Climate change and preventive medicine

Infectious Disease Specialists' awareness, perceptions and attitudes toward ecological transition in healthcare: a cross-sectional study in France

INTRODUCTION

Climate change is having a major impact on public health. The healthcare system is responsible for around 8% of greenhouse gas emissions in France. Infectious diseases (ID) lie at the heart of these consequences.

OBJECTIVES

The primary aim of this study was to assess the expectations of French ID specialists in terms of a sustainable healthcare transition. Secondary objectives included the assessment of awareness regarding this subject, perceptions, adopted attitudes and opportunities for actions.

METHODS

A survey on sustainable healthcare transition was sent to all the French Society for ID members.

RESULTS

Of the 860 physicians approached, 220 responded. More than 78% of respondents responded correctly to questions concerning the impact of climate change on public health. The environmental impact of the healthcare system was less well understood. A higher level of environmental anxiety was associated with a higher rate of declaration of concrete actions. People under 40 years of age declared themselves to be more active. Regarding attitudes towards the roles of different stakeholders in a sustainable healthcare transition, the role of medical societies is prominent. Respondents' main expectations and suggestions are the following: (1) creation of a cross functional group dedicated to a sustainable healthcare transition, (2) creation of a training program, to meet the training needs of 94% of respondents, (3) continuation of the French Society for ID's lobbying for the relocation of antibiotic production in Europe, research on life-cycle analysis of anti-infective drugs, single-dose packaging for antibiotics, (4) reflection on the concept of "sustainably designed healthcare" in ID, (5) continued exploration of the "One Health" concept and (6) development of recommendations for sustainably designed hygiene practice.

CONCLUSION

This national survey of French ID specialists is a prerequisite for the implementation of actions within the French Society for ID.

Health Risks of Temperature Variability on Hospital Admissions in Cape Town, 2011-2016

Epidemiological studies have provided compelling evidence of associations between temperature variability (TV) and health outcomes. However, such studies are limited in developing countries. This study aimed to investigate the relationship between TV and hospital admissions for cause-specific diseases in South Africa. Hospital admission data for cardiovascular diseases (CVD) and respiratory diseases (RD) were obtained from seven private hospitals in Cape Town from 1 January 2011 to 31 October 2016. Meteorological data were obtained from the South African Weather Service (SAWS). A quasi-Poisson regression model was used to investigate the association between TV and health outcomes after controlling for potential effect modifiers. A positive and statistically significant association between TV and hospital admissions for both diseases was observed, even after controlling for the non-linear and delayed effects of daily mean temperature and relative humidity. TV showed the greatest effect on the entire study group when using short lags, 0-2 days for CVD and 0-1 days for RD hospitalisations. However, the elderly were more sensitive to RD hospitalisation and the 15-64 year age group was more sensitive to CVD hospitalisations. Men were more susceptible to hospitalisation than females. The results indicate that more attention should be paid to the effects of temperature variability and change on human health. Furthermore, different weather and climate metrics, such as TV, should be considered in understanding the climate component of the epidemiology of these (and other diseases), especially in light of climate change, where a wider range and extreme climate events are expected to occur in future.

Climatic influences on cardiovascular diseases

Classical risk factors only partially account for variations in cardiovascular disease incidence; therefore, also other so far unknown features, among which meteorological factors, may influence heart diseases (mainly coronary heart diseases, but also heart failure, arrhythmias, aortic dissection and stroke) rates. The most studied phenomenon is ambient temperature. The relation between mortality, as well as cardiovascular diseases incidence, and temperature appears graphically as a ''U'' shape. Exposure to cold, heat and heat waves is associated with an increased risk of acute coronary syndromes. Other climatic variables, such as humidity, atmospheric pressure, sunlight hours, wind strength and direction and rain/snow precipitations have been hypothesized as related to fatal and non-fatal cardiovascular diseases incidence. Main limitation of these studies is the unavailability of data on individual exposure to weather parameters. Effects of weather may vary depending on other factors, such as population disease profile and age structure. Climatic stress may increase direct and indirect risks to human health via different, complex pathophysiological pathways and exogenous and endogenous mechanisms. These data have attracted growing interest because of the recent earth's climate change, with consequent increasing ambient temperatures and climatic fluctuations. This review evaluates the evidence base for cardiac health consequences of climate conditions, and it also explores potential further implications.

Global warming and obesity: a systematic review

Global warming and the obesity epidemic are two unprecedented challenges mankind faces today. A literature search was conducted in the PubMed, Web of Science, EBSCO and Scopus for articles published until July 2017 that reported findings on the relationship between global warming and the obesity epidemic. Fifty studies were identified. Topic-wise, articles were classified into four relationships - global warming and the obesity epidemic are correlated because of common drivers (n = 21); global warming influences the obesity epidemic (n = 13); the obesity epidemic influences global warming (n = 13); and global warming and the obesity epidemic influence each other (n = 3). We constructed a conceptual model linking global warming and the obesity epidemic - the fossil fuel economy, population growth and industrialization impact land use and urbanization, motorized transportation and agricultural productivity and consequently influences global warming by excess greenhouse gas emission and the obesity epidemic by nutrition transition and physical inactivity; global warming also directly impacts obesity by food supply/price shock and adaptive thermogenesis, and the obesity epidemic impacts global warming by the elevated energy consumption. Policies that endorse deployment of clean and sustainable energy sources, and urban designs that promote active lifestyles, are likely to alleviate the societal burden of global warming and obesity.

Obesity and Climate Change

Obesity and climate change are 2 modern world dilemmas. However, despite an understanding of many of the causal factors relating to each, large-scale interventions have had minimal impact on either problem to date. Some behaviors associated with obesity (eg, processed food consumption, nonrenewable fuel use, etc) also affect greenhouse gas (GHG) emissions associated with climate change. This suggests that interventions aimed at curbing GHGs might also have public health benefits. Personal carbon trading is an emission reduction intervention that has been proposed to influence obesity-related behaviors. This article builds on the links between obesity and climate change and discusses some of the early findings of the Norfolk Island Carbon and Health Evaluation study designed to assess the impact of personal carbon trading on obesity and GHG emissions. Early results suggest that health and environmental scientists should be working more closely to develop cross-disciplinary initiatives and messages around health and environmental issues.

Enchentes e saúde pública: uma questão na literatura científica recente das causas, consequências e respostas para prevenção e mitigação

As enchentes são os desastres naturais com maior frequência e afetam a vida de aproxi madamente 102 milhões de pessoas a cada ano, principalmente nos países em desenvolvimento e em grandes centros urbanos, com tendência de aumento nas próximas décadas. O objetivo é oferecer subsídios para uma melhor compreensão destes eventos, através dos resultados e experiências encontrados na literatura científica recente. Por meio de busca no Pubmed foram analisados 70 trabalhos aos quais se teve acesso e se enquadraram nos critérios de abordar pelo menos um dos itens selecionados para análise, que eram: causas; consequências; respostas e ações; encaminhamento de propostas e soluções para a prevenção e/ou mitigação dos riscos; e, impactos das enchentes. A partir destes critérios foram montados quadros para cada um dos itens de análise de modo a sistematizar e sintetizar os resultados para as causas, as consequências ambientais, a infraestrutura, os serviços e a saúde e para as respostas e ações de prevenção e mitigação. Considerou-se que, dados os cenários de aumento na frequência e gravidade destes eventos, os desafios para o setor saúde para a redução de riscos de desastres exigem respostas integradas com amplas políticas para o desenvolvimento sustentável.

Effects of ambient temperature, humidity, and other meteorological variables on hospital admissions for angina pectoris

BACKGROUND

Seasonal peaks in cardiovascular disease incidence have been widely reported, suggesting weather has a role.

DESIGN

The aim of our study was to determine the influence of climatic variables on angina pectoris hospital admissions.

METHODS

We correlated the daily number of angina cases admitted to a western Sicilian hospital over a period of 12 years and local weather conditions (temperature, humidity, wind force and direction, precipitation, sunny hours and atmospheric pressure) on a day-to-day basis. A total of 2459 consecutive patients were admitted over the period 1987-1998 (1562 men, 867 women; M/F - 1:8).

RESULTS

A seasonal variation was found with a noticeable winter peak. The results of Multivariate Poisson analysis showed a significant association between the daily number of angina hospital admission, temperature, and humidity. Significant incidence relative ratios (95% confidence intervals/measure unit) were, in males, 0.988 (0.980-0.996) (p = 0.004) for minimal temperature, 0.990 (0.984-0.996) (p = 0.001) for maximal humidity, and 1.002 (1.000-1.004) (p = 0.045) for minimal humidity. The corresponding values in females were 0.973 (0.951-0.995) (p < 0.017) for maximal temperature and 1.024 (1.001-1.048) (p = 0.037) for minimal temperature.

CONCLUSIONS

Environmental temperature and humidity may play an important role in the pathogenesis of angina, although it seems different according to the gender. These data may help to understand the mechanisms that trigger ischemic events and to better organize hospital assistance throughout the year.

Global warming: is weight loss a solution?

The current climate change has been most likely caused by the increased greenhouse gas emissions. We have looked at the major greenhouse gas, carbon dioxide (CO(2)), and estimated the reduction in the CO(2) emissions that would occur with the theoretical global weight loss. The calculations were based on our previous weight loss study, investigating the effects of a low-carbohydrate diet on body weight, body composition and resting metabolic rate of obese volunteers with type 2 diabetes. At 6 months, we observed decreases in weight, fat mass, fat free mass and CO(2) production. We estimated that a 10 kg weight loss of all obese and overweight people would result in a decrease of 49.560 Mt of CO(2) per year, which would equal to 0.2% of the CO(2) emitted globally in 2007. This reduction could help meet the CO(2) emission reduction targets and unquestionably would be of a great benefit to the global health.

Obesity and chronic disease: always offender or often just accomplice?

Over a decade ago, the finding of a form of low-grade systemic inflammation ('metaflammation') associated with obesity, insulin resistance and chronic disease proffered a causal explanation for the latter. However, recent work has shown that metaflammation is also associated with several modern lifestyle-related and environmental inducers, with or without obesity. Here, we present accumulating data to show a link between metaflammation and a number of non-microbial environmental and lifestyle stimulants, both with and without obesity. This implies that obesity may often be an accomplice to, as much as an offender in, major metabolic disease. The real (albeit distal) cause of such a disease appears to lie in aspects of the modern techno-industrial environment driving unhealthy lifestyle behaviours. If true, this suggests that while individual weight loss may be a component of chronic disease management, it may be neither 'necessary' nor 'sufficient' to reduce the problem at a population level. Greater multidisciplinary and policy input is needed to modify the economic and political drivers of the modern, obesogenic environment.