A study protocol

BACKGROUND

The following protocol pertains to a pioneer study, aiming to investigate how weather sensitivity and walking in different environments affects the psychophysiological responses to the stress of individuals with coronary artery disease (CAD) during rehabilitation (WE_SENSE_THE_NATURE). This randomised control trial will provide fresh insight on the influence of the environmental exposure in CAD patients, as it is seldom investigated in association to the disease. Additionally, findings on the link between personality traits and cognitive functions (especially cognitive flexibility), and weather sensitivity may help reveal a fine-grained perspective on the treatment possibilities for individuals with CAD at risk to stress-vulnerability.

METHODS

The proposed protocol is for a randomised control trial among individuals attending a cardiac rehabilitation program. We aim to recruit 164 individuals, collecting information related to demographic characteristics, weather sensitivity, functional capacity, personality traits, subjective mental health status, cognitive function, and basal cortisol level of participating individuals. Basal cortisol level refers to cortisol concentration in saliva and will be tested in the morning and the afternoon prior to the day of the experiment. After baseline measurements, the patients will be randomly assigned to either walking outdoors or walking indoors. All measures and their sequential order will remain the same within each group, while the treatment condition (i.e., walking environment) will vary between groups. On the day of the experiment, hemodynamic parameters (assessed via 6-hour blood pressure measurements), stress level (consisting of assessments of cortisol level), and mood (assessed using visual analogues scale) will be registered. Cold stress test will be administered to evaluate the effect of walking in different environments.

DISCUSSION

The outcomes of this study may have direct clinical applications for the use of different types of exercise environments in cardiac rehabilitation programs. Awareness about the potential influence of weather sensitivity on the psychophysiological reactions to stress in individuals with CAD may contribute to a timely planning and implementation of actions leading to improved medical care services and preventive measures, especially considering the expected weather oscillations and extreme weather events due to unfolding of the climate change.

TRIAL REGISTRATION

This protocol has been retrospectively registered in ClinicalTrials.gov with identifier code: NCT06139705 on November 20, 2023.

Self-Reported Weather Sensitivity is Associated with Clinical Symptoms and Structural Abnormalities in Patients with Knee Osteoarthritis: A Cross-Sectional Study

INTRODUCTION

Patients with knee osteoarthritis (KOA) often complain about clinical symptoms affected by weather-related factors. The purpose of the present study was to use cross-sectional analysis to determine whether weather sensitivity was associated with clinical symptoms, as well as structure abnormalities, in KOA patients.

METHODS

Data from 80 participants were obtained from the Feng Hans Shi Effects on OA (FHS) study, an OA cohort study initiated in China in 2015. The weather sensitivity of each participant was determined by a self-reported questionnaire. The following measurements were used to assess clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for symptoms, and semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) for cartilage defects and marrow abnormalities of magnetic resonance imaging (MRI). Chi-square with Cochran-Armitage test for trend and regression analysis were used to evaluate the associations between weather sensitivity and WOMAC and WORMS of KOA patients.

RESULTS

Most of the KOA participants (57.5%) perceived the weather as affecting their knee-joint clinical symptoms. After adjusting for age, gender, and body mass index (BMI), weather sensitivity was not only associated with knee pain [OR = 3.3 (95% CI 1.1, 9.9), P = 0.032], dysfunction [OR = 5.5 (95% CI 1.8, 16.8), P = 0.003], and overall clinical symptoms [OR = 3.3 (95% CI 1.1, 10.2), P = 0.034], but also associated with cartilage defect [OR = 3.1 (95% CI 1.1, 8.5), P = 0.027] and marrow abnormality [OR = 3.0 (95% CI 1.1, 8.1), P = 0.029].

CONCLUSIONS

In KOA patients, weather sensitivity was associated with clinical symptoms and structural abnormalities. Future longitudinal study is warranted for the causal relationship. INFOGRAPHIC.

Weather influences on zoo visitation (Cabárceno, Northern Spain)

The general relationship between weather and climate with recreation and tourism has been widely acknowledged, but research on more activity-specific assessments is still required. The links between atmospheric conditions and visitation to the Nature Park of Cabárceno, an outdoor zoo located in Cantabria (Northern Spain), have been analyzed by conducting in situ surveys and comparing the daily number of attendants and meteorological parameters from a nearby weather station. The sensitivity of zoo visitation to weather variability was seasonally dependent, so winter attendance is directly related to the frequency of dry, warm, calm, and cloudless days; in summer, attendance was less sensitive to weather, with visitors attending in largest numbers during mild, cloudy, and breezy days. Moreover, a dissociation exists between perception and behavior during the period of the largest influx of visitors: visitors remark the importance of weather when planning the activity, but they show little flexibility when visiting. Socio-economic factors (origin of visitors, family structure) fade the weather influence.

Weather-related subjective well-being in patients with coronary artery disease

One of the particularly vulnerable groups for adverse weather conditions is people with heart disease. Most of the studies analyzed the association between certain weather conditions and increased mortality, morbidity, hospital admissions, calls, or visits to the emergency department and used as statistical data. This study evaluated associations between daily weather conditions and daily weather-related well-being in patients with coronary artery disease (CAD). From June 2008 to October 2012, a total of 865 consecutive patients with CAD (mean age 60 years; 30% of women) were recruited from the cardiac rehabilitation program at the Hospital Palanga Clinic, Lithuania. To evaluate the well-being, all patients filled in Palanga self-assessment diary for weather sensitivity every day from 8 to 21 days (average 15 ± 3 days) about their well-being (psychological, cardiac, and physical symptoms) on the last day. The weather data was recorded in the database eight times every day with a 3-hour interval using the weather station "Vantage Pro2 Plus" which was located in the same Clinic. The daily averages of the eight time records for weather parameters were calculated and were linked to the same-day diary data. We found that the well-being of patients with CAD was associated with weather parameters; specifically, general well-being was better within the temperature range 9-15 °C and worse on both sides of this range. Worsened general well-being was also associated with higher relative humidity and lower atmospheric pressure. Weather parameters can explain from 3 to 8% of the variance of well-being in patients with CAD.

Development of a data-driven weather index for beach parks tourism

The complexity of the human-environment interface predicates the need for tools and techniques that can enable the effective translation of weather and climate products into decision-relevant information. Indices are a category of such tools that may be used to simplify multi-faceted climate information for economic and other decision-making. Climate indices for tourism have been popularized in the literature over the past three decades, but despite their prevalence, these indices have a number of limitations, including coarse temporal resolution, subjective rating and weighting schemes, and lack of empirical validation. This paper critically assesses the design of the tourism climate index, the holiday climate index-beach, and a new, mathematically optimized index developed for the unique contextual realities of Great Lakes beach tourism. This new methodology combines the use of expert knowledge, stated visitor preferences, and mathematical optimization to develop an index that assigns daily weather scores based on four weather sub-indices (thermal comfort, wind speed, precipitation, and cloud cover). These daily scores are then averaged to the monthly level and correlated to visitation data at two beach parks in Ontario (Canada). This optimized index demonstrates a strong fit (R² = 0.734, 0.657) with observed visitation at Pinery Provincial Park and Sandbanks Provincial Park, outperforming both the tourism climate index (R² = 0.474, 0.018) and the holiday climate index-beach (R² = 0.668, 0.427). This study advances our understanding of the magnitude and seasonality of weather impact on beach tourist visitation and can inform decision-making of tourism marketers and destination managers.

Weather effects on breeding parameters of two insectivorous passerines in a polluted area

Direct and indirect effects of environmental pollution affect negatively to birds' breeding performance in both urban and industrial environments, but much less is known on how pollution and natural stress factors work together. In our long-term study (1991-2018), we explored whether industrial pollution and associated habitat changes increase the sensitivity of breeding parameters (hatching and fledging success, nestling growth) to temperature and precipitation in two insectivorous bird species, the great tit (Parus major) and the pied flycatcher (Ficedula hypoleuca). We found that both species are rather weather sensitive in terms of their fledging success, but especially in the F. hypoleuca, the negative effect was strengthened in a polluted environment. For both study species, all the breeding parameters, except growth of F. hypoleuca nestlings, were inferior in the polluted area and negatively affected by cold weather. Independent of pollution, the duration of rainy spells during the nestling period had an overall negative effect on fledging success of F. hypoleuca, and this effect became stronger at cold temperatures. The length of rainy spells was, however, positively associated with nestling wing length in both species, possibly because of better availability of some important food resources for wing growth in more humid conditions. The weather-pollution interactions in our study populations were not overwhelmingly strong, but those found in F. hypoleuca show that such interactions exist, they are species-specific and in our study system most likely associated to pollution-related resource (e.g. food) limitation. Higher sensitivity of F. hypoleuca to low temperatures is likely related to its less well-insulated nests and higher dependence on aerial prey, the availability of which is especially reduced during cold and rainy spells. Our study indicates that anthropogenic stress, such as pollution, has synergistic effects with natural stress factors affecting passerine birds' breeding performance.

Weather sensitivity for zoo visitation in Toronto, Canada: a quantitative analysis of historical data

Based on a case study of the Toronto Zoo (Canada), multivariate regression analysis, involving both climatic and social variables, was employed to assess the relationship between daily weather and visitation. Zoo visitation was most sensitive to weather variability during the shoulder season, followed by the off-season and, then, the peak season. Temperature was the most influential weather variable in relation to zoo visitation, followed by precipitation and, then, wind speed. The intensity and direction of the social and climatic variables varied between seasons. Temperatures exceeding 26 °C during the shoulder season and 28 °C during the peak season suggested a behavioural threshold associated with zoo visitation, with conditions becoming too warm for certain segments of the zoo visitor market, causing visitor numbers to decline. Even light amounts of precipitation caused average visitor numbers to decline by nearly 50 %. Increasing wind speeds also demonstrated a negative influence on zoo visitation.