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OBJECTIVE Ambient extreme temperatures have been associated with mental and behavior disorders (MBDs). However, few studies have assesed whether vulnerability factors such as ambient air pollution, pre-existing mental health conditions and residential environmental factors increase susceptibility. This study aims to evaluate the associations between short-term variations in outdoor ambient extreme temperatures and MBD-related emergency department (ED) visits and how these associations are modified by vulnerability factors. METHODS We conducted a case-crossover study of 9,958,759 MBD ED visits in Alberta and Ontario, Canada made between March 1st, 2004 and December 31st, 2020. Daily average temperature was assigned to individual cases with ED visits for MBD using gridded data at a 1 km × 1 km spatial resolution. Conditional logistic regression was used to estimate associations between extreme temperatures (i.e., risk of ED visit at the 2.5th percentile temperature for cold and 97.5th percentile temperature for heat for each health region compared to the minimal temperature risk) and MBD ED visits. Age, sex, pre-existing mental health conditions, ambient air pollution (i.e. PM2.5, NO2 and O3) and residential environmental factors (neighborhood deprivation, residential green space exposure and urbanization) were evaluated as potential effect modifiers. RESULTS Cumulative exposure to extreme heat over 0-5 days (odds ratio [OR] = 1.145; 95% CI: 1.121-1.171) was associated with ED visits for any MBD. However, cumulative exposure to extreme cold was associated with lower risk of ED visits for any MBD (OR = 0.981; 95% CI: 0.976-0.987). We also found heat to be associated with ED visits for specific MBDs such as substance use disorders, dementia, neurotic disorders, schizophrenia and personality behavior disorder. Individuals with pre-existing mental health conditions, those exposed to higher daily concentrations of NO2 and O3 and those residing in neighborhoods with greater material and social deprivation were at higher risk of heat-related MBD ED visits. Increasing tree canopy coverage appeared to mitigate risks of the effect of heat on MBD ED visits. CONCLUSIONS Findings provide evidence that the impacts of heat on MBD ED visits may vary across different vulnerability factors.

Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations., Masna Rai, Massimo Stafoggia, Francesca K. de’ Donato, Sofia Zafeiratou, Liliana Vazquez Fernandez, Siqi Zhang, Klea Katsouyanni, Evangelia Samoli, Shilpa Rao, Antonio Gasparrini, Pierre Masselot, and Alexandra Schneider were supported by the European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655). Joana Madureira was supported by the Fundação para a Ciência e a Tecnologia (FCT) (Grant SFRH/BPD/115112/2016).

Studies have shown that larger temperature-related health impacts may be associated with cold rather than with hot temperatures. Although it remains unclear the cold-related health burden in warmer regions, in particular at the national level in Brazil. We address this gap by examining the association between low ambient temperature and daily hospital admissions for cardiovascular and respiratory diseases in Brazil between 2008 and 2018. We first applied a case time series design in combination with distributed lag non-linear modeling (DLNM) framework to assess the association of low ambient temperature with daily hospital admissions by Brazilian region. Here, we also stratified the analyses by sex, age group (15-45, 46-65, and >65 years), and cause (respiratory and cardiovascular hospital admissions). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our sample included more than 23 million hospitalizations for cardiovascular and respiratory diseases nationwide between 2008 and 2018, of which 53% were admissions for respiratory diseases and 47% for cardiovascular diseases. Our findings suggest that low temperatures are associated with a relative risk of 1.17 (95% CI: 1.07; 1.27) and 1.07 (95% CI: 1.01; 1.14) for cardiovascular and respiratory admissions in Brazil, respectively. The pooled national results indicate robust positive associations for cardiovascular and respiratory hospital admissions in most of the subgroup analyses. In particular, for cardiovascular hospital admissions, men and older adults (>65 years old) were slightly more impacted by cold exposure. For respiratory admissions, the results did not indicate differences among the population groups by sex and age. This study can help decision-makers to create adaptive measures to protect public health from the effects of cold temperature.

The established evidence associating air pollution with health is limited to populations from specific regions. Further large-scale studies in several regions worldwide are needed to support the literature to date and encourage national governments to act. Brazil is an example of these regions where little research has been performed on a large scale. To address this gap, we conducted a study looking at the relationship between daily PM

International audience; BACKGROUND AND AIM: Previous studies have reported a decrease in air pollution following the enforcement of lockdown measures during the first wave of the COVID-19 pandemic. However, these investigations were mostly based on simple pre-post comparisons using past years as a reference, and did not assess the role of different policy interventions. In this contribution, we quantitatively evaluated the association between various lockdown measures and the decrease in NO2, O3, PM2.5, and PM10 levels across 47 European cities and the associated short-term mortality in the period of February-July 2020. METHODS: We used data from several chemical transport models developed by the Copernicus Atmosphere Monitoring Service (CAMS) to define trends in air pollution under business-as-usual and lockdown scenarios, thus removing differences due to weather conditions and other differences affecting pre-post comparisons. We then applied an advanced spatio-temporal Bayesian non-linear mixed effect model to determine the association with stringency indices of individual policy measures, allowing non-linear relationships and geographical correlations. RESULTS: The findings indicate evidence of non-linear relationships, with a stronger decrease in NO2 and to a lesser extent PMs under very strict lockdown regimes. The effects of lockdown measures vary geographically, with a stronger decline in pollution in Southern and Central Europe. The comparative analysis of separate lockdown policies suggests important differences across interventions. Specifically, actions linked to school/workplace closure, limitations on gatherings, and stay-at-home requirements had strong effects, while restrictions on internal movement and international travels showed little impact. The observed decrease in pollution potentially resulted in hundreds of avoided deaths across the European cities. CONCLUSIONS: This study provides important evidence on the differential impacts of various policies implemented during the COVID-19 pandemic in decreasing the level of pollutants in urban areas across Europe.

It is uncertain what climate change could bring to populations and countries in the hot desert environment of the Arabian Peninsula. Not only because they are already hot, countries in this region also have unique demographic profiles, with migrant populations potentially more vulnerable and constituting a large share of the population. In Kuwait, two-thirds of the population are migrant workers and record-high temperatures are already common. We quantified the temperature-related mortality burdens in Kuwait in the mid- (2050–2059) and end-century (2090–2099) decades under moderate (SSP2-4.5) and extreme (SSP5-8.5) climate change scenarios. We fitted time series distributed lag non-linear models to estimate the baseline temperature–mortality relationship which was then applied to future daily mean temperatures from the latest available climate models to estimate decadal temperature-mortality burdens under the two scenarios. By mid-century, the average temperature in Kuwait is predicted to increase by 1.80 °C (SSP2-4.5) to 2.57 °C (SSP5-8.5), compared to a 2000–2009 baseline. By the end of the century, we could see an increase of up to 5.54 °C. In a moderate scenario, climate change would increase heat-related mortality by 5.1% (95% empirical confidence intervals: 0.8, 9.3) by end-century, whereas an extreme scenario increases heat-related mortality by 11.7% (2.7, 19.0). Heat-related mortality for non-Kuwaiti migrant workers could increase by 15.1% (4.6, 22.8). For every 100 deaths in Kuwait, 13.6 (−3.6, 25.8) could be attributed to heat driven by climate change by the end of the century. Climate change induced warming, even under more optimistic mitigation scenarios, may markedly increase heat-related mortality in Kuwait. Those who are already vulnerable, like migrant workers, could borne a larger impact from climate change.

Introduction: Children constitute a subgroup of potential high vulnerability to heat. However, few studies have specifically focused on it. Our aim was to examine the association between summer tem...