Preventing and mitigating health risks of climate change

A review of national public health strategies in selected countries

National public health strategies play an essential role in defining a country's vision, policy direction and approaches for ensuring the health of its population. Gaining an understanding of the public health issues which countries prioritize, and how these health issues are improved upon, may provide insights into effective methods of national public health strategy development and delivery. National public health strategies were identified for ten countries and a descriptive analysis of strategy contents and development was undertaken. All of the identified national public health strategies included an overall aim of improving health and wellbeing, and all strategy scopes extended beyond the health domain. Themes or priorities frequently identified included promoting healthy living or behaviors, the strengthening of public health, and equity or equality. Approaches to strategy implementation were considered to be prescriptive or interpretive, with prescriptive approaches including detailed implementation plans with specific actions and key performance indicators, and interpretive approaches including high-level strategic actions along with principles to support their implementation. National public health strategy development was informed by both evidence and engagement with stakeholders, including the public, experts, and representatives from governmental and non-governmental organizations at local, regional and national levels. Overall, while the information gained in this analysis assists in the development of a national public health strategy, variation observed across the included strategies indicates that consideration should be given to factors which vary from country to country. These factors include the national health profile, the political context, underpinning and associated policies, and the availability of resources.

Mapping climate change interaction with human health through DPSIR framework: Qatar perspective

This study investigates the interactions between climate change and human health with a particular focus on Qatar, using the DPSIR (Driving Forces, Pressures, States, Impacts, Responses) framework. Key drivers, including economic development and population growth, contribute to increased greenhouse gas (GHG) emissions, exerting pressure on Qatar's climate through rising temperatures and altered precipitation patterns, as modeled by the MIT Regional Climate Model (MRCM). The findings reveal critical gaps in understanding the state of climate-health interactions, including insufficient disease data, incomplete climate-health linkages, and significant research gaps. These limitations hinder targeted responses to climate-sensitive diseases, which have shown an increase over the years. The study identifies the pathways through which climatic shifts contribute to immediate health risks, such as heat-related illnesses and respiratory conditions, as well as long-term impacts, including chronic diseases and mental health challenges. Despite Qatar's efforts through national and international strategies, the DPSIR analysis highlights the urgent need for enhanced research, improved data collection, and tailored actions to address these challenges. Strengthened adaptation, resilience-building, and emission reduction strategies remain essential for safeguarding public health in the face of accelerating climate change.

Climate Change and Health: A Study of the Attitudes of Future Science Teachers

Living beings as open systems depend on climate and weather to survive. However, changes in the Earth's climatology, which have become more frequent since the industrial period, have affected different territories of the planet, limiting access to ecosystem services and causing imbalances in health and well-being. The first purpose of this study is to conduct a literature review on academic production regarding climate change and its impact on health, in the context of education, using international academic production condensed in the Web of Science (WOS) database over the last 10 years as a reference. The second purpose focuses on identifying the environmental attitudes of science teachers in initial training regarding aspects related to climate change. The study results show three categories emerging from the literature review: Climate Change and Health, Nature and Risks, and Environment and Energy. For the analysis of environmental attitudes, a survey was conducted with 51 pre-service teachers, consisting of 59 items distributed in five categories: (a) environment, (b) climate change, (c) health, (d) education, and (e) lifestyle. Although the results reveal a positive attitude towards all analyzed categories, it is important to advance effective mitigation and adaptation strategies from the teacher training processes themselves.

Daily diurnal temperature range associated with emergency ambulance calls: a nine-year time-series study

Background

Diurnal temperature range (DTR) is associated with the increased risk of morbidity and mortality. However, the relationship between DTR and emergency ambulance calls (EACs), which more accurately and immediately reflect the health impacts of temperature changes, remains underexplored in China.

Methods

We collected daily data on EACs and meteorological factors from 2009 to 2017 in Guangzhou, China. DTR, representing the temperature range within a day, was calculated by subtracting the minimum temperature from the maximum temperature for each day. Generalized additive models were used to estimate the association between DTR and EACs for all-cause, cardiovascular diseases, and respiratory diseases. Additionally, subgroup and sensitivity analyses were conducted in our study.

Results

We found significant associations between daily DTR and EACs. The excess risks (ERs) were 0.47% (95% CI: 0.14, 0.81%) for all-cause EACs, 0.94% (95% CI: 0.46, 1.43%) for cardiovascular-related EACs, and 1.31% (95% CI: 0.76, 1.86%) for respiratory -related EACs at lag01, respectively. Subgroup analyses indicated that these associations were notably stronger among the older, males, and during the warm season. Specifically, there was an increase of 1.16% (95% CI: 0.59, 1.74%) in cardiovascular-related EACs among the older adult, compared to 0.45% (95% CI: -0.21, 1.12%) among those younger than 65 years. Among males, the increase was 1.39% (95% CI: 0.79, 1.99%), compared to 0.13% (95% CI: -0.53, 0.79%) among females. During the warm season, the increase was 1.53% (95% CI: 0.74, 2.34%), compared to 0.75% (95% CI: 0.14, 1.37%) during the cold season.

Conclusion

DTR might increase the risk of daily all-cause, cardiovascular-related, and respiratory-related EACs in Guangzhou, China. The associations were particularly strong among older adults, males, and during the warm season. Implementing public health policies is essential to mitigate the adverse health effects of DTR.

Temperature, relative humidity and elderly type 2 diabetes mortality: A spatiotemporal analysis in Shandong, China

BACKGROUND

The mortality of type 2 diabetes mellitus (T2DM) can be affected by environmental factors. However, few studies have explored the effects of environmental factors across diverse regions over time. Given the vulnerability observed in the elderly group in previous research, this research applied Bayesian spatiotemporal models to assess the associations in the elderly group.

METHODS

Data on T2DM death in the elderly group (aged over 60 years old) at the county level were collected from the National Death Surveillance System between 1st January 2013 and 31st December 2019 in Shandong Province, China. A Bayesian spatiotemporal model was employed with the integrated Nested Laplace Approach to explore the associations between socio-environmental factors (i.e., temperatures, relative humidity, the Normalized Difference Vegetation Index (NDVI), particulate matter with a diameter of 2.5 μm or less (PM2.5) and gross domestic product (GDP)) and T2DM mortality.

RESULTS

T2DM mortality in the elderly group was found to be associated with temperature and relative humidity (i.e., temperature: Relative Risk (RR) = 1.41, 95% Credible Interval (CI): 1.27-1.56; relative humidity: RR = 1.05, 95% CI:1.03-1.06), while no significant associations were found with NDVI, PM2.5 and GDP. In winter, significant impacts from temperature (RR = 1.18, 95% CI: 1.06-1.32) and relative humidity (RR = 0.94, 95% CI: 0.89-0.99) were found. Structured and unstructured spatial effects, temporal trends and space-time interactions were considered in the model.

CONCLUSIONS

Higher mean temperatures and relative humidities increased the risk of elderly T2DM mortality in Shandong Province. However, a higher humidity level decreased the T2DM mortality risk in winter in Shandong Province. This research indicated that the spatiotemporal method could be a useful tool to assess the impact of socio-environmental factors on health by combining the spatial and temporal effects.

Nocturnal heat exposure and stroke risk

BACKGROUND AND AIMS

In recent decades, nighttime temperatures have increased faster than daytime temperatures. The increasing prevalence of nocturnal heat exposure may pose a significant risk to cardiovascular health. This study investigated the association between nighttime heat exposure and stroke risk in the region of Augsburg, Germany, and examined its temporal variations over 15 years.

METHODS

Hourly meteorological parameters, including mean temperature, relative humidity, and barometric pressure, were acquired from a local meteorological station. A data set was obtained consisting of 11 037 clinical stroke cases diagnosed during warmer months (May to October) between the years 2006 and 2020. The average age of cases was 71.3 years. Among these cases, 642 were identified as haemorrhagic strokes, 7430 were classified as ischaemic strokes, and 2947 were transient ischaemic attacks. A time-stratified case-crossover analysis with a distributed lag non-linear model was used to estimate the stroke risk associated with extreme nighttime heat, as measured by the hot night excess (HNE) index after controlling for the potential confounding effects of daily maximum temperature and other climatic variables. Subgroup analyses by age group, sex, stroke subtype, and stroke severity were performed to identify variations in susceptibility to nighttime heat.

RESULTS

Results suggested a significant increase in stroke risk on days with extreme nighttime heat (97.5% percentile of HNE) (odds ratio 1.07, 95% confidence interval 1.01-1.15) during the full study period. When comparing the results for 2013-20 with the results for 2006-12, there was a significant increase (P < .05) in HNE-related risk for all strokes and specifically for ischaemic strokes during the more recent period. Furthermore, older individuals, females, and patients with mild stroke symptoms exhibited a significantly increased vulnerability to nighttime heat.

CONCLUSIONS

This study found nocturnal heat exposure to be related to elevated stroke risk after controlling for maximum daytime temperature, with increasing susceptibility between 2006 and 2020. These results underscore the importance of considering nocturnal heat as a critical trigger of stroke events in a warming climate.

The association between climate variables and tuberculosis in Kolaka District, Southeast Sulawesi Province, Indonesia, 2013-2020: a Bayesian autoregressive model

Background

Tuberculosis is one of the diseases that requires comprehensive treatment. This disease is highly contagious and can be transmitted through the air. Climate factors play a role in the increasing cases of tuberculosis. This study aimed to determine the correlation between climatic variables and TB in Kolaka District, Southeast Sulawesi Province, Indonesia.

Methods

This research was modeled using an autoregressive (AR) Bayesian model with three possible likelihoods; Gaussian, Poisson and Negative Binomial responses.

Results

Minimum temperature and average temperature, a coefficient of 4.234 suggests that for every 1 degree increase in minimum temperature, there is an estimated increase of approximately four cases, assuming other variables remain constant. Maximum temperature, a coefficient of 17.851 suggests that for every 1 degree increase in maximum temperature, there is an estimated increase of around 17-18 cases, assuming other variables remain constant. Humidity, a coefficient of -13.413 suggests that for every 1% increase in humidity, there is an estimated decrease of around 13 cases, assuming other variables remain constant. Rainfall, a coefficient of -0.327 suggests that for every 1 mm increase in rainfall, there is an estimated decrease of around 0.327 cases, assuming other variables remain constant. Light, a coefficient of -4.322 suggests that for every 1-hour increase in light duration, there is an estimated decrease of around four cases, assuming other variables remain constant.

Conclusions

Climate change has a significant impact on tuberculosis through temperature-related factors. These factors influence the prevalence, spread, and vulnerability to TB. Addressing these challenges requires a holistic approach involving adaptation planning. Strong public health systems and healthcare infrastructure can help mitigate the risks and impacts of climate change-related tuberculosis.

Assessing climate change and health provisions among staff in higher education institutions: A preliminary investigation

Climate change can have direct and indirect effects on human health. Direct effects can include an increase in extreme weather events, such as heatwaves and floods, as well as an increase in the spread of vector-borne and infectious diseases, which may lead to a set of health problems and diseases. Indirect effects can include changes in air quality, water availability, and food production and distribution. These changes can lead to an increase in respiratory problems, malnutrition, and increased food insecurity. There is a perceived need to investigate the extent to which Higher Education Institutions (HEIs) are engaged in efforts to foster a greater understanding of the connections between climate change and health. In this context, this preliminary investigation offers an overview of the relationships between climate change and health. By means of a survey among teaching staff and researchers at HEIs from 42 countries across all continents working on the connection between climate change and health. The study has investigated the extent to which current provisions for education and training on the connection between climate change and health are being considered and how current needs in terms of policy development, research, and training are being met. A series of case studies illustrate how universities worldwide are actively developing strategies and implementing measures to address climate change and health. The study concludes by providing specific recommendations aimed at facilitating the handling of issues related to climate change and health in a higher education context.

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.

A review on high-pressure heterogeneous catalytic processes for gas-phase CO2 valorization

This review discusses the importance of mitigating CO2 emissions by valorizing CO2 through high-pressure catalytic processes. It focuses on various key processes, including CO2 methanation, reverse water-gas shift, methane dry reforming, methanol, and dimethyl ether synthesis, emphasizing pros and cons of high-pressure operation. CO2 methanation, methanol synthesis, and dimethyl ether synthesis reactions are thermodynamically favored under high-pressure conditions. However, in the case of methane dry reforming and reverse water-gas shift, applying high pressure, results in decreased selectivity toward desired products and an increase in coke production, which can be detrimental to both the catalyst and the reaction system. Nevertheless, high-pressure utilization proves industrially advantageous for cost reduction when these processes are integrated with Fischer-Tropsch or methanol synthesis units. This review also compiles recent advances in heterogeneous catalysts design for high-pressure applications. By examining the impact of pressure on CO2 valorization and the state of the art, this work contributes to improving scientific understanding and optimizing these processes for sustainable CO2 management, as well as addressing challenges in high-pressure CO2 valorization that are crucial for industrial scaling-up. This includes the development of cost-effective and robust reactor materials and the development of low-cost catalysts that yield improved selectivity and long-term stability under realistic working environments.

Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas

BACKGROUND

Diabetes mortality varies between coastal and inland areas in Shandong Province, China. However, evidence about the reasons for this disparity is limited. We assume that distinct environmental conditions may contribute to the disparities in diabetes mortality patterns between coastal and inland areas.

METHOD

Qingdao and Jinan were selected as typical coastal and inland cities in Shandong Province, respectively, with similar socioeconomic but different environmental characteristics. Data on diabetes deaths and environmental factors (i.e., temperature, relative humidity and air pollution particles with a diameter of 2.5 μm or less (PM2.5)) were collected from 2013 to 2020. Spatial kriging methods were used to estimate the aggregated diabetes mortality at the city level. A distributed lag non-linear model (DLNM) was used to quantify the possible cumulative and non-cumulative associations between environmental factors and diabetes mortality by age, sex and location.

RESULTS

In the coastal city (Qingdao), the maximum cumulative relative risks (RRs) of temperature and PM2.5 associated with diabetes deaths were 2.54 (95 % confidence interval (CI): 1.25-5.15), and 1.17 (95 % CI: 1.01-1.37) respectively, at lag 1 week. In the inland city (Jinan), only temperature exhibited significant cumulative associations with diabetes deaths (RR = 1.54, 95 % CI: 1.07-2.23 at 29 °C). Lower relative humidity (22 %-45 %) had a lag-specific association with diabetes deaths in inland areas at lag 3 weeks (RR = 1.33, 95 % CI: 1.03-1.70 at 22 %).

CONCLUSION

Despite the lower PM2.5 concentrations in the coastal location, diabetes mortality exhibited stronger links to environmental variables in the coastal city than in the inland city. These findings suggest that the control of air pollution could decrease the mortality burden of diabetes, even in the region with relatively good air quality. Additionally, the spatial estimation method is recommended to identify associations between environmental factors and diseases in studies with limited data.

Nonoptimum Temperatures Are More Closely Associated With Fatal Myocardial Infarction Than With Nonfatal Events

BACKGROUND

Ambient temperatures trigger hospitalisation, mortality, and emergency department visits for myocardial infarction (MI). However, nonoptimum temperature-related risks of fatal and nonfatal MI have not yet been compared.

METHODS

From 2007 to 2019, 416,894 MI events (233,071 fatal and 183,823 nonfatal) were identified in Beijing, China. A time-series analysis with a distributed-lag nonlinear model was used to compare the relative and population-attributable risks of fatal and nonfatal MI associated with nonoptimum temperatures.

RESULTS

The reference was the optimum temperature of 24.3°C. For single-lag effects, cold (-5.2°C) and heat (29.6°C) effects had associations that persisted for more days for fatal MI than for nonfatal MI. For cumulative-lag effects over 0 to 21 days, cold effects were higher for fatal MI (relative risk [RR] 1.99, 95% confidence interval [CI] 1.68-2.35) than for nonfatal MI (RR 1.60, 95% CI 1.32-1.94) with a P value for difference in effect sizes of 0.048. In addition, heat effects were higher for fatal MI (RR 1.33, 95% CI 1.24-1.44) than for nonfatal MI (RR 0.99, 95% CI 0.91-1.08) with a P value for difference in effect sizes of 0.002. The attributable fraction of nonoptimum temperatures was higher for fatal MI (25.6%, 95% CI 19.7%-30.6%) than for nonfatal MI (19.1%, 95% CI 12.1%-25.0%).

CONCLUSIONS

Fatal MI was more closely associated with nonoptimum temperatures than nonfatal MI, as evidenced by single-lag effects that have associations which persisted for more days, higher cumulative-lag effects, and higher attributable risks for fatal MI. Strategies are needed to mitigate the adverse effects of nonoptimum temperatures.

Climate change and human health in Vietnam: a systematic review and additional analyses on current impacts, future risk, and adaptation

This study aims to investigate climate change's impact on health and adaptation in Vietnam through a systematic review and additional analyses of heat exposure, heat vulnerability, awareness and engagement, and projected health costs. Out of 127 reviewed studies, findings indicated the wider spread of infectious diseases, and increased mortality and hospitalisation risks associated with extreme heat, droughts, and floods. However, there are few studies addressing health cost, awareness, engagement, adaptation, and policy. Additional analyses showed rising heatwave exposure across Vietnam and global above-average vulnerability to heat. By 2050, climate change is projected to cost up to USD1-3B in healthcare costs, USD3-20B in premature deaths, and USD6-23B in work loss. Despite increased media focus on climate and health, a gap between public and government publications highlighted the need for more governmental engagement. Vietnam's climate policies have faced implementation challenges, including top-down approaches, lack of cooperation, low adaptive capacity, and limited resources.

Anticipating older populations' health risk exacerbated by compound disasters based on mortality caused by heart diseases and strokes

The health of older populations in the Southeastern U.S. receives threats from recurrent tropical cyclones and extreme heat, which may exacerbate the mortality caused by heart diseases and strokes. Such threats can escalate when these extremes form compound disasters, which may be more frequent under climate change. However, a paucity of empirical evidence exists concerning the health threats of compound disasters, and anticipations regarding the health risks of older populations under future compound disaster scenarios are lacking. Focusing on Florida, which has 67 counties and the second-largest proportion of older populations among U.S. states, we calibrate Poisson regression models to explore older populations' mortality caused by heart diseases and strokes under single and compound disasters. The models are utilized to estimate the mortality across future disaster scenarios, the changing climate, and the growing population. We identify that under multiple hurricanes or heat, current-month hurricanes or heat can affect mortality more heavily than previous-month hurricanes or heat. Under future scenarios, co-occurring hurricanes and extreme heat can exacerbate the mortality more severely than other disaster scenarios. The same types of compound disasters can coincide with an average of 20.5% higher mortality under RCP8.5-SSP5 than under RCP4.5-SSP2. We assess older populations' future health risks, alerting health agencies to enhance preparedness for future "worst-case" scenarios of compound disasters and proactively adapt to climate change.

Carbon emission reduction effects of renewable energy technological innovation in China: New insights into the intellectual property rights protection

Renewable energy technological innovation (RETI) is of great significance in reducing carbon emissions. A deeper understanding of the impact of intellectual property rights (IPR) protection on the carbon reduction effect of RETI can provide policymakers with more specific information. Using the dataset from 30 provinces in China during 2007-2018, we provide a detailed analysis of the moderating role of IPR protection in RETI's impact on carbon emissions. The results suggest that RETI has a significant carbon reduction effect, but this effect is not substantial in hydropower technological innovation. Moreover, we find that IPR protection moderates the impact of RETI on carbon emissions; increased levels of IPR protection can enhance RETI's carbon mitigation effect. Specifically, this positive moderating effect is only evidenced in the high energy self-sufficiency ratio and eastern regions, and it diminishes as carbon emissions increase. However, we do not find any evidence that IPR protection moderates the impact of energy storage technological innovation on carbon emissions.

Projected climate extremes over agro-climatic zones of Ganga River Basin under 1.5, 2, and 3° global warming levels

Recurring floods, droughts, heatwaves, and other hydro-meteorological extreme events are likely to be increased under the climate change scenarios. The increased risk of these extreme events might have more exposure to the population; thus, it is important to discuss such extreme events and their projected behavior under a changing climate scenario. In the present study, we have computed the extreme precipitation and temperature indices over the 10 agro-climatic zones falling under the Ganga River Basin (GRB)utilizing a high-resolution daily gridded temperature and precipitation multi-model ensembled CMIP6 dataset (0.25° × 0.25°) under global warming levels of 1.5 °C, 2 °C, and 3 °C. We found that the annual daily minimum temperature (TNN) showed a higher rise of about 67% than the maximum temperature (TXX) of 48% in GRB. The basin also experiences a greater increase in the frequency of warm nights (TN90P) of about 67.71% compared to warm days (TX90P) of 29.1% for the 3 °C global warming level. Along with extreme indices, the population exposed due to the impact of the extreme maximum temperature has also been analyzed for progressive warming levels. Population exposure to extreme temperature event (TXX) has been analyzed with 20-year return period using GEV distribution method. The study concludes that the exposed population to extreme temperature event experienced an increase from 46.99 to 52.16% for the whole Ganga Basin. Consecutive dry days (CDD) and consecutive wet days (CWD) both show a significant increasing trend, but CWD has a significant increase in the majority of the zones, while CDD shows a significant decreasing trend for some of the zones for three warming levels periods. Extreme climate indices help to understand the frequency and intensity of extreme weather events such as heavy rainfall, droughts, and heatwaves to develop early warning systems and adaptation strategies to mitigate such events.

Impact of Global Climate Change on Pulmonary Health: Susceptible and Vulnerable Populations

As fossil fuel combustion continues to power the global economy, the rate of climate change is accelerating, causing severe respiratory health impacts and large disparities in the degree of human suffering. Hotter and drier climates lead to longer and more severe wildland fire seasons, impairing air quality around the globe. Hotter temperatures lead to higher amounts of ozone and particles, causing the exacerbation of chronic respiratory diseases and premature mortality. Longer pollen seasons and higher pollen concentrations provoke allergic airway diseases. In arid regions, accelerated land degradation and desertification are promoting dust pollution and impairing food production and nutritional content that are essential to respiratory health. Extreme weather events and flooding impede healthcare delivery and can lead to poor indoor air quality due to mold overgrowth. Climate and human activities that harm the environment and ecosystem may also affect the emergence and spread of viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and associated morbidity and mortality exacerbated by air pollution. Children and elderly individuals are more susceptible to the adverse health effects of climate change. Geographical and socioeconomic circumstances, together with a decreased capacity to adapt, collectively increase vulnerability to the adverse effects of climate change. Successful mitigation of anthropogenic climate change is dependent on the commitment of energy-intensive nations to manage greenhouse gas emissions, as well as societal support and response to aggravating factors. In this review, we focus on the respiratory health impacts of global climate change, with an emphasis on susceptible and vulnerable populations and low- and middle-income countries.

Association of high ambient temperature with daily hospitalization for cardiorespiratory diseases in Brazil: A national time-series study between 2008 and 2018

Further research is needed to examine the nationwide impact of temperature on health in Brazil, a region with particular challenges related to climate conditions, environmental characteristics, and health equity. To address this gap, in this study, we looked at the relationship between high ambient temperature and hospital admissions for circulatory and respiratory diseases in 5572 Brazilian municipalities between 2008 and 2018. We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by PM_2.5, O₃, relative humidity, and time-varying confounders. We estimated relative risks (RRs) of the association of heat (percentile 99th) with hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. In the second stage, we applied meta-analysis with random effects to estimate the national RR. Our study population includes 23,791,093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. The robustness of the RR and the effect size varied significantly by region, sex, age group, and health outcome. Overall, our findings suggest that i) respiratory admissions had the highest RR, while circulatory admissions had inconsistent or null RR in several subgroup analyses; ii) there was a large difference in the cumulative risk ratio across regions; and iii) overall, women and the elderly population experienced the greatest impact from heat exposure. The pooled national results for the whole population (all ages and sex) suggest a relative risk of 1.29 (95% CI: 1.26; 1.32) associated with respiratory admissions. In contrast, national meta-analysis for circulatory admissions suggested robust positive associations only for people aged 15-45, 46-65, >65 years old; for men aged 15-45 years old; and women aged 15-45 and 46-65 years old. Our findings are essential for the body of scientific evidence that has assisted policymakers to promote health equity and to create adaptive measures and mitigations.

Assessing Psychosocial Health Impacts of Climate Adaptation: A Critical Review

The urgency of dealing with risks associated with climate change and the need for effective response measures to their impacts are increasing daily the world over. Literature abounds regarding the impacts of climate change on physical, psychosocial, and other health outcomes. In contrast, little research exists on the health impacts of response measures to climate change. This critical review seeks to contribute towards closing this gap through a synthesis of current literature on the psychosocial health outcomes of climate adaptation actions. Our results found both positive and negative outcomes associated with psychosocial health that may result from climate adaptation actions. We propose the utilization of well-developed conceptual frameworks and evaluation tools in assessment and analysis of these outcomes. Ultimately, there is need to expand similar and related areas of research more broadly and on psychosocial effects, specifically.

Determining the Impact of Heatwaves on Emergency Ambulance Calls in Queensland: A Retrospective Population-Based Study

Heatwaves are a significant and growing threat to the health and well-being of the residents of Queensland, Australia. This threat is increasing due to climate change. Excess heat increases the demand for health services, including ambulance calls, and the purpose of this study was to explore this impact across Queensland. A state-wide retrospective analysis of heatwaves and emergency 'Triple Zero' (000) calls to Queensland Ambulance (QAS) from 2010-2019 was undertaken. Call data from the QAS and heatwave data from the Bureau of Meteorology were analysed using a case-crossover approach at the postcode level. Ambulance calls increased by 12.68% during heatwaves. The effect was greatest during low-severity heatwaves (22.16%), followed by severe (14.32%) and extreme heatwaves (1.16%). The impact varied by rurality, with those living in very remote areas and major cities most impacted, along with those of low and middle socioeconomic status during low and severe intensity heat events. Lag effects post-heatwave continued for at least 10 days. Heatwaves significantly increase ambulance call centre workload, so ambulance services must actively prepare resources and personnel to address increases in heatwave frequency, duration, and severity. Communities must be informed of the risks of heatwaves at all severities, particularly low severity, and the sustained risks in the days following a heat event.

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

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

Green initiatives towards environmental sustainability: Insights from libraries in Kenya

Environmental protection is an increasingly pressing issue all over the world. Ozone depletion, the greenhouse effect, global climate change and global warming are among the rising environmental concerns. The increasing number of environmentally conscious consumers has resulted in numerous Go Green campaigns and a Go Green movement, along with solutions and calls for consumers, corporations and governments to be more proactive in going green in every aspect. Libraries are no exception. Although it is so important, little is known about the green-library concept in the African context and among Kenyan libraries. Like some other developing countries, Kenya has responded to climate change in various ways because of its adverse impacts. It is important to explore how libraries are planning for a sustainable future. Subsequently, this study aimed to explore the adoption of green-library concepts in Kenya for environmental sustainability with a view to proposing strategies that can be used to guide libraries in going green. The study adopted a qualitative approach. A sample of 12 libraries was purposively drawn from a population of 227 academic, public and special libraries in Kenya. Data was collected using semi-structured interview schedules complemented by observation and a document review, and analysed using grounded theory. The findings show that libraries in Kenya, under their umbrella organizations, have taken advantage of their knowledge of green concepts through adopting and implementing green practices and coming up with strategies to enhance green libraries and promote environmental sustainability. They have done this mainly through redesigning and renovating to meet ever-changing user demands in line with green-library standards. The study concludes that librarians in Kenyan libraries understand green-building concepts and have adopted different green initiatives, albeit partially to reposition and maintain their position globally. The study proposes three strategies for fully going green: active user involvement in green initiatives; improving performance and growth measuring metrics; and maintaining green-library standards in accordance with the IFLA’s Environment, Sustainability and Libraries Section (ENSULIB) green-library checklist.

Ability to adapt to seasonal temperature extremes among atrial fibrillation patients. A nation-wide study of hospitalizations in Israel

BACKGROUND

In recent years, temperature fluctuations and adverse weather events have become major concerns, influencing overall mortality and morbidity. While the association between extreme temperatures and atrial fibrillation (AF) has been supported by research, there is limited evidence on the ability of AF patients to adapt to the changing temperatures. We explored this question among AF patients in Israel featured by extreme temperature conditions.

METHODS

We examined the association between exposure to extreme temperatures and hospitalizations related to AF in a nationwide cohort in Israel. A case-crossover design with a distributed nonlinear model (DLNM) was applied to assess possible effects of temperature fluctuations during each season. We considered the 7 days prior to the event as the possible window period.

RESULTS

During 2004-2018 we recorded a total of 54,909 hospitalizations for AF. Low temperatures in winter and high in summer adversely affected AF-related hospitalizations. The effect recorded for the first few weeks of each season was of higher magnitude and decreased or faded off completely as the seasons progressed (OR in winter: from 1.14, 95%CI 0.98, 1.32 to 0.90, 95%CI: 0.77, 1.06;OR in summer: from 1.95, 95%CI: 1.51, 2.52 to 1.22, 95%CI: 0.90, 1.65). Patients living in the south region and patients with low socioeconomic status were more susceptible to extreme temperatures.

CONCLUSIONS

Although extreme hot and cold temperatures are associated with an increased risk of hospitalization for AF, the patients are likely to adapt to temperature change over the course of the first weeks of the season.

Air quality and health benefits of increasing carbon mitigation tech-innovation in China

Most studies on the short-term local benefits of carbon mitigation technologies on air quality improvement and health focus on specific technologies such as biofuels or carbon sequestration technologies, while ignoring the overall role of the growing scale of low-carbon technologies. Based on STIRPAT model and EKC hypothesis, this paper takes 30 provinces in China from 2004 to 2016 as research samples. We builded the panel double fixed effect model to empirical analysis of climate change on carbon mitigation tech-innovation suppressing the influence of haze pollution, on this basis, the mediating effect model was used to explore the mediation function of industrial structure and energy structure. Meanwhile, we drawed on the existing studies on air quality and health benefits, and quantify the co-benefits of carbon mitigation tech-innovation on health through the equivalent substitution formula. It shows that a 1% increase in the number of low-carbon patent applications can reduce haze pollution by 0.066%. According to this estimate, to 2029, China's carbon mitigation tech-innovation could reduce PM2.5 concentration to 15 μg/m³ preventing 5.597 million premature deaths. Moreover, carbon mitigation tech-innovation can also indirectly inhibit haze pollution by triggering more systematic economic structure changes such as energy and industrial structure. Additionally, we found that the role of gray tech-innovation (GT) related to improving the efficiency of fossil energy is stronger than that of clean technology (CT) related to the use of renewable energy. This suggests that for a large economy such as China, where coal is still the dominant source of energy consumption, the short-term local benefits of improving air quality and health through the use of gray tech-innovation to improve energy and industrial structure are still important to balance the cost of carbon mitigation.

Effect of ambient temperature variability on sperm quality: A retrospective population-based cohort study

BACKGROUNDS

Abnormal sperm quality in men is one of the common causes of infertility. Both ambient temperature and extreme heat exposure have been shown to be associated with sperm quality, but there is no epidemiological evidence for the effect of ambient temperature variability. Our aim was to investigate the association between ambient temperature variability exposure and a decline in sperm quality at different stages of sperm development.

METHODS

A total of 4912 semen samples collected from the Guangdong Human Sperm Bank between 1 January 2019 and 31 December 2019 were analyzed. We selected three exposure periods: the full-stage (0-90 lag days), early-stage (34-77 lag days) and late-stage (0-37 lag days) of sperm development, and then calculated the standard deviation of daily temperature (TVSD), the maximum day-to-day temperature difference (TVD_max) and the mean day-to-day temperature difference (TVD_mean) for the three exposure periods. A linear mixed model was used to explore the exposure response relationship between temperature variability exposure and sperm quality indicators (including sperm concentration, sperm count and sperm motility).

RESULTS

There was a significant negative association of decreased sperm count with the exposure to temperature variability during 0-90 days prior to sperm collection. (TVD_max: -0.041; -0.063, -0.019; TVD_mean: -0.237; -0.386, -0.088; TVSD: -0.103; -0.196, -0.011). We observed a significant association between the decline in sperm concentration, sperm count and per 1 °C increase in TVD_mean during early spermatogenesis. No significant association of temperature variability with sperm motility was found.

CONCLUSIONS

The results indicate that exposure to temperature variability during the entire period of sperm development is significantly associated with a decline in sperm counts. We found that mean day-to-day temperature differences had a detrimental effect on sperm counts in the early-stage. Our findings provide a scientific basis for public health policy and further mechanistic studies.

An analysis of past and future heatwaves based on a heat-associated mortality threshold: towards a heat health warning system

Heatwaves can have severe impacts on human health extending from illness to mortality. These health effects are related to not only the physical phenomenon of heat itself but other characteristics such as frequency, intensity, and duration of heatwaves. Therefore, understanding heatwave characteristics is a crucial step in the development of heat-health warning systems (HHWS) that could prevent or reduce negative heat-related health outcomes. However, there are no South African studies that have quantified heatwaves with a threshold that incorporated a temperature metric based on a health outcome. To fill this gap, this study aimed to assess the spatial and temporal distribution and frequency of past (2014 - 2019) and future (period 2020 - 2039) heatwaves across South Africa. Heatwaves were defined using a threshold for diurnal temperature range (DTR) that was found to have measurable impacts on mortality. In the current climate, inland provinces experienced fewer heatwaves of longer duration and greater intensity compared to coastal provinces that experienced heatwaves of lower intensity. The highest frequency of heatwaves occurred during the austral summer accounting for a total of 150 events out of 270 from 2014 to 2019. The heatwave definition applied in this study also identified severe heatwaves across the country during late 2015 to early 2016 which was during the strongest El Niño event ever recorded to date. Record-breaking global temperatures were reported during this period; the North West province in South Africa was the worst affected experiencing heatwaves ranging from 12 to 77 days. Future climate analysis showed increasing trends in heatwave events with the greatest increases (80%-87%) expected to occur during summer months. The number of heatwaves occurring in cooler seasons is expected to increase with more events projected from the winter months of July and August, onwards. The findings of this study show that the identification of provinces and towns that experience intense, long-lasting heatwaves is crucial to inform development and implementation of targeted heat-health adaptation strategies. These findings could also guide authorities to prioritise vulnerable population groups such as the elderly and children living in high-risk areas likely to be affected by heatwaves.

"Digital Dividend" or "Digital Divide": What Role Does the Internet Play in the Health Inequalities among Chinese Residents?

With the vigorous development of the medical industry in China, residents' health has been significantly improved. However, along with the income gap, urban-rural gap, and healthcare resource gap caused by economic development, health inequality has become a fundamental barrier to the promotion of residents' health. The popularity of the Internet has helped close the gap to some extent, but it also has drawbacks. Using data from the China Family Panel Studies (CFPS) from 2014 to 2018, we evaluated the effects of Internet usage on health disparities among residents using fixed effect models, mediation effect models, and other methodologies. The findings indicate that Internet usage can help to minimize health inequality since it lowers income inequality, promotes health consciousness, and reduces depression. Furthermore, Internet usage plays a greater role on the health improvement of the middle-aged, the elderly, urban residents, and females. Although the Internet has brought "digital dividends" in general, the Internet usage rates among different groups also reveal that there is a clear "digital gap" among rural residents, elderly groups, and low-income groups. These results have significant implications for promoting healthcare equality.

Effect of association of temperature and pollutant levels on COVID-19 spread over Jaipur

The association of temperature and air pollutants is a very prominent factor which significantly affects human health and may cause diseases such as respiratory illness, cardiovascular mortality in spreading of different pathogenic diseases. The pandemic due to covid-19 infection may be affected by temperature and concentration of pollutants. Jaipur is one of the most polluted cities in Rajasthan of India as per World Health Organization, 2016; also, Jaipur city has a hot semi-arid climate with extremely hot summers. This fact tempered us to examine the impact of the association of temperature and pollutants on corona-virus infection in humans over Jaipur. Analysis was conducted by correlating air pollutants (PM10, PM2.5, NO2, SO2, CO) on seasonal variations because the temperature is one of the major factors in changing seasons. Association between the number of Covid cases and temperature in Jaipur was observed during December 2019 to December 2020. Seasonal analysis indicated that the intensity of Covid-19 infection varied according to increase or decrease in temperature.

Evaluation of climate change adaptation measures for childhood asthma: A systematic review of epidemiological evidence

Global climate change (GCC) is widely accepted as the biggest threat to human health of the 21st century. Children are particularly vulnerable to GCC due to developing organ systems, psychological immaturity, nature of daily activities, and higher level of per-body-unit exposure. There is a rising trend in the disease burden of childhood asthma and allergies in many parts of the world. The associations of CC, air pollution and other environmental exposures with childhood asthma are attracting more research attention, but relatively few studies have focused on CC adaptation measures and childhood asthma. This study aimed to bridge this knowledge gap and conducted the first systematic review on CC adaptation measures and childhood asthma. We searched electronic databases including PubMed, Embase, and Web of Science using a set of MeSH terms and related synonyms, and identified 20 eligible studies included for review. We found that there were a number of adaptation measures proposed for childhood asthma in response to GCC, including vulnerability assessment, improving ventilation and heating, enhancing community education, and developing forecast models and early warning systems. Several randomized controlled trials show that improving ventilation and installing heating in the homes appear to be an effective way to relieve childhood asthma symptoms, especially in winter. However, the effectiveness of most adaptation measures, except for improving ventilation and heating, have not been explored and quantified. Given more extreme weather events (e.g., cold spells and heatwaves) may occur as climate change progresses, this finding may have important implications. Evidently, further research is urgently warranted to evaluate the impacts of CC adaptation measures on childhood asthma. These adaptation measures, if proven to be effective, should be integrated in childhood asthma control and prevention programs as GCC continues.

Impact of climatic and non-climatic stressors on ocean life and human health: A review

Ocean life forms are fundamentally well adapted to natural environmental variations, and they can even tolerate extreme conditions for a short time. However, several anthropogenic stressors are causing such drastic changes in the ocean ecosystem. First, the review attempts to outline the impact of climatic and non-climatic stressors on ocean life, and it also outlines the synergistic impact of both stressors. Then the impact on human health caused by the damage of the marine ecosystem has been discussed. Furthermore, the type of prior studies and current mitigation adaptation programs have been presented. Finally, some perspectives about future research and mitigation adaptation are offered.

Financial stability role on climate risks, and climate change mitigation: Implications for green economic recovery

As a response to the topic of how financial stability might be used to effectively finance for the mitigation of climate change and climate risks, it is important to look at the carbon risk that is still present in G-5 nations. The goal of our research is to determine the impact of financial stability on climate risk in order to effectively manage climate mitigation efforts. A technique called GMM is used to achieve this goal. Climate change mitigation was found to be substantial at 18 percent, while financial stability and carbon hazards were found significant at 21 percent, according to the conclusions of the study. Furthermore, the G-5 countries' 19.5% correlation between financial stability and emissions drift, which raises climate change concerns, is noteworthy. In order to implement green economic recovery methods, one of the most strongly regarded approaches to mitigating climate change and ensuring long-term financial potential at the national scale, a country's financial stability is required. The research on green economic expansion also offers the associated stakeholders with detailed policy implications on this relevance.

Climate change and global health: A call to more research and more action

There is increasing understanding, globally, that climate change and increased pollution will have a profound and mostly harmful effect on human health. This review brings together international experts to describe both the direct (such as heat waves) and indirect (such as vector-borne disease incidence) health impacts of climate change. These impacts vary depending on vulnerability (i.e., existing diseases) and the international, economic, political, and environmental context. This unique review also expands on these issues to address a third category of potential longer-term impacts on global health: famine, population dislocation, and environmental justice and education. This scholarly resource explores these issues fully, linking them to global health in urban and rural settings in developed and developing countries. The review finishes with a practical discussion of action that health professionals around the world in our field can yet take.

Strategic Investment in Open Hardware for National Security

Free and open-source hardware (FOSH) development has been shown to increase innovation and reduce economic costs. This article reviews the opportunity to use FOSH as a sanction to undercut imports and exports from a target criminal country. A formal methodology is presented for selecting strategic national investments in FOSH development to improve both national security and global safety. In this methodology, first the target country that is threatening national security or safety is identified. Next, the top imports from the target country as well as potentially other importing countries (allies) are quantified. Hardware is identified that could undercut imports/exports from the target country. Finally, methods to support the FOSH development are enumerated to support production in a commons-based peer production strategy. To demonstrate how this theoretical method works in practice, it is applied as a case study to a current criminal military aggressor nation, who is also a fossil-fuel exporter. The results show that there are numerous existing FOSH and opportunities to develop new FOSH for energy conservation and renewable energy to reduce fossil-fuel-energy demand. Widespread deployment would reduce the concomitant pollution, human health impacts, and environmental desecration as well as cut financing of military operations.

Microcosm study on cold adaptation and recovery of an exotic mangrove plant, Laguncularia racemosa in China

Laguncularia racemosa (a white mangrove) is an exotic mangrove species commonly distributed in southern intertidal zones in China since it was introduced for reforestation purposes in 1999. However, the invasiveness of this exotic species and its cold adaptability have rarely been reported. The present work determined the cold resistance level of L. racemosa and its recovery from cold stress, aiming to speculate its potential invasive capability in China. Results showed that the germination of L. racemosa seeds in sand or in simulated sea field models was significantly inhibited by a series of cold treatments, with no germination at 5 °C and decreased in germination at low temperatures (15-25 °C). Low temperature also reduced net photosynthetic rate (A), water use efficiency (WUE), transpiration rate (E), and stomatal conductance (Gs) of the seedlings of L. racemosa. On the other hand, cold stress up-regulated in leaves of malondialdehyde (MDA) and antioxidant activities, including superoxide dismutase (SOD), glutathione reductase (GR), and ascorbate peroxidase (APX). Additionally, these physiological and biochemical indexes of cold-stressed L. racemosa could recover to the original levels if the plants were returned to room temperature with a few exceptions. For instance, the cold exposure duration altered seedlings' physiology, but the photosynthetic related activities could not recover if cold treatment lasted for 120 h. This study suggests that L. racemosa can tolerate low temperatures to some extent, thus settle and even invade the coast of China at high latitudes having cold winter, which poses a challenge to the conservation and management of local mangrove ecosystems.

Climate Change Impacts on Health in Remote Indigenous Communities in Australia

Human-induced climate change in Australia is affecting the frequency and intensity of extreme events, including bushfires, cyclones and drought. Human health is affected by these climate impacts through direct impacts which include injuries and death from extreme events; indirect impacts through natural system changes such as impacts on water, food and air; and indirect impacts on human systems including mental health, productivity, and damage to housing and health-care facilities. Remote settlements are vulnerable to these climate impacts and associated health impacts due to isolated location, quality of the infrastructure, economic resources, limited transport, and existing health vulnerabilities that enable resilience or vulnerability. Remote Indigenous communities are particularly vulnerable. This research sought to identify vulnerabilities of human health of residents in remote Indigenous communities to human-induced climate change to contribute to adequate responses of prevention and preparation.

Do soil conservation practices exceed their relevance as a countermeasure to greenhouse gases emissions and increase crop productivity in agriculture?

Globally, agriculture sector is the significant source of greenhouse gases (GHGs) emissions into the atmosphere. To achieve the goal of limiting or mitigating these emissions, a rigorous abatement strategy with an additional focus on improving crop productivity is now imperative. Replacing traditional agriculture with soil conservation-based farming can have numerous ecological benefits. However, most assessments only consider improvements in soil properties and crop productivity, and often preclude the quantitative impact analysis on GHGs emissions. Here, we conducted a meta-analysis to evaluate crop productivity (i.e., biomass, grain, total yield) and GHGs emissions (i.e., CO₂, N₂O, CH₄) for three major soil conservation practices i.e., no-tillage, manures, and biochar. We also examined the yield potential of three major cereal crops (i.e., wheat, rice, maize) and their significance in mitigating GHGs emissions. None of the manures were able to reduce GHGs emissions, with poultry manure being the largest contributor to all GHGs emissions. However, pig-manure had the greatest impact on crop yield while emitting the least CO₂ emissions_. Use of biochar showed a strong coupling effect between reduction of GHGs (i.e., CH₄ by -37%; N₂O by -25%; CO₂ by -5%) and the increase in crop productivity. In contrast, no-tillage resulted in higher GHGs emissions with only a marginal increase in grain yield. Depending on crop type, all cereal crops showed varied degrees of GHGs mitigation under biochar application, with wheat responding most strongly due to the additional yield increment. The addition of biochar significantly reduced CO₂ and N₂O emissions under both rainfed and irrigated conditions, although CH₄ reductions were identical in both agroecosystems. Interestingly, the use of biochar resulted in a greater yield benefit in rainfed than in irrigated agriculture. Despite significant GHGs emissions, manure application contributed to higher crop yields, regardless of soil type or agroecosystem. Moreover, no-tillage showed a significant reduction in CH₄ and N₂O emissions under rainfed and irrigated conditions. Notably , biochar application in coarse while no-till in fine textured soils contributed to N₂O mitigation. Most importantly, effectiveness of no-tillage as a countermeasure to GHGs emissions while providing yield benefits is inconsistent. Overall, the decision to use farm manures should be reconsidered due to higher GHGs emissions. We conclude that the use of biochar could be an ideal way to reduce GHGs emissions. However, further understanding of the underlying mechanisms and processes affecting GHGs emissions is needed to better understand the feedback effects in conservation agriculture.

Climate Change and State of the Science for Children's Health and Environmental Health Equity

INTRODUCTION

Climate change is impacting the physical and mental health of children and families. This is a state of the science update regarding the impacts of climate change for pediatric-focused health care providers and advanced practice registered nurses.

METHOD

Using an equity lens, the authors reviewed and synthesized current literature regarding the adverse impacts of climate change.

RESULTS

The poor and communities of color are disproportionately impacted by climate change. Physical health impacts include increased vector and water-born infectious diseases, increases in asthma and respiratory infections, and undernutrition. Social disruptions lead to human trafficking. Climate change is associated with mental health concerns, including anxiety and posttraumatic stress after natural disasters.

DISCUSSION

As clinicians, pediatric-focused providers, and advanced practice registered nurses should use multipronged and interdisciplinary approaches to address or prevent the adverse impacts of climate change. Advocacy at all government levels is necessary to safeguard children and vulnerable populations.

Climate change impacts on infectious diseases in the Eastern Mediterranean and the Middle East (EMME)-risks and recommendations

The Eastern Mediterranean and Middle East (EMME) region has rapid population growth, large differences in socio-economic levels between developed and developing countries, migration, increased water demand, and ecosystems degradation. The region is experiencing a significant warming trend with longer and warmer summers, increased frequency and severity of heat waves, and a drier climate. While climate change plays an important role in contributing to political instability in the region through displacement of people, food insecurity, and increased violence, it also increases the risks of vector-, water-, and food-borne diseases. Poorer and less educated people, young children and the elderly, migrants, and those with long-term health problems are at highest risk. A result of the inequalities among EMME countries is an inconsistency in the availability of reliable evidence about the impacts on infectious diseases. To help address this gap, a search of the literature was conducted as a basis for related recommended responses and suggested actions for preparedness and prevention. Since climate change already impacts the health of vulnerable populations in the EMME and will have a greater impact in future years, risk assessment and timely design and implementation of health preparedness and adaptation strategies are essential. Joint national and cross-border infectious diseases management systems for more effective preparedness and prevention are needed, supported by interventions that improve the environment. Without such cooperation and effective interventions, climate change will lead to an increasing morbidity and mortality in the EMME from infectious diseases, with a higher risk for the most vulnerable populations.

Temporal changes in associations between high temperature and hospitalizations by greenspace: Analysis in the Medicare population in 40 U.S. northeast counties

Although research indicates health and well-being benefits of greenspace, little is known regarding how greenspace may influence adaptation to health risks from heat, particularly how these risks change over time. Using daily hospitalization rates of Medicare beneficiaries ≥65 years for 2000-2016 in 40 U.S. Northeastern urban counties, we assessed how temperature-related hospitalizations from cardiovascular causes (CVD) and heat stroke (HS) changed over time. We analyzed effect modification of those temporal changes by Enhanced Vegetation Index (EVI), approximating greenspace. We used a two-stage analysis including a generalized additive model and meta-analysis. Results showed that relative risk (RR) (per 1 °C increase in lag0-3 temperature) for temperature-HS hospitalization was higher in counties with the lowest quartile EVI (RR = 2.7, 95% CI: 2.0, 3.4) compared to counties with the highest quartile EVI (RR = 0.40, 95% CI: 0.14, 1.13) in the early part of the study period (2000-2004). RR of HS decreased to 0.88 (95% CI: 0.31, 2.53) in 2013-2016 in counties with the lowest quartile EVI. RR for HS changed over time in counties in the highest quartile EVI, with RRs of 0.4 (95% CI: -0.7, 1.4) in 2000-2004 and 2.4 (95% CI: 1.6, 3.2) in 2013-2016. Findings suggest that adaptation to heat-health associations vary by greenness. Greenspace may help lower risks from heat but such health risks warrant continuous local efforts such as heat-health plans.

Urban heat: an increasing threat to global health

Shilu Tong and colleagues describe the health consequences of extreme urban heat and the priorities for action and research to mitigate the harms

Climate change and infectious disease in Europe: Impact, projection and adaptation

Europeans are not only exposed to direct effects from climate change, but also vulnerable to indirect effects from infectious disease, many of which are climate sensitive, which is of concern because of their epidemic potential. Climatic conditions have facilitated vector-borne disease outbreaks like chikungunya, dengue, and West Nile fever and have contributed to a geographic range expansion of tick vectors that transmit Lyme disease and tick-borne encephalitis. Extreme precipitation events have caused waterborne outbreaks and longer summer seasons have contributed to increases in foodborne diseases. Under the Green Deal, The European Union aims to support climate change health policy, in order to be better prepared for the next health security threat, particularly in the aftermath of the traumatic COVID-19 experience. To bolster this policy process we discuss climate change-related hazards, exposures and vulnerabilities to infectious disease and describe observed impacts, projected risks, with policy entry points for adaptation to reduce these risks or avoid them altogether.

Systematic review of climate change impact research in Nigeria: implication for sustainable development

There is evidence that Nigeria is already experiencing environmental challenges attributed to climate change (CC) and its impacts. This has clearly highlighted the need for knowledge-based strategies to help plan adequate mitigation and adaptation measures for the country. One of the basic requirements to ensure such strategies is the development of a database of national CC research. This will aid in the assessment of past and present scientific publications from which directions for future study can be mapped. The present study used standard, systematic, and bibliographic literature reviews to analyse the trend, focus, spatial variability, and effectiveness of published research on CC impacts in Nigeria. Four thematic areas of CC impact research were defined: Agriculture, Environment, Human and Multi-disciplinary study. A total of 701 articles were found to be relevant and the review shows that CC impacts and adaptations in the literature vary across research categories and locations. The period between 2011 (68 studies) and 2015 (80 studies) showed a tremendous rise in CC impact research with a peak in 2014 (84 studies). Studies in the agriculture category had the highest publications in 23 States of Nigeria. The review revealed three research gaps: (1) lack of research that investigated the magnitude of present and potential future impacts in the aquatic environment (2) little attention on CC impacts and adaptation in the Northern regions of Nigeria (3) absence of study investigating the effects of multiple variables of CC at the same time. The findings suggest that it would be useful to advance CC research in Nigeria beyond perceptive approaches to more quantitative ones. This is particularly important for highly vulnerable animals, crops, locations, and for better planning of adaptation strategies.

Heart healthy cities: genetics loads the gun but the environment pulls the trigger

The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

Trends and gaps in climate change and health research in North America

The Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (2014) assessed the state of climate change and health knowledge, globally through the Human Health: Impacts, Adaptation, and Co-Benefits Chapter and regionally through chapters, such as the North America Chapter. With IPCC's 6th Assessment Report scheduled to be released in 2021-22, we asked: how has climate change and health research in North America advanced since the IPCC's 5th Assessment Report in 2014? Specifically, we systematically identified and examined trends in the extent, range, and nature of climate-health research conducted in North America. We used a scoping review methodology to systematically identify literature and map publication trends. A search string was used to search five academic databases. Two independent reviewers first screened titles and abstracts, and then the full texts of articles for relevance. Research articles and reviews using systematic methods published since 2013 were eligible for inclusion, and no language restrictions were applied. To be included, articles had to measure and link climatic variables or hazards to health outcomes in North America. Relevant articles were analysed using descriptive statistics to explore publication trends. The number of climate-health articles has significantly increased since the last IPCC Assessment Report. Published research about climate change impacts, heat-related mortality and morbidity, and respiratory illness taking place in urban centres and in the USA continue to dominate the North American climate-health literature, reflected by the high proportion of articles published. Important research gaps on previously neglected climate-sensitive health outcomes, however, are beginning to be filled, including climate change impacts on mental health, nutrition, and foodborne disease. We also observed progress in research that included future projections of climate-health risks; however, projection research is still relatively nascent and under-studied for many climate-sensitive health outcomes in North America, and would benefit from considering social and demographic variables in models. Important research disparities in geographical coverage were noted, including research gaps in Canada and Mexico, and in rural and remote regions. Overall, these publication trends suggest an improved understanding of exposure-response relationships and future projections of climate-health risks for many climate-sensitive health outcomes in North America, which is promising and provides an evidence-base to inform the IPCC 6th Assessment Report. Despite these advancements and considering the urgent policy and practice implications, more research is needed to deepen our understanding of climate-sensitive health outcomes, as well as examine new arising issues that have limited evidence-bases. In particular, transdisciplinary and cross-sector research, that includes the social sciences, examining current and future climate-health adaptation, mitigation, and the adaptation-mitigation nexus should become a top priority for research, given the urgent need for this evidence to inform climate change policies, actions, and interventions.

Modelling of Temperature-Attributable Mortality among the Elderly in Lisbon Metropolitan Area, Portugal: A Contribution to Local Strategy for Effective Prevention Plans

Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperature-attributable mortality among age groups (0-64 years; 65-74 years; 75-84 years; and 85+ years) in Lisbon Metropolitan Area, from 1986-2015. Non-linear and delayed exposure-lag-response relationships between temperature and mortality were fitted with a distributed lag non-linear model (DLNM). In general, the adverse effects of cold and hot temperatures on mortality were greater in the older age groups, presenting a higher risk during the winter season. We found that, for all ages, 10.7% (95% CI: 9.3-12.1%) deaths were attributed to cold temperatures in the winter, and mostly due to moderately cold temperatures, 7.0% (95% CI: 6.2-7.8%), against extremely cold temperatures, 1.4% (95% CI: 0.9-1.8%). When stratified by age, people aged 85+ years were more burdened by cold temperatures (13.8%, 95% CI: 11.5-16.0%). However, for all ages, 5.6% of deaths (95% CI: 2.7-8.4%) can be attributed to hot temperatures. It was observed that the proportion of deaths attributed to exposure to extreme heat is higher than moderate heat. As with cold temperatures, people aged 85+ years are the most vulnerable age group to heat, 8.4% (95% CI: 3.9%, 2.7%), and mostly due to extreme heat, 1.3% (95% CI: 0.8-1.8%). These results provide new evidence on the health burdens associated with alert thresholds, and they can be used in early warning systems and adaptation plans.

Wild Zebrafish Sentinels: Biological Monitoring of Site Differences Using Behavior and Morphology

Environmental change poses a devastating risk to human and environmental health. Rapid assessment of water conditions is necessary for monitoring, evaluating, and addressing this global health danger. Sentinels or biological monitors can be deployed in the field using minimal resources to detect water quality changes in real time, quickly and cheaply. Zebrafish (Danio rerio) are ideal sentinels for detecting environmental changes due to their biomedical tool kit, widespread geographic distribution, and well-characterized phenotypic responses to environmental disturbances. Here, we demonstrate the utility of zebrafish sentinels by characterizing phenotypic differences in wild zebrafish between two field sites in India. Site 1 was a rural environment with flowing water, low-hypoxic conditions, minimal human-made debris, and high iron and lead concentrations. Site 2 was an urban environment with still water, hypoxic conditions, plastic pollution, and high arsenic, iron, and chromium concentrations. We found that zebrafish from Site 2 were smaller, more cohesive, and less active than Site 1 fish. We also found sexually dimorphic body shapes within the Site 2, but not the Site 1, population. Advancing zebrafish sentinel research and development will enable rapid detection, evaluation, and response to emerging global health threats.