Do temperature changes cause eczema flares? An English cohort study.

BACKGROUND: It is unclear if ambient temperature changes affect eczema. It is also unclear if people with worse disease are more susceptible to weather-related flares, or specific types of emollient offer protection. Substantiating these links may help inform action plans and patients self-management. OBJECTIVE: To investigate the effect of short-term temperature variations on eczema symptoms in children. METHODS: Data from a UK cohort of 519 children (6 months-12 years) with at least mild eczema, participating in a randomised trial comparing four types of emollients on eczema symptoms, were combined with observed temperature data from the Hadley Centre's Integrated Surface Database.Hot & cold weeks were defined by average regional temperature >75th or <25th percentile, January 2018-February 2020. Eczema flares were defined as ≥3 point change in patient-oriented eczema measure (POEM). Random effects logistic regression models were used to estimate the odds ratios of flares in hot & cold weeks (reference group: temperate weeks). The likelihood ratio test assessed for evidence of effect modification by disease severity and emollient type. RESULTS: The baseline mean age was 4.9 years (SD 3.2) and POEM score was 9.2 (SD 5.5), indicating moderate eczema. 90% of participants lived within 20 km of their nearest weather station. From the 519 participants there were 6,796 consecutively paired POEMs and 1,082 flares.Seasonal variation in POEM scores was observed, suggesting symptoms worsening with colder weather in winter and improving with warmer weather in summer. Odds ratios of flares were: 1.15 (p = 0.136, 95%CI 0.96-1.39) in cold weeks, 0.85 (p = 0.045, 95%CI 0.72-1.00) in hot weeks. Likelihood ratio test showed no evidence of this differing by disease severity (p = 0.53) or emollient type used (p = 0.55). CONCLUSIONS: Our findings are consistent with previous studies demonstrating either improvements in eczema symptoms or reduced flares in hot weather. Worse disease and different emollient types did not increase susceptibility or provide protection against temperature changes. Further work should investigate the role of sunlight, humidity, air pollution and other environmental factors

The vertical profile of recent tropical temperature trends: Persistent model biases in the context of internal variability

This is the final version. Available on open access from IOP Publishing via the DOI in this recordData Availability: The data that support the findings of this study are openly available at https://esgf-index1.ceda.ac.uk/projects/cmip6-ceda/. ERA5 data are available from ECMWF. Radiosonde data are available from Leopold Haimberger. Our code is freely available at https://github.com/BrisClim/.Tropospheric and stratospheric tropical temperature trends in recent decades have been notoriously hard to simulate using climate models, particularly in the upper troposphere. Aside from the warming trend itself, this has broader implications, e.g. atmospheric circulation trends depend on latitudinal temperature gradients. In this study, tropical temperature trends in the CMIP6 models are examined, from 1979 to 2014, and contrasted with trends from the RICH/RAOBCORE radiosondes, and the ERA5/5.1 reanalysis. As in earlier studies, we find considerable warming biases in the CMIP6 modeled trends, and we show that these biases are linked to biases in surface temperature. We also uncover previously undocumented biases in the lower-middle stratosphere: the CMIP6 models appear unable to capture the time evolution of stratospheric cooling, which is non-monotonic owing to the Montreal Protocol. Finally, using models with large ensembles, we show that their standard deviation in tropospheric temperature trends, which is due to internal variability alone, explains ∼ 50% (± 20%) of that from the CMIP6 models.Natural Environment Research Council (NERC)University of BristolUS National Science Foundatio

Having a Family Doctor is Associated with Some Better Patient-Reported Outcomes of Primary Care Consultations

Background: Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference. Methods: We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient’s concerns. Results: One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient’s concerns. Conclusion: People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations.published_or_final_versio

Cost-Effectiveness of a Short Message Service Intervention to Prevent Type 2 Diabetes from Impaired Glucose Tolerance

Aims. To investigate the costs and cost-effectiveness of a short message service (SMS) intervention to prevent the onset of type 2 diabetes mellitus (T2DM) in subjects with impaired glucose tolerance (IGT). Methods. A Markov model was developed to simulate the cost and effectiveness outcomes of the SMS intervention and usual clinical practice from the health provider’s perspective. The direct programme costs and the two-year SMS intervention costs were evaluated in subjects with IGT. All costs were expressed in 2011 US dollars. The incremental cost-effectiveness ratio was calculated as cost per T2DM onset prevented, cost per life year gained, and cost per quality adjusted life year (QALY) gained. Results. Within the two-year trial period, the net intervention cost of the SMS group was $42.03 per subject. The SMS intervention managed to reduce 5.05$118.39 per subject over two years. In the lifetime model, the SMS intervention dominated the control by gaining an additional 0.071 QALY and saving $1020.35 per person. The SMS intervention remained dominant in all sensitivity analyses. Conclusions. The SMS intervention for IGT subjects had the superiority of lower monetary cost and a considerable improvement in preventing or delaying the T2DM onset. This trial is registered with ClinicalTrials.gov NCT01556880.published_or_final_versio

Robust increase in population exposure to heat stress with increasing global warming

This is the final version. Available on open access from IOP Publishing via the DOI in this recordData availability statement: No new data were created or analysed in this study.Extreme heat, particularly if combined with humidity, poses a severe risk to human health. To estimate future global risk of extreme heat with humidity on health, we calculate indicators of heat stress that have been commonly used: The Heat Index, the Wet-Bulb Globe Temperature and the Wet-Bulb Temperature, from the latest Climate Model Intercomparison Project (CMIP6) projections. We analyse how and where different levels of heat stress hazards will change, from severe to deadly, and how results are sensitive to the choice of the index used. We evaluate this risk at country-level and use population and GDP | PPP growth scenario to estimate the vulnerability of each nation. Consistent with previous studies, we find that South and East Asia, and the Middle-East, are highly exposed to heat stress hazards, and that this exposure increases by 20%-60% with global mean temperature change from 1.5 to 3 âC. However, we also find substantial increases in heat health risk for some vulnerable countries with less adaptive capacity, such as West Africa, and Central and South America. For these regions, about 20 to more than 50% of the population could be exposed to severe heat stress each year on average, independent of the index used. For global warming of 3â, European countries and the USA will also be exposed several times per year to conditions with daily mean heat stress level equal to the maximum heat stress of the 2003 heat wave.Natural Environment Research Council (NERC

The 2021 western North America heat wave among the most extreme events ever recorded globally

This is the final version. Available on open access from the American Association for the Advancement of Science via the DOI in this recordData and materials availability: ERA5 dataset is available from the Copernicus Climate Change Service (C3S) Climate Data Store. JRA55 dataset is available from the JRA project webpage. CanESM5 data are available from CMIP6 search interface, https://esgf-node.llnl.gov/search/cmip6/. GHCNd station data are available from NOAA Climate Data Online. The code used to generate the figures in this paper and the Supplementary Materials is available from https://zenodo.org/record/6325508 or https://github.com/BrisClim, and this can be used to rapidly assess the extremeness of heat waves relative to other events globally. All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials.In June 2021, western North America experienced a record-breaking heat wave outside the distribution of previously observed temperatures. While it is clear that the event was extreme, it is not obvious whether other areas in the world have also experienced events so far outside their natural variability. Using a novel assessment of heat extremes, we investigate how extreme this event was in the global context. Characterizing the relative intensity of an event as the number of standard deviations from the mean, the western North America heat wave is remarkable, coming in at over four standard deviations. Throughout the globe, where we have reliable data, only five other heat waves were found to be more extreme since 1960. We find that in both reanalyses and climate projections, the statistical distribution of extremes increases through time, in line with the distribution mean shift due to climate change. Regions that, by chance, have not had a recent extreme heat wave may be less prepared for potentially imminent events.Natural Environment Research Council (NERC

The many possible climates from the Paris Agreement’s aim of 1.5 °C warming

The United Nations’ Paris Agreement includes the aim of pursuing efforts to limit global warming to only 1.5 °C above pre-industrial levels. However, it is not clear what the resulting climate would look like across the globe and over time. Here we show that trajectories towards a ‘1.5 °C warmer world’ may result in vastly different outcomes at regional scales, owing to variations in the pace and location of climate change and their interactions with society’s mitigation, adaptation and vulnerabilities to climate change. Pursuing policies that are considered to be consistent with the 1.5 °C aim will not completely remove the risk of global temperatures being much higher or of some regional extremes reaching dangerous levels for ecosystems and societies over the coming decades

On the attribution of the impacts of extreme weather events to anthropogenic climate change

Investigations into the role of anthropogenic climate change in extreme weather events are now starting to extend into analysis of anthropogenic impacts on non-climate (e.g. socio-economic) systems. However, care needs to be taken when making this extension, because methodological choices regarding extreme weather attribution can become crucial when considering the events' impacts. The fraction of attributable risk (FAR) method, useful in extreme weather attribution research, has a very specific interpretation concerning a class of events, and there is potential to misinterpret results from weather event analyses as being applicable to specific events and their impact outcomes. Using two case studies of meteorological extremes and their impacts, we argue that FAR is not generally appropriate when estimating the magnitude of the anthropogenic signal behind a specific impact. Attribution assessments on impacts should always be carried out in addition to assessment of the associated meteorological event, since it cannot be assumed that the anthropogenic signal behind the weather is equivalent to the signal behind the impact because of lags and nonlinearities in the processes through which the impact system reacts to weather. Whilst there are situations where employing FAR to understand the climate change signal behind a class of impacts is useful (e.g. 'system breaking' events), more useful results will generally be produced if attribution questions on specific impacts are reframed to focus on changes in the impact return value and magnitude across large samples of factual and counterfactual climate model and impact simulations. We advocate for constant interdisciplinary collaboration as essential for effective and robust impact attribution assessments