The impact of climate change on the epidemiology and control of Rift Valley fever

Climate change is likely to change the frequency of extreme weather events, such as tropical cyclones, floods, droughts and hurricanes, and may destabilise and weaken the ecosystem services upon which human society depends. Climate change is also expected to affect animal, human and plant health via indirect pathways: it is likely that the geography of infectious diseases and pests will be altered, including the distribution of vector-borne diseases, such as Rift Valley fever, yellow fever, malaria and dengue, which are highly sensitive to climatic conditions. Extreme weather events might then create the necessary conditions for Rift Valley fever to expand its geographical range northwards and cross the Mediterranean and Arabian seas, with an unexpected impact on the animal and human health of newly affected countries. Strengthening global, regional and national early warning systems is crucial, as are co-ordinated research programmes and subsequent prevention and intervention measures.     

异常低温阴雨天气对传染病突发公共卫生事件发生的影响

目的 通过分析罕见低温阴雨天气对南宁市传染病突发公共卫生事件发生的影响,为预防控制因极端天气事件导致传染病突发公共卫生事件的发生提供依据.方法 对南宁市2008年初和2012年初的极端低温阴雨天气期间及后延1个月的传染病突发公共卫生事件的发生情况进行分析.结果 极端低温阴雨天气使传染病突发公共卫生事件发生概率升高,且因传染病事件所致的罹患率也明显上升.2012年初传染病事件发生数最多,2008年初因传染病事件所致罹患率最高.2008年初传染病事件所致罹患率分别是2012年同期的1.528倍(x2=40.439,p＜0.001)和2005年来其它各年同期的1.685倍(x2=72.131,p＜0.001).2012年初因传染病事件所致罹患率分别是2005年来其它各年同期的1.103倍(x2=6.187,p＜0.05)和2009-2011年同期的1.384倍(x2=86.419,p＜0.001).结论 极端低温阴雨天气对传染病突发公共卫生事件的发生产生影响,但此期间发生的传染病突发公共卫生事件的病原以有有效疫苗预防的呼吸道传染病事件为主,因此,在经历极端气候条件时,应注重疫苗接种的宣传工作,扩大免疫接种范围,以减少传染病的发生和传播.     

Differential and combined impacts of extreme temperatures and air pollution on human mortality in south–central Canada. Part I: historical analysis

This paper forms the first part of an introduction to a synoptic weather typing approach to assess differential and combined impacts of extreme temperatures and air pollution on human mortality in south–central Canada, focusing on historical analysis (a companion paper—Part II focusing on future estimates). In this study, an automated synoptic weather typing procedure was used to identify weather types that have a marked association with high air pollution levels and temperature extremes, and facilitates assessments of the differential and combined health impacts of extreme temperatures and air pollution. Annual mean elevated mortality (when daily mortality exceeds the baseline) associated with extreme temperatures and acute exposures to air pollution, based on 1954–2000, was 1,082 [95% confidence interval (CI) of 1,017–1,147] for Montreal, 1,047 (CI 994–1,100) for Toronto, 462 (CI 438–486) for Ottawa, and 327 (CI 311–343) for Windsor. Of this annual mean elevated mortality, extreme temperatures are usually associated with roughly 20%, while air pollution is associated with the remaining 80%. Three pollutants (ozone, sulfur dioxide, and nitrogen dioxide) are associated with approximately 75% of total air pollution-related mortality across the study area. The remaining 25% is almost evenly associated with suspended particles and carbon monoxide, the other two pollutants addressed in this study. Of the five pollutants, ozone is most significantly associated with elevated mortality, making up one-third of the total air pollution-related mortality. PM_2.5 and PM₁₀ were not used as a measure of particulate in the study due to brief data records. The study results also suggest that, on the basis of daily mortality risks, extreme temperature-related weather presents a much greater risk to human health during heat waves and cold spells than air pollution. For example, in Montreal and Toronto, daily mean elevated mortality counts within the hottest weather type were twice as high as those within air pollution-related weather types.     

Impact of extreme weather events and climate change for health and social care systems

This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.     

童年时期父母去世与老年人晚年认知功能的关系——基于2018年CLASS数据的分析

目的 本研究旨在探索我国60岁及以上老年人的认知功能现状以及童年时期经历父母去世对老年人晚年认知功能的影响。方法 使用2018年中国老年社会追踪调查（CLASS）数据,纳入有效样本11 088个;采用简易精神状态量表（MMSE）测量老年人的认知功能,t检验用于分析老年人的认知功能在不同特征对象中的差异,多元线性回归分析用于探索童年时期经历父母去世对老年人晚年认知功能的影响。结果 共有1 177位老年人有过童年父母去世经历,约占总人数的10.6%;经历过童年父母去世的老年人的MMSE平均得分为（12.87±3.19）,没有经历过的老年人MMSE平均得分为（13.37±3.07）,差异存在统计学意义（t=5.18,P<0.001）;多模型多元线性回归结果表明,童年时期是否经历父母去世与老年人晚年的认知功能相关（β=-0.02,P=0.007）,有此经历的老年人认知功能更差。结论 目前我国老年人的认知功能较差,童年时期经历父母去世会对老年人晚年的认知功能产生影响,需要采取针对性的措施来减缓老年人认知功能的下降。     

热浪与早产、低出生体质量关系的研究进展

近年来全球气候发生显著变化,夏季频发高温热浪已成为世界范围内的极端天气灾害事件,严重威胁人类健康.不少国际机构与气象、环境和流行病等学科专家已开始探讨热浪对个体健康的危害及影响机制.笔者拟就国内外热浪与婴儿早产、低出生体质量（LBW）关系的研究现状进行综述,重点关注孕妇群体及全球暖化与早产、LBW的最新研究,旨在为我国预防和遏制日益高发的不良妊娠结局寻找突破口,同时也丰富人们对气候变化与人类健康关系的认知.     

Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events

This report describes the development of novel syndromic cold weather public health surveillance indicators for use in monitoring the impact of extreme cold weather on attendances at EDs, using data from the 2010–11 and 2011–12 winters.     

El Niño and human health

The El Niño-Southern Oscillation (ENSO) is the best known example of quasi-periodic natural climate variability on the interannual time scale. It comprises changes in sea temperature in the Pacific Ocean (El Niño) and changes in atmospheric pressure across the Pacific Basin (the Southern Oscillation), together with resultant effects on world weather. El Niño events occur at intervals of 2-7 years. In certain countries around the Pacific and beyond, El Niño is associated with extreme weather conditions that can cause floods and drought. Globally it is linked to an increased impact of natural disasters. There is evidence that ENSO is associated with a heightened risk of certain vector-borne diseases in specific geographical areas where weather patterns are linked with the ENSO cycle and disease control is limited. This is particularly true for malaria, but associations are also suggested in respect of epidemics of other mosquito-borne and rodent-borne diseases that can be triggered by extreme weather conditions. Seasonal climate forecasts, predicting the likelihood of weather patterns several months in advance, can be used to provide early indicators of epidemic risk, particularly for malaria. Interdisciplinary research and cooperation are required in order to reduce vulnerability to climate variability and weather extremes.     

Differential and combined impacts of extreme temperatures and air pollution on human mortality in south–central Canada. Part II: future estimates

This paper forms the second part of an introduction to a synoptic weather typing approach to assess differential and combined impacts of extreme temperatures and air pollution on human mortality, focusing on future estimates. A statistical downscaling approach was used to downscale daily five general circulation model (GCM) outputs (three Canadian and two US GCMs) and to derive six-hourly future climate information for the selected cities (Montreal, Ottawa, Toronto, and Windsor) in south–central Canada. Discriminant function analysis was then used to project the future weather types, based on historical analysis defined in a companion paper (Part I). Future air pollution concentrations were estimated using the within-weather-type historical simulation models applied to the downscaled future GCM climate data. Two independent approaches, based on (1) comparing future and historical frequencies of the weather groups and (2) applying within-weather-group elevated mortality prediction models, were used to assess climate change impacts on elevated mortality for two time windows (2040–2059 and 2070–2089). Averaging the five GCM scenarios, across the study area, heat-related mortality is projected to be more than double by the 2050s and triple by the 2080s from the current condition. Cold-related mortality could decrease by about 45–60% and 60–70% by the 2050s and the 2080s, respectively. Air pollution-related mortality could increase about 20–30% by the 2050s and 30–45% by the 2080s, due to increased air pollution levels projected with climate change. The increase in air pollution-related mortality would be largely driven by increases in ozone effects. The population acclimatization to increased heat was also assessed in this paper, which could reduce future heat-related mortality by 40%. It is most likely that the estimate of future extreme temperature- and air pollution-related mortality from this study could represent a bottom-line figure since many of the factors (e.g., population growth, age structure changes, and adaptation measures) were not directly taken into account in the analyses.     

The effects of water supply on infant and childhood mortality: a review of historical evidence

The provision of clean water is mentioned as an important factor in many studies dealing with the decline of mortality in Europe during the late nineteenth and early twentieth centuries. In developing countries too, improved water supply is assumed to have a strong impact on mortality. When studying the effect of water supply on public health, researchers are confronted with many methodological problems. Most of these also apply to historical studies of the subject. We review the evidence from this historical research, taking into account the methodological problems observed in contemporary impact evaluation studies, and we use more refined data from the Dutch city of Tilburg, enabling us to overcome many of these shortcomings. Finally, we discuss some factors which may explain why we failed to discover an effect of the availability of piped water on the level of childhood mortality.     

West Nile virus and the climate

West Nile virus is transmitted by urban-dwelling mosquitoes to birds and other animals, with occasional “spillover” to humans. While the means by which West Nile virus was introduced into the Americas in 1999 remain unknown, the climatic conditions that amplify diseases that cycle among urban mosquitoes, birds, and humans are warm winters and spring droughts. This information can be useful in generating early warning systems and mobilizing timely and the most environmentally friendly public health interventions. The extreme weather conditions accompanying long-term climate change may also be contributing to the spread of West Nile virus in the United States and Europe.     

The association between climatic factors and childhood illnesses presented to hospital emergency among young children

There has been an increasing concern about the effect of climatic change on human health in recent years. It has been suggested that young children are particularly at risk due to the reduced regulating mechanism against extreme climatic changes. However, few studies on the associations between climatic factors and childhood illness, specifically among young children, have been found in the literature. This epidemiological study utilized data collected on all young patients aged less than 6 years who presented to an emergency department for a period of two years. Information on climate and outdoor air quality variables was obtained from the Bureau of Meteorology. Data were analysed with various ARIMA time series models for each common childhood illness. Results suggested that maximum daily temperature was a significant risk factor for fever (t = 5.29, p < 0.001) with a regression coefficient of 0.37 (SE = 0.07) and gastroenteritis (t = 2.69, p = 0.007) with a regression coefficient of 0.10 (SE = 0.04). The UV index was also found to be significantly but negatively related to gastroenteritis (t = -2.37, p = 0.018). However, none of the climatic variables were associated with respiratory problems after adjusting for other air quality variables and infectious disease.     

2003—2007年上海市低温寒流季节超额死亡分析

[目的]分析低温寒流天气对上海市居民超额死亡的影响,为加强极端气候应急预警,提高防灾减灾能力提供依据。[方法]收集2003—2007年低温期间（当年11月20日至次年3月30日）的死亡个案资料,与同期气象数据进行对比,分析寒流季节气温变化与居民超额死亡关系。[结果]2008年1月中旬至2月下旬,上海市各旬日平均气温较历年平均气温偏低1.13～5.17℃。2007年低温期期间,上海市共死亡43441人,较往年同期平均超额死亡2641人。2003—2007年低温期间,随着日平均气温、最高气温和最低气温的下降,每日死亡人数随之上升,死亡人数与气温之间存在明显负相关关系（相关系数分别为r平均气温=-0.45、r最高气温=-0.38、r最低气温=-0.49）。[结论]低温天气灾害带来的气温骤降和天气急剧变化影响群众生命健康,导致居民超额死亡的增加。     

中国极端天气气候事件对传染性疾病的影响

对1995～2008年间发表的有关中国极端天气气候事件对传染性疾病的影响的研究予以综述。各种极端天气气候事件中以洪涝灾害、暖冬、高温干旱对传染性疾病的影响最为明显,文中分类综述了它们对媒介生物和感染性寄生虫的流行范围和活动能力的影响,以及导致相应的传染性疾病发病率和流行规模的变化。     

The impact of weather on human health

The impact of weather on human health is a well-known fact, yet, alas, neglected in the past. Bioclimatology, a vast field of medical knowledge, has only been developed in the past few years. It shows that the air we breathe has a profound influence on our well-being. Electrical charges of the air, such as ions, spherics and electrofields can affect our endocrine, vegetative and autonomous nerve system. It may even be responsible for post-operative thromboembolism. The present article describes weather reactions, electric radiations, climate rhythm, medical aspects of weather changes, and their effect on health and disease. Special devotion is also given to the manifestations of evil winds.     

The influence of climate change on human cardiovascular function

Abstract

Climate change is considered to have great impact on human health. The heat waves have been associated with excess morbidity and mortality of cardiovascular diseases (CVD) across various populations and geographic locations. Important role in the heat-induced cardiovascular damage has endothelial dysfunction. It has been noticed that hot weather can impair tone and structure of the blood vessels via interfering with variety of biological factors such as nitric oxide synthesize, cytokine production and systemic inflammation. Also, due to dehydration and increased blood viscosity, by promoting thrombogenesis, heat has important impact on patients with atherosclerosis. During chronic exposure to the cold or hot weather cardiovascular function can be decreased, leading to a higher risk of developing heart attack, malignant cardiac arrhythmias, thromboembolic diseases and heat-induced sepsis like shock. It has been shown that changes in the ambient temperature through increasing blood pressure, blood viscosity, and heart rate, contribute to the cardiovascular mortality. The majority of deaths due to heat waves especially affect individuals with preexisting chronic CVD. This population can experience a decline in the health status, since extreme ambient temperature affects pharmacokinetic parameters of many cardiovascular drugs. Increased mortality from ischemic or hemorrhagic stroke can also be related to extreme temperature variations. On a cellular level, higher ambient temperature can limit storage of ATP and O₂ increase amount of free radicals and toxic substances and induce neuronal apoptotic signal transduction, which all can lead to a stroke. Preserving cardiovascular function in context of extreme climate changing tends to be particularly challenging.     

The long-term cognitive consequences of early childhood malnutrition: The case of famine in Ghana

We examine the role of early childhood health in human capital accumulation. Using a unique data set from Ghana with comprehensive information on individual, family, community, school quality characteristics and a direct measure of intelligence together with test scores, we examine the long-term cognitive effects of the 1983 famine on survivors. We show that differences in intelligence test scores can be robustly explained by the differential impact of the famine in different parts of the country and the impacts are most severe for children under two years of age during the famine. We also account for model uncertainty by using Bayesian Model Averaging.     

中西医治疗方式控制儿童哮喘复发效果的比对研究

目的 比较中医治疗方式与西医治疗方式对控制儿童哮喘复发的效果,为儿童哮喘的治疗提供理论参考.方法 选择某院近两年3～7岁哮喘儿童患者179例并随机分为两组,其中中医组儿童患者在哮喘间歇期采取黄芪辅助治疗,西医组儿童患者采取耱皮质激素的方法进行辅助治疗.对治疗效果进行评价并测定IL-2及IL-4水平,利用统计学方法进行数据分析.结果 在间歇期利用黄芪进行治疗的儿童患者总有效率为86％,而利用糖皮质激素进行治疗的儿童患者总有效率为90％,两组之间不存在显著差异.两组治疗前后细胞因子IL-2及IL-4的均有不同程度的变化,两组间不存在显著差异,但黄芪治疗组的细胞因子更趋向于正常.结论 利用中西医方式对儿童哮喘患者在间歇期进行治疗的效果不具有显著差异,然考虑到糖皮质激素的诸多副作用及儿童成长的需要,建议对该类患者哮喘间歇期采取黄芪进行辅助治疗.     

Climate change and human health impacts in the United States: an update on the results of the U.S. national assessment

The health sector component of the first U.S. National Assessment, published in 2000, synthesized the anticipated health impacts of climate variability and change for five categories of health outcomes: impacts attributable to temperature, extreme weather events (e.g., storms and floods) , air pollution, water- and food-borne diseases, and vector- and rodent-borne diseases. The Health Sector Assessment (HSA) concluded that climate variability and change are likely to increase morbidity and mortality risks for several climate-sensitive health outcomes, with the net impact uncertain. The objective of this study was to update the first HSA based on recent publications that address the potential impacts of climate variability and change in the United States for the five health outcome categories. The literature published since the first HSA supports the initial conclusions, with new data refining quantitative exposure-response relationships for several health end points, particularly for extreme heat events and air pollution. The United States continues to have a very high capacity to plan for and respond to climate change, although relatively little progress has been noted in the literature on implementing adaptive strategies and measures. Large knowledge gaps remain, resulting in a substantial need for additional research to improve our understanding of how weather and climate, both directly and indirectly, can influence human health. Filling these knowledge gaps will help better define the potential health impacts of climate change and identify specific public health adaptations to increase resilience.     

Short-Term Effects of the 2008 Cold Spell on Mortality in Three Subtropical Cities in Guangdong Province,China

Background: Few studies have been conducted to investigate the impact of extreme cold events on mortality in subtropical regions.Objective: In the present study we aimed to investigate the effects of the 2008 cold spell on mortality and the possibility of mortality displacement in three subtropical cities in China.Methods: Daily mortality, air pollution, and weather data were collected from 2006 to 2009 in Guangzhou, Nanxiong (no air pollutants), and Taishan. We used a polynomial distributed lag model (DLM) to analyze the relationship between the 2008 cold spell and mortality. To observe the mortality displacement of the cold spell, we estimated the cumulative effects at lag0, lag0–6, lag0–13, lag0–20, and lag0–27 separately.Results: During the 2008 cold spell, the cumulative risk of nonaccidental mortality increased significantly in Guangzhou [relative risk (RR) = 1.60; 95% CI: 1.19, 2.14] and Taishan (RR = 1.60; 95% CI: 1.06, 2.40) when lagged up to 4 weeks after the cold spell ended. Estimated effects at lag0–27 were more pronounced for males than for females, for respiratory mortality than for cardiovascular mortality, and for the elderly (≥ 75 years of age) than for those 0–64 years of age. Most of the cumulative RRs increased with longer lag times in Guangzhou and Taishan. However, in Nanxiong, the trend with cumulative RRs was less consistent, and we observed no statistically significant associations at lag0–27.Conclusion: We found associations between the 2008 cold spell and increased mortality in the three subtropical cities of China. The lag effect structure of the cold spell varied with location and the type of mortality, and evidence of short-term mortality displacement was inconsistent. These findings suggest that extreme cold is an important public health problem in subtropical regions.