An approach for assessing human health vulnerability and public health interventions to adapt to climate change.

Assessments of the potential human health impacts of climate change are needed to inform the development of adaptation strategies, policies, and measures to lessen projected adverse impacts. We developed methods for country-level assessments to help policy makers make evidence-based decisions to increase resilience to current and future climates, and to provide information for national communications to the United Nations Framework Convention on Climate Change. The steps in an assessment should include the following: a) determine the scope of the assessment; b) describe the current distribution and burden of climate-sensitive health determinants and outcomes; c) identify and describe current strategies, policies, and measures designed to reduce the burden of climate-sensitive health determinants and outcomes; d) review the health implications of the potential impacts of climate variability and change in other sectors; e) estimate the future potential health impacts using scenarios of future changes in climate, socioeconomic, and other factors; f) synthesize the results; and g) identify additional adaptation policies and measures to reduce potential negative health impacts. Key issues for ensuring that an assessment is informative, timely, and useful include stakeholder involvement, an adequate management structure, and a communication strategy

Drinking Water Salinity and Maternal Health in Coastal Bangladesh: Implications of Climate Change.

Background: Drinking water from natural sources in coastal Bangladesh has become contaminated by varying degrees of salinity due to saltwater intrusion from rising sea levels, cyclone and storm surges and upstream withdrawal of freshwater. Objective: Our objective was to estimate salt intake from drinking water sources and examine environmental factors that may explain a seasonal excess of hypertension in pregnancy. Methods: Water salinity data (1998-2000) for Dacope, in rural coastal Bangladesh, were obtained from the Centre for Environment and Geographic Information System. Information on drinking water sources, 24-hour urine samples and blood pressure were obtained from 343 pregnant Dacope women during the dry season (October 2009 - March 2010). The hospital-based prevalence of hypertension in pregnancy was determined for 969 pregnant women (July 2008 - March 2010). Results: Average estimated sodium intakes from drinking water ranged from 5 to 16 g/day in the dry season, compared to 0.6 - 1.2 g/day in the rainy season. Average daily sodium excretion in urine was 3.4 g/day (range 0.4 - 7.7 g/d). Women who drank shallow tubewell water were more likely to have urine sodium > 100 mmol/d than women who drank rainwater (OR=2.05, 95% CI: 1.11 - 3.80). The annual hospital prevalence of hypertension in pregnancy was higher in the dry season (12.2%, 95% CI: 9.5 - 14.8) than the rainy season (5.1%, 95% CI: 2.91 - 7.26). Conclusions: The estimated salt intake from drinking water in this population exceeded recommended limits. The problem of saline intrusion into drinking water has multiple causes and is likely to be exacerbated by climate change induced sea-level rise

Decrease in water clarity of the southern and central North Sea during the 20th century

Light in the marine environment is a key environmental variable coupling physics to marine biogeochemistry and ecology. Weak light penetration reduces light available for photosynthesis, changing energy fluxes through the marine food web. Based on published and unpublished data, this study shows that the central and southern North Sea has become significantly less clear over the second half of the 20th century. In particular, in the different regions and seasons investigated, the average Secchi depth pre-1950 decreased between 25% and 75% compared to the average Secchi depth post-1950. Consequently, in summer pre-1950, most (74%) of the sea floor in the permanently mixed area off East Anglia was within the photic zone. For the last 25+ years, changes in water clarity were more likely driven by an increase in the concentration of suspended sediments, rather than phytoplankton. We suggest that a combination of causes have contributed to this increase in suspended sediments such as changes in sea-bed communities and in weather patterns, decreased sink of sediments in estuaries, and increased coastal erosion. A predicted future increase in storminess (Beniston et al., 2007; Kovats et al., 2014) could enhance the concentration of suspended sediments in the water column and consequently lead to a further decrease in clarity, with potential impacts on phytoplankton production, CO2 fluxes, and fishery production

The Tychonoff uniqueness theorem for the G-heat equation

In this paper, we obtain the Tychonoff uniqueness theorem for the G-heat equation

The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers

Background: Occupational heat stress is a well-known problem, particularly in tropical countries, affecting workers, health and well-being. There are very few recent studies that have reported on the effect of heat stress on mental health, or overall health in workers, although socioeconomic development and rapid urbanization in tropical developing countries like Thailand create working conditions in which heat stress is likely. Objective: This study is aimed at identifying the relationship between self-reported heat stress and psychological distress, and overall health status in Thai workers. Results: 18% of our large national cohort (>40,000 subjects) often works under heat stress conditions and males are exposed to heat stress more often than females. Furthermore, working under heat stress conditions is associated with both worse overall health and psychological distress (adjusted odds ratios ranging from 1.49 to 1.84). Conclusions: This association between occupational heat stress and worse health needs more public health attention and further development on occupational health interventions as climate change increases Thailand's temperatures

The effectiveness of public health interventions to reduce the health impact of climate change:a systematic review of systematic reviews

Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases

A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses

Background: To understand the impact of weather on infectious diseases, information on weather parameters at patient locations is needed, but this is not always accessible due to confidentiality or data availability. Weather parameters at nearby locations are often used as a proxy, but the accuracy of this practice is not known. Methods: Daily Campylobacter and Cryptosporidium cases across England and Wales were linked to local temperature and rainfall at the residence postcodes of the patients and at the corresponding postcodes of the laboratory where the patient’s specimen was tested. The paired values of daily rainfall and temperature for the laboratory versus residence postcodes were interpolated from weather station data, and the results were analysed for agreement using linear regression. We also assessed potential dependency of the findings on the relative geographic distance between the patient’s residence and the laboratory. Results: There was significant and strong agreement between the daily values of rainfall and temperature at diagnostic laboratories with the values at the patient residence postcodes for samples containing the pathogens Campylobacter or Cryptosporidium. For rainfall, the R-squared was 0.96 for the former and 0.97 for the latter, and for maximum daily temperature, the R-squared was 0.99 for both. The overall mean distance between the patient residence and the laboratory was 11.9 km; however, the distribution of these distances exhibited a heavy tail, with some rare situations where the distance between the patient residence and the laboratory was larger than 500 km. These large distances impact the distributions of the weather variable discrepancies (i.e. the differences between weather parameters estimated at patient residence postcodes and those at laboratory postcodes), with discrepancies up to ±10 °C for the minimum and maximum temperature and 20 mm for rainfall. Nevertheless, the distributions of discrepancies (estimated separately for minimum and maximum temperature and rainfall), based on the cases where the distance between the patient residence and the laboratory was within 20 km, still exhibited tails somewhat longer than the corresponding exponential fits suggesting modest small scale variations in temperature and rainfall. Conclusion: The findings confirm that, for the purposes of studying the relationships between meteorological variables and infectious diseases using data based on laboratory postcodes, the weather results are sufficiently similar to justify the use of laboratory postcode as a surrogate for domestic postcode. Exclusion of the small percentage of cases where there is a large distance between the residence and the laboratory could increase the precision of estimates, but there are generally strong associations between daily weather parameters at residence and laboratory

Elucidating the aetiology of human Campylobacter coli infections

Peer reviewedPublisher PD

Cytokine-mediated degradation of the transcription factor ERG impacts the pulmonary vascular response to systemic inflammatory challenge

BACKGROUND: During infectious diseases, proinflammatory cytokines transiently destabilize interactions between adjacent vascular endothelial cells (ECs) to facilitate the passage of immune molecules and cells into tissues. However, in the lung, the resulting vascular hyperpermeability can lead to organ dysfunction. Previous work identified the transcription factor ERG (erythroblast transformation-specific-related gene) as a master regulator of endothelial homeostasis. Here we investigate whether the sensitivity of pulmonary blood vessels to cytokine-induced destabilization is due to organotypic mechanisms affecting the ability of endothelial ERG to protect lung ECs from inflammatory injury. METHODS: Cytokine-dependent ubiquitination and proteasomal degradation of ERG were analyzed in cultured HUVECs (human umbilical vein ECs). Systemic administration of TNFα (tumor necrosis factor alpha) or the bacterial cell wall component lipopolysaccharide was used to cause a widespread inflammatory challenge in mice; ERG protein levels were assessed by immunoprecipitation, immunoblot, and immunofluorescence. Murine Erg deletion was genetically induced in ECs (Ergfl/fl;Cdh5[PAC]-CreERT2), and multiple organs were analyzed by histology, immunostaining, and electron microscopy. RESULTS: In vitro, TNFα promoted the ubiquitination and degradation of ERG in HUVECs, which was blocked by the proteasomal inhibitor MG132. In vivo, systemic administration of TNFα or lipopolysaccharide resulted in a rapid and substantial degradation of ERG within lung ECs but not ECs of the retina, heart, liver, or kidney. Pulmonary ERG was also downregulated in a murine model of influenza infection. Ergfl/fl;Cdh5(PAC)-CreERT2 mice spontaneously recapitulated aspects of inflammatory challenges, including lung-predominant vascular hyperpermeability, immune cell recruitment, and fibrosis. These phenotypes were associated with a lung-specific decrease in the expression of Tek-a gene target of ERG previously implicated in maintaining pulmonary vascular stability during inflammation. CONCLUSIONS: Collectively, our data highlight a unique role for ERG in pulmonary vascular function. We propose that cytokine-induced ERG degradation and subsequent transcriptional changes in lung ECs play critical roles in the destabilization of pulmonary blood vessels during infectious diseases

Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France

<p>Abstract</p> <p>Background</p> <p>The health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France.</p> <p>Methods</p> <p>Data recorded from 49 emergency departments since July 2004, were transmitted daily via the Internet to the French Institute for Public Health Surveillance. Items collected on patients included diagnosis (ICD10 codes), outcome, and age. Statistical t-tests were used to compare, for several health conditions, the daily averages of patients within different age groups and periods (whether 'on alert' or 'off alert').</p> <p>Results</p> <p>A limited number of adverse health conditions occurred more frequently during hot period: dehydration, hyperthermia, malaise, hyponatremia, renal colic, and renal failure. Over all health conditions, the total number of patients per day remained equal between the 'on alert' and 'off alert' periods (4,557.7/day vs. 4,511.2/day), but the number of elderly patients increased significantly during the 'on alert' period relative to the 'off alert' period (476.7/day vs. 446.2/day p < 0.05).</p> <p>Conclusion</p> <p>Our results show the interest to monitor specific indicators during hot periods and to focus surveillance efforts on the elderly. Syndromic surveillance allowed the collection of data in real time and the subsequent optimization of the response by public health agencies. This method of surveillance should therefore be considered as an essential part of efforts to prevent the health effects of heat waves.</p