Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory Care/statistics & numerical data* ; Cardiovascular Diseases/therapy* ; Child ; Child, Preschool ; China/epidemiology* ; Cold Temperature/adverse effects* ; Cost of Illness ; Digestive System Diseases/therapy* ; Facilities and Services Utilization/statistics & numerical data* ; Female ; Hot Temperature/adverse effects* ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Poisson Distribution ; Respiratory Tract Diseases/therapy* ; Risk Factors ; Young Adult

BACKGROUND: Ambient temperature may contribute to seasonality of mortality; in particular, a warming climate is likely to influence the seasonality of mortality. However, few studies have investigated seasonality of mortality under a warming climate. METHODS: Daily mean temperature, daily counts for all-cause, circulatory, and respiratory mortality, and annual data on prefecture-specific characteristics were collected for 47 prefectures in Japan between 1972 and 2015. A quasi-Poisson regression model was used to assess the seasonal variation of mortality with a focus on its amplitude, which was quantified as the ratio of mortality estimates between the peak and trough days (peak-to-trough ratio (PTR)). We quantified the contribution of temperature to seasonality by comparing PTR before and after temperature adjustment. Associations between annual mean temperature and annual estimates of the temperature-unadjusted PTR were examined using multilevel multivariate meta-regression models controlling for prefecture-specific characteristics. RESULTS: The temperature-unadjusted PTRs for all-cause, circulatory, and respiratory mortality were 1.28 (95% confidence interval (CI): 1.27-1.30), 1.53 (95% CI: 1.50-1.55), and 1.46 (95% CI: 1.44-1.48), respectively; adjusting for temperature reduced these PTRs to 1.08 (95% CI: 1.08-1.10), 1.10 (95% CI: 1.08-1.11), and 1.35 (95% CI: 1.32-1.39), respectively. During the period of rising temperature (1.3 °C on average), decreases in the temperature-unadjusted PTRs were observed for all mortality causes except circulatory mortality. For each 1 °C increase in annual mean temperature, the temperature-unadjusted PTR for all-cause, circulatory, and respiratory mortality decreased by 0.98% (95% CI: 0.54-1.42), 1.39% (95% CI: 0.82-1.97), and 0.13% (95% CI: - 1.24 to 1.48), respectively. CONCLUSION Seasonality of mortality is driven partly by temperature, and its amplitude may be decreasing under a warming climate.
Cardiovascular Diseases/mortality* ; Cause of Death ; Climate Change/mortality* ; Cold Temperature/adverse effects* ; Hot Temperature/adverse effects* ; Humans ; Japan/epidemiology* ; Mortality/trends* ; Regression Analysis ; Respiratory Tract Diseases/mortality* ; Seasons ; Time

BACKGROUND: An acute upper respiratory tract infection (URI) is the most common disease worldwide, irrespective of age or sex. This study aimed to evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) visits for URI in Seoul, Korea, between 2009 and 2013. METHODS: Daily ER visits for URI were selected from the National Emergency Department Information System, which is a nationwide daily reporting system for ER visits in Korea. URI cases were defined according to International Classification of Diseases, 10 RESULTS: There were 529,527 ER visits for URI during the study period, with a daily mean of 290 visits (range, 74-1942 visits). The mean daily DTR was 8.05 °C (range, 1.1-17.6 °C). The cumulative day (lag 02) effect of DTR above 6.57 °C per 1 °C increment was associated with a 1.42% (95% confidence interval [CI] 0.04-2.82) increase in total URI. Children (≤ 5 years of age) were affected by DTR above 6.57 °C per 1 °C, with 1.45% (95% CI 0.32-2.60) at lag 02, adults (19-64 years) with 2.77% (95% CI 0.39-5.20) at lag 07. When the DTR (lag02) was 6.57 °C to 11.03 °C, the relative risk was significant at 6.01% (95% CI 2.45-9.69) for every 1 °C increase in youth subjects aged for 6 to 18 years. CONCLUSIONS DTR was associated with a higher risk for ER visits for URI. In addition, the results suggested that the lag effects and relative risks of DTR on URI were quite different according to age.
Acute Disease/epidemiology* ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cold Temperature/adverse effects* ; Emergency Service, Hospital/statistics & numerical data* ; Female ; Hot Temperature/adverse effects* ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Republic of Korea/epidemiology* ; Respiratory Tract Infections/etiology* ; Young Adult

BACKGROUND: Need to a simple, available, accurate, comprehensive, and valid indicator is felt to assess thermal effects. Therefore, the present study was aimed to develop and validate the environmental heat strain risk assessment (EHSRA) index using structural equation modeling (SEM) based on empirical relations. METHODS: This cross-sectional study was performed on 201 male workers in environments with various climatic conditions. The heart rate and tympanic temperature of the individuals were monitored at times of 30, 60, and 90 min after beginning the work. At these times, values of dry temperature, wet temperature, globe temperature, and air velocity were also measured and metabolism rate and clothing thermal insulation value were estimated. At the end, a theoretical model was depicted in AMOS software and obtained coefficients were applied to develop a novel index. The scores of this indicator were categorized into four risk levels via ROC curves and validate using linear regression analysis. RESULTS: Indirect effect coefficients of the globe temperature, dry temperature, wet temperature, air velocity, metabolism, and clothing thermal insulation variables on the tympanic temperature were computed by 0.77, 0.75, 0.69, 0.24, 0.49, and 0.39, respectively. These coefficients were applied to develop the index. Optimal cut-off points of boundaries between risk levels included 12.02, 15.88, and 17.56. The results showed that the EHSRA index justified 75% of the variations of the tympanic temperature (R CONCLUSIONS The novel index possesses appropriate validity. It was suggested that this indicator is applied and validated in various environments in the next studies.
Adult ; Environmental Health/methods* ; Heat-Shock Response ; Hot Temperature/adverse effects* ; Humans ; Iran ; Latent Class Analysis ; Male ; Middle Aged ; Risk Assessment/methods* ; Young Adult

OBJECTIVE: To investigate the effects of vitamin E on the respiratory function impairment in rats with chronic obstructive pulmonary disease (COPD) after exposed to high temperature and PM. METHODS: Fifty-four 7-week-old SPF male Wistar rats were randomly divided into 9 experimental groups (n=6). The rat COPD model was established by lipopolysaccharide (LPS) and smoke exposure. After modeled, the rats were tracheal instilled with PM (0 mg/ml, 3.2 mg/ml) and intraperitoneally injected with vitamin E at the dose of 40 mg/kg (20 mg/ml). Part of rats (high temperature groups) were then exposed to high temperature (40℃), once (8 h) a day for three consecutive days. After the last exposure, the lung function of rats was detected. The expression levels of inducible nitric oxide synthase (iNOS), tumor necrosis factor-α (TNF-α) and monocyte chemotactic protein-1 (MCP-1) were detected by corresponding ELISA kits. RESULTS: Compared with the control group, exposure of high temperature and PM could inhibit the lung function of COPD rats significantly (P＜0.05); the level of MCP-1 was increased significantly in PM-exposure groups (P＜0.05); iNOS was increased significantly in the groups of high temperature (P＜0.05). Compared with the single-PM exposure groups, TNF-α in lung was decreased in the normal temperature health group and high temperature COPD group (P＜0.05) after treated with vitamin E; MCP-1 was decreased in all vitamin E-treated groups (P＜0.05); the decreased iNOS only appeared in the group of high temperature with vitamin E treatment. CONCLUSION High temperature and PM could aggravate the inflammation of COPD rats. As an antioxidant, vitamin E may protect the lung from the damage effects.
Animals ; Chemokine CCL2 ; metabolism ; Hot Temperature ; adverse effects ; Lung ; physiopathology ; Male ; Nitric Oxide Synthase Type II ; metabolism ; Particulate Matter ; adverse effects ; Pulmonary Disease, Chronic Obstructive ; drug therapy ; Random Allocation ; Rats ; Rats, Wistar ; Tumor Necrosis Factor-alpha ; metabolism ; Vitamin E ; pharmacology

OBJECTIVE: To investigate the effects of ginsenoside-Rg on mechanical allodynia, heat hyperalgeia, depressive state of rats with chronic sciatic nerve constriction injury. METHODS: Fifty SD rats were randomly divided into 5 groups: blank control group (Normal, normal + saline),sham operation group (Sham, sham operation + saline),chronic constriction injury of the sciatic nerve group (CCI, CCI + saline),ginsenoside-Rg low dose group (CCI + Rg 5 mg/kg), and ginsenoside-Rg high dose group (CCI + Rg 10 mg/kg).After the CCI model was established,drug were injected into the abdominal cavity through the syringe once a day,for 14 consecutive days.The mechanical shrinkage foot reflex threshold (MWT) and thermal withdrawal latency(TWL) were determined at 1 d before the operation and at 1,3,5,7,10 and 14 d after the operation.Light-dark transition test, forced swimming test were determined at 1 d before the operation and at 14 d after the operation. RESULTS: Compared with the sham group, the MWL and TWL of the CCI rats were decreased significantly (P＜0.01), time in the light compartment and number of transition were decreased (P＜0.01), the immobility time in FST was also prolonged significantly (P＜0.01). At 14 days after CCI operation, the MWL and TWL of the ginsenoside-Rg groups were increased significantly (P＜0.01), time in the light compartment and number of transition were also shortened significantly (P＜0.01), the immobility time in FST was also shortened significantly (P＜0.01). CONCLUSION Intraperitoneal injection of ginsenoside-Rg can inhibit the mechanical and thermal pain sensitivity of CCI rats,and can relieve depressive state.
Animals ; Constriction ; Ginsenosides ; pharmacology ; Hot Temperature ; adverse effects ; Hyperalgesia ; drug therapy ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; injuries

OBJECTIVES: Most of the studies on the effect of heat stress on preterm birth (PTB) are conducted in temperate climates. Evidence on this effect in hot and arid countries with low and middle income is limited. This paper describes the short-term effect of exposure to the hot and cold environment on a daily number of PTB in Iran. METHODS: The daily number of PTB was obtained from all hospitals of the city. Meteorological and air pollution data from 2011 to 2017 were obtained from a metrological station in the city. A semi-parametric generalized additive model following a quasi-Poisson distribution with the distributed lag non-linear model was selected as a modeling framework for time-series analysis to simultaneously model the short-term and lagged effect of heat stress on PTB in the Sabzevar city. RESULTS: The minimum and maximum daily temperature were - 11.2 and 45.4 °C respectively. The highest risk estimate at extreme cold temperature was found for apparent temperature (relative risk (RR) 1.83; 95% CI 1.61: 2.09). This pattern was seen for both models. For extreme hot temperatures, the model with mean temperature showed the highest risk increase for both the main model and air pollution adjusted model (RR 1.36; 95% CI 1.25: 1.49). The lowest risk estimate in extremely cold conditions was found in the model with mean temperature. However, for extremely hot temperature conditions, the lowest risk estimate was found for both maximum and apparent temperature. CONCLUSION Obstetricians working in semi-arid areas should be aware of the influence of environmental extreme temperature on the incidence of PTB.
Air Pollutants ; analysis ; Climate ; Cold Temperature ; adverse effects ; Environmental Exposure ; adverse effects ; Environmental Monitoring ; methods ; Female ; Hospital Records ; Hot Temperature ; adverse effects ; Humans ; Infant, Newborn ; Iran ; epidemiology ; Poisson Distribution ; Pregnancy ; Premature Birth ; etiology ; Risk Factors

Objective: To understand the associations between changes of high air temperature and mortality in summer in 31 cities in China. Methods: Daily mortality and meteorological data in 31 cities in China from January 1, 2008 to December 31, 2013 were collected. Distributed lag nonlinear model was used to evaluate the association between high air temperature change and mortality in early summer and late summer after controlling for the long-term trend and the effect of "day of week" . Results: The relative risk of high air temperature on mortality was higher in early summer, with relative risk in the range of 1.08-2.14 in early summer and 1.03-1.67 in late summer. In early summer, the influence of high temperature on mortality was mainly below 5(th) of percentile and above 50(th) of percentile, while in late summer it was mainly above 95(th) of percentile. The lag effect of high air temperature on mortality in early summer was 6 days, while the lag effect in late summer was only about 2 days. Conclusions: Association existed between high air temperature and mortality. The influence of high air temperature on mortality in early summer was stronger than that in late summer. It is necessary to take targeted protection measures.
Air Pollution ; China ; Cities ; Hot Temperature/adverse effects* ; Mortality ; Nonlinear Dynamics ; Temperature

OBJECTIVETo reduce health-related threats of heat waves, interventions have been implemented in many parts of the world. However, there is a lack of higher-level evidence concerning the intervention efficacy. This study aimed to determine the efficacy of an intervention to reduce the number of heat-related illnesses.

METHODSA quasi-experimental design was employed by two cross-sectional surveys in the year 2014 and 2015, including 2,240 participants and 2,356 participants, respectively. Each survey was designed to include one control group and one intervention group, which conducted in Licheng, China. A representative sample was selected using a multistage sampling method. Data, collected from questionnaires about heat waves in 2014 and 2015, were analyzed using a difference-in-difference analysis and cost effectiveness analysis. Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables.

RESULTSRelative to the control participants, the prevalence of heat-related illness in the intervention participants decreased to a greater extent in rural areas than in urban areas (OR=0.495 vs. OR=1.281). Moreover, the cost-effectiveness ratio in the intervention group was less than that in the control group (US$15.06 vs. US$15.69 per participant). Furthermore, to avoid one additional patient, the incremental cost-effectiveness ratio showed that an additional US$14.47 would be needed for the intervention compared to when no intervention was applied.

CONCLUSIONThe intervention program may be considered a worthwhile investment for rural areas that are more likely to experience heat waves. Meanwhile, corresponding improving measures should be presented towards urban areas. Future research should examine whether the intervention strategies could be spread out in other domestic or international regions where heat waves are usually experienced.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Community Networks ; Cost-Benefit Analysis ; Cross-Sectional Studies ; Female ; Heat Stress Disorders ; epidemiology ; prevention & control ; Hot Temperature ; adverse effects ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Young Adult

OBJECTIVETo evaluate the influence of extreme ambient temperature on mortality and years of life lost (YLL) in Chongqing.

METHODSThe daily mortality, meteorology and air pollution index data in Chongqing from the 1(st) January 2010 to the 31(st) December 2013 were collected. Distributed lag non-linear model (DLNM) was used to assess the influence of daily ambient temperature on daily number of deaths and daily YLL respectively. The delayed and cumulative effects of extreme temperature on sex, age, and cause-specific mortality were also assessed.

RESULTSThe relationships between ambient temperature and non-accidental, cardiovascular disease and respiratory disease mortalities and YLL were U-shaped or W-shaped. The effect of heat was obvious on that day, peaked on day 7, and lasted for two weeks, whereas the effect of cold was obvious a week later and lasted for a month. As 1 ℃ increase of ambient temperature, the cumulative relative risks (CRR) of high temperature across lag 0-7 days on non-accidental, respiratory disease and cardiovascular disease mortalities were 1.05 (95%CI: 1.03-1.07), 1.08 (95%CI: 1.05-1.11) and 1.05 (95%CI: 1.01-1.09) respectively. The effects of heat on YLL for each cause were 23.81 (95%CI: 12.31-35.31), 14.34 (95%CI: 8.98-19.70) and 4.43 (95%CI: 1.64-7.21), respectively. On cold days, 1 ℃ decrease of ambient temperature was correlated with an increase in CRR of 1.06 (95%CI: 1.04-1.08), 1.09 (95%CI:1.06-1.12) and 1.06 (95%CI: 1.02-1.11) from lag 0 to 14 for non-accidental, respiratory disease and cardiovascular disease mortalities, respectively. The estimated YLL were 23.34 (95%CI: 10.04-36.64), 16.39 (95%CI: 10.19-22.59) and 2.61 (95%CI: -0.61-5.82). People aged ≥65 years tend to have higher CRR and YLL than those aged <65 years. On high temperature days, the CRR in women was higher than that in men, while the YLL in women was lower than that in men. On low temperature days, both the CRR and YLL in women were higher than those in men.

CONCLUSIONSBoth high and low ambient temperature have adverse health effects. People aged ≥65 years are more sensitive to both high and low ambient temperature. Younger men are more sensitive to high ambient temperature and women and elder men are sensitive to low ambient temperature. It is necessary to take targeted measures to protect the population in Chongqing from the adverse influence of extreme ambient temperature.

Adult ; Aged ; Cardiovascular Diseases ; mortality ; China ; epidemiology ; Cold Temperature ; adverse effects ; Female ; Hot Temperature ; adverse effects ; Humans ; Life Expectancy ; trends ; Male ; Mortality ; trends ; Nonlinear Dynamics ; Respiratory Tract Diseases ; mortality ; Temperature