Comparison for the effects of different components of temperature variability on mortality: A multi-country time-series study.

BACKGROUND: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. OBJECTIVES: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality. METHODS: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates. RESULTS: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0-7 (0.9 °C). An IQR increase in inter-day TV0-7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0-7 and inter-day TV0-7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type. CONCLUSIONS: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.

Climate change integration in nursing education: A scoping review.

BACKGROUND: The environmental impacts of climate change such as extreme weather, affects human physical and mental health; therefore, including climate change and health is important in nursing education. Despite the recognition of the link between climate change and health, this important knowledge has not yet been systematically integrated into nursing curricula, highlighting the need for immediate action to prepare nurses for these emerging human health challenges. OBJECTIVES: The objective of this review was to gain an overview of the existing literature exploring climate change in nursing curricula and answer following questions: DESIGN: Scoping review. METHODS: A protocol was created and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-SrC). Five data bases were searched: CINAHL, Academic Search Premier, PubMed, Scopus and Cochraine, in addition to databases, grey literature was searched from different sources (reference lists, Google). A total of 1055 articles were derived from the search and 47 articles were included in this review. After selection results from selected studies on educational interventions and climate change education, and opinion pieces were charted, followed by a team review and consensus on the findings. CONCLUSION: This review shows the importance of integrating the topic of climate change into nursing curricula. This integration of climate change-related content into nursing curricula is essential for preparing students, not just for their future roles in healthcare, but also their role in policy and climate justice. These results also reflect strong support from students for that integration. But while progress has been made, further research is essential to evaluate the impacts of these teaching strategies on nursing education.

Prenatal and early life exposure to air pollution and the risk of severe lower respiratory tract infections during early childhood: the Espoo Cohort Study.

BACKGROUND: There is inconsistent evidence of the effects of exposure to ambient air pollution on the occurrence of lower respiratory tract infections (LRTIs) in early childhood. We assessed the effects of individual-level prenatal and early life exposure to air pollutants on the risk of LRTIs in early life. METHODS: We studied 2568 members of the population-based Espoo Cohort Study born between 1984 and 1990 and living in 1991 in the City of Espoo, Finland. Exposure assessment was based on dispersion modelling and land-use regression for lifetime residential addresses. The outcome was a LRTI based on data from hospital registers. We applied Poisson regression to estimate the incidence rate ratio (IRR) of LTRIs, contrasting incidence rates in the exposure quartiles to the incidence rates in the first quartile. We used weighted quantile sum (WQS) regression to estimate the joint effect of the studied air pollutants. RESULTS: The risk of LRTIs during the first 2 years of life was significantly related to exposure to individual and multiple air pollutants, measured with the Multipollutant Index (MPI), including primarily sulphur dioxide (SO2), particulate matter with a dry diameter of up to 2.5 µm (PM2.5) and nitrogen dioxide (NO2) exposures in the first year of life, with an adjusted IRR of 1.72 per unit increase in MPI (95% CI 1.20 to 2.47). LRTIs were not related to prenatal exposure. CONCLUSIONS: We provide evidence that ambient air pollution exposure during the first year of life increases the risk of LRTIs during the first 2 years of life. SO2, PM2.5 and NO2 were found to contribute the highest weights on health effects.

Residential greenness during pregnancy and early life and development of asthma up to 27 years of age: The Espoo Cohort Study.

Previous studies have suggested that living close to green spaces has protective health effects, but potential effects on asthma are contradictory. We investigated the association between the amount of greenness in the residential area during pregnancy and early life and development of asthma in the first 27 years of life. The study population included all 2568 members of the Espoo Cohort Study, Finland. We calculated individual-level exposure to green space measured as cumulative Normalized Difference Vegetation Index (cumNDVI in unit-months) within 300 m of the participant's residence during pregnancy and the first two years of life in both spring and summer seasons. The onset of asthma was assessed using information from the baseline and follow-up surveys. Exposure to residential greenness in the spring season during pregnancy was associated with an increased risk of asthma up to 6 years of age, with an adjusted hazard ratio (aHR) of 3.72 (95% confidence interval (CI): 1.11, 12.47) per 1 unit increase in cumNDVI. Increased greenness in the summer during pregnancy associated with asthma up to 6 years, with an aHR of 1.41 (95% CI: 0.85, 2.32). The effect was found to be related to increased greenness particularly during the third trimester of pregnancy, with an aHR of 2.37 (95% CI: 1.36, 4.14) per 1 unit increase of cumNDVI. These associations were weaker at the ages of 12 and 27 years. No association was found between NDVI in the first two years of life and the development of asthma. Our findings provide novel evidence that exposure to greenness during pregnancy increases the risk of developing asthma. The adverse effects were strongest for the prenatal greenness in the spring season and in the third trimester of pregnancy. Both the season and trimester of exposure to greenness are critical in the development of asthma.

Seasonality of mortality under climate change: a multicountry projection study.

BACKGROUND: Climate change can directly impact temperature-related excess deaths and might subsequently change the seasonal variation in mortality. In this study, we aimed to provide a systematic and comprehensive assessment of potential future changes in the seasonal variation, or seasonality, of mortality across different climate zones. METHODS: In this modelling study, we collected daily time series of mean temperature and mortality (all causes or non-external causes only) via the Multi-Country Multi-City Collaborative (MCC) Research Network. These data were collected during overlapping periods, spanning from Jan 1, 1969 to Dec 31, 2020. We projected daily mortality from Jan 1, 2000 to Dec 31, 2099, under four climate change scenarios corresponding to increasing emissions (Shared Socioeconomic Pathways [SSP] scenarios SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). We compared the seasonality in projected mortality between decades by its shape, timings (the day-of-year) of minimum (trough) and maximum (peak) mortality, and sizes (peak-to-trough ratio and attributable fraction). Attributable fraction was used to measure the burden of seasonality of mortality. The results were summarised by climate zones. FINDINGS: The MCC dataset included 126 809 537 deaths from 707 locations within 43 countries or areas. After excluding the only two polar locations (both high-altitude locations in Peru) from climatic zone assessments, we analysed 126 766 164 deaths in 705 locations aggregated in four climate zones (tropical, arid, temperate, and continental). From the 2000s to the 2090s, our projections showed an increase in mortality during the warm seasons and a decrease in mortality during the cold seasons, albeit with mortality remaining high during the cold seasons, under all four SSP scenarios in the arid, temperate, and continental zones. The magnitude of this changing pattern was more pronounced under the high-emission scenarios (SSP3-7.0 and SSP5-8.5), substantially altering the shape of seasonality of mortality and, under the highest emission scenario (SSP5-8.5), shifting the mortality peak from cold seasons to warm seasons in arid, temperate, and continental zones, and increasing the size of seasonality in all zones except the arid zone by the end of the century. In the 2090s compared with the 2000s, the change in peak-to-trough ratio (relative scale) ranged from 0·96 to 1·11, and the change in attributable fraction ranged from 0·002% to 0·06% under the SSP5-8.5 (highest emission) scenario. INTERPRETATION: A warming climate can substantially change the seasonality of mortality in the future. Our projections suggest that health-care systems should consider preparing for a potentially increased demand during warm seasons and sustained high demand during cold seasons, particularly in regions characterised by arid, temperate, and continental climates. FUNDING: The Environment Research and Technology Development Fund of the Environmental Restoration and Conservation Agency, provided by the Ministry of the Environment of Japan.

Dietary Polycyclic Aromatic Hydrocarbon (PAH) Consumption and Risk of Adverse Birth Outcomes: A Systematic Review and Meta-Analysis.

BACKGROUND: There is suggestive epidemiological evidence that maternal dietary polycyclic aromatic hydrocarbons (PAH) may increase the risk of adverse birth outcomes. We sought to summarize the available evidence on the effect of dietary PAH exposure on birth outcomes. METHODS: PubMed and Scopus databases were systematically searched from inception up to November 2022. Studies were included if they were original articles, were conducted in a human population, assessed dietary PAH consumption, and investigated the relationship between dietary PAH consumption and any adverse birth outcomes. Risk of bias in the included studies was assessed qualitatively and quantitatively. A random effects model was used to compute summary effect estimates in the meta-analysis. RESULTS: Six observational studies (five prospective cohort studies, and one prevalence case-control study) were included. The included studies assessed dietary PAH exposure using dietary questionnaires. Information on the outcomes of interest was obtained from medical records. Three of the included studies were rated as good quality with the remaining three studies rated as fair quality. One study was considered as having low risk of bias for selection, information and confounding bias. Dietary PAH consumption was associated with 5.65g [95% confidence interval (CI): -16.36, 5.06] and 0.04cm (95% CI: -0.08, 0.01) reductions in birth weight and birth length, respectively, and an increase in head circumference [effect size (ES)=0.001; 95% CI: -0.003, 0.005]. The CI of all the summary effect estimates, however, included the null value. In the sensitivity analysis that included only studies that assessed dietary PAH exposure as the primary exposure of interest, dietary PAH consumption was associated with much higher reductions in birth weight (ES=-14.61; 95% CI: -21.07, -8.15) and birth length (ES=-0.06; 95% CI: -0.1, -0.03). High statistical heterogeneity was observed in the birth weight and birth length analysis and in the head circumference sensitivity analysis. DISCUSSION: The body of epidemiological evidence suggests that maternal dietary PAH exposure is associated with reduced fetal growth, measured as birth weight and length. There was considerable heterogeneity in the measurement of PAH exposure among the included studies. Also, nonstandardized and validated dietary questionnaires were employed by a majority of the included studies with potential exposure misclassification. These issues are likely to impact the summary effect estimates computed and underscores the need for high-quality epidemiological studies with improved exposure assessment and adequate confounding control to strengthen the evidence base. https://doi.org/10.1289/EHP12922.

Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients.

Background: A cold environment and exercise separately affect the autonomic nervous system (ANS), baroreflex sensitivity (BRS), and blood pressure variability (BPV) but their combined effects on post-exercise recovery are not known. Our cross-over trial examined these responses following upper-body static and dynamic exercise performed in a cold and neutral environment in patients with coronary artery disease (CAD). Methods: 20 patients with stable coronary artery disease performed both graded static (10%-30% of maximal voluntary contraction) and dynamic (light, moderate and high perceived intensity) upper-body exercise at -15°C and +22°C for 30 min. Electrocardiogram and continuous blood pressure were measured to compute post-exercise (10 and 30 min after exercise) spectral powers of heart rate (HR), blood pressure variability and BRS at low (0.04-0.15 Hz) and high (0.15-0.4 Hz) frequencies. Results: Static upper-body exercise performed in a cold environment increased post-exercise high frequency (HF) spectral power of heart rate (HF RR) (p < 0.001) and reduced heart rate (p = 0.001) and low-to-high frequency (LF/HF) ratio (p = 0.006) more than in a neutral environment. In addition, post-exercise mean BRS (p = 0.015) and high frequency BRS (p = 0.041) increased more following static exercise in the cold than in a neutral environment. Dynamic upper-body exercise performed in a cold environment reduced post-exercise HF BRS (p = 0.019) and systolic blood pressure (p = 0.003). Conclusion: Static upper-body exercise in the cold increased post-exercise BRS and overall vagal activity but without reduced systolic blood pressure. Dynamic upper-body exercise in the cold reduced post-exercise vagal BRS but did not affect the other parameters. The influence of cold exposure on post-exercise autonomic and cardiovascular responses following static upper-body exercise require further studies. This information helps understanding why persons with cardiovascular diseases are vulnerable to low environmental temperature. ClinicalTrials.gov: NCT02855905 (04/08/2016).

Joint effect of heat and air pollution on mortality in 620 cities of 36 countries.

BACKGROUND: The epidemiological evidence on the interaction between heat and ambient air pollution on mortality is still inconsistent. OBJECTIVES: To investigate the interaction between heat and ambient air pollution on daily mortality in a large dataset of 620 cities from 36 countries. METHODS: We used daily data on all-cause mortality, air temperature, particulate matter ≤ 10 µm (PM10), PM ≤ 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) from 620 cities in 36 countries in the period 1995-2020. We restricted the analysis to the six consecutive warmest months in each city. City-specific data were analysed with over-dispersed Poisson regression models, followed by a multilevel random-effects meta-analysis. The joint association between air temperature and air pollutants was modelled with product terms between non-linear functions for air temperature and linear functions for air pollutants. RESULTS: We analyzed 22,630,598 deaths. An increase in mean temperature from the 75th to the 99th percentile of city-specific distributions was associated with an average 8.9 % (95 % confidence interval: 7.1 %, 10.7 %) mortality increment, ranging between 5.3 % (3.8 %, 6.9 %) and 12.8 % (8.7 %, 17.0 %), when daily PM10 was equal to 10 or 90 µg/m3, respectively. Corresponding estimates when daily O3 concentrations were 40 or 160 µg/m3 were 2.9 % (1.1 %, 4.7 %) and 12.5 % (6.9 %, 18.5 %), respectively. Similarly, a 10 µg/m3 increment in PM10 was associated with a 0.54 % (0.10 %, 0.98 %) and 1.21 % (0.69 %, 1.72 %) increase in mortality when daily air temperature was set to the 1st and 99th city-specific percentiles, respectively. Corresponding mortality estimate for O3 across these temperature percentiles were 0.00 % (-0.44 %, 0.44 %) and 0.53 % (0.38 %, 0.68 %). Similar effect modification results, although slightly weaker, were found for PM2.5 and NO2. CONCLUSIONS: Suggestive evidence of effect modification between air temperature and air pollutants on mortality during the warm period was found in a global dataset of 620 cities.

Effect of cold winters on the risk of new asthma: a case-crossover study in Finland.

BACKGROUND: Cold weather increases respiratory symptoms and provokes exacerbations of asthma, but there are no previous studies on its role in the aetiology of asthma. OBJECTIVE: We tested the hypothesis that a cold winter increases the risk of developing asthma during the following 1 to 2 years. METHODS: We conducted a case-crossover study of 315 newly diagnosed cases of asthma from the population-based Espoo Cohort Study from birth to the age of 27 years. The hazard period constituted 3 winter months preceding the onset of asthma and bidirectional reference periods of 1 year before hazard period and 1 year after onset of asthma. Exposure constituted average ambient temperature during the winter months of December, January and February. The outcome of interest was new doctor-diagnosed asthma. The measure of effect was OR of asthma estimated by conditional logistic regression analysis. RESULTS: The average winter temperature for the study period from winter 1983 to 2010 was -4.4°C (range -10.7 to 0.4). A 1°C decrease in the average winter temperature predicted a 7% increase in the risk of new asthma (OR=1.07, 95% CI 1.02 to 1.13). A cold winter with an average temperature below the climate normal value (-4.5°C; period 1981-2010) increased the risk of new asthma by 41% during the following year (OR: 1.41; 95% CI 1.04 to 1.90). CONCLUSIONS: This case-crossover study provides original evidence that a cold winter with below normal average temperatures increases the risk of developing new asthma during the following 1 to 2 years.

Associations of residential greenness and ambient air pollution with overweight and obesity in older adults.

OBJECTIVE: This study aimed to examine the impact of greenness and fine particulate matter <2.5 µm (PM2.5 ) on overweight/obesity among older adults in China. METHODS: A total of 21,355 participants aged ≥65 years were included from the Chinese Longitudinal Healthy Longevity Survey between 2000 and 2018. Normalized difference vegetation index (NDVI) with a radius of 250 m and PM2.5 in a 1 × 1-km grid resolution were calculated around each participant's residence. Cox proportional hazards models were used to estimate the effects of NDVI and PM2.5 on overweight/obesity. Interaction and mediation analyses were conducted to explore combined effects. RESULTS: The study observed 1895 incident cases of overweight/obesity over 109,566 person-years. For every 0.1-unit increase in NDVI the hazard ratio of overweight/obesity was 0.91 (95% CI: 0.88-0.95), and for every 10-µg/m3 increase in PM2.5 the hazard ratio was 1.11 (95% CI: 1.07-1.14). The effect of NDVI on overweight/obesity was partially mediated by PM2.5 , with a relative mediation proportion of 20.10% (95% CI: 1.63%-38.57%). CONCLUSIONS: Greenness exposure appears to lower the risk of overweight/obesity in older adults in China, whereas PM2.5 , acting as a mediator, partly mediated this protective effect.

Occupation and occurrence of respiratory infections among adults with newly diagnosed asthma.

BACKGROUND: Work environments are potential areas for spreading respiratory infections. We hypothesized that certain occupations increase susceptibility to respiratory infections among adults with asthma. Our objective was to compare the occurrence of respiratory infections among different occupations in adults with newly diagnosed asthma. METHODS: We analysed a study population of 492 working-age adults with newly diagnosed asthma who were living in the geographically defined Pirkanmaa Area in Southern Finland during a population-based Finnish Environment and Asthma Study (FEAS). The determinant of interest was occupation at the time of diagnosis of asthma. We assessed potential relations between occupation and occurrence of both upper and lower respiratory tract infections during the past 12 months. The measures of effect were incidence rate ratio (IRR) and risk ratio (RR) adjusted for age, gender, and smoking habits. Professionals, clerks, and administrative personnel formed the reference group. RESULTS: The mean number of common colds in the study population was 1.85 (95% CI 1.70, 2.00) infections in the last 12 months. The following occupational groups showed increased risk of common colds: forestry and related workers (aIRR 2.20, 95% CI 1.15-4.23) and construction and mining (aIRR 1.67, 95% CI 1.14-2.44). The risk of lower respiratory tract infections was increased in the following groups: glass, ceramic, and mineral workers (aRR 3.82, 95% CI 2.54-5.74), fur and leather workers (aRR 2.06, 95% CI 1.01-4.20) and metal workers (aRR 1.80, 95% CI 1.04-3.10). CONCLUSIONS: We provide evidence that the occurrence of respiratory infections is related to certain occupations.

Effects of occupational exposures on respiratory health in steel factory workers.

Background: The steel factory work environment contains various chemical exposures that can affect indoor air quality and have impact on respiratory health of the workers. Aims: The objective of this study was to assess potential effects of occupational exposures in steel factory workers in Iran on the respiratory symptoms, occurrence and the lung function levels. Method: This was a cross-sectional study of 133 men working in a steel factory forming the exposed group and 133 male office workers forming the reference group from a steel company in Iran. The participants filled in a questionnaire and underwent spirometry. Work history was used both as dichotomous (exposed/reference) and a quantitative measure of exposure, the latter measured as duration of exposure in the specified work (in years) for the exposed group and zero for the reference group. Results: Multiple linear regression and Poisson regression were used to adjust for confounding. In Poisson regression analyses, an increased prevalence ratio (PR) of all respiratory symptoms was observed in the exposed group. Lung function parameters were significantly reduced in the exposed group (p < 0.001). There was a dose-response relation between duration of occupational exposures and reduction in the predicted value of FEV1/FVC level (0.177, 95% CI -0.198 to -0.156) in all models. Conclusion: The results of these analyses showed that occupational exposures in steel factory work increase the prevalence of respiratory symptoms and reduce lung function. Safety training and workplace conditions were found to need improvement. In addition, use of proper personal protective equipment is recommended.

Heat-related cardiorespiratory mortality: Effect modification by air pollution across 482 cities from 24 countries.

BACKGROUND: Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations. OBJECTIVES: We investigated the effects of heat on cardiovascular and respiratory mortality and its modification by air pollution during summer months (six consecutive hottest months) in 482 locations across 24 countries. METHODS: Location-specific daily death counts and exposure data (e.g., particulate matter with diameters ≤ 2.5 µm [PM2.5]) were obtained from 2000 to 2018. We used location-specific confounder-adjusted Quasi-Poisson regression with a tensor product between air temperature and the air pollutant. We extracted heat effects at low, medium, and high levels of pollutants, defined as the 5th, 50th, and 95th percentile of the location-specific pollutant concentrations. Country-specific and overall estimates were derived using a random-effects multilevel meta-analytical model. RESULTS: Heat was associated with increased cardiorespiratory mortality. Moreover, the heat effects were modified by elevated levels of all air pollutants in most locations, with stronger effects for respiratory than cardiovascular mortality. For example, the percent increase in respiratory mortality per increase in the 2-day average summer temperature from the 75th to the 99th percentile was 7.7% (95% Confidence Interval [CI] 7.6-7.7), 11.3% (95%CI 11.2-11.3), and 14.3% (95% CI 14.1-14.5) at low, medium, and high levels of PM2.5, respectively. Similarly, cardiovascular mortality increased by 1.6 (95%CI 1.5-1.6), 5.1 (95%CI 5.1-5.2), and 8.7 (95%CI 8.7-8.8) at low, medium, and high levels of O3, respectively. DISCUSSION: We observed considerable modification of the heat effects on cardiovascular and respiratory mortality by elevated levels of air pollutants. Therefore, mitigation measures following the new WHO Air Quality Guidelines are crucial to enhance better health and promote sustainable development.

Risk of ischemic and hemorrhagic stroke in relation to cold spells in four seasons.

BACKGROUND: Cold winter weather increases the risk of stroke, but the evidence is scarce on whether the risk increases during season-specific cold weather in the other seasons. The objective of our study was to test the hypothesis of an association between personal cold spells and different types of stroke in the season-specific context, and to formally assess effect modification by age and sex. METHODS: We conducted a case-crossover study of all 5396 confirmed 25-64 years old cases with stroke in the city of Kaunas, Lithuania, 2000-2015. We assigned to each case a one-week hazard period and 15 reference periods of the same calendar days of other study years. A personal cold day was defined for each case with a mean temperature below the fifth percentile of the frequency distribution of daily mean temperatures of the hazard and reference periods. Conditional logistic regression was applied to estimate odds ratios (OR) and 95% confidence intervals (95% CI) representing associations between time- and place-specific cold weather and stroke. RESULTS: There were positive associations between cold weather and stroke in Kaunas, with each additional cold day during the week before the stroke increases the risk by 3% (OR 1.03; 95% CI 1.00-1.07). The association was present for ischemic stroke (OR 1.05; 95% CI 1.01-1.09) but not hemorrhagic stroke (OR 0.98; 95% CI 0.91-1.06). In the summer, the risk of stroke increased by 8% (OR 1.08; 95% CI 1.00-1.16) per each additional cold day during the hazard period. Age and sex did not modify the effect. CONCLUSIONS: Our findings show that personal cold spells increase the risk of stroke, and this pertains to ischemic stroke specifically. Most importantly, cold weather in the summer season may be a previously unrecognized determinant of stroke.

Self-Assessed Threshold Temperature for Cold among Poultry Industry Workers in Thailand.

The self-assessed threshold temperature for cold in the workplace is not well known. We asked 392 chicken industry workers in Thailand what they regard as the cold threshold (CT) and compared subgroups of workers using linear and quantile regressions by CT sextiles (percentiles P17, P33, P50, P67, and P83, from warmest to coldest). The variables of interest were sex, office work, and sedentary work, with age, clothing thermal insulation, and alcohol consumption as adjustment factors. The mean CT was 14.6 °C. Office workers had a 6.8 °C higher mean CT than other workers, but the difference ranged from 3.8 °C to 10.0 °C from P17 to P83. Sedentary workers had a 2.0 °C higher mean CT than others, but the difference increased from 0.5 °C to 3.0 °C through P17-P83. The mean CT did not differ between sexes, but men had a 1.6-5.0 °C higher CT at P17-P50 (>20 °C) and a 5.0 °C lower CT at P83 (<10 °C). The CT was relatively high at warm (≥10 °C), dry (relative humidity <41%), and drafty (air velocity > 0.35 m/s) worksites. We conclude that office, sedentary, and female workers and those working at warm, dry, and draughty sites are sensitive to the coldest temperatures, whereas male workers are sensitive even to moderate temperatures.

Subtypes of Adult-Onset Asthma at the Time of Diagnosis: A Latent Class Analysis.

INTRODUCTION: Only a few previous studies have investigated the subtypes of adult-onset asthma. No previous study has assessed whether these subtypes are different between men and women, or whether these subtypes have different risk factors. METHODS: We applied latent class analyses to the Finnish Environment and Asthma Study population, including 520 new cases of adult-onset asthma. We formed subtypes separately between women and men and analyzed the following determinants as potential predictors for these subtypes: age, body mass index, smoking, and parental asthma. RESULTS: Among women, the subtypes identified were: 1. Moderate asthma, 2. Cough-variant asthma, 3. Eosinophilic asthma, 4. Allergic asthma, and 5. Difficult asthma. Among men, the subtypes were: 1. Mild asthma, 2. Moderate asthma, 3. Allergic asthma, and 4. Difficult asthma. Three of the subtypes were similar among women and men: Moderate, Allergic, and Difficult asthma. In addition, women had two distinct subtypes: Cough-variant asthma, and Eosinophilic asthma. These subtypes had different risk factor profiles, e.g., heredity was important for Eosinophilic and Allergic asthma (RR for Both parents having asthma in Eosinophilic 3.55 (1.09 to 11.62)). Furthermore, smoking increased the risk of Moderate asthma among women (RR for former smoking 2.21 (1.19 to 4.11)) and Difficult asthma among men but had little influence on Allergic or Cough-variant asthma. Conclusion: This is an original investigation of the subtypes of adult-onset asthma identified at the time of diagnosis. These subtypes differ between women and men, and these subtypes have different risk factor profiles. These findings have both clinical and public health importance for the etiology, prognosis, and treatment of adult-onset asthma.

Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries.

BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. METHODS: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. RESULTS: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1-2.3) and 9.1 (95% eCI, 8.9-9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4-2.8) and 12.8 (95% eCI, 12.2-13.1) for every 1000 heart failure deaths, respectively. CONCLUSIONS: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day-and especially under a changing climate.