Health Problems Heat Up: Climate Change and the Public's Health

Examines the health effects of climate change, the needed public health response, concerns for communities at high risk, and state planning and funding for climate change assessments and strategies. Makes federal, state, and local policy recommendations

Evaluation of vaccines cold chain monitoring during distribution from litha vaccines to the medical depots in Gauteng

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine, Pharmaceutical Affairs Johannesburg, 2016An uninterrupted cold chain is very important in maintaining the quality and the potency of vaccines. The aim of this study was to assess if the cold chain is maintained at 2°C-8°C during vaccine distribution from Litha Vaccines® to the different depots in the Gauteng Province in RSA. To establish if Litha Vaccines® has a secure cold chain and was not exposing the vaccines to the risk of compromised quality and efficacy. The vaccines were dispatched from Litha with 2 CCM cards, 2 FW’s and 1 data logger per shipper. These were dispatched to the 4 different depots in Gauteng. Two sites declined to participate in the study. The receiving manager at the depot completed the questionnaire which was designed for the purposes of this study to collate important information on the shipment. The temperature data was downloaded from the data logger at Litha after the delivery of the vaccines to assess the temperature recordings for the particular shipment. Of the 186 CCM cards analysed, none had a colour change. All the 186 Freeze watches were intact. This confirmed that the vaccines were not exposed to undesirable storage conditions during transportation to the depots. The total number of data loggers evaluated was 86. The maximum temperatures of all the loggers were constant between 5°C-9°C whereas the minimum temperatures were between 2°C-8°C. Eighty seven percent of all the readings were within the recommended temperature range of 2°C-8°C. The integrity and the quality of the vaccines were not compromised. The study found that although the results were satisfactory there is still a lot of room for improvement. Cold chain monitoring studies such as this one need to be conducted frequently and in different points of the vaccine distribution channel including the storage facilities and the immunization points. Failure to monitor the cold chain all the way means that efforts to maintain the cold chain might be futile since the end user might still receive a vaccine that has lost its potency along the distribution channel. It is crucial to emphasize the importance of continuous staff training on proper vaccine handling and the need for evaluation of vaccine monitoring processes. The managers need to ensure that there are clear guidelines and vaccine handling standard operating procedures (SOP’s) on cold chain maintenance and staff training informed by the Good Distribution Practices. Due to the effects of climate change and global warming, the study might need to be validated for the hotter summer months.MT201

Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa.

Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was -0.2°C (95% CI -0.43; 0.01, p = 0.06) post 1 h and -0.28°C (95% CI -0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE

Disaster recovery in urban communities

Recovery after disasters is becoming a more prominent focal area of research as the geography literature on disaster management embraces a resilience approach. The damaging impacts of natural disasters on individuals are often compounded by problems and failures in managing recovery after the event. Such problems and failures in recovery take on specific dimensions when disaster events damage the well-established and well-functioning but costly infrastructure and built environments of affluent urban societies. In these circumstances, the extent and nature of property damage combines with the specific pattern of economic and institutional resources available and the disaster recovery management applied to shape the long-term recovery process. As such events become more common and costly, it is important to develop systematic knowledge of how to have a successful and organized recovery process, and, curiously, especially in the case of developed countries. There is a need for a better understanding of what constitutes a successful recovery process, what happens with this process, what long-term recovery is, and how to use the process to mitigate future disasters. The purpose of this research is therefore to compare and contrast long-term recovery planning and management following major disasters in order to identify common lessons, challenges, and ways to mitigate future losses and damages. Although recovery is not everywhere managed the same, there are important lessons that can be learned from the experiences of others. In particular, it is worth identifying the effects of local institutions on recovery and the learning processes that occur. This research seeks to understand and assess disaster recovery in urban communities by examining the relationship between disaster resilience, housing and insurance. This dissertation addresses five research questions, which are addressed in separate chapters, each of which will be published separately: (1) How to assess urban resilience policies supporting disaster risk reduction approaches? The 100 Resilient Cities (100RC) was launched by the Rockefeller Foundation to build worldwide resilience. An evaluation of each member city Resilient Strategies plan took place using directed and summative content analysis to determine whether or not vulnerability and risk narratives were applied in its disaster risk reduction approaches. The results reveal the differences produced among member cities due to the role of actors and power expressed in the policy design and implementation. The overall findings suggest that the 100RC program has not fundamentally addresses issues related to the Sendai Framework for Disaster Risk Reduction goals to reduce disaster risk and vulnerabilities. While many members identified many disaster risks and challenges among shocks and stresses, most were overlooked when designing and implementing key policies for urban resilience. This research was published as a journal article in a special publication focused on reviewing the five-year progress of the Sendai Framework for Disaster Risk Reduction implementation for insight into lessons and planning (Hofmann Zavareh, 2021). (2) How do urban-rural linkages in sustainability transitions impact disaster recovery management and recovery? Analysis of urban-rural linkages in recovery from the earthquake events in Christchurch, New Zealand reveal how desired transformations were entangled in rural, national and international linkages. Three key findings are found; (1) the elements in urban-rural linkages framework are interconnected; (2) the relationalities assumed in the framework do not always hold, and (3) emphasis on urban-rural linkages may obscure other geographies of recovery. This reveals the complexity of the task to map spatial flows, linkages and partnerships among urban, peri-urban and rural areas managing transition pathways for sustainable development. This research was published as part of a special peer-reviewed book publication focused on Rural-Urban Linkages for Sustainable Development edited by Armin Kratzer and Jutta Kister with Routledge (Winder & Hofmann Zavareh, 2020). (3) How to analyze natural disaster damage for specific localized regions to obtain calculations of losses for communities managing recovery using economic models? Micro-level assessments of regional and local disaster impacts in tourist destinations provide the opportunity for economic geographers to assist in calculating precise damage assessments at small regional scales that in turn support the tourism sector and other inter-dependent economies facing reconstruction challenges after disasters. To calculate precise damage assessments, a micro-level assessment model is developed. The island of Dominica is chosen as an example for the model using statistical data from the tourism sector to outline and detail the consequences of a disaster specifically for communities. The results highlight the importance of damage assessments on a small-scale level needed for communities to better understand impacts for residents and the local tourism sector. Only after identifying regional impacts, it is then possible to apply adequate disaster recovery financing needed for residents and the tourism sector recovery. This research was published in the Tourism Geographies journal as part of the Tourism in Changing Natural Environments special publication (Schmude et al., 2018). (4) How to measure long-term community housing recovery using dynamic economic resilience? The research assesses long-term housing recovery and community resilience in the case of Broadmoor, a community located in New Orleans. The community long-term housing measurement is calculated using housing recovery scenarios (dynamic economic resilience). The dynamic economic resilience scenario results provide an indication as to how significant implementation of new disaster recovery policies and procedures can be centered on a more efficient handling of applications for building permits, as well as financial claims for rebuilding or buy-outs, and a more effective management of constrained reconstruction resources for community resilience rebuilding. These results also support recent Munich Re disaster risk modeling studies to improve flood protection in New Orleans. This case demonstrates the role of measuring long-term housing is necessary to better understand the housing recovery processes in different market types. The Broadmoor case also highlights that the speed of recovery was greatly influenced by adopting a community-based approach to managing local and regional resources. This research has been accepted for publication as a journal article in Environmental Hazards (Zavareh & Winder, 2021). (5) What is the role of insurance in managing overall community recovery and housing resilience? The role of insurance, and government buy-outs in recovery are explored in two case study communities (Broadmoor, New Orleans and Avonside, Christchurch). Analysis of case studies using a framework based on “Build Back Better” demonstrating the role of insurance embedded in the scale of long-term housing recovery processes in different market types. Regardless of how the financing or insurance scheme was employed, the most significant factor appears to be the rate (time compression) at which households were able to successfully access and implement financial resources. These two aspects of time compression are interconnected for the success of financing recovery schemes. Successive events or extreme events as seen in both cases, placed considerable burdens on complex institutional systems (local, state, national) that are often disruptive in a nonlinear recovery process. The cases highlight the speed of recovery as the main influencer of long-term housing recovery, given that personal liability is rather manageable if able to access funding for rebuilding efforts. This suggests that a reconceptualization of what exactly community housing resilience is, is needed as it relates to the field of disaster recovery. Here resilience is the opposite of simply rebuilding, contesting the current housing recovery paradigm in “Build Back Better” and disasters research. This research is currently under review for publication. There is still much to be learned about disaster resilience, sustainability transitions, measuring disaster damages and losses, as well as housing recovery for long-term community resilience. Future research should aim to provide more robust modeling and attempt to bridge the gaps in literature and knowledge in collaboration with community stakeholders of post-disaster recovery

Natural ventilation : an evaluation of strategies for improving indoor air quality in hospitals located in semi-arid climates

PhD ThesisThis thesis is an investigation into improving natural ventilation in low rise hospital wards in Northern Nigeria. The climate of this region is semi-arid, during the dry season, sub-Saharan fine dust (Harmattan dust) is blown into the region from the North East and during the wet season, Mosquitos are prevalent. The energy infrastructure in the whole of Nigeria is under resourced; hence ventilation strategies’ based on mechanical extraction are not possible. Five wards within low rise hospital buildings were studied; these were purpose designed hospital buildings, not converted buildings. Questionnaire surveys of health care workers in the hospitals was conducted and revealed dissatisfaction with the buildings’ ventilation and Indoor Air Quality. The questionnaires were then followed up by Tracer Gas measurements and during the period of measurement there was only one occasion when a ward achieved an air change rate of 6-ach-1, the ASHREA Standard requirement for hospital buildings. To investigate methods of improving natural ventilation in these wards, a CFD model was developed of a representative ward, the model was validated against the Tracer Gas measurements; with an acceptable agreement of ≤ 15%. Using the CFD model, achievable ventilation strategies within the context of the location, were investigated, and a combination of cross ventilation utilizing windows on the windward and leeward sides of the ward together with a roof ventilator on the leeward side proved the most successful. All openings were screened to prevent the entry of mosquitos. This best case was further investigated with the wind direction at an oblique angle to the ward side. The oblique angle of wind attack reduced the air change rates but improved air circulation/mixing within the ward. With the exception when the wind direction was parallel to the ward side. To reduce the ingress of Harmattan Dust, was problematic given the energy restrictions, a low energy solution of introducing screened plenums on both the windward and leeward sides of the building proved successful. Larger dust particles were detained within the windward plenum and the smaller dust particles were exhausted into the leeward plenum. With the mosquito screens located on the large surface area of the plenum, the window screens were removed resulting in higher air change rates. Thus, it is recommended that, openings should be provided on the windward and leeward walls and on the roof toward the leeward side for efficient ventilation and airflow circulation at the occupancy level. The longer sides of the wards should be oriented toward the North-South to capture the North-East trade winds and South-West monsoon winds with oblique angle of attack. Plenums should be incorporated to the windward and leeward facades and Insect screen should be installed on the plenums instead of the wards’ openings to increase ventilation rates while excluding mosquitoes and decreasing dust particle concentration in the hospital wards. Openings should be at the middle of the windward and leeward walls and on the roof toward the leeward to avoid airflow short-circuiting. It is recommended to use insect screen with the porosity of 0.2 and when the outdoor local wind speed is ≤ 1.26 m/s (2 m/s: airport value), the ventilation should be supplemented with fan.Ramat Polytechnic Maiduguri, Borno State Government and Tertiary Education Trust Fund (TETFUND

Mosquito Ovitraps IoT Sensing System (MOISS): Internet of Things-based System for Continuous, Real-Time and Autonomous Environment Monitoring

The monitoring of environmental parameters is indispensable for controlling mosquito populations. The abundance of mosquitoes mainly depends on climate conditions, weather and water (i.e., physicochemical parameters). Traditional techniques for immature mosquito surveillance are based on remote sensing and weather stations as primary data sources for environmental variables, as well as water samples which are collected in the field by environmental health agents to characterize water quality impacts. Such tools may lead to misidentifications, especially when comprehensive surveillance is required. Innovative methods for timely and continuous monitoring are crucial for improving the mosquito surveillance system, thus, increasing the efficiency of mosquitoes' abundance models and providing real-time prediction of high-risk areas for mosquito infestation and breeding. Here, we illustrate the design, implementation, and deployment of a novel IoT -based environment monitoring system using a combination of weather and water sensors with a real-time connection to the cloud for data transmission in Madeira Island, Portugal. The study provides an approach to monitoring some environmental parameters, such as weather and water, that are related to mosquito infestation at a fine spatiotemporal scale. Our study demonstrates how a combination of sensor networks and clouds can be used to create a smart and fully autonomous system to support mosquito surveillance and enhance the decision-making of local environmental agents

INVESTIGATION OF HANTAVIRUS AND LEPTOSPIRA AS POSSIBLE CONTRIBUTING FACTORS OF THE UNEXPLAINED KIDNEY DISEASE EPIDEMIC IN NICARAGUA

Throughout Latin America, an epidemic of a kidney disease of an unknown etiology has been occurring since the late 1990s, and this disease is being called “Mesoamerican nephropathy.” Mesoamerican nephropathy predominantly affects male sugarcane workers. In Chichigalpa, Chinandega, Nicaragua, there is sugarcane plantation that is being heavily impacted by the Mesoamerican nephropathy epidemic, and they invited researchers from Baylor College of Medicine to investigate the epidemic. The prospective epidemic investigation began in 2015, and it is an ongoing investigation. Based on the compilation of data collected during the preliminary investigation, our hypothesis is that a possible zoonotic disease, such as hantavirus and/or Leptospira, could be causing Mesoamerican Nephropathy due to the large rodent population in the fields. Our specific aims were to determine the prevalence of hantavirus and Leptospira among the study population and to describe and evaluate the differences between potential risk factors for MeN. We tested for IgM and IgG antibodies using ELISA kits for hantavirus and Leptospira. For hantavirus, we tested 149 cases and 50 controls. Due to kit validation issues, we tested 92 controls for Leptospira IgM and IgG antibodies, and we tested 104 cases for Leptospira IgM antibodies and 45 cases for Leptospira IgG antibodies. We also built a multivariate logistic model using the purposeful model selection method to evaluate potential risk factors for the disease. The model was tested for goodness of fit and validated. We found that hantavirus had an overall prevalence of 12.1% and Leptospira had 27% prevalence for IgM antibodies with 1.5% for IgG antibodies. Hantavirus and Leptospira were not statistically found to be probable causes for the epidemic. The results from the multivariate model found that the use of some types of protective equipment and access to safe drinking water help to reduce the odds of disease. Having an immediate family member also increases the odds. While the results of this study allow us to eliminate hantavirus and Leptospira, it does not eliminate a possible zoonotic pathogen. Implementing the use of protective equipment and providing access to safe drinking water may be possible prevention strategies. Continued investigation is needed to determine the etiology of the epidemic

Impact of climate change on allergic diseases in Germany

Background: Allergic diseases, especially inhalant allergies, have reached epidemic levels and environmental factors play an important role in their development. Climate change influences the occurrence, frequency, and severity of allergic diseases. Methods: The contents of this article were selected by the authors and developed section by section according to their expertise and the current state of knowledge. The sections were then discussed and agreed upon amongst all authors. Results: The article highlights direct and indirect effects of climate change on allergies. It goes into detail about the connections between climate change and (new) pollen allergens as well as (new) occupational inhalation allergens, explains the effects of climate change on the clinical picture of atopic dermatitis, discusses the connections between air pollutants and allergies, and provides information about the phenomenon of thunderstorm asthma. Conclusions: There is a need for action in the field of pollen and fungal spore monitoring, allergy and sensitisation monitoring, urban planning from an allergological perspective, and changes in the working environment, among others. This is part of a series of articles that constitute the German Status Report on Climate Change and Health 2023