Resilience: conceptualisations and challenges for effective heatwave public health planning

OBJECTIVES

This article examines diverse perspectives on heatwave resilience in public health planning, interviewing stakeholders from various sectors. It identifies challenges, including operational, political, economic, and cultural aspects, hindering effective strategies. The study advocates for a holistic approach to heatwave resilience, emphasising interdisciplinary research and collaboration for targeted interventions. Enhancing resilience is crucial to mitigating adverse health impacts and safeguarding vulnerable populations during heatwaves. Conceptualisations of resilience related to heatwave public health planning and heatwave resilience vary significantly. There is a need to unveil the multifaceted nature of resilience in the context of heatwaves and identify key challenges that hinder effective public health planning efforts.

STUDY DESIGN

Qualitative study to explore key stakeholders' conceptualisations of resilience and highlight challenges and opportunities needed for greater heatwave resilience and public health planning.

METHODS

Interviews were conducted with a diverse group of key stakeholders involved in local, regional, and national heatwave planning, academics, civil sector and private sector representatives.

RESULTS

The findings of this study highlight diverse conceptualisations of resilience. Conceptualisations of resilience mainly differ on the following: 'whom'; 'what'; 'how'; 'when'; and 'why'. This analysis shows that the concept of resilience is well understood but has different functions. The analysis of challenges revealed several key problems, such as operational and technical; political and governance; organisational and institutional; economic; linguistic; cultural, social, and behavioural; and communication, information, and awareness. These significantly hinder effective heatwave public health planning strategies.

CONCLUSIONS

The study emphasises the need for a holistic and integrated approach to heatwave resilience. Addressing these challenges is crucial for enhancing heatwave public health planning. This study provides valuable insights into the complexities of heatwave resilience, offering guidance for different sectors of society to develop targeted interventions and strategies. The development of new resilience interdisciplinary and intersectoral research, practice, and governance will prove crucial to ongoing efforts to strengthen national heatwave resilience public health planning. By fostering resilience, societies can mitigate the adverse impacts of heatwaves and safeguard the health and well-being of vulnerable populations.

The gut microbiota facilitate their host tolerance to extreme temperatures

BACKGROUND

Exposure to extreme cold or heat temperature is one leading cause of weather-associated mortality and morbidity in animals. Emerging studies demonstrate that the microbiota residing in guts act as an integral factor required to modulate host tolerance to cold or heat exposure, but common and unique patterns of animal-temperature associations between cold and heat have not been simultaneously examined. Therefore, we attempted to investigate the roles of gut microbiota in modulating tolerance to cold or heat exposure in mice.

RESULTS

The results showed that both cold and heat acutely change the body temperature of mice, but mice efficiently maintain their body temperature at conditions of chronic extreme temperatures. Mice adapt to extreme temperatures by adjusting body weight gain, food intake and energy harvest. Fascinatingly, 16 S rRNA sequencing shows that extreme temperatures result in a differential shift in the gut microbiota. Moreover, transplantation of the extreme-temperature microbiota is sufficient to enhance host tolerance to cold and heat, respectively. Metagenomic sequencing shows that the microbiota assists their hosts in resisting extreme temperatures through regulating the host insulin pathway.

CONCLUSIONS

Our findings highlight that the microbiota is a key factor orchestrating the overall energy homeostasis under extreme temperatures, providing an insight into the interaction and coevolution of hosts and gut microbiota.

[Impact of heat and cold on cause -specific mortality in Italy]

OBJECTIVES

to estimate the impact of daily exposure to extreme air temperatures (heat and cold) on cause-specific mortality in Italy and to evaluate the differences in the association between urban, suburban and rural municipalities.

DESIGN

time series analyses with two-stage approach were applied: in the first stage, multiple Poisson regression models and distributed lag non-linear models (DLNM) were used to define the association between temperature and mortality; in the second one, meta-analytic results were obtained by adopting BLUP (Best Linear Unbiased Prediction) coefficients at provincial level, which were then used to estimate the Attributable Fractions of cause-specific deaths.

SETTING AND PARTICIPANTS

cause-specific deaths from 2006to 2015 in Italy have been analysed by region and overall.

MAIN OUTCOME MEASURES

5,648,299 total deaths included. Fractions (and relative 95% empirical confidence interval) of deaths attributable to increases from 75th to 99th percentiles of temperature, for heat, and decreases from 25th to 1st percentile, for cold.

RESULTS

the overall impact of air temperature on causespecificmortality is higher for heat than for cold. When considering heat, the attributable fraction is higher for diseases of the central nervous system (3.6% 95% CI 1.9-4.9) and mental health disease (3.1% 95% CI 1.7-4.4), while considering cold, ischemic disease (1.3% 95% CI 1.1-1.6) and diabetes (1.3% 95% CI 0.7-1.8) showed the greater impact. By urbanization level, similar impacts were found for cold temperature, while for heat there was an indication of higher vulnerability in rural areas emerged.

CONCLUSIONS

results are relevant for the implementation and promotion of preventive measures according to climate change related increase in temperature. The available evidence can provide the basis to identify vulnerable areas and population subgroups to which address current and future heat and cold adaptation plans in Italy.

[BIGEPI project: environmental and health data]

OBJECTIVES

the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures.

DESIGN

the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin.

SETTING AND PARTICIPANTS

BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4).

MAIN OUTCOME MEASURES

environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation.

RESULTS

BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 µg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P.

CONCLUSIONS

BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers.

Chemical drivers of ozone change in extreme temperatures in eastern China

Surface ozone pollution has become the biggest issue in China's air pollution since particulate matters have been improved in the atmosphere. Compared with normal winter/summer, extremely cold/hot weather sustained several days and nights by unfavorable meteorology is more impactful in this regard. However, ozone changes in extreme temperatures and their driving processes remain rarely understood. Here, we combine comprehensive observational data analysis and 0-D box models to quantify the contributions of different chemical processes and precursors to ozone change in these unique environments. Analyses of radical cycling indicate that temperature accelerates OH-HO₂-RO₂, optimizing ozone production efficiency in higher temperatures. The HO₂ + NO → OH + NO₂ reaction was the most influenced by temperature change, followed by OH + VOCs → HO₂/RO₂. Although most reactions in ozone formation increased with temperature, the increase in ozone production rates was greater than the rate of ozone loss, leading to a fast net ozone accumulation in heat waves. Our results also show that the ozone sensitivity regime is VOC-limited in extreme temperatures, highlighting the significance of volatile organic compound (VOC) control (particularly the control of alkenes and aromatics). In the context of global warming and climate change, this study helps us deeply understand ozone formation in extreme environments and design abatement policies for ozone pollution in such conditions.

Impatto sanitario dell'inquinamento atmosferico e della temperatura dell'aria in Italia: evidenze per azioni concrete

OBJECTIVES

to estimate the impact (number of deaths and attributable fraction) of air pollution (chronic exposure to PM2.5 and NO2) and high summer temperatures (acute exposure) on mortality in Italy.

DESIGN

observational study. Time series analysis (for estimating acute effects of air temperature), and computation of deaths attributable to heat/pollution using standard health impact assessment functions.

SETTING AND PARTICIPANTS

for the assessment of the impact due to chronic exposure to air pollutants, the study period considered was 2016-2019. For the assessment of the acute effects of air temperature and related impacts, the municipal daily series of deaths from all causes relating to the period 2003-2015 were used.

MAIN OUTCOME MEASURES

mortality for all causes (effects and impacts of acute exposure to air temperature), cause-specific mortality (impact of chronic exposure to pollution).

RESULTS

concerning chronic exposure to PM2.5, each year during 2016-2019, 72,083 deaths (11.7%) were estimated to be attributable to annual mean levels of PM2.5 above 5 µg/m3 (WHO-2021 Air Quality Guideline value). Of these, 39,628 were estimated in the regions of the Po Valley and 10,232 in the 6 Italian cities with >500,000 inhabitants. With reference to acute effects of air temperature, over 14,500 deaths (2.3%) were estimated to be attributable to daily temperature increases from the 75th to the 99th percentile of the municipality-specific distribution for the year 2015. Conclusions: high air pollution concentrations and summer temperatures are two environmental risk factors extremely relevant for public health. Although the prevention and mitigation interventions carried out in recent years have contributed to reducing the exposure of the population, there are still alarming numbers of deaths attributable to high levels of particulate matter, nitrogen oxides, and air temperature in the Italian population.

Association between ambient temperatures and injuries: a time series analysis using emergency ambulance dispatches in Chongqing, China

BACKGROUND

Global warming and increasing extreme weather have become a severe problem in recent years, posing a significant threat to human health worldwide. Research exploring the link between injury as one of the leading causes of death globally and ambient temperature was lacking. Based on the hourly injury emergency ambulance dispatch (IEAD) records from 2019-2021 in the main urban area of Chongqing, this study explored the role of temperature extremes on the pathogenesis of injury by different mechanisms and identified sensitive populations for different mechanisms of injury.

METHODS

In this study, we collected hourly injury emergency ambulance dispatch (IEAD) records from Chongqing Emergency Dispatch Center in the main urban area of Chongqing from 2019 to 2021, and used a distributed lagged nonlinear model (DLNM) with quasi-Poisson distribution to evaluate the association between ambient temperature and IEADs. And the stratified analysis was performed by gender, age and different injury mechanisms to identify susceptible groups. Finally, the attributable burden of ambient extreme temperatures was also investigated.

RESULTS

The risk for total IEADs increased significantly at high temperature (32 °C) compared with optimal temperature (9 °C) (CRR: 1.210; 95%CI[1.127,1.300]). The risks of traffic accident injury (CRR: 1.346; 95%CI[1.167,1.552]), beating injury (CRR: 1.508; 95%CI[1.165,1.952]), fall-height injury (CRR: 1.871; 95%CI[1.196-2.926]) and injury of sharp penetration (CRR: 2.112; 95%CI[1.388-3.213]) were significantly increased. At low temperature (7 °C), the risk of fall injury (CRR: 1.220; 95% CI [1.063,1.400]) increased significantly. Lag for 24 hours at extreme low temperature (5 °C), the risk of 18-45 years (RR: 1.016; 95%CI[1.009,1.024]) and over 60 years of age (RR: 1.019; 95%CI[1.011,1.025]) increased significantly. The effect of 0 h delay in extreme high temperature (36 °C) on males aged 18-45 years (RR: 1.115; 95%CI[1.071,1.162]) and 46-59 years (RR: 1.069; 95%CI[1.023,1.115]) had significant impact on injury risk.

CONCLUSIONS

This study showed that ambient temperature was significantly related to the risk of injury, and different mechanisms of injury were affected differently by extreme temperature. The increasing risk of traffic accident injury, beating injury, fall-height injury and sharp penetrating injury was associated with extreme heat, while fall injury was associated with extreme cold. The risk of injury in high temperature environment was mainly concentrated in males and young adults. The results of this study can help to identify the sensitive population with different injury mechanisms in extreme temperature environment, and provide reference for public health emergency departments to respond to relevant strategies in extreme temperature environment to minimize the potential risk to the public.

Interplay of Methodology and Conceptualization in Plant Abiotic Stress Signaling

Characterizing the mechanisms of plant sensitivity and reactivity to physicochemical cues related to abiotic stresses is of utmost importance for understanding plant-environment interactions, adaptations of the sessile lifestyle, and the evolutionary dynamics of plant species and populations. Moreover, plant communities are confronted with an environmental context of global change, involving climate changes, planetary pollutions of soils, waters and atmosphere, and additional anthropogenic changes. The mechanisms through which plants perceive abiotic stress stimuli and transduce stress perception into physiological responses constitute the primary line of interaction between the plant and the environment, and therefore between the plant and global changes. Understanding how plants perceive complex combinations of abiotic stress signals and transduce the resulting information into coordinated responses of abiotic stress tolerance is therefore essential for devising genetic, agricultural, and agroecological strategies that can ensure climate change resilience, global food security, and environmental protection. Discovery and characterization of sensing and signaling mechanisms of plant cells are usually carried out within the general framework of eukaryotic sensing and signal transduction. However, further progress depends on a close relationship between the conceptualization of sensing and signaling processes with adequate methodologies and techniques that encompass biochemical and biophysical approaches, cell biology, molecular biology, and genetics. The integration of subcellular and cellular analyses as well as the integration of in vitro and in vivo analyses are particularly important to evaluate the efficiency of sensing and signaling mechanisms in planta. Major progress has been made in the last 10-20 years with the caveat that cell-specific processes and in vivo processes still remain difficult to analyze and with the additional caveat that the range of plant models under study remains rather limited relatively to plant biodiversity and to the diversity of stress situations.

Impact of extreme temperatures on emergency hospital admissions by age and socio-economic deprivation in England

Climate change poses an unprecedented challenge to population health and health systems' resilience, with increasing fluctuations in extreme temperatures through pressures on hospital capacity. While earlier studies have estimated morbidity attributable to hot or cold weather across cities, we provide the first large-scale, population-wide assessment of extreme temperatures on inequalities in excess emergency hospital admissions in England. We used the universe of emergency hospital admissions between 2001 and 2012 combined with meteorological data to exploit daily variation in temperature experienced by hospitals (N = 29,371,084). We used a distributed lag model with multiple fixed-effects, controlling for seasonal factors, to examine hospitalisation effects across temperature-sensitive diseases, and further heterogeneous impacts across age and deprivation. We identified larger hospitalisation impacts associated with extreme cold temperatures than with extreme hot temperatures. The less extreme temperatures produce admission patterns like their extreme counterparts, but at lower magnitudes. Results also showed an increase in admissions with extreme temperatures that were more prominent among older and socioeconomically-deprived populations - particularly across admissions for metabolic diseases and injuries.

Same environment, stratified impacts? Air pollution, extreme temperatures, and birth weight in South China

This paper investigates whether associations between birth weights and prenatal ambient environmental conditions-pollution and extreme temperatures-differ by 1) maternal education; 2) children's innate health; and 3) interactions between these two. We link birth records from Guangzhou, China, during a period of high pollution, to ambient air pollution (PM₁₀ and a composite measure) and extreme temperature data. We first use mean regressions to test whether, overall, maternal education is an "effect modifier" in the relationships between ambient air pollution, extreme temperature, and birth weight. We then use conditional quantile regressions to test for effect heterogeneity according to the unobserved innate vulnerability of babies after conditioning on other confounders. Results show that 1) the negative association between ambient exposures and birth weight is twice as large at lower conditional quantiles of birth weights as at the median; 2) the protection associated with college-educated mothers with respect to pollution and extreme heat is heterogeneous and potentially substantial: between 0.02 and 0.34 standard deviations of birth weights, depending on the conditional quantiles; 3) this protection is amplified under more extreme ambient conditions and for infants with greater unobserved innate vulnerabilities.

Relevance of Earth-Bound Extremophiles in the Search for Extraterrestrial Life

The recent discovery of extrasolar Earth-like planets that orbit in their habitable zone of their system, and the latest clues of the presence of liquid water in the subsurface of Mars and in the subglacial ocean of Jupiter's and Saturn's moons, has reopened debates about habitability and limits of life. Although liquid water, widely accepted as an absolute requirement for terrestrial life, may be present in other bodies of the solar system or elsewhere, physical and chemical conditions, such as temperature, pressure, and salinity, may limit this habitability. However, extremophilic microorganisms found in various extreme terrestrial environments are adapted to thrive in permanently extreme ranges of physicochemical conditions. This review first describes promising environments for life in the Solar System and the microorganisms that inhabit similar environments on the Earth. The effects of extreme temperatures, salt, and hydrostatic pressure conditions on biomolecules will be explained in some detail, and recent advances in understanding biophysical and structural adaptation strategies allowing microorganisms to cope with extreme physicochemical conditions are reviewed to discuss promising environments for life in the Solar System in terms of habitability.

Recent changes in heatwaves and maximum temperatures over a complex terrain in the Himalayas

The temperature response to anthropogenic global warming and forest cover changes is dependent on regional climatic characteristics. It is challenging to segregate the impacts of the two anthropogenic changes on local temperatures and heatwaves over complex mountainous regions. Here we present estimates of regional and local heat stress responses to the recent global climate change and local forest cover loss in complex terrain in the Himalayas using a satellite-based high-resolution land-surface temperature dataset. We find large-scale decreasing trends in the observed frequency of heatwaves and heat days, and localized increases in urbanized and high-elevation regions. Our results show large-scale significant decreasing trends in annual maximum and mean surface temperatures over the period 2003-2019. In locations that have witnessed large-scale forest losses, the declines in the surface temperatures were steeper compared to no-loss regions. We develop a regional multiple linear regression model to estimate the regional and local temperature responses to global climatic change and to segregate them from the response to forest cover losses. Our model estimates a regional decrease of about 2.0 °C in annual maximum temperature over the recent 2003-2019 period, which is locally modulated by the extent of urbanization, forest cover, and elevation. At the locations of intense deforestation, our model successfully predicts a steeper decrease in maximum surface temperature, and estimates the temperature response due to forest loss, after controlling for elevation and initial forest cover. The local cooling effect due to deforestation was reaffirmed by comparing the regions with contrasting forest cover losses. The results suggest that forest clearing amplifies the anthropogenic climate change over the region.

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.

Effect of extreme temperatures on daily emergency room visits for mental disorders

Relatively few studies investigated the effects of extreme temperatures (both heat and cold) on mental health (ICD-9: 290-319; ICD-10: F00-F99) and the potential effect modifications by individuals' age, sex, and race. We aimed to explore the effect of extreme temperatures of both heat and cold on the emergency room (ER) visits for mental health disorders, and conducted a stratified analysis to identify possible susceptible population in Erie and Niagara counties, NY, USA. To assess the short-term impacts of daily maximum temperature on ER visits related to mental disorders (2009-2015), we applied a quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM). The model was adjusted for day of the week, precipitation, long-term time trend, and seasonality. We found that there were positive associations between short-term exposure to extreme ambient temperatures and increased ER visits for mental disorders, and the effects can vary by individual factors. We found heat effect (relative risk (RR) = 1.16; 95% confidence intervals (CI), 1.06-1.27) on exacerbated mental disorders became intense in the study region and subgroup of population (the elderly) being more susceptible to extreme heat than any other age group. For extreme cold, we found that there is a substantial delay effect of 14 days (RR = 1.25; 95% CI = 1.08-1.45), which is particularly burdensome to the age group of 50-64 years old and African-Americans. Our findings suggest that there is a positive association between short-term exposure to extreme ambient temperature (heat and cold) and increased ER visits for mental disorders, and the effects vary as a function of individual factors, such as age and race.

Extreme temperatures and cardiovascular mortality: assessing effect modification by subgroups in Ganzhou, China

Background

Many people die from cardiovascular diseases each year, and extreme temperatures are regarded as a risk factor for cardiovascular deaths. However, the relationship between temperature and cardiovascular deaths varies in different regions because of population density, demographic inequality, and economic situation, and the evidence in Ganzhou, China is limited and inconclusive.

Objective

This study aimed to assess extreme temperature-related cardiovascular mortality and identify the potential vulnerable people.

Methods

After controlling other meteorological measures, air pollution, seasonality, relative humidity, day of the week, and public holidays, we examined temperature-related cardiovascular mortality along 21 lag days by Poisson in Ganzhou, China.

Results

A J-shaped relationship was observed between mean temperature and cardiovascular mortality. Extremely low temperatures substantially increased the relative risks (RR) of cardiovascular mortality. The effect of cold temperature was delayed by 2–6 days and persisted for 4–10 days. However, the risk of cardiovascular mortality related to extremely high temperatures was not significant (p > 0.05). Subgroup analysis indicated that extremely low temperatures had a stronger association with cardiovascular mortality in people with cerebrovascular diseases (RR: 1.282, 95% confidence interval [CI]: 1.020–1.611), males (RR: 1.492, 95% CI: 1.175–1.896), married people (RR: 1.590, 95% CI: 1.224–2.064), and people above the age of 65 years (RR: 1.641, 95% CI: 1.106–2.434) than in people with ischemic heart disease, females, unmarried people, and the elderly (≥65 years old), respectively.

Conclusions

The type of cardiovascular disease, sex, age, and marital status modified the effects of extremely low temperatures on the risk of cardiovascular mortality. These findings may help local governments to establish warning systems and precautionary measures to reduce temperature-related cardiovascular mortality.

Multiple stresses occurring with boron toxicity and deficiency in plants

Boron (B), an essential nutrient for plants, participates in many physiological processes, with emphasis its role in the formation of the plant's cell wall. In soil, the range between deficiency and toxicity of B is very narrow as compared to other nutrients, which makes its management in agriculture very difficult, as it depends on the soil and environmental conditions. B stress simultaneously acts with others (extreme temperatures, excess of light, high concentration of CO₂, drought, salinity or heavy metal contamination, etc.). The effects of these other stresses could increase the sensitivity of plants to B toxicity or deficiency. The simultaneous combination (B stress × other abiotic stresses) is a complex interaction that should be analyzed in detail if the resistance of crops to climate change is needed. This article reviews the response of plants when facing a combination of B stress with other stresses, and compares this response with the individual stresses. Also, in the last few years, the role of B has been described in multiple plant functions that can improve its resilience to specific stresses. Thus, this article also analyses in what conditions the application of B can be efficient for the improvement of the plant's response to other stresses.

Increased susceptibility to heat for respiratory hospitalizations in Hong Kong

BACKGROUND

Emerging studies have shown temperature-mortality association is changing over time, but little is known about the temporal changes of the temperature-morbidity association.

OBJECTIVES

We aimed to evaluate the temporal variations in both temperature-respiratory hospitalizations associations and temperature-related attributable risks in Hong Kong.

METHODS

We collected 17-year time-series data on daily ambient temperature and emergency hospital admissions for respiratory diseases between 2000 and 2016 in Hong Kong. Quasi-Poisson regression with a time-varying distributed lag nonlinear model was used to estimate the year-specific association between temperature and respiratory hospitalizations [total respiratory, pneumonia, and chronic obstructive pulmonary disease (COPD)] and the year-specific attributable fraction (AF) for heat and cold (defined as above/below the optimum temperature, respectively).

RESULTS

Heat-related risks and AFs increased continuously for total respiratory, pneumonia and COPD hospitalizations during the past 17 years, respectively. Cold-hospitalization associations and cold-related AFs showed heterogeneous patterns, showing a decreasing trend for pneumonia but a general increasing trend for COPD for both the associations and AFs. The total temperature-related AFs remained stable for total respiratory (p for trend = 0.136) and pneumonia (p for trend = 0.406), but showed an increasing trend for COPD (p for trend < 0.001) from 10% (95% empirical CI: 2%, 17%) in 2000 to 17% (95% empirical CI: 11%, 22%) in 2016.

CONCLUSIONS

Our findings indicate an increased susceptibility to heat but a decreased susceptibility to cold for respiratory hospitalizations during the past 17 years. The overall temperature-related hospitalization burden for respiratory diseases was generally stable in Hong Kong.

Effects of extreme temperatures on cerebrovascular mortality in Lisbon: a distributed lag non-linear model

Cerebrovascular diseases are the leading cause of mortality in Portugal, especially when related with extreme temperatures. This study highlights the impacts of the exposure-response relationship or lagged effect of low and high temperatures on cerebrovascular mortality, which can be important to reduce the health burden from cerebrovascular diseases. The purpose of this study was to assess the effects of weather on cerebrovascular mortality, measured by ambient temperature in the District of Lisbon, Portugal. A quasi-Poisson generalized additive model combined with a distributed lag non-linear model was applied to estimate the delayed effects of temperature on cerebrovascular mortality up to 30 days. With reference to minimum mortality temperature threshold of 22 °C, there was a severe risk (RR = 2.09, 95% CI 1.74, 2.51) of mortality for a 30-day-cumulative exposure to extreme cold temperatures of 7.3 °C (1st percentile). Similarly, the cumulative effect of a 30-day exposure to an extreme hot temperature of 30 °C (99th percentile) was 52% (RR = 1.65, 95% CI 1.37, 1.98) higher than same-day exposure. Over the 13 years of study, non-linear effects of temperature on mortality were identified, and the probability of dying from cerebrovascular disease in Lisbon was 7% higher in the winter than in the summer. The findings of this study provide a baseline for future public health prevention programs on weather-related mortality.

Bootstrap approach to validate the performance of models for predicting mortality risk temperature in Portuguese Metropolitan Areas

BACKGROUND

There has been increasing interest in assessing the impacts of extreme temperatures on mortality due to diseases of the circulatory system. This is further relevant for future climate scenarios where marked changes in climate are expected. This paper presents a solid method do identify the relationship between extreme temperatures and mortality risk by using as predictors simulated temperature data for cold and hot conditions in two urban areas in Portugal.

METHODS

Based on the mortality and meteorological data from Porto Metropolitan Area (PMA) and Lisbon Metropolitan Area (LMA), a distributed lag nonlinear model (DLNM) was implemented to estimate the temperature effects on mortality due to diseases of the circulatory system. The performance of the models was validated via bootstrapping approaching by creating resamples with replacement from the validating data. Bootstrapping was also used to identify the best candidate model and to evaluate the sensitivity of the spline functions to the exposure-lag-response relationship.

RESULTS

It is found that the model is able to reproduce the temperature-related mortality risk for two metropolitan areas. Temperature previously simulated by climate models is useful and even better than observed temperature. Although, the biases in predictions in both metropolitan areas are low, mortality risk predictions in PMA are more accurate than in LMA. Using parametric bootstrapping, we found that the overall cumulative association estimated under different bi-dimensional exposure-lag-response relationship are relatively stable, especially for the model selected by Quasi-Akaike Information Criteria (QAIC). Exposure to summer temperature conditions is best related to mortality risk. The association between winter temperature and mortality risk is somewhat less strong.

CONCLUSIONS

The use of QAIC to choose from several candidate models provides valid predictions and reduced the uncertainty in the estimated relative risk for circulatory disease mortality. Our findings can be applied to better understand the characteristics and facilitate the prevention of circulatory disease mortality in Porto and Lisbon Metropolitan Areas, namely if we consider the actual context of climate change.

Dynamic changes in the starch-sugar interconversion within plant source and sink tissues promote a better abiotic stress response

Starch is a significant store of sugars, and the starch-sugar interconversion in source and sink tissues plays a profound physiological role in all plants. In this review, we discuss how changes in starch metabolism can facilitate adaptive changes in source-sink carbon allocation for protection against environmental stresses. The stress-related roles of starch are described, and published mechanisms by which starch metabolism responds to short- or long-term water deficit, salinity, or extreme temperatures are discussed. Numerous examples of starch metabolism as a stress response are also provided, focusing on studies where carbohydrates and cognate enzymes were assayed in source, sink, or both. We develop a model that integrates these findings with the theoretical and known roles of sugars and starch in various species, tissues, and developmental stages. In this model, localized starch degradation into sugars is vital to the plant cold stress response, with the sugars produced providing osmoprotection. In contrast, high starch accumulation is prominent under salinity stress, and is associated with higher assimilate allocation from source to sink. Our model explains how starch-sugar interconversion can be a convergent point for regulating carbon use in stress tolerance at the whole-plant level.

Effects of extreme temperatures on hospital emergency room visits for respiratory diseases in Beijing, China

Extreme temperature is closely associated with human health, but limited evidence is available for the effects of extreme temperatures on respiratory diseases in China. The goal of this study is to evaluate the effects of extreme temperatures on hospital emergency room (ER) visits for respiratory diseases in Beijing, China. We used a distributed lag non-linear model (DLNM) coupled with a generalized additive model (GAM) to estimate the association between extreme temperatures and hospital ER visits for different age and gender subgroups in Beijing from 2009 to 2012. The results showed that the exposure-response curve between temperature and hospital ER visits was almost W-shaped, with increasing relative risks (RRs) at extremely low temperature. In the whole year period, strong acute hot effects were observed, especially for the elders (age > 65 years). The highest RR associated with the extremely high temperature was 1.36 (95% CI, 0.96-1.92) at lag 0-27. The longer-lasting cold effects were found the strongest at lag 0-27 for children (age ≤ 15 years) and the relative risk was 1.96 (95% CI, 1.70-2.26). We also found that females were more susceptible to extreme temperatures than males.

Weather and gastrointestinal disease in Spain: A retrospective time series regression study

BACKGROUND

A few studies in high-income countries have investigated the relationship between ambient temperature and/or precipitation and the occurrence of gastroenteritis. In most of the cases, hot temperatures and heavy precipitation events have been related to increases in infections. This is of concern as climate change predictions indicate an increase of those extreme events. Our aim was to evaluate the association between meteorological variables and daily gastroenteritis hospitalizations in Spain for the period 1997-2013.

METHODS

We obtained data on all hospitalizations which occurred in Spain for the study period from administrative databases and selected those with gastroenteritis as the main diagnosis. Meteorological data was obtained from the European Climate Assessment & Dataset. Daily counts of hospitalizations were linked to meteorological variables in a retrospective ecological time series study using quasi-Poisson regression models with overdispersion and applying the Distributed Lag Non-linear Model (DLNM) framework.

RESULTS

Both high and cold temperatures increased the risk of gastroenteritis hospitalizations (relative risk (RR) = 1.21, 95% confidence interval (CI): 1.09, 1.34; and RR = 1.07, 95% CI: 1.00, 1.15, respectively), whereas heavy precipitation was found protective for those hospitalizations (RR = 0.74, 95% CI: 0.63, 0.86). Hot temperatures increased hospitalizations for gastroenteritis classified as foodborne or idiopathic but not those in the group of Others, which were composed mainly of infections by rotavirus and were associated with cold temperatures.

CONCLUSIONS

Our findings suggest an important role of ambient temperatures, especially hot temperatures, in increasing gastroenteritis hospitalizations, while the exposure to heavy precipitation events pose opposite and unexpected effects on these infections.

The impact of heat waves and cold spells on respiratory emergency department visits in Beijing, China

The objectives of this article were (i) to find the association between extreme temperatures and respiratory emergency department (ED) visits and (ii) to explore the added effects of heat waves and cold spells on respiratory ED visits in Beijing from 2009 to 2012. A quasi-Poisson generalised linear model combined with a distributed lag non-linear model was performed to quantify this association. The results indicated that (i) ambient temperature related to respiratory ED visits exhibited a U-shaped association. The minimum-morbidity temperature was 21.5°C. (ii) the peak relative risk (RR) of cold spells on respiratory ED visits was observed in relatively mild cold spells with a threshold below the 3rd percentile for 4days (RR=1.885, 95% CI: 1.300-2.734), and there was a reduction in risk during extremely chilly cold spells (RR=1.811, 95% CI: 1.229-2.667). However, the risk of heat waves increased with the thresholds, and the greatest risk was found for extremely hot heat waves (RR=1.932, 95% CI: 1.461-2.554). (iii) the added effect of heat waves was small, and we observed that the added heat wave effect only introduced additional risk in females (RR=1.166, 95% CI: 1.007-1.349). No added effect of cold spells was identified. In conclusion, the main effects of heat waves and cold spells on respiratory ED visits showed different change trends. In addition, the added effects of extreme temperatures on respiratory ED visits were small and negligible.

Mortality attributable to extreme temperatures in Spain: A comparative analysis by city

BACKGROUND

The Low Temperature Days (LTD) have attracted far less attention than that of High Temperature Days (HTD), though its impact on mortality is at least comparable. This lower degree of attention may perhaps be due to the fact that its influence on mortality is less pronounced and longer-term, and that there are other concomitant infectious winters factors. In a climate-change scenario, the studies undertaken to date report differing results. The aim of this study was to analyse mortality attributable to both thermal extremes in Spain's 52 provinces across the period 2000-2009, and estimate the related economic cost to show the benefit or "profitability" of implementing prevention plans against LTD.

METHODS

Previous studies enabled us: to obtain the maximum daily temperature above which HTD occurred and the minimum daily temperature below which LTD occurred in the 52 provincial capitals analysed across the same study period; and to calculate the relative and attributable risks (%) associated with daily mortality in each capital. These measures of association were then used to make different calculations to obtain the daily mean mortality attributable to both thermal extremes. To this end, we obtained a summary of the number of degrees whereby the temperature exceeded (excess °C) or fell short (deficit °C) of the threshold temperature for each capital, and calculated the respective number of extreme temperatures days. The economic estimates rated the prevention plans as being 68% effective.

RESULTS

Over the period considered, the number of HTD (4373) was higher than the number of LTD (3006) for Spain as a whole. Notwithstanding this, in every provincial capital the mean daily mortality attributable to heat was lower (3deaths/day) than that attributable to cold (3.48deaths/day). In terms of the economic impact of the activation of prevention plans against LTD, these could be assumed to avoid 2.37 deaths on each LTD, which translated as a saving of €0.29M. Similarly, in the case of heat, 2.04 deaths could be assumed to be avoided each day on which the prevention plan against HTD was activated, amounting to a saving of €0.25M. While the economic cost of cold-related mortality across the ten-year period 2000-2009 was €871.7M, that attributable to heat could be put at €1093.2M.

CONCLUSION

The effect of extreme temperatures on daily mortality was similar across the study period for Spain overall. The lower number of days with LTD meant, however, that daily cold-related mortality was higher than daily heat-related mortality, thereby making prevention plans against LTD more "profitable" prevention plans against HTD in terms of avoidable mortality.

Influence of extreme ambient temperatures and anaerobic conditions on Peltigera aphthosa (L.) Willd. viability

Lichen are symbiotic systems constituted by heterotrophic fungi (mycobionts) and photosynthetic microorganism (photobionts). These organisms can survive under extreme stress conditions. The aim of this work was to study the influence of low (-70 °C) or high (+70 °C) temperatures, temperature fluctuations from +70 °C to -70 °C, and anaerobic conditions on P. aphthosa (L.) Willd. viability. None of the studied stress factors affected significantly photosynthetic and respiratory activity of the thalli. No changes in morphology or ultrastructure of the cells were revealed for both photobiont and mycobiont components after extreme temperature treatment of P. aphthosa thalli. The data show the extreme tolerance of P. aphthosa to some stress factors inherent to the space flight conditions.

Variation in vulnerability to extreme-temperature-related mortality in Japan: A 40-year time-series analysis

BACKGROUND

Although the impact of extreme heat and cold on mortality has been documented in recent years, few studies have investigated whether variation in susceptibility to extreme temperatures has changed in Japan.

METHODS

We used data on daily total mortality and mean temperatures in Fukuoka, Japan, for 1973-2012. We used time-series analysis to assess the effects of extreme hot and low temperatures on all-cause mortality, stratified by decade, gender, and age, adjusting for time trends. We used a multivariate meta-analysis with a distributed lag non-linear model to estimate pooled non-linear lag-response relationships associated with extreme temperatures on mortality.

RESULTS

The relative risk of mortality increased during heat extremes in all decades, with a declining trend over time. The mortality risk was higher during cold extremes for the entire study period, with a dispersed pattern across decades. Meta-analysis showed that both heat and cold extremes increased the risk of mortality. Cold effects were delayed and lasted for several days, whereas heat effects appeared quickly and did not last long.

CONCLUSIONS

Our study provides quantitative evidence that extreme heat and low temperatures were significantly and non-linearly associated with the increased risk of mortality with substantial variation. Our results suggest that timely preventative measures are important for extreme high temperatures, whereas several days' protection should be provided for extreme low temperatures.