Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation

Association between ambient temperature and cause-specific mortality: An individual-level case-crossover study in Suzhou, China

The changing climate poses a growing challenge to the population health. The objective of this study was to assess the association between ambient temperature and cause-specific mortality in Suzhou. Based on the non-accidental mortality data collected during 2008-2022 in Suzhou, China, this study utilized an individual-level case-crossover design to evaluate the associations of temperature with cause-specific mortality. We applied a distributed lag nonlinear model with a maximum lag of 14 days to account for lag effects. Mortality risk due to extreme cold (<2.5th percentile) and extreme heat (>97.5th percentile) was analyzed. A total of 634,530 non-accidental deaths were analyzed in this study. An inverse J-shaped exposure-response relationship was observed between ambient temperature and non-accidental mortality, with the minimum mortality temperature (MMT) at 29.1℃. The relative risk (RR) of mortality associated with extreme cold (2.5th percentile) was 1.37 [95 % confidence interval (CI): 1.30, 1.44], higher than estimate of 1.09 (95 %CI: 1.07, 1.11) for extreme heat (97.5th percentile) relative to the MMT. Heat effect lasted for 2-3 days, while cold effect could persist for almost 14 days. Higher mortality risk estimates were observed for cardiorespiratory deaths compared to total deaths, with statistically significant between-group differences. Consequently, this study provides first-hand evidence on the associations between ambient temperatures and mortality risks from various causes, which could help local government and policy-makers in designing targeted strategies and public health measures against the menace of climate change.

Human adaptation to heat in the context of climate change: A conceptual framework

Climate change is causing serious damage to natural and social systems, as well as having an impact on human health. Among the direct effects of climate change is the rise in global surface temperatures and the increase in the frequency, duration, intensity and severity of heat waves. In addition, understanding of the adaptation process of the exposed population remains limited, posing a challenge in accurately estimating heat-related morbidity and mortality. In this context, this study seeks to establish a conceptual framework that would make it easier to understand and organise knowledge about human adaptation to heat and the factors that may influence this process. An inductive approach based on grounded theory was used, through the analysis of case studies connecting concepts. The proposed conceptual framework is made up of five components (climate change, vulnerability, health risks of heat, axes of inequality and health outcomes), three heat-adaptation domains (physiological, cultural and political), two levels (individual and social), and the pre-existing before a heat event. The application of this conceptual framework facilitates the assistance of decision-makers in planning and implementing effective adaptation measures. Recognizing the importance of addressing heat adaptation as a health problem that calls for political solutions and social changes. Accordingly, this requires a multidisciplinary approach that would foster the participation and collaboration of multiple actors for the purpose of proposing effective measures to address the health impact of the rise in temperature.

Effects of temperature anomaly on sperm quality: A multi-center study of 33,234 men

Backgrounds

Global fertility rates continue to decline and sperm quality is a prime factor affecting male fertility. Both extreme cold and heat have been demonstrated to be associated with decreased sperm quality, but no epidemiological studies have considered human adaptation to long-term temperature. Our aim was to conduct a multi-center retrospective cohort study to investigate exposure-response relationship between temperature anomaly (TA) that deviate from long-term climate patterns and sperm quality.

Methods

A total of 78,952 semen samples measured in 33,234 donors from 6 provincial human sperm banks in China were collected. This study considered heat and cold acclimatization to prolonged exposure in humans and explored the exposure-response relationship between TAs and sperm quality parameters (sperm concentrations, sperm count, progressive motility, progressive sperm count, total motility and total motile sperm count) during the hot and cold seasons, respectively. Linear mixed models and generalized linear models were built separately for specific centers to pool in a meta-analysis to obtain the pooled effect of TA on sperm quality, considering repeated measurements data structure and spatial heterogeneity.

Results

We identified an inverted U-shaped exposure-response relationship between TA and sperm quality during the hot season. Significant negative effect of anomalous cold on sperm quality during the hot season was found after additional adjustment for Body mass index, marital status and childbearing history. The heat-related TA in hot season was significantly negatively associated with sperm concentration, progressive sperm count and total motile sperm count (all P-values<0.05). After adjusting the relative humidity, the cold-related TA in cold season was negatively associated with the sperm total motility (P-values<0.05).

Conclusions

Our results suggest both heat-related and cold-related TAs are associated with decreased sperm quality. The findings highlight the importance of reducing exposure to anomalous temperatures to protect male fertility.

Understanding the connections between climate change, air pollution, and human health in Africa: Insights from a literature review

Climate change and air pollution are two interconnected global challenges that have profound impacts on human health. In Africa, a continent known for its rich biodiversity and diverse ecosystems, the adverse effects of climate change and air pollution are particularly concerning. This review study examines the implications of air pollution and climate change for human health and well-being in Africa. It explores the intersection of these two factors and their impact on various health outcomes, including cardiovascular disease, respiratory disorders, mental health, and vulnerable populations such as children and the elderly. The study highlights the disproportionate effects of air pollution on vulnerable groups and emphasizes the need for targeted interventions and policies to protect their health. Furthermore, it discusses the role of climate change in exacerbating air pollution and the potential long-term consequences for public health in Africa. The review also addresses the importance of considering temperature and precipitation changes as modifiers of the health effects of air pollution. By synthesizing existing research, this study aims to shed light on complex relationships and highlight the key findings, knowledge gaps, and potential solutions for mitigating the impacts of climate change and air pollution on human health in the region. The insights gained from this review can inform evidence-based policies and interventions to mitigate the adverse effects on human health and promote sustainable development in Africa.

Temperature dependence of emission of volatile organic compounds (VOC) from litters collected in two Mediterranean ecosystems determined before the flaming phase of biomass burning

Fire represents a major threat to Mediterranean terrestrial ecosystems because of the high temperatures reached during summer. While massive loads of organic, inorganic compounds and particulate matter are known to be emitted into the atmosphere from forest wildfires, less is known about the emission from vegetation surrounding fires where air temperatures higher than 100 °C can be reached. Little information exists on the emission from dead vegetation accumulated as litter over forest soils, from which fires often starts. In this study, the response of litter to heatwaves generated by nearby fires was investigated under controlled conditions. Litter samples collected in a Mediterranean maquis and a Holm oak stand during summer were placed in an enclosure flushed with a continuous flow of air, the temperature of the enclosure was progressively risen to 125 °C, until some smog developed but no flaming occurred. The gas from the enclosure was analysed for the content of CO2, H2O, and volatile organic compounds (VOC) to assess the dependence of emission from the air temperature. VOC emission was continuously determined by Proton-Transfer-Reaction mass spectrometry with time of flight (PTR-TOF-MS). Data obtained were complemented with those obtained by collecting VOC on traps that were later analysed by Gas chromatography-mass spectrometry (GC-MS). Results provided useful information to understand the emission mechanism of VOC and other gases from dead vegetation present in the litter of two Mediterranean ecosystems, both dominated by evergreen vegetation species. The study demonstrated that low molecular weight VOC and aromatic hydrocarbons (arenes) produced mostly by thermal oxidation of the wood biopolymers are emitted in addition to isoprenoids typically associated to storage organs and photosynthetic pathway. Moreover, our results support parameterization of litter VOC emission processes in air quality models.

Salinity spatial patterns in Mediterranean coastal areas: The legacy of historical water infrastructures

Mediterranean coastal areas have been occupied and developed intensively for a long time facing issues related to agricultural production, urbanization, tourism, preservation of natural resources often linked to salinity. This article explores the relationship between historical land planning and water management, and current soil and water salinity to gain insights into future projections. Soil samples (1185) were collected in a coastal plain of 114 km2 in the south of France and saturated paste extract Electrical Conductivity (ECsp) was deduced from 1:5 dilution. Soil salinity exhibits a wide range of variation (from 0.54 to 113.1 mS cm-1) and spatial patterns. ECsp is significantly different among soil types, higher at depth than at the surface and influenced by the distance to ancient water infrastructures (Pettitt test). Surface water and shallow groundwater samples were collected for trace element concentrations and Oxygen (18O/16O) isotope ratio measurements. The geochemical signatures indicate a mixture between surface freshwater and seawater, reveal the presence of over-salted seawater and a stratification of salinity from the surface to the depth. Results suggest that groundwater is the source of soil salinity, and illustrate the long-term impact of old water infrastructures. Less saline soils are found near the freshwater supply channel (constructed from 15th to 18th), while more saline soils are located near drainage channels. The presence of over-salted water reflects temporal evolution of the plain over the last few centuries (initially under seawater, gradually filled in, presence of ponds and salt works that have now disappeared). The current soil salinity patches continue to be a visible reminder of this evolution. The trend towards desalinization of the plain over the last few centuries has been made possible by massive freshwater inflows, which are now under threat due to the general decrease of water resources availability.

No heat, no eat: (Dis)entangling insecurities and their implications for health and well-being

This study explores the associations between energy poverty, food insecurity, and a set of outcomes-including the self-reported burden of chronic illness, physical disabilities, and mental health-among social-aid recipients across Israel. We highlight the socio-demographic characteristics and housing conditions of energy-poor households and analyze the association between energy poverty and health and well-being using multivariate regression models. Of 1390 aid-recipient respondents, more than 85% met the criteria for living in an energy-poor household, and almost all of them also struggled with food insecurity and were raised in poor households as children. In addition, the severity of energy poverty was positively and significantly associated with the occurrence of diabetes, hypertension, and mental illness, and, as compared with energy-secure households, severely energy-poor households were more prone to forgo acquiring prescription medications, medical aid, or required health treatments due to financial hardships. These findings highlight the nuanced negotiation over necessities that aid-supported households make; despite being at greater risk of being sick, energy-poor households are more likely to forgo buying medicines and seeking healthcare so as to pay the electricity bills. Hidden energy poverty, coupled with what might be hidden morbidity, may have significant implications for healthcare systems, and a climate-sensitive health policy at both the municipal and national levels is required to strengthen resilience among low-income households.

Exploratory analysis of local extreme-temperature attributable mortality in an urban city of Madrid

AIM

to assess the Heat (HW) and Cold Waves (CW) risks on health in the urban municipality of Getafe.

METHODOLOGY

time series analysis between 01/01/1999-31/10/2013.

DEPENDENT VARIABLE

daily mortality due to natural causes - (ICD-10): A99-R99-.

INDEPENDENT VARIABLES

the maximum (Tmax) and minimum (Tmin) daily temperature. The mortality-temperature relationship was analysed to determine the thresholds of HW (Thresholdheat) and CW (Thresholdcold). Using Poisson GLM (link = log), the Relative Risk (RR), Attributable Risk (AR) and Attributable Mortality (AM) were determined for each degree of the Tmax exceeding the Thresholdheat (Theat) and for each degree of Tmin under the Thresholdcold (Tcold). Finally, socioeconomic variables were analysed descriptively.

RESULTS

Thresholdheat was 36 °C while Thresholdcold was 0 °C. The RRs associated with Theat, i.e. 1.08 (1.03 1.14), are akin to those obtained for Tcold, i.e. 1.05 (1.03 1.08). There were 202 HW and 430 CW episodes. The AM to HW totalled 61 (25, 96) deaths, while that attributable to CW reached 146 (82,211) deaths. The vulnerability in Getafe seems to be lower than in surrounding similar urban and rural cities.

CONCLUSIONS

The singular urban development of the municipality may have granted it an advantage over surrounding municipalities regarding temperature extremes.

Disclosing the native blueberry rhizosphere community in Portugal-an integrated metagenomic and isolation approach

Backgorund

The production of red fruits, such as blueberry, has been threatened by several stressors from severe periods of drought, nutrient scarcity, phytopathogens, and costs with fertilization programs with adverse consequences. Thus, there is an urgent need to increase this crop's resilience whilst promoting sustainable agriculture. Plant growth-promoting microorganisms (PGPMs) constitute not only a solution to tackle water and nutrient deficits in soils, but also as a control against phytopathogens and as green compounds for agricultural practices.

Methods

In this study, a metagenomic approach of the local fungal and bacterial community of the rhizosphere of Vaccinium corymbosum plants was performed. At the same time, both epiphytic and endophytic microorganisms were isolated in order to disclose putative beneficial native organisms.

Results

Results showed a high relative abundance of Archaeorhizomyces and Serendipita genera in the ITS sequencing, and Bradyrhizobium genus in the 16S sequencing. Diversity analysis disclosed that the fungal community presented a higher inter-sample variability than the bacterial community, and beta-diversity analysis further corroborated this result. Trichoderma spp., Bacillus spp., and Mucor moelleri were isolated from the V. corymbosum plants.

Discussion

This work revealed a native microbial community capable of establishing mycorrhizal relationships, and with beneficial physiological traits for blueberry production. It was also possible to isolate several naturally-occurring microorganisms that are known to have plant growth-promoting activity and confer tolerance to hydric stress, a serious climate change threat. Future studies should be performed with these isolates to disclose their efficiency in conferring the needed resilience for this and several crops.

How do energy prices and climate shocks affect human health? Insights from BRICS

The presented work analyzes the energy prices, climate shock, and health deprivation nexus in the BRICS economies for the period 1995-2020. Panel ARDL-PMG technique is used to reveal the underexplored linkages. The long-run estimates of energy prices are observed to be negatively significant to the health expenditure and life expectancy model, whereas, positively significant to the climate change model. These findings suggest that energy prices significantly reduce health expenditures and life expectancy and, thus, increase the death rate in the BRICS economies. The long-run country-wise estimate of energy prices is found negatively significant in case of Brazil, India, China, and South Africa. Alongside, the group-wise significance of CO2 emissions is discovered to be negatively, positively, and insignificant in the cases of life expectancy, death rate, and health expenditure models, respectively. Besides, country-wise long-run estimate of CO2 emissions witnesses negative significance for Russia, India, China, and South Africa.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Analysis of the heat- and cold-related cardiovascular mortality in an urban mediterranean environment through various thermal indices

During the last decades the effects of thermal stress on public health have been a great concern worldwide. Thermal stress is determined by air temperature in combination with other meteorological parameters, such as relative humidity and wind speed. The present study is focused on the Mediterranean city of Thessaloniki, Greece and it aims to explore the association between thermal stress and mortality from cardiovascular diseases, using both air temperature and other thermal indices as indicators. For that, an over-dispersed Poisson regression function was used, in combination with distributed lag non-linear models, in order to capture the delayed and nonlinear effects of temperature. Our results revealed a reverse J-shaped exposure-response curve for the total population and females and a U-shaped association for males. In all cases examined, the minimum mortality temperature was identified around the 80th percentile of each distribution. It is noteworthy that despite the fact that the highest risks of cardiovascular mortality were estimated for exposure to extreme temperatures, moderate temperatures were found to cause the highest burden of mortality. On the whole, our estimations demonstrated that the population in Thessaloniki is more susceptible to cold effects and in regard with gender, females seem to be more vulnerable to ambient thermal conditions.

The Impact of Ambient Temperature on Cardiorespiratory Mortality in Northern Greece

It is well-established that exposure to non-optimum temperatures adversely affects public health, with the negative impact varying with latitude, as well as various climatic and population characteristics. This work aims to assess the relationship between ambient temperature and mortality from cardiorespiratory diseases in Eastern Macedonia and Thrace, in Northern Greece. For this, a standard time-series over-dispersed Poisson regression was fit, along with a distributed lag nonlinear model (DLNM), using a maximum lag of 21 days, to capture the non-linear and delayed temperature-related effects. A U-shaped relationship was found between temperature and cardiorespiratory mortality for the overall population and various subgroups and the minimum mortality temperature was observed around the 65th percentile of the temperature distribution. Exposure to extremely high temperatures was found to put the highest risk of cardiorespiratory mortality in all cases, except for females which were found to be more sensitive to extreme cold. It is remarkable that the highest burden of temperature-related mortality was attributed to moderate temperatures and primarily to moderate cold. The elderly were found to be particularly susceptible to both cold and hot thermal stress. These results provide new evidence on the health response of the population to low and high temperatures and could be useful to local authorities and policy-makers for developing interventions and prevention strategies for reducing the adverse impact of ambient temperature.

Population vulnerability to extreme cold days in rural and urban municipalities in ten provinces in Spain

BACKGROUND

The objective was to analyze whether there are differences in vulnerability to Extreme Cold Days (ECD) between rural and urban populations in Spain.

METHODOLOGY

Time series analysis carried out from January 1, 2000, through December 31, 2013. Municipalities with over 10,000 inhabitants were included from 10 Spanish provinces, classified into 42 groups by isoclimate and urban/rural character as defined by Eurostat criteria. The statistical strategy was carried out in two phases. First: It was analyzed the relationship between minimum daily temperature (Tmin) (source: AEMET) and the rate of daily winter mortality due to natural causes -CIE-10: A00 - R99- (source: National Statistics Institute). Then, It was determinated the threshold of Tmin that defines the ECD and its percentile in the series of winter Tmin (Pthreshold), which is a measure of vulnerability to ECD so that the higher the percentile, the higher the vulnerability. Second: possible explanatory variables of vulnerability were explored using Mixed Generalized Models, using 13 independent variables related to meteorology, environment, socioeconomics, demographics and housing quality.

RESULTS

The average Pthreshold was 18 %. The final model indicated that for each percentage point increase in unemployment, the vulnerability to ECD increased by 0.4 (0.2, 0.6) points. Also, with each point increase in rurality index, this vulnerability decreased by -6.1 (-2.1, -10.0) points. Although less determinant, other factors that could contribute to explaining vulnerability at the province level included minimum winter daily temperatures and the percentage of housing with poor insulation.

CONCLUSIONS

The vulnerability to ECD was greater in urban zones than in rural zones. Socioeconomic status is a key to understanding how this vulnerability is distributed. These results suggest the need to implement public health prevention plans to address ECD at the state level. These plans should be based on threshold temperatures determined at the smallest scale possible.

Temporal evolution of threshold temperatures for extremely cold days in Spain

In contrast to research on heat waves, there are no studies in recent years that analyze the temporal evolution of threshold temperatures (Tthreshold) for extremely cold days (ECD). It is unknown whether threshold temperatures have increased more quickly than the minimum daily temperature (Tmin) in recent years. The objective of this study was to analyze the temporal evolution of the minimum daily temperature (Tmin) in a group of Spanish provinces and compare it with the evolution of threshold temperatures. An ecological, retrospective time series study was carried out using daily observations between January 1, 1983 and December 31, 2018 (36 years) in 10 provinces that are representative of the different climate territories in Spain. For each representative observatory in each province, the values of Tmin were obtained for the winter months (November-March). The value of Tthreshold was determined for each province and each year, using dispersion diagrams for the pre-whitened series, with daily mortality due to natural causes displayed on the Y axis (CIEX: A00-R99) and Tmin grouped by 10 degree intervals on the X axis. To determine the temporal evolution of Tmin and Tthreshold for each province, linear models were fitted, with time as the independent variable. During the winter months, Tmin increased at an average rate of 0.2 °C/decade (IC95: 0.1-0.3), while Tthreshold remained practically constant during the period, at 0.1 °C/decade (IC95% -0.1 0.3). These values are much lower than those obtained in the case of heat, both in terms of the evolution of maximum daily temperature and that of Tthreshold. In conclusion, the fact that this trend has been maintained across time in a scenario of climate change, with a slow increase in minimum daily temperatures and constant values of Threshold, suggests a decrease in the number of ECD.

Factors Associated with Pro-Environmental Behaviors in Israel: A Comparison between Participants with and without a Chronic Disease

This study examined differences regarding climate change pro-environmental behaviors (PEBs), comparing between individuals with chronic diseases and those without. A cross-sectional survey was conducted among 402 adults, of whom 25% had a chronic disease. Participants completed measures for PEBs, climate change exposure (i.e., exposure to its effects), climate change risk appraisal, environmental self-efficacy, collective efficacy, and sociodemographic variables. Results revealed a significant difference between participants with and without chronic diseases in climate change risk appraisal. Having a chronic disease was associated with higher climate change risk appraisal (β = 0.16, p < 0.001), which in turn was associated with higher collective efficacy (β = 0.29, p < 0.001). The latter was associated with more PEBs (β = 0.10, p = 0.049). Furthermore, higher climate change exposure was associated with higher climate change risk appraisal (β = 0.49, p < 0.001), which in turn was associated with collective efficacy (β = 0.29, p < 0.001). The latter was associated with more PEBs (β = 0.10, p = 0.049). In addition, higher climate change exposure was directly associated with both self-efficacy (β = 0.33, p < 0.001) and collective efficacy (β = 0.10, p = 0.049), which in turn were associated with more PEBs (β = 0.28, p < 0.001 and β = 0.10, p = 0.049, respectively). This study highlights the need to provide efficacy-enhancing information in climate change messaging for PEBs in general. A threat component in environment-relevant messages for people with chronic diseases, specifically, should also be adopted.

Climate Change and Health in Urban Areas with a Mediterranean Climate: A Conceptual Framework with a Social and Climate Justice Approach

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment

Health-Care Risk Waste (HCRW) treatment protects the environment and lives. HCRW is waste from patient diagnostics, immunization, surgery, and therapy. HCRW must be treated before disposal since it pollutes, spreads illnesses, and causes harm. However, waste treatment increases the healthcare sector's carbon footprint, making the healthcare sector a major contributor to anthropogenic climate change. This is because treating HCRW pollutes the environment and requires a lot of energy. Treating HCRW is crucial, but its risks are not well-studied. Unintentionally, treating HCRW leads to climate change. Due to frequent climate-related disasters, present climate-change mitigation strategies are insufficient. All sectors, including healthcare, must act to mitigate and prevent future harms. Healthcare can reduce its carbon footprint to help the environment. All contributing elements must be investigated because healthcare facilities contribute to climate change. We start by evaluating the environmental impact of different HCRW treatment technologies and suggesting strategies to make treatments more sustainable, cost-effective, and reliable to lower the carbon footprint.

Physiological and Structural Responses to Prolonged Water Deficit in Young Trees of Two Olive Cultivars

This study aimed to characterize the physiological and structural responses of potted one-year-old olive trees belonging to two olive cultivars—‘Nocellara del Belice’ and ‘Cerasuola’—exposed to prolonged drought under greenhouse conditions. Two irrigation treatments based on evapotranspiration (ET) were imposed for 69 days, i.e., well-watered (WW, 100% ET) and drought-stressed (DS, 10−30% ET). Leaf stomatal conductance (gs), stem water potential (Ψstem), transpiration (E), photosynthetic capacity (Amax), water use efficiency (WUE), stem (Kstem) and root (Kroot) hydraulic conductance, trunk diameter variations (TDV), and leaf patch attenuated pressure fluctuations (pp, a proxy of the inverse of leaf turgor pressure) were measured in WW and DS trees at different stages of the experiment. Leaf gs did not significantly differ between cultivars under DS, whereas differences in Ψstem only became significant at the end of prolonged drought, when ‘Nocellara del Belice’ experienced Ψstem < −4 MPa. ‘Cerasuola’ trees expressed the best WUE under drought, although they were more susceptible to photoinhibition under optimal plant water status. Both cultivars tended to increase their Kstem at the end of the drought period. A marked reduction in Kroot occurred in ‘Cerasuola’ plants after prolonged drought; however, a similar mechanism was not observed in ‘Nocellara del Belice’. The ratio between Kstem and Kroot exponentially increased towards the end of the prolonged drought period in both cultivars, but more markedly in ‘Cerasuola’. TDV and pp trends suggested that ‘Cerasuola’ plants keep better plant water status under severe drought compared to ‘Nocellara del Belice’ by maintaining high leaf turgor and reduced trunk diameter fluctuations. These responses may be related to reduced cell wall elasticity and xylem vessel size and/or wall thickness—drought avoidance mechanisms. The Kstem/Kroot ratio can serve as an indicator of drought stress avoidance mechanisms to compare genotype-specific responses to drought stress.

Temperature Trend Analysis and Investigation on a Case of Variability Climate

Climate change is now evident on a global scale. In some regions, the phenomenon is especially amplified, generating different consequences for man and the environment. Sicily is one of the Mediterranean regions, the biggest in terms of area, where climatic variations produce significant effects. In this study, temperature trends on monthly time scales are examined in the time frame 1925–2015. The cluster analysis technique (Ward’s method) was used to homogenize the temperature series. The results show four statistically significant clusters, confirming the presence of climatic variability in the region. The non-parametric Mann–Kendall test was used to determine temperature trends. The non-parametric estimator Sen’s slope was used to quantify the variation of trends. The results showed the presence of statistically significant trends. A worrying and unexpected increase in temperatures was found during the winter period. This scenario was presented in three clusters, highlighting a mutation in the winter season, attributable to the climatic changes in progress rather than to territorial factors. If the trends maintain an increasing monotone character, in the coming decades there will be, in many areas of Sicily, a constant loss of fertile soil for the agricultural sector and the advancement of phenomena such as drought and desertification, to which the island is already predisposed. All of this will have serious socio-economic repercussions. Considering that a large part of the region’s economy is based on the agricultural sector, these repercussions will be followed by serious environmental implications that will negatively affect the ecological sustainability of the region.

A Review on Climate, Air Pollution, and Health in North Africa

PURPOSE OF REVIEW

The aim of this review is to summarize and provide clear insights into studies that evaluate the interaction between air pollution, climate, and health in North Africa.

RECENT FINDINGS

Few studies have estimated the effects of climate and air pollution on health in North Africa. Most of the studies highlighted the evidence of the link between climate and air pollution as driving factors and increased mortality and morbidity as health outcomes. Each North African country prioritized research on a specific health factor. It was observed that the health outcome from each driving factor depends on the studied area and data availability. The latter is a major challenge in the region. As such, more studies should be led in the future to cover more areas in North Africa and when more data are available. Data availability will help to explore the applicability of different tools and techniques new to the region. This review explores studies related to climate and air pollution, and their possible impacts on health in North Africa. On one hand, air quality studies have focused mainly on particulate matter exceedance levels and their long-term exposure impacts, namely, morbidity and mortality. The observed differences between the various studies are mainly due to the used exposure-response function, the studied population, background emissions, and natural emission from the Sahara Desert that characterize the region. On the other hand, climate studies have focused primarily on the impact of heat waves, vector-borne disease, and mental disorders. More than half of these studies have been on leishmaniasis disease. The review revealed unbalanced and insufficient research on health impacts from air pollution episodes and climate extremes across the region.

A Review on Climate Change Impacts on Forest Ecosystem Services in the Mediterranean Basin

The Mediterranean Basin covers more than 2 million square kilometres and is surrounded by three continents: Africa, Asia and Europe. The Basin that is rich in biodiversity has tilted towards warmer and drier conditions over the last decades. The emerging climatic conditions particularly the increase in the number of climate extremes are bringing new threats and risks that will exacerbate existing pressures. The present study thoroughly reviewed the recent scientific literature and synthesized existing body of knowledge on the impacts (direct and indirect) of climate change on forest ecosystem services in the Mediterranean Basin. Despite many uncertainties about climate change in the Basin, there appears to be a consensus among a number of studies that climate change is having and will continue to have mostly negative impacts on the Mediterranean forest ecosystem services (wood and non-wood forest products, water resources, carbon storage and recreation and tourism) with possible substantial impacts in the future. Further, evidence is mounting that climate-induced natural disturbances (fires, insect pests, and pathogenic diseases) are becoming frequent and severe. The Mediterranean plants are known for their resilience to natural disturbances. However, the novel climatic conditions may exceed their resilience and alter the ecosystem services. Therefore, there is the need to mitigate the challenges posed by climate change and adapt forest management practices to impending changes to sustain the forest ecosystem services.

Projection of Extreme Temperature Events over the Mediterranean and Sahara Using Bias-Corrected CMIP6 Models

Climate change continues to increase the intensity, frequency and impacts of weather and climate extremes. This work uses bias-adjusted Coupled Model Intercomparison Project Phase six (CMIP6) model datasets to investigate the future changes in temperature extremes over Mediterranean (MED) and Sahara (SAH) regions. The mid- (2041–2070) and far-future (2071–2100) are studied under two Shared Socioeconomic Pathways: SSP2-4.5 and SSP5-8.5 scenarios. Quantile mapping function greatly improved the performance of CMIP6 by reducing the notable biases to match the distribution of observation data, the Climate Prediction Center (CPC). Results show persistent significant warming throughout the 21st century, increasing with the increase in radiative forcing. The MED will record a higher increase in temperature extremes as compared to SAH. The warming is supported by the projected reduction in cold days (TX10p) and cold nights (TN10p), with the reduction in the number of cold nights exceeding cold days. Notably, warm spell duration index (WSDI) and summer days (SU) have a positive trend in both timelines over the entire study area. There is a need to simulate how climate sensitive sectors, such as water and agriculture, are likely to be affected by projected changes under different scenarios for informed decision making in the choice and implementation of adaptation and mitigation effective measures.

Analysis of vulnerability to heat in rural and urban areas in Spain: What factors explain Heat's geographic behavior?

INTRODUCTION

There is currently little knowledge and few published works on the subject of vulnerability to heat in rural environments at the country level. Therefore, the objective of this study was to determine whether rural areas are more vulnerable to extreme heat than urban areas in Spain. This study aimed to analyze whether a pattern of vulnerability depends on contextual, environmental, demographic, economic and housing variables.

METHODS

An ecological, longitudinal and retrospective study was carried out based on time series data between January 01, 2000 and December 31, 2013 in 42 geographic areas in 10 provinces in Spain. We first analyzed the functional relationship between the mortality rate per million inhabitants and maximum daily temperature (Tmax). We then determined the summer temperature threshold (Pthreshold) (June-September) at which increases in mortality are produced that are attributable to heat. In a second phase, based on Pthreshold, a vulnerability variable was calculated, and its distribution was analyzed using mixed linear models from the Poisson family (link = log). In these models, the dependent variable was vulnerability, and the independent variables were exposure to high temperatures, aridity of the climate, deprivation index, percentage of people over age 65, rurality index, percentage of housing built prior to 1980 and condition of dwellings.

RESULTS

Rurality was a protective factor, and vulnerability in urban areas was six times greater. In contrast, risk factors included aridity (RR = 5.89 (2.26 15.36)), living in cool summer zones (2.69 (1.23, 5.91)), poverty (4.05 (1.91 8.59)) and the percentage of dysfunctional housing (1.13 (1.04 1.24)).

CONCLUSIONS

Rural areas are less vulnerable to extreme heat than the urban areas analyzed. Also, population groups with worse working conditions and higher percentages of dwellings in poor conditions are more vulnerable.

Anatomy of the atmospheric emissions from the transport sector in Greece: trends and challenges

Emissions of atmospheric pollutants are well-known for their adverse effects on air quality and public health. Additionally, GHG emissions are responsible for the so called "Radiating Forcing" leading to climate change and degradation of ecosystem services. In this work, we analyze the annual emission trends of various air pollutants, including GHGs, from all 4 sectors of transport (roads, aviation, navigation, and railway) in Greece during the 28-year period between 1990 and 2017, in order to examine the confounding dynamics among external forces, such as the major fiscal recession of 2008, and the GHG/pollutant emissions in the country. The analysis is performed with a suite of statistical tools consisting of bivariate correlation analysis, Mann-Kendall test, Sen's slope estimation, and Joinpoint regression analysis, in order to thoroughly study the trends of emissions. It is found that all transport sectors (except for the railway) show a significant increase in their emissions, despite the fiscal recession of 2008 that temporarily decelerated all aspects of economic activity in the country. Given the major share of transport in GHG emissions (37%) and air pollution in urban centers, it is essential that the road sector adapts to the new challenges, by means of switching to low-emission technologies and electromobilization. The same applies for the navigation and aviation sectors, which are known pillars of the tourist industry in the country.

Assessing the impact of air pollution and climate seasonality on COVID-19 multiwaves in Madrid, Spain

While the COVID-19 pandemic is still in progress, being under the fifth COVID-19 wave in Madrid, over more than one year, Spain experienced a four wave pattern. The transmission of SARS-CoV-2 pathogens in Madrid metropolitan region was investigated from an urban context associated with seasonal variability of climate and air pollution drivers. Based on descriptive statistics and regression methods of in-situ and geospatial daily time series data, this study provides a comparative analysis between COVID-19 waves incidence and mortality cases in Madrid under different air quality and climate conditions. During analyzed period 1 January 2020-1 July 2021, for each of the four COVID-19 waves in Madrid were recorded anomalous anticyclonic synoptic meteorological patterns in the mid-troposphere and favorable stability conditions for COVID-19 disease fast spreading. As airborne microbial temporal pattern is most affected by seasonal changes, this paper found: 1) a significant negative correlation of air temperature, Planetary Boundary Layer height, and surface solar irradiance with daily new COVID-19 incidence and deaths; 2) a similar mutual seasonality with climate variables of the first and the fourth COVID-waves from spring seasons of 2020 and 2021 years. Such information may help the health decision makers and public plan for the future.

Extreme Weather Conditions and Cardiovascular Hospitalizations in Southern Brazil

This research concerns the identification of a pattern between the occurrence of extreme weather conditions, such as cold waves and heat waves, and hospitalization for cardiovascular diseases (CVDs), in the University Hospital of Santa Maria (HUSM) in southern Brazil between 2012 and 2017. The research employed the field experiment method to measure the biometeorological parameters associated with hospital admissions in different seasons, such as during extreme weather conditions such as a cold wave (CW) or a heat wave (HW), using five thermal comfort indices: physiologically equivalent temperature (PET), new standard effective temperature (SET), predicted mean vote (PMV), effective temperatures (ET), and effective temperature with wind (ETW). The hospitalizations were recorded as 0.775 and 0.726 admissions per day for the winter and entire study periods, respectively. The records for extreme events showed higher admission rates than those on average days. The results also suggest that emergency hospitalizations for heart diseases during extreme weather events occurred predominantly on days with thermal discomfort. Furthermore, there was a particularly high risk of hospitalization for up to seven days after the end of the CW. Further analyses showed that cardiovascular hospitalizations were higher in winter than in summer, suggesting that CWs are more life threatening in wintertime.

Climate mitigation in the Mediterranean Europe: An assessment of regional and city-level plans

In Europe, regions in the Mediterranean area share common characteristics in terms of high sensitivity to climate change impacts. Does this translate into specificities regarding climate action that could arise from these Mediterranean characteristics? This paper sheds light on regional and local climate mitigation actions of the Mediterranean Europe, focusing on the plans to reduce greenhouse gases emissions in a representative sample of 51 regions and 73 cities across 9 Mediterranean countries (Croatia, Cyprus, France, Greece, Italy, Malta, Portugal, Slovenia, Spain). The study investigates: (i) the availability of local and regional mitigation plans, (ii) their goals in term of greenhouse gas emissions reduction targets on the short and medium-long term, and (iii) the impact of transnational climate networks on such local and regional climate mitigation planning. Results of this study indicate an uneven and fragmented planning, that shows a Mediterranean West-East divide, and a link with population size. However, overall, both regional and city action seem insufficiently ambitious with regards to meeting the Paris Agreement, at least at city level. While national frameworks are currently weak in influencing regional and local actions, transnational networks seem to be engaging factors for commitment (at city level) and ambitiousness (at regional level). The uneven and fragmented progress revealed by this study, does not align with the characteristics shared by investigated regions and cities in terms of environmental, socio-political, climatic and economic conditions. The results support the call of a common green deal at the Mediterranean level to further address specific Mediterranean challenges and related needs. This will allow to capitalise on available resources, generate local-specific knowledge, build capacities, and support Mediterranean regions and cities in preparing the next generation of more ambitious mitigation plans.

Exploring the linkage between seasonality of environmental factors and COVID-19 waves in Madrid, Spain

Like several countries, Spain experienced a multi wave pattern of COVID-19 pandemic over more than one year period, between spring 2020 and spring 2021. The transmission of SARS-CoV-2 pandemics is a multi-factorial process involving among other factors outdoor environmental variables and viral inactivation.This study aims to quantify the impact of climate and air pollution factors seasonality on incidence and severity of COVID-19 disease waves in Madrid metropolitan region in Spain. We employed descriptive statistics and Spearman rank correlation tests for analysis of daily in-situ and geospatial time-series of air quality and climate data to investigate the associations with COVID-19 incidence and lethality in Madrid under different synoptic meteorological patterns. During the analyzed period (1 January 2020-28 February 2021), with one month before each of three COVID-19 waves were recorded anomalous anticyclonic circulations in the mid-troposphere, with positive anomalies of geopotential heights at 500 mb and favorable stability conditions for SARS-CoV-2 fast diffusion. In addition, the results reveal that air temperature, Planetary Boundary Layer height, ground level ozone have a significant negative relationship with daily new COVID-19 confirmed cases and deaths. The findings of this study provide useful information to the public health authorities and policymakers for optimizing interventions during pandemics.

Development of a groundwater contamination index based on the agricultural hazard and aquifer vulnerability: Application to Portugal

Reducing nitrate leaching may not result in a significant improvement of groundwater quality. The amount of nitrate reaching groundwater depends not only on the hazard related to agricultural activities but also on-site specific groundwater vulnerability. Using national databases and other compiled datasets, the agricultural hazard was calculated as the ratio of (i) the nitrate leached estimated from the N surplus, and (ii) the water surplus, a proxy of the percolating water below the root zone. By combining the hazard with a multi-parameter groundwater vulnerability, a spatially explicit groundwater contamination risk, developed for mainland Portugal, was computed for 1999 and 2009. Results show an increase from 8,800 to 82,679 ha of the territory rated with a very high contamination risk. The priority areas were successfully screened by the Index, coinciding with the current Vulnerable Zones, although additional hotspots were detected in southern Portugal. Percolation, including both irrigation activity and precipitation, was found to be a key driver for the groundwater contamination risk due to its opposite effects in the hazard and in the vulnerability. Reducing nitrogen leaching may be insufficient to reduce the risk of nitrate contamination if there is a relatively larger reduction in precipitation. This index is particularly useful when applied to contrasting situations of vulnerability and hazard, which require distinct mitigation measures to mitigate groundwater contamination.

Towards Understanding Interactions between Sustainable Development Goals: The Role of Climate-Well-Being Linkages. Experiences of EU Countries

The 2030 Agenda with 17 Sustainable Development Goals (SDGs) is a challenge for all countries in the world. Their implementation may turn out to be a compromise or the creation of effective interactions that dynamize sustainable development. To achieve the SDGs, it is essential to understand how they interact with each other. It seems that in the times of the climate and health crisis caused by the COVID-19 pandemic, caring for the environment and ensuring a healthy life and promoting well-being at all ages is the basis for environmental, economic and social sustainable development. The aim of the study is to compare the degree of implementation of the goals of sustainable development in the scope of goal 13 “Climate action” and goal 3 “Good health and well-being” in the EU countries. In addition, we analyze how trade-offs and synergies between these goals have developed. Data from the Eurostat database were used to achieve the goal. The study used the method of multivariate comparative analysis—linear ordering of objects. The technique for order preference by similarity to an ideal solution (TOPSIS) method was used to measure the studied phenomenon. The results indicate a different degree of implementation of the sustainable development goals related to climate change and the improvement of health and social well-being. Only a few countries have synergy in achieving these goals, most of them compromise, manifesting themselves in improving one goal over another. In the group of analyzed EU countries, a simultaneous deterioration in the effectiveness of achieving both objectives were also noted. Our research also shows that energy policy is an important attribute in improving the achievement of these goals. The conducted analysis fills the gap in the research on the implementation of selected sustainable development goals and their interactions. It contributes to the discussion on increasing the links between them, in particular with regard to emerging compromises. This research can provide a basis for re-prioritizing and intensifying the actions where individual EU countries are lagging most behind.

Extreme temperature and out-of-hospital-cardiac-arrest. Nationwide study in a hot climate country

BACKGROUND

Out-of-hospital-cardiac arrest (OHCA) is frequently linked to environmental exposures. Climate change and global warming phenomenon have been found related to cardiovascular morbidity, however there is no agreement on their impact on OHCA occurrence. In this nationwide analysis, we aimed to assess the incidence of the OHCA events attended by emergency medical services (EMS), in relation to meteorological conditions: temperature, humidity, heat index and solar radiation.

METHODS

We analyzed all adult cases of OHCA in Israel attended by EMS during 2016-2017. In the case-crossover design, we compared ambient exposure within 72 h prior to the OHCA event with exposure prior to the four control times using conditional logistic regression in a lag-distributed non-linear model.

RESULTS

There were 12,401 OHCA cases (68.3% were pronounced dead-on-scene). The patients were on average 75.5 ± 16.2 years old and 55.8% of them were males. Exposure to 90th and 10th percentile of temperature adjusted to humidity were positively associated with the OHCA with borderline significance (Odds Ratio (OR) =1.20, 95%CI 0.97; 1.49 and OR 1.16, 95%CI 0.95; 1.41, respectively). Relative humidity below the 10th percentile was a risk factor for OHCA, independent of temperature, with borderline significance (OR = 1.16, 95%CI 0.96; 1.38). Analysis stratified by seasons revealed an adverse effect of exposure to 90th percentile of temperature when estimated in summer (OR = 3.34, 95%CI 1.90; 3.5.86) and exposure to temperatures below 10th percentile in winter (OR = 1.75, 95%CI 1.23; 2.49). Low temperatures during a warm season and high temperatures during a cold season had a protective effect on OHCA. The heat index followed a similar pattern, where an adverse effect was demonstrated for extreme levels of exposure.

CONCLUSIONS

Evolving climate conditions characterized by excessive heat and low humidity represent risk factors for OHCA. As these conditions are easily avoided, by air conditioning and behavioral restrictions, necessary prevention measures are warranted.

Analysis of the impact of heat waves on daily mortality in urban and rural areas in Madrid

The objective of this study was to analyze and compare the effect of high temperatures on daily mortality in the urban and rural populations in Madrid. Data were analyzed from municipalities in Madrid with a population of over 10,000 inhabitants during the period from January 1, 2000 to December 31, 2020. Four groups were generated: Urban Metropolitan Center, Rural Northern Mountains, Rural Center, and Southern Rural. The dependent variable used was the rate of daily mortality due to natural causes per million inhabitants (CIE-X: A00-R99) between the months of June and September for the period. The primary independent variable was maximum daily temperature. Social and demographic "context variables" were included: population >64 years of age (%), deprivation index and housing indicators. The analysis was carried out in three phases: 1) determination of the threshold definition temperature of a heat wave (Tumbral) for each study group; 2) determination of relative risks (RR) attributable to heat for each group using Poisson linear regression (GLM), and 3) calculation of odds ratios (OR) using binomial family GLM for the frequency of the appearance of heat waves associated with context variables. The resulting percentiles (for the series of maximum daily temperatures for the summer months) corresponding to Tthreshold were: 74th percentile for Urban Metropolitan Center, 76th percentile for Southern Rural, 83rd for Rural Northern Mountains and 98th percentile for Center Rural (98). Greater vulnerability was found for the first two. In terms of context variables that explained the appearance of heat waves, deprivation index level, population >64 years of age and living in the metropolitan area were found to be risk factors. Rural and urban areas behaved differently, and socioeconomic inequality and the composition of the population over age 64 were found to best explain the vulnerability of the Rural Center and Southern Rural zones.

Thermal Discomfort Levels, Building Design Concepts, and Some Heat Mitigation Strategies in Low-Income Communities of a South Asian City

Heat stress provokes thermal discomfort to people living in semiarid and arid climates. This study evaluates thermal discomfort levels, building design concepts, and some heat mitigation strategies in low-income neighborhoods of Faisalabad, Pakistan. The outdoor and indoor weather data are collected from April to August 2016 using a weather station installed ad hoc in urban settings, and the 52 houses of the five low-income participating communities living in congested and less environment-friendly areas of Faisalabad. The discomfort index values, related to the building design concepts, including (i) house orientation to sunlight and (ii) house ventilation, are calculated from outdoor and indoor dry-bulb and wet-bulb temperatures. Our results show that although June was the hottest month of summer 2016, based on the monthly mean temperature of the Faisalabad region, the month of May produced the highest discomfort levels, which were higher in houses exposed to sunlight and without ventilation. The study also identifies some popular heat mitigation strategies adopted by the five participating low-income communities during various heat-related health complaints. The strategies are gender-biased and have medical, cultural/customary backgrounds. For example, about 52% of the males and 28% of the females drank more water during dehydration, diarrhea, and eye infection. Over 11% and 19% of the males and females, respectively, moved to cooler places during fever. About 43% of the males and 51% of the females took water showers and rested to combat flu (runny nose), headache, and nosebleed. The people did not know how to cure muscular fatigue, skin allergy (from a type of Milia), and mild temperature. Planting trees in an area and developing open parks with greenery and thick canopy trees can be beneficial for neighborhoods resembling those evaluated in this study.

Toxicological risks on the human health of populations living around the Mediterranean Sea linked to the invasion of non-indigenous marine species from the Red Sea: A review

The Mediterranean region is, by far, a prime travel destination, having hosted more than 330 million tourists in 2016, mostly for seaside holidays. A greatly increased influx of thermophilic Red Sea species, introduced through the Suez Canal in a process referred to as Lessepsian invasion (in honor of Ferdinand de Lesseps who instigated the building of the Suez Canal), have raised awareness among scientists, medical personnel, and the public, of health risks caused by some venomous and poisonous marine species. The main species of concern are the poisonous Lagocephalus sceleratus, and the venomous Plotosus lineatus, Siganus luridus, Siganus rivulatus, Pterois miles, Synancea verrucosa, Rhopilema nomadica, Macrorhynchia philippina and Diadema setosum. Recognizing that the main factors that drive the introduction and dispersal of Red Sea biota in the Mediterranean, i.e., Suez Canal enlargements and warming seawater, are set to increase, and international tourist arrivals are forecasted to increase as well, to 500 million in 2030, an increase in intoxications and envenomations by alien marine species is to be expected and prepared for.

The evolution of minimum mortality temperatures as an indicator of heat adaptation: The cases of Madrid and Seville (Spain)

The increase in the frequency and intensity of heat waves is one of the most unquestionable effects of climate change. Therefore, the progressive increase in maximum temperatures will have a clear incidence on the increase in mortality, especially in countries that are vulnerable due to geographical location or their socioeconomic characteristics. Different research studies show that the mortality attributable to heat is decreasing globally, and research is centred on future scenarios. One way of detecting the existence of a lesser impact of heat is through the increase in the so-called temperature of minimum mortality (TMM). The objective of this study is to determine the temporal evolution of TMM in two Spanish provinces (Seville and Madrid) during the 1983-2018 period and to evaluate whether the rate of adaptation to heat is appropriate. We used the gross rate of daily mortality due to natural causes (CIEX: A00-R99) and the maximum daily temperature (°C) to determine the quinquennial TMM using dispersion diagrams and realizing fit using quadratic and cubic curvilinear estimation. The same analysis was carried out at the annual level, by fitting an equation to the line of TMM for each province, whose slope, if significant (p < 0.05) represents the annual rate of variation in TMM. The results observed in this quinquennial analysis showed that the TMM is higher in Seville than in Madrid and that it is higher among men than women in the two provinces. Furthermore, there was an increase in TMM in all of the quinquennium and a clear decrease in the final period. At the annual level, the linear fit was significant for Madrid for the whole population and corresponds to an increase in the TMM of 0.58 °C per decade. For Seville the linear fits were significant and the slopes of the fitted lines was 1.1 °C/decade. Both Madrid and Seville are adapting to the increase in temperatures observed over the past 36 years, and women are the group that is more susceptible to heat, compared to men. The implementation of improvements and evaluation of prevention plans to address the impact of heat waves should continue in order to ensure adequate adaptation in the future.

Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018

BACKGROUND

Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982-2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants.

METHODS

Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup.

RESULTS

All-cause mortality risk is higher among women (1.88; 95% CI = 1.77, 2.00) and the elderly (2.13; 95% CI = 1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI = 1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI = 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI = 1.38, 2.00) and for separated and divorced in women (2.11; 95% CI = 1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI = 1.39, 1.86), while for women results are almost equivalent between alone and not alone groups.

CONCLUSIONS

The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups.

Modelling climate change impacts on attributable-related deaths and demographic changes in the largest metropolitan area in Portugal: A time-series analysis

Previous studies have consistently analyzed the impact that extreme temperatures will have on human health. However, there are very few data on temperature-related mortality burden considering future demographic changes in a context of climate change in Portugal. This study aims to quantify the impact of climate change on heat-, cold-, and net change mortality burdens, taking into account the future demographic changes in Lisbon Metropolitan Area, Portugal. We applied a time-series generalized linear model with a quasi-Poisson model via a distributed lag nonlinear model to project temperature-related mortality burden for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that the total attributable fraction due to temperature, extreme and moderate cold, is statistically significant in the historical period and the future projected scenarios, while extreme and moderate heat were only significant in the projected future summer period. Net differences were attributed to moderate cold in the future winter months. Projections show a consistent and significant increase in future heat-related mortality burden. The attributable fraction due to heat in the future period, compared to the historical period, ranges from 0 to 1.5% for moderate heat and from 0 to 0.5% for extreme heat. Adaptation should be implemented at the local level, so as to prevent and diminish the effects on citizens and healthcare services, in a context of climate change.

The impact of heat waves on daily mortality in districts in Madrid: The effect of sociodemographic factors

Although there is significant scientific evidence on the impact of heat waves, there are few studies that analyze the effects of sociodemographic factors on the impact of heat waves below the municipal level. The objective of this study was to analyze the role of income level, percent of the population over age 65, existence of air conditioning units and hectares (Ha) of green zones in districts in Madrid, in the impact of heat on daily mortality between January 1, 2010 and December 31, 2013. Seventeen districts were analyzed, and Generalized Linear (GLM) Poisson Regression Models were used to calculate relative risks (RR) and attributable risks (RA) for the impact of heat waves on mortality due to natural causes (CIEX:A00-R99). The pattern of risks obtained was analyzed using GLM univariates and multivariates of the binomial family (link logit), introducing the socioeconomic and demographic variables mentioned above. The results indicate that heat wave had an impact in only three of the districts analyzed. In the univariate models, all of the variables were statistically significant, but Ha of green zones lost significance in the multivariate model. Income level, existence of air conditioning units, and percent of the population over age 65 in the district remained as variables that modulate the impact of heat wave on daily mortality in the municipality of Madrid. Income level was the key variable that explained this behavior. The results obtained in this study show that there are factors at levels below the municipal level (district level) that should be considered as focus areas for health policy in order to decrease the impact of heat and promote the process of adaptation to heat in the context of climate change.

Assessing the relationship between ground levels of ozone (O3) and nitrogen dioxide (NO2) with coronavirus (COVID-19) in Milan, Italy

This paper investigates the correlation between the high level of coronavirus SARS-CoV-2 infection accelerated transmission and lethality, and surface air pollution in Milan metropolitan area, Lombardy region in Italy. For January-April 2020 period, time series of daily average inhalable gaseous pollutants ozone (O3) and nitrogen dioxide (NO2), together climate variables (air temperature, relative humidity, wind speed, precipitation rate, atmospheric pressure field and Planetary Boundary Layer) were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces or direct human-to-human personal contacts, it seems that high levels of urban air pollution, and climate conditions have a significant impact on SARS-CoV-2 diffusion. Exhibited positive correlations of ambient ozone levels and negative correlations of NO2 with the increased rates of COVID-19 infections (Total number, Daily New positive and Total Deaths cases), can be attributed to airborne bioaerosols distribution. The results show positive correlation of daily averaged O3 with air temperature and inversely correlations with relative humidity and precipitation rates. Viral genome contains distinctive features, including a unique N-terminal fragment within the spike protein, which allows coronavirus attachment on ambient air pollutants. At this moment it is not clear if through airborne diffusion, in the presence of outdoor and indoor aerosols, this protein "spike" of the new COVID-19 is involved in the infectious agent transmission from a reservoir to a susceptible host during the highest nosocomial outbreak in some agglomerated industrialized urban areas like Milan is. Also, in spite of collected data for cold season (winter-early spring) period, when usually ozone levels have lower values than in summer, the findings of this study support possibility as O3 can acts as a COVID-19 virus incubator. Being a novel pandemic coronavirus version, it might be ongoing during summer conditions associated with higher air temperatures, low relative humidity and precipitation levels.

Heat warning and public and workers' health at the time of COVID-19 pandemic

The humanity is currently facing the COVID-19 pandemic challenge, the largest global health emergency after the Second World War. During summer months, many countries in the northern hemisphere will also have to counteract an imminent seasonal phenomenon, the management of extreme heat events. The novelty this year concerns that the world population will have to deal with a new situation that foresees the application of specific measures, including adjunctive personal protective equipment (i.e. facemasks and gloves), in order to reduce the potential transmission of the SARS-CoV-2 virus. These measures should help to decrease the risk of the infection transmission but will also represent an aggravating factor to counteract the heat effects on the population health both at occupational and environmental level. The use of a specific heat health warning system with personalized information based on individual, behavioural and environmental characteristics represents a necessary strategy to help a fast adaptation of the population at a time where the priority is to live avoiding SARS-CoV-2 infection.

A new integrative perspective on early warning systems for health in the context of climate change

Climate change causes or aggravates a wide range of exposures with multiple impacts on health, both direct and indirect. Early warning systems have been established to act on the risks posed by these exposures, permitting the timely activation of action plans to minimize health effects. These plans are usually activated individually. Although they show good results from the point of view of minimizing health impacts, such as in the case of high temperature plans, they commonly fail to address the synergies across various climate-related or climate-aggravated exposures. Since several of those exposures tend to occur concurrently, failure to integrate them in prevention efforts could affect their effectiveness and reach. Thus, there is a need to carry out an integrative approach for the multiple effects that climate change has on population health. This article presents a proposal for how these plans should be articulated. The proposed integrated plan would consist of four phases. The first phase, based on early warning systems, would be the activation of different existing individual plans related to the health effects that can be caused by certain circumstances and when possible corrective measures would be implemented. The second phase would attempt to quantify the health impact foreseen by the event in terms of the different health indicators selected. The third phase would be to activate measures to minimize the impact on health, via population alerts and advisories, and additional social and health services, based on the provisions in phase two. Phase four would be related to epidemiological surveillance that permits evaluation of the effects of activating the plan. We believe that this integrative approach should be extended to all of the public health interventions related to climate change.

Effects of air pollutants on the transmission and severity of respiratory viral infections

Particulate matter, sulfur dioxide, nitrogen oxides, ozone, carbon monoxide, volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) are among the outdoor air pollutants that are major factors in diseases, causing especially adverse respiratory effects in humans. On the other hand, the role of respiratory viruses in the pathogenesis of severe respiratory infections is an issue of great importance. The present literature review was aimed at assessing the potential effects of air pollutants on the transmission and severity of respiratory viral infections. We have reviewed the scientific literature regarding the association of outdoor air pollution and respiratory viruses on respiratory diseases. Evidence supports a clear association between air concentrations of some pollutants and human respiratory viruses interacting to adversely affect the respiratory system. Given the undoubted importance and topicality of the subject, we have paid special attention to the association between air pollutants and the transmission and severity of the effects caused by the coronavirus named SARS-CoV-2, which causes the COVID-19. Although to date, and by obvious reasons, the number of studies on this issue are still scarce, most results indicate that chronic exposure to air pollutants delays/complicates recovery of patients of COVID-19 and leads to more severe and lethal forms of this disease. This deserves immediate and in-depth experimental investigations.