Projections of heatwave-attributable mortality under climate change and future population scenarios in China

Scoping review on assessing climate-sensitive health risks

BACKGROUND

Climate change is making the existing health problems worse and also introducing new health problem and therefore calls for a wider evaluation of climate sensitive global diseases. The review sought to assess and collate quantitative and qualitative evidence on the effects of climate change on global health, more specifically, infectious and respiratory diseases, the impacts of extreme weather events as well as the implications for mental health with the view of establishing appropriate sustainable and resilience public health measures and policies.

METHODOLOGY

A scoping review of observational studies carried out between the years 2000 and 2024, synthesized information on climate-sensitive health outcomes: infectious diseases, severe weather events, and mental illnesses. This analysis was based on data from PubMed, Scopus, Web of Science and Cochrane Library, where appropriate, utilizing meta-extraction and Meta-analysis techniques.

RESULTS

A total of 3077 studies were screened, and 96 articles were included for quantitative and qualitative analysis, highlighting the significant health risks posed by climate change. Key areas of concern identified include climate-sensitive infectious diseases, respiratory and cardiovascular conditions, food- and water-borne illnesses, and mental health effects. Rising temperatures and variable rainfall patterns increase the incidence of diseases like malaria (up to 50%) and dengue (8-10% per 1 °C rise). Extreme weather events, such as heatwaves and floods, contribute to a 30% rise in respiratory diseases and a 25% increase in cardiovascular conditions. Food- and water-borne illnesses are more prevalent in regions like Africa (30-40%) due to climate change. Additionally, climate change exacerbates mental health issues, leading to conditions like post-traumatic stress disorder (PTSD), anxiety, and depression.

CONCLUSION AND RECOMMENDATIONS

Climate change amplifies global public health risks, worsening diseases and creating new challenges. To address this, enhance machine learning climate sensitive disease surveillance, strengthen climate resilience health infrastructure, and integrate health into climate adaptation and mitigation strategies, promote sustainable agriculture, improve WASH infrastructure, and foster global collaboration.

Heat acclimation defense against exertional heat stroke by improving the function of preoptic TRPV1 neurons

Rationale: Record-breaking heatwaves caused by greenhouse effects lead to multiple hyperthermia disorders, the most serious of which is exertional heat stroke (EHS) with the mortality reaching 60 %. Repeat exercise with heat exposure, termed heat acclimation (HA), protects against EHS by fine-tuning feedback control of body temperature (Tb), the mechanism of which is opaque. This study aimed to explore the molecular and neural circuit mechanisms of the HA training against EHS. Methods: Male C57BL/6 mice (6-8 weeks) and male TRPV1-Cre mice (6-8 weeks) were used in our experiments. The EHS model with or without HA training were established for this study. RNA sequencing, qPCR, immunoblot, immunofluorescent assays, calcium imaging, optogenetic/ chemical genetic intervention, virus tracing, patch clamp, and other methods were employed to investigate the molecular mechanism and neural circuit by which HA training improves the function of the medial preoptic area (mPOA) neurons. Furthermore, a novel exosome-based strategy targeting the central nervous system to deliver irisin, a protective peptide generated by HA, was established to protect against EHS. Results: HA-related neurons in the mPOA expressing transient receptor potential vanilloid-1 (TRPV1) were identified as a population whose activation reduces Tb; inversely, dysfunction of these neurons contributes to hyperthermia and EHS. mPOATRPV1 neurons facilitate vasodilation and reduce adipose tissue thermogenesis, which is associated with their inhibitory projection to the raphe pallidus nucleus (RPa) and dorsal medial hypothalamus (DMH) neurons, respectively. Furthermore, HA improves the function of preoptic heat-sensitive neurons by enhancing TRPV1 expression, and Trpv1 ablation reverses the HA-induced heat tolerance. A central nervous system-targeted exosome strategy to deliver irisin, a protective peptide generated by HA, can promote preoptic TRPV1 expression and exert similar protective effects against EHS. Conclusions: Preoptic TRPV1 neurons could be enhanced by HA, actively contributing to heat defense through the mPOA"DMH/RPa circuit during EHS, which results in the suppression of adipose tissue thermogenesis and facilitation of vasodilatation. A delivery strategy of exosomes engineered with RVG-Lamp2b-Irisin significantly improves the function of mPOATRPV1 neurons, providing a promising preventive strategy for EHS in the future.

The 2023 report of the synergetic roadmap on carbon neutrality and clean air for China: Carbon reduction, pollution mitigation, greening, and growth

The response to climate change and air pollution control demonstrates strong synergy across scientific mechanisms, targets, strategies, and governance systems. This report, based on a monitoring indicator system for coordinated governance of air pollution and climate change, employs an interdisciplinary approach combining natural and social sciences. It establishes 20 indicators across five key areas: air pollution and climate change, governance systems and practices, structural transformation and technologies, atmospheric components and emission reduction pathways, and health impacts and co-benefits. This report tries to provide actionable insights into the interconnectedness of air pollution and climate governance. It highlights key policy gaps, presents updated indicators, and offers a refined monitoring framework to track progress toward China's dual goals of reducing emissions and improving air quality. Compared to previous editions, this year's report has updated four key indicators: meteorological impacts on air quality, climate change and its effects, governance policies, and low-carbon building energy systems. The aim is to further refine the monitoring framework, track progress, and establish a comprehensive theory for collaborative governance while identifying challenges and proposing solutions for China's pathway to carbon neutrality and clean air. The report comprises six chapters. The executive summary chapter is followed by analyzing air pollution and climate change interactions. Governance systems and practices are discussed in the third chapter, focusing on policy implementation and local experiences. The fourth chapter addresses structural transformations and emission reduction technologies, including energy and industrial shifts, transportation, low-carbon buildings, carbon capture and storage, and power systems. The fifth chapter outlines atmospheric component dynamics and emission pathways, presenting insights into emission drivers and future strategies. The sixth chapter assesses health impacts and the benefits of coordinated actions. Since 2019, China Clean Air Policy Partnership has produced annual reports on China's progress in climate and air pollution governance, receiving positive feedback. In 2023, the report was co-developed with Tsinghua University's Carbon Neutrality Research Institute, involving over 100 experts and multiple academic forums. The collaboration aims to continuously improve the indicator system and establish the report as a key resource supporting China's efforts in pollution reduction, carbon mitigation, greening, and sustainable growth.

Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality

BACKGROUND

The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important.

OBJECTIVE

In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality.

RESULTS

Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves.

CONCLUSIONS

Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.

Characteristics of lower respiratory tract pathogens in critically ill patients with heatstroke: a retrospective multi-center study

This retrospective multicenter study was conducted across 83 intensive care units (ICUs) in 16 cities in Sichuan, China. Critically ill patients diagnosed with heatstroke and lung infections were included in the study. Specimens from the lower respiratory tract were collected for microbiological testing, and the characteristics of the pathogens were described. A total of 462 patients diagnosed with heatstroke-related pulmonary infections were included, 134 patients (29.0%) tested positive for respiratory pathogens. The most frequently isolated strain was Klebsiella pneumoniae (34.3%), followed by Escherichia coli (28.4%), Staphylococcus aureus (20.9%). The results revealed that in the hyperthermic resistance group, there was a higher proportion of Pseudomonas aeruginosa [14(34.1%) vs 11(11.8%), p=0.002] and Stenotrophomonas maltophilia [4(9.8%) vs 1(1.1%), p=0.030] compared to the hyperthermic control group. And a higher proportion of Staphylococcus aureus [27(29.7%) vs 1(2.3%), p<0.001], were obtained during the earlier stages with elevated temperatures. Patients with Klebsiella pneumoniae (38.3 ± 1.9°C), Staphylococcus aureus (38.5 ± 2.2°C), and Pseudomonas aeruginosa (38.7 ± 1.9°C) exhibited a higher temperature environment. Our study provides crucial insights into the lower respiratory tract pathogenesis of heatstroke patients, identifying key pathogens and their temperature-dependent characteristics, thus providing a foundation for future empirical treatment strategies in heatstroke.

Non-optimal temperature-attributable mortality and morbidity burden by cause, age and sex under climate and population change scenarios: a nationwide modelling study in Japan

Background

Future temperature effects on mortality and morbidity may differ. However, studies comparing projected future temperature-attributable mortality and morbidity in the same setting are limited. Moreover, these studies did not consider future population change, human adaptation, and the variations in subpopulation susceptibility. Thus, we simultaneously projected the temperature-related mortality and morbidity by cause, age, and sex under population change, and human adaptation scenarios in Japan, a super-ageing society.

Methods

We used daily mean temperatures, mortality, and emergency ambulance dispatch (a sensitive indicator for morbidity) in 47 prefectures of Japan from 2015 to 2019 as the reference for future projections. Future mortality and morbidity were generated at prefecture level using four shared socioeconomic pathway (SSP) scenarios considering population changes. We calculated future temperature-related mortality and morbidity by combining baseline values with future temperatures and existing temperature risk functions by cause (all-cause, circulatory, respiratory), age (<65 years, ≥65 years), and sex under various climate change and SSP scenarios (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). Full human adaptation was simulated based on empirical evidence using a fixed percentile of minimum mortality or morbidity temperature (MMT), while no adaptation was simulated with a fixed absolute MMT.

Findings

A future temporal decline in mortality burden attributable to non-optimal temperatures was observed, driven by greater cold-related deaths than heat-related deaths. In contrast, temperature-related morbidity increased over time, which was primarily driven by heat. In the 2050s and 2090s, under a moderate scenario, there are 83.69 (95% empirical confidence interval [eCI] 38.32-124.97) and 77.31 (95% eCI 36.84-114.47) all-cause deaths per 100,000 population, while there are 345.07 (95% eCI 258.31-438.66) and 379.62 (95% eCI 271.45-509.05) all-cause morbidity associated with non-optimal temperatures. These trends were largely consistent across causes, age, and sex groups. Future heat-attributable health burden is projected to increase substantially, with spatiotemporal variations and is particularly pronounced among individuals ≥65 y and males. Full human adaptation could yield a decreasing temperature-attributable mortality and morbidity in line with a decreasing population.

Interpretation

Our findings could support the development of targeted mitigation and adaptation strategies to address future heat-related impacts effectively. This includes improved healthcare allocations for ambulance dispatch and hospital preventive measures during heat periods, particularly custom-tailored to address specific health outcomes and vulnerable subpopulations.

Funding

Japan Science and Technology Agency and Environmental Restoration and Conservation Agency and Ministry of the Environment of Japan.

Atmospheric health burden across the century and the accelerating impact of temperature compared to pollution

Anthropogenic emissions alter atmospheric composition and therefore the climate, with implications for air pollution- and climate-related human health. Mortality attributable to air pollution and non-optimal temperature is a major concern, expected to shift under future climate change and socioeconomic scenarios. In this work, results from numerical simulations are used to assess future changes in mortality attributable to long-term exposure to both non-optimal temperature and air pollution simultaneously. Here we show that under a realistic scenario, end-of-century mortality could quadruple from present-day values to around 30 (95% confidence level:12-53) million people/year. While pollution-related mortality is projected to increase five-fold, temperature-related mortality will experience a seven-fold rise, making it a more important health risk factor than air pollution for at least 20% of the world's population. These findings highlight the urgent need to implement stronger climate policies to prevent future loss of life, outweighing the benefits of air quality improvements alone.

Cardiovascular morbidity risk attributable to thermal stress: analysis of emergency ambulance dispatch data from Shenzhen, China

BACKGROUND

Climate change has raised scientific interest in examining the associations of weather conditions with adverse health effects, while most studies determined human thermal stress using ambient air temperature rather than the thermophysiological index.

OBJECTIVES

To evaluate the association between emergency ambulance dispatches (EADs) related to cardiovascular causes and heat/cold stress in Shenzhen, a city in southern China, with the aim of providing new insights for local policymakers.

METHODS

A time series analysis using ambulance dispatch data of cardiovascular diseases in Shenzhen, China (2013-2019) was conducted. A quasi-Poisson nonlinear distributed lag model was applied to explore the relationship between emergency ambulance dispatches (EADs) due to cardiovascular causes and thermal stress (determined by Universal Thermal Climate Index, UTCI). Attributable fractions were estimated to identify which UTCI ranges have a greater health impact.

RESULTS

The relationship between UTCI and EADs due to cardiovascular diseases exhibits a reverse J-shaped curve. The effects of cold stress were immediate and long-lasting, whereas the effects of heat stress were non-significant. Compared with the optimal equivalent temperature (71st percentile of UTCI, 29.22 °C), the relative risks for cumulative (0-21 days) exposures to cold stress (1st percentile, - 0.13 °C; 5th percentile, 7.68 °C) were 1.55 (95%CI:1.28,1.88) and 1.44 (95%CI:1.22,1.69), respectively. Thermal (cold and heat) stress was responsible for 10.81% (95%eCI: 5.67%,15.43%) of EADs for cardiovascular diseases, with 9.46% (95%eCI: 3.98%,14.40%) attributed to moderate cold stress (2.5th ~ 71st percentile). Greater susceptibility to cold stress was observed for males and the elderly. Heat stress showed harmful effects in the warm season.

CONCLUSIONS

Our results demonstrated that cold exposure elevates the risk of EADs for cardiovascular causes in Shenzhen, and moderate cold stress cause the highest burden of ambulance dispatches. Health authorities should consider effective adaptation strategies and interventions responding to cold stress to reduce the morbidity of cardiovascular diseases.

Association between heatwaves and risk and economic burden of injury related hospitalizations in China

BACKGROUND

Public health is greatly affected by heatwaves, especially as a result of climate change. It is unclear whether heatwaves affect injury hospitalization, especially as developing countries facing the impact of climate change.

OBJECTIVES

To assess the impact of heatwaves on injury-related hospitalization and the economic burden.

METHODS

The daily hospitalizations and meteorological data from 2014 to 2019 were collected from 23 study sites in 11 meteorological geographic zones in China. We conducted a two-stage time series analysis based on a time-stratified case-crossover design, combined with DLNM to assess the association between heatwaves and daily injury hospitalization, and to further assess the regional and national economic losses resulting from hospitalization by calculating excess hospitalization costs (direct economic losses) and labor losses (indirect economic losses). To determine the vulnerable groups and areas, we also carried out stratified analyses by age, sex, and region.

RESULTS

We found that 6.542% (95%CI: 3.939%, 9.008 %) of injury hospitalization were attributable to heatwaves during warm season (May to September) from 2014 to 2019. Approximately 361,447 injury hospitalizations were attributed to heatwaves each year in China, leading to an excess economic loss of 5.173 (95%CI: 3.104, 7.196) billion CNY, of which 3.114 (95%CI: 1.454, 4.720) billion CNY for males and 4.785 (95%CI: 3.203, 6.321) billion CNY for people aged 15-64 years. The attributable fraction (AF) of injury hospitalizations due to heatwaves was the highest in the plateau mountain climate zone, followed by the subtropical monsoon climate zone and the temperate monsoon climate zone.

CONCLUSIONS

Heatwaves significantly increase the disease and economic burden of injury hospitalizations, and vary across populations and regions. Our findings implicate the necessity for targeted measures, including raising public awareness, improving healthcare infrastructure, and developing climate resilience policies, to reduce the threat of heatwaves to vulnerable populations and the associated disease and economic burden.

Social-economic transitions and vulnerability to extreme temperature events from 1960 to 2020 in Chinese cities

Climate change leads to more frequent and intense extreme temperature events, causing a significant number of excess deaths. Using an epidemiological approach, we analyze all-cause deaths related to heatwaves and cold spells in 2,852 Chinese counties from 1960 to 2020. Economic losses associated with these events are determined through the value of statistical life. Findings reveal that cold-related cumulative excess deaths (1,133 thousand) are approximately 2.5 times higher than heat-related deaths, despite an increase in heat-related fatalities in recent decades. Monetized mortality due to heat-related events is estimated at 1,284 billion CNY, while cold-related economic loss is 1,510 billion CNY. Notably, cities located in colder regions experience more heat-related excess deaths, and vice versa. Economic development does not significantly reduce mortality risks to heatwaves across China. This study provides insights into the spatial-temporal heterogeneity of heatwaves and cold spells mortality, essential for policymakers ensuring long-term climate adaptation and sustainability.

Health risks from extreme heat in China: Evidence from health insurance

Global warming has accentuated the effects of extreme heat on health. Health insurance, functioning as a risk management tool, has the potential to alleviate these impacts. Consequently, this paper investigates the correlation between extreme heat events and the demand for health insurance in China. Using data from the China Health and Nutrition Survey, we have observed a substantial increase in the likelihood of residents purchasing health insurance during extreme heat events. To be specific, for every extra day of extreme heat events annually, there is a 0.3% increase in the probability of purchasing health insurance. This effect is not uniform across different demographic groups. It is particularly pronounced among middle-aged and elderly individuals, rural residents, those with lower educational levels, higher income brackets, and individuals residing in underprivileged areas with limited access to green spaces and healthcare facilities. Furthermore, our study indicates that the increased frequency of extreme heat events not only impacts individuals' physical health but also triggers negative emotions, which in turn drive risk-averse behavior related to health insurance purchases. These findings carry substantial policy implications for mitigating the economic consequences of climate change.

Experimental research in environmentally induced hyperthermic older persons: A systematic quantitative literature review mapping the available evidence

The heat-related health burden is expected to persist and worsen in the coming years due to an aging global population and climate change. Defining the breadth and depth of our understanding of age-related changes in thermoregulation can identify underlying causes and strategies to protect vulnerable individuals from heat. We conducted the first systematic quantitative literature review to provide context to the historical experimental research of healthy older adults - compared to younger adults or unhealthy age matched cases - during exogenous heat strain, focusing on factors that influence thermoregulatory function (e.g. co-morbidities). We identified 4,455 articles, with 147 meeting eligibility criteria. Most studies were conducted in the US (39%), Canada (29%), or Japan (12%), with 71% of the 3,411 participants being male. About 71% of the studies compared younger and older adults, while 34% compared two groups of older adults with and without factors influencing thermoregulation. Key factors included age combined with another factor (23%), underlying biological mechanisms (18%), age independently (15%), influencing health conditions (15%), adaptation potential (12%), environmental conditions (9%), and therapeutic/pharmacological interventions (7%). Our results suggest that controlled experimental research should focus on the age-related changes in thermoregulation in the very old, females, those with overlooked chronic heat-sensitive health conditions (e.g. pulmonary, renal, mental disorders), the impact of multimorbidity, prolonged and cumulative effects of extreme heat, evidence-based policy of control measures (e.g. personal cooling strategies), pharmaceutical interactions, and interventions stimulating protective physiological adaptation. These controlled studies will inform the directions and use of limited resources in ecologically valid fieldwork studies.

The influence of humid heat on morbidity of megacity Shanghai in China

BACKGROUND

Increased attention has been paid to humid-heat extremes as they are projected to increase in both frequency and intensity. However, it remains unclear how compound extremes of heat and humidity affects morbidity when the climate is projected to continue warming in the future, in particular for a megacity with a large population.

METHODS

We chose the Wet-Bulb Globe Temperature (WBGT) index as the metric to characterize the humid-heat exposure. The historical associations between daily outpatient visits and daily mean WBGT was established using a Distributed Lag Non-linear Model (DLNM) during the warm season (June to September) from 2013 to 2015 in Shanghai, a prominent megacity of China. Future morbidity burden related to the combined effect of high temperature and humidity were projected under four greenhouse gases (GHGs) emission scenarios (SSP126, SSP245, SSP370 and SSP585).

RESULTS

The humid-heat weather was significantly associated with a higher risk of outpatient visits in Shanghai than the high-temperature conditions. Relative to the baseline period (2010-2019), the morbidity burden due to humid-heat weather was projected to increase 4.4 % (95 % confidence interval (CI): 1.1 %-10.1 %) even under the strict emission control scenario (SSP126) by 2100. Under the high-GHGs emission scenario (SSP585), this burden was projected to be 25.4 % (95 % CI: 15.8 %-38.4 %), which is 10.1 % (95 % CI: 6.5 %-15.8 %) more than that due to high-temperature weather. Our results also indicate that humid-hot nights could cause large morbidity risks under high-GHGs emission scenarios particularly in heat-sensible diseases such as the respiratory and cardiovascular disease by the end of this century.

CONCLUSIONS

Humid heat exposures significantly increased the all-cause morbidity risk in the megacity Shanghai, especially in humid-hot nights. Our findings suggest that the combined effect of elevated temperature and humidity is projected to have more substantial impact on health compared to high temperature alone in a warming climate.

The 2022 Summer record-breaking heatwave and health information-seeking behaviours: an infodemiology study in Mainland China

INTRODUCTION

Heatwave is a major global health concern. Many countries including China suffered a record-breaking heatwave during the summer of 2022, which may have a significant effect on population health or health information-seeking behaviours but is yet to be examined.

METHODS

We derived health information-seeking data from the Baidu search engine (similar to Google search engine). The data included city-specific daily search queries (also referred to Baidu Search Index) for heat-sensitive diseases from 2021 to 2022, including heatstroke, hospital visits, cardiovascular diseases and diabetes, respiratory diseases, mental health and urological diseases. For each city, the record-breaking heatwave days in 2022 were matched to days in the same calendar month in 2021.

RESULTS

The 2022 record-breaking heatwave hit most cities (83.64%) in Mainland China. The average heatwave duration was 13 days and the maximum temperature was 3.60°C higher than that in 2021 (p<0.05). We observed increased population behaviours of seeking information on respiratory diseases (RR=1.014, 95% CI: 1.008 to 1.020), urological diseases (RR=1.011, 95% CI: 1.006 to 1.016) and heatstroke (RR=1.026, 95% CI: 1.016 to 1.036) associated with the heatwave intensity in 2022 (per 1°C increase). The heatwave duration in 2022 (per 1 day increase) was also associated with an increase in seeking information on cardiovascular diseases and diabetes (RR=1.003, 95% CI: 1.002 to 1.004), urological diseases (RR=1.005, 95% CI: 1.002 to 1.008), mental health (RR=1.009, 95% CI: 1.006 to 1.012) and heatstroke (RR=1.038, 95% CI: 1.032 to 1.043). However, there were substantial geographical variations in the effect of the 2022 heatwave intensity and duration on health information-seeking behaviours.

CONCLUSION

This infodemiology study suggests that the 2022 summer unprecedented heatwave in Mainland China has significantly increased population demand for health-related information, especially for heatstroke, urological diseases and mental health. Population-based research of real-time disease data is urgently needed to estimate the negative health impact of the exceptional heatwave in Mainland China and elsewhere.

An Early Warning System for Heatwave-Induced Health Risks in China: A Sub-Seasonal to Seasonal Perspective - China, 2022

What is already known about this topic?

Climate change has had a detrimental impact on global health, particularly through the rise of extreme heatwaves. Presently, the early warning system for heatwave-related health risks can forecast potential dangers several days in advance; however, long-term warnings fall short.

What is added by this report?

This report introduces a novel early warning system aimed at predicting heatwave-induced health risks in China at sub-seasonal to seasonal timescales. The outcomes of the assessment suggest this system holds significant potential.

What are the implications for public health practices?

The system facilitates advanced assessment of both the scale and dispersal of risk among various demographic groups. This allows for the proactive management of potential risks with extended lead times.

The impact of cold waves and heat waves on mortality: Evidence from a lower middle-income country

We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people and those living in the hot regions in Southern Vietnam. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios.

Human thermal physiological response of wearing personal protective equipment: An educational building semi-open space experimental investigation

With the outbreak and spread of the COVID-19 epidemic, HCWs are frequently required to wear personal protective equipment (PPE) for nucleic acid sample collection in semi-open transition spaces. Wearing PPE causes significant psychological and physical stress in HCWs. In this study, operative temperature (T_op) and wet-bulb globe temperature (WBGT) were used to assess thermal conditions through field experiments, while multiple physiological parameters were measured in the subjects. The results indicated that the subjects showed statistically significant differences in thermal perception and physiological parameters with and without PPE. Using observed increases in heart rate (HR), auditory canal temperature (T_ac), mean skin temperature (MST), and end-tidal CO₂ pressure, subjects were shown to have an increased metabolic rate and heat storage while wearing PPE. Additionally, a decrease in oxygen concentration was also observed, and this decrease may be linked to fatigue and cognitive impairment. Moreover, HR, MST, and T_ac showed a significant linear relationship, which increased with temperature and operative temperature, and the HR response was stronger with PPE than without PPE. The neutral, preferred, and acceptable temperatures were significantly lower with PPE than without PPE, and the deviations for neutral T_op/WBGT were 9.5/7.1 °C and preferred T_op/WBGT was 2.2/4.0 °C, respectively. Moreover, the upper limits of acceptable WBGT, 29.4 °C with PPE and 20.4 °C without PPE, differed significantly between the two phases. Furthermore, the recorded physiological parameter responses and thermal perception responses of the subjects while wearing PPE indicated that they were at risk of thermal stress. Overall, these results suggest that people who wear PPE should focus on their health and thermal stress. This study provides a reference for the development of strategies to counteract heat stress and improve thermal comfort.

The Emission Reduction Effect of Financial Agglomeration under China's Carbon Peak and Neutrality Goals

The existing literature on the influencing factors of carbon emissions ignores the relationship between financial agglomeration and carbon emissions. Based on the analysis of the emission reduction history of major countries, this paper mainly uses the provincial-level data of China from 2002 to 2018 to explore the impact of financial agglomeration on carbon emissions. The conclusions are as follows: (1) China lacks carbon tax policies; there are many drawbacks in the carbon trading market, and a "bottom-up" voluntary emission reduction mechanism has not been formed. (2) China's carbon emissions and financial development are characterized by spatial agglomeration. (3) Financial agglomeration can reduce carbon emissions. In central China, the low-carbon region, and the pilot regions for carbon trading, financial agglomeration has a greater impact on reducing emissions. (4) Financial agglomeration can reduce emissions by reducing the proportion of the secondary industry and increasing the proportion of the third industry. (5) Financial agglomeration can still lower carbon emissions when the spacing effect is taken into account. Finally, according to the conclusion, this paper puts forward relevant suggestions to help China reduce carbon emissions.

Nanowired Delivery of Cerebrolysin with Mesenchymal Stem Cells Attenuates Heat Stress-Induced Exacerbation of Neuropathology Following Brain Blast Injury

Blast brain injury (bBI) following explosive detonations in warfare is one of the prominent causes of multidimensional insults to the central nervous and other vital organs injury. Several military personnel suffered from bBI during the Middle East conflict at hot environment. The bBI largely occurs due to pressure waves, generation of heat together with release of shrapnel and gun powders explosion with penetrating and/or impact head trauma causing multiple brain damage. As a result, bBI-induced secondary injury causes breakdown of the blood-brain barrier (BBB) and edema formation that further results in neuronal, glial and axonal injuries. Previously, we reported endocrine imbalance and influence of diabetes on bBI-induced brain pathology that was significantly attenuated by nanowired delivery of cerebrolysin in model experiments. Cerebrolysin is a balanced composition of several neurotrophic factors, and active peptide fragment is capable of neuroprotection in several neurological insults. Exposure to heat stress alone causes BBB damage, edema formation and brain pathology. Thus, it is quite likely that hot environment further exacerbates the consequences of bBI. Thus, novel therapeutic strategies using nanodelivery of stem cell and cerebrolysin may further enhance superior neuroprotection in bBI at hot environment. Our observations are the first to show that combined nanowired delivery of mesenchymal stem cells (MSCs) and cerebrolysin significantly attenuated exacerbation of bBI in hot environment and induced superior neuroprotection, not reported earlier. The possible mechanisms of neuroprotection with MSCs and cerebrolysin in bBI are discussed in the light of current literature.