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1.
Sci Rep ; 12(1): 3337, 2022 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-35228631

RESUMO

The overarching goal of this paper is to shed light on the human influence on the changing patterns of heat waves in India using the Heat Wave Magnitude Index daily (HWMId). The HWMId obtained from the observational data sets shows a large increase in the heat waves during the past decades. Investigating the effects of natural (e.g., solar variations and volcanic forcings) and anthropogenic (e.g., greenhouse gas emissions, anthropogenic, land use, and land cover) forcings revealed that the anthropogenic factors have cause a two-fold increase in the occurrence probability of severe heat waves in central and mid-southern India during twentieth century. The spatial distribution of maximum HWMId values under natural and all forcings (including anthropogenic) indicates that in most places human activities have increases the frequency, duration and intensity of extreme heat waves. Under the Representative Concentration Pathway (RCP) 4.5, the risk of heat waves is projected to increase tenfold during the twenty-first century. More than ~ 70% of the land areas in India is projected to be influenced by heat waves with magnitudes greater than 9. Furthermore, we find a significant relationship between heat waves and deficits in precipitation. Results show that concurrent heat waves and droughts are projected to increase in most places in India during the twenty-first century.


Assuntos
Calor Extremo , Temperatura Alta , Secas , Calor Extremo/efeitos adversos , Atividades Humanas , Humanos , Índia
2.
Artigo em Inglês | MEDLINE | ID: mdl-35206601

RESUMO

BACKGROUND: Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a well-established teratogen in animal studies, with a growing body of literature suggesting human pregnancies are similarly at risk. Characterization of extreme heat as a pregnancy risk is problematic due to nonstandard definitions of heat waves, and variable study designs. To better focus future research in this area, we conducted a scoping review to assess the effects of extreme heat on pregnancy outcomes. METHODS: A scoping review of epidemiological studies investigating gestational heat-exposure and published 2010 and 2020, was conducted with an emphasis on study design, gestational windows of sensitivity, adverse pregnancy outcomes and characterization of environmental temperatures. RESULTS: A sample of 84 studies was identified, predominantly set in high-income countries. Preterm birth, birthweight, congenital anomalies and stillbirth were the most common pregnancy outcome variables. Studies reported race/ethnicity and/or socioeconomic variables, however these were not always emphasized in the analysis. CONCLUSION: Use of precise temperature data by most studies avoided pitfalls of imprecise, regional definitions of heat waves, however inconsistent study design, and exposure windows are a significant challenge to systematic evaluation of this literature. Despite the high risk of extreme heat events and limited mitigation strategies in the global south, there is a significant gap in the epidemiological literature from these regions. Greater consistency in study design and exposure windows would enhance the rigor of this field.


Assuntos
Calor Extremo , Nascimento Prematuro , Calor Extremo/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Natimorto , Temperatura
3.
Sci Total Environ ; 808: 152150, 2022 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-34864029

RESUMO

BACKGROUND/OBJECTIVE: Research suggests gestational exposure to particulate matter ≤2.5 µm (PM2.5) and extreme heat may independently increase risk of birth defects. We investigated whether duration of gestational extreme heat exposure modifies associations between PM2.5 exposure and specific congenital heart defects (CHDs). We also explored nonlinear exposure-outcome relationships. METHODS: We identified CHD case children (n = 2824) and non-malformed live-birth control children (n = 4033) from pregnancies ending between 1999 and 2007 in the National Birth Defects Prevention Study, a U.S. population-based multicenter case-control study. We assigned mothers 6-week averages of PM2.5 exposure during the cardiac critical period (postconceptional weeks 3-8) using the closest monitor within 50 km of maternal residence. We assigned a count of extreme heat days (EHDs, days above the 90th percentile of daily maximum temperature for year, season, and weather station) during this period using the closest weather station. Using generalized additive models, we explored logit-nonlinear exposure-outcome relationships, concluding logistic models were reasonable. We estimated joint effects of PM2.5 and EHDs on six CHDs using logistic regression models adjusted for mean dewpoint and maternal age, education, and race/ethnicity. We assessed multiplicative and additive effect modification. RESULTS: Conditional on the highest observed EHD count (15) and at least one critical period day during spring/summer, each 5 µg/m3 increase in average PM2.5 exposure was significantly associated with perimembranous ventricular septal defects (VSDpm; OR: 1.54 [95% CI: 1.01, 2.41]). High EHD counts (8+) in the same population were positively, but non-significantly, associated with both overall septal defects and VSDpm. Null or inverse associations were observed for lower EHD counts. Multiplicative and additive effect modification estimates were consistently positive in all septal models. CONCLUSIONS: Results provide limited evidence that duration of extreme heat exposure modifies the PM2.5-septal defects relationship. Future research with enhanced exposure assessment and modeling techniques could clarify these relationships.


Assuntos
Poluentes Atmosféricos , Calor Extremo , Cardiopatias Congênitas , Poluentes Atmosféricos/toxicidade , Estudos de Casos e Controles , Criança , Calor Extremo/efeitos adversos , Feminino , Cardiopatias Congênitas/epidemiologia , Humanos , Exposição Materna/efeitos adversos , Material Particulado/toxicidade , Gravidez
4.
Environ Int ; 158: 106902, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34627013

RESUMO

Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs.


Assuntos
Calor Extremo , Nascimento Prematuro , Países em Desenvolvimento , Calor Extremo/efeitos adversos , Feminino , Humanos , Renda , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia
5.
Environ Sci Pollut Res Int ; 29(5): 7627-7638, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34476711

RESUMO

Some epidemiological studies have confirmed the association between environmental factors and congenital heart defects (CHD). While the possibility that maternal ambient heat exposures are related to CHD has received little attention. Our study aims to investigate the association between maternal ambient extreme heat exposure early in pregnancy and the risk of CHD in offspring in China. We conducted a retrospective cohort study of 1,918,105 fetuses between 2 and 8 weeks after gestation from May to October in Guangdong, China, 2015-2019. The main heat exposure was defined as extreme heat events (EHE) by using the 90th (EHE90) or 95th (EHE95) percentile of the daily maximum temperature. For each EHE definition, we further defined four indicators: having EHE or not, frequency, duration, and cumulative days. We used the log-binomial regression models to calculate the prevalence ratios (PR) of CHD with 95% confidence intervals (CI) for the associations between CHD and EHE, adjusted for potentially confounding covariates. There are 1,918,105 infants included in the study, of which 9588 had CHD, with a prevalence rate of 499.9 per 100,000 (95% CI: 489.9, 509.8). We found that all EHE indicators were positively associated with the increased risks of overall CHD, some CHD classes (congenital malformations of cardiac septa, congenital malformations of great arteries, and congenital malformations of great arteries), and some CHD subtypes (atrial septal defect and patent ductus arteriosus). In addition, the PR yielded higher estimates when exposing to EHE95. For instance, the risk of suffering congenital malformations of great arteries was 1.548 (95% CI: 1.401, 1.712) for EHE90 exposure and 1.723 (95% CI: 1.565, 1.898) for EHE95 exposure, respectively. Our study demonstrated that EHE during 2-8 weeks postconception was associated with overall CHD in offspring, particularly atrial septal defects and patent ductus arteriosus. The associations strengthened with the extent and cumulative days of maternal exposure to EHE.


Assuntos
Calor Extremo , Cardiopatias Congênitas , Calor Extremo/efeitos adversos , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/etiologia , Temperatura Alta , Humanos , Exposição Materna/efeitos adversos , Gravidez , Estudos Retrospectivos
6.
Paediatr Perinat Epidemiol ; 36(1): 13-22, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34951022

RESUMO

BACKGROUND: Climate change is increasing the frequency and intensity of heatwaves. Prior studies associate high temperature with preterm birth. OBJECTIVES: We tested the hypotheses that acute exposure to extreme heat was associated with higher risk of live spontaneous preterm birth (≥20 and <37 completed weeks), and that risks were higher among people of colour and neighbourhoods with heat-trapping landcover or concentrated racialised economic disadvantage. METHODS: We conducted a retrospective cohort study of people giving birth between 2007 and 2011 in Harris County, Texas (Houston metropolitan area) (n = 198,013). Exposures were daily ambient apparent temperature (ATmax in 5°C increments) and dry-bulb temperatures (Tmax and Tmin >historical [1971-2000] summertime 99th percentile) up to a week prior for each day of pregnancy. Survival analysis controlled for individual-level risk factors, secular and seasonal trends. We considered race/ethnicity, heat-trapping neighbourhood landcover and Index of Concentration at the Extremes as effect modifiers. RESULTS: The frequency of preterm birth was 10.3%. A quarter (26.8%) of people were exposed to ATmax ≥40°C, and 22.8% were exposed to Tmax and Tmin >99th percentile while at risk. The preterm birth rate among the exposed was 8.9%. In multivariable models, the risk of preterm birth was 15% higher following extremely hot days (hazard ratio [HR] 1.15 (95% confidence interval [CI] 1.01, 1.30) for ATmax ≥40°C vs. <20°C; HR 1.15 (95% CI 1.02, 1.28) for Tmax and Tmin >99th percentile). Censoring at earlier gestational ages suggested stronger associations earlier in pregnancy. The risk difference associated with extreme heat was higher in neighbourhoods of concentrated racialised economic disadvantage. CONCLUSIONS: Ambient heat was associated with spontaneous preterm birth, with stronger associations earlier in pregnancy and in racially and economically disadvantaged neighbourhoods, suggesting climate change may worsen existing social inequities in preterm birth rates.


Assuntos
Calor Extremo , Nascimento Prematuro , Calor Extremo/efeitos adversos , Feminino , Idade Gestacional , Temperatura Alta , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
7.
Nature ; 600(7889): 395-407, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34912083

RESUMO

The ocean is warming, losing oxygen and being acidified, primarily as a result of anthropogenic carbon emissions. With ocean warming, acidification and deoxygenation projected to increase for decades, extreme events, such as marine heatwaves, will intensify, occur more often, persist for longer periods of time and extend over larger regions. Nevertheless, our understanding of oceanic extreme events that are associated with warming, low oxygen concentrations or high acidity, as well as their impacts on marine ecosystems, remains limited. Compound events-that is, multiple extreme events that occur simultaneously or in close sequence-are of particular concern, as their individual effects may interact synergistically. Here we assess patterns and trends in open ocean extremes based on the existing literature as well as global and regional model simulations. Furthermore, we discuss the potential impacts of individual and compound extremes on marine organisms and ecosystems. We propose a pathway to improve the understanding of extreme events and the capacity of marine life to respond to them. The conditions exhibited by present extreme events may be a harbinger of what may become normal in the future. As a consequence, pursuing this research effort may also help us to better understand the responses of marine organisms and ecosystems to future climate change.


Assuntos
Ácidos/análise , Organismos Aquáticos , Ecossistema , Aquecimento Global/estatística & dados numéricos , Oceanos e Mares , Oxigênio/análise , Ácidos/química , Animais , Organismos Aquáticos/fisiologia , Calor Extremo/efeitos adversos , Cadeia Alimentar , Concentração de Íons de Hidrogênio , Oxigênio/química
8.
BMJ ; 375: e065653, 2021 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819309

RESUMO

OBJECTIVE: To quantify the association between ambient heat and visits to the emergency department (ED) for any cause and for cause specific conditions in the conterminous United States among adults with health insurance. DESIGN: Time stratified case crossover analyses with distributed lag non-linear models. SETTING: US nationwide administrative healthcare claims database. PARTICIPANTS: All commercial and Medicare Advantage beneficiaries (74.2 million) aged 18 years and older between May and September 2010 to 2019. MAIN OUTCOME MEASURES: Daily rates of ED visits for any cause, heat related illness, renal disease, cardiovascular disease, respiratory disease, and mental disorders based on discharge diagnosis codes. RESULTS: 21 996 670 ED visits were recorded among adults with health insurance living in 2939 US counties. Days of extreme heat-defined as the 95th centile of the local warm season (May through September) temperature distribution (at 34.4°C v 14.9°C national average level)-were associated with a 7.8% (95% confidence interval 7.3% to 8.2%) excess relative risk of ED visits for any cause, 66.3% (60.2% to 72.7%) for heat related illness, 30.4% (23.4% to 37.8%) for renal disease, and 7.9% (5.2% to 10.7%) for mental disorders. Days of extreme heat were associated with an excess absolute risk of ED visits for heat related illness of 24.3 (95% confidence interval 22.9 to 25.7) per 100 000 people at risk per day. Heat was not associated with a higher risk of ED visits for cardiovascular or respiratory diseases. Associations were more pronounced among men and in counties in the north east of the US or with a continental climate. CONCLUSIONS: Among both younger and older adults, days of extreme heat are associated with a higher risk of ED visits for any cause, heat related illness, renal disease, and mental disorders. These results suggest that the adverse health effects of extreme heat are not limited to older adults and carry important implications for the health of adults across the age spectrum.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Calor Extremo/efeitos adversos , Transtornos de Estresse por Calor/epidemiologia , Seguro Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Cross-Over , Bases de Dados Factuais , Feminino , Transtornos de Estresse por Calor/etiologia , Humanos , Nefropatias/epidemiologia , Nefropatias/etiologia , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Risco , Estações do Ano , Estados Unidos/epidemiologia
9.
BMC Public Health ; 21(1): 1999, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732187

RESUMO

BACKGROUND: Previous extreme heat and human health studies have investigated associations either over time (e.g. case-crossover or time series analysis) or across geographic areas (e.g. spatial models), which may limit the study scope and regional variation. Our study combines a case-crossover design and spatial analysis to identify: 1) the most vulnerable counties to extreme heat; and 2) demographic and socioeconomic variables that are most strongly and consistently related to heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, acute renal disease, and respiratory disease) across 67 counties in the state of Florida, U. S over 2008-2012. METHODS: We first used a case-crossover design to examine the effects of air temperature on daily counts of health outcomes. We employed a time-stratified design with a 28-day comparison window. Referent periods were extracted from ±7, ±14, or ± 21 days to address seasonality. The results are expressed as odds ratios, or the change in the likelihood of each health outcome for a unit change in heat exposure. We then spatially examined the case-crossover extreme heat and health odds ratios and county level demographic and socioeconomic variables with multiple linear regression or spatial lag models. RESULTS: Results indicated that southwest Florida has the highest risks of cardiovascular disease, dehydration, acute renal disease, and respiratory disease. Results also suggested demographic and socioeconomic variables were significantly associated with the magnitude of heat-related health risk. The counties with larger populations working in farming, fishing, mining, forestry, construction, and extraction tended to have higher risks of dehydration and acute renal disease, whereas counties with larger populations working in installation, maintenance, and repair workers tended to have lower risks of cardiovascular, dehydration, acute renal disease, and respiratory disease. Finally, our results showed that high income counties consistently have lower health risks of dehydration, heat-related illness, acute renal disease, and respiratory disease. CONCLUSIONS: Our study identified different relationships with demographic/socioeconomic variables for each heat-sensitive health outcome. Results should be incorporated into vulnerability or risk indices for each health outcome.


Assuntos
Calor Extremo , Transtornos de Estresse por Calor , Doenças Respiratórias , Calor Extremo/efeitos adversos , Temperatura Alta , Humanos , Doenças Respiratórias/epidemiologia
10.
Can J Cardiol ; 37(11): 1828-1836, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34802857

RESUMO

As global temperatures continue to rise, extreme heat events are becoming more frequent and intense. Extreme heat affects cardiovascular health as it is associated with a greater risk of adverse cardiovascular events, especially for adults with preexisting cardiovascular diseases. Nonetheless, the pathophysiology underlying the association between extreme heat and cardiovascular risk remains understudied. Furthermore, specific recommendations to mitigate the effects of extreme heat on cardiovascular health remain limited to guide clinical practice within the context of a warming climate. The overall objective of this review article is to raise awareness that extreme heat poses a risk for cardiovascular health. Specifically, the review discusses why cardiovascular healthcare professionals should care about extreme heat, how extreme heat affects cardiovascular health, and recommendations to minimise the cardiovascular consequences of extreme heat. Future research directions are also provided to further our understating of the cardiovascular health consequences of extreme heat. A better awareness and understanding of the cardiovascular consequences of extreme heat will help cardiovascular health professionals assess the risk and optimise the care of their patients exposed to an increasingly warm climate.


Assuntos
Cardiologistas/normas , Competência Clínica , Atenção à Saúde/normas , Exposição Ambiental/efeitos adversos , Calor Extremo/efeitos adversos , Doenças Cardiovasculares , Humanos
12.
Proc Natl Acad Sci U S A ; 118(41)2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34607944

RESUMO

Increased exposure to extreme heat from both climate change and the urban heat island effect-total urban warming-threatens the sustainability of rapidly growing urban settlements worldwide. Extreme heat exposure is highly unequal and severely impacts the urban poor. While previous studies have quantified global exposure to extreme heat, the lack of a globally accurate, fine-resolution temporal analysis of urban exposure crucially limits our ability to deploy adaptations. Here, we estimate daily urban population exposure to extreme heat for 13,115 urban settlements from 1983 to 2016. We harmonize global, fine-resolution (0.05°), daily temperature maxima and relative humidity estimates with geolocated and longitudinal global urban population data. We measure the average annual rate of increase in exposure (person-days/year-1) at the global, regional, national, and municipality levels, separating the contribution to exposure trajectories from urban population growth versus total urban warming. Using a daily maximum wet bulb globe temperature threshold of 30 °C, global exposure increased nearly 200% from 1983 to 2016. Total urban warming elevated the annual increase in exposure by 52% compared to urban population growth alone. Exposure trajectories increased for 46% of urban settlements, which together in 2016 comprised 23% of the planet's population (1.7 billion people). However, how total urban warming and population growth drove exposure trajectories is spatially heterogeneous. This study reinforces the importance of employing multiple extreme heat exposure metrics to identify local patterns and compare exposure trends across geographies. Our results suggest that previous research underestimates extreme heat exposure, highlighting the urgency for targeted adaptations and early warning systems to reduce harm from urban extreme heat exposure.


Assuntos
Exposição Ambiental/efeitos adversos , Calor Extremo/efeitos adversos , Clima Extremo , Temperatura Alta , População Urbana/estatística & dados numéricos , Cidades/estatística & dados numéricos , Clima , Aquecimento Global , Humanos , Saúde Pública , Urbanização
15.
Lancet ; 398(10301): 709-724, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419206

RESUMO

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.


Assuntos
Ar Condicionado/tendências , Ambiente Construído , Mudança Climática , Calor Extremo/efeitos adversos , Temperatura Alta/efeitos adversos , Idoso , Envelhecimento , Água Potável , Eletricidade , Humanos
16.
Environ Int ; 157: 106834, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34461376

RESUMO

BACKGROUND: Heat warnings are issued in advance of forecast extreme heat events, yet little evidence is available regarding their effectiveness in reducing heat-related illness and death. We estimated the association of heat warnings and advisories (collectively, "alerts") issued by the United States National Weather Service with all-cause mortality and cause-specific hospitalizations among Medicare beneficiaries aged 65 years and older in 2,817 counties, 2006-2016. METHODS: In each county, we compared days with heat alerts to days without heat alerts, matched on daily maximum heat index and month. We used conditional Poisson regression models stratified on county, adjusting for year, day of week, federal holidays, and lagged daily maximum heat index. RESULTS: We identified a matched non-heat alert day for 92,029 heat alert days in 2,817 counties, or 54.6% of all heat alert days during the study period. Contrary to expectations, heat alerts were not associated with lower risk of mortality (RR: 1.005 [95% CI: 0.997, 1.013]). However, heat alerts were associated with higher risk of hospitalization for fluid and electrolyte disorders (RR: 1.040 [95% CI: 1.015, 1.065]) and heat stroke (RR: 1.094 [95% CI: 1.038, 1.152]). Results were similar in sensitivity analyses additionally adjusting for same-day heat index, ozone, and PM2.5. CONCLUSIONS: Our results suggest that heat alerts are not associated with lower risk of mortality but may be associated with higher rates of hospitalization for fluid and electrolyte disorders and heat stroke, potentially suggesting that heat alerts lead more individuals to seek or access care.


Assuntos
Calor Extremo , Temperatura Alta , Idoso , Calor Extremo/efeitos adversos , Hospitalização , Hospitais , Humanos , Medicare , Mortalidade , Estados Unidos/epidemiologia
17.
Sci Total Environ ; 794: 148260, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34328123

RESUMO

Extreme heat is an increasing climate threat, most pronounced in urban areas where poor populations are at particular risk. We analyzed heat impacts and vulnerabilities of 1027 outdoor workers who participated in a KAP survey in Hanoi, Vietnam in 2018, and the influence of their mitigation actions, their knowledge of heat-risks, and access to early warnings. We grouped respondents by their main income (vendors, builders, shippers, others, multiple jobs, and non-working) and analyzed their reported heat-health impacts, taking into consideration socioeconomics, knowledge of heat impacts and preventive measures, actions taken, access to air-conditioning, drinking amounts and use of weather forecasts. We applied linear and logistic regression analyses using R. Construction workers were younger and had less knowledge of heat-health impacts, but also reported fewer symptoms. Older females were more likely to report symptoms and visit a doctor. Access to air-conditioning in the bedroom depended on age and house ownership, but did not influence heat impacts as cooling was too expensive. Respondents who knew more heat exhaustion symptoms were more likely to report impacts (p < 0.01) or consult a doctor (p < 0.05). Similarly, those who checked weather updates were more likely to report heat impacts (p < 0.01) and experienced about 0.6 more symptoms (p < 0.01). Even though occupation type did not explain heat illness, builders knew considerably less (40%; p < 0.05) about heat than other groups but were twice as likely to consult a doctor than street vendors (p < 0.01). Knowledge of preventive actions and taking these actions both correlated positively with reporting of heat-health symptoms, while drinking water did not reduce these symptoms (p < 0.01). Child carers and homeowners experienced income losses in heatwaves (p < 0.01). The differences support directed actions, such as dissemination of educational materials and weather forecasts for construction workers. The Red Cross assisted all groups with cooling tents, provision of drinks and health advice.


Assuntos
Calor Extremo , Transtornos de Estresse por Calor , Calor Extremo/efeitos adversos , Feminino , Temperatura Alta , Humanos , Masculino , Percepção , Vietnã
18.
BMC Public Health ; 21(1): 1479, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34325687

RESUMO

BACKGROUND: Many countries have developed heat-health watch and warning systems (HHWWS) or early-warning systems to mitigate the health consequences of extreme heat events. HHWWS usually focuses on the four hottest months of the year and imposes the same threshold over these months. However, according to climate projections, the warm season is expected to extend and/or shift. Some studies demonstrated that health impacts of heat waves are more severe when the human body is not acclimatized to the heat. In order to adapt those systems to potential heat waves occurring outside the hottest months of the season, this study proposes specific health-based monthly heat indicators and thresholds over an extended season from April to October in the northern hemisphere. METHODS: The proposed approach, an adoption and extension of the HHWWS methodology currently implemented in Quebec (Canada). The latter is developed and applied to the Greater Montreal area (current population 4.3 million) based on historical health and meteorological data over the years. This approach consists of determining excess mortality episodes and then choosing monthly indicators and thresholds that may involve excess mortality. RESULTS: We obtain thresholds for the maximum and minimum temperature couple (in °C) that range from (respectively, 23 and 12) in April, to (32 and 21) in July and back to (25 and 13) in October. The resulting HHWWS is flexible, with health-related thresholds taking into account the seasonality and the monthly variability of temperatures over an extended summer season. CONCLUSIONS: This adaptive and more realistic system has the potential to prevent, by data-driven health alerts, heat-related mortality outside the typical July-August months of heat waves. The proposed methodology is general and can be applied to other regions and situations based on their characteristics.


Assuntos
Calor Extremo , Temperatura Alta , Canadá , Calor Extremo/efeitos adversos , Humanos , Mortalidade , Quebeque/epidemiologia , Estações do Ano
19.
Environ Res ; 202: 111738, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34331925

RESUMO

BACKGROUND: Some socioeconomically vulnerable groups may experience disproportionately higher risk of extreme heat illness than other groups, but no study has utilized the presence/absence of a social security number (SSN) as a proxy for vulnerable sub-populations. METHODS: This study focused on the warm season from 2008 to 2012 in Florida, U.S. With a total number of 8,256,171 individual level health outcomes, we devised separate case-crossover models for five heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease), type of health care visit (emergency department (ED) and hospitalization), and patients reporting/not reporting an SSN. Each stratified model also considered potential effect modification by sex, age, or race/ethnicity. RESULTS: Mean temperature raised the odds of five heat-sensitive health outcomes with the highest odds ratios (ORs) for heat-related illness. Sex significantly modified heat exposure effects for dehydration ED visits (Males: 1.145, 95 % CI: 1.137-1.153; Females: 1.110, 95 % CI: 1.103-1.117) and hospitalization (Males: 1.116, 95 % CI: 1.110-1.121; Females: 1.100, 95 % CI: 1.095-1.105). Patients not reporting an SSN between 25 and 44 years (1.264, 95 % CI: 1.192-1.340) exhibited significantly higher dehydration ED ORs than those reporting an SSN (1.146, 95 % CI: 1.136-1.157). We also observed significantly higher ORs for cardiovascular disease hospitalization from the no SSN group (SSN: 1.089, 95 % CI: 1.088-1.090; no SSN: 1.100, 95 % CI: 1.091-1.110). CONCLUSIONS: This paper partially supports the idea that individuals without an SSN could experience higher risks of dehydration (for those 25-45 years), renal disease, and cardiovascular disease than those with an SSN.


Assuntos
Calor Extremo , Transtornos de Estresse por Calor , Serviço Hospitalar de Emergência , Calor Extremo/efeitos adversos , Feminino , Florida/epidemiologia , Transtornos de Estresse por Calor/epidemiologia , Humanos , Masculino , Previdência Social
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