not only on changing temperatures but also on changing humidity. Using 35 simulations from the Community Earth System Model Large Ensemble (CESM LENS), we investigate the long-term evolution of the joint distribution of summer relative humidity (RH) and daily maximum temperature (Tmax) near four U.S. cities (New York City, Chicago, Phoenix, and New Orleans) under the high-emissions Representative Concentration Pathway (RCP) 8.5. We estimate the conditional quantiles of RH givenTmaxwith quantile regression models, using functions of temperature for each city in July for three time periods (1990-2005, 2026-2035, and 2071-2080). Quality-of-fit diagnostics indicate that these models accurately estimate conditional quantiles for each city. As expected, each quantile ofTmaxincreases from 1990-2005 to 2071-2080, while mean RH decreases modestly. Conditional upon a fixed quantile ofTmax, the median and high quantiles of RH decrease, while those of the Heat Index (HI) and dew point both increase. This result suggests that, despite a modest decrease in median relative humidity, heat stress measured by metrics considering both humidity and temperature in a warming climate will increase faster than that measured by temperatures alone would indicate. For a fixedTmax, the high quantiles of RH (and thus of HI and dew point) increase from 1990-2005 to 2071-2080 in all four cities. This result suggests that the heat stress of a day at a givenTmaxwill increase in a warming climate due to the increase of RH.
Background: Extreme heat is associated with increased morbidity but most studies examine this relationship in warm seasons. In Southern California, Santa Ana winds (SAWs) are associated with high temperatures during the fall, winter and spring, especially in the coastal region. Objectives: Our aim was to examine the relationship between hospitalizations and extreme heat events in the fall, winter and spring, and explore the potential interaction with SAWs. Methods: Hospitalizations from 1999-2012 were obtained from the Office of Statewide Health Planning and Development Patient Discharge Data. A time-stratified case crossover design was employed to investigate the association between off-season heat and hospitalizations for various diagnoses. We examined the additive interaction of SAWs and extreme heat events on hospitalizations. Results: Over 1.5 million hospitalizations occurred in the Southern California coastal region during non-summer seasons. The 99th percentile-based thresholds that we used to define extreme heat events varied from a maximum temperature of 22.8 degrees C to 35.1 degrees C. In the fall and spring, risk of hospitalization increased for dehydration (OR: 1.23, 95% CI: 1.04, 1.45 and OR: 1.47 95% CI: 1.25, 1.71, respectively) and acute renal failure (OR: 1.35, 95% CI: 1.15, 1.58 and OR: 1.39, 95% CI: 1.19, 1.63, respectively) during 1-day extreme heat events. We also found an association between 1-day extreme heat events and hospitalization for ischemic stroke, with the highest risk observed in December. The results indicate that SAWs correspond to extreme heat events, particularly in the winter. Finally, we found no additive interaction with SAWs. Discussion: Results suggest that relatively high temperatures in non-summer months are associated with health burdens for several hospitalization outcomes. Heat action plans should consider decreasing the health burden of extreme heat events year-round.
During intense heat episodes, the human population suffers from an increased morbidity and mortality. In order to minimize such negative health impacts, the general public and the public health authorities are informed and warned by means of an advanced procedure known as a “heat health warning system” (HHWS). It is aimed at triggering interventions and at taking preventive measures. The HHWS in Germany has been in operation since 2005. The present work is aimed at showing the updated structure of an advanced HHWS that has been developed further several times during its 15 years of operation. This is to impart knowledge to practitioners about the concept of the system. In Germany, dangerous heat episodes are predicted on the basis of the numerical weather forecast. The perceived temperature as an appropriate thermal index is calculated and used to assess the levels of heat stress. The thermo-physiologically based procedure contains variable thresholds taking into account the short time acclimatization of the people. The forecast system further comprises the nocturnal indoor conditions, the specific characteristics of the elderly population, and the elevation of a region. The heat warnings are automatically generated, but they are published with possible adjustments and a compulsory confirmation by the biometeorology forecaster. Preliminary studies indicate a reduction in the heat related outcomes. In addition, the extensive duration of the strongest heat wave in summer 2018, which lasted three weeks, highlights the necessity of the HHWS to protect human health and life.
The H1N1 “Spanish influenza” pandemic of 1918-1919 caused the highest known number of deaths recorded for a single pandemic in human history. Several theories have been offered to explain the virulence and spread of the disease, but the environmental context remains underexamined. In this study, we present a new environmental record from a European, Alpine ice core, showing a significant climate anomaly that affected the continent from 1914 to 1919. Incessant torrential rain and declining temperatures increased casualties in the battlefields of World War I (WWI), setting the stage for the spread of the pandemic at the end of the conflict. Multiple independent records of temperature, precipitation, and mortality corroborate these findings.
Although seasonal influenza viruses circulate globally, prevention and treatment occur at the level of regions, cities, and communities. At these scales, the timing, duration and magnitude of epidemics vary substantially, but the underlying causes of this variation are poorly understood. Here, based on analyses of a 15-year city-level dataset of 18,250 laboratory-confirmed and antigenically-characterised influenza virus infections from Australia, we investigate the effects of previously hypothesised environmental and virological drivers of influenza epidemics. We find that anomalous fluctuations in temperature and humidity do not predict local epidemic onset timings. We also find that virus antigenic change has no consistent effect on epidemic size. In contrast, epidemic onset time and heterosubtypic competition have substantial effects on epidemic size and composition. Our findings suggest that the relationship between influenza population immunity and epidemiology is more complex than previously supposed and that the strong influence of short-term processes may hinder long-term epidemiological forecasts.
Arid and semi-arid climates, including that of Iran, are more susceptible to environmental changes due to their special ecological structure than other climates. Therefore, climate change in these areas appears to have significant effects on agricultural and food production systems. The present study explores the effect of climatic changes on total horticultural production and food security in agro-ecological zones of Iran. The study was conducted in two steps. In the first step, the effects of climatic parameters on total horticultural production were investigated using time series data (1985-2017) and a regression model. In the second step, due to the important role of horticultural products in per capita food consumption in Iran, the effect of climate parameters on food security was also examined. Results revealed that total horticultural production was influenced by temperature, evapotranspiration, and wind speed at the 0.05 level. With the increase in temperature (at a rate of one unit), total horticultural production is reduced to 0.01 million tons. Evapotranspiration and wind speed have had a negative effect on total horticultural production, and with increasing evapotranspiration and wind speed, total horticultural production was 0.029 and 0.008 million, respectively, tons decreased. Also, food security was influenced by temperature, precipitation, and wind speed.
Objective: To determine the significance of temperature, rainfall and humidity in the seasonal abundance of Anopheles stephensi in southern Iran. Methods: Data on the monthly abundance of Anopheles stephensi larvae and adults were gathered from earlier studies conducted between 2002 and 2019 in malaria prone areas of southeastern Iran. Climatic data for the studied counties were obtained from climatology stations. Generalized estimating equations method was used for cluster correlation of data for each study site in different years. Results: A significant relationship was found between monthly density of adult and larvae of Anopheles stephensi and precipitation, max temperature and mean temperature, both with simple and multiple generalized estimating equations analysis (P<0.05). But when analysis was done with one month lag, only relationship between monthly density of adults and larvae of Anopheles stephensi and max temperature was significant (P<0.05). Conclusions: This study provides a basis for developing multivariate time series models, which can be used to develop improved appropriate epidemic prediction systems for these areas. Long-term entomological study in the studied sites by expert teams is recommended to compare the abundance of malaria vectors in the different areas and their association with climatic variables.
BACKGROUND: Compared to hospital admissions (HAs), emergency ambulance dispatches (EADs) can be considered a real-time outcome for evaluating the public health impacts of ambient temperature. OBJECTIVES: This study aimed to assess if temperature has a causal effect on cause-specific EADs and its potential main and added effect in Shenzhen from 2013 to 2017. METHODS: A distributed lag nonlinear model (DLNM) with quasi-Poisson distribution was applied to quantify the association between temperature and EADs. Likewise, the fraction of EADs attributable to different temperature ranges was calculated to identify extreme temperature ranges affecting population health. We then explored the main and added wave effects of heatwaves. RESULTS: Ambient temperature showed a U-shaped association with EADs. The minimum risk temperature was 17 °C (16th percentile of the daily mean temperature). Compared with the cold, the relative risk (RR) of heat on EADs presented smaller but the attributable risk larger. The main effects of heatwaves on EADs varied with external causes; and the peak RR of heat on EADs was observed in suicidal behaviors with heatwaves defined as 3 or more days with temperatures above the 75th percentile (RR = 4.53, 95% CI: 1.23-16.68), followed by assault (RR = 2.36, 95% CI: 1.25-4.48) and accidents (RR = 1.72, 95% CI: 1.30-2.28), while the added wave effect was negligible. CONCLUSIONS: Heat was responsible for a higher proportion of EADs than cold. Most of the increase in health risk during warm season can be simply ascribed to the independent effects of daily temperature occurrences whether it is or not on the heat-wave day. And the main effects of heatwaves on cause-specific EADs showed varied change trends, of which the incidence of suicides seems more susceptible, followed by assault and accidents.
Although there is significant scientific evidence on the impact of heat waves, there are few studies that analyze the effects of sociodemographic factors on the impact of heat waves below the municipal level. The objective of this study was to analyze the role of income level, percent of the population over age 65, existence of air conditioning units and hectares (Ha) of green zones in districts in Madrid, in the impact of heat on daily mortality between January 1, 2010 and December 31, 2013. Seventeen districts were analyzed, and Generalized Linear (GLM) Poisson Regression Models were used to calculate relative risks (RR) and attributable risks (RA) for the impact of heat waves on mortality due to natural causes (CIEX:A00-R99). The pattern of risks obtained was analyzed using GLM univariates and multivariates of the binomial family (link logit), introducing the socioeconomic and demographic variables mentioned above. The results indicate that heat wave had an impact in only three of the districts analyzed. In the univariate models, all of the variables were statistically significant, but Ha of green zones lost significance in the multivariate model. Income level, existence of air conditioning units, and percent of the population over age 65 in the district remained as variables that modulate the impact of heat wave on daily mortality in the municipality of Madrid. Income level was the key variable that explained this behavior. The results obtained in this study show that there are factors at levels below the municipal level (district level) that should be considered as focus areas for health policy in order to decrease the impact of heat and promote the process of adaptation to heat in the context of climate change.
Hot weather can cause early childbirth, meaning shorter gestation. Daily US birth-rate data from 1969 to 1988 show that deliveries increased on hot days and that those births occurred up to two weeks early. Around 25,000 infants were born early each year, representing over 150,000 gestational days lost annually. Evidence suggests that heat exposure increases delivery risk for pregnant women. Acceleration of childbirth leads to shorter gestation, which has been linked to later health and cognitive outcomes. However, estimates of the aggregate gestational losses resulting from hot weather are lacking in the literature. Here, we use estimated shifts in daily county birth rates to quantify the gestational losses associated with heat in the United States from 1969 to 1988. We find that extreme heat causes an increase in deliveries on the day of exposure and on the following day and show that the additional births were accelerated by up to two weeks. We estimate that an average of 25,000 infants per year were born earlier as a result of heat exposure, with a total loss of more than 150,000 gestational days annually. Absent adaptation, climate projections suggest additional losses of 250,000 days of gestation per year by the end of the century.
The ambient temperature-health relationship is of growing interest as the climate changes. Previous studies have examined the association between ambient temperature and mortality or morbidity, however, there is little literature available on the ambient temperature effects on year of life lost (YLL). Thus, we aimed to quantify the YLL attributable to non-optimum ambient temperature. We obtained data from 1 January 2013 to 31 December 2017 of 70 counties in Hunan, China. In order to combine the effects of each county, we used YLL rate as a health outcome indicator. The YLL rate was equal to the total YLL divided by the population of each county, and multiplied by 100,000. We estimated the associations between ambient temperature and YLL with a distributed lag non-linear model (DNLM) in a single county, and then pooled them in a multivariate meta-regression. The daily mean YLL rates were 22.62 y/(p·100,000), 10.14 y/(p·100,000) and 2.33 y/(p·100,000) within the study period for non-accidental, cardiovascular, and respiratory disease death. Ambient temperature was responsible for advancing a substantial fraction of YLL, with attributable fractions of 10.73% (4.36-17.09%) and 16.44% (9.09-23.79%) for non-accidental and cardiovascular disease death, respectively. However, the ambient temperature effect was not significantly for respiratory disease death, corresponding to 5.47% (-2.65-13.60%). Most of the YLL burden was caused by a cold temperature than the optimum temperature, with an overall estimate of 10.27% (4.52-16.03%) and 15.94% (8.82-23.05%) for non-accidental and cardiovascular disease death, respectively. Cold and heat temperature-related YLLs were higher in the elderly and females than the young and males. Extreme cold temperature had an effect on all age groups in different kinds of disease-caused death. This study highlights that general preventative measures could be important for moderate temperatures, whereas quick and effective measures should be provided for extreme temperatures.
BACKGROUND: For pediatric pneumonia, the meteorological and air pollution indicators had been frequently investigated for their association with viral circulation, however, not for their impact on disease severity. METHODS: We performed a 10-year prospective observational study in one hospital in Chongqing, China to recruit children with pneumonia. Eight commonly seen respiratory viruses were tested. Autoregressive distributed lag (ADL) and Random forest (RF) models were performed to fit monthly detection rates of each virus at population level and predict the possibility of severe pneumonia at individual level, respectively. RESULTS: Between 2009?2018, 6 611 pediatric pneumonia patients were included, and 4 846 (73.3%) tested positive for at least one respiratory virus. The median age of the patients was 9 (IQR: 4?20) months. ADL models demonstrated a decent fitting of detection rates of four viruses (R2 >0.7 for RSV, HRV, PIV, and HMPV). Based on the RF models, the AUC for host-related factors alone is 0.88 (95% CI: 0.87?0.89), 0.86 (95% CI: 0.85?0.88) for meteorological and air pollution indicators alone, and 0.62 (95% CI: 0.60?0.63) for viral infections alone. The final model indicated that nine weather and air pollution indicators were important determinants of severe pneumonia, with relative contribution of 62.53%, significantly higher than respiratory viral infections (7.36%). CONCLUSIONS: Meteorological and air pollution predictors contributed more to severe pneumonia in children than respiratory viruses. These meteorological data could help predict times when children would be at increased risk for severe pneumonia, and interventions such as reducing outdoor activities, may be warranted.
This article aims to present the physical adaptation capabilities of a human, seen as a response to extreme hot and dry or hot and humid conditions. Adaptation capabilities are expressed as safe exposure time in two variants: at rest and during physical activity. The study shows the results of calculations of the variability over time of the core temperature and skin temperature as well as heat balance. Calculations were made according to Standard No. EN ISO 7933:2005 on the basis of assumed and actual meteorological data. The results of the calculations show that in these conditions a hot but dry environment enables a human (although to a limited extent) to stay and perform low physical activity, provided access to drinking water is ensured. In contrast, a hot but humid environment causes more serious problems, due to the inability to reduce skin temperature by evaporation of sweat from the skin surface.
Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR?=?1.61, 95% CI: 1.2, 2.15, p value?=?0.001) occurring three days after exposure. The relative risk of death also varied between males (RR?=?0.31, 95% CI: 0.10, 0.94) and females (RR?=?4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics.
BACKGROUND: Little is known about the association between ambient temperature and cause-specific mental disorders, especially in subtropical areas. OBJECTIVE: To investigate the effect of ambient temperature on mental disorders in subtropical cities. METHOD: Daily morbidity data for mental disorders in three Chinese cities (Shenzhen, Zhaoqing, and Huizhou) were collected from medical record systems of local psychiatric specialist hospitals, covering patients of all ages. Case-crossover design combined with a distributed lag nonlinear model (DLNM) was used to assess the nonlinear and delayed effects of temperatures on five specific mental disorders (affective disorders, anxiety, depressive disorders, schizophrenia, and organic mental disorders), with analyses stratified by gender and age. The temperature of minimum effect was used as the reference value to calculate estimates. RESULTS: We observed inversed J-shaped exposure-response curves between temperature and mental morbidity and observed that low temperatures had a significant and prolonged effect on most types of mental disorders in the three cities. For example, the effect of the cold (2.5th percentile) on anxiety was consistently observed in the three cities with an odds ratio (OR) of 1.29 (95% CI: 1.06-1.57) in Zhaoqing, 1.26 (95% CI: 1.18-1.34) in Shenzhen, and 1.45 (95% CI: 1.17-1.81) in Huizhou. Low temperature was also associated with an increased risk of depressive disorders and schizophrenia. For the high temperature exposure (97.5th percentile), we only observed a significant, harmful effect on anxiety [OR = 1.30 (95% CI: 1.08, 1.58) in Shenzhen, OR = 1.16 (95% CI: 1.00, 1.34) in Zhaoqing], affective disorders [OR = 1.32 (95% CI: 1.08, 1.62) in Shenzhen], and schizophrenia [OR = 1.24 (95% CI: 1.03, 1.48) in Zhaoqing, OR = 1.03 (95% CI: 1.00, 1.06) in Huizhou]. CONCLUSIONS: Our study suggests that both low and high temperatures might be important drivers of morbidity from mental disorders, and low temperature may have a more general and wide-spread effect on this cause-specific morbidity than high temperature.
Mosquitoes are vectors of pathogens, causing human and animal diseases. Their ability to adapt and expand worldwide increases spread of mosquito-borne diseases. Climate changes contribute in enhancing these “epidemic conditions”. Understanding the effect of weather variables on mosquito seasonality and host searching activity contributes towards risk control of the mosquito-borne disease outbreaks. To enable early detection of Aedes invasive species we developed a surveillance network for both invasive and native mosquitoes at the main point of entry for the first time in Cyprus. Mosquito sampling was carried out for one year (May 2017-June 2018), at bimonthly intervals around Limassol port. Morphological and molecular identification confirmed the presence of 5 species in the study region: Culex. pipiens, Aedes detritus, Ae. caspius, Culiseta longiareolata and Cs. annulata. No invasive Aedes mosquito species were detected. The Pearson’s correlation and multiple linear regression were used to compare number of sampled mosquitoes and weather variables for three most numerous species (Cx. pipiens, Ae. detritus and Ae. caspius). The population densities of the most numerous species were highest from February to April. Number of Cx. pipiens (-0.48), Ae. detritus (-0.40) and Ae. caspius (-0.38) specimens sampled was negatively correlated with average daily temperature. Monthly relative humidity showed positive correlation with the numbers of the species sampled, Cx. pipiens (0.66) Ae. detritus (0.68), and Ae. caspius (0.71). Mosquito abundance of Cx. pipiens (0.97) and Ae. detritus (0.98) was strongly correlated to seasonal precipitation as well. Our work is a stepping stone to further stimulate implementation of International Health Regulations and implementation of early warning surveillance system for detection of invasive Aedes mosquitoes, native mosquitoes and arboviruses they may transmit. A network for the surveillance of both invasive and native mosquito species at the main point of entry for the first time in Cyprus was developed. Number of mosquitoes sampled was correlated with weather factors to identify parameters that might predict mosquito activity and species distribution to the prevention of international spread of vector mosquitoes and vector-borne diseases.
Climate change is a global threat that poses significant risks to pregnant women and to their developing fetus and newborn. Educating pregnant women about the risks to their pregnancy may improve maternal and child health outcomes. Prior research suggests that presenting health information in narrative format can be more effective than a didactic format. Hence, the purpose of this study was to test the effectiveness of two brief educational interventions in a diverse group of pregnant women (n = 151). Specifically, using a post-test only randomized experiment, we compared the effectiveness of brief information presented in a narrative format versus a didactic format; both information formats were also compared to a no information control group. Outcome measures included pregnant women’s actual and perceived knowledge, risk perception, affective assessment, self-efficacy, intention to take protective behaviors, and subsequent information seeking behavior. As hypothesized, for all outcome measures, the narrative format was more effective than the didactic format. These results suggest the benefits of a narrative approach (versus a didactic approach) to educating pregnant women about the maternal and child health threats posed by climate change. This study adds to a growing literature on the effectiveness of narrative-based approaches to health communication.
BACKGROUND: Over the span of the last decade, medical research has been increasingly putting greater emphasis on the study of meteorological parameters due to their connection to cardiovascular diseases. The main goal of this study was to explore the relationship between fatal aortic catastrophes and changes in atmospheric pressure and temperature. METHODS: We used a Cox process model to quantify the effects of environmental factors on sudden deaths resulting from aortic catastrophes. We used transfer entropy to draw conclusion about the causal connection between mortality and meteorological parameters. Our main tool was a computer program which we developed earlier in order to evaluate the relationship between pulmonary embolism mortality and weather on data sets comprised of aortic aneurysm (AA) and acute aortic dissection (AAD) cases, where one of these two medical conditions had led to fatal rupture of the aorta. Our source for these cases were the autopsy databases of Semmelweis University, from the time period of 1994 to 2014. We have examined 160 aneurysm and 130 dissection cases in relation to changes in meteorological parameters. The algorythm implemented in our program is based on a non-parametric a Cox process model. It is capable of splitting slowly varying unknown global trends from fluctuations potentially caused by weather. Furthermore, it allows us to explore complex non-linear interactions between meteorological parameters and mortality. RESULTS: Model measures the relative growth of the expected number of events on the n(th) day caused by the deviation of environmental parameters from its mean value. The connection between ruptured aortic aneurysms (rAA) and changes in atmospheric pressure is more significant than their connection with mean daily temperatures. With an increase in atmospheric pressure, the rate of rAA mortality also increased. The effects of meteorological parameters were weaker for deaths resulting from acute aortic dissections (AAD), although low mean daily temperatures increased the intensity of occurrence for AAD-related deaths. CONCLUSION: The occurrence rate of fatal aortic catastrophes showed a slight dependence on the two examined parameters within our groups.
Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. An investigation into the factors related to BPPV could contribute to its prevention and appropriate management. We investigated the association between climatic factors and incidence of BPPV in this study. A total of 365 patients who were diagnosed with idiopathic BPPV in the emergency room of our hospital in 2015 were included. The number of patients diagnosed with BPPV per week was calculated (every week). Climatic factors, including daily average humidity, temperature, atmospheric pressure, cloud amount, sunshine amount, and daylight time, were documented daily. The weekly mean climatic value in each week was calculated. Simple correlation analysis and multivariate regression analyses were performed to identify climatic factors associated with the number of patients diagnosed with BPPV. Simple correlation analysis revealed a significant association between the humidity (r?=?0.276, p?=?0.048), temperature (r?=?0.275, p?=?0.049), and cloud amount (r?=?0.293, p?=?0.035) and the number of BPPV patients diagnosed per week. Multivariate regression analysis revealed that only the cloud amount was a statistically significant factor associated with the number of BPPV patients diagnosed every week. A significant positive association was discovered between the cloud amount and BPPV incidence. Cloud amount can therefore have an association with the incidence of BPPV.
Exposure to high ambient temperatures is an important cause of avoidable, premature death that may become more prevalent under climate change. Though extensive epidemiological data are available in the United States, they are largely limited to select large cities, and hence, most projections estimate the potential impact of future warming on a subset of the U.S. population. Here we utilize evaluations of the relative risk of premature death associated with temperature in 10 U.S. cities spanning a wide range of climate conditions to develop a generalized risk function. We first evaluate the performance of this generalized function, which introduces substantial biases at the individual city level but performs well at the large scale. We then apply this function to estimate the impacts of projected climate change on heat-related nationwide U.S. deaths under a range of scenarios. During the current decade, there are 12,000 (95% confidence interval 7,400-16,500) premature deaths annually in the contiguous United States, much larger than most estimates based on totals for select individual cities. These values increase by 97,000 (60,000-134,000) under the high-warming Representative Concentration Pathway (RCP) 8.5 scenario and by 36,000 (22,000-50,000) under the moderate RCP4.5 scenario by 2100, whereas they remain statistically unchanged under the aggressive mitigation scenario RCP2.6. These results include estimates of adaptation that reduce impacts by ~40-45% as well as population increases that roughly offset adaptation. The results suggest that the degree of climate change mitigation will have important health impacts on Americans.
This paper investigates the effects of prenatal exposure to extreme temperatures on birth outcomes-specifically, the log of birth weight and an indicator for low birth weight-using a nationally representative dataset on rural China. During the time period we examine (1991-2000), indoor air conditioning was not widely available and migration was limited, allowing us to address identification issues endemic in the climate change literature related to adaptation and location sorting. We find substantial heterogeneity in the effects of extreme temperature exposure on birth outcomes. In particular, prenatal exposure to heat waves has stronger negative effects than exposure to cold spells on surviving births.
In recent years, dengue has been rapidly spreading and growing in the tropics and subtropics. Located in southern China, Hong Kong’s subtropical monsoon climate may favour dengue vector populations and increase the chance of disease transmissions during the rainy summer season. An increase in local dengue incidence has been observed in Hong Kong ever since the first case in 2002, with an outbreak reaching historically high case numbers in 2018. However, the effects of seasonal climate variability on recent outbreaks are unknown. As the local cases were found to be spatially clustered, we developed a Poisson generalized linear mixed model using pre-summer monthly total rainfall and mean temperature to predict annual dengue incidence (the majority of local cases occur during or after the summer months), over the period 2002-2018 in three pre-defined areas of Hong Kong. Using leave-one-out cross-validation, 5 out of 6 observations of area-specific outbreaks during the major outbreak years 2002 and 2018 were able to be predicted. 42 out of a total of 51 observations (82.4%) were within the 95% confidence interval of the annual incidence predicted by our model. Our study found that the rainfall before and during the East Asian monsoon (pre-summer) rainy season is negatively correlated with the annual incidence in Hong Kong while the temperature is positively correlated. Hence, as mosquito control measures in Hong Kong are intensified mainly when heavy rainfalls occur during or close to summer, our study suggests that a lower-than-average intensity of pre-summer rainfall should also be taken into account as an indicator of increased dengue risk.
BACKGROUND: A couple of studies suggest that sunshine duration and ambient temperature contribute to suicide. Few studies have happened in East-Central European area. OBJECTIVE: We scrutinized the daily suicide rates and other measured meteorological parameters spanning from 1971 to 2013 in the region of Hungary exhibiting the highest suicide rate. METHODS: The meteorological parameters measured in the area signified the independent variables of the statistical model, while the observed suicide rate connoted the dependent variable. Dynamic Regression, a time series analytical method was employed for creating the model. RESULTS: Three meteorological parameters displayed a weak, yet statistically significant relationship with suicide rates. 1/ Daily sunshine duration has shown an immediate, significant positive correlation, 2/ daily changes in temperature at ground level also exhibited a significant relationship, albeit it followed a complex transient profile overarching three days. Tropopause height was also significant in the model: an immediate positive effect was followed by a negative effect six days later. CONCLUSIONS: We estimated consistent and immediate positive associations between daily suicide and daily change of elevated ambient temperature and duration of sunshine in a high rated area of Hungary.
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.
Numerous studies have examined the effects of weather on emergency ambulance service (EAS) demand. Given Taipei’s unique physical and social environments, empirical evidence collected from other regions may not be applicable. Collecting more information about the characteristics of vulnerable groups and the effects of weather could help the EAS managing authority in formulating cost-effective EAS policies. This study aims to look at the effects of weather on EAS demand in Taipei and to make a comparison with Hong Kong, which is also an Asian city and has a similar cultural context. The study analyzed over 370,000 EAS usage records from the Taipei City Fire Department. These records were aggregated into time series data according to patients’ characteristics and then regressed on meteorological data via multivariate forward regression. The effect size differences of the variance explained by different groups of EAS users’ regression models were compared. Afterward, the results of the regression analysis from Taipei were compared with those from a Hong Kong study. Elderly and critical patients in both cities showed significantly more sensitivity to weather than other patients. Further analysis showed that non-trauma cases were related to weather in Taipei. Although both cities had similar results, the Taipei study clearly showed that elderly and critical patients were more sensitive to weather than other patient subgroups. Health education programs should focus on the vulnerable groups identified in this study in order to increase their awareness and help them protect themselves before the onset of adverse weather conditions. By generating results that are directly applicable to Taipei, the formulation of inappropriate EAS policies can be prevented.
Humans’ ability to efficiently shed heat has enabled us to range over every continent, but a wet-bulb temperature (TW) of 35 degrees C marks our upper physiological limit, and much lower values have serious health and productivity impacts. Climate models project the first 35 degrees C TW occurrences by the mid-21st century. However, a comprehensive evaluation of weather station data shows that some coastal subtropical locations have already reported a TW of 35 degrees C and that extreme humid heat overall has more than doubled in frequency since 1979. Recent exceedances of 35 degrees C in global maximum sea surface temperature provide further support for the validity of these dangerously high TW values. We find the most extreme humid heat is highly localized in both space and time and is correspondingly substantially underestimated in reanalysis products. Our findings thus underscore the serious challenge posed by humid heat that is more intense than previously reported and increasingly severe.
BACKGROUND: Scrub typhus is a major cause of acute febrile illness in the tropics and is endemic over large areas of the Asia Pacific region. The national and global burden of scrub typhus remains unclear due to limited data and difficulties surrounding diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: Scrub typhus reporting data from 2003-2018 were collected from the Thai national disease surveillance system. Additional information including the district, sub-district and village of residence, population, geographical, meteorological and satellite imagery data were also collected for Chiangrai, the province with the highest number of reported cases from 2003-2018. From 2003-2018, 103,345 cases of scrub typhus were reported with the number of reported cases increasing substantially over the observed period. There were more men than women, with agricultural workers the main occupational group affected. The majority of cases occurred in the 15-64 year old age group (72,144/99,543, 72%). Disease burden was greatest in the northern region, accounting for 53% of the total reported cases per year (mean). In the northern region, five provinces-Chiangrai, Chiangmai, Tak, Nan and Mae Hong Son-accounted for 84% (46,927/55,872) of the total cases from the northern region or 45% (46,927/103,345) of cases nationally. The majority of cases occurred from June to November but seasonality was less marked in the southern region. In Chiangrai province, elevation, rainfall, temperature, population size, habitat complexity and diversity of land cover contributed to scrub typhus incidence. INTERPRETATION: The burden of scrub typhus in Thailand is high with disease incidence rising significantly over the last two decades. However, disease burden is not uniform with northern provinces particularly affected. Agricultural activity along with geographical, meteorological and land cover factors are likely to contribute to disease incidence. Our report, along with existing epidemiological data, suggests that scrub typhus is the most clinically important rickettsial disease globally.
INTRODUCTION: Bacterial meningitis still constitutes an important threat in Africa. In the meningitis belt, a clear seasonal pattern in the incidence of meningococcal disease during the dry season has been previously correlated with several environmental parameters like dust and sand particles as well as the Harmattan winds. In parallel, the evidence of seasonality in meningitis dynamics and its environmental variables remain poorly studied outside the meningitis belt. This study explores several environmental factors associated with meningitis cases in the Democratic Republic of Congo (DRC), central Africa, outside the meningitis belt area. METHODS: Non-parametric Kruskal-Wallis’ tests were used to establish the difference between the different health zones, climate and vegetation types in relation to both the number of cases and attack rates for the period 2000-2018. The relationships between the number of meningitis cases for the different health zones and environmental and socio-economical parameters collected were modeled using different generalized linear (GLMs) and generalized linear mixed models (GLMMs), and different error structure in the different models, i.e., Poisson, binomial negative, zero-inflated binomial negative and more elaborated multi-hierarchical zero-inflated binomial negative models, with randomization of certain parameters or factors (health zones, vegetation and climate types). Comparing the different statistical models, the model with the smallest Akaike’s information criterion (AIC) were selected as the best ones. 515 different health zones from 26 distinct provinces were considered for the construction of the different GLM and GLMM models. RESULTS: Non-parametric bivariate statistics showed that there were more meningitis cases in urban health zones than in rural conditions (?2 = 6.910, p-value = 0.009), in areas dominated by savannah landscape than in areas with dense forest or forest in mountainous areas (?2 = 15.185, p-value = 0.001), and with no significant difference between climate types (?2 = 1.211, p-value = 0,449). Additionally, no significant difference was observed for attack rate between the two types of heath zones (?2 = 0.982, p-value = 0.322). Conversely, strong differences in attack rate values were obtained for vegetation types (?2 = 13.627, p-value = 0,001) and climate types (?2 = 13.627, p-value = 0,001). This work demonstrates that, all other parameters kept constant, an urban health zone located at high latitude and longitude eastwards, located at low-altitude like in valley ecosystems predominantly covered by savannah biome, with a humid tropical climate are at higher risk for the development of meningitis. In addition, the regions with mean range temperature and a population with a low index of economic well-being (IEW) constitute the perfect conditions for the development of meningitis in DRC. CONCLUSION: In a context of global environmental change, particularly climate change, our findings tend to show that an interplay of different environmental and socio-economic drivers are important to consider in the epidemiology of bacterial meningitis epidemics in DRC. This information is important to help improving meningitis control strategies in a large country located outside of the so-called meningitis belt.
The increase in the frequency and intensity of heat waves is one of the most unquestionable effects of climate change. Therefore, the progressive increase in maximum temperatures will have a clear incidence on the increase in mortality, especially in countries that are vulnerable due to geographical location or their socioeconomic characteristics. Different research studies show that the mortality attributable to heat is decreasing globally, and research is centred on future scenarios. One way of detecting the existence of a lesser impact of heat is through the increase in the so-called temperature of minimum mortality (TMM). The objective of this study is to determine the temporal evolution of TMM in two Spanish provinces (Seville and Madrid) during the 1983-2018 period and to evaluate whether the rate of adaptation to heat is appropriate. We used the gross rate of daily mortality due to natural causes (CIEX: A00-R99) and the maximum daily temperature (°C) to determine the quinquennial TMM using dispersion diagrams and realizing fit using quadratic and cubic curvilinear estimation. The same analysis was carried out at the annual level, by fitting an equation to the line of TMM for each province, whose slope, if significant (p < 0.05) represents the annual rate of variation in TMM. The results observed in this quinquennial analysis showed that the TMM is higher in Seville than in Madrid and that it is higher among men than women in the two provinces. Furthermore, there was an increase in TMM in all of the quinquennium and a clear decrease in the final period. At the annual level, the linear fit was significant for Madrid for the whole population and corresponds to an increase in the TMM of 0.58 °C per decade. For Seville the linear fits were significant and the slopes of the fitted lines was 1.1 °C/decade. Both Madrid and Seville are adapting to the increase in temperatures observed over the past 36 years, and women are the group that is more susceptible to heat, compared to men. The implementation of improvements and evaluation of prevention plans to address the impact of heat waves should continue in order to ensure adequate adaptation in the future.
As climate change increases temperatures and the frequency of extreme heat events, farm workers are among the most affected. Because of the nature of the work, farmers working at hot temperatures may experience physiological changes in their body such as increases in body temperature, blood pressure, and heart rate, as well as leading to intolerance of blood glucose and blood cholesterol. This study speculates that extreme heat hazards may lead to incidence of heat-related diseases among farmers in the workplace and other metabolic disorders. The purpose of this study is to determine the potential health effects of heat exposure between agroecology and conventional rice farmers. This study recruited 33 agroecology and 25 conventional rice farmers in the northern state of peninsular Malaysia. The adapted questionnaire was used to obtain the respondent’s background information. Also, the environmental and physiological measurements were carried out to determine the heat stress index (HSI) and physiological strain index (PSI). The HSI was monitored by using WetBulb globe temperature meter, whereas the physiological parameters were assessed by using thermometer, blood pressure monitor, and blood cholesterol/glucose monitor kit. The study shows that there is a significant difference between HSI, blood pressure, and blood glucose levels among organic and conventional farmers. Both groups of farmers also have a significant association between blood glucose and blood pressure. The findings of this study suggest that pesticide use can act as a synergistic effect, resulting in more significant health effects for those who were exposed to heat in their work environment. Given the impact of climate change on the agriculture sector, the disparity in the heat-related health effects between pesticides used and nonpesticides used farming community may serve as a critical factor to consider while implementing the workplace heat stress program in the agricultural industry.
BACKGROUND: The disease burden of infectious diarrhea cannot be underestimated. Its seasonal patterns indicate that weather patterns may play an important role and have an important effect on it. The objective of this study was to clarify the relationship between temperature and infectious diarrhea, and diarrhea-like illness. METHODS: Distributed lag non-linear model, which was based on the definition of a cross-basis, was used to examine the effect. RESULTS: Viral diarrhea usually had high incidence in autumn-winter and spring with a peak at -6°C; Norovirus circulated throughout the year with an insignificant peak at 8°C, while related bacteria usually tested positive in summer and peaked at 22°C. The lag-response curve of the proportion of diarrhea-like cases in outpatient and emergency cases revealed that at -6°C, with the lag days increasing, the proportion increased. Similar phenomena were observed at the beginning of the curves of virus and bacterial positive rate, showing that the risk increased as the lag days increased, peaking on days 16 and 9, respectively. The shape of lag-response curve of norovirus positive rate was different from others, presenting m-type, with 2 peaks on day 3 and day 18. CONCLUSION: Weather patterns should be taken into account when developing surveillance programs and formulating relevant public health intervention strategies.
Yellow Fever (YF) is an arbovirus endemic in tropical regions of South America and Africa and it is estimated to cause 78,000 deaths a year in Africa alone. Climate change may have substantial effects on the transmission of YF and we present the first analysis of the potential impact on disease burden. We extend an existing model of YF transmission to account for rainfall and a temperature suitability index and project transmission intensity across the African endemic region in the context of four climate change scenarios. We use these transmission projections to assess the change in burden in 2050 and 2070. We find disease burden changes heterogeneously across the region. In the least severe scenario, we find a 93.0%[95%CI(92.7, 93.2%)] chance that annual deaths will increase in 2050. This change in epidemiology will complicate future control efforts. Thus, we may need to consider the effect of changing climatic variables on future intervention strategies.
BACKGROUND: The Crimean-Congo Hemorrhagic fever (CCHF) is endemic in Iran and has a high fatality rate. The aim of this study was to investigate the association between CCHF incidence and meteorological variables in Zahedan district, which has a high incidence of this disease. METHODS: Data about meteorological variables and CCHF incidence was inquired from 2010 to 2017 for Zahedan district. The analysis was performed using univariate and multivariate Seasonal Autoregressive Integrated Moving Average (SARIMA) models and Generalized Additive Models (GAM) using R software. AIC, BIC and residual tests were used to test the goodness of fit of SARIMA models, and R(2) was used to select the best model in GAM/GAMM. RESULTS: During the years under study, 190 confirmed cases of CCHF were identified in Zahedan district. The fatality rate of the disease was 8.42%. The disease trend followed a seasonal pattern. The results of multivariate SARIMA showed the (0,1,1) (0,1,1)(12) model with maximum monthly temperature lagged 5?months, forecasted the disease better than other models. In the GAM, monthly average temperature lagged 5?months, and the monthly minimum of relative humidity and total monthly rainfall without lag, had a nonlinear relation with the incidence of CCHF. CONCLUSIONS: Meteorological variables can affect CCHF occurrence.
BACKGROUND: A large number of studies have found a positive association between diurnal temperature range (DTR) and cardiovascular diseases (CVDs) incidence and mortality. Few studies regarding the effects of DTR on blood pressure (BP) are available. OBJECTIVE: To investigate the effects of DTR on BP in Jinchang, northwestern China. METHODS: Based on a prospective cohort research, a total of 46,609 baseline survey data were collected from 2011 to 2015. The meteorological observation data and environmental monitoring data were collected in the same period. The generalized additive model (GAM) was used to estimate the relationship between DTR and BP after adjusting for confounding variables. RESULTS: Our study found that there was a positive linear correlation between DTR and systolic blood pressure (SBP) and plus pressure (PP), and a negative linear correlation between DTR and diastolic blood pressure (DBP). With a 1 °C increase of DTR, SBP and PP increased 0.058 mmHg (95%CI: 0.018-0.097) and 0.114 mmHg (95%CI: 0.059-0.168) respectively, and DBP decreased 0.039 mmHg (95%CI:-0.065 ~ -0.014). There was a significant interaction between season and DTR on SBP and PP. DTR had the greatest impact on SBP and PP in hot season. The association between DTR and BP varied significantly by education level. CONCLUSION: There was a significant association between DTR and BP in Jinchang, an area with large temperature change at high altitudes in northwestern China. These results provide new evidence that DTR is an independent risk factor for BP changes among general population. Therefore, effective control and management of BP in the face of temperature changes can help prevent CVDs.
Embedding nature-based solutions (NBS) in cities is expected to bring quantifiable benefits, including resilience to flooding, drought, and heatwaves, and air quality improvement. Among NBS, green roofs have an important role in temperature regulation in buildings and in lowering the damaging effects of heatwaves on human health. In this paper a spatial microsimulation model is implemented to simulate temperature impacts of green roofs installations in cities and their capacity to attenuate the effects of heatwave episodes. Particularly vulnerable to heatwaves are elderly people with limited mobility, who have limited means to seek cooling and create cooler indoor environments. The model, implemented using the Netlogo platform (version 6.0.4), considers as agents the elderly citizens in a city area and simulates the heatwave-related health impacts, which are measured in mortality likelihood. In particular, the model simulates a generalised 1.5 degrees C to 3 degrees C indoor temperature reduction range induced by green roofs (based on inferences from green roof literature) in four different European cities: Szeged (Hungary), Alcal’a de Henares (Spain), Metropolitan City of Milan (Italy) and Cankaya municipality (Turkey). The simulation utilises a ceteris paribus modelling approach, meaning that the relationships of the observed phenomenon (mortality induced by heatwaves) with other possible influencing factors (e.g. level of sport and physical activities practiced by people) are not taken into account. In the case of Szeged, Alcal’a de Henares, and Cankaya municipality a substantial reduction in mortality is found to occur associated with green roofs roll out. In the case of the Metropolitan city of Milan, green roofs installations show a low mitigation effect in some scenarios. The underlying factor is the temperature threshold parameter of the model, above which heatwave mortality occurs. This parameter was inferred from the literature (Baccini M., et al., 2008) and it resulted to be substantially higher in the Metropolitan city of Milan (31.8 degrees C) than in the other cities. The simulation helps in obtaining results which are specific to a given city and particular scenarios therein, and provides additional insights, such as expected temperature mitigation effect induced by green roofs under climate change conditions, or the indoor temperature reduction targets that are needed for a particular city to have a maximum desired heatwave mitigation impact. However, the model parameters have to be carefully selected, after an accurate study of the domain literature.
We investigated whether persons with dementia (PwD) are at particular risk of mortality when exposed to extreme temperatures and whether the temperature effect depends on long-term care (LTC) need and residency. German health claims data provide information on inpatient and outpatient sectors. Data from the German Meteorological Service were merged, and measures of immediate and delayed heat, cold, and normal temperature (Heat Index, Wind Chill Temperature Index) were calculated. Cox models were applied to explore the interaction of temperature, dementia, and LTC, as well as residency. Immediate and delayed effects of heat and cold were tested as compared to normal temperatures. Models were adjusted for age, sex, comorbidities, urban/rural living, and summer/winter climate zones. The 182,384 persons aged >= 65 contributed 1,084,111 person-years and 49,040 deaths between 2004 and 2010. At normal temperatures, PwD had a 37% (p-value < 0.001) increased mortality risk compared to persons without dementia (PwoD). Immediate heat effects further increased this effect by 11% (p = 0.031); no immediate heat effect existed for PwoD. The immediate heat effect was even greater for PwD suffering from severe or extreme physical impairment and for those living in private households and nursing homes. Immediate and delayed cold effects increased mortality independent of dementia. Care level and type of residency did not modify this effect among PwD. PwD revealed an increased vulnerability to immediate heat effects. Cold waves were risk factors for both groups. LTC need appeared to be an important intervening factor.
We aimed to reveal the relationship between the meteorological variables and suicide rates (completed suicides and suicide attempts) independently of the seasonal cycle and holiday effects. This is an observational retrospective study. We collected the data on age, gender, and suicide method of all suicide cases transferred to hospitals from the scene by emergency medical services as well as those cases in which the victim died on the scene between January 1, 2017 and June 30, 2019. We also collected data on maximum, minimum, and average temperatures (°C), average humidity (%), and average actual pressure (hPa) measured daily in Ankara. The total number of cases due to suicide between the given dates was 6777. The suicide method in 60.1% of the cases was drug poisoning, which was the most common suicide method. Investigating the effect of meteorological variables on suicide cases (suicide attempts and completed suicides), the present study found that after smoothing the effect of the day of the week and seasonality, an increase in the minimum temperature on the day of the application by 1 unit (1°C degree) leads to an increase in the number of suicides by 0.01 point (0.01?±?0.005, p =?0.046). There was no significant change in the variables other than the minimum temperature. We believe that the results of the present study will contribute to growing body literature about the epidemiology of suicide. We also believe that there is a need for large-scale studies that include individual data to reveal causality.
Air temperature, both cold and hot, has impacts on mortality and morbidities, which are exacerbated by poor health service and protection responses, particularly in under-developed countries. This study was designed to analyze the effects of air temperature on the risk of deaths for all and specific causes in two regions of Brazil (Florianopolis and Recife), between 2005 and 2014. The association between temperature and mortality was performed through the fitting of a quasi-Poisson non-linear lag distributed model. The association between air temperature and mortality was identified for both regions. The results showed that temperature exerted influence on both general mortality indicators and specific causes, with hot and cold temperatures bringing different impacts to the studied regions. Cerebrovascular and cardiovascular deaths were more sensitive to cold temperatures for Florianopolis and Recife, respectively. Based on the application of the very-well documented state-of-the-art methodology, it was possible to conclude that there was evidence that extreme air temperature influenced general and specific deaths. These results highlighted the importance of consolidating evidence and research in tropical countries such as Brazil as a way of understanding climate change and its impacts on health indicators.
Rhegmatogenous retinal detachment (RRD) frequency was observed to be higher with an increase in the daily temperature range. This showed that a wide daily range of temperature, rather than the absolute value of the temperature, is associated with the occurrence of RRD. Purpose. To investigate the association between the frequency of rhegmatogenous retinal detachment (RRD) and the atmospheric temperature. Method. A retrospective review of consecutive eyes that had undergone primary RRD surgery from 1996 to 2016 at Chungbuk National University Hospital was conducted. Temperature data (highest, lowest, and mean daily temperatures and daily temperature range) in Chungbuk Province were obtained from the Korean Meteorological Administration database. We investigated the relationship between the daily temperature range and the frequency of RRD surgery. We also analyzed the association between various temperature data and the frequency of RRD surgery. Result. There were 1,394 RRD surgeries from 1996 to 2016. Among them, 974 eyes were included in this study. The monthly average number of RRD operations showed a bimodal peak (in April and October) throughout the year. With the same tendency as the frequency of RRD, the monthly average of the daily temperature range over 1 year also showed a bimodal peak in April and October. There was a significant positive correlation between the monthly average of the daily temperature range and the number of RRD surgeries (r?=?0.297, P < 0.001). However, there were no associations between RRD frequency and the mean temperature, highest temperature, and lowest temperature. Conclusion. The higher the daily temperature range, the higher was the RRD frequency observed. We speculated that dynamic changes in temperature during the day may affect degrees in chorioretinal adhesion and liquefaction of the vitreous, which may eventually result in retinal detachment. Therefore, further experimental studies on the correlation between temperature changes and retinal detachment are needed.
BACKGROUND: The association between temperature and mortality has been widely reported. However, it remains largely unclear whether inflammation-related diseases, caused by excessive or inappropriate inflammatory reaction, may be affected by ambient temperature, particularly in low-income areas. OBJECTIVES: To explore the association between ambient temperature and clinical visits for inflammation-related diseases in rural villages in the Ningxia Hui Autonomous Region, China, during 2012?2015. METHODS: Daily data on inflammation-related diseases and weather conditions were collected from 258 villages in Haiyuan (161 villages) and Yanchi (97 villages) counties during 2012?2015. A Quasi-Poisson regression with distributed lag non-linear model was used to examine the association between temperature and clinical visits for inflammation-related diseases. Stratified analyses were performed by types of diseases including arthritis, gastroenteritis, and gynecological inflammations. RESULTS: During the study period, there were 724,788 and 288,965 clinical visits for inflammation-related diseases in Haiyuan and Yanchi, respectively. Both exposure to low (RR: 2.045, 95% CI: 1.690, 2.474) and high temperatures (RR: 1.244, 95% CI: 1.107, 1.399) were associated with increased risk of total inflammation-related visits in Haiyuan county. Low temperatures were associated with increased risks of all types of inflammation-related diseases in Yanchi county (RR: 4.344, 95% CI: 2.887, 6.535), while high temperatures only affected gastroenteritis (RR: 1.274, 95% CI: 1.040, 1.561). Moderate temperatures explained approximately 26% and 33% of clinical visits due to inflammation-related diseases in Haiyuan and Yanchi, respectively, with the burden attributable to cold exposure higher than hot exposure. The reference temperature values ranged from 17 to 19 in Haiyuan, and 12 to 14 in Yanchi for all types of clinical visits. CONCLUSIONS: Our findings add additional evidence for the adverse effect of suboptimal ambient temperature and provide useful information for public health programs targeting people living in rural villages.
BACKGROUND: Few epidemiological investigations have focused on the influence of environmental temperature on human sperm quality. Here, we evaluated the potential association between ambient temperature and human sperm quality in Wuhan, China, and examined the interactive effect of particulate matter (PM(2.5)) and temperature. METHODS: 1780 males who had been living in Wuhan for no less than three months and received semen analysis at the Department of Reproductive Medicine in Renmin Hospital of Wuhan University between April 8, 2013 and June 30, 2015 were recruited. Daily mean meteorological data and air pollution data (PM(2.5), O(3) and NO(2)) in Wuhan between 2013 and 2015 were collected. A generalized linear model was used to explore the associations between ambient temperature and sperm quality (including sperm concentration, percentage of normal sperm morphology, and progressive motility) at 0-9, 10-14, 15-69, 70-90, and 0-90?days before semen examination, and the interaction between temperature and PM(2.5). RESULTS: The associations between ambient temperature and sperm quality were an inverted U-shape at five exposure windows, except for a lag of 0-9?days for sperm concentration. A 1?°C increase in ambient temperature above the thresholds was associated with a 2.038 (1.292?~?2.783), 1.814 (1.217?~?2.411), 1.458 (1.138?~?1.777), 0.934(0.617?~?1.251) and 1.604 (1.258?~?1.951) decrease in the percentage of normal sperm morphology at lag 0-9, lag 10-14, lag 15-69, lag 70-90, and lag 0-90?days, respectively. The interaction p-values of PM(2.5) and temperature were mostly less than 0.05 at five exposure windows. When ambient temperature exposure levels were above the thresholds, a 0.979 (0.659-1.299) and 3.559 (0.251?~?6.867) decrease in percentage of normal sperm morphology per 1?°C increase in temperature at lag 0-90?days was observed in the PM(2.5)???P(50) group and PM(2.5)?>?P(50) group, respectively. CONCLUSIONS: Our results indicate that exposure to ambient temperature has a threshold effect on sperm quality, and PM(2.5) enhances the effect of temperature on sperm quality when temperatures are above the threshold.
BACKGROUND: The aim of this study was to investigate the possible relation of meteorological parameters and air pollutant particle concentrations with the incidence of spontaneous pneumothorax in the Bolu region of Turkey. METHODS: Between January 2015 and February 2019, a total of 200 patients (175 males, 25 females; mean age 42.5±19.9 years, range, 10 to 88 years) with spontaneous pneumothorax were retrospectively analyzed. For each day, standard weather parameters including daily average temperature, relative humidity, wind speed, actual pressure, and daily total precipitation and concentration of air pollutants (PM(10) and SO(2)) were recorded. RESULTS: During the study period, there were 200 cases with spontaneous pneumothorax within 178 days. The number of days with spontaneous pneumothorax represented 11.8% of the total number of days (1,504 days). In the study, 76.9% of the days with spontaneous pneumothorax were clustered. All meteorological (temperature, humidity, pressure, wind speed, and precipitation) and air pollution parameters (PM10 a nd SO(2)) were available for 1,438 days (95.61%) and 853 days (56.71%), respectively. There was a significant relationship between spontaneous pneumothorax and air temperature (r=-0.094, p=0.001), and air pollution (PM10, r=-0.080, p=0.020; SO(2), r=-0.067, p=0.045). CONCLUSION: Our study results show a relationship between spontaneous pneumothorax and air temperature, and air pollution. Preventing air pollution, which is a public health problem, can lead to a reduction in spontaneous pneumothorax.
From 2011 through 2018, there was a notable increase in sporadic Legionnaires’ disease in the state of Minnesota. Sporadic cases are those not associated with a documented outbreak. Outbreak-related cases are typically associated with a common identified contaminated water system; sporadic cases typically do not have a common source that has been identified. Because of this, it is hypothesised that weather and environmental factors can be used as predictors of sporadic Legionnaires’ disease. An ecological design was used with case report surveillance data from the state of Minnesota during 2011 through 2018. Over this 8-year period, there were 374 confirmed Legionnaires’ disease cases included in the analysis. Precipitation, temperature and relative humidity (RH) data were collected from weather stations across the state. A Poisson regression analysis examined the risk of Legionnaires’ disease associated with precipitation, temperature, RH, land-use and age. A lagged average 14-day precipitation had the strongest association with Legionnaires’ disease (RR 2.5, CI 2.1-2.9), when accounting for temperature, RH, land-use and age. Temperature, RH and land-use also had statistically significant associations to Legionnaires’ disease, but with smaller risk ratios. This study adds to the body of evidence that weather and environmental factors play an important role in the risk of sporadic Legionnaires’ disease. This is an area that can be used to target additional research and prevention strategies.
BACKGROUND AND OBJECTIVES: The number of pediatric patients diagnosed with influenza types A and B is increasing annually, especially in temperate regions such as Shanghai (China). The onset of pandemic influenza viruses might be attributed to various ambient meteorological factors including temperature, relative humidity (Rh), and PM(1) concentrations, etc. The study aims to explore the correlation between the seasonality of pandemic influenza and these factors. METHODS: We recruited pediatric patients aged from 0 to 18?years who were diagnosed with influenza A or B from July 1st, 2017 to June 30th, 2019 in Shanghai Children’s Medical Centre (SCMC). Ambient meteorological data were collected from the Shanghai Meteorological Service (SMS) over the same period. The correlation of influenza outbreak and meteorological factors were analyzed through preliminary Pearson’s r correlation test and subsequent time-series Poisson regression analysis using the distributed lag non-linear model (DLNM). RESULTS: Pearson’s r test showed a statistically significant correlation between the weekly number of influenza A outpatients and ambient meteorological factors including weekly mean, maximum, minimum temperature and barometric pressure (P?
OBJECTIVES: to evaluate the effect of air pollution (ozone – O3 and particulate matter <=10 ?m and <=2.5 ?m - PM10 and PM2.5) on the severity of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc). DESIGN: cross-sectional, observational, and single centre study. SETTING AND PARTICIPANTS: all consecutive SSc patients residing in Lombardy (Northern Italy) were enrolled. PM10, PM2.5, and O3 concentrations were calculated for each patient at municipality resolution in the week before the evaluation. Similar considerations were made for meteorological variables (temperature and humidity). MAIN OUTCOME MEASURES: patients were asked to assess RP severity during the week before the evaluation according to a visual analogue scale (VAS). Ordinal logistic regression models were fitted to evaluate the short-term effect of temperature and air pollution with respect to RP. A univariate linear regression model was created to consider the association between temperature and pollutants. RESULTS: in this study, 87 SSc patients were enrolled. Temperature was confirmed to strongly influence RP severity. PM10 and PM.5 were found to significantly worsen RP severity for the first four days before the evaluation, including the day of the visit, and as mean up to six days before the evaluation. O3 seemed to exert a protective effect on RP severity that was significant for the first four days before the evaluation, including the day of the visit, and as mean up to seven days before the evaluation. CONCLUSIONS: since the overwhelming effect of temperature on RP, final conclusions about the exact contribution of pollutants on RP severity cannot be drawn because of the strong inter-correlation between air pollution and temperature.
Hand, foot and mouth disease (HFMD) is a growing threat to children’s health, causing a serious public health burden in China. The relationships between associated meteorological factors and HFMD have been widely studied. However, the HFMD burden due to relative humidity from the perspective of attributable risk has been neglected. This study investigated the humidity-HFMD relationship in three comprehensive perspectives, humidity-HFMD relationship curves, effect modification and attributable risks in the Sichuan Basin between 2011 and 2017. We used multistage analyses composed of distributed lag nonlinear models (DLNMs), a multivariate meta-regression model and the calculations of attributable risk to quantify the humidity-HFMD association. We observed a J-shaped pattern for the pooled cumulative humidity-HFMD relationship, which presented significant heterogeneity relating to the geographical region and number of primary school students. Overall, 27.77% (95% CI 25.24-30.02%) of HFMD infections were attributed to humidity. High relative humidity resulted in the greatest burden of HFMD infections. The proportion of high humidity-related HFMD in the southern basin was higher than that in the northern basin. The findings provide evidence from multiple perspectives for public health policy formulation and health resource allocation to develop priorities and targeted policies to ease the HFMD burden associated with humidity.
Hot weather episodes are globally associated with excess mortality rates. Elevated ozone concentrations occurring simultaneously also contribute to excess mortality rates during these episodes. However, the relative importance of both stressors for excess mortality rates is not yet known and assumed to vary from region to region. This study analyzes time series of daily observational data of air temperature and ozone concentrations for eight of the largest German cities during the years 2000 and 2017 with respect to the relative importance of both stressors for excess mortality rates in each city. By using an event-based risk approach, various thresholds for air temperature were explored for each city to detect hot weather episodes that are statistically associated with excess mortality rates. Multiple linear regressions were then calculated to investigate the relative contribution of variations in air temperature and ozone concentrations to the explained variance in mortality rates during these episodes, including the interaction of both predictors. In all cities hot weather episodes were detected that are related to excess mortality rates. Across the cities, a strong increase of this relation was observed around the 95th percentile of each city-specific air temperature distribution. Elevated ozone concentrations during hot weather episodes are also related to excess mortality rates in all cities. In general, the relative contribution of elevated ozone concentrations on mortality rates declines with increasing air temperature thresholds and occurs mainly as a statistically inseparable part of the air temperature impact. The specific strength of the impact of both stressors varies across the investigated cities. City-specific drivers such as background climate and vulnerability of the city population might lead to these differences and could be the subject of further research. These results underline strong regional differences in the importance of both stressors during hot weather episodes and could thus help in the development of city-specific heat- ozone-health warning systems to account for city-specific features.
RATIONALE: Unprecedented heatwaves over the past several years are getting worse with longer duration in the course of global warming. Heatstroke is a medical emergency with multiple organ involvement and life-threatening illness with a high mortality rate of up to 71%. Uncontrolled damage to the central nervous system can result in severe cerebral edema, permanent neurological sequelae, and death. However, regarding the therapeutic aspects of heat stroke, there was no therapeutic strategy after the rapid cooling of the core body temperature to <39°C to prevent further injury. PATIENT CONCERNS: Each of 3 patients developed a change of mental statuses after the exposure to summer heatwaves or relatively high environmental temperatures with high humidity in the sauna. DIAGNOSES: The patients were diagnosed with severe heatstroke since they showed cerebral edema and multiple organ dysfunction based on the results from laboratory tests and the findings in brain computed tomography scan. INTERVENTIONS: The patients underwent induced therapeutic hypothermia (<36°C) between 24 and 36?hours in the management of severe heatstroke. OUTCOMES: The patients survived from cerebral edema and multiple organ dysfunction. LESSONS: We believe that targeted temperature management (<36°C) will help treat severe heatstroke. Thus it should be considered for reducing the chance of development of complications in multiple organs, especially in the central nervous system, when managing patients with severe heatstroke.
BACKGROUND: For the past decade, hand, foot and mouth disease (HFMD), caused by entero and coxsackie viruses, has been spreading in Asia, particularly among children, overloading healthcare settings and creating economic hardships for parents. Recent studies have found meteorological factors, such as temperature, are associated with HFMD in Asia. However, few studies have explored the relationship in the United States, although HFMD cases have steadily increased recently. As concerns of climate change grow, we explored the association between temperature and HFMD admissions to the Emergency Department (ED) in California. METHODS: Weekly counts of HFMD for 16 California climate zones were collected from 2005 to 2013. We calculated weekly temperature for each climate zone using an inverse distance-weighting method. For each climate zone stratified by season, we conducted a time-series using Poisson regression models. We adjusted models for weekly averaged relative humidity, average number of HFMD cases in previous weeks and long-term temporal trends. Climate zone estimates were combined to obtain an overall seasonal estimate. We attempted stratified analyses by region, race/ethnicity, and sex to identify sensitive subpopulations. RESULTS: Risk of ED visits for HFMD per 1 °F increase in mean temperature during the same week increased 2.00% (95% confidence intervals 1.15, 2.86%) and 2.35% (1.38, 3.33%) during the warm and cold seasons, respectively. The coastal region showed a higher, though not statistically different, association during the cold season [3.18% (1.99, 4.39)] than the warm season [1.64% (0.47, 2.82)]. CONCLUSIONS: Our findings indicated an association between temperature and ED visits for HFMD, with variation by season and region. Thus, the causative pathogen’s ability to persist in the atmosphere may vary by season. Furthermore, the mild and wet winter in the coastal region of California may contribute to different results than studies in Asia. With the onset of climate change, HFMD cases will likely grow in California, warranting further investigation on this relationship, including new populations at-risk.
Previous studies have revealed associations of meteorological factors with tuberculosis (TB) cases. However, few studies have examined their lag effects on TB cases. This study was aimed to analyse nonlinear lag effects of meteorological factors on the number of TB notifications in Hong Kong. Using a 22-year consecutive surveillance data in Hong Kong, we examined the association of monthly average temperature and relative humidity with temporal dynamics of the monthly number of TB notifications using a distributed lag nonlinear models combined with a Poisson regression. The relative risks (RRs) of TB notifications were >1.15 as monthly average temperatures were between 16.3 and 17.3 °C at lagged 13-15 months, reaching the peak risk of 1.18 (95% confidence interval (CI) 1.02-1.35) when it was 16.8 °C at lagged 14 months. The RRs of TB notifications were >1.05 as relative humidities of 60.0-63.6% at lagged 9-11 months expanded to 68.0-71.0% at lagged 12-17 months, reaching the highest risk of 1.06 (95% CI 1.01-1.11) when it was 69.0% at lagged 13 months. The nonlinear and delayed effects of average temperature and relative humidity on TB epidemic were identified, which may provide a practical reference for improving the TB warning system.
BACKGROUND: Cercarial dermatitis (swimmer’s itch) caused by bird schistosome cercariae, released from intermediate host snails, is a common disorder also at higher latitudes. Several cases were observed in the artificial Danish freshwater Ringen Lake frequently used by the public for recreational purposes. The lake may serve as a model system when establishing a risk analysis for this zoonotic disease. In order to explain high risk periods we determined infection levels of intermediate host snails from early spring to late summer (March, June and August) and elucidated the effect of temperature and light on parasite shedding, behavior and life span. RESULTS: Field studies revealed no shedding snails in March and June but in late summer the prevalence of Trichobilharzia szidati infection (in a sample of 226 pulmonate Lymnaea stagnalis snails) reached 10%. When investigated under laboratory conditions the cercarial shedding rate (number of cercariae shed per snail per day) was positively correlated to temperature raising from a mean of 3000 (SD 4000) at 7 °C to a mean of 44,000 (SD 30,000) at 27 °C). The cercarial life span was inversely correlated to temperature but the parasites remained active for up to 60 h at 20 °C indicating accumulation of cercariae in the lake during summer periods. Cercariae exhibited positive phototaxy suggesting a higher pathogen concentration in surface water of the lake during daytime when the public visits the lake. CONCLUSION: The only causative agent of cercarial dermatitis in Ringen Lake detected was T. szidati. The infection risk associated with aquatic activities is low during spring and early summer (March-June). In late summer the risk of infection is high since the release, behavior and life span of the infective parasite larvae have optimal conditions.
INTRODUCTION: This study aims to determine the association between temperature and preeclampsia and whether it is affected by seasonality and rural/urban lifestyle. METHODS: This cohort study included women who delivered at our medical center from 2004 to 2013 (31,101 women, 64,566 deliveries). Temperature values were obtained from a spatiotemporally resolved estimation model performing predictions at a 1×1km spatial resolution. In “Warm” pregnancies >50% of gestation occurred during the spring-summer period. In cold pregnancies >50% of gestation occurred during the fall and winter. Generalized estimating equation multivariable models were used to estimate the association between temperature and incidence of preeclampsia. RESULTS: 1) The incidence of preeclampsia in at least one pregnancy was 7% (2173/64,566); 2) during “warm” pregnancies, an elevation of one IQR of the average temperature in the 1st or the 3rd trimesters was associated with an increased risk to develop preeclampsia [patients with Jewish ethnicity: 1st trimester: relative risk (RR) of 2.38(95%CI 1.50; 3.80), 3rd trimester 1.94(95%CI 1.34;2.81); Bedouins: 1st trimester: RR = 2.91(95%CI 1.98;4.28), 3rd trimester: RR = 2.37(95%CI 1.75;3.20)]; 3) In “cold” pregnancies, an elevation of one IQR of average temperature was associated with a lower risk to develop preeclampsia among patients with Bedouin-Arab ethnicity RR = 0.68 (95% CI 0.49-0.94) for 1st trimester and RR = 0.62 (95% CI 0.44-0.87) for 3rd trimester. CONCLUSIONS: 1) Elevated averaged temperature during the 1st or 3rd trimesters in “warm” pregnancies confer an increased risk for the development of preeclampsia, especially in nomadic patients; 2) Of interest, during cold pregnancies, elevated averaged temperature was associated with a lower risk to develop preeclampsia for nomadic patients. 3) These findings suggest temperature might be associated with perturbations in maternal heat homeostasis resulting in reallocation of energy resources and their availability to the fetus that may increase the risk for preeclampsia. This observation is especially relevant in the context of global warming and its effects on maternal/fetal reproductive health.
This study estimates the association between temperature and self-reported mental health. We match individual-level mental health data for over three million Americans between 1993 and 2010 to historical daily weather information. We exploit the random fluctuations in temperature over time within counties to identify its effect on a 30-day measure of self-reported mental health. Compared to the temperature range of 60-70°F, cooler days in the past month reduce the probability of reporting days of bad mental health while hotter days increase this probability. We also find a salience effect: cooler days have an immediate effect, whereas hotter days tend to matter most after about 10 days. Using our estimates, we calculate the willingness to pay to avoid an additional hot day in terms of its impact on self-reported mental health.
Climate change and air pollution are two independent risk factors to cardiovascular diseases (CVD). Few studies investigated their interaction and potential effect modification of one another in developing countries. Individual level CVD hospital admission (ICD10: I00-I99) data for 1 January 2011 to 31 October 2016 were obtained from seven private hospitals in Cape Town. NO(2), SO(2), PM(10), temperature and relative humidity data were obtained from the South African Weather Services and the City of Cape Town. A case-crossover epidemiological study design and conditional logistic regression model were applied. Various cut-off values were applied to classify cold and warm days. In total, 54,818 CVD hospital admissions were included in the study. In general, on warm and cold days the 15-64 years old group was more at risk for CVD hospitalization with increasing air pollution levels compared to all ages combined or the ??65 years old group. Females appeared to be more at risk than males with increasing PM(10) levels. In contrast, males were more vulnerable to the effects of NO(2) and SO(2) than females. The study showed the modification effect of temperature on air pollution associated with CVD hospital admissions. The consideration of such interaction will help in policy making and public health interventions dealing with climate change-related health risks.
OBJECTIVE: The aim was to use a novel statistical test to predict the trend of subarachnoid hemorrhage (SAH) incidence in response to temperature change and demonstrate its delayed effect in a short hazard period. PATIENTS AND METHODS: In a retrospective study, data collected between January 2005 and September 2019 were analyzed and 1682 consecutive SAH patients from one hospital were enrolled. Meteorological data in this period including temperature, atmospheric pressure, and humidity were obtained from the China Surface Meteorological Station. Using a case-crossover analysis and distributed lag linear model (DLM) with 4 days lag period to assess the association of temperature change from the previous day (TCP) and risk of SAH. Results were presented as overall cumulative odds ratios (ORs) and 95% CI. RESULTS: Temperature decline was associated with increased risks of SAH: overall cumulative OR was 1.14 (95% CI: 1.05-1.23) for -1.1°C; 2.11 (95% CI: 1.37-3.25) for -6.2°C, as compared with a reference TCP of 0°C. Temperature decline on the day of SAH onset was significantly associated with SAH incidence days, ORs 1.34 (95% CI: 1.19-1.52). In addition, December, ORs 1.49 (95% CI: 1.17-1.90) in winter was the ictus peak in Rizhao throughout the year. CONCLUSIONS: Temperature decline from the previous day is a trigger for the occurrence of SAH. Its effect was most apparent on the day of exposure.
Exposure to particulate matter of smaller than 2.5 ?m in diameter (PM(2.5)) is linked to increased human mortality, and could be further complicated by concurrent ambient air temperatures. Published reports indicate that the association between ambient temperatures and mortality due to PM(2.5) exposure is dissimilar across different geographic areas. Thus, it is unclear how ambient temperatures at different geographic locations can together modulate the influence of PM(2.5) on mortality. In this paper, we examined how temperature modulated the association between mortality and PM(2.5) exposure in 15 Chinese cities during 2014-2016. For analysis, First, Poisson generalized additive models under different temperature stratifications (<10th, 10-90th, and >90th temperature percentiles) was used to estimate PM(2.5) associations to mortality, which were specific to different cities. Second, we used a meta-analysis to combine the effects at each temperature stratum and region (southern and northern China). Results revealed that high temperatures (daily mean temperature >90th percentile) robustly amplified observed associations of mortality and PM(2.5) exposure, and the modifications were heterogeneous geographically. In the northern regions, a 10 ?g/m(3) increment in PM(2.5) was associated with 0.18%, 0.28%, and 1.54% increase in non-accidental mortalities and 0.33%, 0.39%, and 1.32% increase in cardiovascular mortalities at low, moderate, and high temperature levels, respectively. In the southern regions, a 10 ?g/m(3) increment in PM(2.5) was associated with 0.52%, 0.62%, and 1.90% increase in non-accidental mortalities and 0.55%, 0.98%, and 2.25% increase in cardiovascular mortalities at low, moderate, and high temperature levels, respectively. It is concluded that temperature altered PM(2.5)-mortality associations in southern and northern China synergistically, but the effect was more pronounced in the south. Therefore, geography and temperature need to be considered when studying how PM(2.5) affects health.
PURPOSE: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic diseases causing considerable social and economic burden globally. Despite substantial evidence on temperature-COPD association, few studies have investigated the acute effect of temperature variability (TV), a potential trigger of exacerbation of COPD disease, and it remains unknown what fraction of the disease burden of COPD is attributable to TV. PATIENTS AND METHODS: Based on 71,070 COPD hospitalizations during 2013-2015 in Guangzhou, China, we conducted a time-series analysis using quasi-Poisson regression to assess the association between TV and hospital admission for COPD after adjusting for daily mean temperature. Short-term TV was captured by the standard deviation of hourly or daily temperatures across various exposure days. We also provided the fraction (total number) of COPD attributable to TV. Stratified analyses by admission route, sex, age, occupation, marital status and season were performed to identify vulnerable subpopulations. RESULTS: We found a linear relationship between TV and COPD hospitalization, with a 1°C increase in hourly TV and daily TV associated with 4.3% (95%CI: 2.2-6.4) and 4.0% (2.3-5.8) increases in COPD, respectively. The greater relative risks of TV identified males, people aged 0-64 years, blue collar, and divorced/widowed people as vulnerable population. There were 12.0% (8500 cases) of COPD hospitalization attributable to hourly TV during the study period. Daily TV produced similar estimates of relative effects (relative risk) but grater estimates of absolute effects (attributable fraction) than hourly TV. CONCLUSION: We concluded that TV was an independent risk factor of COPD morbidity, especially among the susceptible subgroups. These findings would be helpful to guide the development of targeted public intervention.
Identifying ecological drivers of disease transmission is central to understanding disease risks. For vector-borne diseases, temperature is a major determinant of transmission because vital parameters determining the fitness of parasites and vectors are highly temperature-sensitive, including the extrinsic incubation period required for parasites to develop within the vector. Temperature also underlies dramatic differences in the individual-level variation in the extrinsic incubation period, yet the influence of this variation in disease transmission is largely unexplored. We incorporate empirical estimates of dengue virus extrinsic incubation period and its variation across a range of temperatures into a stochastic model to examine the consequences for disease emergence. We find that such variation impacts the probability of disease emergence because exceptionally rapid, but empirically observed incubation – typically ignored by modelling only the average – increases the chance of disease emergence even at the limits of the temperature range for dengue transmission. We show that variation in the extrinsic incubation period causes the greatest proportional increase in the risk of disease emergence at cooler temperatures where the mean incubation period is long, and associated variation is large. Thus, ignoring EIP variation will likely lead to underestimation of the risk of vector-borne disease emergence in temperate climates.
BACKGROUND: Investigating future changes in temperature-related mortality as a function of global mean temperature (GMT) rise allows for the evaluation of policy-relevant climate change targets. So far, only few studies have taken this approach, and, in particular, no such assessments exist for Germany, the most populated country of Europe. METHODS: We assess temperature-related mortality in 12 major German cities based on daily time-series of all-cause mortality and daily mean temperatures in the period 1993-2015, using distributed-lag non-linear models in a two-stage design. Resulting risk functions are applied to estimate excess mortality in terms of GMT rise relative to pre-industrial levels, assuming no change in demographics or population vulnerability. RESULTS: In the observational period, cold contributes stronger to temperature-related mortality than heat, with overall attributable fractions of 5.49% (95%CI: 3.82-7.19) and 0.81% (95%CI: 0.72-0.89), respectively. Future projections indicate that this pattern could be reversed under progressing global warming, with heat-related mortality starting to exceed cold-related mortality at 3 °C or higher GMT rise. Across cities, projected net increases in total temperature-related mortality were 0.45% (95%CI: -0.02-1.06) at 3 °C, 1.53% (95%CI: 0.96-2.06) at 4 °C, and 2.88% (95%CI: 1.60-4.10) at 5 °C, compared to today’s warming level of 1 °C. By contrast, no significant difference was found between projected total temperature-related mortality at 2 °C versus 1 °C of GMT rise. CONCLUSIONS: Our results can inform current adaptation policies aimed at buffering the health risks from increased heat exposure under climate change. They also allow for the evaluation of global mitigation efforts in terms of local health benefits in some of Germany’s most populated cities.
This study established the correlation between respiratory syncytial virus (RSV) bronchiolitis and climate factors in the area of Sousse, Tunisia, during 13 years (2003-2015), from neonates and children <=?5 years old and hospitalized in Farhat Hached University-Hospital of Sousse. The meteorological data of Sousse including temperature, rainfall, and humidity were obtained. RSV detection was carried out with the direct immunofluorescence assay. The impact of climate factors on viral circulation was statistically analyzed. From 2003 to 2015, the total rate of RSV bronchiolitis accounted for 34.5% and peaked in 2007 and 2013. RSV infection was higher in male cases and pediatric environment (p<0.001) and was detected in 47.3% of hospitalizations in intensive care units. The epidemic of this pathogen started in October and peaked in January (41.6%). When the infectivity of RSV was at its maximum, the monthly average rainfall was high (31 mm) and the monthly average temperature and the monthly average humidity were at their minimum (11 °C and 66%, respectively). RSV activity was negatively correlated with temperature (r?=?-?0.78, p?=?0.003) and humidity (r?=?-?0.62, p?=?0.03). Regression analysis showed that the monthly average temperature fits into a linear model (R(2)?=?61%, p?
Seniors constitute the population group generally most at risk of mortality due to heat stress. As life expectancy increases and health conditions of elderly people improve over time, vulnerability of the population to heat changes as well. We employed the years-of-life-lost (YLL) approach, considering life expectancy at the time of each death, to investigate how population ageing affects temporal changes in heat-related mortality in the Czech Republic. Using an updated gridded meteorological database, we identified heat waves during 1994-2017, and analysed temporal changes in their impacts on YLL and mortality. The mean impact of a heat-wave day on relative excess mortality and YLL had declined by approximately 2-3% per decade. That decline abated in the current decade, however, and the decreasing trend in mean excess mortality as well as YLL vanished when the short-term mortality displacement effect was considered. Moreover, the cumulative number of excess deaths and YLL during heat waves rose due to increasing frequency and intensity of heat waves during the examined period. The results show that in studies of temporal changes it is important to differentiate between mean effects of heat waves on mortality and the overall death burden associated with heat waves. Analysis of the average ratio of excess?YLL/death per heat-wave day indicated that the major heat-vulnerable population group shifted towards older age (70+?years among males and 75+?years among females). Our findings highlight the importance of focusing heat-protection measures especially upon the elderly population, which is most heat-vulnerable and whose numbers are rising.
BACKGROUND: In the context of global warming, studies have turned to assess the temporal trend of the association between temperature and health outcomes, which can be used to reflect whether human beings have adapted to the local temperature. However, most studies have only focused on hot temperature and mortality. We aim to investigate the temporal variations in the association between ambient temperature and hospitalisations for cardiovascular diseases in Queensland, Australia from 1995 to 2016. METHODS AND FINDINGS: We obtained data on 1,855,717 cardiovascular hospitalisations (mean age: 65.9 years, 42.7% female) from all 443 postal areas in Queensland, Australia between January 1, 1995 and December 31, 2016. Grid-level meteorological data were downloaded from scientific information for landowners. We used a time-stratified case-crossover design fitted with a conditional quasi-Poisson regression model and time-varying distributed lag nonlinear model (DLNM) to evaluate the association between temperature and cardiovascular hospitalisations and the temporal trends of the associations. Stratified analyses were performed in different age, sex, and climate zones. In all groups, relative risks (RRs) of cardiovascular hospitalisations associated with high temperatures (heat effects) increased, but cold effects showed a decreasing trend from 1995 to 2016. The increasing magnitude of heat effects was larger (p = 0.002) in men than in women and larger (p < 0.001) in people aged ?69 years than in those aged ?70 years. There was no apparent difference amongst different climate zones. The study was limited by the switch from ICD-9 to ICD-10 coding systems, by being unable to separate first-time hospitalisation from repeated hospitalisations, and possibly by confounding by air pollution or by influenza infections. CONCLUSION: The impacts of cold temperatures on cardiovascular hospitalisations have decreased, but the impacts of high temperatures have increased in Queensland, Australia. The findings highlight that Queensland people have adapted to the impacts of cold temperatures, but not high temperatures. The burden of cardiovascular hospitalisations due to high temperatures is likely to increase in the context of global warming.
BACKGROUND: Heat stress during pregnancy may limit fetal growth, with ramifications throughout the life course. However, critical exposure windows are unknown, and effects of meteorological variability have not been investigated. OBJECTIVES: We aimed to identify sensitive windows for the associations of mean and variability of temperature and humidity with term birthweight. METHODS: We analyzed data from two French mother-child cohorts, EDEN and PELAGIE (n = 4771), recruited in 2002-2006. Temperature exposure was assessed using a satellite-based model with daily 1-km(2) resolution, and relative humidity exposure data were obtained from Météo France monitors. Distributed lag models were constructed using weekly means and standard deviation (SD, to quantify variability) from the first 37 gestational weeks. Analyses were then stratified by sex. Results for each exposure were adjusted for the other exposures, gestational age at birth, season and year of conception, cohort and recruitment center, and individual confounders. RESULTS: There was no evidence of association between term birthweight and mean temperature. We identified a critical window in weeks 6-20 for temperature variability (cumulative change in term birthweight of -54.2 g [95% CI: -102, -6] for a 1 °C increase in SD of temperature for each week in that window). Upon stratification by sex of the infant, the relationship remained for boys (weeks 1-21, cumulative change: -125 g [95% CI: -228, -21]). For mean humidity, there was a critical window in weeks 26-37, with a cumulative change of -28 g (95% CI: -49, -7) associated with a 5% increase in humidity for each week. The critical window was longer and had a stronger association in boys (weeks 29-37; -37 g, 95% CI: -63, -11) than girls (week 14; -1.8 g, 95% CI: -3.6, -0.1). DISCUSSION: Weekly temperature variability and mean humidity during critical exposure windows were associated with decreased term birthweight, especially in boys.
In recent decades, a considerable increase in the number of tick-bitten humans has been recorded in the north of European Russia. At the same time, significant climatic changes, such as an increase in air temperature, were noticed in this region. The northern border of the ixodidae distribution area lies in the north of European Russia, therefore the analysis of the population dynamics is of particular interest regarding the possible impact of the climate changes. Unfortunately, in such a large territory field, studies on tick abundance are very difficult. In our study, the official statistics for the number of tick-bitten humans were used. This kind of statistical analysis has been conducted in the Russian Federation for many years, and can be used for the estimation of climate change impact on tick abundance. Statistical data on tick-bitten humans have been collected in three large regions for several decades. For the same regions, the average annual air temperature was calculated and modeled. An S-shaped distribution of the number of victims depending on the average annual air temperature was established, which can be described as “Verhulst’s law”, or logistic function. However, the development of the population does not depend on time, but on the temperature of the ambient air.
Thermal comfort standards are essential to ensure comfortable and enjoyable indoor conditions, and they also help in optimizing energy use. Thermal comfort studies, either climate chamber-based or field investigation, are conducted across the globe in order to ascertain the comfort limits as per the climatic and other adaptive features. However, very few studies are conducted when the occupants are subjected to a stressed condition, like the COVID-19 lockdown, which may not only have the health impacts but also have psychological impacts on the adaptation. In this paper, we present the results of the online study conducted regarding the status of thermal comfort during the COVID-19 lockdown in India. A total of 406 complete responses were collected from subjects located across 3 different climatic regions of India, that is, cold climate, composite climate, and hot and humid climate. Variations in clothing insulation, thermal sensation, and preference were noted across the different climatic regions. We also present the variation in opening of windows and running of fans with the variation in outdoor mean air temperature. The self-judged productivity, comfort, desire to go outdoors, and effectiveness of working from home were seen to vary with the increase in the days of lockdown.
As the main venue for sports training and competition, the thermal environment of a stadium directly could affect the comfort and health of a moving body and sports performance. In this study, the quantitative relationship between ambient temperature and subjective sensation evaluation was established by monitoring the actual thermal sensation evaluation, fatigue sensation cognition and physiological response with high physical activity, under different conditions of ambient temperature. The results show that 90% of subjects can actually accept an ambient temperature range of 18.6 degrees C-26 degrees C. This is 2 degrees C higher than the maximum recommended range in the ISO 7730:2005 thermal comfort standard, reflecting a strong tolerance of the moving human body to low or high temperature environments. A high temperature environment could cause exercise fatigue to occur prematurely. Moreover, the study suggests that the critical point for early occurrence of fatigue sensation in a moving human body is 28 degrees C. The relationship between the environmental temperature and the physiological response was evaluated by mean skin temperature, blood pressure and heart rate of the human body. These are used as evaluation indexes of physiological parameters. Ambient temperature has a significant effect on the objective physiological response of the moving human body, which coincides with the subject’s definition of subjective sensory evaluation to the ambient temperature.
This paper examines the relationship between weather conditions and child nutrition in Ethiopia. We link data from four rounds of the Ethiopia Demographic and Health Survey to high-resolution climate data to measure exposure to rainfall and temperature in utero and during early life. We then estimate a set of multivariate regression models to understand how weather conditions impact child stunting, an indicator of sustained early life undernutrition. We find that greater rainfall during the rainy seasons in early life is associated with greater height for age. In addition, higher temperatures in utero, particularly during the first and third trimesters, and more rainfall during the third trimester, are positively associated with severe stunting, though stunting decreases with temperature in early life. We find potential evidence for a number of pathways underlying the weather-child nutrition relationship including agricultural livelihoods, heat stress, infectious disease transmission, and women’s time use during pregnancy. These findings illuminate the complex pathways through which climate change may influence child health and should motivate additional research focused on identifying the causal mechanisms underlying these links.
Different authors have identified geographic variations in the rates of suicide. This study aims to discuss the limitations of the officially recorded suicide data and to evaluate the statistical relationship between a biometeorological index, Apparent Temperature (AT), and suicide in Madrid and Lisbon. We performed a time-series study. The association was analyzed using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of AT on suicides, a lag non-linear model was fitted in a generalized additive model. There was an average rate of 3.30 suicides/100,000 inhabitants in Madrid and of 7.92 suicides/100,000 inhabitants in Lisbon, and a downward trend was found throughout the period. In Madrid, there is no statistically significant association between AT and suicide. However, in Lisbon, under higher AT, there was a higher risk of suicide. The highest accumulated statistically significant Relative Risk (RR) of suicide was detected at 7 days after the exposure, when at 38 °C, the risk of suicide is 2.7 times that existing at the median AT, 20.62°. The average mortality rate recorded in Lisbon was 41.6% higher than that registered in Madrid. However, the limitations of suicide record databases in Spain and Portugal have to be taken into account when analyzing incidence and especially when comparing data from different countries. It is necessary to improve the filing systems of violent deaths in order to perform reliable epidemiological studies.
BACKGROUND: Suicidal behavior is determined by the consequence of an interaction between biological, psychological and sociological factors, as well as between individual and environmental effects. Fluctuations in meteorological factors can modify human behavior and affect suicidal rates. We hypothesize that high temperatures can be associated with an increase rate of suicidal attempts. METHODS: We included all the patients admitted to Soroka University Medical Center (SUMC) due to suicide attempts between the years 2002-2017 and were residents of Southern Israel. We computed two sets of regression models: first, a time stratified case-crossover design to control for seasonality and individual differences. Results are presented as odds ratio (OR) with confidence interval (CI); and then, time-series analyses to calculate the incidence rate ratio (IRR) and the cumulative effect of temperature on the daily incidences of emergency department (ED) admissions after suicide attempts. We stratified the analyses by demographic variables to identify significant individual differences. RESULTS: We identified 3100 attempts, by 2338 patients who lived in Be’er Sheva between 16 and 90 years of age; 421 patients made 2+ attempts. Suicide attempts were associated with a 5 °C increase during the summer season (OR 1.59, 95% CI 1.22-2.08) and a 5 °C increase in all seasons was associated with those who have made multiple attempts (OR 1.18, 95% CI 1.0005-1.38). The cumulative effect of 5 °C increment is associated with more suicide attempts over 2 days (IRR 1.10, 95% CI 0.98; 1.24) and 5 days (IRR 1.04, 95% CI 1.00; 1.08). The associations were greater for patients with psychiatric diagnosis and patients with multiple attempts. In a stratified analysis by individual characteristics we didn’t find significant association. CONCLUSION: High temperatures and low amount of precipitations are evidently of great impact on people’s susceptibility to suicidal behavior, especially for individuals who have had a prior suicide attempt. Our findings indicate the need for public health attention in the summer when temperature increases precipitously over days, especially for those who have made a prior suicide attempt.
This study consists of nine case studies addressing thermal comfort in the public areas of city centres, with particular emphasis on the measurable effects of blue and green infrastructure on thermal exposure. Daytime on-site measurements were taken in summer in the paved areas of squares, in the proximity of water fountains, and in the shade of trees in order to evaluate levels of heat stress based on the universal thermal climate index (UTCI). The differences in UTCI values between the research points confirm substantial cooling associated with high vegetation (trees induced differences up to 10.5 degrees C in UTCI), while the measurable cooling effect of low vegetation was negligible (not more than 2.3 degrees C UTCI). It was also quite low around water fountains, spray fountains, and misting systems. It follows that municipal authorities should consider the differences in cooling effect potential of individual types of blue and green infrastructure when incorporating climate adaptation measures into urban planning.
The sub-divided unit (SDU) is the major type of substandard housing in Hong Kong. This study monitored the microclimatic conditions in eight SDUs for 24 h in summer. The mean CO2 concentration (1012 mg/m(3)) under natural ventilation was much higher than the outdoor level (similar to 410 mg/m(3)), suggesting that ventilation was ineffective in most SDUs. The mean predicted mean vote (PMV) was 1.7 (warm), corresponding to 75% predicted percentage dissatisfied (PPD). None of the SDUs was thermally acceptable (PPD < 20%) at any time in the monitoring period. If the adaptive thermal comfort standard was considered, the acceptable temperature range would be between 23.4 degrees C and 30.4 degrees C in operative temperature and the thermally acceptable time would be 47%. Larger openable window size, larger external wall area and poor ventilation significantly contributed to higher maximum indoor air temperature.
BACKGROUND: The incidence of many infections is seasonal e.g. surgical site infections, urinary tract infection and bloodstream infections. We questioned whether there is seasonal variation even in climate-controlled hospitalized patients, and analyzed the influence of climate parameters on nosocomial bloodstream infections. METHODS AND FINDINGS: The retrospective cohort study is based on two databases: The German national surveillance system for nosocomial infections in intensive care units (ICU-KISS) from 2001 to 2015 and aggregated monthly climate data. Primary bloodstream infection (PBSI) is defined as a positive blood culture with one (or more) pathogen(s) which are not related to an infection on another site and which were not present at admission. Monthly infection data were matched with postal code, calendar month and corresponding monthly climate and weather data. All analyses were exploratory in nature. 1,196 ICUs reported data on PBSI to KISS. The ICUs were located in 779 hospitals and in 728 different postal codes in Germany. The majority of the 19,194 PBSI were caused by gram-positive bacteria. In total, the incidence density of BSI was 17% (IRR 1.168, 95%CI 1.076-1.268) higher in months with high temperatures (?20°C) compared to months with low temperatures (<5°C). The effect was most prominent for gram-negatives; more than one third (38%) higher followed by gram-positives with 13%. Fungi reached their highest IRR at moderately warm temperatures between 15-20°C. At such temperatures fungi showed an increase of 33% compared to temperatures below 5°C. PBSI spiked in summer with a peak in July and August. PBSI differed by pathogen: The majority of bacteria increased with rising temperatures. Enterococci showed no seasonality. S. pneumoniae reached a peak in winter time. The association of the occurrence of PBSI and temperatures ?20°C was stronger when the mean monthly temperature in the month prior to the occurrence of BSI was considered instead of the temperature in the month of the occurrence of BSI. High average temperatures ?20°C increased the risk of the development of a PBSI by 16% compared with low temperatures <5°C. CONCLUSIONS: Most nosocomial infections are endogenous in nature; the microbiome plays a crucial role in host health. If gut and skin microbiome varies with season, environmental parameters will contribute to the observed incidence patterns. Similarly, the impact of global warming on both local weather patterns and extreme weather events may influence the acquisition of pathogens. A better understanding of the etiology of these infections is needed to provide guidance for future infection control strategies.
As heat waves become more extreme, there is a growing concern for the health of elderly city dwellers who have poor living conditions and limited access to resources. Much research has documented socioeconomic links to heat vulnerability, but limited studies have investigated the detailed living conditions of vulnerable populations, despite increasing requests from local communities. In this paper, we examine the summertime thermal performance of 24 senior apartments within 3 public housing sites (2 conventional multifamily and 1 LEED-rated building), and the seniors’ adaptive responses in Elizabeth, NJ, USA. Time-series data were collected from sensors, interviews and observations on the thermal environment and behavior, from May-October 2017. Our multi-level, occupant-centric approach utilizes the indoor heat index as a proxy for heat stress, against site and building characteristics, and environmental and personal variables. Panel regressions show thermal variations among sites/apartments and illustrate the significant effect of actions, such as window opening and air conditioner use. Results also show how the seniors’ adaptive responses vary by site; residents with central air-conditioning use it, while residents from the two older sites engage in a wider range of adaptive actions, and in some cases achieve similar indoor heat indexes as apartments from the green building. Indoor heat stress experienced by low-income seniors can be greatly reduced through cost-effective strategies that target individual behaviors and outdoor amenities. This implies the need for integrated solutions to the heat waves problem across scales; including changes to residents’ habits, building envelopes, building operations, and outdoor spaces.
The effects of heat waves (HW) are more pronounced in urban areas than in rural areas due to the additive effect of the urban heat island (UHI) phenomenon. However, the synergies between UHI and HW are still an open scientific question and have only been quantified for a few metropolitan cities. In the current study, we explore the synergies between UHI and HW in Seoul city. We consider summertime data from two non-consecutive years (i.e., 2012 and 2016) and ten automatic weather stations. Our results show that UHI is more intense during HW periods than non-heat wave (NHW) periods (i.e., normal summer background conditions), with a maximum UHI difference of 3.30°C and 4.50°C, between HW and NHW periods, in 2012 and 2016 respectively. Our results also show substantial variations in the synergies between UHI and HW due to land use characteristics and synoptic weather conditions; the synergies were relatively more intense in densely built areas and under low wind speed conditions. Our results contribute to our understanding of thermal risks posed by HW in urban areas and, subsequently, the health risks on urban populations. Moreover, they are of significant importance to emergency relief providers as a resource allocation guideline, for instance, regarding which areas and time of the day to prioritize during HW periods in Seoul.
Numerous studies have demonstrated the relationship between summer temperatures and increased heat-related deaths. Epidemiological analyses of the health effects of climate exposures usually rely on observations from the nearest weather station to assess exposure-response associations for geographically diverse populations. Urban climate models provide high-resolution spatial data that may potentially improve exposure estimates, but to date, they have not been extensively applied in epidemiological research. We investigated temperature-mortality relationships in the city of Barcelona, and whether estimates vary among districts. We considered georeferenced individual (natural) mortality data during the summer months (June-September) for the period 1992-2015. We extracted daily summer mean temperatures from a 100-m resolution simulation of the urban climate model (UrbClim). Summer hot days (above percentile 70) and reference (below percentile 30) temperatures were compared by using a conditional logistic regression model in a case crossover study design applied to all districts of Barcelona. Relative Risks (RR), and 95% Confidence Intervals (CI), of all-cause (natural) mortality and summer temperature were calculated for several population subgroups (age, sex and education level by districts). Hot days were associated with an increased risk of death (RR = 1.13; 95% CI = 1.10-1.16) and were significant in all population subgroups compared to the non-hot days. The risk ratio was higher among women (RR = 1.16; 95% CI= 1.12-1.21) and the elderly (RR = 1.18; 95% CI = 1.13-1.22). Individuals with primary education had similar risk (RR = 1.13; 95% CI = 1.08-1.18) than those without education (RR = 1.10; 95% CI= 1.05-1.15). Moreover, 6 out of 10 districts showed statistically significant associations, varying the risk ratio between 1.12 (95% CI = 1.03-1.21) in Sants-Montjuïc and 1.25 (95% CI = 1.14-1.38) in Sant Andreu. Findings identified vulnerable districts and suggested new insights to public health policy makers on how to develop district-specific strategies to reduce risks.
BACKGROUND: As global progress to reduce malaria transmission continues, it is increasingly important to track changes in malaria incidence rather than prevalence. Risk estimates for Africa have largely underutilized available health management information systems (HMIS) data to monitor trends. This study uses national HMIS data, together with environmental and geographical data, to assess spatial-temporal patterns of malaria incidence at facility catchment level in Uganda, over a recent 5-year period. METHODS: Data reported by 3446 health facilities in Uganda, between July 2015 and September 2019, was analysed. To assess the geographic accessibility of the health facilities network, AccessMod was employed to determine a three-hour cost-distance catchment around each facility. Using confirmed malaria cases and total catchment population by facility, an ecological Bayesian conditional autoregressive spatial-temporal Poisson model was fitted to generate monthly posterior incidence rate estimates, adjusted for caregiver education, rainfall, land surface temperature, night-time light (an indicator of urbanicity), and vegetation index. RESULTS: An estimated 38.8 million (95% Credible Interval [CI]: 37.9-40.9) confirmed cases of malaria occurred over the period, with a national mean monthly incidence rate of 20.4 (95% CI: 19.9-21.5) cases per 1000, ranging from 8.9 (95% CI: 8.7-9.4) to 36.6 (95% CI: 35.7-38.5) across the study period. Strong seasonality was observed, with June-July experiencing highest peaks and February-March the lowest peaks. There was also considerable geographic heterogeneity in incidence, with health facility catchment relative risk during peak transmission months ranging from 0 to 50.5 (95% CI: 49.0-50.8) times higher than national average. Both districts and health facility catchments showed significant positive spatial autocorrelation; health facility catchments had global Moran’s I?=?0.3 (p <?0.001) and districts Moran’s I?=?0.4 (p <?0.001). Notably, significant clusters of high-risk health facility catchments were concentrated in Acholi, West Nile, Karamoja, and East Central – Busoga regions. CONCLUSION: Findings showed clear countrywide spatial-temporal patterns with clustering of malaria risk across districts and health facility catchments within high risk regions, which can facilitate targeting of interventions to those areas at highest risk. Moreover, despite high and perennial transmission, seasonality for malaria incidence highlights the potential for optimal and timely implementation of targeted interventions.
Natural environmental disasters in the developing countries of West Africa are at alarming rate which necessitate the investigation of long-term trend of rainfall and temperature. Current variation, trends of temperature, and rainfall across Nigeria were investigated using parametric and non-parametric statistical tools. Meteorological data obtained from the Nigeria Meteorological Agency in Lagos, Nigeria, from 1970 to 2010 were used for this analysis. Seasonal and annual trends of maximum temperature, minimum temperature, and rainfall were carried out using Mann-Kendall and Sen’s slope methods. Long-term linear regression of these meteorological variables was analyzed across eighteen locations in the country. Spatial distribution of seasonal trends of these variables was also estimated for the four seasons in Nigeria. The result of the linear regression on temperatures and rainfall showed increasing trends in most of the locations across the country. Similarly, Mann-Kendall and Sen’s slope analysis showed a significant increasing trend in most areas across the country. Consequently, recent phenomena of environmental hazard such as an outbreak of airborne diseases and flooding leading to the collapse of buildings and various environmental disasters can be linked to the observed result.
Urban heat islands (UHIs) can present significant risks to human health. Santiago, Chile has around 7 million residents, concentrated in an average density of 480 people/km(2). During the last few summer seasons, the highest extreme maximum temperatures in over 100 years have been recorded. Given the projections in temperature increase for this metropolitan region over the next 50 years, the Santiago UHI could have an important impact on the health and stress of the general population. We studied the presence and spatial variability of UHIs in Santiago during the summer seasons from 2005 to 2017 using Moderate Resolution Imaging Spectroradiometer (MODIS) satellite imagery and data from nine meteorological stations. Simple regression models, geographic weighted regression (GWR) models and geostatistical interpolations were used to find nocturnal thermal differences in UHIs of up to 9 degrees C, as well as increases in the magnitude and extension of the daytime heat island from summer 2014 to 2017. Understanding the behavior of the UHI of Santiago, Chile, is important for urban planners and local decision makers. Additionally, understanding the spatial pattern of the UHI could improve knowledge about how urban areas experience and could mitigate climate change.
Hand, Foot, and Mouth Disease (HFMD) is a common and widespread infectious disease. Previous studies have presented evidence that climate factors, including the monthly averages of temperature, relative humidity, air pressure, wind speed and Cumulative Risk (CR) all have a strong influence on the transmission of HFMD. In this paper, the monthly time-lag geographically- weighted regression model was constructed to investigate the spatiotemporal variations of effect of climate factors on HFMD occurrence in Inner Mongolia Autonomous Region, China. From the spatial and temporal perspectives, the spatial and temporal variations of effect of climate factors on HFMD incidence are described respectively. The results indicate that the effect of climate factors on HFMD incidence shows very different spatial patterns and time trends. The findings may provide not only an indepth understanding of spatiotemporal variation patterns of the effect of climate factors on HFMD occurrence, but also provide helpful evidence for making measures of HFMD prevention and control and implementing appropriate public health interventions at the county level in different seasons.
In the past decades, severe heat waves have frequently occurred in many parts of the world. These conspicuous heat waves exerted terrible influences on human health, society, the economy, agriculture, the ecosystem and so on. Based on observed daily temperatures in China, an integrated index of heat waves and extreme-temperature days was established involving the frequency, duration, intensity and scale of these events across large cities in China. Heat waves and extreme-temperature days showed an increasing trend in most regions except northwest China from 1955 to 2014. After the late 1980s, the increasing trend was more obvious than the decades before. The cities in the middle and lower reaches of the Yangtze River were threatened by the most serious heat events in the past 60 years, especially Chongqing and Changsha. Due to the subtropical monsoon climate and special terrain, Chongqing experienced the most heat events in a long period of time. In particular, there was obvious fluctuation of hot years in 31 cities, which did not continuously rise with global warming; 21 cities mainly located in the eastern and southern regions of China had an obvious rising trend; eight cities had a clear declining trend which was mainly distributed in the western and northern regions of China; and there were no extreme-temperature days in Kunming and Lhasa in the past 60 years. The study revealed an obvious differentiation of heat events for 31 cities under climate change; heat threat in most cities is increasing but declining or remaining unchanged in the other cities. The trend is likely to intensify with global warming.
Heat waves seriously affect the productivity and daily life of human beings. Therefore, they bring great risks and uncertainties for the further development of countries in the One Belt and One Road (OBOR) region. In this study, we used daily meteorological monitoring data to calculate the daily apparent temperature and annual heat wave dataset for 1989-2018 in the OBOR region. Then, we studied their spatiotemporal distribution patterns. Additionally, multi-source data were used to assess heat wave risk in the OBOR region. The main results are as follows: (1) The daily apparent temperature dataset and annual heat wave dataset for 1989-2018 in the OBOR region at 0.1 degrees x 0.1 degrees gridded resolution were calculated. China, South Asia and Southeast Asia are suffering the most serious heat waves in the OBOR region, with an average of more than six heat waves, lasting for more than 60 days and the extreme apparent temperature has reached over 40 degrees C. Additionally, the frequency, duration and intensity of heat waves have been confirmed to increase continuously. (2) The heat wave risk in the OBOR region was assessed. Results show that the high heat wave risk areas are distributed in eastern China, northern South Asia and some cities. The main conclusion is that the heat wave risk in most areas along the OBOR route is relatively high. In the process of deepening the development of countries in the OBOR region, heat wave risk should be fully considered.
Heat waves have pronounced impacts on human health, ecosystems, and society. Heat waves have become more frequent and intense globally and are likely to intensify further in a warming climate. Across the United States there is a warming trend in average surface temperatures, but concordant increase in heat wave severity appears absent. Limitations in heat waves studies may be responsible for limited detection of a heat wave warming signal. We track daily spatiotemporal evolution of heat waves using geometric concepts and clustering algorithms to investigate how heat manifests on the land surface. We develop a spatial metric combining heat wave frequency, magnitude, duration, and areal extent. We find mixed trends in some individual heat wave characteristics across the United States during 1981-2018. However, exploration of the spatiotemporal evolution of combined heat wave characteristics shows considerable increases during this period and indicates a substantial increase in heat wave hazard across the United States.
BACKGROUND: Human brucellosis imposes a heavy burden on the health and economy of endemic regions. Since 2011, China has reported at least 35,000 human brucellosis cases annually, with more than 90% of these cases reported in the northern. Given the alarmingly high incidence and variation in the geographical distribution of human brucellosis cases, there is an urgent need to decipher the causes of such variation in geographical distribution. METHOD: We conducted a retrospective epidemiological study in Shaanxi Province from January 1, 2005 to December 31, 2018 to investigate the association between meteorological factors and transmission of human brucellosis according to differences in geographical distribution and seasonal fluctuation in northwestern China for the first time. RESULTS: Human brucellosis cases were mainly distributed in the Shaanbei upland plateau before 2008 and then slowly extended towards the southern region with significant seasonal fluctuation. The results of quasi-Poisson generalized additive mixed model (GAMM) indicated that air temperature, sunshine duration, rainfall, relative humidity, and evaporation with maximum lag time within 7 months played crucial roles in the transmission of human brucellosis with seasonal fluctuation. Compared with the Shaanbei upland plateau, Guanzhong basin had more obvious fluctuations in the occurrence of human brucellosis due to changes in meteorological factors. Additionally, the established GAMM model showed high accuracy in predicting the occurrence of human brucellosis based on the meteorological factors. CONCLUSION: These findings may be used to predict the seasonal fluctuations of human brucellosis and to develop reliable and cost-effective prevention strategies in Shaanxi Province and other areas with similar environmental conditions.
Fecal coliform bacteria are a key indicator of human health risks; however, the spatiotemporal variability and key influencing factors of river fecal coliform have yet to be explored in a rural-suburban-urban watershed with multiple land uses. In this study, the fecal coliform concentrations in 21 river sections were monitored for 20 months, and 441 samples were analyzed. Multivariable regressions were used to evaluate the spatiotemporal dynamics of fecal coliform. The results showed that spatial differences were mainly dominated by urbanization level, and environmental factors could explain the temporal dynamics of fecal coliform in different urban patterns except in areas with high urbanization levels. Reducing suspended solids is a direct way to manage fecal coliform in the Beiyun River when the natural factors are difficulty to change, such as temperature and solar radiation. The export of fecal coliform from urban areas showed a quick and sensitive response to rainfall events and increased dozens of times in the short term. Landscape patterns, such as the fragmentation of impervious surfaces and the overall landscape, were identified as key factors influencing urban non-point source bacteria. The results obtained from this study will provide insight into the management of river fecal pollution.
OBJECTIVE: The study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China. SETTING: Guangxi, China. PARTICIPANTS: This study was done among 7804 asthma patients. PRIMARY AND SECONDARY OUTCOME MEASURES: Spearman correlation coefficient was used to estimate correlation between environmental factors and asthma hospitalisation rates in multiple regions. Generalised additive model (GAM) with Poisson regression was used to estimate effects of environmental factors on asthma hospitalisation rates in 14 regions of Guangxi. RESULTS: The strongest effect of carbon monoxide (CO) was found on lag1 in Hechi, and every 10?µg/m(3) increase of CO caused an increase of 25.6% in asthma hospitalisation rate (RR 1.26, 95%?CI 1.02 to 1.55). According to the correlation analysis, asthma hospitalisations were related to the daily temperature, daily range of temperature, CO, nitrogen dioxide (NO(2)) and particulate matter (PM(2.5)) in multiple regions. According to the result of GAM, the adjusted R(2) was high in Beihai and Nanning, with values of 0.29 and 0.21, which means that environmental factors are powerful in explaining changes of asthma hospitalisation rates in Beihai and Nanning. CONCLUSION: Asthma hospitalisation rate was significantly and more strongly associated with CO than with NO(2), SO(2) or PM(2.5) in Guangxi. The risk factors of asthma exacerbations were not consistent in different regions, indicating that targeted measures should differ between regions.
Several studies emphasize that temperature-related mortality can be expected to have differential effects on different subpopulations, particularly in the context of climate change. This study aims to evaluate and quantify the future temperature-attributable mortality due to circulatory system diseases by age groups (under 65 and 65+ years), in Lisbon metropolitan area (LMA) and Porto metropolitan area (PMA), over the 2051-2065 and 2085-2099 time horizons, considering the greenhouse gas emissions scenario RCP8.5, in relation to a historical period (1991-2005). We found a decrease in extreme cold-related deaths of 0.55% and 0.45% in LMA, for 2051-2065 and 2085-2099, respectively. In PMA, there was a decrease in cold-related deaths of 0.31% and 0.49% for 2051-2065 and 2085-2099, respectively, compared to 1991-2005. In LMA, the burden of extreme heat-related mortality in age group 65+ years is slightly higher than in age group <65 years, at 2.22% vs. 1.38%, for 2085-2099. In PMA, only people aged 65+ years showed significant temperature-related burden of deaths that can be attributable to hot temperatures. The heat-related excess deaths increased from 0.23% for 2051-2065 to 1.37% for 2085-2099, compared to the historical period.
Background: despite the increase in malaria control and elimination efforts, weather patterns and ecological factors continue to serve as important drivers of malaria transmission dynamics. This study examined the statistical relationship between weather variables and malaria incidence in Abuja, Nigeria. Methodology/Principal Findings: monthly data on malaria incidence and weather variables were collected in Abuja from the year 2000 to 2013. The analysis of count outcomes was based on generalized linear models, while Pearson correlation analysis was undertaken at the bivariate level. The results showed more malaria incidence in the months with the highest rainfall recorded (June-August). Based on the negative binomial model, every unit increase in humidity corresponds to about 1.010 (95% confidence interval (CI), 1.005-1.015) times increase in malaria cases while the odds of having malaria decreases by 5.8% for every extra unit increase in temperature: 0.942 (95% CI, 0.928-0.956). At lag 1 month, there was a significant positive effect of rainfall on malaria incidence while at lag 4, temperature and humidity had significant influences. Conclusions: malaria remains a widespread infectious disease among the local subjects in the study area. Relative humidity was identified as one of the factors that influence a malaria epidemic at lag 0 while the biggest significant influence of temperature was observed at lag 4. Therefore, emphasis should be given to vector control activities and to create public health awareness on the proper usage of intervention measures such as indoor residual sprays to reduce the epidemic especially during peak periods with suitable weather conditions.
Occupational heat stress has an important negative impact on the well-being, health and productivity of workers and should; therefore, be recognized as a public health issue in Europe. There is no comprehensive heat health warning system in Slovenia combining public health measures with meteorological forecasts. The aim of this research was to provide insight into the development of such a system in Slovenia, turning the communication from the current meteoalarm into a broader system that has more information for different social groups. To achieve this goal, the following steps were used: Analysis of summer temperatures and issued meteoalarms, a survey of the general knowledge about heat among the public, organization and management of two stakeholder symposia, and a final survey on workers’ opinions on heat stress and measures, supplemented by interviews with employers. Summer average daily temperature distributions in Slovenia changed during the investigated period (1961-2019) and the mean values increased over time by 2-3 °C. Additionally, the number of days with fulfilled yellow (potentially dangerous) and especially orange (dangerous) meteoalarm conditions increased significantly after 1990. The survey of the general public about heat stress and warnings showed that efforts to raise awareness of heat issues need to be intensified and that public health measures should effectively target vulnerable groups. Stakeholder symposia and further surveys have shown that awareness and understanding of the negative effects of heat stress on health and productivity are still quite low, so effective ways of disseminating information to different sectors while striking the best balance between efficiency, feasibility and economic cost have to be found.
Previous research has associated snowfall with risk of myocardial infarction (MI). Most studies have been conducted in regions with harsh winters; it remains unclear whether snowfall is associated with risk of MI in regions with milder or more varied climates. A case-crossover design was used to investigate the association between snowfall and death from MI in British Columbia, Canada. Deaths from MI among British Columbia residents between October 15 and March 31 from 2009 to 2017 were identified. The day of each death from MI was treated as the case day, and each case day was matched to control days drawn from the same day of the week during the same month. Daily snowfall amount was assigned to case and control days at the residential address, using weather stations within 15 km of the residence and 100 m in elevation. In total, 3,300 MI case days were matched to 10,441 control days. Compared with days that had no snowfall, odds of death from MI increased 34% (95% confidence interval: 0%, 80%) on days with heavy snowfall (?5 cm). In stratified analysis of deaths from MI as a function of both maximum temperature and snowfall, risk was significantly increased on snowfall days when the temperature was warmer.
The causes and consequences of indoor heat exposure are receiving growing attention as global temperature rises and people seek respite from the heat in indoor spaces. In this study, we measured indoor temperatures of 46 air-conditioned residences in Phoenix, Arizona, United States. Temperatures were collected concurrently at 5-min intervals from August 21 to September 19, 2016. Indoor temperatures exhibited significant heterogeneity across all residences, ranging from 16.5 to 37.2 degrees C with a mean (SD) of 26.4 degrees C (2.2 degrees C). On average, the 5-min indoor temperatures were moderately correlated with outdoor temperature (r = 0.421), although individual household correlations were highly variable, ranging from r = -0.244 to r = 0.924. Households were grouped into six clusters using K-means based on 19 temperature metrics. We tested for differences in demographic, behavior, and infrastructure indicators between those six clusters based on responses to a social survey. Nearly half the variance in preferred thermostat setting was explained by cluster (R-2 = 0.455, p < .001). For the most part, measures of air-conditioning use, limitations on air-conditioning use, and household resources (e.g., income) did not vary significantly by cluster. The same was true for heat-related health and comfort outcomes. Two households that did not pay their own electric bill were by far the coldest homes (average temperature of 20.0 degrees C). We conclude that indoor temperature preference may supersede concerns related to the cost of using air-conditioning and that resource-constrained households may be sacrificing other necessities to keep their homes comfortable.
BACKGROUND: Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982-2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants. METHODS: Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup. RESULTS: All-cause mortality risk is higher among women (1.88; 95% CI?=?1.77, 2.00) and the elderly (2.13; 95% CI?=?1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI?=?1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI?=?1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI?=?1.38, 2.00) and for separated and divorced in women (2.11; 95% CI?=?1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI?=?1.39, 1.86), while for women results are almost equivalent between alone and not alone groups. CONCLUSIONS: The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups.
Although several studies have reported that social isolation is one of the important health risk factors in the elderly population living in urban areas, its effects on vulnerability to heatwaves have been studied relatively less than climatic and other socio-economic factors. Thus, we investigated the association between social isolation levels and heatwave-related mortality risk in the elderly population in 119 urban administrative districts in Korea, using a time-series multi-city dataset (2008-2017). We used a two-stage analysis. In the first stage, we estimated the heatwave-related mortality risk in the elderly population (age ? 65) for each district using a time-series regression with a distributed lag model. Subsequently, in the second stage, we applied meta-regressions to pool the estimates across all the districts and estimate the association between social isolation variables and heatwave-related mortality risk. Our findings showed that higher social gathering and mutual aid levels were associated with lower heatwave-related mortality risk. Further, the lower percentage of single elderly households living in detached houses was also related to higher heatwave-related mortality risk. The associations were generally more evident in males compared to females. Our findings suggest that vulnerability to heatwave-related mortality among the urban, city-dwelling, elderly population may be amplified by higher isolation indicators.
INTRODUCTION: Leptospirosis is an endemic disease in Brazil that can become an epidemic during the rainy season resulting from floods in areas susceptible to natural disasters. These areas are widespread in Santa Catarina, particularly in the coastal region. Therefore, the objective of this study was to identify environmental, climatic, and demographic factors associated with the incidence of leptospirosis in the municipalities of Santa Catarina from 2001 to 2015, taking into account possible spatial dependence. METHODS: This was an ecological study aggregated by municipality. To evaluate the association between the incidence of leptospirosis and the factors under study (temperature, altitude, occurrence of natural disasters, etc.) while taking into account spatial dependence, linear regression models and models with global spatial error were used. RESULTS: Lower altitudes, higher temperatures, and areas of natural disaster risk in the municipality contributed the most to explaining the variability in the incidence rate. After taking spatial dependence into account, only the minimum altitude variable remained significant. The regions of lower altitude, where the highest rates of leptospirosis were recorded, corresponded to the eastern portion of the state near the coastal region, where floods, urban floods, and overflows are common occurrences. No associations were found concerning demographic factors. CONCLUSIONS: The incidence of leptospirosis in Santa Catarina was associated with environmental factors, particularly low altitude, even when considering the spatial dependence structure present in the data. The spatial error model allowed for adequate modeling of spatial autocorrelation.
BACKGROUND: Exposure to temperature variability has been associated with increased risk of mortality and morbidity. We aimed to evaluate whether the association between short-term temperature variability and hospitalisation was affected by local socioeconomic level in Brazil. METHODS: In this time-series study, we collected city-level socioeconomic data, and daily hospitalisation and weather data from 1814 Brazilian cities between Jan 1, 2000, and Dec 31, 2015. All-cause and cause-specific hospitalisation data was from the Hospital Information System of the Unified Health System in Brazil. City-specific daily minimum and maximum temperatures came from a 0·25°?×?0·25° Brazilian meteorological dataset. We represented city-specific socioeconomic level using literacy rate, urbanisation rate, average monthly household income per capita (using the 2000 and 2010 Brazilian census), and GDP per capita (using statistics from the Brazilian Institute of Geography and Statistics for 2000-15), and cities were categorised according to the 2015 World Bank standard. We used quasi-Poisson regression to do time-series analyses and obtain city-specific associations between temperature variability and hospitalisation. We pooled city-specific estimates according to different socioeconomic quartiles or levels using random-effect meta-analyses. Meta-regressions adjusting for demographic and climatic characteristics were used to evaluate the modification effect of city-level socioeconomic indicators on the association between temperature variability and hospitalisation. FINDINGS: We included a total of 147?959?243 hospitalisations (59·0% female) during the study period. Overall, we estimated that the hospitalisation risk due to every 1°C increase in the temperature variability in the current and previous day (TV(0-1)) increased by 0·52% (95% CI 0·50-0·55). For lower-middle-income cities, this risk was 0·63% (95% CI 0·58-0·69), for upper-middle-income cities it was 0·50% (0·47-0·53), and for high-income cities it was 0·39% (0·33-0·46). The socioeconomic inequality in vulnerability to TV(0-1) was especially evident for people aged 0-19 years (effect estimate 1·21% [1·11-1·31] for lower-middle income vs 0·52% [0·41-0·63] for high income) and people aged 60 years or older (0·60% [0·50-0·70] vs 0·43% [0·31-0·56]), and for hospitalisation due to infectious diseases (1·62% [1·46-1·78] vs 0·56% [0·30-0·82]), respiratory diseases (1·32% [1·20-1·44] vs 0·55% [0·37-0·74]), and endocrine diseases (1·21% [0·99-1·43] vs 0·32% [0·02-0·62]). INTERPRETATION: People living in less developed cities in Brazil were more vulnerable to hospitalisation related to temperature variability. This disparity could exacerbate existing health and socioeconomic inequalities in Brazil, and it suggests that more attention should be paid to less developed areas to mitigate the adverse health effects of short-term temperature fluctuations. FUNDING: None.
Wildfires constitute a serious threat for both the environment and human well-being. The US fire policy aims to tackle this problem, devoting a sizeable amount of resources and resorting extensively to fire suppression strategies. The theoretical literature has established a link between climate conditions and wildfire incidence. Using state-level data from 2002 to 2013 for the USA, this work proposes a wildfire incidence indicator and runs a generalized spatial ordered probit model in order to test the findings of the previous literature empirically. Moreover, this article investigates the extent of spatial spillovers in the climatic covariates. The results highlight a significant impact of precipitation and temperature on fire incidence and provide some evidence of the role of spatial spillovers. In particular, transitions from lower to higher wildfire incidence levels are significantly encouraged by increases in local temperature and significantly discouraged by increases in both local precipitation and lagged precipitation. The present analysis complements the recent literature, confirming the previous findings with a solid empirical investigation and offering a policy-oriented picture of wildfire risks all over the USA.
BACKGROUND: Heat exposure, which will increase with global warming, has been linked to increased risk of a range of types of cause-specific hospitalizations. However, little is known about socioeconomic disparities in vulnerability to heat. We aimed to evaluate whether there were socioeconomic disparities in vulnerability to heat-related all-cause and cause-specific hospitalization among Brazilian cities. METHODS AND FINDINGS: We collected daily hospitalization and weather data in the hot season (city-specific 4 adjacent hottest months each year) during 2000-2015 from 1,814 Brazilian cities covering 78.4% of the Brazilian population. A time-stratified case-crossover design modeled by quasi-Poisson regression and a distributed lag model was used to estimate city-specific heat-hospitalization association. Then meta-analysis was used to synthesize city-specific estimates according to different socioeconomic quartiles or levels. We included 49 million hospitalizations (58.5% female; median [interquartile range] age: 33.3 [19.8-55.7] years). For cities of lower middle income (LMI), upper middle income (UMI), and high income (HI) according to the World Bank’s classification, every 5°C increase in daily mean temperature during the hot season was associated with a 5.1% (95% CI 4.4%-5.7%, P < 0.001), 3.7% (3.3%-4.0%, P < 0.001), and 2.6% (1.7%-3.4%, P < 0.001) increase in all-cause hospitalization, respectively. The inter-city socioeconomic disparities in the association were strongest for children and adolescents (0-19 years) (increased all-cause hospitalization risk with every 5°C increase [95% CI]: 9.9% [8.7%-11.1%], P < 0.001, in LMI cities versus 5.2% [4.1%-6.3%], P < 0.001, in HI cities). The disparities were particularly evident for hospitalization due to certain diseases, including ischemic heart disease (increase in cause-specific hospitalization risk with every 5°C increase [95% CI]: 5.6% [-0.2% to 11.8%], P = 0.060, in LMI cities versus 0.5% [-2.1% to 3.1%], P = 0.717, in HI cities), asthma (3.7% [0.3%-7.1%], P = 0.031, versus -6.4% [-12.1% to -0.3%], P = 0.041), pneumonia (8.0% [5.6%-10.4%], P < 0.001, versus 3.8% [1.1%-6.5%], P = 0.005), renal diseases (9.6% [6.2%-13.1%], P < 0.001, versus 4.9% [1.8%-8.0%], P = 0.002), mental health conditions (17.2% [8.4%-26.8%], P < 0.001, versus 5.5% [-1.4% to 13.0%], P = 0.121), and neoplasms (3.1% [0.7%-5.5%], P = 0.011, versus -0.1% [-2.1% to 2.0%], P = 0.939). The disparities were similar when stratifying the cities by other socioeconomic indicators (urbanization rate, literacy rate, and household income). The main limitations were lack of data on personal exposure to temperature, and that our city-level analysis did not assess intra-city or individual-level socioeconomic disparities and could not exclude confounding effects of some unmeasured variables. CONCLUSIONS: Less developed cities displayed stronger associations between heat exposure and all-cause hospitalizations and certain types of cause-specific hospitalizations in Brazil. This may exacerbate the existing geographical health and socioeconomic inequalities under a changing climate.
Based on the disaster census data of four types of meteorological disasters (floods induced by rainstorms, droughts, damages due to low temperatures and high temperatures and heat waves) in 637 counties (districts) of East China, the spatial distribution and inter-annual variation in the number of records and the amount of impacts or losses caused by the four types of disasters were analyzed. The results indicate that rainstorm-induced flood disasters had the largest number of records and the largest affected population, death population, affected crop, total crop failure and direct economic loss in East China. The yearly percentage of affected population and direct economic loss caused by the four types of meteorological disasters increased significantly at rates of 1.4 and 2.2% per decade, respectively, but the deaths decreased significantly at a rate of 2.2% per decade during 1984-2010. There was no statistical significance in the percentage change of affected crop area and total crop failure area in East China. Spatially, the total number of people affected by the four types of meteorological disasters was higher in Anhui and Jiangxi, and the deaths were more in southern Anhui, Jiangxi, Zhejiang, and Fujian. Both the affected area and the total failure area of crops were higher in northern Anhui, eastern Jiangsu and eastern Shandong, and the direct economic losses were higher in the southern part of East China and Anhui province.
Dengue is an important emerging vector-borne disease in Bhutan. This study aimed to quantify the spatial and temporal patterns of dengue and their relationship to environmental factors in dengue-affected areas at the sub-district level. A multivariate zero-inflated Poisson regression model was developed using a Bayesian framework with spatial and spatiotemporal random effects modelled using a conditional autoregressive prior structure. The posterior parameters were estimated using Bayesian Markov Chain Monte Carlo simulation with Gibbs sampling. A total of 708 dengue cases were notified through national surveillance between January 2016 and June 2019. Individuals aged ?14 years were found to be 53% (95% CrI: 42%, 62%) less likely to have dengue infection than those aged >14 years. Dengue cases increased by 63% (95% CrI: 49%, 77%) for a 1°C increase in maximum temperature, and decreased by 48% (95% CrI: 25%, 64%) for a one-unit increase in normalized difference vegetation index (NDVI). There was significant residual spatial clustering after accounting for climate and environmental variables. The temporal trend was significantly higher than the national average in eastern sub-districts. The findings highlight the impact of climate and environmental variables on dengue transmission and suggests prioritizing high-risk areas for control strategies.
Optimise control strategies of infectious diseases, identify factors that favour the circulation of pathogens, and propose risk maps are crucial challenges for global health. Ecological niche modelling, once relying on an adequate framework and environmental descriptors can be a helpful tool for such purposes. Despite the existence of a vaccine, yellow fever (YF) is still a public health issue. Brazil faced massive sylvatic YF outbreaks from the end of 2016 up to mid-2018, but cases in human and non-human primates have been recorded until the beginning of 2020. Here we used both human and monkey confirmed YF cases from two epidemic periods (2016/2017 and 2017/2018) to describe the spatial distribution of the cases and explore how biotic and abiotic factors drive their occurrence. The distribution of YF cases largely overlaps for humans and monkeys, and a contraction of the spatial extent associated with a southward displacement is observed during the second period of the epidemics. More contributive variables to the spatiotemporal heterogeneity of cases were related to biotic factors (mammal richness), abiotic factors (temperature and precipitation), and some human-related variables (population density, human footprint, and human vaccination coverage). Both projections of the most favourable conditions showed similar trends with a contraction of the more at-risk areas. Once extrapolated at a large scale, the Amazon basin remains at lower risk, although surrounding forest regions and notably the North-West region, would face a higher risk. Spatial projections of infectious diseases often relied on climatic variables only; here for both models, we instead highlighted the importance of considering local biotic conditions, hosts vulnerability, social and epidemiological factors to run the spatial risk analysis correctly: all YF cases occurring later on, in 2019 and 2020, were observed in the predicted at-risk areas.
Heat-related illness, an environmental exposure-related outcome commonly treated in U.S. hospital emergency departments (ED), is likely to rise with increased incidence of heat events related to climate change. Few studies demonstrate the spatial and statistical relationship of social vulnerability and heat-related health outcomes. We explore relationships of Georgia county-level heat-related ED visits and mortality rates (2002–2008), with CDC’s Social Vulnerability Index (CDC SVI). Bivariate Moran’s I analysis revealed significant clustering of high SVI rank and high heat-related ED visit rates (0.211, p <0.001) and high smoothed mortality rates (0.210, p <0.001). Regression revealed that for each 10% increase in SVI ranking, ED visit rates significantly increased by a factor of 1.18 (95% CI ¼1.17–1.19), and mortality rates significantly increased by a factor of 1.31 (95% CI ¼1.16–1.47). CDC SVI values are spatially linked and significantly associated with heat-related ED visit, and mortality rates in Georgia.
The increasing frequency and intensity of heat events have weighty impacts on public health in Vietnam, but their effects vary across regions. In this study, we have applied a vulnerability assessment framework (VAF) to systematically assess the spatial pattern of health vulnerability to heatwaves in Vietnam. The VAF was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity, with the indicators for each dimension derived from the relevant literature, consultation with experts, and available data. An analytic hierarchy process (AHP) was used to determine the weight of indicators. Each province in Vietnam’s vulnerability to the health impacts of heatwaves was evaluated by applying the vulnerability index, computed using 13 indicators (sensitivity index, 9; adaptive capacity index, 3; and exposure index, 1). As a result of this analysis, this study has identified heatwave vulnerability ‘hotspots’, primarily in the Southeast, Central Highlands, and South Central Coast of Vietnam. However, these hotspots are not necessarily the same as the area most vulnerable to climate change, because some areas that are more sensitive to heatwaves may have a higher capacity to adapt to them due to a host of factors including their population characteristics (e.g. rates of the elderly or children), socio-economic and geographical conditions, and the availability of air-conditioners. This kind of information, provided by the vulnerability index framework, allows policymakers to determine how to more efficiently allocate resources and devise appropriate interventions to minimise the impact of heatwaves with strategies tailored to each region of Vietnam.
Heat is known to cause illness and death not only at extreme temperatures, but also at moderate levels. Although substantial research has shown how summertime temperature distributions have changed over recent decades in the United States, less is known about howthe heat index-a potentially more health applicable metric of heat-has similarly evolved over this period. Moreover, the extent to which these distributional changes have overlapped with indicators of social vulnerability has not been established, despite the applicability of co-varying climatic and sociodemographic characteristics to heat-related health adaptations. Presented here is an analysis of trends in the median, 95th percentile, and ‘warm-tail spread’ (i.e., intra-seasonal range between the upper extreme andmedian) of warm-season (May-September) maximum heat index between 1979 and 2018 across the conterminous US. Using 40 years of data from the North American Regional Reanalysis dataset, it is shown that most of the US has experienced statistically significant positive trends in summertime heat, and that both the magnitude of trends and the shape of the frequency distributions of these measures vary regionally. Comparisons with data from the Social Vulnerability Index show that the most socially vulnerable counties appear to be warming faster than the least vulnerable, but that opposite patterns hold for trends in warm-tail spread. These findings may be applicable to further studies on climate change, heat adaptations, and environmental justice in the US.
BACKGROUND: Malaria continues to be a disease of massive burden in Africa, and the public health resources targeted at surveillance, prevention, control, and intervention comprise large outlays of expense. Malaria transmission is largely constrained by the suitability of the climate for Anopheles mosquitoes and Plasmodium parasite development. Thus, as climate changes, shifts in geographic locations suitable for transmission, and differing lengths of seasons of suitability will occur, which will require changes in the types and amounts of resources. METHODS: The shifting geographic risk of malaria transmission was mapped, in context of changing seasonality (i.e. endemic to epidemic, and vice versa), and the number of people affected. A published temperature-dependent model of malaria transmission suitability was applied to continental gridded climate data for multiple future AR5 climate model projections. The resulting outcomes were aligned with programmatic needs to provide summaries at national and regional scales for the African continent. Model outcomes were combined with population projections to estimate the population at risk at three points in the future, 2030, 2050, and 2080, under two scenarios of greenhouse gas emissions (RCP4.5 and RCP8.5). RESULTS: Estimated geographic shifts in endemic and seasonal suitability for malaria transmission were observed across all future scenarios of climate change. The worst-case regional scenario (RCP8.5) of climate change predicted an additional 75.9 million people at risk from endemic (10-12 months) exposure to malaria transmission in Eastern and Southern Africa by the year 2080, with the greatest population at risk in Eastern Africa. Despite a predominance of reduction in season length, a net gain of 51.3 million additional people is predicted be put at some level of risk in Western Africa by midcentury. CONCLUSIONS: This study provides an updated view of potential malaria geographic shifts in Africa under climate change for the more recent climate model projections (AR5), and a tool for aligning findings with programmatic needs at key scales for decision-makers. In describing shifting seasonality, it was possible to capture transitions between endemic and epidemic risk areas, to facilitate the planning for interventions aimed at year-round risk versus anticipatory surveillance and rapid response to potential outbreak locations.
BACKGROUND: Although the effects of seasonal variations and ambient temperature on the incidence of tuberculosis (TB) have been well documented, it is still unknown whether ambient temperature change is an independent risk factor for TB. The aim of this study was to assess the association between ambient temperature change and the risk of TB admissions. METHOD: A distributed lag non-linear model (DLNM) combined with Poisson generalized linear regression model was performed to assess the association between ambient temperature change and the risk of TB admissions from 2014 to 2018 in Hefei, China. Two temperature change metrics including temperature change between neighboring days (TCN) and diurnal temperature range (DTR) were used to assess the effects of temperature change exposure. Subgroup analyses were performed by gender, age and season. Besides, the attributable risk was calculated to evaluated the public health significance. RESULTS: The overall exposure-response curves suggested that there were statistically significant associations between two temperature change metrics and the risk of TB admissions. The maximum lag-specific relative risk (RR) of TB admissions was 1.088 (95%CI: 1.012-1.171, lag 4 day) for exposing to large temperature drop (TCN= -4 °C) in winter. Besides, the overall cumulative risk of TB admissions increased continuously and peaked at a lag of 7 days (RR=1.350, 95%CI: 1.120-1.628). Subgroup analysis suggested that exposure to large temperature drop had an adverse effect on TB admissions among males, females and adults. Similarly, large level of DTR exposure (DTR=15 °C) in spring also increased the risk of TB admissions on lag 0 day (RR=1.039, 95%CI: 1.016-1.063), and the cumulative RRs peaked at a lag of 1 days (RR=1.029, 95%CI: 1.012-1.047). We also found that females and elderly people were more vulnerable to the large level of DTR exposure. Additionally, the assessment of attributable risk suggested that taking target measures for the upcoming large temperature drop (b-AF = 4.17%, 95% eCI: 1.24%, 7.22%, b-AN = 1195) may achieve great public health benefits for TB prevention. CONCLUSION: This study suggests that ambient temperature change is associated with the risk of TB admissions. Besides, TCN may be a better predictor for the TB prevention and public health.
Extreme air temperature directly affected human health. However, the short-term effect of extreme air temperature on the incidence of cardiovascular diseases has rarely been reported in China. In this study, we focused on Beijing, China, and assessed the effects of cold/warm days and nights on the number of hospital emergency room (ER) visits for cardiovascular diseases from 2009 to 2012. We used a generalized additive model (GAM) to estimate the association between extreme air temperature and the number of hospital ER visits for cardiovascular diseases. We divided the entire study group into two gender subgroups and three age subgroups. The results showed that the short-term effect of extreme air temperature on hospital ER visits for cardiovascular diseases was more profound in females and the elderly (aged ??75 years). Among all the study subgroups, the highest relative risk (RR) of cardiovascular diseases associated with extremely cold days, warm days, cold nights, and warm nights was 3.0% (95% CI, 1.6%-4.4%), 0.8% (95% CI, -?0.9%-2.6%), 2.8% (95% CI, 1.6%-4.2%), and 1.8% (95% CI, 0.6%-4.3%), respectively. Overall, the effect of extremely low air temperature (during both days and nights) on the incidence of cardiovascular diseases was stronger and more acute than that of extremely high air temperature.
The objective of this study is to analyze the short-term effects of atmospheric pollutant concentrations (PM(10), NO(2) and O(3)) and heat and cold waves on the number of pre-term births and cases of low birth weight related to Saharan dust advection and biomass combustion. The dependent variables used in this analysis were the total number of births, births with low weight (>2.500?g) and pre-term births (<37?weeks), that occurred at the province level. Data provided by the NSI included: days with Saharan dust intrusion or biomass advection classified in terms of information provided by MITECO for each of the nine regions in Spain. A representative city was selected for reach region in which the registered average daily concentrations of PM(10), NO(2) and O(3) (?g/m(3)) were used. These were also provided by MITECO. The daily maximum and daily minimum temperature (°C) used was those registered by the meteorological observatory station located in each province capital, provided by AEMET. Using Poisson log linear regression models, the associated relative risks (RR) were measured as well as the population attributable risk (PAR) corresponding to the variables that resulted statistically significant at p?
Short-term effects of air pollution on the health of residents in the Metropolitan Area of Monterrey, Mexico were assessed from 2012-2015 using a time-series approach. Guadalupe had the highest mean concentrations for SO(2), CO and O(3); whereas Santa Catarina showed the highest NO(2) concentrations. Escobedo and Garcia registered the highest levels for PM(10). Only PM(10) and O(3) exceeded the maximum permissible values established in the Mexican official standards. Most of pollutants and municipalities showed a great number of associations between an increase of 10% in their current concentrations and mortality, especially for people >60 years. Different scenarios resulting from climatic change were built (increases of 5-25% in daily mean temperature), but only the increase of 25% (5 °C) showed a significant association with air pollutant concentrations and mortality. All pollutants and municipalities showed significant increases in relative risk indexes (RRI) resulting from an increase of 5 °C when people >60 years was considered. Results were comparable to those reported by other authors around the world. The RRI were low but significant, and thus are of public concern. This study demonstrated that the elderly is strongly threatened not only by atmospheric pollution but also by climatic change scenarios in warm and semiarid places.
Diurnal temperature range (DTR) is a key indicator reflecting climate stability. Many previous studies have examined the effects of ambient temperature, both hot and cold, on human morbidity and mortality, but few studies have evaluated health effects of DTR, especially those in developing countries. This study aimed to investigate the association between short-term exposure to DTR and hospital admissions for cardiovascular and respiratory diseases in Bangkok, Thailand. We obtained daily meteorological variables from the Thai Meteorological Department from January 2006 through December 2014 and daily hospital admissions from the National Health Security Office during the same period. Quasi-Poisson generalized linear regression model combined with distributed lag non-linear model was used to examine the association between DTR and cardiovascular and respiratory hospital admissions controlling for daily average temperature, relative humidity, day of the week, public holiday, and seasonal and long-term trend. A J-shape relationship between DTR and hospital admissions was observed. With 7.8 °C DTR as a reference value, the relative risks for cardiovascular and respiratory hospital admission associated with extremely high DTR (11.6 °C) at cumulative lag 0-21 (21-day cumulative effects) were 1.206 (95% CI: 1.002-1.452) and 1.021 (95% CI: 0.856-1.218), respectively. The effects of extremely high DTR relative to a reference value did not significantly differ between males and females, as well as between young people (<65 years) and the elderly (?65 years) for both cardiovascular and respiratory admission. When stratifying the effects by season, the effect of extremely high DTR in winter was greater than that in summer and rainy season. This study showed that short-term exposure to extremely high DTR was significantly associated with increased risk of hospital admissions for cardiovascular disease in Bangkok, especially during winter. Results from this study could provide important scientific evidence for policy decision making to protect populations from adverse health effects of DTR.
Extreme temperature-related cardiovascular diseases (CVDs) have become a growing public health concern. However, the impact of temperature on the cause of specific CVDs has not been well studied in the study area. The objective of this study was to assess the impact of temperature on cause-specific cardiovascular hospital admissions in Beijing, China. We obtained data from 172 large general hospitals from the Beijing Public Health Information Center Cardiovascular Case Database and China. Meteorological Administration covering 16 districts in Beijing from 2013 to 2017. We used a time-stratified case crossover design with a distributed lag nonlinear model (DLNM) to derive the impact of temperature on CVD in hospitals back to 27 days on CVD admissions. The temperature data were stratified as cold (extreme and moderate ) and hot (moderate and extreme ). Within five years (January 2013-December 2017), a total of 460,938 (male 54.9% and female 45.1%) CVD admission cases were reported. The exposure-response relationship for hospitalization was described by a “J” shape for the total and cause-specific. An increase in the six-day moving average temperature from moderate hot (30.2 °C) to extreme hot (36.9 °C) resulted in a significant increase in CVD admissions of 16.1%(95% CI = 12.8%-28.9%). However, the effect of cold temperature exposure on CVD admissions over a lag time of 0-27 days was found to be non significant, with a relative risk of 0.45 (95% CI = 0.378-0.55) for extreme cold (-8.5 °C)and 0.53 (95% CI = 0.47-0.60) for moderate cold (-5.6 °C). The results of this study indicate that exposure to extremely high temperatures is highly associated with an increase in cause-specific CVD admissions. These finding may guide to create and raise awareness of the general population, government and private sectors regarding on the effects of current weather conditions on CVD.
BACKGROUND: PM(2·5) is an important but modifiable environmental risk factor, not only for pulmonary diseases and cancers, but for cardiovascular health. However, the evidence regarding the association between air pollution and acute cardiac events, such as out-of-hospital cardiac arrest (OHCA), is inconsistent, especially at concentrations lower than the WHO daily guideline (25 ?g/m(3)). This study aimed to determine the associations between exposure to ambient air pollution and the incidence of OHCA. METHODS: In this nationwide case-crossover study, we linked prospectively collected population-based registry data for OHCA in Japan from Jan 1, 2014, to Dec 31, 2015, with daily PM(2·5), carbon monoxide (CO), nitrogen dioxide (NO(2)), photochemical oxidants (O(x)), and sulphur dioxide (SO(2)) exposure on the day of the arrest (lag 0) or 1-3 days before the arrest (lags 1-3), as well as the moving average across days 0-1 and days 0-3. Daily exposure was calculated by averaging the measurements from all PM(2·5) monitoring stations in the same prefecture. The effect of PM(2·5) on risk of all-cause or cardiac OHCA was estimated using a time-stratified case-crossover design coupled with conditional logistic regression analysis, adjusted for daily temperature and relative humidity. Single-pollutant models were also investigated for the individual gaseous pollutants (CO, NO(2), O(x), and SO(2)), as well as two-pollutant models for PM(2·5) with these gaseous pollutants. Subgroup analyses were done by sex and age. FINDINGS: Over the 2 years, 249?372 OHCAs were identified, with 149?838 (60·1%) presumed of cardiac origin. The median daily PM(2·5) was 11·98 ?g/m(3) (IQR 8·13-17·44). Each 10 ?g/m(3) increase in PM(2·5) was associated with increased risk of all-cause OHCA on the same day (odds ratio [OR] 1·016, 95% CI 1·009-1·023) and at lags of up to 3 days, ranging from OR 1·015 (1·008-1·022) at lag 1 to 1·033 (1·023-1·043) at lag 0-3. Results for cardiac OHCA were similar (ORs ranging from 1·016 [1·007-1·025] at lags 1 and 2 to 1·034 [1·021-1·047] at lag 0-3). Patients older than 65 years were more susceptible to PM(2·5) exposure than younger age groups but no sex differences were identified. CO, O(x), and SO(2) were also positively associated with OHCA while NO(2) was not. However, in two-pollutant models of PM(2·5) and gaseous pollutants, only PM(2·5) (positive association) and NO(2) (negative association) were independently associated with increased risk of OHCA. INTERPRETATION: Short-term exposure to PM(2·5) was associated with an increased risk of OHCA even at relatively low concentrations. Regulatory standards and targets need to incorporate the potential health gains from continual air quality improvement even in locations already meeting WHO standards. FUNDING: None.
Climate change affects individual life-history characteristics and species interactions, including predator-prey interactions. While effects of warming on Aedes aegypti adults are well known, clarity the interactive effects of climate change (temperature and CO2 concentration) and predation risk on the larval stage remains unexplored. In this study, we performed a microcosm experiment simulating temperature and CO2 changes in Manaus, Amazonas, Brazil, for the year 2100. Simulated climate change scenarios (SCCS) were in accordance with the Fourth Assessment Report of Intergovernmental Panel on Climate Change (IPCC). Used SCCS were: Control (real-time current conditions in Manaus: average temperature is ~25.76°C ± 0.71°C and ~477.26 ± 9.38 parts per million by volume (ppmv) CO2); Light: increase of ~1,7°C and ~218 ppmv CO2; Intermediate: increase of ~2.4°C and ~446 ppmv CO2; and Extreme: increase of ~4.5°C and ~861 ppmv CO2, all increases were relative to a Control SCCS. Light, Intermediate and Extreme SCCS reproduced, respectively, the B1, A1B, and A2 climatic scenarios predicted by IPCC (2007). We analyzed Aedes aegypti larval survivorship and adult emergence pattern with a factorial design combining predation risk (control and predator presence-Toxorhynchites haemorrhoidalis larvae) and SCCS. Neither SCCS nor predation risk affected Aedes aegypti larval survivorship, but adult emergence pattern was affected by SCCS. Accordingly, our results did not indicate interactive effects of SCCS and predation risk on larval survivorship and emergence pattern of Aedes aegypti reared in SCCS in western Amazonia. Aedes aegypti is resistant to SCCS conditions tested, mainly due to high larval survivorship, even under Extreme SCCS, and warmer scenarios increase adult Aedes aegypti emergence. Considering that Aedes aegypti is a health problem in western Amazonia, an implication of our findings is that the use of predation cues as biocontrol strategies will not provide a viable means of controlling the accelerated adult emergence expected under the IPCC climatic scenarios.
The recent emergence and established presence of Aedes aegypti in the Autonomous Region of Madeira, Portugal, was responsible for the first autochthonous outbreak of dengue in Europe. The island has not reported any dengue cases since the outbreak in 2012. However, there is a high risk that an introduction of the virus would result in another autochthonous outbreak given the presence of the vector and permissive environmental conditions. Understanding the dynamics of a potential epidemic is critical for targeted local control strategies. Here, we adopt a deterministic model for the transmission of dengue in Aedes aegypti mosquitoes. The model integrates empirical and mechanistic parameters for virus transmission, under seasonally varying temperatures for Funchal, Madeira Island. We examine the epidemic dynamics as triggered by the arrival date of an infectious individual; the influence of seasonal temperature mean and variation on the epidemic dynamics; and performed a sensitivity analysis on the following quantities of interest: the epidemic peak size, time to peak, and the final epidemic size. Our results demonstrate the potential for summer and autumn season transmission of dengue, with the arrival date significantly affecting the distribution of the timing and peak size of the epidemic. Late-summer arrivals were more likely to produce large epidemics within a short peak time. Epidemics within this favorable period had an average of 11% of the susceptible population infected at the peak, at an average peak time of 95 days. We also demonstrated that seasonal temperature variation dramatically affects the epidemic dynamics, with warmer starting temperatures producing large epidemics with a short peak time and vice versa. Overall, our quantities of interest were most sensitive to variance in the date of arrival, seasonal temperature, transmission rates, mortality rate, and the mosquito population; the magnitude of sensitivity differs across quantities. Our model could serve as a useful guide in the development of effective local control and mitigation strategies for dengue fever in Madeira Island.
BACKGROUND: Acute appendicitis represents an extremely common surgical emergency, yet its aetiology remains uncertain. A multifactorial understanding of its causation has emerged along with increasing evidence of seasonal variation. This study seeks to find evidence for such a circannual trend within the United Kingdom (UK), and further assess key meteorological indicators which may be causative of any such variation. METHODS: The patient records of a region health body in the North East of England were retrospectively assessed over a 7-year period. The incident cases of acute appendicitis were recorded and averaged by month before undergoing statistical analysis for variation and correlation with average temperature, sunlight hours, and rainfall. RESULTS: The incidence of acute appendicitis revealed significant seasonal variation with only 38 incident cases in the months of January compared to 73 in July, a 92.1% increase. Only a weak correlation was seen between incidence and average sunlight hours/rainfall, however a significant, positive correlation was found between incidence and average temperature (r?=?0.58, p?=?0.048). CONCLUSION: Compelling evidence is found to support the existence of a circannual trend for acute appendicitis. Data suggests a seasonal peak in the month of July, accompanied by a low in January, a finding that develops the understanding of this trend from previously equivocal research in the UK. A clear correlation is also established between the incidence of acute appendicitis and average temperature. The 92.1% increase between the coolest and warmest months suggests a greater magnitude for this as a risk factor than has previously been shown.
Hand, foot, and mouth disease (HFMD) is a common infectious disease in the Asia-Pacific region that primarily affects children younger than 5 years. Previous studies have confirmed that the seasonal transmission of this disease is strongly related to meteorological factors, but the results are not consistent. In addition, the associations between weather conditions and HFMD in northwestern China have not been investigated. Therefore, we aimed to examine this issue in Xi’an, the largest city of northwestern China that has been suffering from serious HFMD epidemics. In the current study, data for HFMD and six meteorological factors were collected from 2009 to 2018. Using cross-correlation analysis, the Granger causality test, and the distributed lag nonlinear model, we estimated the quantitative relationships and exposure-lag-response effects between weekly meteorological factors and HFMD incidence among children. We found that the seasonal distribution of HFMD in Xi’an has two peaks each year and is significantly impacted by the weekly temperature, precipitation, and evaporation over an 8-week period. Higher values of temperature and evaporation had positive associations with disease transmission, whereas the association between precipitation and HFMD showed an inverted-U shape. The maximum relative risks (RRs) of HFMD for the weekly mean temperature (approximately 31.1°C), weekly cumulative evaporation (57.9 mm), and weekly cumulative precipitation (30.0 mm) were 1.56 (95% CI: 1.35-1.81), 1.40 (95% CI: 1.05-1.88), and 1.16 (95% CI: 1.11-1.70), respectively. The identified risk determinants and lag effects could provide important information for early interventions to reduce the local disease burden.
Aedes albopictus is an invasive mosquito that has colonized several European countries as well as Portugal, where it was detected for the first time in 2017. To increase the knowledge of Ae. albopictus population dynamics, a survey was carried out in the municipality of Loulé, Algarve, a Southern temperate region of Portugal, throughout 2019, with Biogents Sentinel traps (BGS traps) and ovitraps. More than 19,000 eggs and 400 adults were identified from May 9 (week 19) and December 16 (week 50). A positive correlation between the number of females captured in the BGS traps and the number of eggs collected in ovitraps was found. The start of activity of A. albopictus in May corresponded to an average minimum temperature above 13.0 °C and an average maximum temperature of 26.2 °C. The abundance peak of this A. albopictus population was identified from September to November. The positive effect of temperature on the seasonal activity of the adult population observed highlight the importance of climate change in affecting the occurrence, abundance, and distribution patterns of this species. The continuously monitoring activities currently ongoing point to an established population of A. albopictus in Loulé, Algarve, in a dispersion process to other regions of Portugal and raises concern for future outbreaks of mosquito-borne diseases associated with this invasive mosquito species.
BACKGROUND: Influenza is a disease under surveillance worldwide with different seasonal patterns in temperate and tropical regions. Previous studies have conducted modeling of influenza seasonality using climate variables. This study aimed to identify potential meteorological factors that are associated with influenza seasonality in Jinan, China. METHODS: Data from three influenza sentinel hospitals and respective climate factors (average temperature, relatively humidity (RH), absolute humidity (AH), sunshine duration, accumulated rainfall and speed of wind), from 2013 to 2016, were collected. Statistical and wavelet analyses were used to explore the epidemiological characteristics of influenza virus and its potential association with climate factors. RESULTS: The dynamic of influenza was characterized by annual cycle, with remarkable winter epidemic peaks from December to February. Spearman’s correlation and wavelet coherence analysis illuminated that temperature, AH and atmospheric pressure were main influencing factors. Multiple wavelet coherence analysis showed that temperature and atmospheric pressure might be the main influencing factors of influenza virus A(H3N2) and influenza virus B, whereas temperature and AH might best shape the seasonality of influenza virus A(H1N1)pdm09. During the epidemic season, the prevalence of influenza virus lagged behind the change of temperature by 1-8 weeks and atmospheric pressure by 0.5-3 weeks for different influenza viruses. CONCLUSION: Climate factors were significantly associated with influenza seasonality in Jinan during the influenza epidemic season and the optional time for influenza vaccination is before November. These finding should be considered in influenza planning of control and prevention.
BACKGROUND: Southeast Brazil has recently experienced a Yellow Fever virus (YFV) outbreak where the mosquito Haemagogus leucocelaenus was a primary vector. Climatic factors influence the abundance of mosquito vectors and arbovirus transmission. OBJECTIVES: We aimed at describing the population dynamics of Hg. leucocelaenus in a county touched by the recent YFV outbreak. METHODS: Fortnightly egg collections with ovitraps were performed from November 2012 to February 2017 in a forest in Nova Iguaçu, Rio de Janeiro, Brazil. The effects of mean temperature and rainfall on the Hg. leucocelaenus population dynamics were explored. FINDINGS: Hg. leucocelaenus eggs were continuously collected throughout the study, with a peak in the warmer months (December-March). The climatic variables had a time-lagged effect and four weeks before sampling was the best predictor for the positivity of ovitraps and total number of eggs collected. The probability of finding > 50% positive ovitraps increased when the mean temperature was above 24ºC. The number of Hg. leucocelaenus eggs expressively increase when the mean temperature and accumulated precipitation surpassed 27ºC and 100 mm, respectively, although the effect of rainfall was less pronounced. MAIN CONCLUSIONS: Monitoring population dynamics of Hg. leucocelaenus and climatic factors in YFV risk areas, especially mean temperature, may assist in developing climate-based surveillance procedures to timely strengthening prophylaxis and control.
More than 40% of the human population reside in global tropical zones despite the extreme climates that frequently approach the upper thermotolerance levels for human physical activity and societal flourishing. Many of these regions also regularly subject resident populations to extreme weather events. Australia’s tropical regions experience exceptionally high climatic variability, making it one of the world’s most challenging for human settlements. Adaptation planning, project management and health protection agencies working at local scales require localized analysis on long-term climatic trends and projections. Utility of existing large-scale analyses is constrained by climatic heterogeneity across expansive national scales. Here we track historical changes in seasonal climatic extremes for seven key population centres across Australia’s north between the periods 1911-1940 and 1988-2017 as measured against the 1961-1990 period. Shifts in daily minimum temperature (20 degrees C or more), maximum temperature (10th, 90th and 95th percentiles), trends in heatwaves (5 days or longer) and in 1- and 3-day heavy rainfall events (95th and 98th percentiles) are provided. Results indicate the greatest warming has occurred during the Dry season and in coastal locations. Rainfall extremes demonstrate a pattern of marked spatial non-uniformity. This location-centred approach to identifying shifts in climatic extremes has wide applicability for adaptation planning across diverse global climatic regions.
Vector control is one of the main aspects to reach the target of eliminating visceral leishmaniasis from Indian sub-continent as set by the World Health Organisation. Data on different aspects of vector like ecology, behaviour, population dynamics and their association with environmental factors are very important for formulating an effective vector control strategy. The present work was designed to study the species abundance and impact of environmental factors on population dynamics of vector P. argentipes in a visceral leishmaniasis endemic area of Malda district, West Bengal. Adult sand flies were collected using light traps and mouth aspirators from twelve kala-azar affected villages of Habibpur block of Malda district, on a monthly basis from January to December, 2018. Morphological and molecular methods were used for species identification. Population dynamics were assessed by man hour density and per night per trap collection. Data were analysed using SPSS software to determine the impact of environmental factors on vector population P. argentipes was found to the predominant species and prevalent throughout the year. A significantly higher number of sand flies were collected from cattle sheds than human dwellings and peri-domestic vegetation. A portion of the P. argentipes population was exophilic and exophagic as evidenced by their collection from peri-domestic vegetation. The highest population density was recorded during April to September. Population dynamics were mostly influenced by average temperature along humidity and rain fall. Resting behaviour of sand flies was not restricted to the lower portion of the wall but equally distributed throughout the wall and ceiling. Programme officials should consider management of outdoor populations of the sand flies and timings of indoor residual spray for chemical control purpose.
BACKGROUND: We purposed to evaluate the seasonality and associated factors of the incidence of gout attacks in Korea. METHODS: We prospectively enrolled patients with gout attacks who were treated at nine rheumatology clinics between January 2015 and July 2018 and followed them for 1-year. Demographic data, clinical and laboratory features, and meteorological data including seasonality were collected. RESULTS: Two hundred-five patients (men, 94.1%) were enrolled. The proportion of patients with initial gout attacks was 46.8% (n = 96). The median age, body mass index, attack duration, and serum uric acid level at enrollment were 50.0 years, 25.4, 5.0 days, and 7.4 mg/dL, respectively. Gout attacks were most common during spring (43.4%, P < 0.001) and in March (23.4%, P < 0.001). A similar pattern of seasonality was observed in the group with initial gout attacks. Alcohol was the most common provoking factor (39.0%), particularly during summer (50.0%). The median diurnal temperature change on the day of the attack was highest in the spring (9.8°C), followed by winter (9.3°C), fall (8.6°C), and summer (7.1°C) (P = 0.027). The median change in humidity between the 2 consecutive days (the day before and the day of the attack) was significantly different among the seasons (3.0%, spring; 0.3%, summer; -0.9%, fall; -1.2%, winter; P = 0.015). One hundred twenty-five (61%) patients completed 1-year follow-up (51% in the initial attack group). During the follow-up period, 64 gout flares developed (21 in the initial attack group). No significant seasonal variation in the follow-up flares was found. CONCLUSION: In this prospective study, the most common season and month of gout attacks in Korea are spring and March, respectively. Alcohol is the most common provoking factor, particularly during summer. Diurnal temperature changes on the day of the attack and humidity changes from the day before the attack to the day of the attack are associated with gout attack in our cohort.
PURPOSE: To delineate the seasonality of acute primary angle-closure (APAC) admission in a coastal city of southern China and its association with climatic factors. METHODS: A total of 1155 Chinese subjects with principal diagnosis of APAC attack were recruited from 2012 to 2016, and their medical records were retrieved. Monthly climatic factors were obtained from the Meteorological Bureau of Shantou. Monthly and seasonal APAC admissions were compared, and its correlation with climatic factors was evaluated. RESULTS: APAC admission was higher in female subjects (75.9%) with an overall mean age of 64.7 ± 9.3 years. APAC admission was highest in summer with the peak onset in June. The peak of APAC admission for female subjects aged ? 65 years was in June, and that for> 65 years was in July. The peak of APAC admission for male subjects aged > 65 years was in August. Precipitation was positively correlated with APAC admission rate for both aged ? 65 (? = 0.415, p = 0.001) and > 65 years old (? = 0.364, p = 0.004) female subjects. In contrast, surface temperature was positively correlated with APAC admission rate for male subjects aged > 65 years (? = 0.441, p < 0.001). No climatic factor was correlated with APAC admission rate for male subjects ? 65 years. CONCLUSIONS: This study revealed the peak season of APAC admission in summer, and surface temperature and precipitation are the associated factors. Close monitoring of climate changes could help to reduce the incidence of APAC attack.
AIMS: To determine whether the neonatal and delivery outcomes of gestational diabetes vary seasonally in the context of a relatively cool temperate climate. METHODS: A retrospect cohort of 23 735 women consecutively delivering singleton, live-born term infants in a single tertiary obstetrics centre in the UK (2004-2008) was identified. A total of 985 (4.1%) met the diagnostic criteria for gestational diabetes. Additive dynamic regression models, adjusted for maternal age, BMI, parity and ethnicity, were used to compare gestational diabetes incidence and outcomes over annual cycles. Outcomes included: random plasma glucose at booking; gestational diabetes diagnosis; birth weight centile; and delivery mode. RESULTS: The incidence of gestational diabetes varied by 30% from peak incidence (October births) to lowest incidence (March births; P=0.031). Ambient temperature at time of testing (28 weeks) was strongly positively associated with diagnosis (P<0.001). Significant seasonal variation was evident in birth weight in gestational diabetes-affected pregnancies (average 54(th) centile June to September; average 60(th) centile December to March; P=0.027). Emergency Caesarean rates also showed significant seasonal variation of up to 50% (P=0.038), which was closely temporally correlated with increased birth weights. CONCLUSIONS: There is substantial seasonal variation in gestational diabetes incidence and maternal-fetal outcomes, even in a relatively cool temperate climate. The highest average birth weight and greatest risk of emergency Caesarean delivery occurs in women delivering during the spring months. Recognizing seasonal variation in neonatal and delivery outcomes provides new opportunity for individualizing approaches to managing gestational diabetes.
BACKGROUND: The human skin is greatly affected by external factors such as UV radiation (UVR), ambient temperature (T), and air humidity. These factors oscillate during the year giving rise to the seasonal variations in the skin properties. The aim of this study was to evaluate the effect of seasons, environmental T, relative and absolute humidity on the skin parameters of Caucasian women, perform a literature review and discuss the possible factors lying behind the found changes. MATERIALS AND METHODS: We measured stratum corneum (SC) hydration, transepidermal water loss (TEWL), sebum level, erythema index, and elasticity parameters R2 and R7 on the forehead and the cheek of Caucasian women from the Czech Republic throughout the year. We also performed a non-systematic literature review focused on the seasonal variations in these skin parameters. RESULTS: We confirmed a well-documented low SC hydration and sebum production in winter. In spring, we found the lowest TEWL (on the forehead) and the highest SC hydration but also the highest erythema index and the lowest elasticity presumably indicating skin photodamage. For most of the skin parameters, the seasonal variations probably arise due to a complex action of different factors as we extensively discussed. CONCLUSION: The data about the seasonal variations in the skin parameters are still highly inconsistent and further studies are needed for better understanding of the normal skin changes throughout the year.
Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, especially in the elderly. Several studies have revealed a possible seasonality to BPPV. However, whether the seasonality of BPPV also exists in China is unclear. The characteristics of cardio-cerebrovascular risk factors for BPPV in the cold season have not yet been investigated. Objectives: (1) To investigate the seasonality of BPPV; (2) To explore the relationship between cardio-cerebrovascular risk factors and seasonality of BPPV. Methods: A retrospective observational study was performed in Beijing Tiantan Hospital from Jan 2016 to Dec 2018. The study included 1,409 new-onset BPPV patients aged 18-88 years. The demographic data, onset time, and medical history of BPPV were collected. The meteorological data, including temperature, atmospheric pressure, rainfall, and insolation, was obtained from Beijing Meteorological service. The x (2) goodness of fit test was used to evaluate whether BPPV patients’ numbers were significantly different among different months of the year. The Spearman correlation was used to detect the correlation between numbers of BPPV patients diagnosed monthly with each climatic parameter. The chi-square test for linear-by-linear association were used to investigate the relationship between cardio-cerebrovascular risk factor and seasonality of BPPV. Results: November to next March is the top 5 months with higher BPPV patient numbers (P < 0.001). The numbers of BPPV diagnosed monthly were conversely correlated with temperature and rainfall (r = -0.736, P = 0.010; r = -0.650, P = 0.022, respectively), positively correlated with atmospheric pressure (r = 0.708, P = 0.010), but no significant correlated with insolation. BPPV in the cold season (including January, February, March, November, and December) had a higher proportion, accounting for 54.2% of all BPPV patients. Among BPPV patients with ?2, 1, and none cardio-cerebrovascular risk factors, the cold season accounted for 57.0, 56.0, 49.8%, respectively. As the number of cardio-cerebrovascular risk factors increased, the proportion of patients in the cold season of BPPV increased (P = 0.025). Conclusions: BPPV patients are seen more in the months with low temperature, low rainfall, and high atmospheric pressure. Compared with the non-cold season, BPPV patients have more risk factors for cardio-cerebrovascular diseases in the cold season.
This study combines wearable sensors, weather data, and self-reported mood surveys to assess mental stress on older adults from heat experience. It is designed as a pilot and feasibility study in preparation for a large-scale experiment of older adults; mental wellbeing during extreme heat events. Results show that on-body temperatures from two i-Button sensors coupled with heart rate monitored from a smart watch are important indicators to evaluate individualized heat stress given a relatively uniform outdoor temperature. Furthermore, assessing their mood in their own environment demonstrates potential for understanding mental wellbeing that can change with varying time and location.
Respiratory syncytial virus (RSV) infects young children and causes influenza-like illness. RSV circulation and prevalence differ among countries and climates. To better understand whether climate factors influence the seasonality of RSV in Thailand, we examined RSV data from children???5 years-old who presented with respiratory symptoms from January 2012-December 2018. From a total of 8,209 nasopharyngeal samples, 13.2% (1,082/8,209) was RSV-positive, of which 37.5% (406/1,082) were RSV-A and 36.4% (394/1,082) were RSV-B. The annual unimodal RSV activity from July-November overlaps with the rainy season. Association between meteorological data including monthly average temperature, relative humidity, rainfall, and wind speed for central Thailand and the incidence of RSV over 7-years was analyzed using Spearman’s rank and partial correlation. Multivariate time-series analysis with an autoregressive integrated moving average (ARIMA) model showed that RSV activity correlated positively with rainfall (r?=?0.41) and relative humidity (r?=?0.25), but negatively with mean temperature (r?=?-?0.27). The best-fitting ARIMA (1,0,0)(2,1,0)(12) model suggests that peak RSV activity lags the hottest month of the year by 4 months. Our results enable possible prediction of RSV activity based on the climate and could help to anticipate the yearly upsurge of RSV in this region.
BACKGROUND: Protein and some minerals of rice seed are negatively affected by projected carbon dioxide (CO(2) ) levels. However, an in-depth assessment of rice quality that encompasses both CO(2) and temperature for a wide range of nutritional parameters is not available. Using a free-air CO(2) enrichment facility with temperature control, we conducted a field experiment with two levels of CO(2) (ambient; ambient?+?200?ppm) and two levels of temperature (ambient; ambient?+?1.5 °C). An in-depth examination of qualitative factors indicated a variable nutritional response. RESULTS: For total protein, albumin, glutelin, and prolamin, elevated CO(2) reduced seed concentrations irrespective of temperature. Similarly, several amino acids declined further as a function of higher temperature and elevated CO(2) relative to elevated CO(2) alone. Higher temperature increased the lipid percentage of seed; however, elevated CO(2) reduced the overall lipid content. At the nutrient elements level, whereas elevated CO(2) reduced certain elements, a combination of CO(2) and temperature could compensate for CO(2) reductions but was element dependent. CONCLUSION: Overall, these data are, at present, the most detailed analysis of rising CO(2) /temperature on the qualitative characteristics of rice. They indicate that climate change is likely to significantly impact the nutritional integrity of rice, with subsequent changes in human health on a global basis. © 2020 Society of Chemical Industry.
A growing number of epidemiological studies have recently assessed temporal variations in vulnerability and/or mortality attributable to hot and cold temperatures. However, the eventual changes in the seasonal distribution of temperature-attributable mortality remain unexplored. Here, we analyse countrywide daily time-series of temperature and mortality counts from respiratory diseases by sex, age group and province of residence during the period 1980-2016 in Spain. We show the complete reversal of the seasonality of temperature-attributable mortality, with a significant shift of the maximum monthly incidence from winter to summer, and the minimum monthly incidence from early and late summer to winter. The reversal in the seasonal distribution of the attributable deaths is not driven by the observed warming in both winter and summer temperatures, but rather by the very large decrease in the risk of death due to cold temperatures and the relatively much smaller reduction due to hot temperatures. We conclude that the projected decrease in the number of moderate and extreme cold days due to climate warming will not contribute to a further reduction of cold-attributable respiratory deaths.
The frequency and intensity of heat waves in the United States is projected to increase in the 21st century. We investigate dry and humid heat waves in a pair of high-resolution model simulations that constrain large-scale atmospheric circulation, to isolate the thermodynamic impacts on characteristics of present and future heat waves over the United States. The two kinds of heat waves show differences in mean intensity, amplitude, duration, and frequency over the Southeast, Northeast, and Midwest, while their characteristics are largely similar in the drier central and western United States. In a warmer climate, relative humidity is projected to decrease during dry heat waves, whereas it remains unchanged during humid heat waves. However, the overall increase in daily maximum temperature intensifies the heat stress during future humid and dry heat waves across all regions. With large-scale circulation constrained, these simulations emphasize the importance of thermodynamic drivers in determining future heat wave characteristics.
BACKGROUND: Extreme ambient temperatures and air quality have been directly associated with various human diseases from several studies around the world. However, few analyses involving the association of these environmental circumstances with mental and behavioral disorders (MBD) have been carried out, especially in developing countries such as Brazil. METHODS: A time series study was carried out to explore the associations between daily air pollutants (SO(2), NO(2), O(3), and PM(10)) concentrations and meteorological variables (temperature and relative humidity) on hospital admissions for mental and behavioral disorders for Curitiba, Brazil. Daily hospital admissions from 2010 to 2016 were analyzed by a semi-parametric generalized additive model (GAM) combined with a distributed lag non-linear model (DLNM). RESULTS: Significant associations between environmental conditions (10??g/m(3) increase in air pollutants and temperature °C) and hospitalizations by MBD were found. Air temperature was the environmental variable with the highest relative risk (RR) at 0-day lag for all ages and sexes analyzed, with RR values of 1.0182 (95% CI: 1.0009-1.0357) for men, and 1.0407 (95% CI: 1.0230-1.0587) for women. Ozone exposure was a risk for all women groups, being higher for the young group, with a RR of 1.0319 (95% CI: 1.0165-1.0483). Elderly from both sexes were more susceptible to temperature variability, with a RR of 1.0651 (95% CI: 1.0213-1.1117) for women, and 1.0215 (95% CI: 1.0195-1.0716) for men. CONCLUSIONS: This study suggests that temperatures above and below the thermal comfort threshold, in addition to high concentrations of air pollutants, present significant risks on hospitalizations by MBD; besides, there are physiological and age differences resulting from the effect of this exposure.
OBJECTIVE: The objective of this study was to identify frequency, severity, and risk factors associated with bronchiolitis in Puerto Rican children. METHODS: A cross-sectional was study performed at 4 emergency departments of Puerto Rico’s metropolitan area, between June 2014 and May 2015. We included children younger than 24 months, with a clinical diagnosis of bronchiolitis, who were born and living in Puerto Rico at the time of recruitment. A physician-administered questionnaire inquiring about the patient’s medical, family, and social history and a bronchiolitis severity assessment were performed. Daily weather conditions were monitored, and aeroallergens were collected with an air sample and precision weather station within the metropolitan area to evaluate environmental factors. RESULTS: We included 600 patients for 12 months. More than 50% of the recruited patients had a previous episode of bronchiolitis, of which 40% had been hospitalized. Older age (odds ratio [OR], 18.3; 95% confidence interval [CI], 9.2-36.5), male sex (OR, 1.6; 95% CI, 1.1-2.4), history of asthma (OR, 8.9; 95% CI, 3.6-22), allergic rhinitis (OR, 3.6; 95% CI, 1.8-7.4), and smoke exposure by a caretaker (OR, 2.3; 95% CI, 1.2-4.4) were predictors of bronchiolitis episodes. Bronchiolitis episodes were associated with higher severity score (P = 0.040), increased number of atopic factors (P < 0.001), and higher number of hospitalizations (P < 0.001). CONCLUSIONS: This study identifies Puerto Rican children who may present a severe clinical course of disease without traditional risk factors. Atopy-related factors are associated with frequency and severity of bronchiolitis. Puerto Rican children present risk factors related to atopy earlier in life, some of which may be modified to prevent the subsequent development of asthma.
BACKGROUND: As climate change increases global temperatures, heat-related morbidity and mortality are projected to rise. Outdoor workers and those who perform exertional tasks are particularly susceptible to heat-related illness (HRI). Using workers’ compensation data, we aimed to describe rates of occupational HRI in California and identify demographic and occupational risk factors to inform prevention efforts. METHODS: We identified HRI cases during 2000-2017 in the California Workers’ Compensation Information System (WCIS) using International Classification of Diseases Ninth and Tenth Revision codes, WCIS nature and cause of injury codes, and HRI keywords. We assigned industry and occupation codes using the NIOSH Industry and Occupation Computerized Coding System (NIOCCS). We calculated HRI rates by sex, age group, year, county, industry, and occupation, and estimated confidence intervals using generalized linear models. RESULTS: We identified 15,996 HRI cases during 2000-2017 (6.0 cases/100,000 workers). Workers aged 16-24 years had the highest HRI rate (7.6) among age groups, and men (8.1) had a higher rate than women (3.5). Industry sectors with the highest HRI rates were Agriculture, Farming, Fishing, and Forestry (38.6), and Public Administration (35.3). Occupational groups with the highest HRI rates were Protective Services (56.6) and Farming, Fishing, and Forestry (36.6). Firefighters had the highest HRI rate (389.6) among individual occupations. CONCLUSIONS: Workers in certain demographic and occupational groups are particularly susceptible to HRI. Additional prevention efforts, including outreach and enforcement targeting high-risk groups, are needed to reduce occupational HRI. Workers’ compensation data can provide timely information about temporal trends and risk factors for HRI.
Global climate change has led to a significant increase in temperature over the last century and has been associated with significant increases in the severity and frequency of heat injury (HI). The consequences of HI included dehydration and rhabdomyolysis, leading to acute kidney injury, which is now recognized as a clear risk factor for chronic kidney disease (CKD). We aimed to investigate the effects of HI on the risk of CKD. This nationwide longitudinal population-based retrospective cohort study utilized the Taiwan National Health Insurance Research Database (NHIRD) data. We enrolled patients with HI who were followed in NHIRD system between 2000 and 2013.We excluded patients diagnosed with CKD or genital-urinary system-related disease before the date of the new HI diagnosis. The control cohort consisted of individuals without HI history. The patients and control cohort were selected by 1:4 matching according to the following baseline variables: sex, age, index year, and comorbidities. The outcome measure was CKD diagnosis. In total, 815 patients diagnosed with HI were identified. During the 13 year observation period, we identified 72 CKD events (8.83%) in the heat stroke group and 143 (4.38%) CKD events in the control group. Patients with heat stroke had an increased risk of CKD than the control patients (adjusted HR = 4.346, P < 0.001) during the follow-up period. The risk of end-stage renal disease was also significantly increased in the heat stroke group than in the control group (adjusted hazards ratio: 9.078, p < 0.001). HI-related CKD may represent one of the first epidemics due to global warming. When compared to those without HI, patients with HI have an increased CKD risk.
Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR ?30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period; incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.
Morbidity and mortality impacts of extreme heat amplified by climate change will be unequally distributed among communities given pre-existing differences in socioeconomic, health, and environmental conditions. Many governments are interested in adaptation policies that target those especially vulnerable to the risks, but there are important questions about how to effectively identify and support communities most in need of heat adaptations. Here, we use an equity-oriented adaptation program from the state of California as a case study to evaluate the implications of the currently used environmental justice index (CalEnviroScreen 3.0) for the identification of socially vulnerable communities with climate change adaptation needs. As CalEnviroScreen is geared towards air and water pollution, we assess how community heat risks and adaptation needs would be evaluated differently under two more adaptation-relevant vulnerability indices: the Social Vulnerability Index and the Heat-Health Action Index. Our analysis considers communities at the census tract scale, as well as the patterns emerging at the regional scale. Using the current index, the state designates 25% of its census tracts as “disadvantaged” communities eligible for special adaptation funds. However, an additional 12.6% of the state’s communities could be considered vulnerable if the two other indices were considered instead. Only 13.4% of communities are vulnerable across all three vulnerability indices studied. Choice of vulnerability index shapes statewide trends in extreme heat risk and is linked to a community’s likelihood of receiving heat-related California Climate Investments (CCI) projects. Tracts that are vulnerable under the current pollution-focused index, but not under the heat-health specific index, received four times the number of heat-related interventions as tracts vulnerable under the reverse scenario. This study demonstrates important nuances relevant to implementing equity-oriented adaptation and explores the challenges, trade-offs, and opportunities in quantifying vulnerability.
AIMS: This study aimed to investigate the influence of climatic factors on the onset of Takotsubo syndrome (TTS). METHODS AND RESULTS: We performed a retrospective nationwide study among patients registered in the Japanese Registry of All Cardiac and Vascular Diseases and Diagnosis Procedure Combination (JROAD-DPC) discharge database, between 2012 and 2016. Before the analysis, a multicentre validation study was conducted for assessing the accuracy of the JROAD-DPC classification for TTS. First, we investigated the seasonal variation of incidences of TTS. Second, we analysed the associations between the incidence of TTS and climatic factors using the hierarchical Poisson regression modelling, and we also investigated the associations between typhoon landfalls and hospitalization for TTS, using the fixed-effects conditional Poisson regression model. The sensitivity and specificity for diagnosis were 83% and 100%, respectively. Then we analysed 5643 patients with TTS. The mean patient age was 74 (standard deviation ± 11) years; 79% were female. TTS was diagnosed significantly more frequently in the summer and early autumn. The incidence of TTS was related to higher temperatures; adjusted incidence rate ratios were 1.46 [95% confidence interval (CI): 1.33-1.60, P < 0.01] and 1.47 (95% CI: 1.34-1.62, P < 0.01) for temperatures of 20-25°C and >25°C, respectively. The incidence rate ratio for the first 2 days after a typhoon landfall was 1.85 (95% CI: 1.07-3.19; P = 0.03). CONCLUSIONS: This study demonstrates distinct patterns of seasonal variation in the incidence of TTS, as well as a significant association between its onset and climatic factors, including typhoon landfalls.
OBJECTIVES: There has been increasing interest in identifying the adverse effects of ambient environmental factors on asthma exacerbations (AE), but season-stratified effects of meteorological factors on childhood asthma remain unclear. We explored the season-stratified effects of meteorological factors on childhood AE in Shanghai, China. METHODS: Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to examine the lagged and nonlinear effects of meteorological factors on childhood AE after adjustment for putative confounders. We also performed a season-stratified analysis to determine whether the season modified the relationship between meteorological factors and childhood AE. RESULTS: There were 23,103 emergency department visits (EDVs) for childhood AE, including 15,466 boys and 7637 girls during 2008-2017. Most meteorological factors (e.g., temperature, diurnal temperature range (DTR), relative humidity (RH) and wind speed (WS)) were significantly associated with EDVs for childhood AE, even after adjustment for the confounding effects of air pollutants. In the whole year, extreme cold, moderate heat, higher DTR, lower RH and WS increased the relative risk (RR) for childhood AE. In the cold season, lower RH and wind speed increased the risks of childhood AE (RR(lag0-28) for the 5th percentile (p5) of RH: 9.744, 95% CI: 3.567, 26.616; RR(lag0-28) for the p5 of wind speed: 10.671, 95% CI: 1.096, 103.879). In the warm season, higher temperature and DTR, lower RH and WS increased the RR for childhood AE (RR(lag0-5) for the p95 of temperature: 1.871, 95% CI: 1.246, 2.810; RR(lag0-2) for the p95 of DTR: 1.146, 95% CI: 1.010, 1.300; RR(lag0-5) for the p5 of RH: 1.931, 95% CI: 1.191, 3.128; RR(lag0-2) for the p5 of WS: 1.311, 95% CI: 1.005, 1.709). CONCLUSIONS: Extreme meteorological factors appeared to be triggers of EDVs for childhood AE in Shanghai and the effects modified by season. These findings provide evidence for developing season-specific and tailored strategies to prevent and control childhood AE.
On the basis of a newly developed observational dataset and a suite of climate model simulations, we evaluate changes in summer mean wet bulb globe temperature (WBGT) in China from 1961 through 2080. We show that summer mean WBGT has increased almost everywhere across China since 1961 as a result of human-induced climate change. Consequently, hot summers as measured by summer mean WBGT are becoming more frequent and more conducive to heat stress. Hot summers like the hottest on record during 1961-2015 in western or eastern China are now expected occur once every 3-4 years. These hot WBGT summers have become more than 140 times as likely in eastern China in the present decade (2010s) as in the 1961-90 baseline period and more than 1000 times as likely in western China. The substantially larger influence in western China is associated with its stronger warming signal, which is likely due to the high Bowen ratio of sensible to latent heat fluxes of dry soils and increases in absorbed solar radiation from the decline in mountain snow cover extent. Observation-constrained projections of future summer mean WBGT under the RCP8.5 emissions scenario indicate that, by the 2040s, almost every summer in China will be at least as hot as the hottest summer in the historical record, and by the 2060s it will be common (on average, every other year) for summers to be as much as 3.0 degrees C hotter than the historical record, pointing to potentially large increases in the likelihood of human heat stress and to a massive adaption challenge.
BackgroundThe rapid increase of bacterial antibiotic resistance could soon render our most effective method to address infections obsolete. Factors influencing pathogen resistance prevalence in human populations remain poorly described, though temperature is known to contribute to mechanisms of spread.AimTo quantify the role of temperature, spatially and temporally, as a mechanistic modulator of transmission of antibiotic resistant microbes.MethodsAn ecologic analysis was performed on country-level antibiotic resistance prevalence in three common bacterial pathogens across 28 European countries, collectively representing over 4?million tested isolates. Associations of minimum temperature and other predictors with change in antibiotic resistance rates over 17?years (2000-2016) were evaluated with multivariable models. The effects of predictors on the antibiotic resistance rate change across geographies were quantified.ResultsDuring 2000-2016, for Escherichia coli and Klebsiella pneumoniae, European countries with 10°C warmer ambient minimum temperatures compared to others, experienced more rapid resistance increases across all antibiotic classes. Increases ranged between 0.33%/year (95%?CI:?0.2?to?0.5) and 1.2%/year (95%?CI:?0.4?to?1.9), even after accounting for recognised resistance drivers including antibiotic consumption and population density. For Staphylococcus aureus a decreasing relationship of -0.4%/year (95%?CI:? -0.7 to 0.0) was found for meticillin resistance, reflecting widespread declines in meticillin-resistant S. aureus across Europe over the study period.ConclusionWe found evidence of a long-term effect of ambient minimum temperature on antibiotic resistance rate increases in Europe. Ambient temperature might considerably influence antibiotic resistance growth rates, and explain geographic differences observed in cross-sectional studies. Rising temperatures globally may hasten resistance spread, complicating mitigation efforts.
BACKGROUND: Between 1999 and 2008 Russia experienced a flare-up of transmission of vivax malaria following its massive importation with more than 500 autochthonous cases in European Russia, the Moscow region being the most affected. The outbreak waned soon after a decrease in importation in mid-2000s and strengthening the control measures. Compared with other post-eradication epidemics in Europe this one was unprecedented by its extension and duration. METHODS: The aim of this study is to identify geographical determinants of transmission. The degree of favourability of climate for vivax malaria was assessed by measuring the sum of effective temperatures and duration of season of effective infectivity using data from 22 weather stations. For geospatial analysis, the locations of each of 405 autochthonous cases detected in Moscow region have been ascertained. A MaxEnt method was used for modelling the territorial differentiation of Moscow region according to the suitability of infection re-emergence based on the statistically valid relationships between the distribution of autochthonous cases and environmental and climatic factors. RESULTS: In 1999-2004, in the beginning of the outbreak, meteorological conditions were extremely favourable for malaria in 1999, 2001 and 2002, especially within the borders of the city of Moscow and its immediate surroundings. The greatest number of cases occurred at the northwestern periphery of the city and in the adjoining rural areas. A significant role was played by rural construction activities attracting migrant labour, vegetation density and landscape division. A cut-off altitude of 200 m was observed, though the factor of altitude did not play a significant role at lower altitudes. Most likely, the urban heat island additionally amplified malaria re-introduction. CONCLUSION: The malariogenic potential in relation to vivax malaria was high in Moscow region, albeit heterogeneous. It is in Moscow that the most favourable conditions exist for vivax malaria re-introduction in the case of a renewed importation. This recent event of large-scale re-introduction of vivax malaria in a temperate area can serve as a case study for further research.
The human-biometeorological conditions in Kyiv (Ukraine) and changes in the frequency of heat stress during the summer period due to recent climate trends were analyzed. The evaluation based on physiologically equivalent temperature (PET). The results revealed the highest probability of thermal comfortable conditions in Kyiv is from the last 10-day period of April to the end of June and from the last 10-day period of August to the end of September. The probability of heat stress reached nearly 90% during the second and third 10-day periods of July. A pronounced increase in thermal stress during the studied heat wave cases (HW), as well as increasing amount of days with heat stress in the period 1991-2015, were found.
INTRODUCTION: As the global climate changes, heat waves are having a disproportionate impact on seniors and other socially vulnerable groups. In order to mitigate the threats of extreme heat, it is critical to develop and promote resources for coping during these events. A better understanding of the role of risk perceptions and the factors that influence them is needed in order to improve public responses to threatening events, particularly among seniors. METHODS: This mixed-methods study examined risk perceptions and coping practices in seniors using qualitative interviews (n = 15) and a survey (n = 244) of seniors across Waterloo Region, Ontario. RESULTS: Seniors showed relatively accurate risk tracking as indicated by the link between measures of actual risk and perception of personal risk. While vulnerability to heat is often believed to be associated with inaccurate perceptions of risk, within our sample, vulnerability appears more strongly related to social location and access to resources. Participants described social connections as important resources for resilience, but the stigma surrounding vulnerability, and other social norms, as barriers to seeking support. CONCLUSION: The positive relationship between participants’ risk perceptions and actual risk for negative consequences of extreme heat was an important finding, given that problems of emergency preparedness and risk reduction are often framed as issues of awareness of risk, rather than social location and inequality. Along with increased public resources for coping with extreme heat, communicating about resources, fostering social connections and reducing stigma may be important leverage points for increasing the resiliency of seniors to heat waves.
OBJECTIVE: It is well known that air temperature is closely related to health outcomes. We investigated the relationship between air temperature parameters and the number of deaths stratified by cause in Gifu prefecture, Japan. METHODS: The number of deaths stratified by cause in Gifu prefecture Japan between January 2007 and December 2016 was obtained from the official homepage of Gifu prefecture, Japan. Air temperature parameters (?), i.e., the mean air temperature, mean of the highest air temperature, mean of the lowest air temperature, the highest air temperature, and the lowest air temperature during the same period in Gifu city were also obtained from the Japan Meteorological Agency official home page. The relationship between air temperature parameters and the number of deaths was evaluated in an ecological study. RESULTS: The number of deaths due to heart disease, cerebrovascular disease, pneumonia, accidents, or renal failure in January (coldest winter season in Japan) was the highest among the months. Simple correlation analysis also demonstrated a significant and negative relationship between air temperature parameters and the number of deaths due to heart disease, cerebrovascular disease, senility, pneumonia, accidents, and renal failure. CONCLUSION: Lower air temperature may be associated with a higher number of deaths due to diseases in Gifu prefecture, Japan.
The incidence of asthma exacerbation depends on atmospheric conditions, including such meteorological factors as the ambient temperature, relative air humidity or concentration of atmospheric aerosols. An assessment of relations between the frequency of asthma exacerbation and environmental conditions was made according to the meteorological components, the biometeorological index UTCI (Universal Thermal Climate Index), as well as selected air quality parameters, including concentrations of PM(10) and PM(2.5). The study was conducted on the basis of a retrospective analysis of medical data collected at the Independent Public Hospital of Tuberculosis and Pulmonary Diseases in Olsztyn (Poland). Our analysis of patient data (from 1 January 2013 until 31 December 2017) showed a significant correlation between the number of asthma exacerbation and the UTCI value. More frequent asthma exacerbations are observed in patients aged over 65 years when air humidity increases. The UTCI values contained within class 5, describing thermoneutral conditions, correspond to an average frequency of asthma exacerbation. A decline in the UTCI value leads to a reduced number of asthma exacerbation, while a rise makes the cases of asthma exacerbations increase.
The main objective of this article is to demonstrate that passive energy refurbishment interventions influence comfort conditions of households for both cold and hot annual periods, while they help to avoid or promote temperature-related health risk situations. However, improving the thermal efficiency of the building envelope is encouraged in order to reduce energy demand for heating and cooling instead of considering also their impact on users’ health. The calculation methodology to quantify improvements, on the other hand, is drawn from regulation-based standards, which describe the optimal achievable efficiency levels and energy cost savings. The present study, however, addresses how diverse thermal performance variables are (climate, thermal comfort range and occupancy rate), and shows that different thermal assessment standards influence the obtained results. An energy simulation approach was developed to evaluate different scenarios and compare the results. In conclusion, the results contribute to an understanding or to a discussion of the suitability of current energy renovation policies with regard to indoor thermal comfort and temperature-related health risk situations.
INTRODUCTION: Environmental temperature has been described to affect plasma glucose levels after oral glucose tolerance testing (OGTT). AIMS: We evaluated the relationship between seasons and environmental temperature and gestational diabetes mellitus (GDM) diagnosis and treatment. METHODS: We analyzed data from 2374 women retrospectively. GDM was diagnosed in 473 patients by a 100-g OGTT. OGTT results and needing of insulin therapy were evaluated in relation to seasons and environmental temperature (mean temperature and temperature change) the day of the OGTT and the preceding 14 and 28 days. RESULTS: We found significant seasonal differences in the percentage of GDM: 24.4% in summer vs. 15.6% in autumn (p < 0.01). The odds ratio (OR) for being diagnosed with GDM was 1.78 in summer relative to autumn, after controlling for age. A higher mean temperature the day of the OGTT and the preceding 14 and 28 days increased the risk of being diagnosed with GDM the months in which temperature was rising (March-August) but not the months in which temperature was decreasing (September-February). We observed a negative correlation between temperature and fasting glucose and a positive correlation with post-load glucose. Neither the season nor the environmental temperature affected the risk of requiring insulin therapy. CONCLUSIONS: There is a higher prevalence of GDM diagnosis at warmer seasons and at rising temperatures the 2-4 weeks prior to the OGTT. The impact of temperature is different between fasting and post-load glucose.
A small number of studies suggest atmospheric particulate matter with diameters 2.5 micron and smaller (PM(2.5)) may possibly play a role in the transmission of influenza and influenza-like illness (ILI) symptoms. Those studies were predominantly conducted under moderately to highly polluted outdoor atmospheres. The purpose of this study was to extend the data set to include a less polluted atmospheric environment. A relationship between PM2.5 and ILI activity extended to include lightly to moderately polluted atmospheres could imply a more complicated mechanism than that suggested by existing studies. We obtained concurrent PM(2.5) mass concentration data, meteorological data and reported Influenza and influenza-like illness (ILI) activity for the light to moderately polluted atmospheres over the Tucson, AZ region. We found no relation between PM2.5 mass concentration and ILI activity. There was an expected relation between ILI, activity, temperature, and relative humidity. There was a possible relation between PM2.5 mass concentration anomalies and ILI activity. These results might be due to the small dataset size and to the technological limitations of the PM measurements. Further study is recommended since it would improve the understanding of ILI transmission and thereby improve ILI activity/outbreak forecasts and transmission model accuracies.
BACKGROUND: Gastroesophageal reflux disease (GERD) is a highly prevalent disease of the upper gastrointestinal tract, and it is associated with environmental and lifestyle habits. Due to an increasing interest in the environment, several groups are studying the effects of meteorological factors and air pollutants (MFAPs) on disease development. AIM: To identify MFAPs effect on GERD-related medical utilization. METHODS: Data on GERD-related medical utilization from 2002 to 2017 were obtained from the National Health Insurance Service of Korea, while those on MFAPs were obtained from eight metropolitan areas and merged. In total, 20071900 instances of GERD-related medical utilizations were identified, and 200000 MFAPs were randomly selected from the eight metropolitan areas. Data were analyzed using a multivariable generalized additive Poisson regression model to control for time trends, seasonality, and day of the week. RESULTS: Five MFAPs were selected for the prediction model. GERD-related medical utilization increased with the levels of particulate matter with a diameter ? 2.5 ?m (PM(2.5)) and carbon monoxide (CO). S-shaped and inverted U-shaped changes were observed in average temperature and air pollutants, respectively. The time lag of each variable was significant around nine days after exposure. CONCLUSION: Using five MFAPs, the final model significantly predicted GERD-related medical utilization. In particular, PM(2.5) and CO were identified as risk or aggravating factors for GERD.
BACKGROUND: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions. METHODS: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985-2015) and future (2020-99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk. FINDINGS: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by -0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2-7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4-10·3% in 2090-99. INTERPRETATION: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health. FUNDING: Korea Ministry of Environment.
Summertime heat stress future projections from multi-model mean of 18 CMIP5 models show unprecedented increasing levels in the RCP 4.5 and RCP 8.5 emission scenarios over India. The estimated heat stress is found to have more impact on the coastal areas of India having exposure to more frequent days of extreme caution to danger category along with the increased probability of occurrence. The explicit amount of change in temperature, increase in the duration and intensity of warm days along with the modulation in large scale circulation in future are seemingly connected to the increasing levels of heat stress over India. A decline of 30 to 40% in the work performance is projected over India by the end of the century due to the elevated heat stress levels which pose great challenges to the country policy makers to design the safety mechanisms and to protect people working under continuous extreme hot weather conditions.
BACKGROUND: Numerous studies have been conducted to project temperature-related mortality under climate change scenarios. However, most of the previous evidence has been limited to the total or non-accidental mortality, resulting in insufficient knowledge on the influence of climate change on different types of disease. OBJECTIVES: We aimed to project future temperature impact on mortality from 16 causes under multiple climate change models in a coastal city of China. METHODS: We first estimated the baseline exposure-response relationships between daily average temperature and cause-specific mortality during 2009-2018. Then, we acquired downscaled future temperature projections from 28 general circulation models (GCMs) under two Representative Concentration Pathway (RCP4.5 and RCP8.5). Finally, we combined these exposure-response associations with projected temperature to estimate the change in the temperature-related death burden in different future decades in comparison to the 2010 s, assuming no demographic changes and population acclimatization. RESULTS: We found a consistently decreasing trend in cold-related mortality but a steep rise in heat-related mortality among 16 causes under climate change scenarios. Compared with the 2010 s, the net change in the fraction of total mortality attributable to temperature are projected to -0.54% (95% eCI: -1.69% to 0.71%) and -0.38% (95% eCI: -2.73% to 2.12%) at the end of the 21st century under RCP4.5 and RCP8.5, respectively. However, the magnitude of future cold and heat effects varied by different causes of death. A net reduction of future temperature-related death burden was observed among 10 out of 15 causes, with estimates ranging from -5.02% (95% eCI: -17.42% to 2.50%) in mental disorders to -1.01% (95% eCI: -5.56% to 3.28%) in chronic lower respiratory disease. Conversely, the rest diseases are projected to experience a potential net increase of temperature-related death burden, with estimates ranging from 0.44% (95% eCI: -4.40% to 6.02%) in ischemic heart disease and 4.80% (95% eCI: -0.04% to 9.84%) in external causes. CONCLUSIONS: Our study indicates that the mortality burden of climate change varied greatly by the mortality categories. Further investigations are warranted to comprehensively understand the impacts of climate change on different types of disease across various regions.
This time-series study collects data on stroke-related mortality, years of life lost (YLL), air pollution, and meteorological conditions in 96 Chinese cities from 2013 to 2016 and proposes a three-stage strategy to generate the national and regional estimations of avoidable YLL, gains in life expectancy and stroke-related population attributable fraction by postulating that the daily fine particulate matter (PM(2.5)) has been kept under certain standards. A total of 1 318 911 stroke deaths are analyzed. Each 10 µg m(-3) increment in PM(2.5) at lag(03) is associated with a city-mean increase of 0.31 (95% CI: 0.19, 0.44) years of life lost from stroke. A number of 914.11 (95% CI: 538.28, 1288.94) years of city-mean life lost from stoke could be avoided by attaining the WHO’s Air Quality Guidelines (AQG) (25 µg m(-3)). Moreover, by applying the AQG standard, 0.11 (0.08, 0.15) years of life lost might be prevented for each death, and about 0.91% (95% CI: 0.62%, 1.19%) of the total years of life lost from stroke might be explained by the daily excess PM(2.5) exposure. This study indicates that stroke patients can have a longer life expectancy if stricter PM(2.5) standards are put in place, especially ischemic stroke patients.
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.
BACKGROUND: Hand, foot, and mouth disease (HFMD) is a widespread infectious disease in China. Associated meteorological factors have been widely studied, but their attributable risks have not been well quantified. OBJECTIVES: The study aimed to quantify the HFMD burden attributable to temperature and other meteorological factors. METHODS: The daily counts of HFMD and meteorological factors in all 574 counties of East China were obtained for the period from 2009 to 2015. The exposure-lag-response relationships between meteorological factors and HFMD were quantified by using a distributed lag non-linear model for each county and the estimates from all the counties were then pooled using a multivariate mete-regression model. Attributable risks were estimated for meteorological variables according to the exposure-lag-response relationships obtained before. RESULTS: The study included 4,058,702 HFMD cases. Non-optimal values of meteorological factors were attributable to approximately one third of all HFMD cases, and the attributable numbers of non-optimal ambient temperature, relative humidity, wind speed and sunshine hours were 815,942 (95% CI: 796,361-835,888), 291,759 (95% CI: 226,183-358,494), 92,060 (95% CI: 59,655-124,738) and 62,948 (95% CI: 20,621-105,773), respectively. The exposure-response relationship between temperature and HFMD was non-linear with an approximate “M” shape. High temperature had a greater influence on HFMD than low temperature did. There was a geographical heterogeneity related to water body, and more cases occurred in days with moderate high and low temperatures than in days with extreme temperature. The effects of meteorological factors on HFMD were generally consistent across subgroups. CONCLUSIONS: Non-optimal temperature is the leading risk factor of HFMD in East China, and moderate hot and moderate cold days had the highest risk. Developing subgroup-targeted and region-specific programs may minimize the adverse consequences of non-optimum weather on HFMD risk.
This study reveals the best combination of meteorological variables for the prediction of the number of emergency transport due to heat stroke over 64 years old in Tokyo metropolis based on a generalized linear model using 2008-2016 data. Temperature, relative humidity, wind speed, and solar radiation were used as candidates of the explanatory variables. The variable selection with Akaike’s information criterion (AIC) showed that all the four meteorological elements were selected for the prediction model. Additional analysis showed that the combination of daily mean temperature, maximum relative humidity, maximum wind speed, and total solar radiation as explanatory variables gives the best prediction, with approximately 19% less error than the conventional single-variable model which only uses the daily mean temperature. Finally, we quantitatively estimated the relative contribution of each variable to the prediction of the daily number of heat stroke patients using standardized partial regression coefficients. The result reveals that temperature is the largest contributor. Solar radiation is second, with approximately 20% of the temperature effect. Relative humidity and wind speed make relatively small contributions, each contributing approximately 10% and 9% of the temperature, respectively. This result provides helpful information to propose more sophisticated thermal indices to predict heat stroke risk.
Here, we develop a dry eye syndrome (DES) incidence rate prediction model using air pollutants (PM10, NO2, SO2, O-3, and CO), meteorological factors (temperature, humidity, and wind speed), population rate, and clinical data for South Korea. The prediction model is well fitted to the incidence rate (R-2= 0.9443 and 0.9388,p< 2.2 x 10(-16)). To analyze regional deviations, we classify outpatient data, air pollutant, and meteorological factors in 16 administrative districts (seven metropolitan areas and nine states). Our results confirm NO(2)and relative humidity are the factors impacting regional deviations in the prediction model.
The rising probability of extremely high temperatures and an increasing number of consecutive hot days caused by climate change-combined with the impact of these high temperatures on human health-is widely discussed in the literature. There are calls for the development of heatwave adaptation measures by governmental and scientific institutions. In this research, the predictors of health-related heat risk perception of urban citizens in Augsburg, Germany, were investigated. An online survey was conducted with 468 citizens, asking about their heat risk perception, knowledge about heat risks, and demographic data and health information. Statistical methods (Spearman correlation, unpaired t-test, ANOVA and multiple regression) were used to determine which factors were significant and relevant. The results show that the knowledge of heat risks, heat risk sensitivity and an external locus of control are the most important factors for heat risk perception. The health implication score and chronic disease show significant effects in descriptive statistics. Furthermore, younger people showed the highest heat risk perception of all age groups. Surprisingly, income, education, living alone and gender did not play a role in heat risk perception. The findings imply a need for better and intensified heat risk communication in urban areas-especially among elderly people-and thus are important for creating acceptance towards heat wave risks, which is a prerequisite of willingness to adapt.
BACKGROUND: Preterm birth is a major determinant of adverse health consequences, and early term births are also associated with increased risk of various outcomes. In light of climate change, the effect of ambient temperature on earlier delivery is an important factor to consider. Several studies have focused on associations of ambient air temperature (Ta) on preterm birth, but few have examined associations with early term births. AIMS: To investigate the association of prenatal exposure to Ta with preterm birth (<37 completed gestation weeks) and with early-term birth (<39 completed gestation weeks) in a semi-arid climate. METHODS: All singleton deliveries at the Soroka Medical Center from the Southern district of Israel, with estimated conception dates between May 1, 2004 and March 31, 2013 (N = 62,547) were linked to prenatal Ta estimates from a spatiotemporally resolved model, with daily 1 km resolution. We used time-dependent Cox regression models with weekly mean Ta throughout gestation, adjusted for calendar month and year of conception, ethnicity, census-level socio-economic status and population density. RESULTS: Ta was positively associated with late preterm birth (31 + 0/7 - 36 + 6/7 weeks), with increased risk in the upper Ta quintile as compared to the third quintile, hazard ratio (HR) = 1.31, 95% confidence interval (CI) = 1.11-1.56. Ta also associated with early term birth (37 + 0/6 - 38 + 6/7), with increased risk in the upper Ta quintile as compared to the third quintile, HR = 1.24, 95% CI = 1.13-1.36. CONCLUSION: Exposure to high ambient temperature during pregnancy is associated with a higher risk of preterm and early term birth in southern Israel.
There is a lack of evidence on causal effects of air pollution on gestational age (GA) at delivery. METHODS: Inverse probability weighting (IPW) quantile regression was applied to derive causal marginal population-level GA reduction for GA percentiles associated with increased ambient particulate matter with diameter <2.5 ?m (PM(2.5)) levels at maternal residential address for each trimester and the month preceding delivery using Massachusetts birth registry 2001 to 2015. Stratified analyses were conducted for neonatal sex, maternal age/race/education, and extreme ambient temperature conditions. RESULTS: For neonates at 2.5th, 10th, 25th, 50th, 75th, and 97.5th percentiles of GA at delivery, we estimated an adjusted GA reduction of 4.2 days (95% confidence interval [CI] = 3.4, 5.0), 1.9 days (1.6, 2.1), 1.2 days (1.0, 1.4), 0.82 days (0.72, 0.92), 0.74 days (0.54, 0.94), and 0.54 days (0.15, 0.93) for each 5 ?g/m3 increment in third trimester average PM(2.5) levels. Final gestational month average exposure yielded a similar effect with greater magnitude. Male neonates and neonates of younger (younger than 35 years) and African American mothers as well as with high/low extreme temperature exposure in third trimester were more affected. Estimates were consistently higher at lower GA percentiles, indicating preterm/early-term births being more affected. Low-exposure analyses yielded similar results, restricting to areas with PM(2.5) levels under US ambient annual standard of 12 ?g/m(3). CONCLUSIONS: Prenatal exposure to PM(2.5) in late pregnancy reduced GA at delivery among Massachusetts neonates, especially among preterm/early-term births, male neonates, and neonates of younger and African American mothers. Exposure to extremely high/low temperature amplifies the effect of PM(2.5) on GA.
The number of dengue fever incidence and its distribution has increased considerably in recent years in Africa. However, due to inadequate research at the continental level, there is a limited understanding regarding the current and future spatial distribution of the main vector, the mosquitoAedes aegypti, and the associated dengue risk due to climate change. To fill this gap we used reported dengue fever incidences, the presence of Ae. aegypti, and bioclimatic variables in a species distribution model to assess the current and future (2050 and 2070) climatically suitable areas. High temperatures and with high moisture levels are climatically suitable for the distribution of Ae. aegypti related to dengue fever. Under the current climate scenario indicated that 15.2% of the continent is highly suitable for dengue fever outbreaks. We predict that climatically suitable areas for Ae. aegypti related to dengue fever incidences in eastern, central and western part of Africa will increase in the future and will expand further towards higher elevations. Our projections provide evidence for the changing continental threat of vector-borne diseases and can guide public health policy decisions in Africa to better prepare for and respond to future changes in dengue fever risk.
BACKGROUND: The prevalence of Acute Myocardial Infarction (AMI) varies from region to region caused by seasonal climate changes and temperature variation. This study aimed to assess the relationship between changing meteorological conditions and incidence of AMI in Iran. METHODS: This retrospective prevalence study was based on medical records of the heart center of Mazandaran Province on all patients diagnosed with AMI in Mazandaran, northern Iran between 2013 and 2015. Patients’ sex and the day, month, year and time of hospital admission were extracted from patients’ records. Moreover, the meteorological reports were gathered. RESULTS: A statistically significant difference was found between the distributions of AMI cases across 12 months of the year (P < 0.01). Fuzzy clustering analysis using 16 different climatic variables showed that March, April, and May were in the same cluster together. The other 9 months were in different clusters. CONCLUSION: Significant increase in AMI was seen in March, April and May (cold to hot weather).
We have examined the heat and cold-related mortality risk subject to cold and heat extremes by using a generalized additive model (GAM) regression technique to quantify the effect of the stimulus of mortality in the presence of covariate data for 2007-2014 in Nicosia, Cyprus. The use of the GAM technique with multiple linear regression allowed for the continuous covariates of temperature and diurnal temperature range (DTR) to be modeled as smooth functions and the lag period was considered to relate mortality to lagged values of temperature. Our findings indicate that the previous three days’ temperatures were strongly predictive of mortality. The mortality risk decreased as the minimum temperature (T-min) increased from the coldest days to a certain threshold temperature about 20-21 degrees C (different for each age group and gender), above which the mortality risk increased as T-min increased. The investigated fixed factors analysis showed an insignificant association of gender-mortality, whereas the age-mortality association showed that the population over 80 was more vulnerable to temperature variations. It was recommended that the minimum mortality temperature is calculated using the minimum daily temperatures because it has a stronger correlation to the probability for risk of mortality. It is still undetermined as to what degree a change in existing climatic conditions will increase the environmental stress to humans as the population is acclimatized to different climates with different threshold temperatures and minimum mortality temperatures.
Severe fever with thrombocytopenia syndrome (SFTS), a tick-borne infectious disease, is difficult to differentiate from other common febrile diseases. Clinically distinctive features and climate variates associated with tick growth can be useful predictors for SFTS. This retrospective study (2013-2019) demonstrated the role of climatic factors as predictors of SFTS and developed a clinical scoring system for SFTS using climate variables and clinical characteristics. The presence of the SFTS virus was confirmed using reverse transcription polymerase chain reaction (RT-PCR) tests. In the univariate analysis, the SFTS-positive group was significantly associated with higher mean ambient temperature and humidity compared with the SFTS-negative group (22.5 °C vs. 18.9 °C; 77.9% vs. 70.7%, all p < 0.001). In the multivariate analysis, poor oral intake (Odds ratio [OR] 5.87, 95% CI: 2.42-8.25), lymphadenopathy (OR 7.20, 95% CI: 6.24-11.76), mean ambient temperature ? 20 °C (OR 4.62, 95% CI: 1.46-10.28), absolute neutrophil count ? 2000 cells/?L (OR 8.95, 95% CI: 2.30-21.25), C-reactive protein level ? 1.2 mg/dL (OR 6.42, 95% CI: 4.02-24.21), and creatinine kinase level ? 200 IU/L (OR 5.94, 95% CI: 1.42-24.92) were significantly associated with the SFTS-positive group. This study presents the risk factors, including ambient temperature and clinical characteristics, that physicians should consider when suspecting SFTS.
This is the first study to look at future temporal urban heath island (UHI) trends of Athens (Greece) under different UHI intensity regimes. Historical changes in the Athens UHI, spanning 1971-2016, were assessed by contrasting two air temperature records from stable meteorological stations in contrasting urban and rural settings. Subsequently, we used a five-member regional climate model (RCM) sub-ensemble from EURO-CORDEX with a horizontal resolution of 0.11 degrees (similar to 12 x 12 km) to simulate air temperature data, spanning the period 1976-2100, for the two station sites. Three future emissions scenarios (RCP2.6, RCP4.5, and RCP8.5) were implanted in the simulations after 2005 covering the period 2006-2100. Two 20-year historical reference periods (1976-1995 and 1996-2015) were selected with contrasting UHI regimes; the second period had a stronger intensity. The daily maximum and minimum air temperature data (T(max)and T-min) for the two reference periods were perturbed to two future periods, 2046-2065 and 2076-2095, under the three RCPs, by applying the empirical quantile mapping (eqm) bias-adjusting method. This novel approach allows us to assess future temperature developments in Athens under two UHI intensity regimes that are mainly forced by differences in air pollution and heat input. We found that the future frequency of days with T-max> 37 degrees C in Athens was only different from rural background values under the intense UHI regime. Thus, the impact of heatwaves on the urban environment of Athens is dependent on UHI intensity. There is a large increase in the future frequency of nights with T-min> 26 degrees C in Athens under all UHI regimes and climate scenarios; these events remain comparatively rare at the rural site. This large urban amplification of the frequency of extremely hot nights is likely caused by air pollution. Consequently, local mitigation policies aimed at decreasing urban atmospheric pollution are expected to be highly effective in reducing urban temperatures and extreme heat events in Athens under future climate change scenarios. Such policies directly have multiple benefits, including reduced electricity (energy) needs, improved living quality and strong health advantages (heat- and pollution-related illness/deaths).
Climate change is postulated to alter the distribution and abundance of species which serve as vectors for pathogens and is thus expected to affect the transmission of infectious, vector-borne diseases such as malaria. The ability to project and therefore, to mitigate the risk of potential expansion of infectious diseases requires an understanding of how vectors respond to environmental change. Here, we used an extensive dataset on the distribution of the mosquito Anopheles sacharovi, a vector of malaria parasites in Greece, southeast Europe, to build a modeling framework that allowed us to project the potential species range within the next decades. In order to account for model uncertainty, we employed a multi-model approach, combining an ensemble of diverse correlative niche models and a mechanistic model to project the potential expansion of species distribution and to delineate hotspots of potential malaria risk areas. The performance of the models was evaluated using official records on autochthonous malaria incidents. Our projections demonstrated a gradual increase in the potential range of the vector distribution and thus, in the malaria receptive areas over time. Linking the model outputs with human population inhabiting the study region, we found that population at risk increases, relative to the baseline period. The methodological framework proposed and applied here, offers a solid basis for a climate change impact assessment on malaria risk, facilitating informed decision making at national and regional scales.
Respiratory diseases cause significant morbidity and mortality, especially in developing countries. Recently, the influence of global warming on respiratory disease mortality has become a growing concern in research. Data on respiratory disease mortality, meteorological elements and air pollutants during 2014-2017 were collected from Yancheng in China. We applied the distributed lag non-linear model (DLNM) and performed a quasi-Poisson distribution fitting to evaluate the baseline relationship between the mean temperature and total respiratory diseases mortality, and then projected the future changes of total respiratory diseases mortality without adaptation and with adaptation in Yancheng during three future periods under two Representative Concentration Pathways (RCP) scenarios(RCP4.5 and RCP8.5) and three population scenarios including one constant and two Shared Socio-economic Pathways (SSP) scenarios (55P2 and 55P5). Under four combination scenarios, future warming causes additional heat-related mortality but reduced cold-related mortality in Yancheng from the 2030s to the 2070s. Under SSP population scenarios, the reduced numbers of cold-related deaths offsetting the additional numbers of heat-related deaths lead to the decreases in net temperature-related mortality in the 2050s and 2070s. Future population change has more influence on respiratory mortality than future climate change scenarios does. When the adaptation was adpoted, the heat-related mortality risks and the net temperature-related mortality risks become smaller, but the cold-related mortality risks become larger than that without adaptation.
BACKGROUND: Estimating the effects of climate change on human health can help health policy makers plan for the future. In Iran, there are few studies, about investigating the effects of climate change on mortality. This study aimed to project the effect of low (cold) and high (heat) temperature on mortality in a dry region of Iran, Kerman. METHODS: Mortality attributed to temperature was projected by estimating the temperature-mortality relation for the observed data, projection of future temperatures by the statistical downscaling model (SDSM), and quantifying the attributable fraction by applying the observed temperature-mortality relation on the projected temperature. Climate change projection was done by three climate scenarios base on Representative Concentration Pathways (RCP2.6, RCP4.5 and RCP8.5). Adaptation was considered by using different minimum mortality temperatures (MMT) and risk reduction approaches. The current decade (2010-19) was considered as the reference period. RESULTS: All three climate change scenarios, showed that the mean of temperature will rise about 1 °C, by 2050 in Kerman. The number of deaths attributed to heat were obviously higher than cold in all periods. Assuming no adaptation, over 3700 deaths attributed to temperature will happen in each decade (2020s, 2030s and 2040s) in the future, in which over 3000 deaths will be due to heat and over 450 due to cold. In the predictions, as Minimum Mortality Temperature (MMT) went up, the contribution of heat to mortality slightly decreased, and cold temperature played a more important role. By considering the risk reduction due to adaptation, the contribution of heat in mortality slightly and insignificantly decreased. CONCLUSION: The results showed that although low temperatures will contribute to temperature-related mortality in the future, but heat will be a stronger risk factor for mortality, especially if adaptation is low.
BACKGROUND AND AIMS: As, the COVID-19 has been deemed a pandemic by World Health Organization (WHO), and since it spreads everywhere throughout the world, investigation in relation to this disease is very much essential. Investigation of pattern in the occurrence of COVID-19, to check the influence of different meteorological factors on the incidence of COVID-19 and prediction of incidence of COVID-19 are the objectives of this paper. METHODS: For trend analysis, Sen’s Slope and Man-Kendall test have been used, Generalized Additive Model (GAM) of regression has been used to check the influence of different meteorological factors on the incidence and to predict the frequency of COVID-19, and Verhulst (Logistic) Population Model has been used. RESULTS: Statistically significant linear trend found for the daily-confirmed cases of COVID-19. The regression analysis indicates that there is some influence of the interaction of average temperature (AT) and average relative humidity (ARH) on the incidence of COVID-19. However, this result is not consistent throughout the study area. The projections have been made up to 21st May, 2020. CONCLUSIONS: Trend and regression analysis give an idea of the incidence of COVID-19 in India while projection made by Verhulst (Logistic) Population Model for the confirmed cases of the study area are encouraging as the sample prediction is as same as the actual number of confirmed COVID-19 cases.
When studying the thermal adaptation of building occupants, understanding the effects of different thermal experiences on adaptation is necessary, particularly for moderate and severe heat exposure. However, this area has seen limited research. Further, skin temperature, a common parameter for quantifying thermal sensation, may insufficiently reflect the automatic thermoregulation of the human body. This study investigates the effects of long-term heat exposure on the human body using multiple physiological and subjective indexes. Two heat exposure experiments were conducted on healthy male participants from northern and southern China. Participant responses, including skin temperature, heart rate, heart rate variability, blood volume pulse (BVP), subjective thermal comfort, thermal sensation, thermal acceptability, and normalized high and low frequency values were collected and compared. The results indicated that the subjective responses of northern and southern participants were not significantly different; however, the subjective physiological symptoms and self-reported discomfort of the latter were less than those of the former, indicating that the southern participants had superior heat tolerance. Additionally, the physiological responses of all the participants were largely similar. However, southern participants showed slightly higher normalized high frequency and BVP values, indicating that they have more active vagus nerves and better vasodilation. They also showed a wider acceptable temperature range and better acclimation to heat exposure. Notably, the mean skin temperature could not effectively predict thermal sensation during heat exposure; this was more accurately achieved using the rate of change of skin temperature. These findings suggest that long-term thermal experiences can affect building occupants’ thermal adaptability.
Population ageing, an increase in the older age group’s portion of the total population, worsens the heat tolerance of a society. However, impacts of ageing on the social exposure to projected unprecedented hot summers (UHSs) are uncertain. We show that a shifting of the population distribution towards older ages amplifies the vulnerability of a country to the increasing frequency of UHSs as a result of warming during 2040-2070, especially in most populated regions such as China, India, and sub-Saharan countries. The warming scenarios from Representative Concentration Pathway (RCP) 8.5 are combined with population scenarios from three Shared Socio-economic Pathways (SSPs) SSP2, SSP3, and SSP5 together to estimate the exposure to UHSs. The ageing-driven increase in the exposure of elderly to UHSs ranges 51-198, 91-261, and 47-156 million in China, India, and sub-Saharan countries, respectively, between population scenarios. In China, with decreasing total population, the exposure to UHSs will be increased by rapid population ageing. In India and sub-Saharan countries, the potential of ageing to raise the exposure to UHSs will be even larger than that of warming. In contrast, in aged societies with slow ageing trend, e.g. United States and Europe, the warming mainly increases the exposure to UHSs. Our results suggest the changing age structure could exacerbate a country’s heat vulnerability despite limiting warming to a certain level in the future.
Heatwaves are likely to increase over different regions of the world as the climate warms, which poses potential risk to the environment, society, and public health. Concurrent daytime and nighttime heatwaves have a more significant impact on human health than individually occurring heatwaves, especially in regions with high population density. The Huai River Basin (HRB) is taken as a case in this study to explore the characteristics of concurrent daytime and nighttime heatwaves in a high-population-density area, including quantification of the population’s exposure to concurrent heatwaves. Nighttime hot events are found to increase to greater extent than daytime hot events from 1961 to 2017. A single daytime or nighttime hot event can provide 40-60 % capacity for the concurrent daytime and nighttime hot events. The concurrent daytime and nighttime heatwaves show an obvious southeast-northwest gradient with high values in the southeast and low values in the northwest of the HRB. Daytime hot events, nighttime hot events, and concurrent daytime and nighttime heatwave events all show significant upward trends from 1987 to 2017. The population exposed to the heat extremes increased significantly over this period, especially in regards to concurrent daytime and nighttime heatwaves. The population exposure in terms of the quantity, duration, and magnitude of concurrent daytime and nighttime heatwaves increased by around 5-, 9-, and 35-fold from 1984 to 2017. Atmospheric circulation analysis of the 2013 concurrent daytime and nighttime heatwaves in the HRB shows a long-lasting anomalous circulation background (e.g., anomalous high pressure system and low cloud water content) leading to severe concurrent daytime and nighttime heatwaves.
Research on population exposure to extreme heat is hindered by the limited spatial coverage of weather station and single exposure characteristic. In this study, a random forest regression model was developed to estimate monthly mean maximum temperature and extreme temperature. A cross-regional statistics in mean maximum temperature and extreme temperature was created to calculate a threshold which was used to reflect extreme temperature events. The threshold was used to develop the frequency, intensity and duration in extreme heat exposure for mean maximum temperature and extreme temperature, and quantified their spatiotemporal trends across residential areas in China in summer, 2001-2013. Results show that the risk of extreme heat was the highest in East China and was lower in Northeast and Northwest. The frequency of extreme heat exposure increased in most areas for mean maximum temperature, decreased in northern areas and increased in southern areas for extreme temperature. The intensity of extreme heat exposure increased in East, Central, South, and Southwest China for both mean maximum temperature and extreme temperature. The duration of extreme heat exposure increased nationwide for mean maximum temperature, and decreased in northern areas for extreme temperature. Frequency, intensity and duration of extreme heat exposure increased significantly, accompanied by high frequency, intense intensity and long-lasting in East, Central, Southwest, and South China. Overall, the results identify the high-risk hotspots over China in summer, 2000-2013.
Long endemicity of the Highly Pathogenic Avian Influenza (HPAI) H5N1 subtype in Egypt poses a lot of threats to public health. Contrary to what is previously known, outbreaks have been circulated continuously in the poultry sectors all year round without seasonality. These changes call the need for epidemiological studies to prove or deny the influence of climate variability on outbreak occurrence, which is the aim of this study. This work proposes a modern approach to examine the degree to which the HPAI-H5N1disease event is being influenced by climate variability as a potential risk factor using generalized estimating equations (GEEs). GEE model revealed that the effect of climate variability differs according to the timing of the outbreak occurrence. Temperature and relative humidity could have both positive and negative effects on disease events. During the cold seasons especially in the first quarter, higher minimum temperatures, consistently show higher risks of disease occurrence, because this condition stimulates viral activity, while lower minimum temperatures support virus survival in the other quarters of the year with the highest negative effect in the third quarter. On the other hand, relative humidity negatively affects the outbreak in the first quarter of the year as the humid weather does not support viral circulation, while the highest positive effect was found in the second quarter during which low humidity favors the disease event.
Many cities are developing mitigation plans in an effort to reduce the population health impacts from expected future increases in the frequency and intensity of heat waves. To inform heat mitigation and adaptation planning, information is needed on the extent to which available mitigation strategies, such as reflective and green roofs, could result in significant reductions in heat exposure. Using the Weather Research and Forecasting (WRF) model, we analysed the impact of green and cool (reflective) roofs on the urban heat island (UHI) and temperature-related deaths in the Greater Boston area (GBA) and New England area (NEA) in summer and winter. In the GBA, green and cool roofs reduced summertime population-weighted temperature by 0.35 degrees C and 0.40 degrees C, respectively. In winter, green roofs did not affect temperature, whereas cool roofs caused a temperature reduction of 0.40 degrees C. In the NEA, the cooler summers induced by green and cool roofs were estimated to reduce the heat-related mortality rates by 0.21% and 0.17%, respectively, compared to baseline. Cool-roof-induced temperature reduction in winter could increase the cold-related mortality rate by 0.096% compared to baseline. These results suggest that both green and cool roofing strategies have the potential to reduce the impact of heat on premature deaths. Additionally, the differing effects in winter suggest the need for a careful consideration of health trade-offs in choosing heat island mitigation strategies.
PURPOSE: The effects of meteorological parameters on stroke occurrence remain debated. The aim of the study was to assess the association between meteorological parameters and ischemic stroke onset in cold seasons in Tianjin. PATIENTS AND METHODS: Patients with acute ischemic stroke (946) were identified by standard sampling from one stroke unit in the Second Hospital of Tianjin Medical University, Tianjin, China, from 10/1/2014 to 4/30/2019. Generalized linear Poisson regression models were used to explore the effect of meteorological parameters (air temperature, barometric pressure, and relative humidity) on daily ischemic stroke onset after adjusting for air pollutants, day of week, and public holiday. RESULTS: The results showed that ischemic stroke onset was positively associated with the diurnal variation of temperature (? coefficient: 0.020, 95% CI [0.001, 0.038] p<0.05). Significant positive correlation between ischemic stroke onset and barometric pressure (mean, minimum) was found (? coefficient: 0.010, 95% CI [0.001,0.019] p<0.05; 0.010, 95% CI [0.001,0.019] p<0.05). The subgroup analysis considering age and gender difference showed that the older and the female were more vulnerable to weather conditions. CONCLUSION: Our study demonstrated that there was a measurable effect of weather parameters on daily ischemic stroke onset in colder seasons, suggesting that meteorological variables may, at least in part, play as risk factors for ischemic stroke onset, especially for the aging and female population.
As climate change progresses, understanding the impact on human health associated with the temperature and air pollutants has been paramount. However, the predicted effect on temperature associated with particulate matter (PM(10)) is not well understood due to the difficulty in predicting the local and regional PM(10). We compared temperature-attributable mortality for the baseline (2003-2012), 2030s (2026-2035), 2050s (2046-2055), and 2080s (2076-2085) based on a distributed lag non-linear model by simultaneously considering assumed levels of PM(10) on historical and projected temperatures under representative concentration pathway (RCP) scenarios. The considered projected PM(10) concentrations of 35, 50, 65, 80, and 95 ?g/m(3) were based on historical concentration quantiles. Our findings confirmed greater temperature-attributable risks at PM(10) concentrations above 65 ?g/m(3) due to the modification effect of the pollutants on temperature. In addition, this association between temperature and PM(10) was higher under RCP8.5 than RCP4.5. We also confirmed regional heterogeneity in temperature-attributable deaths by considering PM(10) concentrations in South Korea with higher risks in heavily populated areas. These results demonstrated that the modification association of air pollutants on health burdens attributable to increasing temperatures should be considered by researchers and policy makers.
BACKGROUND AND AIMS: Future climate change may adversely impact human health. The direct effects of extreme hot temperatures on mortality are well established, and their future impact well modelled. However, less extreme changes in ambient temperature (Ta) have been previously associated with increased mortality from circulatory and metabolic diseases, but their future impact is less clear. METHODS: We evaluated the spatial association between cardiovascular diseases (CVD) and stroke mortality with average Ta across the US mainland, and then used this relationship to model future temporal trends in mortality from CVD and stroke until the end of the century (2099), using different warming scenarios for each US county. RESULTS: Ta was significantly associated with crude levels of CVD mortality (R(2) = 0.269) and stroke mortality (R(2) = 0.264). Moreover, there was a strong positive link between Ta and physical inactivity (PIA) (R(2) = 0.215). Once adjusted for PIA the associations between Ta and CVD and stroke mortality were much reduced (R(2) = 0.054 and R(2) = 0.091 respectively) but still highly significant. CONCLUSIONS: By 2099 modelling suggests between 8844 and 25,486 extra deaths each year from CVD, and between 2,063 and 13,039 extra deaths for stroke, beyond the increases expected from population expansion. Mortality due to changes in the mean Ta may be as, or more, significant than the impacts of extreme hot weather events.
Identifying Aedes aegypti breeding hotspots in urban areas is crucial for the design of effective vector control strategies. Remote sensing techniques offer valuable tools for mapping habitat suitability. In this study, we evaluated the association between urban landscape, thermal features, and mosquito infestations. Entomological surveys were conducted between 2016 and 2019 in Vila Toninho, a neighborhood of São José do Rio Preto, São Paulo, Brazil, in which the numbers of adult female Ae. aegypti were recorded monthly and grouped by season for three years. We used data from 2016 to 2018 to build the model and data from summer of 2019 to validate it. WorldView-3 satellite images were used to extract land cover classes, and land surface temperature data were obtained using the Landsat-8 Thermal Infrared Sensor (TIRS). A multilevel negative binomial model was fitted to the data, which showed that the winter season has the greatest influence on decreases in mosquito abundance. Green areas and pavements were negatively associated, and a higher cover of asbestos roofs and exposed soil was positively associated with the presence of adult females. These features are related to socio-economic factors but also provide favorable breeding conditions for mosquitos. The application of remote sensing technologies has significant potential for optimizing vector control strategies, future mosquito suppression, and outbreak prediction.
Mali aims to reach the pre-elimination stage of malaria by the next decade. This study used functional regression models to predict the incidence of malaria as a function of past meteorological patterns to better prevent and to act proactively against impending malaria outbreaks. All data were collected over a five-year period (2012-2017) from 1400 persons who sought treatment at Dangassa’s community health center. Rainfall, temperature, humidity, and wind speed variables were collected. Functional Generalized Spectral Additive Model (FGSAM), Functional Generalized Linear Model (FGLM), and Functional Generalized Kernel Additive Model (FGKAM) were used to predict malaria incidence as a function of the pattern of meteorological indicators over a continuum of the 18 weeks preceding the week of interest. Their respective outcomes were compared in terms of predictive abilities. The results showed that (1) the highest malaria incidence rate occurred in the village 10 to 12 weeks after we observed a pattern of air humidity levels >65%, combined with two or more consecutive rain episodes and a mean wind speed <1.8 m/s; (2) among the three models, the FGLM obtained the best results in terms of prediction; and (3) FGSAM was shown to be a good compromise between FGLM and FGKAM in terms of flexibility and simplicity. The models showed that some meteorological conditions may provide a basis for detection of future outbreaks of malaria. The models developed in this paper are useful for implementing preventive strategies using past meteorological and past malaria incidence.
OBJECTIVE: To test the hypothesis that particulate matter with an aerodynamic diameter of less than 10 ?m (PM(10)) and temperature are associated with an increased risk of adverse clinical outcomes in patients with atrial fibrillation (AF) taking vitamin K antagonists (VKAs). PATIENTS AND METHODS: We included patients with AF whose condition was stable while taking VKAs (international normalized ratio, 2.0 to 3.0) for 6 months seen in a tertiary hospital (recruitment from May 1, 2007, to December 1, 2007). During a median follow-up of 6.5 years (interquartile range, 4.3 to 7.9 years), ischemic strokes, major bleeding, adverse cardiovascular events, and mortality were recorded. From 2007 to 2016, data on average temperature and PM(10) were compared with clinical outcomes. RESULTS: The study group included 1361 patients (663 [48.7%] male; median age, 76 years [interquartile range, 71 to 81 years]). High PM(10) and low temperatures were associated with higher risk of major bleeding (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.22 to 1.70 and aHR, 1.03; 95% CI, 1.01 to 1.05, respectively) and mortality (aHR, 1.50; 95% CI, 1.34 to 1.69 and aHR, 1.04; 95% CI, 1.02 to 1.06, respectively); PM(10) was also associated with ischemic stroke and temperature with cardiovascular events. The relative risk (RR) for cardiovascular events and mortality increased in months in the lower quartile of temperature (RR, 1.12; 95% CI, 1.04 to 1.21 and RR, 1.41; 95% CI, 1.15 to 1.74, respectively). Comparing seasons, there were higher risks of cardiovascular events in spring, autumn, and winter than in summer, whereas the risk of mortality increased only in winter. CONCLUSION: In patients with AF taking VKAs, high PM(10) and low temperature were associated with increased risk of ischemic stroke and cardiovascular events, respectively. Both factors increased major bleeding and mortality risks, which were higher during colder months and seasons.
Energy-poor households in Africa’s burgeoning urban informal settlements are especially likely to suffer from heatwaves because of thermally inefficient dwellings and lack of affordable cooling options. This study utilised a controlled experiment to assess the effectiveness of passive cooling through specially formulated paints (cool coatings) in standard informal structures. The test structures were built to simulate typical shack dwellings in South Africa’s urban informal settlements. Results showed that the mean daily maximum temperatures of the coated structure were up to 4.3 degrees C lower than those in the uncoated structure. The same cooling trend was observed for the minimum daily temperatures, which were lower by an average of 2.2 degrees C. Besides, the annual frequency of maximum temperature exceedances beyond the critical heat stroke value of 40 degrees C dropped from 19% for the uncoated structure to 1% for the coated structure. These temperature differences were found to be statistically and subjectively significant, implying that cool coatings may be effective in promoting thermal comfort and climate resilience in poor urban communities. It is recommended that governmental authorities and relevant role players invest in the production and assisted application of cool coatings in urban informal settlements. The interventions promise hope of reduced energy burden on poor households and could be implemented in parallel with ongoing efforts focused on the design and implementation of low-cost, durable and thermally comfortable houses for indigent communities. Ultimately, the endeavours could be a potential policy change to assist in expanding poor households’ access to alternative and green energy resources.
Over the years, Jamaica has experienced sporadic cases of dengue fever. Even though the island is vulnerable to dengue, there is paucity in the spatio-temporal analysis of the disease using Geographic Information Systems (GIS) and remote sensing tools. Further, access to time series dengue data at the community level is a major challenge on the island. This study therefore applies the Water-Associated Disease Index (WADI) framework to analyze vulnerability to dengue in Jamaica based on past, current and future climate change conditions using three scenarios: (1) WorldClim rainfall and temperature dataset from 1970 to 2000; (2) Climate Hazard Group InfraRed Precipitation with Station data (CHIRPS) rainfall and land surface temperature (LST) as proxy for air temperature from the Moderate Resolution Imaging Spectroradiometer (MODIS) for the period 2002 to 2016, and (3) maximum temperature and rainfall under the Representative Concentration Pathway (RCP) 8.5 climate change scenario for 2030 downscaled at 25 km based on the Regional Climate Model, RegCM4.3.5. Although vulnerability to dengue varies spatially and temporally, a higher vulnerability was depicted in urban areas in comparison to rural areas. The results also demonstrate the possibility for expansion in the geographical range of dengue in higher altitudes under climate change conditions based on scenario 3. This study provides an insight into the use of data with different temporal and spatial resolution in the analysis of dengue vulnerability.
In 2015, Karachi saw its first ever epidemic of severe heatrelated illnesses that resulted in an extraordinary number of hospital admissions, especially in the intensive care, for fatal heat stroke within-hospital mortality of 3.7%.We conducted this study to elucidate the patient-related factors that lead to an increase in hospital admissions with heat-related illnesses in a tertiary care hospital. It was a descriptive case series conducted in the department of medicine at the Aga Khan University in June 2015. A total of 134 patients were admitted with heat-related illnesses of which 76(56.7%) were males. The mean age of the patients was 66 ±14.5 years. Heatstroke was present in 86 (64.2%) patients, followed by heat exhaustion in 48 (35.8%) and in-hospital mortality from heat-related illnesses was 5(3.7%). Hypertension (OR 2(95 % CI 1.0, 3.6) and insufficient sleep or food or water intake (OR 1.7(95 % CI 0.8, 3.8) was associated with severe heat-related illnesses. The effects remained even after adjusting for type and area of residence.
The Phyllosoma complex is a Triatominae (Hemiptera: Reduviidae) group of medical importance involved in Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) transmission. Most of the members of this group are endemic and sympatric species with distribution in Mexico and the southern U.S.A. We employed MaxEnt to construct ecological niche models of nine species of Triatominae to test three hypothesis: (a) whether species with a broad climatic niche breadth occupy a broader geographical range than species with a narrow climatic breadth, (b) whether species with broad distribution present high degree of climatic fragmentation/isolation, which was tested through landscape metrics; and (c) whether the species share the same climatic niche space (niche conservatism) considered through an equivalence test implemented in ENMtools. Overall, our results suggest that the geographical distribution of this complex is influenced mainly by temperature seasonality where all suitable areas are places of current and potential transmission of T. cruzi. Niche breadth in the Phyllosoma complex is associated with the geographical distribution range, and the geographical range affects the climatic connectivity. We found no strong evidence of niche climatic divergence in members of this complex. We discuss the epidemiological implications of these results.
Climate change, especially as reflected in heat waves, is a rising threat worldwide. Appropriate use of cooling devices can protect people from health impacts during a heat wave. A population-based telephone survey was conducted in a representative sample of residents in Hong Kong to investigate ownership and use of domestic cooling devices, identify correlates, and examine their associations with risk perception of potential health impact of climate change. More than 90% of the 1002 respondents owned and used cooling devices at home. The majority (57.7%) perceived the potential health risk of climate change at a high level. However, risk perception had no relationship with ownership and utilization of cooling devices. Old people (>= 65 years), the low-educated, those with low income, and those with chronic diseases were more likely not to use air conditioners when feeling hot. Our findings suggest that there are no signs showing people have taken more protective actions although half of respondents recognized climate change as a threat. Familial economic condition may be a major determinant in ownership and use of air conditioners at home. Old people and those with chronic diseases are at high risk of adverse exposure to climate change and therefore should be equipped with appropriate measures to use cooling devices.
Heat stress caused by high air temperature and high humidity is a serious health concern for urban residents. Mobile measurement of these two parameters can complement weather station observations because of its ability to capture data at fine spatial scales and in places where people live and work. In this paper, we describe a smart temperature and humidity sensor (Smart-T) for use on bicycles to characterize intracity variations in human thermal conditions. The sensor has several key characteristics of internet of things (IoT) technology, including lightweight, low cost, low power consumption, ability to communicate and geolocate the data (via the cyclist’s smartphone), and the potential to be deployed in large quantities. The sensor has a reproducibility of 0.03 degrees-0.05 degrees C for temperature and of 0.18%-0.33% for relative humidity (one standard deviation of variation among multiple units). The time constant with a complete radiation shelter and moving at a normal cycling speed is 9.7 and 18.5 s for temperature and humidity, respectively, corresponding to a spatial resolution of 40 and 70 m. Measurements were made with the sensor on street transects in Nanjing, China. Results show that increasing vegetation fraction causes reduction in both air temperature and absolute humidity and that increasing impervious surface fraction has the opposite effect.
In response to more frequent heatwaves, various regional or national heat-health warning systems (HHWSs) have been developed recently as adaptation measures. A wide range of methodologies have been utilized to issue warnings, as there is no universal definition of “heat event” or “heatwave”, nor are there quantified thresholds of human-health tolerance to extreme weather. The performance of these warning systems has rarely been evaluated with actual heat-health data, especially the morbidity data, in regions with severe impact. In this study, we assessed the performance of the Shanghai HHWS based on heat-related illness data collected by the Chinese Center for Disease Control and Prevention (China CDC) and then conducted a comparative analysis among the Shanghai HHWS, the China Meteorological Administration HHWS, the Chinese national standard for heatwave indexes, the heat index adopted by the USA’s National Weather Service and the definition suggested by the World Meteorological Organization to understand their potential performance for application in Shanghai and to evaluate the temperature thresholds and different meteorological indices employed. The results show that: 1) during the research period, 50% of heat-related illnesses and 58.2% of heat-related deaths in Shanghai occurred on dates that had no heat warnings; 2) for the current threshold (35 °C), the single metric of temperature outperformed the temperature-duration two-parameter method; 3) different from existing studies, while infants and seniors are deemed as vulnerable population groups to heat, young and middle-aged males were found to suffer more heat-related illnesses in hot weather. More detailed analyses reveal that the performance of heat-health warning systems needs to be evaluated and revised periodically, and warning thresholds utilized must be localized to reflect public tolerance to heat and to address the vulnerability of target population groups. Temperature is the dominant threshold in heat-related morbidity and mortality analysis. While a decrease in the temperature threshold would definitely increase the warning frequency and socioeconomic costs, it might also cause warning fatigue. The trade-off between these two aspects is essential for decision-makers and other stakeholders in HHWS design and improvement.
The duration and intensity of future heat waves are analyzed for 53 cities in the Middle East and the North Africa (MENA) region for the 21st century under two different scenarios (RCP4.5 and RCP8.5). A consistent approach is carried out using data from 13 Regional models within the framework of the Coordinated Regional Climate Downscaling Experiment (CORDEX). By the end of the century, 80% of the most populated MENA cities are expected to be at least 50% of the days under heat wave conditions during the warm season. In addition, the mean and maximum intensity of the heat waves will also increase. Changes in the duration and intensity of heat waves have shown to be negatively correlated. Therefore, the vulnerability of the MENA cities to future heat waves was determined using a cumulative index (CI) that takes into account both duration and intensity. This CI indicates that Middle East and the eastern part of Africa will suffer the most unfavorable temperature conditions in the future. Assuming no intervention trough adaptation/mitigation strategies, these results, together with the particular properties of the MENA region, such as aridity or lack of precipitation, make it likely that the area will be affected by disease or famine.
Organophosphate esters (OPEs) in atmospheric fine particles (PM(2.5)) were comprehensively investigated in the Beijing-Tianjin-Hebei (BTH) region from April 2016 to March 2017. The concentrations of ?(8)OPEs in all the five sampling sites ranged from 90 to 8291 pg/m(3) (mean 1148 ± 1239 pg/m(3); median 756 pg/m(3)). The highest level (median 1067 pg/m(3)) was found at one of the urban sites in Beijing, followed by Tianjin (746 pg/m(3)) and Shijiazhuang (724 pg/m(3)). Tris(2-chloroethyl) phosphate (TCEP) and tri[(2R)-1-chloro-2-propyl] phosphate (TCPP) were the dominant compounds across the five sampling locations. Generally, the concentrations of chlorinated OPEs were relatively higher in summer than in winter (p < 0.05), but no significant seasonal difference was discovered for non-chlorinated individual OPEs. The concentrations of tri-n-butyl phosphate (TBP), TCEP, TCPP and triphenyl phosphate (TPP) were positively correlated with the meteorological parameters (i.e. temperature and relative humidity) (p < 0.05), indicating an evident influence of meteorological condition on OPE distribution. We observed a negative correlation (p < 0.05) between octanol-air partition coefficients (logK(oa)) and the ratio of PM(2.5)-bound OPE concentrations to total suspended particulates-bound OPE concentrations, suggesting that physicochemical properties affect the particle-size distribution of OPEs. Furthermore, the median value of cancer hazard quotients (HQs) of TCEP was higher than TBP and tris(2-ethylhexyl) phosphate (TEHP). The health risk assessment showed that HQ values for children were ~1.6 times higher than those for adults. Relatively higher health risk induced by PM(2.5)-bound OPEs via inhalation was found during severe hazy days than in clear days.
Extreme weather conditions affect human health. This study analyses the association of high and low temperature with cardiovascular and respiratory diseases on people over 65?years old for the years 2007 to 2015, in the region of Chania, Greece. The mortality is examined by time series analysis and further investigated by Poisson, and Negative Binomial regression, showing that one-lag in maximum temperature strongly affects the health of the elderly. Finally, cluster analysis is used from May to October, which is confirmed by discriminant analysis.
Climate change is one of the most significant environmental issues facing communities, while poor construction and absence of effective air-conditioning (AC) predominantly cause indoor overheating. Although AC may help meeting indoor comfort, it increases the vulnerability of low-income residents, triggers large energy consumption, and generates anthropogenic heat, which worsens heat stress out-door. The capacity of buildings to maintain comfortable thermal conditions without mechanical cooling is the key factor protecting occupants against the rising temperature. Residents of Darwin, Australia, will be largely affected by increasing temperature where the annual peak ambient temperature may increase by 7.4 degrees C in 2060, while the number of hours above 30 degrees C will rise by 70%. Based on regional climate modelling for the Australian area and using a building energy simulation platform, we computed that by 2060 the indoor air temperature in a typical residential building may exceed 30 degrees C for over 4000 h under free-floating condition, with a peak daytime and night-time temperatures of 39 degrees C and 36.5 degrees C, respectively. The sensible thermal energy need for cooling per unit area under thermostatically controlled condition will increase from the current level of 110.7 kWh/m 2 to 196.8 kWh/m(2) in 2060. Different adaptation techniques when applied to the typical residential building yield to the peak indoor air temperature drop by 3.3-12 degrees C, and cooling energy needs reductions by 23.5-195.3 kWh/m(2) (12-99.7%) for low, medium, and high retrofit buildings compared to the typical residential building in 2060. Our study indicates that improved building quality is necessary to enhance survivability and energy efficiency in Darwin considering the role of building adaptation measures to counterbalance the impacts of global warming. (C) 2020 Elsevier B.V. All rights reserved.
Fine particulate matter (PM(2.5), aerodynamic diameter ?2.5?µm) impacts the climate, reduces visibility and severely influences human health. The Indo-Gangetic Plain (IGP), home to about one-seventh of the world’s total population and a hotspot of aerosol loading, observes strong enhancements in the PM(2.5) concentrations towards winter. We performed high-resolution (12?km × 12?km) atmospheric chemical transport modeling (WRF-Chem) for the post-monsoon to winter transition to unravel the underlying dynamics and influences of regional emissions over the region. Model, capturing the observed variations to an extent, reveals that the spatial distribution of PM(2.5) having patches of enhanced concentrations (?100 µgm(-3)) during post-monsoon, evolves dramatically into a widespread enhancement across the IGP region during winter. A sensitivity simulation, supported by satellite observations of fires, shows that biomass-burning emissions over the northwest IGP play a crucial role during post-monsoon. Whereas, in contrast, towards winter, a large-scale decline in the air temperature, significantly shallower atmospheric boundary layer, and weaker winds lead to stagnant conditions (ventilation coefficient lower by a factor of ~4) thereby confining the anthropogenic influences closer to the surface. Such changes in the controlling processes from post-monsoon to winter transition profoundly affect the composition of the fine aerosols over the IGP region. The study highlights the need to critically consider the distinct meteorological processes of west-to-east IGP and changes in dominant sources from post-monsoon to winter in the formulation of future pollution mitigation policies.
Malaria is a Plasmodium parasitic disease transmitted by infected female Anopheles mosquitoes. Climatic factors, such as temperature, humidity, rainfall, and wind, have significant effects on the incidence of most vector-borne diseases, including malaria. The mosquito behavior, life cycle, and overall fitness are affected by these climatic factors. This paper presents the results obtained from investigating the optimal control strategies for malaria in the presence of temperature variation using a temperature-dependent malaria model. The study further identified the temperature ranges in four different geographical regions of sub-Saharan Africa, suitable for mosquitoes. The optimal control strategies in the temperature suitable ranges suggest, on average, a high usage of both larvicides and adulticides followed by a moderate usage of personal protection such as bednet. The average optimal bednet usage mimics the solution profile of the mosquitoes as the mosquitoes respond to changes in temperature. Following the results from the optimal control, this study also investigates using a temperature-dependent model with insecticide-sensitive and insecticide-resistant mosquitoes the impact of insecticide-resistant mosquitoes on disease burden when temperature varies. The results obtained indicate that optimal bednet usage on average is higher when insecticide-resistant mosquitoes are present. Besides, the average bednet usage increases as temperature increases to the optimal temperature suitable for mosquitoes, and it decreases after that, a pattern similar to earlier results involving insecticide-sensitive mosquitoes. Thus, personal protection, particularly the use of bednets, should be encouraged not only at low temperatures but particularly at high temperatures when individuals avoid the use of bednets. Furthermore, control and reduction of malaria may be possible even when mosquitoes develop resistance to insecticides.
INTRODUCTION: Unique weather patterns can dramatically increase the number of emergency department (ED) visits due to falls on snow or ice compared to winter averages. They can create “Orthomageddon” incidences; days when the number of orthopedic injuries dramatically exceeds average. The study objective was to identify weather-dependent differences in demographics, length-of-stay (LOS) predictors, and volume for fall-injury presenting to the ED. The authors placed emphasis on Chinook or Foehn phenomenon (rapid freeze-thaw cycles) common east of the Rocky Mountains. METHOD: Patients with extremity and hip fractures from fall on snow or ice were identified from the Calgary Zone Alberta Health Services ED database from November 1st 2013 to March 31st 2018 (n = 3894). High-volume dates were the 90th percentile of all dates by volume (n = 76). This equated to all dates with >10 fall-injuries. The authors compared post-Chinook, night-freezing, high-volume, and regular winter conditions. Meteorological data was collected from the Environment Canada weather station at the Calgary International Airport. RESULTS: The authors identified 588 post-Chinook, and 1149 night-freezing presenters. Weather was strongly predictive of ED fall-injury volume. Night-freezing events (above-freezing temperatures prior to 1800 hours the preceding day, followed by freezing temperatures prior to 0600 hours the following day) correlated with elevated fall-injury volume (OR, 6.84; 95% CI, 5.88, 7.97) as were recent Chinook events (OR, 2.19; 95% CI, 1.84, 2.62). CONCLUSION: Weather, particularly nighttime conditions, are highly predictive of winter, fall-related ED volume. This may inform future population-level alerts for dates of elevated fall risk and ED staffing patterns.
Outdoor Thermal Comfort (OTC) is largely influenced by urban morphology and geometry of the urban landscape. In this study, the Local Climatic Zones (LCZs) approach was adopted to assess the OTC in different settings of Sriniketan-Santiniketan Planning Area (SSPA) during the summer season. The basic objective of this study is to assess OTC from both subjective and objective perspectives over eight LCZs. This study assessed OTC over LCZs using both field measurements and questionnaire survey. Non-parametric tests such as ANOVA and Kruskal-Wallis tests were also performed to find out the significant difference of perception across LCZs. The result of ANOVA and Krushkal-Walls test showed that subjective perception of OTC across LCZs varied due to diversified physical landscape settings. The result also showed that the maximum (above 40 degrees C) and minimum (28 degrees C) temperature was recorded in built types (particularly compact low rise) and natural land cover types (dense forest and water) respectively. Highest PET was also recorded over the built-up LCZs (about 50 degrees C) that led to this planning region thermally very hot or extreme heat stress. The respondents living in LCZ3 and LCZ6 were more sensitive to the thermal sensation as compared to those living in other LCZs.This study was probably the first attempt dealing with the assessment of OTC over the tropical planning region using LCZ approach from subjective and objective perspectives. Therefore, this research study has an immense potentiality to formulate strategies to deal with the outdoor thermal conditions as well to implement climate sensitive planning for urban sustainability in tropical cities.
Extreme heat and associated health risks increasingly become threats to urban populations, especially in developing countries of the tropics. Although human thermal exposure in cities has been studied across the globe, current narratives insufficiently discuss mixed-used spaces, informal economic activity settings, and informal settlements. This study assessed outdoor human thermal comfort in the tropical city of Kolkata, India where uncomfortable hot and humid climatic conditions prevail year-round. Thermal Comfort Perception Surveys (TCPS) and biometeorological observations were conducted during summer and winter in three microentrepreneurial neighborhoods (Kumartuli, Boipara, and Mallickghat). A one-way ANOVA was performed to investigate the variance in Physiologically Equivalent Temperature (PET) values of 318 survey samples across neighborhoods. Through multiple linear regression and ANCOVA, significant relationships were established between various climatic and non-climatic parameters. No respondent reported a neutral thermal sensation during the summer. Annual neutral PET across neighborhoods was 23.6 °C with a neutral PET range of 19.5 °C to 27.6 °C. Annual neutral PET was 22.7 °C and 26.5 °C in Mallickghat and Boipara, respectively. Respondents in Boipara were more sensitive towards warmer sensation than in Mallickghat. Even in the winter, people reported warmer sensation votes. PET was a better predictor of the mean Thermal Sensation Vote (mTSV) compared to air temperature. In a few cases, acclimatization and expectations improved thermal comfort. Results can be useful in formulating strategies towards improving outdoor microclimate and heat health in tropical cities.
Thermal comfort plays a main role in encouraging people to use outdoor spaces, specifically in hot arid and humid climates. The reconciliation of climatic aspects during the urban design phase is limited in implementation, due to the need for multidisciplinary collaboration between desperate scientific fields of climatology, urban planning, and urban environmental modelling. This paper aims to create an integrated interface between the microclimate, outdoor thermal comfort, and design guidelines. The investigation combines subjective and objective approaches, including on-site field measurements, a structured questionnaire using the seven-point American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE 55) thermal sensation votes, and a correlation study of these votes and the microclimatic parameters. Pedestrian thermal comfort was then examined under six shading scenarios, addressing the form and opening of shading devices using computational fluid dynamics. Modelling is based on four dependent variables: wind velocity, ventilation flow rate, air temperature, and the physiological equivalent temperature (PET) index. Findings indicate that the form and location of apertures of the shading devices were the dominant factors in achieving thermal comfort on the urban scale, and led to a reduction in air temperature and a physiological equivalent temperature of 2.3-2.4 degrees C. Subjective votes indicate that people who live in hot arid climates have a wider range of adaptation and tolerance to local climatic conditions Accordingly, a psychometric chart, for the case study outdoor thermal comfort was developed.
Global climate change is an environmental hazard with significant public health impacts. High-impact weather events including periods of extreme temperature or extreme precipitation are frequently associated with adverse effects on human health. This study evaluates the impact of extreme weather events on injuries across New Hampshire. A set of five daily extreme weather metrics (EWMs) was analyzed: daily maximum temperature <= 32 degrees F (0 degrees C), daily maximum temperature >= 90 degrees F (32 degrees C), daily maximum temperature >= 95 degrees F (35 degrees C), daily precipitation >= 1 ”, and daily precipitation >= 2 ”. Exposure to these EWMs was defined by linking the population within 10 miles of nine weather stations distributed across the state. Injuries were defined as hospitalizations categorized as: all-cause injury, vehicle accidents, accidental falls, accidents due to natural and environmental causes (including excessive heat, excessive cold, exposure due to weather conditions, lightning, and storms and floods), accidental drowning, and carbon monoxide poisoning. The associations between all injury categories and all EWMs as well as daily maximum temperature and daily precipitation were explored. A quasi-Poisson regression model was used to evaluate the relationship between the four strongest exposure-outcome pairs linking maximum temperature to all-cause injury-, vehicle accident-, accidental fall-, and heat-related hospital visits. Results indicate that daily maximum temperature (>90 degrees F) was most strongly associated with heat-related hospital visits and was also associated with all-cause injury-related hospital visits. Future work should include further analysis of cold weather metrics and incorporate these findings into public health planning and response efforts.
In this study, we applied the Weather Research and Forecasting model to project 2050 urban and rural temperature. We applied a time-stratified analysis to compare it with mortality between 2001 and 2014 and between 2011 and 2014, to estimate the elevated risk of a 2050 heat event. We included change in daytime versus nighttime and urban versus rural temperatures as factors to project mortality, to evaluate the potential influence of climate change on mortality risk. Increases of 2.9 degrees C and 2.6 degrees C in maximum and minimum air temperature are projected in a 2050 heat event, with a day and a night that will have respective temperatures 9.8 degrees C and 4.9 degrees C higher than 2001-2014. Significantly higher mortality risk is forecasted in 2050 compared to 2001-2014 (IRR 1.721 [1.650, 1.796]) and 2011-2014 (IRR 1.622 [1.547, 1.701]) without consideration of temperature change. After consideration of changing temperature, change in maximum temperature in rural areas will induce the highest mortality risk during 2050, possibly due to rapid urbanization across the city, and with the second highest mortality risk induced by the change in minimum temperature in urbanized areas, possibly because local people in the city have been adapted to the maximum level of urban thermal stress during a summer day. Improvements to heat warning systems and sustainable planning protocols are urgently needed for climate change mitigation.
Mountains are characterized by their specificities such as fragility, marginality and remoteness. They are prone to various hazards such as drought, flood, forest fire, landslide and therefore physical, ecological and social systems of the mountains are at risk. Climate change adds to intensifying the magnitude of multi-hazard risk in mountains. The present study attempts to evaluate risk induced by multi-hazard and climate change in the Indian Himalayan Region (IHR) using the Intergovernmental Panel on Climate Change (IPCC) framework. The proposed multi-hazard risk index was based on indicators from a broader domain and applied on 109 administrative districts of IHR. Exposure, sensitivity, adaptive capacity, and coping capacity were defined using comprehensive and sub-regional indicators identified through inductive and deductive approaches. The result showed that the differential risks among the districts of IHR were governed by the multiplicity of the factor such as demography, amenities, natural capital, partnership, technology and spatial specificities of the districts. The result highlighted the need of inclusion of spatial specificities for the risk mitigation in the IHR and therefore a Mountain Specific Risk Management Framework (MSMRMF) was proposed for sustaining the mountainous communities. The proposed MSMRMF contained two broad components as risk assessment and risk addressal. The framework detailed the risk mitigation and coping strategies (based on adjustment of internal and external strengths) for addressing risks. Risk mitigation was proposed to achieved through habitation resilience, natural capital enhancement, external partnerships, climate change adaptation, and technological interventions. The framework would provide an insight of risk and risk management strategies for the multi-hazard prone mountain regions for the sustainable development under the global change.
Continuous climate change has increased the intensity and frequency of abnormal weather, temperature fluctuations, and natural disasters, along with their subsequent damages. The temperature rise is related to the increased number of days with heat waves and tropical nights, which generate problems in many different areas. The risks from heat waves appear in multiple forms, such as disease severity and energy shortages. To respond effectively to such complex risks, it is necessary to analyze where and what risks occur. Recently, Bayesian Network methodology has been applied in various fields, and the causality and probability of occurrence of complex events can be evaluated. Particularly, it is suitable for fields, such as climate change and disaster because of its consideration to uncertainty. Therefore, in this study, multi-risk networks were built, and a multi risk assessment using Bayesian Network was performed considering statistical probabilities. In addition, this study examined the change in future risks by reflecting the climate scenarios proposed by Intergovernmental Panel on Climate Change. The disease risks related to heat waves have increased with time, particularly in the areas adjacent to the coast, centering on the southeast side of South Korea. As for energy shortage, the risk increased in the region around Daegu, a city known for its high temperatures as well as in the Seoul metropolitan areas. Through this study, it is possible to improve the methodology for evaluating multi-risks, and the analyzed results will be able to provide support for effective responses to risks caused by heat waves in Korea.
In this study, we examine the concepts of spatial dependence and spatial heterogeneity in the effect of macro-level and micro-level factors on stunting among children aged under five in Uganda. We conducted a cross-sectional analysis of 3624 Ugandan children aged under five, using data from the 2016 Ugandan Demographic and Health Survey. Multilevel mixed-effect analysis, spatial regression methods and multi-scale geographically weight regression (MGWR) analysis were employed to examine the association between our predictors and stunting as well as to analyse spatial dependence and variability in the association. Approximately 28% of children were stunted. In the multilevel analysis, the effect of drought, diurnal temperature and livestock per km(2) on stunting was modified by child, parent and household factors. Likewise, the contextual factors had a modifiable effect on the association between child’s sex, mother’s education and stunting. The results of the spatial regression models indicate a significant spatial error dependence in the residuals. The MGWR suggests rainfall and diurnal temperature had spatial varying associations with stunting. The spatial heterogeneity of rainfall and diurnal temperature as predictors of stunting suggest some areas in Uganda might be more sensitive to variability in these climatic conditions in relation to stunting than others.
Air pollution and heat are significant threats to public health, especially in urban areas with intensive human activities under the trend of climate change. However, the mediation effects of urban form on health via air pollution and heat have been overlooked in previous investigations. This study explored the potential impacts and pathways of urban form on cardiovascular mortality through air pollutants and heat by using partial least squares model with data from Taiwan. The measurable characteristics of urban form include city size, urban sprawl, and mixed land use. Other factors that influence cardiovascular mortality, such as urban industrial level, economic status, aging population, and medical resource, were also considered in the model. Results revealed that maximizing mixed land use and minimizing city size and urban sprawl can help reduce cardiovascular mortality, and the minimizing city size was the most important one. Urban industrial level, economic status, aging population, and medical resource were also influential factors. This is the first study to consider the pathways and impacts of urban form on cardiovascular mortality, and our results indicate that proper urban planning and policy could reduce cardiovascular mortality.
Reported dengue fever cases are increasing day by day in the world as well as in Sri Lanka. Model, Prediction and Control are three major parts of the process of analysis of the dengue incidence which leads to reduce the burden of the dengue. There is an increasing trend in the applications and developments in interval-valued data analysis over recent years. Particularly, under regressions there have being developed various techniques to handle interval-valued dependent and independent variables. Representation of data as intervals is very much useful to capture uncertainty and missing details associated with variables. Further, the predictions in intervals suit well when the situations of exact forecasts may not necessary. In this study interval-valued dengue data with interval-valued minimum temperature, maximum temperature and rainfall from 2009 to 2015 in the Colombo district, Sri Lanka were model using three interval valued regression procedures, namely, Center Method (CM), Center and Range Method (CRM) and Constrained Center and Range Method (CCRM). Predicted dengue cases in a range is particularly important because actions taking towards controlling the dengue do not depend on exact number but on magnitude of the values represent in the interval. Data in the year 2016 used for the validation of the models which is developed under three methods. Root of the mean square error, coefficient of determination as well as square root of variance of the models were used to select the best procedure to predict dengue cases. Among the three regression procedures both CRM and CCRM perform well in predicting monthly dengue cases in Colombo.
The aim of this study was to analyze the association between season of birth and daily temperature for neonatal mortality in two Swedish rural parishes between 1860 and 1899. Further, we aimed to study whether the association varied according to ethnicity (indigenous Sami reindeer herders and non-Sami settlers) and gender. The source material for this study comprised digitized parish records from the Demographic Data Base, Umeå University, combined with local weather data provided by the Swedish Meteorological and Hydrological Institute. Using a time event-history approach, we investigated the association between daily temperature (at birth and up to 28 days after birth) and the risk of neonatal death during the coldest months (November through March). The results showed that Sami neonatal mortality was highest during winter and that the Sami neonatal mortality risk decreased with higher temperatures on the day of birth. Male neonatal risk decreased with higher temperatures during the days following birth, while no effect of temperature was observed among female neonates. We conclude that weather vulnerability differed between genders and between the indigenous and non-indigenous populations.
The tick Ixodes ricinus is the vector of various pathogens, including Chlamydiales bacteria, which potentially cause respiratory infections. In this study, we modeled the spatial distribution of I. ricinus and associated Chlamydiales over Switzerland from 2009 to 2019. We used a total of 2,293 ticks and 186 Chlamydiales occurrences provided by a Swiss Army field campaign, a collaborative smartphone application, and a prospective campaign. For each tick location, we retrieved from Swiss federal data sets the environmental factors reflecting the topography, climate, and land cover. We then used the Maxent modeling technique to estimate the suitability of particular areas for I. ricinus and to subsequently build the nested niche of Chlamydiales bacteria. Results indicate that I. ricinus habitat suitability is determined by higher temperature and normalized difference vegetation index (NDVI) values, lower temperature during the driest months, and a higher percentage of artificial and forest areas. The performance of the model was improved when extracting the environmental variables for a 100-m radius buffer around the sampling points and when considering the climatic conditions of the 2 years previous to the sampling date. Chlamydiales bacteria were favored by a lower percentage of artificial surfaces, drier conditions, high precipitation during the coldest months, and short distances to wetlands. From 2009 to 2018, we observed an extension of areas suitable to ticks and Chlamydiales, associated with a shift toward higher altitude. The importance of considering spatiotemporal variations in the environmental conditions for obtaining better prediction was also demonstrated.IMPORTANCE Ixodes ricinus is the vector of pathogens including the agent of Lyme disease, the tick-borne encephalitis virus, and the less well-known Chlamydiales bacteria, which are responsible for certain respiratory infections. In this study, we identified the environmental factors influencing the presence of I. ricinus and Chlamydiales in Switzerland and generated maps of their distribution from 2009 to 2018. We found an important expansion of suitable areas for both the tick and the bacteria during the last decade. Results also provided the environmental factors that determine the presence of Chlamydiales within ticks. Distribution maps as generated here are expected to bring valuable information for decision makers in controlling tick-borne diseases in Switzerland and establishing prevention campaigns. The methodological framework presented could be used to predict the distribution and spread of other host-pathogen pairs to identify environmental factors driving their distribution and to develop control or prevention strategies accordingly.
INTRODUCTION: This study aimed to investigate the effects of temperature variability on rotavirus infections among children under 5 years of age in Kathmandu, Nepal. Findings may inform infection control planning, especially in relation to the role of environmental factors in the transmission of rotavirus infection. METHODS: Generalized linear Poisson regression equations with distributed lag non-linear model were fitted to estimate the effect of temperature (maximum, mean and minimum) variation on weekly counts of rotavirus infections among children under 5 years of age living in Kathmandu, Nepal, over the study period (2013 to 2016). Seasonality and long-term effects were adjusted in the model using Fourier terms up to the seventh harmonic and a time function, respectively. We further adjusted the model for the confounding effects of rainfall and relative humidity. RESULTS: During the study period, a total of 733 cases of rotavirus infection were recorded, with a mean of 3 cases per week. We detected an inverse non-linear association between rotavirus infection and average weekly mean temperature, with increased risk (RR: 1.52; 95% CI: 1.08-2.15) at the lower quantile (10th percentile) and decreased risk (RR: 0.64; 95% CI: 0.43-0.95) at the higher quantile (75th percentile). Similarly, we detected an increased risk [(RR: 1.93; 95% CI: 1.40-2.65) and (RR: 1.42; 95% CI: 1.04-1.95)] of rotavirus infection for both maximum and minimum temperature at their lower quantile (10th percentile). We estimated that 344 (47.01%) cases of rotavirus diarrhoea among the children under 5 years of age were attributable to minimum temperature. The significant effect of temperature on rotavirus infection was not observed beyond lag zero week. CONCLUSION: An inverse non-linear association was estimated between rotavirus incidence and all three indices of temperature, indicating a higher risk of infection during the cooler times of the year, and suggesting that transmission of rotavirus in Kathmandu, Nepal may be influenced by temperature.
Although previous studies have reported that meteorological factors might affect the risk of Japanese encephalitis (JE), the relationship between meteorological factors and JE remains unclear. This study aimed to evaluate the relationship between meteorological factors and JE and identify the threshold temperature. Daily meteorological data and JE surveillance data in Dazhou, Sichuan, were collected for the study period from 2005 to 2012 (restricting to May-October because of the seasonal distribution of JE). A distributed lag nonlinear model was used to analyze the lagged and cumulative effect of daily average temperature and daily rainfall on JE transmission. A total of 622 JE cases were reported over the study period. We found JE was positively associated with daily average temperature and daily rainfall with a 25-day lag and 30-day lag, respectively. The threshold value of the daily average temperature is 20°C. Each 5°C increase over the threshold would lead to a 13% (95% CI: 1-17.3%) increase in JE. Using 0 mm as the reference, a daily rainfall of 100 mm would lead to a 132% (95% CI: 73-311%) increase in the risk of JE. Japanese encephalitis is climate-sensitive; meteorological factors should be taken into account for the future prevention and control measure making, especially in a warm and rainy weather condition.
To examine the effects of temperature on the daily cases of hand, foot, and mouth disease (HFMD).Data on the daily cases of HFMD in Lanzhou from 2008 to 2015 were obtained, and meteorological data from the same period were collected. A distributed lag nonlinear model was fitted to reveal the relationship between the daily mean temperature and the daily cases of HFMD.From 2008 to 2015, 25,644 cases were reported, of which children under 5 years of age accounted for 78.68% of cases. The highest peak of HFMD cases was usually reported between April to July each year. An inverse V-shaped relationship was observed between daily mean temperature and HFMD cases; a temperature of 18°C was associated with a maximum risk of HFMD. The relative risk (RR) was 1.57 (95% confidence interval: 1.23-1.23), and boys and children aged 3 to 5 years were populations with the highest risk. The cumulative risks of high temperature (20.2°C and 25.2°C) in the total, age-specific, and gender-specific groups peaked on lag 14 days; RR was higher in girls than in boys and in children aged 1 to 2 years than in other age groups. However, the effects of low temperature (-5.3°C, 2.0°C, and 12.8°C) were not significant for both gender-specific and age-specific patients.High temperature may increase the risk of HFMD, and boys and children aged 3 to 5 years were at higher risks on lag 0 day; however, the cumulative risks in girls and children aged 1 to 2 years increased with the increasing number of lag days.
It has been reported that suicide is associated with ambient temperature; however, the heterogeneity in this association and its underlying factors have not been extensively investigated. Therefore, we investigated the spatial and temporal variation in the temperature-suicide association and examined climatic, demographic, and socioeconomic factors that may underlie such heterogeneity. We analyzed the daily time-series data for the suicide counts and ambient temperature, which were collected for the 47 prefectures of Japan from 1972 to 2015, using a two-stage analysis. In the first stage, the prefecture-specific temperature-suicide association was estimated by using a generalized linear model. In the second stage, the prefecture-specific associations were pooled, and key factors explaining the spatial and temporal variation were identified by using mixed effects meta-regression. Results showed that there is an inverted J-shape nonlinear association between temperature and suicide; the suicide risk increased with temperature but leveled off above 24.4 °C. The nationwide relative risk (RR) for the maximum suicide temperature versus 5th temperature percentile (2.9 °C) was estimated as 1.26 (95% CI: 1.22, 1.29). The RRs were larger for females than for males (1.32 vs. 1.22) and larger for elderly people (?65 y) than for the non-elderly (15-64 y) (1.51 vs. 1.18). The RRs were larger for rural prefectures, which are characterized by smaller population, higher proportions of females and elderly people, and lower levels of financial capability and the proportion of highly educated people. The RRs were also larger in colder and less humid prefectures. These findings may help in understanding the potential mechanism of the temperature-suicide association and projecting the future risk of suicide under climate change.
Rising temperature and heat stress risks in the changing climate scenario might potentially affect workers globally, especially the ones with strenuous workload in tropical settings. We used a cross-sectional study design to profile the heat exposures of similar to 1900 workers from eight industrial sectors using a QuesTemp Wet Bulb Globe Temperature (WBGT) monitor, quantified select heat-strain indicators viz., rise in Core Body Temperature, Sweat Rate, and Urine Specific Gravity and evaluated the perceived health impacts of heat stress using a structured questionnaire. Heat exposures (average WBGT: 30.1 +/- 2.6 degrees C) exceeded the Threshold Limit Value for 67% workers and was positively associated with the rise in Core Body Temperature >1 degrees C in 13% and elevated Urine Specific Gravity >1.020 in 9% workers. Heat-related health concerns were reported by 86% workers, and the heat-exposed workers had 2.3 times higher odds of adverse health outcomes compared to unexposed workers (p < 0.0001). Exposure to higher WBGT and adverse renal health among salt-pan workers were significantly associated (p = 0.004), and steel workers had 9% prevalence of kidney stones. Evidence presented clearly points to heat stress as a health and productivity risk factor that could have long-term and irreversible health impacts. In-depth assessments are urgently needed to develop scientifically sound preventative interventions and protective labor policies to avert the adverse occupational health and productivity consequences for millions of workers globally, thereby aiding poverty reduction.
Influenza usually breaks out seasonally in temperate regions, especially in winter, infection rates and mortality rates of influenza increase significantly, which means that dry air and cold temperatures accelerate the spread of influenza viruses. However, the meteorological factors that lead to seasonal influenza outbreaks and how these meteorological factors play a decisive role in influenza transmission remain unclear. During the epidemic of infectious diseases, the neglect of unreported cases leads to an underestimation of infection rates and basic reproduction number. In this paper, we propose a new non-autonomous periodic differential equation model with meteorological factors including unreported cases. First, the basic reproduction number is obtained and the global asymptotic stability of the disease-free periodic solution is proved. Furthermore, the existence of periodic solutions and the uniformly persistence of the model are demonstrated. Second, the best-fit parameter values in our model are identified by the MCMC algorithm on the basis of the influenza data in Gansu province, China. We also estimate that the basic reproduction number is 1.2288 (95% CI:(1.2287, 1.2289)). Then, to determine the key parameters of the model, uncertainty and sensitivity analysis are explored. Finally, our results show that influenza is more likely to spread in low temperature, low humidity and low precipitation environments. Temperature is a more important factor than relative humidity and precipitation during the influenza epidemic. In addition, our results also show that there are far more unreported cases than reported cases.
A deterministic mathematical model for brucellosis that incorporates seasonality on direct and indirect transmission parameters for domestic ruminants, wild animals, humans, and the environment was formulated and analyzed in this paper. Both analytical and numerical simulations are presented. From this study, the findings show that variations in seasonal weather have the great impact on the transmission dynamics of brucellosis in humans, livestock, and wild animals. Thus, in order for the disease to be controlled or eliminated, measures should be timely implemented upon the fluctuation in the transmission of the disease.
BACKGROUND: More than 80,000 dengue cases including 215 deaths were reported nationally in less than 7 months between 2016 and 2017, a fourfold increase in the number of reported cases compared to the average number over 2010-2016. The region of Negombo, located in the Western province, experienced the greatest number of dengue cases in the country and is the focus area of our study, where we aim to capture the spatial-temporal dynamics of dengue transmission. METHODS: We present a statistical modeling framework to evaluate the spatial-temporal dynamics of the 2016-2017 dengue outbreak in the Negombo region of Sri Lanka as a function of human mobility, land-use, and climate patterns. The analysis was conducted at a 1?km?×?1?km spatial resolution and a weekly temporal resolution. RESULTS: Our results indicate human mobility to be a stronger indicator for local outbreak clusters than land-use or climate variables. The minimum daily temperature was identified as the most influential climate variable on dengue cases in the region; while among the set of land-use patterns considered, urban areas were found to be most prone to dengue outbreak, followed by areas with stagnant water and then coastal areas. The results are shown to be robust across spatial resolutions. CONCLUSIONS: Our study highlights the potential value of using travel data to target vector control within a region. In addition to illustrating the relative relationship between various potential risk factors for dengue outbreaks, the results of our study can be used to inform where and when new cases of dengue are likely to occur within a region, and thus help more effectively and innovatively, plan for disease surveillance and vector control.
Ciguatera poisoning (CP), arising from ciguatoxins produced by toxic dinoflagellate Gambierdiscus, is one of the most common food-borne diseases in the South Pacific. Climate change as well as its related events have been hypothesized to a higher abundance and wider presence of toxic dinoflagellates, hence a higher risk of the disease. Yet existing studies assessing the relationship between climate factors and CP are limited or based on old data. In this study, we used prewhitened cross-correlation analysis and auto-regressive integrated moving-average (ARIMA) modeling to develop predictive models of monthly CP incidence in Cook Islands and French Polynesia, two ciguatera-endemic regions in the South Pacific, utilizing the latest epidemiological data. Results reveal the significant time-lagged associations between the monthly CP incidence rate and several indicators relating to sea surface temperature (SST). In particular, SST anomaly is proven to be a strong positive predictor of an increased ciguatera incidence for both countries. If these time-lags can be supported by more investigations, it will allow health authorities to take appropriate actions, to limit or avoid an epidemic risk, especially on high-risk climate scenarios.
This study statistically identified the association of remotely sensed environmental factors, such as Land Surface Temperature (LST), Night Time Light (NTL), rainfall, the Normalised Difference Vegetation Index (NDVI) and elevation with the incidence of leptospirosis in Thailand based on the nationwide 7,495 confirmed cases reported during 2013-2015. This work also established prediction models based on empirical findings. Panel regression models with random-effect and fixed-effect specifications were used to investigate the association between the remotely sensed environmental factors and the leptospirosis incidence. The Local Indicators of Spatial Association (LISA) statistics were also applied to detect the spatial patterns of leptospirosis and similar results were found (the R2 values of the random-effect and fixed-effect models were 0.3686 and 0.3684, respectively). The outcome thus indicates that remotely sensed environmental factors possess statistically significant contribution in predicting this disease. The highest association in 3 years was observed in LST (random- effect coefficient = -9.787, P<0.001; fixed-effect coefficient = -10.340, P=0.005) followed by rainfall (random-effect coefficient = 1.353, P<0.001; fixed-effect coefficient = 1.347, P<0.001) and NTL density (random-effect coefficient = -0.569, P=0.004; fixed-effect coefficient = -0.564, P=0.001). All results obtained from the bivariate LISA statistics indicated the localised associations between remotely sensed environmental factors and the incidence of leptospirosis. Particularly, LISA’s results showed that the border provinces in the northeast, the northern and the southern regions displayed clusters of high leptospirosis incidence. All obtained outcomes thus show that remotely sensed environmental factors can be applied to panel regression models for incidence prediction, and these indicators can also identify the spatial concentration of leptospirosis in Thailand.
Previous studies have consistently analyzed the impact that extreme temperatures will have on human health. However, there are very few data on temperature-related mortality burden considering future demographic changes in a context of climate change in Portugal. This study aims to quantify the impact of climate change on heat-, cold-, and net change mortality burdens, taking into account the future demographic changes in Lisbon Metropolitan Area, Portugal. We applied a time-series generalized linear model with a quasi-Poisson model via a distributed lag nonlinear model to project temperature-related mortality burden for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that the total attributable fraction due to temperature, extreme and moderate cold, is statistically significant in the historical period and the future projected scenarios, while extreme and moderate heat were only significant in the projected future summer period. Net differences were attributed to moderate cold in the future winter months. Projections show a consistent and significant increase in future heat-related mortality burden. The attributable fraction due to heat in the future period, compared to the historical period, ranges from 0 to 1.5% for moderate heat and from 0 to 0.5% for extreme heat. Adaptation should be implemented at the local level, so as to prevent and diminish the effects on citizens and healthcare services, in a context of climate change.
BACKGROUND: Climate change is predicted to impact the transmission dynamics of vector-borne diseases. Tsetse flies (Glossina) transmit species of Trypanosoma that cause human and animal African trypanosomiasis. A previous modelling study showed that temperature increases between 1990 and 2017 can explain the observed decline in abundance of tsetse at a single site in the Mana Pools National Park of Zimbabwe. Here, we apply a mechanistic model of tsetse population dynamics to predict how increases in temperature may have changed the distribution and relative abundance of Glossina pallidipes across northern Zimbabwe. METHODS: Local weather station temperature measurements were previously used to fit the mechanistic model to longitudinal G. pallidipes catch data. To extend the use of the model, we converted MODIS land surface temperature to air temperature, compared the converted temperatures with available weather station data to confirm they aligned, and then re-fitted the mechanistic model using G. pallidipes catch data and air temperature estimates. We projected this fitted model across northern Zimbabwe, using simulations at a 1 km × 1 km spatial resolution, between 2000 to 2016. RESULTS: We produced estimates of relative changes in G. pallidipes mortality, larviposition, emergence rates and abundance, for northern Zimbabwe. Our model predicts decreasing tsetse populations within low elevation areas in response to increasing temperature trends during 2000-2016. Conversely, we show that high elevation areas (> 1000 m above sea level), previously considered too cold to sustain tsetse, may now be climatically suitable. CONCLUSIONS: To our knowledge, the results of this research represent the first regional-scale assessment of temperature related tsetse population dynamics, and the first high spatial-resolution estimates of this metric for northern Zimbabwe. Our results suggest that tsetse abundance may have declined across much of the Zambezi Valley in response to changing climatic conditions during the study period. Future research including empirical studies is planned to improve model accuracy and validate predictions for other field sites in Zimbabwe.
Both ozone exposure and extreme temperatures are found to be significantly associated with mortality; however, inconsistent results have been obtained on the modification effects of temperature on the ozone-mortality association. In the present study, we conducted a nationwide time-series analysis in 128 counties from 2013-2018 to examine whether temperature modifies the association between short-term ozone exposure with nonaccidental and cause-specific mortality in China. First, we analyzed the effects of ozone exposure on mortality at different temperature levels. Then, we calculated the pooled effects through a meta-analysis across China. We found that high-temperature conditions (>75th percentile in each county) significantly enhanced the effects of ozone on nonaccidental, cardiovascular, and respiratory mortality, with increases of 0.44% (95% confidence interval (CI): 0.36 and 0.51%), 0.42% (95% CI: 0.32 and 0.51%) and 0.50% (95% CI: 0.31 and 0.68%), respectively, for a 10 ?g/m(3) increase in ozone at high temperatures. Stronger effects on nonaccidental and cardiovascular mortality were observed at high temperatures among elderly individuals aged 65 years and older compared with the younger people. Our findings provide evidence that health damage because of ozone may be influenced by the impacts of increasing temperatures, which point to the importance of mitigating ozone exposure in China under the context of climate change to further reduce the public health burden.
OBJECTIVES: This study investigated the modification of temperature effects on cardiovascular and respiratory mortality by air pollutants (particulate matter less than 2.5 and 10 µm in diameter [respectively], ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide). METHODS: Poisson additive models with a penalized distributed lag non-linear model were used to assess the association of air temperature with the daily number of deaths from cardiovascular and respiratory diseases in Ahvaz, Iran from March 21, 2014 to March 20, 2018, controlling for day of the week, holidays, relative humidity, wind speed, air pollutants, and seasonal and long-term trends. Subgroup analyses were conducted to evaluate the effect modification for sex and age group. To assess the modification of air pollutants on temperature effects, the level of each pollutant was categorized as either greater than the median value or less than/equal to the median value. RESULTS: We found no significant associations between temperature and cardiovascular and respiratory mortality. In the subgroup analyses, however, high temperatures were significantly associated with an increased risk of cardiovascular mortality among those 75 years old and older, with the strongest effect observed on day 0 relative to exposure. The results revealed a lack of interactive effects between temperature and air pollutants on cardiovascular and respiratory mortality. CONCLUSIONS: A weak but significant association was found between high temperature and cardiovascular mortality, but only in elderly people. Air pollution did not significantly modify the effect of ambient temperature on cardiovascular and respiratory mortality.
Ozone (O-3) pollution in China tends to become increasingly severe despite recent emission reductions. O(3 )is sensitive to atmospheric conditions, but its modulations by changing synoptic systems and climate are unclear, especially in mountain-basin areas such as the Sichuan Basin (SCB). This study examines the impacts of typical synoptic systems and their secular changes on O-3 pollution and its health risks in mountain-basin areas, by taking SCB as an example. Seven dominant synoptic patterns are identified and three typical synoptic patterns with high- (low-) pressure are associated with high (low) O-3 concentrations over entire SCB, while the pattern with uniform-pressure is accompanied by heavy (light) pollution in western (eastern) SCB. Under the synoptic patterns with high-pressure, clear weather with fewer clouds, strong solar radiation, weak convection, and hot and dry atmosphere enhances the photochemical reactions of O-3 precursors and weakens the vertical mixing of O-3 and its precursors, thus favoring heavy O-3 pollution and posing higher health risks; whereas, the synoptic patterns with low-pressure induce the opposite changes in O-3 concentration and health risks. The uniform-pressure pattern is accompanied by district spatial variations of O-3 via favoring O-3-related physical and chemical processes in eastern SCB and inhibiting that in the west. Under climatic changes, increasing synoptic pattern with high-pressure and decreasing synoptic pattern with low-pressure over SCB significantly increased O-3 concentration and the resultant health risks over the past 40 years. Our findings provide scientific evidence from synoptic and climatic views for forecasting O-3 and its health risks and for mitigating O-3 pollution in mountain-basin areas.
Intensive irrigation in India has been demonstrated to decrease surface temperature, but the influence of irrigation on humidity and extreme moist heat stress is not well understood. Here we analysed a combination of in situ and satellite-based datasets and conducted meteorological model simulations to show that irrigation modulates extreme moist heat. We found that intensive irrigation in the region cools the land surface by 1 degrees C and the air by 0.5 degrees C. However, the decreased sensible heat flux due to irrigation reduces the planetary boundary layer height, which increases low-level moist enthalpy. Thus, irrigation increases the specific and relative humidity, which raises the moist heat stress metrics. Intense irrigation over the region results in increased moist heat stress in India, Pakistan, and parts of Afghanistan-affecting about 37-46 million people in South Asia-despite a cooler land surface. We suggest that heat stress projections in India and other regions dominated by semi-arid and monsoon climates that do not include the role of irrigation overestimate the benefits of irrigation on dry heat stress and underestimate the risks. Intensive irrigation in India cools the land surface, but increases the moist heat stress in South Asia, according to an analysis of observational datasets and meteorological models.
Investigation of temperature extremes is very important as one of the most important climate parameters in different parts. If exposed to enough heat, humans will suffer from extreme heat. Maximum temperature and heat can adversely affect many living organisms. The effects of extreme heat on people with chronic lung disease, including asthma and emphysema, are greater; even for people with healthy lungs, outdoor activities are not recommended during high ozone levels. The purpose of this study is to monitor and analyze the effects of atmospheric temperature extreme and extreme heat on human health in Central Iran. Therefore, the minimum and maximum data of 15 synoptic stations in the study area for the period (1988-2018) using hybrid artificial neural network (HANN) and adaptive neuro-fuzzy inference system (ANFIS) models were used. Finally, multi-criteria decision-making (MCDM) models TOSIS and SAW were used to prioritize the areas exposed to rising temperature. The results showed that according to ANFIS modelling for predicting extreme temperatures, the lowest mean training error and the mean error of validation for the minimum temperature were equal to 0.10 for the Yazd Station and 1.66% for the Damghan station. The lowest mean training error and the mean error of validation for the maximum extreme temperature obtained 0.016 for the Garmsar station and 9.39% for the Shahroud station. The maximum extreme temperature of two stations of Garmsar and Bafgh (1 and 0.9689, respectively) was more exposed to extreme temperatures based on the TOPSIS model. Garmsar and Salafchegan Stations (1 and 0.9873, respectively) were more exposed to extreme temperatures based on the SAW model. Climate change is fundamentally changing the Earth’s climate system in a way that directly and indirectly endangers human physical and mental health. Severe increase in temperature is directly associated with death from cardiovascular and respiratory diseases, especially in the elderly. Also in the study area, the house is a place for peace and comfort for every human being. Climatic and weather conditions have a direct impact on creating a sense of comfort in any architectural space. Proper heating and air conditioning in the interior of the building is another case of architecture that will not be easy because this architectural issue is related to the comfort or non-comfort of man, and the concepts of heat or cold are mostly due to the natural feeling of man and his physiological conditions. The rising trend of thermal stresses in the studied stations increases the need to pay attention to the issue of thermal stresses and the spread of diseases (heat attack, syncope, and muscle cramps) in terms of crisis planning and management.
The flaviviruses are small single-stranded RNA viruses that are typically transmitted by mosquitoes or tick vectors and are etiological agents of acute zoonotic infections. The viruses are found around the world and account for significant cases of human diseases. We investigated population of culicine mosquitoes in central region of Korean Peninsula, Incheon Metropolitan City and Hwaseong-si. Aedes vexans nipponii was the most frequently collected mosquitoes (56.5%), followed by Ochlerotatus dorsalis (23.6%), Anopheles spp. (10.9%), and Culex pipiens complex (5.9%). In rural regions of Hwaseong, Aedes vexans nipponii was the highest population (62.9%), followed by Ochlerotatus dorsalis (23.9%) and Anopheles spp. (12.0%). In another rural region of Incheon (habitat of migratory birds), Culex pipiens complex was the highest population (31.4%), followed by Ochlerotatus dorsalis (30.5%), and Aedes vexans vexans (27.5%). Culex pipiens complex was the predominant species in the urban region (84.7%). Culicine mosquitoes were identified at the species level, pooled up to 30 mosquitoes each, and tested for flaviviral RNA using the SYBR Green-based RT-PCR and confirmed by cDNA sequencing. Three of the assayed 2,683 pools (989 pools without Anopheles spp.) were positive for Culex flaviviruses, an insect-specific virus, from Culex pipiens pallens collected at the habitats for migratory birds in Incheon. The maximum likelihood estimation (the estimated number) for Culex pipiens pallens positive for Culex flavivirus was 25. Although viruses responsible for mosquito-borne diseases were not identified, we encourage intensified monitoring and long-term surveillance of both vector and viruses in the interest of global public health.
Global warming is projected to intensify during the twenty-first century. Yet, only few studies investigate how global warming could be perceived by future populations. Here, we propose an assessment of how climate change could be perceived by combining climatological indicators. We analyse extremes of temperature (T-99) and simplified Wet-Bulb Globe Temperature (WBGT(99)), a heat stress index assessing the combined effect of elevated temperature and humidity on the human body. The speed of change is defined for each year as the difference between the previous 20 years and the twenty upcoming years (i.e. with a moving baseline), and we assess how these speeds emerge from each last 20-year interannual variability. Using a set of 12 CMIP5 models, speeds of change ofT(99)and WBGT(99)in 2080 are both twice as fast compared with current speeds in mid-latitudes, and by up to four times faster in the tropics under the RCP8.5 scenario. Warming accelerations are thus similar forT(99)and WBGT(99). However, these speeds in tropical regions in 2080 are projected to be 2.3 times larger than the last 20-year interannual variability for WBGT(99), and only 1.5 to 1.8 times larger forT(99). According to the models, the WBGT(99)intensification will be more emergent from the recent year-to-year variability than theT(99)warming. This analysis suggests that the accelerated warming of heat extremes will be felt more strongly by populations than current changes for RCP8.5, and that this evolution will be more perceived in heat stress than in temperature, particularly within the tropics.
Heat waves are extreme climate events that have the potential to cause immense stress on human health, agriculture, and energy systems, so understanding the processes leading to their onset is crucial. There is no single accepted definition for heat waves, but they are generally described as a sustained amount of time over which temperature exceeds a local threshold. Multiple different temperature variables are potentially relevant, because high values of both daily maximum and minimum temperatures can be detrimental to human health. In this study, we focus explicitly on the different mechanisms associated with summertime heat waves manifested during daytime hours versus nighttime hours over the contiguous United States. Heat waves are examined using the National Aeronautics and Space Administration Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2). Over 1980-2018, the increase in the number of heat-wave days per summer was generally stronger for nighttime heat-wave days than for daytime heat-wave days, with localized regions of significant positive trends. Processes linked with daytime and nighttime heat waves are identified through composite analysis of precipitation, soil moisture, clouds, humidity, and fluxes of heat and moisture. Daytime heat waves are associated with dry conditions, reduced cloud cover, and increased sensible heating. Mechanisms leading to nighttime heat waves differ regionally across the United States, but they are typically associated with increased clouds, humidity, and/or low-level temperature advection. In the midwestern United States, enhanced moisture is transported from the Gulf of Mexico during nighttime heat waves.
The connection between mental health and weather extremes is a public health concern, but less studied to date than physical health. This exploratory study examines the mental health impacts of two kinds of weather extremes increasingly linked to climate change-summer heat waves and extreme winter weather-in a low- to middle-income population in the Southeastern U.S. The distribution of mental health impacts, and potential pathways to them, are examined with a focus on race. Data are from a random-sample survey of 426 participants and are analyzed with bivariate statistics and path analysis. Self-reported mental health impacts, in both seasons, were common in our study, with White participants tending to report worse impacts than participants who identified with other racial groups. Physical health had direct effects on mental health across several models, overall and by racial group. For summer heat waves, concern about climate change and social cohesion had direct and indirect effects, respectively, on mental health in White participants only. For extreme winter weather, preparedness had a direct negative effect on mental health in White, but not Black, participants. Results suggest that there may be racial differences in the influence of human and social capital factors on mental health related to weather extremes, warranting further study of this critical topic and with larger racial subgroup samples.
Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004-2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects’ characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0-2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4-8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.
Although a number of studies have demonstrated seasonal variations in acute cardiovascular events, the association between winter and low temperatures and the incidence rate of acute aortic dissection has not been fully elucidated. In this study, we investigated the association between meteorological and chronobiological factors and the occurrence of acute aortic dissection classified by the Stanford type, sex and age. We retrospectively collected 131 patients who had been admitted consecutively to our institution with acute aortic dissection, including 58 type A patients and 73 type B patients, from January 2013 to December 2017. The meteorological data were downloaded from the homepage of the Japan Meteorological Agency. The daily incidence of aortic dissection was higher in winter (10.2%) than in fall (5.3%) (P?=?0.04), and a significant winter peak was also observed in the sub-groups of males and type B, while there were no significant differences in the proportions of type A, female, and ??70- and >?70-year-old patients. The maximum, mean and minimum temperatures on the days with aortic dissection were significantly lower than on the days without aortic dissection. Divided into four seasons, lower temperatures were found only in spring. The most significant and greatest difference was observed between the maximum temperature on the day of aortic dissection and that at 2 days earlier. The multivariate logistic regression analysis showed that the difference in the maximum temperature between the day of and 2 days before the incident (odds ratio 0.91; 95% confidence interval 0.87-0.96; P?
Meteorological drivers are known to affect transmissibility of respiratory viruses including respiratory syncytial virus (RSV), but there are few studies quantifying the role of these drivers. We used daily RSV hospitalization data to estimate the daily effective reproduction number (R(t)), a real-time measure of transmissibility, and examined its relationship with environmental drivers in Singapore from 2005 through 2015. We used multivariable regression models to quantify the proportion of the variance in R(t) explained by each meteorological driver. After constructing a basic model for RSV seasonality, we found that by adding meteorological variables into this model we were able to explain a further 15% of the variance in RSV transmissibility. Lower and higher value of mean temperature, diurnal temperature range (DTR), precipitation and relative humidity were associated with increased RSV transmissibility, while higher value of maximum wind speed was correlated with decreased RSV transmissibility. We found that a number of meteorological drivers were associated with RSV transmissibility. While indoor conditions may differ from ambient outdoor conditions, our findings are indicative of a role of ambient temperature, humidity and wind speed in affecting RSV transmission that could be biological or could reflect indirect effects via the consequences on time spent indoors.
INTRODUCTION: Respiratory syncytial virus (RSV) infection is a major cause of hospitalization in children. Meteorological factors are known to influence seasonal RSV epidemics, but the relationship between meteorological factors and RSV infection in children is not well understood. We aimed to explore the relationship between meteorological factors and RSV infections among hospitalized children, using different statistical models. METHODS: We conducted a retrospective review concerning children with RSV infections admitted to a tertiary pediatric hospital in Wenzhou, China, between January 2008 and December 2017. The relationship between meteorological factors (average daily temperatures, average daily relative humidity, rainfall, rainfall days, and wind speed) and the incidence of RSV in hospitalized children was analyzed using three time-series models, namely an autoregressive integrated moving average (ARIMA) model, a generalized additive model (GAM), and a least absolute shrinkage and selection operator (LASSO)-based model. RESULTS: In total, 15?858 (17.6%) children tested positive for RSV infection. The ARIMA model revealed a marked seasonal pattern in the RSV detection rate, which peaked in winter and spring. The model was a good predictor of RSV incidence (R(2) : 83.5%). The GAM revealed that a lower temperature and higher wind speed preceded increases in RSV detection. The LASSO-based model revealed that temperature and relative humidity were negatively correlated with RSV detection. CONCLUSIONS: Seasonality of RSV infection in hospitalized children correlated strongly with temperature. The LASSO-based model can be used to predict annual RSV epidemics using weather forecast data.
Numerous studies in epidemiology, meteorology, and climate change research have demonstrated a significant association between abnormal ambient temperature and mortality. However, there is a shortage of research attention to a systematic assessment of potential mitigation measures which could effectively reduce the heat-related morbidity and mortality risks. This study first illustrates a conceptualization of a systems analysis version of urban framework for climate service (UFCS). It then constructs a system dynamics (SD) model for the UFCS and employs this model to quantify the impacts of heat waves on public health system in Shanghai and to evaluate the performances of two mitigation measures in the context of a real heat wave event in July 2013 in the city. Simulation results show that in comparison with the baseline without mitigation measures, if the hospital system could prepare 20% of beds available for emergency response to heat waves once receiving the warning in advance, the number of daily deaths could be reduced by 40-60 (15.8-19.5%) on the 2 days of day 7 and day 8; if increasing the minimum living allowance of 790 RMB/month in 2013 by 20%, the number of daily deaths could be reduced by 50-70 (17.7-21.9%) on the 2 days of day 8 and day 12. This tool can help policy makers systematically evaluate adaptation and mitigation options based on performance assessment, thus strengthening urban resilience to changing climate.
Extreme heat threatens desert city residents throughout the hot summer months and inhibits outdoor recreation and activity. Ecosystem services provide various benefits for urban environments. For desert cities, few are more critical than microclimate regulation and water treatment and conservation. This study evaluates the degree to which artificial wetlands support cooler microclimates and reduce the local urban heat island effect. The authors use (a) remotely sensed temperature data for Avondale, Arizona, to measure temperature differences between neighborhoods with and without water features and (b) resident surveys to evaluate perceptions of potential cooling effects. Results show substantial differences in the daytime surface temperatures for the wetland neighborhood compared to those without water features. More than a third of residents perceived a cooling effect throughout the year. The authors conclude that artificial wetlands within a desert city increase human comfort by reducing surface and air temperature and should be considered an urban heat island mitigation strategy.
Malaria, a vector-borne disease, is a significant public health problem in Keonjhar district of Odisha (the malaria capital of India). Prediction of malaria, in advance, is an urgent need for reporting rolling cases of disease throughout the year. The climate condition do play an essential role in the transmission of malaria. Hence, the current study aims to develop and assess a simple and straightforward statistical model of an association between malaria cases and climate variates. It may help in accurate predictions of malaria cases given future climate conditions. For this purpose, a Bayesian Gaussian time series regression model is adopted to fit a relationship of the square root of malaria cases with climate variables with practical lag effects. The model fitting is assessed using a Bayesian version of R(2) (RsqB). Whereas, the predictive ability of the model is measured using a cross-validation technique. As a result, it is found that the square root of malaria cases with lag 1, maximum temperature, and relative humidity with lag 3 and 0 (respectively), are significantly positively associated with the square root of the cases. However, the minimum and average temperatures with lag 2, respectively, are observed as negatively (significantly) related. The considered model accounts for moderate amount of variation in the square root of malaria cases as received through the results for RsqB. We also present Absolute Percentage Errors (APE) for each of the 12 months (January-December) for a better understanding of the seasonal pattern of the predicted (square root of) malaria cases. Most of the APEs obtained corresponding to test data points is reasonably low. Further, the analysis shows that the considered model closely predicted the actual (square root of) malaria cases, except for some peak cases during the particular months. The output of the current research might help the district to develop and strengthen early warning prediction of malaria cases for proper mitigation, eradication, and prevention in similar settings.
Dengue is one of the most serious vector-borne infectious diseases in India, particularly in Kolkata and its neighbouring districts. Dengue viruses have infected several citizens of Kolkata since 2012 and it is amplifying every year. It has been derived from earlier studies that certain meteorological variables and climate change play a significant role in the spread and amplification of dengue infections in different parts of the globe. In this study, our primary objective is to identify the relative contribution of the putative drivers responsible for dengue occurrences in Kolkata and project dengue incidences with respect to the future climate change. The regression model was developed using maximum temperature, minimum temperature, relative humidity and rainfall as key meteorological factors on the basis of statistically significant cross-correlation coefficient values to predict dengue cases. Finally, climate variables from the Coordinated Regional Climate Downscaling Experiment (CORDEX) for South Asia region were input into the statistical model to project the occurrences of dengue infections under different climate scenarios such as Representative Concentration Pathways (RCP4.5 and RCP8.5). It has been estimated that from 2020 to 2100, dengue cases will be higher from September to November with more cases in RCP8.5 (872 cases per year) than RCP4.5 (531 cases per year). The present research further concludes that from December to February, RCP8.5 leads to suitable warmer weather conditions essential for the survival and multiplication of dengue pathogens resulting more than two times dengue cases in RCP8.5 than in RCP4.5. Furthermore, the results obtained will be useful in developing early warning systems and provide important evidence for dengue control policy-making and public health intervention.
Background This ecological study aims to model the trend of changes in exposure of outdoor workers to heat stress in outdoors in the coming decades with the use of the Wet-Bulb Globe Temperature (WBGT), Hadley Coupled Atmosphere- Ocean General Circulation Model, version 3 (HADCM3), and Long Ashton Research Station Weather Generator (LARS-WG) in Tehran, Iran, considering the climate change and the global warming. Methods The hourly values of environmental parameters including minimum and maximum air temperature, relative humidity, precipitation and radiation related to Prakash , Shahriar and Damavand cities were obtained from the Meteorological Organization of Iran. These data were recorded during 1965 to 2015. The climate modeling was done for 2011-2030, 2046-2065, and 2080-2099. Results The minimum and maximum air temperatures in the different months of the year in the three studied cities show an increasing trend. Our finding shows that the WBGT will be increased by 2099. In Pakdasht, this index will be close to the danger zone in the coming years, especially in 2080-2099. Conclusions All the results obtained indicate an increase in risk of heat stress in outdoor workplaces, given the global warming.
The first long-term monitoring to document both activity and density of questing ixodid ticks in Vienna, Austria, is introduced. It was started in 2017 and is planned to run over decades. Such long-term monitorings are needed to quantify possible effects of climate change or to develop tick density forecast models. The monthly questing tick density at three sites has been observed by using a standardized sampling method by dragging an area of [Formula: see text] at each occasion. Popular recreational areas were chosen as study sites. These are the Prater public park, the wooded Kahlenberg, and a wildlife garden in Klosterneuburg. First results show a 3-year time series of nymphs and adults of the Ixodes ricinus species complex and Haemaphysalis concinna for the period 2017-2019. Whereas questing nymphs of the I. ricinus species complex were collected from February to November, H. concinna nymphs were only dragged from May to October. The peak of nymphal activity of the I. ricinus species complex was in May, that of H. concinna in August. In addition, a brief overview is given about ticks and tick-borne pathogens occurring in urban and suburban areas of Vienna.
Urbanisation and industrialisation led to the increase of ambient particulate matter (PM) concentration. While subsequent regulations may have resulted in the decrease of some PM matrices, the simultaneous changes in climate affecting local meteorological conditions could also have played a role. To gain an insight into this complex matter, this study investigated the long-term trends of two important matrices, the particle mass (PM(2.5)) and particle number concentrations (PNC), and the factors that influenced the trends. Mann-Kendall test, Sen’s slope estimator, the generalised additive model, seasonal decomposition of time series by LOESS (locally estimated scatterplot smoothing) and the Buishand range test were applied. Both PM(2.5) and PNC showed significant negative monotonic trends (0.03-0.6 ?g m(-3). yr(-1) and 0.40-3.8 × 10(3) particles. cm(-3). yr(-1), respectively) except Brisbane (+0.1 ?g m(-3). yr(-1) and +53 particles. cm(-3). yr(-1), respectively). For the period covered in this study, temperature increased (0.03-0.07 °C.yr(-1)) in all cities except London; precipitation decreased (0.02-1.4 mm. yr(-1)) except in Helsinki; and wind speed was reduced in Brisbane and Rochester but increased in Helsinki, London and Augsburg. At the change-points, temperature increase in cold cities influenced PNC while shifts in precipitation and wind speed affected PM(2.5). Based on the LOESS trend, extreme events such as dust storms and wildfires resulting from changing climates caused a positive step-change in concentrations, particularly for PM(2.5). In contrast, among the mitigation measures, controlling sulphur in fuels caused a negative step-change, especially for PNC. Policies regarding traffic and fleet management (e.g. low emission zones) that were implemented only in certain areas or in a progressive uptake (e.g. Euro emission standards), resulted to gradual reductions in concentrations. Therefore, as this study has clearly shown that PM(2.5) and PNC were influenced differently by the impacts of the changing climate and by the mitigation measures, both metrics must be considered in urban air quality management.
Little evidence is available about the relationship between ambient temperatures and hypoglycemia in Taiwan. The purpose of the present paper is to investigate whether there is an association between ambient temperatures and hypoglycemia in patients with type 2 diabetes.An ecological study was conducted to analyze the type 2 diabetes dataset of the Taiwan National Health Insurance Program. Every episode of hypoglycemia diagnosed at emergency department among subjects with type 2 diabetes was identified monthly between 2006 and 2013. Average monthly ambient temperatures in Celsius between 2006 and 2013 were measured according to the database of the Central Weather Bureau in Taiwan.The incidence rates of hypoglycemia were higher during the period of cold ambient temperatures (from December to March) than the period of warm ambient temperatures (from April to November). The peak period of hypoglycemia always occurred in winter months (January and February).Patients with type 2 diabetes in Taiwan are more susceptible to hypoglycemia during the period of cold ambient temperatures, particularly in winter months. Clinicians in Taiwan should remind patients to make a preventive strategy for hypoglycemia during the periods of cold ambient temperatures.
The robust estimate and forecast capability of random forests (RF) has been widely recognized, however this ensemble machine learning method has not been widely used in mosquito-borne disease forecasting. In this study, two sets of RF models were developed at the national (pooled department-level data) and department level in Colombia to predict weekly dengue cases for 12-weeks ahead. A pooled national model based on artificial neural networks (ANN) was also developed and used as a comparator to the RF models. The various predictors included historic dengue cases, satellite-derived estimates for vegetation, precipitation, and air temperature, as well as population counts, income inequality, and education. Our RF model trained on the pooled national data was more accurate for department-specific weekly dengue cases estimation compared to a local model trained only on the department’s data. Additionally, the forecast errors of the national RF model were smaller to those of the national pooled ANN model and were increased with the forecast horizon increasing from one-week-ahead (mean absolute error, MAE: 9.32) to 12-weeks ahead (MAE: 24.56). There was considerable variation in the relative importance of predictors dependent on forecast horizon. The environmental and meteorological predictors were relatively important for short-term dengue forecast horizons while socio-demographic predictors were relevant for longer-term forecast horizons. This study demonstrates the potential of RF in dengue forecasting with a feasible approach of using a national pooled model to forecast at finer spatial scales. Furthermore, including sociodemographic predictors is likely to be helpful in capturing longer-term dengue trends.
BACKGROUND: Accumulating evidence has linked environmental exposure, such as ambient air pollution and meteorological factors, to the development and severity of cardiovascular diseases (CVDs), resulting in increased healthcare demand. Effective prediction of demand for healthcare services, particularly those associated with peak events of CVDs, can be useful in optimizing the allocation of medical resources. However, few studies have attempted to adopt machine learning approaches with excellent predictive abilities to forecast the healthcare demand for CVDs. This study aims to develop and compare several machine learning models in predicting the peak demand days of CVDs admissions using the hospital admissions data, air quality data and meteorological data in Chengdu, China from 2015 to 2017. METHODS: Six machine learning algorithms, including logistic regression (LR), support vector machine (SVM), artificial neural network (ANN), random forest (RF), extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM) were applied to build the predictive models with a unique feature set. The area under a receiver operating characteristic curve (AUC), logarithmic loss function, accuracy, sensitivity, specificity, precision, and F1 score were used to evaluate the predictive performances of the six models. RESULTS: The LightGBM model exhibited the highest AUC (0.940, 95% CI: 0.900-0.980), which was significantly higher than that of LR (0.842, 95% CI: 0.783-0.901), SVM (0.834, 95% CI: 0.774-0.894) and ANN (0.890, 95% CI: 0.836-0.944), but did not differ significantly from that of RF (0.926, 95% CI: 0.879-0.974) and XGBoost (0.930, 95% CI: 0.878-0.982). In addition, the LightGBM has the optimal logarithmic loss function (0.218), accuracy (91.3%), specificity (94.1%), precision (0.695), and F1 score (0.725). Feature importance identification indicated that the contribution rate of meteorological conditions and air pollutants for the prediction was 32 and 43%, respectively. CONCLUSION: This study suggests that ensemble learning models, especially the LightGBM model, can be used to effectively predict the peak events of CVDs admissions, and therefore could be a very useful decision-making tool for medical resource management.
It is often difficult to define the relationship and the influence of climate on the occurrence and distribution of disease. To examine this issue, the effects of climate indices on the distributions of malaria and meningitis in Nigeria were assessed over space and time. The main purpose of the study was to evaluate the relationships between climatic variables and the prevalence of malaria and meningitis, and develop an early warning system for predicting the prevalence of malaria and meningitis as the climate varies. An early warning system was developed to predetermine the months in a year that people are vulnerable to malaria and meningitis. The results revealed a significant positive relationship between rainfall and malaria, especially during the wet season with correlation coefficient R-2 >= 60.0 in almost all the ecological zones. In the Sahel, Sudan and Guinea, there appears to be a strong relationship between temperature and meningitis with R-2 > 60.0. In all, the results further reveal that temperatures and aerosols have a strong relationship with meningitis. The assessment of these initial data seems to support the finding that the occurrence of meningitis is higher in the northern region, especially the Sahel and Sudan. In contrast, malaria occurrence is higher in the southern part of the study area. We suggest that a thorough investigation of climate parameters is critical for the reallocation of clinical resources and infrastructures in economically underprivileged regions.
BACKGROUND AND OBJECTIVE: Malaria is an arthropod-borne infectious disease transmitted by the mosquito Anopheles and claims millions of lives globally every year. Reasons for failure to eradicate this disease are multifactorial. The seasonality of the malaria is principally determined by climatic factors conducive for breeding of the vector. We aimed to study the relationship between climatic variability and the seasonality of malaria over an eight-year duration. METHODS: This was a retrospective medical chart review of 8,844 confirmed cases of malaria which presented to The Indus Hospital, Karachi from January 2008 to November 2015. Cases were plotted against meteorological data for Karachi to elicit monthly variation. RESULTS: A secular incline and seasonality in malaria cases over the duration of eight years was seen. More cases were reported in the summer, rainy season compared with the other three seasons in each year. There was significant association with specific climate variables such as temperature, moisture, and humidity. CONCLUSION: There is a marked seasonal variation of malaria in Karachi, influenced by various environmental factors. Identification of the ‘the concentrated period’ of malaria can be helpful for policymakers to deploy malaria control interventions.
BACKGROUND: Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30?years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda. METHODS: Times-series data on malaria cases (2011-2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period. RESULTS: Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases. CONCLUSIONS: Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.
Heat-health risk is a growing concern in many regions of China due to the more frequent occurrence of extremely hot weather. Spatial indexes based on various heat assessment frameworks can be used for the assessment of heat risks. In this study, we adopted two approaches-Crichton’s risk triangle and heat vulnerability index (HVI) to identify heat-health risks in the Northern Jiangxi Province of China, by using remote sensing and socio-economic data. The Geographical Information System (GIS) overlay and principal component analysis (PCA) were separately used in two frameworks to integrate parameters. The results show that the most densely populated community in the suburbs, instead of city centers, are exposed to the highest heat risk. A comparison of two heat assessment mapping indicates that the distribution of HVI highlights the vulnerability differences between census tracts. In contrast, the heat risk index of Crichton’s risk triangle has a prominent representation for regions with high risks. The stepwise multiple linear regression zero-order correlation coefficient between HVI and outdoor workers is 0.715, highlighting the vulnerability of this particular group. Spearman’s rho nonparametric correlation and the mean test reveals that heat risk index is strongly correlated with HVI in most of the main urban regions in the study area, with a significantly lower value than the latter. The analysis of variance shows that the distribution of HVI exhibits greater variety across urban regions than that of heat risk index. Our research provides new insight into heat risk assessment for further study of heat health risk in developing countries.
BACKGROUND: Extreme heat poses current and future risks to human health. Heat vulnerability indices (HVIs), commonly developed using principal components analysis (PCA), are mapped to identify populations vulnerable to extreme heat. Few studies critically assess implications of analytic choices made when employing this methodology for fine-scale vulnerability mapping. OBJECTIVE: We investigated sensitivity of HVIs created by applying PCA to input variables and whether training input variables on heat-health data produced HVIs with similar spatial vulnerability patterns for Detroit, Michigan, USA. METHODS: We acquired 2010 Census tract and block group level data, land cover data, daily ambient apparent temperature, and all-cause mortality during May-September, 2000-2009. We used PCA to construct HVIs using: a) “unsupervised”-PCA applied to variables selected a priori as risk factors for heat-related health outcomes; b) “supervised”-PCA applied only to variables significantly correlated with proportion of all-cause mortality occurring on extreme heat days (i.e., days with 2-d mean apparent temperature above month-specific 95th percentiles). RESULTS: Unsupervised and supervised HVIs yielded differing spatial vulnerability patterns, depending on selected land cover input variables. Supervised PCA explained 62% of variance in the input variables and was applied on half the variables used in the unsupervised method. Census tract-level supervised HVI values were positively associated with increased proportion of mortality occurring on extreme heat days; supervised PCA could not be applied to block group data. Unsupervised HVI values were not associated with extreme heat mortality for either tracts or block groups. DISCUSSION: HVIs calculated using PCA are sensitive to input data and scale. Supervised HVIs may provide marginally more specific indicators of heat vulnerability than unsupervised HVIs. PCA-derived HVIs address correlation among vulnerability indicators, although the resulting output requires careful contextual interpretation beyond generating epidemiological research questions. Methods with reliably stable outputs should be leveraged for prioritizing heat interventions. https://doi.org/10.1289/EHP4030.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with increasing spread. Currently SFTS transmission has expanded beyond Asian countries, however, with definitive global extents and risk patterns remained obscure. Here we established an exhaustive database that included globally reported locations of human SFTS cases and the competent vector, Haemaphysalis longicornis (H. longicornis), as well as the explanatory environmental variables, based on which, the potential geographic range of H. longicornis and risk areas for SFTS were mapped by applying two machine learning methods. Ten predictors were identified contributing to global distribution for H. longicornis with relative contribution >= 1%. Outside contemporary known distribution, we predict high receptivity to H. longicornis across two continents, including northeastern USA, New Zealand, parts of Australia, and several Pacific islands. Eight key drivers of SFTS cases occurrence were identified, including elevation, predicted probability of H. longicornis presence, two temperature-related factors, two precipitation-related factors, the richness of mammals and percentage coverage of water bodies. The globally model-predicted risk map of human SFTS occurrence was created and validated effective for discriminating the actual affected and unaffected areas (median predictive probability 0.74 vs. 0.04, P < 0.001) in three countries with reported cases outside China. The high-risk areas (probability >= 50%) were predicted mainly in east-central China, most parts of the Korean peninsula and southern Japan, and northern New Zealand. Our findings highlight areas where an intensive vigilance for potential SFTS spread or invasion events should be advocated, owing to their high receptibility to H. longicornis distribution.
Extreme heat is the leading cause of heat-related mortality around the world. Extracting heat vulnerability information from the urban complexity system is crucial for urban health studies. Using heat vulnerability index (HVI) is the most common approach for urban planners to locate the places with high vulnerability for intervention and protection. Previous studies have demonstrated that HVI can play a vital role in determining which areas are at risk of heat-related deaths. Both equal weight approach (EWA) and principal component analysis (PCA) are the conventional methods to aggregate indicators to HVI. However, seldom studies have compared the differences between these two approaches in estimating HVI. In this paper, we evaluated the HVIs in Hangzhou in 2013, employing EWA and PCA, and assessed the accuracies of these two HVIs by using heat-related deaths. Our results show that both HVI maps showed that areas with high vulnerability are located in the central area while those with low vulnerability are located in the suburban area. The comparison between HVI(EWA)and HVI(PCA)shows significantly different spatial distributions, which is caused by the various weight factors in EWA and PCA. The relationship between HVI(EWA)and heat-related deaths performs better than the relationship between HVI(PCA)and deaths, implying EWA could be a better method to evaluate heat vulnerability than PCA. The HVI(EWA)can provide a spatial distribution of heat vulnerability at intracity to direct heat adaptation and emergency capacity planning.
BACKGROUND: Vibrio growth in the environment is related to sea surface temperature (SST). The incidence of human Vibrio illness increased sharply in British Columbia (BC) between 2008 and 2015 for unknown reasons, culminating in the largest outbreak of shellfish-associated Vibrio parahaemolyticus (Vp) in Canadian history in 2015. Our objective was to assess the relationship between SST and Vibrio illness in BC, Canada during 1992-2017 and assess the role of SST and other environmental factors in the 2015 Vp outbreak. METHODS: Cases of Vibrio infection reported to the BC Centre for Disease Control during 1992-2017 were used. SST data were obtained from NOAA and NASA. We assessed changes in incidence trend of annual Vibrio cases during 1992-2017 using a Poisson regression. We assessed the correlation between annual Vibrio cases and the average annual maximum SST using a Spearman rank-order correlation. We modeled the association between weekly Vp case counts, SST and other environmental factors during 2007-2017 using a Poisson regression. RESULTS: There was a significant increase in Vibrio cases between 2008 and 2015 (annual slope?=?0.163, P?
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.
The association between temperature and cardiovascular disease has been widely reported. In the city of Jiuquan, a developing area that has seldom been studied, the association is still unclear. The hospital data of cardiovascular disease (CVD) admissions and meteorological data were collected from the new rural cooperative medical insurance of Gansu Province and China Meteorological Science Data Sharing Service, respectively. A total of 26,383 cases were admitted during the research period. Poisson regression with a distributed lag nonlinear model was selected to evaluate the association between temperature and the hospital admissions of CVD. Subgroup analysis was performed according to gender and age. At first, the low temperature effect was obvious, but it then attenuated at lags 0-7 days. The maximum impact caused by high temperature occurred on the current day (lag 0) and then attenuated along the lag days. The cold effect was more harmful than heat effect. The adults and males were found to be more vulnerable to the temperature than the elderly and females, respectively. The study provides some reference for the development of the local public health by quantifying these impacts.
Human capital generally, and cognitive skills specifically, play a crucial role in determining economic mobility and macroeconomic growth. While elevated temperatures have been shown to impair short-run cognitive performance, much less is known about whether heat exposure affects the rate of skill formation. We combine standardized achievement data for 58 countries and 12,000 US school districts with detailed weather and academic calendar information to show that the rate of learning decreases with an increase in the number of hot school days. These results provide evidence that climatic differences may contribute to differences in educational achievement both across countries and within countries by socioeconomic status and that may have important implications for the magnitude and functional form of climate damages in coupled human-natural systems.
BACKGROUND: Although the effect of ambient temperature on cardiovascular disease (CVDs) has been well explored, studies using years of life lost (YLLs) as the outcome especially evaluating the average life loss per death attributable to temperatures were rare. We examine the associations between ambient temperature and YLLs of CVDs, and further quantify temperature-related life loss per death. METHODS: Daily YLL rates were calculated using death data from 364 locations across China during 2006-2017, and meteorological data were collected for the same period. A distributed-lag nonlinear model and meta-regression were applied to examine the relationships between temperature and YLL rates of CVDs. Subgroup analyses by age, gender, region, and cause-specific CVDs were investigated. The total YLLs and average YLLs per death attributable to temperature were further quantified to assess life loss caused by non-optimal temperature. RESULTS: Both high and low temperatures significantly increased YLL rates of CVDs, with greater effects for cold than heat. Cerebrovascular diseases (CEDs) account for the largest proportion (47.17%) of total YLLs of CVDs attributable to non-optimal temperature. On average, life loss per CVD death attributable to non-optimal temperatures was 1.51 (95% eCI: 1.33, 1.69) years, with 1.07 (95% eCI: 1.00, 1.15) years from moderate cold. Average life losses per death were observed higher for males (1.71, 95% eCI: 1.43, 1.99), younger population (3.82, 95% eCI: 2.86, 4.75), central China (1.62; 95% eCI: 1.41, 1.83) and hemorrhagic stroke (2.86, 95% eCI: 2.63, 3.10) than their correspondents. CONCLUSIONS: We found that non-optimal temperature significantly aggravated premature death of CVD, with CEDs being the most affected, and most of temperature-related life loss of CVD was attributed to moderate cold. Our findings imply that peoples with CEDs in moderate cold days are vulnerable populations, which may contribute to a better understanding the adverse effects and pathogenesis of temperature on CVDs.
Purpose: This study investigated the effects of heat exposure and previous experience on thermoregulatory and cardiovascular responses to performing a loaded march in the HEAT and on FORCE Combat (TM) circuit performance. Methods: Ten civilians (inexperienced) and 10 infantry reservists (experienced) performed a 60 min loaded march (similar to 35kg), in NORMAL (21 +/- 0.2 degrees C) and HEAT (30 +/- 0.2 degrees C) conditions and the FORCE Combat (TM) military physical performance evaluation. Participant groups were matched for morphology and physiological capacity. Results: Out of the 10 experienced participants that participated in the loaded march in HEAT, 9 completed the full 60 min but only 5 of 10 inexperienced participants were able to do the same. Performing a loaded march in the HEAT caused a state of uncompensable heat stress (continuous increase in core temperature) for both the inexperienced and experienced participants. Heart rate (134 +/- 12vs143 +/- 9bpm,p=0.027), rate of perceived exertion (13 +/- 1vs10 +/- 1,p=0.001) and thermal comfort (1.9 +/- 0.5vs2.4 +/- 0.4,p=0.011) were lower in the experienced compared to the inexperienced group during the loaded march in HEAT. The FORCE Combat (TM) completion times were higher in HEAT compared to NORMAL, but lower in experienced participants in both conditions (p=0.05). Conclusion: Both heat exposure and previous experience had an effect on cardiovascular, thermal and subjective measures during the loaded march and on completion time of the FORCE Combat (TM) circuit.
BACKGROUND: Climate change and extreme weather poses significant threats to community health, which need to be addressed by local health workforce. This study investigated the perceptions of primary healthcare professionals in Southern China on individual and institutional strategies for actions on health impacts of climate change and the related barriers. METHODS: A mixed methodological approach was adopted, involving a cross-sectional questionnaire survey of 733 primary healthcare professionals (including medical doctors, nurses, public health practitioners, allied health workers and managers) selected through a multistage cluster randomized sampling strategy, and in-depth interviews of 25 key informants in Guangdong Province, China. The questionnaire survey investigated the perceptions of respondents on the health impacts of climate change and the individual and institutional actions that need to be taken in response to climate change. Multivariate logistic regression models were established to determine sociodemographic factors associated with the perceptions. The interviews tapped into coping strategies and perceived barriers in primary health care to adapt to tackle challenges of climate change. Contents analyses were performed to extract important themes. RESULTS AND CONCLUSION: The majority (64%) of respondents agreed that climate change is happening, but only 53.6% believed in its human causes. Heat waves and infectious diseases were highly recognized as health problems associated with climate change. There was a strong consensus on the need to strengthen individual and institutional capacities in response to health impacts of climate change. The respondents believed that it is important to educate the public, take active efforts to control infectious vectors, and pay increased attention to the health care of vulnerable populations. The lack of funding and limited local workforce capacity is a major barrier for taking actions. Climate change should be integrated into primary health care development through sustainable governmental funding and resource support.
Exposure to extreme heat contributes to high morbidity and mortality relative to other climate hazards. The city of Philadelphia, PA is particularly vulnerable to the impacts of extreme heat, due to the urban heat island effect and high prevalence of sensitive populations. We developed a heat vulnerability index, which identified priority areas that are most at-risk of experiencing adverse heat-related health outcomes and in need of preparedness and mitigation interventions. An interactive website was created to display the maps and allow the public to navigate the data with links to potential resources for relief from extreme heat days. Such methods can be adapted for other cities that wish to identify and target long-term priority areas.
BACKGROUND: Differences in multiple sclerosis (MS) risk by latitude have been observed worldwide; however, the exposures driving these associations are unknown. Ultraviolet radiation (UV) has been explored as a risk factor, and ambient temperature has been correlated with disease progression. However, no study has examined the impact of all three exposures. We examined the association between these exposures and incidence of MS within two nationwide prospective cohorts of women, the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII). METHODS: Both cohorts were followed with biennial questionnaires to ascertain new diagnoses and risk factors. Time-varying exposures to latitude, cumulative average July temperature (°C), and cumulative average July erythemal UV (mW/m(2)) were predicted at each participant’s biennially updated residential addresses. Using Cox proportional hazards models adjusted for MS risk factors, we calculated hazard ratios (HR) and 95% confidence intervals (CIs) within each cohort and pooled via meta-analyses. RESULTS: In multivariable models, there were suggestions that decreasing latitude (meta-analysis multivariable-adjusted HR = 0.72; 95% CI 0.55, 0.94 for women living <35.73° compared with those ?42.15°, P-for-trend = 0.007) and increasing cumulative average July temperature (meta-analysis multivariable-adjusted HR = 0.81; 95% CI 0.72, 0.91 for each interquartile range increase [3.91°]) were associated with decreasing risk of MS. There was no evidence of heterogeneity between cohorts. We did not observe consistent associations with cumulative average UV. CONCLUSION: Our results suggest that adult exposures to decreasing latitude and increasing temperature, but not UV, were associated with reduced MS risk in these two cohorts of women. Studies of MS incidence may want to consider temperature as a risk factor.
The risk levels of heat-related extreme events need to be estimated for prediction and real-time monitoring to mitigate their impacts on air quality, public health, the ecosystem, and critical infrastructure. Many countries have adopted meteorological variable base thresholds for assessing the risk level of heat-related extreme events. These thresholds provide an approximate risk level for a specific event but do not consider its intensity and duration in the risk assessment. The current study provides a statistical tool to assess the risk of heat-related extreme events while concurrently considering their intensities and durations based on the wet-bulb globe temperature (WBGT). To this end, the intensity-duration-frequency (IDF) relationship of the extreme WBGT in South Korea was derived. Regional frequency analysis was employed to understand the IDF relationship. Return levels of heat-related extreme events in South Korea were calculated and their characteristics were investigated based on the annual maximum WBGT observations. The results showed that the IDF relationship could provide the risks of heat-related extreme events while concurrently considering their intensities and durations. The extreme WBGT in South Korea was used to categorize two regions such as coastal and inland based on their statistical characteristics. The return levels of the annual maximum WBGT events were found to vary largely by location. The return levels corresponding to 32 °C with 3-h duration for stations in the coastal and inland regions ranged from 1- to 100-years and 3- to 1000-years, respectively. Mean values of return levels for heatwave events in Seoul, Incheon, Daejon, Gwangju, Daegu, and Busan were 2.8-, 8.4-, 15.3-, 2.8-, 1.6-, and 2.2-years, respectively. The return levels of heatwaves for the warmer cities are smaller than those for cooler cities. The return levels of the heatwave events in South Korea showed a significant increasing trend in several cities, supporting the notion that the impact of heatwave events on South Korea might become more severe in the future.
Several studies have reported that air pollution and climatic factors are major contributors to human morbidity and mortality globally. However, the combined interactive effects of air pollution and climatic factors on human health remain largely unexplored. This study aims to investigate the interactive effects of air pollution and climatic factors on circulatory and respiratory mortality in Xi’an, China. Time-series analysis and the distributed lag non-linear model (DLNM) were employed as the study design and core statistical method. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for temperature and Air Quality Index (AQI) interaction on circulatory mortality were 0.973(0.969, 0.977) and -0.055(-0.059, -0.048), respectively; while for relative humidity and AQI interaction, 1.098(1.011, 1.072) and 0.088(0.081, 0.107) respectively, were estimated. Additionally, the IRR and RERI for temperature and AQI interaction on respiratory mortality were 0.805(0.722, 0.896) and -0.235(-0.269, -0.163) respectively, while 1.008(0.965, 1.051) and -0.031(-0.088, 0.025) respectively were estimated for relative humidity and AQI interaction. The interaction effects of climatic factors and AQI were synergistic and antagonistic in relation to circulatory and respiratory mortality, respectively. Interaction between climatic factors and air pollution contributes significantly to circulatory and respiratory mortality.
BACKGROUND: Haemorrhagic fever with renal syndrome (HFRS) is climate sensitive. HFRS-weather associations have been investigated by previous studies, but few of them looked into the interaction of meteorological factors on HFRS in different climate zones. OBJECTIVE: We aim to explore the interactions and marginal effects of meteorological factors on HFRS in China. METHODS: HFRS surveillance data and meteorological data were collected from 254 cities during 2006-2016. A monthly time-series study design and generalized estimating equation models were adopted to estimate the interactions and marginal effects of meteorological factors on HFRS in different climate zones of China. RESULTS: Monthly meteorological variables and the number of HFRS cases showed seasonal fluctuations and the patterns varied by climate zone. We found that maximum lagged effects of temperature on HFRS were 1-month in temperate zone, 2-month in warm temperate zone, 3-month in subtropical zone, respectively. There is an interaction effect between mean temperature and precipitation in temperate zone, while in warm temperate zone the interaction effect was found between mean temperature and relative humidity. CONCLUSION: The interaction effects and marginal effects of meteorological factors on HFRS varied from region to region in China. Findings of this study may be helpful for better understanding the roles of meteorological variables in the transmission of HFRS in different climate zones, and provide implications for the development of weather-based HFRS early warning systems.
BACKGROUND: Daily air quality index (AQI) forecast can provide early warning information, and it is not clear whether it is appropriate for childhood asthma hospitalizations (CAHs). Furthermore, little is known about the effects of AQI on CAHs, as well as the interactions between temperature, humidity and AQI. METHODS: We collected 32,238 cases in Hefei from 2013 to 2016 and estimated the association between daily CAHs and AQI by combining the Poisson Generalized Linear Models (PGLMs) with the Distributed Lag Nonlinear Models (DLNMs). The interaction between AQI and temperature was tested by stratifying AQI and temperature, as well as humidity. RESULTS: AQI was associated with an increased risk of hospitalizations for childhood asthma. The adverse effect first appeared on the 3rd day, with the RR of 1.011 (95%CI: 1.000-1.023) and continued until the 19th day of lag (RR = 1.010, 95%CI: 1.001-1.020). In the subgroup analysis, the male and pre-school children were more sensitive to AQI, and there are seasonal differences in the effects of AQI on CAHs. Besides, in a stratified analysis with an AQI of 150, we found synergies between temperature, humidity and AQI. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for the interaction between temperature and AQI were 1.157 (95%CI: 1.029-1.306) and 0.122 (95%CI: 0.022-0.223) respectively. For the humidity, the IRR and RERI were 1.090 (95%CI: 1.056-1.206) and 0.083 (95%CI: 0.083-0.143) respectively. Exploring different subgroups in the interaction analyses, it was worth noting that female and pre-school children were more sensitive to the interaction between AQI and temperature, while school-age children were more sensitive to the interaction between AQI and humidity. CONCLUSIONS: The study found that not only AQI can significantly increase the risk of CAHs, but also that under the context of climate change, temperature and humidity have a synergistic effect on AQI, suggesting that considering only the warning information of air pollution is not enough to strengthen the prevention of childhood asthma hospitalization.
A comprehensive analysis of meteorological (air temperature, relative humidity, wind speed and global radiation) and outdoor thermal comfort (OTC) conditions (Physiological Equivalent Temperature and Mean Radiant Temperature) was carried out in six Local Climate Zones (LCZs) in Ghent (Belgium) on annual and seasonal level (2017) and during two heat waves (moderate in 2017 and record-breaking in 2019). The continuously monitored data originates from the local urban climate network MOCCA (Monitoring the City’s Climate and Atmosphere). The maximum hourly urban heat island (UHI) of 8.7 degrees C was noticed during the record-breaking 2019 heat wave. OTC was calculated with RayMan based on the observations from the MOCCA network and characteristics of the micro-environment which affect the estimated OTC conditions. The results show that cold stress is more apparent in Ghent during all seasons, except for summer. Downtown locations had more comfortable conditions on seasonal and annual level when compared to the rural location which had the most uncomfortable OTC conditions mostly due to cold stress. However, during the daytime period of heat waves, the open downtown and rural location were most frequently exposed to extreme heat stress, while the urban park in the sparsely built LCZ was the most comfortable area because it was able to effectively mitigate heat stress. This study illustrates the subtlety of the results of a thermal comfort study if one investigates both heat and cold stress on a yearly basis and during the extreme heat wave periods in a city with a moderate climate.
There is currently an increase in the number of heat waves occurring worldwide. Moscow experienced the effects of an extreme heat wave in 2010, which resulted in more than 10,000 extra deaths and significant economic damage. This study conducted a comprehensive assessment of the social risks existing during the occurrence of heat waves and allowed us to identify the spatial heterogeneity of the city in terms of thermal risk and the consequences for public health. Using a detailed simulation of the meteorological regime based on the COSMO-CLM regional climate model and the physiologically equivalent temperature (PET), a spatial assessment of thermal stress in the summer of 2010 was carried out. Based on statistical data, the components of social risk (vulnerabilities and adaptive capacity of the population) were calculated and mapped. We also performed an analysis of their changes in 2010-2017. A significant differentiation of the territory of Moscow has been revealed in terms of the thermal stress and vulnerability of the population to heat waves. The spatial pattern of thermal stress agrees quite well with the excess deaths observed during the period from July to August 2010. The identified negative trend of increasing vulnerability of the population has grown in most districts of Moscow. The adaptive capacity has been reduced in most of Moscow. The growth of adaptive capacity mainly affects the most prosperous areas of the city.
Urbanization is one of the most significant contributing factors to anthropogenic climate change. However, a lack of projected city land use data has posed significant challenges to factoring urbanization into climate change modeling. Thus, the results from current models may contain considerable errors in estimating future climate scenarios. The Pearl River Delta region was selected as a case study to provide insight into how large-scale urbanization and different climate change scenarios impact the local climate. This study adopts projected land use data from freely available satellite imagery and applies dynamic simulation land use results to the Weather Research and Forecasting Model (WRF). The simulation periods cover the summer periods in 2010 and 2029-2031, the latter of which is averaged to represent the year 2030. The WRF simulation used the observed local climate conditions in 2010 to represent the current scenario and the projected local climate changes for 2030 as the future scenario. Under all three future climate change scenarios, the warming trend is prominent (around 1-2 degrees C increase), with a widespread reduction in wind speed in inland areas (1-2 ms(-1)). The vulnerability of human health to thermal stress was evaluated by adopting the wet-bulb globe temperature (WBGT). The results from the future scenarios suggest a high public health risk due to rising temperatures in the future. This study provides a methodology for a more comprehensive understanding of future urbanization and its impact on regional climate by using freely available satellite images and WRF simulation tools. The simulated temperature and WBGT results can serve local governments and stakeholders in city planning and the creation of action plans that will reduce the potential vulnerability of human health to excessive heat.
Measles is a major cause of child mortality in sub-Saharan Africa. Current immunization strategies achieve low coverage in areas where transmission drivers differ substantially from those in high-income countries. A better understanding of measles transmission in areas with measles persistence will increase vaccination coverage and reduce ongoing transmission. We analysed weekly reported measles cases at the district level in Niger from 1995 to 2004 to identify underlying transmission mechanisms. We identified dominant periodicities and the associated spatial clustering patterns. We also investigated associations between reported measles cases and environmental drivers associated with human activities, particularly rainfall. The annual and 2-3-year periodicities dominated the reporting data spectrum. The annual periodicity was strong with contiguous spatial clustering, consistent with the latitudinal gradient of population density, and stable over time. The 2-3-year periodicities were weaker, unstable over time and had spatially fragmented clustering. The rainy season was associated with a lower risk of measles case reporting. The annual periodicity likely reflects seasonal agricultural labour migration, whereas the 2-3-year periodicity potentially results from multiple mechanisms such as reintroductions and vaccine coverage heterogeneity. Our findings suggest that improving vaccine coverage in seasonally mobile populations could reduce strong measles seasonality in Niger and across similar settings.
The increasing frequency of extreme hot days has a considerable impact on health and energy. Heat stress related to high temperatures cause increased rates of mortality and morbidity, particularly amongst vulnerable populations such as those belonging to lower socio-economic groups. Most studies on heat related mortality and morbidity generally use temperatures from weather stations that do not consider the urban heat island (UHI) effect, leading to inaccurate predictions, particularly during heat waves. This study uses data collected by citizen scientists in predicting outdoor thermal comfort as well as indoor heat stress and peak cooling energy for low income housing in Australia. The results show that the outdoor Universal thermal climate index (UTCI) values estimated during hot afternoon ranged from 26 degrees C to 46 degrees C which equate to moderate to extreme heat stress. The indoor Discomfort index (DI) values calculated inside the living and bedrooms were below the heat stress limits (DI < 28) when Bureau of Meteorology (BoM) data was used as the input for calculation. However, indoor DI exceeded the threshold when actual on-ground data was used in the calculations, indicating that people will be at severe risks of heat related illnesses. It was also found that 60% of the time DI exceeded the threshold value as opposed to 2% with the use of BoM data. Furthermore, the peak cooling load was increased by 24% when on-ground data was used. The results show that low income houses and the neighbourhoods where they are located can cause significant heat related health risks which are normally overlooked in typical simulation studies. This study demonstrated a cost-effective way of collecting microclimate data for urban heat island mitigation and adaptation studies. (C) 2020 Published by Elsevier B.V.
SARS CoV-2 (COVID-19) Coronavirus cases are confirmed throughout the world and millions of people are being put into quarantine. A better understanding of the effective parameters in infection spreading can bring about a logical measurement toward COVID-19. The effect of climatic factors on spreading of COVID-19 can play an important role in the new Coronavirus outbreak. In this study, the main parameters, including the number of infected people with COVID-19, population density, intra-provincial movement, and infection days to end of the study period, average temperature, average precipitation, humidity, wind speed, and average solar radiation investigated to understand how can these parameters effects on COVID-19 spreading in Iran? The Partial correlation coefficient (PCC) and Sobol’-Jansen methods are used for analyzing the effect and correlation of variables with the COVID-19 spreading rate. The result of sensitivity analysis shows that the population density, intra-provincial movement have a direct relationship with the infection outbreak. Conversely, areas with low values of wind speed, humidity, and solar radiation exposure to a high rate of infection that support the virus’s survival. The provinces such as Tehran, Mazandaran, Alborz, Gilan, and Qom are more susceptible to infection because of high population density, intra-provincial movements and high humidity rate in comparison with Southern provinces.
The transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the severity of the related disease (COVID-19) are influenced by a large number of factors. This study aimed to investigate the correlation of COVID-19 case and death rates with possible causal climatological and sociodemographic factors for the March to May 2020 (first wave) period in a worldwide scale by statistically processing data for over one hundred countries. The weather parameters considered herein were air temperature, relative humidity, cumulative precipitation, and cloud cover, while sociodemographic factors included population density, median age, and government measures in response to the pandemic. The results of this study indicate that there is a statistically significant correlation between average atmospheric temperature and the COVID-19 case and death rates, with chi-square test p-values in the 0.001-0.02 range. Regarding sociodemographic factors, there is an even stronger dependence of the case and death rates on the population median age (p = 0.0006-0.0012). Multivariate linear regression analysis using Lasso and the forward stepwise approach revealed that the median age ranks first in importance among the examined variables, followed by the temperature and the delays in taking first governmental measures or issuing stay-at-home orders.
Climate change has led to increases in global temperatures, raising concerns regarding the threat of lethal heat waves and deterioration of the thermal environment. In the present study, we adopted two methods for spatial modelling of the thermal environment based on sensible heat and temperature. A vulnerability map reflecting daytime temperature was derived to plot thermal vulnerability based on sensible heat and climate change exposure factors. The correlation (0.73) between spatial distribution of sensible heat vulnerability and mortality rate was significantly greater than that (0.30) between the spatial distribution of temperature vulnerability and mortality rate. These findings indicate that deriving thermally vulnerable areas based on sensible heat are more objective than thermally vulnerable areas based on existing temperatures. Our findings support the notion that the distribution of sensible heat vulnerability at the community level is useful for evaluating the thermal environment in specific neighbourhoods. Thus, our results may aid in establishing spatial planning standards to improve environmental sustainability in a metropolitan community.
The recent emergence of Vibrio infections at high latitudes represents a clear human health risk attributable to climate change. Here, we investigate the population dynamics of three Vibrio species: Vibrio parahaemolyticus, Vibrio vulnificus and Vibrio cholerae within a British coastal estuarine site, with contrasting salinity and temperature regimes during an intense heatwave event. Water samples were collected weekly through the summer of 2018 and 2019 and filtered using membrane filtration and subsequently grown on selective media. Suspected vibrios were confirmed using a conventional species-specific PCR assay and further analysed for potential pathogenic markers. Results showed that Vibrio parahaemolyticus, Vibrio vulnificus and Vibrio cholerae were present at high concentrations throughout both years, with their populations at substantially greater abundances corresponding to conditions of higher water temperatures during the heatwave of 2018 and at lower salinity sites, which is comparable to the results of previous studies. A subset of strains isolated during the extreme heatwave event in 2018 (46 Vibrio parahaemolyticus, 11 Vibrio cholerae and 4 Vibrio vulnificus) were genomically sequenced. Analysis of these 63 sequenced strains revealed a broad phenotypic and genomic diversity of strains circulating in the environment. An analysis of pathogenicity attributes identified a broad array of virulence genes across all three species, including a variety of genes associated with human disease. This study highlights the importance of the need for an increased Vibrio spp. surveillance system in temperate regions and the potential impact warming events such as heatwaves may have on the abundance of potentially pathogenic bacteria in the environment.
India and other Southeast Asian countries are severely affected by Japanese encephalitis (JE), one of the deadliest vector-borne disease threat to human health. Several epidemiological observations suggest climate variables play a role in providing a favorable environment for mosquito development and virus transmission. In this study, generalized additive models were used to determine the association of JE admissions and mortality with climate variables in Gorakhpur district, India, from 2001-2016. The model predicted that every 1 unit increase in mean (Tmean;°C), and minimum (Tmin;°C) temperature, rainfall (RF; mm) and relative humidity (RH; %) would on average increase the JE admissions by 22.23 %, 17.83 %, 0.66 %, and 5.22 % respectively and JE mortality by 13.27 %, 11.77 %, 0.94 %, and 3.27 % respectively Conversely, every unit decrease in solar radiation (Srad; MJ/m(2)/day) and wind speed (WS; Kmph) caused an increase in JE admission by 17% and 11.42% and in JE mortality by 9.37% and 4.88% respectively suggesting a protective effect at higher levels. The seasonal analysis shows that temperature was significantly associated with JE in pre-monsoon and post-monsoon while RF, RH, Srad, and WS are associated with the monsoon. Effect modification due to age and gender showed an equal risk for both genders and increased risk for adults above 15 years of age, however, males and age groups under 15 years outnumbered females and adults. Sensitivity analysis results to explore lag effects in climate variables showed that climate variables show the strongest association at lag 1 to 1.5 months with significant lag effect up tp lag 0-60 days. The exposure-response curve for climate variables showed a more or less linear relationship, with an increase in JE admissions and mortality after a certain threshold and decrease were reported at extreme levels of exposure. The study concludes that climate variables could influence the JE vector development and multiplication and parasite maturation and transmission in the Gorakhpur region whose indirect impact was noted for JE admission and mortality. In response to the changing climate, public health interventions, public awareness, and early warning systems would play an unprecedented role to compensate for future risk.
Kerteszia cruzii is a sylvatic mosquito and the primary vector of Plasmodium spp., which can cause malaria in humans in areas outside the Amazon River basin in Brazil. Anthropic changes in the natural environments are the major drivers of massive deforestation and local climate change, with serious impacts on the dynamics of mosquito communities and on the risk of acquiring malaria. Considering the lack of information on the dynamics of malaria transmission in areas across the Atlantic Forest biome, where Ke. cruzii is the dominant vector, and the impact of climate drivers of malaria, the present study aimed to: (i) investigate the occurrence and survival rate of Ke. cruzii based on the distinct vegetation profiles found in areas across the coastal region of the Brazilian Atlantic Forest biome; (ii) estimate the extrinsic incubation period (EIP) and survival rates of P. vivax and P. falciparum parasites in Ke. cruzii under current and future scenarios. The potential distribution of Plasmodium spp. was estimated using simulation analyses under distinct scenarios of average temperature increases from 1 °C to 3.7 °C. Our results showed that two conditions are necessary to explain the occurrence and survival of Ke. cruzii: warm temperature and presence of the Atlantic Forest biome. Moreover, both Plasmodium species showed a tendency to decrease their EIP and increase their estimated survival rates in a scenario of higher temperature. Our findings support that the high-risk malaria areas may include the southern region of the distribution range of the Atlantic Forest biome in the coming years. Despite its limitations and assumptions, the present study provides robust evidence of areas with potential to be impacted by malaria incidence in a future scenario. These areas should be monitored in the next decades regarding the occurrence of the mosquito vector and the potential for malaria persistence and increased occurrence.
Historical declines in multiple insect taxa have been documented across the globe in relation to landscape-level changes in land use and climate. However, declines have either not been universally observed in all regions or examined for all species. Because mosquitoes are insects of public health importance, we analyzed a longitudinal mosquito surveillance data set from Connecticut (CT), United States (U.S.) from 2001 to 2019 to identify changes in mosquito community composition over time. We first analyzed annual site-level collections and metrics of mosquito community composition with generalized linear/additive mixed effects models; we also examined annual species-level collections using the same tools. We then examined correlations between statewide collections and weather variables as well as site-level collections and land cover classifications. We found evidence that the average trap night collection of mosquitoes has increased by ~?60% and statewide species richness has increased by ~?10% since 2001. Total species richness was highest in the southern portion of CT, likely due to the northward range expansion of multiple species within the Aedes, Anopheles, Culex, and Psorophora genera. How the expansion of mosquito populations in the northeast U.S. will alter mosquito-borne pathogen transmission in the region will require further investigation.
BACKGROUND: Hypernatraemia is associated with morbidity and mortality, particularly in the older person. Last summer, Ireland experienced prolonged periods of excessive heat. The Irish meteorological service defines a heatwave as temperatures exceeding 25°C for five consecutive days. AIM: This study sought to compare the frequency of hypernatraemia (sodium (Na+) >145 mmol/l) observed during a modest heatwave with that during average ambient temperature in the temperate Irish climate. DESIGN: Retrospective cross-sectional analysis with nested case-control study. METHODS: The 10-day period from 24 June to 3 July in 2017 and 2018 were chosen as the control and heatwave periods, respectively. Patients aged >65 with at least one Na+ value recorded on the laboratory information system were included. Local meteorological data, age, gender and Na+ levels were evaluated. RESULTS: Maximum air temperatures were significantly higher during the heatwave period (mean 27°C vs. 16.8°C, P?
Rapid and significant range expansion of both Zika virus (ZIKV) and its Aedes vector species has resulted in ZIKV being declared a global health threat. Mean temperatures are projected to increase globally, likely resulting in alterations of the transmission potential of mosquito-borne pathogens. To understand the effect of diurnal temperature range on the vectorial capacity of Ae. aegypti and Ae. albopictus for ZIKV, longevity, blood-feeding and vector competence were assessed at two temperature regimes following feeding on infectious blood meals. Higher temperatures resulted in decreased longevity of Ae. aegypti [Log-rank test, ?2, df 35.66, 5, P < 0.001] and a decrease in blood-feeding rates of Ae. albopictus [Fisher's exact test, P < 0.001]. Temperature had a population and species-specific impact on ZIKV infection rates. Overall, Ae. albopictus reared at the lowest temperature regime demonstrated the highest vectorial capacity (0.53) and the highest transmission efficiency (57%). Increased temperature decreased vectorial capacity across groups yet more significant effects were measured with Ae. aegypti relative to Ae. albopictus. The results of this study suggest that future increases in temperature in the Americas could significantly impact vector competence, blood-feeding and longevity, and potentially decrease the overall vectorial capacity of Aedes mosquitoes in the Americas.
Winter activities on ice are culturally important for many countries, yet they constitute a high safety risk depending upon the stability of the ice. Because consistently cold periods are required to form stable and thick ice, warmer winters could degrade ice conditions and increase the likelihood of falling through the ice. This study provides the first large-scale assessment of winter drowning from 10 Northern Hemisphere countries. We documented over 4000 winter drowning events. Winter drownings increased exponentially in regions with warmer winters when air temperatures neared 0°C. The largest number of drownings occurred when winter air temperatures were between -5°C and 0°C, when ice is less stable, and also in regions where indigenous traditions and livelihood require extended time on ice. Rates of drowning were greatest late in the winter season when ice stability declines. Children and adults up to the age of 39 were at the highest risk of winter drownings. Beyond temperature, differences in cultures, regulations, and human behaviours can be important additional risk factors. Our findings indicate the potential for increased human mortality with warmer winter air temperatures. Incorporating drowning prevention plans would improve adaptation strategies to a changing climate.
BACKGROUND: Both extreme heat and air pollution exposure during pregnancy have been associated with preterm birth; however, their combined effects are unclear. OBJECTIVES: Our goal was to estimate the independent and joint effects of heatwaves and fine particulate matter [PM < 2.5 ?m in aerodynamic diameter (PM2.5)], exposure during the final gestational week on preterm birth. METHODS: Using birth registry data from Guangzhou, China, we included 215,059 singleton live births in the warm season (1 May-31 October) between January 2015 and July 2017. Daily meteorological variables from 5 monitoring stations and PM2.5 concentrations from 11 sites were used to estimate district-specific exposures. A series of cut off temperature thresholds and durations (2, 3, and 4 consecutive d) were used to define 15 different heatwaves. Cox proportional hazard models were used to estimate the effects of heatwaves and PM2.5 exposures during the final week on preterm birth, and departures from additive joint effects were assessed using the relative excess risk due to interaction (RERI). RESULTS: Numbers of preterm births increased in association with heatwave exposures during the final gestational week. Depending on the heatwave definition used, hazard ratios (HRs) ranged from 1.10 (95% CI: 1.01, 1.20) to 1.92 (1.39, 2.64). Associations were stronger for more intense heatwaves. Combined effects of PM2.5 exposures and heatwaves appeared to be synergistic (RERIs > 0) for less extreme heatwaves (i.e., shorter or with relatively low temperature thresholds) but were less than additive (RERIs < 0) for more intense heatwaves. CONCLUSIONS: Our research strengthens the evidence that exposure to heatwaves during the final gestational week can independently trigger preterm birth. Moderate heatwaves may also act synergistically with PM2.5 exposure to increase risk of preterm birth, which adds new evidence to the current understanding of combined effects of air pollution and meteorological variables on adverse birth outcomes. https://doi.org/10.1289/EHP5117.
BACKGROUND: Due to variations in climatic conditions, the effects of meteorological factors and PM(2.5) on influenza activity, particularly in subtropical regions, vary in existing literature. In this study, we examined the relationship between influenza activity, meteorological parameters, and PM(2.5) . METHODS: A total of 20 165 laboratory-confirmed influenza cases in Hangzhou, Zhejiang province, were documented in our dataset and aggregated into weekly counts for downstream analysis. We employed a combination of the quasi-Poisson-generalized additive model and the distributed lag non-linear model to examine the relationship of interest, controlling for long-term trends, seasonal trends, and holidays. RESULTS: A hockey-stick association was found between absolute humidity and the risk of influenza infections. The overall cumulative adjusted relative risk (ARR) was statistically significant when weekly mean absolute humidity was low (<10 µg/m(3) ) and high (>17.5 µg/m(3) ). A slightly higher ARR was observed when weekly mean temperature reached over 30.5°C. A statistically significantly higher ARR was observed when weekly mean relative humidity dropped below 67%. ARR increased statistically significantly with increasing rainfall. For PM(2.5) , the ARR was marginally statistically insignificant. In brief, high temperature, wet and dry conditions, and heavy rainfall were the major risk factors associated with a higher risk of influenza infections. CONCLUSIONS: The present study contributes additional knowledge to the understanding of the effects of various environmental factors on influenza activities. Our findings shall be useful and important for the development of influenza surveillance and early warning systems.
The frequency and magnitude of extreme summer temperature events in the United States have increased in the past few decades. Long-term exposure to extreme summer temperatures can be detrimental to human health, due to potential risks of dehydration and thermoregulation strains on the cardiovascular system, which may often lead to heat-related mortality (HRM). The summer climate of the United States is influenced by variability in Atlantic and Pacific sea surface temperatures, driven in part by Atlantic Multidecadal Oscillation (AMO) and El-Nino Southern Oscillation (ENSO), respectively. However, the influence of AMO and ENSO on HRM in the United States has not been investigated. Here the longest time series of HRM spanning the past five decades is analyzed in relation with AMO and ENSO. We find that HRM doubled in the early-1990s, coinciding with the positive phase of the AMO. Furthermore, we note a positive association between the variability in HRM and summer temperatures across all regions of the United States, with the strongest association found over the Southern United States. Therefore, this research suggests that variability in Atlantic and Pacific sea surface temperatures has both a nationwide and regional impact on HRM in the United States. Hence, by understanding variability in sea surface temperatures, the future burden of heat-attributed emergencies during extreme summer temperature events can be reduced not only for the United States, but also worldwide.
International reports indicate a rising incidence of nontuberculous mycobacterial (NTM) disease. Many infectious diseases have seasonal variation in incidence, and major weather events and climate change have been implicated. The aim of this study was to explore the relationship between climate variables and NTM incident cases in Queensland, Australia. METHODS: NTM data were obtained from the Queensland notifiable conditions database for the period 2001-2016. Rainfall and temperature data were obtained from the Australian Bureau of Meteorology. Poisson regression models were used to assess notification rates (incidence cases per 100,000 population) over time and to estimate incidence rate ratios (IRR). Cross correlation coefficients were used to examine the relationship between rainfall and temperature data and NTM incidence over time in each Hospital and Health Service (HHS). RESULTS: 12,219 NTM cases were reported. The most common species was M. intracellulare (39.1%), followed by M. avium (9.8%), M abscessus (8.5%), M. fortuitum (8.3%), M. chelonae (3.3%), and M. kansasii (2.4%). The estimated incidence rate increased from 11.10 (95% CI 8.10-15.22) in 2001 to 25.88 (95%CI 21.78-30.73) per 100,000 in 2016. The estimated IRR increased for all common species, except M. kansasii. Although increased IRRs were observed for most NTM species, geospatial heterogeneity was observed. The effect of rainfall and temperature on NTM incidence differed between species and geographic regions. CONCLUSIONS: The incidence of NTM infections increased between 2001 and 2016. Variations in temperature and rainfall may play a role in environmental exposure to some species of NTM. Spatial variation in IRR suggests that there may also be other environmental factors that influence transmission.
OBJECTIVES: Human sexual dimorphism is frequently assessed through skull and pelvic size and shape. Researchers suggest that climatic variation and the associated stress may be significant factors in sexual dimorphism’s etiology. However, little research has specifically investigated climatic effects on nonmetric skeletal indicators of sex. To further appreciate the plasticity of human biology, a comparative study of standard skull and pelvic nonmetric sex indicators is presented. METHODS: A Native Alaskan archeological sample (n = 104) and a component of the Terry collection (n = 99) represent populations originating from different climatic environments in recent history. These sex-balanced groups are compared through Tukey-Kramer’s method and Greene’s t-test to determine any variation in degree of sexual dimorphism within and between samples. RESULTS: The results reinforce the complex and multifaceted relationship between climate and sexual dimorphism. The Terry sample demonstrated a greater degree of sexual dimorphism with statistically significant differences in robusticity of the mastoid process and nuchal crest compared with the Native Alaskans. A more “male” morphotype and reduced dimorphism are appreciated in the pelves of Native Alaskans than the Terry sample. CONCLUSIONS: This research highlights a reduction in sexual dimorphism in populations under greater climatic stress and contributes to the production of more accurate skeletal assessments in future investigations. Discussion of confounding factors suggest more research is necessary to untangle climate and human morphology’s complex relationship. This study contributes to a greater appreciation of human biological plasticity, ecogeographic variation, and the evolution of modern human diversity.
AIM: To elucidate possible causal relationships on climate change and intracranial haematomas. MATERIAL and METHODS: In a retrospective study we examined all patients (N=1169) treated for subarachnoid haemorrhage (SAH; n=484), intracerebral haemorrhage (ICH; n=417) or chronic subdural haematoma (CSDH; n=268) in our department over a 7-year-period between 1st June 2005 until 31th May 2012. The date of admission was correlated with the corresponding meteorological parameters which included; mean daily temperature (degrees C), relative humidity (%), vapor pressure (hPa), barometric pressure (hPa), cloud amount (/8), and wind speed (m/s). RESULTS: Incidence of SAH tended to increase in April, ICH in January and CSDH in July, respectively, but X-2 test did not reveal any statistical significance in seasonality for the three bleeding pathologies. Comparing the arithmetic average of meteorological key parameters of uneventful and eventful days by using student’s t-test within the three groups (SAH, ICH, CSDH) we could not demonstrate any statistical significance (p>0.05). For SAH, logistic regression analyses revealed an increased risk associated with a decrease of barometric pressure (p=0.021). CONCLUSION: Although our data suggest seasonal variabilities of SAH, ICH and CSDH, the single weather parameters do not demonstrate causal relationships with the incidence of cerebrovascular events. However, incidence of SAH tended to increase with changes of barometric pressure which confirms previously published results and might indicate a possible underlying relationship.
OBJECTIVE: To explore associations between temperature, humidity and hand, foot and mouth disease (HFMD) incidence in Guangzhou, China from 2013 to 2017. METHODS: A distributed lag non-linear model was applied to estimate the effects of daily temperature and humidity on HFMD incidence after adjusting for long-term trends, seasonal trends, and day of the week. RESULTS: In total, 353,431 confirmed HFMD cases were reported in Guangzhou over the study period. A bimodal seasonal pattern was observed. High temperatures had acute short-term effects on HFMD incidence that declined quickly over time. The effects of low humidity declined over lag periods, but increased when the humidity surpassed 60.5%. Temperature and humidity were both inversely associated with HFMD incidence during lag days 0 to 3 and with lag periods. CONCLUSIONS: Temperature and humidity play important roles in HFMD incidence. These data are important for developing public health strategies.
Although impacts of extremely cold temperatures on human health have been widely studied, adverse effects of other extreme weather phenomena have so far received much less attention. We employed a high-quality long-term mortality time series (1982-2017) to evaluate impacts of extreme winter weather in the Czech Republic. We aimed to clarify whether compound events of extreme weather cause larger impacts on mortality than do each type of extreme if evaluated individually. Using daily data from the E-OBS and ERA5 datasets, we analyzed 9 types of extreme events: extreme wind gust, precipitation, snowfall, and sudden temperature and pressure changes. Relative mortality deviations from the adjusted baseline were used to estimate the immediate effect of the selected extreme events on excess mortality. The impact was adjusted for the effect of extreme cold. Extreme events associated with sudden rise of minimum temperature and pressure drops had generally significant impact on excess mortality (3.7% and 1.4% increase). The impacts were even more pronounced if these events occurred simultaneously or were compounded with other types of extremes, such as heavy precipitation, snowfall, maximum temperature rise, and their combinations (increase as great as 14.4%). Effects of some compound events were significant even for combinations of extremes having no significant impact on mortality when evaluated separately. On the other hand, a “protective” effect of pressure increases reduced the risk for its compound events. Meteorological patterns during extreme events linked to excess mortality indicate passage of a low-pressure system northerly from the study domain. We identified extreme winter weather events other than cold temperatures with significant impact on excess mortality. Our results suggest that occurrence of compound extreme events strengthen the impacts on mortality and therefore analysis of multiple meteorological parameters is a useful approach in defining adverse weather conditions.
BACKGROUND: The aim of this study was to investigate the correlation between meteorological factors and the occurrence of acute aortic dissection (AAD) in Fujian Province, China. METHODS: The clinical data of 2004 patients diagnosed with AAD in our hospital and the relevant local meteorological data from January 2013 to November 2019 were retrospectively analyzed. RESULTS: The incidence of AAD had a clear tendency toward concentration, and the corresponding peak in terms of the occurrence date was from January 13 to 14. The average minimum temperature, the average maximum temperature, and the average daily temperature differences on the “day with AAD” were significantly lower than those on the “day without AAD”. From 5?days to 3?days before AAD onset, the average daily temperature difference showed a downward trend, but statistical analysis showed that the average minimum, average maximum and average daily temperature differences were not significantly different from the values 5?days to 0?days before AAD onset. CONCLUSIONS: The incidence of AAD is related to the season and month. The lowest average temperature may increase the incidence of AAD in patients with complicated cardiovascular diseases.
NEW FINDINGS: What is the central question of this study? Does passive heat acclimation alter glomerular filtration rate and urine-concentrating ability in response to passive heat stress? What is the main finding and its importance? Glomerular filtration rate remained unchanged after passive heat stress, and heat acclimation did not alter this response. However, heat acclimation mitigated the reduction in urine-concentrating ability and reduced the incidence of albuminuria in young healthy adults after passive heat stress. Collectively, these results suggest that passive heat acclimation might improve structural integrity and reduce glomerular permeability during passive heat stress. ABSTRACT: Little is known about the effect of heat acclimation on kidney function during heat stress. The purpose of this study was to determine the impact of passive heat stress and subsequent passive heat acclimation on markers of kidney function. Twelve healthy adults (seven men and five women; 26 ± 5 years of age; 72.7 ± 8.6 kg; 172.4 ± 7.5 cm) underwent passive heat stress before and after a 7 day controlled hyperthermia heat acclimation protocol. The impact of passive heat exposure on urine and serum markers of kidney function was evaluated before and after heat acclimation. Glomerular filtration rate, determined from creatinine clearance, was unchanged with passive heat stress before (pre, 133 ± 41 ml min(-1) ; post, 127 ± 51 ml min(-1) ; P = 0.99) and after (pre, 129 ± 46 ml min(-1) ; post, 130 ± 36 ml min(-1) ; P = 0.99) heat acclimation. The urine-to-serum osmolality ratio was reduced after passive heating (P < 0.01), but heat acclimation did not alter this response. In comparison to baseline, free water clearance was greater after passive heating before (pre, -0.86 ± 0.67 ml min(-1) ; post, 0.40 ± 1.01 ml min(-1) ; P < 0.01) but not after (pre, -0.16 ± 0.57 ml min(-1) ; post, 0.76 ± 1.2 ml min(-1) ; P = 0.11) heat acclimation. Furthermore, passive heating increased the fractional excretion rate of potassium (P < 0.03) but not sodium (P = 0.13) or chloride (P = 0.20). Lastly, heat acclimation reduced the fractional incidence of albuminuria after passive heating (before, 58 ± 51%; after, 8 ± 29%; P = 0.03). Collectively, these results demonstrate that passive heat stress does not alter the glomerular filtration rate. However, heat acclimation might improve urine-concentrating ability and filtration within the glomerulus.
Acute aortic syndromes (AAS) have been related to significant circadian and seasonal conditions. We used time series analyses to study the impact of meteorological variations on AAS occurrence. We retrospectively assessed 140 patients presenting with AAS over a 6-year period in a French university hospital. Average daily temperature (T) and atmospheric pressure (AP) at the location of the event were collected within the previous 10 days, and their association with AAS investigated with generalized additive models. A decrease in temperature of more than 5?°C within the previous seven days was significantly associated with an increased risk of AAS occurrence (OR equal to 1.86 [1.06; 3.44]). Subgroup analysis revealed that the risk was only significant among normotensive individuals (n?=?41) free from blood pressure lowering medication (OR equal to 2.3 [1.05; 5.37]), but not among hypertensive individuals under blood pressure lowering medication despite a larger patient number (n?=?99). Similarly, only among the subgroup of normotensive individuals a decrease of AP between 2 and 4 kPa within the previous 3 days was associated with an increased risk of AAS (OR equal to 2.93 [1.1; 8.15]) and an increased between 2 and 4 kPa was associated with a decreased risk (OR equal to 0.59 [0.36; 1.00]). Variations of meteorological conditions (temperature and AP) within the previous week seem to have effects on triggering AAS especially among the population free from blood pressure lowering medication.
Since Zika virus (ZIKV) emerged as a global human health threat, numerous studies have pointed to Aedes aegypti as the primary vector due to its high competence and propensity to feed on humans. The majority of vector competence studies have been conducted between 26-28°C, but arboviral extrinsic incubation periods (EIPs), and therefore transmission efficiency, are known to be affected strongly by temperature. To better understand the relationship between ZIKV EIPs and temperature, we evaluated the effect of adult mosquito exposure temperature on ZIKV infection, dissemination, and transmission in Ae. aegypti at four temperatures: 18°C, 21°C, 26°C, and 30°C. Mosquitoes were exposed to viremic mice infected with a 2015 Puerto Rican ZIKV strain, and engorged mosquitoes were sorted into the four temperatures with 80% RH and constant access to 10% sucrose. ZIKV infection, dissemination, and transmission rates were assessed via RT-qPCR from individual mosquito bodies, legs and wings, and saliva, respectively, at three to five time points per temperature from three to 31 days, based on expectations from other flavivirus EIPs. The median time from ZIKV ingestion to transmission (median EIP, EIP50) at each temperature was estimated by fitting a generalized linear mixed model for each temperature. EIP50 ranged from 5.1 days at 30°C to 24.2 days at 21°C. At 26°C, EIP50 was 9.6 days. At 18°C, only 15% transmitted by day 31 so EIP50 could not be estimated. This is among the first studies to characterize the effects of temperature on ZIKV EIP in Ae. aegypti, and the first to do so based on feeding of mosquitoes on a live, viremic host. This information is critical for modeling ZIKV transmission dynamics to understand geographic and seasonal limits of ZIKV risk; it is especially relevant for determining risk in subtropical regions with established Ae. aegypti populations and relatively high rates of return travel from the tropics (e.g. California or Florida), as these regions typically experience cooler temperature ranges than tropical regions.
BACKGROUND: Many studies have shown an association of childhood respiratory diseases with short-term temperature variability such as diurnal temperature range (DTR) and temperature change between two neighboring days (TCN). However, the impact of temperature variability on allergic rhinitis (AR) has not been investigated so far. This study sought to evaluate the short-term effect of temperature variability (i.e., TCN and DTR) on AR, as well as to identify vulnerable subpopulations. METHOD: We collected daily data on emergency room visits and outpatients for AR and weather variables in Hefei, China during 2014-2016. A distributed lag non-linear model that controlled for long-term trend and seasonality, mean temperature, relative humidity, day of week was used to fit the associations of AR with DTR and TCN. Stratified analyses by age, sex and occupation were also performed. RESULTS: During the study period, there were a total of 53,538 cases and the average values of DTR and TCN were 8.4?°C (range: 1.0?°C to 21.2?°C) and 0?°C (range: -?12.2?°C to 5.9?°C), respectively. While we did not observe an adverse effect of DTR on AR, TCN was significantly associated with increased risk of AR. Specifically, a large temperature drop between two adjacent days (3.8?°C, 5th percentile of TCN) has a delayed and short-lasting effect on AR, with the estimated relative risk of 1.02 (95% confidence interval: 1.01 to 1.04) at lag 12. Moreover, boys and children older than 15?years seemed to be more vulnerable to the effect of TCN. CONCLUSIONS: This study provided evidence of an adverse effect of large temperature drops between two adjacent days on childhood AR. Attention paid to boys and older children may help prevent AR attacks.
The sensitivities of meteorological and chemical predictions to urban effects over four major North American cities are investigated using the high-resolution (2.5-km) Environment and Climate Change Canada’s air quality model with the Town Energy Balance (TEB) scheme. Comparisons between the model simulation results with and without the TEB effect show that urbanization has great impacts on surface heat fluxes, vertical diffusivity, air temperature, humidity, atmospheric boundary layer height, land-lake circulation, air pollutants concentrations and Air Quality Health Index. The impacts have strong diurnal variabilities, and are very different in summer and winter. While the diurnal variations of the impacts share some similarities over each city, the magnitudes can be very different. The underlying mechanisms of the impacts are investigated. The TEB impacts on the predictions of meteorological and air pollutants over Toronto are evaluated against ground-based observations. The results show that the TEB scheme leads to a great improvement in biases and root-mean-square deviations in temperature and humidity predictions in downtown, uptown and suburban areas in the early morning and nighttime. The scheme also leads to a big improvement of predictions of NOx, PM2.5 and ground-level ozone in the downtown, uptown and industrial areas in the early morning and nighttime.
OBJECTIVE: The weather-related conditions change the ecosystem and pose a threat to social, economic and environmental development. It creates unprecedented or unanticipated human health problems in various places or times of the year. Africa is the world’s second largest and most populous continent and has relatively changeable weather conditions. The present study aims to investigate the impact of weather conditions, heat and humidity on the incidence and mortality of COVID-19 pandemic in various regions of Africa. MATERIALS AND METHODS: In this study, 16 highly populated countries from North, South, East, West, and Central African regions were selected. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization. The daily temperature and humidity figures were obtained from the weather web “Time and Date”. The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of “Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)” in the African region, from Feb 14 to August 2, 2020. RESULTS: In African countries, the daily basis mean temperature from Feb 14, 2020 to August 2, 2020 was 26.16±0.12°C, and humidity was 57.41±0.38%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.192, p<0.001) and deaths (r= -0.213, p<0.001). Similarly, a significant inverse correlation was found between temperature and the number of cases (r= -0.25, p<0.001) and deaths (r=-0.18, p<0.001). Furthermore, the regression results showed that with 1% increase in humidity the number of cases and deaths was significantly reduced by 3.6% and 3.7% respectively. Congruently, with 1°C increase in temperature, the number of cases and deaths was also significantly reduced by 15.1% and 10.5%, respectively. CONCLUSIONS: Increase in relative humidity and temperature was associated with a decrease in the number of daily cases and deaths due to COVID-19 pandemic in various African countries. The study findings on weather events and COVID-19 pandemic have an impact at African regional levels to project the incidence and mortality trends with regional weather events which will enhance public health readiness and assist in planning to fight against this pandemic.
In recent decades, the occurrence and distribution of arboviral diseases transmitted by Aedes aegypti mosquitoes has increased. In a new control strategy, populations of mosquitoes infected with Wolbachia are being released to replace existing populations and suppress arboviral disease transmission. The success of this strategy can be affected by high temperature exposure, but the impact of low temperatures on Wolbachia-infected Ae. aegypti is unclear, even though low temperatures restrict the abundance and distribution of this species. In this study, we considered low temperature cycles relevant to the spring season that are close to the distribution limits of Ae. aegypti, and tested the effects of these temperature cycles on Ae. aegypti, Wolbachia strains wMel and wAlbB, and Wolbachia phage WO. Low temperatures influenced Ae. aegypti life-history traits, including pupation, adult eclosion, and fertility. The Wolbachia-infected mosquitoes, especially wAlbB, performed better than uninfected mosquitoes. Temperature shift experiments revealed that low temperature effects on life history and Wolbachia density depended on the life stage of exposure. Wolbachia density was suppressed at low temperatures but densities recovered with adult age. In wMel Wolbachia there were no low temperature effects specific to Wolbachia phage WO. The findings suggest that Wolbachia-infected Ae. aegypti are not adversely affected by low temperatures, indicating that the Wolbachia replacement strategy is suitable for areas experiencing cool temperatures seasonally.
The aim of the present study was to evaluate the relationship between cognitive performance, health and environmental comfort as a function of indoor air temperature (T-a) variation. A total of 360 undergraduate students were subjected to the variation of the T-a at 20, 24 and 30 degrees C; their thermal responses were evaluated over three consecutive days. Performance variables measured in the study were cognitive performance, blood pressure, heart rate (HR) and comfort. The environmental variables measured were T-a, globe temperature (T-g), illumination, noise, airflow velocity and air quality. The variation in HR was influenced by the variables, relative air humidity and mean radiant temperature (T-rm) during the three days of observation, where HR was higher than 100 bpm when T-g was greater than T-a. T-rm increased proportionally to the increase in T-g, thus characterising heat exchange by radiation. The number of correct answers and test response time were also positively influenced by T-rm when T-a was 20 degrees C. Teaching environments (TEs) with increased heat load due to the individual body heat of students, increased outdoor T-a and urban morphology associated with the building of the TEs result in increasing in T-rm due to the T-g being higher than the air temperature, with possible impacts on health and performance variables.
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.
Urbanization and climate change have been rapidly occurring globally. Evidence-based healthy city development is required to improve living quality and mitigate the adverse impact of the outdoor neighborhood environment on public health. Taking Guangzhou as an example to explore the association of neighborhood environment and public health and preferably to offer some implications for better future city development, we measured ten environmental factors (temperature (T), wind-chill index (WCI), thermal stress index (HSI), relative humidity (RH), average wind speed (AWS), negative oxygen ions (NOI), PM2.5, luminous flux (LF), and illuminance (I)) in four seasons in four typical neighborhoods, and the SF-36 health scale was employed to assess the physical and mental health of neighborhood residents in nine subscales (health transition(HT), physiological functions (PF), general health status (GH), physical pain (BP), physiological functions (RP), energy vitality (VT), mental health (MH), social function (SF), and emotional functions (RE)). The linear mixed model was used in an analysis of variance. We ranked the different environmental factors in relation to aspects of health and weighted them accordingly. Generally, the thermal environment had the greatest impact on both physical and mental health and the atmospheric environment and wind environment had the least impact on physical health and mental health, respectively. In addition, the physical health of the resident was more greatly affected by the environment than mental health. According to the results, we make a number of strategic suggestions for the renewal of the outdoor neighborhood environment in subtropical monsoon climate high-density cities and provide a theoretical basis for improving public health through landscape architecture at the neighborhood scale.
Climate change-related excess mortality estimates clearly demonstrate a dramatic impact on public health and human mortality. However, life expectancy at birth is more easily communicated and understood by the public. By properly situating climate change mortality within the contexts of life expectancy, we better represent the cost of climate change on longevity. In this paper, we convert excess mortality estimates due to increases in extreme weather from climate change (heat waves, cold waves, droughts, wildfires, river and coastal floods, and windstorms) into potential reductions in life expectancy at birth in thirty-one European countries. We project climate change extremes to reduce life expectancy at birth by 0.24 years for the average European country with differences in excess of 1.0 years in some countries by 2100. We only estimate the impact of mortality directly related to climate extremes, making our estimates conservative. Thus, the cost of inaction on climate change could approach, and likely to exceed, one year of life in some European countries.
Continental-scale models of malaria climate suitability typically couple well-established temperature-response models with basic estimates of vector habitat availability using rainfall as a proxy. Here we show that across continental Africa, the estimated geographic range of climatic suitability for malaria transmission is more sensitive to the precipitation threshold than the thermal response curve applied. To address this problem we use downscaled daily climate predictions from seven GCMs to run a continental-scale hydrological model for a process-based representation of mosquito breeding habitat availability. A more complex pattern of malaria suitability emerges as water is routed through drainage networks and river corridors serve as year-round transmission foci. The estimated hydro-climatically suitable area for stable malaria transmission is smaller than previous models suggest and shows only a very small increase in state-of-the-art future climate scenarios. However, bigger geographical shifts are observed than with most rainfall threshold models and the pattern of that shift is very different when using a hydrological model to estimate surface water availability for vector breeding.
INTRODUCTION: Snakebites represent a serious global public health problem, especially in tropical countries. In Brazil, the incidence of snakebites ranges from 19 to 22 thousand cases per 100000 persons annually. The state of Rondônia, in particular, has had an increasing incidence of snakebites. METHODS: A retrospective cross-sectional study on snakebites was conducted from January 2007 to December 2018. Brazil’s Information System for Notifiable Diseases was queried for all snakebites reported in Porto Velho, Ariquemes, Cacoal, and Vilhena. Data on land surface temperatures during the day and night, precipitation, and humidity were obtained using the Google Earth Engine. A Bayesian time series model was constructed to describe the pattern of snakebites and their relationship with climate data. RESULTS: In total, 6326 snakebites were reported in Rondônia. Accidents were commonly caused by Bothrops sp. (n=2171, 81.80%). Snakebites most frequently occurred in rural areas (n=2271, 85.5%). Men, with a median age of 34 years (n=2101, 79.1%), were the most frequent bitten. Moderate clinical manifestation was the most common outcome of an accident (n=1101, 41.50%). There were clear seasonal patterns with respect to rainfall, humidity, and temperature. Rainfall and land surface temperature during the day or night did not increase the risk of snakebites in any city; however, changes in humidity increased the risk of snakebites in all cities. CONCLUSION: This study identified the population exposed to snakes and the influence of anthropic and climatic factors on the incidence of snakebites. According to climate data, changes in humidity increased the risk of snakebites.
Background: Few studies have previously explored the relationship between hand, foot, and mouth disease (HFMD) and meteorological factors with the effect modification of air pollution, and these studies had inconsistent findings. We therefore applied a time-series analysis assessing the effects of temperature and humidity on the incidence of HFMD in Wuhan, China to deepen our understanding of the relationship between meteorological factors and the risk of HFMD. Methods: Daily HFMD cases were retrieved from Hubei Provincial Center for Disease Control and Prevention from 1 February 2013 to 31 January 2017. Daily meteorological data including 24 h average temperature, relative humidity, wind velocity, and atmospheric pressure were obtained from Hubei Meteorological Bureau. Data on Air pollution was collected from 10 national air-monitoring stations in Wuhan city. We adopted a distributed lag non-linear model (DLNM) combined with Poisson regression and time-series analysis to estimate the effects of temperature and relative humidity on the incidence HFMD. Results: We found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate “M” shape with two peaks occurring at 2.3 °C (RR = 1.760, 95% CI: 1.218-2.542) and 27.9 °C (RR = 1.945, 95% CI: 1.570-2.408), respectively. We observed an inverted “V” shape between relative humidity and HFMD. The risk of HFMD reached a maximum value at a relative humidity of 89.2% (RR = 1.553, 95% CI: 1.322-1.824). The largest delayed cumulative effects occurred at lag 6 for temperature and lag 13 for relative humidity. Conclusions: The non-linear relationship between meteorological factors and the incidence of HFMD on different lag days could be used in the early targeted warning system of infectious diseases, reducing the possible outbreaks and burdens of HFMD among sensitive populations.
It is an overwhelming concern that increases in global average temperature lead to serious consequences on the natural environment in the form of deteriorating water resource quality and damaging healthcare sustainability agenda. The sustainable innovation forum (COP21) shows a high concern on climate changes and suggested to reduce global average temperature less than 2 °C. The study brings an idea from the stated theme and analyzed the relationship between climate change and water resource quality in order to redesign economic and environmental policies to improve water quality and healthcare sustainability in the context of Pakistan. The country has serious issues regarding the provision of safe drinking water, improved water resource quality, and healthcare sustainability, which can be achieved by sustainable policies to handle the extreme temperature in Pakistan. The study employed simultaneous generalized method of moments (GMM) technique in order to estimate parameters of the study during the period of 1980-2016. The results show that energy demand and industry value added substantially decrease water resource quality (WRQ), while agriculture value added and per capita income significantly increase WRQ in a country. The other regression apparatus, where health expenditures serve as the response variable, shows that average temperature, industry value added, population growth, and foreign direct investment (FDI) inflows significantly increase healthcare expenditures while WRQ has a negative impact on healthcare expenditures in a country. The final regression model shows that average temperature and per capita income decrease, while WRQ and industrial value added increase mortality rate in a country. The overall results confirm that WRQ affected by climate change, energy demand, and population growth that need sustainable water resource policies in order to achieve long-term sustained growth. The climate actions required more policy instruments to combat environmental challenges that should support healthcare sustainability agenda across the globe.
OBJECTIVES: Pneumonia is a significant contributor to mortality and morbidity in children aged <5 years, and it is also one of the leading causes of hospitalisation for children in this age group. This study assessed the association between climate variability, patient characteristics (i.e. age, sex, weight, parental education, socio-economic status) and length of stay (LOS) in hospital for childhood pneumonia and its economic impact on rural Bangladesh. STUDY DESIGN: An ecological study design was used. METHODS: Data on daily hospitalisation for pneumonia in children aged <5 years (including patient characteristics) and daily climate data (temperature and relative humidity) between 1st January 2012 and 31st December 2016 were obtained from the Matlab Hospital (the International Centre for Diarrhoeal Disease Research, Bangladesh) and the Bangladesh Meteorological Department, respectively. A generalised linear model with Poisson link was used to quantify the association between climate factors, patient characteristics and LOS in hospital. RESULTS: The study showed that average temperature, temperature variation and humidity variation were positively associated with the LOS in hospital for pneumonia. A 1°C rise in average temperature and temperature variation during hospital stay increased the LOS in hospital by 1% (relative risk [RR]: 1.010, 95% confidence interval [CI]: 1.001-1.018) and 9.3% (RR: 1.093, 95% CI: 1.051-1.138), respectively. A 1% increase in humidity variation increased the LOS in hospital for pneumonia by 2.2% (RR: 1.022, 95% CI: 1.004-1.039). In terms of economic impact, for every 1° C temperature variation during the period of hospital stay, there is an addition of 0.81 USD/day/patient as a result of direct costs and 1.8 USD/day/patient for total costs. Annually, this results in an additional 443 USD for direct and 985 USD for total costs. CONCLUSIONS: Climate variation appears to significantly contribute to the LOS in hospital for childhood pneumonia. These findings may help policymakers to develop effective disease management and prevention strategies.
The impact of climate factors on the epidemiology of diseases in general and leishmaniasis in particular continues to be a subject of research and analysis. Changes in climatic parameters contribute to the creation of ecological conditions favorable to the multiplication of the vectors of certain diseases. With this in mind, this study presents an entomological survey conducted in Meknes prefecture and the study of the link between the abundance of sandflies, an indicator of the risk of leishmaniasis in a given area, and the climatic factors. Monthly trapping of this fauna was carried out during a year from March 2016 until April 2017 using adhesive traps. Climatic data from the region were used to determine the effect of climate on the distribution of sandflies. A total of 941 leishmaniasis vector specimens were captured. The dominant species is Ph. sergenti (73.32), followed by Ph. longicuspis (8.25%), then Ph. perniciosus (7.94%) and Ph. papatasi (6.31%). The sex ratio study showed that males are more abundant than females for all species. The seasonal fluctuation is bimodal with two peaks, the first in July and the second in September. The results show a positive correlation between temperature and abundance of sandflies (r?=?0.99) and a negative correlation with humidity and precipitation with a correlation coefficient of r?=?-0.87 and r?=?-0.72. Indeed, the medium-term climatological forecasts are essential tools to develop a warning system for leishmaniasis.
Background: Around 2-3% of hospitalizations have been reported due to dermatological adverse drug reactions. Recent studies suggest that climatic variations affect the skin barrier function and extreme conditions aggravate skin disorders.
Objective: The present study was designed to compare the impact of climatic variations on drug-induced skin reactions in the Northern and Eastern regions of India. Methods: We performed a one-year retrospective study to evaluate the impact of climatic variations (temperature and humidity) in Eastern (Kalyani, West Bengal) and Northern (Karnal, Haryana) regions on drug-induced skin reactions. Drug-induced skin reactions were reported month-wise in both the Eastern and Northern regions. Temperature and humidity level were also noted month-wise in both the regions. The direct correlation between climatic variations and number of drug reactions were assessed using Pearson’s correlation and quadratic regression analysis.
Results and Discussion: Overall, 99 and 81 dermatological adverse drug reactions were reported in tertiary care hospitals in the Northern and Eastern regions, respectively. During the summer season, the humidity level was found to be low in the Northern region as compared to the Eastern region. During this period, drug-induced skin reactions were reported significantly (p<0.05) more in the Northern region as compared to the Eastern region. Furthermore, quadratic regression analysis revealed that climatic variations contributed to drug reaction variability in the Northern region (68.5%) and Eastern region (23.5%).
Conclusion: Therefore, the difference in the prevalence of drug-induced skin reactions may be related to the different climatic conditions among these two regions. Further studies in controlled climatic conditions should be performed for definitive correlations and to look into possible solutions.
.BACKGROUND: Cutaneous leishmaniasis (CL) is a dermal and parasitic disease.. The aim of this study was to determine the effect of environmental and climate factors on spatial distribution of CL in northeastern Iran by utilizing remote sensing from 20 March 2016 to 19 March 2017. METHODS: In this ecological study, the data were divided into two parts: The descriptive data on human CL cases were gathered from Communicable Diseases center of Iran. The remote sensing techniques and satellite imagery data (TRMM, MODIS-Aqua, MODIS-Terra and AMSR-2 with spatial resolution 0.25°, 0.05°, 5600m and 10km) of environmental and climate factors were used to determine the spatial pattern changes of cutaneous leishmaniasis incidence. RESULTS: The incidence of CL in North Khorasan, Razavi Khorasan, and South Khorasan was 35.80 per 100,000 people (309/863092), 34.14 per 100,000 people (2197/6,434,501) and 7.67 per 100,000 people (59/768,898), respectively. The incidence of CL had the highest correlation with soil moisture and evapotranspiration. Moreover, the incidence of disease was significantly correlated with Normalized Difference Vegetation Index (NDVI) and air humidity while it had the lowest correlation with rainfall. Furthermore, the CL incidence had an indirect correlation relation with the air temperature meaning that with an increase in the temperature, the incidence of disease decreased. CONCLUSION: As such, the incidence of disease was also higher in the northern regions; most areas of North Khorasan and northern regions of Razavi Khorasan; where the rainfall, vegetation, specific humidity, evapotranspiration, and soil moisture was higher than the southern areas.
Coronavirus Disease 2019 (COVID-19) pandemic poses extreme threat to public health and economy, particularly to the nations with higher population density. The disease first reported in Wuhan, China; later, it spreads elsewhere, and currently, India emerged as COVID-19 hotspot. In India, we selected 20 densely populated cities having infection counts higher than 500 (by 15 May) as COVID-19 epicenters. Daily COVID-19 count has strong covariability with local temperature, which accounts approximately 65-85% of the explained variance; i.e., its spread depends strongly on local temperature rise prior to community transmission phase. The COVID-19 cases are clustered at temperature and humidity ranging within 27-32°C and 25-45%, respectively. We introduce a combined temperature and humidity profile, which favors rapid COVID-19 growth at the initial phase. The results are highly significant for predicting future COVID-19 outbreaks and modeling cities based on environmental conditions. On the other hand, CO(2) emission is alarmingly high in South Asia (India) and entails high risk of climate change and extreme hot summer. Zoonotic viruses are sensitive to warming induced climate change; COVID-19 epicenters are collocated on CO(2) emission hotspots. The COVID-19 count distribution peaks at 31.0°C, which is 1.0°C higher than current (2020) and historical (1961-1990) mean, value. Approximately, 72% of the COVID-19 cases are clustered at severe to record-breaking hot extremes of historical temperature distribution spectrum. Therefore, extreme climate change has important role in the spread of COVID-19 pandemic. Hence, a strenuous mitigation measure to abate greenhouse gas (GHG) emission is essential to avoid such pandemics in future.
Introduction and objectives. The increase in mortality and hospital admissions associated with high and low temperatures is well established. However, less is known about the influence of extreme ambient temperature conditions on cardiovascular ambulance dispatches. This study seeks to evaluate the effects of minimum and maximum daily temperatures on cardiovascular morbidity in the cities of Vigo and A Coruña in North-West Spain, using emergency medical calls during the period 2005-2017. Methods. For the purposes of analysis, we employed a quasi-Poisson time series regression model, within a distributed non-linear lag model by exposure variable and city. The relative risks of cold- and heat-related calls were estimated for each city and temperature model. Results. A total of 70,537 calls were evaluated, most of which were associated with low maximum and minimum temperatures on cold days in both cities. At maximum temperatures, significant cold-related effects were observed at lags of 3-6 days in Vigo and 5-11 days in A Coruña. At minimum temperatures, cold-related effects registered a similar pattern in both cities, with significant relative risks at lags of 4 to 12 days in A Coruña. Heat-related effects did not display a clearly significant pattern. Conclusions. An increase in cardiovascular morbidity is observed with moderately low temperatures without extremes being required to establish an effect. Public health prevention plans and warning systems should consider including moderate temperature range in the prevention of cardiovascular morbidity.
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.
Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.
People exposed to heat experience symptoms of varying severity, from mild manifestations to heat stroke. Due to global warming, interest in the impact of heat exposure on human health has been increasing. This study investigated the association between outdoor thermal conditions and heat-related symptoms experienced by pedestrians in a temperate-Mediterranean and hot semi-arid climate. In the study, pedestrians participated in questionnaire-based surveys at outdoor sites in Cyprus in summer and autumn 2019 while the weather conditions at the sites were recorded. In the surveys, pedestrians reported whether they had experienced heat-related symptoms. The physiologically equivalent temperature (PET) was used to estimate the effect of the thermal environment. Statistical analyses of the data included the use of multivariable logistic regression models. In total, 1880 individuals (999 males, 54.2%; mean age +/- standard deviation 38.4 +/- 18.4 years) responded to the surveys of heat-related symptoms. An increase of 1 degrees C in air temperature (adjusted odds ratio (aOR): 1.10, 95% confidence interval (CI): 1.04-1.16) or PET (aOR: 1.04, 95% CI: 1.01-1.07) was associated with an elevated probability of reporting heat-related symptoms. The magnitude of the association of PET with the reporting of heat-related symptoms was found to be higher for nonpermanent residents in Cyprus (aOR: 1.11, 95% CI: 1.02-1.21). Females were more likely than males to report heat-related symptoms (aOR: 2.36, 95% CI: 1.82-3.06). Visiting the monitoring site for work (aOR: 1.69, 95% CI: 1.26-2.26) or reporting a medical history of respiratory disease (aOR: 3.60, 95% CI: 2.39-5.42) were associated with an increased likelihood of reporting heat-related symptoms. The thermal conditions and participant characteristics were associated with increased reporting of heat-related symptoms during non-heat-wave but warm periods in Cyprus. These results could have implications for adaptation measures, healthcare delivery, and public health services.
More than four hundred million people suffer from respiratory diseases each year. Respiratory diseases are associated with a large disease burden. Heatwaves and cold spells, the two most common extreme weather events, have been shown to have crucial negative effects on the prevalence of respiratory diseases. However, impacts of extreme weather on the prevalence of respiratory diseases has been largely overlooked in western China, where more intense and frequent extreme temperature events have been occurring over the past decades. This research gap will obtain an attribution bias in the effects of extreme weather events on the prevalence of respiratory diseases. Therefore, in this study, we analyzed the impact of heatwaves and cold spells on the morbidity of respiratory diseases using a distributed lag nonlinear model with daily disease cases from 2013 to 2016 in Lanzhou, one of the largest cities in western China. A reverse U-shaped relationship depicted the relationship between temperature and the morbidity of respiratory diseases. The highest relative risk was found at 2.6 degrees C by 1.15 (95% confidence interval: 1.09-1.21). Furthermore, we found a significant decrease in the relative risk for heatwaves and a significant increase in the relative risk of cold spells when the temperature exceeded the corresponding threshold by 1 degrees C. Heatwaves and cold spells play harvest effects on the morbidity of respiratory diseases. Our study suggest that the relative risk of respiratory diseases will increase as the climate warms in the future, and thus a preventive system is needed for individuals and medical policy-makers.
The purpose of the present study is to explore the associations between novel coronavirus disease 2019 (COVID-19) case counts and meteorological factors in 30 provincial capital cities of China. We compiled a daily dataset including confirmed case counts, ambient temperature (AT), diurnal temperature range (DTR), absolute humidity (AH) and migration scale index (MSI) for each city during the period of January 20th to March 2nd, 2020. First, we explored the associations between COVID-19 confirmed case counts, meteorological factors, and MSI using non-linear regression. Then, we conducted a two-stage analysis for 17 cities with more than 50 confirmed cases. In the first stage, generalized linear models with negative binomial distribution were fitted to estimate city-specific effects of meteorological factors on confirmed case counts. In the second stage, the meta-analysis was conducted to estimate the pooled effects. Our results showed that among 13 cities that have less than 50 confirmed cases, 9 cities locate in the Northern China with average AT below 0 °C, 12 cities had average AH below 4 g/m(3), and one city (Haikou) had the highest AH (14.05 g/m(3)). Those 17 cities with 50 and more cases accounted for 90.6% of all cases in our study. Each 1 °C increase in AT and DTR was related to the decline of daily confirmed case counts, and the corresponding pooled RRs were 0.80 (95% CI: 0.75, 0.85) and 0.90 (95% CI: 0.86, 0.95), respectively. For AH, the association with COVID-19 case counts were statistically significant in lag 07 and lag 014. In addition, we found the all these associations increased with accumulated time duration up to 14 days. In conclusions, meteorological factors play an independent role in the COVID-19 transmission after controlling population migration. Local weather condition with low temperature, mild diurnal temperature range and low humidity likely favor the transmission.
Objective: To examine whether high ambient temperature and diurnal temperature range during the summer are associated with risk of stroke/transient ischemic attack (TIA). Methods: A time-stratified case-crossover study design was conducted. The study sample comprised all individuals aged >= 50 years who had a stroke/TIA reported to the Israeli National Stroke Registry between 2014 and 2016 during the summer season. Daily temperature data were retrieved from the Israel Meteorological Service. Conditional logistic regression models were used with relative humidity and air pollution as covariates. Results: The sample included 15,123 individuals who had a stroke/TIA during the summer season (mean age 73 +/- 12 years; 54% males). High ambient temperature was associated with stroke/TIA risk starting from the day before the stroke event, and increasing in strength over a six-day lag (OR = 1.10 95%CI 1.09-1.12). Moreover, a larger diurnal temperature range prior to stroke/TIA occurrence was associated with decreased stroke/TIA risk (OR = 0.96 95%CI 0.95-0.97 for a six-day lag). Conclusions: High ambient temperature may be linked to increased risk of cerebrovascular events in subsequent days. However, relief from the heat during the night may attenuate this risk.
STUDY OBJECTIVES: This study investigated the association between ambient nighttime temperature and sleep problems assessed by the prescription dose of sleeping pills in South Korean adults. METHODS: We used the 2002-2015 National Health Insurance Service-National Sample Cohort. A total of 711,079 adults who were 20 years old or older were included, wherein 42,858 adults (~6%) had been prescribed hypnotic medications including zolpidem (N05CF02) and triazolam (N05CD05). Ambient temperature data was calculated as the mean highest temperature of nighttime (23:00-07:00) for every month from January to December. We combined the drug-prescribed date with the administrative districts-level daily nighttime temperature between 2002 and 2015. RESULTS: We found that a non-linear, U-shaped relationship between nighttime temperature and hypnotic medication prescription. With an increase per 1°C temperature or an increase in a square per 1°C, the prescription dose of sleeping pills was significantly increased (both p < 0.05). At each 5°C nighttime temperature, subjects belonging to low (?0°C and 0-5°C) or high (20-25°C and ?25°C) temperature categories had significantly higher doses of sleeping pills than those at the reference temperature (10-15°C). Changes in nighttime temperature had a significant non-linear effect on the prescribed dosage of hypnotic medications for both adults (p < 0.0001) and the elderly (p = 0.0006). CONCLUSION: We found that either a high or low nighttime temperature was significantly associated with a high daily dose of hypnotic medications in the Korean population.
Epidemiology suggests ambient temperature is the triggers and potential activator of asthma. The role of high and low temperatures on airway inflammation of asthma, and the underlying molecular mechanism are not yet understood. A mouse model of asthma was adopted in our experiment. The BALB/c mice were exposed at different temperature for 4 h (2 h in the morning and 2 h in the afternoon) on weekday. The exposure temperatures were 10 degrees C, 24 degrees C and 40 degrees C. Ovalbumin (OVA) was used to sensitize the mice on days 14, 18, 22, 26, and 30, followed by an aerosol challenge for 30 min from day 32-38. After the final OVA challenge, lung function, serum protein and pulmonary inflammation were assessed. Comparing the OVA with the saline group at 24 degrees C, we saw a significant increase in: serum Total-IgE (p <0.05); OVA-sIgE (p <0.01); IL-4 (p <0.05); IL-beta (p <0.01); IL-6 (p <0.01); TNIF-alpha (p <0.01); and the ratio of IL-4/IFN-gamma (p <0.01). At the same time, there was a significant decrease in IFN-gamma (p <0.01). As the temperature increase, there is a U shape for immune proteins and pro-inflammatory factors with a peak value at 24 degrees C, exception for IFN-gamma (inverted U-shape). After the high and low temperature exposure, the Ri and Re increased significantly, while Cldyn decreased significantly compared with the 24 degrees C group. Histopathological analysis of the OVA groups showed airway remodeling, airway wall thickening and deforming, and subepithelial fibrosis. More obvious changes were found in the high and low temperature exposure groups. The immunohistochemistry suggested that TRPs changed with temperatures. High and low temperatures can aggravate airway inflammation in a mouse model of asthma. TRPs play an important role in temperature aggravation of allergic asthma. The results suggest that asthmatics should avoid exposure to high and low temperatures for too long time. (C) 2019 Elsevier Ltd. All rights reserved.
High temperatures are one of the main causes of work safety accidents associated with cognitive impairment. However, the effects of elevated ambient temperature on cognitive performance during moderate-intensity activities are unclear. In this study, subjects (N = 32) were exposed to four different air temperatures, i.e., 26, 30, 33, and 37 degrees C, and a relative humidity of 70% in a climate chamber. During the experiment, the subjects were required to complete neurobehavioral cognitive tests while walking on a treadmill with an estimated metabolic rate of 165 W/m(2). During the 90-min experiment, the tympanic temperature, weight loss, heart rate, and percentage of adjacent inter-beat cardiac intervals differing by > 50 ms (pNN50) were measured. Subjective responses were collected using questionnaires.The accuracy of subjects’ responses to the semantic interference and visual perception tests were significantly decreased at 37 degrees C after 45 min of exercise. Additionally, over the exposure period at 37 degrees C, the accuracy of various cognitive tests also decreased, while the speed increased. The changes in the cognitive test results at 37 degrees C were associated with the elevation of the tympanic temperature, heart rate, dehydration rate, and decline of the pNN50. Similarly, the elevated thermal discomfort and intensity of neurobehavioral symptoms were related to these changes.In conclusion, exposure to a temperature of 37 degrees C for 45 min has a negative impact on the accuracy of personnel with moderate-activity intensity. Therefore, 45 min is recommended as a safe time for continuous work with moderate intensity at 37 degrees C.
BACKGROUND: Health impacts of high temperatures on hospital emergency department visits (EDVs) have been less reported, especially from developing countries. OBJECTIVES: To investigate high temperature-EDVs relationship in various regions with different climatic characteristics, to explore the regional differences, to identify vulnerable populations, and to provide scientific evidence for climate change adaptation strategies in China. METHODS: Daily data on weather, air pollution and EDVs were collected from 18 sites in China from June to August during 2014-2017. A quasi-Poisson generalized additive regression model was applied to examine the high temperature-EDVs relationship in each site. Site-specific risks of EDVs were pooled using a random effect meta-analysis model. Stratified analyses were performed by gender, age-groups, cause-specific EDVs and regions. Attributable fractions of EDVs due to high temperatures were calculated in different regions. RESULTS: 1 °C increase in daily mean temperature was associated with 1.07% (95% CI, 0.46-1.67%) increase in EDVs across all study regions. The negative health effects from high temperatures were worse for the people living in southern China, in subtropical monsoon climate zone or in counties, with percentage change of 1.96% (95% CI, 0.92-3.02%), 1.35% (95% CI, 0.95-1.76%) and 1.41% (95% CI, 0.48-2.34%), respectively. People under 18 were more vulnerable to high temperatures. Exposure to high temperatures increased EDVs risks from endocrine, respiratory, and digestive diseases and injury. The attributable fraction due to high temperatures was 8.64% for overall EDVs, 11.70% for the people living in southern China, 10.80% for people living in subtropical monsoon climate zone and 12.65% for the county population. CONCLUSIONS: Exposure to high temperatures resulted in extra burden to China’s already overloaded hospital emergency departments. More resources are needed to meet increasing demands and effective preventative measurements are warranted to tackle such a challenge. Further studies should pay more attention to both heat and cold-related EDVs risks and socioeconomic cost for better climate change adaptation.
Overheated outdoor environments adversely impact urban sustainability and livability. Urban areas are particularly affected by heat waves and global climate change, which is a serious threat due to increasing heat stress and thermal risk for residents. The tropical city of Darwin, Australia, for example, is especially susceptible to urban overheating that can kill inhabitants. Here, using a modeling platform supported by detailed measurements of meteorological data, we report the first quantified analysis of the urban microclimate and evaluate the impacts of heat mitigation technologies to decrease the ambient temperature in the city of Darwin. We present a holistic study that quantifies the benefits of city-scale heat mitigation to human health, energy consumption, and peak electricity demand. The best-performing mitigation scenario, which combines cool materials, shading, and greenery, reduces the peak ambient temperature by 2.7 °C and consequently decreases the peak electricity demand and the total annual cooling load by 2% and 7.2%, respectively. Further, the proposed heat mitigation approach can save 9.66 excess deaths per year per 100,000 people within the Darwin urban health district. Our results confirm the technological possibilities for urban heat mitigation, which serves as a strategy for mitigating the severity of cumulative threats to urban sustainability.
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.
Findings of the association between hot weather and suicide in a subtropical city such as Hong Kong are inconsistent. This study aimed to revisit the association by identifying meteorological risk factors for older-adult suicides in Hong Kong using a time-series approach. A retrospective study was conducted on older-adult (aged ?65) suicide deaths in Hong Kong from 1976 to 2014. Suicides were classified into those involving violent methods and those involving nonviolent methods. Meteorological data, including ambient temperature, were retrieved. Transfer function time-series models were fitted. In total, 7314 older-adult suicide deaths involving violent methods and 630 involving nonviolent methods were recorded. For violent-method suicides, a monthly average daily minimum ambient temperature was determined to best predict the monthly rate, and a daily maximum ambient temperature of 30.3 °C was considered the threshold. For suicide deaths involving nonviolent methods, the number of days in a month for which the daily maximum ambient temperature exceeded 32.7 °C could best predict the monthly rate. Higher ambient temperature was associated with more older-adult suicide deaths, both from violent and nonviolent methods. Weather-focused preventive measures for older-adult suicides are necessary, such as the provision of more public air-conditioned areas where older adults can shelter from extreme hot weather.
Infectious diseases are a major health challenge for the worldwide population. Since their rapid spread can cause great distress to the real world, in addition to taking appropriate measures to curb the spread of infectious diseases in the event of an outbreak, proper prediction and early warning before the outbreak of the threat of infectious diseases can provide an important basis for early and reasonable response by the government health sector, reduce morbidity and mortality, and greatly reduce national losses. However, if only traditional medical data is involved, it may be too late or too difficult to implement prediction and early warning of an infectious outbreak. Recently, medical big data has become a research hotspot and has played an increasingly important role in public health, precision medicine, and disease prediction. In this paper, we focus on exploring a prediction and early warning method for influenza with the help of medical big data. It is well known that meteorological conditions have an influence on influenza outbreaks. So, we try to find a way to determine the early warning threshold value of influenza outbreaks through big data analysis concerning meteorological factors. Results show that, based on analysis of meteorological conditions combined with influenza outbreak history data, the early warning threshold of influenza outbreaks could be established with reasonable high accuracy.
Two extreme heatwaves hit Western Europe in the summer of 2019, with historical records broken by more than a degree in many locations, and significant societal impacts, including excess mortality of several thousand people. The extent to which human influence has played a role in the occurrence of these events has been of large interest to scientists, media and decision makers. However, the outstanding nature of these events poses challenges for physical and statistical modeling. Using an unprecedented number of climate model ensembles and statistical extreme value modeling, we demonstrate that these short and intense events would have had extremely small odds in the absence of human-induced climate change, and equivalently frequent events would have been 1.5 degrees C to 3 degrees C colder. For instance, in France and in The Netherlands, the July 3-day heatwave has a 50-150-year return period in the current climate and a return period of more than 1000 years without human forcing. The increase in the intensities is larger than the global warming by a factor 2 to 3. Finally, we note that the observed trends are much larger than those in current climate models.
Oestrus ovis is the most common cause of human ophthalmomyiasis. So far, majority of ophthalmomyiasis cases have been reported from Mediterranean countries, but not from Croatia. In current study, we present first two cases of human ophthalmomyiasis in Croatia, caused by O. ovis larvae. Reviewing a PubMed database, additional 259 cases of human ophthalmomyiasis in countries of Mediterranean basin have been reported. A total of 260 (99.62%) cases had external, while 1 (0.38%) had internal form of ocular myiasis. In all cases, O. ovis larvae were identified as the causative agent. O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well. Various climatic factors influence O. ovis larvipositional activity. Air temperature is the most important factor affecting O. ovis larviposition, while humidity, wind speed, and time of the day play only a moderate role. Most common symptoms of ophthalmomyiasis are irritation and redness, and in more than half of cases infestation is multiple. Ophthalmomyiasis interna is eye-compromising condition. Since there is reduced awareness among patients and medical professionals, the real number of ophthalmomyiasis cases is probably significantly higher than published. Global warming predisposes future increase of O. ovis prevalence in humans, which emphasizes the need for mandatory reporting and surveillance of disease.
Urban heat island (UHI) is the best acknowledged climate-change related phenomenon also because it affects population health conditions in dense urban areas, even exacerbated during heat waves. While most of field studies are performed by means of permanent weather stations, this paper presents an intra-urban microclimate analysis through wearable sensing techniques for monitoring and characterizing granular peculiarities as perceived by urban pedestrians. The study is implemented in four areas of New York City presenting already mitigation techniques. These strategies are specifically analyzed from the pedestrians’ perspective, who may walk along parks and sidewalks, to better study real boundary conditions responsible for thermal perception, even in those areas where vehicles are not allowed. A novel cluster analysis procedure is then carried out to perform data-driven identification of urban microclimate peculiarities in relation to its morphology (e.g. urban canyons etc.). Results show a non-negligible dependency from urban configuration both in winter and in summer. Measurements in the high-packed district winter daytime show a drop off of 0.6 degrees C in air temperature close to small parks. The packed low-rise district presents highest values of CO2, with respect to the other monitored areas both in winter and in summer. The same areas are automatically recognized through the data-driven clustering process. The data-driven approach may be therefore successfully integrated into classic measurements to investigate UHI and heat stress in dense anthropized areas.
The negative effects of urban heat islands (UHIs) on citizens’ well-being and life quality are widely acknowledged, but they still represent critical challenges, particularly since urban population is predicted to rise to 60% of the world population by 2030. Computational models have become useful tools for addressing these challenges and investigating urban microclimate repercussions on citizens’ comfort and urban liveability. Despite that, humans typically remain absent from such models. This work bridges this gap, moving beyond purely thermodynamic Urban Canopy Models (UCMs) to highlight the importance of integrating even simplified pedestrians’ biophysics for comfort assessment. Human physiology parameterization is therefore introduced into the Princeton Urban Canopy Model (PUCM), which had been designed to investigate the effect of greenery and novel materials on the UHI. Human thermal comfort is assessed in terms of the skin temperature and then evaluated against the apparent temperature, a widely-used thermal comfort indicator. Different configurations of the same urban canyon are therefore tested to assess the effectiveness of cool materials and trees for human thermal comfort enhancement. Results show that cool skins in the canyon’s built environment lead to an air temperature reduction up to 1.92 K, but slightly worsen human comfort in terms of a warmer computed skin temperature by 0.27 K. The indirect effect of trees, that exclude shading, are negligible for human thermal comfort. The new integrated human-centric model can help policymakers and urban planners to easily assess the potential benefits or threats to citizens’ well-being associated with specific urban configurations.
INTRODUCTION: Asthma is a disease that has been associated with the presence of different genetic and socio-environmental factors. OBJECTIVE: To identify and evaluate the seasonality of respiratory syncytial virus (RSV) and human rhinovirus (RV) in asthmatic children and adolescents in tropical climate, as well as to assess the socioeconomic and environmental factors involved. METHODS: The study was conducted in a referral hospital, where a total of 151 children were recruited with a respiratory infection. The International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a questionnaire were applied, and a skin prick test was performed. The nasal swab was collected to detect RV and RSV through molecular assay. National Meteorological Institute (INMET) database was the source of climatic information. RESULTS: The socio-environmental characterization of asthmatic children showed the family history of allergy, disturbed sleep at night, dry cough, allergic rhinitis, individuals sensitized to at least one mite. We identified RV in 75% of children with asthma and 66.7% of RSV in children with asthma. There was an association between the presence of RV and the dry season whereas the presence of the RSV was associated with the rainy season. Contributing to these results, a negative correlation was observed between the RSV and the wind speed and the maximum temperature (T. Max) and a positive correlation with precipitation. CONCLUSIONS: The results suggest a high prevalence of RV and RSV in asthmatic children and the seasonality of these viruses were present in different climatic periods. This has significant implications for understanding short- and long-term clinical complications in asthmatic patients.
Background: Malaria remains a global challenge with approximately 228 million cases and 405,000 malaria-related deaths reported in 2018 alone; 93% of which were in sub-Saharan Africa. Aware of the critical role than environmental factors play in malaria transmission, this study aimed at assessing the relationship between precipitation, temperature, and clinical malaria cases in East Africa and how the relationship may change under 1.5 C and 2.0 C global warming levels (hereinafter GWL1.5 and GWL2.0, respectively). Methods: A correlation analysis was done to establish the current relationship between annual precipitation, mean temperature, and clinical malaria cases. Differences between annual precipitation and mean temperature value projections for periods 2008-2037 and 2023-2052 (corresponding to GWL1.5 and GWL2.0, respectively), relative to the control period (1977-2005), were computed to determine how malaria transmission may change under the two global warming scenarios. Results: A predominantly positive/negative correlation between clinical malaria cases and temperature/precipitation was observed. Relative to the control period, no major significant changes in precipitation were shown in both warming scenarios. However, an increase in temperature of between 0.5 C and 1.5 C and 1.0 C to 2.0 C under GWL1.5 and GWL2.0, respectively, was recorded. Hence, more areas in East Africa are likely to be exposed to temperature thresholds favourable for increased malaria vector abundance and, hence, potentially intensify malaria transmission in the region. Conclusions: GWL1.5 and GWL2.0 scenarios are likely to intensify malaria transmission in East Africa. Ongoing interventions should, therefore, be intensified to sustain the gains made towards malaria elimination in East Africa in a warming climate.
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.
BACKGROUND: The substantial disease burden attributed to heat waves, and their increasing frequency and intensity due to climate change, highlight the importance of understanding the health consequences of heat waves. We explore the mortality risk due to heat wave characteristics, including the timing in the seasons, the day of the heat wave, the intensity and the duration, and the modifying effect of temperature zones. METHODS: Heat waves were defined as ? 2?days with a temperature ?99th percentile for the county from 1 May through 30 September. Heat waves were characterized by their intensity, duration, timing in the season, and day of the heat wave. Within each county, we estimated the total non-accidental death and cardiovascular disease mortality during each heat wave compared with non-heat wave days by controlling for potential confounders in summer. We combined individual heat wave effect estimates using a random-effects model to calculate overall effects at the temperature zone and national levels. RESULTS: The average daily total number of non-accidental deaths was nine in the warm season (across all the counties). Approximately half of the daily total number of non-accidental deaths were cardiovascular-related deaths (approximately four persons per day). The average and maximum temperatures across the study area were 23.1?°C (range: -1.2-35.9?°C) and 28.3?°C (range: 5.4-42.8?°C), respectively. The average relative humidity during the study was 68.9% (range: 8.0-100.0%). Heat waves increase the risk of total non-accidental death by 15.7% [95% confidence interval (CI): 12.5, 18.9] compared with non-heat wave periods, and the risk of cardiovascular-related death increases by 22.0% (95% CI: 16.9, 27.4). The risk of non-accidental death during the first heat wave of the season increases by 16.3% (95% CI: 12.6, 20.2), the risk during the second heat wave increases by 6.3% (95% CI: 2.8, 9.9) and during subsequent heat waves increases by -2.1% (95% CI: -4.6, 0.4). The first day and the second to third days of heat waves increase the risk of total non-accidental death by 11.7% (95% CI: 7.6, 15.9) and 17.0% (95% CI: 13.1, 21.0), respectively. Effects of heat waves on mortality lasted more than 4?days (6.3%, 95% CI: 2.4, 10.5) and are non-significantly different from the first day of heat waves. We found non-significant differences of the heat wave-associated mortality risks across mid-, Warm and subtropical temperature zones. CONCLUSIONS: In China, the effect of heat waves on mortality is acute, and varies by certain characteristics of heat waves. Given these results, national heat wave early warning systems should be developed, as well as precautions and protection warranted according to characteristics of heat waves.
Background: There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001-2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (?75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.
We examine the impact of extreme heat during pregnancy on infant mortality and check if public interventions can serve as effective adaptation strategies. We show that 2 children die as infants out of 1000 births in India for high temperature during pregnancy, tentatively due to reduced agricultural yields, wages, and greater disease prevalence like diarrhea. The heat-infant mortality relationship holds in rural India only. Using phased introduction of an employment guarantee program and partial introduction of a community health care worker program for identification, we find that only the health program is effective in modifying the temperature-infant mortality relationship in rural India.
OBJECTIVES: Maricopa County, Arizona (2017 population about 4.3 million), is located in the Sonoran Desert. In 2005, the Maricopa County Department of Public Health (MCDPH) established a heat-associated mortality surveillance system that captures data on circumstances of death for Maricopa County residents and visitors. We analyzed 2006-2016 surveillance system data to understand the characteristics and circumstances of heat-associated deaths. METHODS: We classified heat-associated deaths based on International Classification of Diseases, Tenth Revision codes (X30, T67.X, and P81.0) and phrases (heat exposure, environ, exhaustion, sun, heat stress, heat stroke, or hyperthermia) in part I or part II of the death certificate. We summarized data on decedents’ demographic characteristics, years lived in Arizona, location of death (indoors vs outdoors), presence and functionality of air conditioning, and whether the decedent had been homeless. We examined significant associations between variables by using the Pearson ?(2) tests and logistic regression. RESULTS: During 2006-2016, MCDPH recorded data on 920 heat-associated deaths, 912 of which included location of injury. Of 565 (62%) heat-associated deaths that occurred outdoors, 458 (81%) were among male decedents and 243 (43%) were among decedents aged 20-49. Of 347 (38%) heat-associated deaths that occurred indoors, 201 (58%) were among decedents aged ?65. Non-Arizona residents were 5 times as likely as Arizona residents to have a heat-associated death outdoors (P < .001). Of 727 decedents with data on duration of Arizona residency, 438 (60%) had resided in Arizona ?20 years. CONCLUSIONS: Ongoing evaluation of interventions that target populations at risk for both outdoor and indoor heat-associated deaths can further inform refinement of the surveillance system and identify best practices to prevent heat-associated deaths.
BACKGROUND: Heat-related illness is a common medical emergency. There is failure of thermoregulatory mechanisms of the body resulting in multiple organ dysfunction syndrome which if not identified and treated urgently can result in high mortality rate and permanent neurological damage. This study provides description of clinical profile patients presenting with heat-related illness and identifies clinical and laboratory variables resulting in poor outcome. METHODS: This retrospective study was done identifying adult patients admitted with a diagnosis of heat-related illness from April to August 2019 in tertiary care center. Their clinical profile, laboratory investigations and outcome were extracted from medical records and variables associated with poor outcome were analyzed for statistical significance. RESULTS: Mean age of the patients in the study was 61 years with mean heat index of the localities being 39.6-degree C. 66% of patients had multiple organ dysfunction with central nervous system dysfunction (77%) followed by respiratory distress syndrome (61%) as the most common organ derangement. Evaporative cooling measures were incorporated in management of all patients, followed by cold saline infusion in 60%. Higher J-ERATO score at admission was found to be a predictor for underlying multiple organ dysfunction syndrome (P value < 0.029). The mortality rate associated with heat-related illness in this study was 11.1%. CONCLUSIONS: Multiple organ dysfunction is seen in majority of the patients and calculation of simple admission J-ERATO score helps in predicting the same. Declining mortality rate observed in our study as compared to the earlier studies could be attributed to increased awareness, prompt diagnosis and initiation of rapid cooling measures.
Introduction: Hot weather poses occupational health and safety concerns for people working in hot environments. It is known that work-related injuries increase during hot weather, yet there is an incomplete understanding of the underlying factors. Methods: A national online survey was conducted in Australia among health and safety representatives (HSRs) to better understand factors contributing to heat-related injuries in workplaces. Risk factors and preventive measures associated with reported injuries were identified using log-poisson regression models. Results: In total, 222 HSRs completed the survey. Overall, 43% reported that injuries or incidents caused by hot/very humid weather occur sometimes or often in their workplace. Factors found to be associated with reported heat-related injuries included ‘the wearing of personal protective equipment (PPE)’ which can hinder the loss of body heat, and ‘inadequate resources and facilities’. ‘Piece-rate workers’ and ‘new workers’ were identified as being at high risk. The most frequently adopted preventive measures for outdoor and indoor workers were the provision of PPE (despite some identified issues) and access to cool drinking water. HSRs reported that less injuries occurred in hot weather among outdoor workers if work was rescheduled to cooler times and shade was provided; and in indoor environments where there was adequate ventilation, heat sources were shielded and workers were able to self-pace. Conclusion: Organisational issues, workplace hazards, personal factors and preventive measures, are all determinants of heat-related injuries in Australian workplaces. Wider adoption of identified prevention measures could reduce the incidence of heat-related injuries in outdoor and indoor workplaces.
Temperature record-breaking events, such as the observed more intense, longer-lasting, and more frequent heat waves, pose a new global challenge to health sectors worldwide. These threats are of particular interest in low-income regions with limited investments in public health and a growing urban population, such as Brazil. Here, we apply a comprehensive interdisciplinary climate-health approach, including meteorological data and a daily mortality record from the Brazilian Health System from 2000 to 2015, covering 21 cities over the Metropolitan Region of Rio de Janeiro. The percentage of absolute mortality increase due to summer extreme temperatures is estimated using a negative binomial regression modeling approach and maximum/minimum temperature-derived indexes as covariates. Moreover, this study assesses the vulnerability to thermal stress for different age groups and both genders and thoroughly analyzes four extremely intense heat waves during 2010 and 2012 regarding their impacts on the population. Results showed that the highest absolute mortality values during heat-related events were linked to circulatory illnesses. However, the highest excess of mortality was related to diabetes, particularly for women within the elderly age groups. Moreover, results indicate that accumulated heat stress conditions during consecutive days preferentially preceded by persistent periods of moderate-temperature, lead to higher excess mortality rather than sporadic single hot days. This work may provide directions in human health policies related to extreme climate events in large tropical metropolitan areas from developing countries, contributing to altering the historically based purely reactive response.
BACKGROUND: As a consequence of global warming, heat waves are expected to become more frequent, more intense, and longer. The elderly and persons with chronic diseases are especially vulnerable to health problems due to heat. This article is devoted to the question of the extent to which the effects of heat waves in Germany are changing over time, and whether preventive health measures are working. METHODS: We use a statistical model to quantify the effect of high mean temperatures on mortality. Within this model, different exposure-response curves for the three temporal intervals 1992-2000, 2001-2010, and 2011-2017 are estimated. Attention is also paid to the delayed effect on mortality of high mean temperatures in the preceding week. RESULTS: Our analysis reveals a clear, systematic association of the mean temperature in the current week, as well as the mean temperature in the preceding week, with weekly mortality. This association is more pronounced for higher age groups and decreases over the years under analysis, with the exception of a relatively weak effect of heat in southern Germany in 1992-2000. The strongest effects were related to the heat waves in 1994 and 2003, with approximately 10 200 and 9600 fatalities, respectively. Approximately 7800 fatalities were estimated for the summer of 2006, and 4700 and 5200 for 2010 and 2015, respectively. CONCLUSION: In Germany, as elsewhere, climate change has been causing more frequent, more intense, and longer periods of heat in the summer. The harmful effect of heat on health is reduced by adaptive processes, presumably including successful preventive measures. Such measures should be extended in the future, and perhaps complemented by other measures in order to further diminish the effect of heat on mortality .
Purpose Agricultural workers represent an important part of the population exposed to high heat-related health and productivity risks. This study aims to estimate the heat-related productivity loss (PL) for moderate work activities in sun and shady areas and evaluating the economic cost locally in an Italian farm and generally in the whole province of Florence. Benefits deriving by working in the shade or work-time shifting were provided. Comparisons between PL estimated in Mediterranean (Florence, Italy) and subtropical (Guangzhou, China) areas were also carried out. Design/methodology/approach Meteorological data were collected during summers 2017-2018 through a station installed in a farm in the province of Florence and by two World Meteorological Organization (WMO)-certified meteorological stations located at the Florence and Guangzhou airports. These data were used to calculate the wet-bulb globe temperature and to estimate the hourly PL and the economic cost during the typical working time (from 8 a.m. to 5 p.m.) and by advancing of 1 h and 2 h the working time. Significant differences were calculated through nonparametric tests. Findings The hourly PL and the related economic cost significantly decreased (p < 0.05) by working in the shade and by work-time shifting. Higher PL values were observed in Guangzhou than in Florence. The decrease of PL observed by work-time shifting was greater in Florence than in Guangzhou. Originality/value Useful information to plan suitable heat-related prevention strategies to counteract the effects of heat in the workplace are provided. These findings are essential to quantify the beneficial effects due to the implementation of specific heat-related adaptation measures to counter the impending effects of climate change.
Climate change increases the frequency and intensity of heatwaves, causing significant human and material losses every year. Big data, whose volumes are rapidly increasing, are expected to be used for preemptive responses. However, human cognitive abilities are limited, which can lead to ineffective decision making during disaster responses when artificial intelligence-based analysis models are not employed. Existing prediction models have limitations with regard to their validation, and most models focus only on heat-associated deaths. In this study, a random forest model was developed for the weekly prediction of heat-related damages on the basis of four years (2015-2018) of statistical, meteorological, and floating population data from South Korea. The model was evaluated through comparisons with other traditional regression models in terms of mean absolute error, root mean squared error, root mean squared logarithmic error, and coefficient of determination (R-2). In a comparative analysis with observed values, the proposed model showed an R-2 value of 0.804. The results show that the proposed model outperforms existing models. They also show that the floating population variable collected from mobile global positioning systems contributes more to predictions than the aggregate population variable.
Assessing heatwave-induced human health risk is of critical importance in order to mitigate hazards caused by extreme environmental events. Air temperature or land surface temperature in previous studies was often used to characterize the severity of heatwaves, and human perception of the thermal environment was neglected as a key component in the heatwave-induced risk assessment. In order to redress this issue, in this study we applied the Universal Thermal Climate Index (UTCI) to represent human thermal comfort perception and embedded the measure within an assessment framework of heat stress-social vulnerability-human exposure. The heatwave-induced human health risk was then evaluated in Wuhan City, China across 177 blocks covering the entire city area and local risk governance measures were also explored based on risk zoning. The results showed that spatial patterns of heatwave-induced human health risk followed a decreasing trend from the city center towards the surrounding areas, with the average risk of the main urban area being 1.6 times that beyond the metropolitan development area. Through the heatwave-induced human health risk zoning, about 73.45% of the 177 blocks in Wuhan City demonstrated a positive relationship between heat stress and human exposure, and both were opposite with social vulnerability. Multiple linear regression between UTCI and the proportion of greenspace, water body and construction land indicated that, more blue or green infrastructure should be integrated within the urban fabric to help mitigate heat stress particularly in the main urban area, while in the metropolitan development area construction land dominating heat stress should be strictly regulated. Furthermore, protecting vulnerable groups such as left-behind children and elderly people should be a priority in rural areas that were generally associated with higher levels of social vulnerability. This study proposed a new heatwave-induced human health risk framework with a local evidence in Wuhan City, and further emphasized that risk zoning could be used as a basic yet important approach to facilitating more effective urban planning guidelines for risk governance.
Studies on the pattern of heatwave mortality using nationwide data that include rural areas are limited. This study aimed to assess the risk of heatwave-related mortality and evaluate the health risk-based definition of heatwave. We collected data on daily temperature and mortality from 229 districts in South Korea in 2011-2017. District-specific heatwave-related mortality risks were calculated using a distributed lag model. The estimates were pooled in the total areas and for each urban and rural area using meta-regression. In the total areas, the threshold point of heatwave mortality risk was estimated at the 93rd percentile of temperature, and it was lower in urban areas than in rural areas (92nd percentile vs. 95th percentile). The maximum risk of heatwave-related mortality in the total area was 1.11 (95% CI: 1.01-1.22), and it was slightly greater in rural areas than in the urban areas (RR: 1.23, 95% CI: 0.99-1.53 vs. RR: 1.10, 95% CI: 1.01-1.20). The results differ by age- and cause-specific deaths. In conclusion, the patterns of heatwave-related mortality risk vary by area and sub-population in Korea. Thus, more target-specific heatwave definitions and action plans should be established according to different areas and populations.
BACKGROUND: Many studies have shown associations between rising temperatures, El Niño events and dengue incidence, but the effect of sustained periods of extreme high temperatures (i.e., heatwaves) on dengue outbreaks has not yet been investigated. This study aimed to compare the short-term temperature-dengue associations during different dengue outbreak periods, estimate the dengue cases attributable to temperature, and ascertain if there was an association between heatwaves and dengue outbreaks in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS: Dengue outbreaks were assigned to one of three categories (small, medium and large) based on the 50th, 75th, and 90th percentiles of distribution of weekly dengue cases during 2008-2016. Using a generalised linear regression model with a negative binomial link that controlled for temporal trends, temperature variation, rainfall and population size over time, we examined and compared associations between weekly average temperature and weekly dengue incidence for different outbreak categories. The same model using weeks with or without heatwaves as binary variables was applied to examine the potential effects of extreme heatwaves, defined as seven or more days with temperatures above the 95th percentile of daily temperature distribution during the study period. This study included 55,801 dengue cases, with an average of 119 (range: 0 to 1454) cases per week. The exposure-response relationship between temperature and dengue risk was non-linear and differed with dengue category. After considering the delayed effects of temperature (one week lag), we estimated that 4.6%, 11.6%, and 21.9% of incident cases during small, medium, and large outbreaks were attributable to temperature. We found evidence of an association between heatwaves and dengue outbreaks, with longer delayed effects on large outbreaks (around 14 weeks later) than small and medium outbreaks (4 to 9 weeks later). Compared with non-heatwave years, dengue outbreaks (i.e., small, moderate and large outbreaks combined) in heatwave years had higher weekly number of dengue cases (p<0.05). Findings were robust under different sensitivity analyses. CONCLUSIONS: The short-term association between temperature and dengue risk varied by the level of outbreaks and temperature seems more likely affect large outbreaks. Moreover, heatwaves may delay the timing and increase the magnitude of dengue outbreaks.
Heatwaves are defined as unusually high temperature events that occur for at least three consecutive days with major impacts to human health, economy, agriculture and ecosystems. This paper investigates: 1) changes in heatwave characteristics such as peak temperature, number of events, frequency and duration over a past 67-year period in Australia; 2) projected changes in heatwave characteristics for this century in Queensland, northeast Australia; and 3) the avoided heatwave impacts of limiting global warming by 1.5 °C, 2.0 °C and 3.0 °C. The results reveal that heatwaves have increased in intensity, frequency and duration across Australia over the past 67 years, such intensification was particularly higher on recent decades. Downscaled future climate projections for Queensland suggest that heatwaves will further intensify over the current century. The projections also highlight that distinct climatic regions within Queensland may have different heatwave responses under global warming, where tropical and equatorial heatwaves appear to be more sensitive to elevated atmospheric CO(2) concentrations than temperate and arid regions. The results offer new insights to support climate adaptation and mitigation at regional scales. These findings are already being used by health and emergency services to inform the development of statewide policies to mitigate heatwave impacts.
BACKGROUND: Heatwaves kill more people than floods, tornadoes, and earthquakes combined and disproportionally affect older persons and those with chronic conditions. Commonly used medications for chronic conditions, e.g., diuretics, antipsychotics disrupt thermoregulation or fluid/electrolyte balance and may sensitive patients to heat. However, the effect of heat-sensitizing medications and their interactions with heatwaves are not well-quantified. We evaluated effects of potentially heat-sensitizing medications in vulnerable older patients. METHODS: US Medicare data were linked at the zip code level to climate data with surface air temperatures for June-August of 2007-2012. Patients were Medicare beneficiaries aged ?65 years with chronic conditions including diabetes, dementia, and cardiovascular, lung, or kidney disease. Exposures were potentially heat-sensitizing medications including diuretics, anticholinergics, antipsychotics, beta blockers, stimulants, and anti-hypertensives. A heatwave was defined as ?2 days above the 95th percentile of historical zip code-specific surface air temperatures. We estimated associations of heat-sensitizing medications and heatwaves with heat-related hospitalization using self-controlled case series analysis. RESULTS: We identified 9,721 patients with at least one chronic condition and heat-related hospitalization; 42.1% of these patients experienced a heatwave. Heatwaves were associated with an increase in heat-related hospitalizations ranging from 21% (95% CI: 7% to 38%) to 33% (95% CI: 14% to 55%) across medication classes. Several drug classes were associated with moderately elevated risk of heat-related hospitalization in the absence of heatwaves, with rate ratios ranging from 1.16 (95% CI: 1.00 to 1.35) to 1.37 (95% CI: 1.14 to 1.66). We did not observe meaningful synergistic interactions between heatwaves and medications. CONCLUSIONS: Older patients with chronic conditions may be at heightened risk for heat-related hospitalization due to the use of heat-sensitizing medications throughout the summer months, even in the absence of heatwaves. Further studies are needed to confirm these findings and also to understand the effect of milder and shorter heat exposure.
Cities must adapt to aging populations and mitigate the effects of climate change and urbanization on health. This study analyses the outdoor thermal and acoustic comfort of older adults in public spaces in Madrid. We compared the subjective perception with real environmental conditions measured in-situ and two thermal comfort indices Physiological Equivalent Temperature (PET) and Universal Thermal Index (UTCI). Additionally, use and stay of older people in those public spaces was assessed. Results showed that older adults represent 26.35% of the users, environmental variables such as mean radiant temperature, air temperature, and noise levels are the most relevant variables for them to decide to stay in these places. Although most of the 413 interviewees perceived the environment as comfortable, this research shows that in dense urban areas there is a significant health risk due to noise pollution and extreme temperatures. Average noise levels measured exceed the maximum threshold recommended by the World Health Organization and according to PET and UTCI indices around 73% of the interviewees would be in risk of thermal stress in winter and 98.2% in summer. The need for further research to find strategies to mitigate the environmental risks of older people in public spaces is evident.
Relationships of larger scale meteorological predictors with ground-level daily maximum ozone (O-3max) and daily maximum air temperature (T-max) for stations in Bavaria were analysed. O-3max and T-max as well as threshold exceedances of these variables were assessed under the constraints of ongoing climate change until the end of the twenty-first century. Under RCP8.5 scenario conditions, a substantial increase of T-max in the months from April to September arose, with a mean value of 5 K in the period 2081-2100 compared with the historical period 1986-2005. Statistical downscaling projections pointed to a mean O-3max rise of 17 mu g/m(3). The frequency of threshold exceedances showed also large changes. Hot days may occur in the future at about 30% of all days. Exceedances of O-3max > 100 mu g/m(3) were projected to increase to about 40% of all days at urban traffic sites and up to about 70% in the rural regional background. Days with O-3max > 120 mu g/m(3) occurred still at about 20% of all days at urban traffic sites and at about 45% in rural regional background locations. With respect to combined T-max > 30 degrees C and O-3max > 100 mu g/m(3) events in the future, an occurrence of such events at about 27-29% of all days in the summer months from April to September was assessed. The increases were mainly associated with the strong temperature rise until the end of the century. In summary, the projected T-max and O-3max changes point to a considerable increased health burden in Bavaria until the end of the century, resulting from strong changes of both variables and their associated individual and combined impact on human health.
Susceptibility to heat illness during physically demanding work in hot environments is greater on the second of two consecutive workdays. While it has been demonstrated that heat storage is exacerbated on the second compared to first workday in older workers (50-65?yr), the effects on heart rate variability (HRV), an established surrogate of cardiac autonomic modulation, remain unclear. This study evaluated HRV in older workers on the day following prolonged work in the heat. Electrocardiogram was recorded in nine older (53-64?yr) males at rest, during three 30-min bouts of semi-recumbent cycling at fixed rates of metabolic heat production (150, 200, 250?W/m(2)), each separated by 15-min recovery. Experiments were conducted in hot-dry conditions (40?°C, 20% relative humidity), immediately prior to (Day 1), and on the day following (Day 2), a prolonged work simulation (?7.5?hr) involving moderate intensity intermittent exercise in hot-dry conditions (38?°C, 34% relative humidity). Core temperature, as well as time, frequency, and nonlinear HRV indices were derived for analysis during rest, the final 5-min of exercise at the highest heat production and recovery. The change in core temperature at the end of work (mean?±SD) was significantly greater on Day 2 (1.0?°C?±0.3) relative to Day 1 (0.8?°C?±0.2; p??0.05). Prolonged work in the heat did not modulate next-day heart rhythms, as reflected by HRV, despite augmented core temperature. While HRV can reflect physiological aspects of cardiac autonomic stressors, these findings indicate it does not provide a means to identify exacerbated heat strain in older workers over consecutive work shifts in the heat.
BACKGROUND: The Threshold Limit Values (TLV) of the American Conference of Governmental and Industrial Hygienists indicate the levels of heat stress that all workers may be repeatedly exposed to without adverse health effects. In this study, we evaluated heart rate variability (HRV) during moderate-to-heavy work performed continuously or according to different TLV work-rest (WR) allocations in healthy physically active older workers. METHODS: Nine healthy older (58?±?5?years) males performed three different 120-minute conditions in accordance with TLV guidelines for moderate-to-heavy intensity work (360?W fixed rate of heat production) in different wet-bulb globe temperatures (WBGT): continuous cycling at 28°C WBGT (CON), as well as intermitted work performed at WR of 3:1 in 29°C WBGT (WR3:1), and at WR of 1:1 at 30°C (WR1:1). Rectal temperature and HRV (3-lead electrocardiogram [ECG]) were assessed throughout. RESULTS: Coefficient of Variation, Poincaré SD2, and Shannon Entropy were decreased during the CON compared with the WR3:1 when core temperature exceeded 38°C and after 1?hour of continuous work (P?
Air pollution and hot temperatures present two major health risks, especially for vulnerable groups such as children, the elderly, and people with pre-existing conditions. Episodes of high ozone concentrations and heat waves have been registered throughout Europe and are expected to continue to grow due to climate change. Here, several different heat and ozone wave definitions were applied to characterize the wave-type extremes for two climatically different regions, i.e., Portugal (South Europe) and Bavaria (Central Europe), and their impacts were evaluated considering each type of hazard independently but also when they occur simultaneously. Heat and ozone waves were analyzed with respect to the underlying atmospheric circulation patterns and in terms of their association with human mortality. Heat waves were identified as the most frequent wave type and, despite different climate settings, a comparable exposure to heat and ozone waves was found in Central and South Europe. Waves were associated with in-situ built-up as well as with advection of air masses. However, in Bavaria waves showed the strongest connection with autochthonous weather conditions, while for Portugal, the strongest relationship appeared for eastern and north-eastern inflow. The most severe events, as measured by excess mortality, were always associated to compound heat-ozone waves.
The effect of tropical deforestation on heat exposure and subsequent human health outcomes remains understudied, especially among an increasingly vulnerable population-healthy, adult subsistence workers in rural industrializing tropical countries. We report on a field experiment that estimated the short-term effects of heat exposure from deforestation on cognitive performance. We randomly assigned rural, adult subsistence workers in East Kalimantan, Indonesia to deforested or forested settings, and standard or high incentive piece rate payments. Participants worked in forested or deforested settings for up to 90 min, where ambient and black globe temperatures in deforested areas were, on average, 2.1 degrees C and 10 degrees C higher. After completing the experimental task, participants were asked to take a validated general cognitive assessment test (CAT) and episodic memory test (EMT). We found participants in deforested settings had statistically significant lower scores on both CAT and EMT. Effects were largely driven by heat effects on male participants and those working after noon. Our results highlight how heat exposure from tropical deforestation may lead to declines in cognitive performance even in favorable work settings. Policymakers should consider how land use planning that takes into account the cooling services of trees can play a significant role in increasing resilience to heat from climate and land use change in the tropics.
Global warming with increasing weather extremes, like heat events, is enhancing impacts to public health. This essay focuses on unusual extreme summer heat extremes occurring in Germany at higher frequency, longer duration, and with new temperature records. Large areas of the country are affected, particularly urban settlements, where about 77% of the population lives, which are exposed to multiple inner-city threats, such as urban heat islands. Because harm to public health is directly released by high ambient air temperatures, local and national studies on heat-related morbidity and mortality indicate that vulnerable groups such as the elderly population are predominantly threatened with heat-related health problems. After the severe mortality impacts of the extreme summer heat 2003 in Europe, in 2008, Germany took up the National Adaptation Strategy on Climate Change to tackle and manage the impacts of weather extremes, for example to protect people’s health against heat. Public health systems and services need to be better prepared to improve resilience to the effects of extreme heat events, e.g., by implementing heat health action plans. Both climate protection as well as adaptation are necessary in order to be able to respond as adequate as possible to the challenges posed by climate change.
More than half of the world’s population currently live in urban areas and are particularly at risk from the combined effects of the urban heat island phenomenon and heat increases due to climate change. Here, by using remotely sensed surface temperature data and social-ecological indicators, focusing on the hot dry season, and applying the risk framework of the Intergovernmental Panel on Climate Change, we assessed the current heat health risk in 139 Philippine cities, which account for about 40% of the country’s total population. The cities at high or very high risk are found in Metro Manila, where levels of heat hazard and exposure are high. The most vulnerable cities are, however, found mainly outside the national capital region, where sensitivity is higher and capacity to cope and adapt is lower. Cities with high levels of heat vulnerability and exposure must be prioritized for adaptation. Our results will contribute to risk profiling in the Philippines and to the understanding of city-level heat health risks in developing regions of the Asia-Pacific.
BACKGROUND: Heat related illness (HRI) places a significant burden on the health and safety of working populations and its impacts will likely increase with climate change. The aim of this study was to characterize the demographic and occupational characteristics of Washington workers who suffered from HRI from 2006 to 2017 using workers’ compensation claims data. METHODS: We used Washington workers’ compensation data linked to weather station data to identify cases of work-related HRI. We utilized Occupational Injury and Illness Classification System codes, International Classification of Diseases 9/10 codes, and medical review to identify accepted and rejected Washington State (WA) workers’ compensation claims for HRI from 2006 to 2017. We estimated rates of HRI by industry and evaluated patterns by ambient temperature. RESULTS: We detected 918 confirmed Washington workers’ compensation HRI claims from 2006 to 2017, 654 were accepted and 264 were rejected. Public Administration had the highest third quarter rate (131.3 per 100?000 full time employees [FTE]), followed by Agriculture, Forestry, Fishing, and Hunting (102.6 per 100?000 FTE). The median maximum daytime temperature was below the Washington heat rule threshold for 45% of the accepted HRI claims. Latinos were estimated to be overrepresented in HRI cases. CONCLUSION: The WA heat rule threshold may not be adequately protecting workers and racial disparities are present in occupational HRI. Employers should take additional precautions to prevent HRI depending on the intensity of heat exposure. States without heat rules and with large industry sectors disproportionately affected by HRI should consider regulations to protect outdoor workers in the face of more frequent and extreme heat waves.
BACKGROUND: Summer temperatures are expected to increase and heat waves will occur more frequently, be longer, and be more intense as a result of global warming. A growing body of evidence indicates that increasing temperature and heatwaves are associated with excess mortality and therefore global heating may become a major public health threat. However, the heat-mortality relationship has been shown to be location-specific and differences could largely be explained by the most frequent temperature. So far, in Belgium there is little known regarding the heat-mortality relationship in the different urban areas. OBJECTIVES: The objective of this study is to assess the heat-mortality relationship in the two largest urban areas in Belgium, i.e. Antwerp and Brussels for the warm seasons from 2002 until 2011 taking into account the effect of air pollution. METHODS: The threshold in temperature above which mortality increases was determined using segmented regressions for both urban areas. The relationship between daily temperature and mortality above the threshold was investigated using a generalized estimated equation with Poisson distribution to finally determine the percentage of deaths attributable to the effect of heat. RESULTS: Although only 50 km apart, the heat-mortality curves for the two urban areas are different. More specifically, an increase in mortality occurs above a maximum temperature of 25.2 °C in Antwerp and 22.8 °C in Brussels. We estimated that above these thresholds, there is an increase in mortality of 4.9% per 1 °C in Antwerp and of 3.1% in Brussels. During the study period, 1.5% of the deaths in Antwerp and 3.5% of the deaths in Brussels can be attributed to the effect of heat. The thresholds differed considerably from the most frequent temperature, particularly in Antwerp. Adjustment for air pollution attenuated the effect of temperature on mortality and this attenuation was more pronounced when adjusting for ambient ozone. CONCLUSION: Our results show a significant effect of temperature on mortality above a city-specific threshold, both in Antwerp and in Brussels. These findings are important given the ongoing global warming. Recurrent, intense and longer episodes of high temperature and expected changes in air pollutant levels will have an important impact on health in urban areas.
The purpose of this study was to assess the heat strain experienced by children during unstructured physical activity outdoors in a temperate continental summer climate. Eighteen children (7 girls, 12.1 ± 1.7 years) performed up to 4 h of outdoor free-play (duration: 218 ± 33 min; air temperature of 24.5 ± 3.9°C and relative humidity of 66.2 ± 9.2%). Urine specific gravity (USG) was measured pre- and post-free-play, while body core temperature (T(co), ingestible pill) and heart rate (HR) were measured continuously. Physiological strain index (PSI) was calculated from T(co) and HR (scale: 0 (none) to 10 (very high)). Activity levels were categorized as rest, light, moderate, and vigorous based on the metabolic equivalent of task, estimated from video analysis. Most children were euhydrated pre (78%, USG ? 1.020), but not post-free-play (28%, USG ? 1.020). Mean and peak T(co), HR, and PSI responses were 37.8 ± 0.3°C and 38.4 ± 0.3°C, 133 ± 14 bpm and 180 ± 12 bpm, and 4.7 ± 1.1 (low) and 7.4 ± 1.0 (high), respectively. All children reached peak T(co)?38.0°C, with seven ?38.5°C, and the highest at 38.9°C. The children spent 58 ± 15% of free-play engaged in moderate-to-vigorous intensity physical activity. During free-play, all of the children performed moderate-to-vigorous intensity physical activity, which was associated with pronounced elevations in heat strain.
The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1-31.8 °C)) than in Singapore (22.0 °C (IQR 18.8-24.8 °C)) (p < 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p < 0.001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore (p < 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.
Currently, occupational heat exposure is usually measured using environmental variables such as the wet bulb globe temperature index. The costs of heat stress monitoring include the acquisition of specialized equipment and the recruitment of trained personnel. In rapidly changing environments, such as outdoor settings, these assessments must be conducted on a daily basis. The wet bulb globe temperature index has been criticized as a measure of heat stress for its failure to account for individual differences in susceptibility to heat stress, age, body mass index, physical fitness, clothing, illnesses and use of alcohol or drugs. The objective of this study was to assess the relationship between heart rate and body temperature in heat-exposed workers to determine whether heart rate can be used to monitor and prevent heat stress and physiological strain. This study was based on previous literature as well as physiological and environmental data collected from 10 individuals engaged in heavy physical labor. Heart rate, which has been recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) as a possible measure of heat stress, follows a similar trend to body temperature with a slight temporal delay. Heart rate monitors with alarm systems could be developed to notify workers when to slow down their activities or take a break for thermal recovery, thereby contributing to the prevention of heat-related illness.
There is an urgent need to map the geographic location of climate change risks and vulnerability, especially for cities in sub-Saharan Africa, which are experiencing the greatest urban development challenges and vulnerability to climate change impacts. The aim of this study is to investigate current and projected future heat risk, expressed as a heat stress exposure index using high-resolution climate change projections, and a social vulnerability index, to identify areas of potential future heat stress risk in the Durban (eThekwini) metropolitan area, South Africa. Additionally, this is the first study to use high-resolution downscaled climate change projections under Representative Concentration (RCP) 8.5, to construct the heat exposure index using apparent temperature and increases in minimum temperature and a social vulnerability index, using demographic and socio-economic census and land use data to, derived from principal component analysis (PCA) to spatially characterize heat stress within a South African city. Results show that while heat stress is not a current concern, it is projected to increase and become a future concern, mainly as a function of social vulnerability due to household demographic and infrastructural characteristics, and will be experienced in both the rural and inner-city areas of the metro. This study contributes a heat risk framework to identify locations for specific research and adaptation activities on heat stress risk and for urban planning in sub-Saharan African cities, which are characterized by both rural and urban contexts, to address climate change adaptation targeting and priority setting.
Extreme heat stress has a deep impact on physiological reactions, which results in occupational injuries and deaths. In this paper, an attempt is made to understand the impact of heat stress on construction accidents in Oman. A literature review on heat stress is discussed in the first section followed by an analysis of 623 accidents that occurred in a highway project. The analysis of these accidents reveals that more severe accidents on this project took place from 11:00 to 17:00. The semi-structured interview held with some of the workers involved in these accidents confirmed excessive heat as one of the main reason behind these accidents. The health profile of the same workers is measured in terms of their body mass index and blood pressure. The results show that 80% of the workers from the selected sample were found to be overweight or obese and 40% of the participants were hypertensive. The safety performance of such workers is particularly discussed in relation to heat stress. The effective implementations of day time break in summer, a healthy diet, appropriate sleeping habit, scheduling physically demanding tasks during early morning and evening and adopting light colour and loose fitting uniform could reduce the impact of heat stress.
Prolonged or intense exposure to heat can lead to a range of health effects. This study investigated heat exposure and heat-related symptoms which sugarcane workers (90 sugarcane cutters and 93 factory workers) experienced during a harvesting season in Thailand. During the hottest month of harvesting season, wet bulb globe temperature was collected in the work environment, and workloads observed, to assess heat stress. Urine samples for dehydration test, blood pressure, heart rate, and body temperature were measured pre- and post-shift to measure heat strain. Fluid intake and heat-related symptoms which subjects had experienced during the harvesting season were gathered via interviews at the end of the season. From the results, sugarcane cutters showed high risk for heat stress and strain, unlike factory workers who had low risk based on the American Conference of Governmental Industrial Hygiene (ACGIH) threshold limit values (TLVs) for heat stress. Dehydration was observed among sugarcane cutters and significant physiological changes including heart rate, body temperature, and systolic blood pressure occurred across the work shift. Significantly more sugarcane cutters reported experiencing heat-related symptoms including weakness/fatigue, heavy sweating, headache, rash, muscle cramp, dry mouth, dizziness, fever, dry/cracking skin, and swelling, compared to sugarcane factory workers. We conclude that the heat stress experienced by sugarcane cutters working in extremely hot environments, with high workloads, is associated with acute health effects. Preventive and control measures for heat stress are needed to reduce the risk of heat strain.
Heat waves are the deadliest type of natural hazard among all weather extremes in the United States. Given the observed and anticipated increase in heat risks associated with ongoing climate change, this study examines community vulnerability to extreme heat and the degree to which heat island mitigation (HIM) actions by state/local governments reduce heat-induced fatalities. The analysis uses all heat events that occurred over the 1996-2011 period for all United States counties to model heat vulnerability. Results show that: (1) Higher income reduces extreme heat vulnerability, while poverty intensifies it; (2) living in mobile homes or rental homes heightens susceptibility to extreme heat; (3) increased heat vulnerability due to the growth of the elderly population is predicted to result in a two-fold increase in heat-related fatalities by 2030; and (4) community heat island mitigation measures reduce heat intensities and thus heat-related fatalities. Findings also show that an additional locally implemented measure reduces the annual death rate by 15%. A falsification test rules out the possibility of spurious inference on the life-saving role of heat island mitigation measures. Overall, these findings inform efforts to protect the most vulnerable population subgroups and guide future policies to counteract the growing risk of deadly heat waves.
The Metropolitan Region of Sao Paulo (MRSP) is one of the main regions of Brazil that in recent years has shown an increase in the number of days with heat waves, mainly affecting the health of the most sensitive populations, such as the elderly. In this study, we identified the heat waves in the MRSP using three different definitions regarding the maximum daily temperature threshold. To analyze the impact of heat waves on elderly mortality, we used distributed lag nonlinear models (dlnm) and we quantified the heat wave-related excess mortality of elderly people from 1985 to 2005 and made projections for the near future (2030 to 2050) and the distant future (2079-2099) under the climate change scenarios RCP4.5 and RCP8.5 (RCP: Representative Concentration Paths). An important aspect of this research is that for the projections we take into account two assumptions: non-adaptation and adaptation to the future climate. Our projections show that the heat wave-related excess of elderly mortality will increase in the future, being highest when we consider no adaptation, mainly from cardiovascular diseases in women (up to 587 deaths per 100,000 inhabitants per year). This study can be used for public policies to implement preventive and adaptive measures in the MRSP.
BACKGROUND: Although many studies have provided evidence for all-cause mortality attributed to extreme temperature across India, few studies have provided a systematic analysis of the association between all-cause mortality and temperature. OBJECTIVE: To estimate the risk associated with heat waves during two major heat waves of Nagpur occurred in 2010 and 2014. METHODS: The association between temperature and mortality was measured using a distributed lag non-linear model (DLNM) and the attributable deaths associated with the heat waves with forward perspective in the DLNM framework. RESULTS: From the ecological analysis, we found 580 and 306 additional deaths in 2010 and 2014, respectively. Moving average results also gave similar findings. DLNM results showed that the relative risk was 1.5 for the temperature above 45 °C; forward perspective analysis revealed that the attributable deaths during 2010 and 2014 were 505 and 376, respectively. Results from different methods showed that heat waves in different years had variable impacts for various reasons. However, all the results were consistent during 2010 and 2014; there were 30% and 14% extra-mortalities due to heat comparing to non-heat wave years. CONCLUSION: We strongly recommend the city Government to implement the action plans based on this research outcome to reduce the risk from the heat wave in future.
BACKGROUND: Sport organizations must comprehensively assess the degree to which their athletes are susceptible to exertional heat illnesses (i.e. vulnerable) to appropriately plan and adapt for heat-related hazards. Yet, no heat vulnerability framework has been applied in practice to guide decision making. OBJECTIVES: We quantify heat vulnerability of state-level requirements for health and safety standards affecting United States (US) high school athletes as a case study. DESIGN: Observational. METHODS: We utilize a newly developed climate vulnerability to sports organizations framework (CVSO), which considers the heat hazard of each state using summer maximum wet bulb globe temperature (WBGT) in combination with an 18-point heat safety scoring system (18 = best policy). Heat vulnerability is categorized as “problem” [higher heat (>27.9°C) and lower policy score (?9)], “fortified” [higher heat (>27.9°C) and higher policy score (>9)], “responsive” [lower heat (<27.9°C) and lower policy score (?9)], and “proactive” [lower heat (<27.9°C) and higher policy score (>9)]. RESULTS: Across the US, the mean WBGT was 28.4±2.4°C and policy score was 6.9±4.7. In combination, we observed organizations within each of the four vulnerability categories with 16% (n=8) in fortified, 16% (n=8) in proactive, 29% (n=15) in problem, and 39% (n=20) in responsive. CONCLUSIONS: The CSVO framework allowed us to identify different degrees of vulnerability among the state’s and to highlight the 29% (n=15) of states with immediate needs for policy revisions. We found the CSVO framework to be highly adaptable in our application, suggesting feasibility for use with other sports governing bodies.
Accounting for only a limited fraction of Earth’s land surface, urban areas accommodate more than half the global population. The projected increasing severe heat waves with global warming exert a profound threat to the dense urban population and infrastructure. Despite abundant past studies on heat waves, there was a lack of attention to the daytime-nighttime compound heat waves. Here, we categorize summertime heat waves into three distinct types, that is, independent daytime or nighttime heat waves and compound heat waves. Using a universal heat wave metric, we identify the strongest compound heat waves on record (1961-2015) in three vast urban agglomerations in China. We demonstrate substantial increase of the land areas affected by severe compound heat waves over the past three decades. We further quantify the changes in areal and population exposures to future unprecedented compound heat waves. Our results show that under a high-end emission scenario, 50% (100%) of the land area in the Beijing-Tianjin-Hebei region, the Yangtze River Delta, and the Pearl River Delta will be exposed to historically unprecedented compound heat waves on a regular basis by 2050 (2090), 2050 (2070), and 2030 (2050), respectively. Such enhancing heat hazard will induce increasing population exposure of nearly 70, 90, and 60 million to unprecedented compound heat waves by the end of this century (relative to the 2010s). Our findings call for effective mitigation and adaptation strategies to alleviate the risks of unprecedented compound heat waves in rapidly developing populous urban areas. Plain Language Summary Extreme heat waves impose devastating impacts on human health, economy, and the environment. The risk of extreme heat stress tends to be higher in urban areas than in surroundings, due to greater population exposure and added heat stress from urban heat island. Compared to daytime- or nighttime-only heat waves, the risk of compound heat waves that combine scorching days and sweltering nights sequentially tends to be higher. Focusing on top three populous urban agglomerations in China, this study dissects summertime heat waves into three nonoverlapping types and identifies the strongest heat waves on record based on a universal metric of heat wave magnitude. Projections show that unprecedented compound heat waves will become the norm since around 2045 (2060), 2045 (2065), and 2030 (2040) in the Beijing-Tianjin-Hebei region, the Yangtze River Delta, and the Pearl River Delta, respectively, under RCP8.5 (RCP4.5) emission scenario. Enhancing heat hazards will translate into increasing population exposure of about 70, 90, and 60 million to unprecedented compound heat waves by the end of this century, which are concentrated on the highly urbanized areas, such as Beijing, Shanghai, Guangzhou, and Shenzhen. This study highlights the urgent adaptation and mitigation efforts for cities against compound heat waves in particular.
Growing evidence indicates that the risk of heat extremes will increase as climate change progresses and create a significant threat to public health and the economy. Socioeconomic exposure is the key component for assessing the risk of such events. To quantify socioeconomic exposure to heat extremes for 2016-2035 and 2046-2065, we use the projections of five global climate models forced by using three representative concentration pathways (RCPs) and projections of population and gross domestic product (GDP), and we take into account the geographic change in the distribution in shared socioeconomic pathways (SSPs). The exposure of the global population for 2046-2065 is the greatest under the RCP8.5-SSP3 scenario, up to 1037(+/- 164) x 10(9) person-days, and the global GDP exposure for 2046-2065 is greatest under the RCP2.6-SSP1 scenario, up to 18(+/- 2) x 10(15) dollar-days. Asia has the highest exposure among all continents for both population and GDP, accounting for over half of the global exposure. Africa has the largest increase in exposure, with the annual population and GDP exposures increasing by over 9- and 29-fold, respectively, compared with the base period (1986-2005). The effect of climate makes the dominant contribution (47%-53%) globally for the change in population exposure. Changes in the geographic distribution of GDP cause nearly 50% of the total change in GDP exposure for 2016-2035. Mitigating emissions of greenhouse gases, either at the level of the RCP2.6 scenario or at a more ambitious target, is essential for reducing socioeconomic exposure to heat extremes. In addition, designing and implementing effective measures of adaptation are urgently needed in Asia and Africa to aid socioeconomic systems suffering from heat extremes due to climate change. (C) 2020 Elsevier Ltd. All rights reserved.
PURPOSE: The time-of-day variations in environmental heat stress have been known to affect thermoregulatory responses and the risk of exertional heat-related illness during outdoor exercise in the heat. However, such effect and risk are still needed to be examined during indoor sports/exercises. The current study investigated the diurnal relationships between thermoregulatory strain and environmental heat stress during regular judo training in a judo training facility without air conditioning on a clear day in the heat of summer. METHODS: Eight male high school judokas completed two 2.5-h indoor judo training sessions. The sessions were commenced at 09:00 h (AM) and 16:00 h (PM) on separate days. RESULTS: During the sessions, indoor and outdoor heat stress progressively increased in AM but decreased in PM, and indoor heat stress was less in AM than PM (mean ambient temperature: AM 32.7±0.4°C; PM 34.4±1.0°C, P<0.01). Mean skin temperature was higher in AM than PM (P<0.05), despite greater dry and evaporative heat losses in AM than PM (P<0.001). Infrared tympanic temperature, heart rate and thermal sensation demonstrated a trial by time interaction (P<0.001) with no differences at any time point between trials, showing relatively higher responses in these variables in PM compared to AM during the early stages of training and in AM compared to PM during the later stages of training. There were no differences between trials in body mass loss and rating of perceived exertion. CONCLUSIONS: This study indicates a greater thermoregulatory strain in the morning from 09:00 h than the late afternoon from 16:00 h during 2.5-h regular judo training in no air conditioning facility on a clear day in the heat of summer. This observation is associated with a progressive increase in indoor and outdoor heat stress in the morning, despite a less indoor heat stress in the morning than the afternoon.
BACKGROUND: Rodent-borne hantaviruses (genus Orthohantavirus) are the etiologic agents causing two human diseases: hemorrhagic fever with renal syndrome (HFRS) in Euroasia; and hantavirus pulmonary syndrome (HPS) in North and South America. In South America fatality rates of HPS can reach up to 35%-50%. The transmission of pathogenic hantaviruses to humans occurs mainly via inhalation of aerosolized excreta from infected rodents. Thus, the epidemiology of HPS is necessarily linked to the ecology of their rodent hosts and the contact with a human, which in turn may be influenced by climatic variability. Here we examined the relationship between climatic variables and hantavirus transmission aim to develop an early warning system of potential hantavirus outbreaks based on ecologically relevant climatic factors. METHODOLOGY AND MAIN FINDINGS: We compiled reported HPS cases in northwestern Argentina during the 1997-2017 period and divided our data into biannual, quarterly, and bimestrial time periods to allow annual and shorter time delays to be observed. To evaluate the relationship of hantavirus transmission with mean temperature and precipitation we used dynamic regression analysis. We found a significant association between HPS incidence and lagged rainfall and temperature with a delay of 2 to 6 months. For the biannual and quarterly models, hantavirus transmission was positively associated with lagged rainfall and temperature; whereas the bimestrial models indicate a direct relationship with the rainfall but inverse for temperature in the second lagged period. CONCLUSIONS/SIGNIFICANCE: This work demonstrates that climate variability plays a significant role in the transmission of hantavirus in northwestern Argentina. The model developed in this study provides a basis for the forecast of potential HPS outbreaks based on climatic parameters. Our findings are valuable for the development of public health policies and prevention strategies to mitigate possible outbreaks. Nonetheless, a surveillance program on rodent population dynamics would lead to a more accurate forecast of HPS outbreaks.
Extreme heat events can lead to increased risk of heat-related deaths. Furthermore, urban areas are often hotter than their rural surroundings, exacerbating heat waves. Unfortunately, validation is difficult; to our knowledge, most validations, even if they control for temperatures, really only validate a social vulnerability index instead of a heat vulnerability index. Here we investigate how to construct and validate a heat vulnerability index given uncertainty ranges in data for the city of Rio de Janeiro. First, we compare excess deaths of certain types of circulatory diseases during heat waves. Second, we use demographic and environmental data and factor analysis to construct a set of unobserved factors and respective weightings related to heat vulnerability, including a Monte Carlo analysis to represent the uncertainty ranges assigned to the input data. Finally, we use distance to hospital and clinics and their health record data as an instrumental variable to validate our factors. We find that we can validate the Rio de Janeiro heat vulnerability index against excess deaths during heat waves; specifically, we use three types of regressions coupled with difference in difference calculations to show this is indeed a heat vulnerability index as opposed to a social vulnerability index. The factor analysis identifies two factors that contribute to >70% of the variability in the data; one socio-economic factor and one urban form factor. This suggests it is necessary to add a step to existing methods for validation of heat vulnerability indices, that of the difference-in-difference calculation.
Urban areas are increasingly impacted by the urban heat island effect, especially during heat waves. In the context of improving energy efficiency in buildings, passive and energy-efficient cooling methods are needed for reducing indoor heat stress and lowering building energy consumption during heat waves. In this study, a whole building simulation model that includes both moisture and heat transport in wall envelopes and indoor environment is developed. An analytical solution and two test cases are used to validate the developed model. The developed model is applied to study indoor thermal conditions in urban areas in Zurich, Switzerland in a hot summer. The results show that indoor temperature could not be accurately simulated when moisture transport in the wall envelopes is neglected. Due to the urban heat island effect, night ventilation is not sufficient to cool down the indoor environment during the heat wave in the urban area. The potential of precooling before the heat wave and moisture-desorption cooling from hygroscopic materials have been studied to reduce indoor heat stress in the urban area. The average operative temperature during the heat wave can be reduced by 0.43 degrees C by precooling before the start of the heat wave, whereas desorption cooling from hygroscopic materials could reduce the average operative temperature during heat waves by 1.31 degrees C. A combination of these two mitigation measures could lead to enhanced passive cooling effect. There is a large potential of using desorption of hygroscopic material to reduce heat stress during heatwaves, while minimizing energy consumption of buildings.
BACKGROUND: As a mosquito-borne infectious disease, dengue fever (DF) has spread through tropical and subtropical regions worldwide in recent decades. Dengue forecasting is essential for enhancing the effectiveness of preventive measures. Current studies have been primarily conducted at national, sub-national, and city levels, while an intra-urban dengue forecasting at a fine spatial resolution still remains a challenging feat. As viruses spread rapidly because of a highly dynamic population flow, integrating spatial interactions of human movements between regions would be potentially beneficial for intra-urban dengue forecasting. METHODOLOGY: In this study, a new framework for enhancing intra-urban dengue forecasting was developed by integrating the spatial interactions between urban regions. First, a graph-embedding technique called Node2Vec was employed to learn the embeddings (in the form of an N-dimensional real-valued vector) of the regions from their population flow network. As strongly interacting regions would have more similar embeddings, the embeddings can serve as “interaction features.” Then, the interaction features were combined with those commonly used features (e.g., temperature, rainfall, and population) to enhance the supervised learning-based dengue forecasting models at a fine-grained intra-urban scale. RESULTS: The performance of forecasting models (i.e., SVM, LASSO, and ANN) integrated with and without interaction features was tested and compared on township-level dengue forecasting in Guangzhou, the most threatened sub-tropical city in China. Results showed that models using both common and interaction features can achieve better performance than that using common features alone. CONCLUSIONS: The proposed approach for incorporating spatial interactions of human movements using graph-embedding technique is effective, which can help enhance fine-grained intra-urban dengue forecasting.
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.
Climate change affects the dynamics of vector-borne diseases. Culex pipiens Linnaeus is the main vector of West Nile fever, a widely distributed arbovirus, it is continuously increasing its distribution. Using a species distribution model, maps of suitable habitats of Cx. pipiens were generated for Chile in the current climate and three climate change scenarios, using global and regional georeferenced vector presence records as input, plus bioclimatic variables. Since this virus has not yet arrived in Chile, the purpose of this study is to anticipate potential risk areas and to prevent the establishment and spread of the virus. Cx. pipiens is widely distributed in Chile. The suitable habitats in Chile were concentrated mostly from 32 degrees to 35 degrees S, increasing in future scenarios up to 113 % in the northern zone and moving towards the mountains. This species conserves around 90 % of its niche in the future, and shows a reduction of 11.4 % in the severe climate change scenario. It is anticipated that Chile will experience an increase in the environmental suitability for Cx. pipiens moving from the Andes to the coastal zone throughout the country, mainly in the center-south. This will raise the risk of local virus transmission if the virus is introduced to the country via diverse routes.
The flow of the Earth’s atmosphere not only largely determines its temperature status, but also profoundly affects aerosol concentrations. Therefore, exploring how to evaluate the synthetical effects of temperature and aerosol pollution on human health is an important topic. Regarding the atmosphere as a whole, we quantified the mortality burden attributable to short-term exposure to abnormal temperatures and PM2.5 in Beijing from the perspective of atmospheric flow. We first divided the atmospheric stability into three levels (including disturbed, normal, and stable conditions) according to the variations in meteorological conditions and PM2.5 concentrations across the stable weather index levels. We then applied a generalized additive model to separately evaluate the short-term effects of temperature and PM2.5 on mortality under each level of atmospheric stability. We further estimate the associated mortality burden using two indicators, namely attributable fraction and attributable number of deaths. Abnormal temperatures were responsible for most of the mortality burden. Cold temperatures accounted for a substantially higher mortality burden than hot temperatures. The synthetical mortality effects of temperature and PM2.5 varied for different atmospheric stabilities. A stable atmosphere poses the strongest synthetical effects of temperature and PM2.5, while a normal atmosphere provides comparatively beneficial conditions for human health. Our results indicated that the synthetical health impacts of temperature and PM2.5 driven by atmospheric flow need to be considered in the further promulgation of public health policies and air pollution abatement strategies, particularly in the context of climate change.
Background and objectives: Progressing climate change is accompanied by a worldwide increase in the intensity, frequency, and duration of heat wave events. Research has shown that heat waves are an emerging public health problem, as they have a significant impact on mortality. As studies exploring this relationship are scarce for Latvia, this study aims to investigate the short-term associations between heat waves and all-cause mortality as well as cause-specific mortality, during the summer months (May-September) in Riga. Materials and Methods: An ecological time series study using daily reported mortality and temperature data from Riga between 2009 and 2015 was employed. Heat waves were defined based on the categories of the Latvian and Swedish heat warning system. Using a Quasi-Poisson regression, the relationships between heat waves and all-cause as well as cause-specific mortality were investigated. Results: Heat waves in Riga were associated with a 10% to 20% increase in the risk of all-cause mortality, depending on the applied heat wave definition, compared to days with normal temperature. In addition, heat-related mortality was found to increase significantly in the ?65 age group between 12% and 22% during heat waves. In terms of cause-specific mortality, a significant increase of approximately 15% to 26% was observed for cardiovascular mortality. No significant associations were found between heat waves and respiratory or external causes of mortality. Conclusion: These results indicate that there are short-term associations between heat waves and all-cause as well as cardiovascular mortality in Riga and that heat waves therefore represent a public health problem in this Baltic city.
The aim of the current paper is to evaluate spatial and temporal characteristics of the distribution of bioclimatic comfort within the Arkhangelsk region (Russian Federation) with two modern indices of thermal comfort: PET and UTCI. Its average values calculated for the modern climatic period (1981-2010) in the monthly mean give a clear picture of spatial heterogeneity for the warmest month (July) and for the coldest one (January). The spatial picture of both indices in July allows us to distinguish three large internal regions: the Arkhangelsk province, the continental part of the Nenets Autonomous Okrug (NAO) and Novaya Zemlya islands (NZ). Winter distribution of thermal discomfort is fundamentally different: the coldest regions (with extreme cold stress) are equally NZ and the eastern half of NAO; intermediate position is occupied by the west of the NAO and the extreme north-east of the Arkhangelsk region, the highest winter UTCI values are observed in the rest of the region. In Archangelsk-city extreme cold stress in January has repeatability 6.7%, in February 4%, in December 2.2%, respectively. The average number of time points during the year at which thermal stress is not observed is only 19%. Obtained results will be the basis for planning relevant health measures and providing reliable forecasts of the effects of climate change in the Arctic region.
Construction materials and systems for the thermal building envelope have played a key role in the improvement of energy efficiency in buildings. Urban heat islands together with the upcoming rising global temperature demand construction solutions that are adapted to the specific microclimate conditions. These circumstances are even more dramatic in the case of healthcare buildings where the need to preserve constant indoor temperatures is a priority for the proper recovery of patients. A new neonatal hospital, located in Madrid (Spain), has been monitored, and building energy simulations were performed to evaluate the effect of the building envelope on the energy demand. Based on the simulation results, the design of the building envelope was found to be insufficiently optimised to properly protect the building from the external heat flow. This is supported by the monitored results of the indoor temperatures, which went over the standard limit for about 50% of the hours, achieving up to 27 degrees C in June and July, and 28 degrees C in August. The results showed, on one hand, that solar radiation gains transmitted through the facade have an important impact on the indoor temperature in the analysed rooms. Heat gains through the opaque envelope showed an average of 8.37 kWh/day, followed by heat gains through the glazing with an average value of 5.29 kWh/day; while heat gains from lighting and occupancy were 5.21 kWh/day and 4.47 kWh/day, respectively. Moreover, it was shown that a design of the envelope characterised by large glass surfaces and without solar protection systems, resulted in excessive internal thermal loads that the conditioning system was not able to overcome.
Thermal comfort is an important determinant of quality of life and economic vitality in cities. Strategies to improve thermal comfort may become a more critical part of urban sustainability efforts with projections of continued urban growth and climate change. A case study was performed in the hot, dry summertime climate of Tempe, Arizona to quantify the influence of evaporative misters on the thermal environment in outdoor restaurants and to understand business managers’ motivations to use misters. Microclimate measurements (air temperature (T(a)), wind speed, relative humidity, globe temperature) were taken at five restaurants midday within four exposures: misted sun, misted shade, sun only, and shade only. We assessed T(a), mean radiant temperature (MRT), universal thermal climate index (UTCI), and physiological equivalent temperature (PET) between these four conditions within each location. Misters improved thermal comfort across all days, sites, and exposure conditions. MRT was on average 7.6 °C lower in misted locations, which significantly lowered average PET (- 6.5 °C) and UTCI (- 4.4 °C) (p < 0.05). Thermal comfort was most improved using mist in combination with shade. Under such conditions, PET and UTCI were reduced by 15.5 °C and 9.7 °C (p < 0.05), respectively. Business managers identified customer comfort and increased seating capacity as the principal factors for mister use. Esthetics of misters further encouraged use, while cost and environmental concerns were perceived to be less important. While this case study demonstrates value in outdoor misting in a hot, dry climate, additional work is needed to more fully evaluate tradeoffs between cost, water use, and comfort with continuing urban growth.
Ciguatera poisoning (CP) results from the consumption of seafood contaminated with ciguatoxins (CTXs). This disease is highly prevalent in French Polynesia with several well-identified hotspots. Rapa Island, the southernmost inhabited island in the country, was reportedly free of CP until 2007. This study describes the integrated approach used to investigate the etiology of a fatal mass-poisoning outbreak that occurred in Rapa in 2009. Symptoms reported in patients were evocative of ciguatera. Several Gambierdiscus field samples collected from benthic assemblages tested positive by the receptor binding assay (RBA). Additionally, the toxicity screening of ?250 fish by RBA indicated ?78% of fish could contain CTXs. The presence of CTXs in fish was confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The potential link between climate change and this range expansion of ciguatera to a subtropical locale of French Polynesia was also examined based on the analysis of temperature time-series data. Results are indicative of a global warming trend in Rapa area. A five-fold reduction in incidence rates was observed between 2009 and 2012, which was due in part to self-regulating behavior among individuals (avoidance of particular fish species and areas). Such observations underscore the prominent role played by community outreach in ciguatera risk management.
Background.Exposure to high air temperature in late pregnancy is increasingly recognized as a risk factor for preterm birth (PTB). However, the combined effects of heatwaves with air pollution and green space are still unexplored. In the context of climate change, investigating the interaction between environmental factors and identifying communities at higher risk is important to better understand the etiological mechanisms and design targeted interventions towards certain women during pregnancy.Objectives.To examine the combined effects of heatwaves, air pollution and green space exposure on the risk of PTB.Methods.California birth certificate records for singleton births (2005-2013) were obtained. Residential zip code-specific daily temperature during the last week of gestation was used to create 12 definitions of heatwave with varying temperature thresholds and durations. We fit multi-level Cox proportional hazard models with time to PTB as the outcome and gestational week as the temporal unit. Relative risk due to interaction (RERI) was applied to estimate the additive interactive effect of air pollution and green space on the effect of heatwaves on PTB.Results.In total, 1 967 300 births were included in this study. For PM2.5, PM(10)and O-3, we found positive additive interactions (RERIs >0) between heatwaves and higher air pollution levels. Combined effects of heatwaves and green space indicated negative interactions (RERIs <0) for less intense heatwaves (i.e. shorter duration or relatively low temperature), whereas there were potential positive interactions (RERIs >0) for more intense heatwaves.Conclusion.This study found synergistic harmful effects for heatwaves with air pollution, and potential positive interactions with lack of green space on PTB. Implementing interventions, such as heat warning systems and behavioral changes, targeted toward pregnant women at risk for high air pollution and low green space exposures may optimize the benefits of reducing acute exposure to extreme heat before delivery.
Hyperthermia stimulates endogenous carbohydrate metabolism during exercise; however, it is not known if exercise intensity impacts the metabolic effect of heat stress. In the first study of this two-part investigation, endurance-trained male cyclists performed incremental exercise assessments in 18 and 35 degrees C (60% rH). The stimulatory effect of heat stress on carbohydrate oxidation rates was greater at high vs. moderate vs. low relative intensity (P < 0.05). In agreement, no effects of heat stress on carbohydrate oxidation rates were observed during 60-min of subsequent low-intensity cycling. In study two, endurance-trained male cyclists performed 20-min of moderate-intensity (power at the first ventilatory threshold) and 5-min of high-intensity (power at the second ventilatory threshold) cycling in 18, 28, 34, and 40 degrees C (60% rH). At moderate-intensity, carbohydrate oxidation rates were significantly elevated by heat stress in 40 degrees C (P < 0.05), whereas at high-intensity carbohydrate oxidation rates were significantly elevated by heat stress in 34 and 40 degrees C (P < 0.05). This exercise intensity-mediated regulation of the effect of heat stress on carbohydrate oxidation may be partially attributable to observed plasma adrenaline responses. Our data suggest that under moderate environmental heat stress (34-35 degrees C, 60% rH), heat stress-induced changes in CHO oxidation rates are unlikely to occur unless the relative exercise intensity is high (81 +/- 8%(V)over dotO(2max)), whereas under more extreme environmental heat stress (40 degrees C, 60% rH), these changes occur at lower relative intensities (69 +/- 8%(V)over dotO(2max)). This provides indication of when heat stress-induced metabolic changes during exercise are likely to occur.
Leptospirosis outbreaks in various parts of the world have been linked to changes in the weather. Furthermore, the effects have been shown to occur at different lags of up to 10 months, affecting the performance of simulation models that predict leptospirosis occurrence. In Malaysia, the link between different weather parameters, at different time lags, has yet to be established despite an increasing number of cases in recent years. In this study, a combination of data mining and machine learning is used to analyze, capture, and predict the relation between leptospirosis occurrence and temperature, rainfall, and relative humidity using the Seremban district in Malaysia as a case study. First, the optimal time lags for rainfall were determined using graphical exploratory data analysis (EDA) while non-graphical EDA was used for temperature. Then, an artificial neural network (ANN) model is developed to classify the combination of selected features into disease occurrence and non-occurrence using back-propagation training, optimizing the number of hidden layers and hidden nodes. The success is measured using accuracy, sensitivity, and specificity of each model. EDA has shown that leptospirosis occurrence in Seremban is highly correlated with weekly average temperature at lag 16 weeks and weekly rainfall amount at lag 12-20 weeks. Using these selected features, the ANN model achieved the highest accuracy, sensitivity, and specificity at 84.00, 86.44, and 79.33%, respectively. Overall, the EDA approach has increased the accuracy of the predictive model by 13.30-31.26% from the baseline models.
Although only a small proportion of the landmass of South Africa is classified as high risk for malaria, the country experiences on-going challenges relating to malaria outbreaks. Climate change poses a growing threat to this already dire situation. While considerable effort has been placed in public health campaigns in the highest-risk regions, and national malaria maps are updated to account for changing climate, malaria cases have increased. This pilot study considers the sub-population of South Africans who reside outside of the malaria area, yet have the means to travel into this high-risk region for vacation. Through the lens of the governmental “ABC of malaria prevention”, we explore this sub-population’s awareness of the current boundaries to the malaria area, perceptions of the future boundary under climate change, and their risk-taking behaviours relating to malaria transmission. Findings reveal that although respondents self-report a high level of awareness regarding malaria, and their boundary maps reveal the broad pattern of risk distribution, their specifics on details are lacking. This includes over-estimating both the current and future boundaries, beyond the realms of climate-topographic possibility. Despite over-estimating the region of malaria risk, the respondents reveal an alarming lack of caution when travelling to malaria areas. Despite being indicated for high-risk malaria areas, the majority of respondents did not use chemoprophylaxis, and many relied on far less-effective measures. This may in part be due to respondents relying on information from friends and family, rather than medical or governmental advice.
Although heat exposure is the leading cause of mortality for undocumented immigrants attempting to traverse the Mexico-U.S. border, there has been little work in quantifying risk. Therefore, our study aims to develop a methodology projecting increase in core temperature over time and space for migrants in Southern Arizona using spatial analysis and remote sensing in combination with the heat balance equation-adapting physiological formulae to a multi-step geospatial model using local climate conditions, terrain, and body specifics. We sought to quantitatively compare the results by demographic categories of age and sex and qualitatively compare them to known terrestrial conditions and prior studies of those conditions. We demonstrated a more detailed measure of risk for migrants than those used most recently: energy expenditure and terrain ruggedness. Our study not only gives a better understanding of the ‘funnel effect’ mechanisms, but also provides an opportunity for relief and rescue operations.
Malaria occurrence in the Chittagong Hill Tracts in Bangladesh varies by season and year, but this pattern is not well characterized. The role of environmental conditions on the occurrence of this vector-borne parasitic disease in the region is not fully understood. We extracted information on malaria patients recorded in the Upazila (sub-district) Health Complex patient registers of Rajasthali in Rangamati district of Bangladesh from February 2000 to November 2009. Weather data for the study area and period were obtained from the Bangladesh Meteorological Department. Non-linear and delayed effects of meteorological drivers, including temperature, relative humidity, and rainfall on the incidence of malaria, were investigated. We observed significant positive association between temperature and rainfall and malaria occurrence, revealing two peaks at 19 °C (logarithms of relative risks (logRR) = 4.3, 95% CI: 1.1-7.5) and 24.5 °C (logRR = 4.7, 95% CI: 1.8-7.6) for temperature and at 86 mm (logRR = 19.5, 95% CI: 11.7-27.3) and 284 mm (logRR = 17.6, 95% CI: 9.9-25.2) for rainfall. In sub-group analysis, women were at a much higher risk of developing malaria at increased temperatures. People over 50 years and children under 15 years were more susceptible to malaria at increased rainfall. The observed associations have policy implications. Further research is needed to expand these findings and direct resources to the vulnerable populations for malaria prevention and control in the Chittagong Hill Tracts of Bangladesh and the region with similar settings.
The WHO Housing and health guidelines recommend a minimum indoor temperature of 18°C to prevent cold-related diseases. In Japan, indoor temperatures appear lower than in Euro-American countries because of low insulation standards and use of partial intermittent heating. This study investigated the actual status of indoor temperatures in Japan and the common characteristics of residents who live in cold homes. We conducted a nationwide real-world survey on indoor temperature for 2 weeks in winter. Cross-sectional analyses involving 2190 houses showed that average living room, changing room, and bedroom temperatures were 16.8°C, 13.0°C, and 12.8°C, respectively. Comparison of average living room temperature between prefectures revealed a maximum difference of 6.7°C (Hokkaido: 19.8°C, Kagawa: 13.1°C). Compared to the high-income group, the odds ratio for living room temperature falling below 18°C was 1.38 (95% CI: 1.04-1.84) and 2.07 (95% CI: 1.28-3.33) for the middle- and low-income groups. The odds ratio was 1.96 (95% CI: 1.19-3.22) for single-person households, compared to households living with housemates. Furthermore, lower room temperature was correlated with local heating device use and a larger amount of clothes. These results will be useful in the development of prevention strategies for residents who live in cold homes.
INTRODUCTION: Haemagogus are mosquitoes with diurnal habits that live preferentially in forest areas. In Brazil, they are considered the primary vectors of wild yellow fever. METHODS: The ecological relationships between Haemagogus spegazzinii, the environment, and some of its activities in the semiarid region of Rio Grande do Norte were analyzed by collecting eggs with ovitraps, actively searching in tree holes, capturing adults in Shannon traps, and conducting an investigation for viral infections. RESULTS: A total of 2420 eggs, 271 immature specimens (larvae and pupae), and 206 adults were collected. Egg collection depended on rainfall and relative humidity, with oviposition occurring between January and May. Larvae were found in five plant species, including Tabebuia aurea (craibeira), with 160 larvae collected. We observed shared breeding sites between Hg. spegazzinii and the following species: Aedes albopictus, Aedes terrens, Culex spp., and Toxorhynchites theobaldi. Adults exhibited greater activity between 5 pm and 6 pm, when 191 (92.7%) specimens were captured, while only 1 (0.5%) was collected between 7 pm and 8 pm. The relationship between Hg. spegazzinii and rainfall was significant, with positive correlations with accumulated rainfall 5, 10, 15, 20, and 30 days before mosquito collection. We found that the species was infected with the DENV-2 virus. CONCLUSIONS: This work contributes new information on the bioecology of Hg. spegazzinii, with data on the main reproduction periods, oviposition, breeding sites, activity times, and the relationship between the species and meteorological variables in the Caatinga of northeastern Brazil.
Objective: To establish a spatial geo-database for scorpions in Iran, and to identify the suitable ecological niches for the most dangerous scorpion species under different climate change scenarios. Methods: The spatial distribution of six poisonous scorpion species of Iran were modeled: Hemiscorpius lepturus, Androctonus crassicauda, Mesobuthus eupeus, Hottentotta saulcyi, Hottentotta zagrosensis, and Odontobuthus (O.) doriae, under RCP2.6 and RCP8.5 climate change scenarios. The MaxEnt ecological niche model was used to predict climate suitability for these scorpion species in the 2030s and 2050s, and the data were compared with environmental suitability under the current bioclimatic data. Results: A total of 73 species and subspecies of scorpions belonging to 19 genera in Iran were recorded. Khuzestan Province has the highest species diversity with 34 species and subspecies. The most poisonous scorpion species of Iran are scattered in the semi-arid climates, at an altitudinal range between 11 m and 2 954 m above sea level. It is projected that O. doriae, Androctonus crassicauda and Mesobuthus eupeus species would be widely distributed in most parts of the country, whereas the most suitable ecological niches for the other species would be limited to the west and/or southwestern part of Iran. Conclusions: Although the environmental suitability for all the species would change under the two climate change scenarios, the change would be more significant for O. doriae under RCP8.5 in the 2050s. These findings can be used as basis for future studies in the areas with the highest environmental suitability for the most dangerous scorpion species to fill the gaps in the ecology of scorpion species in these areas.
The effectiveness of urban hydrological processes in mitigating the urban heat island (UHI) effect and human thermal stress in the megacity of Nanjing during an extreme heat wave event (6th-10th August 2013) was assessed using Weather Research and Forecasting Single-Layer Urban Canopy Models. The inclusion of urban hydrological processes improved model performance, with more reasonable diurnal cycles and smaller mean errors, root mean square errors, and normalized root mean square errors for meteorological variables. Through evaporative cooling, urban hydrological processes can greatly increase specific and relative humidity, while reducing near-surface and surface temperatures, wind speed, and planetary boundary layer (PBL) height, and the cooling and wetting effects could affect the entire PBL, especially in low-intensity residential areas. Urban hydrological processes can effectively mitigate both the near-surface and surface UHI effect. The city-wide mitigation effectiveness of near-surface UHI ranged between 0.9 degrees C and 1.1 degrees C throughout the day, while the city-wide mitigation effectiveness of surface UHI at noon reached similar to 5 degrees C. The maximum reduction of near-surface and surface UHI in low-intensity residential areas reached 1.3 degrees C and 10.0 degrees C, respectively. Changes in heat stress indices indicate that the cooling effect improves human thermal comfort at night, while the increased humidity outweighs the cooling effect and exacerbates human thermal discomfort during daytime. The city-wide thermal stress increased by up to 0.4 degrees C, 0.2 degrees C, and 0.5 degrees C during daytime and decreased by up to 0.4 degrees C, 0.3 degrees C, and 0.6 degrees C at night for wet-bulb globe temperature, apparent temperature, and humidity index, respectively.
OBJECTIVE: Diurnal temperature range (DTR) is an important meteorological indicator of global climate change; high values of DTR may induce stroke morbidity, while the related high-risk periods and sensitive populations are not clear. This study aims to evaluate the effects of DTR on first-ever strokes in different seasons and in relation to sensitive populations. METHODS: We collected data on 142?569 first-ever strokes during 2005-2016 in Shenzhen. We fitted a time-series Poisson model in our study, estimating the associations between DTR and first-ever strokes, with a distributed lag non-linear model. Then, we calculated strokes attributable to high DTR in different genders, age groups, education levels and stroke subtypes. RESULTS: High DTR had a significant association with first-ever strokes, and the risk of stroke increased with the rise of DTR in the summer and winter. In total, 3.65% (95% empirical CI (eCI) 1.81% to 5.53%) of first-ever strokes were attributable to high DTR (5.5°C and higher) in the summer, while 2.42% (95% eCI 0.05% to 4.42%) were attributable to high DTR (8°C and higher) in the winter. In the summer, attributable fraction (AF) was significant in both genders, middle-aged and old patients, patients with different levels of education, as well as patients with cerebral infarction (CBI); in the winter, AF was significant in middle-aged patients, patients with primary and lower education level, as well as patients with CBI. CONCLUSIONS: High DTR may trigger first-ever strokes in the summer and winter, and CBI is more sensitive than intracerebral haemorrhage to DTR. Most people are sensitive to high DTR in the summer, while middle-aged and low-education populations are sensitive in the winter. It is recommended that the DTR values be reported and emphasised in weather forecast services, together with the forecasts of heat and cold.
Arboviruses transmitted by Aedes aegypti and Aedes albopictus have been introduced to Florida on many occasions. Infrequently, these introductions lead to sporadic local transmission and, more rarely, sustained local transmission. Both mosquito species are present in Florida, with spatio-temporal variation in population composition. We developed a two-vector compartmental, deterministic model to investigate factors influencing Chikungunya virus (CHIKV) establishment. The model includes a nonlinear, temperature-dependent mosquito mortality function based on minimum mortality in a central temperature region. Latin Hypercube sampling was used to generate parameter sets used to simulate transmission dynamics, following the introduction of one infected human. The analysis was repeated for three values of the mortality function central temperature. Mean annual temperature was consistently important in the likelihood of epidemics, and epidemics increased as the central temperature increased. Ae. albopictus recruitment was influential at the lowest central temperature while Ae. aegypti recruitment was influential at higher central temperatures. Our results indicate that the likelihood of CHIKV establishment may vary, but overall Florida is permissive for introductions. Model outcomes were sensitive to the specifics of mosquito mortality. Mosquito biology parameters are variable, and improved understanding of this variation will improve our ability to predict the outcome of introductions.
Solar radiation intensity affects both subjective reactions and physiological functions, especially for people who exercise heavily. Field experiments including a questionnaire survey at various ambient temperatures were performed; outdoor activities under shading (irradiance I = 50 +/- 20 W/m(2)) and non-shading (I = 700 +/- 50 W/m(2)) conditions during summer in Xi’an were recorded. The results of questionnaires indicated that when the human body reached an extremely hot state, the corresponding environmental temperature was 3.7 degrees C lower under the non-shading condition, and the range of actual acceptable temperatures was narrower. In terms of thermal sensation, there was a significant difference for people who exercise heavily and those who do not. The results also showed that the curve of fatigue sensation exhibited an inverse Gaussian distribution. Namely, fatigue was promoted under both colder and hotter conditions. Moreover, under non-shading condition, the lowest fatigue incidence was higher, and the corresponding ambient temperature was lower. Changes in objective physiological responses indicated that the solar radiation might cause heat stress. Therefore, when the ambient temperature was higher than 32 degrees C, physiological stress was higher. Under the same exercise load, the blood pressure was higher under the non-shading condition and systolic blood pressure increased with ambient temperature.
There has been growing concern over the effects of heat waves on health. However, the effects of heat waves on the health of individuals in vulnerable groups have rarely been examined. We aimed to investigate the acute health effects of heat waves in elderly individuals living in rural areas and to survey their adaptation capacity. Repeated measurements of body temperature (BT), blood pressure, sleep disturbance, and indoor temperature were conducted up to six times for each of 104 elderly individuals living in rural areas of South Korea during the 2018 heat wave. Changes in BT, systolic blood pressure (SBP), and diastolic blood pressure (DBP) according to variations in indoor and outdoor temperature were analyzed using linear mixed effect models controlling for age, sex, smoking, and drug use. We also surveyed heat wave adaptation capacity, heat wave shelters, and self-reported health problems. The average indoor temperature measured during the study period was 30.5°C (range: 22.9-38.3°C) and that of ambient temperature was 30.6°C (range: 24.6-36.3°C). BT significantly increased with indoor and outdoor temperatures. The effect on BT was greater in elderly women and the elderly with hypertension. DBP generally decreased with increasing indoor temperature, though the correlation was only statistically significant among the elderly with hypertension. Only 22 (21.2%) individuals used air conditioners during the heat wave. Most did not use an air conditioner mainly to avoid high electricity costs. Of the participants, 58.7% reported experiencing sleep disturbance, which was the most frequent self-reported health problem. Elderly individuals living in rural areas are directly exposed to high temperatures during heat waves, and their vital signs are sensitive to increases in indoor temperature due to poor adaptation capacity. Well-designed strategies for alleviating health-related stress during heat waves are necessary.
Increasing population and economic growth has intensified water supply pressure on the Olifants River Basin causing it to become water-stressed. Climate change is expected to aggravate existing water supply challenges in the basin if urgent interventions are not implemented. This study evaluates the impacts of climate change on water availability and demand in the Olifants River Basin of South Africa, and assesses to what extent a combination of management strategies can mitigate current and longer term impacts using the Water Evaluation and Planning (WEAP) model. The results demonstrated by the two projected climate change scenarios (RCP4.5 and RCP8.5) showed a rise in temperature of approximately 1 degrees C-4 degrees C, and a decrease in precipitation of 5%-30%, as compared to the baseline climate of 1976-2005. Results also showed that pressure on water supply due to increased economic activities and a decline in streamflow will increase unmet water demand by 58% and 80% for the mid and end century periods respectively. Results further revealed that the combination of management measures proposed by decision makers is expected to decrease future unmet water demand from 1006MCM to 398MCM, 1205MCM to 872MCM and 1251MCM to 940MCM for reference, RCP4.5 and RCP 8.5 scenario respectively. The study therefore concludes that the combination of management strategies provides a much better and more efficient solution to water scarcity issues in the basin, compared to a reliance on a single strategy.
Climate change has caused an increased occurrence of heat waves. As a result of rising temperatures, implications for health and the environment have been more frequently reported. Outdoor labour activities deserve special attention, as is the case with agricultural and construction workers exposed to extreme weather conditions, including intense heat. This paper presents an overview of heat stress conditions in Brazil from 1961 to 2010. It also presents computer-simulated projections of heat stress conditions up to the late 21st century. The proposed climate analysis drew on historical weather data obtained from national weather stations and on reanalysis data, in addition to future projections with the ETA (regarding the model’s unique vertical coordinate) regional forecast model. The projections took into consideration two Representative Concentration Pathways (RCP)-the 4.5 and 8.5 climate scenarios, namely, moderate and high emissions scenarios, respectively. Heat stress was inferred based on the wet-bulb globe temperature (WBGT) index. The results of this climate analysis show that Brazilian outdoor workers have been exposed to an increasing level of heat stress. These results suggest that future changes in the regional climate may increase the probability of heat stress situations in the next decades, with expectations of WBGT values greater than those observed in the baseline period (1961-1990). In terms of spatial distribution, the Brazilian western and northern regions experienced more critical heat stress conditions with higher WBGT values. As a response to the increased frequency trends of hot periods in tropical areas, urgent measures should be taken to review public policies in Brazil. Such policies should include actions towards better working conditions, technological development to improve outdoor labour activities, and employment legislation reviews to mitigate heat impacts on occupational health.
Sri Lanka is experiencing various social and environmental challenges, including drought, storms, floods, and landslides, due to climate change. One of Sri Lanka’s biggest cities, Kurunegala, is a densely populated city that is gradually turning into an economic revitalization area. This fast-growing city needs to establish an integrated urban plan that takes into account the risks of climate change. Thus, a climate change risk assessment was conducted for both the water and heat wave risks via discussions with key stakeholders. The risk assessment was conducted as a survey based on expert assessment of local conditions, with awareness surveys taken by residents, especially women. The assessment determined that the lack of drinking water was the biggest issue, a problem that has become more serious due to recent droughts caused by climate change and insufficient water management. In addition, the outbreak of diseases caused by heat waves was identified as a serious concern. Risk assessment is integral to developing an action plan for minimizing the damage from climate change. It is necessary to support education and awareness in developing countries so that they can perform risk assessment well and develop both problem-solving and policy-making abilities to adapt to a changing climate.
Climatic variability affects many underlying determinants of child malnutrition, including food availability, access, and utilization. Evidence of the effects of changing temperatures and precipitation on children’s nutritional status nonetheless remains limited. Research addressing this knowledge gap is merited given the shortand long-run consequences of malnutrition. We address this issue by estimating the effects of temperature and precipitation anomalies on the weight and wasting status of children ages 0-59 months across 18 countries in sub-Saharan Africa. Linear regression models show that high temperatures and low precipitation are associated with reductions in child weight, and that high temperatures also lead to increased risk of wasting. We find little evidence of substantively meaningful differences in these effects across sub-populations of interest. Our results underscore the vulnerability of young children to climatic variability and its second-order economic and epidemiological effects. The study also highlights the corresponding need to design and assess interventions to effectively mitigate these impacts.
Background: Rotavirus diarrhea is often referred as “winter diarrheal disease” as it causes nearly 50% of the pediatric hospitalizations during winter season. This study was done with the objective of bringing out the epidemiological nexus of rotavirus cases with different seasonal parameters like maximum, minimum temperature, humidity, and average rainfall. Methods: This prospective observational study was conducted in a tertiary care teaching hospital of Eastern India from February 2016 to December 2018. Data on daily maximum and minimum temperature, relative humidity, and rainfall were collected. Result: Of 964 children admitted, 768 stool samples were collected for rotavirus assay. A total of 222 children (29%) were positive. The maximum, minimum temperature, average rainfall, and average humidity of 83.4 mm, 79.2%, 28.1, and 21.9, respectively, were significantly associated with positive rotaviral cases. Conclusions: The incidence of rotavirus positivity cases was found to be inversely associated with average temperature, humidity, and rainfall. The knowledge about the seasonal pattern in a particular geographical area would help in the reallocation of hospital services (staff and bed) to tackle the epidemic or emergency situations resulting from clustering of cases.
While the associations of heat with health outcomes is well researched, there is less consensus on the measures used to define heat exposure and the short-term and delayed impacts of different temperature metrics on health outcomes. We investigate the nonlinear and short-term relationship of three temperature metrics and reported incidence of three gastrointestinal illnesses: salmonellosis, campylobacteriosis and cryptosporidiosis in the Australian Capital Territory (ACT). We also examine the nonlinear association of these illnesses with extreme heat (5th, 75th, 90th percentile of all heat measures). Generalized linear models with Poisson regression accounting for overdispersion, seasonal and long-term trend, weekly number of outbreaks and rainfall were developed for mean and maximum weekly temperature and the heat stress index (EHI(accl)). Bacterial illnesses (salmonellosis and campylobacteriosis) showed an overall positive association with extreme heat (75th and 90th percentile of all three heat measures) and an inverse association with low temperature (5th percentile). The shape of the exposure-response curve across a range of temperatures and the lagged effects varied for each disease. Modelling the short-term and delayed effects of heat using different metrics across a range of illnesses can help identify the most appropriate measure to inform local public health intervention planning for heat-related emergencies.
In India, a reduction in wheat crop yield would lead to a widespread impact on food security. In particular, the most vulnerable people are severely exposed to food insecurity. This study estimates the climate change vulnerability of wheat crops with respect to heterogeneities in time, space, and weighting methods. The study uses the Intergovernmental Panel on Climate Change (IPCC) framework of vulnerability while using composite indices of 27 indicators to explain exposure, sensitivity, and adaptive capacity. We used climate projections under current (1975-2005) conditions and two future (2021-2050) Representation Concentration Pathways (RCPs), 4.5 and 8.5, to estimate exposure to climatic risks. Consistency across three weighting methods (Analytical Hierarchy Process (AHP), Principal Component Analysis (PCA), and Equal Weights (EWs)) was evaluated. Results of the vulnerability profile suggest high vulnerability of the wheat crop in northern and central India. In particular, the districts Unnao, Sirsa, Hardoi, and Bathinda show high vulnerability and high consistency across current and future climate scenarios. In total, 84% of the districts show more than 75% consistency in the current climate, and 83% and 68% of the districts show more than 75% consistency for RCP 4.5 and RCP 8.5 climate scenario for the three weighting methods, respectively. By using different weighting methods, it was possible to quantify “method uncertainty” in vulnerability assessment and enhance robustness in identifying most vulnerable regions. Finally, we emphasize the importance of communicating uncertainties, both in data and methods in vulnerability research, to effectively guide adaptation planning. The results of this study would serve as the basis for designing climate impacts adjusted adaptation measures for policy interventions.
BACKGROUND: Adverse health effects among agricultural workers due to chronic heat exposure have been characterized in the literature as not only due to high ambient temperatures but also due to intensive manual labor in hot and humid conditions. The aim of this study was to use biomonitoring equipment to examine the effectiveness of selected cooling devices at preventing agricultural workers from exceeding the core body temperature threshold of 38.0°C (Tc38) and attenuating heat-related illness symptoms. METHODS: A convenience sample of 84 agricultural workers in Florida was randomized to one of four groups: (a) no intervention, clothing as usual; (b) cooling bandana; (c) cooling vest; and (d) both the cooling bandana and cooling vest. Biomonitoring equipment worn by the participants included core body temperature monitor and an accelerometer to capture physical activity. FINDINGS: A total of 78 agricultural workers completed one intervention workday trial. Compared with the control group, the bandana group had lower odds of exceeding Tc38 (odds ratio [OR] = 0.7, 90% confidence interval [CI] = [0.2, 3.2]) and the vest group had higher odds of exceeding Tc38 (OR = 1.8, 90% CI = [0.4, 7.9]). The simultaneous use of cooling vest and bandana showed an effect little different from the control group (OR = 1.3, 90% CI = [0.3, 5.6]). CONCLUSION/APPLICATION TO PRACTICE: This is the first field-based study to examine cooling intervention among agricultural workers in the United States using biomonitoring equipment. This study found that using a bandana while working in a hot agricultural environment has the potential to be protective against exceeding the recommended Tc38 threshold.
People are exposed to multiple stimuli in urban environments, but most studies have investigated the unimodal effect of thermal and visual conditions on human comfort perception. It remains unclear whether the cross-modal effect found in indoor multisensory studies applies to outdoor environments. To understand the cross-modal effect of thermal and visual conditions on outdoor comfort perception, we conducted a thermal comfort survey (n = 4304) in Guangzhou and Zhuhai (September 2018). We used the Universal Thermal Climate Index (UTCI) heat stress classification and sky conditions to stratify our results. The thermal sensation vote was positively correlated with sun sensation vote. There was a significant interaction between UTCI heat stress conditions and sunlight preference vote on thermal comfort vote. The sun sensation (brightness) and sunlight preference vote had a cross-modal effect on thermal sensation and thermal comfort vote under various UTCI heat stress conditions. Under extreme heat stress, respondents’ thermal sensation did not differ significantly between different sun sensation and sunlight preference groups. Thermal sensation, preference and comfort vote had a cross-modal effect on sun sensation and sunlight preference under different sky conditions. Under partly cloudy conditions, sun sensation did not differ significantly between certain thermal sensation and preference groups. A theoretical framework is provided to explain the cross-modal effect between thermal and visual perception. Our findings suggest outdoor thermal discomfort can be alleviated by improving visual comfort and vice versa. Therefore, urban design should consider the combined effect of visual-thermal stimulants in optimizing overall pedestrian comfort and promoting urban liveability.
It is speculated that floods in many areas of the world have become more severe with global warming. This study describes the 2017 spring floods in Kazakhstan, which, with about six people dead or missing, prompted the government to call for more than 7,000 people to leave their homes. Then, based on the Climatic Research Unit (CRU), the NCEP/NCAR Reanalysis 1, and the Coupled Model Intercomparison Project 5 (CMIP5) simulations, the seasonal trends of temperature were calculated using the linear least-squares regression and the Mann-Kendall trend test. The correlation between the surface air temperature and atmospheric circulation was explored, and the attributable risk of the 2017 spring floods was evaluated using the conventional fraction of the attributable risk (FAR) method. The results indicate that the north plains of Kazakhstan had a higher (March-April) mean temperature anomaly compared to the south plains, up to 3 degrees C, relative to the 1901 – 2017 average temperature. This was the primary cause of flooding in Kazakhstan. March and April were the months with a higher increasing trend in temperature from 1901 to 2017 compared with other months. In addition, a positive anomaly of the geopotential height and air temperature for the March-April 2017 period (based on the reference period 1961 – 1990) was the reason for a warmer abnormal temperature in the northwest region of Kazakhstan. Finally, the FAR value was approximately equal to 1, which supported the claim of a strong anthropogenic influence on the risk of the 2017 March-April floods in Kazakhstan. The results presented provide essential information for a comprehensive understanding of the 2017 spring floods in Kazakhstan and will help government officials identify flooding situations and mitigate damage in future.
OBJECTIVE: Cold exposure provokes cardiac remodeling and cardiac dysfunction. Autophagy participates in cold stress-induced cardiovascular dysfunction. This study was designed to examine the impact of Beclin1 haploinsufficiency (BECN(+/-)) in cold stress-induced cardiac geometric and contractile responses. METHODS AND MATERIALS: Wild-type (WT) and BECN(+/-) mice were assigned to normal or cold exposure (4?°C) environment for 4?weeks prior to evaluation of cardiac geometry, contractile and mitochondrial properties. Autophagy, apoptosis and ferroptosis were evaluated. RESULTS: Our data revealed that cold stress triggered cardiac remodeling, compromised myocardial contractile capacity including ejection fraction, fractional shortening, peak shortening and maximal velocity of shortening/relengthening, duration of shortening and relengthening, intracellular Ca(2+) release, intracellular Ca(2+) decay, mitochondrial ultrastructural disarray, superoxide production, unchecked autophagy, apoptosis and ferroptosis, the effects of which were negated by Beclin1 haploinsufficiency. Circulating levels of corticosterone were elevated in both WT and BECN(+/-) mice. Treatment of corticosterone synthesis inhibitor metyrapone or ferroptosis inhibitor liproxstatins-1 rescued cold stress-induced cardiac dysfunction and mitochondrial injury. In vitro study noted that corticosterone challenge compromised cardiomyocyte function, provoked lipid peroxidation and mitochondrial injury, the effects of which were nullified by Beclin1 haploinsufficiency, inhibitors of lipoxygenase, ferroptosis and autophagy. In addition, ferroptosis inducer erastin abrogated Beclin1 deficiency-offered cardioprotection. CONCLUSION: These data suggest that Beclin1 haploinsufficiency protects against cold exposure-induced cardiac dysfunction possibly through corticosterone- and ferroptosis-mediated mechanisms.
Introduction: Overexposure to heat conditions can affect the functioning of the cardiovascular system and may promote cardiovascular disorders. Heat shock induced myocardial injury via increasing endoplasmic reticulum response-mediated apoptosis. This study investigated the impact of pretreatment with Rosa canina (RC), a natural antioxidant, on myocardial damage induced by heat stress exposure and underlying mechanisms in cardiomyocytes in rats. Methods: Sixty adult male Wistar rats were allocated into five groups, including Control: received normal saline (NS), Heat Stress (HS), and HS+RC groups. Animals in the HS groups were subjected to heat stress (43 degrees C) for 15 minutes once a day for two weeks. Animals in the HS+RC groups received three doses of RC (250, 500, and 1000 mg/mL) one hour before being subjected to heat shock. The endoplasmic reticulum (ER) transmembrane kinases, including PKR-like endoplasmic reticulum kinase (PERK), immunoreactivity of CCAAT/enhancer-binding protein homologous protein (CHOP), and eukaryotic translation initiation factor 2-alpha (eIF2 alpha) as well as caspase 8 were detected by Western blot. The levels of reactive oxygen species (ROS) were assessed. Moreover, histopathological changes and apoptosis were also assayed in the heart tissue by using histopathological and TUNEL assays. Results: Heat exposure increased the level of ROS and induced oxidative damage in the heart tissue. The results demonstrated that RC administration decreased the overproduction of ROS induced by heat stress in cardiomyocytes. Moreover, heat stress upregulated the expression of p-PERK, p-eIF2 alpha, and CHOP protein while pretreatment with RC decreased expression of ER stress-related markers in cardiomyocytes. Besides, RC diminished heat stress-induced cellular damage and apoptosis associated with inhibition of caspase 8 activation, a pro-apoptotic protein in cardiomyocytes. Conclusion: These findings indicate that RC exerts a protective effect on heart tissue, at least in part, through inactivation of PERK/eIF2 alpha/CHOP pathway or inhibition of ER stress and oxidative stresstriggered apoptosis in cardiomyocytes induced by heat stress.
BACKGROUND AND PURPOSE: Studies looking at seasonal variation on cerebral venous thrombosis (CVT) are few with conflicting conclusions. In this region-specific study, we looked for climatic influence and seasonal trends on the incidence of CVT. METHODS: Imaging proven adult CVT cases treated over a period of 18 years from a specific geographical location with similar seasons and climatic conditions were studied. Metrological parameters prepared using 30 years of data was used. Quantum geographical information system (QGIS software) and SPSS v 22 were used for patient plotting and analysis. RESULTS: Total of 970 cases were studied. The incidence was significantly higher in summer 411 (42.3%) compared with autumn 317 (32.7%) and winter 242 (25.05); P = 0.038. This trend was consistent across all the 18 years in time series analysis. Mean age was 33.5 years (range 18-88 years). A significant majority 673 (69.4%) were below 40 years of age; P = 0.012. Females constituted 394 (40.6%) of cases. Postpartum CVT cases constituted 237 (30%). Interaction analysis showed younger age (<40 years) were more vulnerable for CVT in summer; P = 0.009. There was no seasonal influence on postpartum CVT. Apart for a weak positive correlation between rain fall (r = 0.18, P < 0.01); humidity and cloud cover was not influencing the incidence. CONCLUSIONS: Higher ambient temperatures were consistently associated with higher incidence of CVT. This is the largest region-specific study on CVT in the world. These results may be applicable to other regions with similar climatic conditions.
Wet bulb globe temperature (WBGT), a combined measure of temperature and humidity effects on thermal comfort, is used to define heat stress waves (HSWs). While emerging research has raised concerns on future changes in heat stress, for the first time, this study examines spatiotemporal changes in multiple HSW characteristics (intensity, duration, frequency, and cumulative mean intensity) in the 21st century under three emissions scenarios. It is the sustained nature of HSWs that impose more adverse impacts than extreme heat on a single day. HSWs are expected to be more intense, persistent, frequent, and influential due to anthropogenic influence. Models project the largest increases in multiple HSW characteristics will occur over the tropics and subtropics. The exception is maximum intensity, which displays a relative uniform increase over most global land areas. Analysis of regional population exposure to HSWs under different climate and socioeconomic scenarios emphasizes the importance of aggressive mitigation to minimize the potential impacts of HSWs. We further investigate how different regional HSW characteristics are projected to change relative to increasing global mean surface temperature (GMST). Our results confirm the varying rates and different trajectories at which regional HSWs change, independent of forcing pathway, strongly related to GMST. On both globally aggregated and regional scales, the maximum intensity and GMST are highly linearly associated, with an approximately 1:1 increase. However, the other three HSW characteristics are projected to change at a nonlinear rate per degree of GMST increase in general and display large regional variation in the rates of their changes. Plain Language Summary Besides air temperature, air humidity is another important factor in determining the impact of heat waves on humans. High humidity will reduce the efficiency of evaporative cooling and, when combined with high temperature, could pose a serious threat to human health or even life safety. Heat stress indices, taking into account both temperature and humidity effects, are considered to be better indicators of environmental conditions conducive to heat stress on human health. We here employ a widely used heat stress index, wet bulb globe temperature, to define heat waves, namely, heat stress waves (HSWs). Heat waves can be considered through a number of characteristics, and it is their distinctive characteristics that result in the vast array of adverse impacts. This also applies to HSWs. Our results show that more intense, longer-lasting, frequent, and influential HSWs are anticipated during the 21st century, and anthropogenic warming substantially increases the occurrence of HSWs. Except intensity, tropical regions will generally witness the largest increases in multiple HSW characteristics and the number of people that may be exposed to HSWs. Changes in HSW characteristics are confirmed not to depend on whether a particular warming is reached sooner or later; they are strongly related to global mean surface temperature.
Despite improvements to global economic conditions, child undernourishment has increased in recent years, with approximately 7.5% of children suffering from wasting. Climate change is expected to worsen food insecurity and increase potential threats to nutrition, particularly in low-income and lower-middle income countries where the majority of undernourished children live. We combine anthropometric data for 192,000 children from 30 countries in Sub-Saharan Africa with historical climate data to directly estimate the effect of temperature on key malnutrition outcomes. We first document a strong negative relationship between child weight and average temperature across regions. We then exploit variation in weather conditions to statistically identify the effects of increased temperatures over multiple time scales on child nutrition. Increased temperatures in the month of survey, year leading up to survey and child lifetime lead to meaningful declines in acute measures of child nutrition. We find that the lifetime-scale effects explain most of the region-level negative relationship between weight and temperature, indicating that high temperatures may be a constraint on child nutrition. We use CMIP5 local temperature projections to project the impact of future warming, and find substantial increases in malnutrition depending on location: western Africa would see a 37% increase in the prevalence of wasting by 2100, and central and eastern Africa 25%.
The history of the Eastern Mediterranean is punctuated by major crises that have influenced many of the region’s established socioeconomic models. Recent studies have underscored the role of drought and temperature oscillations in driving changes but attempts to quantify their magnitude remain equivocal, hindering long-term assessments of the potential interplay between climate and society. Here, we fill this knowledge gap using a 6,000-year pollen-based reconstruction of temperature and precipitation from Hala Sultan Tekke, Cyprus. We find that major social changes and plague outbreaks often occurred in tandem with cooler climate conditions, with anomalies ranging from -3 +/- 0.4 degrees C to -1 +/- 0.5 degrees C, coupled with changing precipitation patterns. We suggest that major climate changes may weaken societies by affecting primary livelihood systems. This long-term view highlights recurrent cold periods in the Eastern Mediterranean’s climate history and advocates that, despite frequent adversity and pandemics, Near Eastern populations adapted and were ultimately resilient to major climate changes.
BACKGROUND: Climate change is a significant threat to the health of the Ghanaian people. Evidence abounds in Ghana that temperatures in all the ecological zones are rising, whereas rainfall levels have been generally reducing and patterns are increasingly becoming erratic. The study estimated the impact of climate variation between seasons on biochemical markers of kidney disease. METHODS: This study conveniently recruited 50 apparently healthy peasant farmers and hawkers at Wa in the Upper West Region of Ghana. A pre-study screening for hepatitis A and C, Diabetes mellitus, hypertension was done. Serum creatinine and urea levels were analyzed to rule out kidney preexisting kidney disease. Baseline data was collected by estimating urea, creatinine, sodium, potassium, eGFR (estimated glomerular filtration rate) as well as for hemoglobin (Hb) and hematocrit (Hct) concentrations. Anthropometric data such as height, weight and blood pressure were measured by trained personnel. The study participants were closely followed and alerted deep in the dry season for the second sampling (urea, creatinine, hemoglobin, hematocrit, blood pressure, anthropometry). RESULTS: This study recruited more males (58.82%) than females (41.15%), majority (52.92%) of which were aged 25-29?years with the youngest being 22?years and the eldest being 35?years. The study found body mass index (p?<?0.001), systolic blood pressure (p?=?0.019), creatinine (p?<?0.001), urea (p?=?0.013) and eGFR (p?<?0.001) to be significantly influenced by climate change. Stage 1 hypertension was predominant among the study participants during the dry season, 8 (15.69%) than was observed during the rainy season, 4 (7.84%) nonetheless the number of participants with normal BMI rose from 49.02% in the rainy season to 62.75% during the dry reason. Additionally, the study observed that the impact of climate change on systolic blood pressure and urea varied based on age and sex. CONCLUSION: This study revealed that climatic changes cause variations in various biochemical parameters used to assess kidney function. Public health education on climatic changes and its implication including precautionary measures should be done among inhabitants of Wa and its environs to reduce its effect. Additionally, appropriate dietary patterns should also be advised to avoid the development of non-communicable diseases such as hypertension and obesity that are known principal causes of Chronic Kidney Disease (CKD).
Overheating in residential building is a challenging problem that causes thermal discomfort, productivity reduction, and health problems. This paper aims to assess the climate change impact on thermal comfort in a Belgian reference case. The case study represents a nearly zero energy building that operates without active cooling during summer. The study quantifies the impact of climate change on overheating risks using three representative concentration pathway (RCP) trajectories for greenhouse gas concentration adopted by the Intergovernmental Panel on Climate Change (IPCC). Building performance analysis is carried out using a multizone dynamic simulation program EnergyPlus. The results show that bioclimatic and thermal adaptation strategies, including adaptive thermal comfort models, cannot suppress the effect of global warming. By 2050, zero energy buildings will be vulnerable to overheating.
In today’s urban environments with complex design and configurations, heterogeneous spatial clusters of communities with different socioeconomic characteristics may result in disproportionate exposure of some groups of citizens to natural hazards. The objective of this study was to compare the associations between communities’ socioeconomic characteristics and exposure to different types of natural hazards in New York City (NYC) to examine whether commonly accepted indicators of social vulnerability are associated with similar levels of exposure across various natural hazards. First, we collected socioeconomic data (e.g., population, median income, unemployment rate) at a zip code level of granularity provided by the United States Census Bureau. Next, we identified and gathered spatial data for coastal storms, flooding, extreme heat, and pandemic disease in NYC. We then conducted a pairwise Kendall’s tau-b test to compare the associations. The outcomes showed that the significance and direction of the associations depend on the type of natural hazard. Particularly, the results indicated that zip codes with lower socioeconomic factors and greater percentage of minority ethnicities are exposed disproportionately to extreme heat and COVID-19. On the other hand, zip codes with higher percentage of areas prone to flooding have relatively higher socioeconomic factors. Furthermore, the results did not show any statistically significant association between socioeconomic factors and exposure to coastal storm inundations. The outcomes of this study will help decision makers design and implement better optimized and effective emergency preparedness plans by prioritizing their target areas based on socioeconomic factors in order to enhance social justice.
Human actions intensify the greenhouse effect, aggravating climate changes in the Amazon and elsewhere in the world. The Intergovernmental Panel on Climate Change (IPCC) foresees a global increase of up to 4.5 °C and 850 ppm CO(2) (above current levels) by 2100. This will impact the biology of the Aedes aegypti mosquito, vector of Dengue, Zika, urban Yellow Fever and Chikungunya. Heat shock proteins are associated with adaptations to anthropic environments and the interaction of some viruses with the vector. The transcription of the hsp26, hsp83 and hsc70 genes of an A. aegypti population, maintained for more than forty-eight generations, in the Current, Intermediate and Extreme climatic scenario predicted by the IPCC was evaluated with qPCR. In females, highest levels of hsp26, hsp83 and hsc70 expression occurred in the Intermediate scenario, while in males, levels were high only for hsp26 gene in Current and Extreme scenarios. Expression of hsp83 and hsc70 genes in males was low under all climatic scenarios, while in the Extreme scenario females had lower expression than in the Current scenario. The data suggest compensatory or adaptive processes acting on heat shock proteins, which can lead to changes in the mosquito’s biology, altering vectorial competence.
Snakebite envenoming is an important public health problem in Iran, despite its risk not being quantified. This study aims to use venomous snakes’ habitat suitability as an indicator of snakebite risk, to identify high-priority areas for snakebite management across the country. Thus, an ensemble approach using five distribution modelling methods: Generalized Boosted Models, Generalized Additive Models, Maximum Entropy Modelling, Generalized Linear Models, and Random Forest was applied to produce a spatial snakebite risk model for Iran. To achieve this, four venomous snakes’ habitat suitability (Macrovipera lebetinus, Echis carinatus, Pseudocerastes persicus and Naja oxiana) were modelled and then multiplied. These medically important snakes are responsible for the most snakebite incidents in Iran. Multiplying habitat suitability models of the four snakes showed that the northeast of Iran (west of Khorasan-e-Razavi province) has the highest snakebite risk in the country. In addition, villages that were at risk of envenoming from the four snakes were identified. Results revealed that 51,112 villages are at risk of envenoming from M. lebetinus, 30,339 from E. carinatus, 51,657 from P. persicus and 12,124 from N. oxiana. Precipitation seasonality was identified as the most important variable influencing distribution of the P. persicus, E. carinatus and M. lebetinus in Iran. Precipitation of the driest quarter was the most important predictor of suitable habitats of the N. oxiana. Since climatic variables play an important role in shaping the distribution of the four venomous snakes in Iran, thus their distribution may alter with changing climate. This paper demonstrates application of species distribution modelling in public health research and identified potential snakebite risk areas in Iran by using venomous snakes’ habitat suitability models as an indicating factor. Results of this study can be used in snakebite and human-snake conflict management in Iran. We recommend increasing public awareness of snakebite envenoming and education of local people in areas which identified with the highest snakebite risk.
Future heat stress under six future global warming (Delta T-GW) scenarios (IPCCRCP8.5) in an Asian megacity (Osaka) is estimated using a regional climate model with an urban canopy and air-conditioning (AC). An urban heat ‘stress’ island is projected in all six scenarios (Delta T-GW = +0.5 to +3.0 degrees C in 0.5 degrees C steps). Under. TGW = +3.0 degrees C conditions, people outdoors experience ‘extreme’ heat stress, which could result in dangerously high increases in human body core temperature. AC-induced feedback increases heat stress roughly linearly as Delta T-GW increases, reaching 0.6 degrees C(or 12% of the heat stress increase). As this increase is similar to current possible heat island mitigation techniques, this feedback needs to be considered in urban climate projections, especially where AC use is large.
Air pollution and the urban heat island effect are consistently linked to numerous respiratory and heat-related illnesses. Additionally, these stressors disproportionately impact low-income and historically marginalized communities due to their proximity to emissions sources, lack of access to green space, and exposure to other adverse environmental conditions. Here, we use relatively low-cost stationary sensors to analyze PM2.5 and temperature data throughout the city of Richmond, Virginia, on the ten hottest days of 2019. For both hourly means within the ten hottest days of 2019 and daily means for the entire record for the year, the temperature was found to exhibit a positive correlation with PM2.5. Analysis of hourly means on the ten hottest days yielded a diurnal pattern in which PM2.5 levels peaked in the early morning and reached their minima in the mid-afternoon. Spatially, sites exhibiting higher temperatures consistently had higher PM2.5 readings, with vulnerable communities in the east end and more intensely developed parts of the city experiencing significantly higher temperatures and PM2.5 concentrations than the suburban neighborhoods in the west end. These findings suggest an uneven distribution of air pollution in Richmond during extreme heat events that are similar in pattern but less pronounced than the temperature differences during these events, although further investigation is required to verify the extent of this relationship. As other studies have found both of these environmental stressors to correlate with the distribution of green space and other land-use factors in cities, innovative and sustainable planning decisions are crucial to the mitigation of these issues of inequity going forward.
BACKGROUND: Since the huge epidemic of Zika virus (ZIKV) in Brazil in 2015, questions were raised to understand which mosquito species could transmit the virus. Aedes aegypti has been described as the main vector. However, other Aedes species (e.g. Ae. albopictus and Ae. japonicus) proven to be competent for other flaviviruses (e.g. West Nile, dengue and yellow fever), have been described as potential vectors for ZIKV under laboratory conditions. One of these, the Asian bush mosquito, Ae. japonicus, is widely distributed with high abundances in central-western Europe. In the present study, infection, dissemination and transmission rates of ZIKV (Dak84 strain) in two populations of Ae. japonicus from Switzerland (Zürich) and France (Steinbach, Haut-Rhin) were investigated under constant (27 °C) and fluctuating (14-27 °C, mean 23 °C) temperature regimes. RESULTS: The two populations were each able to transmit ZIKV under both temperature regimes. Infectious virus particles were detected in the saliva of females from both populations, regardless of the incubation temperature regime, from 7 days post-exposure to infectious rabbit blood. The highest amount of plaque forming units (PFU) (400/ml) were recorded 14 days post-oral infection in the Swiss population incubated at a constant temperature. No difference in terms of infection, dissemination and transmission rate were found between mosquito populations. Temperature had no effect on infection rate but the fluctuating temperature regime resulted in higher dissemination rates compared to constant temperature, regardless of the population. Finally, transmission efficiency ranged between 7-23% and 7-10% for the constant temperature and 0-10% and 3-27% under fluctuating temperatures for the Swiss and the French populations, respectively. CONCLUSIONS: To the best of our knowledge, this is the first study confirming vector competence for ZIKV of Ae. japonicus originating from Switzerland and France at realistic summer temperatures under laboratory conditions. Considering the continuous spread of this species in the northern part of Europe and its adaptation at cooler temperatures, preventative control measures should be adopted to prevent possible ZIKV epidemics.
Objectives: Inconsistent results have been found between pneumonia and meteorological factors. We aimed to identify principal meteorological factors associated with pneumonia, and to estimate the effect size and lag time. Methods: This was nationwide population-based study used a healthcare claims database merged with a weather database in eight metropolitan cities in Korea. We applied a stepwise approach using the Granger causality test and generalized additive model to elucidate the association between weekly pneumonia incidence (WPI) and meteorological factors/air pollutants (MFAP). Impulse response function was used to examine the time lag. Results: In total, 2 011 424 cases of pneumonia were identified from 2007 to 2017. Among MFAP, diurnal temperature range (DTR), humidity and particulate matter <= 2.5 mm in diameter (PM2.5) showed statistically significant associations with WPI (p < 0.001 for all 3 MFAPs). The association of DTR and WPI showed an inverted U pattern for bacterial and unspecified pneumonia, whereas for viral pneumonia, WPI increased gradually in a more linear manner with DTR and no substantial decline. Humidity showed a consistent pattern in all three pneumonia categories. WPI steeply increased up to 10 to 20 mu g/m(3) of PM2.5 but did not show a further increase in higher concentrations. On the basis of the result, we examined the effect of MFAP in different lag times up to 3 weeks. Conclusions: DTR, humidity and PM2.5 were identified as MFAP most closely associated with WPI. With the model, we were able to visualize the effectetime association of MFAP and WPI. (C) 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
BACKGROUND: Sedentary behavior is a worldwide public health concern. There is consistent and growing evidence linking sedentary behavior to mortality and morbidity. Early monitoring and assessment of environmental factors associated with sedentary behaviors at a young age are important initial steps for understanding children’s sedentary time and identifying pertinent interventions. OBJECTIVE: This study examines the association between daily temperature (maximum, mean, minimum, and diurnal variation) and all-day sedentary time among 4-6 year old children in Mexico City (n = 559) from the year 2013 to 2015. METHODS: We developed a spatiotemporally resolved hybrid satellite-based land use regression temperature model and calculated percent daily sedentary time from aggregating 10-second epoch vertical counts captured by accelerometers that participants wore for one week. We modeled generalized additive models (GAMs), one for each temperature type as a covariate (maximum, mean, minimum, and diurnal variation). All GAMs included percent all-day sedentary time as the outcome and participant-level random intercepts to account for repeated measures of sedentary time. Our models were adjusted for demographic factors and environmental exposures. RESULTS: Daily maximum temperature, mean temperature, and diurnal variation have significant negative linear relationships with all-day sedentary time (p<0.01). There is no significant association between daily minimum temperature and all-day sedentary time. Children have on average 0.26% less daily sedentary time (approximately 2.2 minutes) for each 1°C increase in ambient maximum temperature (range 7.1-30.2°C), 0.27% less daily sedentary time (approximately 2.3 minutes) for each 1°C increase in ambient mean temperature (range 4.3-22.2°C), and 0.23% less daily sedentary time (approximately 2.0 minutes) for each 1°C increase in diurnal variation (range 3.0-21.6°C). CONCLUSIONS: These results are contrary to our hypothesis in which we expected a curvilinear relationship between temperature (maximum, mean, minimum, and diurnal variation) and sedentary time. Our findings suggest that temperature is an important environmental factor that influences children’s sedentary behavior.
BACKGROUND AND AIMS: Outdoor temperature and bright sunlight may directly and/or indirectly modulate systemic metabolism. We assessed the associations between outdoor temperature and bright sunlight duration with metabolomics. METHODS AND RESULTS: Cross-sectional analyses were undertaken in non-diabetic individuals from the Oxford BioBank (OBB; N = 6368; mean age 47.0 years, males 44%) and the Netherlands Epidemiology of Obesity (NEO; N = 5916; mean age 55.6 years, males 43%) study. Data on mean outdoor bright sunlight and temperature were collected from local weather stations in the week prior to blood sampling. Fasting serum levels of 148 metabolites, including 14 lipoprotein subclasses, were measured using NMR spectroscopy. Linear regression analyses were performed to assess the associations between mean outdoor temperature and bright sunlight duration with metabolomics adjusted for age, sex, body mass index, season and either outdoor temperature or bright sunlight. A higher mean outdoor temperature was associated with increased serum concentrations of lipoprotein (sub)particles (? (SE) = 0.064 (0.018) SD per 5 °C, p = 5.03e(-4)) and certain amino acids such as phenylalanine (0.066 (0.016) SD, p = 6.44e(-05)) and leucine (0.111 (0.018) SD, p = 1.25e(-09)). In contrast, longer duration of bright sunlight was specifically associated with lower concentrations of very low-density lipoprotein (sub)particles (e.g., VLDL cholesterol (-0.024 (0.005) SD per 1-h bright sunlight, p = 8.06e(-6))). The direction of effects was generally consistent between the OBB and NEO, although effect sizes were generally larger in the OBB. CONCLUSIONS: Increased bright sunlight duration is associated with an improved metabolic profile whilst higher outdoor temperature may adversely impact cardiometabolic health.
Objective: Given the lack of studies examining the associations between daily weather and air pollution with nightly objective sleep over multiple weeks, we quantified these associations in a prospective cohort of healthy participants with episodic migraine. Methods: Ninety-eight participants completed daily electronic diaries and wore an actigraph for an average of 45 ds, and a total 4406 nights of data were collected. Nightly sleep characteristics including duration, wake after sleep onset (WASO), and efficiency were assessed using wrist actigraphy. Daily weather parameters and air pollution levels were collected from local weather station and ground-level air quality monitors. We used linear fixed effects models adjusting for participant, day of the week, and day of the year (for weather analysis), and additionally adjusted for temperature and relative humidity (for air pollution analysis). Results: The participants were 35 +/- 12 yrs old and 86 were women. A 10 degrees F higher daily average temper-ature was associated with 0.88 (95% CI: 0.06, 1.70) minutes longer WASO and 0.14% (95% CI:-0.01%, 0.30%) lower sleep efficiency on that night. A 14 parts per billion (ppb) (interquartile range) higher daily maximum eight-h ozone was associated with 7.51 (95% CI: 3.23, 11.79) minutes longer sleep duration on that night. Associations did not differ between cold (October-March) and warm (April-September) seasons. Conclusions: Higher daily ozone was associated with longer sleep duration and modest associations were observed between higher temperature and lower WASO and lower efficiency. (c) 2020 Elsevier B.V. All rights reserved.
Following a distinct summer heat wave, nine autochthonous cases of West Nile fever and West Nile neuroinvasive disease, including one fatality, were observed in Leipzig, Germany, in August and September 2020. Phylogenetic analysis demonstrated close relationships in viruses from humans, animals and mosquitos in eastern Germany, obtained during the preceding 2 years. The described large cluster of autochthonous West Nile virus infections in Germany indicates endemic seasonal circulation of lineage 2 viruses in the area.
BACKGROUND: Despite the substantial role indoor exposure has played in heat wave-related mortality, few epidemiological studies have examined the health effects of exposure to indoor heat. As a result, knowledge gaps regarding indoor heat-health thresholds, vulnerability, and adaptive capacity persist. OBJECTIVE: We evaluated the role of indoor heat exposure on mortality and morbidity among the elderly ( ? 65?years of age) in Houston, Texas. METHODS: Mortality and emergency hospital admission data were obtained through the Texas Department of State Health Services. Summer indoor heat exposure was modeled at the U.S. Census block group (CBG) level using building energy models, outdoor weather data, and building characteristic data. Indoor heat-health associations were examined using time-stratified case-crossover models, controlling for temporal trends and meteorology, and matching on CBG of residence, year, month, and weekday of the adverse health event. Separate models were fitted for three indoor exposure metrics, for individual lag days 0-6, and for 3-d moving averages (lag 0-2). Effect measure modification was explored via stratification on individual- and area-level vulnerability factors. RESULTS: We estimated positive associations between short-term changes in indoor heat exposure and cause-specific mortality and morbidity [e.g., circulatory deaths, odds ratio per?5°C?increase = 1.16 (95% CI: 1.03, 1.30)]. Associations were generally positive for earlier lag periods and weaker across later lag periods. Stratified analyses suggest stronger associations between indoor heat and emergency hospital admissions among African Americans compared with Whites. DISCUSSION: Findings suggest excess mortality among certain elderly populations in Houston who are likely exposed to high indoor heat. We developed a novel methodology to estimate indoor heat exposure that can be adapted to other U.S. LOCATIONS: In locations with high air conditioning prevalence, simplified modeling approaches may adequately account for indoor heat exposure in vulnerable neighborhoods. Accounting for indoor heat exposure may improve the estimation of the total impact of heat on health. https://doi.org/10.1289/EHP6340.
Compared with mortality, the impact of weather and climate on human morbidity is less well understood, especially in the cold season. We examined the relationships between weather and emergency department (ED) visitation at hospitals in Roanoke and Charlottesville, Virginia, two locations with similar climates and population demographic profiles. Using patient-level data obtained from electronic medical records, each patient who visited the ED was linked to that day’s weather from one of 8 weather stations in the region based on each patient’s ZIP code of residence. The resulting 2010-2017 daily ED visit time series were examined using a distributed lag non-linear model to account for the concurrent and lagged effects of weather. Total ED visits were modeled separately for each location along with subsets based on gender, race, and age. The relationship between the relative risk of ED visitation and temperature or apparent temperature over lags of one week was positive and approximately linear at both locations. The relative risk increased about 5% on warm, humid days in both cities (lag 0 or lag 1). Cold conditions had a protective effect, with up to a 15% decline on cold days, but ED visits increased by 4% from 2 to 5 days after the cold event. The effect of thermal extremes tended to be larger for non-whites and the elderly, and there was some evidence of a greater lagged response for non-whites in Roanoke. Females in Roanoke were more impacted by winter cold conditions than males, who were more likely to show a lagged response at high temperatures. In Charlottesville, males sought ED attention at lower temperatures than did females. The similarities in the ED response patterns between these two hospitals suggest that certain aspects of the response may be generalizable to other locations that have similar climates and demographic profiles.
Urban heat islands are an increasing concern even in small- to medium-sized cities, although these areas are still understudied especially in terms of the economic feasibility of adaptation options. This paper uses adaptation scenarios produced by an urban climate model as inputs to a social cost-benefit analysis in three small- to medium-sized cities in Austria: Modling, Klagenfurt, and Salzburg. The adaptation scenarios, which consider measures such as increasing the reflectivity of different sealed surfaces (referred to as the White City scenario) as well as greening measures (i.e. the Green City scenario), show decreases in the number of hot days (T-max >= 30 degrees C) when implemented. Benefits include reductions in heat-related mortality, which are modeled based on trends of daily mortality and climate data, reduced morbidity, productivity loss, and numerous urban ecosystem services. The results demonstrate favorable benefit-cost ratios of a combination of measures (White and Green City) of 1.27, 1.36, and 2.68 for Modling, Klagenfurt, and Salzburg, respectively, indicating positive economic grounds for supporting policies in line with the adaptation scenarios. Furthermore, results of the Green City vs. White City showed higher benefits for the combined and Green City scenarios despite higher costs for each of the cities.
Compound dry and hot events (CDHEs) are commonly defined as occurrences of dry and hot events at the same time or in close succession. These events have occurred frequently in past decades and caused great losses to multiple sectors including water security, food security, and human health. This calls for an improved understanding of their characteristics and variations. This study provides a database for different characteristics, including frequency, severity, duration, and magnitude, and their variations of CDHEs for the period 1951-2012 over global land areas. We first demonstrate different characteristics of CDHEs during the summers of 2003 and 2010 in Europe to compare these two events from different perspectives. We then evaluate changes in different characteristics of CDHEs over global land areas for the past 62 years. The frequency, severity, duration, and magnitude of CDHEs during 1951-2012 show temporal increases over global land areas with the slope of 0.15 days/decade, 0.25%/decade, 0.06 days/decade, and 0.52%/decade, respectively. Besides, remarkable increases in these characteristics are observed in regions such as central Africa, Europe, Mediterranean regions, and northern parts of East Asia. The results of this study could shed light on ways to improve the documentation and understanding of CDHEs to mitigate their negative impacts.
OBJECTIVES: We examine the public health response to an unprecedented multiple mortality event in bats following an extreme heat event. The main public health risk associated with the event and the environmental clean-up was potential human infection with Australian bat lyssavirus. We also consider the public health implications as we enter an age of climate change, vulnerability and unexpected events. Type of service: The Tropical Public Health Service of Far North Queensland worked collaboratively with the local council to coordinate a practical public health and health protection response to a mass mortality event in bats in late 2018. METHODS: A coordinated response was instigated to remove thousands of decaying bat corpses from residential areas. This occurred alongside a health education campaign advising the public to avoid handling bats. RESULTS: The combined efforts were successful; those requiring vaccination and post-exposure prophylaxis were treated appropriately and owing to a successful campaign, exposures were minimised. However, significant issues with misinformation and social media messaging were noted, alongside amateur bat carers handling sick and injured bats inappropriately, compounding the challenge for public health services. This mass mortality event has implications regarding the preparation for and management of other unexpected public health crises related to climate change. LESSONS LEARNT: It is vital that areas populated with bats be prepared for extreme heat events (EHEs). Public health units need to be prepared for the unexpected events of climate change, advocate for a ‘one health’ approach to public health, and work with local and national governments to become ‘climate ready’.
Hybrid personal cooling systems (HPCS) incorporated with ventilation fans and phase change materials (PCMs) have shown its superior capability for mitigating workers’ heat strain while performing heavy labor work in hot environments. In a previous study, the effects of thermal resistance of insulation pads, and latent heat and melting temperature of PCMs on the HPCS’s thermal performance have been investigated. In addition to the aforementioned factors, environmental conditions, i.e., ambient temperature and relative humidity, also significantly affect the thermal performance of the HPCS. In this paper, a numerical parametric study was performed to investigate the effects of the environmental temperature and relative humidity (RH) on the thermal management of the HPCS. Five levels of air temperature under RH = 50% (i.e., 32, 34, 36, 38 and 40 °C) and four levels of environmental RH at two ambient temperatures of 36 and 40 °C were selected (i.e., RH = 30, 50, 70 and 90%) for the numerical analysis. Results show that high environmental temperatures could accelerate the PCM melting process and thereby weaken the cooling performance of HPCS. In the moderately hot environment (36 °C), HPCS presented good cooling performance with the maximum core temperature at around 37.5 °C during excise when the ambient RH ? 70%, whereas good cooling performance could be only seen under RH ? 50% in the extremely hot environment (40 °C). Thus, it may be concluded that the maximum environmental RH under which the HPCS exhibiting good cooling performance decreases with an increase in the environmental temperature.
Measures to mitigate climate change are being considered all over the world. Reducing the use of air conditioners is one such measure. While it seems to be effective in mitigating climate change, it may also reduce individuals’ well-being and increase the risk of heatstroke. To compare the impact of reducing air conditioner use and the mortality risks, the indicator Loss of Happy Life Expectancy (LHpLE), which measures the reduction in the length of life that individuals can spend happily, was used. The reduction in well-being due to non-use of air conditioners was obtained by applying the propensity score matching method to the results of a questionnaire. We evaluated the impact of reducing air conditioner use in both the current and future situation in comparison to the mortality risk from flood and heatstroke, respectively. The increase in mortality risk due to flooding was estimated based on numerical simulation, and the increase in the risk of mortality due to heatstroke was estimated based on existing reports in Japan. Using these results, the magnitude of the impacts on LHpLE caused by the reduction in well-being due to the non-use of an air conditioner and the increase in the mortality risks were compared, both for the current situation and the future. The results show that LHpLE due to non-use of air conditioners was much greater than that due to the risk of mortality due to flood and heatstroke, and implied that reducing air conditioner use is not necessarily a good way as a mitigation measure. This result would be useful for creating and implementing measures to counter climate change and could also be applied in many other fields.
Coronaviruses are a family of viruses causing mild to severe upper respiratory tract syndrome. Recent pandemic threat caused by SARS-CoV-2 first appeared in Wuhan, China in December 2019. Whether the COVID-19 might be affected by warming global temperatures like some of previous pandemic flues. Therefore, the current study aims to analyze the effect of temperature and relative humidity (RH) on the spreading of the SARS-CoV-2 infection. The confirmed cases of COVID-19 in 31 different provinces in China and 274 provinces and/or countries were obtained from an online database. The real time temperature and humidity of the respective regions were taken from another online weather reporting data source. Spearman [R(s)] rank correlation was performed to identify the relationship between the variables (e.g., temperature, number of confirmed cases etc.). The overall spreading of SARS-CoV-2 in relations to temperature was inversely correlated. Among 29 of 31 provinces of China the overall correlation coeffient of the relationship between temperature and viral spread was negative [-R(s)] where in 15 provinces the correlation was at significant level (p<0.05). Furthermore, there was a significant negative relationship observed between the SARS-CoV-2 spreading and air temperature throughout the 274 provinces and/or countries of the world. However, there was no significant corelationship between humidity and COVID-19 spreading either in China or among countries and/or various regions of the world. The SARS-CoV-2 infection seems to be spread in a wide range of temperature throughout the world. Thus, several factors including temperature, may influnce the SARS-CoV-2 spreading. As a results, relatively elevated air temperature could not completely prevent viral spread but it might be one of the important detrimental factors for SARS-CoV-2 rapid spread.
Liquid cooling garments (LCGs) are considered feasible cooling equipment to protect individuals from hyperthermia and heat-related illness when working in extremely hot and stressful environments. So far, the goals for the optimization design of LCGs are mostly from the perspective of enhancing its efficiency and working time. However, thermal comfort is the key factor that is often not considered. In fact, many situations may cause discomfort. For example, the inlet temperature of the liquid-cooling vest changes constantly resulting in the change of thermal states of the human body. So, it is very significative to develop a method to evaluate the performance of LCGs considering thermal comfort. In this paper, an uncomfortable time ratio was proposed to evaluate the performance of LCGs considering thermal comfort. A series of tests were conducted by a modified thermal manikin method to evaluate the thermal properties. According to the analyses, the duration working time was 82.77 min, while the uncomfortable time ratio was too large, up to 57.6%. It showed that the thermal comfort should be considered when optimizing the performance of LCGs. The influences of different parameters such as volume of ice, flowrate, inlet temperature on the performance of LCGs were investigated through orthogonal experimental design. The statistical analysis illustrated that the influence of the volume of ice on the uncomfortable time ratio is greater than that of flowrate and ambient temperature. It is concluded that this method is useful for the control and design of LCGs considering thermal comfort.
Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The decision-support tool simultaneously quantifies the environmental and health impacts of specified selected policies. Methods: The ‘Cities Rapid Assessment Framework for Transformation (CRAFT)’ tool was applied to Greater London. CRAFT quantifies the effects of ten environmental policies on changes in (1) greenhouse gas (GHG) emissions, (2) exposures to environmental hazards, (3) travel-related physical activity, and (4) mortality (the number of attributable deaths avoided in one typical year). Publicly available data and epidemiological evidence were used to make rapid quantitative estimates of these effects based on proportional reductions in GHG emissions and environmental exposures from current baseline levels and to compute the mortality impacts. Results: The CRAFT tool estimates that, of roughly 50,000 annual deaths in Greater London, the modelled hazards (PM (2.5) (from indoor and outdoor sources), outdoor NO (2), indoor radon, cold, overheating) and low travel-related physical activity are responsible for approximately 10,000 premature environment-related deaths. Implementing the selected polices could reduce the annual mortality number by about 20% (~1,900 deaths) by 2050. The majority of these deaths (1,700) may be avoided through increased uptake in active travel. Thus, out of ten environmental policies, the ‘active travel’ policy provides the greatest health benefit. Also, implementing the ten policies results in a GHG reduction of around 90%. Conclusions: The CRAFT tool quantifies the effects of city policies on reducing GHG emissions, decreasing environmental health hazards, and improving public health. The tool has potential value for policy makers through providing quantitative estimates of health impacts to support and prioritise policy options.
BACKGROUND: Air conditioning has been proposed as one of the key factors explaining reductions of heat-related mortality risks observed in the last decades. However, direct evidence is still limited. METHODS: We used a multi-country, multi-city, longitudinal design to quantify the independent role of air conditioning in reported attenuation in risk. We collected daily time series of mortality, mean temperature, and yearly air conditioning prevalence for 311 locations in Canada, Japan, Spain, and the USA between 1972 and 2009. For each city and sub-period, we fitted a quasi-Poisson regression combined with distributed lag non-linear models to estimate summer-only temperature-mortality associations. At the second stage, we used a novel multilevel, multivariate spatio-temporal meta-regression model to evaluate effect modification of air conditioning on heat-mortality associations. We computed relative risks and fractions of heat-attributable excess deaths under observed and fixed air conditioning prevalences. RESULTS: Results show an independent association between increased air conditioning prevalence and lower heat-related mortality risk. Excess deaths due to heat decreased during the study periods from 1.40% to 0.80% in Canada, 3.57% to 1.10% in Japan, 3.54% to 2.78% in Spain, and 1.70% to 0.53% in the USA. However, increased air conditioning explains only part of the observed attenuation, corresponding to 16.7% in Canada, 20.0% in Japan, 14.3% in Spain, and 16.7% in the USA. CONCLUSIONS: Our findings are consistent with the hypothesis that air conditioning represents an effective heat adaptation strategy, but suggests that other factors have played an equal or more important role in increasing the resilience of populations.
