Progress in climate change adaptation research

The scientific literature on climate change adaptation has become too large to assess manually. Beyond standard scientometrics, questions about if and how the field is progressing thus remain largely unanswered. Here we provide a novel, inquisitive, computer-assisted evidence mapping methodology that combines expert interviews (n = 26) and structural topic modelling to evaluate open-ended research questions on progress in the field. We apply this to 62 191 adaptation-relevant scientific publications (1988–2020), selected through supervised machine learning from a comprehensive climate change query. Comparing the literature to key benchmarks of mature adaptation research, our findings align with trends in the adaptation literature observed by most experts: the field is maturing, growing rapidly, and diversifying, with social science and implementation topics arising next to the still-dominant natural sciences and impacts-focused research. Formally assessing the representativeness of IPCC citations, we find evidence of a delay effect for fast-growing areas of research like adaptation strategies and governance. Similarly, we show significant topic biases by geographic location: especially disaster and development-related topics are often studied in Southern countries by authors from the North, while Northern countries dominate governance topics. Moreover, there is a general paucity of research in some highly vulnerable countries. Experts lastly signal a need for meaningful stakeholder involvement. Expanding on the methods presented here would aid the comprehensive and transparent monitoring of adaptation research. For the evidence synthesis community, our methodology provides an example of how to move beyond the descriptive towards the inquisitive and formally evaluating research questions

Mapping global research on climate and health using machine learning (a systematic evidence map)

Climate change is already affecting health in populations around the world, threatening to undermine the past 50 years of global gains in public health. Health is not only affected by climate change via many causal pathways, but also by the emissions that drive climate change and their co-pollutants. Yet there has been relatively limited synthesis of key insights and trends at a global scale across fragmented disciplines. Compounding this, an exponentially increasing literature means that conventional evidence synthesis methods are no longer sufficient or feasible. Here, we outline a protocol using machine learning approaches to systematically synthesize global evidence on the relationship between climate change, climate variability, and weather (CCVW) and human health. We will use supervised machine learning to screen over 300,000 scientific articles, combining terms related to CCVW and human health. Our inclusion criteria comprise articles published between 2013 and 2020 that focus on empirical assessment of: CCVW impacts on human health or health-related outcomes or health systems; relate to the health impacts of mitigation strategies; or focus on adaptation strategies to the health impacts of climate change. We will use supervised machine learning (topic modeling) to categorize included articles as relevant to impacts, mitigation, and/or adaptation, and extract geographical location of studies. Unsupervised machine learning using topic modeling will be used to identify and map key topics in the literature on climate and health, with outputs including evidence heat maps, geographic maps, and narrative synthesis of trends in climate-health publishing. To our knowledge, this will represent the first comprehensive, semi-automated, systematic evidence synthesis of the scientific literature on climate and health

Renal hemodynamics in diabetic kidney disease:Relevance for intervention

The biphasic pattern of glomerular filtration rate over time has long since supported a pathogenetic role of glomerular hypertension and hyperfiltration in the progressive renal damage of diabetes [1]. It is driven by intertwined effects of deranged glycemia and deranged sodium and volume status and is associated with an increased renal as well as cardiovascular risk. A milder early phenotype of hyperfiltration is present even in the absence of diabetes, in association with overweight, central body fat distribution, and high sodium intake, suggesting that drivers of end-organ damage are present decades before onset of diabetes as such, paving the way for overt organ damage later on. It provides a target for pharmacological intervention by older and new classes of drugs, as well as for lifestyle measures, namely, achievement of a healthy body weight, and avoiding sodium excess, throughout the course of development of diabetes and its complications

Cardiovascular Risk Associated with Interactions among Polymorphisms in Genes from the Renin-Angiotensin, Bradykinin, and Fibrinolytic Systems

Vascular fibrinolytic balance is maintained primarily by interplay of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1). Previous research has shown that polymorphisms in genes from the renin-angiotensin (RA), bradykinin, and fibrinolytic systems affect plasma concentrations of both t-PA and PAI-1 through a set of gene-gene interactions. In the present study, we extend this finding by exploring the effects of polymorphisms in genes from these systems on incident cardiovascular disease, explicitly examining two-way interactions in a large population-based study

Monocyte Gene Expression Signature of Patients with Early Onset Coronary Artery Disease

The burden of cardiovascular disease (CVD) cannot be fully addressed by therapy targeting known pathophysiological pathways. Even with stringent control of all risk factors CVD events are only diminished by half. A number of additional pathways probably play a role in the development of CVD and might serve as novel therapeutic targets. Genome wide expression studies represent a powerful tool to identify such novel pathways. We compared the expression profiles in monocytes from twenty two young male patients with premature familial CAD with those from controls matched for age, sex and smoking status, without a family history of CVD. Since all patients were on statins and aspirin treatment, potentially affecting the expression of genes in monocytes, twelve controls were subsequently treated with simvastatin and aspirin for 6 and 2 weeks, respectively

Is social stress in the first half of life detrimental to later physical and mental health in both men and women?

This study examined gender differences in the associations between affection- and status-related stressors encountered in the first half of life and physical and mental health problems later on. Based on the theory of Social Production Functions (SPF) two hypotheses have been formulated, which were tested in a representative sample of 446 men and 514 women (aged 40–79). Main outcome measures were number of chronic somatic diseases and level of psychological distress. As expected, regression analyses showed no gender differences in the associations between affection-related stressors and physical and mental health problems later on. In contrast, but as also expected, status-related stressors encountered in the first half of life were associated with later physical and mental health for men only. It is concluded that the gender differences in the associations between earlier social stressors and later health problems may be more complex than the common assumption that men are only affected by status stress and women only by affection stress. This study contributes to the knowledge on gender differences concerning the link between social stress and health, and it indicates that social experiences encountered earlier in life are of importance for being healthy and happy in later life

Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care

BACKGROUND: Poorly controlled hypertension is independently associated with mortality, cardiovascular risk and disease progression in chronic kidney disease (CKD). In the UK, CKD stage 3 is principally managed in primary care, including blood pressure (BP) management. Controlling BP is key to improving outcomes in CKD. This study aimed to investigate associations of BP control in people with CKD stage 3. METHODS: 1,741 patients with CKD 3 recruited from 32 general practices for the Renal Risk in Derby Study underwent medical history, clinical assessment and biochemistry testing. BP control was assessed by three standards: National Institute for Health and Clinical Excellence (NICE), National Kidney Foundation Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Descriptive statistics were used to compare characteristics of people achieving and not achieving BP control. Univariate and multivariate logistic regression was used to identify factors associated with BP control. RESULTS: The prevalence of hypertension was 88%. Among people with hypertension, 829/1426 (58.1%) achieved NICE BP targets, 512/1426 (35.9%) KDOQI targets and 859/1426 (60.2%) KDIGO targets. Smaller proportions of people with diabetes and/or albuminuria achieved hypertension targets. 615/1426 (43.1%) were only taking one antihypertensive agent. On multivariable analysis, BP control (NICE and KDIGO) was negatively associated with age (NICE odds ratio (OR) 0.27; 95% confidence interval (95% CI) 0.17-0.43) 70–79 compared to <60), diabetes (OR 0.32; 95% CI 0.25-0.43)), and albuminuria (OR 0.56; 95% CI 0.42-0.74)). For the KDOQI target, there was also association with males (OR 0.76; 95% CI 0.60-0.96)) but not diabetes (target not diabetes specific). Older people were less likely to achieve systolic targets (NICE target OR 0.17 (95% CI 0.09,0.32) p < 0.001) and more likely to achieve diastolic targets (OR 2.35 (95% CI 1.11,4.96) p < 0.001) for people >80 compared to < 60). CONCLUSIONS: Suboptimal BP control was common in CKD patients with hypertension in this study, particularly those at highest risk of adverse outcomes due to diabetes and or albuminuria. This study suggests there is scope for improving BP control in people with CKD by using more antihypertensive agents in combination while considering issues of adherence and potential side effects

The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action