Non-optimal Temperatures Research Articles

Promoting eCo-responsibility, eCo-literacy, and eCo-centricity in emergency triAge Regarding climate changE consequences (I-CARE THE 3 Cs): study protocol

Background: Climate change, ambient air pollution, and non-optimal temperatures are recognized as a global health emergency. Many studies have highlighted increases in the number of emergency hospital admissions and hospitalizations for respiratory and cardiovascular diseases associated with non-optimal temperatures, unconventional gas reserves, particulate matter, grounded level O3, sulphur dioxide, or nitrogen dioxide exposure. Problem statement: According to the Swiss Health Observatory, 14% of the Swiss population used a hospital emergency department (ED) at least once in 2016, representing 1,7 million admissions or 4,718 admissions per day. In the face of evolving climate-associated reasons for presenting at the ED, the scales used for emergency triage are now proving insufficient for their task. It is becoming critical to introduce and implement more appropriate ED triage tools that incorporate risk factors such as ambient temperature and air pollution. It will also require raising nurses’ eco-literacy, eco-responsibility, and eco-centricity, which are currently rated as moderate to low, to ensure adaptation and/or mitigation in the face of this global threat. Future directions and perspectives for the nursing discipline: The nursing discipline must develop its eco-literacy, eco-responsibility, and eco-centricity to take social and professional responsibility for addressing the health-related impacts of climate change. To do so, the research project’s overall aim, which will be achieved in five stages, is to develop, pilot-test, and evaluate the feasibility of a complex nursing intervention named “Education Intervention promoting eCo-literacy, eCo-responsibility, and eCo-centricity in emergency triAge Regarding climate changE consequences (I-CARE the 3 Cs). The I-CARE the 3 Cs intervention aims to provide an adequate, effective, efficient, fair, safe, and patient-centered response to patients’ and nurses’ needs and to develop guidelines for dealing with the health consequences of climate change.

Effects of apparent temperature on daily outpatient and inpatient visits for cause-specific respiratory diseases in Ganzhou, China: a time series study.

Non-optimum temperatures are associated with increased risk of respiratory diseases, but the effects of apparent temperature (AT) on respiratory diseases remain to be investigated. Using daily data from 2016 to 2020 in Ganzhou, a large city in southern China, we analyzed the impact of AT on outpatient and inpatient visits for respiratory diseases. We considered total respiratory diseases and five subtypes (influenza and pneumonia, upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), asthma and chronic obstructive pulmonary disease [COPD]). Our analysis employed a distributed lag nonlinear model (DLNM) combined with a generalized additive model (GAM). We recorded 94,952 outpatients and 72,410 inpatients for respiratory diseases. We found AT significantly non-linearly associated with daily outpatient and inpatient visits for total respiratory diseases, influenza and pneumonia, and URTI, primarily during comfortable AT levels, while it was exclusively related with daily inpatient visits for LRTI and COPD. Moderate heat (32.1 °C, the 75.0th centile) was observed with a significant effect on both daily outpatient and inpatient visits for total respiratory diseases at a relative risk of 1.561 (1.161, 2.098) and 1.276 (1.027, 1.585), respectively (both P < 0.05), while the results of inpatients became insignificant with the adjustment for CO and O3. The attributable fractions in outpatients and inpatients were as follows: total respiratory diseases (24.43% and 18.69%), influenza and pneumonia (31.54% and 17.33%), URTI (23.03% and 32.91%), LRTI (37.49% and 30.00%), asthma (9.83% and 3.39%), and COPD (30.67% and 10.65%). Stratified analyses showed that children ≤5 years old were more susceptible to moderate heat than older participants. In conclusion, our results indicated moderate heat increase the risk of daily outpatient and inpatient visits for respiratory diseases, especially among children under the age of 5.

Association between temperature and mortality: a multi-city time series study in Sichuan Basin, southwest China.

There are few multi-city studies on the association between temperature and mortality in basin climates. This study was based on the Sichuan Basin in southwest China to assess the association of basin temperature with non-accidental mortality in the population and with the temperature-related mortality burden. Daily mortality data, meteorological and air pollution data were collected for four cities in the Sichuan Basin of southwest China. We used a two-stage time-series analysis to quantify the association between temperature and non-accidental mortality in each city, and a multivariate meta-analysis was performed to obtain the overall cumulative risk. The attributable fractions (AFs) were calculated to access the mortality burden attributable to non-optimal temperature. Additionally, we performed a stratified analyses by gender, age group, education level, and marital status. A total of 751,930 non-accidental deaths were collected in our study. Overall, 10.16% of non-accidental deaths could be attributed to non-optimal temperatures. A majority of temperature-related non-accidental deaths were caused by low temperature, accounting for 9.10% (95% eCI: 5.50%, 12.19%), and heat effects accounted for only 1.06% (95% eCI: 0.76%, 1.33%). The mortality burden attributable to non-optimal temperatures was higher among those under 65 years old, females, those with a low education level, and those with an alternative marriage status. Our study suggested that a significant association between non-optimal temperature and non-accidental mortality. Those under 65 years old, females, and those with a low educational level or alternative marriage status had the highest attributable burden.

Global burden of non-optimal temperature attributable stroke: The long-term trends, population growth and aging effects

Since the 20th century, the world has undergone climate change, population growth and population aging, which may result in alterations in the epidemiology of non-optimal temperature-associated strokes. We employed multiple methodologies and data from the global burden of disease 2019 to unveil the long-term curvilinear trends in strokes attributed to non-optimal temperature and the impact of aging and population growth on its changing epidemiology. From 1990 to 2019, the age-standardized DALYs rate (ASDR) of strokes attributable to low temperature had been decreasing, but from 2016, the continued downward trend in ASDR disappeared and began to remain stable. On the contrary, the ASDR of strokes attributable to high temperature continued to increase. The high socio-demographic index (SDI) region experienced the fastest decreased trend. The disease burden of stroke attributable to low temperature is increased by aging in 178 countries (87.25%), compared with 130 (63.73%) for high temperature. After excluding aging and population growth, the DALY rate for strokes attributed to high temperature was increasing in 87 countries and territories (42.64%). The disease burden of strokes attributed to low temperature is far greater than that of high temperature in absolute figures. However, globally, there is a significant trend toward an increase in strokes attributed to high temperature. Social development has largely offset the burden of strokes attributed to low temperature, but most regions of the world are equally affected by strokes attributed to high temperature. Simultaneously, in the framework of climate change, aging is also largely hindering stroke prevention efforts.

The impact of ambient temperature and air pollution on SARS-CoV2 infection and Post COVID-19 condition in Belgium (2021–2022)

IntroductionThe associations between non-optimal ambient temperature, air pollution and SARS-CoV-2 infection and post COVID-19 condition (PCC) remain constrained in current understanding. We conducted a retrospective analysis to explore how ambient temperature affected SARS-CoV-2 infection in individuals who later developed PCC compared to those who did not. We investigated if these associations were modified by air pollution. MethodsWe conducted a bidirectional time-stratified case-crossover study among individuals who tested positive for SARS-CoV-2 between May 2021 and June 2022. We included 6302 infections, with 2850 PCC cases. We used conditional logistic regression and distributed lag non-linear models to obtain odds ratios (OR) and 95% confidence intervals (CI) for non-optimal temperatures relative to the period median temperature (10.6 °C) on lags 0 to 5. For effect modification, daily average PM2.5 concentrations were categorized using the period median concentration (8.8 μg/m3). Z-tests were used to compare the results by PCC status and PM2.5. ResultsNon-optimal cold temperatures increased the cumulative odds of infection (OR = 1.93; 95%CI:1.67–2.23, OR = 3.53; 95%CI:2.72–4.58, for moderate and extreme cold, respectively), with the strongest associations observed for non-PCC cases. Non-optimal heat temperatures decreased the odds of infection except for moderate heat among PCC cases (OR = 1.32; 95%CI:0.89–1.96). When PM2.5 was >8.8 μg/m3, the associations with cold were stronger, and moderate heat doubled the odds of infection with later development of PCC (OR = 2.18; 95%CI:1.01–4.69). When PM2.5 was ≤8.8 μg/m3, exposure to non-optimal temperatures reduced the odds of infection. ConclusionExposure to cold increases SARS-CoV2 risk, especially on days with moderate to high air pollution. Heated temperatures and moderate to high air pollution during infection may cause PCC. These findings stress the need for mitigation and adaptation strategies for climate change to reduce increasing trends in the frequency of weather extremes that have consequences on air pollution concentrations.

The combined effect of air pollution and non-optimal temperature on mortality in Shandong Province, China: establishment of air health index.

The air health index (AHI) captures the combined effects of air pollution and non-optimal temperatures and helps assess the atmospheric environment's overall health risk. Shandong Province is a crucial industrial base in China, and the health effects of air pollution and non-optimal temperature cannot be ignored. To construct an AHI for Shandong Province and assess the district-level mortality burden due to AHI in the study area. Daily district-specific mortality, meteorological, and air pollution data over 2013-2018 were collected in Shandong Province, China. The AHI construction eventually incorporated PM2.5 and NO2, O3, and non-optimal temperatures. Attributable fraction (AF) and attributable number (AN) were used to estimate the district-specific mortality burden attributable to AHI. The average AHI value observed in Shandong Province was 6. Our research revealed a positive association between the total AHI and total mortality, with an overall trend of a slow increase followed by a rapid increase. The exposure-response curves, when stratified by gender, age, and cause of death, were approximately consistent with the overall trend. The provincial attributable fraction (AF) was 5.31% (95% CI 4.58%, 5.91%), and the attributable number (AN) was 188,246 (95% CI 162,396, 209,533). Overall, higher ANs mainly appeared in the southwestern area, while higher values of AF were observed in the central-eastern and central-northern areas. The air health index performs well in predicting death burden and can convey health risks related to exposure to the ambient environment to the public.

Temperature-related death burden of various neurodegenerative diseases under climate warming: a nationwide modelling study

Limited knowledge exists regarding the ramifications of climate warming on death burden from neurodegenerative diseases. Here, we conducted a nationwide, individual-level, case-crossover study between 2013 and 2019 to investigate the effects of non-optimal temperatures on various neurodegenerative diseases and to predict the potential death burden under different climate change scenarios. Our findings reveal that both low and high temperatures are linked to increased risks of neurodegenerative diseases death. We project that heat-related neurodegenerative disease deaths would increase, while cold-related deaths would decrease. This is characterized by a steeper slope in the high-emission scenario, but a less pronounced trend in the scenarios involving mitigation strategies. Furthermore, we predict that the net changes in attributable death would increase after the mid-21st century, especially under the unrestricted-emission scenario. These results highlight the urgent need for effective climate and public health policies to address the growing challenges of neurodegenerative diseases associated with global warming.

Effects of cooling on thyroid hormone secretion and growth of eastern bluebird (Sialia sialis) nestlings

Achieving endothermic homeothermy is a critical aspect of avian development. In pre-homeothermic altricial nestlings, variation in parental brooding behavior results in variable exposure of nestlings to cooling, with consequences for the developing endocrine system. Nestlings facing repeated cooling challenges may benefit from upregulation of thyroid hormone secretion, allowing for earlier onset of thermoregulatory capability to mitigate the potentially negative effects of exposure to non-optimal temperatures during development. We examined the effects of (1) a single cooling challenge on thyroid hormone secretion in pre-homeothermic nestlings, and (2) repeated cooling challenges prior to the onset of homeothermy on nestling growth and thyroid hormone secretion prior to fledging. We found that pre-homeothermic eastern bluebird nestlings exposed to a single cooling challenge increased circulating triiodothyronine (T3), demonstrating that the thyroid system can be activated by cooling early in life. However, we found no consequences of repeated cooling during the first week of life on nestling growth or baseline T3 levels prior to fledging. This work addresses how the nestling hypothalamic-pituitary-thyroid axis responds to acute cooling challenges prior to the development of endothermic homeothermy; future work will confirm whether such responses allow nestlings to hasten the onset of physiological thermoregulation when conditions demand it.

A Nationwide Comparative Analysis of Temperature-Related Mortality and Morbidity in Japan.

The impact of temperature on morbidity remains largely unknown. Moreover, extensive evidence indicates contrasting patterns between temperature-mortality and temperature-morbidity associations. A nationwide comparison of the impact of temperature on mortality and morbidity in more specific subgroups is necessary to strengthen understanding and help explore underlying mechanisms by identifying susceptible populations. We performed this study to quantify and compare the impact of temperature on mortality and morbidity in 47 prefectures in Japan. We applied a two-stage time-series design with distributed lag nonlinear models and mixed-effect multivariate meta-analysis to assess the association of temperature with mortality and morbidity by causes (all-cause, circulatory, and respiratory) at prefecture and country levels between 2015 and 2019. Subgroup analysis was conducted by sex, age, and regions. The patterns and magnitudes of temperature impacts on morbidity and mortality differed. For all-cause outcomes, cold exhibited larger effects on mortality, and heat showed larger effects on morbidity. At specific temperature percentiles, cold (first percentile) was associated with a higher relative risk (RR) of mortality [1.45; 95% confidence interval (CI): 1.39, 1.52] than morbidity (1.33; 95% CI: 1.26, 1.40), as compared to the minimum mortality/morbidity temperature. Heat (99th percentile) was associated with a higher risk of morbidity (1.30; 95% CI: 1.28, 1.33) than mortality (1.04; 95% CI: 1.02, 1.06). For cause-specific diseases, mortality due to circulatory diseases was more susceptible to heat and cold than morbidity. However, for respiratory diseases, both cold and heat showed higher risks for morbidity than mortality. Subgroup analyses suggested varied associations depending on specific outcomes. Distinct patterns were observed for the association of temperature with mortality and morbidity, underlying different mechanisms of temperature on different end points, and the differences in population susceptibility are possible explanations. Future mitigation policies and preventive measures against nonoptimal temperatures should be specific to disease outcomes and targeted at susceptible populations. https://doi.org/10.1289/EHP12854.

Saccharomyces cerevisiae survival against heat stress entails a communication between CCT and cell wall integrity pathway.

The chaperonin TRiC/CCT is cytosolic cylindrical complex of 16 subunits encoded by eight essential genes CCT1-8. It contributes to folding 10% of cellular polypeptides in yeast. The strain carrying substitution point mutation G412E in the equatorial domain of Cct7p resulted in the improper folding of substrates. In this study, the Cct7p mutant exhibited sensitivity to non-optimal growth temperatures and cell wall stressors. Heat shock is known to disrupt cell wall and protein stability in budding yeast. Mitogen-activated protein kinase-mediated cell wall integrity pathway gets activated to compensate the perturbed cell wall. Overexpression of the PKC1 and SLT2 genes of MAPK signaling pathway in mutant rescued the growth and cell division defects. Additionally, the genes of the CWI pathway such as SED1, GFA1, PIR1, and RIM21 are down-regulated. The Cct7p mutant strain (G412E) is unable to withstand the heat stress due to the underlying defects in protein folding and cell wall maintenance. Taken together, our results strongly indicate the interaction between CCT and cell wall integrity pathway.

Nonoptimum Temperatures Are More Closely Associated With Fatal Myocardial Infarction Than With Nonfatal Events

BackgroundAmbient temperatures trigger hospitalisation, mortality, and emergency department visits for myocardial infarction (MI). However, nonoptimum temperature-related risks of fatal and nonfatal MI have not yet been compared. MethodsFrom 2007 to 2019, 416,894 MI events (233,071 fatal and 183,823 nonfatal) were identified in Beijing, China. A time-series analysis with a distributed-lag nonlinear model was used to compare the relative and population-attributable risks of fatal and nonfatal MI associated with nonoptimum temperatures. ResultsThe reference was the optimum temperature of 24.3°C. For single-lag effects, cold (−5.2°C) and heat (29.6°C) effects had associations that persisted for more days for fatal MI than for nonfatal MI. For cumulative-lag effects over 0 to 21 days, cold effects were higher for fatal MI (relative risk [RR] 1.99, 95% confidence interval [CI] 1.68-2.35) than for nonfatal MI (RR 1.60, 95% CI 1.32-1.94) with a P value for difference in effect sizes of 0.048. In addition, heat effects were higher for fatal MI (RR 1.33, 95% CI 1.24-1.44) than for nonfatal MI (RR 0.99, 95% CI 0.91-1.08) with a P value for difference in effect sizes of 0.002. The attributable fraction of nonoptimum temperatures was higher for fatal MI (25.6%, 95% CI 19.7%-30.6%) than for nonfatal MI (19.1%, 95% CI 12.1%-25.0%). ConclusionsFatal MI was more closely associated with nonoptimum temperatures than nonfatal MI, as evidenced by single-lag effects that have associations which persisted for more days, higher cumulative-lag effects, and higher attributable risks for fatal MI. Strategies are needed to mitigate the adverse effects of nonoptimum temperatures.

Impact of air pollution changes and meteorology on asthma outpatient visits in a megacity in North China Plain

The effects of air pollution and meteorology on asthma is less studied in North China Plain. In the last decade, air quality in this region is markedly mitigated. This study compared the short-term effects of air pollutants on daily asthma outpatient visits (AOV) within different sex and age groups from 2014 to 2016 and 2017–2019 in Tianjin, with the application of distributed lag nonlinear model. Moreover, relative humidity (RH) and temperature as well as the synergistic impact with air pollutants were assessed. Air pollutants-associated risk with linear (different reference values were used) and non-linear assumptions were compared. In 2014–2016, PM10 and PM2.5 exhibited a larger impact on AOV, with the corresponding cumulative excess risks (ER) for every 10 μg/m3 increase at 1.04 % (95%CI:0.67–1.40 %, similarly hereafter) and 0.79 % (0.35–1.23 %), as well as increased to 43 % (26–63 %) and 20 % (10–31 %) at severe pollution. In 2017–2019, NO2 and MDA8 O3 exhibited a larger impact on AOV, with a cumulative ER for every 10 μg/m3 increase at 1.0 (0.63–1.4 %) and 0.36 % (0.15–0.57 %), with corresponding values of 7.9 % (4.8–11 %) and 5.6 % (2.3–9.0 %), at severe pollution. SO2 associated risk was only significant from 2014 to 2016. Cold effect, including extremely low temperature exposure and sharp temperature drop could generate a pronounced increase in AOV at 9.6 % (3.8–16 %) and 24 % (9.1–41 %), respectively. Moderate low temperature combined with air pollutants can enhance AOV during winter. Higher temperature in spring and autumn could trigger asthma by increasing pollen levels. Low RH resulted in AOV increase by 4.6 % (2.4–6.9), while higher RH generated AOV increase by 3.4 % (1.6–5.3). Females, children, and older adults tended to have a higher risk for air pollution, non-optimum temperature, and RH. As air pollution-associated risks on AOV tends to be weaker due to air quality improvement in recent years, the impact of extreme meteorological condition amidst climate change on asthma visits warrants further attention.

Differentiating the impacts of ambient temperature on pneumonia mortality of various infectious causes: a nationwide, individual-level, case-crossover study

It remains unknown how ambient temperature impact pneumonia of various infectious causes. Based on the national death registry covering all counties in Chinese mainland, we conducted an individual-level case-crossover study in China from 2013 to 2019. Exposures were assigned at residential addresses for each decedent. Conditional logistic regression model combined with distributed lag non-linear models were used to estimate the exposure-response associations. The attributable fractions due to non-optimum temperature were calculated after accounting for spatial and temporal patterns for the excess risks. The exposure-response curves were inversely J-shaped with both low and high temperature increasing the risks, and the effect of low temperature was stronger. Extremely low temperature was associated with higher magnitude of influenza-related pneumonia [relative risk (RR): 2.46, 95% confidence interval (CI): 1.62-3.74], than viral pneumonia (RR: 1.89, 95% CI: 1.55-2.30) and bacterial pneumonia (RR: 1.81, 95% CI: 1.56-2.09). The magnitudes of RRs associated with extremely high temperature were similar among the three categories of pneumonia. The mortality attributable fraction for influenza-related pneumonia (29.78%) was the highest. The effects were stronger in people of low education level or residence in the north. This nationwide study presents findings on the varied risk and burden of pneumonia mortality of various infectious causes, and highlights the susceptibility of influenza-related pneumonia to ambient low temperature. This study is supported by the National Key Research and Development Program (2022YFC3702701), the Shanghai Municipal Science and Technology Commission (21TQ015) and Shanghai International Science and Technology Partnership Project (21230780200).

Environmental exposure assessment in the German National Cohort (NAKO)

Abstract Background The environment plays a major role in human health and wellbeing. Air pollution, non-optimal temperatures, noise and lack of greenspace have been identified as the main external drivers, but their interplay is not well understood. Moreover, negative impacts are expected to increase in the coming decades due to population growth and climate change, especially in urban areas. Therefore, we aimed to assess the exposure to multiple environmental indicators and compare the spatial variation across NAKO participants to lay the foundation for subsequent health analyses. Methods We collected German-wide data from different sources for the following environmental indicators: short- and long-term air pollution (particulate matter, nitrogen dioxide, ozone), short- and long-term meteorology (air temperature, relative humidity), noise and greenness. All exposures were assigned to the NAKO participants based on their baseline residential addresses. Results The NAKO study regions ranged from highly urbanized areas (Berlin, Hamburg) with up to 4,123 inhabitants/km2 to rural regions (Neubrandenburg) with 732 inhabitants/km2. This large variation is reflected in the individual environmental exposures. PM2.5 and NO2 levels ranged from 7.7-16.2 and 4.2-32.6 µg/m3, respectively. Annual mean temperature for 2017 ranged between 8.1-11.7 °C. Noise data were available only for 22% of participants, of which 42% fell into the lowest and 1.9% into the highest category of Lden 55-59 and Lden &amp;gt;75 dB(A), respectively. Greenness also showed considerable contrasts (Normalized Difference Vegetation Index between 0.09-0.82). Conclusions An extensive population-based data set with high-quality environmental indicators is available for the first time across Germany. Expanding the database by adding innovative indicators (e.g. light pollution, walkability) as well as socioeconomic factors (e.g. unemployment rate, deprivation) will further increase its impact on science and public health.

The correlation of climate change and mortality: climate change as a factor for health inequalities

Abstract Recent research has found robust evidence that climate change is often negatively impacting on human health. These impacts are distributed spatially unequal both across the countries of the world and within the countries. While research has clearly outlined this unequal distribution on the country level, for instance with the recently added non-optimal temperature risk factor of the Global Burden of Disease 2019 dataset, thereby acknowledging the impact of unfavorable average temperatures on health, the spatial differences in climate change impacts on health on the subnational level is hardly researched. By operationalizing climate data for a climate change trend analysis of various climate change parameters in GIS, and by applying mortality data for different high-, low-, and middle-income countries on administrative area level 2 for both an Ordinary Least Squared (OLS) and Geographically Weighted (GWR) regression analysis, the proposed article is analyzing the unequal impact of climate change on health inequalities within different countries. Under the assumption that climate change-induced changes of local climate-related conditions affect those areas that already are in a disadvantaged position when it comes to health inequality, the paper is expected to show that inequality gaps are further widening due to climate change, not only but especially in low- and middle-income countries that are more affected by climate change than most of the high-income countries. Therefore, it will have to be discussed, how these increasing health inequalities can be dealt with in a just way and under consideration of already existing vulnerabilities in the most affected areas of climate change. Key messages • Climate change directly influences mortality in all analyzed countries with a bigger impact on low- and middle-income countries. • Climate change contributes to widening health inequalities on a subnational level and especially in low- and middle-income countries.

Measuring Nurses' Knowledge and Awareness of Climate Change and Climate-Associated Diseases: Protocol for a Systematic Review of Existing Instruments.

Climate change is a health emergency. Each year, it is estimated to cost more than 230 million years of life expectancy, with 4-9 million premature deaths associated with air pollution, and 9 million excess deaths due to non-optimal temperatures, representing 7% more temperature-related deaths since 2015 and 66% more since 2000. Identify and evaluate the reliability, fidelity, and validity of instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. A systematic literature review will retrieve and assess studies examining instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. Using predefined search terms for nurses, climate change, literacy and scales or tools, we will search for published articles recorded in the following electronic databases, with no language or date restrictions, from their inception until 31 October 2023: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb], from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Library Wiley (from 1992), Web of Science Core Collection (from 1900), the Trip Database (from 1997), JBI OVID SP (from 1998), and the GreenFILE EBSCO. We will also hand-search relevant articles' bibliographies and search for unpublished studies using Google Scholar, ProQuest Dissertations and Theses Global, and DART-EUrope.eu. This will be completed by exploring the gray literature in OpenGrey and the Grey Literature Report, from inception until 31 October 2023, in collaboration with a librarian. Twelve bibliographic databases will be searched for publications up to 31 October 2023. The papers selected will be assessed for their quality. The electronic database searches were completed in May 2023. Retrieved articles are being screened, and the study will be completed by October 2023. After removing duplicates, our search strategy has retrieved 3449 references. This systematic review will provide specific knowledge about instruments to measure nurses' knowledge, awareness, motivation, attitudes, behaviors, beliefs, skills, and competencies regarding climate change and climate-associated diseases.

Countrywide analysis of heat- and cold-related mortality trends in the Czech Republic: growing inequalities under recent climate warming.

Only little is known about trends in temperature-mortality associations among the most vulnerable subgroups, especially in the areas of central and eastern Europe, which are considered major climatic hotspots in terms of heatwave exposure. Thus, we aimed to assess trends in temperature-related mortality in the Czech Republic by sex, age and cause of death, and to quantify the temporal evolution of possible inequalities. We collected daily time series of all-cause (1987-2019) and cause-specific (1994-2019) mortality by sex and age category, and population-weighted daily mean 2-metre temperatures for each region of the Czech Republic. We applied a quasi-Poisson regression model to estimate the trends in region-specific temperature-mortality associations, with distributed lag non-linear models and multivariate random-effects meta-analysis to derive average associations across the country. We then calculated mortality attributable to non-optimal temperatures and implemented the indicator of sex- and age-dependent inequalities. We observed a similar risk of mortality due to cold temperatures for men and women. Conversely, for warm temperatures, a higher risk was observed for women. Results by age showed a clear pattern of increasing risk due to non-optimum temperatures with increasing age category. The relative risk (RR) related to cold was considerably attenuated in most of the studied subgroups during the study period, whereas an increase in the RR associated with heat was seen in the overall population, in women, in the age category 90+ years and with respect to respiratory causes. Moreover, underlying sex- and age-dependent inequalities experienced substantial growth. Our findings suggest ongoing adaptation to cold temperatures. Mal/adaptation to hot temperatures occurred unequally among population subgroups and resulted in growing inequalities between the sexes and among age categories.

Effects of air temperature on the risk of death from COPD in major microregions in Brazil: a time series study.

To evaluate the association between the risk of death from COPD and air temperature events in ten major Brazilian microregions. This was a time series analysis of daily COPD deaths and daily mean air temperatures between 1996 and 2017. Using distributed nonlinear lag models, we estimated the cumulative relative risks of COPD mortality for four temperature percentiles (representing moderate and extreme cold and heat events) in relation to a minimum mortality temperature, with a lag of 21 days, in each microregion. Significant associations were found between extreme air temperature events and the risk of death from COPD in the southern and southeastern microregions in Brazil. There was an association of extreme cold and an increased mortality risk in the following microregions: 36% (95% CI, 1.12-1.65), in Porto Alegre; 27% (95% CI, 1.03-1.58), in Curitiba; and 34% (95% CI, 1.19-1.52), in São Paulo; whereas moderate cold was associated with an increased risk of 20% (95% CI, 1.01-1.41), 33% (95% CI, 1.09-1.62), and 24% (95% CI, 1.12-1.38) in the same microregions, respectively. There was an increased COPD mortality risk in the São Paulo and Rio de Janeiro microregions: 17% (95% CI, 1.05-1.31) and 12% (95% CI, 1,02-1,23), respectively, due to moderate heat, and 23% (95% CI, 1,09-1,38) and 32% (95% CI, 1,15-1,50) due to extreme heat. Non-optimal air temperature events were associated with an increased risk of death from COPD in tropical and subtropical areas of Brazil.

Projection of temperature-related mortality among the elderly under advanced aging and climate change scenario

Advanced aging is expected to become a major social problem in China during the second half of the 21st century. Current projections of temperature-related mortality in the context of advanced aging are inadequate, and may underestimate the risks posed by global warming on people aged 90+ years. The present study addresses this issue in Nantong City, which was the city in China with the highest aging and advanced aging rates in the 2000, 2010, and 2020 population censuses. Based on 27 global climate models from the Coupled Model Intercomparison Project Phase 6 and statistical downscaling methods, the impacts of climate change and advanced aging on future temperature-related elderly mortality were explored. Our results indicate that global warming will continue to increase the proportion of people who die from non-optimal temperatures even without considering the impact of advanced aging. Moreover, a higher warming range led to a more significant increase in net-temperature-related mortality and advanced aging is likely to increase heat-related mortality and offset the decline in cold-related mortality. Our study demonstrates a “1 + 1 > 2” effect between advanced aging and climate change, under the four shared socioeconomic pathway climate change scenarios considered here. These findings contribute to a better understanding of the impact of climate change on elderly health and facilitate the development of more effective adaptive strategies for advanced aging societies.

Developmental plasticity of thermal performance curve for reproduction in Drosophila melanogaster.

In ectotherms, body temperature is a crucial determinant of performance and fitness, as captured by thermal performance curves (TPCs). Since survival in variable environments is often facilitated by phenotypic plasticity, to reliably assess an organism's ability to cope with thermal changes, it is necessary to characterize not only TPCs but also their reaction norms. While previous studies have investigated plasticity in TPCs, these studies focus only on selected parameters and a few developmental temperatures. They may, therefore, overlook the complexity of developmental plasticity in TPCs. Here, we examined the full extent of thermal developmental plasticity in TPCs for fecundity and hatchability in Drosophila melanogaster. By employing a factorial design with ten developmental and twelve adult temperatures, our study enabled a comprehensive characterization of reaction norms of all key TPC parameters. We found that developmental temperature had a significant impact on the egg production rate, with minor effects on other TPC parameters. Nonoptimal developmental temperatures negatively affected most TPC parameters, whereas development at 22-26 °C maximized reproductive fitness. We also revealed that developmental plasticity for the maximum reproductive performance might be predominantly caused by developmentally-induced changes in ovariole number. Our results in conjunction with previous studies on intraspecific variation suggest that any changes in TPC for reproduction primarily involve the egg production rate, indicating that adaptive evolution and phenotypic plasticity followed the same pathway. Overall, our findings underscore the limitations of developmental plasticity in enhancing reproductive fitness, suggesting that while certain traits, such as egg production rate, may be relatively plastic, these changes may not be sufficient to enable effective adjustment to environmental shifts.