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Ajumobi O, Verdugo SR, Labus B, Reuther P, Lee B, Koch B, Davidson PJ, Wagner KD. Identification of Non-Fatal Opioid Overdose Cases Using 9-1-1 Computer Assisted Dispatch and Prehospital Patient Clinical Record Variables. PREHOSP EMERG CARE 2022; 26:818-828. [PMID: 34533427 PMCID: PMC9043039 DOI: 10.1080/10903127.2021.1981505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/11/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
Background: The current epidemic of opioid overdoses in the United States necessitates a robust public health and clinical response. We described patterns of non-fatal opioid overdoses (NFOODs) in a small western region using data from the 9-1-1 Computer Assisted Dispatch (CAD) record and electronic Patient Clinical Records (ePCR) completed by EMS responders. We determined whether CAD and ePCR variables could identify NFOOD cases in 9-1-1 data for intervention and surveillance efforts. Methods: We conducted a retrospective analysis of 1 year of 9-1-1 emergency medical CAD and ePCR (including naloxone administration) data from the sole EMS provider in the response area. Cases were identified based on clinician review of the ePCR, and categorized as definitive NFOOD, probable NFOOD, or non-OOD. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the most prevalent CAD and ePCR variables were calculated. We used a machine learning technique-Random-Forests (RF) modeling-to optimize our ability to accurately predict NFOOD cases within census blocks. Results: Of 37,960 9-1-1 calls, clinical review identified 158 NFOOD cases (0.4%), of which 123 (77.8%) were definitive and 35 (22.2%) were probable cases. Overall, 106 (67.1%) received naloxone from the EMS responder at the scene. As a predictor of NFOOD, naloxone administration by paramedics had 67.1% sensitivity, 99.6% specificity, 44% PPV, and 99.9% NPV. Using CAD variables alone achieved a sensitivity of 36.7% and specificity of 99.7%. Combining ePCR variables with CAD variables increased the diagnostic accuracy with the best RF model yielding 75.9% sensitivity, 99.9% specificity, 71.4% PPV, and 99.9% NPV. Conclusion: CAD problem type variables and naloxone administration, used alone or in combination, had sub-optimal predictive accuracy. However, a Random Forests modeling approach improved accuracy of identification, which could foster improved surveillance and intervention efforts. We identified the set of NFOODs that EMS encountered in a year and may be useful for future surveillance efforts.
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Affiliation(s)
| | | | - Brian Labus
- School of Public Health, University of Nevada Las Vegas, Nevada
| | | | - Bradford Lee
- Regional Emergency Medical Services Authority, Reno, Nevada
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Dwyer IJ, Barry SJE, Megiddo I, White CJ. Evaluations of heat action plans for reducing the health impacts of extreme heat: methodological developments (2012-2021) and remaining challenges. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1915-1927. [PMID: 35835887 PMCID: PMC9283094 DOI: 10.1007/s00484-022-02326-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
The recent report of the Intergovernmental Panel on Climate Change is stark in its warnings about the changing climate, including future increases in the frequency and intensity of extremely hot weather. The well-established impacts of extreme heat on human health have led to widespread implementation of national and city-wide heat plans for mitigating such impacts. Evaluations of the effectiveness of some heat plans have been published, with previous reviews highlighting key methodological challenges. This article reviews methods used since and that address those challenges, so helping to set an agenda for improving evaluations of heat plans in terms of their effectiveness in reducing heat-health impacts. We examined the reviews that identified the methodological challenges and systematically searched the literature to find evaluations that had since been conducted. We found 11 evaluations. Their methods help address the key challenge of identifying study control groups and address other challenges to a limited extent. For future evaluations, we recommend: utilising recent evaluation methodologies, such as difference-in-differences quasi-experimental designs where appropriate; cross-agency working to utilise data on morbidity and confounders; adoption of a proposed universal heat index; and greater publication of evaluations. More evaluations should assess morbidity outcomes and be conducted in low- and middle-income countries. Evaluations of heat plans globally should employ robust methodologies, as demonstrated in existing studies and potentially transferrable from other fields. Publication of such evaluations will advance the field and thus help address some of the health challenges resulting from our changing climate.
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Affiliation(s)
- Ian J Dwyer
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
| | - Sarah J E Barry
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Christopher J White
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
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Pascal M, Lagarrigue R, Tabai A, Bonmarin I, Camail S, Laaidi K, Le Tertre A, Denys S. Evolving heat waves characteristics challenge heat warning systems and prevention plans. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1683-1694. [PMID: 33811538 PMCID: PMC8019079 DOI: 10.1007/s00484-021-02123-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/08/2021] [Accepted: 03/28/2021] [Indexed: 05/14/2023]
Abstract
This paper analyses how recent trends in heat waves impact heat warning systems. We performed a retrospective analysis of the challenges faced by the French heat prevention plan since 2004. We described trends based on the environmental and health data collected each summer by the French heat warning system and prevention plan. Major evolutions of the system were tracked based on the evaluations organized each autumn with the stakeholders of the prevention plan. Excess deaths numbering 8000 were observed during heat waves between 2004 and 2019, 71% of these between 2015 and 2019. We observed major changes in the characteristics, frequency and the geographical spread of heat waves since 2015. Feedbacks led to several updates of the warning system such as the extension of the surveillance period. They also revealed that risk perception remained limited among the population and the stakeholders. The sharp increase in the number of heat warnings issued per year since 2015 challenges the acceptability of the heat warnings. Recent heat waves without historical equivalent interfere with the development of evidence-based prevention strategies. The growing public health impacts heat waves emphasize the urgent need to act to adapt the population, at different levels of intervention, from individual comportments to structural modifications. A specific attention should be given to increase the resources allocated to the evaluation and the management of heat-related risks, especially considering the needs to catch with the rapid rhythm of the changing climate.
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Affiliation(s)
- Mathilde Pascal
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France.
| | - Robin Lagarrigue
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Anouk Tabai
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Isabelle Bonmarin
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Sacha Camail
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Karine Laaidi
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Alain Le Tertre
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
| | - Sébastien Denys
- Santé publique France, 12 Rue du Val d'Osne, 94415, Saint Maurice, France
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Effective Community-Based Interventions for the Prevention and Management of Heat-Related Illnesses: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168362. [PMID: 34444112 PMCID: PMC8394078 DOI: 10.3390/ijerph18168362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Background: Extreme temperatures have negative consequences on the environment, ecosystem, and human health. With recent increases in global temperatures, there has been a rise in the burden of heat-related illnesses, with a disproportionate impact on low- and middle-income countries. Effective population-level interventions are critical to a successful public health response. Objective: This scoping review aims to summarize the evidence on the effectiveness of population-level heat-related interventions and serve as a potential guide to the implementation of these interventions. Methods: Studies that evaluated the effectiveness of community-based interventions to mitigate or reduce the impact of extreme heat on heat-related mortality and morbidity were sought by searching four electronic databases. Studies published in the English language and those that had quantifiable, measurable mortality, morbidity or knowledge score outcomes were included. Results: The initial electronic search yielded 2324 articles, and 17 studies were included. Fourteen studies were based in high-income countries (HICs) (Europe, US, Canada) and discussed multiple versions of (1) heat action plans, which included but were not limited to establishing a heat monitoring system, informative campaigns, the mobilization of health care professionals, volunteers, social workers and trained caregivers in the surveillance and management of individuals with known vulnerabilities, or stand-alone (2) education and awareness campaigns. Multi-pronged heat action plans were highly effective in reducing heat-related mortality and morbidity, especially among vulnerable populations such as the elderly and those with chronic conditions. Conclusions: The heat action plans covered in these studies have shown promising results in reducing heat-related mortality and morbidity and have included instituting early warning systems, building local capacity to identify, prevent or treat and manage heat-related illnesses, and disseminating information. Nevertheless, they need to be cost-effective, easy to maintain, ideally should not rely on a mass effort from people and should be specifically structured to meet the local needs and resources of the community.
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Pascal M, Goria S, Wagner V, Sabastia M, Guillet A, Cordeau E, Mauclair C, Host S. Greening is a promising but likely insufficient adaptation strategy to limit the health impacts of extreme heat. ENVIRONMENT INTERNATIONAL 2021; 151:106441. [PMID: 33640693 DOI: 10.1016/j.envint.2021.106441] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Adapting the urban environment to heat is a public health priority in the context of climate change. Cities are now considering interventions on specific urban characteristics known to contribute to the urban heat island (UHI) such as vegetation and imperviousness. OBJECTIVES To explore how these urban characteristics influence the temperature-mortality relationship in the Paris region. METHODS We modeled the temperature-mortality relationship for the 1300 municipalities of the region from 1990 to 2015, while including an interaction with indicators that summarize the municipalities' main urban characteristics. Four indicators were tested: lack of green spaces, lack of trees, proportion of impervious surface, and overexposed population to a potential night UHI. RESULTS The shape of the temperature-mortality relationship was similar across all municipalities, but with a higher slope at the highest temperatures in municipalities with less green spaces, less trees, and more impervious soil. For instance, in Paris and its close suburbs, the relative risk associated with a temperature in the 99th percentile of the temperature distribution (compared to the 50th percentile) was 2.17 [IC95% 1.98:2.38] in municipalities with 40% of their surface covered by trees compared to 2.57 [IC 95% 2.47:2.68] in municipalities with only 3% of their surface covered by trees. DISCUSSION A lack of vegetation and a high degree of imperviousness were associated with a higher risk of heat-related mortality in the Paris region. Therefore, we can assume that interventions targeting these characteristics could reduce the health impacts of extreme heat. Such interventions should be coupled with other initiatives such as protecting the most vulnerable and promoting appropriate behaviors.
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Pogačar T, Žnidaršič Z, Kajfež Bogataj L, Črepinšek Z. Steps Towards Comprehensive Heat Communication in the Frame of a Heat Health Warning System in Slovenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5829. [PMID: 32806556 PMCID: PMC7459531 DOI: 10.3390/ijerph17165829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/24/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
Occupational heat stress has an important negative impact on the well-being, health and productivity of workers and should; therefore, be recognized as a public health issue in Europe. There is no comprehensive heat health warning system in Slovenia combining public health measures with meteorological forecasts. The aim of this research was to provide insight into the development of such a system in Slovenia, turning the communication from the current meteoalarm into a broader system that has more information for different social groups. To achieve this goal, the following steps were used: Analysis of summer temperatures and issued meteoalarms, a survey of the general knowledge about heat among the public, organization and management of two stakeholder symposia, and a final survey on workers' opinions on heat stress and measures, supplemented by interviews with employers. Summer average daily temperature distributions in Slovenia changed during the investigated period (1961-2019) and the mean values increased over time by 2-3 °C. Additionally, the number of days with fulfilled yellow (potentially dangerous) and especially orange (dangerous) meteoalarm conditions increased significantly after 1990. The survey of the general public about heat stress and warnings showed that efforts to raise awareness of heat issues need to be intensified and that public health measures should effectively target vulnerable groups. Stakeholder symposia and further surveys have shown that awareness and understanding of the negative effects of heat stress on health and productivity are still quite low, so effective ways of disseminating information to different sectors while striking the best balance between efficiency, feasibility and economic cost have to be found.
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Affiliation(s)
- Tjaša Pogačar
- Centre of Agrometeorology, Department of Agronomy, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia; (L.K.B.); (Z.Č.)
| | - Zala Žnidaršič
- Department of Physics, Faculty of Mathematics and Physics, University of Ljubljana, Jadranska 19, 1000 Ljubljana, Slovenia;
| | - Lučka Kajfež Bogataj
- Centre of Agrometeorology, Department of Agronomy, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia; (L.K.B.); (Z.Č.)
| | - Zalika Črepinšek
- Centre of Agrometeorology, Department of Agronomy, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia; (L.K.B.); (Z.Č.)
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Occurrence and Coupling of Heat and Ozone Events and Their Relation to Mortality Rates in Berlin, Germany, between 2000 and 2014. ATMOSPHERE 2019. [DOI: 10.3390/atmos10060348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Episodes of hot weather and poor air quality pose significant consequences for public health. In this study, these episodes are addressed by applying the observational data of daily air temperature and ozone concentrations in an event-based risk assessment approach in order to detect individual heat and ozone events, as well as events of their co-occurrence in Berlin, Germany, in the years 2000 to 2014. Various threshold values are explored so as to identify these events and to search for the appropriate regressions between the threshold exceedances and mortality rates. The events are further analyzed in terms of their event-specific mortality rates and their temporal occurrences. The results reveal that at least 40% of all heat events during the study period are accompanied by increased ozone concentrations in Berlin, particularly the most intense and longest heat events. While ozone events alone are only weakly associated with increased mortality rates, elevated ozone concentrations during heat events are found to amplify mortality rates. We conclude that elevated air temperatures during heat events are one major driver for increased mortality rates in Berlin, but simultaneously occurring elevated ozone concentrations act as an additional stressor, leading to an increased risk for the regional population.
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Pascal M, Wagner V, Corso M, Laaidi K, Ung A, Beaudeau P. Heat and cold related-mortality in 18 French cities. ENVIRONMENT INTERNATIONAL 2018; 121:189-198. [PMID: 30216771 DOI: 10.1016/j.envint.2018.08.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Understanding the dynamics of the temperature-mortality relationship is an asset to support public health interventions. We investigated the lag structure of the mortality response to cold and warm temperatures in 18 French cities between 2000 and 2010. METHODS A distributed lag non-linear generalized model using a quasi-Poisson distribution and controlling for classical confounding factors was built in each city. A fitted meta-analytical model combined the city-specific models to derive the best linear unbiased prediction of the association, and a meta-regression explored the influence of background characteristics of the cities. The fraction of mortality attributable to cold and heat was estimated with reference to the minimum mortality temperature. RESULTS Between 2000 and 2010, 3.9% [CI 95% 3.2:4.6] of the total mortality was attributed to cold, and 1.2% [1.1:1.2] to heat. The immediate increase in mortality following high temperatures was partly compensated by a harvesting effect when temperatures were below the 99.2 percentiles of the mean temperature distributions. DISCUSSION Cold represents a significant public health burden, mostly driven by moderate temperatures (between percentiles 2.5 and 25). The population is better adapted to warm temperatures, up to a certain intensity when heat becomes an acute environmental health emergency (above percentile 99). The rapid increase in mortality risk at very high temperatures percentiles calls for an active adaptation in a context of climate change.
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Affiliation(s)
- Mathilde Pascal
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France.
| | - Vérène Wagner
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Magali Corso
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Karine Laaidi
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Aymeric Ung
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Pascal Beaudeau
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
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Social Interventions to Prevent Heat-Related Mortality in the Older Adult in Rome, Italy: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040715. [PMID: 29641436 PMCID: PMC5923757 DOI: 10.3390/ijerph15040715] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
This study focuses on the impact of a program aimed at reducing heat-related mortality among older adults residing in central Rome by counteracting social isolation. The mortality of citizens over the age of 75 living in three Urban Areas (UAs) located in central Rome is compared with that of the residents of four adjacent UAs during the summer of 2015. The data, broken down by UA, were provided by the Statistical Office of the Municipality of Rome, which gathers them on a routine basis. During the summer of 2015, 167 deaths were recorded in those UAs in which the Long Live the Elderly (LLE) program was active and 169 in those in which it was not, implying cumulative mortality rates of 25‰ (SD ± 1.4; Cl 95%: 23–29) and 29‰ (SD ± 6.7; Cl 95%: 17–43), respectively. Relative to the summer of 2014, the increase of deaths during the summer of 2015 was greater in UAs in which the LLE program had not been implemented (+97.3% vs. +48.8%). In conclusion, the paper shows the impact of a community-based active monitoring program, focused on strengthening individual relationship networks and the social capital of the community, on mortality in those over 75 during heat waves.
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Sanderson M, Arbuthnott K, Kovats S, Hajat S, Falloon P. The use of climate information to estimate future mortality from high ambient temperature: A systematic literature review. PLoS One 2017; 12:e0180369. [PMID: 28686743 PMCID: PMC5501532 DOI: 10.1371/journal.pone.0180369] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Heat related mortality is of great concern for public health, and estimates of future mortality under a warming climate are important for planning of resources and possible adaptation measures. Papers providing projections of future heat-related mortality were critically reviewed with a focus on the use of climate model data. Some best practice guidelines are proposed for future research. METHODS The electronic databases Web of Science and PubMed/Medline were searched for papers containing a quantitative estimate of future heat-related mortality. The search was limited to papers published in English in peer-reviewed journals up to the end of March 2017. Reference lists of relevant papers and the citing literature were also examined. The wide range of locations studied and climate data used prevented a meta-analysis. RESULTS A total of 608 articles were identified after removal of duplicate entries, of which 63 were found to contain a quantitative estimate of future mortality from hot days or heat waves. A wide range of mortality models and climate model data have been used to estimate future mortality. Temperatures in the climate simulations used in these studies were projected to increase. Consequently, all the papers indicated that mortality from high temperatures would increase under a warming climate. The spread in projections of future climate by models adds substantial uncertainty to estimates of future heat-related mortality. However, many studies either did not consider this source of uncertainty, or only used results from a small number of climate models. Other studies showed that uncertainty from changes in populations and demographics, and the methods for adaptation to warmer temperatures were at least as important as climate model uncertainty. Some inconsistencies in the use of climate data (for example, using global mean temperature changes instead of changes for specific locations) and interpretation of the effects on mortality were apparent. Some factors which have not been considered when estimating future mortality are summarised. CONCLUSIONS Most studies have used climate data generated using scenarios with medium and high emissions of greenhouse gases. More estimates of future mortality using climate information from the mitigation scenario RCP2.6 are needed, as this scenario is the only one under which the Paris Agreement to limit global warming to 2°C or less could be realised. Many of the methods used to combine modelled data with local climate observations are simplistic. Quantile-based methods might offer an improved approach, especially for temperatures at the ends of the distributions. The modelling of adaptation to warmer temperatures in mortality models is generally arbitrary and simplistic, and more research is needed to better quantify adaptation. Only a small number of studies included possible changes in population and demographics in their estimates of future mortality, meaning many estimates of mortality could be biased low. Uncertainty originating from establishing a mortality baseline, climate projections, adaptation and population changes is important and should be considered when estimating future mortality.
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Affiliation(s)
| | - Katherine Arbuthnott
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, United Kingdom
| | - Sari Kovats
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shakoor Hajat
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nitschke M, Tucker G, Hansen A, Williams S, Zhang Y, Bi P. Evaluation of a heat warning system in Adelaide, South Australia, using case-series analysis. BMJ Open 2016; 6:e012125. [PMID: 27436672 PMCID: PMC4964181 DOI: 10.1136/bmjopen-2016-012125] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Heatwave warning systems aim to assist in reducing health effects during extreme heat. Evaluations of such systems have been limited. This study explored the effect of a heatwave warning programme on morbidity and mortality in Adelaide, South Australia, by comparing extreme events in 2009 and 2014, the latter with exposure to the preventive programme. METHODS The health outcomes during the two heatwaves were compared using the incidence rate ratios (IRRs) of daily ambulance call-outs, emergency presentations and mortality data during the heatwaves compared with non-heatwave periods during the warm seasons. Excess or reduced numbers of cases were calculated and the differences in cases between the two heatwaves were estimated. RESULTS IRRs for total ambulance call-outs and emergency presentations were lower during the 2014 heatwaves compared with the 2009 event. The estimated differences in health-specific outcomes between 2009 and 2014 were statistically significant with 207 (59%) for cardiac-related call-outs, 134 (30%) for renal and 145 (56%) for heat-related emergency presentations. Mortality was not reduced in 2014. There were an estimated 34.5 excess deaths in 2009 and 38.2 in 2014. CONCLUSIONS Morbidity outcomes were reduced significantly during the 2014 event. The fact that cardiac, renal and heat-related diagnoses were significantly reduced is likely to be associated with the intervention in 2014, which comprised a public warning through media and intense preventive measures directed to individual populations at risk. Further analysis of risk factors of mortality during heatwaves should be explored.
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Affiliation(s)
- Monika Nitschke
- Public Health Services, Department for Health and Ageing, Adelaide, South Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Graeme Tucker
- Epidemiology, Department for Health and Ageing, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Alana Hansen
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Williams
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Ying Zhang
- International Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peng Bi
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
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Mitigating and adapting to climate change: a call to public health professionals. Int J Public Health 2016; 60:631-2. [PMID: 26227490 DOI: 10.1007/s00038-015-0722-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sun X, Sun Q, Zhou X, Li X, Yang M, Yu A, Geng F. Heat wave impact on mortality in Pudong New Area, China in 2013. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 493:789-794. [PMID: 25000574 DOI: 10.1016/j.scitotenv.2014.06.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND In 2013 southeast China suffered from an unusual high temperature, which had broken the heat records in the past 141 years. Few studies have examined the impact of heat waves on mortality in Asia. OBJECTIVE To estimate the impact of the heat wave in 2013 on mortality among the registered permanent residence population and identify susceptible subpopulations in Pudong New Area. METHODS To model the relationship between the maximum temperature and mortality, a quasi-poisson generalized additive model was applied using data from 1 January 2008 to 15 June 2013. Extrapolating the model the estimated daily expected number of deaths was calculated over the period of 16 June 2013 to 15 September 2013. RESULTS There were four heat waves in 2013, causing 167 (95% CI: 46-280) excess deaths in all-cause mortality, corresponding to an excess mortality of 10.51%. After the first two heat waves, the cumulative excess death counts gradually reduced to the level before the start of the heat waves. In contrast, the cumulative excess death numbers increased rapidly during the last two heat waves, without decreasing after the heat waves. Females (male: 10.43%, female: 11.79%) and people aged ≥ 80 years old (excess deaths were 129 (95% CI: 47-203) and excess mortality was 16.64%) were strongly affected by the heat waves. The excess mortalities of cardiovascular and respiratory disease were 22.34% and 20.68% respectively, which were higher than that of all-cause deaths. CONCLUSIONS The 2013 heat wave had a significant impact on mortality even after the considered "mortality displacement". Females and people aged ≥ 80 years old were significantly vulnerable to the heat waves. The observed excess mortalities of cardiovascular and respiratory disease were higher than all-cause deaths. These results could provide scientific evidences for policy makers to frame heat wave-related prevention measures, which may help in reducing the mortality.
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Affiliation(s)
- Xiaoming Sun
- Health and Family Planning Commission, Pudong New Area, Shanghai, China.
| | - Qiao Sun
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Xianfeng Zhou
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Xiaopan Li
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Minjuan Yang
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Aiqing Yu
- Center for Disease Prevention and Control, Pudong New Area, Shanghai, China.
| | - Fuhai Geng
- Meteorological Bureau, Pudong New Area, Shanghai, China.
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14
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Brunetti ND, Amoruso D, De Gennaro L, Dellegrottaglie G, Di Giuseppe G, Antonelli G, Di Biase M. Hot Spot: Impact of July 2011 Heat Wave in Southern Italy (Apulia) on Cardiovascular Disease Assessed by Emergency Medical Service and Telemedicine Support. Telemed J E Health 2014; 20:272-81. [DOI: 10.1089/tmj.2013.0086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Daniele Amoruso
- Unità Operativa Cardiologia, Azienda Ospedaliera Policlinico, Bari, Italy
| | | | | | | | | | - Matteo Di Biase
- Department of Cardiology, University of Foggia, Foggia, Italy
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