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Wang J, Wang P, Liu B, Kinney PL, Huang L, Chen K. Comprehensive evaluation framework for intervention on health effects of ambient temperature. ECO-ENVIRONMENT & HEALTH 2024; 3:154-164. [PMID: 38646097 PMCID: PMC11031729 DOI: 10.1016/j.eehl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 04/23/2024]
Abstract
Despite the existence of many interventions to mitigate or adapt to the health effects of climate change, their effectiveness remains unclear. Here, we introduce the Comprehensive Evaluation Framework for Intervention on Health Effects of Ambient Temperature to evaluate study designs and effects of intervention studies. The framework comprises three types of interventions: proactive, indirect, and direct, and four categories of indicators: classification, methods, scope, and effects. We trialed the framework by an evaluation of existing intervention studies. The evaluation revealed that each intervention has its own applicable characteristics in terms of effectiveness, feasibility, and generalizability scores. We expanded the framework's potential by offering a list of intervention recommendations in different scenarios. Future applications are then explored to establish models of the relationship between study designs and intervention effects, facilitating effective interventions to address the health effects of ambient temperature under climate change.
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Affiliation(s)
- Jiaming Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Peng Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
- Faculty of Civil Engineering and Mechanics, Jiangsu University, Zhenjiang 212013, China
| | - Beibei Liu
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lei Huang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
- Center for Public Health Research, Medical School of Nanjing University, Nanjing 210093, China
| | - Kai Chen
- Department of Environmental Health Sciences, Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT 06510, USA
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2
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Bach AJE, Cunningham SJK, Morris NR, Xu Z, Rutherford S, Binnewies S, Meade RD. Experimental research in environmentally induced hyperthermic older persons: A systematic quantitative literature review mapping the available evidence. Temperature (Austin) 2024; 11:4-26. [PMID: 38567267 PMCID: PMC7615797 DOI: 10.1080/23328940.2023.2242062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/21/2023] [Indexed: 04/04/2024] Open
Abstract
The heat-related health burden is expected to persist and worsen in the coming years due to an aging global population and climate change. Defining the breadth and depth of our understanding of age-related changes in thermoregulation can identify underlying causes and strategies to protect vulnerable individuals from heat. We conducted the first systematic quantitative literature review to provide context to the historical experimental research of healthy older adults - compared to younger adults or unhealthy age matched cases - during exogenous heat strain, focusing on factors that influence thermoregulatory function (e.g. co-morbidities). We identified 4,455 articles, with 147 meeting eligibility criteria. Most studies were conducted in the US (39%), Canada (29%), or Japan (12%), with 71% of the 3,411 participants being male. About 71% of the studies compared younger and older adults, while 34% compared two groups of older adults with and without factors influencing thermoregulation. Key factors included age combined with another factor (23%), underlying biological mechanisms (18%), age independently (15%), influencing health conditions (15%), adaptation potential (12%), environmental conditions (9%), and therapeutic/pharmacological interventions (7%). Our results suggest that controlled experimental research should focus on the age-related changes in thermoregulation in the very old, females, those with overlooked chronic heat-sensitive health conditions (e.g. pulmonary, renal, mental disorders), the impact of multimorbidity, prolonged and cumulative effects of extreme heat, evidence-based policy of control measures (e.g. personal cooling strategies), pharmaceutical interactions, and interventions stimulating protective physiological adaptation. These controlled studies will inform the directions and use of limited resources in ecologically valid fieldwork studies.
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Affiliation(s)
- Aaron J. E. Bach
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Cities Research Institute, Griffith University, Gold Coast, QLD, Australia
| | - Sarah J. K. Cunningham
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Cities Research Institute, Griffith University, Gold Coast, QLD, Australia
| | - Norman R. Morris
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Metro North Hospital and Health Service, The Prince Charles Hospital. Allied Health Research Collaborative, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Cities Research Institute, Griffith University, Gold Coast, QLD, Australia
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
- Cities Research Institute, Griffith University, Gold Coast, QLD, Australia
| | - Sebastian Binnewies
- School of Information and Communication Technology, Griffith University, Gold Coast, QLD, Australia
| | - Robert D. Meade
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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3
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Thomson TN, Rupasinghe R, Hennessy D, Easton M, Stewart T, Mulvenna V. Population vulnerability to heat: A case-crossover analysis of heat health alerts and hospital morbidity data in Victoria, Australia. Aust N Z J Public Health 2023; 47:100092. [PMID: 37852815 DOI: 10.1016/j.anzjph.2023.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE From 2010 to 2022, the Victorian Department of Health operated a heat health alert system. We explored whether changes to morbidity occurred during or directly after these alerts, and how this differed for certain population groups. METHODS We used a space-time-stratified case-crossover design and conditional logistic regression to examine the associations between heat health alerts and heat-related and all-cause emergency department (ED) presentations and hospital admissions at the state-wide level, with models created for the whole population and subgroups. Data were included for the warm season (November-March) from 2014 to 2021. RESULTS Increases occurred in heat-related ED presentations (OR 1.73, 95% CI: 1.53-1.96) and heat-related hospital admissions (OR 1.23, 95% CI: 1.16-1.30) on days on or after heat health alerts. Effect sizes were largest for those 65 years and older, Aboriginal and Torres Strait Islander people, and those living in the most disadvantaged areas. CONCLUSIONS We confirm that increases in morbidity occurred in Victoria during heat health alerts and describe which population groups are more likely to require healthcare in a hospital. IMPLICATIONS FOR PUBLIC HEALTH These findings can inform responses before and during periods of extreme heat, data-driven adaptation strategies, and the development of heat health surveillance systems.
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Affiliation(s)
- Tilda N Thomson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia; Public Health Division, Victorian Department of Health, Melbourne, Australia.
| | - Rayiky Rupasinghe
- Public Health Division, Victorian Department of Health, Melbourne, Australia
| | - Daneeta Hennessy
- Public Health Division, Victorian Department of Health, Melbourne, Australia
| | - Marion Easton
- Public Health Division, Victorian Department of Health, Melbourne, Australia
| | - Tony Stewart
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Vanora Mulvenna
- Public Health Division, Victorian Department of Health, Melbourne, Australia
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Nawaro J, Gianquintieri L, Pagliosa A, Sechi GM, Caiani EG. Heatwave Definition and Impact on Cardiovascular Health: A Systematic Review. Public Health Rev 2023; 44:1606266. [PMID: 37908198 PMCID: PMC10613660 DOI: 10.3389/phrs.2023.1606266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives: We aimed to analyze recent literature on heat effects on cardiovascular morbidity and mortality, focusing on the adopted heat definitions and their eventual impact on the results of the analysis. Methods: The search was performed on PubMed, ScienceDirect, and Scopus databases: 54 articles, published between January 2018 and September 2022, were selected as relevant. Results: In total, 21 different combinations of criteria were found for defining heat, 12 of which were based on air temperature, while the others combined it with other meteorological factors. By a simulation study, we showed how such complex indices could result in different values at reference conditions depending on temperature. Heat thresholds, mostly set using percentile or absolute values of the index, were applied to compare the risk of a cardiovascular health event in heat days with the respective risk in non-heat days. The larger threshold's deviation from the mean annual temperature, as well as higher temperature thresholds within the same study location, led to stronger negative effects. Conclusion: To better analyze trends in the characteristics of heatwaves, and their impact on cardiovascular health, an international harmonization effort to define a common standard is recommendable.
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Affiliation(s)
- Julia Nawaro
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Lorenzo Gianquintieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | - Enrico Gianluca Caiani
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
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Sapari H, Selamat MI, Isa MR, Ismail R, Wan Mahiyuddin WR. The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e44702. [PMID: 37843898 PMCID: PMC10616749 DOI: 10.2196/44702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/02/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. OBJECTIVE This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. METHODS We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. RESULTS This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. CONCLUSIONS The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. TRIAL REGISTRATION PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44702.
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Affiliation(s)
- Hadita Sapari
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Mohamad Ikhsan Selamat
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
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Yüzen D, Graf I, Tallarek AC, Hollwitz B, Wiessner C, Schleussner E, Stammer D, Padula A, Hecher K, Arck PC, Diemert A. Increased late preterm birth risk and altered uterine blood flow upon exposure to heat stress. EBioMedicine 2023:104651. [PMID: 37355458 PMCID: PMC10363435 DOI: 10.1016/j.ebiom.2023.104651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Climate change, in particular the exposure to heat, impacts on human health and can trigger diseases. Pregnant people are considered a vulnerable group given the physiological changes during pregnancy and the potentially long-lasting consequences for the offspring. Evidence published to date on higher risk of pregnancy complications upon heat stress exposure are from geographical areas with high ambient temperatures. Studies from geographic regions with temperate climates are sparse; however, these areas are critical since individuals may be less equipped to adapt to heat stress. This study addresses a significant gap in knowledge due to the temperature increase documented globally. METHODS Birth data of singleton pregnancies (n = 42,905) from a tertiary care centre in Hamburg, Germany, between 1999 and 2021 were retrospectively obtained and matched with climate data from the warmer season (March to September) provided by the adjacent federal meteorological station of the German National Meteorological Service to calculate the relative risk of heat-associated preterm birth. Heat events were defined by ascending temperature percentiles in combination with humidity over exposure periods of up to 5 days. Further, ultrasound data documented in a longitudinal prospective pregnancy cohort study (n = 612) since 2012 were used to identify pathophysiological causes of heat-induced preterm birth. FINDINGS Both extreme heat and prolonged periods of heat exposure increased the relative risk of preterm birth (RR: 1.59; 95% CI: 1.01-2.43; p = 0.045; RR: 1.20; 95% CI: 1.02-1.40; p = 0.025). We identified a critical period of heat exposure during gestational ages 34-37 weeks that resulted in increased risk of late preterm birth (RR: 1.67; 95% CI: 1.14-1.43; p = 0.009). Pregnancies with a female fetus were more prone to heat stress-associated preterm birth. We found heat exposure was associated with altered vascular resistance within the uterine artery. INTERPRETATION Heat stress caused by high ambient temperatures increases the risk of preterm birth in a geographical region with temperate climate. Prenatal routine care should be revised in such regions to provide active surveillance for women at risk. FUNDING Found in acknowledgements.
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Affiliation(s)
- Dennis Yüzen
- Department of Obstetrics and Fetal Medicine, Laboratory for Experimental Feto-Maternal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany; Institute of Immunology, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Isabel Graf
- Department of Obstetrics and Fetal Medicine, Laboratory for Experimental Feto-Maternal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Ann-Christin Tallarek
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Bettina Hollwitz
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Centre of Hamburg-Eppendorf, Germany
| | | | - Detlef Stammer
- Centre for Earth System Research and Sustainability (CEN), University Hamburg, Germany
| | - Amy Padula
- Division of Maternal-Fetal Medicine, Department of Obstetrics, University of California, San Francisco, USA
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Petra Clara Arck
- Department of Obstetrics and Fetal Medicine, Laboratory for Experimental Feto-Maternal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany.
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
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Sayili U, Siddikoglu E, Pirdal BZ, Uygur A, Toplu FS, Can G. The heat wave knowledge, awareness, practice and behavior scale: Scale development, validation and reliability. PLoS One 2022; 17:e0279259. [PMID: 36542649 PMCID: PMC9770401 DOI: 10.1371/journal.pone.0279259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Heat waves are extreme weather and climate events that threaten public health by increasing morbidity and mortality. To reduce the health effects of heat waves, it is necessary to increase the knowledge level of the public, conduct awareness and protection activities and monitor these activity outcomes. The present study aimed to develop and validate a Turkish language scale of heat wave knowledge, awareness, practice and behavior for Turkish nationality. After item generation and creating dimensions, content validity analysis was performed. To evaluate the validity and reliability of the knowledge construct, the difficulty index, discriminant index and Kuder Richardson 20 (KR20) were used. The validity and reliability of the awareness, practice and behavior constructs were evaluated with exploratory and confirmatory factor analyses, and Cronbach's alpha was used. The 15 items had a good difficulty, discrimination index and KR20 in the knowledge construct. The 14 items were yielded in EFA; 13 items were retained in CFA, and Cronbach's alpha values of 0.878, 0.768, 0.855, and 0.858 were obtained for total items, practice, awareness and behavior, respectively. Eventually, a Turkish language scale was developed that is reliable and valid for assessing heat wave knowledge, awareness, practice and behavior.
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Affiliation(s)
- Ugurcan Sayili
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Department of Biostatistics and Medical Informatics, Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Türkiye
- * E-mail:
| | - Esin Siddikoglu
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | | | - Abdulkerim Uygur
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ferdane Seyma Toplu
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Gunay Can
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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Khraishah H, Alahmad B, Ostergard RL, AlAshqar A, Albaghdadi M, Vellanki N, Chowdhury MM, Al-Kindi SG, Zanobetti A, Gasparrini A, Rajagopalan S. Climate change and cardiovascular disease: implications for global health. Nat Rev Cardiol 2022; 19:798-812. [PMID: 35672485 DOI: 10.1038/s41569-022-00720-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Environmental & Occupational Health Department, Faculty of Public Health, Kuwait University, Hawalli, Kuwait
| | | | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nirupama Vellanki
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammed M Chowdhury
- Department of Vascular and Endovascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sadeer G Al-Kindi
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Antonio Gasparrini
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Rajagopalan
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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9
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Du J, Cui L, Ma Y, Zhang X, Wei J, Chu N, Ruan S, Zhou C. Extreme cold weather and circulatory diseases of older adults: A time-stratified case-crossover study in jinan, China. ENVIRONMENTAL RESEARCH 2022; 214:114073. [PMID: 35964671 DOI: 10.1016/j.envres.2022.114073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to investigate the acute effect of extreme cold weather on circulatory disease mortality of older adults in Jinan, with individual and regional-scale characteristics as subgroup analyses to further identify vulnerable populations. METHODS This study contained the death data of Jinan from 2011 to 2020 (Nov-Mar). A time-stratified case-crossover method was used to estimate the effects of extreme cold weather and lags 0-8 days, controlling for holiday and relative humidity. To evaluate the impact of different durations and thresholds of extreme cold weather, we considered 4 cold day and 12 cold wave definitions RESULTS: Our results showed an increase in circulatory disease deaths under several definitions. The number of older adults died of circulatory diseases totaled 92,119 during the study period. In the definitions of cold day, the maximum significant effect ranging from 1.08 (95% CI: 1.03,1.14) to 1.13 (95% CI: 1.04,1.24) and appeared on Lag5 or Lag6. In the definitions of cold wave, the maximum significant effect ranging from 1.07 (95% CI: 1.02, 1.12) to 1.14 (95% CI: 1.03, 1.25). The cold effect is mainly attributable to cold day rather than an added effect related to the duration. Our research confirmed that extreme cold weather had a stronger impact on women [maximum effects with an OR of 1.21 (95% CI: 1.08, 1.36) in P1, 1.19 (95% CI: 1.05, 1.36) in M12)], and the effect gradient increased with age. CONCLUSIONS Our findings support the evidence on the impact of extreme cold weather on circulatory disease mortality and provide a basis for policymakers to select target groups to develop policies and reduce the public health burden.
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Affiliation(s)
- Jipei Du
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Liangliang Cui
- Jinan Municipal Center for Disease Control and Prevention; Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China
| | - Yiwen Ma
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xianhui Zhang
- Jinan Municipal Center for Disease Control and Prevention; Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China
| | - Jinli Wei
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Nan Chu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Shiman Ruan
- Jinan Municipal Center for Disease Control and Prevention; Jinan Municipal Center for Disease Control and Prevention Affiliated to Shandong University, 2 Weiliu Road, Huaiyin District, Jinan, 250021, China.
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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10
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Li T, Chen C, Cai W. The global need for smart heat-health warning systems. Lancet 2022; 400:1511-1512. [PMID: 36522205 DOI: 10.1016/s0140-6736(22)01974-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China.
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Wenjia Cai
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Ecological Field Station for East Asian Migratory Birds, Tsinghua University, Beijing, China
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11
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Adnan MSG, Dewan A, Botje D, Shahid S, Hassan QK. Vulnerability of Australia to heatwaves: A systematic review on influencing factors, impacts, and mitigation options. ENVIRONMENTAL RESEARCH 2022; 213:113703. [PMID: 35716815 DOI: 10.1016/j.envres.2022.113703] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/04/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Heatwaves have received major attention globally due to their detrimental effects on human health and the environment. The frequency, duration, and severity of heatwaves have increased recently due to changes in climatic conditions, anthropogenic forcing, and rapid urbanization. Australia is highly vulnerable to this hazard. Although there have been an increasing number of studies conducted in Australia related to the heatwave phenomena, a systematic review of heatwave vulnerability has rarely been reported in the literature. OBJECTIVES This study aims to provide a systematic and overarching review of the different components of heatwave vulnerability (e.g., exposure, sensitivity, and adaptive capacity) in Australia. METHODS A systematic review was conducted using the PRISMA protocol. Peer-reviewed English language articles published between January 2000 and December 2021 were selected using a combination of search keywords in Web of Science, Scopus, and PubMed. Articles were critically analyzed based on three specific heatwave vulnerability components: exposure, sensitivity, and adaptive capacity. RESULTS AND DISCUSSION A total of 107 articles meeting all search criteria were chosen. Although there has been an increasing trend of heat-related studies in Australia, most of these studies have concentrated on exposure and adaptive capacity components. Evidence suggests that the frequency, severity, and duration of heatwaves in Australian cities has been increasing, and that this is likely to continue under current climate change scenarios. This study noted that heatwave vulnerability is associated with geographical and climatic factors, space, time, socioeconomic and demographic factors, as well as the physiological condition of people. Various heat mitigation and adaptation measures implemented around the globe have proven to be efficient in reducing the impacts of heatwaves. CONCLUSION This study provides increased clarity regarding the various drivers of heatwave vulnerability in Australia. Such knowledge is crucial in informing extreme heat adaptation and mitigation planning.
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Affiliation(s)
- Mohammed Sarfaraz Gani Adnan
- Department of Urban and Regional Planning, Chittagong University of Engineering and Technology (CUET), Chittagong, 4319, Bangladesh; Environmental Change Institute, School of Geography and the Environment, University of Oxford, OX1 3QY, United Kingdom.
| | - Ashraf Dewan
- School of Earth and Planetary Sciences, Curtin University, Perth, WA, 6102, Australia
| | - Dirk Botje
- School of Earth and Planetary Sciences, Curtin University, Perth, WA, 6102, Australia
| | - Shamsuddin Shahid
- Department of Hydraulics & Hydrology, Faculty of Civil Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
| | - Quazi K Hassan
- Department of Geomatics Engineering, University of Calgary, 2500 University Drive NW, Calgary Alberta, T2N 1N4, Canada
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Bedi NS, Adams QH, Hess JJ, Wellenius GA. The Role of Cooling Centers in Protecting Vulnerable Individuals from Extreme Heat. Epidemiology 2022; 33:611-615. [PMID: 35706096 PMCID: PMC9378433 DOI: 10.1097/ede.0000000000001503] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Quinn H. Adams
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jeremy J. Hess
- University of Washington, Schools of Medicine and Public Health, Departments of Emergency Medicine, Environmental and Occupational Health Sciences, and Global Health, Seattle, Washington
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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13
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Dwyer IJ, Barry SJE, Megiddo I, White CJ. Evaluations of heat action plans for reducing the health impacts of extreme heat: methodological developments (2012-2021) and remaining challenges. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1915-1927. [PMID: 35835887 PMCID: PMC9283094 DOI: 10.1007/s00484-022-02326-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
The recent report of the Intergovernmental Panel on Climate Change is stark in its warnings about the changing climate, including future increases in the frequency and intensity of extremely hot weather. The well-established impacts of extreme heat on human health have led to widespread implementation of national and city-wide heat plans for mitigating such impacts. Evaluations of the effectiveness of some heat plans have been published, with previous reviews highlighting key methodological challenges. This article reviews methods used since and that address those challenges, so helping to set an agenda for improving evaluations of heat plans in terms of their effectiveness in reducing heat-health impacts. We examined the reviews that identified the methodological challenges and systematically searched the literature to find evaluations that had since been conducted. We found 11 evaluations. Their methods help address the key challenge of identifying study control groups and address other challenges to a limited extent. For future evaluations, we recommend: utilising recent evaluation methodologies, such as difference-in-differences quasi-experimental designs where appropriate; cross-agency working to utilise data on morbidity and confounders; adoption of a proposed universal heat index; and greater publication of evaluations. More evaluations should assess morbidity outcomes and be conducted in low- and middle-income countries. Evaluations of heat plans globally should employ robust methodologies, as demonstrated in existing studies and potentially transferrable from other fields. Publication of such evaluations will advance the field and thus help address some of the health challenges resulting from our changing climate.
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Affiliation(s)
- Ian J Dwyer
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
| | - Sarah J E Barry
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Christopher J White
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
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Mascarenhas MS, Silva DDD, Nogueira MC, Farias WCMD, Ferreira CDCM, Ferreira LDCM. The effect of air temperature on mortality from cerebrovascular diseases in Brazil between 1996 and 2017. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.05092022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Cerebrovascular diseases (CVD) are one of the leading causes of mortality globally. Air temperature is one of the risk factors for CVD; however, few studies have investigated the relationship between air temperature and mortality from these diseases in Brazil. This time series study investigated the relationship between air temperature and CVD mortality in 10 microregions located across Brazil’s five regions during the period 1996 to 2017 using mortality data from the national health information system, DATASUS and daily mean temperature data. The association between mean air temperature and mortality from CVD was measured using generalized additive models with Poisson distribution and relative and attributable risks were estimated together with 95% confidence intervals using distributed lag non-linear models and a 14-day lag. There were 531,733 deaths from CVD during the study period, 21,220 of which (11,138-30,546) were attributable to air temperature. Minimum mortality temperatures ranged from 20.1ºC in Curitiba to 29.6ºC in Belém. Associations between suboptimal air temperatures and increased risk of death from CVD were observed in all of Brazil’s five regions. Relative risk from the cold was highest in Manaus (RR 1.53; 1.22-1.91) and Campo Grande (RR 1.52; 1.18-1.94), while relative risk from heat was highest in Manaus (RR 1.75; 1.35-2.26) and Brasília (RR 1.36; 1.15-1.60).
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15
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Mascarenhas MS, Silva DDD, Nogueira MC, Farias WCMD, Ferreira CDCM, Ferreira LDCM. The effect of air temperature on mortality from cerebrovascular diseases in Brazil between 1996 and 2017. CIENCIA & SAUDE COLETIVA 2022; 27:3295-3306. [PMID: 35894339 DOI: 10.1590/1413-81232022278.05092022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Cerebrovascular diseases (CVD) are one of the leading causes of mortality globally. Air temperature is one of the risk factors for CVD; however, few studies have investigated the relationship between air temperature and mortality from these diseases in Brazil. This time series study investigated the relationship between air temperature and CVD mortality in 10 microregions located across Brazil's five regions during the period 1996 to 2017 using mortality data from the national health information system, DATASUS and daily mean temperature data. The association between mean air temperature and mortality from CVD was measured using generalized additive models with Poisson distribution and relative and attributable risks were estimated together with 95% confidence intervals using distributed lag non-linear models and a 14-day lag. There were 531,733 deaths from CVD during the study period, 21,220 of which (11,138-30,546) were attributable to air temperature. Minimum mortality temperatures ranged from 20.1ºC in Curitiba to 29.6ºC in Belém. Associations between suboptimal air temperatures and increased risk of death from CVD were observed in all of Brazil's five regions. Relative risk from the cold was highest in Manaus (RR 1.53; 1.22-1.91) and Campo Grande (RR 1.52; 1.18-1.94), while relative risk from heat was highest in Manaus (RR 1.75; 1.35-2.26) and Brasília (RR 1.36; 1.15-1.60).
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Affiliation(s)
- Mikaela Santos Mascarenhas
- Faculdade de Medicina, Universidade Federal de Juiz de Fora (UFJF). Av. Eugênio do Nascimento s/n, Dom Bosco. 36038-330 Juiz de Fora MG Brasil.
| | - Diego Duque da Silva
- Faculdade de Medicina, Universidade Federal de Juiz de Fora (UFJF). Av. Eugênio do Nascimento s/n, Dom Bosco. 36038-330 Juiz de Fora MG Brasil.
| | - Mário Círio Nogueira
- Faculdade de Medicina, Universidade Federal de Juiz de Fora (UFJF). Av. Eugênio do Nascimento s/n, Dom Bosco. 36038-330 Juiz de Fora MG Brasil.
| | | | | | - Letícia de Castro Martins Ferreira
- Faculdade de Medicina, Universidade Federal de Juiz de Fora (UFJF). Av. Eugênio do Nascimento s/n, Dom Bosco. 36038-330 Juiz de Fora MG Brasil.
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Negev M, Zea-Reyes L, Caputo L, Weinmayr G, Potter C, de Nazelle A. Barriers and Enablers for Integrating Public Health Cobenefits in Urban Climate Policy. Annu Rev Public Health 2022; 43:255-270. [PMID: 34936826 DOI: 10.1146/annurev-publhealth-052020-010820] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Urban climate policy offers a significant opportunity to promote improved public health. The evidence around climate and health cobenefits is growing but has yet to translate into widespread integrated policies. This article presents two systematic reviews: first, looking at quantified cobenefits of urban climate policies, where transportation, land use, and buildings emerge as the most studied sectors; and second, looking at review papers exploring the barriers and enablers for integrating these health cobenefits into urban policies. The latter reveals wide agreement concerning the need to improve the evidence base for cobenefits and consensus about the need for greater political will and leadership on this issue. Systems thinking may offer a way forward to help embrace complexity and integrate health cobenefits into decision making. Knowledge coproduction to bring stakeholders together and advance policy-relevant research for urban health will also be required. Action is needed to bring these two important policy agendas together.
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Affiliation(s)
- Maya Negev
- School of Public Health, University of Haifa, Haifa, Israel
| | - Leonardo Zea-Reyes
- Centre for Environmental Policy, Imperial College London, London, United Kingdom; .,Research Area, Cónclave Consultora, Guadalajara, Jalisco, Mexico.,University Centre for the Arts, Architecture, and Design; University of Guadalajara, Jalisco, Mexico
| | - Livio Caputo
- Energy Futures Lab, Imperial College London, London, United Kingdom
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Clive Potter
- Centre for Environmental Policy, Imperial College London, London, United Kingdom;
| | - Audrey de Nazelle
- Centre for Environmental Policy, Imperial College London, London, United Kingdom; .,MRC Centre for Environment and Health, Imperial College London
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17
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Ioannou LG, Dinas PC, Notley SR, Gofa F, Gourzoulidis GA, Brearley M, Epstein Y, Havenith G, Sawka MN, Bröde P, Mekjavic IB, Kenny GP, Bernard TE, Nybo L, Flouris AD. Indicators to assess physiological heat strain – Part 2: Delphi exercise. Temperature (Austin) 2022; 9:263-273. [PMID: 36211947 PMCID: PMC9542877 DOI: 10.1080/23328940.2022.2044738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this second paper of the series, we identified the criteria to consider when adopting a TSI to protect individuals who work in the heat, and we weighed their relative importance using a Delphi exercise with 20 experts. Two Delphi iterations were adequate to reach consensus within the expert panel (Cronbach's α = 0.86) for a set of 17 criteria with varying weights that should be considered when adopting a TSI to protect individuals who work in the heat. These criteria considered physiological parameters such as core/skin/mean body temperature, heart rate, and hydration status, as well as practicality, cost effectiveness, and health guidance issues. The 17 criteria were distributed across three occupational health-and-safety pillars: (i) contribution to improving occupational health (55% of total importance), (ii) mitigation of worker physiological strain (35.5% of total importance), and (iii) cost-effectiveness (9.5% of total importance). Three criteria [(i) relationship of a TSI with core temperature, (ii) having categories indicating the level of heat stress experienced by workers, and (iii) using its heat stress categories to provide recommendations for occupational safety and health] were considered significantly more important when selecting a TSI for protecting individuals who work in the heat, accumulating 37.2 percentage points. These 17 criteria allow the validation and comparison of TSIs that presently exist as well as those that may be developed in the coming years.
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Affiliation(s)
- Leonidas G. Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Department of Nutrition, Exercise and Sports, August Krogh Building, University of Copenhagen, Copenhagen, Denmark
| | - Petros C. Dinas
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Sean R. Notley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Flora Gofa
- Hellenic National Meteorological Service, Athens, Greece
| | | | - Matt Brearley
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Thermal Hyperformance, Pty Ltd, Takura, Australia
| | - Yoram Epstein
- Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - Michael N. Sawka
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Peter Bröde
- Department of Immunology, Leibniz Research Centre for Working Environment and Human Factors (IfADO), Dortmund, Germany
| | - Igor B. Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Thomas E. Bernard
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, August Krogh Building, University of Copenhagen, Copenhagen, Denmark
| | - Andreas D. Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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18
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Williams S, Nitschke M, Wondmagegn BY, Tong M, Xiang J, Hansen A, Nairn J, Karnon J, Bi P. Evaluating cost benefits from a heat health warning system in Adelaide, South Australia. Aust N Z J Public Health 2021; 46:149-154. [PMID: 34939708 DOI: 10.1111/1753-6405.13194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the cost benefits of a heat health warning system (HHWS) in South Australia. METHODS Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS-attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts. RESULTS The estimated cost for a one-week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS-attributable reductions in hospital admissions and ambulance callouts with an estimated benefit-cost ratio of 2.0-3.3. CONCLUSIONS On the basis of estimated cost benefit, the South Australian HHWS is a no-regret public health response to heatwaves. Implications for public health: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost-effective public health interventions.
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Affiliation(s)
- Susan Williams
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Monika Nitschke
- South Australian Department for Health and Wellbeing, Adelaide, South Australia
| | | | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Alana Hansen
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - John Nairn
- South Australian Bureau of Meteorology, Adelaide, South Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia
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19
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Weinberger KR, Wu X, Sun S, Spangler KR, Nori-Sarma A, Schwartz J, Requia W, Sabath BM, Braun D, Zanobetti A, Dominici F, Wellenius GA. Heat warnings, mortality, and hospital admissions among older adults in the United States. ENVIRONMENT INTERNATIONAL 2021; 157:106834. [PMID: 34461376 DOI: 10.1016/j.envint.2021.106834] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, "alerts") issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM2.5. CONCLUSIONS Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.
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Affiliation(s)
- Kate R Weinberger
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Xiao Wu
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shengzhi Sun
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Keith R Spangler
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Amruta Nori-Sarma
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Weeberb Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasilia, SGAN (Setor de Grandes Áreas Norte) Quadra 602 - Módulos A, B e C - Asa Norte, Brasilia, DF 70830-051, Brasil
| | - Benjamin M Sabath
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Danielle Braun
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Francesca Dominici
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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20
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Health Risks to the Russian Population from Temperature Extremes at the Beginning of the XXI Century. ATMOSPHERE 2021. [DOI: 10.3390/atmos12101331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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 journal articles 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.
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Lung SCC, Yeh JCJ, Hwang JS. Selecting Thresholds of Heat-Warning Systems with Substantial Enhancement of Essential Population Health Outcomes for Facilitating Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189506. [PMID: 34574429 PMCID: PMC8471601 DOI: 10.3390/ijerph18189506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Most heat-health studies identified thresholds just outside human comfort zones, which are often too low to be used in heat-warning systems for reducing climate-related health risks. We refined a generalized additive model for selecting thresholds with substantial health risk enhancement, based on Taiwan population records of 2000–2017, considering lag effects and different spatial scales. Reference-adjusted risk ratio (RaRR) is proposed, defined as the ratio between the relative risk of an essential health outcome for a threshold candidate against that for a reference; the threshold with the highest RaRR is potentially the optimal one. It was found that the wet-bulb globe temperature (WBGT) is a more sensitive heat-health indicator than temperature. At lag 0, the highest RaRR (1.66) with WBGT occurred in emergency visits of children, while that in hospital visits occurred for the working-age group (1.19), presumably due to high exposure while engaging in outdoor activities. For most sex, age, and sub-region categories, the RaRRs of emergency visits were higher than those of hospital visits and all-cause mortality; thus, emergency visits should be employed (if available) to select heat-warning thresholds. This work demonstrates the applicability of this method to facilitate the establishment of heat-warning systems at city or country scales by authorities worldwide.
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Affiliation(s)
- Shih-Chun Candice Lung
- Research Center for Environmental Changes, Academia Sinica, Taipei 11529, Taiwan;
- Department of Atmospheric Sciences, National Taiwan University, Taipei 10617, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-2-27875908
| | - Jou-Chen Joy Yeh
- Research Center for Environmental Changes, Academia Sinica, Taipei 11529, Taiwan;
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan;
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22
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Effective Community-Based Interventions for the Prevention and Management of Heat-Related Illnesses: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168362. [PMID: 34444112 PMCID: PMC8394078 DOI: 10.3390/ijerph18168362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Background: Extreme temperatures have negative consequences on the environment, ecosystem, and human health. With recent increases in global temperatures, there has been a rise in the burden of heat-related illnesses, with a disproportionate impact on low- and middle-income countries. Effective population-level interventions are critical to a successful public health response. Objective: This scoping review aims to summarize the evidence on the effectiveness of population-level heat-related interventions and serve as a potential guide to the implementation of these interventions. Methods: Studies that evaluated the effectiveness of community-based interventions to mitigate or reduce the impact of extreme heat on heat-related mortality and morbidity were sought by searching four electronic databases. Studies published in the English language and those that had quantifiable, measurable mortality, morbidity or knowledge score outcomes were included. Results: The initial electronic search yielded 2324 articles, and 17 studies were included. Fourteen studies were based in high-income countries (HICs) (Europe, US, Canada) and discussed multiple versions of (1) heat action plans, which included but were not limited to establishing a heat monitoring system, informative campaigns, the mobilization of health care professionals, volunteers, social workers and trained caregivers in the surveillance and management of individuals with known vulnerabilities, or stand-alone (2) education and awareness campaigns. Multi-pronged heat action plans were highly effective in reducing heat-related mortality and morbidity, especially among vulnerable populations such as the elderly and those with chronic conditions. Conclusions: The heat action plans covered in these studies have shown promising results in reducing heat-related mortality and morbidity and have included instituting early warning systems, building local capacity to identify, prevent or treat and manage heat-related illnesses, and disseminating information. Nevertheless, they need to be cost-effective, easy to maintain, ideally should not rely on a mass effort from people and should be specifically structured to meet the local needs and resources of the community.
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A heat-health watch and warning system with extended season and evolving thresholds. BMC Public Health 2021; 21:1479. [PMID: 34325687 PMCID: PMC8320165 DOI: 10.1186/s12889-021-10982-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries have developed heat-health watch and warning systems (HHWWS) or early-warning systems to mitigate the health consequences of extreme heat events. HHWWS usually focuses on the four hottest months of the year and imposes the same threshold over these months. However, according to climate projections, the warm season is expected to extend and/or shift. Some studies demonstrated that health impacts of heat waves are more severe when the human body is not acclimatized to the heat. In order to adapt those systems to potential heat waves occurring outside the hottest months of the season, this study proposes specific health-based monthly heat indicators and thresholds over an extended season from April to October in the northern hemisphere. METHODS The proposed approach, an adoption and extension of the HHWWS methodology currently implemented in Quebec (Canada). The latter is developed and applied to the Greater Montreal area (current population 4.3 million) based on historical health and meteorological data over the years. This approach consists of determining excess mortality episodes and then choosing monthly indicators and thresholds that may involve excess mortality. RESULTS We obtain thresholds for the maximum and minimum temperature couple (in °C) that range from (respectively, 23 and 12) in April, to (32 and 21) in July and back to (25 and 13) in October. The resulting HHWWS is flexible, with health-related thresholds taking into account the seasonality and the monthly variability of temperatures over an extended summer season. CONCLUSIONS This adaptive and more realistic system has the potential to prevent, by data-driven health alerts, heat-related mortality outside the typical July-August months of heat waves. The proposed methodology is general and can be applied to other regions and situations based on their characteristics.
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Nguyen HT, Le HT, Connelly LB. Weather and children's time allocation. HEALTH ECONOMICS 2021; 30:1559-1579. [PMID: 33864321 DOI: 10.1002/hec.4264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/23/2020] [Accepted: 03/05/2021] [Indexed: 06/12/2023]
Abstract
This paper presents the first causal estimates of the effect of weather on children's time allocation. It exploits exogenous variations in local weather observed during the random diary dates of two nationally representative cohorts of Australian children whose time-use diaries were surveyed biennially over 10 years. Unfavorable weather conditions, as represented by cold or hot temperature or rain, cause children to switch activities from outdoors to indoors, mainly by reducing the time allocated to active pursuits and travel and increasing the time allocated to media. Furthermore, the effects of bad weather are more pronounced on weekends and for children with asthma. Our results also provide some evidence of adaptation, as temperature tends to have greater impact not only in winter months but also in colder regions. Our findings are robust to a wide range of sensitivity checks, including controlling for individual fixed effects and using alternative model specifications. Overall, the results suggest that extreme weather conditions may diminish children's health, development and long-term achievements through their effects on children's time allocation.
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Affiliation(s)
- Ha Trong Nguyen
- Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Huong Thu Le
- Telethon Kids Institute, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Luke B Connelly
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
- Department of Sociology and Business Law, the University of Bologna, Bologna, Italy
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Wang S, Wu CYH, Richardson MB, Zaitchik BF, Gohlke JM. Characterization of heat index experienced by individuals residing in urban and rural settings. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:641-653. [PMID: 33597724 PMCID: PMC8273073 DOI: 10.1038/s41370-021-00303-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
Heatwave warning systems rely on forecasts made for fixed-point weather stations (WS), which do not reflect variation in temperature and humidity experienced by individuals moving through indoor and outdoor locations. We examined whether neighborhood measurement improved the prediction of individually experienced heat index in addition to nearest WS in an urban and rural location. Participants (residents of Birmingham, Alabama [N = 89] and Wilcox County, Alabama [N = 88]) wore thermometers clipped to their shoe for 7 days. Shielded thermometers/hygrometers were placed outdoors within participant's neighborhoods (N = 43). Nearest WS and neighborhood thermometers were matched to participant's home address. Heat index (HI) was estimated from participant thermometer temperature and WS humidity per person-hour (HI[individual]), or WS temperature and humidity, or neighborhood temperature and humidity. We found that neighborhood HI improved the prediction of individually experienced HI in addition to WS HI in the rural location, and neighborhood heat index alone served as a better predictor in the urban location, after accounting for individual-level factors. Overall, a 1 °C increase in HI[neighborhood] was associated with 0.20 °C [95% CI (0.19, 0.21)] increase in HI[individual]. After adjusting for ambient condition differences, we found higher HI[individual] in the rural location, and increased HI[individual] during non-rest time (5 a.m. to midnight) and on weekdays.
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Affiliation(s)
- Suwei Wang
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
- Translational Biology, Medicine and Health (TBMH), Virginia Tech, Blacksburg, VA, USA
| | - Connor Y H Wu
- Department of Geospatial Informatics, Troy University, Troy, AL, USA
| | - Molly B Richardson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benjamin F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Julia M Gohlke
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA.
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Spatial variation in the joint effect of extreme heat events and ozone on respiratory hospitalizations in California. Proc Natl Acad Sci U S A 2021; 118:2023078118. [PMID: 34031244 DOI: 10.1073/pnas.2023078118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Extreme heat and ozone are co-occurring exposures that independently and synergistically increase the risk of respiratory disease. To our knowledge, no joint warning systems consider both risks; understanding their interactive effect can warrant use of comprehensive warning systems to reduce their burden. We examined heterogeneity in joint effects (on the additive scale) between heat and ozone at small geographical scales. A within-community matched design with a Bayesian hierarchical model was applied to study this association at the zip code level. Spatially varying relative risks due to interaction (RERI) were quantified to consider joint effects. Determinants of the spatial variability of effects were assessed using a random effects metaregression to consider the role of demographic/neighborhood characteristics that are known effect modifiers. A total of 817,354 unscheduled respiratory hospitalizations occurred in California from 2004 to 2013 in the May to September period. RERIs revealed no additive interaction when considering overall joint effects. However, when considering the zip code level, certain areas observed strong joint effects. A lower median income, higher percentage of unemployed residents, and exposure to other air pollutants within a zip code drove stronger joint effects; a higher percentage of commuters who walk/bicycle, a marker for neighborhood wealth, showed decreased effects. Results indicate the importance of going beyond average measures to consider spatial variation in the health burden of these exposures and predictors of joint effects. This information can be used to inform early warning systems that consider both heat and ozone to protect populations from these deleterious effects in identified areas.
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Vanderplanken K, van den Hazel P, Marx M, Shams AZ, Guha-Sapir D, van Loenhout JAF. Governing heatwaves in Europe: comparing health policy and practices to better understand roles, responsibilities and collaboration. Health Res Policy Syst 2021; 19:20. [PMID: 33588863 PMCID: PMC7885367 DOI: 10.1186/s12961-020-00645-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The expectation that climate change will further exacerbate extreme weather events such as heatwaves is of primary concern to policymakers and scientists. Effective governance is fundamental to preparedness for and response to such threats. This paper explores the governance structures of European heat health action plans and provides insights into key stakeholders, roles, responsibilities and collaboration. METHODS This was a two-phase qualitative study, in which we complemented a desk review of 15 European national heat health action plans (NHHAPs) with, after obtaining informed consent, 68 interviews in nine countries with key informants involved in the development, implementation and/or evaluation of these NHHAPs. A thematic analysis was used to analyze the NHHAPs inductively. This analysis focused on three themes: identifying key stakeholders, defining and assigning roles and collaboration among stakeholders. The iteratively created codebook was then applied to the analysis of the key informant interviews. All analyses were done using NVivo 10 qualitative analysis software. RESULTS The majority of the NHHAPs have governance as one of their main objectives, to support the coordination of actions and collaboration among involved stakeholders. There are, however, significant differences between plan and practice. On the basis of the available data, we have little insight into the process of stakeholder identification, but we do find that most countries involve the same types of stakeholders. Roles are mainly defined and assigned in relation to the alert levels of the warning system, causing other role aspects and other roles to be vague and ambiguous. Collaboration is key to many NHHAP elements and is mainly experienced positively, though improvements and new collaborations are considered. CONCLUSIONS Our findings show a need for a more deliberate and structured approach to governance in the context of NHHAPs. A cross-sectoral approach to the identification of key stakeholders can facilitate a broader preparedness and response to heatwaves. Roles and responsibilities of stakeholders should be defined and assigned more clearly to avoid confusion and to improve effective implementation. To this extent, we identify and describe seven key roles and potential stakeholders to which these roles are usually assigned. Finally, also collaboration among stakeholders can benefit from a cross-sectoral approach, but also formal structures can be beneficial.
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Affiliation(s)
- Kirsten Vanderplanken
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-Aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium
| | - Peter van den Hazel
- International Network On Children’s Health, Environment and Safety (INCHES), Kastanjelaan 5, 6955AM Ellecom, The Netherlands
| | - Michael Marx
- Evaplan at the University Hospital, Heidelberg, Ringstr.19b, 69115 Heidelberg, Germany
| | - Ahmad Zia Shams
- Evaplan at the University Hospital, Heidelberg, Ringstr.19b, 69115 Heidelberg, Germany
| | - Debarati Guha-Sapir
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-Aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium
| | - Joris Adriaan Frank van Loenhout
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-Aux-Champs 30, 1200 Woluwé-Saint-Lambert, Brussels, Belgium
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Abstract
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.
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Ryti NRI, Korpelainen A, Seppänen O, Jaakkola JJK. Paradoxical home temperatures during cold weather: a proof-of-concept study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:2065-2076. [PMID: 32852609 PMCID: PMC7658083 DOI: 10.1007/s00484-020-01998-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 02/16/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
There is substantial epidemiological evidence on the associations between cold weather and adverse health effects. Meteorological alarm systems are being developed globally, and generalized protective advice is given to the public based on outdoor exposure parameters. It is not clear how these shared outdoor exposure parameters relate to the individual-level thermal exposure indoors, where the majority of time is spent. We hypothesized a priori that there are opposite correlations between indoor and outdoor temperatures in residential apartments. Apartments were classified into 3 categories according to their response to declining outdoor temperature: under-controlled apartments cool down, controlled apartments maintain constant indoor temperature level, and over-controlled apartments warm up. Outdoor and indoor temperatures were measured in 30-min intervals in 417 residential apartments in 14 buildings in Kotka, Finland, between February and April 2018 with outdoor temperatures ranging from - 20.4 °C to + 14.0 °C. Different apartment types were present in all buildings. Floor and orientation did not explain the divergence. Indoor temperatures below the limit value + 20 °C by building code occurred in 26.2%, 7.9%, and 23.6% of the under-controlled, controlled, and over-controlled apartments, some in conjunction with increasing outdoor temperatures. Indoor temperatures above the limit + 25 °C occurred but were more rare. This proof-of-concept study demonstrates that while the home environment may be a source of thermal stress during cold weather, generalized advice for adjusting the heating may lead to paradoxical exposures in some cases. More elaborate conceptualizations of everyday thermal exposures are needed to safely reduce weather-related health risks using shared meteorological alarm systems.
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Affiliation(s)
- Niilo R I Ryti
- Center for Environmental and Respiratory Health Research (CERH), Faculty of Medicine, University of Oulu, PO Box 5000, FI-90014, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anton Korpelainen
- Center for Environmental and Respiratory Health Research (CERH), Faculty of Medicine, University of Oulu, PO Box 5000, FI-90014, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), Faculty of Medicine, University of Oulu, PO Box 5000, FI-90014, Oulu, Finland.
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
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Evaluating Mortality Response Associated with Two Different Nordic Heat Warning Systems in Riga, Latvia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217719. [PMID: 33105717 PMCID: PMC7672594 DOI: 10.3390/ijerph17217719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022]
Abstract
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.
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Alahmad B, Shakarchi AF, Khraishah H, Alseaidan M, Gasana J, Al-Hemoud A, Koutrakis P, Fox MA. Extreme temperatures and mortality in Kuwait: Who is vulnerable? THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 732:139289. [PMID: 32438154 DOI: 10.1016/j.scitotenv.2020.139289] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers. OBJECTIVE To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait. METHODS We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models. RESULTS A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52). CONCLUSIONS Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Haitham Khraishah
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammad Alseaidan
- Environmental Health Department, Public Health Administration, Ministry of Health, Kuwait
| | - Janvier Gasana
- Environmental and Occupational Health Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Petros Koutrakis
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mary A Fox
- Department of Health Policy and Management and Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sera F, Armstrong B, Tobias A, Vicedo-Cabrera AM, Åström C, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Matus Correa P, Cruz JC, Dang TN, Hurtado-Diaz M, Do Van D, Forsberg B, Guo YL, Guo Y, Hashizume M, Honda Y, Iñiguez C, Jaakkola JJK, Kan H, Kim H, Lavigne E, Michelozzi P, Ortega NV, Osorio S, Pascal M, Ragettli MS, Ryti NRI, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tong S, Zanobetti A, Gasparrini A. How urban characteristics affect vulnerability to heat and cold: a multi-country analysis. Int J Epidemiol 2020; 48:1101-1112. [PMID: 30815699 DOI: 10.1093/ije/dyz008] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.
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Affiliation(s)
- Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | - Bing-Yu Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | | | | | - Julio Cesar Cruz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Tran Ngoc Dang
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
| | - Magali Hurtado-Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Dung Do Van
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Yue Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan.,Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Carmen Iñiguez
- Department of Statistics and Computational Research, Environmental Health Research Joint Reseaech Unit FISABIO-UV-UJI CIBERESP, University of València, València, Spain
| | - Jouni J K Jaakkola
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Air Health Science Division, Health Canada, Ottawa, Canada
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Niilo R I Ryti
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Xerxes Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Shilu Tong
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China.,School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Dutta A, Bhattacharya S, Ak K, Pati S, Swain S, Nanda L. At which temperature do the deleterious effects of ambient heat "kick-in" to affect all-cause mortality? An exploration of this threshold from an eastern Indian city. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:187-197. [PMID: 30855980 DOI: 10.1080/09603123.2019.1587389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Despite experiencing hot weathers, limited studies from India explored relationships between ambient heat and health. We studied associations between heat and all-cause mortality to estimate heat threshold(s) affecting health, and examine other affecting dimensions. We conducted time-series analysis with daily maximum temperature and all-cause mortality data of Bhubaneswar city (March-July, 2007-2017), and explored their interactions. Mortality risks rose when daily maximum temperatures were >36.2°C (lower threshold), and even more when >40.5°C (upper threshold). Every degree above36.2°C increased the mortality risk by 2% (mortality rate ratio: 1.02; 95% CI 1.01, 1.03). The effects of maximum temperature increased on days when minimum temperatures were >25.6°C (median). The effect of heat was immediate and lasted for 0-1 day with no lagged effect. Two temperature thresholds with varying mortality risks provided an opportunity for a graded heat warning system. The accentuation of the deleterious effects of heat by the higher minimum temperature calls for its inclusion in the heat warning system in future.
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Affiliation(s)
- Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
- School of Public Health, Kalinga Institute of Industrial Technology deemed to be University, Bhubaneswar, India
| | - Shreeporna Bhattacharya
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
| | - Kavitha Ak
- School of Public Health, Kalinga Institute of Industrial Technology deemed to be University, Bhubaneswar, India
| | - Sanghamitra Pati
- Regional Medical Research Centre Indian Council of Medical Research, Bhubaneswar, India
| | | | - Lipika Nanda
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, India
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The Heat Health Warning System in Germany—Application and Warnings for 2005 to 2019. ATMOSPHERE 2020. [DOI: 10.3390/atmos11020170] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Röösli M, Cissé G. Towards health for future. Int J Public Health 2019; 65:1-2. [PMID: 31748922 DOI: 10.1007/s00038-019-01314-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Guéladio Cissé
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Heat Health Prevention Measures and Adaptation in Older Populations-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224370. [PMID: 31717424 PMCID: PMC6888447 DOI: 10.3390/ijerph16224370] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 11/25/2022]
Abstract
The population of older people is increasing at a rapid rate, with those 80 years and older set to triple by 2050. This systematic review aimed to examine older people’s perceptions and behaviours against existing heatwaves prevention measures and systematically categorize and analyse those measures using the Ottawa charter for health promotion framework. Peer-reviewed published literature between 22nd September 2006 and 24th April 2018 was retrieved, according to the PRISMA guidelines, from five different databases. Eighteen articles were finally included. There is a lack of published studies from developing countries. Results were categorized and analysed using the Ottawa charter five action areas. Mitigation strategies from current heat action plans are discussed and gaps are highlighted. A lack of systematic evaluation of heat action plans efficacy was identified. Older people are not demonstrating all recommended preventative measures during heatwaves. Support personnel and health professionals are not being pro-active enough in facilitating prevention of adverse effects from heatwaves. Governments are beginning to implement policy changes, but other recommended support measures outlined in the Ottawa charter are still lacking, and hence require further action. Linkage between specific components of heat action plans and outcomes cannot be ascertained; therefore, more systematic evaluation is needed.
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Xu X, Li J, Gao J, Liu K, Liu Q. Effective analysis of a community-based intervention during heat waves to improve knowledge, attitude and practice in a population in Licheng District, Jinan City, China. J Public Health (Oxf) 2019; 40:573-581. [PMID: 28977506 DOI: 10.1093/pubmed/fdx121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 01/21/2023] Open
Abstract
Background Intervention strategies that focus on coping with continuous heat wave threats have been implemented in many countries. Despite these efforts, we still lack evidence concerning intervention efficacy. A Heat Wave Intervention Program (HWIP) that impacts knowledge, attitude and practice (KAP) was designed, and its effectiveness during heat waves was evaluated. Methods A stratified two-stage probability proportion to size sampling method was employed to analyze an intervention group and a control group. Two cross-sectional surveys, which included questions about heat waves in 2014 and 2015, were analyzed using difference-in-difference (DID) analysis. Results Mean KAP scores among participants with different demographic characteristics in the intervention group were higher in 2015 than those in 2014. Further analysis by DID found that implementing interventions was positively associated with knowledge (ß = 0.387, P < 0.001) and attitude (ß = 0.166, P < 0.01). Conclusion Intervention measures can significantly promote levels of knowledge and attitude. However, as the practice level, most of the sub-groups showed no significant differences for net values between in the intervention group and control group. A cost-benefit analysis was suggested as future work to check the effectiveness of the program. Therefore, further improvement measures should be targeted towards the populations to enable them to effectively cope with the heat waves.
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Affiliation(s)
- Xin Xu
- Department of Dentistry, Affiliated Hospital, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Jing Li
- Public Health Department of Weifang Medical University, Weifang, Shandong Province, PR China.,State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Jinghong Gao
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Keke Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
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Ferreira LDCM, Nogueira MC, Pereira RVDB, de Farias WCM, Rodrigues MMDS, Teixeira MTB, Carvalho MS. Ambient temperature and mortality due to acute myocardial infarction in Brazil: an ecological study of time-series analyses. Sci Rep 2019; 9:13790. [PMID: 31551489 PMCID: PMC6760184 DOI: 10.1038/s41598-019-50235-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Ambient temperature may lead to decompensation of cardiovascular diseases and deaths by acute myocardial infarction (AMI). Little is known about this relationship in South American countries located in regions of a hot climate. This study aims to investigate the effects of ambient temperature on mortality due to AMI in six Brazilian micro-regions, which present different climates. We analyzed daily records of deaths by AMI between 1996 and 2013. We estimated the accumulate relative and attributable risks with lags of up to 14 days, using distributed non-linear lag model. Micro-regions that were closest to the equator did not show an association between temperature and mortality. The lowest risk temperatures varied between 22 °C and 28 °C, in the Southern region of Brazil and the Midwest region, respectively. Low temperatures associated with the highest mortality risk were observed in the same areas, varying between 5 °C and 15 °C. The number of deaths attributed to cold temperatures varied from 176/year in Brasilia to 661/year in São Paulo and those deaths attributed to hot temperatures in Rio de Janeiro amounted to 115/year. We showed the relative risk and the attributable risk of warmer and colder days in tropical regions. The estimate of the number of deaths due to climate, varying according to each area, is a way of bringing information to those responsible for health policies based on easily-understood measurements.
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Affiliation(s)
| | - Mário Círio Nogueira
- Public Health Department, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | | | | | | | - Marilia Sá Carvalho
- Oswaldo Cruz Foundation, Scientific Computing Program, Rio de Janeiro, RJ, Brazil
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Fox M, Zuidema C, Bauman B, Burke T, Sheehan M. Integrating Public Health into Climate Change Policy and Planning: State of Practice Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183232. [PMID: 31487789 PMCID: PMC6765852 DOI: 10.3390/ijerph16183232] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022]
Abstract
Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.
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Affiliation(s)
- Mary Fox
- Department of Health Policy and Management, Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Christopher Zuidema
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Bridget Bauman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Thomas Burke
- Department of Health Policy and Management, Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Mary Sheehan
- Department of Health Policy and Management, Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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40
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Martinez GS, Linares C, Ayuso A, Kendrovski V, Boeckmann M, Diaz J. Heat-health action plans in Europe: Challenges ahead and how to tackle them. ENVIRONMENTAL RESEARCH 2019; 176:108548. [PMID: 31247429 DOI: 10.1016/j.envres.2019.108548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 05/04/2023]
Abstract
High temperatures have periodically affected large areas in Europe and urban settings. In particular, the deadly 2003 summer heat waves precipitated a multitude of national and subnational health prevention and research efforts. Building on these and other international experiences the WHO Regional Office for Europe developed and published in 2008 a comprehensive framework for prevention, the heat-health action plans (HHAPs). This provided a blueprint used by several national and subnational authorities to design their prevention efforts. A decade after the publication of the WHO guidance, a wealth of new evidence and acquired implementation experience has emerged around HHAP effectiveness; heat exposure; acclimatization and adaptation; heat-health governance and stakeholder involvement; and the role of urban design and greening interventions in prevention. This evidence and experience can guide the strategies to tackle current and upcoming challenges in protecting health from heat under a warming climate.
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Affiliation(s)
| | | | - Ana Ayuso
- Carlos III National Institute of Health, Madrid, Spain
| | | | | | - Julio Diaz
- Carlos III National Institute of Health, Madrid, Spain
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Kim JH, Ryoo HW, Moon S, Jang TC, Jin SC, Mun YH, Do BS, Lee SB, Kim JY. Determining the correlation between outdoor heatstroke incidence and climate elements in Daegu metropolitan city. Yeungnam Univ J Med 2019; 36:241-248. [PMID: 31620639 PMCID: PMC6784657 DOI: 10.12701/yujm.2019.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/06/2022] Open
Abstract
Background Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS). Methods We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression. Results Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102-3.017). The most suitable cutoff point for MHI by Youden's index was 30.0°C (sensitivity, 77.4%; specificity, 73.7%). Conclusion Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was 30.0°C.
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Affiliation(s)
- Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sungbae Moon
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Chang Jang
- Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang Chan Jin
- Department of Emergency Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - You Ho Mun
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Soo Do
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sam Beom Lee
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jong-yeon Kim
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Runkle JD, Cui C, Fuhrmann C, Stevens S, Del Pinal J, Sugg MM. Evaluation of wearable sensors for physiologic monitoring of individually experienced temperatures in outdoor workers in southeastern U.S. ENVIRONMENT INTERNATIONAL 2019; 129:229-238. [PMID: 31146157 DOI: 10.1016/j.envint.2019.05.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
Climate-related increases in global mean temperature and the intensification of heat waves present a significant threat to outdoor workers. Limited research has been completed to assess the potential differences in heat exposures that exist between individuals within similar microenvironments. Yet, there is a paucity of individual data characterizing patterns of individually experienced temperatures in workers and the associated physiologic heat strain response. The objective of this study was to apply a wearable sensor-based approach to examine the occupational, environmental, and behavioral factors that contribute to individual-level variations in heat strain in grounds maintenance workers. Outdoor workers from three diverse climatic locations in the southeastern United States - high temperature, high temperature + high humidity, and moderate temperature environments - participated in personal heat exposure monitoring during a 5-day work period in the summer. We performed Cox proportional hazards modeling to estimate associations between multiple heat strain events per worker and changes in individually experienced temperatures. Heat strain risk was higher among workers with a place to cool-off, higher education, and who worked in hotter temperatures. A mismatch was observed between workers' perceptions of heat strain and actual heat strain prevalence across exposure groups. We also used a quasi-Poisson regression with distributed lag non-linear function to estimate the non-linear and lag effects of individually experienced temperatures on risk of heat strain. The association between increasing temperature and heat strain was nonlinear and exhibited an U-shaped relationship. Heat strain was less common during issued heat warnings demonstrating behavioral adaptive actions taken by workers. This study is one of the first temperature monitoring studies to quantify the individual-level exposure-response function in this vulnerable population and highlights the elevated risk of heat strain both immediately and several days after worker exposure to high temperatures.
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Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, United States of America.
| | - Can Cui
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, United States of America
| | - Chris Fuhrmann
- Department of Geosciences, Mississippi State University, 208 Hilbun Hall, MS 39762, United States of America
| | - Scott Stevens
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, United States of America
| | - Jeff Del Pinal
- Grounds and Building Services, North Carolina State University, Campus Box 7516, Raleigh, NC, United States of America
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC 28608, United States of America
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Overview of Existing Heat-Health Warning Systems in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152657. [PMID: 31349585 PMCID: PMC6695887 DOI: 10.3390/ijerph16152657] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 01/29/2023]
Abstract
The frequency of extreme heat events, such as the summer of 2003 in Europe, and their corresponding consequences for human beings are expected to increase under a warmer climate. The joint collaboration of institutional agencies and multidisciplinary approaches is essential for a successful development of heat-health warning systems and action plans which can reduce the impacts of extreme heat on the population. The present work constitutes a state-of-the-art review of 16 European heat-health warning systems and heat-health action plans, based on the existing literature, web search (over the National Meteorological Services websites) and questionnaires. The aim of this study is to pave the way for future heat-health warning systems, such as the one currently under development in the framework of the Horizon 2020 HEAT-SHIELD project. Some aspects are highlighted among the variety of examined European warning systems. The meteorological variables that trigger the warnings should present a clear link with the impact under consideration and should be chosen depending on the purpose and target of the warnings. Setting long-term planning actions as well as pre-alert levels might prevent and reduce damages due to heat. Finally, education and communication are key elements of the success of a warning system.
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The Use of a Quasi-Experimental Study on the Mortality Effect of a Heat Wave Warning System in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122245. [PMID: 31242672 PMCID: PMC6617315 DOI: 10.3390/ijerph16122245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022]
Abstract
Many cities and countries have implemented heat wave warning systems to combat the health effects of extreme heat. Little is known about whether these systems actually reduce heat-related morbidity and mortality. We examined the effectiveness of heat wave alerts and health plans in reducing the mortality risk of heat waves in Korea by utilizing the discrepancy between the alerts and the monitored temperature. A difference-in-differences analysis combined with propensity score weighting was used. Mortality, weather monitoring, and heat wave alert announcement data were collected for 7 major cities during 2009–2014. Results showed evidence of risk reduction among people aged 19–64 without education (−0.144 deaths/1,000,000 people, 95% CI: −0.227, −0.061) and children aged 0–19 (−0.555 deaths/1,000,000 people, 95% CI: −0.993, −0.117). Decreased cardiovascular and respiratory mortality was found in several subgroups including single persons, widowed people, blue-collar workers, people with no education or the highest level of education (university or higher). No evidence was found for decreased all-cause mortality in the population (1.687 deaths/1,000,000 people per day; 95% CI: 1.118, 2.255). In conclusion, heat wave alerts may reduce mortality for several causes and subpopulations of age and socio-economic status. Further work needs to examine the pathways through which the alerts impact subpopulations differently.
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Martínez-Solanas È, Basagaña X. Temporal changes in the effects of ambient temperatures on hospital admissions in Spain. PLoS One 2019; 14:e0218262. [PMID: 31194811 PMCID: PMC6564013 DOI: 10.1371/journal.pone.0218262] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The exposure to extreme ambient temperatures has been reported to increase mortality, although less is known about its impact on morbidity. The analysis of temporal changes in temperature-health associations has also focused on mortality with no studies on hospitalizations worldwide. Studies on temporal variations can provide insights on changes in susceptibility or on effectiveness of public health interventions. We aimed to analyse the effects of temperature on cause-specific hospital admissions in Spain and assess temporal changes using two periods, the second one characterized by the introduction of a heat health prevention plan. METHODS Daily counts of non-scheduled hospital admissions for cardiovascular, cerebrovascular and respiratory diseases and daily maximum temperature were obtained for each Spanish province for the period 1997-2013. The relationship between temperature and hospitalizations was estimated using distributed lag non-linear models. We compared the risk of hospitalization due to temperatures (cold, heat and extreme heat) in two periods (1997-2002 and 2004-2013). RESULTS Cold temperatures were associated with increased risk of cardiovascular, cerebrovascular and respiratory hospital admissions. Hot temperatures were only associated with higher hospital admissions for respiratory causes while hospitalizations for cardiovascular and cerebrovascular diseases did not increase with heat. There was a small reduction in heat-related respiratory admissions in period 2. Whereas cold-related hospitalizations for cardiovascular and cerebrovascular diseases increased in period 2, a significant reduction for respiratory hospitalizations was reported. CONCLUSIONS Our results suggested that heat had an adverse impact on hospital admissions for respiratory diseases, while cold increased the risk of the three studied cause-specific hospitalizations. Public health interventions should also focus on morbidity effects of temperature.
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Affiliation(s)
- Èrica Martínez-Solanas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Perceptions of, and Practices for Coping with, Heat Exposure among Male Arab Pilgrims to the Hajj, 1436. Prehosp Disaster Med 2019; 34:161-174. [PMID: 30968815 DOI: 10.1017/s1049023x19000025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The problems associated with exposure to excessive heat are a key health concern throughout the world, and are likely to become increasingly important as Earth's climate warms. Heat exposure is particularly problematic when large groups of people gather, but there is relatively little literature on the subject. Islam requires all adherents who are able to undertake a pilgrimage to Mecca (Saudi Arabia), known as the Hajj. This can result in huge numbers of pilgrims travelling to Mecca in the summer months, during which the temperatures can be very high, and to undertake physically demanding activities. OBJECTIVE The aim of this study was to identify the perception level of heat-related health issues and the coping behaviors adopted by pilgrims in the face of excessive heat exposure. METHODS A cross-sectional study was conducted in Mecca, Saudi Arabia among male Arab pilgrims performing Hajj of the Islamic calendar year 1436 (Summer 2015). Sample was divided into two strata: domestic pilgrims and international Arabs. A total of 14 camps were selected randomly, seven from each stratum. A total of 412 participants completed the questionnaire. RESULTS Mean age was 43.48 (SD = 13.42) years. Majority of pilgrims had never performed Hajj before (68.2%). Almost 89.5% among pilgrims more than 40 years of age had more water intake compared to only 76.5% for people under 40 years. Only 7.3% of educated people used to go out at noon time, and almost two-fold of pilgrims with lower educational level did so (15.4%). Approximately 51.8% among those who were aware of Mecca's weather used cotton clothes, compared to 36.0% among pilgrims unaware of Mecca's weather. CONCLUSION This study reveals the extent of pilgrims' understanding of, and abilities to cope with, excessive heat and also suggests coping strategies and options for improved understanding of heat-related health issues world-wide.Al Mayahi ZK, Ali Kabbash I. Perceptions of, and practices for coping with, heat exposure among male Arab pilgrims to the Hajj, 1436. Prehosp Disaster Med. 2019;34(2):161-174.
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Green H, Bailey J, Schwarz L, Vanos J, Ebi K, Benmarhnia T. Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research. ENVIRONMENTAL RESEARCH 2019; 171:80-91. [PMID: 30660921 DOI: 10.1016/j.envres.2019.01.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 05/13/2023]
Abstract
Heat waves and high air temperature are associated with increased morbidity and mortality. However, the majority of research conducted on this topic is focused on high income areas of the world. Although heat waves have the most severe impacts on vulnerable populations, relatively few studies have studied their impacts in low and middle income countries (LMICs). The aim of this paper is to review the existing evidence in the literature on the impact of heat on human health in LMICs. We identified peer-reviewed epidemiologic studies published in English between January 1980 and August 2018 investigating potential associations between high ambient temperature or heat waves and mortality or morbidity. We selected studies according to the following criteria: quantitative studies that used primary and/or secondary data and report effect estimates where ambient temperature or heat waves are the main exposure of interest in relation to human morbidity or mortality within LMICs. Of the total 146 studies selected, eighty-two were conducted in China, nine in other countries of East Asia and the Pacific, twelve in South Asia, ten in Sub-Saharan Africa, eight in the Middle East and North Africa, and seven in each of Latin America and Europe. The majority of studies (92.9%) found positive associations between heat and human morbidity/mortality. Additionally, while outcome variables and study design differed greatly, most utilized a time-series study design and examined overall heath related morbidity/mortality impacts in an entire population, although it is notable that the selected studies generally found that the elderly, women, and individuals within the low socioeconomic brackets were the most vulnerable to the effects of high temperature. By highlighting the existing evidence on the impact of extreme heat on health in LMICs, we hope to determine data needs and help direct future studies in addressing this knowledge gap. The focus on LMICs is justified by the lack of studies and data studying the health burden of higher temperatures in these regions even though LMICs have a lower capacity to adapt to high temperatures and thus an increased risk.
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Affiliation(s)
- Hunter Green
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA
| | - Jennifer Bailey
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Lara Schwarz
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Jennifer Vanos
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Kristie Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, WA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
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48
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Vaidyanathan A, Saha S, Vicedo-Cabrera AM, Gasparrini A, Abdurehman N, Jordan R, Hawkins M, Hess J, Elixhauser A. Assessment of extreme heat and hospitalizations to inform early warning systems. Proc Natl Acad Sci U S A 2019; 116:5420-5427. [PMID: 30833395 PMCID: PMC6431221 DOI: 10.1073/pnas.1806393116] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Heat early warning systems and action plans use temperature thresholds to trigger warnings and risk communication. In this study, we conduct multistate analyses, exploring associations between heat and all-cause and cause-specific hospitalizations, to inform the design and development of heat-health early warning systems. We used a two-stage analysis to estimate heat-health risk relationships between heat index and hospitalizations in 1,617 counties in the United States for 2003-2012. The first stage involved a county-level time series quasi-Poisson regression, using a distributed lag nonlinear model, to estimate heat-health associations. The second stage involved a multivariate random-effects meta-analysis to pool county-specific exposure-response associations across larger geographic scales, such as by state or climate region. Using results from this two-stage analysis, we identified heat index ranges that correspond with significant heat-attributable burden. We then compared those with the National Oceanic and Atmospheric Administration National Weather Service (NWS) heat alert criteria used during the same time period. Associations between heat index and cause-specific hospitalizations vary widely by geography and health outcome. Heat-attributable burden starts to occur at moderately hot heat index values, which in some regions are below the alert ranges used by the NWS during the study time period. Locally specific health evidence can beneficially inform and calibrate heat alert criteria. A synchronization of health findings with traditional weather forecasting efforts could be critical in the development of effective heat-health early warning systems.
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Affiliation(s)
- Ambarish Vaidyanathan
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341;
| | - Shubhayu Saha
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Ana M Vicedo-Cabrera
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | | | - Michelle Hawkins
- National Weather Service, National Oceanic and Atmospheric Administration, Silver Spring, MD 20910
| | - Jeremy Hess
- Center for Health and the Global Environment, University of Washington, Seattle, WA 98105
| | - Anne Elixhauser
- Agency for Healthcare Research and Quality, Rockville, MD 20852
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49
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Martínez-Solanas È, Basagaña X. Temporal changes in temperature-related mortality in Spain and effect of the implementation of a Heat Health Prevention Plan. ENVIRONMENTAL RESEARCH 2019; 169:102-113. [PMID: 30447497 DOI: 10.1016/j.envres.2018.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 05/16/2023]
Abstract
Exposure to extreme ambient temperatures has been widely described to increase mortality. Exploring changes in susceptibility to temperatures over time can provide useful information for policy planning and can provide insights on the effectiveness of health preventive plans. The aims of this study were i) to compare changes in temperature-related mortality in Spain during a 20-year period and ii) to assess whether the number of actions implemented in each region as part of a Heat Health Prevention Plan (HHPP) was associated with the temporal changes in heat-related mortality. Daily counts of deaths and daily maximum temperature were obtained for each Spanish province (1993-2013). We used time-varying distributed lag non-linear models to estimate the relationship between temperature and mortality. We compared the risk of death due to extreme temperatures (cold and heat) in the two periods (1993-2002 and 2004-2013), assuming a constant temperature distribution and different temperature-mortality function. Results were reported as mortality attributable fraction (%) (AF). Overall, there was a decrease in mortality attributable to temperature in period 2, more remarkable for extreme cold (from 1.01% to 0.52%), while for moderate heat there was an increase (from 0.38% to 1.21%). Provinces with more actions implemented in their HHPP showed stronger decreases in mortality attributable to extreme heat. Other variables (e.g. average temperature) could explain this association. The highest mortality-AF reductions were detected among the elderly, in mortality for cardiovascular causes and in towns with high socioeconomic vulnerability. Our results suggest that the implementation of the Spanish HHPP could help reduce heat-related mortality.
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Affiliation(s)
- Èrica Martínez-Solanas
- ISGlobal, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Xavier Basagaña
- ISGlobal, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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50
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Park J, Kim J. Defining heatwave thresholds using an inductive machine learning approach. PLoS One 2018; 13:e0206872. [PMID: 30403743 PMCID: PMC6221332 DOI: 10.1371/journal.pone.0206872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
Establishing appropriate heatwave thresholds is important in reducing adverse human health consequences as it enables a more effective heatwave warning system and response plan. This paper defined such thresholds by focusing on the non-linear relationship between heatwave outcomes and meteorological variables as part of an inductive approach. Daily data on emergency department visitors who were diagnosed with heat illnesses and information on 19 meteorological variables were obtained for the years 2011 to 2016 from relevant government agencies. A Multivariate Adaptive Regression Splines (MARS) analysis was performed to explore points (referred to as “knots”) where the behaviour of the variables rapidly changed. For all emergency department visitors, two thresholds (a maximum daily temperature ≥ 32.58°C for 2 consecutive days and a heat index ≥ 79.64) were selected based on the dramatic rise of morbidity at these points. Nonetheless, visitors, who included children and outside workers diagnosed in the early summer season, were reported as being sensitive to heatwaves at lower thresholds. The average daytime temperature (from noon to 6 PM) was determined to represent an alternative threshold for heatwaves. The findings have implications for exploring complex heatwave-morbidity relationships and for developing appropriate intervention strategies to prevent and mitigate the health impact of heatwaves.
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Affiliation(s)
- Juhyeon Park
- School of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Jeongseob Kim
- School of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
- * E-mail:
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