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Lee EY, Park S, Kim YB, Lee M, Lim H, Ross-White A, Janssen I, Spence JC, Tremblay MS. Exploring the Interplay Between Climate Change, 24-Hour Movement Behavior, and Health: A Systematic Review. J Phys Act Health 2024; 21:1227-1245. [PMID: 39187251 DOI: 10.1123/jpah.2023-0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Given the emergence of climate change and health risks, this review examined potential relationships between varying indicators of climate change, movement behaviors (ie, physical activity [PA], sedentary behavior, and sleep), and health. METHODS Seven databases were searched in March 2020, April 2023, and April 2024. To be included, studies must have examined indicators of climate change and at least one of the movement behaviors as either an exposure or a third variable (ie, mediator/moderator), and a measure of health as outcome. Evidence was summarized by the role (mediator/moderator) that either climate change or movement behavior(s) has with health measures. Relationships and directionality of each association, as well as the strength and certainty of evidence were synthesized. RESULTS A total of 79 studies were eligible, representing 6,671,791 participants and 3137 counties from 25 countries (40% low- and middle-income countries). Of 98 observations from 17 studies that examined PA as a mediator, 34.7% indicated that PA mediated the relationship between climate change and health measure such that indicators of adverse climate change were associated with lower PA, and worse health outcome. Of 274 observations made from 46 studies, 28% showed that PA favorably modified the negative association between climate change and health outcome. Evidence was largely lacking and inconclusive for sedentary behavior and sleep, as well as climate change indicators as an intermediatory variable. CONCLUSIONS PA may mitigate the adverse impact of climate change on health. Further evidence is needed to integrate PA into climate change mitigation, adaptation, and resilience strategies.
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Affiliation(s)
- Eun-Young Lee
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
- Department of Gender Studies, Queen's University, Kingston, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa,ON, Canada
- Institute of Sport Science, Seoul National University, Seoul, South Korea
| | - Seiyeong Park
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
- Institute of Sport Science, Seoul National University, Seoul, South Korea
| | - Yeong-Bae Kim
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Mikyung Lee
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Heejun Lim
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
- Department of Health Sciences, Queen's University, Kingston, ON, Canada
| | - John C Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa,ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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Zhang X, Zhang T, Chen X, Ni J, Xu S, Peng Y, Wang G, Sun W, Liu X, Pan F. The impact of short-term exposure to meteorological factors on the risk of death from hypertension and its major complications: a time series analysis based on Hefei, China. Int Arch Occup Environ Health 2024; 97:313-329. [PMID: 38403848 DOI: 10.1007/s00420-024-02046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This study aimed to reveal the short-term impact of meteorological factors on the mortality risk in hypertensive patients, providing a scientific foundation for formulating pertinent prevention and control policies. METHODS In this research, meteorological factor data and daily death data of hypertensive patients in Hefei City from 2015 to 2018 were integrated. Time series analysis was performed using distributed lag nonlinear model (DLNM) and generalized additive model (GAM). Furthermore, we conducted stratified analysis based on gender and age. Relative risk (RR) combined with 95% confidence interval (95% CI) was used to represent the mortality risk of single day and cumulative day in hypertensive patients. RESULTS Single-day lag results indicated that high daily mean temperature (T mean) (75th percentile, 24.9 °C) and low diurnal temperature range (DTR) (25th percentile, 4.20 °C) levels were identified as risk factors for death in hypertensive patients (maximum effective RR values were 1.144 and 1.122, respectively). Extremely high levels of relative humidity (RH) (95th percentile, 94.29%) reduced the risk of death (RR value was 0.893). The stratified results showed that the elderly and female populations are more susceptible to low DTR levels, whereas extremely high levels of RH have a more significant protective effect on both populations. CONCLUSION Overall, we found that exposure to low DTR and high T mean environments increases the risk of death for hypertensive patients, while exposure to extremely high RH environments significantly reduces the risk of death for hypertensive patients. These findings contribute valuable insights for shaping targeted prevention and control strategies.
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Affiliation(s)
- Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xuyang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Jianping Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Siwen Xu
- School of Medicine, Tongji University, 500 Zhennan Road, Shanghai, 200333, China
| | - Yongzhen Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Guosheng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Wanqi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Hospital Management Research, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Xuxiang Liu
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Hefei, 230032, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Vencloviene J, Beresnevaite M, Cerkauskaite S, Grizas V, Kriukelyte D, Benetis R. The short-term effect of weather variables on heart rate variability in patients after open-heart surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1357-1367. [PMID: 35704554 DOI: 10.1080/09603123.2022.2087864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study was to detect the associations between heart rate variability (HRV) and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The study was performed in Kaunas, Lithuania, during 2008-2012. We used data of 220 patients. HRV was assessed by a 5-minute electrocardiogram. The data were collected at 1.5 months, 1 year, and 2 years after the surgery (495 measurements). A negative association of standard deviation of beat-to-beat interval (SDNN), very low frequency (VLF), low frequency, and high frequency (HF) powers with a decrease in air temperature (T) during a 3-day period in the range of T < 1°C wind speed >2.75 knots 2 days before, and the daily North Atlantic Oscillation indices were observed. The effect of wind speed on SDNN and VLF power was stronger in males. Two days after relative humidity >89%, a lower mean VLF and higher HF in normalized units were found; in females, this effect was stronger 1.5 months after the surgery. Among patients after open-heart surgery, the HRV variables may be related to specific weather changes and the effect of weather was different for males and females and at different times after the surgery.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Sonata Cerkauskaite
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Vytautas Grizas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Kriukelyte
- Nursing Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Nursing Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Vencloviene J, Radisauskas R, Kranciukaite-Butylkiniene D, Tamosiunas A, Vaiciulis V, Rastenyte D. Association between stroke occurrence and changes in atmospheric circulation. BMC Public Health 2021; 21:42. [PMID: 33407282 PMCID: PMC7789358 DOI: 10.1186/s12889-020-10052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. Methods The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. Results During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14–1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16–0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04–1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November–March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03–1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85–0.99). Conclusions The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Donelaicio St. 58, LT-44248, Kaunas, Lithuania. .,Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Daina Kranciukaite-Butylkiniene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Family Medicine, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Vidmantas Vaiciulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania.,Health Research Institute, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Daiva Rastenyte
- Department of Neurology, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
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Vencloviene J, Radisauskas R, Vaiciulis V, Kiznys D, Bernotiene G, Kranciukaite-Butylkiniene D, Tamosiunas A. Associations between Quasi-biennial Oscillation phase, solar wind, geomagnetic activity, and the incidence of acute myocardial infarction. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1207-1220. [PMID: 32291532 DOI: 10.1007/s00484-020-01895-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/28/2020] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
An increase in the daily rate of acute myocardial infarction (AMI) has been observed during days of geomagnetic storm (GS). However, the analysis of associations between the daily number of AMI and geomagnetic activity (GMA) over longer periods sometimes yields controversial results. The study aimed to detect the complex association between the daily numbers of AMI and weather, the Quasi-biennial Oscillation (QBO) phase, GMA, and solar wind variables. We used data of Kaunas population-based Ischemic Heart Disease Register of residents of Kaunas city (Lithuania) for 2000-2012. The associations between weather and space weather variables and the daily number of AMI were evaluated by applying the multivariate Poisson regression. A higher risk of AMI was positively associated with active-stormy local GMA (rate ratio (RR) = 1.06 (95% CI 1.01-1.10)), solar wind dynamic pressure with a lag of 4 days (RR = 1.02 (1.01-1.04) per 1 nPa increase), and solar wind speed with a lag of 3-7 days (RR = 1.03 (1.01-1.05) per 100 km/s increase). A positive association was found between the west QBO phase and the risk of AMI during winter (RR = 1.08 (1.01-1.16)), and a negative association was observed between them during March-November (RR = 0.93 (0.90-0.97)). The risk of AMI positively associated with the GS due to stream interaction regions with a lag of 0-2 days during the east QBO phase (RR = 1.10, p = 0.046) and was negatively associated with them during the west QBO phase (RR = 0.82, p = 0.024). These results may help understand the population's sensitivity under different weather and space weather conditions. The QBO phase may modify the effect of GS.
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Affiliation(s)
- Jone Vencloviene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Donelaicio St. 58, LT-44248, Kaunas, Lithuania.
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Vidmantas Vaiciulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Deivydas Kiznys
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Donelaicio St. 58, LT-44248, Kaunas, Lithuania
| | - Gailute Bernotiene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania
| | - Daina Kranciukaite-Butylkiniene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania
- Department of Family Medicine, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
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Kiznys D, Vencloviene J, Milvidaitė I. The associations of geomagnetic storms, fast solar wind, and stream interaction regions with cardiovascular characteristic in patients with acute coronary syndrome. LIFE SCIENCES IN SPACE RESEARCH 2020; 25:1-8. [PMID: 32414482 DOI: 10.1016/j.lssr.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/14/2019] [Accepted: 01/16/2020] [Indexed: 06/11/2023]
Abstract
It is shown the statistical associations between space weather pattern and humans' cardiovascular system. We investigated the association between space weather events and cardiovascular characteristics of 4076 randomly selected patients with acute coronary syndrome (ACS) who were admitted for inpatient treatment in Kaunas city, Lithuania during 2000-2005. We hypothesized that days of the space weather events, 1-3 days after, and the period between two events, named as intersection days (1-3 days after the event, which coincided with 1-3 days before the event), might be associated with patients' cardiovascular characteristics. The multivariate logistic regression was applied, and the patients' risk was evaluated by odds ratio (OR), adjusting for age, sex, smoking status, the day of the week, and seasonality. During the intersection days of geomagnetic storms (GS), the risk of ACS increases in obese patients (OR=1.72, p = 0.008). The risk of ventricular fibrillation during admission was associated with stream interaction region (SIR) with a lag of 0-3 days (OR=1.44, p = 0.049) The risk of ACS in patients with chronic atrial fibrillation was associated with fast solar wind (FSW) (≥600 km/s) (lag 0-3 days, OR=1.39, p = 0.030) and with days of solar proton event (lag 0-3) going in conjunction with SIR (lag 0-3) (OR=2.06, p = 0.021). During days which were not assigned as GS with a lag of (-3 to 3) days, FSW (lag 0-3) was associated with the risk of ACS in patients with renal disease (OR=1.71, p = 0.008) and days of SIR - with the risk in patients with pulmonary disease (OR=1.53, p = 0.021). A SIR event, days between two space weather events, and FSW without GS may be associated with a risk to human health.
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Affiliation(s)
- Deivydas Kiznys
- Department of Environmental Sciences, Vytautas Magnus University, Donelaicio St. 58, Kaunas LT-44248, Lithuania.
| | - Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Donelaicio St. 58, Kaunas LT-44248, Lithuania.
| | - Irena Milvidaitė
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu str.17, Kaunas LT-50028, Lithuania.
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Skutecki R, Jalali R, Dragańska E, Cymes I, Romaszko J, Glińska-Lewczuk K. UTCI as a bio-meteorological tool in the assessment of cold-induced stress as a risk factor for hypertension. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 688:970-975. [PMID: 31726579 DOI: 10.1016/j.scitotenv.2019.06.280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hypertension (HT) affects >1/3 of adult populations in developed countries. Several studies reported periodic changes in blood pressure (BP) values depending on atmospheric conditions, and analyzed the impact of outdoor temperature, atmospheric pressure, relative humidity and other meteorological parameters. The Universal Thermal Climate Index (UTCI) is a bio-meteorological index derived from an analysis of human thermal balance that comprehensively describes the impact of meteorological factors, including both cold stress and heat stress and their physiological consequences. AIM Our aim was to assess the relationship between UTCI values and the number of consultations for HT within the framework of the healthcare system. METHODS This work presents a retrospective epidemiological study of data collected in Olsztyn (Poland), characterized by cold climate type. The analytical material comprised 5578 consultations in emergency departments (EDs) due to HT. RESULTS Seasonal differences in the numbers of HT consultations with a significant increase in winter months were noticed, especially as regards women. Under cold stress conditions, the relative risk (RR) related to consultations for HT was 2-fold higher for women as compared to thermoneutral conditions (p < 0.001). For men these differences were also statistically significant, though at a much smaller level (p = 0.03). The increased RR of HT due to cold stress was found among younger and older women contrary to the women at the perimenopausal age. CONCLUSIONS Cold stress should be considered as a significant risk factor among patients, particularly women, diagnosed with cardiovascular diseases. The UTCI is an adequate bio-meteorological tool for the assessment of relationships between atmospheric conditions and occurrence of cardiac symptoms.
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Affiliation(s)
- Rafał Skutecki
- School of Medicine, Family Medicine Unit, University of Warmia and Mazury in Olsztyn, Poland.
| | - Rakesh Jalali
- School of Medicine, Department of Emergency Medicine, University of Warmia and Mazury in Olsztyn, Poland
| | - Ewa Dragańska
- Department of Water Resources, Climatology and Environmental Management, University of Warmia and Mazury in Olsztyn, Poland
| | - Iwona Cymes
- Department of Water Resources, Climatology and Environmental Management, University of Warmia and Mazury in Olsztyn, Poland
| | - Jerzy Romaszko
- School of Medicine, Family Medicine Unit, University of Warmia and Mazury in Olsztyn, Poland
| | - Katarzyna Glińska-Lewczuk
- Department of Water Resources, Climatology and Environmental Management, University of Warmia and Mazury in Olsztyn, Poland
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