When resilience is not enough: 2022 extreme marine heatwave threatens climatic refugia for a habitat-forming Mediterranean octocoral.

Climate change is impacting ecosystems worldwide, and the Mediterranean Sea is no exception. Extreme climatic events, such as marine heat waves (MHWs), are increasing in frequency, extent and intensity during the last decades, which has been associated with an increase in mass mortality events for multiple species. Coralligenous assemblages, where the octocoral Paramuricea clavata lives, are strongly affected by MHWs. The Medes Islands Marine Reserve (NW Mediterranean) was considered a climate refugia for P. clavata, as their populations were showing some resilience to these changing conditions. In this study, we assessed the impacts of the MHWs that occurred between 2016 and 2022 in seven shallow populations of the octocoral P. clavata from a Mediterranean Marine Protected Area. The years that the mortality rates increased significantly were associated with the ones with strong MHWs, 2022 being the one with higher mortalities. In 2022, with 50 MHW days, the proportion of total affected colonies was almost 70%, with a proportion of the injured surface of almost 40%, reaching levels never attained in our study site since the monitoring was started. We also found spatial variability between the monitored populations. Whereas few of them showed low levels of mortality, others lost around 75% of their biomass. The significant impacts documented here raise concerns about the future of shallow P. clavata populations across the Mediterranean, suggesting that the resilience of this species may not be maintained to sustain these populations face the ongoing warming trends.

El canvi climatic està impactant els ecosistemes arreu del planeta, i el Mar Mediterrani no n'és una excepció. Els esdeveniments climàtics extrems, com ara les onades de calor marines, estan augmentant en freqüència, extensió i intensitat en les darreres dècades, i estan sent associades a un increment dels esdeveniments de mortalitat massiva de múltiples espècies. El coral·ligen, on hi viu l'octocorall Paramuricea clavata, està altament afectat per les onades de calor marines. La Reserva Marina de les Illes Medes (NO del Mediterrani) es considerava un refugi climàtic per aquesta espècie, degut a que les seves poblacions mostraven certa resiliència a les condicions canviants. En aquest estudi hem avaluat els impactes de les onades de calor marines succeïdes entre els anys 2016 i 2022 a set poblacions someres de l'octocorall P. clavata, en una Àrea Marina Protegida del Mediterrani. Els anys en els quals les taxes de mortalitat van incrementar significativament s'associen amb els anys amb fortes onades de calor marines, sent el 2022 l'any amb la mortalitat més elevada. Al 2022, amb 50 dies d'onada de calor, la proporció total de colònies afectades va ser prop del 70%, amb un percentatge de superfície afectada de gairebé el 40%, arribant a valors mai observats en el lloc d'estudi des de que es va iniciar el seguiment d'aquestes poblacions. També hem observat variabilitat espacial entre les poblacions mostrejades. Mentre que algunes d'elles han mostrat poca mortalitat, altres han perdut al voltant del 75% de la seva biomassa. Els impactes documentats en aquest estudi mostren un futur preocupant de les poblacions someres de P. clavata arreu del Mediterrani, i això suggereix que la resiliència d'aquesta espècie podria no ser suficient per mantenir les seves poblacions en l'escenari d'escalfament que es preveu.

Human adaptation to heat in the context of climate change: A conceptual framework.

Climate change is causing serious damage to natural and social systems, as well as having an impact on human health. Among the direct effects of climate change is the rise in global surface temperatures and the increase in the frequency, duration, intensity and severity of heat waves. In addition, understanding of the adaptation process of the exposed population remains limited, posing a challenge in accurately estimating heat-related morbidity and mortality. In this context, this study seeks to establish a conceptual framework that would make it easier to understand and organise knowledge about human adaptation to heat and the factors that may influence this process. An inductive approach based on grounded theory was used, through the analysis of case studies connecting concepts. The proposed conceptual framework is made up of five components (climate change, vulnerability, health risks of heat, axes of inequality and health outcomes), three heat-adaptation domains (physiological, cultural and political), two levels (individual and social), and the pre-existing before a heat event. The application of this conceptual framework facilitates the assistance of decision-makers in planning and implementing effective adaptation measures. Recognizing the importance of addressing heat adaptation as a health problem that calls for political solutions and social changes. Accordingly, this requires a multidisciplinary approach that would foster the participation and collaboration of multiple actors for the purpose of proposing effective measures to address the health impact of the rise in temperature.

Impact of drought on mental and behavioral disorders, contributions of research in a climate change context. A narrative review.

Mental and behavioral disorders are an important public health problem and constitute a priority for the WHO, whose recommendations include the surveillance of their risk factors. On the other hand, drought episodes have been increasing in frequency and severity in Europe since 1980. Therefore, to review the present knowledge about the impact of drought on mental and behavioral disorders, in the present climate change context, and to underline potential research gaps, could be of major interest. Thus, we performed a narrative review using online academic databases with the aim of identifying relevant literature about the impact of drought on mental and behavioral disorders. To the best of our knowledge, no study in Europe quantifies the potential association between drought and mental disorders. A limited number of studies have found significant associations between droughts (with different temporal ranges) and various measures of mental health. However, according to our review, only three of them quantified the association between drought and objective mental health outcomes, such as number of emergencies due to clinically diagnosed mental disorders or suicides. Additionally, few studies used specific indices as a measure of drought; and finally, as far as authors are aware, none of them has analyzed this relationship adjusting for various other potential environmental confounders. Moreover, the eventual association could vary between different geographical areas within the same country. Therefore, national and regional studies would be especially necessary. Thus, there is a need for specific national and regional studies, in Europe and globally, that assess the impact of specific indices of drought (with different temporal ranges) on objective mental health outcomes controlling for potential environmental confounders. Moreover, the quantification of its cost would be necessary for health prioritization, evidence-based policies and strategic health planning.

Marine Citizen Science and the Conservation of Mediterranean Corals: The Relevance of Training, Expert Validation, and Robust Sampling Protocols.

Marine Citizen Science (MCS) has emerged as a promising tool to enhance conservation efforts. Although the quality of volunteer data has been questioned, the design of specific protocols, effective training programs, and data validation by experts have enabled us to overcome these quality concerns, thus ensuring data reliability. Here, we validated the effectiveness of volunteer training in assessing the conservation status of Mediterranean coral species. We conducted a comparative analysis of data collected by volunteers with different levels of expertise, demonstrating improvements in data precision and accuracy with only one training session, thereby achieving values equivalent to those obtained by scientists. These outcomes align with the feedback received from volunteers through a qualitative survey. Finally, we analysed the data generated by volunteers and validated by experts using the developed protocol in the Coral Alert project from the Observadores del Mar MCS initiative. Our findings highlight the importance of proper training, expert validation, robust sampling protocols, and a well-structured platform to ensure the success of long-term MCS projects. Overall, our results stress the key role MCS plays in enhancing the conservation and management strategies designed to mitigate the ongoing environmental crisis.

Philadelphia-negative chronic myeloproliferative neoplasm follow-up: when the phone rings. Changes during the COVID-19 pandemic and patient satisfaction. Experience in 30 health centers in Spain.

The SARS-CoV-2 pandemic has favored the expansion of telemedicine. Philadelphia-negative chronic myeloproliferative neoplasms (Ph-MPN) might be good candidates for virtual follow-up. In this study, we aimed to analyze the follow-up of patients with Ph-MPN in Spain during COVID-19, its effectiveness, and acceptance among patients. We present a multicenter retrospective study from 30 centers. Five hundred forty-one patients were included with a median age of 67 years (yr). With a median follow-up of 19 months, 4410 appointments were recorded. The median of visits per patient was 7 and median periodicity was 2.7 months; significantly more visits and a higher frequency of them were registered in myelofibrosis (MF) patients. 60.1% of visits were in-person, 39.5% were by telephone, and 0.3% were videocall visits, with a predominance of telephone visits for essential thrombocythemia (ET) and polycythemia vera (PV) patients over MF, as well as for younger patients (< 50 yr). The proportion of phone visits significantly decreased after the first semester of the pandemic. Pharmacological modifications were performed only in 25.7% of the visits, and, considering overall management, ET patients needed fewer global treatment changes. Telephone contact effectiveness reached 90% and only 5.4% required a complementary in-person appointment. Although 56.2% of the cohort preferred in-person visits, 90.5% of our patients claimed to be satisfied with follow-up during the pandemic, with an 83% of positive comments. In view of our results, telemedicine has proven effective and efficient, and might continue to play a complementary role in Ph-MPN patients' follow-up.

The influence of climate change on food production and food safety.

Food security and food safety are two concepts related to food risks. The majority of studies regarding climate change and food risks are related to the security of food provision. The objective of this study was to review the current state of knowledge of the influence of climate change on food production and food safety. The literature search was carried out by specifying each area individually (crops, ranching, fishing, food safety, etc.), including the term "climate change" and other specific factors such as CO2, ozone, biotoxins, mortality, heat, etc.) The increase in carbon dioxide concentrations together with the increase in global temperatures theoretically produces greater yields in crops destined for human and animal consumption. However, the majority of studies have shown that crop yields are decreasing, due to the increase in the frequency of extreme weather events. Furthermore, these climate anomalies are irregularly distributed, with a greater impact on developing countries that have a lower capacity to address climate change. All of these factors result in greater uncertainty in terms of food provision and market speculation. An increase in average temperatures could lead to an increased risk of proliferation of micro-organisms that produce food-borne illnesses, such as salmonella and campylobacter. However, in developed countries with information systems that document the occurrence of these diseases over time, no clear trend has been determined, in part because of extensive food conservation controls.

Lethal and sublethal effects of thermal stress on octocorals early life-history stages.

The frequency and severity of marine heatwaves causing mass mortality events in tropical and temperate coral species increases every year, with serious consequences on the stability and resilience of coral populations. Although recovery and persistence of coral populations after stress events is closely related to adult fitness, as well as larval survival and settlement, much remains unknown about the effects of thermal stress on early life-history stages of temperate coral species. In the present study, the reproductive phenology and the effect of increased water temperature (+4°C and +6°C above ambient, 20°C) on larval survival and settlement was evaluated for two of the most representative Mediterranean octocoral species (Eunicella singularis and Corallium rubrum). Our study shows that reproductive behavior is more variable than previously reported and breeding period occurs over a longer period in both species. Thermal stress did not affect the survival of symbiotic E. singularis larvae but drastically reduced the survival of the non-symbiotic C. rubrum larvae. Results on larval biomass and caloric consumption suggest that higher mortality rates of C. rubrum exposed to increased temperature were not related to depletion of endogenous energy in larvae. The results also show that settlement rates of E. singularis did not change in response to elevated temperature after 20 days of exposure, but larvae may settle fast and close to their native population at 26°C (+6°C). Although previous experimental studies found that adult colonies of both octocoral species are mostly resistant to thermal stress, our results on early life-history stages suggest that the persistence and inter-connectivity of local populations may be severely compromised under continued trends in ocean warming.

Marine heatwaves drive recurrent mass mortalities in the Mediterranean Sea.

Climate change is causing an increase in the frequency and intensity of marine heatwaves (MHWs) and mass mortality events (MMEs) of marine organisms are one of their main ecological impacts. Here, we show that during the 2015-2019 period, the Mediterranean Sea has experienced exceptional thermal conditions resulting in the onset of five consecutive years of widespread MMEs across the basin. These MMEs affected thousands of kilometers of coastline from the surface to 45 m, across a range of marine habitats and taxa (50 taxa across 8 phyla). Significant relationships were found between the incidence of MMEs and the heat exposure associated with MHWs observed both at the surface and across depths. Our findings reveal that the Mediterranean Sea is experiencing an acceleration of the ecological impacts of MHWs which poses an unprecedented threat to its ecosystems' health and functioning. Overall, we show that increasing the resolution of empirical observation is critical to enhancing our ability to more effectively understand and manage the consequences of climate change.

Climate change transforms the functional identity of Mediterranean coralligenous assemblages.

Quantifying changes in functional community structure driven by disturbance is critical to anticipate potential shifts in ecosystem functioning. However, how marine heatwaves (MHWs) affect the functional structure of temperate coral-dominated communities is poorly understood. Here, we used five long-term (> 10 years) records of Mediterranean coralligenous assemblages in a multi-taxa, trait-based analysis to investigate MHW-driven changes in functional structure. We show that, despite stability in functional richness (i.e. the range of species functional traits), MHW-impacted assemblages experienced long-term directional changes in functional identity (i.e. their dominant trait values). Declining traits included large sizes, long lifespans, arborescent morphologies, filter-feeding strategies or calcified skeletons. These traits, which were mostly supported by few sensitive and irreplaceable species from a single functional group (habitat-forming octocorals), disproportionally influence certain ecosystem functions (e.g. 3D-habitat provision). Hence, MHWs are leading to assemblages that are deficient in key functional traits, with likely consequences for the ecosystem functioning.

Does exposure to noise pollution influence the incidence and severity of COVID-19?

Research that analyzes the effect of different environmental factors on the impact of COVID-19 focus primarily on meteorological variables such as humidity and temperature or on air pollution variables. However, noise pollution is also a relevant environmental factor that contributes to the worsening of chronic cardiovascular diseases and even diabetes. This study analyzes the role of short-term noise pollution levels on the incidence and severity of cases of COVID-19 in Madrid from February 1 to May 31, 2020. The following variables were used in the study: daily noise levels averaged over 14 days; daily incidence rates, average cumulative incidence over 14 days; hospital admissions, Intensive Care Unit (ICU) admissions and mortality due to COVID-19. We controlled for the effect of the pollutants PM10 and NO2 as well as for variables related to seasonality and autoregressive nature. GLM models with Poisson regressions were carried out using significant variable selection (p < 0.05) to calculate attributable RR. The results of the modeling using a single variable show that the levels of noise (leq24 h) were related to the incidence rate, the rate of hospital admissions, the ICU admissions and the rate of average cumulative incidence over 14 days. These associations presented lags, and the first association was with incidence (lag 7 and lag 10), then with hospital admissions (lag 17) and finally ICU admissions (lag 22). There was no association with deaths due to COVID-19. In the results of the models that included PM10, NO2, Leq24 h and the control variables simultaneously, we observed that only Leq24 h went on to become a part of the models using COVID-19 variables, including the 14-day average cumulative incidence. These results show that noise pollution is an important environmental variable that is relevant in relation to the incidence and severity of COVID-19 in the Province of Madrid.

The effect of alignment on the rate-dependent behavior of a main-chain liquid crystal elastomer.

This study investigated the effect of alignment on the rate-dependent behavior of a main-chain liquid crystal elastomer (LCE). Polydomain nematic LCE networks were synthesized from a thiol-acrylate Michael addition reaction in the isotropic state. The polydomain networks were stretched to different strain levels to induce alignment then crosslinked in a second stage photopolymerization process. The LCE networks were subjected to dynamic mechanical tests to measure the temperature-dependent storage modulus and uniaxial tension load-unload tests to measure the rate-dependence of the Young's modulus, mechanical dissipation, and characteristics of the soft stress response. Three-dimensional (3D) digital image correlation (DIC) was used to characterize the effect of domain/mesogen relaxation on the strain fields. All LCE networks exhibited a highly rate-dependent stress response with significant inelastic strains after unloading. The Young's modulus of the loading curve and hysteresis of the load-unload curves showed a power-law dependence on the strain rate. The Young's modulus increased with alignment and larger anisotropy and a smaller power-law exponent was measured for the Young's modulus and hysteresis for the highly aligned monodomains. The polydomain and pre-stretched networks loaded perpendicular to the alignment direction exhibited a soft stress response that featured a rate-dependent peak stress, strain-softening, and strain-stiffening. The 3D-DIC strain fields for the polydomain network and programmed networks stretched in the perpendicular direction were highly heterogeneous, showing regions of alternating higher and lower strains. The strain variations increased initially with loading, peaked during the strain softening part of the stress response, then decreased during the strain stiffening part of the stress response. Greater variability was measured for lower strain rates. These observations suggest that local domain/mesogen relaxation led to the development of the heterogeneous strain patterns and strain softening in stress response. These findings improved understanding of the kinetics of mesogen relaxation and its contributions to the rate-dependent stress response and mechanical dissipation.

Direct assessment of health impacts on hospital admission from traffic intensity in Madrid.

In this paper we establish the attributable risk on respiratory and cardiovascular disorders related to traffic intensity in Madrid. In contrast to previous related studies, the proposed approach directly associates road traffic counts to patient emergency admission rates instead of using primary air pollutants. By applying Shapley values over gradient boosting machines, a first selection step is performed among all traffic observation points based on their influence on patient emergency admissions at Gregorio Marañon hospital. A subsequent quantification of the relative risk associated to traffic intensity of the selected point is calculated via ARIMA and log-linear Poisson regression models. The results obtained show that 13% of respiratory cases are related to traffic intensity while, in the case of cardiovascular disorders, the percentage increases to 39%.

Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation.

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are "win-win situation" from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.

Impact of air pollution on low birth weight in Spain: An approach to a National Level Study.

BACKGROUND: According to the WHO, low birth weight (<2500 gr) is a primary maternal health indicator as the cause of multiple morbi-mortality in the short and long-term. It is known that air pollution from road traffic (PM10, NO2) and O3 have an important impact on low birth weight (LBW), but there are few studies of this topic in Spain. The objective of this study is to determine the possible exposure windows in the gestational period in which there is greater susceptibility to urban air pollution and to quantify the relative risks (RR) and population attributable risks (PAR) of low birth weight associated with pollutant concentrations in Spain. METHODS: We calculated the weekly average births with low birth weight (ICD-10: P07.0-P07.1) for each Spanish province for the period 2001-2009, using the average weekly concentrations of PM10, NO2 and O3, measured in the capital cities of the provinces. The estimation of RR and PAR were carried out using generalized linear models with link Poisson, controlling for the trend, seasonality and auto-regressive character of the series and for the influence of temperature during periods of heat waves and/or cold. Finally, a meta-analysis was used to estimate the global RR and PAR based on the RR obtained for each of the provinces. RESULTS: The RR for the whole of Spain is 1.104 (CI95%: 1.072, 1.138) for the association between LBW and PM10, and 1.091 (CI95%: 1.059, 1.124) for the association between NO2 and LBW. Our results suggest that 5% of low birth weight births in the case of PM10 and 8% in the case of NO2 could have been avoided with a reduction of 10 µg/m3 in the concentrations of these pollutants. CONCLUSIONS: The impact of the results obtained- with 6105 cases attributable to PM10 and up to 9385 cases attributable to NO2 in a period of 9 study years- suggest the need to design structural and awareness public health measures to reduce air pollution in Spain.

Heat-health action plans in Europe: Challenges ahead and how to tackle them.

High temperatures have periodically affected large areas in Europe and urban settings. In particular, the deadly 2003 summer heat waves precipitated a multitude of national and subnational health prevention and research efforts. Building on these and other international experiences the WHO Regional Office for Europe developed and published in 2008 a comprehensive framework for prevention, the heat-health action plans (HHAPs). This provided a blueprint used by several national and subnational authorities to design their prevention efforts. A decade after the publication of the WHO guidance, a wealth of new evidence and acquired implementation experience has emerged around HHAP effectiveness; heat exposure; acclimatization and adaptation; heat-health governance and stakeholder involvement; and the role of urban design and greening interventions in prevention. This evidence and experience can guide the strategies to tackle current and upcoming challenges in protecting health from heat under a warming climate.

System dynamics for predicting the impact of traffic noise on cardiovascular mortality in Madrid.

The impact of road traffic noise on health is an important issue worldwide. In Madrid (Spain), the existing high daily noise levels all year round have been associated with short-term cardiovascular mortality. A system dynamics model is constructed to estimate the evolution of the traffic noise impact on the population older than 65 in Madrid over the upcoming years. This strategy allows to make predictions based on yearly variations in traffic intensity, population at risk, motor vehicle-related technological advances and lifestyles, and urban planning policies. Madrid harbours a persisting noise epidemic since 1980, which would be eradicated in 2040 at the earliest if significant action for noise abatement were taken.

Cold-related mortality vs heat-related mortality in a changing climate: A case study in Vilnius (Lithuania).

INTRODUCTION: Direct health effects of extreme temperatures are a significant environmental health problem in Lithuania, and could worsen further under climate change. This paper attempts to describe the change in environmental temperature conditions that the urban population of Vilnius could experience under climate change, and the effects such change could have on excess heat-related and cold-related mortality in two future periods within the 21st century. METHODS: We modelled the urban climate of Vilnius for the summer and winter seasons during a sample period (2009-2015) and projected summertime and wintertime daily temperatures for two prospective periods, one in the near (2030-2045) and one in the far future (2085-2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the historical relationship between temperature and mortality for the period 2009-2015, and estimated the projected mortality in the near future and far future periods under a changing climate and population, assuming alternatively no acclimatisation and acclimatisation to heat and cold based on a constant-percentile threshold temperature. RESULTS: During the sample period 2009-2015 in summertime we observed an increase in daily mortality from a maximum daily temperature of 30 °C (the 96th percentile of the series), with an average of around 7 deaths per year. Under a no acclimatisation scenario, annual average heat-related mortality would rise to 24 deaths/year (95% CI: 8.4-38.4) in the near future and to 46 deaths/year (95% CI: 16.4-74.4) in the far future. Under a heat acclimatisation scenario, mortality would not increase significantly in the near or in the far future. Regarding wintertime cold-related mortality in the sample period 2009-2015, we observed increased mortality on days on which the minimum daily temperature fell below - 12 °C (the 7th percentile of the series), with an average of around 10 deaths a year. Keeping the threshold temperature constant, annual average cold-related mortality would decrease markedly in the near future, to 5 deaths/year (95% CI: 0.8-7.9) and even more in the far future, down to 0.44 deaths/year (95% C: 0.1-0.8). Assuming a "middle ground" between the acclimatisation and non-acclimatisation scenarios, the decrease in cold-related mortality will not compensate the increase in heat-related mortality. CONCLUSION: Thermal extremes, both heat and cold, constitute a serious public health threat in Vilnius, and in a changing climate the decrease in mortality attributable to cold will not compensate for the increase in mortality attributable to heat. Study results reinforce the notion that public health prevention against thermal extremes should be designed as a dynamic, adaptive process from the inception.

Effects of noise on telephone calls to the Madrid Regional Medical Emergency Service (SUMMA 112).

BACKGROUND: Although the effects of noise on population morbidity and mortality have been observed both in the short and long term, the morbidity and mortality indicators used to date have not enabled information on such health effects to be accessed in real time. At an international level, there are relatively few studies, mostly recent, which have considered an alternative indicator, such as the demand for medical attention provided by emergency services, taking into account environmental factors other than noise. OBJECTIVES: To ascertain the short-term effect of road-traffic noise levels on medical care, broken down by organic, circulatory and respiratory causes, provided by the Madrid Regional Medical Emergency Service (Servicio de Urgencia Médica de Madrid/SUMMA 112). METHODS: We used an ecological time-series study and fitted Poisson regression models, to analyse the number of daily, cause-specific episodes of care provided in situ by SUMMA 112, via emergency ambulance dispatches, across the period 01/01/2008-31/12/2009. To this end, we considered diurnal (Leqd: 7-23h), nocturnal (Leqn: 23-7h) and daily (Leq24: 24h) noise (in db(A)) as the principal factor, and chemical air pollution (µg/m3) and temperature (°C) as the control variables. We also controlled for trend and seasonalities, the autoregressive nature of the series, and day of the week. RESULTS: Nocturnal noise exceeded the WHO threshold (55 db(A)) on 100% of nights, despite displaying a downward trend across the study period. For all causes, with the exception of emergency calls due to ischaemic disease, it was nocturnal rather than diurnal noise levels that had a short-term effect (lags 0-1) on SUMMA 112 calls, with this impact being greater for respiratory than for circulatory causes. Hence, for every increase of 1db in Leqn, the relative risks (RRs) were as follows: 1.11 (95% CI 1.09-1.13) for organic causes; 1.14 (95% CI: 1.11-1.18) for respiratory causes; and 1.08 (95% CI: 1.05-1.10) for circulatory causes. CONCLUSION: SUMMA 112 data give access to real-time information on the health effects associated with increases in noise levels, which cannot be obtained via mortality or hospital-admission data, since these are collected in the longer term. Accordingly, this is something that would be immediately applicable in any future implementation of a syndromic surveillance system focusing on the effects of environmental pollutants on health.

Saharan dust intrusions in Spain: Health impacts and associated synoptic conditions.

BACKGROUND: A lot of papers have been published about the impact on mortality of Sahara dust intrusions in individual cities. However, there is a lack of studies that analyse the impact on a country and scarcer if in addition the analysis takes into account the meteorological conditions that favour these intrusions. OBJECTIVES: The main aim is to examine the effect of Saharan dust intrusions on daily mortality in different Spanish regions and to characterize the large-scale atmospheric circulation anomalies associated with such dust intrusions. METHODS: For determination of days with Saharan dust intrusions, we used information supplied by the Ministry of Agriculture, Food & Environment, it divides Spain into 9 main areas. In each of these regions, a representative province was selected. A time series analysis has been performed to analyse the relationship between daily mortality and PM10 levels in the period from 01.01.04 to 31.12.09, using Poisson regression and stratifying the analysis by the presence or absence of Saharan dust advections. RESULTS: The proportion of days on which there are Saharan dust intrusions rises to 30% of days. The synoptic pattern is characterised by an anticyclonic ridge extending from northern Africa to the Iberian Peninsula. Particulate matter (PM) on days with intrusions are associated with daily mortality, something that does not occur on days without intrusions, indicating that Saharan dust may be a risk factor for daily mortality. In other cases, what Saharan dust intrusions do is to change the PM-related mortality behaviour pattern, going from PM2.5. CONCLUSIONS: A study such as the one conducted here, in which meteorological analysis of synoptic situations which favour Saharan dust intrusions, is combined with the effect on health at a city level, would seem to be crucial when it comes to analysing the differentiated mortality pattern in situations of Saharan dust intrusions.

Association of Streptococcus gallolyticus subspecies gallolyticus with colorectal cancer: Serological evidence.

The colonic opportunist Streptococcus gallolyticus subspecies gallolyticus (SGG) is potentially associated with colorectal cancer (CRC). Large-scale seroepidemiological data for SGG antibodies and their possible association with CRC is currently missing. Associations between CRC and antibody responses to SGG were examined in 576 CRC cases and 576 controls matched by sex, age and province from a population-based multicase-control project (MCC-Spain). MCC-Spain was conducted between 2008 and 2013 in 12 Spanish provinces. Antibody responses to recombinant affinity-purified SGG pilus proteins Gallo1569, 2039, 2178 and 2179 were analysed by multiplex serology. Polyomavirus (PyV) JC VP1 and PyV 6 VP1 proteins served as disease-specificity controls. In the control population, antibody responses to pilus proteins were mostly weak. Antibody responses to individual pilus proteins Gallo2039 (OR: 1.58, 95% CI: 1.09-2.28), Gallo2178 (OR: 1.58, 95% CI: 1.09-2.30) and Gallo2179 (OR: 1.45, 95% CI: 1.00-2.11) were significantly associated with CRC risk. The association was stronger for positivity to two or more pilus proteins of Gallo1569, Gallo2178 and Gallo2179 (OR:1.93, 95% CI: 1.04-3.56) and for double-positivity to Gallo2178 and Gallo2179 (OR: 3.54, 95% CI: 1.49-8.44). The association between SGG infection and CRC risk was stronger among individuals younger than 65 years. For the first time we demonstrated a statistically significant association of exposure to SGG antigens and CRC in a large seroepidemiological study. These results should stimulate further studies on the role of SGG in CRC pathogenesis.