Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.
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.
El Nino is a critical part of global inter-annual climate variability, and the intensity of El Nino has major implications for rainfall-induced natural hazards in many vulnerable countries. The impact of landslides triggered by rainfall is likely to be modulated by the strength of El Nino, but the nature of this connection and the places where it is most relevant remains unconstrained. Here we combine new satellite rainfall data with a global landslide exposure model to show that El Nino has far-reaching effects on landslide impacts to people and infrastructure. We find that the impact of El Nino on landslide exposure can be greater in parts of Southeast Asia and Latin America than that due to seasonal rainfall variability. These findings improve our understanding of hazard variability around the world and can assist disaster mitigation efforts on seasonal timescales.
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.
Ischemic heart disease (IHD) is one of the leading causes of death worldwide. While extreme summer surface air temperatures are thought to be a risk factor for IHD, it is unclear whether large-scale climate patterns also influence this risk. This multi-national population-based study investigated the association between summer Pacific and Atlantic sea surface temperature (SST) variability and annual acute myocardial infarction (AMI) or IHD event rates among older adults residing in North America and the United Kingdom. Overall, a shift from cool to warm phase of the El Niño Southern Oscillation (ENSO) was associated with reduced AMI admissions in western Canada (adjusted rate ratio [RR] 0.89; 95% CI, 0.80-0.99), where this climate pattern predominatly forces below-normal cloud cover and precipitation during summertime, and increased AMI deaths in western United States (RR 1.09; 95% CI, 1.04-1.15), where it forces increased cloud cover and precipitation. Whereas, the Atlantic Multidecadal Oscillation (AMO) during a strong positive phase was associated with reduced AMI admissions in eastern Canada (RR 0.93; 95% CI, 0.87-0.98) and increased IHD mortality during summer months in the United Kingdom (RR 1.08; 95% CI, 1.03-1.14). These findings suggest that SST variability can be used to predict changes in cardiovascular event rates in regions that are susceptible.
No abstract available.
Long-term trends of ambient gaseous pollutants and particulate matter in Helsinki metropolitan area were analyzed from 1994 to 2019. Measurement data from ten monitoring stations located in different types of urban environments including traffic, urban background, rural background, and suburban area were included in this study. We analyzed gas-phase air pollutants, such as NO, NO2, NOx, O-3, SO2 and CO; and for aerosol pollutants, we explored mass concentrations for particles smaller than 10 mu m and 2.5 mu m in diameter (PM10 and PM2.5, respectively). In order to quantify trends in the data, we deployed a non-parametric Mann-Kendall test and Theil-Sen method. The results were compared with the regional emissions trends and changes in meteorological conditions. Our analysis indicates that SO2 and CO in all stations have decreased to values corresponding to their regional background concentration levels and their role as urban air pollutants have diminished. Our results from the Helsinki Metropolitan area during the last 25 years show that the air quality improved and all the air pollutant concentrations show a decreasing trend, except ozone. Based on our analysis of the Air Quality Index (AQI) at traffic and urban background environments, NO2 concentration, which have typically represented the health effects resulting from vehicular traffic, is rapidly decreasing also in traffic environments. The current AQI standard therefore lacks clarity on the potential health risks from other air pollutants emitted from traffic exhaust. In addition, the air quality indicators currently considered in the AQI do not represent well enough residential wood burning and the possible health outcomes from its exposure. We suggest that the current AQI should be revised in a way that new air quality parameters would be considered, which would better represent the health effects resulting from these local combustion sources.
Myocardial infarctions (MIs) are a major cause of death worldwide, and both high and low temperatures (i.e. heat and cold) may increase the risk of MI. The relationship between health impacts and climate is complex and influenced by a multitude of climatic, environmental, socio-demographic and behavioural factors. Here, we present a machine learning (ML) approach for predicting MI events based on multiple environmental and demographic variables. We derived data on MI events from the KORA MI registry dataset for Augsburg, Germany, between 1998 and 2015. Multivariable predictors include weather and climate, air pollution (PM10, NO, NO2, SO2 and O-3), surrounding vegetation and demographic data. We tested the following ML regression algorithms: decision tree, random forest, multi-layer perceptron, gradient boosting and ridge regression. The models are able to predict the total annual number of MIs reasonably well (adjusted R-2 = 0.62-0.71). Inter-annual variations and long-term trends are captured. Across models the most important predictors are air pollution and daily temperatures. Variables not related to environmental conditions, such as demographics need to be considered as well. This ML approach provides a promising basis to model future MI under changing environmental conditions, as projected by scenarios for climate and other environmental changes.
There is a wealth of scientific literature that scrutinizes the relationship between mortality and temperature. The aim of this paper is to identify the nexus between temperature and three different causes of mortality (i.e., cardiological, respiratory, and cardiorespiratory) for three countries (Scotland, Spain, and Greece) and eleven cities (i.e., Glasgow, Edinburgh, Aberdeen, Dundee, Madrid, Barcelona, Valencia, Seville, Zaragoza, Attica, and Thessaloniki), emphasizing the differences among these cities and comparing them to gain a deeper understanding of the relationship. To quantify the association between temperature and mortality, temperature thresholds are defined for each city using a robust statistical analysis, namely threshold regression analysis. In a more detailed perspective, the threshold used is called Minimum Mortality Temperature (MMT), the temperature above or below which mortality is at minimum risk. Afterward, these thresholds are compared based on the geographical coordinates of each city. Our findings show that concerning all-causes of mortality under examination, the cities with higher latitude have lower temperature thresholds compared to the cities with lower latitude. The inclusion of the relationship between mortality and temperature in the array of upcoming climate change implications is critical since future climatic scenarios show an overall increase in the ambient temperature.
The quality of the indoor microclimate in museums is a problem of great interest to the contemporary society, given that it is in close connection with the health and comfort of visitors and employees, as well as with the integrity of the exhibits. Taking into account the fact that museums are places that have a special role in the community’s life and therefore attract a very large number of visitors of all ages, a very important issue is to determine the degree of safety that the indoor microclimate presents. Thus, the quality of the indoor microclimate was investigated inside an iconic museum in Romania, dating back to the 19th century, because pollutants from external or internal sources of the building, generated secondary, often anthropogenic, as a tendency to defend/adapt to climate change (CC), contribute to both local and regional pollution, but also lead to challenges in identifying links between air quality (AQ) and and climate change (CC). The methodology used was based on monitoring the main parameters of the microclimate (temperature, relative humidity and CO2) over a period of between October 2020 and March 2021, 21 weeks, as well as on determining the microbiological contamination of the air and some indoor exhibits located in three different areas of the museum. At the same time, the study aims to identify cheap, easy to implement and non-invasive solutions for removing fungi identified on exhibits for long-term preservation and reducing the risk of various pathologies in humans following prolonged exposure. The results obtained show that the indoor microclimate in the old heritage building favours the development of fungi, which have a high degree of contamination of the air (over 800 CFU/m(3)) and of the exhibits, representing a potential risk for the health of the visitors and museum workers. Thus, six species of yeast and five different fungi genera were identified in the air, while on the exhibits were individualised six fungi genera, a species of yeast and a bacterium. The most viable solution for cleaning materials, prolonging their lifespan and reducing the risk of disease in humans was represented by the use of essential oils (EO). Three essential oils (lavender, mint and lemon) were applied on an exhibit with five different microorganism genera, and it was observed that they have the ability to inhibit the spores from moulds and bacteria, being a very good alternative to the usual chemical treatments that are used in the cultural heritage field.
BACKGROUND: Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students’ perceptions of climate change and sustainability. OBJECTIVES: To explore nursing students’ perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector. DESIGN: It is a qualitative, descriptive exploratory study. SETTINGS: A nursing program at a university in central Sweden. PARTICIPANTS: Nursing students. METHODS: Individual in-depth interviews and one group interview were conducted for the study. RESULTS: The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society’s joint obligation to achieve the right to a good life for all people equally. CONCLUSIONS: Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.
BACKGROUND: Emergency department (ED) visits show a high volatility over time. Therefore, EDs are likely to be crowded at peak-volume moments. ED crowding is a widely reported problem with negative consequences for patients as well as staff. Previous studies on the predictive value of weather variables on ED visits show conflicting results. Also, no such studies were performed in the Netherlands. Therefore, we evaluated prediction models for the number of ED visits in our large the Netherlands teaching hospital based on calendar and weather variables as potential predictors. METHODS: Data on all ED visits from June 2016 until December 31, 2019, were extracted. The 2016-2018 data were used as training set, the 2019 data as test set. Weather data were extracted from three publicly available datasets from the Royal Netherlands Meteorological Institute. Weather observations in proximity of the hospital were used to predict the weather in the hospital’s catchment area by applying the inverse distance weighting interpolation method. The predictability of daily ED visits was examined by creating linear prediction models using stepwise selection; the mean absolute percentage error (MAPE) was used as measurement of fit. RESULTS: The number of daily ED visits shows a positive time trend and a large impact of calendar events (higher on Mondays and Fridays, lower on Saturdays and Sundays, higher at special times such as carnival, lower in holidays falling on Monday through Saturday, and summer vacation). The weather itself was a better predictor than weather volatility, but only showed a small effect; the calendar-only prediction model had very similar coefficients to the calendar+weather model for the days of the week, time trend, and special time periods (both MAPE’s were 8.7%). CONCLUSIONS: Because of this similar performance, and the inaccuracy caused by weather forecasts, we decided the calendar-only model would be most useful in our hospital; it can probably be transferred for use in EDs of the same size and in a similar region. However, the variability in ED visits is considerable. Therefore, one should always anticipate potential unforeseen spikes and dips in ED visits that are not shown by the model.
Contemporary challenges linked to public health and climate change demand more effective decision-making and urban planning practices, in particular by taking greater account of evidence. In order to do this, trust-building relationships between scientists and urban practitioners through collaborative research programmes is required. Based on a policy-relevant research project, Complex Urban Systems for Sustainability and Health (CUSSH), this project aims to support the transformation of cities to meet environmental imperatives and to improve health with a quantitative health impact assessment. A case study in Rennes, France, focuses on the role of a policy decision-support tool in the production and use of knowledge to support evidence-informed decision-making. Although the primary objective of informing decision-making through evidence-based science is not fulfilled, the use of a decision-making support tool can lay the foundations for relationship-building. It can serve as a support for boundary-spanning activities, which are recognised for their effectiveness in linking science to action. This case study illustrates that the path of knowledge transfer from science to policy can be challenging, and the usefulness of using models may not be where it was thought to have been.
BACKGROUND AND AIMS: Seasonal variations in several risk factors for cardiovascular events (CVD) were described. Here, we evaluate the impact of seasonal variations in blood pressure (BP), lipid profile and glycemic control on estimated CVD risk in patients with type 2 diabetes (T2D). METHODS AND RESULTS: Retrospective monocentric study of patients with T2D who were visited at least once in the winter period and once in the summer period, less than 8 months apart, for which data related to systolic (S) BP, diastolic (D) BP, body mass index, glycosylated hemoglobin (HbA1c), total cholesterol, HDL cholesterol and smoking habit were available on both occasions. The 10-year CVD risk was calculated using the UKPDS risk engine and the ASCVD risk estimator. As many as 411 patients were included in the study. Significant within-patient differences between summer and winter were found for the absolute risk of events assessed with both calculators (Δs-w UKPDS-CHD: -1.33%, Δs-w UKPDS-Stroke: -0.84%, Δs-w ASCVD: -2.21%). The seasonal change in SBP was the main responsible for the change in risk estimated with both the UKPDS-Stroke (r(2) = 0.43) and the ASCVD (r(2) = 0.50) scores, while the change in total cholesterol was the main determinant of the change in risk for the UKPDS-CHD (r(2) = 0.34). A significant correlation was identified between changes in temperature and changes in SBP (ρ = 0.130, p = 0.008), but not in other risk factors. CONCLUSIONS: Seasonal variations in the classic CVD risk factors influence the risk estimated using validated calculators.
PURPOSE: To investigate the monthly and seasonal variation in adult osteoporotic fragility fractures and the association with weather. METHODS: 12-year observational study of a UK Fracture Liaison Service (outpatient secondary care setting). Database analyses of the records of adult outpatients aged 50 years and older with fragility fractures. Weather data were obtained from the UK’s national Meteorological Office. In the seasonality analyses, we tested for the association between months and seasons (determinants), respectively, and outpatient attendances, by analysis of variance (ANOVA) and Tukey’s test. In the meteorological analyses, the determinants were mean temperature, mean daily maximum and minimum temperature, number of days of rain, total rainfall and number of days of frost, per month, respectively. We explored the association of each meteorological variable with outpatient attendances, by regression models. RESULTS: The Fracture Liaison Service recorded 25,454 fragility fractures. We found significant monthly and seasonal variation in attendances for fractures of the: radius or ulna; humerus; ankle, foot, tibia or fibula (ANOVA, all p-values <0.05). Fractures of the radius or ulna and humerus peaked in December and winter. Fractures of the ankle, foot, tibia or fibula peaked in July, August and summer. U-shaped associations were showed between each temperature parameter and fractures. Days of frost were directly associated with fractures of the radius or ulna (p-value <0.001) and humerus (p-value 0.002). CONCLUSION: Different types of fragility fractures present different seasonal patterns. Weather may modulate their seasonality and consequent healthcare utilisation.
BACKGROUND/AIM: Although many headache patients report that the frequency and severity of attacks vary according to the season or weather in clinical practice, the relationship between the characteristics of the attacks and the weather is not very clear in episodic headaches. We aimed to compare the effects of weather variables (temperature, wind speed, wind direction, humidity, pressure, ultraviolet index, and sunshine duration) on episodic migraine (EM) and episodic tension-type headache (ETTH) attacks (incidence, duration, and severity). MATERIALS AND METHODS: Fifty patients with EM and fifty patients with ETTH diagnosed according to International Classification of Headache Disorders-II are included in the study. Patients were given one diary for headache follow-up. The evaluation form on the relationship between the duration, frequency, and severity of the pain and the findings obtained from the headache diaries were compared with the daily weather data, and the two headache groups were compared with each other in terms of the effect of meteorological data on the pain characteristics. RESULTS: It is determined that mean wind velocity in EM attacks is significantly higher when compared to the tension-type headache (TTH) attacks and mean UV index is significantly higher in TTH attacks (p = 0.018 and 0.039). Mean UV index in TTH attack days was reported higher in women than men (p = 0.044). Mean sunshine duration in TTH attack days was reported longer in women than men (p = 0.050). When mean age gets higher in patients with migraine, mean temperature in the days of attack gets lower (r = –0.146 and p = 0.046). CONCLUSION: During the treatment of migraine and TTH patients, recommendations and warnings about weather conditions can be made. This information can guide patients to regulate their daily living activities. The importance of considering the weather-headache relationship during the review of the current treatment in cases of unresponsiveness to treatment should be kept in mind.
In recent years climate change and its impacts have become a separate field of inquiry. Climate-related risks to food security, water supply, biodiversity and human health are expected to increase with further global warming. The purpose of this study is to show how the definition of food security in particular has changed in times of climate change. It is a multidimensional phenomenon that has no legal definition so far. Associated mainly with physical access to food, food security was identified as a global problem by Food and Agriculture Organization (FAO) in 1975 at the Word Food Conference. At the European Union level, food security is strictly connected with the Common Agriculture Policy. One of the new aims of that policy is to make agriculture more sustainable and responsive to current and future challenges, including climate variability. There is the dual challenge of both adapting production systems to new conditions and reducing greenhouse gases produced by agriculture.
When meteorological conditions deviate from the optimal range for human well-being, the risks of illness, injury, and death increase, and such impacts are feared in particular with more frequent and intense extreme weather conditions resulting from climate change. Thermal indices, such as the universal thermal climate index (UTCI), can better assess human weather-related stresses by integrating multiple weather components. This paper quantifies and compares the seasonal and spatial association of UTCI with mortality, morbidity, and road accidents in the federal state of Bavaria, Germany. Linear regression was applied to seasonally associate daily 56 million hospital admissions and 2.5 million death counts (1995-2015) as well as approximately 930,000 road accidents and 1.7 million people injured (2002-2015) with spatially interpolated same day- and lagged- (up to 14 days) average UTCI values. Additional linear regressions were performed stratifying by age, gender, region, and district. UTCI effects were clear in all three health outcomes studied: Increased UTCI resulted in immediate (1-2 days) rises in morbidity and even more strongly in mortality in summer, and lagged (up to 14 days) decreases in fall, winter, and spring. The strongest UTCI effects were found for road accidents where increasing UTCI led to immediate decreases in daily road accidents in winter but pronounced increases in all other seasons. Differences in UTCI effects were observed e.g. between in warmer north-western regions (Franconia, more districts with heat stress-related mortality, but hospital admissions for lung, heart and external reasons decreasing with summer heat stress), the touristic alpine regions in the south (immediate effect of increasing UTCI on road accidents in summer), and the colder south-eastern regions (increasing hospital admissions for lung, heart and external reasons in winter with UTCI). Districts with high percentages of elderly suffered from higher morbidity and mortality, particularly in winter. The influences of UTCI as well as the spatial and temporal patterns of this influence call for improved infrastructure planning and resource allocation in the health sector.
Several cardiovascular conditions exhibit seasonality in frequency and mortality, but little is known about the seasonality of Venous ThromboEmbolism (VTE), a very relevant medical condition, and seasonal influences are still conflicting. Patients having co-morbidities, individual suffered from dyspnea, swelling, edema of lower limb, pain (chest, lower limbs) are admitted frequently to the hospital emergency room (HER), particularly. Both mark a potential risk for VTE, that can be increased also by seasonality. A four years retrospective analysis (2016-2019) was carried out in individuals and patients admitted to the HER of the Hospital of Catania (a Mediterranean city of Sicily, Italy) to evaluate the VTE frequency and its seasonal differences, common symptoms, potential usage of some common laboratory tests. Dyspnea, swelling, edema of lower limb and pain (chest, lower limbs) were considered to suspect pulmonary embolism (PE) or for deep vein thrombosis of lower limb (DVT). Platelet count, platelet volume, fibrinogen, C-reactive protein, and D-dimer were considered. VTE frequency per year was 2.9/10,000 (2016), 4.9/10,000 (2017) 3.6/10,000 (2018), and 5.1/10,000 (2019) respectively. Dyspnea was highly frequent for PE, edema and lower limb pain were frequent in DVT patients. Fibrinogen, C reactive protein, and D-dimer values were found raised in all the VTE patients. Platelet volume was found higher in DVT than PE VTE events that occurred in warm periods were modestly greater (57 VTE: 38 DVT, 19 PE) compared to cold months (52 VTE: 34 DVT, 18 PE). Our results could be explained by the increased sweating due to the high temperatures, which in turn, can affect both on plasma concentration and on hematocrit value coupled to the reduction in atmospheric pressure determining both a hyper-coagulative condition. Climate seasonal characteristics, and environmental conditions in Catania city (Sicily) may be as reasonable items in expecting on different VTE rates in warm period compared to cold. This study highlights no specific symptoms, and confirms the common lab tests for individuals and patients admitted to HER as simple and helpful tools in initiating none or mini-invasive diagnostic strategy for the VTE. Finally, the climate/seasonality coupled with latitude can have a direct influence on the incidence of DVT.
In the Adriatic Sea, massive rainfall events are causing flooding of rivers and streams, with severe consequences on the environment. The consequent bacterial contamination of bathing water poses public health risks besides damaging tourism and the economy. This study was conducted in the framework of WATERCARE, an EU Interreg Italy-Croatia Project, which aims at reducing the impact of microbial contamination on Adriatic bathing water due to heavy rainfall events drained in the local sewage network and; enhancing the quality of local waters; and providing support for the decision-making processes regarding the management of bathing water in line with EU regulations. The study involved the development of an innovative water quality integrated system that helps meet these objectives. It consists of four components: a real time hydro-meteorological monitoring system; an autosampler to collect freshwater samples during and after significant rainfall events; a forecast system to simulate the dispersion of pollutants in seawater; and a real-time alert system that can predict the potential ecological risk from the microbial contamination of seawater. The system was developed and tested at a pilot site (Fano, Italy). These preliminary results will be used to develop guidelines for urban wastewater and coastal system quality assessments to contribute to develop policy actions and final governance decisions.
Background: Most respiratory viruses show pronounced seasonality, but for SARS-CoV-2, this still needs to be documented. Methods: We examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application. Findings: Meta-analysis of the mortality risk in seven European hospitals estimated odds ratios per 1-day increase in the admission date to be 0.981 (0.973-0.988, p < 0.001) and per increase in ambient temperature of 1°C to be 0.854 (0.773-0.944, p = 0.007). Statistically significant decreases of comparable magnitude in median hospital stay, probability of transfer to the intensive care unit, and need for mechanical ventilation were also observed in most, but not all hospitals. The analysis of individually reported symptoms of 37,187 individuals in the UK also showed the decrease in symptom duration and disease severity with time. Interpretation: Severity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation.
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.
Tropical cyclones are highly destructive weather systems, especially in coastal areas. Tropical cyclones with maximum sustained winds exceeding 74 mph (≈119 kph) are classified as typhoons in the Northwest Pacific, whilst the term ‘hurricanes’ applies to other regions. This study aims to investigate the general characteristics of the most devastating and catastrophic tropical cyclones in the USA Europe, and Asia. To achieve the study objectives, the three most devastating typical tropical cyclones in each region were selected. The tropical cyclones were examined based on various features, such as the number of deaths, minimum pressure, highest wind speed, total financial losses, and frequency per year. In contrast to Europe and Asia, the USA has recorded the highest number of catastrophic tropical cyclones. The damage induced by hurricanes Katrina, Harvey, and Maria in the USA totalled approximately USD USD 380 billion. In addition, the present research highlights the demand to improve the public attitude and behaviour toward the impact of climate change along with the enhancement of climate change alleviation strategies. The number of intense tropical cyclones is expected to rise, and the tropical cyclone-related precipitation rate is expected to increase in warmer-climate areas. Stakeholders and industrial practitioners may use the research findings to design resilience and adaptation plans in the face of tropical cyclones, allowing them to assess the effects of climate change on tropical cyclone incidents from an academic humanitarian logistics viewpoint in the forthcoming years.
OBJECTIVE: We studied potential effects of outdoor air temperatures or barometric pressure on births, preterm births and births associated with maternal hypertension. METHODS: 12,269 births were retrospectively reviewed in Brussel and 25,880 in South Reunion Island. National Belgium and French weather reference centers provided outdoor air temperatures and barometric pressures from the nearest weather stations on the corresponding birthdays. Poisson regression models were used to assess if outdoor air temperatures or barometric pressure could be correlated, immediately and several days later, with the number of daily births, preterm births and births associated with hypertension. RESULTS: Outdoor air temperature was significantly correlated to the number of daily births in Brussels. For each additional degree Celsius, overall births increased by 0.4% during the same day. Four days later, overall births increased by 1.8%, preterm births by 2.6% and births associated with hypertension by 5.7%. Similar observations on numbers of daily births were reported in South Reunion Island, without reaching statistical significance (p = .08). CONCLUSION: As previously demonstrated in recent studies, increased air temperature leads progressively to higher rates of births and preterm births. An even stronger delayed effect of air temperature was observed on births associated with hypertension. This would be worth further investigating.
BACKGROUND: Mainstreaming sustainable healthcare into the curricula of health professions is a key action to raise awareness and change attitudes. Therefore, the present study aimed to assess the contribution of scenario-based learning and augmented reality to the environmental awareness and attitudes toward climate change and sustainability among undergraduate nursing students. METHODS: This study was designed as a time-series analysis. Undergraduate nursing students in their 3 years were introduced to sustainability and climate change in the context of healthcare through scenario-based learning sessions. Questionnaires were used to collect data on participants’ attitudes towards sustainability and climate change, the usefulness of the educational sessions and the extent to which students changed their clinical practice. A data summary, related sample Friedman and Wilcoxon signed-rank tests were used to test for differences in survey scores. RESULTS: Attitudes and environmental awareness toward climate change and sustainability increased significantly as students received the learning sessions over the 3 years. After their first clinical training period, students already showed a high awareness of unsustainable practices in their working environment; however, they still struggled to apply sustainability and address unsustainable practices in healthcare settings. Most students felt that the scenarios helped them to make links between climate change, resources, and health. CONCLUSIONS: The scenario-based learning and augmented reality increase environmental awareness and attitudes toward climate change and sustainability among nursing students. Students are very aware of unsustainable practices in their work environment, but more work needs to be done on the application of sustainability principles to nursing practice.
Harmful algal blooms pose a challenge regarding food safety due to their erratic nature and forming circumstances which are yet to be disclosed. The best strategy to protect human consumers is through legislation and monitoring strategies. Global warming and anthropological intervention aided the migration and establishment of emerging toxin producers into Europe’s temperate waters, creating a new threat to human public health. The lack of information, standards, and reference materials delay effective solutions, being a matter of urgent resolution. In this work, the recent findings of the presence of emerging azaspiracids, spirolildes, pinnatoxins, gymnodimines, palitoxins, ciguatoxins, brevetoxins, and tetrodotoxins on European Coasts are addressed. The information concerning emerging toxins such as new matrices, locations, and toxicity assays is paramount to set the risk assessment guidelines, regulatory levels, and analytical methodology that would protect the consumers.
BACKGROUND: Aspergillosis is a serious infection, and in Spain, the influence of epidemiology and climate on the resulting expenses of aspergillosis is not well established. AIM: A retrospective descriptive study using the Minimum Basic Data Set was performed on records of patients admitted to hospitals of the National Health System between 1997 and 2017 with a diagnosis of aspergillosis. The weather parameters were obtained from the State Agency of Meteorology from Spain. RESULTS: A total of 32,960 patients were identified, of whom 22,383 were men (68%). The mean age (±SD) was 61.1 ± 19.1 years. The mean incidence rate for all diagnoses was 3.54 cases per 100,000 person-years (95% CI, 3.50-3.57). The incidence rate in men was twice as high as that in women, 4.89 (95% CI, 4.82-4.95) vs. 2.24 (95% CI, 2.19-2.27) cases per 100,000 person-years (p > .001). The highest incidence rates were concentrated in northern Spain. One in four patients died (8,080 cases; 25%). There was a moderate positive linear association between rainfall and incidence rate (r(P) = .508; p = .026). In contrast, the Pearson’s correlation coefficient indicated a moderate negative linear relationship between temperature and incidence rate (r(P) = -.447; p = .050). We observed a higher incidence in the months with higher humidity and rainfall. CONCLUSIONS: Our study supports a high burden of aspergillosis in Spain, with an increase in cases in the past two decades. Additionally, the influence of climatological factors on the incidence of aspergillosis is highlighted. Despite preemptive treatment strategies, this infection still has a high mortality.
Estimates of future climate change impacts using numerical impact models are commonly based on a limited selection of projections of climate and other key drivers. However, the availability of large ensembles of such projections offers an opportunity to estimate impact responses probabilistically. This study demonstrates an approach that combines model-based impact response surfaces (IRSs) with probabilistic projections of climate change and population to estimate the likelihood of exceeding pre-specified thresholds of impact. The changing likelihood of exceeding impact thresholds during the 21st century was estimated for selected indicators in three European case study regions (Iberian Peninsula, Scotland and Hungary), comparing simulations that incorporate adaptation to those without adaptation. The results showed high likelihoods of increases in heat-related human mortality and of yield decreases for some crops, whereas a decrease of NPP was estimated to be exceptionally unlikely. For a water reservoir in a Portuguese catchment, increased likelihoods of severe water scarce conditions were estimated for the current rice cultivation. Switching from rice to other crops with lower irrigation demand changes production risks, allowing for expansion of the irrigated areas but introducing a stronger sensitivity to changes in rainfall. The IRS-based risk assessment shown in this paper is of relevance for policy making by addressing the relative sensitivity of impacts to key climate and socio-economic drivers, and the urgency for action expressed as a time series of the likelihood of crossing critical impact thresholds. It also examines options to respond by incorporating alternative adaptation actions in the analysis framework, which may be useful for exploring the types, choice and timing of adaptation responses.
BACKGROUND: Climate change has been associated with an increase in extreme weather conditions. The aim of this study was to identify environmental factors and the effect of extreme weather events (95th percentile) on the risk for epistaxis-related emergency room visits (EV). METHODS: A total of 2179 epistaxis-related EVs were identified between 2015 and 2018. A distributed lag non-linear model was fitted to investigate the relationship between extreme weather conditions and the total number of epistaxis-related EVs per day. Cumulative relative risk (cRR) is defined as the cumulated daily risk of EV for epistaxis within a stated period after an extreme weather condition compared to the risk of EV at the median value of that weather condition. RESULTS: At a mean daily temperature of 27°C (P95), cRR for epistaxis-related EV was 2.00. At a relative humidity of 39% (P5), cRR was highest on day 3 at 1.59, while extremely high humidity (92%, P99) led to a decreased cRR of 0.7 on day 1. Intense precipitation of 24mm (P99) reduced the cRR on day 3 to 0.38. For prolonged extreme conditions over three days, extremely low wind speed, as well as both high and low atmospheric pressure events, diminished cRR. CONCLUSIONS: Extreme temperatures, relative humidity, and precipitation, as well as extended periods of extreme wind speeds and atmospheric pressure, significantly impact cRR for epistaxis-related EVs.
There is a global climate emergency, and also a global health concern related to climate change. The British Society of Gastroenterology (BSG) acknowledges these issues, and supports the concerns of its members to address them. Climate change has adverse effects on gastroenterological and liver disease, and on healthcare systems. The healthcare industry, itself, is also a major contributor to greenhouse gases. BSG has developed a strategy on Climate Change and Sustainability, which encompasses all of the activities of the society, and its members: personal, professional, organisational, political, international and research.
The World Health Organization estimates that every year air pollution kills seven million people worldwide. As it is expected that climate change will affect future air quality patterns, the full understanding of the links between air pollution and climate change, and how they affect human health, are challenges for future research. In this scope, a methodology to assess the air quality impacts on health was developed. The WRF-CAMx modelling framework was applied for the medium-term future climate (considering the SSP2-4.5 scenario) and for the recent past (considered as baseline). Following the WHO recommendations, mortality health indicators were used to estimate the health impacts of long-term exposures. For that, the Aveiro Region, in Portugal, was considered as a case study. Future climate results indicate the occurrence of higher temperatures, and lower total precipitation. Despite that, improvements in the main pollutants’ concentrations, and consequently in the reduction of the related premature deaths are foreseen, mainly due to the reduction of pollutants emissions imposed by the European legislation for the upcoming years. The applied approach constitutes an added value in this research field, being crucial to anticipate the effects of climate change on air quality and evaluate their impacts on human health.
The present work starts from the definition of the concept “human right to water and sanitation ” (HRWS). Then, it delimits its content, in a strict sense, to finally argue that it is an autonomous and subjective right. In other words, it is a right of immediate applicability, which means that it binds both the State and the private sector-that is, public or private supply and sanitation companies. Therefore, there is a minimum that cannot be denied to anyone, especially to individuals or families who cannot afford to pay their water bills. Next, I propose possible solutions for water and sanitation companies to ensure HRWS-avoiding water cuff-off-without compromising their economic and financial sustainability. Finally, I conclude that to comply with the principle of full cost recovery (FCR)-established by the EU Water Framework Directive (FWD)-the water bill will have to progressively increase-especially in regions where water is scarce and (due to the effects of climate change) will become an increasingly precious good. But, for those who cannot afford to pay the water bill, State will have to subsidize to guarantee the minimum service, per person and per day, which is a human right.
Climate change generates negative impacts on human health. However, little is known about specific impacts on eye diseases, especially in arid and semi-arid areas where increases in air temperatures are expected. Therefore, the main goals of this research are: (i) to highlight the association between common eye diseases and environmental factors; and (ii) to analyze, through the available literature, the health expenditure involved in combating these diseases and the savings from mitigating the environmental factors that aggravate them. Mixed methods were used to assess the cross-variables (environmental factors, eye diseases, health costs). Considering Southern Spain as an example, our results showed that areas with similar climatic conditions could increase eye diseases due to a sustained increase in temperatures and torrential rains, among other factors. We highlight that an increase in eye diseases in Southern Spain is conditioned by the effects of climate change by up to 36.5%; the economic burden of the main eye diseases, extrapolated to the rest of the country, would represent an annual burden of 0.7% of Spain’s Gross Domestic Product. In conclusion, the increase in eye diseases has a strong economic and social impact that could be reduced with proper management of the effects of climate change. We propose a new concept: disease sink, defined as any climate change mitigation action which reduces the incidence or morbidity of disease.
BACKGROUND: Environmental pollution and weather changes unfavorably impact on cardiovascular disease. However, limited research has focused on ST-elevation myocardial infarction (STEMI), the most severe yet distinctive form of acute coronary syndrome. METHODS AND RESULTS: We appraised the impact of environmental and weather changes on the incidence of STEMI, analysing the bivariate and multivariable association between several environmental and atmospheric parameters and the daily incidence of STEMI in two large Italian urban areas. Specifically, we appraised: carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NOX), ozone, particulate matter smaller than 10 μm (PM10) and than 2.5 μm (PM2.5), temperature, atmospheric pressure, humidity and rainfall. A total of 4285 days at risk were appraised, with 3473 cases of STEMI. Specifically, no STEMI occurred in 1920 (44.8%) days, whereas one or more occurred in the remaining 2365 (55.2%) days. Multilevel modelling identified several pollution and weather predictors of STEMI. In particular, concentrations of CO (p = 0.024), NOX (p = 0.039), ozone (p = 0.003), PM10 (p = 0.033) and PM2.5 (p = 0.042) predicted STEMI as early as three days before the event, as well as subsequently, and NO predicted STEMI one day before (p = 0.010), as well as on the same day. A similar predictive role was evident for temperature and atmospheric pressure (all p < 0.05). CONCLUSIONS: The risk of STEMI is strongly associated with pollution and weather features. While causation cannot yet be proven, environmental and weather changes could be exploited to predict STEMI risk in the following days.
Blood pressure (BP) shows a seasonal variation with higher levels at lower temperatures. Many hypertensives, however, report on BP disturbances rather in association with acutely changing weather conditions than with absolute temperatures. To date, the impact of changing meteorological parameters on hypertensive episodes remains elusive. We performed a retrospective time series regression analysis on 203,703 patients in three hospitals in Germany between 2010 and 2018, of whom 7362 patients were admitted for hypertensive disease. Numbers of daily admissions for hypertension were associated with metereological data obtained from three nearby weather stations. Data comprised temperature (mean, maximal, minimal and range within 24 h), athmospheric pressure, and precipitation. Changes of these parameters were calculated over a two and three day period. There was an inverse correlation between maximal daily temperature and the number of admissions for hypertensive disease, which remained significant both after adjustment for seasonality and week day in a spline model and in a constrained distributed lag model. A decrease of maximal temperature by 5 °C was associated with a 3% increase of risk for admission for hypertension and vice versa. There were no significant effects of precipitation and athmospheric pressure on the number of admissions. With regard to all observed metereological parameters, neither the change within two, nor within three days was consistently associated with the number of daily admissions. High temperatures are associated with lower numbers of hypertensive episodes requiring hospital admission. In contrast to the subjective perception of many hypertensive patients, however, acutely changing weather conditions are not associated with a higher risk of hypertensive emergency.
BACKGROUND: Acute type A aortic dissection (AAAD) is a life-threatening condition with high mortality within 24 hours. We hypothesized if there is a correlation between seasonal weather changes and the occurrence of AAAD. The aim of the present study was to identify seasonal specific weather and patient characteristics predicting the occurrence of AAAD. METHODS: This is a retrospective analysis of all consecutive patients of our department with AAAD between January 1st 2006 and December 31st 2016. The national meteorological department provided the data of temperature, humidity and air pressure during the study period. The occurrence of AAAD, preoperative neurological impairment and mortality were analyzed in correlation with the obtained daily weather data within the entire cohort and in patients with and without hypertension separately. RESULTS: A total of 517 patients were included. Mean age was 63.4±13 years, 69.4% were male and 68.8% had documented hypertension. In-hospital mortality was 17.7%. In the whole cohort, the occurrence of AAAD was significantly increased in March, October, December (P=0.016). In hypertensive patients, the occurrence was increased 34% with rising temperature (0.1-9.6 °C, OR1.34, 95% CI: 1.06-1.69, P=0.015). There was no correlation between weather variables and preoperative neurological impairment or mortality. CONCLUSIONS: Our data suggests a relation between an increasing number of events of AAAD and certain months within our catchment area and a significantly increased occurrence with rising temperatures (independent from absolute temperature at time of the event) in hypertensive patients.
Human thermal climate in the Hungarian lowland is investigated by using a clothing resistance-operative temperature model performing individual, local, and long-term concurrent observations of weather and human thermal perception. Human thermal load is characterized in terms of clothing resistance r(cl) and operative temperature T-o. The model is also used as a tool to analyse the relationship between r(cl) and the structural parameters of the body (relative fat mass index (fatBMI) and relative muscle mass index (muscleBMI)). This analysis works with data collected on more than 1,000 occasions of weather and thermal perception observation and uses body structure data of more than 3,000 adults and children. By analysing the data, the following human thermal climate characteristics have been established. (a) T-o of about 80 degrees C can be considered as the upper limit of heat stress in the Hungarian lowland, similarly, T-o of about -35 to -37 degrees C can be taken as the lower limit of cold stress. (b) Interpersonal thermal load variations increase with increasing of cold stress; these variations are the smallest within the “thermoneutral” zone. (c) In cold stress situations, there is a significant sexual dimorphism in the relationship between r(cl) and fatBMI. (d) In night time period of the day, T-o can vary between 25 degrees C and the lower limit of cold stress. In this range of T-o, thermal perception types “neutral,” “cool,” “cold,” and “very cold” occurred. Based on the results, it can be seen that interpersonal thermal load variations cannot be neglected in extreme cold weather conditions, and that interpersonal variations of fatBMI index are determinant in the formation of individual clothing resistance.
PURPOSE: Implementing adherence to pulmonary rehabilitation (PR) programs is key to obtaining the best results. The objective of our study was to evaluate the influence of weather conditions (humidity, temperature, and precipitation) on attendance to a PR program in chronic obstructive pulmonary disease (COPD) patients. METHODS: This prospective observational study, carried out in Seville (Spain), included COPD patients who participated in a 36-session outpatient mixed (strength and endurance) training program for 12 weeks. The program included educational sessions as well. The attendance at the program scheduled sessions during 1 year was evaluated in relation to the meteorological conditions of relative humidity in percentage (%), temperature in degree centigrade (°C), and precipitation in millimeters (mm) according to the data from the State Meteorological Agency (AEMET) and the meteorological center of La Rinconada. RESULTS: A total of 81 COPD patients who underwent 2903 sessions were analyzed. The annual average attendance of the program was 78.6%. No differences were found in the attendance to the program depending on the climatic conditions evaluated throughout the year. CONCLUSIONS: In a specific geographical area such as Seville, meteorological conditions are not a determining factor of attendance to the PR program for COPD patients.
Poland has one of the worst air qualities in the European Union, particularly regarding concentrations of particulate matter (PM). This study aimed to evaluate the short-term effects of air pollution and weather conditions on all-cause mortality and pneumonia-related hospitalizations in three Polish agglomerations. We investigated data from 2011 to 2018 on a number of health outcomes, concentrations of PM2.5, PM10, nitrogen dioxide (NO2), ozone (O-3), and selected meteorological parameters. To examine the impact of air pollutants and weather conditions on mortality and pneumonia burden, we identified optimal general regression models for each agglomeration. The final models explained <24% of the variability in all-cause mortality. In the models with interactions, O-3 concentration in Warsaw, NO2, O-3, and PM2.5 concentrations in Cracow and PM10 and O-3 concentrations in the Tricity explained >10% of the variability in the number of deaths. Up to 46% of daily variability in the number of pneumonia-related hospitalizations was explained by the combination of both factors, i.e., air quality and meteorological parameters. The impact of NO2 levels on pneumonia burden was pronounced in all agglomerations. We showed that the air pollution profile and its interactions with weather conditions exert a short-term effect on all-cause mortality and pneumonia-related hospitalizations. Our findings may be relevant for prioritizing strategies to improve air quality.
Streptococcus pneumoniae (pneumococcus) is the most commonly identified bacterial cause of pneumonia and the leading infectious cause of death in children under 5 years of age worldwide. Pneumococcal disease follows a seasonal pattern with increased incidence during winter. Pneumonia burden is also associated with poor air quality. Nasopharyngeal carriage of the bacterium is a pre-requisite of invasive disease. We aimed to determine if susceptibility to nasopharyngeal pneumococcal carriage varied by season and which environmental factors might explain such variation. We also evaluated the influence of sex on susceptibility of carriage. We collated data from five studies in which human volunteers underwent intranasal pneumococcal challenge. Generalised linear mixed-effects models were used to identify factors associated with altered risk of carriage acquisition, specifically climate and air-quality data. During 2011-2017, 374 healthy adults were challenged with type 6B pneumococcus. Odds of carriage were significantly lower in males (OR, 0.61; 95% CI, 0.40-0.92; p=0.02), and higher with cooler temperatures (OR, 0.79; 95% CI, 0.63-0.99; p=0.04). Likelihood of carriage was also associated with lower concentrations of local fine particulate matter concentrations (PM(2.5)) and increased local rainfall. In contrast to epidemiological series, experimental challenge allowed us to test propensity to acquisition during controlled exposures; immunological explanations for sex and climatic differences should be sought.
Climate changes exert negative impacts on the global environments and the human beings. They imply more frequent extreme weather events, which are responsible of sea level rise, coastal erosion, flooding, droughts, and desertification. Mitigation and adaptation represent intertwined strategies for counteracting climate changes. Mitigation is associated to the lessening of the causes of climate changes and includes actions reducing greenhouse gas emissions. Adaptation is a proactive concept addressing how humans can adapt and benefit from climate change. The mainstreaming and integration of adaptation to climate change into routine practice can be favored by Strategic Environmental Assessment (SEA) of regional policies, plans and programmes. In this study, we aim at scrutinizing a set of SEA reports of regional plans and programmes adopted in Sardinia (Italy), to investigate if -and to what extent- adaptation to climate change has characterized planning and programming tools. Evidence shows that the integration of adaptation-driven issues into regional planning is still in its infancy but presents the signs of promising expansion.
OBJECTIVES: The aim of this study was to determine the frequency of seborrheic dermatitis (SD) by months and seasons in Istanbul, Turkey, and to examine the relationships between SD frequency and meteorological data, such as average temperature (°C), average humidity (%), average sunshine duration, and solar radiation per months. METHODS: The study was conducted at Dermatology Department of Haseki Training and Research Hospital. The data of all adult patients who applied to the dermatology outpatient clinic between June 2018 and May 2020 were obtained. Monthly average climate data values of Istanbul between the same period were requested from the Turkish Ministry of Agriculture and Forestry, General Directorate of Meteorology. RESULTS: During the study period, SD was diagnosed in 5316 patients (5.9% of the outpatient clinic). Among these, 2721 (51.2%) were male, 2595 (48.8%) were female, and mean age was 35.9±15.1 years-old. With respect to monthly distributions, SD frequency was 7.3% in December, 7.1% in February, 6.7% in November, and 6.6% in January; whereas June (3.8%) and July (3.9%) represented the lowest proportion of patients. Frequency of SD was similar in the autumn and winter seasons, despite considerable difference in average temperature. The frequency of SD was found to be strongly and inversely correlated with temperature values (r=-0,646, p<0.001) and monthly maximum humidity value (r=-0.609, p=0.001), while it was also moderately correlated with solar radiation levels (r=-0.442, p=0.027). Minimum or average humidity values and sunshine durations (daily and monthly) were not associated with frequency of SD. Spearman's Rho correlation was calculated to assess the directional relationships between continuous variables. CONCLUSION: Our study shows that environmental factors such as low temperature, low ultraviolet index, and low humidity are critical factors that increase the likelihood of SD development. These data support previous studies in terms of indicating that SD frequency might be increased in climate conditions favoring the growth of Malassezia species.
BACKGROUND: Melanoma is the deadliest type of skin cancer. It is the eighth most common cancer in males and the tenth in females in Cyprus, an island in the Mediterranean with a high ultraviolet (UV) index. Cyprus is expected to be strongly affected by climate change and consequently, melanoma will likely become an increasing public health problem. Melanoma prevention is possible; however, it is unknown if people living in Cyprus are aware of melanoma and prevention methods. To this end, we used a validated survey to evaluate the level of melanoma knowledge and factors associated with it in the Cypriot population. METHODS: We conducted a 47-item survey with sections on demographics, knowledge of melanoma and risk factors, attitudes toward relevant health practices, and protective behaviors among six hundred Cypriot residents from October 2015 to April 2016. RESULTS: Our results revealed that only 59% of participants check their skin for moles, 87% protect their skin from the sun during summer holidays, and 57% do not take measures to protect their skin from the sun during non-holiday periods. Protective behavior was positively associated with educational level (P=0.016) and district of residence (P<0.0001). Melanoma knowledge was positively associated with education level (P=0.002) and district of residence (P=0.004). Level of Concern was positively associated with age (P=0.026) and education level (P=0.041). CONCLUSIONS: There are gaps in melanoma knowledge and prevention practices in the study population. Further education on melanoma and its prevention should be specifically targeted to individuals of lower education levels as well as teenagers, such that protective behaviors for melanoma are adopted early in life.
BACKGROUND: In recent years, healthcare has faced many different crises around the world such as HIV-, Ebola- or H1N1-outbrakes, opioid addiction, natural disasters and terrorism attacks). In particular, the current pandemic of Covid-19 has challenged the resilience of health systems. In many healthcare systems, primary care practices play a crucial role in the management of crises as they are often the first point of contact and main health care provider for patients. Therefore, this study explored which situations are perceived as crises by primary care practice teams and potential strategies for crisis management. METHODS: A qualitative observational study was conducted. Data were collected in interviews and focus groups with experts from primary care practices and stakeholders focusing on primary care practices in Germany such as physicians, medical assistants, practice managers, quality managers, hygiene managers and institutions on health system level (politics, research and health insurance). All interviews and focus groups were audio-recorded and transcribed verbatim. A qualitative content analysis was performed using a rapid qualitative analysis approach first, followed by a thematic analysis. RESULTS: Two focus groups and 26 interviews including 40 participating experts were conducted. Many different situations were perceived as crises, varying from issues in the practice organization to problems on health system level and international disasters. Distinct aspects associated with the perception of a crisis situation by interviewees were the presence of emotional reactions, a need for organizational changes and a lack of necessary resources. A broad spectrum of possible strategies was discussed that could help to cope with or even prevent the emergence of an actual crisis. In particular, strengthening communication within practice teams and resilience among employees was perceived to be fundamental for improving responses to crises or preventing them. CONCLUSIONS: The study provides perspectives of primary health care workers on crises in health, that could inform health policy regarding prevention and management of future crises in primary care facilities.
This paper presents a consistent series of policy-relevant indicators of changing climate hazards and resources for the UK, spanning the health, transport, energy, agriculture, flood and water sectors and based on UKCP18 climate projections. In the absence of explicit adaptation, risks will increase across the whole of the UK, but at different rates and from different starting values in different regions. The likelihood of heat extremes affecting health, the road and rail network and crop growth will increase very markedly. Agricultural and hydrological drought risks increase across the UK, as does wildfire danger. River flood risk increases particularly in the north and west. Demand for cooling energy will increase, but demand for heating energy will decline. Crop growing degree days will increase, benefiting the production of perennial crops. In general, the risks associated with high temperature extremes will increase the most in warmer southern and eastern England, but the rate of increase from a lower base may be greater further north and west. Reducing emissions reduces risks in the long term but has little effect over the next two or three decades. The results provide evidence to support the development of national and local climate and resilience policy. Measures to enhance resilience are needed alongside policies to achieve net zero emissions by 2050. Resilience policy should recognise the variability in change in risk across the UK, and therefore different local priorities. Explicit choices need to be made about ‘worst case’ emissions scenarios as they can influence strongly estimated changes in risk: the increase in risk with RCP8.5 can be considerably higher than with a pathway reaching 4 degrees C by 2100.
Climate disturbs urban systems with unusual events, making climate change preparedness a hot-topic in strategic regional planning discourses. Due to their complex structure, metropolitan regions require a comprehensive perspective including all services and sectors to determine climate change threats and provide effective strategies. This study aimed to identify priority planning areas in the Istanbul Metropolitan Region in terms of climate change vulnerability and risk levels to reveal sectors having the highest threats and requiring urgent improvements for climate change resilience. Istanbul is the largest metropolitan region in Turkey which has a country-wide hinterland, so it was chosen as the case study area. Priority planning areas represent the most important management areas of the regional government related to regional climate associated vulnerabilities and risks. Regional systems were defined by 11 urban sectors (culture, biodiversity and ecology, infrastructure, materials, land use and development, transportation, energy, water resources, agriculture and health) and 25 planning areas as components of the system likely to be impacted by climate change. To assess priority levels of planning areas, in-depth interviews were conducted with experts, representatives of companies, institutions, scientists, academics and researchers, and a vulnerability-risk matrix developed to rank the planning areas. The results of this study revealed that urban risk areas, heat, biodiversity, water supply and storm water management have the highest priority scores, while waste collection and cycling the lowest. These results may be a guide for regional governments addressing the starting point of climate change preparedness actions and important for enlightening paths towards more sustainable and resilient cities during climate change.
BACKGROUND: As the climate changes, it is crucial to focus not only on mitigation measures but also on building climate change resilience by developing efficient adaptation strategies. Although population adaptation is a major determinant of future climate-related health burden, it is not well accounted for in studies that project the health impact of climate change. We propose a methodological framework for temperature-related mortality that incorporates two simultaneous adaptation-sensitivity pathways: the physiological pathway, considering both heat adaptation and cold sensitivity, and the socioeconomic pathway, which is influenced by changes in future adaptive capacities. To demonstrate its utility we apply the framework to a case study mortality time-series dataset from Bavaria, Germany. METHODS: In this modelling framework, we used extrapolated location-specific and age-specific baseline exposure-response functions and propose different future scenarios of cold sensitivity and heat adaptation on the basis of varying slopes of these exposure-response functions. We also incorporated future socioeconomic adaptation in the exposure-response functions using projections of gross domestic product under the respective shared socioeconomic pathways. Future adaptable fractions, representing the deaths avoided under each of the future scenarios, are projected under combinations of two climate change scenarios (shared socioeconomic pathway [SSP]1-2.6 and SSP3-7.0) and the respective plausible population projection scenarios (SSP1 and SSP3), also incorporating the future changes in demographic age structure and mortality. The case study for this framework was done for five districts in Bavaria, for both total non-accidental mortality and cardiovascular disease mortality. The baseline data was obtained for the period 1990-2006, and the future period was defined as 2083-99. FINDINGS: In our Bavaria case study, average temperature was projected to increase by 2099 by an average of 1·1°C under SSP1-2.6 and by 4·1°C under SSP3-7.0. We observed the adaptable fraction to be largely influenced by socioeconomic adaptation for both total mortality and cardiovascular disease mortality, and for both climate change scenarios. For example, for total mortality, the highest adaptable fraction of 18·56% (95% empirical CI 10·77-23·67) was observed under the SSP1-2.6 future scenario, in the presence of socioeconomic adaptation and under the highest heat adaptation (10%) provided the cold sensitivity remains 0%. The cold adaptable fraction is lower than the heat adaptable fraction under all scenarios. In the absence of socioeconomic adaptation, population ageing will lead to higher temperature-related mortality. INTERPRETATION: Our developed framework helps to systematically understand the effectiveness of adaptation mechanisms. In the future, socioeconomic adaptation is estimated to play a major role in determining temperature-related excess mortality. Furthermore, cold sensitivity might outweigh heat adaptation in the majority of locations worldwide. Similarly, population ageing is projected to continue to determine future temperature-related mortality. FUNDING: EU Horizon 2020 (EXHAUSTION).
AIM: This study aims to evaluate the knowledge and awareness of the nursing students taking the Public Health Nursing course about global warming, climate change, the impact on health and the role of the public health nurse. DESIGN: The study is a mixed method study that includes descriptive data and focus group discussions on global warming, the effects of climate change and the role of the public health nurse. METHODS: The data were collected from the nursing faculty of a university located in the Central Anatolia region, where agricultural lands are widespread and climate change effects are most commonly observed. The data were collected from 154 undergraduate senior nursing students between February 2020 and May 2020. Firstly, the students completed the Global Warming Questionnaire that includes 26 items about global warming, climate change, their effects and the role of the public health nurse. Secondly, some students (n = 19) selected through the purposive sampling method participated in online focus group meetings. RESULTS: Our study revealed that 87.7% of the students know the main cause of climate change. The mean scale scores of the students who watch documentaries on the environment, who participate in activities related to the environment, and who know that climate change, sustainable development and health services are closely related were found to be statistically significantly higher (p ≤ 0.005). The views of the students on global warming and the environment were analyzed in focus group interviews according to five themes (global warming perception; the impact of global warming on health; methods of protection; roles of nurses; nursing education). CONCLUSION: Global warming and climate change are sensitive and important issues that cannot be evaluated considering only knowledge level. IMPACT: Global warming, climate change, their effects on health and the roles and responsibilities of nurses need to be included in the nursing curricula so that health professionals who can take measures against global warming, climate change and their health effects can be educated.
This study explores the concerns, needs, and expectations of inpatients with the goal to develop a patient-centered climate change adaptation agenda for hospitals. Statements of patients from geriatrics, internal medicine, psychiatry, and surgery (N = 25) of a German tertiary care hospital were analyzed using semi-structured interviews and the framework method. Areas of future adaptation were elaborated in joint discussions with transdisciplinary experts. Concerns included the foresight of severe health problems. The requested adaptations comprised the change to a patient-centered care, infrastructural improvements including air conditioning, and adjustments of the workflows. Guidelines for the behavior of patients and medical services appropriate for the climatic conditions were demanded. The patient-centered agenda for adaptation includes the steps of partnering with patients, reinforcing heat mitigation, better education for patients and medical staff, and adjusting work processes. This is the first study demonstrating that hospital patients are gravely concerned and expect adjustments according to climate change. Since heat is seen as a major risk by interviewees, the fast implementation of published recommendations is crucial. By synthesizing inpatients’ expectations with scientific recommendations, we encourage patient-centered climate change adaptation. This can be the start for further collaboration with patients to create climate change resilient hospitals.
BACKGROUND: Stroke is a major health problem around the world. Several studies have examine the influence of ambient temperature on incidence of stoke, but they reported different results for different types of stroke and different geographical regions. Hence, effect of ambient temperature is still much of interest, when focusing on ischemic stroke (IS) in regions that have not been examined yet. The aim of our study is to analyse association between IS incidences and short, delayed and cumulative effect of average daily ambient temperature, humidity and pressure in central Europe. To the best of our knowledge, this is the first IS study conducted between 45° and 50° latitude where large part of Central European population resides. METHODS: We linked daily hospitals’ admission data for whole population and separately for two specific age groups with ambient temperature data. We considered patients coming from Ljubljana basin and its immediate surrounding. Data were gathered daily from January 2012 to December 2017. To measure the effect of average ambient temperature, humidity and pressure we used generalized linear model with a log-link-function and a Poisson distribution. RESULTS: The results of our study show a statistically significant immediate, delayed and cumulative effects of ambient temperatures on IS incidence for the whole population and the population older than 65 years. Specifically, 1 °C reduction in ambient temperature on a given day (Lag 0) increases the IS risk for approximately 5‰ (all population) or 6‰ (population older than 65 years). Similar effects were found for lags from 1 to 6. Analysis of time windows from 0 to 1 days up to 0-28 days also show statistically significant cumulative effect for the same two age groups. IS incidence was not found to be significantly related to pressure or humidity in any group. CONCLUSION: The findings of this study may help healthcare authorities in central Europe improve existing stroke prevention measures and raise public awareness.
Background: One Health is a comprehensive and multisectoral approach to assess and examine the health of animals, humans and the environment. However, while the One Health approach gains increasing momentum, its practical application meets hindrances. This paper investigates the environmental pillar of the One Health approach, using two case studies to highlight the integration of environmental considerations. The first case study pertains to the Danish monitoring and surveillance programme for antimicrobial resistance, DANMAP. The second case illustrates the occurrence of aflatoxin M1 (AFM1) in milk in dairy-producing ruminants in Italian regions. Method: A scientific literature search was conducted in PubMed and Web of Science to locate articles informing the two cases. Grey literature was gathered to describe the cases as well as their contexts. Results: 19 articles and 10 reports were reviewed and informed the two cases. The cases show how the environmental component influences the apparent impacts for human and animal health. The DANMAP highlights the two approaches One Health and farm to fork. The literature provides information on the comprehensiveness of the DANMAP, but highlights some shortcomings in terms of environmental considerations. The AFM1 case, the milk metabolite of the carcinogenic mycotoxin aflatoxin B1, shows that dairy products are heavily impacted by changes of the climate as well as by economic drivers. Conclusions: The two cases show that environmental conditions directly influence the onset and diffusion of hazardous factors. Climate change, treatment of soils, water and standards in slaughterhouses as well as farms can have a great impact on the health of animals, humans and the environment. Hence, it is important to include environmental considerations, for example, via engaging environmental experts and sharing data. Further case studies will help to better define the roles of environment in One Health scenarios.
The aim of this study was to determine the association between the daily number of cases of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients aged 25-64 years and the El Nino-Southern Oscillation (ENSO) events during 2000-2015. As an indicator of the effect of the ENSO, the monthly NINO 3.4 index (Equatorial Pacific Sea Surface Temperature) was used. During the 5844-day study period, 5600 cases of stroke (3170 (56.61%) in men and 2430 (43.39%) in women) were analyzed. Of these, 4354 (77.8%) cases were IS, and 1041 (18.6%) cases were HS. In 3496 (62.2%) cases, stroke occurred in the age group of 55-64 years. In the analysis, we used the following categories of the ENSO events: strong La Nina, moderate La Nina, moderate El Nino, and strong El Nino. The effect of the ENSO was examined by using the multivariate Poisson regression adjusting for weather variables. The highest risk of both strokes (BS) was observed on days of strong and moderate La Nina (rate ratio (RR) 1.27, 95% CI 1.13-1.42) and RR = 1.15 (1.07-1.23), respectively), while the risk for IS was the highest on days of moderate El Nino (RR = 1.11(1.02-1.20)). A lower risk for BS was found on days of strong El Nino (RR = 0.77(0.62-0.97)). We found that ENSO events affected the occurrence of BS and IS in all age groups, and the strongest effect was observed among females. The results of this study provide new evidence that ENSO events may affect the risk of stroke, especially the risk of IS.
BACKGROUND: The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. METHODS: The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. RESULTS: During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14-1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16-0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04-1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November-March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03-1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85-0.99). CONCLUSIONS: The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.
European Union (EU) has set ambitious energy and climate targets for the EU Member States. Some EU Member States (MS) confirmed to attain 100% of renewables in power generation by 2050 and implement carbon-free economy target. The purpose of this study is to assess and compare the avoided external costs of electricity generation due to the penetration of renewables in the Baltic States by implementing EU energy and climate targets for 2020, 2030 and 2050. The switching to renewables has significant social benefits for the EU member states, as fossil fuel burning is linked with the climate change and emission of classical air pollutants (SO(2), NOx, particulate matter, NH(3), NMVOC), which can have various negative impacts on the human health. The analysis and forecasts of external costs of power generation by 2050 in the selected countries, i.e., the Baltic States, has shown that Estonia is able to achieve the highest avoided external costs and highest health benefits from renewable promotion due to the oil shale that is dominating in the power generation structure. The main input of this study performed in the Baltic States is to show how subsidies for renewables correspond to the reduction of external costs of power generation and to provide important policy implications for these countries. Moreover, this can be an example for other countries how to assess the benefits of renewables support.
Climate change is putting the achievement of all Sustainable Development Goals at risk and leads to negative impacts on human health and well-being. Consequently, tremendous social responsibility lies with public health professionals and their associations. Therefore, this study addressed the following question: “How can the Association of Schools of Public Health in the European Region (ASPHER) best support the goals of the European Green Deal through its network of public health schools and departments?” This study looked at the implementation of climate education in public health schools in the European region and climate action taken by these public health schools. An online survey among ASPHER members with a 51% overall response rate (excluding non-European members) shows that 64% of the responding schools provide climate-health educational offerings, while 63% consider these for the future. Additionally, most climate actions taken by the schools were ad hoc actions. These findings show that a systematic approach is missing, and there is a general lack of strategy in most schools. We consequently recommend that schools invest in climate and health education in their curricula and become exemplars for climate action to actively contribute to the achievement of Europe’s climate goals.
Climate change (CC) represents a real fact with consequences that start to be seen more and more often and that is why it cannot be ignored anymore. It affects many domains of the human activities and also the health of the people. Climate-specific actions are needed to be taken in order to protect the people and to save the environment. For each affected domain, new regulations and actions regarding climate change prevention must be designed, promoted and implemented. Besides phenomena like heat waves, storms, increased temperature, forest fires, floods, etc. which represent direct results of the CC, also indirect results like human health may be encountered. Human health is affected by elements that are having a big impact over the environment of the people and over the resources that they need (resources like water, food, air, natural resources, etc.). CC has also implications on people migration, the fight over the natural resources, political and economic environments. This paper offers an overview of the most important factors that are affecting the health of the people from the CC point of view and which are the main challenges that most affected countries from EU are dealing with.
Although previous studies have examined the association between temperature exposure and pregnancy losses (mainly focusing on the risk of stillbirth), causal estimates are still missing. The literature also lacks projections on the impacts of climate change. Using Hungarian administrative data spanning 1984 to 2018, this paper estimates the effect of temperature on the weekly spontaneous pregnancy loss rate. We show that, compared to a mild temperature, heat causes a substantial increase in the risk of pregnancy loss, whereas cold temperatures slightly decrease it. These impacts are not due to near-term displacement of some pregnancy losses but represent changes in the pregnancy outcomes. Combining the estimated effects with outputs of thirty climate models implies that climate change will increase the spontaneous pregnancy loss rate in the 21st century. The risk of pregnancy loss will be especially elevated during summer.
OBJECTIVE: Physical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of ‘do no harm’ imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders’ perceptions of hospitals’ GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital. METHODS: We conducted 29 semistructured qualitative expert interviews at one of Germany’s largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach. RESULTS: Concerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients’ health could be jeopardised by climate change mitigation measures. CONCLUSION: Perceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health-a basic principle of medical ethics.
Asthma is a complex disease with multiple environmental factors proposed to contribute to aetiology. Geographical analyses can shed light on the determinants of asthma. Ultraviolet radiation has been associated with asthma prevalence in past ecological studies. We have increased the detail of examining the association between asthma and ultraviolet radiation with addition of the variables of temperature, relative humidity and precipitation. An ecological study was designed to investigate meteorological factors associated with asthma prevalence in England. Data from the 2005 quality outcomes framework were used to determine the prevalence of asthma in primary care in England. This information was supplemented with indicators of obesity and smoking of the General Practitioner practice and population (by age and sex), deprivation and ethnicity at lower super output level from the 2001 and 2011 census. Annual mean meteorological data was attained from the Met Office and Joint Research Centre. We used a multiple linear regression to examine individual and multiple climatic factors through a principal components analysis. We tested for an association with asthma prevalence, after taking into account the spatial autocorrelation of the data. Asthma prevalence from general practice surgeries in England was 5.88% (95% CI 5.83 to 5.92). In the highest ultraviolet radiation weighted by the pre-vitamin D action spectrum (UV(vitd)) quartile (2.12 to 2.50 kJ/m(2)/day), asthma had a 5% reduction in prevalence; compared to the lowest quartile here (0.95 (95% CI 0.92 to 0.98)). Similar reductions were found in the higher temperature 0.93 (95% CI 0.90 to 96). The opposite was found with relative humidity 1.09 (95% CI 1.05 to 1.12). A combination of high temperature and UVvitd highlighted postcode districts in the South East of England with a climate beneficial to low asthma prevalence. The South West of England represented a climate which had both beneficial and detrimental associations with asthma development. Climate is associated with asthma prevalence in England. Understanding the contribution of multiple climatic factors and the relationship with the indoor environment could help to explain the population distribution of asthma.
Objective To investigate the possible correlation between benign paroxysmal positional vertigo (BPPV), seasonality, and climatic variations as indicators of vitamin D deficiency, since otoconia are calcium carbonate crystals. Methods This is a study of patients who received the diagnosis of BPPV from September 2015 to August 2019. Gender, age, and month of diagnosis were factors recorded and analyzed. The cut-off age of 50 years is used to include osteoporotic patients and postmenopausal women. Meteorological and climatic data of latitude, temperature, sunshine hours, humidity, precipitation, wind force, atmospheric pressure, and horizontal solar irradiance were collected. Results Four hundred and eighty-five patients were included in the study; 206 were male (42%) and 279 were female (58%). The mean age was 57.8 +/- 15.4 and 54.9 +/- 13.9, respectively; 192 patients were <= 50 years old (121 female and 71 male) and 293 patients were over 50 years old (135 male and 158 female). A statistical significance in seasonal variation during autumn months was demonstrated (p-value=5.2 e-05, z-statistic: 9.8164). There was no statistical correlation between the median number of BPPV patients and the median sunshine hours per month, horizontal solar irradiance, or other climatic variables. Conclusions Our study demonstrates seasonality in BPPV patients in Greece but no correlation between BPPV and climatic variations as a proxy for Vitamin-D levels was documented.
Semen quality has a direct relation to male fertility. Whether sperm variables in humans have decreased over the last years is still uncertain, with some studies showing a decline and others reporting no changes. In this regard, previous research has suggested that lifestyle and environmental conditions may contribute to this variability, calling for regional studies. The present work is a retrospective, unicentric study that includes semen samples analyzed between 1997 and 2017 at the Parc Taulí Hospital (Barcelona metropolitan area). First, a multivariate analysis including the age as a confounding factor showed a statistically significant decrease in semen volume, pH, progressive motility, morphology and total motile sperm over time. Contrarily, no significant variation in sperm count or concentration was observed. Mean reductions per year were -0.02 mL for volume, -0.57% for progressively motile sperm and -0.72% for sperm with normal morphology. Interestingly, the average annual temperature registered by the Spanish Meteorology Agency negatively correlated to sperm morphology and sperm count (Rs = -0.642; p = 0.002 and Rs = -0.435; p = 0.049, respectively). In conclusion, the present study based on infertile patients from the Barcelona area found a decline in sperm motility and morphology, without effects on sperm count. Changes in temperature appeared to be associated to this decline, but further studies are needed to address the mechanisms linked to the observed variations.
INTRODUCTION: Our study aimed to evaluate the relationship between pneumonia, air pollution (sulfur dioxide [SO2] and particulate matter [PM10]) and meteorological data (atmospheric pressure, amount of rainfall, temperature, rate of humidity, sunshine duration and wind velocity). MATERIALS AND METHODS: Our study included 822 of the 826 patients who were admitted to the emergency service of our hospital between August 2016 and July 2017 and who were diagnosed with pneumonia. Four patients whose information was not available were excluded from the study. The data for the patients were obtained retrospectively from the hospital information system and patient emergency files. The meteorological data were obtained from the website of the Ministry of the Environment and Urbanization and from the Directorate General of Meteorology of our city. Daily meteorological data (SO2, PM10, air pressure, temperature, humidity, wind speed and sunshine duration) were compared with the number of daily patients admitted to the emergency department and diagnosed with pneumonia. Statistical analysis was performed using Pearson correlation analysis. RESULT: Three hundred and twenty-nine of the patients were female, and 493 were male. A total of 605 inpatients, of whom 106 were in the intensive care unit, were treated in the hospital, while 217 were outpatients. A statistically significant relationship was found between the number of patients with pneumonia and the intensity of SO2 (r= 0.740; p<0.001), atmospheric pressure (r= -0.691; p<0.01), wind velocity (r= 0.777; p<0.001), average humidity rate (r= -0.454; p<005) and sunshine duration (r= 0.475; p<0.05). CONCLUSIONS: We determined that meteorological changes are important risk factors in the development of pneumonia and that reducing air pollution and taking protective measures may decrease the frequency of pneumonia and the mortality rates related to pneumonia.
BACKGROUND: To estimate a possible association between the effects of daily meteorological variation and climatological changes (temperature, air pressure, humidity, sunniness level) on pregnant women with hyperemesis gravidarum (HG) according to symptoms grade and hospitalization state. METHODS: A retrospective study was conducted with 118 patients diagnosed and hospitalized with HG. HG patients were graded as mild, moderate, or severe according to the Pregnancy Unique Quantification of Emesis (PUQE-24) scale. Data regarding demographic characteristics, PUQE scale value, gestational week on hospitalization, hospital admission and discharge dates, weather conditions, daily meteorological values during hospitalization ( temperature, air pressure, humidity, sunniness level), seasonal averages, and daily changes were recorded. Weather records were obtained from the Ankara Meteorology General Directorate (Ankara, Turkey). Differences between groups were compared according to HG grade. RESULTS: HG cases were classified as mild (33.1%), moderate (44.9%), or severe (22.0%). The number of hospitalization days significantly differed between these three groups (p<0.05). In contrast, no statistically significant differences were identified between the HG grade level groups in regard to humidity, pressure, temperature, and sunniness level data (p>0.05). In addition, no statistically significant relationship was identified between HG grades and seasonal conditions according to the chi-square test (p>0.05). CONCLUSION: Changes in the meteorological and climate values examined were independent of symptom severity and hospitalization rate for our HG patients. However, it is possible that climate changes occurring around the world may affect the pregnancy period and should be further investigated.
The Eastern Mediterranean Region (EMR) is considered among the world’s most vulnerable to the dire impacts of climate change. This review paper aims at (1) characterizing climate change in countries of the EMR; (2) examining the potential effects of climate change on the nutritional and health status of the population; and (3) identifying the most vulnerable population groups. The paper explored several climate change indicators including daily temperatures, extreme temperature, daily precipitation, extreme precipitation (flooding, drought, storms, etc.), humidity, CO(2) concentrations and sea surface temperature in EMR countries. Findings suggest that climate change will exert a significant adverse effect on water and food security and showed that the nutritional status of the population, which is already characterized by the triple burden of malnutrition, is likely to worsen via three main pathways mediated by climate change, namely, its impact on food security, care and health. Women, infants, children, those living in poor households and those experiencing displacement will be among the most vulnerable to the nutritional impacts of climate change. The paper concludes with a set of recommendations from the Initiative on Climate Action and Nutrition, which can support the region in tackling the critical nexus of climate change and nutrition.
The Mediterranean region is regarded as the meeting point between Europe, Africa and the Middle East. Due to favourable climatic conditions, many civilizations have flourished here. Approximately, about half a billion people live in the Mediterranean region, which provides a key passage for trading between Europe and Asia. Belonging to the middle latitude zone, this region experiences high meteorological variability that is mostly induced by contrasting hot and cold air masses that generally come from the west. Due to such phenomenon, this region is subject to frequent intensive precipitation events. Besides, in this complex physiographic and orographic region, human activities have contributed to enhance the geo-hydrologic risk. Further, in terms of climate change, the Mediterranean is a hot spot, probably exposing it to future damaging events. In this framework, this research focuses on the analysis of precipitation related events recorded in the EM-DAT disasters database for the period 1979-2018. An increasing trend emerges in both event records and related deaths. Then a possible linkage with two meteorological variables was investigated. Significant trends were studied for CAPE (Convective Available Potential Energy) and TCWV (Total Column Water Vapor) data, as monthly means in 100 km(2) cells for 18 major cities facing the Mediterranean Sea. The Mann-Kendall trend test, Sen’s slope estimation and the Hurst exponent estimation for the investigation of persistency in time series were applied. The research provides new evidence and quantification for the increasing trend of climate related disasters at the Mediterranean scale: recorded events in 1999-2018 are about four times the ones in 1979-1998. Besides, it relates this rise with the trend of two meteorological variables associated with high intensity precipitation events, which shows a statistically significative increasing trend in many of the analysed cities facing the Mediterranean Sea.
Blooms of the benthic toxic dinoflagellate genus Ostreopsis have been recorded more frequently during the last two decades, particularly in warm temperate areas such as the Mediterranean Sea. The proliferation of Ostreopsis species may cause deleterious effects on ecosystems and can impact human health through skin contact or aerosol inhalation. In the eastern Atlantic Ocean, the toxic O. cf. ovata has not yet been reported to the north of Portugal, and the only species present further north was O. cf. siamensis, for which the toxic risk is considered low. During summer blooms of unidentified Ostreopsis species on the French Basque coast (Atlantic) in 2020 and 2021, people suffered from irritations and respiratory disorders, and the number of analyzed cases reached 674 in 2021. In order to investigate the causes, sampling was carried out during summer 2021 to (i) taxonomically identify Ostreopsis species present using a molecular approach, (ii) isolate strains from the bloom and culture them, and (iii) characterize the presence of known toxins which may be involved. For the first time, this study reports the presence of both O. cf. siamensis and O. cf. ovata, for which the French Basque coast is a new upper distribution limit. Furthermore, the presence of ovatoxins a, b, c, and d in the environmental sample and in a cultivated strain in culture confirmed the toxic nature of the bloom and allowed identifying O. cf. ovata as the producer. The present data identify a new health risk in the area and highlight the extended distribution of some harmful dinoflagellates, presumably in relation to climate change.
The effects of climate change on the built environment represents an important research challenge. Today, green roofs (GRs) represent a viable solution for enhancing energy and urban resilience in the face of climate change, as they can have a positive impact on the building’s indoor thermal comfort and energy demand, as well as inducing various environmental benefits (easing urban heat island effects, improving the management of runoff water, reducing air pollution, etc.). Thus, it is important to be able to assess their effectiveness, both today and under future climate conditions, in order to evaluate whether they can also provide a valid long-term solution. In this paper, a simulation approach is proposed to evaluate the energy and indoor-comfort efficacy of GRs installed on a cluster of buildings with respect to climate change and demographic growth. To illustrate the proposed methodology, it has been applied to two European urban environments characterized by very different climatic conditions (Esch-sur-Alzette in Luxembourg and Palermo in Italy) considering their behaviour over a period of 60 years (2020, 2050, 2080). Results showed that, with respect to standard existing roofs (i.e., without the presence of green coverage), and considering the rising temperatures due to climate change, during cooling seasons GRs enabled significant energy savings (ranging from 20% to 50% for Esch-sur-Alzette and from 3% to 15% for Palermo), improvement of the indoor comfort (reduction of the average predicted mean votes – PMVs) and attenuation of the ceiling temperatures (2-5 degrees C for both contexts) of the buildings’ top floors.
The study assesses the extent to which public health is integrated into European national and urban climate change adaptation policy and planning. We analyse national adaptation documents from the 27 European Union member states and interview city-level experts (n = 17) on the integration of three categories of adaptation efforts: general efforts to minimize health impacts related to climate change, targeted efforts to enhance resilience in health systems, and supportive efforts to foster the potential of the first two categories. At a national level, general efforts to address vector-borne diseases and heat-related illness are covered comprehensively, whereas efforts addressing several climate-related health risks are neglected (e.g. water-borne diseases, injuries from extreme weather and cardiopulmonary health) or overlooked (e.g. malnutrition and mental health). Targeted efforts to inform policy decisions, such as carrying out research, risk monitoring and assessments, are often described in detail, but efforts to manage day-to-day health care delivery and emergency situations receive little attention. At the urban level, health issues receive less attention in climate adaptation policy and planning. If health topics are included, they are often described as indirect benefits of adaptation efforts in other sectors and not perceived as the priority of the involved authorities. This effectively means that general and targeted efforts are the responsibility of other sectoral departments, while supportive efforts are the responsibility of the national government or external organizations. As a result, at an urban level, climate-related health system adaptation is not a policy aim in its own right, and many potentially high health risks are being ignored. In order for health risks to be better integrated into adaptation policy and planning, it is critical to interconnect national and urban levels, reduce sectoral thinking and welcome external expertize and facilitate large-scale data collection and sharing of health and climate indicators.Key policy insightsWe recommend focussing on cooperatively drafting strategies for integrating health issues into climate policy and planning with stakeholders at the national and urban levels, in different policy sectors and in society.Policy planners can build on the strengths of adaptation documents from other countries or cities and take note of any weaknesses.We advocate to foster co-benefits for health and climate action of various adaptation measures (e.g. by promoting active mobility and urban greenery, health impacts related to heat, (mental and physical) stress and air pollution are reduced).Large-scale data collection and sharing of health and climate indicators should be facilitated to support learning and pro-active decision-making.
Air pollution poses a major threat to human health. Far from unidimensional, air pollution is multifaceted, but quasi-experimental studies have been struggling to grasp the consequences of the multiple hazards. By selecting optimal instruments from a novel and large set of altitude-weather instrumental variables, we disentangle the impact of five air pollutants in a comprehensive assessment of their short-term health impact in the largest urban areas of France over 2010-2015. We find that higher levels of at least two air pollutants, ozone and sulfur dioxide, lead to more respiratory-related emergency admissions. Children and elderly are mostly affected. Carbon monoxide increases emergency admissions for cardiovascular diseases while particulate matter is found responsible for increasing the cardiovascular-related mortality rate, and sulfur dioxide the respiratory-related mortality rate. Assuming a five air pollutants context, we show that an analyst who ignored the presence of interrelations between air pollutants would have reached partially false conclusions.
Objectives: The rapid growth in population, urbanization, and industrialization reduces the natural green space environment and increases air pollution on the planet. The green space environment minimizes air pollutants, and swift climate changes and provides fresh and clean air. This study investigates the prevalence of diabetes mellitus in environmentally highly green and less green countries in Europe. Subjects and methods: Based on the Environmental Performance Index (EPI) score, which rates a country’s environment, 43 European countries with 760 million people were selected. The EPI score was recorded from the USA’s Environmental Performance Index (EPI) website. 60% of the EPI score is based on seven categories related to ecosystem vitality: biodiversity and habitat, ecosystem, fisheries, climate change, pollution emissions, agriculture, and water resources. 40% of the score is based on four categories related to environmental health: air quality, sanitation and drinking water, heavy metals, and waste management system. The prevalence of diabetes mellitus in all 43 European countries was obtained from the International Diabetes Federation (IDF). The European countries’ populations were obtained from the World Bank. We divided the countries into three groups based on each country’s EPI score. The 11 countries with an EPI score of more than 75 were classified as highly green space, 24 countries with an EPI score of 50-75 were classified as moderately green space, and 8 countries with an EPI score of less than 50 were classified as less green space environment countries in Europe. Results: The mean prevalence of diabetes mellitus for highly green space environment countries was 7.49 +/- 1.53%; moderately green space countries were 8.98 +/- 2.38%, and for less green space environment countries was 9.79 +/- 3.05%. In countries with less green space (i.e., environment, EPI scores less than 50), the prevalence of DM was significantly higher than in green space countries with EPI scores of more than 75 (p = 0.041). The results revealed a negative correlation between the green space environment (EPI Score) and the prevalence of diabetes mellitus. Conclusions: The prevalence of diabetes mellitus is significantly reduced in environmentally high green space countries than in low green space countries in Europe. This means that countries with environmentally sustainable environment policies have less diabetes. It is suggested to establish strategies to keep the living environment green and clean to minimize air pollution and fight against diabetes mellitus. (C) 2022 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
BACKGROUND: Despite mounting evidence, there is uncertainty on the impact of the interplay between weather and pollution features on the risk of acute cerebrovascular events (CVE). We aimed at appraising role of weather and pollution on the daily risk of CVE. METHODS: Anonymized data from a hub CVE center in a large metropolitan area were collected and analyzed according to weather (temperature, pressure, humidity, and rainfall) and pollution (carbon monoxide [CO], nitrogen dioxide [NO2], nitrogen oxides [NOX], ozone [O3], and particulate matter [PM]) on the same and the preceding days. Poisson regression and time series analyses were used to appraise the association between environmental features and daily CVE, distinguishing also several subtypes of events. RESULTS: We included a total of 2534 days, with 1363 days having ≥1 CVE, from 2012 to 2017. Average daily rate was 1.56 (95% confidence interval: 1.49; 1.63) for CVE, with other event rates ranging between 1.42 for stroke and 0.01 for ruptured intracranial aneurysm. Significant associations were found between CVE and temperature, pressure, CO, NO2, NOX, O3, and PM <10 µm (all P<0.05), whereas less stringent associations were found for humidity, rainfall, and PM <2.5 µm. Time series analysis exploring lag suggested that associations were stronger at same-day analysis (lag 0), but even environmental features predating several days or weeks were significantly associated with events. Multivariable analysis suggested that CO (point estimate 1.362 [1.011; 1.836], P=0.042) and NO2 (1.011 [1.005; 1.016], P<0.001) were the strongest independent predictors of CVE. CONCLUSIONS: Environmental features are significantly associated with CVE, even several days before the actual event. Levels of CO and NO2 can be potentially leveraged for population-level interventions to reduce the burden of CVE.
Urban greening is an effective mitigation option for climate change in urban areas. In this contribution, a European Union (EU)-wide assessment is presented to quantify the benefits of urban greening in terms of availability of green water, reduction of cooling costs and CO(2) sequestration from the atmosphere, for different climatic scenarios. Results show that greening of 35% of the EU’s urban surface (i.e. more than 26,000 km(2)) would avoid up to 55.8 Mtons year(-1) CO(2) equivalent of greenhouse gas emissions, reducing energy demand for the cooling of buildings in summer by up to 92 TWh per year, with a net present value (NPV) of more than 364 billion Euro. It would also transpire about 10 km(3) year(-1) of rain water, turning into “green” water about 17.5% of the “blue” water that is now urban runoff, helping reduce pollution of the receiving water bodies and urban flooding. The greening of urban surfaces would decrease their summer temperature by 2.5-6 °C, with a mitigation of the urban heat island effect estimated to have a NPV of 221 billion Euro over a period of 40 years. The monetized benefits cover less than half of the estimated costs of greening, having a NPV of 1323 billion Euro on the same period. Net of the monetized benefits, the cost of greening 26,000 km(2) of urban surfaces in Europe is estimated around 60 Euro year(-1) per European urban resident. The additional benefits of urban greening related to biodiversity, water quality, health, wellbeing and other aspects, although not monetized in this study, might be worth such extra cost. When this is the case, urban greening represents a multifunctional, no-regret, cost-effective solution.
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
Climate risk events act on existing inequalities, causing unequal damage across social groups and showing that established vulnerability should be a key consideration in preventing and mitigating the consequences of weather extremes. The disastrous snowfalls that affected Asturias in Northern Spain in the winter of 1888 provide an intriguing and useful historical example of why such consideration is vital. This article is based on analysis of church records and population censuses of 22 mountain parishes over a 21-year period. It examines the long-term sociodemographic impacts of that weather event and reveals dramatic changes in fertility, mortality, and nuptiality. Marriages and births decreased by 67% in the 2 years following the snowstorms, when the highest levels of mortality were reached. The excess mortality especially affected those adults over 70, infants under 5, and, most notably, women. A livelihood crisis was at the base of these long-term effects. Those demographic impacts point to the event’s severity and show that the repercussions of a disaster go far beyond deaths and material losses and are deeply rooted in social factors. These findings reinforce the idea that reconstructing old disastrous episodes is of great social and scientific interest now. That is because, as governments and others are progressively paying more attention to the possibilities of adaptation to global change, there is greater appreciation of the fact that delving into the long-term impacts of past natural disasters can guide our main future strategies.
Climate change and emerging drug resistance make the control of many infectious diseases increasingly challenging and diminish the exclusive reliance on drug treatment as sole solution to the problem. As disease transmission often depends on environmental conditions that can be modified, such modifications may become crucial to risk reduction if we can assess their potential benefit at policy-relevant scales. However, so far, the value of environmental management for this purpose has received little attention. Here, using the parasitic disease of fasciolosis in livestock in the UK as a case study, we demonstrate how mechanistic hydro-epidemiological modelling can be applied to understand disease risk drivers and the efficacy of environmental management across a large heterogeneous domain. Our results show how weather and other environmental characteristics interact to define disease transmission potential and reveal that environmental interventions such as risk avoidance management strategies can provide a valuable alternative or complement to current treatment-based control practice.
Academic attention is increasing to examine historical epidemics from the perspective of human ecology. Studies are still inadequate, however, from a macro-scale perspective (quantitative studies in particular) focusing on long-term dynamics of epidemics in pre-industrial Europe. In this study, two pathways in Europe during AD1350-1850, namely, climate plus economy on epidemics and climate plus population on epidemics, were empirically investigated via correlation, multivariate regression analysis, and autoregressive exogenous (ARX) analysis under the framework of human ecology. The statistical findings show that climate change, particularly cooling, affected epidemics significantly. Economic well-being was the important factor that influenced the dynamics of epidemics alongside climate change. Furthermore, if considering climatic impacts, population was also significant, but its effects had limited importance on epidemics compared with economic well-being. This study not only supplements current understanding of epidemic mechanisms within the context of human ecology, but also examines the economy-epidemic link from a pre-industrial perspective to consider the role of economy in epidemic outbreaks in the modern time. Lessons from macro-history will provide historical references to current societies when facing to unprecedented pandemic globally.
Seasonal disease outbreaks are perennial features of human infectious disease but the factors generating these patterns are unclear. Here we investigate seasonal and daytime variability in multiple immune parameters in 329,261 participants in UK Biobank and test for associations with a wide range of environmental and lifestyle factors, including changes in day length, outdoor temperature and vitamin D at the time the blood sample was collected. Seasonal patterns were evident in lymphocyte and neutrophil counts, and C-reactive protein CRP, but not monocytes, and these were independent of lifestyle, demographic, and environmental factors. All the immune parameters assessed demonstrated significant daytime variation that was independent of confounding factors. At a population level, human immune parameters vary across season and across time of day, independent of multiple confounding factors. Both season and time of day are fundamental dimensions of immune function that should be considered in all studies of immuno-prophylaxis and disease transmission.
BACKGROUND: Hospital-acquired bloodstream infections (HABSIs) cause increased morbidity, mortality, and hospital costs that are partially preventable. HABSI seasonality has been described for gram-negative bacteria but has not been stratified per infection origin. OBJECTIVE: To assess seasonality among all types of HABSIs and their associations with climate. METHODS: Hospitals performing surveillance for at least 1 full calendar year between 2000 and 2014 were included. Mixed-effects negative binomial regression analysis calculated the peak-to-low monthly ratio as an adjusted HABSI incidence rate ratio (IRR) with 95% confidence intervals (CIs). Another regression model examined associations between HABSI rates and climate variables. These analyses were stratified by microorganism and infectious origin. RESULTS: The study population included 104 hospitals comprising 44,111 HABSIs. Regression analysis identified an incidence rate ratio (IRR) peak in August for gram-negative HABSIs (IRR, 1.59; 95% CI, 1.49-1.71), CLABSIs (IRR, 1.49; 95% CI, 1.30-1.70), and urinary tract HABSI (IRR, 1.52; 95% CI, 1.34-1.74). The gram-negative incidence increased by 13.1% (95% CI, 9.9%-16.4%) for every 5°C increase in temperature. Seasonality was most present among E. coli, K. pneumoniae, E. cloacae, and the nonfermenters. Gram-positive and pulmonary HABSIs did not demonstrate seasonal variation. CONCLUSIONS: Seasonality with summer spikes occurred among gram-negative bacteria, CLABSIs, and urinary tract HABSIs. Higher ambient temperature was associated with gram-negative HABSI rates. The preventable causative factors for seasonality, such as the nurse-to-patient ratio, indoor room temperature or device-utilization, need to be examined to assess areas for improving patient safety.
Central line-associated bloodstream infections (CLABSI) cause increased morbidity, mortality, and hospital costs that are partially preventable. The phenomenon of seasonality among CLABSI rates has not been fully elucidated, but has implications for accurate surveillance and infection prevention trials. Longitudinal dynamic cohort of hospitals participating in hospital-wide and intensive care unit bloodstream infection surveillance for at least one full year over 2000 to 2014. Mixed-effects negative binomial regression analysis calculated the peak-to-low ratio between months as an adjusted CLABSI incidence rate ratio (IRR) with 95% confidence intervals (CI). Multivariate regression models examined the associations between CLABSI pathogens and ambient temperature and relative humidity. The study population included 104 hospital sites comprising 11,239 CLABSI. Regression analysis identified a hospital-wide increase in total CLABSI during July-August, with a higher gram-negative peak-to-low incidence rate ratio (IRR 2.52 [95% CI 1.92-3.30], p < 0.001) compared to gram-positive bacteria (IRR 1.29 [95% CI 1.11-1.48], p < 0.001). Subgroup analysis replicated this trend for CLABSI diagnosed in the intensive care unit. Only gram-negative CLABSI rates were associated with increased temperature (IRR + 30.3% per 5 °C increase [95% CI 17.3-43.6], p < 0.001) and humidity (IRR + 22.9% per 10% increase [95% CI 7.7-38.3), p < 0.001). The incidence and proportion of gram-negative CLABSI approximately doubled during the summer periods. Ambient temperature and humidity were associated with increases of hospital-acquired gram-negative infections. CLABSI surveillance, preventive intervention trials and epidemiological studies should consider seasonal variation and climatological factors when preparing study designs or interpreting their results.
Climate information plays a key role in adaptation to climate change, but providing and using it in effective ways is a challenge. Climate information often remains underutilized and even when used, its influence on policy making is far from clear. In the Netherlands, climate stress tests were introduced to inform and stimulate climate adaptation policy on a municipal level. In the stress tests, risks and vulnerabilities were estimated for scenarios of extreme precipitation, heat stress, drought, and flooding. This article examines whether and how this new tool has effectuated mainstreaming of climate adaptation information into municipal policy. Based on interviews with municipal officials and document analysis we show that the stress tests did so along two general pathways. In the ‘applied’ pathway, the stress tests were used in an instrumental way to influence policy goals and measures. In the ‘configuring’ pathway, stress tests were primarily used for learning and persuasion, and mostly influenced problem perceptions and actor involvement. In the ‘applied’ pathway, the accuracy and resolution of the information were key factors; in the ‘configuring’ pathway, its influence depended on the accessibility of information and the kind of interaction during policy formulation. Which of the pathways predominated depended on how an adaptation problem fitted with existing policy arrangements. The findings show that stress tests are a promising tool for policy mainstreaming and for promoting local climate adaptation. They also highlight the importance of identifying the pathways of information use, in order to increase the impact of climate information.
Achieving sustainability and resilience transformations under climate change requires trans -formative and multi-scale visions to stimulate coherent thinking and action towards radically alternative futures. We present our approach to co-produce transformative visions contextualised in different regions across Europe, while exploring emergent ‘pan-European’ vision elements to guide transformative climate action across scales. We co-produced visions with stakeholders in four case studies: European, national (Scotland), transboundary river basin (Iberia) and two municipalities (Hungary). All visions share core aspirations for good living, justice and social and environmental wellbeing in Europe, while allowing contextualised interpretation to remain meaningful in view of context-specific needs, priorities, cultural perceptions and aspirations. The visions point to areas where deep transformations are required: in service provisioning from critical infrastructures like energy, food, health and education, and in lifestyles and governance. We discuss two key methodological considerations for the co-production of transformative visions across multiple scales. Firstly, the application of a systematic and comprehensive framework across all scales provided a guide to compare and ensure coherence between visions across multiple scales. Secondly, the creation of transformative spaces to co-produce the visions with stakeholders supported critical reflections and learning about the radical and multi-dimensional changes necessary in different regions in Europe.
INTRODUCTION: Faced with the challenges of climate change, countries are seeking to decarbonise their economies. A greater understanding of what comprises the carbon footprint of care in healthcare systems will identify potential strategies for reduction of greenhouse gas (GHG) emissions. In respiratory care, the focus has been on preventer inhalers, thereby omitting contributions from other aspects such as healthcare resource utilisation (HCRU) and reliever inhaler use. The healthCARe-Based envirONmental cost of treatment (CARBON) programme aims to provide a broader understanding of the carbon footprint associated with respiratory care. METHODS: CARBON will quantify the carbon footprint of medications and HCRU among approximately 2.5 million patients with respiratory diseases from seven ongoing studies spanning more than 40 countries. Across studies, to obtain the carbon footprint of all inhaled, oral, and injectable medications, SimaPro life cycle assessment software modelling resource and energy consumption data, in addition to Ecoinvent(®) data sets and certified published studies, will be used. The carbon footprint of HCRU in the United Kingdom will be estimated by applying the methodology and data obtained from the Sustainable Healthcare Coalition Care Pathway Guidance. PLANNED OUTCOMES: In asthma, CARBON studies will quantify GHG emissions associated with well-controlled versus not well-controlled asthma, the contribution of short-acting β(2)-agonist (SABA) reliever inhalers (and their potential overuse) to the carbon footprint of care, and how implementation of treatment guidelines can drive improved outcomes and footprint reduction. In chronic obstructive pulmonary disease (COPD), CARBON studies will assess the impact of exacerbation history on GHG emissions associated with HCRU and SABA use in subsequent years and estimate the carbon footprint associated with all aspects of COPD care. CONCLUSION: CARBON aims to show that the principle of evidence-led care focused on improvement of clinical outcomes has the potential to benefit patients and the environment.
Where people live and work together it is not always possible to modify the ambient temperature; ways must therefore be found that allow individuals to feel thermally comfortable in such settings. The Embr Wave® is a wrist-worn device marketed as a ‘personal thermostat’ that can apply a local cooling stimulus to the skin. The aim of the present study was to determine the effect of an intermittent mild cold stimulus of 25 °C for 15-20 s every 5 min over 3.5 days under free-living conditions on 1) skin temperature, 2) perception of skin temperature, 3) sleep quality and 4) resting energy expenditure (REE) in young, healthy adults. Ten subjects wore the device for 3.5 consecutive days. This intervention reduced distal skin temperature after correcting for personal ambient temperature (P < 0.05), but did not affect the subjects' the perception of skin temperature, sleep quality or REE (all P ≥ 0.051). Thus, this intermittent mild cold regime can reduce distal skin temperature, and wearing it under free-living conditions for 3.5 days does not seem to impair the perception of skin temperature and sleep quality or modify REE.
Background: Temperature-related circulatory mortality has gained consistent public health importance worldwide due to changes in inter-annual average temperatures and the increased frequency of extreme events over time. This study investigates the association between temper-ature and circulatory deaths in one of the highest population densities in the world (Malta) with a Mediterranean climate. Methods: Daily deaths relating to circulatory mortality (32,847 deaths) were obtained from January 1992 to December 2017. A distributed lag non-linear model (DLNM) with a Poisson distribution was utilized to estimate effects of ambient temperatures and heatwaves or cold spells (2-4 consecutive days). Effects were also explored for the specific cause of death, different age groups, gender and time periods. Results: The study observed a U-shaped cumulative exposure-response curve with a greater mortality risk due to cooler temperatures (8-15 degrees C) after adjusting for harvesting effects (0-27 days). Colder temperatures (<8.9
INTRODUCTION AND OBJECTIVES: Some atmospheric features have been linked to the triggering of myocardial infarction. Because data from the Temperate-Mediterranean is scarce, we sought to study whether meteorological parameters influence the incidence of ST-elevation myocardial infarction (STEMI) as confirmed by primary percutaneous intervention in a city with temperate weather (Porto, Portugal). METHODS: Retrospective analysis of a series of STEMI-patients from January 2010 to December 2017. Temperature (T), relative humidity (RH), precipitation, and atmospheric pressure were obtained from a government-led institute. We utilized a generalized linear model (GLM) with a Poisson distribution, where a series of models with multivariable analysis were computed. The effects (GLM coefficients) are presented as excess relative risk (ERR). RESULTS: One thousand and four consecutive STEMI-patients were included. The most important predictors of STEMI were Tmin two days before (for 1°C drop ERR=1.9%, p=0.009) and a 1% increase in RH three days before (EER=0.7%, p=0.006). Conversely, the same increase in RH the day before reduced the relative risk (EER=-0.6%, p=0.023). Temperature range, atmospheric pressure and precipitation had no impact on STEMI incidence. CONCLUSION: In a Temperate-Mediterranean city hot or cold temperature extremes, temperature drop and relative humidity had a significant impact on the occurrence of STEMI.
Mycobacterium avium subsp. paratuberculosis (MAP) may play a role in the pathology of human inflammatory bowel disease (IBD). Previously, we found a high frequency (98% in patients with active disease) of MAP DNA detection in the blood of Portuguese Crohn’s Disease patients, suggesting this cohort has high exposure to MAP organisms. Water is an important route for MAP dissemination, in this study we therefore aimed to assess MAP contamination within water sources in Porto area (the residential area of our IBD study cohort). Water and biofilms were collected in a wide variety of locations within the Porto area, including taps connected to domestic water sources and from municipal water distribution systems. Baseline samples were collected in early autumn plus further domestic water samples in early winter, to assess the effect of winter rainfall. DNA was extracted from all 131 samples and IS900-based nested PCR used to assess the frequency of MAP presence. Our results show high MAP positivity in municipal water sources (20.7% of water samples and 41.4% of biofilm samples) and even higher amongst domestic sources (30.8% of water samples and 50% of biofilm samples). MAP positivity in biofilms correlated with positivity in water samples from the same sources. A significantly higher frequency of MAP-positivity was observed during winter rains as compared with samples collected in autumn prior to the winter rainfall period (61.9% versus 30.8%). We conclude that domestic and municipal water sources of Porto region have a high burden of MAP contamination and this prevalence increases with rainfall. We hypothesize that human exposure to MAP from local water supplies is commonplace and represents a major route for MAP transmission and challenge which, if positively linked to disease pathology, may contribute to the observed high prevalence of IBD in Porto district.
The far-reaching impact of the Sun on Earth’s climate and on people’s health and well-being is a poorly understood and non-consensual scientific issue, with empirical literature stressing the need to expand the knowledge of such relationships. Here, the interplay between solar activity (SA) and climate, and its likely cascading effects on all-cause mortality, were examined at several time scales. To this end, the parish records of Braga (1700-1880) and Torre de Moncorvo (1700-1850), in two different geographical locations of northern Portugal (Iberia, SW Europe), were used. Crude mortality rate (CMR) and winter-summer ratio (W/S) values were computed to characterize mortality patterns/trends and couple them with potential relevant drivers: total solar irradiance (TSI) as a proxy of SA, the North Atlantic Oscillation (NAO), and key historical events. What emerged, albeit incomplete, was a complex picture of death deeply embedded in people’s physical and socioeconomic environments, at a time when ubiquitous poverty (and co-morbid malnutrition) was the most inveterate cause of ill health. After identifying the positive mortality episodes in both municipalities, their incidence was found to be higher in periods of weakened SA (normal/grand minima). Standard inference statistics were used to estimate the significance of the observations. The highest CMR peaks matched not only with wars but also with known wide-ranging mortality crises, which seem to have been triggered by major agricultural production shortfalls, followed by substantial increases in food prices, driven, in turn, by climate deterioration, including extreme weather occurrences. The outcome was social unrest, famines, and outbreaks of infectious diseases, heightening the death toll. The influence of prominent solar/climate variations was investigated using wavelet transform coherence analysis (WTC). The results showed (multi)decadal oscillations in both (TSI and NAO) somehow regulating mortality. But the WTC analysis also estimated SA signals in low-frequency mortality dynamics disguised by time-varying determinants, where distinct players of space weather might have been implicated.
The methodology and results of economic assessment and forecasting of the consequences of the most negative global climate change IPCC scenario (RCP 8.5) representative for the conditions of the Russian Arctic in the form of thawing and degradation of permafrost for healthcare facilities in eight Arctic regions of the Russian Federation are discussed. It is shown that the additional costs associated with these consequences for the maintenance and restoration of healthcare facilities in 2021-2050 may amount to about ₽60 bln, or about ₽2 bln per year (in 2021 prices) at the average rate of permafrost degradation and increase thawing depth, rising to ₽219 bln (₽7.5 bln bln annually) under the maximum expected damage.
Mining regions in different parts of the world have been associated with the significant pollution of water, sediments, and soils by manganese and other chemical elements. This study assessed the degree of geochemical transformation caused by open-pit extraction and processing of mineral resources in the Kovdorsky District of Murmansk Oblast, 20 km from the Russia-Finland border. A second objective was to predict further changes co-driven by industrial pressure and high climatic instability in the polar region. The field study involved sampling water and sediments from virgin background streams and from the tailings storage facility, settling ponds, rivers, and lakes affected by ore mining and disintegration. Laboratory analyses included the study of elemental composition, redox potential, alkalinity and acidity, organic matter content, and other geochemical characteristics for a better understanding of pollutant migration patterns. We revealed elevated levels of potentially toxic elements in surface waters and bottom sediments which pose a risk to the human health via the household and drinking water supply. Pollution with manganese (Mn) was found to be the major environmental issue. Its natural presence in the river water was overridden a hundredfold by anthropogenic enrichment. This is problematic as Mn is easily bioaccumulated, which can lead to unwanted ecotoxicological effects, and-in the case of prolonged exposure to high doses of Mn and its compounds-to detrimental human health impacts. We believe that the changing climate may raise the water flow and thus expand the area of the hydrochemical anomaly. On the other hand, the activation of self-purification and dilution processes could lead to decreasing environmental Mn concentrations.
The data presented in this article is part in essence of a more extensive dataset aimed at evaluating patterns of change in the temperature-mortality relationship on population health in the city of Valencia, Spain on population health in the city of Valencia, Spain. The complete dataset was used in the framework of the European multi-city project PHASE (Public Health Adaptation Strategies to Extreme weather events) [1]. The data includes daily counts of all-cause mortality, excluding external causes and cardiovascular and respiratory diseases. All-cause mortality is also classified by gender and age groups. Besides temperature, we included other meteorological variables and air pollutants from the PHASE dataset, as well as influenza epidemics. The variable Saharan dust events was also added. All these data were collected from public Governmental data repositories accessible under request. The dataset of this article provides a basis for comparison with similar models for time-series regression, allowing researchers to integrate additional model components without duplication of effort.
OBJECTIVES: Recreational physical activity is an integral part of our society, and the injuries caused by sports activities are a concern for public health. We studied the effect of outdoor ambient temperature on hospital emergency department visits caused by sports injuries in Madrid, Spain, and accounted for its seasonal changes. METHODS: We used a time-series design. Data was analysed with quasi-Poisson regression models. We calculated the proportion of emergency visits attributable to seasonal changes before and after adjusting for daily ambient temperature. We modelled the association between emergency visits and temperature using distributed lag non-linear models. RESULTS: The proportion of emergency visits attributable to seasonal changes was 24.1% and decreased to 7.6% after adjusting for temperature. We found a high risk of emergency visits associated with cold and hot temperatures, whereas the risk was higher for heat. CONCLUSION: Sports and recreational physical activity injuries are not rare events; therefore, appropriate healthcare decisions should consider the impact of outdoor ambient temperature and seasonal changes.
Changes in the frequency and magnitude of extreme weather events represent one of the key indicators of climate change and variability. These events can have an important impact on mortality rates, especially in the ageing population. This study assessed the spatial and seasonal distributions of mortality rates in mainland Spain and their association with climatic conditions over the period 1979-2016. The analysis was done on a seasonal and annual basis using 79 climatic indices and regional natural deaths data. Results indicate large spatial variability of natural deaths, which is mostly related to how the share of the elderly in the population varied across the studied regions. Spatially, both the highest mortality rates and the largest percentage of elders were found in the northwest areas of the study domain, where an extreme climate prevails, with very cold winters and hot summers. A strong seasonality effect was observed, winter shows more than 10% of natural deaths compared to the rest of the seasons. Also, results suggest a strong relation between climatic indices and natural deaths, albeit with a high spatial and seasonal variability. Climatic indices and natural deaths show a stronger correlation in winter and summer than in spring and autumn.
BACKGROUND: Climate vulnerability of the unborn can contribute to adverse birth outcomes, in particular, but it is still not well understood. We investigated the association between ambient temperature and stillbirth risk among a historical population in northern Sweden (1880-1950). METHODS: We used digitized parish records and daily temperature data from the study region covering coastal and inland communities some 600 km north of Stockholm, Sweden. The data included 141,880 births, and 3,217 stillbirths, corresponding to a stillbirth rate of 22.7 (1880-1950). The association between lagged temperature (0-7 days before birth) and stillbirths was estimated using a time-stratified case-crossover design. Incidence risk ratios (IRR) with 95% confidence intervals were computed, and stratified by season and sex. RESULTS: We observed that the stillbirth risk increased both at low and high temperatures during the extended summer season (April to September), at -10°C, and the IRR was 2.3 (CI 1.28, 4.00) compared to the minimum mortality temperature of +15°C. No clear effect of temperature during the extended winter season (October to March) was found. Climate vulnerability was greater among the male fetus compared to the female counterparts. CONCLUSION: In this subarctic setting before and during industrialization, both heat and cold during the warmer season increased the stillbirth risk. Urbanization and socio-economic development might have contributed to an uneven decline in climate vulnerability of the unborn.
BACKGROUND: Evidence indicates that high temperatures are a risk factor for preterm birth. Increasing heat exposures due to climate change are therefore a concern for pregnant women. However, the large heterogeneity of study designs and statistical methods across previous studies complicate interpretation and comparisons. We investigated associations of short-term exposure to high ambient temperature with preterm birth in Sweden, applying three complementary analytical approaches. METHODS: We included 560,615 singleton live births between 2014 and 2019, identified in the Swedish Pregnancy Register. We estimated weekly mean temperatures at 1-km(2) spatial resolution using a spatiotemporal machine learning methodology, and assigned them at the residential addresses of the study participants. The main outcomes of the study were gestational age in weeks and subcategories of preterm birth (<37 weeks): extremely preterm birth (<28 weeks), very preterm birth (from week 28 to <32), and moderately preterm birth (from week 32 to<37). Case-crossover, quantile regression and time-to-event analyses were applied to estimate the effects of short-term exposure to increased ambient temperature during the week before birth on preterm births. Furthermore, distributed lag nonlinear models (DLNM) were applied to identify susceptibility windows of exposures throughout pregnancy in relation to preterm birth. RESULTS: A total of 1924 births were extremely preterm (0.4%), 2636 very preterm (0.5%), and 23,664 moderately preterm (4.2%). Consistent across all three analytical approaches (case-crossover, quantile regression and time-to-event analyses), higher ambient temperature (95th vs 50th percentile) demonstrated increased risk of extremely preterm birth, but associations did not reach statistical significance. In DLNM models, we observed no evidence to suggest an increased effect of high temperature on preterm birth risk. Even so, a suggested trend was observed in both the quantile regression and time-to-event analyses of a higher risk of extremely preterm birth with higher temperature during the last week before birth. CONCLUSIONS: In Sweden, with high quality data on exposure and outcome, a temperate climate and good quality ante-natal health care, we did not find an association between high ambient temperatures and preterm births. Results were consistent across three complementary analytical approaches.
BACKGROUND: Antimicrobial resistance (AMR) is a growing global crisis with long-term and unpredictable health, social and economic impacts, with which climate change is likely to interact. Understanding how to govern AMR amidst evolving climatic changes is critical. Scenario planning offers a suitable approach. By envisioning alternative futures, stakeholders more effectively can identify consequences, anticipate problems, and better determine how to intervene. This study explored future worlds and actions that may successfully address AMR in a changing climate in a high-income country, using Sweden as the case. METHODS: We conducted online scenario-building workshops and interviews with eight experts who explored: (1) how promising interventions (taxation of antimicrobials at point of sale, and infection prevention measures) could each combat AMR in 2050 in Sweden given our changing climate; and (2) actions to take starting in 2030 to ensure success in 2050. Transcripts were thematically analyzed to produce a narrative of participant validated alternative futures. RESULTS: Recognizing AMR to be a global problem requiring global solutions, participants looked beyond Sweden to construct three alternative futures: (1) “Tax Burn Out” revealed taxation of antimicrobials as a low-impact intervention that creates inequities and thus would fail to address AMR without other interventions, such as infection prevention measures. (2) “Addressing the Basics” identified infection prevention measures as highly impactful at containing AMR in 2050 because they would contribute to achieving the Sustainable Development Goals (SDGs), which would be essential to tackling inequities underpinning AMR and climate change, and help to stabilize climate-induced mass migration and conflicts; and (3) “Siloed Nations” described a movement toward nationalism and protectionism that would derail the “Addressing the Basics” scenario, threatening health and wellbeing of all. Several urgent actions were identified to combat AMR long-term regardless which future un-folds, such as global collaboration, and a holistic approach where AMR and climate change are addressed as interlinked issues. CONCLUSION: Our participatory scenario planning approach enabled participants from different sectors to create shared future visions and identify urgent actions to take that hinge on global collaboration, addressing AMR and climate change together, and achieving the SDGs to combat AMR under a changing climate.
The article describes and reflects upon how multi-level governance and planning in Sweden have been affected by and reacted upon three pending major challenges confronting humanity, namely climate change, migration and the Covid-19 pandemic. These ‘crises’ are broadly considered ‘existential threats’ in need of ‘securitisation’. Causes and adequate reactions are contested, and there are no given solutions how to securitise the perceived threats, neither one by one, no less together. Government securitisation strategies are challenged by counter-securitisation demands, and plaguing vulnerable groups in society by in-securitising predicaments. Taking Sweden as an example the article applies an analytical approach drawing upon strands of securitisation, governance and planning theory. Targeting policy responses to the three perceived crises the intricate relations between government levels, responsibilities, capacities, and actions are scrutinized, including a focus upon the role of planning. Overriding research questions are: How has the governance and planning system – central, regional and local governments – in Sweden responded to the challenges of climate change, migration and Covid-19? What threats were identified? What solutions were proposed? What consequences could be traced? What prospects wait around the corner? Comparing crucial aspects of the crises’ anatomies the article adds to the understanding of the way multilevel, cross-sectional, hybrid governance and planning respond to concurrent crises, thereby also offering clues for action in other geopolitical contexts. The article mainly draws upon recent and ongoing research on manifestations of three cases in the Swedish context. Applying a pragmatic, methodological approach combining elements of securitisation, governance and planning theories with Carol Lee Bacchi’s ‘What is the problem represented to be’ and a touch of interpretive/narrative theory, the study reveals distinct differences between the anatomies of the three crises and their handling. Urgency, extension, state of knowledge/epistemology, governance and planning make different imprints on crises management. Sweden’s long-term climate change mitigation and adaptation strategies imply slow, micro-steps forward based on a combination of social-liberal, ‘circular’ and a touch of ‘green growth’ economies. Migration policy displays a Janus face, on the one hand largely respecting the UN refugee quota system on the other hand applying a detailed regulatory framework causing severe insecurity especially for minor refugees wanting to stay and make their living in Sweden. The Covid-19 outbreak revealed a lack of foresight and eroded/fragmented responsibility causing huge stress upon personnel in elderly and health care and appalling death rates among elderly patients, although governance and planning slowly adapted through securitising policies, leading to potential de-securitisation of the issue. The three crises have caused a security wake-up among governments at all levels and the public in general, and the article concludes by discussing whether this ‘perfect storm’ of crises will result in a farewell to neoliberalism – towards a neo-regulatory state facing further challenges and crises for governance, planning and the role of planners. The tentative prospect rather indicates a mixture of context-dependent ‘hybrid governance’, thus also underlining the crucial role of planners’ role as ‘chameleons’ in complicated governance processes of politics, policy and planning.
The purpose of this study was to describe the epidemiology of Lyme neuroborreliosis (LNB) in Kalmar County, in southern Sweden, between 2008 and 2019, and to analyse the relationship between the LNB incidence and climate factors. Data containing cerebrospinal fluid (CSF) cell counts and borrelia CSF/serum antibody index results was received from the departments of clinical chemistry and microbiology at Kalmar County hospital. For this study, we defined LNB as a case with a positive borrelia antibody CSF/serum index and CSF leukocytes > 5 x 10^6/L.. Climate data including mean temperature, humidity and precipitation covering Kalmar County was collected from the Swedish Meteorological and Hydrological Institute. A total of 5051 paired serum-CSF samples from 4835 patients were investigated of which 251 laboratory LNB cases were found. The average annual LNB incidence in Kalmar County 2008-2019 was 8.8 cases per 100,000 inhabitants. Positive relationships were observed between mean temperature and LNB incidence (p<0.001) as well as precipitation and LNB incidence (p=0.003), both with a one calendar month delay. The results suggest an association between climate factors such as mean temperature and precipitation and LNB incidence, presumably through increased/decreased human-tick interactions. This calls for increased awareness of LNB in both the short perspective after periods of warmth and heavy precipitation as well as in a longer perspective in relation to possible climate change. Further studies with larger study groups, covering other geographical areas and over longer periods of time are needed to confirm these findings.
We aimed to investigate the relation between air pollution and the number of daily hospitalizations due to pneumonia, asthma, bronchitis in children aged 0-18 in Bursa city of Turkey, between the years 2013-2018. The daily values of air pollutants (PM10, SO2, NO2, NOx, CO, and O3) from 2013 until 2018, were obtained. Adjusted Quasi-Poisson regression models including distributed lags, controlled for climate variables were used for data analysis. Increases in SO2, ozone, PMs, and nitrogen oxides were associated with pneumonia hospitalizations, increases in SO2 NOx and PMs were associated with asthma hospitalizations, and increases in SO2 and ozone were associated with bronchitis hospitalizations. Male hospitalization was related with SO2, ozone, and NOx; while female hospitalization was only related with SO2. This study showed that short-term exposure to air pollution is associated with an increased risk of pneumonia, asthma, and bronchitis hospitalization among children in Bursa.
AIM: Studies fall short when it comes to determining the relationship between thermal comfort and cardiovascular diseases. Studies examining the relationship between thermal comfort conditions and human health in Turkey, located in the transition zone of air masses at mid-latitudes, are quite limited. This is the first study conducted in Turkey that deals with thermal comfort conditions and CVDs, which is the leading cause of death. This study aimed to examine the relationship between thermal comfort conditions and CVDs of Amasya, a medium-sized exemplary Turkish city. SUBJECT AND METHODS: To determine the thermal comfort conditions in the study area between 2014-2019, the physiologically equivalent temperature (PET) index obtained from the Rayman model, which uses hourly air temperature (ºC), relative humidity (%), wind speed (m/s), and cloud cover (octa) data, was used. The relationship between PET values and CVDs was determined by Pearson correlation analysis and linear regression analysis. RESULTS: The study indicated a negative, high, and moderate correlation between PET values and cardiovascular diseases (p < 0.001). The results show that when PET values increase by 1 ºC, patient admissions will decrease by about 104 to 108 patients (-104.737 to -108.619 units.). CONCLUSION: These results can be informative and guiding for both the protection of public health and studies on climate change and human health.
İpsala district located in the northwest of Turkey is an intensive agricultural area, where paddy cultivation has been carried out for more than 50 years. The main source for drinking water in the area is groundwater. Since large amounts of agrochemicals are applied to the paddy fields, groundwater in the study area can be contaminated with toxic metal (loid)s (TMs). In this study, levels of eight TMs in the drinking water samples taken from the district and its 22 villages in the dry and wet seasons were measured and compared with drinking water quality guidelines. In addition, non-carcinogenic and carcinogenic health risks, and pollution status of TMs were assessed. The mean values of Cd, Ni, Cu, Zn, Mn, Pb, As and Cr in both seasons were below the drinking water limits. High clay content and low infiltration rate of the soils in the study area may have caused low TM concentrations. The TMs levels were higher in the wet season due to high rainfall intensity. Metal pollution indices indicated that groundwater quality is suitable for potable uses. All hazard quotient and hazard index results for children and adults in both seasons were lower than the acceptable risk level of 1. Carcinogenic risk results of As and Cr in both seasons were within or below the acceptable risk range. These findings revealed that the TMs in the drinking water would not pose health risks to the local residents.
Global warming is projected to have major implications on global health. It is however not yet clear how this will translate to impacts on the healthcare system. By linking changes in temperature with changes in required bed days at a hospital level, through the use of a simple bed model, we quantify the projected impacts UK hospitals will need to adapt to. We show that there is already a local peak of bed days required in the main summer months due to hot temperatures. The results further show that there will be a significant increase during the main summer in both the mean and maximum number of beds needed, but a non-significant decrease during the peak winter months. These changes lead to a more constant need of care of the year and shift the seasonal cycle of lowest hospital needs.
AIMS: There are a growing number of organisations working to address the connections between climate change and health. This article introduces the concept of ‘theories of change’ – the methodology by which organisations or movements hope to bring about social change – and applies it to the current climate change and health movement in England. Through movement mapping, the article describes and offers reflections on the climate change and health ecosystems in England. METHODS: Organisations working on climate change and health in England were identified and publicly available information was collated to map movement characteristics, target stakeholders and methodologies deployed, using an inductive, iterative approach. RESULTS: A total of 98 organisations working on health and climate change (and/or sustainability) were initially identified, of which 70 met the inclusion criteria. Most organisations target two or more stakeholders, with healthcare workers, management structures, and government being most commonly cited. Methodological approaches identified include Formal education programmes; Awareness-raising; Purchasing-procurement power; Advocacy; Financial; Media-messaging; Networking; Knowledge generation; and Policy making, of which education, awareness-raising, and advocacy are most commonly used. CONCLUSION: There is a tendency for climate change and health organisations in England to focus on individual level and sectoral change over system change. More could be made of the potential for the healthcare professions’ voice and messaging for the wider climate movement. Given the rapid boom of climate change and health organisations in recent years, a mind-set shift that recognises different players as part of a cohesive ecosystem with better coordination and collaboration may reduce unnecessary work, and facilitate more cohesive outcomes.
Previous studies have investigated the effects of air pollution on chronic obstructive pulmonary disease (COPD) patients using either fixed-site measurements or a limited number of personal measurements, usually for one pollutant and a short time period. These limitations may introduce bias and distort the epidemiological associations as they do not account for all the potential sources or the temporal variability of pollution.We used detailed information on individuals’ exposure to various pollutants measured at fine spatiotemporal scale to obtain more reliable effect estimates. A panel of 115 patients was followed up for an average continuous period of 128 days carrying a personal monitor specifically designed for this project that measured temperature, nitrogen dioxide (NO(2)), ozone (O(3)), nitric oxide (NO), carbon monoxide (CO), and particulate matter with aerodynamic diameter <2.5 and <10 μm at 1-min time resolution. Each patient recorded daily information on respiratory symptoms and measured peak expiratory flow (PEF). A pulmonologist combined related data to define a binary variable denoting an "exacerbation". The exposure-response associations were assessed with mixed effects models.We found that gaseous pollutants were associated with a deterioration in patients' health. We observed an increase of 16.4% (95% CI 8.6-24.6%), 9.4% (95% CI 5.4-13.6%) and 7.6% (95% CI 3.0-12.4%) in the odds of exacerbation for an interquartile range increase in NO(2), NO and CO, respectively. Similar results were obtained for cough and sputum. O(3) was found to have adverse associations with PEF and breathlessness. No association was observed between particulate matter and any outcome.Our findings suggest that, when considering total personal exposure to air pollutants, mainly the gaseous pollutants affect COPD patients' health.
Climate change has drastic consequences on human physical and mental health. However, research on the psychological effects of climate change awareness is still inconclusive. To examine the mental burden posed by climate change awareness and potential resilience factors, n = 203 medical students were surveyed about their awareness of the implications of climate change. Furthermore, well-established mental health questionnaires (PHQ-9, GAD-7, PTSS-10, PSQ-20) were presented twice, in their original form and in a modified version to specifically ask about the respective psychological burden regarding climate change. For identification of potential resilience factors, measures for attachment style (RQ), structural abilities (OPD-SF), and sense of coherence (SOC-13) were used. The results of our study suggest that medical students in Germany have an increased risk to suffer from mental health problems and predominantly experience significant perceived stress in regard to climate change. However, the reported stress does not yet translate into depressive, anxious, or traumatic symptoms. Climate-related perceived stress correlates negatively with potential resilience factors preventing the development of mental disorders such as attachment style, structural abilities, and sense of coherence.
The Climate Anxiety Scale (CAS) is a 13-item questionnaire for assessing climate anxiety (CA) as a psychological response to climate change. The CAS consists of two subscales, namely, cognitive impairment and functional impairment. This study aimed to validate the Polish version of the CAS. The sample included 603 respondents (344 females, 247 males, and 12 non-binary), aged 18-70 years (M = 25.32, SD = 9.59). Based on the exploratory factor analysis results, we proposed a 3-factor solution (i.e., intrusive symptoms, reflections on CA, and functional impairment), which seems to be theoretically more consistent with the content of the CAS statements. The confirmatory factor analysis showed that the original 2-factor solution and the 3-factor one had a satisfactory and a good fit to the data, respectively, as well as both were invariant across different gender, age, and educational level categories. Despite the fact that the 3-factor solution had the best-fit indices, we recommended to examine the CAS structure in different samples and use the overall CAS score in cross-cultural research. Cognitive and functional impairment subscales were positively correlated with personal experience of climate change, behavioral engagement, environmental identity, and environmental motives, but they were negatively correlated with climate change denial and sense of safety. The CAS subscales were correlated with depressive symptoms, but contrary to expectations, they were not associated with anxiety symptoms and any cognitive coping strategies. The Polish version of the CAS has satisfactory psychometric properties. Overall, we reported low CA levels in the Polish sample. Women and younger people experienced higher CA.
BACKGROUND: Season of birth is a risk factor of schizophrenia, and it is possible that cumulative exposure to climatic factors during childhood affects the risk of schizophrenia. We conducted a cohort study among 365,482 persons born in Finland in 1990-1995 to examine associations of 10-year cumulative exposure to global solar radiation and ambient temperature in childhood with schizophrenia. METHODS: Data on schizophrenia diagnoses and sociodemographic factors from the Finnish population register and health care register were linked to daily meteorological data using residential information. The study population was followed from age 10 until the first schizophrenia diagnosis, death, emigration or December 31, 2017, whichever came first. Hazard ratios (HR) for the risk of schizophrenia were estimated using Cox proportional hazards model. RESULTS: Compared to the lowest quintile of global solar radiation or ambient temperature, growing up in the second highest quintile (Q4) was associated with greater risk of schizophrenia. These hazard ratios were attenuated after adjustment for parental mental disorder, parental education, parental income, area-level socioeconomic characteristics and urbanicity (HR = 1.29, 95 % CI 1.06-1.58 for radiation; HR = 1.24, 95 % CI, 1.02-1.52 for temperature). Continuous linear terms evaluated in secondary models suggested a greater risk of schizophrenia at greater childhood exposure to global radiation and ambient temperature, but these associations did not remain in fully adjusted models. CONCLUSIONS: We found no consistent evidence that cumulative exposure to sunlight and ambient temperature in childhood is associated with the risk of developing schizophrenia. Studies in other populations residing in different latitudes are needed.
No data exist on the influence of meteorological factors on alcohol use disorders (AUD). The aim of this study was to investigate the relationship between meteorological factors and AUD. All patients who were admitted to an emergency department (ED) in the Paris-region for an alcohol-related condition were included using the Oscour database over the period January 1, 2015 to December 31, 2019. Meteorological data were collected by Meteo-France (French Weather service). All data were aggregated by week. We performed Pearson correlations between weather variables and the number of ED visits for AUD. We observed 98,748 ED visits for alcohol-related conditions over the study period. We found significant positive correlations between the number of alcohol-related ED visits and the mean temperature (r = 0.55; p = 1.87e^(-5), 95% Confidence Interval (CI) = 0.33, 0.72) and the duration of sunlight (r = 0.42; p = .0015, 95% CI = 0.17, 0.62). Negative correlations were also found significant with rain (r = -0.40; p = .0014, 95% CI = -0.62, -0.18), humidity (r = -0.41; p = .0023, 95% CI = -0.62, -0.16) and wind speed (r = -0.40; p = .0031, 95% CI = -0.60, -0.14). Emergency visits for AUD seem to increase with the temperature and duration of sunlight, and decrease with rain, humidity and wind speed. Further studies are needed on a larger scale and taking into account potential confounding factors to confirm these findings.
BACKGROUND: Cystic and alveolar echinococcosis (CE and AE) are neglected tropical diseases caused by Echinococcus granulosus sensu lato and E. multilocularis, and are emerging zoonoses in Kyrgyzstan. In this country, the spatial distribution of CE and AE surgical incidence in 2014-2016 showed marked heterogeneity across communities, suggesting the presence of ecological determinants underlying CE and AE distributions. METHODOLOGY/PRINCIPAL FINDINGS: For this reason, in this study we assessed potential associations between community-level confirmed primary CE (no.=2359) or AE (no.=546) cases in 2014-2016 in Kyrgyzstan and environmental and climatic variables derived from satellite-remote sensing datasets using conditional autoregressive models. We also mapped CE and AE relative risk. The number of AE cases was negatively associated with 10-year lag mean annual temperature. Although this time lag should not be considered as an exact measurement but with associated uncertainty, it is consistent with the estimated 10-15-year latency following AE infection. No associations were detected for CE. We also identified several communities at risk for CE or AE where no disease cases were reported in the study period. CONCLUSIONS/SIGNIFICANCE: Our findings support the hypothesis that CE is linked to an anthropogenic cycle and is less affected by environmental risk factors compared to AE, which is believed to result from spillover from a wild life cycle. As CE was not affected by factors we investigated, hence control should not have a geographical focus. In contrast, AE risk areas identified in this study without reported AE cases should be targeted for active disease surveillance in humans. This active surveillance would confirm or exclude AE transmission which might not be reported with the present passive surveillance system. These areas should also be targeted for ecological investigations in the animal hosts.
Diatoms of the genus Pseudo-nitzschia are cosmopolitans spread in seas and oceans worldwide, with more than 50 described species, dozens of which have been confirmed to produce domoic acid (DA). Here, we characterized and investigated the toxicological activity of secondary metabolites excreted into the growth media of different Pseudo-nitzschia species sampled at various locations in the northern Adriatic Sea (Croatia) using human blood cells under in vitro conditions. The results revealed that three investigated species of the genus Pseudo-nitzschia were capable of producing DA indicating their toxic potential. Moreover, toxicological data suggested all three Pseudo-nitzschia species can excrete toxic secondary metabolites into the surrounding media in addition to the intracellular pools of DA, raising concerns regarding their toxicity and environmental impact. In addition, all three Pseudo-nitzchia species triggered oxidative stress, one of the mechanisms of action likely responsible for the DNA damage observed in human blood cells. In line with the above stated, our results are of great interest to environmental toxicologists, the public and policy makers, especially in light of today’s climate change, which favours harmful algal blooms and the growth of DA producers with a presumed negative impact on the public health of coastal residents.
Energy affordability and climatic variability are associated to human health and this study investigates their impacts on public health for Cyprus, an eastern Mediterranean island afflicted by extreme summer heat and cold winters, especially in the Troodos mountains. Energy poverty indicators are computed through statistical analysis of mortality data and household consumption information, the latter collected through a tailored survey. Results show that almost half of the survey participants spend large proportions of their incomes towards essential energy services. Moreover, ambient temperature is significantly linked to mortality, with a 20-fold higher risk of death in winter and a major shift in mortality noticed around 2013, following a severe financial crisis which exposed rural populations to a higher mortality risk.
This paper presents an analysis of fatalities attributable to weather conditions in the Czech Republic during the 2000-2019 period. The database of fatalities deployed contains information extracted from Pravo, a leading daily newspaper, and Novinky.cz, its internet equivalent, supplemented by a number of other documentary sources. The analysis is performed for floods, windstorms, convective storms, rain, snow, glaze ice, frost, heat, and fog. For each of them, the associated fatalities are investigated in terms of annual frequencies, trends, annual variation, spatial distribution, cause, type, place, and time as well as the sex, age, and behaviour of casualties. There were 1164 weather-related fatalities during the 2000-2019 study period, exhibiting a statistically significant falling trend. Those attributable to frost (31 %) predominated, followed by glaze ice, rain, and snow. Fatalities were at their maximum in January and December and at their minimum in April and September. Fatalities arising out of vehicle accidents (48 %) predominated in terms of structure, followed by freezing or hypothermia (30 %). Most deaths occurred during the night. Adults (65 %) and males (72 %) accounted for the majority of fatalities, while indirect fatalities were more frequent than direct ones (55% to 45 %). Hazardous behaviour accounted for 76 %. According to the database of the Czech Statistical Office, deaths caused by exposure to excessive natural cold are markedly predominant among five selected groups of weather-related fatalities, and their numbers exhibit a statistically significant rise during 2000-2019. Police yearbooks of the fatalities arising out of vehicle accidents indicate significantly decreasing trends in the frequency of inclement weather patterns associated with fatal accidents as well as a decrease in their percentage in annual numbers of fatalities. The discussion of results includes the problems of data uncertainty, comparison of different data sources, and the broader context.
BACKGROUND: Seasonal variation in exacerbations, hospitalisations, and mortality statistics has been reported for some diseases. To our knowledge, however, no published studies exist on the seasonality of health-related quality of life (HRQoL) amongst rhinologic patients. AIMS/OBJECTIVES: This study, therefore, aimed to investigate the possible seasonal variation in rhinologic patients’ HRQoL using the rhinologic disease-specific Sino-Nasal Outcome Test-22 (SNOT-22) and the generic 15D HRQoL instrument. MATERIAL AND METHODS: We enrolled unselected adult rhinologic patients requiring specialist care at the Helsinki University Hospital in this cross-sectional, questionnaire-based prospective study during four seasons: February (winter), May (spring), August (summer), and November (autumn). Patients received SNOT-22 and 15D questionnaires via post. The Finnish Meteorological Institute supplied climate data from these months. RESULTS: SNOT-22 and 15D data were available for 301 and 298 patients, respectively. We found no statistically significant differences (p = 0.948) between the mean monthly 15D scores or mean SNOT-22 scales. Furthermore, the mean SNOT-22 subscales did not differ between the monthly study periods. CONCLUSIONS AND SIGNIFICANCE: Our study shows that seasonality did not impact rhinologic patients’ SNOT-22 or 15D HRQoL scores. Thus, these questionnaires can be used for follow-up amongst rhinologic patients regardless of season.
Road weather is a major concern for the public safety and health, industries and transport sectors. Half of the yearly 27,000 road and 50,000 pedestrian injuries in Finland, Norway and Sweden can be traced back to slippery road and walkway conditions. We simulated the climate change impacts on future roads and walkways for mid- and end-century in Finland, Norway and Sweden with the road weather model RoadSurf, driven by the regional climate model HCLIM38 with boundary data from two global climate models following the RCP8.5 scenario. Our simulations for mid-century suggest strong road surface temperature increases, especially in southern Finland (+ 5.1 degrees C) and Sweden (+7.1 degrees C). Snowy and icy road surface conditions decreased by 23 percentage points, causing 18.5 percentage points less difficult driving conditions during the cold season. Zero-degree-crossing days mostly decreased in autumn and spring by up to 7 days and increased in winter by up to 5 days. Sidewalks mostly showed a decrease in slipperiness, but a five percentage point increase of water above ice layers on the sidewalks in winter, suggesting the slip-season might become shorter, but more slippery. Our results are upper extreme estimates but can serve as a reference to help local decision-makers plan mitigation and adaptation measures ahead of time.
OBJECTIVE: Incidence of early-onset type 1 diabetes (T1D) has been increasing worldwide. Only few studies examined the relationship between geographical environmental variation and T1D incidence or its presymptomatic stage of islet autoimmunity. Our study aimed to investigate the effect of long-term environmental exposures during pregnancy and early life on childhood islet autoimmunity. RESEARCH DESIGN AND METHODS: We used data from the Fr1da cohort study which screened children aged 1.75-5.99 years for multiple islet autoantibodies in Bavaria, Germany between 2015 and 2019. We included 85,251 children with valid residential information. Daily averages for particulate matter with a diameter <2.5 μm, nitrogen dioxide, ozone, air temperature, and greenness were averaged for each zip-code or directly assigned to the addresses. The exposure windows included pregnancy, the first year and the first two years of life. Generalized additive models adjusting for individual and socioeconomic variables were used to investigate associations between environmental exposures and islet autoimmunity development. RESULTS: Islet autoimmunity was diagnosed in 272 children. Colder air temperature during pregnancy was associated with developing islet autoimmunity at the address (per 2.2 °C decrease, Odds ratio (OR): 1.49; 95% Confidence interval (CI): 1.21-1.83) and zip-code level (per 2.4 °C decrease, OR: 1.31; 95% CI: 1.08-1.59). Using the addresses, significant associations were also observed during the first years of life. CONCLUSION: In this study, children's residential exposure to lower levels of air temperature during pregnancy and early life increased the risk of islet autoimmunity before the age of six.
Higher incidences of asthma during thunderstorms can pose a serious health risk. In this study, we estimate the thunderstorm asthma risk using statistical methods, with special focus on Bavaria, Southern Germany. In this approach, a dataset of asthma-related emergency cases for the study region is combined with meteorological variables and aeroallergen data to identify statistical relationships between the occurrence of asthma (predictand) and different environmental parameters (set of predictors). On the one hand, the results provide evidence for a weak but significant relationship between atmospheric stability indices and asthma emergencies in the region, but also show that currently thunderstorm asthma is not a major concern in Bavaria due to overall low incidences. As thunderstorm asthma can have severe consequences for allergic patients, the presented approach can be important for the development of emergency strategies in regions affected by thunderstorm asthma and under present and future climate change conditions.
Climate change (CC) is adversely affecting human health and will become far more dangerous in the future, if no substantial measures are taken. Young people in particular are taking an energetic stand for CC awareness. Some CC experts argue that medical doctors are especially well positioned to inform about the impact of CC on public health, as it is well established that they are among the most trusted members of society. However, medical doctors seem to be unsure of their role in addressing CC. This study aimed to investigate future doctors´, i.e., final year medical students´ (FYMS), attitudes towards CC and their personal role in CC education and health care. A questionnaire was developed to examine (1) the expected consequences of CC for FYMS, (2) their perceived individual responsibility, and their attitudes towards an additional (3) professional responsibility. To examine the climate-questionnaire’s component correlations, we ran a factor analysis using oblique (promax) rotation and conducted a one-way ANOVA with repeated measures to compare the mean scores of the factors. Data are presented as mean ± SD or percentage, as appropriate. n = 65 FYMS (response rate: 87%) were participating and all of them completed the questionnaire. Items of the factor professional responsibility showed the lowest level of agreement (47.2 ± 21.2), while the 2 other factors showed higher levels of agreement (expected consequences (75.6 ± 18.4), individual responsibility (75.1 ± 20.6). Future doctors at Heidelberg University Hospital are well-informed about the expected health consequences of CC. They recognize human contributions to CC and make personal decisions to mitigate the impact. However, the opinion that they have a professional responsibility as physicians to patients or society in regard to CC is weaker. Specific teaching could help to change the way future doctors see their role and responsibility in tackling CC.
Greenhouse gases emissions resulting from the combustion of fossil fuels are worsening air quality and affecting the climate system. While climate change impacts on meteorological variables affects air quality by altering the concentration and distribution of pollutants, air pollution significantly influences the climate, leading to negative impacts on human health. Due to the combination of high temperatures, air pollution, and high population density, cities are particularly vulnerable to climate change impacts. The planning and design of public spaces aimed at climate change mitigation and adaptation can result in multiple co-benefits for human health, while reducing social inequalities. To address the major research gaps in the communication between health and planning experts, and the lack of capacity among public sectors and policy makers, it is necessary to promote capacity building and knowledge sharing between the planning and health sectors. The purpose of this article is to develop preliminary recommendations for a process that allows a comprehensive assessment of the interlinkages between climate and health, social, environmental, and economic vulnerabilities, and the quality of the urban spaces, to support local governments, policymakers, and education institutions in making informed decisions for public spaces. The methods applied were a literature review and interviews with experts.
We may translate anthropogenic climate change as a reaction of our planet to our unsustainable economic activities. This research explores whether environmental policies have been impacted by extreme climatic events like droughts, floods, storms, tornados, and wildfires. We use yearly panel data from 1990 to 2017 for the OECD (Organization for Economic Cooperation and Development) countries to examine such a relationship. To have an impartial analysis, we control major variables influencing environmental policies such as energy consumption, gross domestic product (GDP), population, technology, head of the state’s political affiliation, carbon emission, and waste generation. The analysis results suggest that policymakers make more stringent environmental decisions as the death rate increases and environmental threats become more imminent putting human life is at risk; this correlation is stronger in the case of European Countries.
Chronic obstructive pulmonary disease (COPD) is one of the most common causes of death globally, with increasing prevalence and years lived with disability (YLD). We aimed to investigate how extreme weather conditions were associated with the number of daily COPD-related emergency visits. We collected data regarding the number of daily emergency department (ED) visits made by patients with COPD in 2017, along with all relevant daily meteorological data for the same year. An analysis of the relationship between the number of COPD-related ED visits and extreme meteorological events was carried out. Extremely low temperatures (OR = 1.767) and dew points (OR = 1.795), extremely high atmospheric pressure (OR = 1.626), a high amount of precipitation (OR = 1.270), and light wind speed (OR = 1.560) were identified as possible risk factors for a higher number of COPD-related ED visits. In contrast, extremely high temperatures (OR = 0.572) and dew points (OR = 0.606) were found to be possible protective factors for COPD-related ED visits. By determining the meteorological risk factors for a high number of COPD-related ED visits, our study may help provide invaluable data for identifying vulnerable patient groups based on weather events, thus making more optimal capacity planning at the ED possible.
The European Union is significantly investing in the Green Deal that introduces measures to guide Member States to face sustainability and health challenges, especially employing Nature-Based Solutions (NBS) in urban contexts. National governments need to develop appropriate strategies to coordinate local projects, face multiple challenges, and maximize NBS effectiveness. This paper aims to introduce a replicable methodology to integrate NBS into a multi-scale planning process to maximize their cost-benefits. Using Italy as a case study, we mapped three environmental challenges nationwide related to climate change and air pollution, identifying spatial groups of their co-occurrences. These groups serve as functional areas where 24 NBS were ranked for their ecosystem services supply and land cover. The results show eight different spatial groups, with 6% of the national territory showing no challenge, with 42% showing multiple challenges combined simultaneously. Seven NBS were high-performing in all groups: five implementable in permeable land covers (urban forests, infiltration basins, green corridors, large parks, heritage gardens), and two in impervious ones (intensive, semi-intensive green roofs). This work provides a strategic vision at the national scale to quantify and orient budget allocation, while on a municipal scale, the NBS ranking acts as a guideline for specific planning activities based on local issues.
Background: Environmental factors seem to influence clinical manifestations of sickle cell disease (SCD), but few studies have shown consistent findings. We conducted a retrospective multicentric observational study to investigate the influence of environmental parameters on hospitalization for vaso-occlusive crises (VOC) or acute chest syndrome (ACS) in children with SCD. Methods: Hospital admissions were correlated with daily meteorological and air-quality data obtained from Environmental Regional Agencies in the period 2011-2015. The effect of different parameters was assessed on the day preceding the crisis up to ten days before. Statistical analysis was performed using a quasi-likelihood Poisson regression in a generalized linear model. Results: The risk of hospitalization was increased for low maximum temperature, low minimum relative humidity, and low atmospheric pressure and weakly for mean wind speed. The diurnal temperature range and temperature difference between two consecutive days were determined to be important causes of hospitalization. For air quality parameters, we found a correlation only for high levels of ozone and for low values at the tail corresponding to the lowest concentration of this pollutant. Conclusions: Temperature, atmospheric pressure, humidity and ozone levels influence acute complications of SCD. Patients’ education and the knowledge of the modes of actions of these factors could reduce hospitalizations.
BACKGROUND: Climate change (CC) is the greatest threat to the health of the planet. The scientific community has established its connection to human activities and its role in emerging and premature diseases. Our study helps to understand how students of various backgrounds and academic fields retrieve information on CC and highlights the knowledge on the main causes and consequences of global warming and on the role of healthcare workers in the fight towards this threat. METHODS: A cross-sectional study was performed through an online questionnaire administered to university students between January and December 2020. Univariable analyses were performed, Chi-square was calculated and multivariable analysis was used to investigate the relationship between the answers and socio-demographic variables. Statistical significance was set at a p-value of less than 5%. RESULTS: More than 80% of the sample correctly identifies as major consequences of CCs the increase in Earth’s temperature (95.0%), melting of ice caps (89.4%), rising sea levels (81.8%), and the more frequent occurrence of climate-related natural disasters. Across courses of study, the frequency on how CC is addressed differs (p<0.001): 31.5% of the students from the medical field reported the topic to be taught in class, compared to 49.0% from humanities and 63.4% from science and technology. CONCLUSION: The study shows that medical students are less prepared and less aware of the consequences and causes of CC than students in other faculties. Since CC will play a role in every aspect of patients' lives, barriers to health care will have to be overcome through the knowledge and skills acquired during undergraduate courses.
This paper derives from a document commissioned in 2019 by the Italian Minister of Health, and outlines a general strategy for primary prevention of non-communicable diseases in Italy, with a special focus on cobenefits of climate change mitigation. Given that action against climate change is primarily taken via energy choices, limiting the use of fossil fuels and promoting renewable sources, an effective strategy is one in which interventions are designed to prevent diseases and jointly mitigate climate change, the so-called cobenefits. For policies capable of producing relevant co-benefits we focus on three categories of interventions, urban planning, diet and transport that are of special importance. For example, policies promoting active transport (cycling, walking) have the triple effect of mitigating greenhouse gas emissions, preventing diseases related to atmospheric pollution, and increasing physical activity, thus preventing obesity and diabetes.In particular, we propose that for 2025 the following goals are achieved: reduce the prevalence of smokers by 30%, with particular emphasis on young people; reduce the prevalence of childhood obesity by 20%; reduce the proportion of calories obtained from ultraprocessed foods by 20%; reduce the consumption of alcohol by 10%; reduce the consumption of salt by 30%; reduce the consumption of sugary drinks by 20%; reduce the average consumption of meat by 20%; increase the weekly hours of exercise by 10%. The aim is to complement individual health promotion with structural policies (such as urban planning, taxation and incentives) which render the former more effective and result in a reduction in inequality. We strongly encourage the inclusion of primary prevention in all policies, in light of the described cobenefits. Italy’s role as the cohost of the 2020 (now 2021) UN climate negotiations (COP26) presents the opportunity for international leadership in addressing health as an integral component of the response to climate change.
It is now widely accepted that we are in a climate emergency, and the number of people who are concerned about this problem is growing. Yet, qualitative, in-depth studies to investigate the emotional response to climate change were conducted either in high-income, western countries, or in low-income countries particularly vulnerable to climate change. To our knowledge, there are no qualitative studies conducted in countries that share great barriers to decarbonization while being significant contributors to carbon emissions. Since climate change affects people globally, it is crucial to study this topic in a variety of socio-political contexts. In this work, we discuss views and reflections voiced by highly concerned residents of Poland, a Central European country that is a major contributor to Europe’s carbon emissions. We conducted 40 semi-structured interviews with Polish residents, who self-identified as concerned about climate change. A variety of emotions related to climate change were identified and placed in the context of four major themes: dangers posed by climate change, the inevitability of its consequences, attributions of responsibility, and commonality of concern. Our findings highlight a variety of often ambivalent and conflicting emotions that change along with the participant’s thoughts, experiences and behaviours. Furthermore, we describe a wide repertoire of coping strategies, which promoted well-being and sustained long-term engagement in climate action. As such, our work contributes to research on a broad array of climate-related emotions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-03807-3.
Aim: The aim of the first Polish pilot study was to conduct an initial analysis of the occurrence of mental issues related to such experiences as: fear, worry, sense of loss and grief in connection with climate change and ecology. The consequences of climate and environmental changes for physical health are increasingly well-documented. In contrast, psychosocial changes due to climate change and, in particular, the impact on mental health, remain unrecognized. Material and method: Psychologists and psychotherapists were asked to share their clinical experience in diagnosing and treatment of patients reporting climate change-related mental symptoms. Climate change-related mental issues were operationalized as clinically significant symptoms meeting the criteria for anxiety and depressive disorders or adjustment disorders, and are known in literature as a solastalgia and ecological anxiety. The collection of data with the use of an on-line survey started lasted 4 months. Results: Issues relating to ecology and climate change were present both in the contents of patient concerns (48.6% of respondents) and in patients’ hypotheses regarding their symptoms (16.7% of respondents) in the past 6 months of the respondents’ clinical work. Mental health professionals considered psychoeducation (62.5%), psychological support (73.6%), short-term psychotherapy (45.8%) and self-help groups (40.3%) to be appropriate mental health support interventions. Discussion: The presented study provides evidence that mental health issues related to climate change are recognized by Polish psychologists and psychotherapists. The professionals can need comprehensive knowledge of climate-related mental health, including appropriate interventions. Conclusions: These findings may be a ground for designing further research on this topic.
Climate Change, Natural Resources Depletion, COVID-19, and Wars are some of the great challenges of our time. The consequences will affect psychological well-being and could have a harmful impact on mental health. This study aimed to assess the level of preoccupation and fears surrounding issues of the 21st-century and the implication for psychological well-being of the general population from Central/Southern Italy among different age groups. A questionnaire that included sociodemographic characteristics, topics formulated ad-hoc about preoccupation, fears, habits, and willingness to change habits in the future related to the 21st-century challenges, and the Depression Anxiety Stress Scales 21 (DASS-21) was administered online. A sample of 1831 participants (61% F; mean age 47.71 ± 17.30) was obtained. Results showed that young adults and older adults, respectively, reported greater and less psychological well-being. Young adults reported higher scores for preoccupation, changing habits, and willingness to change habits in the future, while older adults reported the lowest scores except for changing habits, also controlling for gender. Results for this variable, as well as correlations between the many variables described, rely on the specificity of age, and 21st-century challenges. Moreover, the main fears related to the 21st-century concerns were different based on both age and gender. In conclusion, the various stresses of the 21st-century discussed in this study have a relationship with personal well-being, and it is important to consider potential global mental health issues resulting from these stressors.
Brexit, COVID-19 and climate change pose challenges of national and global importance. They continue to have impacts across the economy, society, health, and the environment, all of which are determinants of health and well-being. Between 2018 and 2021, Public Health Wales undertook three Health Impact Assessments (HIA) in relation to the impact of the challenges in Wales. Based on these, work has been carried out to map the synergies across the ‘Triple Challenge’. This paper highlights the commonalities in the impact of the three challenges for Wales, discusses the process carried out, learns from it and proposes actions that can be taken to mitigate harm. Results indicate the three components of the Triple Challenge must not be viewed as separate silos as they have cumulative multi-faceted impacts. This affects some population groups more negatively than others and present a ‘Triple Challenge’ to nation states in the UK and Europe. A HIA approach can enable a range of stakeholders to critically view similar challenges not just as single issues but as a holistic whole to mobilise action.
To address the inter-connected climate and biodiversity crises, it is crucial to understand how multifunctional urban green infrastructure (UGI) is perceived to contribute to carbon neutrality, biodiversity, human well-being, and justice outcomes in cities. We explore how urban residents, including youth, associate carbon-related meanings with multifunctional UGI and how these meanings relate to co-benefits to biodiversity, well-being, and broader sustainability outcomes. Our findings are based on a survey distributed among urban residents of Helsinki, Finland (n = 487) and reveal how carbon-related meanings of UGI manifest at different levels of abstraction, agency, and scale, and incorporate community values and concerns attributed to the planning, features, functions, and transformational dimensions of UGI. Core carbon-related meanings of UGI emphasize either actions towards sustainability, carbon neutrality, biodiversity, or unfamiliarity towards such meanings. Perceived justice concerns and the socio-demographic contexts of the respondents covaried with carbon-related meanings associated with UGI. The results illustrate community perceptions of how it is not only possible, but rather expected, that multifunctional UGI is harnessed to tackle climate change, human well-being, and biodiversity loss in cities. Challenges for implementing the carbon-related benefits of UGI include navigating the different expectations placed on UGI and including residents with diverse socio-economic backgrounds during the process. Our findings contribute to a holistic understanding of how multifunctional UGI can help bridge policy agendas related to carbon neutrality, biodiversity protection, and human well-being that cities can implement when aiming for sustainable, just, and socially acceptable transitions towards a good Anthropocene.
Cities are facing the challenges of climate change. The application of nature-based solutions (NBS) to the urban structure is often mentioned in climate change adaptation strategies. In an effort to ensure the greatest possible well-being of citizens in the form of environmentally positive elements, the opinions of citizens are forgotten. This paper presents the results of research focusing on the feelings of unsafety associated with the application of NBS elements directly into the urban structure. In two pilot areas (Ostrava (CZ) and the part of Upper Silesian agglomeration (PL)) the feelings of the inhabitants and the possible feeling of fear or danger in the application of NBS were investigated. In Ostrava, a questionnaire survey was conducted in relation to specific elements of the NBS without discussion of specific locations. In the Upper Silesian agglomeration, residents’ feelings about specific NBS were surveyed at specific locations using guided interviews. Both approaches resulted in the identification of elements of concern. Respondents who discussed a specific location had a better understanding of the urban context and worried less. The two approaches demonstrated the need to communicate with residents before finalizing the design of a particular public space and the desirability of discussing site-specific issues with citizens.
BACKGROUND: Despite a recent increase in engagement with environmental issues among young people, their impact upon adolescent mental health and wellbeing is not yet fully understood. Therefore, this study aimed to explore adolescents’ thoughts and feelings about current environmental issues. METHODS: Semi-structured interviews were conducted with a convenience sample of 15 UK-based adolescents aged 14-18?Çëyears (66.7% female). Transcripts were inductively thematically analysed by the interviewing researcher and two adolescent co-researchers, with priority given to the co-researchers’ impressions to strengthen interpretations of the personal experiences of the interviewees. RESULTS: Six themes were identified: the local environment, efficacy, challenging emotions, information, hindrances and perceptions of the future. The local environment was found to affect adolescents positively and negatively. Factors including greenspace and fresh air had a positive impact, and factors including noise and litter had a negative impact. Most participants reported feeling disempowered to personally influence environmental problems but were engaged with them and felt that trying to make a difference was beneficial for their wellbeing. Adolescents largely reported negative expectations about the environment’s future. CONCLUSION: The UK adolescents interviewed appeared to be very engaged and emotionally affected by a perceived lack of care towards the environment, locally and globally. It is therefore imperative to amplify young people’s voices and involve them in influencing environmental policy, for the benefit of young people and the planet. Further research should quantify the extent to which environmental issues affect young people’s mental health and identify factors that could prevent or alleviate distress.
Ecological challenges are quickly shaping the future of the tourism industry with an increasing focus on how to develop more sustainable adventure tourism practises. Adventure guides play an important role in this transition and in shaping client experiences, however there is a need to better understand how climate change may have important impacts on guides’ wellbeing. This study explored adventure guides’ experiences of nature connectedness and potential links between climate change, nature connexion, and wellbeing for adventure guides. Semi-structured qualitative interviews (x = 11) with adventure guides were analysed using reflexive thematic analysis to explore these relationships. Adventure guides reported experiencing meaningful connexions and relationships with the natural environments in which they worked, while also highlighting why not all types of nature nor time spent outdoors facilitated this connexion. Guides that reported being more connected to nature also reported a higher sense of environmental responsibility, and guides described how this often created “ethical dilemmas” in seeking to resolve tensions between their deep connexion to nature and unsustainable practises that their guiding work often entailed. Analysis also highlighted the value and wellbeing guides derived from sharing their love of nature with clients. These findings expand emerging theoretical models of adventure guide wellbeing, and suggest a range of practises that can support a more ecologically sustainable adventure tourism industry.
There is a lack of conceptual clarity regarding the nature of distress caused by confrontations with climate change as a generalised or global phenomenon (distress often labelled ‘eco-anxiety’). However, existing literature has suggested that existential concerns might be central to the experience. This article explores and conceptualises the experience of eco-anxiety through semi-structured interviews with 15 self-selecting adults. Data were analysed using thematic analysis, which utilised an existential framework – consisting of the concerns of death, meaning, isolation, and freedom/responsibility – in a theory-driven analysis of interview transcripts. Participants’ experiences were conceptualised by four themes derived from the existential framework and six subthemes. Climate change was equated with death or loss and associated with guilt, anger, isolation, powerlessness, and chronic uncertainty about what to do as well with challenges to meaning in life. The study indicates that distress about climate change is a diverse and distressing phenomenon that can be appropriately conceptualised through an existential lens. Implications of this are discussed for climate and clinical psychology.
There is growing evidence that climate change is linked to adverse mental health outcomes, with both direct and indirect impacts already being felt globally, including within the United Kingdom (UK). With the UK parliament tasked with passing legislation to mitigate against and adapt to climate change, it is well placed to take a lead in implementing policies that reduce the impact of climate change on mental health and even provide mental health benefits (e.g., by increasing access to green space). The extent to which the UK parliament considers the relationship between climate change and mental health in its decision-making was previously unknown. We report, through quantitative thematic analysis of the UK Hansard database, that the UK parliament has only infrequently made links between climate change and mental health. Where links have been made, the primary focus of the speeches were around flooding and anxiety. Key mental health impacts of climate change reported in the academic literature, such as high temperature and suicides, or experiences of eco-anxiety, were found to be missing entirely. Further, policies suggested in UK parliament to minimise the impact of climate change on mental health were focused on pushing adaptation measures such as flood defences rather than climate mitigation, indicating potential missed opportunities for effective policies with co-benefits for tackling climate change and mental health simultaneously. Therefore, this research suggests a need to raise awareness for UK policymakers of the costs of climate inaction on mental health, and potential co-benefits of climate action on mental health. Our results provide insight into where links have and have not been made to date, to inform targeted awareness raising and ultimately equip policymakers to protect the UK from the increasingly large impacts of climate change on mental health.
A number of recent studies have demonstrated that adolescents consider the future consequences (CFC) of behaviours domain-specifically. In other words, rather than being a “future orientated person,” it appears that the orientation varies within individuals, depending on the domain in question. The present study matched data gathered in Scottish school children (N = 451) on consideration of four future domains (Health and Well-being, Finances, Academics, and Global Warming) with sociodemographic and academic attainment data provided by Local Government. Results showed that deprivation was significantly related to academic attainment, and that this relationship was partially mediated by the combined effects of academic self-efficacy and on consideration of future consequences-academic. Further, domain specificity was supported by the fact that scores for consideration of future consequences-health and well-being,-finance, and-global warming did not partially mediate the deprivation-attainment relationship. The study identifies two variables which may contribute to closing the poverty-related attainment gap.
Climate change is continuing to impact the social-ecological systems of polar regions. Climate models project substantial warming above the global average and high rates of environmental change in polar regions, but local impacts remain uncertain. These rapid alterations will affect biophysical, economic, and sociocultural conditions. This research aims to uncover early climate change indicators through climate model projections and individuals’ perceptions by focusing on a sample of 39 municipalities north of the Arctic Circle in Norway, Sweden, Finland, and northwestern Russia. The study employs an exploratory sequential approach by combining representations of climate model projections in a geographic information system (GIS) with qualitative analysis from semi-structured interviews with local officials involved in planning decisions for each municipality. And, second, the study combined perceptions of early climate change indicators and their subsequent challenges and opportunities with regional climate projections. Results indicate an overall geographic ‘match’ between climate model projections and perceptions, but differences between north-to-south, coast-to-interior, and national perspectives are notable. Some of these differences point to the roles of nationally, regionally, and locally embedded geographies, producing a multitude of lived experiences. The implications of this study are relevant to global communities experiencing varying climate change risk perception from coastal-versus-interior regions.
Objective: We examined whether seasonal and monthly variations exist in the subjective well-being of weather-sensitive patients with coronary artery disease (CAD) during cardiac rehabilitation. Methods: In this cross-sectional study, 865 patients (30% female, age 60 +/- 9) were recruited within 2-3 weeks of treatment for acute coronary syndrome and during cardiac rehabilitation. The patients completed the Palanga self-assessment diary for weather sensitivity (PSAD-WS) daily, for an average of 15.5 days. PSAD-WS is an 11-item (general) three-factor (psychological, cardiac, and physical symptoms) questionnaire used to assess weather sensitivity in CAD patients. Weather data were recorded using the weather station “Vantage Pro2 Plus”. Continuous data were recorded eight times each day for the weather parameters and the averages of the data were linked to the respondents’ same-day diary results. Results: Weather-sensitive (WS) patients were found to be more sensitive to seasonal changes than patients who were not WS, and they were more likely to experience psychological symptoms. August (summer), December (winter), and March (spring) had the highest numbers of cardiac symptoms (all p < 0.001). In summary, peaks of symptoms appeared more frequently during the transition from one season to the next. Conclusion: This study extends the knowledge about the impact of atmospheric variables on the general well-being of weather-sensitive CAD patients during cardiac rehabilitation.
Many schools in Sweden lack a proper indoor environment due to, e.g., poor thermal-envelope properties, overcrowded classes, poor visual appearance and insufficient ventilation. This study aims to explore the integration of a large number of indoor green plants into classrooms’ environments. This case study consists of three parts: measurements of the indoor environment including a final energy model, a questionnaire to the pupils with questions about their well-being and qualitative interviews with teachers. The case was two classrooms in a secondary education facility in central Sweden with an average annual temperature of 3 degrees C and a long and dark winter period with snow. The results showed 10% lower CO2 and slightly higher and more stable temperatures due to the green plants. Worries about climate change and war among the pupils decreased after several months with the plants and worry about infectious disease increased. The teachers experienced fresher air from the plants and used the plant stands for a flexible classroom design. The conclusion is that indoor plants have the potential to contribute to a better indoor environment, but due to the high number of uncontrolled variables (including the effect of COVID-19) in measurements of real-life conditions, more studies are needed.
In this article we argue that drama can provide complementary knowing for climate change education and shed light on the complexity of related psychosocial issues. We bring together an interdisciplinary understanding of eco-anxiety, psychosocial responses to climate change, and drama education. We draw on performance narratives created with young people in Finland and explore the psychosocial dynamics of climate change education. Three key themes are discussed in more detail in relation to education: 1) psychosocial dynamics; 2) alienation; 3) tragedy. The performance workshops provided a safe and creative space for exploring young people’s thoughts and images related to climate anxiety. Many relevant but often silenced issues became visible and were lived through in the process of performance making. This seemed to be fruitful both to the performers, teachers, and researchers, and suggests future, longer-term work would prove beneficial for engaging with these issues.
With the growing body of knowledge climate change stands out as one of the most important contemporary problems. The Intergovernmental Panel on Climate Change confirms the urgent necessity to reduce greenhouse gases emission, as the window to address the problem is becoming narrow. Rising temperatures and bushfires, melting glaciers and droughts make the acceleration of climate change evident, and citizens around the globe are increasingly worried about the magnitude of the problem. In this article, we propose an existential perspective on climate change-related concerns. Although environmental worries are legitimate, they sometimes cause severe anxiety and distress so aggravated as to be discussed within the framework of psychotherapy. In the course of this research, we examine the experiences of 10 Swedish psychotherapy clients addressing their climate concerns within treatment. We engage them into in-depth conversations about the experience of climate anxiety and inquire about the individual pathways toward recovery. Moreover, we propose the existential perspective as a tool to understand such experiences. We aim to address all existential concerns, as described in Ernesto Spinelli’s themes of existence framework: death anxiety, spatiality, temporality, meaning, relatedness, authenticity, freedom, and responsibility. All of the above are present in participants’ reports of climate anxiety. In conclusion, we emphasize the value of introducing existential perspective to practitioners working with clients experiencing climate distress.
BACKGROUND: Climate change is one of the greatest challenges of the 21st century and it can affect mental health either directly through the experience of environmental traumas or indirectly through the experience of emotional distress and anxiety about the future. However, it is not clear what possible subtypes of the emerging “psychoterratic” syndromes such as eco-anxiety, eco-guilt, and eco-grief exist, how much distress they may cause, and to what extent they facilitate ecofriendly behavior. METHODS: We analyzed semi-structured interviews (N = 17) focusing on the thoughts, emotions, and behaviors related to climate change by using a combination of inductive and deductive qualitative methods. RESULTS AND CONCLUSIONS: The interviews revealed six eco-anxiety components, eight types of eco-guilt, and two types of eco-grief that help to understand the multifactorial nature of these phenomena. The six categories of coping strategies are in line with traditional coping models, and they are linked in various ways to pro-environmental behavior and the management of negative emotions. The results can help practitioners to gain a deeper understanding of emotions related to climate change and how to cope with them, and researchers to develop comprehensive measurement tools to assess these emotions.
BACKGROUND: Climate change is a major global challenge, especially for Indigenous communities. It can have extensive impacts on peoples’ lives that may occur through the living environment, health and mental well-being, and which are requiring constant adaptation. OBJECTIVES: The overall purpose of this research was to evaluate the impacts of climate change and permafrost thaw on mental wellness in Disko Bay, Greenland. It contained two parts: multidisciplinary fieldwork and a questionnaire survey. The aim of the fieldwork was to learn about life and living conditions and to understand what it is like to live in a community that faces impacts of climate change and permafrost thaw. For the questionnaire the aim was to find out which perceived environmental and adaptation factors relate to very good self-rated well-being, quality of life and satisfaction with life. ANALYSIS: Fieldwork data was analyzed by following a thematic analysis, and questionnaire data statistically by cross-tabulation. First, the associations between perceived environmental and adaptation factors were studied either by the Pearson χ(2) test or by Fisher’s exact test. Second, binary logistic regression analysis was applied to examine more in depth the associations between perceived environmental/adaptation variables and self-rated very good well-being, satisfaction with life and quality of life. The binary logistic regression analysis was conducted in two phases: as univariate and multivariate analyses. RESULTS: Nature and different activities in nature were found to be important to local people, and results suggest that they increase mental wellness, specifically well-being and satisfaction with life. Challenges associated with permafrost thaw, such as changes in the physical environment, infrastructure and impacts on culture were recognized in everyday life. CONCLUSIONS: The results offer relevant information for further plans and actions in this field of research and at the policy level. Our study shows the importance of multidisciplinary research which includes the voice of local communities.
Responding effectively to climate change requires an understanding of what shapes people’s individual and collective sense of agency and responsibility towards the future. It also requires transforming this understanding into political engagement to support systems change. Based on a national representative survey in Sweden (N 1,237), this research uses the novel SenseMaker methodology to look into these matters. More specifically, in order to understand the social and institutional prerequisites that must be in place to develop inclusive climate responses, we investigate how citizens perceive their everyday life and future, and the implications for their sense of responsibility, agency, and political engagement. Our research findings show how citizens perceive and act on climate change (individually, cooperatively, and by supporting others), their underlying values, beliefs, emotions and paradigms, inter-group variations, and obstacles and enablers for change. The findings reveal that, in general, individual and public climate action is perceived as leading to improved (rather than reduced) wellbeing and welfare. At the same time, climate anxiety and frustration about structural and governance constraints limit agency, whilst positive emotions and inner qualities, such as human-nature connections, support both political engagement and wellbeing. Our results shed light on individual, collective, and structural capacities that must be supported to address climate change. They draw attention to the need to develop new forms of citizen involvement and of policy that can explicitly address these human interactions, inner dimensions of thinking about and acting on climate change, and the underlying social paradigms. We conclude with further research needs and policy recommendations.
BACKGROUND: The reporting of climate change issues through social media can influence young people’s mental health and engagement. However, there has been little research undertaken directly with young people in relation to social and digital media’s reporting of climate change, and how this is experienced by young people. METHOD: This study aimed to explore the interface between climate change and social media reporting for young people. A two-stage iterative approach to recruitment and data collection included an initial qualitative stage (N=28), consisting of open-ended questions about social media’s reporting of climate change issues. The second stage (N=23) included further open-ended questions and 10 Likert-Scale questions. Overall, 51 young people 16-25-years-old opted to take part (M=11; F=40). Descriptive statistics and an inductive data-driven content analysis are reported. RESULTS: Overall, 95% of the participants reported that they had the personal skills to cope with climate change reporting on social media. Most participants stated that coverage on the climate increased ‘climate change anxiety’ but not their overall mental health difficulties. A four-stage experiential process of observing social media’s reporting of climate change, feeling emotionally affected by the reporting, critically apprising the content and feeling motivated to engage in climate change activism emerged from the content analysis. The participants discussed experiences of digital media, rather than solely social media, in their accounts. CONCLUSIONS: The participants recommended changes to climate change reporting and increasing access to education about climate change issues to reduce anxiety and enhance motivation for positive personal engagement. Involving young people in conversations and education about climate change were seen as protective factors for mental health and enablers for motivation. Motivation, agency and pathways for positive change were associated with hopefulness.
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.
BACKGROUND: The purpose of this study was to describe and analyse the most severe casualties from the flash flood and mudslides occurring on 14 July 2021 in Germany, focusing on patients who were treated in the closest and largest level I trauma centre in the region the disaster occurred. METHODS: A single-centre retrospective study design was employed, and all patients treated because of the flooding and mudslides who needed inpatient treatment were documented. Data on each patient’s demographic characteristics, type of injury, number of surgeries, duration of hospitalisation, operation time, revision rate, injury severity score (ISS), and complications were collected. The primary outcome measure was status at discharge. RESULTS: Within the first week after the flood, a total of 63 patients were documented. Forty-one patients were treated on an outpatient basis in the emergency unit, and 22 patients were hospitalised. Of those hospitalised, 15 patients needed surgical treatment in the operation theatre. The most common injuries were fractures of the lower extremity (n = 7) and soft tissue wounds (n = 4). Overall, 20 surgeries were performed; the mean hospital stay was 7.2 ± 6.4 days, and the mean ISS was 5.7 ± 2.7. CONCLUSION: The July 2021 flood disaster was one of the largest in German history. The included patients showed complex injuries of various types. Because of the effects of climate change, orthopaedic surgeons might face higher numbers of casualties affected by natural disasters. Learning more about the management and profile of these injuries can become a future challenge for orthopaedic and trauma surgeons.
BACKGROUND: Large-scale epidemics of haemorrhagic fever with renal syndrome (HFRS) have been reported mostly in Asia and Europe, with around 100,000 people affected each year. In the Southeast Europe, Balkan region, HFRS is endemic disease with approximately 100 cases per year. Our aim was to describe epidemiological characteristics of HFRS in five Western Balkan (WB) countries and to describe correlation between HFRS incidence and major meteorological event that hit the area in May 2014. METHODS: National surveillance data of HFRS from Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia obtained from 1 January 2006 to 31 December 2015 were collected and analysed. RESULTS: In a 10-year period, a total of 1,065 HFRS patients were reported in five WB countries. Cumulative incidence rate ranged from 0.05 to 15.80 per 100.000 inhabitants (in North Macedonia and Montenegro respectively). Increasing number of HFRS cases was reported with a peak incidence in three specific years (2008, 2012, and 2014). Average incidence for the entire area was higher in males than females (5.63 and 1.90 per 100.000 inhabitants respectively). Summer was the season with the highest number of cases and an average incidence rate of 1.74/100.000 inhabitants across 10-year period. Haemorrhagic fever with renal syndrome incidence was significantly increased (7.91/100.000 inhabitants) in 2014, when a few months earlier, severe floods affected several WB countries. A strong significant negative correlation (r = -.84, p < .01) between the monthly incidence of HFRS and the number of months after May's floods was demonstrated for the total area of WB. CONCLUSION: Our findings demonstrate that the HFRS incidence had similar distribution (general, age, sex and seasonality) across majority of the included countries. Summer was the season with the highest recorded incidence. Common epidemic years were detected in all observed countries as well as a negative correlation between the monthly incidence of HFRS and the number of months after May's cyclone.
In addition to global population growth due to migration from rural areas to urban areas, population density is constantly increasing in certain regions, thereby necessitating the introduction of new settlements in these regions. However, in the selection of settlement areas, no sufficient preliminary examinations have been conducted; consequently, various natural disasters may cause significant life and property losses. Herein, the most suitable settlement areas were determined using GIS (geographic information systems) in Canik District, where the population is continuously increasing. Therefore, this study aimed to incorporate a new perspective into studies on this subject. Within the scope of the study, landslide and flood risks, which are among the most important natural disasters in the region, were primarily evaluated, and high-risk areas were determined. Elevation, slope, aspect, curvature, lithology, topographic humidity index (TWI), and proximity to river parameters were used to produce flood susceptibility maps. A digital elevation model (DEM) of the study area was produced using contours on the 1/25,000 scaled topographic map. The elevation, slope, aspect, curvature, and TWI parameters were produced from the DEM using the relevant analysis routines of ArcGIS software. The raster map of each parameter was divided into 5 subclasses using the natural breaks classification method. In the reclassified raster maps, the most flood-sensitive or flood-prone subclasses were assigned a value of 5, and the least sensitive subclasses were assigned a value of 1. Then, the reclassified maps of the 7 parameters were collected using the “map algebra” function of ArcGIS 10.5 software, and the flood susceptibility index (FSI) map of the study area was obtained. The flood susceptibility map of the study area was obtained by dividing the FSI into 5 subclasses (very low, low, moderate, high, and very high) according to the natural breaks classification method. Thereafter, suitable and unsuitable areas in terms of biocomfort, which affects people’s health, peace, comfort, and psychology and is significant in terms of energy efficiency, were determined. At the last stage of the study, the most suitable settlement areas that were suitable in terms of both biocomfort and low levels of landslide and flood risks were determined. The calculated proportion of such areas to the total study area was only 2.1%. Therefore, because these areas were insufficient for the establishment of new settlements, areas that had low landslide and flood risks but were unsuitable for biocomfort were secondarily determined; the ratio of these areas was calculated as 56.8%. The remaining areas were inconvenient for the establishment of settlements due to the risk of landslides and floods; the ratio of these areas was calculated as 41.1%. This study is exemplary in that the priority for the selection of settlement areas was specified, and this method can be applied for selecting new settlements for each region considering different criteria. Due to the risk of landslides or flooding in the study area, the areas unsuitable for establishing a settlement covered approximately 41.1% of the total study area. The areas that had low flood and landslide risks but were suitable for biocomfort constituted only 2.1% of the study area. In approximately 56.8% of the study area, the risk of landslides or floods was low, and these areas were unsuitable in terms of biocomfort. Therefore, these areas were secondarily preferred as settlement areas. The most suitable areas for settlements constituted only 0.19% of the total study area, and these areas will not be able to meet the increasing demand for settlement area. Therefore, it is recommended to select areas that do not have the risk of landslides and floods but are unsuitable for biocomfort. This study reveals that grading should be performed in the selection of settlement areas. When choosing a settlement area in any region, possible natural disasters in the region should be identified first, and these disasters should be ordered in terms of their threat potential. Moreover, biocomfort areas suitable for settlements should be considered. In the next stages of settlement area selection, the criteria that affect the peace and comfort of people, such as distance to pollution sources, distance to noise sources, and proximity to natural areas, should also be evaluated. Thus, a priority order should be created for the selection of settlement areas using various other criteria.
Landslides are the most frequent and diffuse natural hazards in Italy causing the greatest number of fatalities and damage to urban areas. The integration of natural hazard information and social media data could improve warning systems to enhance the awareness of disaster managers and citizens about emergency events. The news about landslide events in newspapers or crowdsourcing platforms allows fast observation, surveying and classification. Currently, few studies have been produced on the combination of social media data and traditional sensors. This gap indicates that it is unclear how their integration can effectively provide emergency managers with appropriate knowledge. In this work, rainfall, human lives, and earmarked fund data sources were correlated to “landslide news”. Analysis was applied to obtain information about temporal (2010-2019) and spatial (regional and warning hydrological zone scale) distribution. The temporal distribution of the data shows a continuous increase from 2015 until 2019 for both landslide and rainfall events. The number of people involved and the amount of earmarked funds do not exhibit any clear trend. The spatial distribution displays good correlation between “landslide news”, traditional sensors (e.g., pluviometers) and possible effects in term of fatalities. In addition, the cost of soil protection, in monetary terms, indicates the effects of events.
Shallow landslides (SLs) are rapid soil mass movements, typically occurring in the mountain areas, involving the most superficial soil layers up to 5 to 10 m in depth. Damages, and casualties due to shallow landslides are recorded globally, and in literature a variety of models to study landslides have been implemented hitherto. Often times, shallow landslides occur in the wake of snowfall events, when sudden temperature increase triggers fast snow thaw, and soil moisture increases thereby. Several models studied the influence of intensity, and duration of rainfall upon shallow landslides, but the effect of snow melt in spring/summer was little considered so far. Thus, we developed a simple but robust, and parameter-wise parsimonious model, that mimics the triggering mechanism of SLs, accounting for the combined effect of precipitation duration and intensity, and snowmelt at thaw. The model is here applied to the case study of the high altitude Tartano basin, paradigmatic of SLs in the Alps of Lombardia. Our results showed that about 26 % of the Tartano basin slopes display unstable conditions. Using a traditional (i.e. rainfall-based) approach, the occurrence of shallow landslides was predicted in ca. 19 % of the basin, mainly during storms in October and November. In contrast, when snowmelt was included, the model was able to mimic potential SLs even during April and May, when snow melt rate is the highest, and may increase SLs triggering potential, to ca. 26 % of the treated area. With better spatial and temporal description of slope failure as achieved here, validated against observed failures, a public authority may be prepared to implement emergency plans, to prevent injuries, causalities, and damages to infrastructures even during springtime, when shallow landslides may occur in response to fast snowmelt, even during dry, clear sky days, and with scarce/null precipitation.
We present Flood-SHE, a data-driven, statistically-based procedure for the delineation of areas expected to be inundated by river floods. We applied Flood-SHE in the 23 River Basin Authorities (RBAs) in Italy using information on the presence or absence of inundations obtained from existing flood zonings as the dependent variable, and six hydro-morphometric variables computed from a 10 m × 10 m DEM as covariates. We trained 96 models for each RBA using 32 combinations of the hydro-morphometric covariates for the three return periods, for a total of 2208 models, which we validated using 32 model sets for each of the covariate combinations and return periods, for a total of 3072 validation models. In all the RBAs, Flood-SHE delineated accurately potentially inundated areas that matched closely the corresponding flood zonings defined by physically-based hydro-dynamic flood routing and inundation models. Flood-SHE delineated larger to much larger areas as potentially subject of being inundated than the physically-based models, depending on the quality of the flood information. Analysis of the sites with flood human consequences revealed that the new data-driven inundation zones are good predictors of flood risk to the population of Italy. Our experiment confirmed that a small number of hydro-morphometric terrain variables is sufficient to delineate accurate inundation zonings in a variety of physiographical settings, opening to the possibility of using Flood-SHE in other areas. We expect the new data-driven inundation zonings to be useful where flood zonings built on hydrological modelling are not available, and to decide where improved flood hazard zoning is needed.
Understanding of public health adaptation (PHA) to climate change and implementation is limited. This study therefore focuses on one specific PHA issue: adaptation to the oak processionary moth (OPM). The aim is to examine the development of OPM adaptation in order to offer a problem description of the complexities involved in OPM adaptation. In this explorative case study, we investigate adaptation strategies based on semi-structured interviews with 26 actors involved in OPM adaptation in The Netherlands. The results indicate that the context of OPM adaptation is relatively complex, given the involvement of many interdependent actors. OPM adaptation was developed with limited knowledge and strategies were based on ad hoc approaches in which there was ambiguity about tasks and expertise. In addition, different actors have different perceptions and values concerning health, sustainability, risks and responsibilities influencing decision-making processes, while also posing a challenge to collaboration and the development of a coordinated approach. The generation of knowledge and its translation into practical strategies calls for interdisciplinary cooperation in knowledge development. PHA adaptation involves more than technical and organisational solutions alone. It also entails the development of a shared problem perception and solution space in which citizens are also engaged.
The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.
Urban and peri-urban areas are subject to major societal challenges, like food security, climate change, biodiversity, resource efficiency, land management, social cohesion, and economic growth. In that context, Urban and Peri-urban Agriculture (UPA), thanks to its multifunctionality, could have a high value in providing social, economic, and environmental co-benefits. UPA is an emerging field of research and production that aims to improve food security and climate change impact reduction, improving urban resilience and sustainability. In this paper, a replicable GIS-based approach was used to localize and quantify available areas for agriculture, including both flat rooftop and ground-level areas in the mainland of the city of Venice (Italy). Then, possible horticultural yield production was estimated considering common UPA yield value and average Italian consumption. Climate change mitigation, like CO2 reduction and sequestration, and climate change adaptation, like Urban Flooding and Urban Heat Island reduction, due to the new UPA areas’ development were estimated. Despite the urban density, the identified areas have the potential to produce enough vegetables for the residents and improve climate change mitigation and adaptation, if transformed into agricultural areas. Finally, the paper concludes with a reflection on the co-benefits of UPA multifunctionality, and with some policy suggestions.
The reduction of energy consumption in the built environment by energy renovation strategies is an important target to deal with buildings sector’s negative impact on our planet. Regardless of the potential for energy and emissions savings, building renovation has other relevant effects on users’ quality of life and health that has not been so well assessed. The present study aims to contribute to current building energy efficiency targets, particularly to Spanish residential building sector, from a still non-existing integrated vision. To this end, an evaluation method was developed to discuss the impact of energy renovation interventions on annual energy demand, indoor thermal comfort and indoor thermal health risk variation. The approach was applied to an open linear residential block located in the Basque Country (northern Spain), and twelve scenarios based on three variables were analysed using DesignBuilder tool. The results obtained show a clear contrast in the impacts caused by energy refurbishment interventions. In particular, the generalized decrease in the number of hours in which indoor temperatures are within comfortable ranges is significant in contrast to the noteworthy reduction in annual energy demand. In conclusion, the results suggest new factors to be considered when updating energy renovation policies.
Well-being is transversal to different urban-related challenges such as increasing urbanization or adaptation to the effects of climate change. One possible response to these challenges is the use of nature in cities. The aim of this study is to investigate how the objective quantity of natural space near the home, the perception of these natural elements, and their perceived availability, moderated by the effect of connectedness to nature, could explain levels of well-being. A survey was conducted among a sample of 1343 participants living in seven European cities. Data were collected online via a questionnaire. Indicators of the objective quantity of urban natural space based on remotely sensed satellite imagery were also used. Regression models highlight the association between well-being and perceived amount of nature, accessibility to a community garden, and level of connectedness to nature. A moderating and negative effect of connectedness to nature on the association between the perceived quantity of nature and well-being was also identified. Perception of nature seems to be a better indicator of well-being than the objective one. Results highlight the importance of the social dimension of collective gardens in enhancing well-being. Connectedness to nature could facilitate appropriation of natural elements and its effects on well-being.
BACKGROUND: Temperature may trigger the risk of suicide, however, the extent and shape of the associations show geographical variation. Here, we investigate the short-term effects of temperature on suicide deaths occurring in Brussels between January 1st, 2002 and December 31st, 2011. METHODS: We conducted a bidirectional time-stratified case-crossover study with cases being suicide deaths occurring among Brussels residents aged 5 years or older. Cases were matched by day of the week with control days from the same month and year. The exposure was the daily average temperature measured at the Uccle station (Brussels) and obtained from the Belgian Royal Meteorological Institute. We combined conditional logistic regression with distributed lag non-linear models (DLNM) to obtain one week (lag 0-6) cumulative risk ratios (RR) and their 95% confidence intervals (CI) for the effects of moderate and extreme cold (5th and 1st percentiles of temperature, respectively) and moderate and extreme heat (95th and 99th percentiles of temperature, respectively), relative to the median temperature. RESULTS: In total, 1891 suicide deaths were included. The median temperature was 11.6 °C, moderate and extreme cold temperatures were 0 and -3.1 °C, respectively, and moderate and extreme high temperatures were 20.9 and 24.4 °C, respectively. The cumulative risk of suicide mortality was almost twice higher among lags 0 to 6 for both moderate and extreme heat, relative to the period median temperature (e.g. moderate heat RR = 1.80 CI:1.27-2.54). No statistically significant associations were observed for cold temperatures. CONCLUSIONS: In Brussels, a western European city with temperate climate, high temperatures may trigger suicide deaths up to one week later. In the context of climate change, adaptation strategies must take into consideration the effects of temperature on mental health.
Human activities are a key driver of many environmental problems the world is facing today, including climate change, the disruption of biogeochemical cycles, and biodiversity loss. Behavioural changes at the individual and household level are needed to reduce humanity’s environmental impact, but people also need the capacity to behave in a sustainable way. If their well-being is negatively impacted or if behaving sustainably is too time consuming or too expensive, people might be less inclined to change their behaviour. In this article, we look at the determinants of different types of pro-environmental behaviour and how these are associated with their experienced levels of well-being. More specifically, we focus on the determinants of behaviours that influence both the ecological footprint (EF) and satisfaction with life. In our analysis we include socio-demographic characteristics and a number of psychological antecedents of pro-environmental behaviour (PEB). The data we use was collected in Flanders (Belgium) and allows us to calculate the EF of each respondent individually. Our main conclusions are threefold. First, even if individuals are provided with opportunities to behave in a more sustainable way, they do not always do so (e.g., richer people on average have a higher EF). Efforts could be put in place at the collective side (e.g., public infrastructure) to stimulate people to reduce their environmental impact. Second, as we distinguish seven EF components, we are able to show differential effects of each of the determinants. Third, the association between PEB and satisfaction with life is not strong: only the type of housing is significantly associated with satisfaction with life. Related to that, the psychological antecedents of PEB are only associated with the EF, not with satisfaction with life.
OBJECTIVES: This study aimed to clarify the level and the correlates of climate anxiety in Germany. STUDY DESIGN: This was a quota-based online survey. METHODS: We used data collected in mid-March 2022 from a sample of the general adult population (n = 3091 individuals aged 18-74 years; March 2022). Climate anxiety was quantified using the Climate Anxiety Scale (ranging from 1 to 7, with higher scores corresponding to higher levels of climate anxiety). RESULTS: The average level of climate anxiety in Germany was 2.0 (standard deviation [SD]: 1.2). It differed between subgroups (e.g. individuals aged 18-29 years: 2.4, SD: 1.3; individuals aged 65-74 years: 1.8, SD: 1.0). Log-linear regressions showed that climate anxiety was higher among younger individuals (β = -0.005, P < .001), full-time employed individuals (compared with retired individuals, β = 0.07, P < .01), individuals without chronic conditions (compared with individuals with at least one chronic conditions, β = -0.08, P < .001), individuals already vaccinated against COVID-19 (compared with individuals not vaccinated against COVID-19, β = 0.10, P < .001), individuals with higher levels of coronavirus anxiety (β = 0.06, P < .001), and individuals with greater fear of a conventional war (β = 0.09, P < .001). CONCLUSIONS: Our study showed a rather low level of climate anxiety. It also revealed some correlates of greater climate anxiety such as higher levels of coronavirus anxiety or greater fear of war. Knowledge about the correlates may assist in addressing individuals at risk for high levels of climate anxiety.
Evidence has emerged regarding the role of seasonality and several meteorological parameters on bipolar disorder, schizophrenia and depression. We investigated the relationship between ambient and apparent temperature and hospital admissions of major psychiatric diseases in a psychiatric clinic of a General Hospital situated in Northern Greece during 2013-19. Temperature data was provided by the National Observatory of Athens and diagnosis for psychotic, schizophrenic, manic and bipolar and unipolar depression were retrieved from medical records. A total of 783 admissions were recorded. Poisson regression models adjusted for time trends were applied to analyze the impact of temperature on monthly admissions. A summer peak was observed for the bipolar disorder, irrespectively of substance/alcohol use status. Seasonality emerged also for psychotic and schizophrenic patients with a through in winter. An increase of 1 °C in either ambient or apparent temperature was associated with an increase 1-2% in the monthly admissions in most outcomes under investigation. Alcohol and drug abuse did not modify this effect. Although our results indicate effects of temperature on psychiatric admissions, they are not consistent across subgroups populations and need to be replicated by other methodologically superior studies.
BACKGROUND: Climate change is having significant impacts on health and mental health across Europe and globally. Such effects are likely to be more severe in climate change hotspots such as the Mediterranean region, including Italy. OBJECTIVE: To review existing literature on the relationship between climate change and mental health in Italy, with a particular focus on trauma and PTSD. METHODS: A scoping review methodology was used. We followed guidance for scoping reviews and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for literature in MEDLINE, Global Health, Embase and PsycINFO. Following screening, data was extracted from individual papers and a quality assessment was conducted. Given the heterogeneity of studies, findings were summarized narratively. RESULTS: We identified 21 original research articles investigating the relationship between climate change and mental health in Italy. Climate change stressors (heat and heatwaves in particular) were found to have several negative effects on various mental health outcomes, such as a higher risk of mortality among people with mental health conditions, suicide and suicidal behaviour and psychiatric morbidity (e.g. psychiatric hospitalization and symptoms of mental health conditions). However, there is little research on the relationship between climate change and trauma or PTSD in the Italian context. CONCLUSIONS: More attention and resources should be directed towards understanding the mental health implications of climate change to prevent, promote, and respond to the mental health needs of Italy and the wider Mediterranean region. HIGHLIGHTS: • Climate change stressors in Italy were found to have detrimental impacts on various mental health outcomes, such as psychiatric mortality and morbidity. • Little research on the relationship between climate change stressors and PTSD exists in Italy.
The climate crisis poses a serious threat to the health and well-being of individuals. For many, climate change knowledge is derived from indirect exposure to information transmitted through the media. Such content can elicit a variety of emotional responses, including anger, sadness, despair, fear, and guilt. Worry and anxiety are especially common responses, usually referred to as “climate anxiety”. The main objectives of this study were to analyze how exposure to climate change through the media relates to climate anxiety and individual and collective self-efficacy, and to evaluate the relationship between climate anxiety and efficacy beliefs. A total of 312 Italian university students (aged 18-26 years) participated in the research by filling out an anonymous questionnaire. Participants reported being exposed several times per week to information about climate change, especially from social media, newspapers, and television programs. Moreover, the results showed that the attention paid to information about climate change was not only positively related to climate anxiety, but also to individual and collective self-efficacy. Most notably, participants’ efficacy beliefs were found to be positively related to climate anxiety. This somewhat controversial finding stresses that, in the context of pro-environmental behavior changes, a moderate level of anxiety could engender feelings of virtue, encouraging people to rethink actions with negative ecological impacts.
Climate change is a serious global health threat that has an impact on young people’s lives and may influence their mental health. Since the global climate strike movement, many adolescents have expressed worries about climate change. Thus, the aim of this study is to examine the prevalence of worries about climate change, and factors associated with worries about climate change, in a representative sample of Norwegian adolescents. Data were retrieved from Ungdata, an annual nationwide online youth survey. Adolescents (n = 128,484) from lower and upper secondary school participated in the study. Data were analysed descriptively and with logistic regression. Most of the adolescents were not worried or a little worried about climate change. Girls, pupils who had at least one parent with higher education and pupils from urban areas were more inclined to worry about the climate. Adolescents who worried about the climate had more symptoms of depression than those who were less worried. While worry about climate change may constitute an additional burden for adolescents experiencing depressive symptoms, such worry can also be seen to reflect climate-friendly values.
Background: Children and adolescents are considered to be particularly vulnerable to the psychological effects of climate change, such as extreme weather events. What are the protective factors and stressors for the mental health of the young population after extreme weather events in Germany? Methods: Nine semi-structured interviews with representatives of occupational groups providing care to children, adolescents, and political stakeholders were conducted in Simbach am Inn, a German town affected by flooding in 2016. The interviews were analyzed using qualitative content analysis according to Mayring. Results: The interviews show that the parents’ dealing with what they had experienced and the concern for their relatives were the most influential stressors for children and adolescents. As protective factors, they felt that conversations with familiar people and restoring a certain “normality” were particularly important. The interviewees described both, the time of the flooding, and the time after the initial state of shock had subsided, as particularly stressful. Consequently, the experts reported on children and adolescents acutely complaining of fear, helplessness, and extreme tension. Nevertheless, the demand for psychological care increased only slightly after the flooding in Simbach am Inn. Conclusion: The social environment of children and adolescents is essential for their psychological well-being after an extreme weather event. Research, especially on children and adolescents who have already been affected, must increase in order to be able to describe influencing factors even more precisely, to protect individuals from adverse mental health effects, and to identify healthcare requirements.
Demand for reducing mental health impacts from flooding through collective flood defence is elicited using a contingent valuation method with a sequential hypothetical scenario, which accounts for human resilience and experience. A two-step model fits the survey data: it combines a binary sample selection rule to distinguish protesters and participants with a Tobit model to accommodate true zero responses among participants. Results show that non-symptoms-specific information on mental health risk may bias the willingness to pay downward. Risk-averse individuals who have taken self-insurance protection measures are willing to pay for additional protection through collective defence. Feelings, such as worries and anxiety related to flooding, drive the demand, which supports the risk-as-feelings hypothesis for mental health protection from flooding. Inexperience rather than experience of flooding is found to increase demand, which indicates that individual mental resilience to flooding may increase after an event as posited by the inoculation hypothesis.
This exploratory study empirically shows how community social capital is related to post-disaster depression, whereas most disaster mental health research has focused on posttraumatic stress disorder. We tested the validity of earlier found multilevel social and individual mechanisms of posttraumatic stress for symptoms of post-disaster depression. We used data (n = 231) from a community study after a flood in Morpeth (2008), a rural town in northern England. At the salutary community level, our multilevel analyses showed that, in communities with high social capital, individuals employ less individual social support and coping effort, which protects individuals from developing symptoms of depression. Yet, on the ‘dark’ individual level of our model, we found that perceiving the disaster as less traumatic after a year was related to more feelings of depression in contrast to previous findings for posttraumatic stress. Our explanation of this finding is that, when the appraisal of the disaster as threatening fades into the background, individuals may perceive the full scope of the disaster aftermath and start to feel depressed. We also found that more social support is related to more depression. Although depressed people may attract or receive more social support, this social support can paradoxically become disabling by reinforcing a sense of dependence, thereby undermining self-esteem and leading to feelings of helplessness. Our results imply that to curb post-disaster depression, boosting community level social capital may be an important starting point for building resilience. At the same time, interventionists need to identify risk groups for whom the stressful experience becomes less intrusive and who experience the burden of dependency on an unequal relationship with ones’ social inner circle.
OBJECTIVE: Gender differences in posttraumatic stress disorder (PTSD) prevalence and severity are well established; there is also growing evidence that men and women develop PTSD symptoms differently. This article aims to examine gender differences in the relationship between PTSD symptoms and personality traits according to the Five Factor model (FFM), based on the data from different studies conducted in Poland. METHOD: The meta-analysis method and path analyses were conducted on the data from seven studies, including 1,182 women and 1,150 men. Five studies were carried out among motor vehicle accident survivors, one from fire and flood victims. All of the studies had a cross-sectional design. RESULTS: All FFM traits were significantly related to PTSD symptoms. Neuroticism showed the strongest relationship. Further analyses revealed a moderated mediation of this relationship: It was stronger for men and mediated by peritraumatic emotions and dissociation for women. CONCLUSIONS: The results indicate that PTSD development is mediated by peritraumatic factors, but this mediation is moderated by gender. Men with higher Neuroticism are at particular risk of developing PTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Many risk factors for PTSD have been identified in flood victims. Yet, some have been under-explored, like cognitive coping, which has been identified as a risk factor for PTSD for other traumatic events. Moreover, while flooding can affect places that are important to individuals (e.g. their home and neighbourhood), the role of sense of place in PTSD has been neglected. The objective of this research is to investigate the potential role of under-explored individual and situational risk factors in PTSD in flood victims. To this end, the following var-iables were measured in 79 French flood victims: sense of place (with sense of place scale), cognitive coping (with CERQ), and PTSD (with PCL-5). Results showed that the more individuals use inappropriate cognitive emotional regulation strategies, the more attached they are to their home and city, and the higher their PTSD scores. These results can help to target vulnerable people and improve care.
Background: Disasters negatively impact mental health and well-being. Studying how people adapt and recover after adversity is crucial for disaster preparedness and response. Objective: This study examined how differentially affected communities harness their resources to adapt to the aftermath of a flood. We predicted that stronger individual, interpersonal, and community resources protect against psychosocial resource loss and, through that, are related to fewer symptoms of posttraumatic stress and depression and higher life satisfaction. We also predicted that these effects would be stronger in a flooded community, compared to a threatened, but non-flooded community. Method: Participants were randomly sampled community members from two neighbouring municipalities. One municipality was severely flooded during the 2014 floods in South East Europe (affected community, n (a) = 223), the other was threatened but not flooded (comparison community, n (c) = 224). Interviews were conducted one and a half years after the disaster using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale, the Psychosocial Resource Loss Scale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale Revised and the Satisfaction with Life Scale. Results: Stronger individual, interpersonal, and community resources were found to be related to better post-disaster outcomes directly and indirectly through psychosocial resource loss. In the affected community, interpersonal resources and community social capital and engagement were stronger predictors of positive adaptation. In the comparison community, community economic development and trust in community leadership were more important. Conclusion: This study provides evidence that people affected by disasters can harness their individual, interpersonal, and community resources to recover and adapt. Post-disaster interventions should aim to strengthen family and community ties, thus increasing available social support and community connectedness.
BACKGROUND: Natural disasters are typically associated with the emergence of infectious diseases. On 15 June 2010, severe storms caused flooding in the Var department (France). A rumour about increased risk of Staphylococcusaureus skin infections after bathing in the sea began to circulate on Internet a few days after the floods. The aim of this study was to compare the rumour with the true incidence of cases of infection. METHODS: Since 1999, we have been conducting a prospective survey of S. aureus skin infections in our hospital to study their clinical, laboratory and epidemiologic features. We compared data on cases of Staphylococcus skin infection recorded in our institution from 2008 to 2012. RESULTS: We found that there was no increase in S. aureus skin infections after the floods compared to the previous and subsequent years. CONCLUSION: We had a unique opportunity to check the rumoured increase in incidence of infectious disease with the true incidence. In our study, the fear of S. aureus skin infections following flooding proved to be unfounded.
Flash floods are a worldwide threat to humans, which is why they are being intensively studied using historical event records. As measurements and event data increase, databases are becoming increasingly important for flash flood research. However, the recent literature on flood databases lacks technical details as well as discussions about a suitable database design for scientific investigations. In this paper, we thus show how an event database for the investigation of heavy rain-induced flood occurrences can be created. Based on the HiOS dataset (a German dataset with similar to 23,800 flash flood and pluvial flood events), we exemplify the database design and explore the spatiotemporal characteristics of floods caused by heavy rain in Germany. We outline all aspects relevant to database setup: from database requirements and system architecture through table and attribute design to a key and relationship definition. Furthermore, we clarify why a spatial database with interfaces for GIS softwares should be chosen, why a damage-based event definition is preferable to a hydrometeorological definition, and how table attributes support differentiated analyses. By means of the database, we investigated frequency, temporal evolution, spatial distribution and patterns, fatalities and injuries, as well as the seasonality of heavy rain-induced floods in Germany. The results indicate that floods caused by heavy rain occur throughout Germany but with a tendency toward fewer events in the northern direction. Across the country, we identified seven hot spots in urbanized and mountainous regions. Although heavy rain-induced floods in Germany take place mostly between noon and late afternoon, most people are injured and killed in events starting in the evening. Our investigation indicates an increased incidence of flash flood and pluvial flood-related injuries and fatalities in the identified hot spots. Overall, we observe a pronounced summer seasonality of the heavy rain-induced flood events. This study highlights the importance of event databases for flash flood research and advances our understanding of heavy rain-induced flood occurrences in Germany.
Flash floods are one of the harshest natural hazards, having a wide range of substantial impacts for human and environmental health in the short-term and long-term. On 15 November 2017, a high-intensity storm caused a catastrophic flash flood event in the town of Mandra, a western, outer suburb of the Athens Metropolitan Area in Greece. In this study, we determine the aqua regia extractable concentrations of trace elements in residual sediments and associated soils after the flash flood and evaluate the fractionation of contaminants in geochemical compartments. Geochemical data are coupled with physicochemical parameter measurements and mineralogy to identify possible factors explaining the variability of trace element concentrations, while a dilute acid extraction is used to monitor changes of the reactive fraction of the trace elements over the term of 1 year following the flood event. Aqua regia concentrations in flood-deposited sediments reached values of 1 mg/kg (Cd), 24 mg/kg (Co), 183 mg/kg (Cr), 599mg/kg (Cu), 1080 mg/kg (Mn), 195 mg/kg (Ni), 122 mg/kg (Pb) and 945 mg/kg (Zn). Multivariate statistical techniques classified the elements according to their natural or anthropogenic origin. Trace elements of geogenic origin (As, Co, Cr, Mn, Ni) dominate in flood deposited material. The cluster of anthropogenic elements (Cd, Cu, Pb, Zn,) shows significant correlation with total organic carbon and magnetic susceptibility, while a significant seasonal variation has been observed for total organic carbon, Cd and Mn contents in the deposited sediments. Results allow a better understanding of the distribution of elements in the surface cover during and after catastrophic events in urban areas and provide useful information on the long-term exposure of the residents.
Intensive urbanization and related increase of impervious surfaces, causes negative impacts on the hydrological cycle, amplifying the risk of urban floods. These impacts can get even worse due to potential climate change impacts. The urban areas of the Simeto River Valley (SRV), the largest river valley in Sicily (Italy), have been repeatedly hit by intense rainfall events in the last decades that lead to urban flooding, causing several damages and, in some instances, threats to population. In this paper, we present the results of a 10-question survey on climate change and risk perception in 11 municipalities of the SRV carried out within the activities of the LIFE project SimetoRES, which allowed to collect 1143 feedbacks from the residents. The survey investigated: (a) the level of worry about climate change in relation to extreme storms, (b) elements of urban flooding risk preparedness: the direct experience of the residents during heavy rain events, their trust in a civil protection regional alert system, and their knowledge of the correct behavior in case of flood, and (c) the willingness of citizens to implement sustainable drainage actions for climate change adaptation in their own municipality and real estates. The results show that more than 52% of citizens has inadequate knowledge of the correct behavior during flooding events and only 30% of them feel responsible for mitigation of flooding risk. There is a modest willingness by the population to support the construction of sustainable urban drainage infrastructures. A statistical cross-analysis of the answers to the different questions, based on contingency matrices and conditional frequencies, has shown that a greater worry about climate change has no significant impact either on the behavior of people in dangerous situations occurring during flooding events or on the willingness to support financially sustainable solutions. These results suggest that to build a higher worry about climate change and related urban flooding risk is not sufficient to have better preparedness, and that more direct educative actions are necessary in the area.
Flood simulations are important for flood (fatality) risk assessment. This article provides insight into the sensitivity of flood fatality risks to the model resolution of flood simulations and to several uncertain parameters in the loss of life model used. A case study is conducted for river flooding in a polder in the Netherlands (the Bommelerwaard) where the Dutch approach for loss of life estimation is applied. Flood models with resolutions of 100, 25, and 5 m are considered. Results show locally increased mortality rates in higher resolution simulations nearby structures including road embankments, dikes, and culverts. This causes a larger maximum individual risk value (annual probability of death for a person due to flooding) which has consequences for safety standards based on the individual risk criterion. Mortality rate in the breach zone is also affected by representations of buildings as solid objects versus as roughness elements. Furthermore, changes in the loss of life estimation approach via alternative ways of including people’s behaviour, building characteristics, and age of the population, have a significant impact on flood fatality risk. Results from this study can be used to support future risk assessments and decision making with respect to safety standards.
Spring floods in Siberia annually affect local communities. Major urban settlements in the region implemented flood control structures, so rural areas take a heavy beating. In 2018, spring floods severely hit multiple communities in central Yakutia, exposing deficient flood prevention and risk management practices. Notably, Amga village, an important local center, was severely inundated. Hydrological analysis shows that the 2018 flood had a 50-yr return period, and was caused by an ice jam in a nearby channel bend where mid-channel sand bars impede ice movement during breakup. The cold spells of late April and early May in the middle section of the river promote ice-jam development, causing extreme water stage rise. Highest water stage is unrelated to either winter snow water equivalent or early May rainfall. Estimated tangible direct damage to the Amga community equals 5.1B ($81.5M) in 2018 prices, but only 0.13B ($2.1M), or 2.5% of this total, was reclaimed. A questionnaire survey revealed that most residents report important deterioration of drinking water quality and health after flooding. Residents respond positively to risk mitigation actions, implemented by the local and regional authorities, except ice dusting and cutting, and report minor activity of official sources in spreading information on flood progress.
Major floods in Spain in September 9-13, 2019 resulted in seven casualties and massive losses to agriculture, property and infrastructure. This paper investigates the utility of satellite data to: (1) characterize the event when input into a hydrological model, and to provide an accurate picture of the evolution of the floods; and (2) inform meteorologists in real time in order to complement model forecasts. It is shown that the precipitation estimates from the Global Precipitation Measurement (GPM) Core Observatory (GPM-CO, available since 2014) and the merged satellite estimates provide an extraordinary improvement over previous technologies to monitor severe hydrometeorological episodes in near real time. In spite of known biases and errors, these new satellite precipitation estimates can be of broad practical interest to deal with emergencies and long-term readiness, especially for semi-arid areas potentially affected by ongoing global warming. Comparisons of satellite data of the September event with model outputs and more direct observations such as rain gauges and ground radars reinforce the idea that satellites are fundamental for an appropriate management of hydrometeorological events.
OBJECTIVE: Cutaneous larva migrans (CLM) is a parasitic disease seen in people in contact with soil in tropical countries. Almost all cases reported in regions without a tropical climate have a history of travel to a tropical region. AIM: In our study, we aimed to investigate the effect of climate change on CLM cases and the demographic characteristics of these cases. For this purpose, the climate information of the period in which we determined the case series and the characteristics of the patients were investigated. MATERIAL AND METHOD: The study was designed retrospectively. Patient files and pre- and post-treatment photographic archives were reviewed retrospectively. In addition, the region’s weather history over the last 50 years was examined. RESULTS: The records of patients diagnosed with CLM in 2018 were reviewed retrospectively. In total, 22 cases were detected. The common feature of all cases was that they worked as tea pickers. After examining the weather conditions of the period when the cases were commonly reported, it was determined that there was a sharp temperature increase compared with previous years. CONCLUSION: Due to climate change, an increase in the number of CLM cases is observed in non-tropical regions. Since it is considered a disease-specific to tropical regions, the diagnosis may be overlooked in cases outside these regions. However, CLM should be kept in mind as a diagnostic possibility by clinicians practicing in non-tropical regions as well, especially when treating patients who work with soil, such as tea harvesters.
Tools exist to predict fatalities related to floods, but current models do not focus on fatalities in buildings. For example, Storm Xynthia in France in 2010 resulted in 41 drowning deaths inside buildings. Therefore, there has been increasing recognition of the risk of people becoming trapped in buildings during floods. To identify buildings which could expose their occupants to a risk of death in the case of flooding, we propose the use of the extreme vulnerability index (VIE index), which identifies which buildings are at greatest risk of trapping people during floods. In addition, the “mortality function method” is used to further estimate the expected number of fatalities based on (1) groups of vulnerable people (e.g., aged or disabled), (2) the location of buildings in relation to major watercourses, and (3) the configuration of buildings (e.g., single or multiple entries and single or multiple stories). The overall framework is derived from case studies from Storm Xynthia which give a deterministic approach for deaths inside buildings for coastal floods, which is suited for low-lying areas protected by walls or sandy barriers. This methodology provides a tool which could help make decisions for adaptation strategy implementation to preserve human life.
Climate-change induced disasters, like floods, are expected to increase in the future. In outdoor built environments, flood risk to evacuees depends on interactions between floodwater spreading, built environment features, flood-induced modifications, and individuals’ reaction in emergency phases. Disaster risk reduction strategies should mitigate the immediate flood impacts and improve the community resilience, while being easy-toimplement and effectively supporting evacuees during the initial phases of the emergency. Simulation-based methodologies could support safety planners in evaluating the effectiveness of such strategies, especially if basing on a micro-scale-oriented approach that represents emergency interactions between each individual and the surrounding outdoor built environment. This study adopts an existing micro-scale simulator (FlooPEDS) reproducing experimental-based flood evacuation behaviours. According to a behavioural design-based approach, simulation results focus on individual responses in the outdoor built environment through Key Performance Indicators (KPIs) aimed at providing evidence of critical interactions between evacuees, floodwaters and the outdoor built environment. A case study is selected by considering different flood scenarios to test such KPIs. Risk reduction solutions are then provided, and their effectiveness is checked by simulations. Results show the micro-scale and behavioural design-based approach capabilities in proposing multi-scenarios solutions (e.g.: architectural elements to support evacuees; emergency planning).
This paper joins the growing scholarly concern for the sharpening of social and environmental inequalities in European cities, particularly those generated in Eastern Europe by evictions of poor Roma from inner-city areas and by the invisibilization of their extreme conditions. We argue that these processes – evictions and invisibilizations – create a heightened vulnerability to climate change impacts for these individuals. The paper uses secondary survey data on compact Roma groups in Romania and analyses qualitative and cartographic information collected by the authors (2019) in two mid-sized cities in Romania to flesh out the particular slum ecologies that emerge following evictions. The focus is also on the subtle processes of invisibilization that render displaced Roma vulnerable and rob them of the “right to the city” in terms of climate change adaptation. Our finding is that evicted Roma experience innumerable, “routine” weather-related impacts, such as floods, storms or cold. By exploring Roma’s heightened exposure, sensitivity and reduced adaptive capacity, we show how these impacts increase their vulnerability to future extreme weather events. These findings are indicative of a broader process of fragmentation taking place in urban areas throughout Eastern Europe, which render invisible some very real barriers to climate change adaptation.
Floods affected more than 2 billion people worldwide from 1998 to 2017 and their occurrence is expected to increase due to climate warming, population growth and rapid urbanization. Recent approaches for understanding the resilience of transportation networks when facing floods mostly use the framework of percolation but we show here on a realistic high-resolution flood simulation that it is inadequate. Indeed, the giant connected component is not relevant and instead, we propose to partition the road network in terms of accessibility of local towns and define new measures that characterize the impact of the flooding event. Our analysis allows to identify cities that will be pivotal during the flooding by providing to a large number of individuals critical services such as hospitalization services, food supply, etc. This approach is particularly relevant for practical risk management and will help decision makers for allocating resources in space and time.
The increasing rate of anthropic activities in flood-prone areas and the effects of climate change are aggravating the dangers posed by floods to people. One of the main reasons for fatality during flood events is walking through floodwaters. Although authorities strongly advise against walking in flood waters, evacuations or the accessing of flooded areas by emergency services might be necessary. This research proposes a novel approach to increasing resilience by retrofitting existing infrastructures to enhance evacuation and access routes by reducing flood hazard rate based on flood and pedestrian characteristics. The methodology was applied to flash floods in two case studies in the UK, namely Boscastle and Borth, highlighting that retrofitting small regions of the existing roads and pathways to reduce flood hazard can enhance people’s safety during the evacuation, and hence provides a solution to improve the resilience of the existing environment.
Fatalities associated with severe weather, collected from newspapers and other documentary sources, were used to create a corresponding database for the 1961-2020 period for the Czech Republic. Fatalities attributed to floods, windstorms, convective storms, snow and glaze ice, frost, fog, and other severe weather, on the one hand, and vehicle accident fatalities connected with rain, snow, glaze ice, fog, and inclement weather, on the other, were analysed separately for two standard periods, 1961-1990 and 1991-2020. The number of weather-related fatalities between these two periods increased in the flood, windstorm, and especially frost categories, and decreased for the convective storm and fog categories. For snow and glaze ice they were the same. Despite significant differences in both 30-year periods, the highest proportions of fatalities corresponded to the winter months, and in individual fatality characteristics to males, adults, direct deaths, deaths by freezing or hypothermia, and to hazardous behaviour. A statistically significant (p < 0.05) Spearman rank correlation between fatalities and climate variables was only found in the 1991-2020 period for snow/glaze ice-related fatalities, with the number of days with snow cover depth and frost-related fatalities having days with daily minimum temperatures below -5 degrees C or -10 degrees C. Despite the highest proportions of the rain and wet road categories being in the number of vehicle accident fatalities, a statistically significant correlation was only found for the category of snow-related fatalities in the number of days with snowfall. The results and conclusions of this study have to be evaluated in the broader context of climatological, political, economic, and societal changes within the country, and have the potential to be used in risk management.
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.
In Portugal, forest fires are responsible for disasters that tend to be repeated annually, leading to dramatic consequences, such as those that have occurred in 2017, with the destruction of hundreds of houses and the deaths of dozens of people. Firefighters who are exposed to these potentially traumatic events are considered a high-risk group for the development of stress-related disorders. The aim of this study was to monitor the progress of two firefighters with symptoms of post-traumatic stress disorder (PTSD) treated through dynamic psychotherapy (DP) and to assess the feasibility of implementing this intervention within fire departments. A female firefighter and a male firefighter, with similar sociodemographic characteristics and PTSD symptom severity, were selected to verify the treatment applicability for both genders. The symptomatology changes were assessed through a set of instruments (PHQ-15, PCL-5, BSI, DASS, and CALPAS-P) applied every three months over 15 months (including pre-treatment, treatment period, and post-treatment). DP seemed to be an effective treatment for PTSD symptoms, with patients showing a state of increasing improvement even after the end of treatment. The acceptability to firefighters, the treatment adherence, the therapeutic alliance, and the reduction in PTSD symptoms suggest feasibility for implementing this intervention inside the Portuguese fire departments.
Forest fires burn an average of about 440 000 ha each year in southern Europe. These fires cause numerous casualties and deaths and destroy houses and other infrastructure. In order to elaborate on suitable firefighting strategies, complex interactions between human and environmental factors must be taken into account. In this study, we investigated the spatiotemporal evolution in the burned area over a 50-year period (1970-2019) and its interactions with topography (slope aspect and inclination) and vegetation type in southeastern France by exploiting the geographic information system (GIS) databases. Data were analyzed for two 25-year periods (1970-1994 and 1995-2019), since a new fire suppression policy was put into place after 1994, which focused on rapid extinction of fires in their early phase. In the last 25 years, the burned area decreased sharply, and the geographic distribution of fires also changed, especially in regions where large fires occur (Var administrative division). Elsewhere, even though forest fires remain frequent, the total extent of the burned area decreased substantially. Fire hotspots appear closer to built-up areas in the west, are randomly distributed in the east, and they almost completely disappear in the central region of the study area where there is a history of large fires. Slope orientation presents an increasingly important role in the second period; south-facing slopes are preferred the most by fire, and north-facing slopes are preferentially avoided. Even though the slope inclination is less affected by the new firefighting strategy, low slope inclinations are even more avoided after 1994. The greatest proportion of the burned area is strongly associated with the location of sclerophyllous vegetation clusters which exhibit highly fire prone and expand in area over time. Natural grasslands are also preferred by fire, while broadleaved, coniferous, and mixed forest are increasingly avoided by fire.
This study investigated two high-impact wildland fire events that took place on 23 July 2018 in Attica Region, Central Greece during extreme prevailing weather conditions. The tragic aftermath was 102 life losses in MATI fire event, the largest number of deaths from a fire event in history of the country. The synoptic analysis revealed the presence of a positively tilted trough over the Central Mediterranean and Balkans, propagating eastwards and interacting with the subtropical jet, resulting in a strong westerly flow over Greece. Several surface stations in the wider area recorded wind gusts exceeding 20 m s(-1) between 12:00 and 17:30 UTC. The online coupled atmosphere-fire model WRF-SFIRE was utilized in order to simulate these extreme fire events and to investigate the role of the complex terrain to the mean flow and fire behavior. The numerical simulations revealed the presence of induced orographic waves, paths of high winds on the lee-slopes, transient resemblance of a hydraulic jump downstream of Penteli Mt. (MATI), while indicated a downward transport of energy and momentum during the maximum wind speed occurrences. The turbulent and dynamically unstable conditions on the lee-slopes of Gerania Mts. (KINETA) and Penteli Mt. contributed to the flow kinetic energy. Quite different influences of topography in each fire event were found, where the isolated Gerania Mts. contributed to warmer, drier and windier conditions leeward, while Penteli Mt. had a lesser impact on atmospheric variables downstream.
The summer of 2017 in the Calabria Region (South Italy) was an exceptional wildfire season with the largest area burned by wildfires in the last 11 years (2008-2019). The equivalent black carbon (EBC) and carbon monoxide (CO) measurements, recorded at the high-altitude Global Atmosphere Watch (GAW) Monte Curcio (MCU) regional station, were analyzed to establish the wildfires’ impact on air quality, human health, and the ecosystem. A method was applied to identify the possible wildfires that influenced the air quality based on the integration of fire data (both satellite and ground-based) and the high-resolution WRF-HYSPLIT trajectories. The satellite-based fires applied to WRF-HYSPLIT with 10 km of spatial resolution allowed us to establish that for 52.5% of total cases, wildfires were located outside the Calabria Region, and they were influenced by long-range transport. Nonetheless, the impact on human health, qualitatively evaluated in terms of passively smoked cigarettes (PSC) corresponding to the EBC, was greater when wildfires were local. Indeed, for wildfires located mainly in Calabria, the equivalent PSC ranged from 2.75 to 11.08. This maximum PSC value was close to the daily number of smoked cigarettes in Calabria (approximately 12.4). Even if this analogy does not imply a proportional effect between the estimated number of cigarettes smoked and the effective wildfire EBC exposure, this result suggests that wildfire emissions may have negative effects on people’s health. Moreover, a focus on the Calabria Region was conducted using high-resolution ground-based GPS and higher resolution WRF-HYSPLIT back-trajectories (2 km) to measure wildfires. The validity of the methodology was confirmed by the EBC and CO positive correlation with the ratio between the identified ground-based burned areas and the distance from the sampling station. Moreover, the impact on the ecosystem was studied by analyzing the land vegetation loss due to the wildfires that contributed to air quality reduction at the MCU station. A total of more than 1679 ha of vegetation burned, the main losses comprising forests and shrubland. (C) 2020 Elsevier B.V. All rights reserved.
Climate change has increased the prevalence of wildfires, resulting in longer fire seasons and larger geographic area burned. The aim of this work was to assess the air pollution and health risk to the population caused during exposure to smoke in fire season. The study design included: an analysis of long-term air pollution to determine background levels; an analysis of short-term (<24 h) and subchronic (10-14 days) concentrations during wildfires; and an assessment of the health risk in the industrial center of the Baikal region (Russia). In Irkutsk, at a distance of 2000 km from the fire focal points, the maximum short-term concentrations of pollution were noted during the smoke period, when the average CO level increased 2.4 times, and PM1 increased 1.4 times relative to the background levels in August 2021. In Bratsk, located near the fires, the increases in short-term concentrations were: CO-21.0; SO2-13.0; formaldehyde-12.0; TPM-4.4 times. The hazard indices of respiratory and coronary diseases in the burning period exceeded the acceptable level. Acute reactions to smoke can be expected in 30% of the exposed population near fires and 11% in remote areas (Bratsk). The results obtained from the remote sensing of atmospheric smoke can be used to urgently resolve the issue of organizing medical assistance or evacuating the population groups most sensitive to the effects of smoke in fire season.
Featured Application This review contribute to understand the mechanisms underlying the observed rockfall activity during and after a wildfire, to advance in the solutions and methods to address the study of the problem, and to assess the hazard during and after wildfire, and its impact on not only transportation infrastructure and urban areas, but also the population. The results will help the decision makers and emergencies authorities to evaluate the exposure of elements at risk, to define actions to reduce their vulnerability and to identify measures to mitigate damages and social impact. Understanding processes and conditions that lead to rockfalls during and after a wildfire in different geological contexts is crucial since this phenomenon is one of the major hazards in mountainous regions across Europe. Spain is one of the European countries with the highest rate of wildfires, and rockfalls cause high economic and social impact, with many fatalities every year. The increase of rockfalls during and after wildfires is connected with the merging of different factors, not only in the detached area but also in the propagation and potentially affected area. When wildfire occurred, many actions take place: changes in the mechanical conditions of the rocks, the loss of protective capacity from vegetation, the effect induced by firefighting activities and/or the impact by the high temperatures in the adopted protective measures. After the wildfire, there is an increase in frequency and intensity of rockfalls in the burned area, causing a major impact of rockfalls on not only road networks and built-up areas but also people living. Additionally, the removal of vegetation by wildfires causes an increase in the risk perception, related not only to detached blocks but also to the general appearance of the rock mass. In this review, the main factors that influence the occurrence of rockfalls after a wildfire are analyzed, and three actual case studies in Spain are presented to support the variety of conclusions obtained.
Although England has been experiencing major floods dating back thousands of years, the hazard is increasing in frequency and intensity, exacerbated by climate risks with potentially serious consequences. Despite attempts to mitigate climate risks (manifested via recurrent flooding) in line with international disaster risk reduction agendas, the impacts/effects of floods continue to increase in England. This is partly due to negligence in inculcating contemporary flood risk perceptions (FRP) into climate risk management (CRM) strategies. This research aims to investigate contemporary FRM in England through a qualitative case study approach in Wainfleet All Saints in Lincolnshire County that experienced unprecedented floods in June 2019. Empirical investigation was conducted with the flood-affected community members and flood managers with oversight of CRM in the region. Key findings reveal the June 2019 floods had both tangible and intangible impacts for the affected community with dreadful effects. Challenges to CRM revealed issues around limited funding; climate changes’ potential to increase flood risk and low community perception of their own risks reflected in poor/none-preparedness for contemporary floods. The multi-agency response to the June 2019 floods was found to be positive, albeit with a few concerns. Based on the analysis of the findings, a series of policy recommendations are proffered with the aim to spur organisational/institutional resilience to CRM. This article underscores the relevance to continuously include contemporary FRP into CRM strategies especially to enhance community participation and involvement in mitigating their own risks.
Managed retreat is increasingly advocated as a means to promote resilience and adaptation to climate change. However, there are various uncertainties and challenges associated with the impacts of displacement and attachments to place. In this context, it is useful to study past examples of relocation to understand how these challenges have been addressed. This paper draws on a case study relocation scheme which took place in Ireland following major flooding in 1954. This represented a radical and comprehensive approach to relocation which sought to address the root causes of vulnerability. The analysis shows that this comprehensive approach was made possible through a connection between managed retreat and land reform. The scheme also faced opposition linked to attachments to place and property. This led to compromises and a failure to fully address the effects of flooding on livelihoods but contributed to resilience through ensuring that family and community ties remained intact. The paper’s distinctive contributions are its analysis of the requirements of transformative approaches to adaptation and relocation, its identification of challenges associated with place and property even in the context of such transformative approaches, and its adding of historical depth to contemporary debates on climate adaptation.
OBJECTIVES: Flooding is associated with increased psychological morbidity; however, the impact of living with the uncertainty of flood risk has not been explored. The aim of this study was to generate insight into individual experiences of living with persistent flood risk, how it affects psychological well-being, and the forms of support deemed appropriate to mitigate psychological risks. STUDY DESIGN: A qualitative study was conducted using semistructured interviews with participants who lived in a persistent flood risk area in Nottinghamshire, UK. METHODS: 40 participants were interviewed. The study adopted an interpretivist constructionist position, and the transcripts were analysed using inductive thematic analysis. RESULTS: Persistent flood risk was seen as a significant stressor, regardless of previous flood history. Some participants reported anxiety in anticipation of a future flood event and demonstrated low self-efficacy, with subsequent feelings of helplessness in responding to flood risk. Individuals who lacked acceptance of flood risk displayed higher anxiety and lower resilience. Recognition of flood risk as a psychological stressor was requested in future support. CONCLUSIONS: Living with the uncertainty of persistent flood risk can have significant psychological impacts. Interventions that facilitate the empowerment of individuals living with persistent flood risk may strengthen psychological resilience.
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.
Public communication on water availability is pivotal in highlighting water conservation needs as droughts impact water resources for critical use, such as drinking water quality and accessibility. This paper presents the results of research into public communication on water availability and the implementation of water conservation measures in the Republic of Ireland. The paper analyses social media (Twitter and Facebook) communication and newspaper publications from 2018 to 2020 on water conservation and drought events, in addition, to undertaking six key stakeholder interviews made up of journalists (n = 4), political representatives (n = 1), and a water and communication expert (n = 1). Our analysis indicates that Irish newspapers’ coverage of drought and water availability was greater in 2018 compared to 2020. Uncertainty and risk was also identified as the prevalent frame, used by newspapers to cover drought events. Although the sentiments in communications on drought by the national utility, Irish Water, were scored as positive (63%), its engagement with the public on social media was considerably limited. Accessible information platforms that provides data and information on water resources were also found; nevertheless, no comprehensive national drought information management system nor national drought plan have been developed. Based on our findings, we demonstrate the need for public engagement and collaborative efforts to communicate drought and water conservation measures led by An Fóram Uisce|The Water Forum. Recommendations made in this study also aim to influence decision-making and awareness among stakeholders regarding drought communication on water conservation and resources availability.
Drought affects the European Alpine mountain region, despite a humid climate. Droughts’ damaging character in the past and increasing probability in future projections call for an understanding of drought impacts in the mountain regions. The European Drought Impact report Inventory (EDIT) collects text reports on negative drought impacts. This study presents a considerably updated EDII focusing on the Alpine region. This first version release of an Alpine Drought Impact report Inventory (EDIIALPS) classifies impact reports into categories covering various affected sectors and enables comparisons of the drought impact characteristics. We analysed the distribution of reported impacts on the spatial, temporal and seasonal scale and by drought type for soil moisture drought and hydrological drought. For the spatial analysis, we compared the impact data located in the Alpine region to the whole of Europe. Furthermore, we compared impact data between different climatic and altitudinal domains (the northern region vs. the southern region and the pre-Alpine region vs. the high-altitude region) and between the Alpine countries. Compared to the whole of Europe, in the Alpine region agriculture and livestock farming impacts are even more frequently reported, especially in the southern region. Public water supply is the second most relevant sector but overall less prominent compared to Europe, especially in spring when snowmelt mitigates water shortages. Impacts occur mostly in summer and early autumn, with a delay between those impacts initiated by soil moisture and those initiated by hydrological drought. The high-altitude region shows this delay the strongest. From 1975 to 2020, the number of archived reports increases, with substantially more impacts noted during the drought events of 1976, 2003, 2015 and 2018. Moreover, reported impacts diversify from agricultural dominance to multi-faceted impact types covering forestry, water quality, industry and so forth. Though EDIIALPS is biased by reporting behaviour, the region-specific results of negative drought impacts across the water-rich European mountain region demonstrate the need to move from emergency response to prevention and preparedness actions. These may be guided by EDIIALPS’ insights to regional patterns, seasons and drought types.
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.
There is only limited scientific evidence with varying results on the association between hospital admissions and low ambient temperatures. Furthermore, there has been no research in Northern Europe on cold-associated morbidity. Therefore, this study investigated the associations of daily wintertime temperature and cold spells with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Daily number of non-elective hospital admissions for 2001-2017 was obtained from the national hospital discharge register and meteorological data from the Finnish Meteorological Institute. Quasi-Poisson regression models were fitted, controlling for potential confounders such as time trend, weekday, holidays, air pollution, barometric pressure, and influenza. The associations of cold season daily mean ambient temperature and cold spells with hospital admissions were estimated using a penalized distributed lag linear models with 21 lag days. Decreased wintertime ambient temperature was associated with an increased risk of hospitalization for myocardial infarction in the whole population (relative risk [RR] per 1 degrees C decrease in temperature: 1.017, 95% confidence interval [CI]: 1.002-1.032). An increased risk of hospital admission for respiratory diseases (RR: 1.012, 95% CI: 1.002, 1.022) and chronic obstructive pulmonary disease (RR: 1.031, 95% CI: 1.006, 1.056) was observed only in the >= 75 years age group. There was an independent effect of cold spell days only for asthma admissions (RR: 2.348, 95% CI: 1.026, 5.372) in the all-ages group. Cold temperature increases the need for acute hospital care due to myocardial infarction and respiratory causes during winter in a northern climate.
BACKGROUND: A positive correlation between T1DM onset and winter has been suggested by several studies. We investigated the seasonal variation of T1DM diagnosis and epidemiological parameters in children from Western Greece with T1DM. METHODS: One hundred and five patients, 44 males, aged 1-16 years were studied. The month of the diagnosis, the order of birth, gestational age, birth weight, the mode of delivery, parental age and pubertal status were recorded from the patients’ files. RESULTS: The mean age at diagnosis was 8.1 ± 4.0 years. The majority of the studied patients were diagnosed during the period of October-March. The majority were born at full term, 11.7% were preterm babies and 52.3% were first born. The mean birth weight was 3266 ± 596 g. 60% were born by vaginal delivery. The majority of the patients were prepubertal at diagnosis. CONCLUSIONS: Our results are in agreement with the reported seasonal variation of T1DM onset in other regions of Greece and Europe. The positive correlation between T1DM presentation and colder temperatures may be explained by factors such as viral infections. This is the first report on epidemiological parameters that may be related to T1DM presentation in Western Greece. The study of such parameters extends the understanding on the disease as a whole. IMPACT: A seasonality of the T1DM diagnosis is shown, with a predominance of the colder months of the year. This is in agreement with previous reports from other countries. Our findings confirm previously reported data and add to the existing knowledge on T1DM in general. Additionally, this is one of the few reports on the incidence and epidemiology of T1DM in Greece and the first in the region of Western Greece. Safer and more accurate conclusions can be drawn with regards to the possible causes and predisposing factors of T1DM by the assessment of statistical data from different populations throughout the world. This offers a better understanding of T1DM and may also contribute to the identification of factors that may reduce the incidence of the disease in the future.
Background While many studies analyze the effect of extreme thermal events on health, little has been written about the effects of extreme cold on mortality. This scarcity of papers is particularly relevant when we search studies about extreme cold on the health of rural population. Therefore, we tried to analyze the effect of cold waves on urban areas and rural areas from Madrid and to test whether differentiated effects exist between both population classes. For this purpose, we analyzed data from the municipalities with over 10,000 inhabitants for the period from January 1, 2000 through December 31, 2013. Municipalities were classified as urban or rural (Eurostat), and they were grouped into similar climatological zones: Urban Metropolitan Centre (UMC), Rural Northern Mountains (RNM), Rural Centre (RC) and Southern Rural (SR). The dependent variable was the daily mortality rate due to natural causes per million inhabitants (CIE-X: A00-R99) that occurred between the months of November and March for the period. The independent variable was minimum daily temperature (oC) (T-min). Social and demographic contextual variables were used, including: population > age 64 (%), deprivation index and housing indicators. The analysis was carried out in three phases: (1) determination of the threshold temperature (T-threshold) which defines the cold waves; (2) determination of the relative risk (RR) for cold waves using Poisson linear regression (GLM); and (3) using GLM of the binomial family, Odds Ratios (OR) were calculated to analyze the relationship between the frequency of the appearance of cold waves and the socioeconomic variables. Results The UMC zone experienced 585 extreme cold events related to attributable increases in the mortality rate. The average number of cold waves in the rural zones was 319. The primary risk factor was the percentage of population over age 64, and the primary protective factor was housing rehabilitation. As a whole, the period experienced more cold waves (1542) than heat waves (1130). Conclusion The UMC was more vulnerable than the rural areas. Furthermore, the results support the development of prevention policies, especially considering the fact that cold wave events were more frequent than heat waves.
Acute myocardial infarction (AMI) is a major public health problem. Cold winter weather increases the risk of AMI, but factors influencing susceptibility are poorly known. We conducted an individual-level case-crossover study of the associations between winter cold spells and the risk of AMI, with special focus on survival at 28 days and effect modification by age and sex. All 16,071 adult cases of AMI among the residents of the city of Kaunas in Lithuania in 2000-2015 were included in the study. Cold weather was statistically defined using the 5th percentile of frequency distribution of daily mean temperatures over the winter months. According to conditional logistic regression controlling for time-varying and time-invariant confounders, each additional cold spell day during the week preceding AMI increased the risk of AMI by 5% (95% CI 1-9%). For nonfatal and fatal cases, the risk increase per each additional cold spell day was 5% (95% CI 1-9%) and 6% (95% CI – 2-13%), respectively. The effect estimate was greater for men (OR 1.07, 95% CI 1.02-1.12) than for women (OR 1.02, 95% CI 0.97-1.08), but there was no evidence of effect modification by age. Evidence on factors increasing susceptibility is critical for targeted cold weather planning.
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.
Previous studies on the connection between climate and plague were mostly conducted without considering the influence of large-scale atmospheric circulations and long-term historical observations. The current study seeks to reveal the sophisticated role of climatic control on plague by investigating the combined effect of North Atlantic Oscillation (NAO) and temperature on plague outbreaks in Europe from 1347 to 1760 CE. Moving correlation analysis is applied to explore the non-linear relationship between NAO and plague transmission over time. Also, we apply the cross-correlation function to identify the role of temperature in mediating the NAO-plague connection and the lead-lag relationship in between. Our statistical results show that the pathway from climate change to plague incidence is distinctive in its spatial, temporal, and non-linear patterns. The multi-decadal temperature change exerted a 15-22 years lagged impact on the NAO-plague correlation in different European regions. The NAO-plague correlation in Atlantic-Central Europe primarily remained positive, while the correlation in Mediterranean Europe switched between positive and negative alternately. The modulating effect of temperature over the NAO-plague correlation increases exponentially with the magnitude of the temperature anomaly, but the effect is negligible between 0.3 and -0.3 degrees C anomaly. Our findings show that a lagged influence from the temperature extremes dominantly controls the correlation between NAO and plague incidence. A forecast from our study suggests that large-scale plague outbreaks are unlikely to happen in Europe if NAO remains at its current positive phase during the earth’s future warming. (C) 2020 Elsevier B.V. All rights reserved.
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.
BackgroundWaterborne disease outbreaks (WBDO) associated with tap water consumption are probably underestimated in France.AimIn order to improve their detection, Santé publique France launched a surveillance system in 2019, based on the periodical analysis of health insurance data for medicalised acute gastroenteritis (mAGE).MethodsSpatio-temporal cluster detection methods were applied to mAGE cases to prioritise clusters for further investigation. These investigations determined the plausibility that infection is of waterborne origin and the strength of association.ResultsBetween January 2010 and December 2019, 3,323 priority clusters were detected (53,878 excess mAGE cases). They involved 3,717 drinking water supply zones (WSZ), 15.4% of all French WSZ. One third of these WSZ (33.4%; n = 1,242 WSZ) were linked to repeated clusters. Moreover, our system detected 79% of WBDO voluntarily notified to health authorities.ConclusionEnvironmental investigations of detected clusters are necessary to determine the plausibility that infection is of waterborne origin. Consequently, they contribute to identifying which WSZ are linked to clusters and for which specific actions are needed to avoid future outbreaks. The surveillance system incorporates three priority elements: linking environmental investigations with water safety plan management, promoting the systematic use of rainfall data to assess waterborne origin, and focusing on repeat clusters. In the absence of an alternative clear hypothesis, the occurrence of a mAGE cluster in a territory completely matching a distribution zone indicates a high plausibility of water origin.
Despite the relative prosperity of Scandinavian countries, contamination of the drinking water supply with parasites has occurred on various occasions in the last few decades. These events have resulted in outbreaks of disease involving several thousand cases and/or the necessity for implementation of boil-water advisories. Against this background, in 2008, and again in 2019, the Norwegian Food Safety Authority requested a risk assessment from an independent scientific body regarding parasites in Norwegian drinking water. On each occasion, it was requested that specific questions were addressed. For the first assessment, data, both of general relevance and specific for Norway, were collected from appropriate sources, as available. Based on some of this information, a quantitative probability model was established and run to estimate the number of cases of waterborne cryptosporidiosis and giardiasis that may be expected in Norway, both in the general public and the immunocompromised, and under conditions where water treatment should be optimal, and also when water treatment efficacy may be compromised by weather conditions. For the second assessment, approximately a decade after the first, an update on the previous assessment was requested. Differences in information availability and other changes between the two assessments were described; although more data were available at the second assessment, considerable gaps still remained. For both assessments, data on the occurrence of these parasites in the Norwegian population, particularly those infected in Norway, were considered a challenge. However, due to changes in reporting requirements in 2020, the situation was improved for the second assessment. In addition, data were lacking for both assessments on whether animals or humans are most likely to contaminate water sources, and the species and genotypes of these parasites in Norwegian animals. It was also noted that some of the newer data on parasite numbers detected in water samples should be treated with caution. Due to this, further modelling was not conducted. The relevance of risk-based sampling rather than ad hoc sampling of water sources was also addressed. Despite the data gaps, this article provides an overview of the opportunities provided by conducting such assessments. In addition, some of the challenges encountered in attempting to estimate the risk posed from parasite contamination of water sources in Norway, particularly under predicted conditions of climate change, are described.
Complex, multihazard risks such as private groundwater contamination necessitate multiannual risk reduction actions including seasonal, weather-based hazard evaluations. In the Republic of Ireland (ROI), high rural reliance on unregulated private wells renders behavior promotion a vital instrument toward safeguarding household health from waterborne infection. However, to date, pathways between behavioral predictors remain unknown while latent constructs such as extreme weather event (EWE) risk perception and self-efficacy (perceived behavioral competency) have yet to be sufficiently explored. Accordingly, a nationwide survey of 560 Irish private well owners was conducted, with structural equation modeling (SEM) employed to identify underlying relationships determining key supply management behaviors. The pathway analysis (SEM) approach was used to model three binary outcomes: information seeking, post-EWE action, and well testing behavior. Upon development of optimal models, perceived self-efficacy emerged as a significant direct and/or indirect driver of all three behavior types-demonstrating the greatest indirect effect (beta = -0.057) on adoption of post-EWE actions and greatest direct (beta = 0.222) and total effect (beta = 0.245) on supply testing. Perceived self-efficacy inversely influenced EWE risk perception in all three models but positively influenced supply awareness (where present). Notably, the presence of a vulnerable (infant and/or elderly) household member negatively influenced adoption of post-EWE actions (beta = -0.131, p = 0.016). Results suggest that residential and age-related factors constitute key demographic variables influencing risk mitigation and are strongly mediated by cognitive variables-particularly self-efficacy. Study findings may help contextualize predictors of private water supply management, providing a basis for future risk-based water interventions.
Background Wastewater reuse represents a promising alternative source of water supply considering the water scarcity related to climate change. However, if not adequately treated, wastewater represents a source of microbiological health risk. The purpose of this work was to investigate the role of wastewater treatment on microbiological contamination by evaluating the possible risks associated with wastewater effluent reuse, taking into account new EU legislation (2020/741) on minimum requirements for water reuse. E. coli that produce Shiga toxins (STEC) and thermotolerant Campylobacter were monitored using an enrichment step associated with specific PCR, while Salmonella spp. and Legionella were detected with both cultural and molecular methods (PCR and q-PCR, respectively). Culture method was also used for the enumeration of different microbial indicators. The bacteria detection was compared in different wastewater plants with membrane bioreactor (MBR) system or with disinfection step with chlorine dioxide (ClO2). Moreover a comparison between molecular and culture methods was discussed. Results The results obtained showed good abatement performance for WWTPs equipped with MBR. The high concentrations of E. coli (range between 0.88 and 5.21 Log MPN/100 mL) and contamination by Salmonella spp. in effluent disinfected with ClO2 (17% of samples) showed the need to control the quality of this effluent. In addition, despite the absence of Legionella spp. with the culture method required by EU regulation, high concentrations of Legionella spp. (range between 2 and 7 log GU/L) and the presence of Leg. pneumophila with qPCR (15% of samples) highlight the need to carry out further investigations for reuse associated with aerosol formation (e.g. spray irrigation in agriculture). Conclusions The results obtained underline that the MBR technology can be suitable for wastewater reuse applications allowing to achieve the requirement proposed by the new European legislation. More attention should be given to wastewater reuse of effluents treated with ClO2. The use of the molecular methods for pathogens detection in wastewater could allow a more precautionary risks estimation associated with reuse. The overall results highlight that an evaluation of the effectiveness of the wastewater treatments is required for the prevention of a possible risk to public health.
Reuse of reclaimed wastewater for agricultural irrigation is an expanding practice worldwide. This practice needs to be monitored, partly because of pathogens that the water may contain after treatments. More particularly, sprinkler irrigation is known to generate aerosols which may lead to severe health risks to the population close to irrigated areas in case of the presence of Legionella bacteria in the water. A pilot experiment was conducted on two corn fields in South-Western France, irrigated with wastewater undergoing two different water treatments (ultra-filtration and UV). Water analyses have shown high levels of Legionella in the water even after a standard wastewater treatment plant (WWTP) cleaning process followed by the UV treatment (up to 10(6) GC per L in 2019). In this context, an updated general Bayesian network (GBN), using discrete and continuous random variables, in quantitative microbial risk assessment (QMRA) is proposed to monitor the risk of Legionella infection in the vicinity of the irrigated plots. The model’s originality is based on i) a graphical probabilistic model that describes the exposure pathway of Legionella from the WWTP to the population using observed and non-observed variables and ii) the model inference updating at each new available measurement. Different scenarios are simulated according to the exposure time of the persons, taking into account various distances from the emission source and a large dataset of climatic data. From the learning process included in the Bayesian principle, quantities of interest (contaminations before and after water treatments, inhaled dose, probabilities of infection) can be quantified with their uncertainty before and after the inclusion of each new data collected in situ. This approach gives a rigorous tool that allows monitoring the risks, facilitates discussions with reuse experts and progressively reduces uncertainty quantification through field data accumulation. For the two pilot treatments analyzed in this study, the median annual risk of Legionella infection did not exceed the US EPA annual infection benchmark of 10(-4) for any of the population at risk during the past few months of the pilot experiment (DALYs are estimated up to 10(-5)). The risk still bears watching with support from the method shown in this work.
Extreme weather events (EWEs) may significantly increase pathogenic contamination of private (unregulated) groundwater supplies. However, due to the paucity of protective guidance, private well users may be ill-equipped to undertake adaptive actions. With rising instances of waterborne illness documented in groundwater-dependent, developed regions such as the Republic of Ireland, a better understanding of well user risk perceptions pertaining to EWEs is required to establish appropriate educational interventions. To this end, the current study employed an online and physical questionnaire to identify current risk perceptions and correspondent predictors among Irish private well users concerning extreme weather. Respondents were elicited via purposive sampling, with 515 private well users elucidating perceived supply contamination risk in the wake of five EWEs between the years 2013-2018 including drought and pluvial flooding. A novel scoring protocol was devised to quantify overall risk perception (i.e. perceived likelihood, severity and consequences) of extreme weather impacts. Overall risk perception of EWEs was found to demonstrate a significant relationship with gender (p = 0.017) and event experience (p < 0.001), with female respondents and those reporting prior event experience exhibiting higher median risk perception scores. Risk perception was additionally mediated by perceived self-efficacy in undertaking supply maintenance (p = 0.001), as well users citing confidence in ability scored significantly lower than those citing no confidence. Two-step cluster analysis identified three distinct respondent subsets based on risk perception of EWEs (high, moderate and low perception), with female respondents and those with a third-level education significantly more likely to fall within the high perception cluster. Study findings affirm that certain demographic, experiential and cognitive factors exert a significant influence on private well user risk perceptions of EWE impacts and highlight potential focal points for future educational interventions seeking to reduce the risk of human infection associated with groundwater and extreme weather.
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: Leptospirosis is the most common zoonotic disease in Tuzla Canton. Objective: Determine the influence of environmental and precipitation factors on the incidence of leptospirosis. METHODS: A retrospective study included 80 patients with leptospirosis. Data on precipitation were obtained from the online database of Federal Hydrometeorological Institute of BiH. OpenStreetMap (OSM) was used for spatial analysis; patients were geolocated and put on a map. Statistical data processing included basic tests of descriptive statistics. RESULTS: In the period between 01.01.2014 and 31.12.2014, 80 patients with leptospirosis confirmed by clinical and serological testing were hospitalized in the Clinic for Infectious Diseases of the University Clinical Center Tuzla. Gender wise, out of 80 patients, 54 were male (67.5% of the total), and 26 were female (32.5%). More patients lived in the countryside: 64/80 (or 89%). The largest number of patients was engaged in agriculture and animal husbandry: 48/80 (or 60%), mostly cows 32/80 (40%), chickens 12/80 (15%), sheep 4/80 (5%) and pigs 3/80 (3.8%). Of the total number of patients, 50 (or 62.5%) had contact with domestic animals: dogs 10/80 (or 12.5%) and cats 5/80 (or 6.3%). Half of 53/80 (66.3%) patients had contact with flooded areas in the study period. The increase in leptospirosis diagnosed patients in the City of Srebrenik was statistically significant for 2014 (p<0.01). CONCLUSION: Leptospirosis in one of the neglected infectious diseases in our area, but the proven increase in the number of infected people after heavy rainfall obliges us to control the risks associated with this disease.
The frequency and severity of flooding events will increase over the coming decades due to global climate change. While close attention has typically been paid to infrastructural and environmental outcomes of flood events, the potential adverse human health consequences associated with post-event consumption from private groundwater sources have received minimal attention, leading to a poor understanding of private well users’ preparedness and the drivers of positive behavioural adoption. The current study sought to quantify the capacity of private well users to cope with flood-triggered contamination risks and identify the social psychological determinants of proactive attitudes in the Republic of Ireland, using a cross-sectional questionnaire incorporating two distinct models of health behaviour, the Health Belief Model and Risk-Attitude-Norms-Ability-Self Regulation model. Adoption of healthy behaviours prior to flooding was evaluated with respect to respondents’ risk exposure, risk experience and risk perception, in addition to systematic supply stewardship under normal conditions. Associations between adoption of protective behaviours and perception, experience and socio-demographic factors were evaluated through multinomial and multiple logistic regressions, while a multi-model inferential approach was employed with the predictors of health behaviour models. Findings suggest that floods are not considered likely to occur, nor were respondents worried about their occurrence, with 72.5% of respondents who reported previous flooding experience failing to adopt protective actions. Prior experience of well water contamination increased adoption of proactive attitudes when flooding occurred (+47%), with a failure to adopt healthy behaviours higher among rural non-agricultural residents (136%). Low levels of preparedness to deal with flood-related contamination risks are a side-effect of the general lack of appropriate well stewardship under normal conditions; just 10.1% of respondents adopted both water treatment and frequent testing, in concurrence with limited risk perception and poor awareness of the nexus between risk factors (e.g. floods, contamination sources) and groundwater quality. Perceived risk, personal norms and social norms were the best predictors of protective behaviour adoption and should be considered when developing future awareness campaigns.
During a 6-week period in November and December 2015, a series of Atlantic Storms swept across the Republic of Ireland (ROI) causing widespread pluvial and fluvial flooding. Flooding was particularly severe in the west and midlands, with rainfall up to 200% above normal in many regions, making it the wettest winter ever recorded. While the infrastructural damage and subsequent costs associated with flood events have, and continue to receive widespread attention, far less coverage is given to the associated adverse human health effects. This is particularly significant in the ROI, which is characterised by the highest crude incidence rates of verotoxigenic E. coli (VTEC) enteritis and cryptosporidiosis in Europe. Accordingly, weekly spatially-referenced infection incidence from July 2015 to June 2016 were employed in concurrence with weekly time-series of cumulative antecedent rainfall, surface water discharge and groundwater level, and high-resolution flood risk mapping. An ensemble of statistical and time-series analyses were used to quantify the influence of flood hydrometeorology on the incidence of confirmed infections. Seasonal decomposition (excluding seasonal patterns and long-term trends) identified a high residual infection peak during April 2016, with space-timing scanning used to identify the location, size and temporal extent of clustering. Excess cases of VTEC enteritis were geographically associated with the midlands, while cryptosporidiosis clusters were widespread. Generalised linear modelling of infection locations show that areas with a surface water body exhibited significantly higher incidence rates for both VTEC (OR: 1.225; p < 0.001) and cryptosporidiosis (OR: 1.363; p < 0.001). ARIMA models show a clear association between rainfall, surface water discharge, groundwater levels and infection incidence, with lagged associations from 16 to 20 weeks particularly strong, thus indicating a link between infection peaks (April 2016) and the flood event which began approximately 18 weeks earlier. All three hydrometeorological variables were associated with the increase in cryptosporidiosis during April 2016, while only surface water discharge was associated with VTEC enteritis. Study findings may be employed for improved risk communication, risk management and surveillance to safeguard public health after large hydrometeorological events.
Dermacentor reticulatus ticks are one of the most important vectors and reservoirs of tick-borne pathogens in Europe. Changes in the abundance and range of this species have been observed in the last decade and these ticks are collected in areas previously considered tick-free. This may be influenced by progressive climate change. Eastern Poland is an area where the local population of D. reticulatus is one of the most numerous among those described so far. At the same time, the region is characterized by a significant increase in the mean air temperature in recent years (by 1.81 °C in 2020) and a decrease in the average number of days with snow cover (by 64 days in 2020) and in the number of days with frost (by 20 days in 2020) on an annual basis compared to the long-term average. The aim of our research was to investigate the rhythms of seasonal activity and the population size of D. reticulatus in the era of progressive climate change. To this end, questing ticks were collected in 2017-2020. Next, the weather conditions in the years of observation were analyzed and compared with multi-year data covering 30 years preceding the study. The research results show that, in eastern Poland, there is a stable population of D. reticulatus with the peak of activity in spring or autumn (up to a maximum of 359 individuals within 30 min of collection) depending on the year of observation. Ticks of this species may also be active in winter months. The activity of D. reticulatus is influenced by a saturation deficit.
Human dirofilariasis is a vector-borne helminth disease caused by two species of Dirofilaria: D. repens and D. immitis. The vectors of the helminth are mosquitoes in the family Culicidae. The definitive hosts of Dirofilaria are dogs and, to a lesser extent, cats. Humans are accidental hosts. Dirofilariasis has been reported in the territory of Russia since 1915. Sporadic cases of the disease have been reported occasionally, but the number of cases showed a distinct increasing trend in the late 1980s-early 1990s, when the number of cases reached several hundred in the southern territories of Russia, with geographic coordinates of 43° N-45° N. A comparison of the timing of the global trend of climate warming during the 1990s with the temporal pattern of the incidence of dirofilariasis in the territory of Russia indicated a close association between the two phenomena. At present, the northern range of Dirofilaria includes latitudes higher than 58° in both the European and Asian parts of the country. The phenomenon of climate warming in the territory of Russia has shaped the contemporary epidemiology of the disease. The emerging public health problem of dirofilariasis in Russia warrants the establishment of a comprehensive epidemiological monitoring system.
The paper reports the assessment of the spatiotemporal trends of climatic changes favoring the spread of West Nile fever (WNF) in the southern part of the European Russia. Data from 58 meteorological stations (1997–2018) and ERA-Interim reanalysis data (1981–2018) were used. The degree-day method was employed to assess whether the climatic conditions favor the spread of the West Nile virus (WNV). As a result an increase in the sum of the effective temperatures (ETs) was demonstrated. No increase in the length of the efficient infectivity season was observed. A coincidence of the trends of ET sum growth and the increase in the average air temperature for the epidemic season was noted. This creates favorable conditions for virus development in mosquitoes, because virus circulation becomes more efficient with an increase in ET. The most favorable temperature conditions for WNV form in the Caspian Sea region and the Ciscaucasia, where WNV circulation conditions are further improved due to an increase in the total ET. conditions favoring WNV transmission form more rapidly in the central part of European Russia than in the Cis-Ural region, which may cause further spread of WNF in this region.
West Nile virus (WNV) is an arthropod-born pathogen, which is transmitted from wild birds through mosquitoes to humans and animals. At the end of the 20th century, the first West Nile fever (WNF) outbreaks among humans in urban environments in Eastern Europe and the United States were reported. The disease continued to spread to other parts of the continents. In Serbia, the largest number of WNV-infected people was recorded in 2018. This research used spatial statistics to identify clusters of WNV infection in humans and animals in South Banat County, Serbia. The occurrence of WNV infection and risk factors were analyzed using a negative binomial regression model. Our research indicated that climatic factors were the main determinant of WNV distribution and were predictors of endemicity. Precipitation and water levels of rivers had an important influence on mosquito abundance and affected the habitats of wild birds, which are important for maintaining the virus in nature. We found that the maximum temperature of the warmest part of the year and the annual temperature range; and hydrographic variables, e.g., the presence of rivers and water streams were the best environmental predictors of WNF outbreaks in South Banat County.
After mosquitoes, ticks are the most important vectors of infectious diseases. They play an important role in public health. In recent decades, we discovered new tick-borne diseases; additionally, those that are already known are spreading to new areas because of climate change. Slovenia is an endemic region for Lyme borreliosis and one of the countries with the highest incidence of this disease on a global scale. Thus, the spatial pattern of Slovenian Lyme borreliosis prevalence was modelled with 246 indicators and transformed into 24 uncorrelated predictor variables that were applied in geographically weighted regression and regression tree algorithms. The projected potential shifts in Lyme borreliosis foci by 2050 and 2070 were calculated according to the RCP8.5 climate scenario. These results were further applied to developing a Slovenian Lyme borreliosis infection risk map, which could be used as a preventive decision support system.
BACKGROUND: The emergence of tick-borne disease is increasing because of the effects of the temperature rise driven by global warming. In Turkey, 19 pathogens transmitted by ticks to humans and animals have been reported. Based on this, this study aimed to investigate tick-borne pathogens including Hepatozoon spp., Theileria spp., Babesia spp., Anaplasma spp., Borrelia spp., and Bartonella spp. in tick samples (n = 110) collected from different hosts (dogs, cats, cattle, goats, sheep, and turtles) by molecular methods. METHODS: To meet this objective, ticks were identified morphologically at the genus level by microscopy; after DNA isolation, each tick sample was identified at the species level using the molecular method. Involved pathogens were then investigated by PCR method. RESULTS: Seven different tick species were identified including Rhipicephalus sanguineus, R. turanicus, R. bursa, Hyalomma marginatum, H. anatolicum, H. aegyptium, and Haemaphysalis erinacei. Among the analyzed ticks, Hepatozoon spp., Theileria spp., Babesia spp., and Anaplasma spp. were detected at rates of 6.36%, 16.3%, 1.81%, and 6.36%, respectively while Borrelia spp. and Bartonella spp. were not detected. Hepatozoon spp. was detected in R. sanguineus ticks while Theileria spp., Babesia spp., and Anaplasma spp. were detected in R. turanicus and H. marginatum. According to the results of sequence analyses applied for pathogen positive samples, Hepatozoon canis, Theileria ovis, Babesia caballi, and Anaplasma ovis were identified. CONCLUSION: Theileria ovis and Anaplasma ovis were detected for the first time to our knowledge in H. marginatum and R. turanicus collected from Turkey, respectively. Also, B. caballi was detected for the first time to our knowledge in ticks in Turkey.
Lungworms in the genus Angiostrongylus cause disease in animals and humans. The spread of Angiostrongylus vasorum within Europe and the recent establishment of Angiostrongylus cantonensis increase the relevance of these species to veterinary and medical practitioners, and to researchers in parasitology, epidemiology, veterinary science and ecology. This review introduces the key members of the genus present in Europe and their impacts on health, and updates the current epidemiological situation. Expansion of A. vasorum from localized pockets to wide distribution across the continent has been confirmed by a rising prevalence in foxes and increasing reports of infection and disease in dogs, while the list of carnivore and mustelid definitive hosts continues to grow. The tropically distributed rat lungworm A. cantonensis, meanwhile, has been recorded on islands south of Europe, previously the Canary Islands, and now also the Balearic Islands, although so far with limited evidence of zoonotic disease. Other members of the genus, namely, A. chabaudi, A. daskalovi and A. dujardini, are native to Europe and mainly infect wildlife, with unknown consequences for populations, although spill-over can occur into domestic animals and those in zoological collections. The epidemiology of angiostrongylosis is complex, and further research is needed on parasite maintenance in sylvatic hosts, and on the roles of ecology, behaviour and genetics in disease emergence. Improved surveillance in animals and humans is also required to support risk assessments and management.
The Asian tiger mosquito (Aedes albopictus), a vector of dengue, Zika and other diseases, was introduced in Europe in the 1970s, where it is still widening its range. Spurred by public health concerns, several studies have delivered predictions of the current and future distribution of the species for this region, often with differing results. We provide the first joint analysis of these predictions, to identify consensus hotspots of high and low suitability, as well as areas with high uncertainty. The analysis focused on current and future climate conditions and was carried out for the whole of Europe and for 65 major urban areas. High consensus on current suitability was found for the northwest of the Iberian Peninsula, southern France, Italy and the coastline between the western Balkans and Greece. Most models also agree on a substantial future expansion of suitable areas into northern and eastern Europe. About 83% of urban areas are expected to become suitable in the future, in contrast with ~ 49% nowadays. Our findings show that previous research is congruent in identifying wide suitable areas for Aedes albopictus across Europe and in the need to effectively account for climate change in managing and preventing its future spread.
Understanding and predicting mosquito population dynamics is crucial for gaining insight into the abundance of arthropod disease vectors and for the design of effective vector control strategies. In this work, a climate-conditioned Markov chain (CMC) model was developed and applied for the first time to predict the dynamics of vectors of important medical diseases. Temporal changes in mosquito population profiles were generated to simulate the probabilities of a high population impact. The simulated transition probabilities of the mosquito populations achieved from the trained model are very near to the observed data transitions that have been used to parameterize and validate the model. Thus, the CMC model satisfactorily describes the temporal evolution of the mosquito population process. In general, our numerical results, when temperature is considered as the driver of change, indicate that it is more likely for the population system to move into a state of high population level when the former is a state of a lower population level than the opposite. Field data on frequencies of successive mosquito population levels, which were not used for the data inferred MC modeling, were assembled to obtain an empirical intensity transition matrix and the frequencies observed. Our findings match to a certain degree the empirical results in which the probabilities follow analogous patterns while no significant differences were observed between the transition matrices of the CMC model and the validation data (ChiSq = 14.58013, df = 24, p = 0.9324451). The proposed modeling approach is a valuable eco-epidemiological study. Moreover, compared to traditional Markov chains, the benefit of the current CMC model is that it takes into account the stochastic conditional properties of ecological-related climate variables. The current modeling approach could save costs and time in establishing vector eradication programs and mosquito surveillance programs.
We extend a previously developed epidemiological model for West Nile virus (WNV) infection in humans in Greece, employing laboratory-confirmed WNV cases and mosquito-specific characteristics of transmission, such as host selection and temperature-dependent transmission of the virus. Host selection was defined by bird host selection and human host selection, the latter accounting only for the fraction of humans that develop symptoms after the virus is acquired. To model the role of temperature on virus transmission, we considered five temperature intervals (≤ 19.25 °C; > 19.25 and < 21.75 °C; ≥ 21.75 and < 24.25 °C; ≥ 24.25 and < 26.75 °C; and > 26.75 °C). The capacity of the new model to fit human cases and the week of first case occurrence was compared with the original model and showed improved performance. The model was also used to infer further quantities of interest, such as the force of infection for different temperatures as well as mosquito and bird abundances. Our results indicate that the inclusion of mosquito-specific characteristics in epidemiological models of mosquito-borne diseases leads to improved modelling capacity.
Environmentally suitable habitats of Aedes albopictus (Ae. albopictus) in Europe are identified by several modeling studies. However, it is noticeable that even after decades of invasion process in Europe, the vector mosquito has not yet been established in all its environmentally suitable areas. Natural barriers and human-mediated transport play a role, but the potential of wind speed to explain Ae. albopictus’ absences and its inability to establish in its suitable areas are largely unknown. This study therefore evaluates the potential of wind speed as an explanatory parameter of the non-occurrence of Ae. albopictus. We developed a global ecological niche model with relevant environmental parameters including wind speed and projected it to current climatic conditions in Europe. Differences in average wind speed between areas of occurrence and non-occurrence of Ae. albopictus within its modeled suitable areas were tested for significance. A second global ecological niche model was trained with the same species records and environmental parameters, excluding windspeed parameters. Using multiple linear regression analyses and a test of average marginal effect, the effect of increasing wind speed on the average marginal effect of temperature and precipitation on the projected habitat suitability was estimated. We found that climatically suitable and monitored areas where Ae. albopictus is not established (3.12 ms-1 +/- 0.04 SD) have significantly higher wind speed than areas where the species is already established (2.54 ms-1 +/- 0.04 SD). Among temperature-related bioclimatic variables, the annual mean temperature was the most important variable contributing to the performance of both global models. Wind speed has a negative effect on the predicted habitat suitability of Ae. albopictus and reduces false-positive rates in model predictions. With increasing wind speed, the average marginal effect of annual mean temperatures decreases but that of the annual precipitation increases. Wind speed should be considered in future modeling efforts aimed at limiting the spread and dispersal of Ae. albopictus and in the implementation of surveillance and early warning systems. Local-scale data collected from fieldwork or laboratory experiments will help improve the state of the art on how wind speed influences the distribution, flight, and dispersal activity of the mosquito.
Dirofilariasis is a zoonosis caused by nematodes of the genus Dirofilaria.Dirofilaria immitis is cosmopolitan as regards its distribution in animals, being responsible for human pulmonary dirofilariasis in the New World. However, human infections by Dirofilaria immitis are exceptional in Europe, and the previously reported Italian cases of pulmonary dirofilariasis were due to Dirofilaria repens. We performed a systematic literature review of the Italian cases of human dirofilariasis due to Dirofilariaimmitis according to the PRISMA guidelines. We also report the first autochthonous case of human pulmonary dirofilariasis due to Dirofilariaimmitis, confirmed by polymerase chain reaction analysis. The patient was a 60-year-old man who lived in the Po river valley and had never traveled abroad; on histological examination, the 2-cm nodule found in his right upper lung was an infarct due to a parasitic thrombotic lesion. Only one other autochthonous (but conjunctival) case due to Dirofilariaimmitis (molecularly confirmed) was previously found in the same geographic area. Climatic changes, the increasing movements of animal reservoirs and vectors, and new competent carriers have expanded the geographic distribution of the Dirofilaria species, increasing the risk of human infections. Our report demonstrates that at least some pulmonary Italian cases of human dirofilariasis are due to Dirofilaria immitis, as in the New World.
The Asian tiger mosquito, Aedes albopictus, competent vector of several arboviruses, poses significant impact on human health worldwide. Although global warming is a driver of A . albopictus range expansion, few studies focused on its effects on homodynamicity (i.e. the ability to breed all-year-round), a key factor of vectorial capacity and a primary condition for an Aedes-borne disease to become endemic in temperate areas. Data from a 4-year monitoring network set in Central Italy and records from weather stations were used to assess winter adult activity and weekly minimum temperatures. Winter oviposition occurred in 38 localities with a seasonal mean photoperiod of 9.7 : 14.3 (L : D) h. Positive collections (87) occurred with an average minimum temperature of the two and three weeks before sampling of approximately 4°C. According to these evidences and considering the climate projections of three global climate models and three shared socio-economic pathways for the next three 20-year periods (from 2021 to 2080), the minimum temperature of January will increase enough to allow an all-year-round oviposition of A . albopictus in several areas of the Mediterranean Basin. Due to vector homodynamicity, Aedes-borne diseases could become endemic in Southern Europe by the end of the twenty-first century, worsening the burden on human health.
Increases in temperature and extreme weather events due to global warming can create an environment that is beneficial to mosquito populations, changing and possibly increasing the suitable geographical range for many vector-borne diseases. West Nile Virus (WNV) is a flavivirus, maintained in a mosquito-avian host cycle that is usually asymptomatic but can cause primarily flu-like symptoms in human and equid accidental hosts. In rare circumstances, serious disease and death are possible outcomes for both humans and horses. The main European vector of WNV is the Culex pipiens mosquito. This study examines the effect of environmental temperature on WNV establishment in Europe via Culex pipiens populations through use of a basic reproduction number ( R0 ) model. A metric of thermal suitability derived from R0 was developed by collating thermal responses of different Culex pipiens traits and combining them through use of a next-generation matrix. WNV establishment was determined to be possible between 14°C and 34.3°C, with the optimal temperature at 23.7°C. The suitability measure was plotted against monthly average temperatures in 2020 and the number of months with high suitability mapped across Europe. The average number of suitable months for each year from 2013 to 2019 was also calculated and validated with reported equine West Nile fever cases from 2013 to 2019. The widespread thermal suitability for WNV establishment highlights the importance of European surveillance for this disease and the need for increased research into mosquito and bird distribution.
West Nile virus is a widely spread arthropod-born virus, which has mosquitoes as vectors and birds as reservoirs. Humans, as dead-end hosts of the virus, may suffer West Nile Fever (WNF), which sometimes leads to death. In Europe, the first large-scale epidemic of WNF occurred in 1996 in Romania. Since then, human cases have increased in the continent, where the highest number of cases occurred in 2018. Using the location of WNF cases in 2017 and favorability models, we developed two risk models, one environmental and the other spatio-environmental, and tested their capacity to predict in 2018: 1) the location of WNF; 2) the intensity of the outbreaks (i.e. the number of confirmed human cases); and 3) the imminence of the cases (i.e. the Julian week in which the first case occurred). We found that climatic variables (the maximum temperature of the warmest month and the annual temperature range), human-related variables (rain-fed agriculture, the density of poultry and horses), and topo-hydrographic variables (the presence of rivers and altitude) were the best environmental predictors of WNF outbreaks in Europe. The spatio-environmental model was the most useful in predicting the location of WNF outbreaks, which suggests that a spatial structure, probably related to bird migration routes, has a role in the geographical pattern of WNF in Europe. Both the intensity of cases and their imminence were best predicted using the environmental model, suggesting that these features of the disease are linked to the environmental characteristics of the areas. We highlight the relevance of river basins in the propagation dynamics of the disease, as outbreaks started in the lower parts of the river basins, from where WNF spread towards the upper parts. Therefore, river basins should be considered as operational geographic units for the public health management of the disease.
West Nile Virus (WNV) has recently emerged as a major public health concern in Europe; its recent expansion also coincided with some remarkable socio-economic and environmental changes, including an economic crisis and some of the warmest temperatures on record. Here we empirically investigate the drivers of this phenomenon at a European wide scale by constructing and analyzing a unique spatial-temporal data-set, that includes data on climate, land-use, the economy, and government spending on environmental related sectors. Drivers and risk factors of WNV were identified by building a conceptual framework, and relationships were tested using a Generalized Additive Model (GAM), which could capture complex non-linear relationships and also account for spatial and temporal auto-correlation. Some of the key risk factors identified in our conceptual framework, such as a higher percentage of wetlands and arable land, climate factors (higher summer rainfall and higher summer temperatures) were positive predictors of WNV infections. Interestingly, winter temperatures of between 2 °C and 6 °C were among some of the strongest predictors of annual WNV infections; one possible explanation for this result is that successful overwintering of infected adult mosquitoes (likely Culex pipiens) is key to the intensity of outbreaks for a given year. Furthermore, lower surface water extent over the summer is also associated with more intense outbreaks, suggesting that drought, which is known to induce positive changes in WNV prevalence in mosquitoes, is also contributing to the upward trend in WNV cases in affected regions. Our indicators representing the economic crisis were also strong predictors of WNV infections, suggesting there is an association between austerity and cuts to key sectors, which could have benefited vector species and the virus during this crucial period. These results, taken in the context of recent winter warming due to climate change, and more frequent droughts, may offer an explanation of why the virus has become so prevalent in Europe.
Some of the climate-sensitive infections (CSIs) affecting humans are zoonotic vector-borne diseases, such as Lyme borreliosis (BOR) and tick-borne encephalitis (TBE), mostly linked to various species of ticks as vectors. Due to climate change, the geographical distribution of tick species, their hosts, and the prevalence of pathogens are likely to change. A recent increase in human incidences of these CSIs in the Nordic regions might indicate an expansion of the range of ticks and hosts, with vegetation changes acting as potential predictors linked to habitat suitability. In this paper, we study districts in Fennoscandia and Russia where incidences of BOR and TBE have steadily increased over the 1995-2015 period (defined as ‘Well Increasing districts’). This selection is taken as a proxy for increasing the prevalence of tick-borne pathogens due to increased habitat suitability for ticks and hosts, thus simplifying the multiple factors that explain incidence variations. This approach allows vegetation types and strengths of correlation specific to the WI districts to be differentiated and compared with associations found over all districts. Land cover types and their changes found to be associated with increasing human disease incidence are described, indicating zones with potential future higher risk of these diseases. Combining vegetation cover and climate variables in regression models shows the interplay of biotic and abiotic factors linked to CSI incidences and identifies some differences between BOR and TBE. Regression model projections up until 2070 under different climate scenarios depict possible CSI progressions within the studied area and are consistent with the observed changes over the past 20 years.
There is now considerable evidence that in Europe, babesiosis is an emerging infectious disease, with some of the causative species spreading as a consequence of the increasing range of their tick vector hosts. In this review, we summarize both the historic records and recent findings on the occurrence and incidence of babesiosis in 20 European countries located in southeastern Europe (Bosnia and Herzegovina, Croatia, and Serbia), central Europe (Austria, the Czech Republic, Germany, Hungary, Luxembourg, Poland, Slovakia, Slovenia, and Switzerland), and northern and northeastern Europe (Lithuania, Latvia, Estonia, Iceland, Denmark, Finland, Sweden, and Norway), identified in humans and selected species of domesticated animals (cats, dogs, horses, and cattle). Recorded cases of human babesiosis are still rare, but their number is expected to rise in the coming years. This is because of the widespread and longer seasonal activity of Ixodes ricinus as a result of climate change and because of the more extensive use of better molecular diagnostic methods. Bovine babesiosis has a re-emerging potential because of the likely loss of herd immunity, while canine babesiosis is rapidly expanding in central and northeastern Europe, its occurrence correlating with the rapid, successful expansion of the ornate dog tick (Dermacentor reticulatus) populations in Europe. Taken together, our analysis of the available reports shows clear evidence of an increasing annual incidence of babesiosis across Europe in both humans and animals that is changing in line with similar increases in the incidence of other tick-borne diseases. This situation is of major concern, and we recommend more extensive and frequent, standardized monitoring using a “One Health” approach.
Hyalomma marginatum is the main vector of Crimean-Congo haemorrhagic fever virus (CCHFV) and spotted fever rickettsiae in Europe. The distribution of H. marginatum is currently restricted to parts of southern Europe, northern Africa and Asia, and one of the drivers limiting distribution is climate, particularly temperature. As temperatures rise with climate change, parts of northern Europe currently considered too cold for H. marginatum to be able to survive may become suitable, including the United Kingdom (UK), presenting a potential public health concern. Here we use a series of modelling methodologies to understand whether mean air temperatures across the UK during 2000-2019 were sufficient for H. marginatum nymphs to moult into adult stages and be able to overwinter in the UK if they were introduced on migratory birds. We then used UK-specific climate projections (UKCP18) to determine whether predicted temperatures would be sufficient to allow survival in future. We found that spring temperatures in parts of the UK during 2000-2019 were warm enough for predicted moulting to occur, but in all years except 2006, temperatures during September to December were too cold for overwintering to occur. Our analysis of the projections data suggests that whilst temperatures in the UK during September to December will increase in future, they are likely to remain below the threshold required for H. marginatum populations to become established.
Global warming affects the aquatic ecosystems, accelerating pathogenic microorganisms’ and toxic microalgae’s growth and spread in marine habitats, and in bivalve molluscs. New parasite invasions are directly linked to oceanic warming. Consumption of pathogen-infected molluscs impacts human health at different rates, depending, inter alia, on the bacteria taxa. It is therefore necessary to monitor microbiological and chemical contamination of food. Many global cases of poisoning from bivalve consumption can be traced back to Mediterranean regions. This article aims to examine the marine bivalve’s infestation rate within the scope of climate change, as well as to evaluate the risk posed by climate change to bivalve welfare and public health. Biological and climatic data literature review was performed from international scientific sources, Greek authorities and State organizations. Focusing on Greek aquaculture and bivalve fisheries, high-risk index pathogenic parasites and microalgae were observed during summer months, particularly in Thermaikos Gulf. Considering the climate models that predict further temperature increases, it seems that marine organisms will be subjected in the long term to higher temperatures. Due to the positive linkage between temperature and microbial load, the marine areas most affected by this phenomenon are characterized as ‘high risk’ for consumer health.
The article, based on the reports of the Ministry of Health of Ukraine, presents the materials of the epidemiological surveillance of salmonellosis in 2011-2018. To assess the influence of factors on the epidemic process of salmonellosis, the demographic situation, income and living conditions of the population were studied; average monthly air temperature, relative humidity, precipitation; the quantitative and qualitative composition of the microbiocenosis of patients with signs of acute intestinal infection. It was found that in Ukraine the incidence of salmonellosis is high. Outbreaks of salmonellosis are recorded. S. enteritidis is most often isolated from the clinical material of patients, carriers and human objects (p <0.05). The risk groups for salmonellosis are children (p <0.05), as well as the rural population (p 7lt;0.05). The low level of sanitary and epidemiological control at the stages of production, transportation and sale of food products, water supply contributes to the spread of salmonellosis. Natural factors have a regulating effect on the intensity of the epidemic salmonella process: a strong direct relationship is established between the incidence and air temperature and precipitation (p <0.05). Salmonella enters into a competitive or synergistic relationship with other microorganisms in the intestinal biotope. Thus, the intensity of the epidemic process of salmonellosis can be influenced not only by external (natural and social), but also by internal factors.
Dinophysis is a genus of dinoflagellates with the potential to cause diarrhoeic Shellfish Poisoning (DSP) in humans. The lipophilic toxins produced by some species of Dinophysis spp. can accumulate within shellfish flesh even at low cell abundances, and this may result in the closure of a shellfish farm if toxins exceed the recommended upper limit. Over the period 2014 to 2020 inclusive there were several toxic events along the South West coast of U.K. related to Dinophysis spp. The Food Standards Agency (FSA) monitoring programme measure Dinophysis cell abundances and toxin concentration within shellfish flesh around the coasts of England and Wales, but there are few schemes routinely measuring the environmental parameters that may be important drivers for these Harmful Algal Blooms (HABs). This study uses retrospective data from the FSA monitoring at three sites on the south Cornwall coast as well as environmental data from some novel platforms such as coastal WaveRider buoys to investigate potential drivers and explore whether either blooms or toxic events at these sites can be predicted from environmental data. Wind direction was found to be important in determining whether a bloom develops at these sites, and low air temperature in June was associated with low toxicity in the shellfish flesh. Using real time data from local platforms may help shellfish farmers predict future toxic events and minimise financial loss.
Due to anthropogenic activities, associated with climate change, many freshwater ecosystems are expected to experience an increase in salinity. This phenomenon is predicted to favor the development and expansion of freshwater cyanobacteria towards brackish waters due to their transfer along the estuarine freshwater-marine continuum. Since freshwater cyanobacteria are known to produce toxins, this represents a serious threat for animal and human health. Saxitoxins (STXs) are classified among the most powerful cyanotoxins. It becomes thus critical to evaluate the capacity of cyanobacteria producing STXs to face variations in salinity and to better understand the physiological consequences of sodium chloride (NaCl) exposure, in particular on their toxicity. Laboratory experiments were conducted on three filamentous cyanobacteria species isolated from brackish (Dolichospermum sp.) and fresh waters (Aphanizomenon gracile and Cylindrospermopsis raciborskii) to determine how salinity variations affect their growth, photosynthetic activity, pigment composition, production of reactive oxygen species (ROS), synthesis of compatible solutes and STXs intracellular quotas. Salinity tolerance was found to be species-specific. Dolichospermum sp. was more resistant to salinity variations than A. gracile and C. raciborskii. NaCl variations reduced growth in all species. In A. gracile, carotenoids content was dose-dependently reduced by NaCl. By contrast, in C. raciborskii and Dolichospermum sp., variations in carotenoids content did not show obvious relationships with NaCl concentration. While in Dolichospermum sp. phycocyanin and phycoerythrin increased within the first 24 h exposure to NaCl, in both A. gracile and C. raciborskii, these pigments decreased proportionally to NaCl concentration. Low changes in salinity did not impact STXs production in A. gracile and C. raciborskii while higher increase in salinity could modify the toxin profile and content of C. raciborskii (intracellular STX decreased while dc-GTX2 increased). In estuaries, A. gracile and C. raciborskii would not be able to survive beyond the oligohaline area (i.e. salinity > 5). Conversely, in part due to its ability to accumulate compatible solutes, Dolichospermum sp. has the potential to face consequent salinity variations and to survive in the polyhaline area (at least up to salinity = 24).
Background Geopolitical and climate changes form the background of the current migration crisis. It has many faces. One of them are the tragic cases of poisoning of refugees due to eating wild forest mushrooms for socioeconomic reasons in the Western and Northern European countries. The most serious food poisonings in Europe, but not only, are caused by lamellar mushrooms, the most dangerous being Amanita phalloides. Its poisonous properties can be attributed to alpha-amanitin, an RNA polymerase II inhibitor. Unfortunately, as it is characterized by a delayed onset of symptoms, A. phalloides poisoning has a high risk of complications. Case presentation Our article presents a case of A. phalloides poisoning in a 28-year-old man, in which the responding medical emergency unit made errors in diagnosis and treatment. Since the correct diagnosis was made too late, the typical treatment of A. phalloides poisoning was ineffective. The patient suffered a life-threatening liver failure and needed liver transplant from a deceased donor. Conclusions Mushroom poisoning is a particularly important problem not only in countries with a mushroom picking tradition, but also-due to the inflow of refugees-in countries where mushroom poisoning was very rare until recently. In such cases it is crucial to quickly implement the correct procedure, as this can prevent the need for liver transplant or even death. This is a particularly important consideration for the first medical professionals to contact the patient, especially in cases where the patient reports mushrooms consumption and presents alarming symptoms of the gastrointestinal tract. Such situations cannot be underestimated and ignored.
Current and emerging veterinary public health (VPH) challenges raised by globalization, climate change, and industrialization of food production require the veterinarian’s role to evolve in parallel and veterinary education to adapt to reflect these changes. The European Food Hygiene catalog was developed to provide a list of topics relevant to Day One Competencies in VPH. A study was undertaken to ensure that the catalog and teaching practices were pertinent to the work of public health veterinarians. Relevant stakeholders were consulted using questionnaires and semi-structured interviews. A long questionnaire was distributed to 49 academics teaching VPH in European veterinary schools to review topics listed in the catalog. Eighteen responses were received (36.7%), representing 12 European countries. There was general agreement that most topics were appropriate for the undergraduate VPH curriculum. A short questionnaire was distributed to 348 European veterinarians working in the industry. Twenty-four questionnaires (6.7%) were received, representing eight European countries. Despite the low participation rate, topics needing greater emphasis in the undergraduate curriculum included Hazard Analysis Critical Control Points (HACCP), food microbiology, and audits. Seven semi-structured interviews with public health veterinarians working in the UK identified the need for curricular changes including greater practical experience and a shift from a focus on meat inspection to risk management. This may be partly achieved by replacing traditional lectures with authentic case-based scenarios. The study findings can be used to inform the future direction to VPH education for veterinary students across Europe.
BACKGROUND: Universal mass vaccination (UMV) against rotavirus has been implemented in many but not all European countries. This study investigated the impact of UMV on rotavirus incidence trends by comparing European countries with UMV: Belgium, England/Wales and Germany versus countries without UMV: Denmark and the Netherlands. METHODS: For this observational retrospective cohort study, time series data (2001-2016) on rotavirus detections, meteorological factors and population demographics were collected. For each country, several meteorological and population factors were investigated as possible predictors of rotavirus incidence. The final set of predictors were incorporated in negative binomial models accounting for seasonality and serial autocorrelation, and time-varying incidence rate ratios (IRR) were calculated for each age group and country separately. The overall vaccination impact two years after vaccine implementation was estimated by pooling the results using a random effects meta-analyses. Independent t-tests were used to compare annual epidemics in the pre-vaccination and post-vaccination era to explore any changes in the timing of rotavirus epidemics. RESULTS: The population size and several meteorological factors were predictors for the rotavirus epidemiology. Overall, we estimated a 42% (95%-CI 23;56%) reduction in rotavirus incidence attributable to UMV. Strongest reductions were observed for age-groups 0-, 1- and 2-years (IRR 0.47, 0.48 and 0.63, respectively). No herd effect induced by UMV in neighbouring countries was observed. In all UMV countries, the start and/or stop and corresponding peak of the rotavirus season was delayed by 4-7 weeks. CONCLUSIONS: The introduction of rotavirus UMV resulted in an overall reduction of 42% in rotavirus incidence in Western European countries two years after vaccine introduction and caused a change in seasonal pattern. No herd effect induced by UMV neighbouring countries was observed for Denmark and the Netherlands.
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.
BACKGROUND: Visceral leishmaniasis (VL) is re-emerging in Armenia since 1999 with 167 cases recorded until 2019. The objectives of this study were (i) to determine for the first time the genetic diversity and population structure of the causative agent of VL in Armenia; (ii) to compare these genotypes with those from most endemic regions worldwide; (iii) to monitor the diversity of vectors in Armenia; (iv) to predict the distribution of the vectors and VL in time and space by ecological niche modeling. METHODOLOGY/PRINCIPAL FINDINGS: Human samples from different parts of Armenia previously identified by ITS-1-RFLP as L. infantum were studied by Multilocus Microsatellite Typing (MLMT). These data were combined with previously typed L. infantum strains from the main global endemic regions for population structure analysis. Within the 23 Armenian L. infantum strains 22 different genotypes were identified. The combined analysis revealed that all strains belong to the worldwide predominating MON1-population, however most closely related to a subpopulation from Southeastern Europe, Maghreb, Middle East and Central Asia. The three observed Armenian clusters grouped within this subpopulation with strains from Greece/Turkey, and from Central Asia, respectively. Ecological niche modeling based on VL cases and collected proven vectors (P. balcanicus, P. kandelakii) identified Yerevan and districts Lori, Tavush, Syunik, Armavir, Ararat bordering Georgia, Turkey, Iran and Azerbaijan as most suitable for the vectors and with the highest risk for VL transmission. Due to climate change the suitable habitat for VL transmission will expand in future all over Armenia. CONCLUSIONS: Genetic diversity and population structure of the causative agent of VL in Armenia were addressed for the first time. Further genotyping studies should be performed with samples from infected humans, animals and sand flies from all active foci including the neighboring countries to understand transmission cycles, re-emergence, spread, and epidemiology of VL in Armenia and the entire Transcaucasus enabling epidemiological monitoring.
Harmful algal blooms (HAB) are recurrent phenomena in northern Europe along the coasts of the Baltic Sea, Kattegat-Skagerrak, eastern North Sea, Norwegian Sea and the Barents Sea. These HABs have caused occasional massive losses for the aquaculture industry and have chronically affected socioeconomic interests in several ways. This status review gives an overview of historical HAB events and summarises reports to the Harmful Algae Event Database from 1986 to the end of year 2019 and observations made in long term monitoring programmes of potentially harmful phytoplankton and of phycotoxins in bivalve shellfish. Major HAB taxa causing fish mortalities in the region include blooms of the prymnesiophyte Chrysochromulina leadbeateri in northern Norway in 1991 and 2019, resulting in huge economic losses for fish farmers. A bloom of the prymesiophyte Prymnesium polylepis (syn. Chrysochromulina polylepis) in the Kattegat-Skagerrak in 1988 was ecosystem disruptive. Blooms of the prymnesiophyte Phaeocystis spp. have caused accumulations of foam on beaches in the southwestern North Sea and Wadden Sea coasts and shellfish mortality has been linked to their occurrence. Mortality of shellfish linked to HAB events has been observed in estuarine waters associated with influx of water from the southern North Sea. The first bloom of the dictyochophyte genus Pseudochattonella was observed in 1998, and since then such blooms have been observed in high cell densities in spring causing fish mortalities some years. Dinoflagellates, primarily Dinophysis spp., intermittently yield concentrations of Diarrhetic Shellfish Toxins (DST) in blue mussels, Mytilus edulis, above regulatory limits along the coasts of Norway, Denmark and the Swedish west coast. On average, DST levels in shellfish have decreased along the Swedish and Norwegian Skagerrak coasts since approximately 2006, coinciding with a decrease in the cell abundance of D. acuta. Among dinoflagellates, Alexandrium species are the major source of Paralytic Shellfish Toxins (PST) in the region. PST concentrations above regulatory levels were rare in the Skagerrak-Kattegat during the three decadal review period, but frequent and often abundant findings of Alexandrium resting cysts in surface sediments indicate a high potential risk for blooms. PST levels often above regulatory limits along the west coast of Norway are associated with A. catenella (ribotype Group 1) as the main toxin producer. Other Alexandrium species, such as A. ostenfeldii and A. minutum, are capable of producing PST among some populations but are usually not associated with PSP events in the region. The cell abundance of A. pseudogonyaulax, a producer of the ichthyotoxin goniodomin (GD), has increased in the Skagerrak-Kattegat since 2010, and may constitute an emerging threat. The dinoflagellate Azadinium spp. have been unequivocally linked to the presence of azaspiracid toxins (AZT) responsible for Azaspiracid Shellfish Poisoning (AZP) in northern Europe. These toxins were detected in bivalve shellfish at concentrations above regulatory limits for the first time in Norway in blue mussels in 2005 and in Sweden in blue mussels and oysters (Ostrea edulis and Crassostrea gigas) in 2018. Certain members of the diatom genus Pseudo-nitzschia produce the neurotoxin domoic acid and analogs known as Amnesic Shellfish Toxins (AST). Blooms of Pseudo-nitzschia were common in the North Sea and the Skagerrak-Kattegat, but levels of AST in bivalve shellfish were rarely above regulatory limits during the review period. Summer cyanobacteria blooms in the Baltic Sea are a concern mainly for tourism by causing massive fouling of bathing water and beaches. Some of the cyanobacteria produce toxins, e.g. Nodularia spumigena, producer of nodularin, which may be a human health problem and cause occasional dog mortalities. Coastal and shelf sea regions in northern Europe provide a key supply of seafood, socioeconomic well-being and ecosystem services. I
Free-ranging wild ungulates are widespread in Austria, and act as hosts (i.e. feeding hosts) for ticks, including Ixodes ricinus, and as reservoir hosts for pathogens transmitted by I. ricinus. Due to climate change, the abundance of I. ricinus might be increasing, which could potentially lead to higher prevalences of tick-borne pathogens, such as Babesia spp. and Anaplasma phagocytophilum, some known for their zoonotic potential. Human babesiosis is classified as an emerging zoonosis, but sufficient data of these parasites in central Austria is lacking. In order to assess the abundance of vector-borne pathogens, blood of roe deer (Capreolus capreolus; n = 137), red deer (Cervus elaphus; n = 37), mouflons (Ovis gmelini; n = 2) and chamois (Rupicapra rupicapra; n = 1), was collected and tested for pathogen DNA in two different sampling sites in central Austria. DNA of tick-borne pathogens was detected in 15.5 % (n = 27) of these animals. Babesia capreoli (n = 22 in roe deer; n = 1 in mouflon), Babesia divergens (n = 1, in red deer), and Anaplasma phagocytophilum (n = 4, in roe deer) were detected. DNA sequencing of the 18S rRNA gene of two C. capreolus samples from Upper Austria featured another new genotype of Babesia, which differs in one nucleotide position to B. divergens and B. capreoli, and is intermediate between the main genotypes of B. capreoli and B. divergens within the partial gene sequence analyzed. This study thus confirms that B. capreoli, B. divergens, and A. phagocytophilum are present in free-ranging ungulates in central Austria. Further testing over a longer period is recommended in order to assess the impact of climate change on the prevalence of blood parasites in central Austria.
Recently, ticks of Hyalomma spp. have been found more often in areas previously lacking this tick species. Due to their important role as a vector of different diseases, such as Crimean-Congo-hemorrhagic fever (CCHF), the occurrence and potential spread of this tick species is of major concern. So far, eight Hyalomma sp. ticks were found between 2018 and 2021 in Austria. A serological investigation on antibodies against the CCHF virus in 897 cattle as indicator animals displayed no positive case. During observation of climatic factors, especially in the period from April to September, the year 2018 displayed an extraordinary event in terms of higher temperature and dryness. To estimate the risk for humans to come in contact with Hyalomma sp. in Austria, many parameters have to be considered, such as the resting place of birds, availability of large livestock hosts, climate, density of human population, etc.
In the context of complex public health challenges led by interdependent changes such as climate change, biodiversity loss, and resistance to treatment, it is important to mobilize methods that guide us to generate innovative interventions in a context of uncertainty and unknown. Here, we mobilized the concept-knowledge (CK) design theory to identify innovative, cross-sectoral, and cross-disciplinary research and design programs that address the challenges posed by tick-borne Lyme disease in France, which is of growing importance in the French public health and healthcare systems. Within the CK methodological framework, we developed an iterative approach based on literature analysis, expert interviews, analysis of active French research projects, and work with CK experts to contribute to design “an action plan against Lyme disease.” We produced a CK diagram that highlights innovative concepts that could be addressed in research projects. The outcome is discussed within four areas: (i) effectiveness; (ii) environmental sustainability in prevention actions; (iii) the promotion of constructive involvement of citizens in Lyme challenges; and (iv) the development of care protocols for chronic conditions with an unknown diagnosis. Altogether, our analysis questioned the health targets ranging from population to ecosystem, the citizen involvement, and the patient consideration. This means integrating social and ecological science, as well as the multidisciplinary medical patient journey, from the start. CK theory is a promising framework to assist public health professionals in designing programs for complex yet urgent contexts, where research and data collection are still not sufficient to provide clear guidance.
Ixodes ricinus ticks (Acari: Ixodidae) are the most important vector for Lyme borreliosis in Europe. As climate change might affect their distributions and activities, this study aimed to determine the effects of environmental factors, i.e., meteorological, bioclimatic, and habitat characteristics on host-seeking (questing) activity of I. ricinus nymphs, an important stage in disease transmissions, across diverse climatic types in France over 8 years. Questing activity was observed using a repeated removal sampling with a cloth-dragging technique in 11 sampling sites from 7 tick observatories from 2014 to 2021 at approximately 1-month intervals, involving 631 sampling campaigns. Three phenological patterns were observed, potentially following a climatic gradient. The mixed-effects negative binomial regression revealed that observed nymph counts were driven by different interval-average meteorological variables, including 1-month moving average temperature, previous 3-to-6-month moving average temperature, and 6-month moving average minimum relative humidity. The interaction effects indicated that the phenology in colder climates peaked differently from that of warmer climates. Also, land cover characteristics that support the highest baseline abundance were moderate forest fragmentation with transition borders with agricultural areas. Finally, our model could potentially be used to predict seasonal human-tick exposure risks in France that could contribute to mitigating Lyme borreliosis risk.
BACKGROUND: In the face of ongoing climate warming, vector-borne diseases are expected to increase in Europe, including tick-borne diseases (TBD). The most abundant tick-borne diseases in Germany are Tick-Borne Encephalitis (TBE) and Lyme Borreliosis (LB), with Ixodes ricinus as the main vector. METHODS: In this study, we display and compare the spatial and temporal patterns of reported cases of human TBE and LB in relation to some associated factors. The comparison may help with the interpretation of observed spatial and temporal patterns. RESULTS: The spatial patterns of reported TBE cases show a clear and consistent pattern over the years, with many cases in the south and only few and isolated cases in the north of Germany. The identification of spatial patterns of LB disease cases is more difficult due to the different reporting practices in the individual federal states. Temporal patterns strongly fluctuate between years, and are relatively synchronized between both diseases, suggesting common driving factors. Based on our results we found no evidence that weather conditions affect the prevalence of both diseases. Both diseases show a gender bias with LB bing more commonly diagnosed in females, contrary to TBE being more commonly diagnosed in males. CONCLUSION: For a further investigation of of the underlying driving factors and their interrelations, longer time series as well as standardised reporting and surveillance system would be required.
BACKGROUND: Tick-borne encephalitis (TBE) is the most important tick-borne viral disease in Eurasia and causes disease in humans and in a number of animals, among them dogs and horses. There is still no good correlation between tick numbers, weather conditions and human cases. There is the hypothesis that co-feeding due to simultaneous occurrence of larvae and nymphs may be a factor for the increased transmission of the virus in nature and for human disease. Based on long-term data from a natural TBEV focus, phylogenetic results and meteorological data we sought to challenge this hypothesis. METHODS: Ticks from an identified TBE natural focus were sampled monthly from 04/2009 to 12/2018. Ticks were identified and pooled. Pools were tested by RT-qPCR. Positive pools were confirmed by virus isolation and/or sequencing of additional genes (E gene, NS2 gene). Temperature data such as the decadal (10-day) mean daily maximum air temperature (DMDMAT) were obtained from a nearby weather station and statistical correlations between tick occurrence and minimal infection rates (MIR) were calculated. RESULTS: In the study period from 04/2009 to 12/2018 a total of 15,530 ticks (2,226 females, 2,268 males, 11,036 nymphs) were collected. The overall MIR in nymphs over the whole period was 77/15,530 (0.49%), ranging from 0.09% (2009) to 1.36% (2015). The overall MIR of female ticks was 0.76% (17/2,226 ticks), range 0.14% (2013) to 3.59% (2016). The overall MIR of males was 0.57% (13/2,268 ticks), range from 0.26% (2009) to 0.97% (2015). The number of nymphs was statistically associated with a later start of spring/vegetation period, indicated by the onset of forsythia flowering. CONCLUSION: There was no particular correlation between DMDMAT dynamics in spring and/or autumn and the MIR of nymphs or adult ticks detected. However, there was a positive correlation between the number of nymphs and the number of reported human TBE cases in the following months, but not in the following year. The hypothesis of the importance of co-feeding of larvae and nymphs for the maintenance of transmission cycle of TBEV in nature is not supported by our findings.
Ticks are hematophagous parasites that can transmit a variety of human pathogens, and their life cycle is dependent on several climatic factors for development and survival. We conducted a study in Piedmont and Aosta Valley, Italy, between 2009 and 2018. The study matched human sample serologies for Borrelia spp. with publicly available climatic and meteorological data. A total of 12,928 serological immunofluorescence assays (IFA) and Western blot (WB) tests were analysed. The median number of IFA and WB tests per year was 1236 (range 700-1997), with the highest demand in autumn 2018 (N = 289). In the study period, positive WB showed an increasing trend, peaking in 2018 for both IgM (N = 97) and IgG (N = 61). These results were consistent with a regional climatic variation trending towards an increase in both temperature and humidity. Our results suggest that coupling data from epidemiology and the environment, and the use of a one health approach, may provide a powerful tool in understanding disease transmission and strengthen collaboration between specialists in the era of climate instability.
INTRODUCTION: Lyme disease is the most common tick-borne disease, caused by spirochetes of the genus Borrelia, transmitted by ticks of the Ixodes genus. According to ECDC, Poland should be considered as an endemic area. The risk of Lyme disease incidence in-creases with tick habitats increase, which is a response to environmental factors and climate change. AIM OF THE STUDY: The aim of the study is to assess the epidemiological situation of Lyme disease in Poland in 2018 compared to the situation in previous years. MATERIAL AND METHODS: The epidemiological situation of Lyme disease in Poland was assessed on the basis of the data sent to NIPH-NIH by voivodeship sanitary-epidemiological stations and published in the bulletin ‘Infectious diseases and poisoning in Poland in 2018’ . RESULTS: In 2018; 20,150 Lyme disease cases was registered, 2,124 people were hospitalized. You can also see an increase in cases in the second and third quarter in favor of the fourth quarter. The epidemiological situation in Western European countries is similar to the situation in Poland. SUMMARY AND CONCLUSION: The inability to determine the clear trend of the epidemiological situation in Poland indicates the sensitivity of the surveillance system, but also the difficulty in new cases diagnosis. You can also see a decrease in the number of cases, which may be a sign of having the right tools or experience in the Lyme disease diagnosis.
INTRODUCTION: Lyme disease is caused by Borrelia spirochetes transmitted by ticks of the genus Ixodes. In Poland, Lyme disease is the most common tick-borne disease. The entire territory of Poland is recognized by ECDC as an endemic area of Lyme disease. Environmental factors and climate change are responsible for the increase in the number of tick habitats, which leads to an increased risk of Lyme disease. AIM OF THE STUDY: The aim of the study is to present the epidemiological situation of Lyme disease in Poland in 2019 compared to the previous year. MATERIAL AND METHODS: The analysis of the epidemiological situation of Lyme disease in Poland was based on data sent to NIPH NIH – NRI by voivodeship sanitary-epidemiological stations and published in the bulletin “Infectious diseases and poisoning in Poland in 2019.” RESULTS: In 2019, 20,630 cases of Lyme disease were registered, and 1,701 people were hospitalized. Compared to 2018, there was a shift in the incidence from the first and second quarter to the fourth quarter. The highest incidence of 107.7 / 100,000 population was recorded in the Podlaskie voivodeship, which has belonged to the voivodeships with the highest incidence in the country for many years. Despite an increase in the total number of cases by 2.4% compared to 2018, the percentage of hospitalized cases was lower than in the previous year. SUMMARY AND CONCLUSION: Difficulties in the diagnosis of Lyme disease make it impossible to define an unequivocal trend in the epidemiological situation in Poland. A slight increase in the incidence may result from the growing number of infected ticks and a better understanding of the problem of Lyme diagnosis by doctors.
BACKGROUND: The evidence is sparse regarding the associations between serious mental illnesses (SMIs) prevalence and environmental factors in adulthood as well as the geographic distribution and variability of these associations. In this study, we evaluated the association between availability and proximity of green and blue space with SMI prevalence in England as a whole and in its major conurbations (Greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle). METHODS AND FINDINGS: We carried out a retrospective analysis of routinely collected adult population (≥18 years) data at General Practitioner Practice (GPP) level. We used data from the Quality and Outcomes Framework (QOF) on the prevalence of a diagnosis of SMI (schizophrenia, bipolar affective disorder and other psychoses, and other patients on lithium therapy) at the level of GPP over the financial year April 2014 to March 2018. The number of GPPs included ranged between 7,492 (April 2017 to March 2018) to 7,997 (April 2014 to March 2015) and the number of patients ranged from 56,413,719 (April 2014 to March 2015) to 58,270,354 (April 2017 to March 2018). Data at GPP level were converted to the geographic hierarchy unit Lower Layer Super Output Area (LSOA) level for analysis. LSOAs are a geographic unit for reporting small area statistics and have an average population of around 1,500 people. We employed a Bayesian spatial regression model to explore the association of SMI prevalence in England and its major conurbations (greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle) with environmental characteristics (green and blue space, flood risk areas, and air and noise pollution) and socioeconomic characteristics (age, ethnicity, and index of multiple deprivation (IMD)). We incorporated spatial random effects in our modelling to account for variation at multiple scales. Across England, the environmental characteristics associated with higher SMI prevalence at LSOA level were distance to public green space with a lake (prevalence ratio [95% credible interval]): 1.002 [1.001 to 1.003]), annual mean concentration of PM2.5 (1.014 [1.01 to 1.019]), and closeness to roads with noise levels above 75 dB (0.993 [0.992 to 0.995]). Higher SMI prevalence was also associated with a higher percentage of people above 24 years old (1.002 [1.002 to 1.003]), a higher percentage of ethnic minorities (1.002 [1.001 to 1.002]), and more deprived areas. Mean SMI prevalence at LSOA level in major conurbations mirrored the national associations with a few exceptions. In Birmingham, higher average SMI prevalence at LSOA level was positively associated with proximity to an urban green space with a lake (0.992 [0.99 to 0.998]). In Liverpool and Manchester, lower SMI prevalence was positively associated with road traffic noise ≥75 dB (1.012 [1.003 to 1.022]). In Birmingham, Liverpool, and Manchester, there was a positive association of SMI prevalence with distance to flood zone 3 (land within flood zone 3 has ≥1% chance of flooding annually from rivers or ≥0.5% chance of flooding annually from the sea, when flood defences are ignored): Birmingham: 1.012 [1.000 to 1.023]; Liverpool and Manchester: 1.016 [1.006 to 1.026]. In contrast, in Leeds, there was a negative association between SMI prevalence and distance to flood zone 3 (0.959 [0.944 to 0.975]). A limitation of this study was because we used a cross-sectional approach, we are unable to make causal inferences about our findings or investigate the temporal relationship between outcome and risk factors. Another limitation was that individuals who are exclusively treated under specialist mental health care and not seen in primary care at all were not included in this analysis. CONCLUSIONS: Our study provides further evidence on the significance of socioeconomic associations in patterns of SMI but emphasises the additional importance of considering environmental characteristics alongside socioeconomic variables in understanding these patterns. In this study, we did not observe a significant association between green space and SMI prevalence, but we did identify an apparent association between green spaces with a lake and SMI prevalence. Deprivation, higher concentrations of air pollution, and higher proportion of ethnic minorities were associated with higher SMI prevalence, supporting a social-ecological approach to public health prevention. It also provides evidence of the significance of spatial analysis in revealing the importance of place and context in influencing area-based patterns of SMI.
In late March 2018, a large part of the Eastern Mediterranean experienced an extraordinary episode of African dust, one of the most intense in recent years, here referred to as the “Minoan Red” event. The episode mainly affected the Greek island of Crete, where the highest aerosol concentrations over the past 15 yeas were recorded, although impacts were also felt well beyond this core area. Our study fills a gap in dust research by assessing the multi-sectoral impacts of sand and dust storms and their socioeconomic implications. Specifically, we provide a multi-sectoral impact assessment of Crete during the occurrence of this exceptional African dust event. During the day of the occurrence of the maximum dust concentration in Crete, i.e. March 22nd, 2018, we identified impacts on meteorological conditions, agriculture, transport, energy, society (including closing of schools and cancellation of social events), and emergency response systems. As a result, the event led to a 3-fold increase in daily emergency responses compare to previous days associated with urban emergencies and wildfires, a 3.5-fold increase in hospital visits and admissions for Chronic Obstructive Pulmonary Disease (COPD) exacerbations and dyspnoea, a reduction of visibility causing aircraft traffic disruptions (eleven cancellations and seven delays), and a reduction of solar energy production. We estimate the cost of direct and indirect effects of the dust episode, considering the most affected socio-economic sectors (e.g. civil protection, aviation, health and solar energy production), to be between 3.4 and 3.8 million EUR for Crete. Since such desert dust transport episodes are natural, meteorology-driven and thus to a large extent unavoidable, we argue that the efficiency of actions to mitigate dust impacts depends on the accuracy of operational dust forecasting and the implementation of relevant early warning systems for social awareness.
BACKGROUND: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. METHODS: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants’ compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. DISCUSSION: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03503812 , April 20, 2018.
Desert dust storms (DDS) are natural events that impact not only populations close to the emission sources but also populations many kilometers away. Countries located across the main dust sources, including countries in the Eastern Mediterranean, are highly affected by DDS. In addition, climate change is expanding arid areas exacerbating DDS events. Currently, there are no intervention measures with proven, quantified exposure reduction to desert dust particles. As part of the wider “MEDEA” project, co-funded by LIFE 2016 Programme, we examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation during DDS events and continuous use of air purifier during DDS and non-DDS days) across homes and/or classrooms of schoolchildren with asthma and adults with atrial fibrillation in Cyprus and Crete-Greece. Participants were randomized to a control or intervention groups, including an indoor intervention group with exposure reduction measures and the use of air purifiers. Particle sampling, PM(10) and PM(2.5,) was conducted in participants’ homes and/or classrooms, between 2019 and 2022, during DDS-free weeks and during DDS days for as long as the event lasted. In indoor and outdoor PM(10) and PM(2.5) samples, mass and content in main and trace elements was determined. Indoor PM(2.5) and PM(10) mass concentrations, adjusting for premise type and dust conditions, were significantly lower in the indoor intervention group compared to the control group (PM(2.5-intervention)/PM(2.5-control) = 0.57, 95% CI: 0.47, 0.70; PM(10-intervention)/PM(10-control) = 0.59, 95% CI: 0.49, 0.71). In addition, the PM(2.5) and PM(10) particles of outdoor origin were significantly lower in the intervention vs. the control group (PM(2.5) infiltration intervention-to-control ratio: 0.49, 95% CI: 0.42, 0.58; PM(10) infiltration intervention-to-control ratio: 0.68, 95% CI: 0.52, 0.89). Our findings suggest that the use of air purifiers alongside decreased ventilation measures is an effective protective measure that reduces significantly indoor exposure to particles during DDS and non-DDS in high-risk population groups.
Compared to soil or aquatic ecosystems, the atmosphere is still an underexplored environment for microbial diversity. In this study, we surveyed the composition, variability and sources of microbes (bacteria and fungi) in the near surface atmosphere of a highly populated area, spanning ~ 4,000 Km(2) around the city center of Madrid (Spain), in different seasonal periods along two years. We found a core of abundant bacterial genera robust across space and time, most of soil origin, while fungi were more sensitive to environmental conditions. Microbial communities showed clear seasonal patterns driven by variability of environmental factors, mainly temperature and accumulated rain, while local sources played a minor role. We also identified taxa in both groups characteristic of seasonal periods, but not of specific sampling sites or plant coverage. The present study suggests that the near surface atmosphere of urban environments contains an ecosystem stable across relatively large spatial and temporal scales, with a rather homogenous composition, modulated by climatic variations. As such, it contributes to our understanding of the long-term changes associated to the human exposome in the air of highly populated areas.
In the present study, we analysed how geographical distribution of the fungal pathogen Cryptococcus gattii VGI in Europe and Mediterranean area has evolved in the last four decades based on the climatic changes, and we tried to predict the scenario for the next decade. Niche modelling by Maxent analysis showed that recent climate changes have significantly affected the distribution of the fungus revealing a gradual expansion of the fundamental niche from 1980 to 2009 followed by an impressive increase in the last decade (2010-2019) during which the environmental surface suitable for the fungal survival was more than doubled. In the next decade, our model predicted an increase in the area of distribution of C. gattii VGI from the coasts of the Mediterranean basin towards the more internal sub-continental areas. On the basis of these predictions, an increase of cases of cryptococcosis due to C. gattii VGI is expected in the next decade and a constant monitoring of the epidemiology of this fungal pathogen represents a crucial strategy to detect the onset of future outbreaks.
User behaviour for natural ventilation is known to be strongly corelated to outdoor temperatures. In areas of moderate climate, this leads to an increased fresh air supply in summer, which reduces the exposure level towards airborne pathogens. Modelling of numerous random exposure situations in household, school and various settings, based on the long-term climate data from Berlin, showed that this effect is likely to contribute significantly to the overall seasonality of airborne diseases.
Respiratory syncytial virus (RSV) bronchiolitis is a leading cause of global child morbidity and mortality. Every year, seasonal RSV outbreaks put high pressure on paediatric intensive care units (PICUs) worldwide, including in the Netherlands, and this burden appears to be increasing. Weather conditions have a strong influence on RSV activity, and climate change has been proposed as a potential important determinant of future RSV-related health care utilisation. In this national study spanning a total of 13 years with 2161 PICU admissions for RSV bronchiolitis, we aimed (1) to identify meteorological variables that were associated with the number of PICU admissions for RSV bronchiolitis in the Netherlands and (2) to determine if longitudinal changes in these variables occurred over time as a possible explanation for the observed increase in PICU burden. Poisson regression modelling was used to identify weather variables (aggregated in months and weeks) that predicted PICU admissions, and linear regression analysis was used to assess changes in the weather over time. Maximum temperature and global radiation best predicted PICU admissions, with global radiation showing the most stable strength of effect in both month and week data. However, we did not observe a significant change in these weather variables over the 13-year time period. Based on our study, we could not identify changing weather conditions as a potential contributing factor to the increased RSV-related PICU burden in the Netherlands.
The cold season is usually accompanied by an increased incidence of respiratory infections and increased air pollution from combustion sources. As we are facing growing numbers of COVID-19 cases caused by the novel SARS-CoV-2 coronavirus, an understanding of the impact of air pollutants and meteorological variables on the incidence of respiratory infections is crucial. The incidence of influenza-like illness (ILI) can be used as a close proxy for the circulation of influenza viruses. Recently, SARS-CoV-2 has also been detected in patients with ILI. Using distributed lag nonlinear models, we analyzed the association between ILI, meteorological variables and particulate matter concentration in Bialystok, Poland, from 2013-2019. We found an exponential relationship between cumulative PM(2.5) pollution and the incidence of ILI, which remained significant after adjusting for air temperatures and a long-term trend. Pollution had the greatest effect during the same week, but the risk of ILI was increased for the four following weeks. The risk of ILI was also increased by low air temperatures, low absolute humidity, and high wind speed. Altogether, our results show that all measures implemented to decrease PM(2.5) concentrations would be beneficial to reduce the transmission of SARS-CoV-2 and other respiratory infections.
The global crises of climate change and of the COVID-19 pandemic are straining young peoples’ mental health and their mitigation behaviours. We surveyed German-speaking university students aged 18 to 30 years on their negative emotions regarding both crises repeatedly before and during the COVID-19 crisis. Different emotional patterns emerged for climate change and for COVID-19 with negative emotions regarding COVID-19 increasing during the pandemic. We were further able to differentiate between emotional responses associated with impaired wellbeing and those associated with mitigation efforts. Our findings emphasise the need to focus on a mixture of highly inactivating and activating emotions regarding COVID-19 as they are associated with both reduced wellbeing and mitigation behaviours. The findings broaden the understanding of how young adults react to the burden of two global crises and what role negative emotions play.
COVID-19 pandemic continues to obstruct social lives and the world economy other than questioning the healthcare capacity of many countries. Weather components recently came to notice as the northern hemisphere was hit by escalated incidence in winter. This study investigated the association between COVID-19 cases and two components, average temperature and relative humidity, in the 16 states of Germany. Three main approaches were carried out in this study, namely temporal correlation, spatial auto-correlation, and clustering-integrated panel regression. It is claimed that the daily COVID-19 cases correlate negatively with the average temperature and positively with the average relative humidity. To extract the spatial auto-correlation, both global Moran’s [Formula: see text] and global Geary’s [Formula: see text] were used whereby no significant difference in the results was observed. It is evident that randomness overwhelms the spatial pattern in all the states for most of the observations, except in recent observations where either local clusters or dispersion occurred. This is further supported by Moran’s scatter plot, where states’ dynamics to and fro cold and hot spots are identified, rendering a traveling-related early warning system. A random-effects model was used in the sense of case-weather regression including incidence clustering. Our task is to perceive which ranges of the incidence that are well predicted by the existing weather components rather than seeing which ranges of the weather components predicting the incidence. The proposed clustering-integrated model associated with optimal barriers articulates the data well whereby weather components outperform lag incidence cases in the prediction. Practical implications based on marginal effects follow posterior to model diagnostics.
During the ongoing global COVID-19 pandemic disease, like several countries, Romania experienced a multiwaves pattern over more than two years. The spreading pattern of SARS-CoV-2 pathogens in the Bucharest, capital of Romania is a multi-factorial process involving among other factors outdoor environmental variables and viral inactivation. Through descriptive statistics and cross-correlation analysis applied to daily time series of observational and geospatial data, this study aims to evaluate the synergy of COVID-19 incidence and lethality with air pollution and radon under different climate conditions, which may exacerbate the coronavirus’ effect on human health. During the entire analyzed period 1 January 2020-21 December 2021, for each of the four COVID-19 waves were recorded different anomalous anticyclonic synoptic meteorological patterns in the mid-troposphere, and favorable stability conditions during fall-early winter seasons for COVID-19 disease fast-spreading, mostly during the second, and the fourth waves. As the temporal pattern of airborne SARS-CoV-2 and its mutagen variants is affected by seasonal variability of the main air pollutants and climate parameters, this paper found: 1) the daily outdoor exposures to air pollutants (particulate matter PM2.5 and PM10, nitrogen dioxide-NO(2), sulfur dioxide-SO(2), carbon monoxide-CO) and radon – (222)Rn, are directly correlated with the daily COVID-19 incidence and mortality, and may contribute to the spread and the severity of the pandemic; 2) the daily ground ozone-O(3) levels, air temperature, Planetary Boundary Layer height, and surface solar irradiance are anticorrelated with the daily new COVID-19 incidence and deaths, averageingful for spring-summer periods. Outdoor exposure to ambient air pollution associated with radon is a non-negligible driver of COVID-19 transmission in large metropolitan areas, and climate variables are risk factors in spreading the viral infection. The findings of this study provide useful information for public health authorities and decision-makers to develop future pandemic diseases strategies in high polluted metropolitan environments.
Issues continuously compete for attention in the news media and on social media. Climate change is one of the most urgent problems for society and (re)gained wide public attention in 2019 through the global climate strike protest movement. However, we hypothesize that the outbreak of the COVID-19 pandemic in early 2020 challenged the role of climate change as a routine issue. We use extensive news media and Twitter data to explore if and how the pandemic as a so-called killer issue has shifted public attention away from the issue of climate change in Switzerland. Results show that the climate debate fell victim to the impact of the COVID-19 pandemic in the news media and the Twitter-sphere. Given the vast dominance of the pandemic, there is a strong indication this finding applies similarly to various other issues. Additional hashtag co-occurrence analysis shows that some climate activists react to this development and try to connect the issue of climate change to the pandemic. We argue that suppression of climate change by the pandemic is a problem for its long-term resolution, as it seems to have turned climate change back into a struggling issue.
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.
Hydrometeorological hazards comprise a wide range of events, mainly floods, storms, droughts, and temperature extremes. Floods account for the majority of the related disasters in both developed and developing countries. Flooding alters the natural balance of the environment and frequently establish a favorable habitat for pathogens and vectors to thrive. Diseases caused by pathogens that require vehicle transmission from host to host (waterborne) or a host/vector as part of their life cycle (vector-borne) are those most likely to be affected by flooding. Considering the most notable recent destructive floods events of July 2021 that affected several Central Europe countries, we conducted a systematic literature review in order to identify documented sporadic cases and outbreaks of infectious diseases in humans in Europe, where hydrometeorological hazards, mainly floods, were thought to have been involved. The occurrence of water-, rodent-, and vector-borne diseases in several European countries is highlighted, as flooding and the harsh post-flood conditions favor their emergence and transmission. In this context, strategies for prevention and management of infectious disease outbreaks in flood-prone and flood-affected areas are also proposed and comprise pre- and post-flood prevention measures, pre- and post-outbreak prevention measures, as well as mitigation actions when an infectious disease outbreak finally occurs. Emphasis is also placed on the collision of floods, flood-related infectious disease outbreaks, and the evolving COVID-19 pandemic, which may result in unprecedented multi-hazard conditions and requires a multi-hazard approach for the effective disaster management and risk reduction.
Background Previous studies investigating the relationship of influenza with acute myocardial infarction (AMI) have not distinguished between AMI types 1 and 2. Influenza and cold temperature can explain the increased incidence of AMI during winter but, because they are closely related in temperate regions, their relative contribution is unknown. Methods and Results The temporal relationship between incidence rates of AMI with demonstrated culprit plaque (type 1 AMI) from the regional primary angioplasty network and influenza, adjusted for ambient temperature, was studied in Madrid region (Spain) during 5 influenza seasons (from June 2013 to June 2018). A time-series analysis with quasi-Poisson regression models and distributed lag-nonlinear models was used. The incidence rate of type 1 AMI according to influenza vaccination status was also explored. A total of 8240 cases of confirmed type 1 AMI were recorded. The overall risk ratio (RR) of type 1 AMI during epidemic periods, adjusted for year, month, and temperature, was 1.23 (95% CI, 1.03-1.47). An increase of weekly influenza rate of 50 cases per 100 000 inhabitants resulted in an RR for type 1 AMI of 1.16 (95% CI, 1.09-1.23) during the same week, disappearing 1 week after. When adjusted for influenza, a decrease of 1ºC in the minimum temperature resulted in an increase of 2.5% type 1 AMI. Influenza vaccination was associated with a decreased risk of type 1 AMI in subjects aged 60 to 64 years (RR, 0.58; 95% CI, 0.47-0.71) and ≥65 years (RR, 0.53; 95% CI, 0.49-0.57). Conclusions Influenza and cold temperature were both independently associated with an increased risk of type 1 AMI, whereas vaccination was associated with a reduced risk among older patients.
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.
BACKGROUND: The comprehensive epidemiology and impact of climate on viral meningitis (VM) in Kazakhstan are unknown. We aimed to study the incidence, in-hospital mortality and influence of climatic indicators on VM from 2014 to 2019. METHODS: Nationwide electronic healthcare records were used to explore this study. ICD-10 codes of VM, demographics, and hospital outcomes were evaluated using descriptive statistics and survival analysis. RESULTS: During the 2014-2019 period, 10,251 patients with VM were admitted to the hospital. 51.35% of them were children, 57.85% were males, and 85.9% were from the urban population. Enteroviral meningitis was the main cause of VM in children. The incidence rate was 13 and 18 cases per 100,000 population in 2014 and 2019, respectively. Case fatality rate was higher in 2015 (2.3%) and 2017 (2.0%). The regression model showed 1°C increment in the daily average temperature might be associated with a 1.05-fold (95% CI 1.047-1.051) increase in the daily rate of VM cases, 1hPa increment in the average air pressure and 1% increment in the daily average humidity might contribute to a decrease in the daily rate of VM cases with IRRs of 0.997 (95% CI 0.995-0.998) and 0.982 (95% CI 0.981-0.983), respectively. In-hospital mortality was 35% higher in males compared to females. Patients residing in rural locations had a 2-fold higher risk of in-hospital death, compared to city residents. Elderly patients had a 14-fold higher risk of in-hospital mortality, compared to younger patients. CONCLUSION: This is the first study in Kazakhstan investigating the epidemiology and impact of climate on VM using nationwide healthcare data. There was a tendency to decrease the incidence with outbreaks every 5 years, and mortality rates were higher for Russians and other ethnicities compared to Kazakhs, for males compared to females, for elder patients compared to younger patients, and for patients living in rural areas compared to city residents. The climatic parameters and the days of delay indicated a moderate interaction with the VM cases.
This study examines whether climate change-associated environmental stressors, including air and noise pollution, local heat levels, as well as a lack of surrounding greenspace, mediate the effects of local poverty on mental health, using the 28-item General Health Questionnaire. We recruited 478 adults who were representative of eleven of Berlin’s inner-city neighborhoods. The relationship of individual-level variables, neighborhood-level sociodemographic and environmental data from the Berlin Senate (Department for Urban Development, Building and Housing) to mental health was assessed in a multilevel model using SPSS. We found that neither local exposure to environmental stressors, nor available greenspace as a protective factor, mediated the effects of local poverty on variance in mental health (all p values > 0.2). However, surrounding greenspace (r = -0.24, p < 0.001), nitrogen dioxide levels (r = 0.10, p < 0.05), noise pollution (rho = 0.15, p < 0.01), and particle pollution (r = 0.12, p < 0.001) were associated with local poverty, which, more strongly than individual factors, accounted for variance in mental health (β = 0.47, p < 0.001). Our analysis indicates that the effects of local poverty on mental health are not mediated by environmental factors. Instead, local poverty was associated with both an increased mental health burden and the exposure to climate-related environmental stressors.
Ultrafine particles (UFP), harmful to human health, are emitted at high levels from motorized traffic. Bicycle commuting is increasingly encouraged to reduce traffic emissions and increase physical activity, but higher breathing rates increase inhaled UFP concentrations while in traffic. We assessed exposure to UFP while cycling along a fixed 8.5 km inner-city route in Copenhagen, on weekdays over six weeks (from September to October 2020), during morning and afternoon rush-hour, as well as morning non-rush-hour, traffic time periods starting from 07:45, 15:45, and 09:45 h, respectively. Continuous measurements were made (each second) of particle number concentration (PNC) and location. PNC levels were summarized and compared across time periods. We used generalized additive models to adjust for meteorological factors, weekdays and trends. A total of 61 laps were completed, during 28 days (∼20 per time period). Overall mean PNC was 18,149 pt/cm^(3) (range 256-999,560 pt/cm^(3)) with no significant difference between morning rush-hour (18003 pt/cm^(3)), afternoon rush-hour (17560 pt/cm^(3)) and late morning commute (17560 pt/cm^(3)) [p = 0.85]. There was substantial spatial variation of UFP exposure along the route with highest PNC levels measured at traffic intersections (∼38,000-42000 pt/cm^(3)), multiple lane roads (∼38,000-40000 pt/cm^(3)) and construction sites (∼44,000-51000 pt/cm^(3)), while lowest levels were measured at smaller streets, areas with open built environment (∼12,000 pt/cm^(3)), as well as at a bus-only zone (∼15,000 pt/cm^(3)). UFP exposure in inner-city Copenhagen did not differ substantially when bicycling in either rush-hour or non-rush-hour, or morning or afternoon, traffic time periods. UFP exposure varied substantially spatially, with highest concentrations around intersections, multiple lane roads, and construction sites. This suggests that exposure to UFP is not necessarily reduced by avoiding rush-hours, but by avoiding sources of pollution along the bicycling route.
BACKGROUND: The chronic effects of ozone have only rarely been investigated in disease burden studies to date. Our goal was to determine this disease burden in Germany over the period 2007-2016, with particular attention to estimation based on effect estimates adjusted for particulate matter (PM2.5) and nitrogen dioxide (NO2). METHODS: The nationwide, high-spatial-resolution (2 km × 2 km), population-based exposure to ozone in the summer months (“summer ozone”) was calculated on the basis of modeled ozone data and population counts in Germany. Next, risk estimates derived from cohort studies were used to quantify the burden of chronic obstructive pulmonary disease (COPD). Data on population counts, life expectancy, and mortality in Germany were used to reflect the situation across the country as accurately as possible. RESULTS: The estimates of years of life lost (YLL) due to summer ozone ranged from 18.33 per 100 000 people (95% confidence interval [14.02; 22.08]) in 2007 to 35.77 per 100 000 people [27.45; 42.98] in 2015. These findings indicate that ozone affects the COPD burden independently of other harmful components of the air. No clear secular trend in the COPD burden can be seen over the period 2007 to 2016. CONCLUSION: Long-term exposure to ozone contributes to the COPD burden among the general population in Germany. As climate change may lead to a rise in the ozone concentration, more intensive research is required on the effects of ozone on health.
While many authors have described the adverse health effects of poor air quality and meteorological extremes, there remain inconsistencies on a regional scale as well as uncertainty about the single and joint effects of atmospheric predictors. In this context, we investigated the short-term impacts of weather and air quality on moderate extreme cancer-related mortality events for the urban area of Augsburg, Southern Germany, during the period 2000-2017. First, single effects were uncovered by applying a case-crossover routine. The overall impact was assessed by performing a Mann-Whitney U testing scheme. We then compared the results of this procedure to extreme noncancer-related mortality events. In a second step, we found periods with contemporaneous significant predictors and carried out an in-depth analysis of these joint-effect periods. We were interested in the atmospheric processes leading to the emergence of significant conditions. Hence, we applied the Principal Component Analysis to large-scale synoptic conditions during these periods. The results demonstrate a strong linkage between high-mortality events in cancer patients and significantly above-average levels of nitrogen dioxide (NO(2)) and particulate matter (PM(2.5)) during the late winter through spring period. These were mainly linked to northerly to easterly weak airflow under stable, high-pressure conditions. Especially in winter and spring, this can result in low temperatures and a ground-level increase and the accumulation of air pollution from heating and traffic as well as eastern lateral advection of polluted air. Additionally, above-average temperatures were shown to occur on the days before mortality events from mid-summer through fall, which was also caused by high-pressure conditions with weak wind flow and intense solar radiation. Our approach can be used to analyse medical data with epidemiological as well as climatological methods while providing a more vivid representation of the underlying atmospheric processes.C
BACKGROUND: Previous studies reported a link between short-term exposure to environmental stressors (air pollution and air temperature) and atherothrombotic cardiovascular diseases. However, only few of them reported consistent associations with venous thromboembolism (VTE). Our aim was to estimate the association between daily air temperature and particulate matter (PM) air pollution with hospital admissions for pulmonary embolism (PE) and venous thrombosis (VT) at national level in Italy. METHODS: We collected daily hospital PE and VT admissions from the Italian Ministry of Health during 2006-2015 in all the 8,084 municipalities of Italy, and we merged them with air temperature and daily PM10 concentrations estimated by satellite-based spatiotemporal models. First, we applied multivariate Poisson regression models at province level. Then, we obtained national overall effects by random-effects meta-analysis. RESULTS: This analysis was conducted on 219,952 PE and 275,506 VT hospitalizations. Meta-analytical results showed weak associations between the two exposures and the study outcomes in the full year analysis. During autumn and winter, PE hospital admissions increased by 1.07% (95% confidence intervals [CI]: 0.21%; 1.92%) and 0.96% (95% CI: 0.07%; 1.83%) respectively, per 1 °C decrement of air temperature in the previous 10 days (lag 0-10). In summer we observed adverse effects at high temperatures, with a 1% (95% CI: 0.10%; 1.91%) increasing risk per 1 °C increment. We found no association between VT and cold temperatures. CONCLUSION: Results show a significant effect of air temperature on PE hospitalizations in the cold seasons and summer. No effect of particulate matter was detected.
BACKGROUND: The impact of nitrogen dioxide (NO2) and particulate matter with an aerodynamic diameter of less than or equal to 2.5. microns (PM2.5) exposures on lung function has been investigated mainly in children and less in adults. Furthermore, it is unclear whether short-term deviations of air pollutant concentration need to be considered in long-term exposure models. OBJECTIVES: The aims of this study were to investigate the association between short-term air pollution exposure and lung function and to assess whether short-term deviations of air pollutant concentration should be integrated into long-term exposure models. METHODS: Short-term (daily averages 0-7 d prior) and long-term (1- and 4-y means) NO2 and PM2.5 concentrations were modeled using satellite, land use, and meteorological data calibrated on ground measurements. Forced expiratory volume within the first second (FEV1) of forced exhalation and forced vital capacity (FVC) were measured during a LuftiBus assessment (2003-2012) and linked to exposure information from the Swiss National Cohort for 36,085 adults (ages 18-95 y). We used multiple linear regression to estimate adjusted associations, and additionally adjusted models of long-term exposures for short-term deviations in air pollutant concentrations. RESULTS: A 10 μg/m3 increase in NO2 and PM2.5 on the day of the pulmonary function test was associated with lower FEV1 and FVC (NO2: FEV1 – 8.0 ml [95% confidence interval: – 13.4, – 2.7], FVC – 16.7 ml [ – 23.4, – 10.0]; PM2.5: FEV1 – 15.3 ml [ – 21.9, – 8.7], FVC – 18.5 ml [ – 26.5, – 10.5]). A 10 μg/m3 increase in 1-y mean NO2 was also associated with lower FEV1 ( – 7.7 ml; – 15.9, 0.5) and FVC ( – 21.6 ml; – 31.9, – 11.4), as was a 10 μg/m3 increase in 1-y mean PM2.5 (FEV1: – 42.2 ml; – 56.9, – 27.5; FVC: – 82.0 ml; – 100.1, – 63.9). These associations were robust to adjustment for short-term deviations in the concentration of each air pollutant. CONCLUSIONS: Short- and long-term air pollution exposures were negatively associated with lung function, in particular long-term PM2.5 exposure with FVC. Our findings contribute substantially to the evidence of adverse associations between air pollution and lung function in adults. https://doi.org/10.1289/EHP7529.
The short- and long-term impacts of air pollution on human health are well documented and include cardiovascular, neurological, immune system and developmental damage. Additionally, the irritant qualities of air pollutants can cause respiratory and cardiovascular distress. This can be heightened during exercise and especially so for those with respiratory conditions such as asthma. Meteorological conditions have also been shown to adversely impact athletic performance; but research has mostly examined the impact of pollution and meteorology on marathon times or running under laboratory settings. This study focuses on the half marathon distance (13.1 miles/21.1 km) and utilises the Great North Run held in Newcastle-upon-Tyne, England, between 2006 and 2019. Local meteorological (temperature, relative humidity, heat index and wind speed) and air quality (ozone, nitrogen dioxide and PM(2.5)) data is used in conjunction with finishing times of the quickest and slowest amateur participants, along with the elite field, to determine the extent to which each group is influenced in real-world conditions. Results show that increased temperatures, heat index and ozone concentrations are significantly detrimental to amateur half marathon performances. The elite field meanwhile is influenced by higher ozone concentrations. It is thought that the increased exposure time to the environmental conditions contributes to this greater decrease in performance for the slowest participants. For elite athletes that are performing closer to their maximal capacity (VO(2) max), the higher ozone concentrations likely results in respiratory irritation and decreased performance. Nitrogen dioxide and PM(2.5) pollution showed no significant relationship with finishing times. These results provide additional insight into the environmental effects on exercise, which is particularly important under the increasing effects climate change and regional air pollution. This study can be used to inform event organisation and start times for both mass participation and major elite events with the aim to reduce heat- and pollution-related incidents.
The health impacts of global climate change mitigation will affect local populations differently. However, most co-benefits analyses have been done at a global level, with relatively few studies providing local level results. We aimed to quantify the local health impacts due to fine particles (PM(2.5)) under the governance arrangements embedded in the Shared Socioeconomic Pathways (SSPs1-5) under two greenhouse gas concentration scenarios (Representative Concentration Pathways (RCPs) 2.6 and 8.5) in local populations of Mozambique, India, and Spain. We simulated the SSP-RCP scenarios using the Global Change Analysis Model, which was linked to the TM5-FASST model to estimate PM(2.5) levels. PM(2.5) levels were calibrated with local measurements. We used comparative risk assessment methods to estimate attributable premature deaths due to PM(2.5) linking local population and mortality data with PM(2.5)-mortality relationships from the literature, and incorporating population projections under the SSPs. PM(2.5) attributable burdens in 2050 differed across SSP-RCP scenarios, and sensitivity of results across scenarios varied across populations. Future attributable mortality burden of PM(2.5) was highly sensitive to assumptions about how populations will change according to SSP. SSPs reflecting high challenges for adaptation (SSPs 3 and 4) consistently resulted in the highest PM(2.5) attributable burdens mid-century. Our analysis of local PM(2.5) attributable premature deaths under SSP-RCP scenarios in three local populations highlights the importance of both socioeconomic development and climate policy in reducing the health burden from air pollution. Sensitivity of future PM(2.5) mortality burden to SSPs was particularly evident in low- and middle- income country settings due either to high air pollution levels or dynamic populations.
Frequent and severe PM2.5 pollution over China seriously harms natural environment and human health. Changes in meteorological conditions in recent decades have been recognized to contribute to the long-term increase in PM2.5 pollution in North China (NC). However, the dominant climatic factors driving the interdecadal changes of the weather conditions conducive to PM2.5 pollution remain unclear. Here we identify a potential global teleconnection mechanism: the decadal reduction in European aerosol emissions since the 1980s may have partially contributed to the interdecadal increase in weather conditions conducive to PM2.5 pollution in NC, measured by an Emission-weighted Air Stagnation Index (ASI(E)) that increases at a rate of 6.2% decade(-1) (relative to the 1981-1985 level). By regression analysis, we show that the decreased European aerosol loadings can warm the lower atmosphere and induce anomalous ascending motion in Europe, which potentially stimulates two anomalous Rossby wave trains in the upper troposphere travelling eastward across Eurasia. The teleconnection patterns project on NC by weakening the near-surface horizontal dispersion, which may be favorable to the increase in local ASI(E) and air pollution build-up. The suggested mechanism is further supported by the results from a set of large-ensemble simulations, showing that the European aerosol emission decline since the 1980s excites similar local heating and ascending motion and leads to increasing trends of 0.1-0.5 mu g m(-3) (38 year)(-1) in surface sulfate concentrations over most of NC. This proposed ‘West-to-East Aerosol-to-Aerosol’ teleconnection mechanism helps resolve opposite views on the impact of global versus local aerosol forcing on PM2.5 pollution weather in NC. The policy implication is that the sustained decline in European aerosol emissions in coming decades, in conjunction with unabated global and regional warming, could further exacerbate air pollution in NC, thus imposing stronger pressure to reduce local emission sources quicker and deeper.
BACKGROUND: Ground-level ozone is a major public health issue worldwide. An accurate assessment of ozone exposure is necessary. Modeling tools have been developed to tackle this issue in large areas. However, these models could present inaccuracies at the local scale. OBJECTIVES: The objective of this study was i) to assess whether O(3) concentrations estimated by transnational modeling at the kilometric scale (9 km(2)) could be improved, ii) to propose a potential correction of these downscaled ozone concentrations and iii) to evaluate the efficiency and applicability of such a correction. METHOD: The present work was carried out in three phases. First, the performance of a transnational modeling platform (PREV’EST) was assessed at 6 geographic points by comparison with data from 6 air quality monitoring stations. Performance indicators were used for this purpose (MBE (mean bias error), MAE (mean absolute error), RMSE (root mean square error), r (Pearson correlation coefficient), and target plots). Second, several corrections were developed using MARS (multivariate adaptive regression splines) and integrating different sets of variables (mean temperature, relative humidity, rainfall amount, wind speed, elevation, and date). Their performance was evaluated. Third, external validation of the corrections was conducted using the data from six additional air quality monitoring stations. RESULTS: The uncorrected PREV’EST model presented a lack of exactitude and precision. These concentrations did not reproduce the interday variability of the measurements, leading to a lack of temporal contrast in exposure data. For the best performance enhancement, the correction applied improved MBE, MAE, RMSE and r from 14.67, 19.23, 23.18 and 0.67 to 0.00, 8.00, 10.19 and 0.91, respectively. External validation confirmed the efficiency of the corrections at the regional scale. CONCLUSIONS: We propose a validated and efficient methodology integrating local environmental variables. The methodology is adaptable according to the context, needs and data available.
Air pollution is the fourth greatest overall risk factor for human health. Despite declining levels in Europe, air pollution still represents a major health and economic burden. We collected data from the Global Burden of Disease Study 2019 regarding overall, as well as ischemic heart disease (IHD), stroke, and tracheal, bronchus and lung cancer-specific disability adjusted life years (DALYs), years of life lost (YLL) and mortality attributable to air pollution for 43 European countries between 1990 and 2019. Concentrations of ambient particulate matter (aPM(2.5)), ozone, and household air pollution from solid fuels were obtained from State of Global Air 2020. We analysed changes in air pollution parameters, as well as DALYs, YLL, and mortality related to air pollution, also taking into account gross national income (GNI) and socio-demographic index (SDI). Using a novel calculation, aPM(2.5) ratio (PMR) change and DALY rate ratio (DARR) change were used to assess each country’s ability to decrease its aPM(2.5) pollution and DALYs to at least the extent of the European median decrease within the analysed period. Finally, we created a multiple regression model for reliably predicting YLL using aPM(2.5) and household air pollution. The average annual population-weighted aPM(2.5) exposure in Europe in 1990 was 20.8 μg/m(3) (95% confidence interval (CI) 18.3-23.2), while in 2019 it was 33.7% lower at 13.8 μg/m(3) (95% CI 12.0-15.6). There were in total 368 006 estimated deaths in Europe in 2019 attributable to air pollution, a 42.4% decrease compared to 639 052 in 1990. The majority (90.4%) of all deaths were associated with aPM(2.5). IHD was the primary cause of death making up 44.6% of all deaths attributable to air pollution. The age-standardised DALY rate and YLL rate attributable to air pollution were more than 60% lower in 2019 compared to 1990. There was a strong positive correlation (r=0.911) between YLL rate and aPM(2.5) pollution in 2019 in Europe. Our multiple regression model predicts that for 10% increase in aPM(2.5), YLL increases by 16.7%. Furthermore, 26 of 43 European countries had a positive DARR change. 31 of 43 European countries had a negative PMR change, thus not keeping up with the European median aPM(2.5) concentration decrease. When categorising countries by SDI and GNI, countries in the higher brackets had significantly lower aPM(2.5) concentration and DALY rate for IHD and stroke. Overall, air pollution levels, air pollution-related morbidity and mortality have decreased considerably in Europe in the last three decades. However, with the growing European population, air pollution remains an important public health and economic issue. Policies targeting air pollution reduction should continue to be strongly enforced to further reduce one of the greatest risk factors for human health.
Reduced telomere length (TL) has been associated with increased risk of age-related diseases, most likely through oxidative stress and inflammation, which have also been claimed as mechanisms underlying health effects of air pollution exposure. We aimed to verify whether exposure to particulate matter with diameter ≤10 µm (PM(10)) affects TL. We recruited 1792 participants with overweight/obesity in Milan (Italy) in 2010-2015 who completed a structured questionnaire on sociodemographic data, gave a blood sample for TL measurement by real-time PCR, and were assigned air pollution and meteorological data of their residential address. In multivariate mixed-effects linear models (with a random intercept on PCR plate), we observed a -0.51% change in TL (95% confidence interval (CI): -0.98; -0.05)) per 10 µg/m(3) increase in PM(10) at the day of recruitment. A similar decreasing trend in TL was observed up to two weeks before withdrawal, with percentage changes as low as -1.53% (average exposure of the 12 days before recruitment). Mean annual exposure to PM(10) was associated with -2.57% TL reduction (95%CI: -5.06; -0.08). By showing consistent associations between short- and long-term PM(10) exposures and reduced TL, our findings shed light on the potential mechanisms responsible for the excess of age-related diseases associated with air pollution exposure.
The scientific literature is scarce when referring to the influence of atmospheric pollutants on neurodegenerative diseases for present and future climate change scenarios. In this sense, this contribution evaluates the incidence of dementia (Alzheimer’s disease, AD, and dementia from unspecified cause, DU) occurring in Europe associated with the exposure to air pollution (essentially NO(2) and PM2.5) for the present climatic period (1991-2010) and for a future climate change scenario (RCP8.5, 2031-2050). The GEMM methodology has been applied to air pollution simulations using the chemistry/climate regional model WRF-Chem. Present population data were obtained from NASA’s Center for Socioeconomic Data and Applications (SEDAC); while future population projections for the year 2050 were derived from the United Nations (UN) Department of Economic and Social Affairs-Population Dynamics. Overall, the estimated incidence rate (cases per year) of AD and DU associated with exposure to air pollution over Europe is 498,000 [95% confidence interval (95% CI) 348,600-647,400] and 314,000 (95% CI 257,500-401,900), respectively. An important increase in the future incidence rate is projected (around 72% for both types of dementia) when considering the effect of climate change together with the foreseen changes in the future population, because of the expected aging of European population. The climate penalty (impacts of future climate change alone on air quality) has a limited effect on the total changes of dementia (approx. 0.5%), because the large increase in the incidence rate over southern Europe is offset by its decrease over more northern countries, favored by an improvement of air pollution caused by the projected enhancement of rainfall.
Wildland fires release substantial amounts of hazardous contaminants, contributing to a decline in air quality and leading to serious health risks. Thus, this study aimed to understand the contributions of the 2017 extreme wildland fires in Portugal on children health, compared to 2016 (with burned area, in accordance with the average of the previous 15 years). The impact of long-term exposure to PM(10) and NO(2) concentrations, associated with wildland fires, on postneonatal mortality, bronchitis prevalence, and bronchitis symptoms in asthmatic children was estimated, as well as the associated costs. The excess health burden in children attributable to exposure to PM(10) and NO(2), was calculated based on WHO HRAPIE relative risks. Fire emissions were obtained from the Fire INventory from NCAR (FINN). The results obtained indicate that the smoke from wildfires negatively impacts children’s lung function (PM(10) exposure: increase of 320 and 648 cases of bronchitis in 2016 and 2017; NO(2) exposure: 24 and 40 cases of bronchitis symptoms in asthmatic children in 2016 and 2017) and postneonatal mortality (PM(10) exposure: 0.2 and 0.4 deaths in 2016 and 2017). Associated costs were increased in 2017 by around 1 million € for all the evaluated health endpoints, compared to 2016.
Wildland fires, increasing in recent decades in the Mediterranean region due to climate change, can contribute to PM levels and composition. This study aimed to investigate biological effects of PM(2.5) (Ø < 2.5 µm) and PM(10) (Ø < 10 µm) collected near a fire occurred in the North-West of Italy in 2017 and in three other areas (urban and rural areas). Organic extracts were assessed for mutagenicity using Ames test (TA98 and TA100 strains), cell viability (WST-1 and LDH assays) and genotoxicity (Comet assay) with human bronchial cells (BEAS-2B) and estrogenic activity using a gene reporter assay (MELN cells). In all sites, high levels of PM(10) and PM(2.5) were measured during the fire suggesting that near and distant sites were influenced by fire pollutants. The PM(10) and PM(2.5) extracts induced a significant mutagenicity in all sites and the mutagenic effect was increased with respect to historical data. All extracts induced a slight increase of the estrogenic activity but a possible antagonistic activity of PM samples collected near fire was observed. No cytotoxicity or DNA damage was detected. Results confirm that fires could be relevant for human health, since they can worsen the air quality increasing PM concentrations, mutagenic and estrogenic effects.
Uncontrolled wildfires have a substantial impact on the environment, the economy and local populations. According to the European Forest Fire Information System (EFFIS), between 2000 and 2013 wildfires burned up to 740 000 ha of land annually in the south of Europe, Portugal being the country with the highest percentage of burned area per square kilometre. However, there is still a lack of knowledge regarding the impacts of the wildfire-related pollutants on the mortality of the country’s population. All wildfires occurring during the fire season (June-July-AugustSeptember) from 2001 and 2016 were identified, and those with a burned area above 1000 ha (large fires) were considered for the study. During the studied period (2001-2016), more than 2 million ha of forest (929 766 ha from June to September alone) were burned in mainland Portugal. Although large fires only represent less than 1% of the number of total fires, in terms of burned area their contribution is 46% (53% from June to September). To assess the spatial impact of the wildfires, burned areas in each region of Portugal were correlated with PM10 concentrations measured at nearby background air quality monitoring stations. Associations between PM10 and all-cause (excluding injuries, poisoning and external causes) and cause-specific mortality (circulatory and respiratory) were studied for the affected populations using Poisson regression models. A significant positive correlation between burned area and PM10 was found in some regions of Portugal, as well as a significant association between PM10 concentrations and mortality, these being apparently related to large wildfires in some of the regions. The north, centre and inland of Portugal are the most affected areas. The high temperatures and long episodes of drought expected in the future will increase the probabilities of extreme events and therefore the occurrence of wildfires.
INTRODUCTION: Fine particulate matter with an aerodynamic diameter < 2.5 μm (PM(2.5)) in the ambient air has been associated with increased blood pressure (BP) levels and new-onset hypertension. However, the association of BP with a sudden upsurge of PM(2.5) in extreme conditions has not yet been demonstrated. AIM: To evaluate the association between PM(2.5) pollutants the week before, during, and the week after the 2021 wildfires in Athens (Greece) and home BP measurements. METHODS: Home BP measurements were performed, and the readings were transferred to the doctor's office through a telemonitoring system on the patient's Smartphone application. Data from a calibrated, sensor-based PM(2.5) monitoring network assessed PM(2.5) exposure. RESULTS: PM(2.5) pollutants demonstrated a gradual surge while the particle concentration was not different in the selected air pollution measurement stations. A total of 20 consecutive patients with controlled hypertension, mean age 61 ± 9 years, were included in the analysis. For one unit in μg/m(3) increase of PM(2.5) particle concentration, an average of 2.1 mmHg increment in systolic BP was observed after adjustment for confounders (P = 0.023). CONCLUSIONS: Our findings raise the hypothesis that short-term exposure to raised PM(2.5) concentrations in the air appears to be associated with increases in systolic home BP." Telemonitoring systems of home BP recordings may provide important information for the clinical management of hypertensive patients, at least in conditions of major environmental disturbances, such as wildfires.
Wildfires are a complex environmental problem worldwide. The ashes produced during the fire bear metals and PAHs with high toxicity and environmental persistence. These are mobilized into downhill waterbodies, where they can impair water quality and human health. In this context, the present study aimed at assessing the toxicity of mimicked wildfire runoff to human skin cells, providing a first view on the human health hazardous potential of such matrices. Human keratinocytes (HaCaT) were exposed to aqueous extracts of ashes (AEA) prepared from ash deposited in the soil after wildfires burned a pine or a eucalypt forest stand. Cytotoxicity (MTT assay) and changes in cell cycle dynamics (flow cytometry) were assessed. Cell viability decreased with increasing concentrations of AEA, regardless of the ash source, the extracts preparation method (filtered or unfiltered to address the dissolved or the total fractions of contaminants, respectively) or the exposure period (24 and 48 h). The cells growth was also negatively affected by the tested AEA matrices, as evidenced by a deceleration of the progress through the cell cycle, namely from phase G0/G1 to G2. The cytotoxicity of AEA could be related to particulate and dissolved metal content, but the particles themselves may directly affect the cell membrane. Eucalypt ash was apparently more cytotoxic than pine ash due to differential ash metal burden and mobility to the water phase. The deceleration of the cell cycle can be explained by the attempt of cells to repair metal-induced DNA damage, while if this checkpoint and repair pathways are not well coordinated by metal interference, genomic instability may occur. Globally, our results trigger public health concerns since the burnt areas frequently stand in slopes of watershed that serve as recreation sites and sources of drinking water, thus promoting human exposure to wildfire-driven contamination.
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.
BACKGROUND: Unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined, where food production and consumption are major drivers of increases in greenhouse gas emissions, substantial land use, and adverse health such as cancer and mortality. To assess the potential co-benefits from shifting to more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with all-cause and cause-specific mortality and cancer incidence rates. METHODS: Using data from 443 991 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a multicentre prospective cohort, we estimated associations between dietary contributions to greenhouse gas emissions and land use and all-cause and cause-specific mortality and incident cancers using Cox proportional hazards regression models. The main exposures were modelled as quartiles. Co-benefits, encompassing the potential effects of alternative diets on all-cause mortality and cancer and potential reductions in greenhouse gas emissions and land use, were estimated with counterfactual attributable fraction intervention models, simulating potential effects of dietary shifts based on the EAT-Lancet reference diet. FINDINGS: In the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and all-cause mortality (adjusted hazard ratio [HR] 1·13 [95% CI 1·10-1·16]) and between land use and all-cause mortality (1·18 [1·15-1·21]) when comparing the fourth quartile to the first quartile. Similar associations were observed for cause-specific mortality. Associations were also observed between all-cause cancer incidence rates and greenhouse gas emissions, when comparing the fourth quartile to the first quartile (adjusted HR 1·11 [95% CI 1·09-1·14]) and between all-cause cancer incidence rates and land use (1·13 [1·10-1·15]); however, estimates differed by cancer type. Through counterfactual attributable fraction modelling of shifts in levels of adherence to the EAT-Lancet diet, we estimated that up to 19-63% of deaths and up to 10-39% of cancers could be prevented, in a 20-year risk period, by different levels of adherence to the EAT-Lancet reference diet. Additionally, switching from lower adherence to the EAT-Lancet reference diet to higher adherence could potentially reduce food-associated greenhouse gas emissions up to 50% and land use up to 62%. INTERPRETATION: Our results indicate that shifts towards universally sustainable diets could lead to co-benefits, such as minimising diet-related greenhouse gas emissions and land use, reducing the environmental footprint, aiding in climate change mitigation, and improving population health. FUNDING: European Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1).
INTRODUCTION: Climate change is one of the 21st century’s biggest public health issues and health care contributes up to 10% of the emissions of greenhouse gases in developed countries. About 15 million laparoscopic procedures are performed annually worldwide and single-use medical equipment is increasingly used during these procedures. Little is known about costs and environmental footprint of this change in practice. METHODS: We employed Life Cycle Assessment method to evaluate and compare the environmental impacts of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies at three hospitals in southern Sweden. The environmental impacts were calculated using the IMPACT 2002+ method and a functional unit of 500 procedures. Monte Carlo simulations were used to estimate differences between trocar systems. Data are presented as medians and 2.5th to 97.5th percentiles. Financial costs were calculated using Life Cycle Costing. RESULTS: The single-use system had a 182% higher impact on resources than the reusable system [difference: 5160 MJ primary (4400-5770)]. The single-use system had a 379% higher impact on climate change than the reusable system [difference: 446 kg CO2eq (413-483)]. The single-use system had an 83% higher impact than the reusable system on ecosystem quality [difference: 79 PDF*m2*yr (24-112)] and a 240% higher impact on human health [difference: 2.4×10-4 DALY/person/yr (2.2×10-4-2.6×10-4)]. The mixed and single-use systems had a similar environmental impact. Differences between single-use and reusable trocars with regard to resource use and ecosystem quality were found to be sensitive to lower filling of machines in the sterilization process. For ecosystem quality the difference between the two were further sensitive to a 50% decrease in number of reuses, and to using a fossil fuel intensive electricity mix. Differences regarding effects on climate change and human health were robust in the sensitivity analyses. The reusable and mixed trocar systems were approximately half as expensive as the single-use systems (17360 € and 18560 € versus 37600 €, respectively). CONCLUSION: In the Swedish healthcare system the reusable trocar system offers a robust opportunity to reduce both the environmental impact and financial costs for laparoscopic surgery.
In the current era of globalization, a clean environment remains a crucial factor for the health of the population. Thus, improving air quality is a major focus of environmental policies, as it affects all aspects of nature, including humans. For these reasons, it is appropriate to take into account the health risks posed by greenhouse gas (GHG) emissions released into the atmosphere. With regard to global GHG emissions, there are concerns about the loss of protection of the ozone layer and it is very likely that climate change can be expected, which multiplies the environmental threat and has potentially serious global consequences. In this regard, it is important to pay increased attention to emissions that enter the atmosphere, which include countless toxic substances. The aim of this study was to examine the associations between selected GHG emissions and the health of the European Union (EU) population represented by disability-adjusted life years (DALYs). This aim was achieved using several analytical procedures (descriptive analysis, correlation analysis, cluster analysis, and panel regression analysis), which included five environmental variables (carbon dioxide (CO(2)), methane (CH(4)) in CO(2) equivalent, nitrous oxide (N(2)O) in CO(2) equivalent, hydrofluorocarbons (HFC) in CO(2) equivalent, sulfur hexafluoride (SF(6)) in CO(2) equivalent) and one health variable (DALYs). An emphasis was placed on the use of quantitative methods. The results showed that CO(2) emissions have a dominant position among selected GHG emissions. The revealed positive link between CO(2) and DALYs indicated that a decrease in CO(2) may be associated with a decrease in DALYs, but it is also true that this cannot be done without reducing emissions of other combustion products. In terms of CO(2), the least positive scores were observed in Luxembourg and Estonia. Germany had the lowest score of DALYs, representing the most positive health outcome in the EU. In terms of total GHG emissions, Ireland and Luxembourg were considered to be less positive countries compared to the other analyzed countries. Countries should focus on reducing GHG emissions in general, but from a health point of view, reducing CO(2) emissions seems to be the most beneficial.
Flowering and pollen seasons are sensitive to environmental variability and are considered climate change indicators. However, it has not been concluded to what extent flowering phenology is indeed reflected in airborne pollen season locally. The aim of this study was to investigate, for the commonly represented in temperate climates and with highly allergenic pollen Betula pendula Roth, the responsiveness of flowering to different environmental regimes and also to check for commensurate changes in the respective pollen seasons. The region of Augsburg, Bavaria, Germany, was initially screened for birch trees, which were geolocated at a radius of 25 km. Random trees across the city were then investigated during three full flowering years, 2015-2017. Flowering observations were made 3-7 times a week, from flower differentiation to flower desiccation, in a total of 43 plant individuals. Data were regressed against meteorological parameters and air pollutant levels in an attempt to identify the driving factors of flowering onset and offset. Flowering dates were compared with dates of the related airborne pollen seasons per taxon; airborne pollen monitoring took place daily using a Hirst-type volumetric sampler. The salient finding was that flowering occurred earlier during warmer years; it also started earlier at locations with higher urbanity, and peaked and ended earlier at sites with higher NO(2) concentrations. Airborne pollen season of Betula spp. frequently did not coincide locally with the flowering period of Betula pendula: while flowering and pollen season were synchronized particularly in their onset, local flowering phenology alone could explain only 57.3% of the pollen season variability. This raises questions about the relationship between flowering times and airborne pollen seasons and on the rather underestimated role of the long-distance transport of pollen.
Ragweed pollen is an important component of biological pollution in the urban environment, responsible for increasing respiratory allergies and significant contribution to the health impact of air pollution in the Bucharest area. The aim of this paper is to present the eight-year ragweed pollen monitoring data from Bucharest, to place them in the context of local air pollution, public health regulations and available data on the health impact of ragweed pollen in the urban environment. Our pollen data were correlated with major air pollutant concentrations and with meteorological factors in a recently published local paper and the clinical data of patients with ragweed-induced respiratory symptoms were collected and published in 2019. The ragweed pollen monitoring data, correlated with field data reported by patients and plant specialists confirm the rapid spread of Ambrosia in the Bucharest city area, in addition to some stringent environmental local problems due to air pollution. The number of patients addressed to allergists almost doubled from one year to another, confirming the real alarming health impact of this environmental hazard. Our study confirms the need for more coherent strategies to control ragweed spread, based on application of existing local and international regulations, air pollution control and evaluation of consequences on human health.
Introduction Respiratory allergies represent an important public health problem, with increasing prevalence and severity in Europe during the last decades. The rise of pollen allergies is an issue that continues to negatively impact people’s daily lives across the globe and has become more important in the light of global warming and increasing air pollution. The aim of our paper is to evaluate the prevalence of declared atopy and the influence of lifestyle on allergic diseases, particularly on pollen allergies, in the urban environment from Romania. Methods The study is based on the cooperation Interactive Qualifying Project (IQP) called “Pollen Allergies in Romania: Optimizing Data Analysis in Raising Awareness”, agreed and carried on between a group of North-American students and teachers from Worcester Polytechnic Institute and a hospital-based allergy team from Carol Davila University of Medicine and Pharmacy and Colentina Clinical Hospital from Bucharest. The project aimed to evaluate the prevalence of atopy and lifestyle practices of allergic patients and to develop a data analysis tool to determine correlations between pollen counts and other environmental factors in the city of Bucharest. Results The lifestyle survey revealed that about one-third of allergic patients declared history of atopy. Some of the declared lifestyle practices can be considered environmental risk factors for allergies. This IQP can be considered a model of international, interdisciplinary and intercultural collaboration. Conclusion We concluded that Romania is facing an increasing pollen allergies trend and some actual lifestyle aspects can significantly influence the risk of pollen allergies in the big city environment.
The presence of very high pollen levels in the atmosphere is associated with a strong impact on health and a worsening of symptoms in people who already have a respiratory disease. However, there is no specification on the aerobiological, environmental and meteorological factors that allow for characterizing a pollen event as of great magnitude due to the significant impact it can cause on the population and the environment. This work proposes criteria to typify the levels of atmospheric pollen as an extreme pollen event (EPE), and aims to determine the meteorological variables that can affect the presence and permanence of high pollen concentrations over a period of time. To address this goal, the quasi-climatological pollen dataset recorded in Granada (Southeastern Spain) during the period 1992-2019, has been used. On the daily accumulated pollen concentrations, the 95th, 97th and 99th percentiles were calculated. Spearman’s correlation between the pollen con-centration exceeding the proposed thresholds (C (> P95), C (> P97), C (> P99)) and surface meteorological variables recorded during up to five days before the event were established in order to identify the meteorological conditions that might affect the EPEs. As for the number of days with values higher than the established percentiles, it has been seen that in the case of total pollen and Olea, Cupressaceae and Pinus, there is a robust monotonically ascending trend throughout the study period. Regarding meteorological variables, relative humidity and 24-h accumulated precipitation are shown as the two most influential variables up to three days before the event, although temperatures, visibility and wind direction also show a correlation with some pollen types. The criteria proposed in this work allow us for classifying high levels of pollen as an EPE, and lay the foundations of these extreme events in a context of climate change in which they will become more frequent.
Pollen grains emitted by urban vegetation are the main primary biological airborne particles (PBAPs) which alter the biological quality of urban air and have a significant impact on human health. This work analyses the interactions which exist between pollen-type PBAPs, meteorological variables, and air pollutants in the urban atmosphere so that the complex relationships and trends in future scenarios of changing environmental conditions can be assessed. For this study, the 1992-2018 pollen data series from the city of Granada (southeast Spain) was used, in which the dynamics of the total pollen as well as the 8 main pollen types (Cupressaceae, Olea, Pinus, Platanus, Poaceae, Populus, Quercus and Urticaceae) were analysed. The trend analysis showed that all except Urticaceae trended upward throughout the series. Spearman’s correlations with meteorological variables showed that, in general, the most influential variables on the pollen concentrations were the daily maximum temperature, relative humidity, water vapor pressure, global radiation, and insolation, with different effects on different pollen types. Parallel analysis by neural networks (ANN) confirmed these variables as the predominant ones, especially global radiation. The correlation with atmospheric pollutants revealed that ozone was the pollutant with the highest influence, although some pollen types also showed correlation with NO(2), SO(2), CO and PM(10). The Generalized Linear Models (GLM) between pollen and pollutants also indicated O(3) as the most prominent variable. These results highlight the active role that pollen-type PBAPs have on urban air quality by establishing their interactions with meteorological variables and pollutants, thereby providing information on the behaviour of pollen emissions under changing environmental conditions.
The London plane tree is frequently used in gardens, parks, and avenues in European urban areas for ornamental purposes with the aim to provide shade, and given its tolerance to atmospheric pollution. Nevertheless, unfortunately, over recent decades, bioaerosols such as Platanus pollen grains cause increasing human health problems such as allergies or respiratory tract infections. An aerobiological sampling of airborne Platanus pollen and Pla a 1 allergen was performed using two volumetric traps placed on the roof of the Science Faculty building of the city of Ourense from 2009 to 2020. A volumetric sampler Hirst-type Lanzoni VPPS 2000 (Lanzoni s.r.l. Bologna, Italy) was used for pollen sampling. Pla a 1 aeroallergen was sampled by using a Burkard Multi-Vial Cyclone Sampler (Burkard Manufacturing Co., Ltd., Hertfordshire, UK) and by means of the enzyme-linked immunosorbent assay (ELISA) technique. Data mining algorithms, C5.0 decision trees, and rule-based models were assessed to evaluate the effects of the main meteorological factors in the pollen or allergen concentrations. Plane trees bloom in late winter and spring months in the Northwestern Spain area. Regarding the trends of the parameters that define the Platanus pollen season, the allergen values fitted the concentrations of pollen in the air in most cases. In addition, it was observed that a decrease in maximum temperatures causes a descent in both pollen and allergen concentrations. However, the presence of precipitations only increases the level of allergens. When the risk of allergy symptomatology was jointly assessed for both the concentration of pollen and allergens in the study area, the number of days with moderate and high risk for pollen allergy in sensitive people increased with respect to traditional alerts considering only the pollen values.
Airborne particulate matter such as mineral dust comes mainly from natural sources, and the African regions of Sahara and Sahel originate large amounts of the aerosols dispersed worldwide. There is little knowledge about the influence of dust episodes on airborne pollen concentrations, and although the centre and southeast of the Iberian Peninsula are frequently affected by dust intrusions, until now, no specific works have analysed the effect of these episodes on airborne pollen concentrations in these areas. The aims of this study were to analyse the simultaneous occurrence of airborne pollen peaks and Saharan-Sahel dust intrusions in the central and south-eastern Iberian Peninsula, and to study the weather conditions – air mass pathways and conditions of air temperature, relative humidity and atmospheric pressure – that influence the airborne pollen concentrations during dust episodes. The results showed that the rise in airborne pollen concentrations during dust episodes is apparent in inland Iberian areas, although not in coastal areas in the southeast where pollen concentrations are even observed to decrease, coinciding with prevailing easterly winds from the sea. Total pollen concentrations and specific pollen types such as Olea, Poaceae and Quercus showed an increase in the central Iberian Peninsula during dust episodes when two meteorological phenomena concur: 1) prevailing winds from extensive areas of major wind-pollinated pollen sources over a medium or short distance (mainly from western and southwestern areas); and 2) optimal meteorological conditions that favour pollen release and dispersal into the atmosphere (mainly high temperatures and subsequently low humidity in central areas). Both conditions often occur during the Saharan-Sahel dust intrusions in the centre. Maximum pollen peaks are therefore most likely to occur during dust episodes in the central Iberian Peninsula, thus dramatically increasing the risk of outbreaks of pollinosis and other respiratory diseases in the population.
Due to climate change, air temperature in the Netherlands has gradually increased. Higher temperatures lead to longer pollen seasons. Possible relations between air temperature and increased impact of seasonal allergic rhinitis (SAR) in general practice have not been investigated yet. We explored trends in timing of frequent seasonal allergic rhinitis presentation to general practitioners (GPs) over 25 years and explored associations with air temperature. We performed a retrospective exploratory longitudinal study with data from our Family Medicine Network (1995-2019), including all SAR patients and their GP-encounters per week. We determined patients’ GP-consultation frequency. Every year we identified seasonal periods with substantial increase in SAR related encounters: peak-periods. We determined start date and duration of the peak-period and assessed associations with air temperature in the beginning and throughout the year, respectively. The peak-period duration increased by a mean of 1.3 days (95% CI 0.23-2.45, P = 0.02) per year throughout the study period. Air temperature between February and July showed a statistically significant association with peak-period duration. We could not observe direct effects of warmer years on the start of peak-periods within distinct years (P = 0.06). SAR patients’ contact frequency slightly increased by 0.01 contacts per year (95% CI 0.002-0.017, P = 0.015). These longitudinal findings may help to facilitate further research on the impact of climate change, and raise awareness of the tangible impact of climate change in general practice.
Fungal spores make up a significant proportion of organic matter within the air. Allergic sensitisation to fungi is associated with conditions including allergic fungal airway disease. This systematic review analyses outdoor fungal spore seasonality across Europe and considers the implications for health. Seventy-four studies met the inclusion criteria, the majority of which (n = 64) were observational sampling studies published between 1978 and 2020. The most commonly reported genera were the known allergens Alternaria and Cladosporium, measured in 52 and 49 studies, respectively. Both displayed statistically significant increased season length in south-westerly (Mediterranean) versus north-easterly (Atlantic and Continental) regions. Although there was a trend for reduced peak or annual Alternaria and Cladosporium spore concentrations in more northernly locations, this was not statistically significant. Peak spore concentrations of Alternaria and Cladosporium exceeded clinical thresholds in nearly all locations, with median peak concentrations of 665 and 18,827 per m(3), respectively. Meteorological variables, predominantly temperature, precipitation and relative humidity, were the main factors associated with fungal seasonality. Land-use was identified as another important factor, particularly proximity to agricultural and coastal areas. While correlations of increased season length or decreased annual spore concentrations with increasing average temperatures were reported in multi-decade sampling studies, the number of such studies was too small to make any definitive conclusions. Further, up-to-date studies covering underrepresented geographical regions and fungal taxa (including the use of modern molecular techniques), and the impact of land-use and climate change will help address remaining knowledge gaps. Such knowledge will help to better understand fungal allergy, develop improved fungal spore calendars and forecasts with greater geographical coverage, and promote increased awareness and management strategies for those with allergic fungal disease.
Climate change (CC) is expected to negatively impact respiratory health due to air pollution and increased aeroallergen exposure. Children are among the most vulnerable populations due to high ventilation rates, small peripheral airways, and developing respiratory and immunological systems. To assess the current knowledge among Italian pediatric pulmonologists on the potential effects of CC on pediatric respiratory allergic diseases, a national survey was launched online from February 2020 to February 2021. The members of the Italian Pediatric Respiratory Society (SIMRI) were contacted by email and 117 questionnaires were returned (response rate 16.4%). 72.6% of respondents were females, 53.8% were academic pediatricians, 42.7% had been working >10 years. Most of the participants were aware of the potential health effects of CC and stated that they had noticed an increase in the incidence (90.6%) and severity (67.5%) of allergic respiratory diseases among their patients. About 61% and 41% of participants respectively felt that there had been an increase in the number of children sensitized to pollen and molds. When applying latent class analysis to identify the features characterizing participants with greater awareness and knowledge of CC-related health effects, two classes were identified: almost 60% of the participants were labeled as “poor knowledge” and those with greater awareness were older, had longer work experience, and were those using the Internet to gather information about CC. There is urgent need to increase pediatricians’ awareness of the detrimental effects of CC on children’s respiratory health and integrate them in the educational programs of healthcare professionals.
Allergic rhinitis is an inflammation in the nose caused by overreaction of the immune system to allergens in the air. Managing allergic rhinitis symptoms is challenging and requires timely intervention. The following are major questions often posed by those with allergic rhinitis: How should I prepare for the forthcoming season? How will the season’s severity develop over the years? No country yet provides clear guidance addressing these questions. We propose two previously unexplored approaches for forecasting the severity of the grass pollen season on the basis of statistical and mechanistic models. The results suggest annual severity is largely governed by preseasonal meteorological conditions. The mechanistic model suggests climate change will increase the season severity by up to 60%, in line with experimental chamber studies. These models can be used as forecasting tools for advising individuals with hay fever and health care professionals how to prepare for the grass pollen season.
Background: While airborne pollen is widely recognized as a seasonal cause of sneezing and itchy eyes, its effects on pulmonary function, cardiovascular health, sleep quality, and cognitive performance are less well-established. It is likely that the public health impact of pollen may increase in the future due to a higher population prevalence of pollen sensitization as well as earlier, longer, and more intense pollen seasons, trends attributed to climate change. The effects of pollen on health outcomes have previously been studied through cross-sectional design or at two time points, namely preceding and within the period of pollen exposure. We are not aware of any observational study in adults that has analyzed the dose-response relationship between daily ambient pollen concentration and cardiovascular, pulmonary, cognitive, sleep, or quality of life outcomes. Many studies have relied on self-reported pollen allergy status rather than objectively confirming pollen sensitization. In addition, many studies lacked statistical power due to small sample sizes or were highly restrictive with their inclusion criteria, making the findings less transferable to the “real world.” Methods: The EPOCHAL study is an observational panel study which aims to relate ambient pollen concentration to six specific health domains: (1) pulmonary function and inflammation; (2) cardiovascular outcomes (blood pressure and heart rate variability); (3) cognitive performance; (4) sleep; (5) health-related quality of life (HRQoL); and (6) allergic rhinitis symptom severity. Our goal is to enroll 400 individuals with diverse allergen sensitization profiles. The six health domains will be assessed while ambient exposure to pollen of different plants naturally varies. Health data will be collected through six home nurse visits (at approximately weekly intervals) as well as 10 days of independent tracking of blood pressure, sleep, cognitive performance, HRQoL, and symptom severity by participants. Through repeated health assessments, we aim to uncover and characterize dose-response relationships between exposure to different species of pollen and numerous acute health effects, considering (non-)linearity, thresholds, plateaus and slopes. Conclusion: A gain of knowledge in pollen-health outcome relationships is critical to inform future public health policies and will ultimately lead toward better symptom forecasts and improved personalized prevention and treatment.
A multitude of consequences from global warming and environmental pollution can already be seen for nature and humans. The continuous burning of fossil fuels leads to rising temperatures and rising water levels causing extreme weather phenomena like heat waves and flooding. Increasing levels of air pollution also cause adverse health effects. This is especially important for pollen allergy sufferers because air pollution plays a central role in the interactions between pollen and humans. Today, pollen allergy sufferers are confronted with longer pollen seasons and pollen with potentially increased allergenicity. The effects for pollen allergy sufferers are an increased duration and severity of symptoms. New research results from the Medical University of Vienna prove that out of the most important air pollution parameters (particulate matter, nitrogen dioxide, sulfur dioxide, and ozone) especially ozone causes increased symptom severity in pollen allergy sufferers during the birch, grass, and ragweed pollen seasons.
BACKGROUND: Evidence of the role of interactions between air pollution and pollen exposure in subjects with allergic asthma is limited and need further exploration to promote adequate preventive measures. The objective of this study was to assess effects of exposure to ambient air pollution and birch pollen on exacerbation of respiratory symptoms in subjects with asthma and allergy to birch. METHODS: Thirty-seven subjects from two Swedish cities (Gothenburg and Umeå) with large variation in exposure to both birch-pollen and air pollutants, participated in the study. All subjects had confirmed allergy to birch and self-reported physician-diagnosed asthma. The subjects recorded respiratory symptoms such as rhinitis or eye irritation, dry cough, dyspnoea, the use of any asthma or allergy medication and peak respiratory flow (PEF), daily for five consecutive weeks during two separate pollen seasons and a control season without pollen. Nitrogen oxides (NO(x)), ozone (O(3)), particulate matter (PM(2.5)), birch pollen counts, and meteorological data were obtained from an urban background monitoring stations in the study city centres. The data were analysed using linear mixed effects models. RESULTS: During pollen seasons all symptoms and medication use were higher, and PEF was reduced in the subjects. In regression analysis, exposure to pollen at lags 0 to 2 days, and lags 0 to 6 days was associated with increased ORs of symptoms and decreased RRs for PEF. Pollen and air pollution interacted in some cases; during low pollen exposure, there were no associations between air pollution and symptoms, but during high pollen exposure, O(3) concentrations were associated with increased OR of rhinitis or eye irritation, and PM(2.5) concentrations were associated with increased ORs of rhinitis or eye irritation, dyspnea and increased use of allergy medication. CONCLUSIONS: Pollen and air pollutants interacted to increase the effect of air pollution on respiratory symptoms in allergic asthma. Implementing the results from this study, advisories for individuals with allergic asthma could be improved, minimizing the morbidities associated with the condition.
BACKGROUND: Common ragweed has been spreading as a neophyte in Europe. Elevated CO(2) levels, a hallmark of global climate change, have been shown to increase ragweed pollen production, but their effects on pollen allergenicity remain to be elucidated. METHODS: Ragweed was grown in climate-controlled chambers under normal (380 ppm, control) or elevated (700 ppm, based on RCP4.5 scenario) CO(2) levels. Aqueous pollen extracts (RWE) from control- or CO(2) -pollen were administered in vivo in a mouse model for allergic disease (daily for 3-11 days, n = 5) and employed in human in vitro systems of nasal epithelial cells (HNECs), monocyte-derived dendritic cells (DCs), and HNEC-DC co-cultures. Additionally, adjuvant factors and metabolites in control- and CO(2) -RWE were investigated using ELISA and untargeted metabolomics. RESULTS: In vivo, CO(2) -RWE induced stronger allergic lung inflammation compared to control-RWE, as indicated by lung inflammatory cell infiltrate and mediators, mucus hypersecretion, and serum total IgE. In vitro, HNECs stimulated with RWE increased indistinctively the production of pro-inflammatory cytokines (IL-8, IL-1β, and IL-6). In contrast, supernatants from CO(2) -RWE-stimulated HNECs, compared to control-RWE-stimulated HNECS, significantly increased TNF and decreased IL-10 production in DCs. Comparable results were obtained by stimulating DCs directly with RWEs. The metabolome analysis revealed differential expression of secondary plant metabolites in control- vs CO(2) -RWE. Mixes of these metabolites elicited similar responses in DCs as compared to respective RWEs. CONCLUSION: Our results indicate that elevated ambient CO(2) levels elicit a stronger RWE-induced allergic response in vivo and in vitro and that RWE increased allergenicity depends on the interplay of multiple metabolites.
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.
Introduction: Flooding causes significant mortality and morbidity, with impacts expected to increase with climate change. Ensuring adequate country-level flood mitigation and response capacity is key. Lifeguards, traditionally used for drowning prevention, may represent an additional workforce for flood emergency response. Methods: Through an anonymous, online survey, we explored experiences, beliefs, and attitudes of a convenience sample of surf lifeguards from Australia and England towards lifeguards’ involvement in flood response. Respondents were recruited via Surf Life Saving Australia and Great Britain and had prior training in flood rescue. Analysis comprised descriptive statistics and thematic coding of free-text responses. Results: Forty-four responses were received (93.2% male, 34.1% aged 50-59 years; 61.4% from Australia; 61.4% with >= 16 years lifesaving experience). Twenty-nine respondents (65.9%) self-reported having previously responded to flooding, 15 of which responded prior to receiving flood training. Lifeguards commonly reported being involved in the flood response phase (n = 28). Respondents identified rescue skills (n = 43; 97.7%), awareness of water conditions (n = 40; 90.9%), and radio communication protocols (n = 40; 90.9%) as relevant in a flood scenario. Respondents broadly agreed lifeguards were an asset in flood response due to transferrable skills, including to bolster existing capacity. However, respondents noted need for greater recognition, for involvement earlier in flood response and for flood-specific training and equipment prior to deployment. Discussion & Conclusions: Lifeguards represent a willing and able workforce to support flood mitigation and response, some of whom are already being tasked with such work. Provision of flood-specific training and equipment are vital, as is addressing intemperability tensions.
BACKGROUND: Education is a social tipping intervention necessary for stabilising the earth’s climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness. OBJECTIVES: This study aimed to: i) investigate nursing students’ attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014. DESIGN: A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. SETTINGS: Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia). PARTICIPANTS: A convenience sample of first-year undergraduate nursing students. METHODS: The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020. RESULTS: Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1-6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the ‘inclusion of climate change and sustainability in the nursing curricula’. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students’ attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland). CONCLUSIONS: Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students’ attitudes by integrating these competencies into nursing curricula.
The consequences of climate change and global warming have become irrefutable. Scientists are working to change the alarming scenario awaiting humanity in the future. On the other hand, they have proved that the increasing trend of many life-threatening diseases, such as cancer, are caused by global warming. In this research, data collected from national and international databases were analysed and compared. The aim of this research is presenting the relationship between increasing temperature anomalies and rising cancer trend. As a result of the study, it is determined that the rising global surface temperature and increasing cancer rates are directly related. In the study, data related to Northern Cyprus were also examined. According to the findings; poor waste management and uncontrolled carbon dioxide emissions are responsible for raising cancer rates and cardiovascular diseases in North Cyprus.
BACKGROUND: Evidence from the scientific literature shows a significant variation in greenhouse gas (GHG) emissions from the diet, according to the type of food consumed. We aim to analyze the relationship between the daily dietary GHG emissions according to red meat, fruit and vegetables consumption and their relationship with risk of total mortality, and incident risk of chronic diseases. METHODS: We examined data on the EPIC-Spain prospective study, with a sample of 40 621 participants. Dietary GHG emission values were calculated for 57 food items of the EPIC study using mean emission data from a systematic review of 369 published studies. RESULTS: Dietary GHG emissions (kgCO2eq/day), per 2000 kcal, were 4.7 times higher in those with high red-meat consumption (>140 g/day) than those with low consumption (<70 g/day). The average dietary GHG emissions were similar in males and females, but it was significantly higher in youngest people and in those individuals with lower educational level, as well as for northern EPIC centers of Spain. We found a significant association with the risk of mortality comparing the third vs. the first tertile of dietary GHG emissions [hazard ratio (HR) 1.095; 95% confidence interval (CI) 1.007-1.19; trend test 0.037]. Risk of coronary heart disease (HR 1.26; 95% CI 1.08-1.48; trend test 0.003) and risk of type 2 diabetes (HR 1.24; 95% CI 1.11-1.38; trend test 0.002) showed significant association as well. CONCLUSIONS: Decreasing red-meat consumption would lead to reduce GHG emissions from diet and would reduce risk of mortality, coronary heart disease and type 2 diabetes.
The environmental pollution caused by climate change and global warming pose significant risks to health. This raises the question how environmental disturbances can affect health expenditures. Based on this, this study examines the asymmetric effect of environmental quality on health expenditures in Türkiye using the non-linear ARDL (NARDL) model for the 1975-2019 period. In addition to environmental quality, natural resources, economic growth, and trade openness variables are also included in the health expenditure model. The findings support the existence of an asymmetric cointegration relationship between the series. The findings also indicate that positive environmental pollution shocks affect health expenditures positively in the long run, while negative environmental pollution shocks do not have a statistically significant effect on health expenditures. Positive and negative natural resource shocks affect health expenditures negatively in the long run. Despite the effect of positive economic growth shocks on health expenditures is positive but statistically insignificant, the effect of negative economic growth shocks is positive and significant. Besides, positive trade openness shocks have a negative effect on health expenditures and negative trade openness shocks have a positive effect. The findings prove that the steps to be taken to protect the environment in the current period will increase the effectiveness of health expenditures in the future. This situation has a guiding feature for policy-makers in terms of policy decisions.
Los productos suministrados son: concentraciones en superficie con salidas gráficas horarias de las concentraciones en superficie de NO2, NO, O3, SO2, CO, PM10 y PM2.5 expresadas en µg/m3; índice previsto diario de calidad del aire
calculado a partir de valores de concentración, utilizando la información procedente de las directivas vigentes relacionadas con los distintos contaminantes atmosféricos, e Índice previsto horario de calidad del aire con un horizonte temporal de 48 horas
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 corresponde a tormentas, con cuatro niveles básicos (de menor a mayor riesgo): verde (sin riesgo), amarillo (tormentas fuertes), naranja (tormentas muy fuertes) y rojo (tormentas muy fuertes que por sus características excepcionales pueden tener un alto impacto).
The Izaña Observatory is world-renowned as a pioneer in the studies of mineral dust and its impact on the environment. It is ideally located to serve as a Centre of excellence in future aerosol research and continue to lead research on mineral dust and its role in climate change. Due to the extensive experience available in the Canary Islands and specifically in the Izaña Observatory, in undertaking studies on Sahara mineral dust, it was considered appropriate to carry out a comprehensive multidisciplinary study of the 22-24 February 2020 dust outbreak that severely affected the archipelago. The 22-24 February 2020 dust outbreak, the most intense since there are records in the Canary Islands, is the ideal candidate for this type of study. The increase in the frequency and intensity of adverse meteorological phenomena as a consequence of climate change and global warming requires atmospheric researchers to work together with specialists from other disciplines to be able to assess the impact that adverse meteorological events, such as dust outbreaks, can have on numerous socio-economic activities, and to estimate if possible, their economic cost.
Aerosol atmosférico es un término general utilizado para describir partículas sólidas secas suspendidas en la atmósfera que pueden presentar tamaños desde submicrométricos hasta varias decenas de micras. Los aerosoles pueden viajar miles de kilómetros y tener graves impactos en la salud pública mundial además de degradar la calidad del aire y ocasionar efectos negativos sobre el medio ambiente y algunas actividades económicas. La proximidad de Canarias al continente africano convierte a las islas en un área de elevado interés por la frecuencia de las intrusiones de polvo mineral desértico y el impacto que produce en la población; por tanto, es de suma relevancia la caracterización de las intrusiones de polvo desértico que afectan al archipiélago canario.
En el capítulo 1 de esta nota técnica se exponen generalidades y conceptos básicos del polvo mineral atmosférico. En el capítulo 2 se desarrolla la metodología utilizada y se describen la red de observación y las series históricas de PM10. En el capítulo 3 se presentan los resultados de la caracterización de las intrusiones de polvo desértico en Canarias que incluyen datos relevantes sobre la duración de los eventos, el efecto de las intrusiones en la calidad del aire y la caracterización de los valores PM10 de fondo. En el capítulo 4 se exponen varios casos de estudio que muestran distintos tipos de eventos de intrusión de polvo en Canarias. El capítulo 5 recoge las conclusiones principales de este trabajo. El capítulo 6 incluye una guía básica que pretende servir de ayuda a la hora de afrontar un posible evento de intrusión de polvo desértico.
Esta publicación resume los resultados obtenidos en casi cinco años del proyecto de “Impacto de las intrusiones atmosféricas africanas en la calidad del aire en Canarias y de la Península Ibérica” (2004-2009), entre los que cabe destacar una caracterización completa de los pólenes y esporas de hongos muestreados en el aire de Santa Cruz de Tenerife, la elaboración de predicciones semanales de pólenes y esporas de hongos, así como la obtención de un calendario polínico de utilidad para aquellos profesionales de la medicina que trabajan en alergias y afecciones respiratorias, y para los ciudadanos de Santa Cruz de Tenerife y visitantes que sean alérgicos al polen.
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.
El nivel de riesgo meteorológico diario de incendios forestales está basado en el sistema canadiense y se calcula a partir de los datos de las estaciones meteorológicas de AEMET y de las salidas de un modelo numérico de predicción del tiempo. Las variables de entrada del modelo de estimación de riesgo son: la temperatura del aire seco T (ºC), la humedad relativa del aire Hr (%), la velocidad del viento Vv (km/h) y la precipitación registrada en las últimas 24 horas Pp (mm). Los datos del análisis y pronóstico se refieren a las 12 UTC con el fin de obtener el valor de máximo riesgo diario, lo que sucede en torno al mediodía, si bien su valor tiene validez desde varias horas antes hasta varias horas después de las 12 UTC.
En la AEMET los datos que intervienen en el cálculo de los niveles de riesgo proceden de su red de estaciones sinópticas y automáticas y del modelo CEPPM (resolución espacial de 0.05º y ventana de trabajo de 47.367 puntos de rejilla). Cada punto de rejilla se sitúa en el centro de un cuadrado o píxel de 5 km de lado, por tanto, las variables de cálculo son representativas de un área de 25 km2 o 2500 ha.
El riesgo de incendio se estratifica en cinco clases o niveles de riesgo (bajo, moderado, alto, muy alto y extremo) que serán indicadores de la probabilidad de ocurrencia del fuego así como de la extensión e intensidad del mismo.
El sistema de monitorización de sequías meteorológicas está diseñado para el seguimiento, alerta temprana y evaluación de la sequía meteorológica, para lo que utiliza en tiempo real la información climática y satelital disponible que muestra el desarrollo de las condiciones de sequía meteorológica y la posible evolución de la misma. El sistema incorpora el desarrollo de productos tecnológicos operativos con implicaciones directas para la gestión de los recursos hídricos, las áreas naturales y para la gestión del riesgo de sequía meteorológica en sectores económicos afectados.
El sistema de predicción de radiación ultravioleta de la AEMET pronostica valores del índice UV hasta 5 días utilizando los valores de ozono previstos por el modelo dinámico global del Centro Europeo de Predicción a Plazo Medio, para las capitales de provincia, ciudades autónomas e islas. Estos valores de ozono, junto con otras variables, constituyen la entrada al modelo de Transferencia Radiativa Radtran, que ejecutado diariamente en los ordenadores de la AEMET, proporciona los datos de irradiancia solar en las longitudes de onda del UV, necesarios para calcular el UVI previsto en condiciones de cielo despejado. En un futuro próximo se espera poder proporcionar UVI previsto en condiciones de cielo despejado y nuboso.
This air quality index is used to describe the air quality in simple terms and an easy-to-understand color scale. It is based on measured air quality data and gives an overall characterization of the actual air quality. Finnish air quality index is an hourly index which describes the air quality each day, based on hourly values and updated every hour.
Strong wind gusts may occur in connection with thunderstorms, causing a lot of damage. Severe thunderstorm warnings contains warnings on thunderstorm gusts. There are not any lightning warnings, but in emergency warnings there are.
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.
Sun protection is required when the UV index is 3 or higher. The forecast for the daily maximum UV index is valid for cloudless conditions. Only thick clouds attenuate the UV radiation considerably.
The Finnish Meteorological Institute gives warnings about highly slippery pedestrian weather. Then extra attention should be paid to the choice of footwear and slip guards should be worn. There may be wide local variations in walkway conditions. It depends on factors such as maintenance practices and the volume of traffic.
The warning specifies the cause and duration of slippery conditions. Between about seven and twenty warnings are issued each year per region.
Izmerjeni podatki o kakovosti zraka in napovedi
Sušomer, dnevni in povprečni podatki za kmetovelce, fenološki podatki, relevantne publikacije.
Prikazi podatkov hiroloških postaj in opozorila
Dnevni maksimum in dnavni potek UV indeksa
Napoved obremenitve zraka s cvetnim prahom po vrstah in regijah
There are three different level of forest fire warnings (yellow, orange and red) and one in grass fire warnings (yellow). They all refer in law to the same thing, that it is forbidden to start open fire. Probability for large and quickly progressive forest fires increase, when it is orange or red warning.
A forest fire warning is usually given and cancelled at 6 am. The warnings are specific to each province. Municipality-specific warnings may also be given in Northern Ostrobothnia (mainly for Kuusamo, Taivalkoski and Pudasjärvi) and in Lapland.
Forest fire warnings are issued using an index calculated by means of a model that describes moisture conditions in the top soil layer measuring about 6 centimetres in thickness. The input data for the model includes precipitation and air temperature.
Most often, the first forest fire warnings of the year are issued in early May. The forest fire warning season ends in September or at the latest in early October.
BACKGROUND: Globally, there is increasing scientific evidence of critical links between the oceans and human health, with research into issues such as pollution, harmful algal blooms and nutritional contributions. However, Oceans and Human Health (OHH) remains an emerging discipline. As such these links are poorly recognized in policy efforts such as the Sustainable Development Goals, with OHH not included in either marine (SDG14) or health (SDG3) goals. This is arguably short-sighted given recent development strategies such as the EU Blue Growth Agenda. OBJECTIVES: In this systematic map we aim to build on recent efforts to enhance OHH in Europe by setting a baseline of existing evidence, asking: What links have been researched between marine environments and the positive and negative impacts to human health and wellbeing? METHODS: We searched eight bibliographic databases and queried 57 organizations identified through stakeholder consultation. Results include primary research and systematic reviews which were screened double blind against pre-defined inclusion criteria as per a published protocol. Studies were limited to Europe, US, Australia, New Zealand and Canada. Data was extracted according to a stakeholder-defined code book. A narrative synthesis explores the current evidence for relationships between marine exposures and human health outcomes, trends in knowledge gaps and change over time in the OHH research landscape. The resulting database is available on the website of the Seas, Oceans and Public Health in Europe website (https://sophie2020.eu/). RESULTS: A total of 1,542 unique articles were included in the database, including those examined within 56 systematic reviews. Research was dominated by a US focus representing 50.1% of articles. A high number of articles were found to link: marine biotechnology and cardiovascular or immune conditions, consumption of seafood and cardiovascular health, chemical pollution and neurological conditions, microbial pollution and gastrointestinal or respiratory health, and oil industry occupations with mental health. A lack of evidence relates to direct impacts of plastic pollution and work within a number of industries identified as relevant by stakeholders. Research over time is dominated by marine biotechnology, though this is narrow in focus. Pollution, food and disease/injury research follow similar trajectories. Wellbeing and climate change have emerged more recently as key topics but lag behind other categories in volume of evidence. CONCLUSIONS: The evidence base for OHH of relevance to European policy is growing but remains patchy and poorly co-ordinated. Considerable scope for future evidence synthesis exists to better inform policy-makers, though reviews need to better incorporate complex exposures. Priorities for future research include: proactive assessments of chemical pollutants, measurable impacts arising from climate change, effects of emerging marine industries, and regional and global assessments for OHH interactions. Understanding of synergistic effects across multiple exposures and outcomes using systems approaches is recommended to guide policies within the Blue Growth Strategy. Co-ordination of research across Europe and dedicated centres of research would be effective first steps.
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: 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.
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.
Vector-borne zoonotic diseases (VBZDs) are a major problem for public health and animal welfare all over the world. In recent years, there has been an alarming increase in VBZDs, mainly caused by new or re-emerging arboviruses, bacteria and parasites. The World Health Organization enumerated 10 threats to global health for 2019, notably emphasizing climate change and emerging pathogens as growing priorities. It is important to review potential threats and develop new control programs for rising threats against human health and safety. Changes in host and vector population diversity and density may affect pathogen transmission patterns and influence VBZD emergence processes. In addition to environmental and climate-related changes, human and animal migratory patterns pose future threats. The geographic location and habitat features of Turkey support the establishment of many arthropod species as vectors of various diseases. To date, a total of 107 zoonotic infections have been reported originating from Turkey. Arthropods transmit 19 of 107 such infections, including 2 mosquito-borne, 9 tick-borne, 1 sandfly-borne, 3 flea-borne, 1 simuliid-borne, 1 mite-borne and 2 fly-borne diseases. In this review, we focus on the present status of knowledge on VBZDs as a rising threat to public health in Turkey to provide a foundation for future control efforts.
Climate change affects Arctic marine ecosystems, the ecosystem services they provide, and the human well-being that relies on these services. The impacts of climate change in the Arctic and elsewhere involve cascading effects and feedbacks that flow across social-ecological systems (SES), such as when sea ice loss alters food security through changes in the distribution of marine animals. These cascades and feedbacks across social and ecological systems can exacerbate the effects of climate change or lead to surprising outcomes. Identifying where cascades and feedbacks may occur in SES can help anticipate, or even prevent unexpected outcomes of climate change, and lead to improved policy or responses. Here, we perform a systematic literature review of multidisciplinary Arctic o research to determine the state of knowledge of the impacts of climate change on marine ecosystems. Then, in a case study corresponding to Inuit regions, we use network analysis to integrate research into a SES perspective and identify which linkages have been most sus least studied, and whether some potential cascades and feedbacks have been overlooked. Finally, we propose ways forward to advance knowledge of changing Arctic marine SES, including transdisciplinary approaches involving multiple disciplines and the collaboration of Indigenous and local knowledge holders.
Introduction: Leishmaniasis represents one of the most dangerous neglected tropical diseases. The parasite used to show a well-defined geographical distribution; however, during the last decade the parasite has spread into new areas. This change in the worldwide distribution of the parasite and in leishmaniasis epidemiology is the result of man’s ill-considered interventions in the environment and of the consequent global warming.Areas covered: The present review focuses on Leishmaniasis incidence in the Mediterranean basin and underlines the pressing need to raise awareness toward the real burden of the disease in the European region. The research was undertaken using Pubmed and including all studies up to January 2020.Expert opinion: Environmental and climatic transformations have allowed the shifting northward of sand fly European geographical distribution, affecting areas traditionally considered as Leishmania-free, including Northern Italy, Germany, and even Belgium. The large-scale migration from the Middle East and Africa to Europe, and particularly to Italy for its central position in the Mediterranean basin, represents an additional and critical risk factor for the spread not only of leishmaniasis but also of other potentially life-threatening diseases. These factors highlight how the current epidemiological European scenario could drastically evolve in the next future.
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.
Aflatoxins (AFs) are harmful secondary metabolites produced by various moulds, among which Aspergillus flavus is the major AF-producer fungus. These mycotoxins have carcinogenic or acute toxigenic effects on both humans and food producing animals and, therefore, the health risks and also the potential economic damages mounted by them have led to legal restrictions, and several countries have set maximum allowable limits for AF contaminations in food and feed. While colonization of food and feed and AF production by A. flavus are highly supported by the climatic conditions in tropical and subtropical geographic regions, countries in the temperate climate zones are also increasingly exposed to AF-derived health risks due to climate change. In the present study, we have reviewed the available mathematical models as risk assessment tools to predict the possibility of A. flavus infection and levels of AF contaminations in maize in a changing climatic environment. After highlighting the benefits and possible future improvements of these models, we summarize the current agricultural practices used to prevent or, at least, mitigate the deleterious consequences of AF contaminations.
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.
The world is changing, and parasites adapt. The Nordic-Baltic region in northern Europe – including the Nordic countries Denmark, Finland, Iceland, Norway and Sweden, and the Baltic States Estonia, Latvia and Lithuania – is facing new parasitological challenges due to changes in populations of parasites and their hosts and the spread of new parasites to the region due to climate change. Some changes can also be ascribed to increased awareness and detection. In this paper, we review and discuss a convenience selection of ten timely examples of recent observations that exemplify trends and challenges from different fields of parasitology, with particular focus on climate change and potential changes in epidemiology of pathogens in northern Europe. The examples illustrate how addressing parasitological challenges often requires both intersectoral and international collaboration, and how using both historical baseline data and modern methodologies are needed.
The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk – the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are “win-win situation” from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.
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.
Extreme weather events are increasing in frequency and severity as a consequence of climate change and pose a significant threat to population mental health. This is the case even in temperate regions such as the United Kingdom (UK) where flooding and heat waves are forecast to become more common. We conducted a systematic review to quantify the prevalence and describe the causes of common mental health problems in populations exposed to extreme weather events in the UK. We searched Web of Science, EMBASE and PsycINFO for studies that measured the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) in populations exposed to extreme weather events in the UK, published up to 12 December 2019. We included 17 studies, four of which were included in meta-analyses to determine the point prevalence of common mental health problems in the period within 12 months following extreme weather events. The point prevalence was 19.8% for anxiety (k = 4; n = 1458; 95% CI 7.42 to 32.15), 21.35% for depression (k = 4; n = 1458; 95% CI 9.04 to 33.65) and 30.36% for PTSD (k = 4; n = 1359; 95% CI 11.68 to 49.05). Key factors that affected mental ill health in people exposed to flooding were water depth and absence of flood warnings. Displacement from home underscored the narratives associated with people’s perceptions of the impact of flooding. The high prevalence of common mental health problems suggests that the prevention of mental ill health in populations at risk or exposed to extreme weather events should be a UK public health priority.
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.
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.
Featured Application The data and analysis can be applied to shipping emissions issues at five governmental levels: local (ports and port cities), subnational regional (port authorities), national (Italy and other countries), international regional (European Union and Mediterranean Sea coastal areas), and global (IMO). Ships’ emissions of air pollutants pose problems for local and regional public health and agricultural production, as well as global climate change. The Italian government’s endorsement in 2019 of the creation of a Mediterranean Emission Control Area is a reflection of increasing concern about the emissions. Also, ongoing developments in the International Maritime Organization and in the European Union add to the Italian government’s maritime shipping agenda and increase its complexity and uncertainty. In that context, this review paper addresses two central questions: What are the consequences for human health and agricultural production of ships’ emissions in Italian ports and coastal areas? How can their emissions be reduced? The approach to these questions is inter-disciplinary. It applies the results of studies in atmospheric chemistry and physics; maritime shipping engineering; public health; agriculture; economics; and international law and policymaking to assess current and prospective policy issues in Italy. The principal conclusions are that: (1) Black carbon emissions are threats to human health and agricultural production in Italy, as well as to the global climate. (2) It is important that black carbon emissions receive more serious attention in policymaking processes in order to reflect the significant analytic progress that has been made in terms of understanding the problems it poses and the technological and policy solutions. (3) There are cost-effective, emission-reducing measures that are readily available, as well as other measures needing more time before full-scale implementation. (4) Although existing multi-level governance systems pose complex analytic and policymaking challenges, they also offer opportunities to institute new policies with significant short-term and long-term co-benefits from reductions in emissions.
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.
In this report, the authors provide a contribution of PMCT in assessing the cause of death due to natural disasters. Here, the PMCT findings of 43 subjects who died during both landslide and flood were described. The post-mortem imaging revealed, clearly, traumatic injuries and/or the presence of foreign material in airways allowing to assess the cause of death of each subject, together with external inspection and the collected circumstantial data. Particularly, the PMCT has been helpful for characterization and localization of the clogging substance in airways providing findings on bronchial branches involvement. Moreover, the investigation offered detailed data on skeletal injuries in all anatomic districts and put in evidence both the precise fracturing site and the characteristics of fracture stubs for each bone fracture. This report supports the recommendation of the virtual autopsy in a case with several victims, as in natural disasters, and its role as an alternative diagnostic investigation when the standard autopsy is not feasible.
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.
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.
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 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.
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.
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.
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.
In this paper, we introduce and test a framework to qualitatively assess the environmental impact of climate adaptation innovations with the ambition to facilitate the implementation of these adaptations. The framework was designed to enable continuous environmentally conscious benchmarking based on three environmental performance indicators: sustainable design, environmental impact and ecological impact. It was pilot tested by uninvolved experts and key-persons for two large-scale nature-based flood adaptation innovations in the Netherlands and discussed with environmental assessment professionals. Our findings indicate how the inclusion of our framework helps to identify important knowledge gaps regarding environmental co-benefits and trade-offs, and can be beneficial to both those developing the innovation and the local authorities charged with assessing the suitability of innovations. We conclude by noting how the incorporation of environmental impact assessment from the design stage of adaptations could supplement existing environmental assessment regulations pre-empting concerns rather than reacting to them.
Natural disasters are potentially traumatic events due to their disruptive nature and high impact on social and physical environments, particularly for children and adolescents. The present study aimed to examine the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-13) in a sample of Portuguese children and adolescents exposed to a specific type of natural disaster (i.e., wildfire). The sample was recruited at six school units of the Central region of Portugal following wildfires in the summer of 2017 and included children and adolescents without a clinical diagnosis of a psychopathological condition associated with exposure to the traumatic event (i.e., nonclinical sample, n = 486) and those with a clinical diagnosis of a trauma- and/or stress-related disorder (i.e., posttraumatic stress disorder [PTSD], adjustment disorder, separation anxiety disorder, or grief; clinical sample, n = 54). Confirmatory factor analyses indicated that a two-factor model (i.e., Intrusion/Arousal and Avoidance) provided a better fit than a three-factor model (i.e., Intrusion, Arousal, and Avoidance) and was found to be invariant across gender and age groups. The CRIES-13 showed good reliability for all subscales, with Cronbach’s alpha s > .79. Higher CRIES-13 scores were associated with poorer health and well-being and more internalizing and externalizing problems. The clinical sample presented with significantly higher CRIES-13 scores than the nonclinical sample, eta(2)(p) = .13. These results contribute to the cross-cultural validation of the CRIES-13 and support its use as a reliable and valid measure for assessing posttraumatic symptoms in children and adolescents.
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.
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.
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.
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 (
The aim of this study was to analyse the association between season of birth, temperature and neonatal mortality according to socioeconomic status in northern Sweden from 1880 to 1950. The source material for this study comprised digitised parish records combined with local weather data. The association between temperature, seasonality, socioeconomic status and neonatal mortality was modelled using survival analysis. We can summarise our findings according to three time periods. During the first period (1880–1899), temperature and seasonality had the greatest association with high neonatal mortality, and the socioeconomic differences in vulnerability were small. The second period (1900–1929) was associated with a decline in seasonal and temperature-related vulnerabilities among all socioeconomic groups. For the last period (1930–1950), a new regime evolved with rapidly declining neonatal mortality rates involving class-specific temperature vulnerabilities, and there was a particular effect of high temperature among workers. We conclude that the effect of season of birth on neonatal mortality was declining for all socioeconomic groups (1880–1950), whereas weather vulnerability was pronounced either when the socioeconomic disparities in neonatal mortality were large (1880–1899) or during transformations from high to low neonatal rates in the course of industrialisation and urbanisation.
During the summer of 2018 Sweden experienced a high occurrence of wildfires, most intense in the low-densely populated Jämtland Härjedalen region. The aim of this study was to investigate any short-term respiratory health effects due to deteriorated air quality generated by the smoke from wildfires. For each municipality in the region Jämtland Härjedalen, daily population-weighted concentrations of fine particulate matter (PM(2.5)) were calculated through the application of the MATCH chemistry transport model. Modelled levels of PM(2.5) were obtained for two summer periods (2017, 2018). Potential health effects of wildfire related levels of PM(2.5) were examined by studying daily health care contacts concerning respiratory problems in each municipality in a quasi-Poisson regression model, adjusting for long-term trends, weekday patterns and weather conditions. In the municipality most exposed to wildfire smoke, having 9 days with daily maximum 1-h mean of PM(2.5) > 20 ?g/m(3), smoke days resulted in a significant increase in daily asthma visits the same and two following days (relative risk (RR) = 2.64, 95% confidence interval (CI): 1.28-5.47). Meta-estimates for all eight municipalities revealed statistically significant increase in asthma visits (RR = 1.68, 95% CI: 1.09-2.57) and also when grouping all disorders of the lower airways (RR = 1.40, 95% CI: 1.01-1.92).
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.
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.
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.
The aim of the research is the examination of the factors influencing the public perception of climate change and its impact on natural disasters. This paper presents the results of quantitative research regarding testing the central hypothesis where education is the predicting variable of public perception of climate change and its impact on natural disasters. A multivariate regression analysis was used, identifying the extent of the total scores of the main dependent variables (perception of vulnerability to climate change, perception of the climate change impact on natural disasters, knowledge and fear scores) were associated with five demographic and socio-economic variables: gender, age, marital status, education level, and employment status. A series of 208 face-to-face interviews were conducted during the beginning of 2020 on the central squares in the selected cities in Serbia, Belgrade (76.92%) and Sremska Mitrovica (23.08%). The results showed that education level was the most effective predictor of the mentioned research variables. Besides, employment status has been found to affect perceptions of vulnerability, while age affects the perceptions of climate change. Based on the obtained results, policies and strategies to improve people’s awareness of climate change must take into account a comprehensive understanding of behavioral dispositions.
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.
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.
Exposure to air pollution is of great concern for public health although studies on the associations between exposure estimates and personal exposure are limited and somewhat inconsistent. The aim of this study was to quantify the associations between personal nitrogen oxides (NO(x)), ozone (O(3)) and particulate matter (PM(10)) exposure levels and ambient levels, and the impact of climate and time spent outdoors in two cities in Sweden. Subjects (n?=?65) from two Swedish cities participated in the study. The study protocol included personal exposure measurements at three occasions, or waves. Personal exposure measurements were performed for NO(x) and O(3) for 24 h and PM(10) for 24 h, and the participants kept an activity diary. Stationary monitoring stations provided hourly data of NO(x), O(3) and PM, as well as data on air temperature and relative humidity. Data were analysed using mixed linear models with the subject-id as a random effect and stationary exposure and covariates as fixed effects. Personal exposure levels of NO(x), O(3) and PM(10) were significantly associated with levels measured at air pollution monitoring stations. The associations persisted after adjusting for temperature, relative humidity, city and wave, but the modelled estimates were slightly attenuated from 2.4% (95% CI 1.8-2.9) to 2.0% (0.97-2.94%) for NO(x), from 3.7% (95% CI 3.1-4.4) to 2.1% (95% CI 1.1-2.9%) for O(3) and from 2.6% (95% 0.9-4.2%) to 1.3% (95% CI?-?1.5-4.0) for PM(10). After adding covariates, the degree of explanation offered by the model (coefficient of determination, or R(2)) did not change for NO(x) (0.64 to 0.63) but increased from 0.46 to 0.63 for O(3), and from 0.38 to 0.43 for PM(10). Personal exposure to NO(x), O(3) and PM has moderate to good association with levels measured at urban background sites. The results indicate that stationary measurements are valid as measure of exposure in environmental health risk assessments, especially if they can be refined using activity diaries and meteorological data. Approximately 50-70% of the variation of the personal exposure was explained by the stationary measurement, implying occurrence of misclassification in studies using more crude exposure metrics, potentially leading to underestimates of the effects of exposure to ambient air pollution.
The investigation conducted in the Vojvodina Province, as a typical European and one of the biggest agricultural regions in the Balkans, offers the research methodology that could be used for any non/flooded agricultural region. The flood impact on heavy elements (HE) content in the flooded arable soil (n =?16) in relation to the control soil (n =?16) was examined, as well as their accumulation in the most often cultivated vegetables (n =?96) in the studied area. Results revealed that the flood did not significantly change the pseudo total HEs concentration in the soil as well as their amounts accumulated in different soil fractions. In both soils, only the average content of Ni exceeded the maximum permissible values set by Serbian soil quality standard which is in line with the Dutch standard. In comparison with the background values, notable enrichment is found for most of analyzed elements in both soils. Soil pollution status was assessed through several indices indicating that contamination range was in the domain from a moderate to a highly polluted. The principal component analysis demonstrated that soil contamination was probably originated from agricultural/anthropogenic activities (Cd, Cu, As, Pb), apart from Ni, Cr, and Co which came from natural weathering of the parent material. Carcinogenic and non-carcinogenic risks of selected HEs for Serbian population in the investigated region were below the threshold values. The average levels of Pb in investigated potato and carrot samples were higher than the maximum allowable concentrations established by EU/Serbian regulation. The total hazard quotients (THQ) of HEs through intake of analyzed vegetables were below the safe threshold (? 1), suggesting the absence of adverse health effects.
The current increase and severity of the natural disasters whose effects on the public health are likely to be even more extreme and complex, requires enhancing and developing the disaster preparedness on the population level. In order to be able to do so, it is inevitable and determinative to know the factors that affect people’s preparedness on the population level. Therefore, the objective of this article is to present the results from assessing the factors related to the population preparedness for the disasters on a sample of citizens living from the Slovak Republic. Our research is based on the exploration of the questionnaire survey’ results aimed at investigating the preparedness and preventive proactive behaviour of the population against the disasters. The search for the initiators of such a behaviour and assessment of the influence of various aspects (e.g., the respondents’ experience with disasters, their vulnerability to disasters, the risk awareness, the perception of the disaster risks in the changing environment, etc.) on the respondents’ behaviour against disasters is the main part of the article and is supported by the statistical analysis. The results of the survey suggest that the disaster risk awareness and overall disaster preparedness level is rather poor and the population is inactive. The proactive behaviour of the respondents against the disasters is partially affected by some of their personality and socio-economic characteristics, especially the younger respondents currently incline more to adopting the protective measures. In addition, other aspects, e.g., the negative experience with the disasters in the past influence the preparedness. However, the impacts must have been relatively serious for the proactive behaviour to be influenced. The influences of other aspects as well as the possible methods for improving the disaster preparedness and the possibilities of increasing the resilience of the population as a whole are also discussed in this article.
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.
Climate change threatens mental health via increasing exposure to the social and economic disruptions created by extreme weather and large-scale climatic events, as well as through the anxiety associated with recognising the existential threat posed by the climate crisis. Considering the growing levels of climate change awareness across the world, negative emotions like anxiety and worry about climate-related risks are a potentially pervasive conduit for the adverse impacts of climate change on mental health. In this study, we examined how negative climate-related emotions relate to sleep and mental health among a diverse non-representative sample of individuals recruited from 25 countries, as well as a Norwegian nationally-representative sample. Overall, we found that negative climate-related emotions are positively associated with insomnia symptoms and negatively related to self-rated mental health in most countries. Our findings suggest that climate-related psychological stressors are significantly linked with mental health in many countries and draw attention to the need for cross-disciplinary research aimed at achieving rigorous empirical assessments of the unique challenge posed to mental health by negative emotional responses to climate change.
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.
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%.
Early adolescence (12-13 years old) is a critical but under-researched demographic for the formation of attitudes related to climate change. We address this important area by exploring adolescent views about climate change. This paper presents opinions collected from surveys of?463 1st-year secondary school students (12-13 years old) in public secondary schools in inner-urban centres in Austria and Australia on whether climate change is (1) something about which to worry, (2) caused by humans and (3) happening now. Eligible respondents in both countries showed similar levels of agreement that climate change was probably or definitely something we should (1) worry about (84.6% Austria, 89.1% Australia), which is significantly higher than either country’s adult population. Eligible respondents agreed that climate change probably or definitely is (2) caused by humans (75.6% Austria, 83.6% Australia) and that climate change is probably or definitely something that is (3) happening now (73.1% Austria, 87.5% Australia). Their response differed from the respective adult populations, but in opposite directions. Our results suggest that socio-cultural worldview may not have as much influence on this age group as it does on the respective adult populations and suggests that this age group would be receptive and ready for climate science education and engagement initiatives.
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.
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.
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.
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.
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.
Vulnerability assessments play a central role in deciding on measures for flood risk reduction. Vulnerability itself manifests as tangible (e.g. building damage) and intangible (e.g. distress, disruption of livelihoods) outcomes caused by a flood event. Traditionally, vulnerability assessments have been focusing on the physical and social sources that drive these outcomes, while psychological sources have largely been neglected. This paper expands the current physical and social perspective on vulnerability by demonstrating the added value of psychological sources to more accurately identify those who are most vulnerable to flooding. Based on survey data of 1127 households living in flood-prone areas in Austria, we confirm that tangible and intangible outcomes represent conceptually distinct types of flood impacts. A series of hierarchical regression models shows that psychological sources do not play a critical role for tangible outcomes, as they do not significantly add to the variance already explained by physical and social indicators. However, psychological sources have substantial unique explanatory value for intangible outcomes, and may supersede certain physical indicators (e.g., risk zone is a physical proxy indicator for the underlying psychological factor ‘perceived flood probability’). By contrast, social indicators retain their effect size even if psychological indicators are included. Thus, expanding the scope of vulnerability outcomes calls for simultaneously expanding the scope of sources of vulnerability. The results caution against catch-all risk reducing measures; instead, risk managers should address the vulnerability sources specific to particular outcomes. To improve social equity, flood policy instruments should incorporate intangible outcomes and psychological sources of vulnerability.
Purpose: Climate models predict an increase in frequency and intensity of flood disasters that have the potential to affect human health due to immediate traumatic experiences or long-term secondary stressors. However, only few studies examined the longitudinal course of mental health after floods and those who do lack an inclusion of physical health and evaluation of effective interventions to mitigate adverse health effects. Methods: A longitudinal field study with 3 waves covering a time span of 12 months was conducted in beneficiaries of the Malteser Aid Service (MAS) psycho-social support program after the 2013 flood disaster in Germany. Participants received a self-report questionnaire to inquire mental and physical health parameters. A crosssectional survey in flood-affected but unsupported individuals was conducted as an approximate control group and to specify the characteristics of help seekers to relief organizations. Results: Participants exhibited elevated screening rates of depression (50.3%), post-traumatic stress (35.5%) and reduced physical health-related quality of life (63.1%) with an overall significant improvement of mental health parameters over time. The control group reported lower rates of depression and post-traumatic stress compared to the MAS group. Financial support and supportive counseling were associated with reduced mental health strain and counteracted established vulnerability factors. Conclusion: Selected and targeted psycho-social interventions have the potential to improve mental health and health-related quality of life in flood victims. Results may inform the development of structured education programs for volunteer and professional staff of relief organizations to promote effective psycho-social support measures and improve post-disaster support.
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.
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.
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.
Food security is a global concern affecting even highly developed countries. Ongoing globalisation of food systems, characterised by trading interdependencies, means that agricultural production can be disrupted by climate change, affecting food availability. This study investigated Sweden’s food security by identifying major food import categories and associated trade partners (using the World Integrated Trade System database) and vulnerability to frictions in trade deriving from climate change. Vulnerability was assessed through three indicators: exposure based on diversity of sources, dominance and direct trade from supplying countries; sensitivity, assessed using the Climate Risk Index, and adaptive capacity, assessed using the Fragile State Index. The results revealed that Sweden’s grain imports may be most vulnerable, and animal products least vulnerable, to climate change. Management strategies based on this preliminary assessment can be developed by integrating climate vulnerability deriving from food trading into the ‘Gravity’ model, to improve prediction of trade flows.
Hydro-meteorological risks are a growing issue for societies, economies and environments around the world. An effective, sustainable response to such risks and their future uncertainty requires a paradigm shift in our research and practical efforts. In this respect, Nature-Based Solutions (NBSs) offer the potential to achieve a more effective and flexible response to hydro-meteorological risks while also enhancing human well-being and biodiversity. The present paper describes a new methodology that incorporates stakeholders’ preferences into a multi-criteria analysis framework, as part of a tool for selecting risk mitigation measures. The methodology has been applied to Tamnava river basin in Serbia and Nangang river basin in Taiwan within the EC-funded RECONECT project. The results highlight the importance of involving stakeholders in the early stages of projects in order to achieve successful implementation of NBSs. The methodology can assist decision-makers in formulating desirable benefits and co-benefits and can enable a systematic and transparent NBSs planning process.
The aim of this study was to compare airborne levels of Phl p 1 and Phl p 5, with Poaceae pollen concentrations inside and outside of the pollen season, and to evaluate their association with symptoms in grass allergic patients and the influence of climate and pollution. The Hirst and the Burkard Cyclone samplers were used for pollen and allergen quantification, respectively. The sampling period ran from 23 March 2009 to 27 July 2010. Twenty-three patients with seasonal allergic asthma and rhinitis used an electronic symptom card. The aerosol was extracted and quantified for Phl p 1 and Phl p 5 content. Descriptive statistics, non-parametric paired contrast of Wilcoxon, Spearman’s correlations, and a categorical principal component analysis (CatPCA) were carried out. Significant variations in pollen, aeroallergen levels, pollen allergen potency, and symptoms score were observed in this study. Phl p 5 pollen allergen potency was higher at the beginning of the 2010 grass pollen season. Presence of Phl p 1 outside the pollen season with positive O(3) correlation was clinically relevant. 45.5% of the variance was explained by two dimensions in the CatPCA analysis, showing the symptom relationships dissociated in two dimensions. In the first one, the more important relationship was with grass pollen grains concentration and Phl p 5 and to a lesser extent with Phl p 1 and levels of NO(2) and O(3), and in the second dimension, symptoms were associated with humidity and SO(2). Clinically relevant out-season Phl p 1 was found with a positive O(3) correlation. The effect of climate and pollution may have contributed to the higher seasonal allergic rhinitis symptom score recorded in 2009.
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.
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.
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.
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.
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.
BACKGROUND: Climate change has a direct and indirect impact on human health that include health impacts from rising temperatures and poor air quality. This challenges the health sector in many ways. Nurses should be aware of these health effects and the patients who are particularly vulnerable to the health impacts caused by climate change. PURPOSE: The objective of the study was to identify the health issues that Finnish registered nurses associate with climate change and to determine nurses’ perception of their preparation to address the health impacts of climate change. METHODS: A qualitative descriptive study was conducted through semi-structured focus group interviews. RESULTS: Nurses reported observing changes in health of their patient populations. The nurses attributed some changes in their patients’ health to climate change. Interviewed nurses felt that climate change was not adequately addressed in their basic nursing education and in staff development. CONCLUSIONS: It is important to include climate change and its impact on human health in the nurses’ curriculum and in continuing education for practicing nurses.
Airborne allergenic pollen impact the health of a great part of the global population. Under climate change conditions, the abundance of airborne pollen has been rising dramatically and so is the effect on sensitized individuals. The first line of allergy management is allergen avoidance, which, to date, is by rule achieved via forecasting of daily pollen concentrations. The aim of this study was to elaborate on 3-hourly predictive models, one of the very few to the best of our knowledge, attempting to forecast pollen concentration based on near-real-time automatic pollen measurements. The study was conducted in Augsburg, Germany, during four years (2016-2019) focusing on Betula and Poaceae pollen, the most abundant and allergenic in temperate climates. ARIMA and dynamic regression models were employed, as well as machine learning techniques, viz. artificial neural networks and neural network autoregression models. Air temperature, relative humidity, precipitation, air pressure, sunshine duration, diffuse radiation, and wind speed were additionally considered for the development of the models. It was found that air temperature and precipitation were the most significant variables for the prediction of airborne pollen concentrations. At such fine temporal resolution, our forecasting models performed well showing their ability to explain most of the variability of pollen concentrations for both taxa. However, predictive power of Betula forecasting model was higher achieving R-2 up to 0.62, whereas Poaceae up to 0.55. Neural autoregression was superior in forecasting Betula pollen concentrations, whereas, for Poaceae, seasonal ARIMA performed best. The good performance of seasonal ARIMA in describing variability of pollen concentrations of both examined taxa suggests an important role of plants’ phenology in observed pollen abundance. The present study provides novel insight on per-hour forecasts to be used in real-time mobile apps by pollen allergic patients. Despite the huge need for real-time, short-term predictions for everyday clinical practice, extreme weather events, like in the year 2019 in our case, still comprise an obstacle toward highly performing forecasts at such fine timescales, highlighting that there is still a way to go to this direction.
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.
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.
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.
This publication presents a comparison of the content of pollutants in groundwater samples taken at 117 measurement points in four regions of Poland during a drought period and in the reference period without drought. Based on the chemical analyses of water, an assessment of the health risk resulting from the use of underground water for consumption was carried out. The study aimed to determine whether drought affects the increase in health risk exposure of the population. It was found that despite the occurrence of drought, the expected increase in the concentration of pollutants in water does not take place in all locations. This study found that in some cases the occurrence of drought did not cause an increase in the non-cancerogenic threat expressed by the hazard index. There were also no clear changes in excess lifetime cancer risk values except for selected measurement points. On the other hand, the statistical analysis of all data collected in the regions where the research was conducted showed a general trend of increasing environmental health risk caused by changes in groundwater pollution during drought.
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.
This paper reports household questionnaire survey results on vulnerability and resilience to flooding from one of the largest and most representative samples (n = 593) of households up to 12 years after they were flooded, and is one of the first to provide detailed analysis of social differentiation in long-term flood impacts. A novel finding is that social differentiation in flood impacts is relatively small soon after a flood, but widens over time, with socially disadvantaged groups displaying less recovery. The patterns of social differentiation in vulnerability and resilience to flooding differ markedly according to the type and timescale of the impact, with some normally socially advantaged groups (e.g., professionals and homeowners) being most vulnerable to short-term impacts. Consistent with some existing studies, we found that older residents (age 70+) have greater resilience to flood impacts, although our sample may not capture the frailest individuals. As in previous research, low income is linked to lower resilience, particularly in the long term. We find that prior experience of flooding, despite enhancing preparedness, overall erodes rather than enhances resilience to flooding. Flood warnings are effective at reducing vulnerability to short-term impacts. Underlying influences on resilience to natural disasters are complex and may only be revealed by multivariate analysis and not always be evident in simple observed patterns. The paper concludes that vulnerability and resilience to flooding are sensitive to financial resources, institutional support (chiefly from a landlord), and capacity to deal with disruption (chiefly time availability, which is low among professionals and high among retired people). An implication of these findings is that existing indices of flood vulnerability that use multiple measures of social deprivation should be used with caution, as not all conventional aspects of social deprivation are necessarily associated with greater vulnerability to flood impacts.
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.
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.
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.
The health, economic, and social impact of COVID-19 has been significant across the world. Our objective was to evaluate the association between air pollution (through NO(2) and PM(2.5) levels) and COVID-19 mortality in Spanish provinces from February 3, 2020, to July 14, 2020, adjusting for climatic parameters. An observational and ecological study was conducted with information extracted from Datadista repository (Datadista, 2020). Air pollutants (NO(2) and PM(2.5) levels) were analyzed as potential determinants of COVID-19 mortality. Multilevel Poisson regression models were used to analyze the risk of mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Models were adjusted by four climatic variables (hours of solar radiation, precipitation, daily temperature and wind speed) and population size. The mean levels of PM(2.5) and NO(2) across all provinces and time in Spain were 8.7 ?g/m(3) (SD 9.7) and 8.7 ?g/m(3) (SD 6.2), respectively. High levels of PM(2.5) (IRR?=?1.016, 95% CI: 1.007-1.026), NO(2) (IRR?=?1.066, 95% CI: 1.058-1.075) and precipitation (IRR(NO2)?=?0.989, 95% CI: 0.981-0.997) were positively associated with COVID-19 mortality, whereas temperature (IRR(PM2.5)?=?0.988, 95% CI: 0.976-1.000; and IRR(NO2)?=?0.771, 95% CI: 0.761-0.782, respectively) and wind speed (IRR(NO2)?=?1.095, 95% CI: 1.061-1.131) were negatively associated with COVID-19 mortality. Air pollution can be a key factor to understand the mortality rate for COVID-19 in Spain. Furthermore, climatic variables could be influencing COVID-19 progression. Thus, air pollution and climatology ought to be taken into consideration in order to control the pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11869-021-01062-2.
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.
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.
Portugal (Southwestern Europe) experiences a high incidence of dry hazards such as drought, a phenomenon that entails a notable burden of morbidity and mortality worldwide. For the first time in the Lisbon district, a time-series study was conducted to evaluate the impact of drought measured by the Standardised Precipitation Index (SPI) and Standardised Precipitation-Evapotranspiration Index (SPEI) on the daily natural, circulatory, and respiratory mortality from 1983 to 2016. An assessment by gender and adult age population groups (45-64, 65-74, ?75 years old) was included. To estimate the relative risks and attributable risks, generalised linear models with a Poisson link were used. Additionally, the influence of heatwaves and atmospheric pollution for the period from 2007 to 2016 (available period for pollution data) was considered. The main findings indicate statistically significant associations between drought conditions and all analysed causes of mortality. Moreover, SPEI shows an improved capability to reflect the different risks. People in the 45-64 year-old group did not indicate any significant influence in any of the cases, whereas the oldest groups had the highest risk. The drought effects on mortality among the population varied across the different study periods, and in general, the men population was affected more than the women population (except for the SPEI and circulatory mortality during the long study period). The short-term influence of droughts on mortality could be explained primarily by the effect of heatwaves and pollution; however, when both gender and age were considered in the Poisson models, the effect of drought also remained statistically significant when all climatic phenomena were included for specific groups of the total population and men. This type of study facilitates a better understanding of the population at risk and allows the development of more effective measures to mitigate the drought effects on the population.
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.
A higher risk of hip fracture was found in areas of Norway at higher elevation and farther from the coast. However, the previously seen county variations could not be explained by these geographical factors. INTRODUCTION: Norway is an elongated country extending north of the Arctic Circle with substantial coast-inland variation in topography and climate. Differences in hip fracture incidence between counties and a distinct seasonal variation have previously been shown. The aim of the current study was to explore these variations further by considering associations of height above sea level (elevation) and distance to the coast with hip fracture incidence. METHODS: All patients with hip fractures admitted to Norwegian hospitals in the period 2009-2018 were included. Individual residential elevation and distance to the coast was calculated in Geographic Information Systems and combined with individual-level population data on all Norwegians 50 years of age or older during the observation period, including hospital information on fractures. Age-standardized incidences rate and incidence rate ratios with 95% confidence intervals (IRR, 95% CI) according to elevation and coastal proximity were estimated. The associations were tested using Poisson models adjusting for sex, urban/rural location of residency, country of birth, and season of hip fracture occurrence. RESULTS: From 2009 to 2018, there were 85,776 first hip fractures. There was an increasing risk with higher residential elevation (above versus below mean) for women: IRR?=?1.04, 95% CI: 1.02, 1.05), but not for men (IRR?=?1.00, 95% CI: 0.97, 1.02). Incidence of hip fracture increased with distance from the coast. Women residing the farthest away from the coast (above versus below mean distance) had a higher age-adjusted incidence of hip fracture compared to those living closer to the coast (IRR?=?1.04 (95% CI: 1.02, 1.06), whereas no association was found in men (IRR?=?1.00 (95% CI: 1.00, 1.01). Combining elevation and distance to coast showed a higher incidence in women living at high elevation far from the coast compared with women living at low elevation near the coast (IRR?=?1.07, 95% CI: 1.04, 1.10). A similar result was found in men but only for hip fractures occurring during March-May (IRR?=?1.07, 95% CI: 1.00, 1.15). The previously shown patterns of county differences and seasonal variations were unchanged when considering geography. CONCLUSION: We found a somewhat higher incidence of hip fracture in inland residents living in areas of high elevation, as compared to those living in more coastal proximity; however, the geographic variation did not explain county and seasonal differences in fracture incidence in Norway. More in-depth analyses on temperature and climate factors may give further clues.
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.
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.
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.
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 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.
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.
Global warming and air pollution affect the transmission pathway and the survival of viruses, altering the human immune system as well. The first wave of the COVID-19 pandemic dramatically highlights the key roles of climate and air chemistry in viral epidemics. The elongated form of the Italian peninsula and the two major islands (the largest in Europe) is a perfect case study to assess some of these key roles, as the fate of the virus is mirroring the industrialization in the continental part of our country. Fine particulate matter (PM(2.5)), geography, and climate explain what is happening in Italy and support cleaner air actions to address efficiently other outbreaks. Besides the environmental factors, future works should also address the genetic difference among individuals to explain the spatial variability of the human response to viral infections.
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.
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.
Current models for flu-like epidemics insufficiently explain multi-cycle seasonality. Meteorological factors alone, including the associated behavior, do not predict seasonality, given substantial climate differences between countries that are subject to flu-like epidemics or COVID-19. Pollen is documented to be allergenic, it plays a role in immuno-activation and defense against respiratory viruses, and seems to create a bio-aerosol that lowers the reproduction number of flu-like viruses. Therefore, we hypothesize that pollen may explain the seasonality of flu-like epidemics, including COVID-19, in combination with meteorological variables. We have tested the Pollen-Flu Seasonality Theory for 2016-2020 flu-like seasons, including COVID-19, in the Netherlands, with its 17.4 million inhabitants. We combined changes in flu-like incidence per 100 K/Dutch residents (code: ILI) with pollen concentrations and meteorological data. Finally, a predictive model was tested using pollen and meteorological threshold values, inversely correlated to flu-like incidence. We found a highly significant inverse correlation of r(224) = -0.41 (p < 0.001) between pollen and changes in flu-like incidence, corrected for the incubation period. The correlation was stronger after taking into account the incubation time. We found that our predictive model has the highest inverse correlation with changes in flu-like incidence of r(222) = -0.48 (p < 0.001) when average thresholds of 610 total pollen grains/m(3), 120 allergenic pollen grains/m(3), and a solar radiation of 510 J/cm(2) are passed. The passing of at least the pollen thresholds, preludes the beginning and end of flu-like seasons. Solar radiation is a co-inhibitor of flu-like incidence, while temperature makes no difference. However, higher relative humidity increases with flu-like incidence. We conclude that pollen is a predictor of the inverse seasonality of flu-like epidemics, including COVID-19, and that solar radiation is a co-inhibitor, in the Netherlands.
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.
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.
Previous studies have demonstrated that plants are a very good indicator of global environmental variations. The responses of many plant species to climate change are confirmed by aerobiological research. This paper presents an analysis of many parameters of pollen seasons in the Amaranthaceae family based on measurements of pollen concentrations in atmospheric air. Pollen samples were collected with the volumetric method at a sampling site in Lublin (Poland) in 2001-2019. The obtained data were verified using statistical analyses. Moreover, the presence of pollenkitt on the pollen grain surface was examined in fresh anthers using scanning electron and light microscopes, since there are some difficulties in identification of Amaranthaceae pollen grains deposited on microscopic slides in aerobiological analysis. The pollen season in Amaranthaceae began on average on June 23 and ended on October 5, i.e. it lasted 105 days. The peak value and annual pollen sum were characterized by the highest variability in the study years in comparison with other season characteristics. The annual pollen sum was in the range from 183 to 725. Maximum concentrations were most often recorded in the second half of August, which is associated with the greatest risk of development of pollen allergy symptoms in sensitive subjects during this period. The results obtained in the 19-year study revealed that the pollen seasons began 14 days earlier. Similarly, the end of the season was accelerated by 24 days. The response of these plants to climate change also include the reduced pollen production by representatives of this family, which was manifested by a decrease in the annual sum of daily airborne pollen concentrations, on average by 35%, and a reduction in the maximum pollen concentration, on average by more than 60%. We found that temperature in May and June had an effect on pollen release, and relative air humidity in May influenced pollen concentrations. We noted significant similarities in the pollen release rate during the last 8 years of the study. The scanning electron microscopy examinations showed that the pollen grain surface in the representative of this family was covered completely or partially with pollenkitt. Hence, the apertures characteristic for pollen in this family were poorly visible. The presence of pollenkitt on the surface of these polyaperturate pollen grains may play an important role in preventing water loss during pollen migration in the air. Our research has demonstrated the response of plants flowering in summer to climate change. The results not only have practical importance for public health in the aspect of allergy risk but can also help to assess environmental changes.
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.
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 climate crisis is an unprecedented existential threat that causes disturbing emotions, such as anxiety. Recently, Clayton and Karazsia measured climate anxiety as “a more clinically significant ‘anxious’ response to climate change” (2020, p. 9). To gain a more nuanced understanding of the phenomenon from an empirical psychological perspective, we translated the core of the Climate Anxiety Scale into German and assessed potential correlates in a large German-speaking quota sample (N = 1011, stratified by age and gender). Overall, people reported low levels of climate anxiety. Climate anxiety correlated positively with general anxiety and depressiveness, avoidance of climate change in everyday life, frustration of basic psychological needs, pro-environmental behavioral intentions, and policy support. It correlated negatively with different forms of climate denial and was unrelated to ideological beliefs. We were not able to replicate the two dimensions found in the original scale. Moreover, we argue that items appear to measure a general climate-related emotional impairment, rather than distinctly and comprehensively capturing climate anxiety. Thus, we encourage researchers to rework the scale and include an emotional factor in future research efforts.
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.
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.
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.
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.
Due to population growth, urbanization and economic development, demand for freshwater in urban areas is increasing throughout Europe. At the same time, climate change, eutrophication and pollution are affecting the availability of water supplies. Sicily, a big island in southern Italy, suffers from an increasing drought and consequently water shortage. In the last decades, in Sicilian freshwater reservoirs several Microcystis aeruginosa and more recently Planktothrix rubescens blooms were reported. The aims of the study were: (1) identify and quantify the occurring species of cyanobacteria (CB), (2) identify which parameters, among those investigated in the waters, could favor their growth, (3) set up a model to identify reservoirs that need continuous monitoring due to the presences, current or prospected, of cyanobacterial blooms and of microcystins, relevant for environmental and, consequentially, for human health. Fifteen artificial reservoirs among the large set of Sicilian artificial water bodies were selected and examined for physicochemical and microbiological characterization. Additional parameters were assessed, including the presence, identification and count of the cyanobacterial occurring species, the measurement of microcystins (MCs) levels and the search for the genes responsible for the toxins production. Principal Component Analysis (PCA) was used to relate environmental condition to cyanobacterial growth. Water quality was poor for very few parameters, suggesting common anthropic pressures, and PCA highlighted clusters of reservoirs vulnerable to hydrological conditions, related to semi-arid Mediterranean climate and to the use of the reservoir. In summer, bloom was detected in only one reservoir and different species was highlighted among the Cyanobacteria community. The only toxins detected were microcystins, although always well below the WHO reference value for drinking waters (1.0 ?g/L). However, molecular analysis could not show the presence of potential cyanotoxins producers since a few numbers of cells among total could be sufficient to produce these low MCs levels but not enough high to be proved by the traditional molecular method applied. A simple environmental risk-based model, which accounts for the high variability of both cyanobacteria growth and cyanotoxins producing, is proposed as a cost-effective tool to evaluate the need for monitoring activities in reservoirs aimed to guarantee supplying waters safety.
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.
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.
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.
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.
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: Why human tick-borne encephalitis (TBE) cases differ from year to year, in some years more 100%, has not been clarified, yet. The cause of the increasing or decreasing trends is also controversial. Austria is the only country in Europe where a 40-year TBE time series and an official vaccine coverage time series are available to investigate these open questions. METHODS: A series of generalized linear models (GLMs) has been developed to identify demographic and environmental factors associated with the trend and the oscillations of the TBE time series. Both the observed and the predicted TBE time series were subjected to spectral analysis. The resulting power spectra indicate which predictors are responsible for the trend, the high-frequency and the low-frequency oscillations, and with which explained variance they contribute to the TBE oscillations. RESULTS: The increasing trend can be associated with the demography of the increasing human population. The responsible GLM explains 12% of the variance of the TBE time series. The low-frequency oscillations (10 years) are associated with the decadal changes of the large-scale climate in Central Europe. These are well described by the so-called Scandinavian index. This 10-year oscillation cycle is reinforced by the socio-economic predictor net migration. Considering the net migration and the Scandinavian index increases the explained variance of the GLM to 44%. The high-frequency oscillations (2-3 years) are associated with fluctuations of the natural TBE transmission cycle between small mammals and ticks, which are driven by beech fructification. Considering also fructification 2 years prior explains 64% of the variance of the TBE time series. Additionally, annual sunshine duration as predictor for the human outdoor activity increases the explained variance to 70%. CONCLUSIONS: The GLMs presented here provide the basis for annual TBE forecasts, which were mainly determined by beech fructification. A total of 3 of the 5 years with full fructification, resulting in high TBE case numbers 2 years later, occurred after 2010. The effects of climate change are therefore not visible through a direct correlation of the TBE cases with rising temperatures, but indirectly via the increased frequency of mast seeding.
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.
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.
This study set out to empirically determine the current state of individual and household adaptation to climate change in the United Kingdom and how policy makers can improve on it. The study utilized both qualitative and quantitative approaches (mixed method). For the quantitative aspect of the study, a quota-sampling technique was employed in the selection of 650 respondents for the study using a well-structured questionnaire. The quota representation was based on age and gender. Data were analyzed using descriptive statistics and binary logit regression. In addition, qualitative content/topic analysis of an in-depth interview of the respondents was employed in further analyzing why and how policy makers can improve climate change adaptation. Findings from the study indicate the dire need for continued government support in household and individual adaptation in Leeds, and this support should also be encouraged in other cities where government intervention is low. Interventions in the form of subsidies, direct regulations, and public awareness are needed. The implementation of these measures is expected to generate a wide range of additional benefits to most vulnerable groups who should be central to the rapidly expanding climate change research and policy agenda in the United Kingdom. SIGNIFICANCE STATEMENT Evidence shows that periods of extremely cold winters have been perceived to have increased in frequency in the United Kingdom over the years. This points to the need to uncover what policy and behavioral adaptation measures required to improve individual and household adaptation measures to cold spells in the United Kingdom. We utilized both qualitative and quantitative approaches (mixed method) to find out the drivers and hindrances to adaptation against cold spells, using Leeds as a case study. We found out that over 70% of the respondents adopted all of the short-term coping strategies, whereas 55% did not indicate any changes in their behavior in response to cold spells. Also, government support, the prospect of relocation (people’s intention of leaving their home), and the high technicalities in installing adaptation tools significantly affect individuals’ tendency to adopt long-term coping strategies.
The aim of the paper is to describe the spread forest fire event occurred in the Italian Alps in 2017 under extremely drought conditions. In the study the root causes of wildfires and their direct relapses to the air quality of the Western Po valley and the urban centre of Torino have been assessed by means of air pollution measurements (focused to particulate matter with reference samplers and optical particle counters OPCs), meteorological indicators and additional public data. Results show a good correlation among different urban sites and instrument technologies. Concentration data, compared with environmental conditions and historical values describe the clear impact of fires on both local and regional air quality. Indeed, the deferred impact of wildfires on the local wood biomass energy supply chain is briefly outlined. (C) 2019 Published by Elsevier Ltd.
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.
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.
Citizen observatories are a relatively recent form of citizen science. As part of the flood risk management strategy of the Brenta-Bacchiglione catchment, a citizen observatory for flood risk management has been proposed and is currently being implemented. Citizens are involved through monitoring water levels and obstructions and providing other relevant information through mobile apps, where the data are assimilated with other sensor data in a hydrological- hydraulic model used in early warning. A cost-benefit analysis of the citizen observatory was undertaken to demonstrate the value of this approach in monetary terms. Although not yet fully operational, the citizen observatory is assumed to decrease the social vulnerability of the flood risk. By calculating the hazard, exposure and vulnerability of three flood scenarios (required for flood risk management planning by the EU Directive on Flood Risk Management) with and without the proposed citizen observatory, it is possible to evaluate the benefits in terms of the average annual avoided damage costs. Although currently a hypothetical exercise, the results showed a reduction in avoided damage of 45 % compared to a business as usual scenario. Thus, linking citizen science and citizen observatories with hydrological modelling to raise awareness of flood hazards and to facilitate two-way communication between citizens and local authorities has great potential in reducing future flood risk in the Brenta-Bacchiglione catchment. Moreover, such approaches are easily transferable to other catchments.
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.
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 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: 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.
The global literature on drought and health highlights a variety of health effects for people in developing countries where certain prevailing social, economic and environmental conditions increase their vulnerability especially with climate change. Despite increased focus on climate change, relatively less is known about the health-drought impacts in the developed country context. In the UK, where climate change-related risk of water shortages has been identified as a key area for action, there is need for better understanding of drought-health linkages. This paper assesses people’s narratives of drought on health and well-being in the UK using a source-receptor-impact framing. Stakeholder narratives indicate that drought can present perceived health and well-being effects through reduced water quantity, water quality, compromised hygiene and sanitation, food security, and air quality. Heatwave associated with drought was also identified as a source of health effects through heat and wildfire, and drought-related vectors. Drought was viewed as potentially attributing both negative and positive effects for physical and mental health, with emphasis on mental health. Health impacts were often complex and cross-sectoral in nature indicating the need for a management approach across several sectors that targets drought and health in risk assessment and adaptation planning processes. Two recurring themes in the UK narratives were the health consequences of drought for ‘at-risk’ groups and the need to target them, and that drought in a changing climate presented potential health implications for at-risk groups.
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 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.
Urban waterways are underutilised assets, which can provide benefits ranging from climate-change mitigation and adaptation (e.g., reducing flood risks) to promoting health and well-being in urban settings. Indeed, urban waterways provide green and blue spaces, which have increasingly been associated with health benefits. The present observational study used a unique 17-year longitudinal natural experiment of canal regeneration from complete closure and dereliction in North Glasgow in Scotland, U.K. to explore the impact of green and blue canal assets on all-cause mortality as a widely used indicator of general health and health inequalities. Official data on deaths and socioeconomic deprivation for small areas (data zones) for the period 2001-2017 were analysed. Distances between data zone population-weighted centroids to the canal were calculated to create three 500 m distance buffers. Spatiotemporal associations between proximity to the canal and mortality were estimated using linear mixed models, unadjusted and adjusted for small-area measures of deprivation. The results showed an overall decrease in mortality over time (? = -0.032, 95% confidence interval (CI) [-0.046, -0.017]) with a closing of the gap in mortality between less and more affluent areas. The annual rate of decrease in mortality rates was largest in the 0-500 m buffer zone closest to the canal (-3.12%, 95% CI [-4.50, -1.73]), with smaller decreases found in buffer zones further removed from the canal (500-1000 m: -3.01%, 95% CI [-6.52, 0.62]), and 1000-1500 m: -1.23%, 95% CI [-5.01, 2.71]). A similar pattern of results was found following adjustment for deprivation. The findings support the notion that regeneration of disused blue and green assets and climate adaptions can have a positive impact on health and health inequalities. Future studies are now needed using larger samples of individual-level data, including environmental, socioeconomic, and health variables to ascertain which specific elements of regeneration are the most effective in promoting health and health equity.
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.
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.
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.
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.
In north-western Europe, the common tick, Ixodes ricinus, is widely established, its distribution appears to be increasing and the spread of tick-borne diseases is of increasing concern. The project ‘Flått i Nord’ (Ticks in northern Norway) commenced in spring 2009 with the intention of studying the tick’s distribution and that of its pathogens in northern Norway. Several methods were used: cloth-dragging, collecting from trapped small mammals, and collecting from pets. Since 2010, the occurrence of ticks in the region of northern Norway was determined directly by cloth-dragging 167 times in 109 separate locations between the latitudes of 64 °N and 70 °N (included seven locations in the northern part of Trøndelag County). The northernmost location of a permanent I. ricinus population was found to be Nordøyvågen (66.2204 °N, 12.59 °E) on the Island of Dønna. In a sample of 518 nymphal and adult ticks, the Borrelia prevalence collected close to this distribution limit varied but was low (1-15 %) compared with the locations in Trøndelag, south of the study area (15-27 %). Five specimens (1 %) were positive for Rickettsia helvetica. The length of the vegetation growing season (GSL) can be used as an approximate index for the presence of established populations of I. ricinus. The present study suggests that the threshold GSL for tick establishment is about 170 days, because the median GSL from 1991 to 2015 was 174-184 days at sites with permanent tick populations, showing a clear increase compared with the period 1961-1990. This apparent manifestation of climate change could explain the northward extension of the range of I. ricinus.
While there is much research that focuses on the association between cold waves and their impacts on daily mortality at the city level, few analyze the impact related to social context and demographic variables at levels lower than the municipal. The objective of this study was to determine the role of the percentage of people over age 65, income level and percentage of homes without heating in the analysis of the impact of cold waves on daily mortality between January 1, 2010 and December 31, 2013 in different districts of the municipality of Madrid. We calculated Relative Risks (RR) and Attributable Risks (RA) for each of 17 districts to determine correlations between the effect of cold waves and daily mortality due to natural causes (CIEX: A00-R99) using Generalized Linear Models (GLM) of the Poisson family (link log). The pattern of risks obtained by district was analyzed using binomial family models (link logit), considering socioeconomic and demographic variables. In terms of results, an impact of cold on mortality was detected in 9 of the 17 districts analyzed. The analysis of risk patterns revealed that the probability of detecting an impact in a district increases in a statistically significant way (p-value <0.05) with a higher percentage of homes without heating systems and a higher percentage of population over age 65. The results obtained identify the factors that should be considered in public health policies that target the district level to reduce the impact of cold waves.
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.
BACKGROUND: Flooding is expected to increase due to climate change, population growth and urban development. The longer-term mental health impacts of flooding are not well understood. In 2015, the English National Study of Flooding and Health was established to improve understanding of the impact of flooding on health and inform future public health action. METHODS: We used 3 years of data from the English National Study of Flooding and Health. Participants who had consented to follow up were sent a questionnaire. Participants were classified into either “unaffected”, “disrupted” or “flooded” according to their exposure. Logistic regression models were used to calculate adjusted odds ratios for probable depression, anxiety and post-traumatic stress disorder (PTSD) in each exposure group. The Wald test was used to assess the difference in probable mental health outcomes for those who did and did not experience “persistent damage” to their home. Conditional logistic regression was conducted to assess change in prevalence over the 3 years and to identify possible determinants of recovery. RESULTS: Eight hundred nineteen individuals were included in the final analysis – 119 were classified as unaffected, 421 disrupted and 279 flooded. Overall, 5.7% had probable depression, 8.1% had probable anxiety and 11.8% had probable PTSD, with higher prevalence in the flooded group compared with the unaffected group. After adjustment for potential confounders, probable mental health outcomes were higher in the flooded group compared to the unaffected group, significantly for probable depression (aOR 8.48, 95% CI 1.04-68.97) and PTSD (aOR 7.74, 95% CI 2.24-26.79). Seventy-seven (9.4%) participants reported experiencing persistent damage to their home, most commonly damp (n?=?40) and visible mould (n?=?26) in liveable rooms. Of the 569 participants who responded at all 3 years, a significant reduction in prevalence for all probable mental health outcomes was observed in the flooded group. CONCLUSIONS: Flooding can have severe long-lasting consequences on mental health in affected populations. If these problems are not identified and treated early, they may persist for years. Further research is necessary to develop and evaluate interventions to increase resilience in at risk populations and to ensure timely access to support services following flooding.
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.
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.
Climate change is a ‘super-wicked’ problem associated with challenges including food security, mass migration and biodiversity loss. Young people are increasingly expecting their university education to prepare them to address these challenges. This requires universities to go beyond scientific accounts of climate change, and to engage students in the complex interactions between social, economic and environmental systems. Authentic learning develops students’ understanding of ‘real-world’ challenges and is well aligned with pedagogical traditions in geography. We researched the extent to which climate change is framed as a wicked problem and how students undertake authentic learning about it in UK and Ireland undergraduate geography programmes. Our findings show that while authentic approaches to teaching climate change can be well developed at module level, programme design lacks coherence. Teaching focuses on climate problems rather than progressively scaffolding students’ skills for finding effective solutions. We propose that academic developers have significant potential to enhance climate change teaching. We present seven principles for geography programme teams to improve climate change teaching in degree programmes. The wicked problems concept emerged at a time of social unrest and growing environmental consciousness and so remains a powerful way to frame teaching about global challenges.
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.
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.
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: 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.
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.
A thunderstorm is a risk factor for severe respiratory allergy or asthma attacks in patients suffering from pollen/spore allergy. This study aimed to investigate the changes in the spectrum and quantity of pollen and fungal spores in the air of Bratislava during summer storms as well as the impact of selected environmental parameters on these changes. Pollen/spore samples were collected using a Burkard volumetric aerospore trap during summer 2016. To identify those types of pollen/spores that may harm human health during the storm episodes, we analysed how the concentration of individual bioparticles in the air changed during pre-storm/storm/post-storm periods. The effect of environmental variables on the concentration of selected pollen/spore types was evaluated through Spearman’s correlation analysis. The results of our study suggest that thunderstorm-related respiratory allergy symptoms in the study area may be caused by (1) spores of Myxomycetes, the airborne concentration of which increases due to an increase in wind speed during the pre-storm period; (2) ruptured pollen and Diatripaceae spores, the concentration of which increases due to increase in precipitation and relative air humidity, respectively, during the storm period; and (3) spores of Fusarium and Leptosphaeria, the concentration of which increases due to increase in precipitation and air temperature, respectively, during the post-storm period.
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.
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.
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.
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.
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.
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.
The number of reported cases with Legionnaires’ disease (LD) is increasing in Belgium. Previous studies have investigated the associations between LD incidence and meteorological factors, but the Belgian data remained unexplored. We investigated data collected between 2011 and 2019. Daily exposure data on temperature, relative humidity, precipitation and wind speed was obtained from the Royal Meteorological Institute for 29 weather stations. Case data were collected from the national reference centre and through mandatory notification. Daily case and exposure data were aggregated by province. We conducted a time-stratified case-crossover study. The ‘at risk’ period was defined as 10 to 2 days prior to disease onset. The corresponding days in the other study years were selected as referents. We fitted separate conditional Poisson models for each day in the ‘at risk’ period and a distributed lag non-linear model (DLNM) which fitted all data in one model. LD incidence showed a yearly peak in August and September. A total of 614 cases were included. Given seasonality, a sequence of precipitation, followed by high relative humidity and low wind speed showed a statistically significant association with the number of cases 6 to 4 days later. We discussed the advantages of DLNM in this context.
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?
Spain is a country of southern Europe that is prone to drought, and it is likely that this type of hydrological extreme will become substantially more frequent and intense in the 21st century, which could lead to greater health risks if adequate adaptive measures are not taken. For the first time, we calculated the relative risks (RRs) of daily natural (ICD10: A00-R99), circulatory (ICD10: I00-I99), and respiratory (ICD: J00-J99) mortality associated with drought events in each province of Spain from 2000 to 2009. For this purpose, we compared the performance of the Standardized Precipitation Index (SPI) and Standardized Precipitation- Evapotranspiration Index (SPEI) obtained at 1 month of accumulation (denoted as SPI-1/SPEI-1) to estimate the short-term risks of droughts on daily mortality using generalised linear models. Attributable risks were calculated from the RR data. The main findings of this study revealed statistically significant associations between the different causes of daily mortality and drought events for the different provinces of Spain, and clear spatial heterogeneity was observed across the country. Western Spain (northwest to southwest) was the region most affected, in contrast to northern and eastern Spain, and daily respiratory mortality was the group most strongly linked to the incidence of drought conditions. Moreover, for a considerable number of provinces, the effect of SPI-1 and SPEI-1 largely reflected the impact of atmospheric pollution and/or heatwaves; however, for other regions, the effect of drought conditions on daily mortality remained when these different climatic events were controlled in Poisson models. When the performances of the SPEI and SPI were compared to identify and estimate the risks of drought on daily mortality, the results were very similar, although there were slight differences in the specific causes of daily mortality.
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.
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.
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: Climate and weather are known to affect multiple areas of human life, including mental health. In bipolar disorder (BD), seasonality represents an environmental trigger for mood switches, and climatic variables may contribute to recurrences. Several studies reported seasonal and climatic-related variations in the rate of suicide attempts. Suicide risk is relevant in BD, with approximately 25% of patients attempting suicide. Therefore, this study aimed to assess sensitivity to weather and climatic variations in BD subjects and its relationship with lifetime suicide attempts. METHODS: Three hundred fifty-two euthymic BD and 352 healthy control subjects, homogeneous with respect to socio-demographic characteristics, were enrolled. All participants were administered the METEO-Questionnaire (METEO-Q) to evaluate susceptibility to weather and climatic changes. We also investigated the potential relationship between sensitivity to climate and weather and lifetime suicide attempts in BD patients. RESULTS: METEO-Q scores and the number of subjects reaching the cut-off for meteorosensitivity/meteoropathy were significantly higher in BD patients. Within the clinical group, BD subjects with lifetime suicide attempts obtained higher METEO-Q scores, with no differences between BD-I and BD-II. The number of suicide attempts directly correlated with METEO-Q scores. The presence of suicide attempts was associated with the physical and psychological symptoms related to weather variations. DISCUSSION: Our findings support the relevance of sensitivity to weather and climate variations in a large sample of BD subjects and point out the association of this feature with lifetime suicide attempts.
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.
Floods, which are frequent in France, can trigger a range of psychiatric problems. The most common is post traumatic stress disorder (PTSD). Although personality traits and cognitive emotion regulation strategies have already been shown to play a role in PTSD, the influence of these two dimensions and their interactions has seldom been explored among flood victims. We therefore set out to fill this lacuna, by PTSD symptoms, personality traits and cognitive emotion regulation strategies in 67 adults whose homes had been flooded. Results showed that the more participants used catastrophizing and rumination strategies, and the less they used putting into perspective and positive reappraisal strategies, the higher their PTSD symptom scores. High levels of neuroticism and catastrophizing were major risk factors for PTSD. Results also showed that putting into perspective moderated the influence of neuroticism as a risk factor. In conclusion, we recommend that flood victims showing signs of PTSD, especially those with elevated neuroticism, be offered therapeutic interventions designed foster the development of adaptive emotion regulation strategies such as putting into perspective and positive reappraisal.
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.
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.
This study aimed to examine the psychometric properties of the Child Post-Traumatic Cognitions Inventory (CPTCI) in a sample of Portuguese children and adolescents, following the exposition to a wildfire disaster. The sample included 533 children and adolescents living in regions exposed to the wildfire disaster (non-clinical sample: n = 483; clinical sample: n = 50). The short form of the instrument (CPTCI-SF) including two correlated factors (‘Sense of Disturbing and Permanent Change’ and ‘Sense of Being a Fragile Person in a Scary World’) showed good model fit and was invariant across gender and age-groups. Good internal consistency (> .70) was found, and higher CPTCI scores were associated with poorer adjustment indicators. The clinical sample presented significantly higher CPTCI scores than the non-clinical sample. These results contribute to the cross-cultural validation of the CPTCI and support the adequacy of its short form as a reliable and valid measure to be used with Portuguese children and adolescents.
The Cognitive Emotion Regulation Questionnaire-Kids (CERQ-Kids) is a self-report questionnaire that assesses cognitive emotional regulation strategies that children may employ when they face traumatic or stressful events. However, its psychometric properties were only analyzed among participants from the general community. The goal of this study is to examine the factor structure of the Portuguese CERQ-Kids and to explore its psychometric properties in a sample of children/adolescents exposed to a potentially traumatic event (wildfires). The sample included 488 children/adolescents (Mage = 13.02, SD = 2.5, range = 8-17) who lived in the areas affected by the 2017 Portugal wildfires and who did not receive a diagnosis of a mental disorder, and a clinical group of 50 children/adolescents (Mage = 12, SD = 2.62, range = 8-16) who lived in the same areas and who were diagnosed with a mental disorder. All participants completed the CERQ-Kids and measures of emotion regulation strategies, mental health, and quality of life. The best fitting model was the original nine-factor correlated model. This model was invariant across gender and age groups. With the exception of the Acceptance subscale, the remaining subscales presented adequate internal consistency. Participants from the clinical group scored higher on Self-blame, Rumination, Catastrophizing, and Acceptance than participants from the non-clinical group. Significant correlations were found between the CERQ-Kids subscales and measures of cognitive reappraisal, expressive suppression, prosocial behavior, mental health, and quality of life. The Portuguese version of the CERQ-Kids proved to be a psychometrically adequate measure of cognitive emotion regulation strategies that children and adolescents may use when exposed to a potentially traumatic event.
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.
Knowing how people perceive multiple risks is essential to the management and promotion of public health and safety. Here we present a dataset based on a survey (N?=?4,154) of public risk perception in Italy and Sweden during the COVID-19 pandemic. Both countries were heavily affected by the first wave of infections in Spring 2020, but their governmental responses were very different. As such, the dataset offers unique opportunities to investigate the role of governmental responses in shaping public risk perception. In addition to epidemics, the survey considered indirect effects of COVID-19 (domestic violence, economic crises), as well as global (climate change) and local (wildfires, floods, droughts, earthquakes, terror attacks) threats. The survey examines perceived likelihoods and impacts, individual and authorities’ preparedness and knowledge, and socio-demographic indicators. Hence, the resulting dataset has the potential to enable a plethora of analyses on social, cultural and institutional factors influencing the way in which people perceive risk.
A performance assessment of two different indices (the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI)) for monitoring short-term and short-medium-term drought impacts on daily specific-cause mortality in Spain was conducted. To achieve a comprehensive, nationwide view, a meta-analysis was performed using a combination of provincial relative risks (RRs). Moreover, the subdivisions of Spain based on administrative, climatic, and demographic criteria to obtain the measures of combined risks were also taken into account. The results of the SPEI and SPI calculated at the same timescale were similar. Both showed that longer drought events produced greater RR values, for respiratory mortality. However, at the local administrative level, Galicia, Castilla-y-Leon, and Extremadura showed the greatest risk of daily mortality associated with drought episodes, with Andalucía, País Vasco, and other communities being notably impacted. Based on climatic regionalization, Northwest, Central, and Southern Spain were the regions most affected by different drought conditions for all analyzed causes of daily mortality, while the Mediterranean coastal region was less affected. Demographically, the regions with the highest proportion of people aged 65 years of age and over reflected the greatest risk of daily natural, circulatory, and respiratory mortality associated with drought episodes.
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.
The coronavirus disease 2019 (COVID-19) pandemic is the most severe global health and socioeconomic crisis of our time, and represents the greatest challenge faced by the world since the end of the Second World War. The academic literature indicates that climatic features, specifically temperature and absolute humidity, are very important factors affecting infectious pulmonary disease epidemics – such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS); however, the influence of climatic parameters on COVID-19 remains extremely controversial. The goal of this study is to individuate relationships between several climate parameters (temperature, relative humidity, accumulated precipitation, solar radiation, evaporation, and wind direction and intensity), local morphological parameters, and new daily positive swabs for COVID-19, which represents the only parameter that can be statistically used to quantify the pandemic. The daily deaths parameter was not considered, because it is not reliable, due to frequent administrative errors. Daily data on meteorological conditions and new cases of COVID-19 were collected for the Lombardy Region (Northern Italy) from 1 March, 2020 to 20 April, 2020. This region exhibited the largest rate of official deaths in the world, with a value of approximately 1700 per million on 30 June 2020. Moreover, the apparent lethality was approximately 17% in this area, mainly due to the considerable housing density and the extensive presence of industrial and craft areas. Both the Mann-Kendall test and multivariate statistical analysis showed that none of the considered climatic variables exhibited statistically significant relationships with the epidemiological evolution of COVID-19, at least during spring months in temperate subcontinental climate areas, with the exception of solar radiation, which was directly related and showed an otherwise low explained variability of approximately 20%. Furthermore, the average temperatures of two highly representative meteorological stations of Molise and Lucania (Southern Italy), the most weakly affected by the pandemic, were approximately 1.5 °C lower than those in Bergamo and Brescia (Lombardy), again confirming that a significant relationship between the increase in temperature and decrease in virulence from COVID-19 is not evident, at least in Italy.
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.
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.
In October 2017, hundreds of wildfires ravaged the forests of the north and centre of Portugal. The fires were fanned by strong winds as tropical storm Ophelia swept the Iberian coast, dragging up smoke (together with Saharan dust from north-western Africa) into higher western European latitudes. Here we analyse the long-range transport of particulate matter (PM(10)) and study associations between PM(10) and short-term mortality in the Portuguese population exposed to PM(10) due to the October 2017 wildfires, the worst fire sequence in the country over the last decades. We analysed space- and ground-level observations to track the smoke plume and dust trajectory over Portugal and Europe, and to access PM(10) concentrations during the wildfires. The effects of PM(10) on mortality were evaluated using satellite data for exposure and Poisson regression models. The smoke plume covered most western European countries (including Spain, France, Belgium and the Netherlands), and reached the United Kingdom, where the population was exposed in average to an additional PM(10) level of 11.7 µg/m(3) during seven smoky days (three with dust) in relation to the reference days (days without smoke or dust), revealing the impact of the wildfires on distant populations. In Portugal, the population was exposed in average to additional PM(10) levels that varied from 16.2 to 120.6 µg/m(3) in smoky days with dust and from 6.1 to 20.9 µg/m(3) in dust-free smoky days. Results suggest that PM(10) had a significant effect on the same day natural and cardiorespiratory mortalities during the month of October 2017. For every additional 10 µg/m(3) of PM(10), there was a 0.89% (95% confidence interval, CI, 0-1.77%) increase in the number of natural deaths and a 2.34% (95% CI, 0.99-3.66%) increase in the number of cardiorespiratory-related deaths. With rising temperatures and a higher frequency of storms due to climate change, PM from Iberian wildfires together with NW African dust will tend to be more often transported into Northern European countries, which may carry health threats to areas far from the ignition sites.
Mycotoxin-producing Aspergilli (Circumdati, Flavi, and Nigri), usually associated with contaminated food, may also cause respiratory disorders and are insufficiently studied in water-damaged indoor environments. Airborne (N = 71) and dust borne (N = 76) Aspergilli collected at post-flood and control locations in Croatia resulted in eleven different species based on their calmodulin marker: A. ochraceus, A. ostianus, A. pallidofulvus, A. sclerotiorum, and A. westerdijkiae (Circumdati); A. flavus (Flavi); and A. tubingensis, A. welwitschiae, A. niger, A. piperis, and A. uvarum (Nigri). Most of the airborne (73%) and dust borne (54%) isolates were found at post-flood locations, and the highest concentrations measured in indoor air (5720 colony-forming units (CFU)/m(3)) and dust (2.5 × 10(5) CFU/g) were up to twenty times higher than in the control locations. A. flavus dominated among airborne isolates (25%) at the unrepaired locations, while 56% of the dust borne Aspergilli were identified as A. tubingensis and A. welwitschiae. The ability of identified isolates to produce mycotoxins aflatoxin B(1) (AFB(1)), fumonisin B(2) (FB(2)), and ochratoxin A were assessed by LC-MS analysis. All ochratoxin A (OTA)-producing Circumdati belonged to A. westerdijkiae (13.7 ± 15.81 µg/mL); in the section, FlaviA. flavus produced AFB(1) (2.51 ± 5.31 µg/mL), while A. welwitschiae and A. niger (section Nigri) produced FB(2) (6.76 ± 13.51 µg/mL and 11.24 ± 18.30 µg/mL, respectively). Water damage dominantly supported the occurrence of aflatoxigenic A. flavus in indoor environments. Yet unresolved, the causal relationship of exposure to indoor Aspergilli and adverse health effects may support the significance of this research.
Rivers are representative of the overall contamination found in their catchment area. Contaminant concentrations in watercourses depend on numerous factors including land use and rainfall events. Globally, in Mediterranean regions, rainstorms are at the origin of fluvial multipollution phenomena as a result of Combined Sewer Overflows (CSOs) and floods. Large loads of urban-associated microorganisms, including faecal bacteria, are released from CSOs which place public health – as well as ecosystems – at risk. The impacts of freshwater contamination on river ecosystems have not yet been adequately addressed, as is the case for the release of pollutant mixtures linked to extreme weather events. In this context, microbial communities provide critical ecosystem services as they are the only biological compartment capable of degrading or transforming pollutants. Through the use of 16S rRNA gene metabarcoding of environmental DNA at different seasons and during a flood event in a typical Mediterranean coastal river, we show that the impacts of multipollution phenomena on structural shifts in the particle-attached riverine bacteriome were greater than those of seasonality. Key players were identified via multivariate statistical modelling combined with network module eigengene analysis. These included species highly resistant to pollutants as well as pathogens. Their rapid response to contaminant mixtures makes them ideal candidates as potential early biosignatures of multipollution stress. Multiple resistance gene transfer is likely enhanced with drastic consequences for the environment and human-health, particularly in a scenario of intensification of extreme hydrological events.
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.
A probe of a patient, seeking help in an emergency ward of a French hospital in late December 2019 because of Influenza like symptoms, was retrospectively tested positive to COVID-19. Despite the early appearance of the virus in Europe, the prevalence and virulence appeared to be low for several weeks, before the spread and severity of symptoms increased exponentially, yet with marked spatial and temporal differences. Here, we compare the possible linkages between peaks of fine particulate matter (PM2.5) and the sudden, explosive increase of hospitalizations and mortality rates in the Swiss Canton of Ticino, and the Greater Paris and London regions. We argue that these peaks of fine particulate matter are primarily occurring during thermal inversion of the boundary layer of the atmosphere. We also discuss the influence of Saharan dust intrusions on the COVID-19 outbreak observed in early 2020 on the Canary Islands. We deem it both reasonable and plausible that high PM2.5 concentrations-favored by air temperature inversions or Saharan dust intrusions-are not only modulating but even more so boosting severe outbreaks of COVID-19. Moreover, desert dust events-besides enhancing PM2.5 concentrations-can be a vector for fungal diseases, thereby exacerbating COVID-19 morbidity and mortality. We conclude that the overburdening of the health services and hospitals as well as the high over-mortality observed in various regions of Europe in spring 2020 may be linked to peaks of PM2.5 and likely particular weather situations that have favored the spread and enhanced the virulence of the virus. In the future, we recommended to monitor not only the prevalence of the virus, but also to consider the occurrence of weather situations that can lead to sudden, very explosive COVID-19 outbreaks.
Infectious diseases are emerging and re-emerging due to climate change. Understanding how climate variability affects the transmission of infectious diseases is important for both researchers and the general public. Yet, the widespread knowledge of the general public on this matter is unknown, and quantitative research is still lacking. A survey was designed to assess the knowledge and perception of 1) infectious diseases, 2) climate change and 3) the effect of climate change on infectious diseases. Participants were recruited via convenience sampling, and an anonymous cross-sectional survey with informed consent was distributed to each participant. Descriptive and inferential analyses were performed primarily focusing on the occupational background as well as nationality of participants. A total of 458 individuals participated in this study, and most participants were originally from Myanmar, the Netherlands, Spain, United Kingdom and the United States. Almost half (44%) had a background in natural sciences and had a higher level of knowledge on infectious diseases compared to participants with non-science background (mean score of 12.5 and 11.2 out of 20, respectively). The knowledge of the effect of climate change on infectious diseases was also significantly different between participants with and without a background in natural sciences (13.1 and 11.8 out of 20, respectively). The level of knowledge on various topics was highly correlated with nationality but not associated with age. The general population demonstrated a high awareness and strong knowledge of climate change regardless of their background in natural sciences. This study exposes a knowledge gap in the general public regarding the effect of climate change on infectious diseases, and highlights that different levels of knowledge are observed in groups with differing occupations and nationalities. These results may help to develop awareness interventions for the general public.
INTRODUCTION: The negative effects of climate change affect community subsistence models, thus determining an increase in social conflicts, a loosening of social capital, an increase in the incidence of traumas and diseases, and a push for migration. AIM: This exploratory research compares the perception of climate change, as well as the reduction of social capital and mental health, in two groups of migrants arriving in Italy from African countries with high or extreme vulnerability to climate change. METHODS: The perception of climate change and the degree of social capital were assessed with a semi-structured interview. The psychological condition was investigated through a clinical psychological interview and tests. RESULTS: The group of migrants coming from countries with extreme exposure to climate change perceive greater vulnerability of their country and reports a greater loss of social capital. The level of education does not seem to affect the ability to perceive climate change. In the entire sample, there is a strong correlation between the perception of change and the loss of social capital, and between the loss of social capital and emotional disorders. CONCLUSIONS: The study suggests that actions to preserve the social capital of a community strongly exposed to climate change can mitigate the impact of change on mental health.
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.
Three studies investigated habitual worry about global warming as an example of ‘eco-anxiety’. The key question was whether such worrying is constructive (a motivated pro-environmental response) or unconstructive (a symptom of pathological worry). Pathological worry and worry about global warming were assessed together with two other worry sources, that is, personal issues and the world economy (Study 1) and personal issues and the corona virus (Study 2). In both studies a statistically significant correlation was found between pathological worry and global warming worry. However, this relationship was nonsignificant when controlled for the other two worry sources. Comparisons between Studies 1 and 2 conducted one month before and during the COVID-19 crisis, respectively, as well as between order conditions within Study 2 suggested that global warming worry was unaffected by the COVID-19 context. Study 3 demonstrated that global warming worry was associated with the perception of a proximal as well as a distal threat, and correlated positively with determinants of pro-environmental behaviour, that is, a pro-ecological worldview, pro-environmental values, past pro-environmental behaviour and a ‘green’ identity. Global warming worry also correlated positively with emotion clusters signifying determination, anxiety, and anger, respectively. The three studies together suggest that while habitual global warming worry may be unconstructive and part of intrapersonal dysfunction for some individuals, for many others it is a constructive adaptive pro-environmental response.
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.
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.
Purpose The purpose of this paper is to examine the role of high intensity precipitation events in increasing the vulnerability to floods in Mediterranean Spain. Precipitation intensity in this area appears to have augmented in the last two decades in association with warming trends of the Mediterranean Sea. At the same time, intense urbanization processes, occupying and transforming flood prone land, have produced an important increase in exposure. The main objective is to assess whether higher intensity precipitation and changing patterns in exposure aggravate vulnerability to floods. Design/methodology/approach In this paper, vulnerability is understood as the result of the interrelationships between exposure, sensitivity, impacts and adaptive capacity. Consequently, methods used involved the compilation and analysis of published and unpublished precipitation data, population and land use data, data on insurance claims, and media sources related to those variables. Findings Changes toward episodes of more intense precipitation in the expanding urban areas of Mediterranean Spain increase exposure but not necessarily vulnerability, at least in terms of human deaths. However, adaptative capacity needs to be formulated. Actions that attempt to absorb and eventually reuse flood flows (as the flood park in Alicante) appear to be more effective than traditional hydraulic solutions (as in Majorca). Originality/value The paper provides a systematic and coherent approach to vulnerability analysis taking into account the changing dynamics of its components. Especially, it signals the limits of current adaptive approaches to flooding and advocates for changes toward a more circular and less linear approach to urban drainage.
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.
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.
The occurrence of infectious diseases may change tourists’ perceptions of a destination’s image and value. This article proposes and empirically tests a choice model to measure the effect of the risk of infectious disease outbreaks caused by climate change on tourists’ willingness to pay for holidays to island destinations. With this aim, an online survey was administrated to 2538 European frequent travellers at their country of residence. Tourists were presented with a hypothetical situation whereby they had to choose among eleven well-known European island destinations for their next holiday. The choice cards included the probability of the occurrence of infectious disease events in the context of other potential risks caused by climate change (i.e., forest fires, floods, heat waves, etc.). The results show infectious disease is the risk that more negatively affects tourists’ willingness to pay to visit islands, followed by forest fires. The results have implications for tourism policy, highlighting the importance of prevention and response strategies, and the design of climate-oriented services, which may raise opportunities to work towards the enhancement of those health and environmental conditions of tourist destinations that ensure their sustainability in the longer term.
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.
On 6 June 2019, the Norwegian Institute of Public Health was notified of?more than?50 cases of gastroenteritis in Askøy. A reservoir in a water supply system was suspected as the source of the outbreak because of the acute onset and geographical distribution of cases. We investigated the outbreak to confirm the source, extent of the outbreak and effect of control measures. A case was defined as a person in a household served by Water Supply System A (WSS-A) who had gastroenteritis for more than?24 h between 1 and 19 June 2019. We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. System information of WSS-A was collected. Whole genome sequencing on human and environmental isolates was performed. Among 6,108 individuals, 1,573 fulfilled the case definition. Residents served by the reservoir had a 4.6× higher risk of illness than others. Campylobacter jejuni isolated from cases (n?=?24) and water samples (n?=?4) had identical core genome MLST profiles. Contamination through cracks in the reservoir most probably occurred during heavy rainfall. Water supply systems are susceptible to contamination, particularly to certain weather conditions. This highlights the importance of water safety planning and risk-based surveillance to mitigate risks.
BACKGROUND: Vector-borne infectious diseases (VBDs) represent a major public health concern worldwide. Among VBDs, West Nile virus (WNV) showed an increasingly wider spread in temperate regions of Europe, including Italy. During the last decade, WNV outbreaks have been recurrently reported in mosquitoes, horses, wild birds, and humans, showing great variability in the temporal and spatial distribution pattern. Due to the complexity of the environment-host-vector-pathogen interaction and the incomplete understanding of the epidemiological pattern of the disease, WNV occurrences can be difficult to predict. The analyses of ecological drivers responsible for the earlier WNV reactivation and transmission are pivotal; in particular, variations in the vector population dynamics may represent a key point of the recent success of WNV and, more in general, of the VBDs. METHODS: We investigated the variations of Culex pipiens population abundance using environmental, climatic and trapping data obtained over nine years (2010 to 2018) through the WNV entomological surveillance programme implemented in northeastern Italy. An information theoretic approach (IT-AIC(c)) and model-averaging algorithms were implemented to examine the relationship between the seasonal mosquito population growth rates and both intrinsic (e.g. intraspecific competition) and extrinsic (e.g. environmental and climatic variables) predictors, to identify the most significant combinations of variables outlining the Cx. pipiens population dynamics. RESULTS: Population abundance (proxy for intraspecific competition) and length of daylight were the predominant factors regulating the mosquito population dynamics; however, other drivers encompassing environmental and climatic variables also had a significant impact, although sometimes counterintuitive and not univocal. The analyses of the single-year datasets, and the comparison with the results obtained from the overall model (all data available from 2010 to 2018), highlighted remarkable differences in coefficients magnitude, sign and significance. These outcomes indicate that different combinations of factors might have distinctive, and sometimes divergent, effects on mosquito population dynamics. CONCLUSIONS: A more realistic acquaintance of the intrinsic and extrinsic mechanisms of mosquito population fluctuations in relation to continuous changes in environmental and climatic conditions is paramount to properly reinforce VBDs risk-based surveillance activities, to plan targeted density control measures and to implement effective early detection programmes.
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.
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.
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?
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.
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.
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.
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.
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.
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.
BACKGROUND: Flooding can have extensive effects on the health and wellbeing of affected communities. The impact of flooding on psychological morbidity has been established; however, the wider impacts of flooding exposure, including on health-related quality of life (HRQoL), have not been described. METHODS: Using data from the English National Study of Flooding and Health cohort, HRQoL 2 and 3 years post-flooding was assessed with the EuroQol Group EQ-5D-5L tool. Associations between exposure groups (flooding and disruption from flooding) and HRQoL were assessed, using ordinal and linear regression, adjusting for a priori confounders. RESULTS: For both 2 and 3 years post-flooding, the median HRQoL scores were lower in the flooded and disrupted groups, compared with unaffected respondents. A higher proportion of flooded and disrupted respondents reported HRQoL problems in most dimensions of the EQ-5D-5L, compared with unaffected respondents. In year 2, independent associations between exposure to flooding and experiencing anxiety/depression [adjusted odds ratio (aOR) 7.7; 95% CI 4.6-13.5], problems with usual activities (aOR 5.3; 95% CI 2.5-11.9) and pain/discomfort (aOR 2.4; 95% CI 1.5-3.9) were identified. These problems persisted 3 years post-flooding; associations between exposure to flooding and experiencing anxiety/depression (aOR 4.3; 95% CI 2.5-7.7), problems with usual activities (aOR 2.9; 95% CI 1.5-6.1) and pain/discomfort (aOR 2.5; 95% CI 1.5-4.2) were identified. CONCLUSIONS: Exposure to flooding and disruption from flooding significantly reduces HRQoL. These findings extend our knowledge of the impacts of flooding on health, with implications for multi-agency emergency response and recovery plans.
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.
Political and environmental factors-e.g., regional conflicts and global warming-increase large-scale migrations, posing extraordinary societal challenges to policymakers of destination countries. A common concern is that such a massive arrival of people-often from a country with a disrupted healthcare system-can increase the risk of vaccine-preventable disease outbreaks like measles. We analyze human flows of 3.5 million (M) Syrian refugees in Turkey inferred from massive mobile-phone data to verify this concern. We use multilayer modeling of interdependent social and epidemic dynamics to demonstrate that the risk of disease reemergence in Turkey, the main host country, can be dramatically reduced by 75 to 90% when the mixing of Turkish and Syrian populations is high. Our results suggest that maximizing the dispersal of refugees in the recipient population contributes to impede the spread of sustained measles epidemics, rather than favoring it. Targeted vaccination campaigns and policies enhancing social integration of refugees are the most effective strategies to reduce epidemic risks for all citizens.
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.
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.
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: 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.
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.
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.
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.
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.
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.
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.
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.
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.
Climate change is expected to increase the frequency of extreme weather events, such as extended heat waves and droughts in the northern hemisphere. Besides affecting ecosystems worldwide, these changes in climate patterns will also affect the environmental health of human populations. While the medical community is mostly concerned with the negative impact of climate change, there might also be some beneficial effects. In this study we used laboratory data from a large university clinic in Germany (n = 13 406), to test for any detectable impact of two extreme summers on Vitamin-D [25(OH)D] plasma concentrations over a six year period (2014-2019). For the two years with extreme summers (2018 and 2019) the 25(OH)D plasma concentrations were significantly higher than in the previous four years (p < 0.001). A time series analysis (autoregressive term, AR, ? = 0.84, with an AR of one indicating a persistent effect) showed that 25(OH)D concentrations rise by 0.04 nmol/l (95% CI: 0.04-0.05 nmol/l) per hour of sunshine. The incidence of vitamin D deficiency was generally high (60% for 2014-2017) but dropped by 10% in 2018 and 2019. As such, the summers of 2018 and 2019, which are among the hottest and driest in Germany since the start of modern climate recordings, had a measurable positive effect on 25(OH)D plasma levels of the examined population. Given that 25(OH)D deficiency is widespread in higher latitudes, this implies that while mostly considered negative, climate change might also confer some health benefits with regard to vitamin D related medical conditions.
Floods are acknowledged as one of the most serious threats to people’s lives and properties worldwide. To mitigate the flood risk, it is possible to act separately on its components: hazard, vulnerability, exposure. Emergency management plans can actually provide effective nonstructural practices to decrease both human exposure and vulnerability. Crowding maps depending on characteristic time patterns, herein referred to as dynamic exposure maps, represent a valuable tool to enhance the flood risk management plans. In this paper, the suitability of mobile phone data to derive crowding maps is discussed. A test case is provided by a strongly urbanized area subject to frequent flooding located on the western outskirts of Brescia (northern Italy). Characteristic exposure spatiotemporal patterns and their uncertainties were detected with regard to land cover and calendar period. This novel methodology still deserves verification during real-world flood episodes, even though it appears to be more reliable than crowdsourcing strategies, and seems to have potential to better address real-time rescues and relief supplies.
Social support and an emerging sense of community are common in flooding, but postflood group dynamics have not been fully addressed. In the context of a flooded community, we explore how social identification with one’s community emerges and affects well-being, collective efficacy, and social support. Results from a quantitative survey show that social identification was positively associated with common fate, collective efficacy, and well-being through residents’ expectations of support and shared goals. Importantly, social identification and disaster exposure interacted: For flooded residents, observing support was associated with providing support regardless of levels of social identification. For unaffected residents there was no association between observed and provided support, regardless of levels of social identification. However, for indirectly affected residents observing support was associated to providing support but only when they highly identified with the community. We argue that structural factors should also be considered when exploring the effects of group membership.
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.
The shift towards the new paradigm, that is, the “ecological and humanistic” paradigm, introduced by the United Nations in the Agenda 2030, and the current period of health emergency due to COVID-19 place the human dimension at the centre of the development strategies for our cities. The humanistic dimension, in particular, is related to human wellbeing, health and living conditions. The health and wellbeing of citizens depend on factors and actions that go beyond the health sector. In particular, here, the attention is focused on the negative impacts produced by pollution and climate change, issues that concern (and that are closely related to) most urban agglomerations in the world. The pandemic due to COVID-19 has highlighted the close relationship existing among social, natural and economic systems. Each system is interdependent on the other. Thus, the pandemic has boosted the necessity to accelerate efforts to address climate change. Therefore, in this framework, new urban development models are required. The circular economy model is proposed as a model able to reduce the negative impacts of urban transformations. The attention is then focused on implementation tools for improving decision-making processes and, in particular, on the evaluation tools for assessing the multidimensional impacts of urbanisation on human health.
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.
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.
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.
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.
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.
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.
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.
Global climate change is one of the main problems facing humans at the beginning of the 21st century. In the Republic of Sakha (Yakutia), it has led to significant social consequences, especially those caused by flooding, which is very common in the region. One way of protecting settlements from catastrophic floods is to relocate them to non-flooded terraces. In the article, the author examined the local adaptation to consequences of flooding after relocation the cases two villages, Kyllakh and Khatystyr. Field studies of adaptations to the relocation showed social down sides, including the risks of broken family ties, as well as artificially created gender tension. Currently, residents of the two villages are divided into two groups. Families with children live in the new village sites (mostly women with preschool and schoolchildren), while the older population stay in the old village sites. The article analyses the causes and consequences of this gender situation.
BACKGROUND: Since fungi spores have high concentrations in the atmosphere during most of the year, they have an important place in respiratory allergies. In this regard, the preparation of calendars showing fungi spore loads for residential areas has much importance in the treatment of the patients. The first aim of this study was to present the airborne fungal spore research results from Eastern Anatolia in Turkey. Then, the mold spores’ relationships with the meteorological parameters and skin prick test results were also evaluated. The presence of fungal spores was investigated using a volumetric spore trap in 2018 year. METHODS: In this study, fungal spores within the atmosphere of the Elaz?? city of Turkey was measured through the volumetric method, using a Lanzoni VPPS 2000 device (VPPS 2000 Lanzoni, Bologna, Italy), in 2018 year. Annual data of temperature, humidity, precipitation and wind speed were used for comparing meteorological data with airborne fungal spore counts. In addition, 637 children who were admitted to a pediatric allergy clinic with allergic complaints were enrolled in the study. RESULTS: A total of 145,099 spores/m(3) and 20 fungal taxa belonging to the molds were recorded. Ustilago was the predominant genus (18.10%), followed by Oidium (18.01%), Drechslera (12.82%), and Fusarium (11.60%), which were the most common fungal spores found in Elazig’s atmosphere. The total mold spores in the atmosphere reached the highest level, with 28,153 spores/m(3), in July (mid-summer). Moreover, we found a positive correlation between the mold spores and the temperature, but negative correlations with the humidity and wind speed. In the skin prick tests in the children with allergic complaints, we detected sensitization to Alternaria alternata in 4.4%, Cladosporium herbarum in 3.0%, Penicillium notatum in 1.4%, and Aspergillus fumigatus in 1.1%. Additionally, there was no correlation between fungal spore concentration in the atmosphere with fungal spores sensitization in the skin prick test. CONCLUSIONS: This study was the first aerofungal survey of the Eastern Anatolia region in Turkey; therefore, new information has been introduced in the field of aerobiology in Turkey.
