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Harvey G, Bain-Donohue S, Dewi SP. The impact of extreme heat on older regional and rural Australians: A systematic review. Aust J Rural Health 2024; 32:216-226. [PMID: 38419263 DOI: 10.1111/ajr.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Extreme heat causes a major health burden, especially for older Australians. OBJECTIVE To assess the impact of extreme heat on older regional and rural Australians, including clinical presentations, social implications, and health-seeking behaviours and adaptations. DESIGN A systematic review and narrative synthesis. FINDINGS Ten articles were included in the review with research on this topic limited. Extreme heat causes an increase in mortality and ambulance dispatches for older rural Australians. Social connectedness is negatively affected by extreme heat due to cancellation of events and individuals becoming housebound. Air conditioning is the main cooling mechanism used, although cost is a major concern. Despite this, older rural populations display a depth of knowledge regarding practical behavioural responses to adapt to extreme heat. Studies show older rural Australians do not consider extreme heat to be a threat to health. DISCUSSION Further research needs to examine the role extreme heat may play in contributing to experiences of loneliness. Air conditioning cannot be the ultimate solution in responding to extreme heat due to cost and increased carbon emissions. The low-risk perception of extreme heat for older rural people may inform effective heat health warnings and effective use of primary health care in heat-health education. Listening to First Nations knowledge in dealing with heat may provide a powerful mechanism in which to protect health. CONCLUSION The extensive health effects of extreme heat highlights the necessity of further research and strengthening of services in preparation for an ageing rural population enduring climate change.
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Affiliation(s)
- Grace Harvey
- Medical School - Australian National University (ANU) School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, Australian Capital Territory, Australia
- Rural Clinical School, Australian National University (ANU) School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Suzanne Bain-Donohue
- Rural Clinical School, Australian National University (ANU) School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, Australian Capital Territory, Australia
- Indigenous Health Unit, Australian National University (ANU) School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Sari Puspa Dewi
- Rural Clinical School, Australian National University (ANU) School of Medicine and Psychology, ANU College of Health and Medicine, Canberra, Australian Capital Territory, Australia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Indonesia
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Nyadanu SD, Dunne J, Tessema GA, Mullins B, Kumi-Boateng B, Bell ML, Duko B, Pereira G. Maternal exposure to ambient air temperature and adverse birth outcomes: An umbrella review of systematic reviews and meta-analyses. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 917:170236. [PMID: 38272077 DOI: 10.1016/j.scitotenv.2024.170236] [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: 07/27/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Multiple systematic reviews on prenatal ambient temperature and adverse birth outcomes exist, but the overall epidemiological evidence and the appropriate metric for thermal stress remain unclear. An umbrella review was performed to summarise and appraise the evidence with recommendations. METHODS Systematic reviews and meta-analyses on the associations between ambient temperature and adverse birth outcomes (preterm birth, stillbirth, birth weight, low birth weight, and small for gestational age) up to December 20, 2023, were synthesised according to a published protocol. Databases PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid, Web of Science Core Collection, systematic reviews repositories, electronic grey literature, and references were searched. Risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool. RESULTS Eleven systematic reviews, including two meta-analyses, were included. This comprised 90 distinct observational studies that employed multiple temperature assessment metrics with a very high overlap of primary studies. Primary studies were mostly from the United States while both Africa and South Asia contributed only three studies. A majority (7 out of 11) of the systematic reviews were rated as moderate risk of bias. All systematic reviews indicated that maternal exposures to both extremely high and low temperatures, particularly during late gestation are associated with increased risks of preterm birth, stillbirth, and reduced fetal growth. However, due to great differences in the exposure assessments, high heterogeneity, imprecision, and methodological limitations of the included systematic reviews, the overall epidemiological evidence was classified as probable evidence of causation. No study assessed biothermal metrics for thermal stress. CONCLUSIONS Despite the notable methodological differences, prenatal exposure to extreme ambient temperatures, particularly during late pregnancy, was associated with adverse birth outcomes. Adhering to the appropriate systematic review guidelines for environmental health research, incorporating biothermal metrics into exposure assessment, evidence from broader geodemographic settings, and interventions are recommended in future studies.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, P. O. Box 424, Aflao, Ghana.
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia
| | - Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P. O. Box 237, Tarkwa, Ghana
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT 06511, USA
| | - Bereket Duko
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; enAble Institute, Curtin University, Perth, Kent Street, Bentley, Western Australia 6102, Australia; WHO Collaborating Centre for Climate Change and Health Impact Assessment, Faculty of Health Science, Curtin University, WA, Australia
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Kumar P, Debele SE, Khalili S, Halios CH, Sahani J, Aghamohammadi N, Andrade MDF, Athanassiadou M, Bhui K, Calvillo N, Cao SJ, Coulon F, Edmondson JL, Fletcher D, Dias de Freitas E, Guo H, Hort MC, Katti M, Kjeldsen TR, Lehmann S, Locosselli GM, Malham SK, Morawska L, Parajuli R, Rogers CD, Yao R, Wang F, Wenk J, Jones L. Urban heat mitigation by green and blue infrastructure: Drivers, effectiveness, and future needs. Innovation (N Y) 2024; 5:100588. [PMID: 38440259 PMCID: PMC10909648 DOI: 10.1016/j.xinn.2024.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
The combination of urbanization and global warming leads to urban overheating and compounds the frequency and intensity of extreme heat events due to climate change. Yet, the risk of urban overheating can be mitigated by urban green-blue-grey infrastructure (GBGI), such as parks, wetlands, and engineered greening, which have the potential to effectively reduce summer air temperatures. Despite many reviews, the evidence bases on quantified GBGI cooling benefits remains partial and the practical recommendations for implementation are unclear. This systematic literature review synthesizes the evidence base for heat mitigation and related co-benefits, identifies knowledge gaps, and proposes recommendations for their implementation to maximize their benefits. After screening 27,486 papers, 202 were reviewed, based on 51 GBGI types categorized under 10 main divisions. Certain GBGI (green walls, parks, street trees) have been well researched for their urban cooling capabilities. However, several other GBGI have received negligible (zoological garden, golf course, estuary) or minimal (private garden, allotment) attention. The most efficient air cooling was observed in botanical gardens (5.0 ± 3.5°C), wetlands (4.9 ± 3.2°C), green walls (4.1 ± 4.2°C), street trees (3.8 ± 3.1°C), and vegetated balconies (3.8 ± 2.7°C). Under changing climate conditions (2070-2100) with consideration of RCP8.5, there is a shift in climate subtypes, either within the same climate zone (e.g., Dfa to Dfb and Cfb to Cfa) or across other climate zones (e.g., Dfb [continental warm-summer humid] to BSk [dry, cold semi-arid] and Cwa [temperate] to Am [tropical]). These shifts may result in lower efficiency for the current GBGI in the future. Given the importance of multiple services, it is crucial to balance their functionality, cooling performance, and other related co-benefits when planning for the future GBGI. This global GBGI heat mitigation inventory can assist policymakers and urban planners in prioritizing effective interventions to reduce the risk of urban overheating, filling research gaps, and promoting community resilience.
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Affiliation(s)
- Prashant Kumar
- Global Centre for Clean Air Research (GCARE), School of Sustainability, Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
- Institute for Sustainability, University of Surrey, Guildford GU2 7XH, Surrey, UK
- School of Architecture, Southeast University, 2 Sipailou, Nanjing 210096, China
| | - Sisay E. Debele
- Global Centre for Clean Air Research (GCARE), School of Sustainability, Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Soheila Khalili
- Global Centre for Clean Air Research (GCARE), School of Sustainability, Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Christos H. Halios
- School of Built Environment, University of Reading, Whiteknights, Reading RG6 6BU, UK
| | - Jeetendra Sahani
- Global Centre for Clean Air Research (GCARE), School of Sustainability, Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Nasrin Aghamohammadi
- School Design and the Built Environment, Curtin University Sustainability Policy Institute, Kent St, Bentley 6102, Western Australia
- Harry Butler Institute, Murdoch University, Murdoch 6150, Western Australia
| | - Maria de Fatima Andrade
- Atmospheric Sciences Department, Institute of Astronomy, Geophysics and Atmospheric Sciences, University of Sao Paulo, Sao Paulo 05508-090, Brazil
| | | | - Kamaldeep Bhui
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK
| | - Nerea Calvillo
- Centre for Interdisciplinary Methodologies, University of Warwick, Warwick, UK
| | - Shi-Jie Cao
- Global Centre for Clean Air Research (GCARE), School of Sustainability, Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
- School of Architecture, Southeast University, 2 Sipailou, Nanjing 210096, China
| | - Frederic Coulon
- Cranfield University, School of Water, Environment and Energy, Cranfield MK43 0AL, UK
| | - Jill L. Edmondson
- Plants, Photosynthesis, Soil Cluster, School of Biosciences, University of Sheffield, Sheffield S10 2TN, UK
| | - David Fletcher
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor LL57 2UW, UK
| | - Edmilson Dias de Freitas
- Atmospheric Sciences Department, Institute of Astronomy, Geophysics and Atmospheric Sciences, University of Sao Paulo, Sao Paulo 05508-090, Brazil
| | - Hai Guo
- Air Quality Studies, Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Madhusudan Katti
- Department of Forestry and Environmental Resources, Faculty Excellence Program for Leadership in Public Science, North Carolina State University, Chancellor, Raleigh, NC 27695, USA
| | - Thomas Rodding Kjeldsen
- Departments of Architecture & Civil Engineering, and Chemical Engineering, University of Bath, Bath BA2 7AY, UK
| | - Steffen Lehmann
- School of Architecture, University of Nevada, Las Vegas, NV 89154, USA
| | - Giuliano Maselli Locosselli
- Department of Tropical Ecosystems Functioning, Center of Nuclear Energy in Agriculture, University of São Paulo, Piracicaba 13416-000, Sao Paulo, Brazil
| | - Shelagh K. Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5 AB, UK
| | - Lidia Morawska
- Global Centre for Clean Air Research (GCARE), School of Sustainability, Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
- International Laboratory for Air Quality and Health, Science and Engineering Faculty, Queensland University of Science and Technology, QLD, Australia
| | - Rajan Parajuli
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC 27695, USA
| | - Christopher D.F. Rogers
- Department of Civil Engineering, School of Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Runming Yao
- School of Built Environment, University of Reading, Whiteknights, Reading RG6 6BU, UK
- Joint International Research Laboratory of Green Buildings and Built Environments, Ministry of Education, School of the Civil Engineering, Chongqing University, Chongqing, China
| | - Fang Wang
- State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jannis Wenk
- Departments of Architecture & Civil Engineering, and Chemical Engineering, University of Bath, Bath BA2 7AY, UK
| | - Laurence Jones
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor LL57 2UW, UK
- Liverpool Hope University, Department of Geography and Environmental Science, Hope Park, Liverpool L16 9JD, UK
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Côté JN, Germain M, Levac E, Lavigne E. Vulnerability assessment of heat waves within a risk framework using artificial intelligence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169355. [PMID: 38123103 DOI: 10.1016/j.scitotenv.2023.169355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
Current efforts to adapt to climate change are not sufficient to reduce projected impacts. Vulnerability assessments are essential to allocate resources where they are needed most. However, current assessments that use principal component analysis suffer from multiple shortcomings and are hard to translate into concrete actions. To address these issues, this article proposes a novel data-driven vulnerability assessment within a risk framework. The framework is based on the definitions from the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, but some definitions, such as sensitivity and adaptive capacity, are clarified. Heat waves that occurred between 2001 and 2018 in Quebec (Canada) are used to validate the framework. The studied impact is the daily mortality rates per cooling degree-days (CDD) region. A vulnerability map is produced to identify the distributions of summer mortality rates in aggregate dissemination areas within each CDD region. Socioeconomic and environmental variables are used to calculate impact and vulnerability. We compared abilities of AutoGluon (an AutoML framework), Gaussian process, and deep Gaussian process to model the impact and vulnerability. We offer advice on how to avoid common pitfalls with artificial intelligence and machine-learning algorithms. Gaussian process is a promising approach for supporting the proposed framework. SHAP values provide an explanation for the model results and are consistent with current knowledge of vulnerability. Recommendations are made to implement the proposed framework quantitatively or qualitatively.
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Affiliation(s)
- Jean-Nicolas Côté
- Department of Applied Geomatics, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke J1K 2R1, Quebec, Canada.
| | - Mickaël Germain
- Department of Applied Geomatics, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke J1K 2R1, Quebec, Canada
| | - Elisabeth Levac
- Department of Environment, Agriculture and Geography, Bishop's University, 2600 College St., Sherbrooke J1M 1Z7, Quebec, Canada
| | - Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Oberai M, Xu Z, Bach AJE, Phung D, Watzek JT, Rutherford S. Preparing for a hotter climate: A systematic review and meta-analysis of heatwaves and ambulance callouts in Australia. Aust N Z J Public Health 2024; 48:100115. [PMID: 38286717 DOI: 10.1016/j.anzjph.2023.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE The objective of this study was to quantify the impact of heatwaves on likelihood of ambulance callouts for Australia. METHODS A systematic review and meta-analysis was conducted to retrieve and synthesise evidence published from 1 January 2011 to 31 May 2023 about the association between heatwaves and the likelihood of ambulance callouts in Australia. Different heatwave definitions were used ranging from excess heat factor to heatwave defined as a continuous period with temperatures above certain defined thresholds (which varied based on study locations). RESULTS We included nine papers which met the inclusion criteria for the review. Eight were eligible for the meta-analyses. The multilevel meta-analyses revealed that the likelihood of ambulance callouts for all causes and for cardiovascular diseases increased by 10% (95% confidence interval: 8%, 13%) and 5% (95% confidence interval: 1%, 3%), respectively, during heatwave days. CONCLUSIONS Exposure to heatwaves is associated with an increased likelihood of ambulance callouts, and there is a dose-response association between heatwave severity and the likelihood of ambulance callouts. IMPLICATIONS FOR PUBLIC HEALTH The number of heatwave days are going to increase, and this will mean an increase in the likelihood of ambulance callouts, thereby, spotlighting the real burden that heatwaves place on our already stressed healthcare system. The findings of this study underscore the critical need for proactive measures, including the establishment of research initiatives and holistic heat health awareness campaigns, spanning from the individual and community levels to the healthcare system, in order to create a more resilient Australia in the face of heatwave-related challenges.
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Affiliation(s)
- Mehak Oberai
- School of Medicine and Dentistry, Griffith University, Australia.
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Australia; Cities Research Institute, Griffith University, Australia
| | - Aaron J E Bach
- School of Medicine and Dentistry, Griffith University, Australia; Cities Research Institute, Griffith University, Australia
| | - Dung Phung
- School of Public Health, The University of Queensland, Australia
| | - Jessica T Watzek
- School of Medicine and Dentistry, Griffith University, Australia
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Australia; Cities Research Institute, Griffith University, Australia
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Lo Y, Vosper E, Higgins JP, Howard G. Heat impacts on human health in the Western Pacific Region: an umbrella review. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100952. [PMID: 38022710 PMCID: PMC10652124 DOI: 10.1016/j.lanwpc.2023.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Background High temperatures and heatwaves are occurring more frequently and lasting longer because of climate change. A synthesis of existing evidence of heat-related health impacts in the Western Pacific Region (WPR) is lacking. This review addresses this gap. Methods The Scopus and PubMed databases were searched for reviews about heat impacts on mortality, cardiovascular morbidity, respiratory morbidity, dehydration and heat stroke, adverse birth outcomes, and sleep disturbance. The last search was conducted in February 2023 and only publications written in English were included. Primary studies and reviews that did not include specific WPR data were excluded. Data were extracted from 29 reviews. Findings There is strong evidence of heat-related mortality in the WPR, with the evidence concentrating on high-income countries and China. Associations between heat and cardiovascular or respiratory morbidity are not robust. There is evidence of heat-related dehydration and stroke, and preterm and still births in high-income countries in the WPR. Some evidence of sleep disturbance from heat is found for Australia, Japan and China. Interpretation Mortality is by far the most studied and robust health outcome of heat. Future research should focus on morbidity, and lower income countries in continental Asia and Pacific Island States, where there is little review-level evidence. Funding Funded by the World Health Organization WPR Office.
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Affiliation(s)
- Y.T.Eunice Lo
- Cabot Institute for the Environment, University of Bristol, UK
- Elizabeth Blackwell Institute for Health Research, University of Bristol, UK
| | - Emily Vosper
- Cabot Institute for the Environment, University of Bristol, UK
- School of Geographical Sciences, University of Bristol, UK
| | - Julian P.T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Guy Howard
- Cabot Institute for the Environment, University of Bristol, UK
- School of Civil, Aerospace and Design Engineering, University of Bristol, UK
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Liu L, Qin X. Analysis of heatwaves based on the universal thermal climate index and apparent temperature over mainland Southeast Asia. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:2055-2068. [PMID: 37878089 DOI: 10.1007/s00484-023-02562-9] [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: 06/21/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
Heatwaves have caused significant damage to human health, infrastructure, and economies in recent decades, and the occurrences of heatwaves are becoming more frequent and severe across the globe under climate change. The previous studies on heatwaves have primarily focused on air temperature, neglecting other variables like wind speed, relative humidity, and radiation, which could lead to a serious underestimation of the adverse effects of heatwaves. To address this issue, this study proposed to the use of more sophisticated thermal indices, such as universal thermal climate index (UTCI) and apparent temperature (AT), to define heatwaves and carry out a comprehensive heatwave assessment over mainland southeast Asia (MSEA) from 1961 to 2020. The traditional temperature-based method was also compared. The results of the study demonstrate that the annual maximum temperature in heatwave days (HWA) and the annual average temperature in heatwave days (HWM) are significantly underestimated if only air temperature is considered. However, UTCI and AT tend to predict a lower frequency of yearly heatwave occurrences and shorter durations. Trend analysis indicates a general increase in heatwave occurrences across MSEA under all thermal indices in the past six decades, particularly in the last 30 years. This study's approach and findings provide a holistic view of heatwave characteristics based on thermal indices and highlight the risk of intensified heat stress during heatwaves in MSEA.
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Affiliation(s)
- Lilingjun Liu
- School of Civil and Environmental Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Xiaosheng Qin
- School of Civil and Environmental Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore.
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Nyadanu SD, Tessema GA, Mullins B, Chai K, Yitshak-Sade M, Pereira G. Critical Windows of Maternal Exposure to Biothermal Stress and Birth Weight for Gestational Age in Western Australia. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127017. [PMID: 38149876 PMCID: PMC10752220 DOI: 10.1289/ehp12660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND There is limited and inconsistent evidence on the risk of ambient temperature on small for gestational age (SGA) and there are no known related studies for large for gestational age (LGA). In addition, previous studies used temperature rather than a biothermal metric. OBJECTIVES Our aim was to examine the associations and critical susceptible windows of maternal exposure to a biothermal metric [Universal Thermal Climate Index (UTCI)] and the hazards of SGA and LGA. METHODS We linked 385,337 singleton term births between 1 January 2000 and 31 December 2015 in Western Australia to daily spatiotemporal UTCI. Distributed lag nonlinear models with Cox regression and multiple models were used to investigate maternal exposure to UTCI from 12 weeks preconception to birth and the adjusted hazard ratios (HRs) of SGA and LGA. RESULTS Relative to the median exposure, weekly and monthly specific exposures showed potential critical windows of susceptibility for SGA and LGA at extreme exposures, especially during late gestational periods. Monthly exposure showed strong positive associations from the 6th to the 10th gestational months with the highest hazard of 13% for SGA (HR = 1.13 ; 95% CI: 1.10, 1.14) and 7% for LGA (HR = 1.07 ; 95% CI: 1.03, 1.11) at the 10th month for the 1st UTCI centile. Entire pregnancy exposures showed the strongest hazards of 11% for SGA (HR = 1.11 ; 95% CI: 1.04, 1.18) and 3% for LGA (HR = 1.03 ; 95% CI: 0.95, 1.11) at the 99th UTCI centile. By trimesters, the highest hazards were found during the second and first trimesters for SGA and LGA, respectively, at the 99th UTCI centile. Based on estimated interaction effects, male births, mothers who were non-Caucasian, smokers, ≥ 35 years of age, and rural residents were most vulnerable. CONCLUSIONS Both weekly and monthly specific extreme biothermal stress exposures showed potential critical susceptible windows of SGA and LGA during late gestational periods with disproportionate sociodemographic vulnerabilities. https://doi.org/10.1289/EHP12660.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, Aflao, Ghana
| | - Gizachew A. Tessema
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- enAble Institute, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Kevin Chai
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Bentley, Western Australia, Australia
- World Health Organization Collaborating Centre for Environmental Health Impact Assessment, Faculty of Health Science, Curtin University, Bentley, Western Australia, Australia
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Borg MA, Xiang J, Anikeeva O, Ostendorf B, Varghese B, Dear K, Pisaniello D, Hansen A, Zander K, Sim MR, Bi P. Current and projected heatwave-attributable occupational injuries, illnesses, and associated economic burden in Australia. ENVIRONMENTAL RESEARCH 2023; 236:116852. [PMID: 37558113 DOI: 10.1016/j.envres.2023.116852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia. MATERIALS AND METHODS Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065). RESULTS The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11-0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%), equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation. DISCUSSION Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs.
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Affiliation(s)
- Matthew A Borg
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Jianjun Xiang
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia; School of Public Health, Fujian Medical University, 1 Xue Yuan Road, Minhou Campus, Fuzhou, Fujian Province, 350122, China
| | - Olga Anikeeva
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Bertram Ostendorf
- Ecology and Evolutionary Biology, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia
| | - Blesson Varghese
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Keith Dear
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Dino Pisaniello
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Alana Hansen
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Kerstin Zander
- Northern Institute, Charles Darwin University, Ellengowan Drive, Darwin, NT 0909, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Peng Bi
- School of Public Health, University of Adelaide, 50 Rundle Mall, Adelaide, SA 5000, Australia.
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10
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Lee GW, Vine K, Atkinson AR, Tong M, Longman J, Barratt A, Bailie R, Vardoulakis S, Matthews V, Rahman KM. Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6285. [PMID: 37444133 PMCID: PMC10341403 DOI: 10.3390/ijerph20136285] [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: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
Climate change is exposing populations to increasing temperatures and extreme weather events in many parts of Australia. To prepare for climate challenges, there is a growing need for Local Health Districts (LHDs) to identify potential health impacts in their region and strengthen the capacity of the health system to respond accordingly. This rapid review summarised existing evidence and research gaps on the impact of climate change on health and health services in Northern New South Wales (NSW)-a 'hotspot' for climate disaster declarations. We systematically searched online databases and selected 11 peer-reviewed studies published between 2012-2022 for the Northern NSW region. The most explored health outcome was mental health in the aftermath of floods and droughts, followed by increased healthcare utilisation due to respiratory, cardiovascular and mortality outcomes associated with bushfire smoke or heat waves. Future research directions were recommended to understand: the compounding impacts of extreme events on health and the health system, local data needs that can better inform models that predict future health risks and healthcare utilisation for the region, and the needs of vulnerable populations that require a whole-of-system response during the different phases of disasters. In conclusion, the review provided climate change and health research directions the LHD may undertake to inform future adaptation and mitigation policies and strategies relevant to their region.
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Affiliation(s)
- Grace W. Lee
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
| | - Kristina Vine
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Amba-Rose Atkinson
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- School of Public Health, Faculty of Medicine, the University of Queensland, St. Lucia, QLD 4072, Australia
| | - Michael Tong
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Jo Longman
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- Sydney Environment Institute, University of Sydney, Camperdown, NSW 2006, Australia
| | - Alexandra Barratt
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia;
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Ross Bailie
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sotiris Vardoulakis
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
- College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Veronica Matthews
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Healthy Environments And Lives (HEAL) National Research Network, Canberra, ACT 2601, Australia; (M.T.); (R.B.); (S.V.)
| | - Kazi Mizanur Rahman
- University of Sydney, University Centre for Rural Health, Lismore, NSW 2480, Australia; (G.W.L.); (K.V.); (A.-R.A.); (J.L.); (V.M.)
- Sydney Environment Institute, University of Sydney, Camperdown, NSW 2006, Australia
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11
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Yi C, Kwon H. Spatial Relationship between Heat Illness Incidence and Heat Vulnerability in Gurye and Sunchang, South Korea, 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5992. [PMID: 37297596 PMCID: PMC10252748 DOI: 10.3390/ijerph20115992] [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: 10/31/2022] [Revised: 04/12/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
Heatwaves, along with their affiliated illnesses and mortalities, are increasing in frequency and severity under climate change. Spatial analyses at the level of census output areas can produce detailed maps of heatwave risk factors and potential correlated damages, thus contributing to practical policies to reduce the risk of heatwave illnesses. This study analyzed the 2018 summer heatwave in Gurye and Sunchang counties in South Korea. To compare damages and analyze the detailed causes of heatwave vulnerability, spatial autocorrelation analyses were conducted, incorporating weather, environmental, personal, and disease factors. Gurye and Sunchang, although similar in demographics and region, exhibited large differences in heatwave damage specifically in the number of heat-related illness cases. In addition, exposure data were constructed at the census output area level by calculating the shadow pattern, sky view factor, and mean radiant temperature, revealing a higher risk in Sunchang. Spatial autocorrelation analyses revealed that the factors most highly correlated with heatwave damage were hazard factors, in the case of Gurye, and vulnerability factors, in the case of Sunchang. Accordingly, it was concluded that regional vulnerability factors were better distinguished at the finer scale of the census output area and when detailed and diversified weather factors were incorporated.
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Affiliation(s)
- Chaeyeon Yi
- Research Center for Atmospheric Environment, Global Campus, Hankuk University of Foreign Studies, Yongin 17035, Republic of Korea
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12
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Zhang X, Chen F, Chen Z. Heatwave and mental health. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 332:117385. [PMID: 36738719 DOI: 10.1016/j.jenvman.2023.117385] [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: 11/03/2022] [Revised: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Physical health has been associated with ambient temperature and heatwave. With the frequent occurrence of heatwave, the adaptive effects and mechanisms on mental health remain uncertain. On the basis of the China Health and Nutrition Survey, we estimated the relationship between heatwaves and self-assessed mental health scores in the Chinese population aged 50 and above. This study has identified that with each additional heatwave event, mental health scores decreased by an average of 0.027 points, which is equivalent to 0.3% of the average level. Heat is more likely to affect groups with low education, no medical insurance, and living in rural areas. In mechanistic exploration, we found that stress emotion is a fully mediating effect. Heat led to reduced health activities and more frequent drinking, which may lead to lower psychological well-being. Moreover, good dietary preference is a regulator that can help mitigate the adverse effects of heat on mental health. This study corroborates the impact of heat on spiritual welfare, and demonstrates the mechanisms and channels of impact, which can help reduce global economic losses due to mental health problems.
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Affiliation(s)
- Xin Zhang
- School of Economics, Jinan University, Guangzhou, 510632, China.
| | - Fanglin Chen
- School of Government, Peking University, Beijing, 100871, China.
| | - Zhongfei Chen
- School of Economics, Jinan University, Guangzhou, 510632, China.
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13
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Wang S, Cai W, Tao Y, Sun QC, Wong PPY, Thongking W, Huang X. Nexus of heat-vulnerable chronic diseases and heatwave mediated through tri-environmental interactions: A nationwide fine-grained study in Australia. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 325:116663. [PMID: 36343399 DOI: 10.1016/j.jenvman.2022.116663] [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: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
The warming trend over recent decades has already contributed to the increased prevalence of heat-vulnerable chronic diseases in many regions of the world. However, understanding the relationship between heat-vulnerable chronic diseases and heatwaves remains incomplete due to the complexity of such a relationship mingling with human society, urban and natural environments. Our study extends the Social Ecological Theory by constructing a tri-environmental conceptual framework (i.e., across social, built, and natural environments) and contributes to the first nationwide study of the relationship between heat-vulnerable chronic diseases and heatwaves in Australia. We utilize the random forest regression model to explore the importance of heatwaves and 48 tri-environmental variables that contribute to the prevalence of six types of heat-vulnerable diseases. We further apply the local interpretable model-agnostic explanations and the accumulated local effects analysis to interpret how the heat-disease nexus is mediated through tri-environments and varied across urban and rural space. The overall effect of heatwaves on diseases varies across disease types and geographical contexts (latitudes; inland versus coast). The local heat-disease nexus follows a J-shape function-becoming sharply positive after a certain threshold of heatwaves-reflecting that people with the onset of different diseases have various sensitivity and tolerance to heatwaves. However, such effects are relatively marginal compared to tri-environmental variables. We propose a number of policy implications on reducing urban-rural disparity in healthcare access and service distribution, delineating areas, and identifying the variations of sensitivity to heatwaves across urban/rural space and disease types. Our conceptual framework can be further applied to examine the relationship between other environmental problems and health outcomes.
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Affiliation(s)
- Siqin Wang
- School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland, Australia; Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Japan.
| | - Wenhui Cai
- Centre for Social Policy & Social Change, Lingnan University, China.
| | - Yaguang Tao
- School of Science, RMIT University, Melbourne, Victoria, Australia.
| | - Qian Chayn Sun
- School of Science, RMIT University, Melbourne, Victoria, Australia.
| | | | - Witchuda Thongking
- Department of Engineering and Science, Shibaura Institute of Technology, Tokyo, Japan.
| | - Xiao Huang
- Department of Geosciences, University of Arkansas, Arkansas, USA.
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14
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English T, Larkin M, Vasquez Hernandez A, Hutton J, Currie J. Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16565. [PMID: 36554443 PMCID: PMC9779309 DOI: 10.3390/ijerph192416565] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Extreme heat and hot weather has a negative impact on human health and society. Global warming has resulted in an increase in the frequency and duration of heatwaves. Heat-related illnesses are a significant negative consequence of high temperatures and can be life-threatening medical emergencies. The severity of the symptoms can depend on the pre-existing medical conditions and vary from mild headaches to severe cases that can lead to coma and death. The risk of heat-related illness may be higher for people experiencing homelessness due to a lack of access to cool places and water, and the complex interactions between mental illness, medications and substance use disorder. This paper presents two cases of people experiencing homelessness who were admitted to the emergency department of a hospital in Sydney, Australia during a heatwave in November 2020. Both cases were adult males with known risk factors for heat-related illness including hypertension and schizophrenia (Case One) and hepatitis C, cirrhosis, and alcohol use disorder (Case Two). These cases show that severe weather can not only be detrimental to homeless people's health but can also cause a significant economic toll, evident by the $70,184 AUD expenditure on the care for these two cases. This case report highlights the requirement to determine the risk of heat-related illness to people experiencing homelessness and need to protect this vulnerable population from weather-related illness and death.
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Affiliation(s)
- Timothy English
- Heat and Health Research Incubator, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Matthew Larkin
- Homeless Health Service, St Vincent’s Hospital, Sydney, NSW 2010, Australia
| | | | - Jennie Hutton
- Emergency Department, St Vincent’s Hospital, Melbourne, VIC 3065, Australia
| | - Jane Currie
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4000, Australia
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15
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Nyadanu SD, Tessema GA, Mullins B, Pereira G. Prenatal acute thermophysiological stress and spontaneous preterm birth in Western Australia, 2000-2015: A space-time-stratified case-crossover analysis. Int J Hyg Environ Health 2022; 245:114029. [PMID: 36049361 DOI: 10.1016/j.ijheh.2022.114029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 10/15/2022]
Abstract
Epidemiologic evidence on acute heat and cold stress and preterm birth (PTB) is inconsistent and based on ambient temperature rather than a thermophysiological index. The aim of this study was to use a spatiotemporal thermophysiological index (Universal Thermal Climate Index, UTCI) to investigate prenatal acute heat and cold stress exposures and spontaneous PTB. We conducted a space-time-stratified case-crossover analysis of 15,576 singleton live births with spontaneous PTB between January 1, 2000 and December 31, 2015 in Western Australia. The association between UTCI and spontaneous PTB was examined with distributed lag nonlinear models and conditional quasi-Poisson regression. Relative to the median UTCI, there was negligible evidence for associations at the lower range of exposures (1st to 25th percentiles). We found positive associations in the 95th and 99th percentiles, which increased with increasing days of heat stress in the first week of delivery. The relative risk (RR) and 95% confidence interval (CI) for the immediate (delivery day) and cumulative short-term (up to six preceding days) exposures to heat stress (99th percentile, 31.2 °C) relative to no thermal stress (median UTCI, 13.8 °C) were 1.01 (95% CI: 1.01, 1.02) and 1.05 (95% CI: 1.04, 1.06), respectively. Elevated effect estimates for heat stress were observed for the transition season, the year 2005-2009, male infants, women who smoked, unmarried, ≤ 19 years old, non-Caucasians, and high socioeconomic status. Effect estimates for cold stress (1st percentile, 0.7 °C) were highest in the transition season, during 2005-2009, and for married, non-Caucasian, and high socioeconomic status women. Acute heat stress was associated with an elevated risk of spontaneous PTB with sociodemographic vulnerability. Cold stress was associated with risk in a few vulnerable subgroups. Awareness and mitigation strategies such as hydration, reducing outdoor activities, affordable heating and cooling systems, and climate change governance may be beneficial. Further studies with the UTCI are required.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, Aflao, Ghana.
| | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; EnAble Institute, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, 0473, Oslo, Norway
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