Climate change and mortality in Vienna--a human biometeorological analysis based on regional climate modeling

Accounting for adaptation when projecting climate change impacts on health: A review of temperature-related health impacts

Exposure to high and low ambient temperatures can cause harm to human health. Due to global warming, heat-related health effects are likely to increase substantially in future unless populations adapt to living in a warmer world. Adaptation to temperature may occur through physiological acclimatisation, behavioural mechanisms, and planned adaptation. A fundamental step in informing responses to climate change is understanding how adaptation can be appropriately accounted for when estimating future health burdens. Previous studies modelling adaptation have used a variety of methods, and it is often unclear how underlying assumptions of adaptation are made and if they are based on evidence. Consequently, the most appropriate way to quantitatively model adaptation in projections of health impacts is currently unknown. With increasing interest from decisionmakers around implementation of adaptation strategies, it is important to consider the role of adaptation in anticipating future health burdens of climate change. To address this, a literature review using systematic scoping methods was conducted to document the quantitative methods employed by studies projecting future temperature-related health impacts under climate change that also consider adaptation. Approaches employed in studies were coded into methodological categories. Categories were discussed and refined between reviewers during synthesis. Fifty-nine studies were included and grouped into eight methodological categories. Methods of including adaptation in projections have changed over time with more recent studies using a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most common approaches to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were identified as using an intervention-based empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence.

Future Temperature-Related Deaths in the U.S.: The Impact of Climate Change, Demographics, and Adaptation

Mortality due to extreme temperatures is one of the most worrying impacts of climate change. In this analysis, we use historic mortality and temperature data from 106 cities in the United States to develop a model that predicts deaths attributable to temperature. With this model and projections of future temperature from climate models, we estimate temperature-related deaths in the United States due to climate change, changing demographics, and adaptation. We find that temperature-related deaths increase rapidly as the climate warms, but this is mainly due to an expanding and aging population. For global average warming below 3°C above pre-industrial levels, we find that climate change slightly reduces temperature-related mortality in the U.S. because the reduction of cold-related mortality exceeds the increase in heat-related deaths. Above 3°C warming, whether the increase in heat-related deaths exceeds the decrease in cold-related deaths depends on the level of adaptation. Southern U.S. cities are already well adapted to hot temperatures and the reduction of cold-related mortality drives overall lower mortality. Cities in the Northern U.S. are not well adapted to high temperatures, so the increase in heat-related mortality exceeds the reduction in cold-related mortality. Thus, while the total number of climate-related mortality may not change much, climate change will shift mortality in the U.S. to higher latitudes.

Fluctuations in emergency department visits related to acute otitis media are associated with extreme meteorological conditions

Background

Climate change has been associated with a higher frequency of extreme weather events, resulting in an overall increase in morbidity and mortality. Acute otitis media (AOM) is one of the most common otolaryngological infections and accounts for 1.5% of emergency department visits. This study aimed to identify associations between extreme weather events and the immediate and delayed risks for AOM-related emergency department visits (EV).

Methods

A total of 1,465 AOM-related EVs were identified in the Vienna General Hospital between 2015 and 2018. A distributed lag non-linear model was applied to evaluate the relationship between extreme weather conditions and the total number of AOM-related EVs per day. The relative risk (RR) and cumulative RR (cRR) of single-day events and extended weather events over three days were analyzed over a lag period of 14 days.

Results

AOM-related EVs showed a pronounced seasonality, with the highest occurrence during winter. Single-day weather events affected AOM-related EVs only at high relative humidity. Prolonged extreme weather conditions over three days, however, significantly increased the cRR for AOM-related EVs to 3.15 [1.26-7.88; p = 0.014] and 2.14 [1.14-4.04; p = 0.018] at mean temperatures of -4°C (1^st-percentile - p₁) and 0°C (p₅) on the same day. Relative humidity of 37% (p₁) decreased RR to 0.94 [0.88-0.99; p = 0.032] on day 7, while extremely high humidity of 89% (p₉₉) led to an increased cRR of 1.43 [1.03-2.00; p = 0.034] on day 7. Heavy prolonged precipitation of 24mm (p₉₅) reduced cRR beginning day 4 up until day 14 to 0.52 [0.31-0.86; p = 0.012]. Prolonged low atmospheric pressure events of 985hPa (p₅) reduced the RR to 0.95 [0.91-1.00; p = 0.03], whereas extremely high atmospheric pressure events of 1013hPa (p₉₉) increased the RR to 1.11 [1.03-1.20; p = 0.008]. Extremely low wind speeds significantly diminished the RR of AOM-related EVs.

Conclusions

While single-day extreme weather events had little impact on the occurrence of AOM-related EVs, extended periods of extreme temperatures, relative humidity, precipitation, wind speeds and atmospheric pressure significantly impacted the RR for AOM-related EVs. These findings could help improve healthcare resource allocation in similar climates and aid in educating patients about the role of environmental factors in AOM.

Monitoring Multi-Scale Ecological Change and Its Potential Drivers in the Economic Zone of the Tianshan Mountains' Northern Slopes, Xinjiang, China

Accurately capturing the changing patterns of ecological quality in the urban agglomeration on the northern slopes of the Tianshan Mountains (UANSTM) and researching its significant impacts responds to the requirements of high-quality sustainable urban development. In this study, the spatial and temporal distribution patterns of remote sensing ecological index (RSEI) were obtained by normalization and PCA transformation of four basic indicators based on Landsat images. It then employed geographic detectors to analyze the factors that influence ecological change. The result demonstrates that: (1) In the distribution of land use conversions and degrees of human disturbance, built-up land, principally urban land, and agricultural land, represented by dry land, are rising, while the shrinkage of grassland is the most substantial. The degree of human disturbance is increasing overall for glaciers. (2) The overall ecological environment of the northern slopes of Tianshan is relatively poor. Temporally, the ecological quality changes and fluctuates, with an overall rising trend. Spatially, ecological quality is low in the north and south and high in the center, with high values concentrated in the mountains and agriculture and low values in the Gobi and desert. However, on a large scale, the ecological quality of the Urumqi-Changji-Shihezi metropolitan area has worsened dramatically compared to other regions. (3) Driving factor detection showed that LST and NDVI were the most critical influencing factors, with an upward trend in the influence of WET. Typically, LST has the biggest influence on RSEI when interacting with NDVI. In terms of the broader region, the influence of social factors is smaller, but the role of human interference in the built-up area of the oasis city can be found to be more significant at large scales. The study shows that it is necessary to strengthen ecological conservation efforts in the UANSTM region, focusing on the impact of urban and agricultural land expansion on surface temperature and vegetation.

Achievements and gaps in projection studies on the temperature-attributable health burden: Where should we be headed?

Future projection of the temperature-related health burden, including mortality and hospital admissions, is a growing field of research. These studies aim to provide crucial information for decision-makers considering existing health policies as well as integrating targeted adaptation strategies to evade the health burden. However, this field of research is still overshadowed by large uncertainties. These uncertainties exist to an extent in the future climate and population models used by such studies but largely in the disparities in underlying assumptions. Existing studies differ in the factors incorporated for projection and strategies for considering the future adaptation of the population to temperature. These differences exist to a great degree because of a lack of robust evidence as well as gaps in the field of climate epidemiology that still require extensive input from the research community. This narrative review summarizes the current status of projection studies of temperature-attributable health burden, the guiding assumptions behind them, the common grounds, as well as the differences. Overall, the review aims to highlight existing evidence and knowledge gaps as a basis for designing future studies on temperature-attributable health burden estimation. Finding a robust methodology for projecting the future health burden could be a milestone for climate epidemiologists as this would largely benefit the world when applying this technique to project the climate-attributable cause-specific health burden and adapt our existing health policies accordingly.

Climate Risk Mitigation and Adaptation Concerns in Urban Areas: A Systematic Review of the Impact of IPCC Assessment Reports

Urban areas continue to be the center of action for many countries due to their contribution to economic development. Many urban areas, through the urbanization process, have become vulnerable to climate risk, thereby making risk mitigation and adaptation essential components in urban planning. The study assessed the impacts of IPCC Assessment Reports (ARs) on academic research on risk mitigation and adaptation concerns in urban areas. The study systematically reviewed literature through searches of the Web of Science and Scopus databases; 852 papers were retrieved and 370 were deemed eligible. The results showed that the East Asia and Pacific, and Europe and Central Asia regions were most interested in IPCC ARs, while Sub-Saharan Africa showed little interest. Several urban concerns, including socio-economic, air quality, extreme temperature, sea level rise/flooding, health, and water supply/drought, were identified. Additionally, studies on negative health outcomes due to extreme temperatures and air pollution did not appear in the first four IPCC ARs. However, significant studies appeared after the launch of the AR5. Here, we must state that climate-related problems of urbanization were known and discussed in scientific papers well before the formation of the IPCC. For instance, the works of Clarke on urban structure and heat mortality and Oke on climatic impacts of urbanization. Though the IPCC ARs show impact, their emphasis on combined mitigation and adaptation policies is limited. This study advocates more combined risk mitigation and adaptation policies in urban areas for increased resilience to climate risk.

Review of Biometeorology of Heatwaves and Warm Extremes in Europe

Numerous extreme heatwaves producing large impacts on human health, agriculture, water resources, energy demand, regional economies, and forest ecosystems occurred during the first twenty years of the 21st century. The present study strives to provide a systematic review of recent studies of warm biometeorological extremes in Europe. The main aim of this paper is to provide a methodical summary of the observed changes in warm extremes, duration, and variability in different parts of Europe. During the last decade, much attention has been paid to the negative impacts of heat and humidity on human health. Therefore, the human biometeorology is required to appraise the human thermal environment in a way that human thermoregulation is taken into account. In many European countries and regions, future heat exposure will indeed exceed critical levels, and a steep increase in biometeorological heatwaves and warm extremes are expected. The indices that take into account human energy balance along with weather conditions should be used to examine the impacts of extreme heatwaves on human health and should be used as a basis for the determination of acclimatization to high-heat-stress conditions. A detailed description of recent studies that have used biometeorological indices such as Physiological Equivalent Temperature (PET) and Universal Thermal Climate Index (UTCI) for the estimation of warm extremes and their influence on human health is provided. Additionally, a short overview of the existence of the heat-health warning systems (HHWS), their conceptualization, and implementation across the European continent is considered, as well as the possibilities for further investigations and implementation of effective measures and programs that could reduce the adverse health impacts.

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

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are "win-win situation" from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.

Heat-health action plans in Europe: Challenges ahead and how to tackle them

High temperatures have periodically affected large areas in Europe and urban settings. In particular, the deadly 2003 summer heat waves precipitated a multitude of national and subnational health prevention and research efforts. Building on these and other international experiences the WHO Regional Office for Europe developed and published in 2008 a comprehensive framework for prevention, the heat-health action plans (HHAPs). This provided a blueprint used by several national and subnational authorities to design their prevention efforts. A decade after the publication of the WHO guidance, a wealth of new evidence and acquired implementation experience has emerged around HHAP effectiveness; heat exposure; acclimatization and adaptation; heat-health governance and stakeholder involvement; and the role of urban design and greening interventions in prevention. This evidence and experience can guide the strategies to tackle current and upcoming challenges in protecting health from heat under a warming climate.

Сardiovascular mortality during heat waves in temperate climate: an association with bioclimatic indices

The authors studied the relative predictive powers of several bioclimatic indices as predictors of population mortality during heat waves. Daily mean and maximum values of air temperature, Humidex, apparent, and physiological equivalent temperatures (PETs) were examined. The numbers of daily deaths and daily meteorological data in Rostov-on-Don (southern Russia) were used. The study period spanned April-September between 1999 and 2011. The eight selected bioclimatic indices were used to identify heat waves and calculate the expected increases in mortality during such events from Poisson generalized linear model of daily death counts. All of the bioclimatic indices considered were positively and significantly associated with mortality during heat waves. The best predictor was chosen from a set of similar models by maximization of relative mortality risk estimates. Having compared the relative increases and their significance levels in several cause- and age-specific mortality rates, the authors concluded that PET was the most powerful predictor.

Identifying outdoor thermal risk areas and evaluation of future thermal comfort concerning shading orientation in a traditional settlement

The outdoor thermal environment is expected to be deteriorated under climate change. An approach of risk identification including assessment from aspects of thermal stress effect, people's exposure, and local's vulnerability were adopted to study a hot-and-humid traditional rural community located at Tainan, Taiwan. Layers of each aspect were either constructed by in-situ measurements or simulations. To evaluate the future thermal comfort changes by simulations, the prerequisite hourly climate data of three future time slices were produced. Prognostic simulation model, ENVI-met, in combination with diagnostic model, RayMan, were respectively used for identifying current spatial distribution of thermal stress and for assessing the future thermal comfort changes. High thermal risk area was identified by superimposing layers of hazard, exposure and vulnerability. It revealed that because of the tourists' vulnerability to adapt local climate and the inflexibleness of choosing visiting time, it exhibited a high thermal stress at the Main Courtyard where its thermal comfort conditions will be deteriorated due to climate change. Furthermore, the thermal comfort conditions in various shading orientation were analyzed based on the changing climate in three future time slices, i.e. 2011-2040, 2041-2070, and 2071-2100. The results show the area with shading in the East and West side is more comfort than in the North side. In hot season, shading in the West side contributes less PET increasing, especially in the afternoon period. The severest overheat problem (the physiological equivalent temperature, PET>40°C) at the Main Courtyard will increase from current 10% to 28% in 2071-2100 in terms of overheating occurrence frequency. The results of this study can be used as the guidelines for environment analysis before planning or redesign community.

Heat stress mortality and desired adaptation responses of healthcare system in Poland

Heat stress is one of the environmental factors influencing the health of individuals and the wider population. There is a large body of research to document significant increases in mortality and morbidity during heat waves all over the world. This paper presents key results of research dealing with heat-related mortality (HRM) in various cities in Poland which cover about 25% of the country's population. Daily mortality and weather data reports for the years 1991-2000 were used. The intensity of heat stress was assessed by the universal thermal climate index (UTCI). The research considers also the projections of future bioclimate to the end of twenty-first century. Brain storming discussions were applied to find necessary adaptation strategies of healthcare system (HCS) in Poland, to minimise negative effects of heat stress. In general, in days with strong and very strong heat stress, ones must expect increase in mortality (in relation to no thermal stress days) of 12 and 47%, respectively. Because of projected rise in global temperature and heat stress frequency, we must expect significant increase in HRM to the end of twenty-first century of even 165% in comparison to present days. The results of research show necessity of urgent implementation of adaptation strategies to heat in HCS.

Application of spatial synoptic classification in evaluating links between heat stress and cardiovascular mortality and morbidity in Prague, Czech Republic

Spatial synoptic classification (SSC) is here first employed in assessing heat-related mortality and morbidity in Central Europe. It is applied for examining links between weather patterns and cardiovascular (CVD) mortality and morbidity in an extended summer season (16 May-15 September) during 1994-2009. As in previous studies, two SSC air masses (AMs)-dry tropical (DT) and moist tropical (MT)-are associated with significant excess CVD mortality in Prague, while effects on CVD hospital admissions are small and insignificant. Excess mortality for ischaemic heart diseases is more strongly associated with DT, while MT has adverse effect especially on cerebrovascular mortality. Links between the oppressive AMs and excess mortality relate also to conditions on previous days, as DT and MT occur in typical sequences. The highest CVD mortality deviations are found 1 day after a hot spell's onset, when temperature as well as frequency of the oppressive AMs are highest. Following this peak is typically DT- to MT-like weather transition, characterized by decrease in temperature and increase in humidity. The transition between upward (DT) and downward (MT) phases is associated with the largest excess CVD mortality, and the change contributes to the increased and more lagged effects on cerebrovascular mortality. The study highlights the importance of critically evaluating SSC's applicability and benefits within warning systems relative to other synoptic and epidemiological approaches. Only a subset of days with the oppressive AMs is associated with excess mortality, and regression models accounting for possible meteorological and other factors explain little of the mortality variance.

The Summers 2003 and 2015 in South-West Germany: Heat Waves and Heat-Related Mortality in the Context of Climate Change

After 2003, another hot summer took place in Western and Central Europe in 2015. In this study, we compare the characteristics of the two major heat waves of these two summers and their effect on the heat related mortality. The analysis is performed with focus on South-West Germany (Baden–Württemberg). With an additional mean summer mortality of +7.9% (2003) and +5.8% (2015) both years mark the top-two records of the summer mortality in the period 1968–2015. In each summer, one major heat wave contributed strongly to the excess summer mortality: In August 2003, daily mortality reached anomalies of +70% and in July 2015 maximum deviations of +56% were observed. The August 2003 heat wave was very long-lasting and characterized by exceptional high maximum and minimum temperatures. In July 2015, temperatures were slightly lower than in 2003, however, the high air humidity during the day and night, lead to comparable heat loads. Furthermore, the heat wave occurred earlier during the summer, when the population was less acclimated to heat stress. Using regional climate models we project an increasing probability for future 2003- and 2015-like heat waves already in the near future (2021–2050), with a 2015-like event occurring about every second summer. In the far future (2070–2099) pronounced increases with more than two 2015-like heat waves per summer are possible.

Biometeorological Assessment of Mortality Related to Extreme Temperatures in Helsinki Region, Finland, 1972-2014

Climate change is expected to increase heat-related and decrease cold-related mortality. The extent of acclimatization of the population to gradually-changing thermal conditions is not well understood. We aimed to define the relationship between mortality and temperature extremes in different age groups in the Helsinki-Uusimaa hospital district in Southern Finland, and changes in sensitivity of the population to temperature extremes over the period of 1972-2014. Time series of mortality were made stationary with a method that utilizes 365-day Gaussian smoothing, removes trends and seasonality, and gives relative mortality as the result. We used generalized additive models to examine the association of relative mortality to physiologically equivalent temperature (PET) and to air temperature in the 43-year study period and in two 21-year long sub-periods (1972-1992 and 1994-2014). We calculated the mean values of relative mortality in percentile-based categories of thermal indices. Relative mortality increases more in the hot than in the cold tail of the thermal distribution. The increase is strongest among those aged 75 years and older, but is somewhat elevated even among those younger than 65 years. Above the 99th percentile of the PET distribution, the all-aged relative mortality decreased in time from 18.3 to 8.6%. Among those ≥75 years old, the decrease in relative mortality between the sub-periods were found to be above the 90th percentile. The dependence of relative mortality on cold extremes was negligible, except among those ≥75 years old, in the latter period. Thus, heat-related mortality is also remarkable in Finland, but the sensitivity to heat stress has decreased over the decades.

The use of climate information to estimate future mortality from high ambient temperature: A systematic literature review

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.

Implementation of human thermal comfort information in Köppen-Geiger climate classification-the example of China

Köppen-Geiger climate classification (KGC) is accepted and applied worldwide. The climatic parameters utilised in KGC, however, cannot indicate human thermal comfort (HTC) conditions or air humidity (AH) conditions directly, because they are originally based on climatic effects on vegetation, instead of that on human body directly. In addition, HTC is driven by meteorological parameters together. Thus, the objective of this study is to preliminarily implement the HTC information and the AH information in KGC. Physiologically equivalent temperature (PET) has been chosen as the HTC index, and vapour pressure (VP) is for the quantification of AH conditions. In this preliminary study, 12 Chinese cities in total have been taken into account as the assumed representatives of 11 climate types. Basic meteorological data of each city with 3-h resolution in 2000-2012 has been analysed. RayMan model has been applied to calculate PET within the same time period. Each climate type has been described by frequencies of PET and frequencies of VP. For example, the Aw (Sanya) has the most frequent occurrence of thermally stressful conditions compared to other climate types: PET in 22 % points in time of the year was above 35 °C. The driest AH conditions existed in Dwc (Lhasa) and Dfb (Urumqi) with VP rarely above 18 hPa in the wettest month. Implementation of the HTC information and the additional AH information in each climate type of KGC can be helpful for the topics of human health, energy consumption, tourism, as well as urban planning.

Changes in population susceptibility to heat and cold over time: assessing adaptation to climate change

BACKGROUND

In the context of a warming climate and increasing urbanisation (with the associated urban heat island effect), interest in understanding temperature related health effects is growing. Previous reviews have examined how the temperature-mortality relationship varies by geographical location. There have been no reviews examining the empirical evidence for changes in population susceptibility to the effects of heat and/or cold over time. The objective of this paper is to review studies which have specifically examined variations in temperature related mortality risks over the 20(th) and 21(st) centuries and determine whether population adaptation to heat and/or cold has occurred.

METHODS

We searched five electronic databases combining search terms for three main concepts: temperature, health outcomes and changes in vulnerability or adaptation. Studies included were those which quantified the risk of heat related mortality with changing ambient temperature in a specific location over time, or those which compared mortality outcomes between two different extreme temperature events (heatwaves) in one location.

RESULTS

The electronic searches returned 9183 titles and abstracts, of which eleven studies examining the effects of ambient temperature over time were included and six studies comparing the effect of different heatwaves at discrete time points were included. Of the eleven papers that quantified the risk of, or absolute heat related mortality over time, ten found a decrease in susceptibility over time of which five found the decrease to be significant. The magnitude of the decrease varied by location. Only two studies attempted to quantitatively attribute changes in susceptibility to specific adaptive measures and found no significant association between the risk of heat related mortality and air conditioning prevalence within or between cities over time. Four of the six papers examining effects of heatwaves found a decrease in expected mortality in later years. Five studies examined the risk of cold. In contrast to the changes in heat related mortality observed, only one found a significant decrease in cold related mortality in later time periods.

CONCLUSIONS

There is evidence that across a number of different settings, population susceptibility to heat and heatwaves has been decreasing. These changes in heat related susceptibility have important implications for health impact assessments of future heat related risk. A similar decrease in cold related mortality was not shown. Adaptation to heat has implications for future planning, particularly in urban areas, with anticipated increases in temperature due to climate change.

Quantification and assessment of heat and cold waves in Novi Sad, Northern Serbia

Physiologically equivalent temperature (PET) has been applied to the analysis of heat and cold waves and human thermal conditions in Novi Sad, Serbia. A series of daily minimum and maximum air temperature, relative humidity, wind, and cloud cover was used to calculate PET for the investigated period 1949-2012. The heat and cold wave analysis was carried out on days with PET values exceeding defined thresholds. Additionally, the acclimatization approach was introduced to evaluate human adaptation to interannual thermal perception. Trend analysis has revealed the presence of increasing trend in summer PET anomalies, number of days above defined threshold, number of heat waves, and average duration of heat waves per year since 1981. Moreover, winter PET anomaly as well as the number of days below certain threshold and number of cold waves per year until 1980 was decreasing, but the decrease was not statistically significant. The highest number of heat waves during summer was registered in the last two decades, but also in the first decade of the investigated period. On the other hand, the number of cold waves during six decades is quite similar and the differences are very small.

Acute coronary syndromes related to bio-climate in a Mediterranean area. The case of Ierapetra, Crete Island, Greece

The occurrence of non-fatal acute coronary syndromes (ACS) is examined in relation with the local bioclimatic conditions in the Ierapetra area, in the southernmost part of Crete Island, Greece, during the period 2004-2007. Daily ACS counts and corresponding meteorological parameters, such as maximum and minimum air temperature, relative humidity, wind speed and cloudiness, were analyzed. Besides, the daily values of the human thermal index, physiologically equivalent temperature (PET) was evaluated. Pearson's χ(2) test and generalized linear models (GLM) with Poisson distribution were applied. The ACS syndromes present a multiple variation within the year, with the primary maximum in August and the secondary in May, while relative high ACS frequencies exist in early winter time. The impact of the weather variability on the ACS incidence is not statistically significant (C.L. 95%).