Climate change and human health: present and future risks

Views of Psychiatrists and Psychiatry Trainees on Climate Change: Distress, Training Needs, and Envisioned Role

OBJECTIVE

Increasing evidence demonstrates that climate change has effects on mental health. Given the magnitude of climate change's health consequences, mitigation and adaptation will require massive societal changes and the involvement of individuals and professional organizations. The aim of this research was to assess the views of psychiatrists and psychiatrists-in-training about climate change and its effects on health, perceived barriers to discussing climate change in their clinical, teaching, research, and advocacy work, personal preparedness for climate action, and expected roles of their professional organizations.

METHODS

The authors administered an online anonymous survey to members of two mid-Atlantic professional psychiatric organizations. Measures included an adaptation of The International Climate and Health Survey and demographic and career characteristics. Descriptive statistics for categorical variables were conducted.

RESULTS

The majority of the 67 participants who completed the survey were White and senior in their career, and almost all were clinicians. Most were concerned about climate change and its mental health effects on patients and supported their organizations' engagement in activities related to this topic. Barriers to engagement in climate change action included lack of time and believing it would not make a difference.

CONCLUSIONS

These findings demonstrate a desire of psychiatrists involved in teaching, research, and clinical work to address climate change and a need for training. These findings highlight the need for preparedness as newer generations face more disasters related to climate change, and experience psychological distress related to climate change.

Population genetic structure of Culex tritaeniorhynchus in different types of climatic zones in China

BACKGROUND

Culex tritaeniorhynchus is widely distributed in China, from Hainan Island in the south to Heilongjiang in the north, covering tropical, subtropical, and temperate climate zones. Culex tritaeniorhynchus carries 19 types of arboviruses. It is the main vector of the Japanese encephalitis virus (JEV), posing a serious threat to human health. Understanding the effects of environmental factors on Culex tritaeniorhynchus can provide important insights into its population structure or isolation patterns, which is currently unclear.

RESULTS

In total, 138 COI haplotypes were detected in the 552 amplified sequences, and the haplotype diversity (Hd) value increased from temperate (0.534) to tropical (0.979) regions. The haplotype phylogeny analysis revealed that the haplotypes were divided into two high-support evolutionary branches. Temperate populations were predominantly distributed in evolutionary branch II, showing some genetic isolation from tropical/subtropical populations and less gene flow between groups. The neutral test results of HNQH (Qionghai) and HNHK(Haikou) populations were negative (P < 0.05), indicating many low-frequency mutations in the populations and that the populations might be in the process of expansion. Moreover, Wolbachia infection was detected only in SDJN (Jining) (2.24%), and all Wolbachia genotypes belonged to supergroup B. To understand the influence of environmental factors on mosquito-borne viruses, we examined the prevalence of Culex tritaeniorhynchus infection in three ecological environments in Shandong Province. We discovered that the incidence of JEV infection was notably greater in Culex tritaeniorhynchus from lotus ponds compared to those from irrigation canal regions. In this study, the overall JEV infection rate was 15.27 per 1000, suggesting the current risk of Japanese encephalitis outbreaks in Shandong Province.

CONCLUSIONS

Tropical and subtropical populations of Culex tritaeniorhynchus showed higher genetic diversity and those climatic conditions provide great advantages for the establishment and expansion of Culex tritaeniorhynchus. There are differences in JEV infection rates in wild populations of Culex tritaeniorhynchus under different ecological conditions. Our results suggest a complex interplay of genetic differentiation, population structure, and environmental factors in shaping the dynamics of Culex tritaeniorhynchus. The low prevalence of Wolbachia in wild populations may reflect the recent presence of Wolbachia invasion in Culex tritaeniorhynchus.

The 2018 Heat Wave's Impact on the Mortality of Older People in Seoul, South Korea

Few studies on social welfare in South Korea have examined the effects of climate change, especially heat waves on vulnerable populations. The present study aims to investigate how heat waves affect vulnerable populations. This study utilized a cross-sectional study design, using the daily heat index and heat-related mortality data for Seoul, South Korea, in summer 2018. The research used micro-raw data of deaths caused by hypertensive, ischemic heart, and cerebrovascular diseases, as well as heat index data. An effect was observed for the heat index on mortality for individuals over 65 years of age, men, people with spouses, and those ages 75-79 years.

Random Forest and Feature Importance Measures for Discriminating the Most Influential Environmental Factors in Predicting Cardiovascular and Respiratory Diseases

BACKGROUND

Several studies suggest that environmental and climatic factors are linked to the risk of mortality due to cardiovascular and respiratory diseases; however, it is still unclear which are the most influential ones. This study sheds light on the potentiality of a data-driven statistical approach by providing a case study analysis.

METHODS

Daily admissions to the emergency room for cardiovascular and respiratory diseases are jointly analyzed with daily environmental and climatic parameter values (temperature, atmospheric pressure, relative humidity, carbon monoxide, ozone, particulate matter, and nitrogen dioxide). The Random Forest (RF) model and feature importance measure (FMI) techniques (permutation feature importance (PFI), Shapley Additive exPlanations (SHAP) feature importance, and the derivative-based importance measure (κALE)) are applied for discriminating the role of each environmental and climatic parameter. Data are pre-processed to remove trend and seasonal behavior using the Seasonal Trend Decomposition (STL) method and preliminary analyzed to avoid redundancy of information.

RESULTS

The RF performance is encouraging, being able to predict cardiovascular and respiratory disease admissions with a mean absolute relative error of 0.04 and 0.05 cases per day, respectively. Feature importance measures discriminate parameter behaviors providing importance rankings. Indeed, only three parameters (temperature, atmospheric pressure, and carbon monoxide) were responsible for most of the total prediction accuracy.

CONCLUSIONS

Data-driven and statistical tools, like the feature importance measure, are promising for discriminating the role of environmental and climatic factors in predicting the risk related to cardiovascular and respiratory diseases. Our results reveal the potential of employing these tools in public health policy applications for the development of early warning systems that address health risks associated with climate change, and improving disease prevention strategies.

Ambient heat exposure patterns and emergency department visits and hospitalizations among medicare beneficiaries 2008-2019

OBJECTIVE

To assess the association between ambient heat and all-cause and cause-specific emergency department (ED) visits and acute hospitalizations among Medicare beneficiaries in the conterminous United States.

DESIGN

Retrospective cohort study.

SETTING

Conterminous US from 2008 and 2019.

PARTICIPANTS

2% random sample of all Medicare fee-for-service beneficiaries eligible for Parts A, B, and D.

MAIN OUTCOME MEASURES

All-cause and cause-specific (cardiovascular, renal, and heat-related) ED visits and unplanned hospitalizations were identified using primary ICD-9 or ICD-10 diagnosis codes. We measured the association between ambient temperature - defined as daily mean temperature percentile of summer (June through September) - and the outcomes. Hazard ratios and their associated 95% confidence intervals were estimated using multivariable Cox proportional hazards regression, adjusting for individual level demographics, comorbidities, healthcare utilization factors and zip-code level social factors.

RESULTS

Among 809,636 Medicare beneficiaries (58% female, 81% non-Hispanic White, 24% <65), older beneficiaries (aged ≥65) exposed to >95th percentile temperature had a 64% elevated adjusted risk of heat-related ED visits (HR [95% CI], 1.64 [1.46,1.85]) and a 4% higher risk of all-cause acute hospitalization (1.04 [1.01,1.06]) relative to <25th temperature percentile. Younger beneficiaries (aged <65) showed increased risk of heat-related ED visits (2.69 [2.23,3.23]) and all-cause ED visits (1.03 [1.01,1.05]). The associations with heat related events were stronger in males and individuals dually eligible for Medicare and Medicaid. No significant differences were observed by climatic region. We observed no significant relationship between temperature percentile and risk of CV-related ED visits or renal-related ED visits.

CONCLUSIONS

Among Medicare beneficiaries from 2008 to 2019, exposure to daily mean temperature ≥ 95th percentile was associated with increased risk of heat-related ED visits, with stronger associations seen among beneficiaries <65, males, and patients with low socioeconomic position. Further longitudinal studies are needed to understand the impact of heat duration, intensity, and frequency on cause-specific hospitalization outcomes.

Evaluating the temperature-mortality relationship over 16 years in Cyprus

In many regions of the world, the relationship between ambient temperature and mortality is well-documented, but little is known about Cyprus, a Mediterranean island country where climate change is progressing faster than the global average. We Examined the association between daily ambient temperature and all-cause mortality risk in Cyprus. We conducted a time-series analysis with quasipoisson distribution and distributed lag non-linear models to investigate the association between temperature and all-cause mortality from 1 January 2004 to 31 December 2019 in five districts in Cyprus. We then performed a meta-analysis to estimate the overall temperature-mortality dose-response relationship in Cyprus. Excess mortality was computed to determine the public health burden caused by extreme temperatures. We did not find evidence of heterogeneity between the five districts (p = 0.47). The pooled results show that for cold effects, comparing the 1st, 2.5th, and 5th percentiles to the optimal temperature (temperature associated with least mortality, 25 ℃), the overall relative risks of mortality were 1.55 (95% CI: 1.32, 1.82), 1.41 (95% CI: 1.21, 1.64), and 1.32 (95% CI: 1.15, 1.52), respectively. For heat effects, the overall relative risks of mortality at the 95th, 97.5th and 99th percentiles were 1.10 (95% CI: 1.04, 1.16), 1.17 (95% CI: 1.07, 1.29), and 1.29 (95% CI: 1.11, 1.5), respectively. The excess mortality attributable to cold days accounted for 8.0 deaths (95% empirical CI: 4.5-10.8) for every 100 deaths, while the excess mortality attributable to heat days accounted for 1.3 deaths (95% empirical CI: 0.7-1.7) for every 100 deaths. The results prompt additional research into environmental risk prevention in this under-studied hot and dry region that could experience disproportionate climate change related exposures.Implications: The quantification of excess mortality attributable to temperature extremes shows an urgent need for targeted public health interventions and climate adaptation strategies in Cyprus and similar regions facing rapid climate change. Future steps should look into subpopulation sensitivity, coping strategies, and adaptive interventions to reduce potential future risks.

Associations of short-term ambient temperature exposure with lung function in middle-aged and elderly people: A longitudinal study in China

The short-term associations of ambient temperature exposure with lung function in middle-aged and elderly Chinese remain obscure. The study included 19,128 participants from the Dongfeng-Tongji cohort's first (2013) and second (2018) follow-ups. The lung function for each subject was determined between April and December 2013 and re-assessed in 2018, with three parameters (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], and peak expiratory flow [PEF]) selected. The China Meteorological Data Sharing Service Center provided temperature data during the study period. In the two follow-ups, a total of 25,511 records (average age: first, 64.57; second, 65.80) were evaluated, including 10,604 males (41.57%). The inversely J-shaped associations between moving average temperatures (lag01-lag07) and FVC, FEV1, and PEF were observed, and the optimum temperatures at lag04 were 16.5 °C, 18.7 °C, and 16.2 °C, respectively. At lag04, every 1 °C increase in temperature was associated with 14.07 mL, 9.78 mL, and 62.72 mL/s increase in FVC, FEV1, and PEF in the low-temperature zone ( Collapse

Key Words

• Ambient temperature
• Generalized additive mixed model
• Linear mixed-effects model
• Lung function
• Middle-aged and elderly people
• Vulnerable groups

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Weihong Qiu Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
Bin Wang Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Xiaobing Feng Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Heng He Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
Lieyang Fan Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Zi Ye Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Xiuquan Nie Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Ge Mu Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Wei Liu Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Dongming Wang Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Min Zhou Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Weihong Chen Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Collapse

Breaking through the limitation of carbon price forecasting: A novel hybrid model based on secondary decomposition and nonlinear integration

Carbon trading is one of the pivotal means of carbon emission reduction. Accurate prediction of carbon prices can stabilize the carbon market, mitigate investment risks, and promote green development. In this study, firstly, the IVMD and ICEEMDAN are used to decompose carbon price quadratically; secondly, the Dispersion entropy is used to identify the sequence frequency, and then the SOA-LSSVM model and TCN model are used to predict the high-frequency and low-frequency sequences, respectively; finally, the prediction results are integrated by SOA-GRU. As a result, the hybrid IVMD-ICEEMDAN-SOALSSVM/TCN-SOAGRU model was constructed. This framework consistently performs best under two carbon markets, the CEEX Guangzhou and the EU ETS, compared with 21 comparative models, with MAPEs of 0.42% and 0.83%, respectively. The main contributions are as follows: (1) A novel IVMD-ICEEMDAN secondary decomposition method is proposed, which improves the problem of poorly determining the value of the decomposition modal number K in the traditional VMD method and improves the efficiency of the carbon price sequence decomposition. (2) A hybrid forecasting model of LSSVM and TCN is proposed, effectively capturing the features of different sequences. (3) Optimization for LSSVM and GRU using SOA improves the stability and adaptability of the model. The article provides governments, enterprises, and investors with novel and effective carbon price forecasting tool.

Short-term effects of temperature-related indices on emergency ambulance dispatches due to mental and behavioral disorders in Shenzhen, China

Introduction

The precise associations between temperature-related indices and mental and behavioral disorders (MBDs) have yet to be fully elucidated. Our study aims to ascertain the most effective temperature-related index and assess its immediate impact on emergency ambulance dispatches (EADs) due to MBDs in Shenzhen, China.

Methods

EADs data and meteorological data from January 1, 2013, to December 31, 2020, in Shenzhen were collected. Distributed lag non-linear models (DLNMs) were utilized to examine the non-linear and lagged effects of temperature-related indices on EADs due to MBDs. The Quasi Akaike Information criterion (QAIC) was used to determine the optimal index after standardizing temperature-related indices. After adjusting for confounding factors in the model, we estimated the immediate and cumulative effects of temperature on EADs due to MBDs.

Results

The analysis of short-term temperature effects on EADs due to MBDs revealed Humidex as the most suitable index. Referring to the optimal Humidex (3.2th percentile, 12.00°C), we observed a significant effect of Humidex over the threshold (34.6th percentile, 26.80°C) on EADs due to MBDs at lag 0-5. The cumulative relative risks for high temperature (90th percentile, 41.90°C) and extreme high temperature (99th percentile, 44.20°C) at lag 0-5 were 1.318 (95% CI: 1.159-1.499) and 1.338 (95% CI: 1.153-1.553), respectively. No significant cold effect was observed on EADs due to MBDs.

Conclusion

High Humidex was associated with more EADs due to MBDs in subtropical regions. Health authorities should implement effective measures to raise public awareness of risks related to high temperature and protect vulnerable populations.

Chitosan as Support Material for Metal-Organic Framework based Catalysts

Turning waste into valuable products is one of the main challenges of the chemical industry. In this work, chitosan (CS), an abundant, low-cost, and non-toxic biopolymer derived from chitin, was reshaped into beads of ~3 mm. Their suitability as a support material for active phase catalyst materials was tested for a zirconium-based Metal-Organic Framework (MOF) with incorporated Pt, namely UiO-67-Pt. Its incorporation was investigated via two procedures: a one-pot synthesis (OPS) and a post-synthetic functionalization (PSF) synthesis method. Scanning electron microscopy (SEM) images show good UiO-67-Pt dispersion throughout the CS beads for the one-pot synthesized material (UiO-67-Pt-OPS@CS). However, this uniform dispersion was not observed for the post-synthetically functionalized material (UiO-67-Pt-PSF@CS). The success of the implementation of UiO-67-Pt was evaluated with ultraviolet-visible and infrared spectroscopy for both composite materials. Thermogravimetric analysis (TGA) reveals higher thermal stabilities for UiO-67-Pt-OPS@CS composite beads in comparison to pure CS beads, but not for UiO-67-Pt-PSF@CS. The study provides valuable insights into the potential of chitosan as a green, bead-shaped support material for MOFs, offering flexibility in their incorporation through different synthesis routes. It further contributes to the broader goal of the sustainable and eco-friendly design of a new generation of catalysts made from waste materials, which will be the topic of future studies.

Extension of Japan's Prefectural Emission Accounting and Enrichment of Socioeconomic Data from 1990 to 2020

With the continuous increase in carbon dioxide emissions due to human activities and the resulting severe climate issues, there is global concern about energy conservation and emission reduction. However, detailed data on energy consumption and emissions at a fine-grained scale, particularly regarding spatial dimensions and sector-specific emissions, remains insufficient and in need of refinement and timely updates. In Japan, following the Fukushima nuclear disaster, there has been a significant shift from nuclear power generation to reliance on fossil fuels across various sectors, highlighting disparities in emissions data across different regions and industries. Our work extends the emissions time series for Japan's 47 prefectures, incorporating their socioeconomic characteristics over a broader time frame and with a more detailed sectoral classification. The emissions inventory, covering the period from 1990 to 2020, is based on the consumption of the three main fossil fuels across 32 sectors, with emissions carefully allocated for regional power generation. This dataset, presented in a unified format, is expanded to include longer time scales and more detailed socioeconomic data. It is anticipated to offer crucial insights for establishing regional emission reduction targets and identifying sectoral priorities for decarbonization.

Indian Ocean temperature anomalies predict long-term global dengue trends

Despite identifying El Niño events as a factor in dengue dynamics, predicting the oscillation of global dengue epidemics remains challenging. Here, we investigate climate indicators and worldwide dengue incidence from 1990 to 2019 using climate-driven mechanistic models. We identify a distinct indicator, the Indian Ocean basin-wide (IOBW) index, as representing the regional average of sea surface temperature anomalies in the tropical Indian Ocean. IOBW is closely associated with dengue epidemics for both the Northern and Southern hemispheres. The ability of IOBW to predict dengue incidence likely arises as a result of its effect on local temperature anomalies through teleconnections. These findings indicate that the IOBW index can potentially enhance the lead time for dengue forecasts, leading to better-planned and more impactful outbreak responses.

The mediating role of pro-environmental attitude and intention on the translation from climate change health risk perception to pro-environmental behavior

Climate change is a serious environmental issue appearing in China. As a public service institution operating around the clock, the negative impact of hospitals on the environment is evident, promoting their workers' pro-environmental behavior (PEB) through increasing climate change health risk perception (CHRP) is an effective method to protect the environment and achieve sustainable development. This study investigates how CHRP shapes pro-environmental attitude (PEA), pro-environmental intention (PEI), and pro-environmental behavior (PEB) among hospital workers. Using structural equation modeling (SEM) to determine the chain of causation from CHRP to PEB among hospital workers. The result shows that CHRP positively affects PEA and PEI, and PEI positively affects their PEB. In addition, although CHRP has no significant direct effect on PEB, it can play a crucial indirect effect through the mediating role of PEI. Moreover, the result of multiple regression shows that there are significant differences regarding PEA, PEI, and PEB.

Effect of extreme high temperature on cognitive function at different time scales: A national difference-in-differences analysis

BACKGROUND

Mounting evidence has demonstrated that high temperature was associated with adverse health outcomes, especially morbidity and mortality. Nonetheless, the impact of extreme high temperature on cognitive performance, which is the fundamental capacity for interpreting one's surroundings, decision-making, and acquiring new abilities, has not been thoroughly investigated.

METHODS

We aimed to assess associations between extreme high temperature at different time scales and poor cognitive function. We used longitudinal survey data from the three waves of data from China Family Panel Study, providing an 8-year follow-up of 53,008 participants from China. We assessed temperature and extreme high temperature exposure for each participant based on the residential area and date of cognitive test. We defined the proportion of days/hours above 32 °C as the metric of the exposure to extreme high temperature. Then we used generalized additive model and difference-in-differences approach to explore the associations between extreme high temperature and cognitive function.

RESULTS

Our results demonstrated that either acute exposure or long-term exposure to extreme high temperature was associated with cognitive decline. At hourly level, 0-1 hour acute exposure to extreme high temperature would induce -0.93 % (95 % CI: -1.46 %, -0.39 %) cognitive change. At annual level, 10 percentage point increase in the hours proportion exceeding 32 °C in the past two years induced -9.87 % (95 % CI: -13.99 %, -5.75 %) cognitive change. Furthermore, subgroup analyses indicated adaptation effect: for the same 10 percentage increase in hours proportion exceeding 32 °C, people in warmer areas had cognitive change of -6.41 % (-11.22 %, -1.61 %), compared with -15.30 % (-21.07 %, -9.53 %) for people in cool areas.

CONCLUSION

Our results demonstrated that extreme high temperature was associated with reduced cognitive function at hourly, daily and annual levels, warning that people should take better measures to protect the cognitive function in the context of climate change.

How climate change degrades child health: A systematic review and meta-analysis

BACKGROUND

Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children.

OBJECTIVES

We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research.

METHODS

We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes.

RESULTS

Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.

Climate change-related concerns in psychotherapy: therapists' experiences and views on addressing this topic in therapy

BACKGROUND

While adverse impacts of climate change on physical health are well-known, research on its effects on mental health is still scarce. Thus, it is unclear whether potential impacts have already reached treatment practice. Our study aimed to quantify psychotherapists' experiences with patients reporting climate change-related concerns and their views on dealing with this topic in psychotherapy.

METHODS

In a nationwide online survey, responses were collected from 573 psychotherapists from Germany. Therapists reported on the presence of such patients, their socio-demographic characteristics, and climate change-related reactions. Psychotherapists' views on dealing with this topic in psychotherapy were also assessed. Descriptive statistics were used to analyse the responses.

RESULTS

About 72% (410/573) of psychotherapists indicated having had patients expressing concerns about climate change during treatment. Out of these therapists, 41% (166/410) stated that at least one patient sought treatment deliberately because of such concerns. Patients were mainly young adults with higher education. Most frequent primary diagnoses were depression, adjustment disorder, and generalized anxiety disorder. Psychotherapists having encountered such patients differed from those without such encounters in their views on potential functional impairment and the necessity to target the concerns in treatment. Although 79% (326/415) of all respondents felt adequately prepared by their current therapeutic skills, 50% (209/414) reported a lack of information on how to deal with such concerns in therapy.

CONCLUSIONS

Results indicate that psychotherapists are frequently confronted with climate change-related concerns and regard the mental health impact of climate change on their patients as meaningful to psychotherapeutic care. Regular care could be improved by a continuous refinement of the conceptualization and knowledge of the mental health influences of climate change. This would allow providing tailored methods of assessing and addressing climate change-related concerns in practice.

What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England

BACKGROUND

Healthcare activities significantly contribute to greenhouse gas (GHG) emissions. Blood transfusions require complex, interlinked processes to collect, manufacture, and supply. Their contribution to healthcare emissions and avenues for mitigation is unknown.

STUDY DESIGN AND METHODS

We performed a life cycle assessment (LCA) for red blood cell (RBC) transfusions across England where 1.36 million units are transfused annually. We defined the process flow with seven categories: donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal. We used direct measurements, manufacturer data, bioengineering databases, and surveys to assess electrical power usage, embodied carbon in disposable materials and reagents, and direct emissions through transportation, refrigerant leakage, and disposal.

RESULTS

The central estimate of carbon footprint per unit of RBC transfused was 7.56 kg CO2 equivalent (CO2eq). The largest contribution was from transportation (2.8 kg CO2eq, 36% of total). The second largest was from hospital transfusion processes (1.9 kg CO2eq, 26%), driven mostly by refrigeration. The third largest was donation (1.3 kg CO2eq, 17%) due to the plastic blood packs. Total emissions from RBC transfusion are ~10.3 million kg CO2eq/year.

DISCUSSION

This is the first study to estimate GHG emissions attributable to RBC transfusion, quantifying the contributions of each stage of the process. Primary areas for mitigation may include electric vehicles for the blood service fleet, improving the energy efficiency of refrigeration, using renewable sources of electricity, changing the plastic of blood packs, and using methods of disposal other than incineration.

Surgery, innovation, research and sustainable development

In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.

Assessing Regional Weather's Impact on Spinal Cord Injury Survivors, Caregivers, and General Public in Miami, Florida

(1) Background: Climate change is increasing the already frequent diverse extreme weather events (EWE) across geographic locations, directly and indirectly impacting human health. However, current ongoing research fails to address the magnitude of these indirect impacts, including healthcare access. Vulnerable populations such as persons with spinal cord injury (pSCI) face added physiologic burden such as thermoregulation or mobility challenges like closure of public transportation. Our exploratory research assessed commute and transport to healthcare facilities as well as the knowledge, attitudes and behaviors (KAB) of pSCI regarding EWE and climate change when compared to pSCI caregivers (CG) and the general public (GP). (2) Methods: A KAB survey was employed to conduct a cross-sectional assessment of pSCI, CG, and GP in Miami from October through November 2019 using snowball sampling. Descriptive and logistic regression statistical analyses were used. (3) Results: Of 65 eligible survey respondents, 27 (41.5%) were pSCI, 11 (17%) CG, and 27 (41.5%) GP. Overall, pSCI reported EWE, particularly flooding and heavy rain, affecting their daily activities including healthcare appointments, more frequently than CG or GP. The overall models for logistic regression looking at commute to and attendance of healthcare appointments were statistically significant. pSCI self-report being less vulnerable than others, and a large proportion of each group was not fully convinced climate change is happening. (4) Conclusions: This study provided insight to the KAB of 3 population subgroups in Miami, Florida. pSCI are significantly more vulnerable to the effects of regional weather events yet exhibit disproportionate self-perception of their vulnerability. Continued and more comprehensive research is needed to characterize the barriers that vulnerable populations face during weather events.

Applied insight: studying reducing the carbon footprint of the drying process and its environmental impact and financial return

Harnessing solar energy is one of the most important practical insights highlighted to mitigate the severe climate change (CC) phenomenon. Therefore, this study aims to focus on the use of hybrid solar dryers (HSDs) within an environmentally friendly framework, which is one of the promising applications of solar thermal technology to replace traditional thermal technology that contributes to increasing the severity of the CC phenomenon. The HSD, based on a traditional electrical energy source (HSTEE) and electrical energy from photovoltaic panels (HSPVSE), was evaluated compared to a traditional electrical (TE) dryer for drying some medicinal and aromatic plants (MAPs). This is done by evaluating some of the drying outputs, energy consumed, carbon footprint, and financial return at 30, 40, and 50°C. The best quality of dried MAP samples in terms of essential oil (EO, %) and microbial load was achieved at 40°C. The HSTEE dryer has reduced energy consumption compared to the TE dryer by a percentage ranging from 37% to 54%. The highest CO2 mitigated ratio using the HSTEE dryer was recorded in thyme, marjoram, and lemongrass samples, with values ranging from 45% to 54% at 30, 40, and 50°C. The highest financial return obtained from energy consumption reduction and carbon credit footprint was achieved at 50°C, with values ranging from 5,313.69 to 6,763.03 EGP/year (EGP ≈ 0.0352 USD) when coal was used as a fuel source for the generation of electricity. Moreover, the HSPVSE dryer achieved a 100% reduction in traditional energy consumption and then reduced CO2 emissions by 100%, which led to a 100% financial return from both energy reduction and carbon credit. The highest financial returns were observed at 50°C, with values ranging from 13,872.56 to 15,007.02, 12,927.28 to 13,984.43, and 11,981.99 to 12,961.85 EGP/year (EGP ≈ 0.0352 USD) for coal, oil, and natural gas, respectively. The HS dryers show potential for environmental conservation contribution; furthermore, earning money from energy savings and carbon credit could help improve the living standards and maximize benefits for stakeholders.

Climate change-related distributional range shifts of venomous snakes: a predictive modelling study of effects on public health and biodiversity

BACKGROUND

Climate change is expected to have profound effects on the distribution of venomous snake species, including reductions in biodiversity and changes in patterns of envenomation of humans and domestic animals. We estimated the effect of future climate change on the distribution of venomous snake species and potential knock-on effects on biodiversity and public health.

METHODS

We built species distribution models based on the geographical distribution of 209 medically relevant venomous snake species (WHO categories 1 and 2) and present climatic variables, and used these models to project the potential distribution of species in 2070. We incorporated different future climatic scenarios into the model, which we used to estimate the loss and gain of areas potentially suitable for each species. We also assessed which countries were likely to gain new species in the future as a result of species crossing national borders. We integrated the species distribution models with different socioeconomic scenarios to estimate which countries would become more vulnerable to snakebites in 2070.

FINDINGS

Our results suggest that substantial losses of potentially suitable areas for the survival of most venomous snake species will occur by 2070. However, some species of high risk to public health could gain climatically suitable areas for habitation. Countries such as Niger, Namibia, China, Nepal, and Myanmar could potentially gain several venomous snake species from neighbouring countries. Furthermore, the combination of an increase in climatically suitable areas and socioeconomic factors (including low-income and high rural populations) means that southeast Asia and Africa (and countries including Uganda, Kenya, Bangladesh, India, and Thailand in particular) could have increased vulnerability to snakebites in the future, with potential effects on public human and veterinary health.

INTERPRETATION

Loss of venomous snake biodiversity in low-income countries will affect ecosystem functioning and result in the loss of valuable genetic resources. Additionally, climate change will create new challenges to public health in several low-income countries, particularly in southeast Asia and Africa. The international community needs to increase its efforts to counter the effects of climate change in the coming decades.

FUNDING

German Research Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, German Centre for Integrative Biodiversity Research, Ministerio de Ciencia e Innovación de España, European Regional Development Fund.

Effects of weather and air pollution on outpatient visits for insect-and-mite-caused dermatitis: an empirical and predictive analysis

BACKGROUND

Dermatitis caused by insects and mites, diagnosed as papular urticaria or scabies, is a common skin disease. However, there is still a lack of studies about the effects of weather and air pollution on outpatient visits for this disease. This study aims to explore the impacts of meteorological and environmental factors on daily visits of dermatitis outpatients.

METHODS

Analyses are conducted on a total of 43,101 outpatient visiting records during the years 2015-2020 from the largest dermatology specialist hospital in Guangzhou, China. Hierarchical cluster models based on Pearson correlation between risk factors are utilized to select regression variables. Linear regression models are fitted to identify the statistically significant associations between the risk factors and daily visits, taking into account the short-term effects of temperatures. Permutation importance is adopted to evaluate the predictive ability of these factors.

RESULTS

Short-term temperatures have positive associations with daily visits and exhibit strong predictive abilities. In terms of total outpatients, the one-day lagged temperature not only has a significant impact on daily visits, but also has the highest median value of permutation importance. This conclusion is robust across most subgroups except for subgroups of summer and scabies, wherein the three-day lagged temperature has a negative effect. By contrast, air pollution has insignificant associations with daily visits and exhibits weak predictive abilities. Moreover, weekdays, holidays and trends have significant impacts on daily visits, but with weak predictive abilities.

CONCLUSIONS

Our study suggests that short-term temperatures have positive associations with daily visits and exhibit strong predictive abilities. Nevertheless, air pollution has insignificant associations with daily visits and exhibits weak predictive abilities. The results of this study provide a reference for local authorities to formulate intervention measures and establish an environment-based disease early warning system.

Countrywide analysis of heat- and cold-related mortality trends in the Czech Republic: growing inequalities under recent climate warming

BACKGROUND

Only little is known about trends in temperature-mortality associations among the most vulnerable subgroups, especially in the areas of central and eastern Europe, which are considered major climatic hotspots in terms of heatwave exposure. Thus, we aimed to assess trends in temperature-related mortality in the Czech Republic by sex, age and cause of death, and to quantify the temporal evolution of possible inequalities.

METHODS

We collected daily time series of all-cause (1987-2019) and cause-specific (1994-2019) mortality by sex and age category, and population-weighted daily mean 2-metre temperatures for each region of the Czech Republic. We applied a quasi-Poisson regression model to estimate the trends in region-specific temperature-mortality associations, with distributed lag non-linear models and multivariate random-effects meta-analysis to derive average associations across the country. We then calculated mortality attributable to non-optimal temperatures and implemented the indicator of sex- and age-dependent inequalities.

RESULTS

We observed a similar risk of mortality due to cold temperatures for men and women. Conversely, for warm temperatures, a higher risk was observed for women. Results by age showed a clear pattern of increasing risk due to non-optimum temperatures with increasing age category. The relative risk (RR) related to cold was considerably attenuated in most of the studied subgroups during the study period, whereas an increase in the RR associated with heat was seen in the overall population, in women, in the age category 90+ years and with respect to respiratory causes. Moreover, underlying sex- and age-dependent inequalities experienced substantial growth.

CONCLUSIONS

Our findings suggest ongoing adaptation to cold temperatures. Mal/adaptation to hot temperatures occurred unequally among population subgroups and resulted in growing inequalities between the sexes and among age categories.

Good weather for a ride (or not?): how weather conditions impact road accidents - a case study from Wielkopolska (Poland)

This study offers a likely assessment of extreme meteorological events' impact on human perceptivity, frame of mind or even health during driving which might have had a consequence as a car accident. Research covered an analysis of car accidents during period 2010-2019 in the Wielkopolska (Poland) and four indices like maximum daily temperature, maximum value of humidex, difference between maximum temperatures observed from day to day and also difference between mean atmospheric pressure at the sea level observed from day to day. A distributed lag nonlinear model (DLNM) approach was used to obtain the relationship between these indices and car accidents. Our finding evidence that the "good weather for a ride" conditions are actually generating an increased risk of accidents. For indices related to high temperature, i.e., maximum temperature and humidex, it was possible to identify the critical values by which the risks of car accidents were the highest.

Mathematical modeling of vehicle carbon dioxide emissions

The demand for transportation, driven by an increasing global population, is continuously rising. This has led to a higher number of vehicles on the road and an increased reliance on fossil fuels. Consequently, the rise in atmospheric carbon dioxide (C O 2 ) levels has contributed to global warming. Therefore, it is important to consider sustainable transportation practices to meet climate change mitigation targets. In this research paper, a non-linear mathematical model is developed to study the dynamics of atmospheric C O 2 concentration in relation to human population, economic activities, forest biomass, and vehicle population. The developed model is analyzed qualitatively to understand the long-term behavior of the system's dynamics. Model parameters are fitted to actual data of world population, human economic activities, atmospheric C O 2 , forest biomass, and vehicle population. It is shown that increased vehicular C O 2 emissions have a potential contribution to the increase in atmospheric C O 2 and the decline of human population. Numerical simulations are carried out to verify the analytical findings and we performed global sensitivity analysis to explore the impacts of different sensitive parameters on the C O 2 dynamics.

Assessing the Adoption of One Health Approaches in National Plans to Combat Health Threats: The Pilot of a One Health Conceptual Framework in Armenia

Due to several factors, such as environmental and climate changes, the risk of health threats originating at the human-animal-environment interface, including vector-borne diseases (VBDs) and zoonoses, is increasing. Low-resource settings struggle to counter these multidimensional risks due to their already-strained health systems and are therefore disproportionally affected by the impact caused by these changes. Systemic approaches like One Health (OH) are sought to strengthen prevention and preparedness strategies by addressing the drivers of potential threats with a multidisciplinary and multisectoral approach, considering the whole system at the human-animal-environment interface. The integration of OH in national plans can be challenging due to the lack of effective coordination and collaboration among different sectors. To support the process of knowledge coproduction about the level of OH integration in prevention and preparedness strategies against health threats in Armenia, a situation analysis was performed on Crimean-Congo hemorrhagic fever/virus and anthrax (identified by local stakeholders as priorities to be addressed with the OH approach), and actions to strengthen the national OH system were identified with the support of a OH conceptual framework. The study highlighted that multidisciplinary and multisectoral efforts towards prevention and preparedness against VBDs and zoonoses threats need to be strengthened in Armenia, and priority actions to integrate the OH approach were identified.

Complex adaptive systems-based framework for modeling the health impacts of climate change

Introduction

Climate change is a global phenomenon with far-reaching consequences, and its impact on human health is a growing concern. The intricate interplay of various factors makes it challenging to accurately predict and understand the implications of climate change on human well-being. Conventional methodologies have limitations in comprehensively addressing the complexity and nonlinearity inherent in the relationships between climate change and health outcomes.

Objectives

The primary objective of this paper is to develop a robust theoretical framework that can effectively analyze and interpret the intricate web of variables influencing the human health impacts of climate change. By doing so, we aim to overcome the limitations of conventional approaches and provide a more nuanced understanding of the complex relationships involved. Furthermore, we seek to explore practical applications of this theoretical framework to enhance our ability to predict, mitigate, and adapt to the diverse health challenges posed by a changing climate.

Methods

Addressing the challenges outlined in the objectives, this study introduces the Complex Adaptive Systems (CAS) framework, acknowledging its significance in capturing the nuanced dynamics of health effects linked to climate change. The research utilizes a blend of field observations, expert interviews, key informant interviews, and an extensive literature review to shape the development of the CAS framework.

Results and discussion

The proposed CAS framework categorizes findings into six key sub-systems: ecological services, extreme weather, infectious diseases, food security, disaster risk management, and clinical public health. The study employs agent-based modeling, using causal loop diagrams (CLDs) tailored for each CAS sub-system. A set of identified variables is incorporated into predictive modeling to enhance the understanding of health outcomes within the CAS framework. Through a combination of theoretical development and practical application, this paper aspires to contribute valuable insights to the interdisciplinary field of climate change and health. Integrating agent-based modeling and CLDs enhances the predictive capabilities required for effective health outcome analysis in the context of climate change.

Conclusion

This paper serves as a valuable resource for policymakers, researchers, and public health professionals by employing a CAS framework to understand and assess the complex network of health impacts associated with climate change. It offers insights into effective strategies for safeguarding human health amidst current and future climate challenges.

Climate Changes and COVID-19

Climatic change, which influences population growth and land usage, has been theorized to be linked to the emergence and spread of new viruses like the currently unfolding COVID-19 pandemic. In this chapter, we explain how climate change may have altered the beginning, transmission, and maybe even the sickness consequences of the COVID-19 pandemic. Where possible, we also provide mechanistic explanations for how this may have occurred. We have presented evidence that suggests climate change may have had a role in the establishment and transmission of SARS-CoV-2 infection, and most possibly even in some of its clinical effects. Human activities bringing people into closer contact with bats and animals like pangolins that potentially represent the intermediate hosts, and evidence that climate-induced changes in vegetation are the main reservoir source of coronaviruses for human infection, are among the explanations. Although there are still unsubstantiated indications that the first viral pathogen may have escaped from a laboratory, it is possible that this encounter took place in the field or in marketplaces in the instance of COVID-19. We also present the argument that climate change is working to enhance transmission between diseased and uninfected humans, and this is true regardless of the source of the original development of the disease. Changes in temperature and humidity make it easier for viruses to survive, and the impacts of industrial pollution induce people to cough and sneeze, which releases highly infectious aerosols into the air. These three factors combine to make this a more likely scenario than it would otherwise be. We suggest that changes in climate are contributing to create conditions that are favorable for the development of more severe symptoms of illness. It is more difficult to build the argument for this circumstance, and much of it is indirect. However, climate change has caused some communities to adjust their nutritional habits, both in terms of the quantity of food they eat and the quality of the foods they consume. The effects frequently become apparent as a result of alterations that are imposed on the microbiome of the gut, which, in turn, influence the types of immune responses that are produced. The incidence of comorbidities like diabetes and animal vectors like bats that transmit other illnesses that modify vulnerability to SARS-CoV-2 are also two examples of the factors that have been affected by climate change. In order to curb the development of infectious illnesses caused by new viruses, it is necessary to understand the connection between environmental dynamics and the emergence of new coronaviruses. This knowledge should lead to initiatives aimed at reducing global greenhouse gas emissions.

Covid-19 outbreak associated with demographic-meteorological factors in the arid and semi-arid region Iran: case study Gonabad city, 2020-2021

Since the (Covid-19) pandemic outbreak, questioning regarding climate and incident of Covid-19 infection rates has been debated, while there is no clear research evidence until now in Iran. This study has focused on investigating the association between Covid-19 cases and demographic -meteorological factors in arid and semi-arid zones of Iran (from March 1, 2020, to January 31, 2022) by analyzing with Via Poisson and negative binomial regression. As a result, the incidence rate of both Covid-19 hospitalization and mortality cases reached peaks in the summer followed by the autumn. Interestingly, Covid-19 hospitalization cases are associated with humidity, temperature, and wind factors seasonally and monthly, but mortality cases are just associated with wind. In conclusion, the result demonstrated that demographicand meteorological factorsare positively and negatively associated with Covid-19 cases. Therefore, identifying the environmental factors contributing to the excess Covid-19 can help to prevent future pandemic waves in Iranian arid and semi-arid zone.

Mitigating Salinity Stress in Quinoa (Chenopodium quinoa Willd.) with Biochar and Superabsorber Polymer Amendments

In agriculture, soil amendments are applied to improve soil quality by increasing the water retention capacity and regulating the pH and ion exchange. Our study was carried out to investigate the impact of a commercial biochar (Bc) and a superabsorbent polymer (SAP) on the physiological and biochemical processes and the growth performance of Chenopodium quinoa (variety ICBA-5) when exposed to high salinity. Plants were grown for 25 days under controlled greenhouse conditions in pots filled with a soil mixture with or without 3% Bc or 0.2% SAP by volume before the initiation of 27 days of growth in hypersaline conditions, following the addition of 300 mM NaCl. Without the Bc or soil amendments, multiple negative effects of hypersalinity were detected on photosynthetic CO2 assimilation (Anet minus 70%) and on the production of fresh matter from the whole plant, leaves, stems and roots (respectively, 55, 46, 64 and 66%). Moreover, increased generation of reactive oxygen species (ROS) was indicated by higher levels of MDA (plus 142%), antioxidant activities and high proline levels (plus 311%). In the pots treated with 300 mM NaCl, the amendments Bc or SAP improved the plant growth parameters, including fresh matter production (by 10 and 17%), an increased chlorophyll content by 9 and 13% and Anet in plants (by 98 and 115%). Both amendments (Bc and SAP) resulted in significant salinity mitigation effects, decreasing proline and malondialdehyde (MDA) levels whilst increasing both the activity of enzymatic antioxidants and non-enzymatic antioxidants that reduce the levels of ROS. This study confirms how soil amendments can help to improve plant performance and expand the productive range into saline areas.

American Orthopaedic Foot and Ankle Society Annual Meeting All-in-person Attendance Results in Immense Carbon Expenditure

BACKGROUND

Professional society conferences are integral to the medical profession. However, airline travel is a major contributor to greenhouse gas production, and the environmental impact of in-person attendance at an orthopaedic conference has yet to be described. With growing concern about the climate crisis, we sought to quantify the carbon footprint of in-person attendance to help potential attendees more consciously consider in-person attendance, inform strategies to minimize greenhouse gas emissions during travel to annual meetings, and increase awareness about and momentum for efforts in orthopaedic surgery to reduce the carbon footprint of society conferences.

QUESTIONS/PURPOSES

(1) What was the magnitude of greenhouse gas production resulting from all-in-person 2019 American Orthopaedic Foot and Ankle Society (AOFAS) annual meeting attendance in Chicago, IL, USA? (2) What was the magnitude of greenhouse gas production resulting from the all-virtual 2020 AOFAS annual meeting, and how does it compare with the 2019 AOFAS annual meeting carbon footprint? (3) To what extent could an alternative in-person meeting model with four or seven hubs decrease greenhouse gas production resulting from round-trip air travel compared with the 2019 AOFAS annual meeting?

METHODS

A list of the postal codes and countries of all 1271 registered participants attending the four-day 2019 AOFAS annual meeting in Chicago, IL, USA, was obtained from AOFAS headquarters. The 2019 conference was chosen because it was the last pre-COVID meeting and thus attendance was more likely to resemble that at prepandemic in-person conferences than more recent meetings because of pandemic travel restrictions. We estimated carbon dioxide-equivalent (CO 2 e) production from round-trip air travel using a publicly available internet-based calculator (Myclimate: https://co2.myclimate.org/en/flight_calculators/new ). Emissions produced by the conference venue, car travel, and hotel stays were estimated using published Environmental Protection Agency emission factors. To estimate emissions produced by the all-virtual 2020 AOFAS annual meeting (assuming an equal number of attendees as in 2019), we used the framework published by Faber and summed estimated network data transfer emissions, personal computer and monitor emissions, and server-related emissions. Using the 2019 registrant list, we modeled four-hub and seven-hub in-person meeting alternatives to determine potential decreased round-trip air travel greenhouse gas production. Meeting hub locations were selected by visualizing the geographic distribution of the 2019 registrants and selecting reasonable meeting locations that would minimize air travel for the greatest number of attendees. Registrants were assigned to the nearest hub location. Myclimate was again used to estimate CO 2 e production for round-trip air travel for the hub meeting models.

RESULTS

The total estimated emissions of the all-in-person 2019 AOFAS annual meeting (when accounting for travel, conference space, and hotel stays) was 1565 tons CO 2 e (median 0.61 tons per attendee, range 0.02 to 7.7 tons). The total estimated emissions of the all-virtual 2020 meeting (when accounting for network data transfer emissions, personal computer and monitor emissions, and server-related emissions) was 34 tons CO 2 e (median 0.03 tons per attendee). This corresponds to a 97.8% decrease in CO 2 e emissions compared with the in-person conference. The model of a four-hub in-person meeting alternative with meetings in Chicago, Santiago, London, and Tokyo predicted an estimated 54% decrease in CO 2 e emissions from round-trip air travel. The seven-hub meeting model with meetings in Chicago; Washington, DC; Dallas; Los Angeles; Santiago; London; and Tokyo was predicted to diminish the CO 2 e emissions of round-trip air travel by an estimated 71%.

CONCLUSION

The 2019 AOFAS annual meeting had an enormous carbon footprint and resulted in many individuals exceeding their annual allotted carbon budget (2.5 tons) according to the Paris Agreement. Hosting the meeting virtually greatly reduced the annual meeting carbon footprint, and our hub-based meeting models identified potential in-person alternatives for reducing the carbon footprint of conference attendance.

CLINICAL RELEVANCE

Professional societies must consider our responsibility to decarbonizing the healthcare sector by considering innovative approaches-perhaps such as our multihub proposals-to decarbonize carbon-intensive annual meetings without stalling academic progress.

Climate Change, Summer Temperature, and Heat-Related Mortality in Finland: Multicohort Study with Projections for a Sustainable vs. Fossil-Fueled Future to 2050

BACKGROUND

Climate change scenarios illustrate various pathways in terms of global warming ranging from "sustainable development" (Shared Socioeconomic Pathway SSP1-1.9), the best-case scenario, to 'fossil-fueled development' (SSP5-8.5), the worst-case scenario.

OBJECTIVES

We examined the extent to which increase in daily average urban summer temperature is associated with future cause-specific mortality and projected heat-related mortality burden for the current warming trend and these two scenarios.

METHODS

We did an observational cohort study of 363,754 participants living in six cities in Finland. Using residential addresses, participants were linked to daily temperature records and electronic death records from national registries during summers (1 May to 30 September) 2000 to 2018. For each day of observation, heat index (average daily air temperature weighted by humidity) for the preceding 7 d was calculated for participants' residential area using a geographic grid at a spatial resolution of 1 km × 1 km . We examined associations of the summer heat index with risk of death by cause for all participants adjusting for a wide range of individual-level covariates and in subsidiary analyses using case-crossover design, computed the related period population attributable fraction (PAF), and projected change in PAF from summers 2000-2018 compared with those in 2030-2050.

RESULTS

During a cohort total exposure period of 582,111,979 summer days (3,880,746 person-summers), we recorded 4,094 deaths, including 949 from cardiovascular disease. The multivariable-adjusted rate ratio (RR) for high (≥ 21 ° C ) vs. reference (14 - 15 ° C ) heat index was 1.70 (95% CI: 1.28, 2.27) for cardiovascular mortality, but it did not reach statistical significance for noncardiovascular deaths, RR = 1.14 (95% CI: 0.96, 1.36), a finding replicated in case-crossover analysis. According to projections for 2030-2050, PAF of summertime cardiovascular mortality attributable to high heat will be 4.4% (1.8%-7.3%) under the sustainable development scenario, but 7.6% (3.2%-12.3%) under the fossil-fueled development scenario. In the six cities, the estimated annual number of summertime heat-related cardiovascular deaths under the two scenarios will be 174 and 298 for a total population of 1,759,468 people.

DISCUSSION

The increase in average urban summer temperature will raise heat-related cardiovascular mortality burden. The estimated magnitude of this burden is > 1.5 times greater if future climate change is driven by fossil fuels rather than sustainable development. https://doi.org/10.1289/EHP12080.

Heat exposure intervention, anxiety level, and multi-omic profiles: A randomized crossover study

BACKGROUND

Climate change has led to the frequent occurrence of high-temperature weather, which has various adverse effects on health, ranging from blood metabolism to systemic organ function. In particular, the sequelae of heat stress injury in most people are related to the nervous system. However, the mechanisms between heat stress and mental health conditions, especially heat stress and anxiety, remain unclear.

OBJECTIVE

We attempted to elucidate the effect of heat exposure intervention on anxiety levels in the population and its mechanism.

METHODS

We first carried out a randomized controlled trial in 20 college students in Beijing, China, to observe the results of the effects of heat exposure intervention on human anxiety. Then, we collected blood samples before and after heat exposure experiment and used metabolomic and transcriptomic approaches to quantify serum metabolites and ELISA measurements to explore the underlying mechanisms.

RESULTS

We found that even 1.5-hour heat exposure intervention significantly increased anxiety levels. Heat stress-induced anxiety was mediated by the activation of the HPA axis, inflammation, oxidative stress, and subsequently unbalanced neurotransmitters. Metabolites such as BDNF, GABA, and glucocorticoids released by the adrenal glands are biomarkers of heat stress-induced anxiety.

CONCLUSIONS

We have demonstrated a causal link between heat stress and anxiety, explored possible biological pathway between heat stress and anxiety. Heat stress can cause the activation of the HPA axis and lead to changes in the body's metabolism, resulting in a series of changes such as inflammation and oxidative stress, leading to anxiety. This study reveals hidden health cost of climate change that has been underexplored, and also reminds us the importance of immediate climate actions.

Public Fear and Risk Perception During Dengue Fever Outbreak in Taiwan

This study aimed to understand the public reaction to the 2015 dengue outbreak in Taiwan by determining the key influencing factors. A total of 1104 respondents aged 18 years and over, were recruited by telephone between November 20 and 28, 2015, to investigate fear, risk perception, and psychological distress during the dengue outbreak. Multiple logistic regression analysis showed that fear of dengue was more prevalent in the areas that were most affected, as well as those with infected friends or relatives. Fear was also more pronounced among females and the elderly group, especially in terms of perceived risk of infection, severity of the infection, the uncertain cured rate, the adverse effects on daily life, in which all lead to psychological distress. Fear of dengue fever, perceived risk of dengue infection, and psychological distress associated with the dengue fever pandemic were the main variables investigated in this study. Since media mass can serve as a unified platform for all public health communications, it is recommended that the government utilizes the power of media to deliver pandemic prevention measures. Specifically, health education interventions related to risk communication should focus on the most infected areas while taking gender and age into consideration.

Short-term effect of meteorological factors and extreme weather events on daily outpatient visits for dry eye disease between 2013 and 2020: a time-series study in Urumqi, China

Dry eye disease (DED) is a common disorder of tear secretion on the ocular surface caused by multiple factors with dry eyes as the main symptom, but until now studies focusing on relationship between local meteorological factors and ocular surface diseases in Urumqi are very limited. Besides, the effects of long-term and extreme meteorological factors on DED and the lag effect have not been fully evaluated. Electronic case information of 9970 DED outpatients from the Ophthalmology Department of the First Affiliated Hospital of Xinjiang Medical University (Urumqi, Xinjiang, China) between January 1, 2013, and December 31, 2020, was screened and analyzed. We used a time-series analysis design and a quasi-Poisson generalized linear regression model combined with a distributed lagged nonlinear model (DLNM) to fit the effects of exposure to different meteorological factors and extreme weather on DED outpatient visits. Subgroup analyses were further performed for gender, age, and season. The results showed that exposure to extremely low mean temperature (P1:RR = 1.18), atmospheric pressure (P1:RR = 1.11), and extremely high relative humidity (P99:RR = 1.35) were the risk factors, while extremely high atmospheric pressure (P90:RR = 0.883) and extremely low humidity (P10:RR = 0.856) appeared to have a positive effect on reduced risk of DED. Relative humidity exhibited a 1-day lag effect (RR = 1.06). Increased mean temperature positively affected female DED patients (RR = 0.761) with similar effects in the cold season (RR = 0.926). However, elevated relative humidity had a negative effect on female patients (RR = 1.14). We conducted the first large sample size time-series analysis study in this major city at the farthest distance from the ocean in the world and in northwest China, confirming the association of DED outpatient visits with the remaining three meteorological factors except wind speed in Urumqi, and a larger sample size multi-center epidemiological study with a longer duration is still needed.

Natural and socio-environmental factors contribute to the transmissibility of COVID-19: evidence from an improved SEIR model

COVID-19 has ravaged Brazil, and its spread showed spatial heterogeneity. Changes in the environment have been implicated as potential factors involved in COVID-19 transmission. However, considerable research efforts have not elucidated the risk of environmental factors on COVID-19 transmission from the perspective of infectious disease dynamics. The aim of this study is to model the influence of the environment on COVID-19 transmission and to analyze how the socio-ecological factors affecting the probability of virus transmission in 10 states dramatically shifted during the early stages of the epidemic in Brazil. First, this study used a Pearson correlation to analyze the interconnection between COVID-19 morbidity and socio-ecological factors and identified factors with significant correlations as the dominant factors affecting COVID-19 transmission. Then, the time-lag effect of dominant factors on the morbidity of COVID-19 was investigated by constructing a distributed lag nonlinear model and standard two-stage meta-analytic model, and the results were considered in the improved SEIR model. Lastly, a machine learning method was introduced to explore the nonlinear relationship between the environmental propagation probability and socio-ecological factors. By analyzing the impact of environmental factors on virus transmission, it can be found that population mobility directly caused by human activities had a greater impact on virus transmission than temperature and humidity. The heterogeneity of meteorological factors can be accounted for by the diverse climate patterns in Brazil. The improved SEIR model was adopted to explore the interconnection of COVID-19 transmission and the environment, which revealed a new strategy to probe the causal links between them.

Impacts of Climate Change on Work Health and Safety in Australia: A Scoping Literature Review

This scoping review explores the extant literature on climate change impacts on Workplace Health and Safety (WHS) in Australia. It maps the coverage of climate hazards, occupations at risk, and health and socio-economic impacts with the aim of identifying climate change impacts on WHS in Australia and associated knowledge gaps. We used a scoping review approach to identify and investigate 41 scholarly works at the nexus between climate change and WHS in Australia. Thematic template analysis and the NVivo software helped us identify and structure the main themes and systematically document the analysis process. The review highlighted a research focus on the impacts on WHS of heat and extreme weather events resulting from climate change. Agriculture and construction emerged as the most examined occupations, emphasising climate-related diseases and productivity loss. Other climate-related hazards, occupations, and health and socio-economic impacts were largely overlooked in the included research literature. The analysis revealed there is scope for further research relating to climate change impacts on occupational hazards (e.g., air pollution), occupations (e.g., indoor settings at risk), worker health (e.g., injuries), and socio-economic impacts (e.g., change in social practice). Furthermore, the results highlight that the main themes (hazards, occupations, health, and productivity) are interconnected, and the impacts of climate change can be 'cascading', adding complexity and severity. Hence, it is important to look at WHS as a multifaceted phenomenon in a holistic way to understand the risks and support required.

Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review

Background

Climate change has been shown to be directly linked to multiple physiological sequelae and to impact health consequences. However, the impact of climate change on mental health globally, particularly among vulnerable populations, is less well understood.

Objective

To explore the mental health impacts of climate change in vulnerable populations globally.

Methods

We performed an integrative literature review to identify published articles that addressed the research question: What are the mental health impacts of climate change among vulnerable populations globally? The Vulnerable Populations Conceptual Model served as a theoretical model during the review process and data synthesis.

Findings/Results

One hundred and four articles were selected for inclusion in this review after a comprehensive review of 1828 manuscripts. Articles were diverse in scope and populations addressed. Land-vulnerable persons (either due to occupation or geographic location), Indigenous persons, children, older adults, and climate migrants were among the vulnerable populations whose mental health was most impacted by climate change. The most prevalent mental health responses to climate change included solastalgia, suicidality, depression, anxiety/eco-anxiety, PTSD, substance use, insomnia, and behavioral disturbance.

Conclusions

Mental health professionals including physicians, nurses, physician assistants and other healthcare providers have the opportunity to mitigate the mental health impacts of climate change among vulnerable populations through assessment, preventative education and care. An inclusive and trauma-informed response to climate-related disasters, use of validated measures of mental health, and a long-term therapeutic relationship that extends beyond the immediate consequences of climate change-related events are approaches to successful mental health care in a climate-changing world.

Cause-specific accidental deaths and burdens related to ambient heat in a warming climate: A nationwide study of China

BACKGROUND

Future warming is projected to increase the heat-related mortality burden, especially for vulnerable populations. However, most previous studies focused on non-accidental morbidity or mortality, with far less research on heat-related accidental events.

METHODS

We collected individual accidental death records among all residents in Chinese mainland from June to August during 2013-2019. Accidental deaths were further divided into several subtypes by different causes. We used an individual-level, time-stratified, case-crossover study design to estimate the association between daily mean temperature and accidental deaths, and estimate its variation in seven geo-climatic zones, age (5-64, 65-74, ≥75), and sex (male, female). We then estimated the temperature-related excess accidental deaths under global warming scenarios of 1.5, 2, and 3℃.

FINDINGS

A total of 711,929 accidental death records were included in our study. We found that higher temperatures were associated with increased risks of deaths from the total accidental events and four main subtypes, including traffic, falls, drowning, and unintentional injuries. We also found that younger individuals (ages 5-64) and males faced a higher risk of heat-related mortality due to total accidents, traffic incidents, and drowning. For future climate scenarios, even under the 1.5℃ climate change scenario, 6,939 (95% eCI (empirical Confidence Interval): 6,818-7,067) excess accidental deaths per year are attributed to higher summertime daily temperature over mainland China, and the number of accidental deaths would increase by 16.71% and 33.59% under the 2℃ and 3℃ climate change scenarios, respectively. For residents living in southern coastal and northwest inland regions, the projected increase in accidental death is higher.

CONCLUSIONS

This nationwide study confirms that higher summer temperatures are linked to an increased risk of accidental deaths. Younger age groups and males face a higher risk. This indicates that current estimates of the health effects of climate change might be underestimated, particularly for younger populations.

Disentangling local and global climate drivers in the population dynamics of mosquito-borne infections

Identifying climate drivers is essential to understand and predict epidemics of mosquito-borne infections whose population dynamics typically exhibit seasonality and multiannual cycles. Which climate covariates to consider varies across studies, from local factors such as temperature to remote drivers such as the El Niño-Southern Oscillation. With partial wavelet coherence, we present a systematic investigation of nonstationary associations between mosquito-borne disease incidence and a given climate factor while controlling for another. Analysis of almost 200 time series of dengue and malaria around the globe at different geographical scales shows a systematic effect of global climate drivers on interannual variability and of local ones on seasonality. This clear separation of time scales of action enhances detection of climate drivers and indicates those best suited for building early-warning systems.

The association between temperature and alcohol- and substance-related disorder hospital visits in New York State

BACKGROUND

Limited evidence exists on how temperature increases are associated with hospital visits from alcohol- and substance-related disorders, despite plausible behavioral and physiological pathways.

METHODS

In the present study, we implemented a case-crossover design, which controls for seasonal patterns, long-term trends, and non- or slowly-varying confounders, with distributed lag non-linear temperature terms (0-6 days) to estimate associations between daily ZIP Code-level temperature and alcohol- and substance-related disorder hospital visit rates in New York State during 1995-2014. We also examined four substance-related disorder sub-causes (cannabis, cocaine, opioid, sedatives).

RESULTS

Here we show that, for alcohol-related disorders, a daily increase in temperature from the daily minimum (-30.1 °C (-22.2 °F)) to the 75th percentile (18.8 °C (65.8 °F)) across 0-6 lag days is associated with a cumulative 24.6% (95%CI,14.6%-34.6%) increase in hospital visit rates, largely driven by increases on the day of and day before hospital visit, with an association larger outside New York City. For substance-related disorders, we find evidence of a positive association at temperatures from the daily minimum (-30.1 °C (-22.2 °F)) to the 50th percentile (10.4 °C (50.7 °F)) (37.7% (95%CI,27.2%-48.2%), but not at higher temperatures. Findings are consistent across age group, sex, and social vulnerability.

CONCLUSIONS

Our work highlights how hospital visits from alcohol- and substance-related disorders are currently impacted by elevated temperatures and could be further affected by rising temperatures resulting from climate change. Enhanced social infrastructure and health system interventions could mitigate these impacts.

Do life expectancy and hydropower consumption affect ecological footprint? Evidence from novel augmented and dynamic ARDL approaches

Human activities threaten the future of the ecosystem by emitting pollution to the air, water, and soil. Considering the increasing ecological footprint (EF), the study focuses on investigating the role of life expectancy and hydropower consumption by controlling also income, trade openness, and globalization on the environment under the environmental Kuznets curve (EKC) hypothesis for Turkey during 1971-2018. In this context, the study performs recently developed augmented autoregressive distributed lag (AARDL) and dynamic ARDL (DARDL) methods. The results show that (i) life expectancy increases the environmental pressure; (ii) hydropower consumption has no effect on the EF; (iii) globalization and trade openness reduce the EF; (iv) the EKC hypothesis is valid, but the estimated turning point lies between USD 19,914 and USD 20,571, which is far from the sample period in Turkey. From the overall results, it can be concluded that Turkey cannot solve environmental problems with insufficient income levels, an increasing elderly population, and ineffective use of hydropower. Hence, Turkey should rely on income much more, use hydropower much more efficiently, and benefit from the spillover effect of technological innovations related to globalization and foreign trade to significantly reduce the EF.

Socio-Environmental Determinants of Mental and Behavioral Disorders in Youth: A Machine Learning Approach

Growing evidence indicates that extreme environmental conditions in summer months have an adverse impact on mental and behavioral disorders (MBD), but there is limited research looking at youth populations. The objective of this study was to apply machine learning approaches to identify key variables that predict MBD-related emergency room (ER) visits in youths in select North Carolina cities among adolescent populations. Daily MBD-related ER visits, which totaled over 42,000 records, were paired with daily environmental conditions, as well as sociodemographic variables to determine if certain conditions lead to higher vulnerability to exacerbated mental health disorders. Four machine learning models (i.e., generalized linear model, generalized additive model, extreme gradient boosting, random forest) were used to assess the predictive performance of multiple environmental and sociodemographic variables on MBD-related ER visits for all cities. The best-performing machine learning model was then applied to each of the six individual cities. As a subanalysis, a distributed lag nonlinear model was used to confirm results. In the all cities scenario, sociodemographic variables contributed the greatest to the overall MBD prediction. In the individual cities scenario, four cities had a 24-hr difference in the maximum temperature, and two of the cities had a 24-hr difference in the minimum temperature, maximum temperature, or Normalized Difference Vegetation Index as a leading predictor of MBD ER visits. Results can inform the use of machine learning models for predicting MBD during high-temperature events and identify variables that affect youth MBD responses during these events.

Non-Conventional Risk Factors: "Fact" or "Fake" in Cardiovascular Disease Prevention?

Cardiovascular diseases (CVDs), such as arterial hypertension, myocardial infarction, stroke, heart failure, atrial fibrillation, etc., still represent the main cause of morbidity and mortality worldwide. They significantly modify the patients' quality of life with a tremendous economic impact. It is well established that cardiovascular risk factors increase the probability of fatal and non-fatal cardiac events. These risk factors are classified into modifiable (smoking, arterial hypertension, hypercholesterolemia, low HDL cholesterol, diabetes, excessive alcohol consumption, high-fat and high-calorie diet, reduced physical activity) and non-modifiable (sex, age, family history, of previous cardiovascular disease). Hence, CVD prevention is based on early identification and management of modifiable risk factors whose impact on the CV outcome is now performed by the use of CV risk assessment models, such as the Framingham Risk Score, Pooled Cohort Equations, or the SCORE2. However, in recent years, emerging, non-traditional factors (metabolic and non-metabolic) seem to significantly affect this assessment. In this article, we aim at defining these emerging factors and describe the potential mechanisms by which they might contribute to the development of CVD.

Cold Spells and the Onset of Acute Myocardial Infarction: A Nationwide Case-Crossover Study in 323 Chinese Cities

BACKGROUND

Few studies have explored the relationships between cold spells and acute myocardial infarction (AMI) using the information of symptom onset.

OBJECTIVES

We assessed the impact of cold spells on AMI onset and the potential effect modifiers.

METHODS

We conducted a time-stratified case-crossover study among 456,051 eligible patients with AMI from 2,054 hospitals in 323 Chinese cities between January 2015 and June 2021 during cold seasons (November to March). Nine definitions of cold spells were used by combining three relative temperature thresholds (i.e., lower than the 7.5th, 5th, and 2.5th percentiles) and three durations of at least 2-4 consecutive d. Conditional logistic regressions with distributed lag models were applied to evaluate the cumulated effects of cold spells on AMI onset over lags 0-6 d, after adjusting for daily mean temperature.

RESULTS

The associations generally appeared on lag 1 d, peaked on lag 3 d, and became nonsignificant approximately on lag 5 d. Cold spells defined by more stringent thresholds of temperature were associated with higher risks of AMI onset. For cold spell days defined by a daily mean temperature of ≤ 7.5 th percentile and durations of ≥ 2 d , ≥ 3 d , and ≥ 4 d , the percentage changes in AMI risk were 4.24% [95% confidence interval (CI): 2.31%, 6.20%], 3.48% (95% CI: 1.62%, 5.38%), and 2.82% (95% CI: 0.98%, 4.70%), respectively. Significant AMI risks associated with cold spells were observed among cases from regions without centralized heating, whereas null or much weaker risks were found among those from regions with centralized heating. Patients ≥ 65 years of age were more susceptible to cold spells.

DISCUSSION

This national case-crossover study presents compelling evidence that cold spells could significantly increase the risk of AMI onset. https://doi.org/10.1289/EHP11841.

The Direct and Indirect Influences of Interrelated Regional-Level Sociodemographic Factors on Heat-Attributable Mortality in Europe: Insights for Adaptation Strategies

BACKGROUND

Heat is a significant cause of mortality, but impact patterns are heterogenous. Previous studies assessing such heterogeneity focused exclusively on risk rather than heat-attributable mortality burdens and assume predictors are independent.

OBJECTIVES

We assessed how four interrelated regional-level sociodemographic predictors-education, life expectancy, the ratio of older to younger people (aging index), and relative income-influence heterogeneity in heat-attributable mortality burdens in Europe and then derived insights into adaptation strategies.

METHODS

We extracted four outcomes from a temperature-mortality study covering 16 European countries: the rate of increase in mortality risk at moderate and extreme temperatures (moderate and extreme slope, respectively), the minimum mortality temperature percentile (MMTP), and the underlying mortality rate. We used structural equation modeling with country-level random effects to quantify the direct and indirect influences of the predictors on the outcomes.

RESULTS

Higher levels of education were directly associated with lower heat-related mortality at moderate and extreme temperatures via lower slopes and higher MMTPs. A one standard deviation increase in education was associated with a - 0.46 ± 0.14 , - 0.41 ± 0.12 , and 0.41 ± 0.12 standard deviation (± standard error ) change in the moderate slope, extreme slope, and MMTP, respectively. However, education had mixed indirect influences via associations with life expectancy, the aging index, and relative income. Higher life expectancy had mixed relations with heat-related mortality, being associated with higher risk at moderate temperatures (0.33 ± 0.11 for the moderate slope; - 0.19 ± 0.097 for the MMTP) but lower underlying mortality rates (- 0.72 ± 0.097 ). A higher aging index was associated with higher burdens through higher risk at extreme temperatures (0.13 ± 0.072 for the extreme slope) and higher underlying mortality rates (0.93 ± 0.055 ). Relative income had relatively small, mixed influences.

DISCUSSION

Our novel approach provided insights into actions for reducing the health impacts of heat. First, the results show the interrelations between possible vulnerability-generating mechanisms and suggest future research directions. Second, the findings point to the need for a dual approach to adaptation, with actions that explicitly target heat exposure reduction and actions focused explicitly on the root causes of vulnerability. For the latter, the climate crisis may be leveraged to accelerate ongoing general public health programs. https://doi.org/10.1289/EHP11766.

Multilevel interventions as climate change adaptation response to protect maternal and child health: a scoping review protocol

INTRODUCTION

Growing evidence suggests that climate change-related extreme weather events adversely impact maternal and child health (MCH) outcomes, which requires effective, sustainable and culturally appropriate interventions at individual, community and policy levels to minimise these impacts. This scoping review proposes to map the evidence available on the type, characteristics and outcomes of multilevel interventions implemented as adaptational strategies to protect MCH from the possible adverse effects of climate change.

METHODS

The following databases will be searched: Embase, MEDLINE, Emcare, EPPI-Centre database of health promotion research (BiblioMap) EPPI-Centre Database for promoting Health Effectiveness Reviews (DoPHER), Global Health, CINAHL, Joanna Briggs Institute EBP Database, Maternity and Infant Care Database, Education Resource Information Center, PsycINFO, Scopus, Web of Science and Global Index Medicus, which indexes Latin America and the Caribbean, Index Medicus for the South-East Asia Region, African Index Medicus, Western Pacific Region Index Medicus. Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, conference proceedings, thesis and dissertations, policy and guidelines and their reference lists will also be searched. Two reviewers will independently screen titles and abstracts and full text based on predefined eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews using the Population, Concept and Context framework and the Template for Intervention Description and Replication checklist will be used to structure and report the findings.

ETHICS AND DISSEMINATION

Ethics permission to conduct the scoping review is not required as the information collected is publicly available through databases. Findings will be disseminated through a peer-reviewed publication and conference presentations.

Longitudinal changes in depressive symptoms associated with social isolation after the Great East Japan Earthquake in Iwate Prefecture: findings from the TMM CommCohort study

BACKGROUND

Whether past disaster experiences affect the association between changes in social isolation and depressive symptoms is largely unknown. This study examined the association between changes in social isolation and depressive symptoms among survivors who experienced earthquake damage in the aftermath of the Great East Japan Earthquake (GEJE).

METHODS

We analyzed longitudinal data from 10,314 participants who responded to self-report questionnaires on the Lubben Social Network Scale-6 (LSNS-6) and the Center for Epidemiological Studies-Depressive Scale (CES-D) in both the baseline survey (FY2013 to FY2015) and follow-up survey (FY2017 to FY2019) after the GEJE. According to changes in the presence of social isolation (< 12 of LSNS-6) at two time points, participants were categorized into four groups: "not socially isolated," "improved socially isolated," "newly socially isolated," and "continuously socially isolated." At the follow-up survey, a CES-D score of ≥ 16 indicates the presence of depressive symptoms. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using the logistic regression analysis to examine the influence of the change in social isolation over four years on depressive symptoms.

RESULTS

Participants who were newly socially isolated had a significantly higher prevalence of depressive symptoms than those who were not socially isolated (AOR = 1.89, 95% CI = 1.61 - 2.23). In addition, AORs were highest for those who were continuously socially isolated and had experienced house damage (AOR = 2.17, 95% CI = 1.73 - 2.72) and those who were newly socially isolated and had not experienced the death of family members due to the GEJE (AOR = 1.88, 95%CI = 1.60 - 2.22).

CONCLUSION

Our longitudinal findings suggest that being newly or continuously socially isolated is associated with a risk of depressive symptoms, not only among those who had experienced house damage or the death of a family member, but also those who had not, in the disaster-affected area. Our study underlines the clinical importance of social isolation after a large-scale natural disaster and draws attention to the need for appropriate prevention measures.

Effects of ambient temperature and relative humidity on preterm birth during early pregnancy and before parturition in China from 2010 to 2018: a population-based large-sample cohort study

Background

The progression of global warming and increase in instances of extreme weather have received considerable attention. We conducted a cohort study on women of childbearing age in Yunnan Province, examined the association between ambient temperature and humidity on preterm birth and evaluated the effects of extreme weather during early pregnancy and before parturition on preterm birth.

Methods

We conducted a population-based cohort study on women of childbearing age 18-49 years who participated in National Free Preconception Health Examination Project (NFPHEP) in Yunnan Province from January 1, 2010, to December 31, 2018. Meteorological data, namely daily average temperature (°C) and daily average relative humidity (%), were obtained from China National Meteorological Information Center. Four exposure windows were explored: 1 week of pregnancy, 4 weeks of pregnancy, 4 weeks before delivery, and 1 week before delivery. We used a Cox proportional hazards model and adjusted the potential risk factors for preterm birth to obtain the effects of exposure to temperature and humidity on preterm birth among the stages of pregnancy.

Results

At 1 week of pregnancy and at 4 weeks of pregnancy, the association between temperature and preterm birth was U-shaped. The correlation between relative humidity and the risk of preterm birth was n-type at 1 week of pregnancy. The correlation between preterm birth and temperature and relative humidity at 4 weeks before delivery and at 1 week before delivery is J-shaped. Low temperature and low humidity were protective factors against preterm birth, whereas high temperature and high humidity were risk factors for preterm birth.The effects of high temperature and extremely high temperature were the strongest at 4 weeks before delivery, with HRs of 1.417 (95% CI: 1.362-1.474) and 1.627 (95% CI: 1.537-1.722), respectively. The effects of extremely low humidity and low humidity were strongest at 1 week before delivery, with HRs of 0.681 (95% CI: 0.609-0.761) and 0.696 (95% CI: 0.627-0.771), respectively.

Conclusion

Temperature and relative humidity affect preterm birth differently for each pregnancy stage. The effects of meteorological factors on pregnancy outcomes such as premature birth should not be ignored.

Temporal trend and global burden of type 2 diabetes attributable to non-optimal temperature, 1990-2019: an analysis for the Global Burden of Disease Study 2019

Exposure to hot or cold temperatures was reported to be associated with increased mortality and morbidity of type 2 diabetes, but few studies have estimated the temporal trend and global burden of type 2 diabetes attributable to non-optimal temperature. Based on the Global Burden of Disease Study 2019, we collected data on the numbers and rates of deaths and disability-adjusted life years (DALYs) of type 2 diabetes attributed to non-optimal temperature. The joinpoint regression analysis was used to estimate the temporal trends of the age-standardized rate of mortality and DALYs from 1990 to 2019 by average annual percentage change (AAPC). From 1990 to 2019, globally, the numbers of deaths and DALYs of type 2 diabetes attributable to non-optimal temperature increased by 136.13% (95% (uncertainty interval) UI: 87.04% to 277.76%) and 122.26% (95% UI: 68.77% to 275.59%), with the number from 0.05 (95% UI: 0.02 to 0.07) million and 0.96 (95% UI: 0.37 to 1.51) million in 1990 to 0. 11 (95% UI: 0.07 to 0.15) million and 2.14 (95% UI: 1.35 to 3.13) million in 2019. The age-standardized mortality rate (ASMR) and DALYs rate (ASDR) of type 2 diabetes attributable to non-optimal temperature showed an increasing trend in the high temperature effect and lower (low, low-middle and middle) socio-demographic index (SDI) region, with AAPCs of 3.17%, 1.24%, 1.61%, and 0.79% (all P < 0.05), respectively. The greatest increased ASMR and ASDR were observed in Central Asia, followed by Western Sub-Saharan Africa and South Asia. Meanwhile, the contribution of type 2 diabetes burden attributable to high temperature gradually increased globally and in five SDI regions. In addition, the global age-specific rate of mortality and DALYs of type 2 diabetes attributable to non-optimal temperature for both men and women almost increased with age in 2019. The global burden of type 2 diabetes attributable to non-optimal temperature increased from 1990 to 2019, particularly in high temperature, regions with lower SDI, and the older population. Appropriate temperature interventions are necessary to curb climate change and increasing diabetes.