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Zhang S, Wang T, Yang Z, Tsai PC, Acosta CL, Zhang JJ, Wang Y. Effects of ambient temperature on pediatric incident seizure: A case-crossover analysis using distributed lag non-linear models. ENVIRONMENTAL RESEARCH 2024; 258:119495. [PMID: 38936500 DOI: 10.1016/j.envres.2024.119495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Emerging evidence supports that brain dysfunction may be attributable to environmental factors. This study aims to examine associations of ambient temperature and temperature variability (TV) with seizure incidence in children, which has not been explored. MATERIAL AND METHODS Data on 2718 outpatient visits due to seizure were collected in Shanghai, China, from 2018 to 2023. Exposure to ambient temperature was estimated at children's residential addresses using spatial-temporal models. A time-stratified case-crossover design with a distributed lag non-linear model (DLNM) was conducted to assess the association between seizure incidence and daily average of ambient temperature over a period of 21 days prior to a case date of disease onset. For a given case date, we selected all dates falling on the same day of the week within the same month as control dates. We calculated a composite index of intra-day and inter-day TV, which was the standard deviation of the daily minimum and maximum temperatures, respectively, over 7 days preceding a case date. We then assessed the association between TV and seizure incidence. Stratified analyses were conducted by age (73.51% < 5 years old and 26.49 % ≥ 5 years old), sex (41.83% female), presence of fever (69.72%), and diagnosis of epilepsy (27.63%). RESULTS We observed inversed J-shaped temperature-response curves. Lower temperatures had a significant and prolonged effect than higher temperatures. Using 20 °C (with the minimum effect) as the reference, the cumulative odds ratios (ORs) for over 0-21 days preceding the onset at the 5th percentile of the temperature (3 °C) and at the 95th percentile (29 °C) were 3.17 (95% CI: 1.77, 5.68) and 1.54 (95% CI: 0.97, 2.44), respectively. In addition, per 1 °C increases in TV0-7 was associated with OR of 1.08 (95% CI: 1.01, 1.15). Older children and those experiencing seizure with fever exhibited a higher risk of seizure onset at both lower and higher ambient temperatures. CONCLUSION Both low and high temperatures can contribute to the morbidity related to pediatric seizure. Lower temperatures, however, exerted a longer period of effect prior to seizure onset than higher temperatures. An increased risk for incident seizure was significantly associated with temperature variability during preceding 7 days.
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Affiliation(s)
- Shiyu Zhang
- Duke Global Health Institute & Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Tianqi Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhenchun Yang
- Duke Global Health Institute & Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Peng-Chou Tsai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Christine Ladd Acosta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Junfeng Jim Zhang
- Duke Global Health Institute & Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Balakrishnan AK, Otieno S, Dzombo M, Plaxico L, Ukoh E, Obara LM, Brown H, Musyimi C, Lincoln C, Yang LS, Witte SS, Winter SC. Socio-ecological impacts of extreme weather events in two informal settlements in Nairobi, Kenya. Front Public Health 2024; 12:1389054. [PMID: 38887261 PMCID: PMC11180900 DOI: 10.3389/fpubh.2024.1389054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Climate change is expected to profoundly impact health and coping and widen social and environmental inequalities. People living in informal settlements are especially vulnerable to climate change as they are often located in ecologically sensitive areas more susceptible to extreme weather events (EWEs), such as floods, droughts, and heat waves. Women residing in informal settlements are especially vulnerable to climate change and related EWEs because they are more likely to experience worse health-related impacts than men but are less likely to have access to health-related services. Despite this inequality, there is a dearth of research that focuses on the impacts of EWEs on women in informal settlements. This study aims to explore the multidimensional impacts of EWEs on the daily lives of women in informal settlements through the lens of socio-ecological theory. Study data is from six monthly surveys (1 September 2022-28 February 2023) collected from a probability sample of 800 women living in two of the largest informal settlements in Nairobi, Kenya. This data is part of an ongoing longitudinal study that uses community participatory methods to investigate the effects of climate change on health and wellbeing in informal settlements by a team of 16 community health volunteers who lead data collection and provide expertise in ongoing analysis. Findings show profound impacts on women's health and wellbeing across individual, micro-, meso-, exo-, and macrosystems. These include physical and mental health, financial disruptions, property issues, social impacts, and impacts on their surrounding physical environment, such as disrupted food or water access, poor air quality, drainage issues, and safety concerns. In addition, findings highlight the critical importance of the chrono- and biosphere systems in research focused on the impacts of climate change and related EWEs among climate-vulnerable communities and marginalized populations within them.
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Affiliation(s)
| | | | | | - LaNae Plaxico
- School of Social Work, Columbia University, New York, NY, United States
| | - Ebuka Ukoh
- School of Social Work, Columbia University, New York, NY, United States
| | - Lena Moraa Obara
- Rutgers, School of Social Work, The State University of New Jersey, New Brunswick, NJ, United States
| | - Haley Brown
- School of Social Work, Columbia University, New York, NY, United States
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Chloe Lincoln
- School of Social Work, Columbia University, New York, NY, United States
| | | | - Susan S. Witte
- School of Social Work, Columbia University, New York, NY, United States
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Conway F, Portela A, Filippi V, Chou D, Kovats S. Climate change, air pollution and maternal and newborn health: An overview of reviews of health outcomes. J Glob Health 2024; 14:04128. [PMID: 38785109 PMCID: PMC11117177 DOI: 10.7189/jogh.14.04128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Climate change represents a fundamental threat to human health, with pregnant women and newborns being more susceptible than other populations. In this review, we aimed to describe the current landscape of available epidemiological evidence on key climate risks on maternal and newborn health (MNH). Methods We sought to identify published systematic and scoping reviews investigating the impact of different climate hazards and air pollution on MNH outcomes. With this in mind, we developed a systematic search strategy based on the concepts of 'climate/air pollution hazards, 'maternal health,' and 'newborn health,' with restrictions to reviews published between 1 January 2010 and 6 February 2023, but without geographical or language restriction. Following full text screening and data extraction, we synthesised the results using narrative synthesis. Results We found 79 reviews investigating the effects of climate hazards on MNH, mainly focussing on outdoor air pollution (n = 47, 59%), heat (n = 24, 30%), and flood/storm disasters (n = 7, 9%). Most were published after 2015 (n = 60, 76%). These reviews had consistent findings regarding the positive association of exposure to heat and to air pollution with adverse birth outcomes, particularly preterm birth. We found limited evidence for impacts of climate-related food and water security on MNH and did not identify any reviews on climate-sensitive infectious diseases and MNH. Conclusions Climate change could undermine recent improvements in maternal and newborn health. Our review provides an overview of key climate risks to MNH. It could therefore be useful to the MNH community to better understand the MNH needs for each climate hazard and to strengthen discussions on evidence and research gaps and potential actions. Despite the lack of comprehensive evidence for some climate hazards and for many maternal, perinatal, and newborn outcomes, we observed repeated findings of the impact of heat and air pollutants on birth outcomes, particularly preterm birth. It is time for policy dialogue to follow to specifically design climate policy and actions to protect the needs of MNH.
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Affiliation(s)
- Francesca Conway
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Anayda Portela
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Department of Sexual and Reproductive Health, Geneva, Switzerland
| | - Sari Kovats
- London School of Hygiene and Tropical Medicine, NIHR Health Protection Research Unit in Environmental Change and Health, London, United Kingdom
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4
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Proulx K, Daelmans B, Baltag V, Banati P. Climate change impacts on child and adolescent health and well-being: A narrative review. J Glob Health 2024; 14:04061. [PMID: 38781568 PMCID: PMC11115477 DOI: 10.7189/jogh.14.04061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Worldwide, the climate is changing and affecting the health and well-being of children in many ways. In this review, we provided an overview of how climate change-related events may affect child and adolescent health and well-being, including children's mental and physical health, nutrition, safety and security, learning opportunities, and family caregiving and connectedness. Methods In this narrative review, we highlighted and discussed peer-reviewed evidence from 2012-23, primarily from meta-analyses and systematic reviews. The search strategy used a large and varied number of search terms across three academic databases to identify relevant literature. Results There was consistent evidence across systematic reviews of impact on four themes. Climate-related events are associated with a) increases in posttraumatic stress and other mental health disorders in children and adolescents, b) increases in asthma, respiratory illnesses, diarrheal diseases and vector-borne diseases, c) increases in malnutrition and reduced growth and d) disruptions to responsive caregiving and family functioning, which can be linked to poor caregiver mental health, stress and loss of resources. Evidence of violence against children in climate-related disaster contexts is inconclusive. There is a lack of systematic review evidence on the associations between climate change and children's learning outcomes. Conclusions Systematic review evidence consistently points to negative associations between climate change and children's physical and mental health, well-being, and family functioning. Yet, much remains unknown about the causal pathways linking climate-change-related events and mental and physical health, responsive relationships and connectedness, nutrition, and learning in children and adolescents. This evidence is urgently needed so that adverse health and other impacts from climate change can be prevented or minimised through well-timed and appropriate action.
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Affiliation(s)
| | - Bernadette Daelmans
- World Health Organization, Child Health and Development Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Valentina Baltag
- World Health Organization, Adolescent and Young Adult Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Prerna Banati
- World Health Organization, Adolescent and Young Adult Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
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5
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Freeman T, Morris LM, Michalski BM. Legislative review and recommendations for improving sun protection in schools. Pediatr Dermatol 2024. [PMID: 38712690 DOI: 10.1111/pde.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Sun exposure in schools can account for a large portion of childhood sun exposure before the age of 20 years, yet legislation in the United States is lacking to properly protect children. Schools serve as a foundational resource to introduce and implement sun-safe practices in the youth population. METHODS Federal and state legislation relating to the access of sunscreen, sun-protective apparel, and shade was reviewed via the website LegiScan.com. RESULTS At the time of publication, only 25 states have legislation in place that addresses and allows sunscreen to be used in school, given its classification as an over-the-counter medication. No state has implemented legislation allowing sunglasses to be worn in school, and only two states have laws explicitly allowing hats and other sun-protective apparel at schools. In addition, the provision of shade is addressed in four states. CONCLUSIONS With a significant portion of sun exposure occurring at schools, state and federal legislation must address sun protection for students, opening the door for expanded access and additional research related to skin cancer prevention.
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Affiliation(s)
- Timothy Freeman
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa M Morris
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Basia M Michalski
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Wei EX, Green A, Chang MT, Hwang PH, Sidell DR, Qian ZJ. Environmental Risk Factors for Pediatric Epistaxis vary by Climate Zone. Laryngoscope 2024; 134:1450-1456. [PMID: 37589269 DOI: 10.1002/lary.30961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION AND OBJECTIVE Prior studies have provided variable results regarding environmental risk factors for epistaxis. These studies were conducted in varying climate zones, which may explain discrepancies in results. The objective of this study is to investigate correlations between season, temperature, and humidity on frequency of pediatric epistaxis across climate zones. METHODS Children seen in the outpatient setting for epistaxis were identified from the 2007-2010 IBM MarketScan database. Climate zones were assigned according to International Energy Conservation Code (IECC) classification, where temperature zones in the United States and territories were assigned on an ordinal scale from 1 (tropical) to 8 (subarctic), and humidity zones were categorized as moist, dry, or marine. The control population was a sample of all well-child visits matched by age and county. RESULTS We identified 184,846 unique children seen for epistaxis and 1,897,012 matched controls. Moderate temperature zones were associated with lower odds of epistaxis compared with the hottest and coldest zones. Humidity was associated inversely with epistaxis rates in moderate temperature zones but was not a significant predictor of epistaxis in climates with extreme heat. Additionally, summer was associated with lower odds of epistaxis compared to winter. Interestingly, however, there were significantly higher rates of cautery procedures during summer months, driven largely by increased procedures performed in clinic, as opposed to the operating room or emergency room. CONCLUSIONS Environmental risk factors for epistaxis vary by climate zone. The model presented reconciles prior reports and may allow for more personalized clinical management based on regional climate. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1450-1456, 2024.
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Affiliation(s)
- Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Allen Green
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Michael T Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
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Ahdoot S, Baum CR, Cataletto MB, Hogan P, Wu CB, Bernstein A. Climate Change and Children's Health: Building a Healthy Future for Every Child. Pediatrics 2024; 153:e2023065505. [PMID: 38374808 DOI: 10.1542/peds.2023-065505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Observed changes in temperature, precipitation patterns, sea level, and extreme weather are destabilizing major determinants of human health. Children are at higher risk of climate-related health burdens than adults because of their unique behavior patterns; developing organ systems and physiology; greater exposure to air, food, and water contaminants per unit of body weight; and dependence on caregivers. Climate change harms children through numerous pathways, including air pollution, heat exposure, floods and hurricanes, food insecurity and nutrition, changing epidemiology of infections, and mental health harms. As the planet continues to warm, climate change's impacts will worsen, threatening to define the health and welfare of children at every stage of their lives. Children who already bear higher burden of disease because of living in low-wealth households and communities, lack of access to high quality education, and experiencing racism and other forms of unjust discrimination bear greater risk of suffering from climate change hazards. Climate change solutions, advanced through collaborative work of pediatricians, health systems, communities, corporations, and governments lead to immediate gains in child health and equity and build a foundation for generations of children to thrive. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.
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Affiliation(s)
- Samantha Ahdoot
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary Bono Cataletto
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, New York University Long Island School of Medicine, Mineola, New York
| | - Patrick Hogan
- Pediatric Residency Program, Oregon Health & Science University, Portland, Oregon
| | - Christina B Wu
- O'Neill Center for Global and National Health Law, Georgetown University Law Center, Washington, District of Columbia
| | - Aaron Bernstein
- Division of General Pediatrics, Boston Children's Hospital, and Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Lakhoo DP, Chersich MF, Jack C, Maimela G, Cissé G, Solarin I, Ebi KL, Chande KS, Dumbura C, Makanga PT, van Aardenne L, Joubert BR, McAllister KA, Ilias M, Makhanya S, Luchters S. Protocol of an individual participant data meta-analysis to quantify the impact of high ambient temperatures on maternal and child health in Africa (HE 2AT IPD). BMJ Open 2024; 14:e077768. [PMID: 38262654 PMCID: PMC10824032 DOI: 10.1136/bmjopen-2023-077768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/13/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Globally, recognition is growing of the harmful impacts of high ambient temperatures (heat) on health in pregnant women and children. There remain, however, major evidence gaps on the extent to which heat increases the risks for adverse health outcomes, and how this varies between settings. Evidence gaps are especially large in Africa. We will conduct an individual participant data (IPD) meta-analysis to quantify the impacts of heat on maternal and child health in sub-Saharan Africa. A detailed understanding and quantification of linkages between heat, and maternal and child health is essential for developing solutions to this critical research and policy area. METHODS AND ANALYSIS We will use IPD from existing, large, longitudinal trial and cohort studies, on pregnant women and children from sub-Saharan Africa. We will systematically identify eligible studies through a mapping review, searching data repositories, and suggestions from experts. IPD will be acquired from data repositories, or through collaboration with data providers. Existing satellite imagery, climate reanalysis data, and station-based weather observations will be used to quantify weather and environmental exposures. IPD will be recoded and harmonised before being linked with climate, environmental, and socioeconomic data by location and time. Adopting a one-stage and two-stage meta-analysis method, analytical models such as time-to-event analysis, generalised additive models, and machine learning approaches will be employed to quantify associations between exposure to heat and adverse maternal and child health outcomes. ETHICS AND DISSEMINATION The study has been approved by ethics committees. There is minimal risk to study participants. Participant privacy is protected through the anonymisation of data for analysis, secure data transfer and restricted access. Findings will be disseminated through conferences, journal publications, related policy and research fora, and data may be shared in accordance with data sharing policies of the National Institutes of Health. PROSPERO REGISTRATION NUMBER CRD42022346068.
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Affiliation(s)
- Darshnika Pemi Lakhoo
- Wits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Chris Jack
- Climate System Analysis Group, University of Cape Town, Rondebosch, South Africa
| | - Gloria Maimela
- Wits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Guéladio Cissé
- University Peleforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Ijeoma Solarin
- Wits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Kshama S Chande
- Wits RHI, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Cherlynn Dumbura
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Prestige Tatenda Makanga
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
- Place Alert Labs, Department of Surveying and Geomatics, Faculty of the Built Environment, Midlands State University, Gweru, Zimbabwe
| | - Lisa van Aardenne
- Climate System Analysis Group, University of Cape Town, Rondebosch, South Africa
| | - Bonnie R Joubert
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, North Carolina, USA
| | - Kimberly A McAllister
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, North Carolina, USA
| | - Maliha Ilias
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | | | - Stanley Luchters
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Public Health and Primary Care, Ghent Unviersity, Ghent, Belgium
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Politis MD, Gutiérrez-Avila I, Just A, Pizano-Zárate ML, Tamayo-Ortiz M, Greenberg JH, Téllez-Rojo MM, Sanders AP, Rosa MJ. Recent ambient temperature and fine particulate matter (PM 2.5) exposure is associated with urinary kidney injury biomarkers in children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 907:168119. [PMID: 37884142 PMCID: PMC10842020 DOI: 10.1016/j.scitotenv.2023.168119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Limited research has examined associations between exposure to ambient temperature, air pollution, and kidney function or injury during the preadolescent period. We examined associations between exposure to ambient temperature and particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) with preadolescent estimated glomerular filtration rate (eGFR) and urinary kidney injury biomarkers. METHODS Participants included 437 children without cardiovascular or kidney disease enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors birth cohort study in Mexico City. eGFR and urinary kidney injury biomarkers were assessed at 8-12 years. Validated satellite-based spatio-temporal models were used to estimate mean daily temperature and PM2.5 levels at each participant's residence 7- and 30-days prior to the date of visit. Linear regression and distributed lag nonlinear models (DLNM) were used to examine associations between daily mean temperature and PM2.5 exposure and kidney outcomes, adjusted for covariates. RESULTS In single linear regressions, higher seven-day average PM2.5 was associated with higher urinary alpha-1-microglobulin and eGFR. In DLNM analyses, higher temperature exposure in the seven days prior to date of visit was associated with a decrease in urinary cystatin C of -0.56 ng/mL (95 % confidence interval (CI): -1.08, -0.04) and in osteopontin of -0.08 ng/mL (95 % CI: -0.15, -0.001). PM2.5 exposure over the seven days prior to date of visit was associated with an increase in eGFR of 1.77 mL/min/1.73m2 (95 % CI: 0.55, 2.99) and urinary cystatin C of 0.19 ng/mL (95 % CI: 0.03, 0.35). CONCLUSIONS Recent exposure to ambient temperature and PM2.5 were associated with increased and decreased urinary kidney injury biomarkers that may reflect subclinical glomerular or tubular injury in children. Further research is required to assess environmental exposures and worsening subclinical kidney injury across development.
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Affiliation(s)
- Maria D Politis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Iván Gutiérrez-Avila
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Epidemiology and Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI, United States
| | - María Luisa Pizano-Zárate
- Nutrition and Bioprogramming Coordination, National Institute of Perinatology, Mexico City, Mexico; UMF 4, South Delegation of the Federal District, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Social Security Institute, Mexico City, Mexico; Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, United States
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alison P Sanders
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria José Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Kim HHR, Leschied JR, Noda SM, Sarma A, Pruthi S, Iyer RS. Planetary health: an imperative for pediatric radiology. Pediatr Radiol 2024; 54:20-26. [PMID: 37962606 DOI: 10.1007/s00247-023-05807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.
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Affiliation(s)
- Helen H R Kim
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Jessica R Leschied
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sakura M Noda
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Asha Sarma
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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11
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Wallenberg N, Lindberg F, Thorsson S, Jungmalm J, Fröberg A, Raustorp A, Rayner D. The effects of warm weather on children's outdoor heat stress and physical activity in a preschool yard in Gothenburg, Sweden. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:1927-1940. [PMID: 37726553 PMCID: PMC10643434 DOI: 10.1007/s00484-023-02551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/29/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
Hot weather conditions can have negative impacts on the thermal comfort and physical activity of vulnerable groups such as children. The aim of this study is to analyze the effects of warm weather on 5-year-old children's thermal comfort and physical activity in a preschool yard in Gothenburg, Sweden. In situ measurements were conducted for 1-1.5 h in the early afternoon on 8 days in May, June, and August of 2022. The thermal comfort and physical activity was estimated with GPS-tracks, heart rate monitors, and step counts and compared to observed weather conditions. Results show that physical activity decreases under warmer weather conditions, depicted by a decrease in distance moved, step counts, and highest registered pulse. Moreover, on warm days, the children avoid sunlit areas. For 50% or more of the time spent in sunlit areas, the children are exposed to cautious levels of heat. In shaded areas, on the other hand, the children are less exposed, with five out of 8 days having 50% or more of the time at neutral levels. The study demonstrates the importance of access to shaded areas in preschool yards where children can continue their active play while simultaneously maintaining a safe thermal status.
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Affiliation(s)
- Nils Wallenberg
- Department of Earth Sciences, University of Gothenburg, Gothenburg, Sweden.
| | - Fredrik Lindberg
- Department of Earth Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Thorsson
- Department of Earth Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Jungmalm
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fröberg
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Anders Raustorp
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - David Rayner
- Swedish National Data Service, University of Gothenburg, Gothenburg, Sweden
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12
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Xin X, Hu X, Zhai L, Jia J, Pan B, Han Y, Jiang F. The effect of ambient temperature on hand, foot and mouth disease in Qingdao, China, 2014-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1081-1090. [PMID: 35510292 DOI: 10.1080/09603123.2022.2072818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/27/2022] [Indexed: 06/14/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a kind of infection gastrointestinal disease. The present study aims to explore the association between ambient temperature and HFMD in Qingdao. A distributed lag nonlinear model with Poisson distribution was adopted to explore the effects of daily mean temperature on HFMD incidence. Our results found that the high temperature had acute and short-term effects and then declined rapidly along the lag days, with the maximum risk occurring 0 day of exposure. Compared with low temperature, higher effects were observed for high-temperature exposure. Overall, we found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate "J" shape, with peak value occurring at 30.5℃ (RR = 2.208, 95% CI: 1.995-2.444). Our findings suggest that ambient temperature is significantly associated with the incidence of HFMD in Qingdao. Monitoring ambient temperature changes is an appropriate recommendation to prevent HFMD.
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Affiliation(s)
- Xueling Xin
- Department of Acute Infectious Diseases, Qingdao Municipal Centre of Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Xiaowen Hu
- Department of Acute Infectious Diseases, Qingdao Municipal Centre of Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Long Zhai
- Department of Occupational Health, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Jing Jia
- Department of Acute Infectious Diseases, Qingdao Municipal Centre of Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Bei Pan
- Department of Acute Infectious Diseases, Qingdao Municipal Centre of Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Yalin Han
- Department of Acute Infectious Diseases, Qingdao Municipal Centre of Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Fachun Jiang
- Department of Acute Infectious Diseases, Qingdao Municipal Centre of Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
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13
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Requia WJ, Alahmad B, Schwartz JD, Koutrakis P. Association of low and high ambient temperature with mortality for cardiorespiratory diseases in Brazil. ENVIRONMENTAL RESEARCH 2023; 234:116532. [PMID: 37394170 DOI: 10.1016/j.envres.2023.116532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023]
Abstract
Extreme temperatures are a major public health concern, as they have been linked to an increased risk of mortality from circulatory and respiratory diseases. Brazil, a country with vast geographic and climatic variations, is particularly vulnerable to the health impacts of extreme temperatures. In this study, we examined the nationwide (considering 5572 municipalities) association of low and high ambient temperature (1st and 99th percentiles) with daily mortality for circulatory and respiratory diseases in Brazil between 2003 and 2017. We used an extension of the two-stage time-series design. First, we applied a case time series design in combination with distributed lag non-linear modeling (DLMN) framework to assess the association by Brazilian region. Here, the analyses were stratified by sex, age group (15-45, 46-65, and >65 years), and cause of death (respiratory and circulatory mortality). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our study population included 1,071,090 death records due to cardiorespiratory diseases in Brazil over the study period. We found increased risk of respiratory and circulatory mortality associated with low and high ambient temperatures. The pooled national results for the whole population (all ages and sex) suggest a relative risk (RR) of 1.27 (95% CI: 1.16; 1.37) and 1.11 (95% CI: 1.01; 1.21) associated with circulatory mortality during cold and heat exposure, respectively. For respiratory mortality, we estimated a RR of 1.16 (95% CI: 1.08; 1.25) during cold exposure and a RR of 1.14 (95% CI: 0.99; 1.28) during heat exposure. The national meta-analysis indicated robust positive associations for circulatory mortality on cold days across several subgroups by sex and age, while only a few subgroups presented robust positive associations for circulatory mortality on warm days and respiratory mortality on both cold and warm days. These findings have important public health implications for Brazil and suggest the need for targeted interventions to mitigate the adverse effects of extreme temperatures on human health.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas Brasília, Brazil.
| | - Barrak Alahmad
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States; Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Joel D Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States
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14
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Hou Y, Cao B, Zhu Y, Zhang H, Yang L, Duanmu L, Lian Z, Zhang Y, Zhai Y, Wang Z, Zhou X, Xie J. Temporal and spatial heterogeneity of indoor and outdoor temperatures and their relationship with thermal sensation from a global perspective. ENVIRONMENT INTERNATIONAL 2023; 179:108174. [PMID: 37660634 DOI: 10.1016/j.envint.2023.108174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
People spend most of their time indoors. However, indoor temperature and individual thermal exposure are generally not considered in epidemiological studies of temperature and health. Based on the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) RP-884 Database, the ASHRAE Global Thermal Comfort Database II and the Chinese Thermal Comfort Database, this study first explored the relationship between outdoor temperature, indoor temperature and thermal sensation from a global perspective. Moreover, the potential influence of spatiotemporal heterogeneity on health studies was explored. A breakpoint was found at approximately 11.5 °C in the segmented regression of indoor and outdoor temperature, and the slope of the curve was greater when outdoor temperature was above the breakpoint (n = 67,896). Based on multi-group propensity score matching (PSM) and generalizedadditivemodels (GAM), spatiotemporal heterogeneity was found in the relationship between indoor and outdoor temperatures after adjusting for building type and year. Furthermore, the relationship between indoor temperature and thermal sensation was influenced by the outdoor temperature. This study highlights the importance of considering indoor temperature or individual thermal exposure in temperature-related health studies.
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Affiliation(s)
- Yuchen Hou
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China; Key Laboratory of Eco Planning & Green Building, Ministry of Education (Tsinghua University), Beijing, China
| | - Bin Cao
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China; Key Laboratory of Eco Planning & Green Building, Ministry of Education (Tsinghua University), Beijing, China.
| | - Yingxin Zhu
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control (Tsinghua University), Beijing, China
| | - Hui Zhang
- Center for the Built Environment, University of California, Berkeley, USA
| | - Liu Yang
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an, China
| | - Lin Duanmu
- School of Civil Engineering, Dalian University of Technology, Dalian, China
| | - Zhiwei Lian
- Department of Architecture, School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Yufeng Zhang
- School of Architecture, South China University of Technology, Guangzhou, China
| | - Yongchao Zhai
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an, China
| | - Zhaojun Wang
- School of Architecture, Harbin Institute of Technology, Harbin, China
| | - Xiang Zhou
- School of Mechanical Engineering, Tongji University, Shanghai, China
| | - Jingchao Xie
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
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15
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Nguyen CV, Nguyen MH, Nguyen TT. The impact of cold waves and heat waves on mortality: Evidence from a lower middle-income country. HEALTH ECONOMICS 2023; 32:1220-1243. [PMID: 36810920 DOI: 10.1002/hec.4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 05/04/2023]
Abstract
We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people and those living in the hot regions in Southern Vietnam. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios.
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Affiliation(s)
- Cuong Viet Nguyen
- International School, Vietnam National University, Hanoi, Vietnam
- Mekong Development Research Institute (MDRI), Hanoi, Vietnam
| | - Manh-Hung Nguyen
- Toulouse School of Economics, INRAE, University of Toulouse Capitole, Toulouse, France
| | - Toan Truong Nguyen
- Crawford School of Public Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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16
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Arisco NJ, Sewe MO, Bärnighausen T, Sié A, Zabre P, Bunker A. The effect of extreme temperature and precipitation on cause-specific deaths in rural Burkina Faso: a longitudinal study. Lancet Planet Health 2023; 7:e478-e489. [PMID: 37286245 DOI: 10.1016/s2542-5196(23)00027-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso. METHODS In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area. FINDINGS Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]). INTERPRETATION Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. FUNDING Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation.
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Affiliation(s)
- Nicholas J Arisco
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Maquins O Sewe
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
| | - Till Bärnighausen
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute (AHRI), Somkhele, KwaZulu-Natal, South Africa; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Institut National de Santé Publique, Nouna, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Institut National de Santé Publique, Nouna, Burkina Faso
| | - Aditi Bunker
- Center for Climate, Health and the Global Environment, Harvard T H Chan School of Public Health, Boston, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
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17
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Jibhakate SM, Gehlot LK, Timbadiya PV, Patel PL. Spatiotemporal variability of extreme temperature indices and their implications over the heterogeneous river basin, India. ENVIRONMENTAL MONITORING AND ASSESSMENT 2023; 195:664. [PMID: 37171502 DOI: 10.1007/s10661-023-11196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/01/2023] [Indexed: 05/13/2023]
Abstract
The current study on spatiotemporal variability of temperature presents a holistic approach for quantifying the joint space-time variability of extreme temperature indices over the physio-climatically heterogeneous Tapi River basin (TRB) using two unsupervised machine learning algorithms, i.e., principal component analysis (PCA) and cluster analysis. The long-term variability in extreme temperature indices, recommended by the Expert Team on Climate Change Detection and Indices (ETCCDI), was evaluated for 1951-2016. The magnitude and statistical significance of the temporal trend in extreme temperature indices were estimated using non-parametric Sen's slope estimator and modified Mann Kendall (MMK) tests, respectively. The multivariate assessment of temporal trends using PCA resulted in four principal components (PCs) encapsulating more than 90% variability. The cluster analysis of corresponding PCs resulted in two spatial clusters exhibiting homogeneous spatiotemporal variability. Cluster 1 is characterized by significantly increasing hottest, very hot, and extremely hot days with rising average maximum temperature and intraday temperature variability. On the other hand, cluster 2 showed significantly rising coldest nights, mean minimum, mean temperature, and Tx37 with significantly decreasing intraday and interannual temperature variability, very cold, and extremely cold nights with reducing cold spell durations. The summertime heat stress computation revealed that the Purna sub-catchment of the Tapi basin is more vulnerable to various health issues and decreased work performance (> 10%) for more than 45 days per year. The current study dealing with the associated effects of rising temperature variability on crop yield, human health, and work performance would help policymakers formulate better planning and management strategies to safeguard society and the environment.
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Affiliation(s)
- Shubham M Jibhakate
- Department of Civil Engineering, Sardar Vallabhbhai National Institute of Technology Surat, Surat, Gujarat, 395007, India
| | - Lalit Kumar Gehlot
- Department of Civil Engineering, Sardar Vallabhbhai National Institute of Technology Surat, Surat, Gujarat, 395007, India
| | - P V Timbadiya
- Department of Civil Engineering, Sardar Vallabhbhai National Institute of Technology Surat, Surat, Gujarat, 395007, India.
| | - P L Patel
- Department of Civil Engineering, Sardar Vallabhbhai National Institute of Technology Surat, Surat, Gujarat, 395007, India
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18
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Gunasekara TDKSC, De Silva PMCS, Chandana EPS, Jayasinghe S, Herath C, Siribaddana S, Jayasundara N. Environmental heat exposure and implications on renal health of pediatric communities in the dry climatic zone of Sri Lanka: An approach with urinary biomarkers. ENVIRONMENTAL RESEARCH 2023; 222:115399. [PMID: 36736552 DOI: 10.1016/j.envres.2023.115399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Prolonged heat exposure during outdoor physical exertion can result in adverse renal health outcomes, and it is also supposed to be a driver of chronic kidney disease of uncertain etiology (CKDu) in tropical regions. School students are more likely to experience high heat exposure during outdoor sports practices, and the current knowledge on potential renal health outcomes associated with heat exposure carries many knowledge gaps. Hence, the present study aimed to perform biomarker-based assessment of the likelihood of pediatric renal injury focusing the communities in the dry climatic zone in Sri Lanka, where it prevails relatively harsh climate and high prevalence of CKDu. School students who engaged in regular outdoor sports practices (high-heat exposure), and an age-matched control of students who did not engage in sports practices (low-heat exposure) from four educational zones: Padavi Sripura (N = 159) and Medirigiriya (N = 171), Uhana (N = 165) and Thanamalwila (N = 169) participated in this cross-sectional study representing CKDu endemic and non-endemic regions. Effective temperature (ET), wet-bulb globe temperature (WBGT), heat index (HI) and humidex were used for comparison of thermal comfort in the environment. The intensity of environmental heat measured by thermal comfort indices showed no significant difference (p > 0.05) among the study regions. Urinary kidney injury molecule (KIM-1) and albumin-creatinine ratio (ACR) in participants with high heat exposure did not differ significantly from those in the control groups in the four study zones, where urinary neutrophil gelatinase-associated lipocalin showed substantial differences in some groups. Irrespective of heat exposure, increased KIM-1 excretion was observed (p < 0.01) in participants of CKDu endemic regions compared to those in non-endemic areas. Within the context of our findings, there is no plausibly strong evidence to establish potential association of heat exposure with the likelihood of developing renal injury or abnormal renal outcomes in dry zone school students in Sri Lanka.
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Affiliation(s)
- T D K S C Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka
| | - P Mangala C S De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka.
| | - E P S Chandana
- Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara, 81000, Sri Lanka
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, 10100, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medical & Allied Sciences, Rajarata University, Saliyapura, 50008, Sri Lanka
| | - Nishad Jayasundara
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
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19
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Franklin RC, Mason HM, King JC, Peden AE, Nairn J, Miller L, Watt K, FitzGerald G. Heatwaves and mortality in Queensland 2010-2019: implications for a homogenous state-wide approach. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:503-515. [PMID: 36735072 PMCID: PMC9974727 DOI: 10.1007/s00484-023-02430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/10/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
Heatwaves are a significant cause of adverse health outcomes and mortality in Australia, worsening with climate change. In Queensland, the northeastern-most state, little is known about the impact of heatwaves outside of the capital city of Brisbane. This study aims to explore the impact of heatwaves on mortality across various demographic and environmental conditions within Queensland from 2010 to 2019. The Excess Heat Factor was used to indicate heatwave periods at the Statistical Area 2 (SA2) level. Registered deaths data from the Australian Bureau of Statistics and heatwave data from the Bureau of Meteorology were matched using a case-crossover approach. Relative risk and 95% confidence intervals were calculated across years, regions, age, sex, rurality, socioeconomic status, and cause of death. Heatwaves were associated with a 5% increase in all-cause mortality compared to deaths on non-heatwave days, with variability across the state. The risk of death on a heatwave day versus a non-heatwave day varied by heatwave severity. Individuals living in urban centers, the elderly, and those living in regions of lower socioeconomic status were most impacted by heatwave mortality. The relative risk of dying from neoplasms, nervous system conditions, respiratory conditions, and mental and behavioral conditions increased during heatwaves. As heatwaves increase in Queensland due to climate change, understanding the impact of heatwaves on mortality across Queensland is important to tailor public health messages. There is considerable variability across communities, demographic groups, and medical conditions, and as such messages need to be tailored to risk.
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Affiliation(s)
- Richard C Franklin
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia.
| | - Hannah M Mason
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia
| | - Jemma C King
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia
| | - Amy E Peden
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - John Nairn
- School of Biological Sciences, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, SA, Australia
| | - Lauren Miller
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia
| | - Kerrianne Watt
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia
- Information Support, Research & Evaluation, Queensland Ambulance Service, Brisbane, QLD, Australia
| | - Gerard FitzGerald
- Discipline of Public Health and Tropical Medicine, CPHMVS, James Cook University, Townsville, QLD, 4811, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Sydney, NSW, Australia
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20
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Stowell JD, Sun Y, Spangler KR, Milando CW, Bernstein A, Weinberger KR, Sun S, Wellenius GA. Warm-season temperatures and emergency department visits among children with health insurance. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2023; 1:015002. [PMID: 36337257 PMCID: PMC9623446 DOI: 10.1088/2752-5309/ac78fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023]
Abstract
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Affiliation(s)
- Jennifer D Stowell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Keith R Spangler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Aaron Bernstein
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Kate R Weinberger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
- Optum Labs Visiting Scholar, Eden Prairie, MN, United States of America
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21
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Iungman T, Cirach M, Marando F, Pereira Barboza E, Khomenko S, Masselot P, Quijal-Zamorano M, Mueller N, Gasparrini A, Urquiza J, Heris M, Thondoo M, Nieuwenhuijsen M. Cooling cities through urban green infrastructure: a health impact assessment of European cities. Lancet 2023; 401:577-589. [PMID: 36736334 DOI: 10.1016/s0140-6736(22)02585-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND High ambient temperatures are associated with many health effects, including premature mortality. The combination of global warming due to climate change and the expansion of the global built environment mean that the intensification of urban heat islands (UHIs) is expected, accompanied by adverse effects on population health. Urban green infrastructure can reduce local temperatures. We aimed to estimate the mortality burden that could be attributed to UHIs and the mortality burden that would be prevented by increasing urban tree coverage in 93 European cities. METHODS We did a quantitative health impact assessment for summer (June 1-Aug 31), 2015, of the effect of UHIs on all-cause mortality for adults aged 20 years or older in 93 European cities. We also estimated the temperature reductions that would result from increasing tree coverage to 30% for each city and estimated the number of deaths that could be potentially prevented as a result. We did all analyses at a high-resolution grid-cell level (250 × 250 m). We propagated uncertainties in input analyses by using Monte Carlo simulations to obtain point estimates and 95% CIs. We also did sensitivity analyses to test the robustness of our estimates. FINDINGS The population-weighted mean city temperature increase due to UHI effects was 1·5°C (SD 0·5; range 0·5-3·0). Overall, 6700 (95% CI 5254-8162) premature deaths could be attributable to the effects of UHIs (corresponding to around 4·33% [95% CI 3·37-5·28] of all summer deaths). We estimated that increasing tree coverage to 30% would cool cities by a mean of 0·4°C (SD 0·2; range 0·0-1·3). We also estimated that 2644 (95% CI 2444-2824) premature deaths could be prevented by increasing city tree coverage to 30%, corresponding to 1·84% (1·69-1·97) of all summer deaths. INTERPRETATION Our results showed the deleterious effects of UHIs on mortality and highlighted the health benefits of increasing tree coverage to cool urban environments, which would also result in more sustainable and climate-resilient cities. FUNDING GoGreenRoutes, Spanish Ministry of Science and Innovation, Institute for Global Health, UK Medical Research Council, European Union's Horizon 2020 Project Exhaustion.
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Affiliation(s)
- Tamara Iungman
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marta Cirach
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Evelise Pereira Barboza
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sasha Khomenko
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Marcos Quijal-Zamorano
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Natalie Mueller
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - José Urquiza
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mehdi Heris
- Hunter College, City University of New York, New York, NY, USA
| | - Meelan Thondoo
- Institute for Global Health, Barcelona, Spain; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Mark Nieuwenhuijsen
- Institute for Global Health, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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22
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Phung VLH, Oka K, Honda Y, Hijioka Y, Ueda K, Seposo XT, Sahani M, Wan Mahiyuddin WR, Kim Y. Daily temperature effects on under-five mortality in a tropical climate country and the role of local characteristics. ENVIRONMENTAL RESEARCH 2023; 218:114988. [PMID: 36463996 DOI: 10.1016/j.envres.2022.114988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Climate change and its subsequent effects on temperature have raised global public health concerns. Although numerous epidemiological studies have shown the adverse health effects of temperature, the association remains unclear for children aged below five years old and those in tropical climate regions. METHODS We conducted a two-stage time-stratified case-crossover study to examine the association between temperature and under-five mortality, spanning the period from 2014 to 2018 across all six regions in Malaysia. In the first stage, we estimated region-specific temperature-mortality associations using a conditional Poisson regression and distributed lag nonlinear models. We used a multivariate meta-regression model to pool the region-specific estimates and examine the potential role of local characteristics in the association, which includes geographical information, demographics, socioeconomic status, long-term temperature metrics, and healthcare access by region. RESULTS Temperature in Malaysia ranged from 22 °C to 31 °C, with a mean of 27.6 °C. No clear seasonality was observed in under-five mortality. We found no strong evidence of the association between temperature and under-five mortality, with an "M-" shaped exposure-response curve. The minimum mortality temperature (MMT) was identified at 27.1 °C. Among several local characteristics, only education level and hospital bed rates reduced the residual heterogeneity in the association. However, effect modification by these variables were not significant. CONCLUSION This study suggests a null association between temperature and under-five mortality in Malaysia, which has a tropical climate. The "M-" shaped pattern suggests that under-fives may be vulnerable to temperature changes, even with a small temperature change in reference to the MMT. However, the weak risks with a large uncertainty at extreme temperatures remained inconclusive. Potential roles of education level and hospital bed rate were statistically inconclusive.
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Affiliation(s)
- Vera Ling Hui Phung
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Kyoto, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Kyoto, Japan
| | - Xerxes Tesoro Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mazrura Sahani
- Center for Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Center, Institute for Medical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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23
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Williams PCM, Beardsley J, Isaacs D, Preisz A, Marais BJ. The impact of climate change and biodiversity loss on the health of children: An ethical perspective. Front Public Health 2023; 10:1048317. [PMID: 36743159 PMCID: PMC9895790 DOI: 10.3389/fpubh.2022.1048317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 01/22/2023] Open
Abstract
The reality of human induced climate change is no longer in doubt, but the concerted global action required to address this existential crisis remains inexcusably inert. Together with climate change, biodiversity collapse is increasingly driving the emergence and spread of infectious diseases, the consequences of which are inequitable globally. Climate change is regressive in its nature, with those least responsible for destroying planetary health at greatest risk of suffering the direct and indirect health consequences. Over half a billion of the world's children live in areas vulnerable to extreme weather events. Without immediate action, the health of today's children and future generations will be compromised. We consider the impact of biodiversity collapse on the spread of infectious diseases and outline a duty of care along a continuum of three dimensions of medical ethics. From a medical perspective, the first dimension requires doctors to serve the best interests of their individual patients. The second dimension considers the public health dimension with a focus on disease control and cost-effectiveness. The neglected third dimension considers our mutual obligation to the future health and wellbeing of children and generations to come. Given the adverse impact of our ecological footprint on current and future human health, we have a collective moral obligation to act.
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Affiliation(s)
- Phoebe C. M. Williams
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Darlington, NSW, Australia
- School of Women and Children's Health, The University of NSW School of Women's and Children's Health, Sydney, NSW, Australia
| | - Justin Beardsley
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Darlington, NSW, Australia
| | - David Isaacs
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Anne Preisz
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Ben J. Marais
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Darlington, NSW, Australia
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
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24
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Lu L, Zhao S, Chen Y. Air pollution and timing of childbirth: a retrospective survey analysis based on birth registration data of Chinese newborns. Front Public Health 2023; 11:1032852. [PMID: 37206867 PMCID: PMC10189152 DOI: 10.3389/fpubh.2023.1032852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/07/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives Currently, there is a lack of research on whether people will take action to avoid the harm of air pollution and the heterogeneous behavior of different groups. The goal of this paper is to examine the effects of air pollution on the resulting differential effects on newborns and the timing of pregnancy. Methods Based on a survey of newborns in a total of 32 hospitals in 12 cities across China in 2011, and after matching with city-level air pollution data, a multiple regression statistical method is then used to examine how the pollution level in a certain period is related to the number of conceptions in that certain period, after controlling for region and season fixed effects. Results We first demonstrate that exposure to air pollution during pregnancy is associated with a significant increase in adverse birth outcomes. Most importantly, the empirical results show that the number of conceptions decreased significantly during periods of severe air pollution. Conclusion Evidence suggests that air pollution may be causing some families to delay conception to reduce the possible adverse impact on neonatal outcomes. This helps us to understand the social cost of air pollution more, and then make more accurate environmental policies.
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Affiliation(s)
- Liqi Lu
- School of Economics, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, Henan Province, China
- *Correspondence: Yuxiao Chen,
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25
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Cherian NC, Subasinghe C. Sun-Safe Zones: Investigating Integrated Shading Strategies for Children's Play Areas in Urban Parks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:114. [PMID: 36612436 PMCID: PMC9819332 DOI: 10.3390/ijerph20010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Although Open Space Ratio is a critical control in the Development Approval process, there are no ultraviolet radiation (UVR) protection guidelines for urban parks. This study explores key strategies for shade provision in children's play areas in urban parks, aiming to promote sun-safe play environments against alarming skin cancer trends. The literature review identified primary issues affecting UVR exposure in public venues, and the research comprises a shade audit of Beaton Park in Dalkeith. The methods involved using virtual park modeling and Shadow Analysis simulations to generate the daily average number of hours in shade for each month. Our recommendations based on this analysis are (a) a minimum canopy cover representing 50% of the entire ground cover; (b) a minimum diameter for a shade (umbrella) of about 2.5 times the diameter of the table; and (c) an ideal umbrella height of 90 cm from the table surface. This research proposes a potential nexus between landscape design and a UVR protection framework for child-friendly Sun-safe Zones (SsZ).
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26
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Kanti FS, Alari A, Chaix B, Benmarhnia T. Comparison of various heat waves definitions and the burden of heat-related mortality in France: Implications for existing early warning systems. ENVIRONMENTAL RESEARCH 2022; 215:114359. [PMID: 36152888 DOI: 10.1016/j.envres.2022.114359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France. METHODS Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015. RESULTS The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval "CI": [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types. CONCLUSION Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.
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Affiliation(s)
- Fleur Serge Kanti
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France.
| | - Anna Alari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography University of California, San Diego, La Jolla, San Diego, CA, USA
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27
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Sy I, Cissé B, Ndao B, Touré M, Diouf AA, Sarr MA, Ndiaye O, Ndiaye Y, Badiane D, Lalou R, Janicot S, Ndione JA. Heat waves and health risks in the northern part of Senegal: analysing the distribution of temperature-related diseases and associated risk factors. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:83365-83377. [PMID: 35763140 DOI: 10.1007/s11356-022-21205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
The Sahelian zone of Senegal experienced heat waves in the previous decades, such as 2013, 2016 and 2018 that were characterised by temperatures exceeding 45°C for up to 3 successive days. The health impacts of these heat waves are not yet analysed in Senegal although their negative effects have been shown in many countries. This study analyses the health impacts of observed extreme temperatures in the Sahelian zone of the country, focusing on morbidity and mortality by combining data from station observation, climate model projections, and household survey to investigate heat wave detection, occurrence of climate-sensitive diseases and risk factors for exposure. To do this, a set of climatic (temperatures) and health (morbidity, mortality) data were collected for the months of April, May and June from 2009 to 2019. These data have been completed with 1246 households' surveys on risk factor exposure. Statistical methods were used to carry out univariate and bivariate analyses while cartographic techniques allowed mapping of the main climatic and health indicators. The results show an increase in temperatures compared to seasonal normal for the 1971-2000 reference period with threshold exceedances of the 90th percentiles (42°C) for the maxima and (27°C) the minima and higher temperatures during the months of May and June. From health perspective, it was noted an increase in cases of consultation in health facilities as well as a rise in declared morbidity by households especially in the departments of Kanel (17.7%), Ranérou (16.1 %), Matam (13.7%) and Bakel (13.7%). The heat waves of May 2013 were also associated with cases of death with a reported mortality (observed by medical staff) of 12.4% unequally distributed according to the departments with a higher number of deaths in Matam (25, 2%) and in Bakel (23.5%) than in Podor (8.4%) and Kanel (0.8%). The morbidity and mortality distribution according to gender shows that women (57%) were more affected than men (43%). These health risks have been associated with a number of factors including age, access to drinkable water, type of fuel, type of housing and construction materials, existence of fan and an air conditioner, and health history.The heat wave recurrence has led to a frequency in certain diseases sensitive to rising temperatures, which is increasingly a public health issue in the Sahelian zone of Senegal.
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Affiliation(s)
- Ibrahima Sy
- Centre de Suivi Ecologique (CSE), Dakar, Fann, Senegal.
- Université Cheikh Anta Diop (UCAD), BP 5005, Dakar, Senegal.
| | - Birane Cissé
- Centre de Suivi Ecologique (CSE), Dakar, Fann, Senegal
- Université Cheikh Anta Diop (UCAD), BP 5005, Dakar, Senegal
| | - Babacar Ndao
- Centre de Suivi Ecologique (CSE), Dakar, Fann, Senegal
| | - Mory Touré
- Ecole Supérieure Polytechnique (ESP), Université Cheikh Anta Diop (UCAD), BP 5005, Dakar, Senegal
| | | | | | - Ousmane Ndiaye
- Agence National de l'Aviation Civile et de la Meteorologie (ANACIM), Dakar, Senegal
| | - Youssoupha Ndiaye
- Direction de la Planification, de la Recherche et des Statistiques (DPRS), Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Daouda Badiane
- Ecole Supérieure Polytechnique (ESP), Université Cheikh Anta Diop (UCAD), BP 5005, Dakar, Senegal
| | - Richard Lalou
- Institut de Recherche pour le Développement (IRD), Paris, France
| | - Serge Janicot
- Institut de Recherche pour le Développement (IRD), Paris, France
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28
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Hossain B, Shi G, Ajiang C, Sarker MNI, Sohel MS, Sun Z, Hamza A. Impact of climate change on human health: evidence from riverine island dwellers of Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:2359-2375. [PMID: 34374325 DOI: 10.1080/09603123.2021.1964447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers' health issues.
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Affiliation(s)
- Babul Hossain
- Research Center for Environment and Society, Hohai University, Nanjing, China
| | - Guoqing Shi
- Asian Research Center of Hohai University, Nanjing, China
| | - Chen Ajiang
- Research Center for Environment and Society, Hohai University, Nanjing, China
| | - Md Nazirul Islam Sarker
- School of Political Science and Public Administration, Neijiang Normal University, Neijiang, China
| | | | - Zhonggen Sun
- School of Public Administration, Hohai University, Nanjing, China
| | - Amir Hamza
- Department Sociology, School of Public Administration, Hohai University, Nanjing, China
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29
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Phung VLH, Oka K, Hijioka Y, Ueda K, Sahani M, Wan Mahiyuddin WR. Environmental variable importance for under-five mortality in Malaysia: A random forest approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 845:157312. [PMID: 35839873 DOI: 10.1016/j.scitotenv.2022.157312] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Environmental factors have been associated with adverse health effects in epidemiological studies. The main exposure variable is usually determined via prior knowledge or statistical methods. It may be challenging when evidence is scarce to support prior knowledge, or to address collinearity issues using statistical methods. This study aimed to investigate the importance level of environmental variables for the under-five mortality in Malaysia via random forest approach. METHOD We applied a conditional permutation importance via a random forest (CPI-RF) approach to evaluate the relative importance of the weather- and air pollution-related environmental factors on daily under-five mortality in Malaysia. This study spanned from January 1, 2014 to December 31, 2016. In data preparation, deviation mortality counts were derived through a generalized additive model, adjusting for long-term trend and seasonality. Analyses were conducted considering mortality causes (all-cause, natural-cause, or external-cause) and data structures (continuous, categorical, or all types [i.e., include all variables of continuous type and all variables of categorical type]). The main analysis comprised of two stages. In Stage 1, Boruta selection was applied for preliminary screening to remove highly unimportant variables. In Stage 2, the retained variables from Boruta were used in the CPI-RF analysis. The final importance value was obtained as an average value from a 10-fold cross-validation. RESULT Some heat-related variables (maximum temperature, heat wave), temperature variability, and haze-related variables (PM10, PM10-derived haze index, PM10- and fire-derived haze index, fire hotspot) were among the prominent variables associated with under-five mortality in Malaysia. The important variables were consistent for all- and natural-cause mortality and sensitivity analyses. However, different most important variables were observed between natural- and external-cause under-five mortality. CONCLUSION Heat-related variables, temperature variability, and haze-related variables were consistently prominent for all- and natural-cause under-five mortalities, but not for external-cause.
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Affiliation(s)
- Vera Ling Hui Phung
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.
| | - Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Kyoto, Japan; Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Kyoto, Japan
| | - Mazrura Sahani
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Center, Institute for Medical Research, National Institutes of Health (NIH), Ministry of Health, Shah Alam, Selangor, Malaysia
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Jia H, Xu J, Ning L, Feng T, Cao P, Gao S, Shang P, Yu X. Ambient air pollution, temperature and hospital admissions due to respiratory diseases in a cold, industrial city. J Glob Health 2022; 12:04085. [PMID: 36243957 PMCID: PMC9569423 DOI: 10.7189/jogh.12.04085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The influences of air pollution exposure and temperature on respiratory diseases have become major global health concerns. This study investigated the relationship between ambient air pollutant concentrations and temperature in cold industrial cities that have the risk of hospitalization for respiratory diseases. Methods A time-series study was conducted in Changchun, China, from 2015 to 2019 to analyse the number of daily admissions for respiratory diseases, air pollutant concentrations, and meteorological factors. Time-series decomposition was applied to analyse the trend and characteristics of the number of admissions. Generalized additive models and distributed lag nonlinear models were constructed to explore the effects of air pollutant concentrations and temperature on the number of admissions. Results The number of daily admissions showed an increasing trend, and the seasonal fluctuation was obvious, with more daily admissions in winter and spring than in summer and autumn. There were positive and gradually decreasing lag effects of PM10, PM2.5, NO2, and CO concentrations on the number of admissions, whereas O3 showed a J-shaped trend. The results showed that within the 7-day lag period, 0.5°C was the temperature associated with the lowest relative risk of admission due to respiratory disease, and extremely low and high temperatures (<-18°C, >27°C, respectively) increased the risk of hospitalization for respiratory diseases by 8.3% and 12.1%, respectively. Conclusions From 2015 to 2019, respiratory diseases in Changchun showed an increasing trend with obvious seasonality. The increased concentrations of SO2, NO2, CO, PM2.5, O3 and PM10 lead to an increased risk of hospitalization for respiratory diseases, with a significant lag effect. Both extreme heat and cold could lead to increases in the risk of admission due to respiratory disease.
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Affiliation(s)
- Huanhuan Jia
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Jiaying Xu
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Liangwen Ning
- School of Public Administration, Jilin University, Changchun City, Jilin Province, China
| | - Tianyu Feng
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Peng Cao
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Shang Gao
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Panpan Shang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Xihe Yu
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
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Aoun M, Chelala D. Where do you live and what do you do? Two questions that might impact your kidney health. FRONTIERS IN NEPHROLOGY 2022; 2:1011964. [PMID: 37675017 PMCID: PMC10479685 DOI: 10.3389/fneph.2022.1011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 09/08/2023]
Abstract
In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.
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Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Assessing the Impact of Meteorological Conditions on Outpatient Visits for Childhood Respiratory Diseases in Urumqi, China. J Occup Environ Med 2022; 64:e598-e605. [DOI: 10.1097/jom.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hu Y, Cheng J, Liu S, Tan J, Yan C, Yu G, Yin Y, Tong S. Evaluation of climate change adaptation measures for childhood asthma: A systematic review of epidemiological evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 839:156291. [PMID: 35644404 DOI: 10.1016/j.scitotenv.2022.156291] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Global climate change (GCC) is widely accepted as the biggest threat to human health of the 21st century. Children are particularly vulnerable to GCC due to developing organ systems, psychological immaturity, nature of daily activities, and higher level of per-body-unit exposure. There is a rising trend in the disease burden of childhood asthma and allergies in many parts of the world. The associations of CC, air pollution and other environmental exposures with childhood asthma are attracting more research attention, but relatively few studies have focused on CC adaptation measures and childhood asthma. This study aimed to bridge this knowledge gap and conducted the first systematic review on CC adaptation measures and childhood asthma. We searched electronic databases including PubMed, Embase, and Web of Science using a set of MeSH terms and related synonyms, and identified 20 eligible studies included for review. We found that there were a number of adaptation measures proposed for childhood asthma in response to GCC, including vulnerability assessment, improving ventilation and heating, enhancing community education, and developing forecast models and early warning systems. Several randomized controlled trials show that improving ventilation and installing heating in the homes appear to be an effective way to relieve childhood asthma symptoms, especially in winter. However, the effectiveness of most adaptation measures, except for improving ventilation and heating, have not been explored and quantified. Given more extreme weather events (e.g., cold spells and heatwaves) may occur as climate change progresses, this finding may have important implications. Evidently, further research is urgently warranted to evaluate the impacts of CC adaptation measures on childhood asthma. These adaptation measures, if proven to be effective, should be integrated in childhood asthma control and prevention programs as GCC continues.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Chonghuai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
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Tasmin S, Ng CFS, Stickley A, Yasumoto S, Watanabe C. Acute effects of ambient temperature on lung function of a panel of school children living in Dhaka, Bangladesh. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156139. [PMID: 35618122 DOI: 10.1016/j.scitotenv.2022.156139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Short-term exposure to ambient temperature plays a significant role in human health. However, studies examining ambient temperature and lung function are scarce in locations with a tropical environment. To address this research gap, the current study investigated the effects of short-term ambient temperature on lung function in children and seasonal variation in this association in Dhaka, Bangladesh. METHODS The study was conducted in three schools located in three cities inside and around Dhaka. Repeated lung function measurements were obtained from a panel of 315 school children (including 86 asthmatic children) aged 9-16 years in 2013. Linear mixed-effects models adjusted for potential confounders were used to examine the effect of ambient temperature on lung function. RESULTS Short-term exposure to low ambient temperature was associated with a significant decrement in children's lung function. For each 1 °C decrease in daily mean temperature at cumulative lag of the current and previous day, lung function parameter values were -3.02% (95% CI, -1.69 to -4.35) for peak expiratory flow (PEF), and -1.48% (95% CI, -0.75 to -2.22) for forced expiratory volume within 1 s (FEV1). A significant seasonal variation was also observed in these associations, as the estimated adverse effects of decrease in daily mean temperature on lung function measures were primarily evident in winter. DISCUSSION This study suggests that short-term ambient exposure to decrease in temperature adversely affect lung function. A significant seasonal modification in the association between temperature and lung function was also observed for these children living in an environment with a tropical climatic condition as the adverse effect of decrease in ambient temperature was primarily observed in winter than in summer.
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Affiliation(s)
- Saira Tasmin
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA.
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Andrew Stickley
- Stockholm Center on Health and Social Change (Scohost), Södertörn University, 141 89 Huddinge, Sweden
| | - Shinya Yasumoto
- Kinugasa Research Organization, Ritsumeikan University, Japan
| | - Chiho Watanabe
- National Institute of Environmental Sciences, 16-2 Onogawa, Tsukuba 305-8506, Japan
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Lu C, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Qian H, Wang J, Liu W, Sun Y, Norbäck D, Deng Q. Interaction effect of prenatal and postnatal exposure to ambient air pollution and temperature on childhood asthma. ENVIRONMENT INTERNATIONAL 2022; 167:107456. [PMID: 35952466 DOI: 10.1016/j.envint.2022.107456] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although mounting evidence has associated air pollution and environmental temperature with children's health problems, it is unclear whether there is an interaction between these factors on childhood asthma. OBJECTIVES To explore the effects of temperature-pollution interactions during pre- and post-natal periods on asthma among pre-schoolers. METHODS A retrospective cohort study of 39,782 pre-schoolers was performed during 2010-2012, in seven cities in China. Exposure to three temperature indicators (TI) and three critical ambient air pollutants, including particulate matter with aerodynamic diameter ≤ 10 μm (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) as proxies of industrial and vehicular air pollution, was estimated by an inverse distance weighted (IDW) method. Two-level logistical regression analysis was used to examine the association between both pre- and post-natal exposure and childhood asthma in terms of odds ratio (OR) and 95 % confidence interval (CI). RESULTS Asthma prevalence in pre-schoolers at age of 3-6 years (6.9 %) was significantly associated with traffic-related air pollutant (NO2) exposure, with ORs (95 % CI) of 1.17 (1.06, 1.28), 1.19 (1.05-1.34) and 1.16 (1.03-1.31) for an IQR increase in NO2 exposure during lifetime, pregnancy, and entire postnatal period respectively. Furthermore, childhood asthma was positively associated with exposure to increased temperature during lifetime, pregnancy, and entire postnatal period with ORs (95 % CI) = 1.89 (1.66, 2.16), 1.47 (1.34, 1.61), and 1.15 (1.11, 1.18) respectively, while was negatively associated with decreased temperatures. Childhood asthma was positively related with exposure to extreme heat days (EHD) during postnatal period particularly in first year of life respectively with ORs (95 % CI) = 1.23 (1.04, 1.46) and 1.26 (1.07, 1.47), but was not related with extreme cold days (ECD) exposure. A combination of high air pollutant levels and high temperatures significantly increased the risk of asthma during both pre- and post-natal periods. Strikingly, we found a significantly positive interaction of temperature and PM10 or SO2 on asthma risk among boys and younger children. CONCLUSIONS Prenatal and postnatal exposure to ambient air pollution and high temperatures are independently and jointly associated with asthma risk in early childhood.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy & Environment, Southeast University, Nanjing, China
| | - Juan Wang
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Wei Liu
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Qihong Deng
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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Wang N, Cao Y, Chen X, Sun M, Ma L, Dai X, Zhao Y. Evaluation of the growth and nutritional status of preschool children: a pilot study in the cold area of China. J Pediatr Endocrinol Metab 2022; 35:1020-1027. [PMID: 35771737 DOI: 10.1515/jpem-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The growth and development of children is influenced not only by heredity factors but also by environmental factors, including nutrition and temperature. The aim of this study was to evaluate the growth and nutritional status of preschool children in Daxing'anling, the coldest region of China. METHODS A descriptive, cross-sectional survey was performed among preschool children aged 3-6 years by stratified cluster sampling in Daxing'anling. The children's parents completed the questionnaires. Height, body weight and head circumference were measured, and Z scores for weight for height, weight for age, height for age and head circumference for age were evaluated. Anthropometric data were compared with World Health Organization standards and China's growth references. The levels of vitamin A, E and 25-(OH)-D3 in serum were detected by high-performance liquid chromatography. RESULTS A total of 305 children were recruited. The average height of the preschool children was lower than China's growth reference but higher than the WHO standard. More than half of the preschool children ranged from -1 SD to +1 SD. Both the values of weight for height and of weight for age were positive and higher than the WHO standards (p<0.01), with a significant difference between boys and girls (p<0.01). The incidences of stunting, wasting, and underweight were 4.59%, 2.95%, and 2.30%, respectively, although the prevalence of overweight and obesity was high (18.03% and 6.89%, respectively). The rates of vitamin A and D deficiency were 7.54% and 88.85%, respectively. Vitamin A was also positively associated with 25-(OH)-D3. CONCLUSIONS The burden of malnutrition in preschool children exists in cold regions, and a cold climate may be an important factor. Therefore, we should pay attention to the nutrition and physical growth of local preschool children; in particular, vitamin D deficiency should be given high priority, and necessary nutritional interventions should be made.
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Affiliation(s)
- Nan Wang
- Department of Anesthesiology, The Heilongjiang Province Key Lab of Research on Anesthesiology and Critical Care Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Yue Cao
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Xin Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Mengyun Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Lingyu Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Xuezheng Dai
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
| | - Yan Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P.R. China
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Wu Z, Miao C, Li H, Wu S, Gao H, Liu W, Li W, Xu L, Liu G, Zhu Y. The lag-effects of meteorological factors and air pollutants on child respiratory diseases in Fuzhou, China. J Glob Health 2022; 12:11010. [PMID: 35973040 PMCID: PMC9380967 DOI: 10.7189/jogh.12.11010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The effects of meteorological factors and air pollutants on respiratory diseases (RDs) were various in different populations according to the demographic characteristics, and children were considered a vulnerable population. Previous studies were mainly based in cities with serious air pollution. This study aimed to qualify the lag effects of meteorological factors and air pollution on respiratory diseases among children under 18 years old in Fuzhou. Methods Meteorological data, air pollutants concentrations and hospital admission data of Fujian Maternity and Child Health Hospital between 2015 and 2019 were collected. A Distributed Lag Nonlinear Model (DLNM) was used to evaluate the nonlinear and lagged effect of meteorological factors and air pollutants on daily RDs number. A subgroup analysis was also conducted to evaluate the effect on different sex groups and age groups. Results A total number of 796 125 RDs visits was included during the study period. For meteorological factors, lower mean temperature and relative humidity were significantly associated with daily RDs number (peak relative risk (RR) = 1.032 (95% confidence interval (CI) = 1.011-1.053) and 1.021 (95% CI = 1.013-1.029)), while lower wind speed showed a significant association at low range (peak RR = 0.995 (95% CI = 0.992-0.999)). Temperature warming was a significant protective factor for RDs (peak RR = 0.989 (95% CI = 0.986-0.993)). For air pollutants, SO2, NO2, PM10 and PM2.5 were all significantly associated with RDs (peak RR = 1.028 (95% CI = 1.022-1.035), 1.024 (95% CI = 1.013-1.034), 1.036 (95% CI = 1.025-1.047), 1.028 (95% CI = 1.019-1.037)), and the relationship had no threshold. The estimated RR and peak lag day did not change extremely between subgroups. Conclusions The findings provide statistical evidence for the prevention of child RDs. In addition, our findings suggested that even at low concentrations, air pollutants still have negative effects on the respiratory system.
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Affiliation(s)
- Zhengqin Wu
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chong Miao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Haibo Li
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shaowei Wu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Haiyan Gao
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wenjuan Liu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Wei Li
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Libo Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Guanghua Liu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Yibing Zhu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Disease Research, Fuzhou, China
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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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The Effect of High and Low Ambient Temperature on Infant Health: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159109. [PMID: 35897477 PMCID: PMC9331681 DOI: 10.3390/ijerph19159109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023]
Abstract
Children, and particularly infants, have physiological, anatomic, and social factors that increase vulnerability to temperature extremes. We performed a systematic review to explore the association between acute adverse infant outcomes (children 0–1 years) and exposure to high and low ambient temperatures. MEDLINE (Pubmed), Embase, CINAHL Plus, and Global Health were searched alongside the reference lists of key papers. We included published journal papers in English that assessed adverse infant outcomes related to short-term weather-related temperature exposure. Twenty-six studies met our inclusion criteria. Outcomes assessed included: infant mortality (n = 9), sudden infant death syndrome (n = 5), hospital visits or admissions (n = 5), infectious disease outcomes (n = 5), and neonatal conditions such as jaundice (n = 2). Higher temperatures were associated with increased risk of acute infant mortality, hospital admissions, and hand, foot, and mouth disease. Several studies identified low temperature impacts on infant mortality and episodes of respiratory disease. Findings on temperature risks for sudden infant death syndrome were inconsistent. Only five studies were conducted in low- or middle-income countries, and evidence on subpopulations and temperature-sensitive infectious diseases was limited. Public health measures are required to reduce the impacts of heat and cold on infant health.
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Indoor Thermal Comfort and Adaptive Thermal Behaviors of Students in Primary Schools Located in the Humid Subtropical Climate of India. SUSTAINABILITY 2022. [DOI: 10.3390/su14127072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study investigated children’s perceptions and adaptive behaviors related to indoor thermal conditions of classrooms in primary schools with no air-conditioning systems during both summer and winter in Dehradun City, Uttarakhand, India. Responses were collected from 5297 school children aged 6–13 years. During the measurement periods, 100% and 94% of the samples were obtained under conditions outside an 80% thermally acceptable comfort range in winter and summer, respectively. The analysis using receiver operating characteristics suggested that the students had the least sensitivity to the temperature variation for all scales of the thermal sensation vote (TSV). Approximately 95.1% of students were “very satisfied”, “satisfied”, or “slightly satisfied” with the thermal conditions under the condition of “extreme caution” or “danger” of heat risk. In contrast, adaptive thermal behaviors, such as adjusting clothing insulation ensembles, opening or closing classroom windows and doors, and utilizing ceiling fans, were found to be the most affordable options for optimizing indoor thermal comfort. Children’s reports of thermal sensations and thermal satisfaction did not correspond to the actual physical environment. This draws attention to the adequacy of applying widely used methods of TSV-based identification of the thermal comfort range in classrooms for children, especially in hot environments. The findings of this study are expected to serve as an evidence-based reference for local governments and authorities to take appropriate measures to mitigate heat risks for schoolchildren in the future.
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Alnwisi SMM, Chai C, Acharya BK, Qian AM, Zhang S, Zhang Z, Vaughn MG, Xian H, Wang Q, Lin H. Empirical dynamic modeling of the association between ambient PM 2.5 and under-five mortality across 2851 counties in Mainland China, 1999-2012. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 237:113513. [PMID: 35453020 PMCID: PMC9061697 DOI: 10.1016/j.ecoenv.2022.113513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/01/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ambient fine particulate matter (PM2.5) pollution has been associated with mortality from various diseases, however, its association with under-five mortality rate (U5MR) has remained largely unknown. METHODS Based on the U5MR data across 2851 counties in Mainland China from 1999 to 2012, we employed approximate Bayesian latent Gaussian models to assess the association between ambient PM2.5 and U5MR at the county level for the whole nation and sub-regions. GDP growth rate, normalized difference vegetation index (NDVI), temperature, and night-time light were included as covariates using a smoothing function. We further implemented an empirical dynamic model (EDM) to explore the potential causal relationship between PM2.5 and U5MR. RESULTS We observed a declining trend in U5MR in most counties throughout the study period. Spatial heterogeneity in U5MR was observed. Nationwide analysis suggested that each 10 µg/m3 increase in annual concentration of PM2.5 was associated with an increase of 1.2 (95% CI: 1.0 - 1.3) per 1000 live births in U5MR. Regional analyses showed that the strongest positive association was located in the Northeastern part of China [1.8 (95% CI: 1.4 - 2.1)]. The EDM showed a significant causal association between PM2.5 and U5MR, with an embedding dimension of 5 and 7, and nonlinear values θ of 4 and 6, respectively. CONCLUSION China exhibited a downward trend in U5MR from 1999 to 2012, with spatial heterogeneity observed across the country. Our analysis reveals a positive association between PM2.5 and U5MR, which may support a causal relationship.
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Affiliation(s)
- Sameh M M Alnwisi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chengwei Chai
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Bipin Kumar Acharya
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Aaron M Qian
- Department of Psychology, College of Arts and Sciences Saint Louis University, 3700 Lindell Boulevard, Saint Louis, MO 63108, USA
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, Saint Louis, MO 63103, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Qinzhou Wang
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Yan S, Wang X, Yao Z, Cheng J, Ni H, Xu Z, Wei Q, Pan R, Yi W, Jin X, Tang C, Liu X, He Y, Wu Y, Li Y, Sun X, Liang Y, Mei L, Su H. Seasonal characteristics of temperature variability impacts on childhood asthma hospitalization in Hefei, China: Does PM 2.5 modify the association? ENVIRONMENTAL RESEARCH 2022; 207:112078. [PMID: 34599899 DOI: 10.1016/j.envres.2021.112078] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Evidence of childhood asthma hospitalizations associated with temperature variability (TV) and the attributable risk are limited in China. We aim to use a comprehensive index that reflected both intra- and inter-day TV to assess the TV-childhood asthma relationship and disease burden, further to identify seasonality vulnerable populations, and to explore the effect modification of PM2.5. METHODS A quasi-distributed lagged nonlinear model (DLNM) combined with a linear threshold function was applied to estimate the association between TV and childhood asthma hospitalizations during 2013-2016 in Hefei, China. Subgroup analysis was conducted by age and sex. Disease burden is reflected by the attributable fraction and attributable number. Besides, modifications of PM2.5 were tested by introducing the cross-basis of TV and binary PM2.5 as an interaction term. RESULTS The risk estimates peaked at TV0-3 and TV0-4 in the cool and the warm season separately, with RR of 1.051 (95%CI: 1.021-1.081) and 1.072 (95%CI: 1.008-1.125), and the effects lasted longer in the cool season. The school-age children in the warm season and all subgroups except pre-school children in the cool season were vulnerable to TV. It is estimated that the disease burden related to TV account for 6.2% (95% CI: 2.7%-9.4%) and 4% (95% CI: 0.6%-7.1%) during the cool and warm seasons in TV0-3. In addition, the risks of TV were higher under the high PM2.5 level compared with the low PM2.5 level in the cool season, although no significant differences between them. CONCLUSIONS TV exposure significantly increases the risk and disease burden of childhood asthma hospitalizations, especially in the cool season. More medical resources should be allocated to school-age children. Giving priority to pay attention to TV in the cool season in practice could obtain the greatest public health benefits and those days with high TV and high PM2.5 need more attention.
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Affiliation(s)
- Shuangshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Xu Wang
- Anhui Provincial Children's Hospital, China
| | - Zhenhai Yao
- Anhui Public Meteorological Service Center, Hefei, Anhui, 230011, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Hong Ni
- Anhui Provincial Children's Hospital, China
| | - Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Xiaoyu Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Chao Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Xiangguo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yangyang He
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yudong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yuxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Xiaoni Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yunfeng Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Lu Mei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China.
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Estimation of Daily and Instantaneous Near-Surface Air Temperature from MODIS Data Using Machine Learning Methods in the Jingjinji Area of China. REMOTE SENSING 2022. [DOI: 10.3390/rs14081916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Meteorologically observed air temperature (Ta) is limited due to low density and uneven distribution that leads to uncertain accuracy. Therefore, remote sensing data have been widely used to estimate near-surface Ta on various temporal scales due to their spatially continuous characteristics. However, few studies have focused on instantaneous Ta when satellites overpass. This study aims to produce both daily and instantaneous Ta datasets at 1 km resolution for the Jingjinji area, China during 2018–2019, using machine learning methods based on remote sensing data, dense meteorological observation station data, and auxiliary data (such as elevation and normalized difference vegetation index). Newly released Moderate Resolution Imaging Spectroradiometer (MODIS) Collection 6 surface Downward Shortwave Radiation (DSR) was introduced to improve the accuracy of Ta estimation. Five machine learning algorithms were implemented and compared so that the optimal one could be selected. The random forest (RF) algorithm outperformed the others (such as decision tree, feedforward neural network, generalized linear model) and RF obtained the highest accuracy in model validation with a daily root mean square error (RMSE) of 1.29 °C, mean absolute error (MAE) of 0.94 °C, daytime instantaneous RMSE of 1.88 °C, MAE of 1.35 °C, nighttime instantaneous RMSE of 2.47 °C, and MAE of 1.83 °C. The corresponding R2 was 0.99 for daily average, 0.98 for daytime instantaneous, and 0.95 for nighttime instantaneous. Analysis showed that land surface temperature (LST) was the most important factor contributing to model accuracy, followed by solar declination and DSR, which implied that DSR should be prioritized when estimating Ta. Particularly, these results outperformed most models presented in previous studies. These findings suggested that RF could be used to estimate daily instantaneous Ta at unprecedented accuracy and temporal scale with proper training and very dense station data. The estimated dataset could be very useful for local climate and ecology studies, as well as for nature resources exploration.
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Kemajou DN. Climate variability, water supply, sanitation and diarrhea among children under five in Sub-Saharan Africa: a multilevel analysis. JOURNAL OF WATER AND HEALTH 2022; 20:589-600. [PMID: 35482376 DOI: 10.2166/wh.2022.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Climate variability is expected to increase the risk of diarrhea diseases, a leading cause of child mortality and morbidity in Sub-Saharan Africa (SSA). The risk of diarrhea is more acute when populations have poor access to improved water and sanitation. This study seeks to determine individual and joint effects of climate variation, water supply and sanitation on the occurrence of diarrhea among children under five in SSA using multilevel mixed-effect Poisson regression including cross-level interaction. We merged 57 Demographic and Health Surveys (DHS) from 25 SSA countries covering the period 2000-2019 with climatic data from the DHS geolocation databases. The results of the research indicate that 77.7% of the variation in the occurrence of diarrhea in Sub-Saharan households is due to climatic differences between clusters. Also, a household residing in a cluster with a high incidence of diarrhea is 1.567 times more likely to have diarrhea cases than a household from a cluster with a low incidence. In addition, when average temperature and rainfall increase, households using unimproved sanitation or unimproved water have more cases of diarrhea. For SSA, the results of the multilevel analysis suggest the adoption at both levels; macro (national) and micro (household), of climate change adaption measures in the water sector to reduce the prevalence of diarrhea.
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Aili A, Xu H, Zhao X. Health Effects of Dust Storms on the South Edge of the Taklimakan Desert, China: A Survey-Based Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074022. [PMID: 35409705 PMCID: PMC8998096 DOI: 10.3390/ijerph19074022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/10/2022]
Abstract
Dust storms have already become the most serious environmental problem on the south edge of the Taklimakan desert because of their frequent occurrences. To investigate the health effects of dust storms on public health in Moyu County, one of the most severe dust-storm-affected areas located at the south edge of the Taklimakan desert, China, primary data were collected from 1200 respondents by using a questionnaire survey for 15 health symptoms. The data were analyzed by comparing the mean tool (independent t-test and ANOVA) and the severity of different symptoms among different age groups. Principal component analysis (PCA) was applied to further analyze the multivariate relationships between meteorological factors, dust storm intensity, air pollution level, and severity degree of the different symptoms. The results show that significant correlations exist between dust storm intensity, air pollutants (PM2.5, PM10, O3, SO2, NO2, and CO), meteorological factors, and health symptoms. During dusty weather, no matter the age group, the number of respondents who suffered from different health symptoms was higher compared to non-dusty days. Three types of dusty days were considered in this study: suspended dust, blowing dust, and sand storms. The impacts of sand storm weather on public health are stronger than those from blowing dust weather, suspended dust weather (haze), and non-dust weather. The people in the age groups above 60 years and below 15 years were more sensitive to different dust weather than people in the age groups between 15 and 60. “Dry throat with bitter taste”, “Depression”, “Dry and itchy throat”, and “Mouth ulcer” are the main symptoms caused by dust storms.
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Mapping Heat-Health Vulnerability Based on Remote Sensing: A Case Study in Karachi. REMOTE SENSING 2022. [DOI: 10.3390/rs14071590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
As a result of global climate change, the frequency and intensity of heat waves have increased significantly. According to the World Meteorological Organization (WMO), extreme temperatures in southwestern Pakistan have exceeded 54 °C in successive years. The identification and assessment of heat-health vulnerability (HHV) are important for controlling heat-related diseases and mortality. At present, heat waves have many definitions. To better describe the heat wave mortality risk, we redefine the heat wave by regarding the most frequent temperature (MFT) as the minimum temperature threshold for HHV for the first time. In addition, different indicators that serve as relevant evaluation factors of exposure, sensitivity and adaptability are selected to conduct a kilometre-level HHV assessment. The hesitant analytic hierarchy process (H-AHP) method is used to evaluate each index weight. Finally, we incorporate the weights into the data layers to establish the final HHV assessment model. The vulnerability in the study area is divided into five levels, high, middle-high, medium, middle-low and low, with proportions of 3.06%, 46.55%, 41.85%, 8.53% and 0%, respectively. Health facilities and urbanization were found to provide advantages for vulnerability reduction. Our study improved the resolution to describe the spatial heterogeneity of HHV, which provided a reference for more detailed model construction. It can help local government formulate more targeted control measures to reduce morbidity and mortality during heat waves.
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Demoury C, Aerts R, Vandeninden B, Van Schaeybroeck B, De Clercq EM. Impact of Short-Term Exposure to Extreme Temperatures on Mortality: A Multi-City Study in Belgium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073763. [PMID: 35409447 PMCID: PMC8997565 DOI: 10.3390/ijerph19073763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 12/11/2022]
Abstract
In light of climate change, health risks are expected to be exacerbated by more frequent high temperatures and reduced by less frequent cold extremes. To assess the impact of different climate change scenarios, it is necessary to describe the current effects of temperature on health. A time-stratified case-crossover design fitted with conditional quasi-Poisson regressions and distributed lag non-linear models was applied to estimate specific temperature-mortality associations in nine urban agglomerations in Belgium, and a random-effect meta-analysis was conducted to pool the estimates. Based on 307,859 all-cause natural deaths, the mortality risk associated to low temperature was 1.32 (95% CI: 1.21-1.44) and 1.21 (95% CI: 1.08-1.36) for high temperature relative to the minimum mortality temperature (23.1 °C). Both cold and heat were associated with an increased risk of cardiovascular and respiratory mortality. We observed differences in risk by age category, and women were more vulnerable to heat than men. People living in the most built-up municipalities were at higher risk for heat. Air pollutants did not have a confounding effect. Evidence from this study helps to identify specific populations at risk and is important for current and future public health interventions and prevention strategies.
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Affiliation(s)
- Claire Demoury
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
- Correspondence:
| | - Raf Aerts
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
- Division Ecology, Evolution and Biodiversity Conservation, University of Leuven (KU Leuven), 3001 Leuven, Belgium
- Center for Environmental Sciences, University of Hasselt, 3590 Hasselt, Belgium
| | - Bram Vandeninden
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
| | - Bert Van Schaeybroeck
- Department of Meteorological Research and Development, Royal Meteorological Institute of Belgium, 1180 Brussels, Belgium;
| | - Eva M. De Clercq
- Risk and Health Impact Assessment, Sciensano, 1050 Brussels, Belgium; (R.A.); (B.V.); (E.M.D.C.)
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Ruchiraset A, Tantrakarnapa K. Association of climate factors and air pollutants with pneumonia incidence in Lampang province, Thailand: findings from a 12-year longitudinal study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:691-700. [PMID: 32662678 DOI: 10.1080/09603123.2020.1793919] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study attempted to understand the associations between pneumonia, climate, and environmental air pollutants in Thailand. A 12-year longitudinal study was performed between 2003 and 2014 in Lampang province, the Northern region of Thailand. Spearman correlation and negative binomial regression modelling were used to explore the relationships between climate factors and environmental air pollutants and pneumonia incidence. Spearman correlation shows that pneumonia incidence was positively correlated with humidity and negatively correlated with temperature, NO2, and O3. The regression modelling produced a series of models to predict pneumonia incidence based on information on climate and air quality. The result of the models shows that humidity and PM10 were associated with pneumonia incidence. To better protect the health, public health policy and risk assessment approach for pneumonia incidence should include considerations of the effect of air pollution. This result can be used for further intervention to take care of human health.
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Affiliation(s)
- Apaporn Ruchiraset
- Department of Social Medicine and Environment, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kraichat Tantrakarnapa
- Department of Social Medicine and Environment, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Effectiveness Evaluation of a Primary School-Based Intervention against Heatwaves in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052532. [PMID: 35270225 PMCID: PMC8909389 DOI: 10.3390/ijerph19052532] [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: 01/19/2022] [Revised: 01/25/2022] [Accepted: 02/05/2022] [Indexed: 11/23/2022]
Abstract
Background: Evidence of the effectiveness of intervention against extreme heat remains unclear, especially among children, one of the vulnerable populations. This study aimed to evaluate the effectiveness of a primary school-based intervention program against heatwave and climate change in China to provide evidence for development of policies for adaptation to climate change. Methods: Two primary schools in Dongtai City, Jiangsu Province, China, were randomly selected as intervention and control schools (CTR registration number: ChiCTR2200056005). Health education was conducted at the intervention school to raise students’ awareness and capability to respond to extreme heat during May to September in 2017. Knowledge, attitude, and practice (KAP) of students and their parents at both schools were investigated by questionnaire surveys before and after intervention. The changes in KAP scores after intervention were evaluated using multivariable difference-in-difference (DID) analysis, controlling for age, sex, etc. Results: The scores of knowledge, attitude, and practice of students and their parents increased by 19.9% (95%CI: 16.3%, 23.6%) and 22.5% (95%CI: 17.8%, 27.1%); 9.60% (95%CI: 5.35%, 13.9%) and 7.22% (95%CI: 0.96%, 13.5%); and 9.94% (95%CI: 8.26%, 18.3%) and 5.22% (95%CI: 0.73%, 9.71%), respectively, after intervention. The KAP score changes of boys were slightly higher than those of girls. Older students had higher score changes than younger students. For parents, the higher the education level, the greater the score change, and change in scores was greater in females than in males. All the health education activities in the program were significantly correlated with the changes in KAP scores of primary school students after intervention, especially those curricula with interesting activities and experiential learning approaches. Conclusions: Heat and health education program in primary school was an effective approach to improve cognition and behavior for both students and their parents to better adapt to heatwaves and climate change. The successful experience can be generalized to respond to the increasing extreme weather/climate events in the context of climate change, such as heatwaves, and other emergent occasions or public health education, such as the control and prevention of COVID-19.
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Vanoli J, Coull BA, Ettinger de Cuba S, Fabian PM, Carnes F, Massaro MA, Poblacion A, Bellocco R, Kloog I, Schwartz J, Laden F, Zanobetti A. Postnatal exposure to PM 2.5 and weight trajectories in early childhood. Environ Epidemiol 2022; 6:e181. [PMID: 35169661 PMCID: PMC8835545 DOI: 10.1097/ee9.0000000000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inconsistent evidence has assessed the impact of air pollution exposure on children's growth trajectories. We investigated the role of 90-day average postnatal fine particulate matter (PM2.5) exposures by estimating the magnitude of effects at different ages, and the change in child weight trajectory by categories of exposure. METHODS We obtained weight values from electronic health records at each hospital visit (males = 1859, females = 1601) from birth to 6 years old children recruited into the Boston-based Children's HealthWatch cohort (2009-2014). We applied mixed models, adjusting for individual and maternal confounders using (1) varying-coefficient models allowing for smooth non-linear interaction between age and PM2.5, (2) factor-smooth interaction between age and PM2.5 quartiles. Additionally, we stratified by sex and low birthweight (LBW) status (≤2500 g). RESULTS Using varying-coefficient models, we found that PM2.5 significantly modified the association between age and weight in males, with a positive association in children younger than 3 years and a negative association afterwards. In boys, for each 10 µg/m3 increase in PM2.5 we found a 2.6% increase (95% confidence interval = 0.8, 4.6) in weight at 1 year of age and a -0.6% (95% confidence interval = -3.9, 2.9) at 5 years. We found similar but smaller changes in females, and no differences comparing growth trajectories across quartiles of PM2.5. Most of the effects were in LBW children and null for normal birthweight children. CONCLUSIONS This study suggests that medium-term postnatal PM2.5 may modify weight trajectories nonlinearly in young children, and that LBW babies are more susceptible than normal-weight infants.
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Affiliation(s)
- Jacopo Vanoli
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Statistics and Quantitative Methods, Universita degli Studi di Milano-Bicocca, Milan, Italy
| | - Brent A. Coull
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Patricia M. Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Fei Carnes
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Marisa A. Massaro
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Ana Poblacion
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, Universita degli Studi di Milano-Bicocca, Milan, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Francine Laden
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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