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Heatwaves and soil droughts are increasing in frequency and intensity, leading many tree species to exceed their thermal thresholds, and driving wide-scale forest mortality. Therefore, investigating heat tolerance and canopy temperature regulation mechanisms is essential to understanding and predicting tree vulnerability to hot droughts. We measured the diurnal and seasonal variation in leaf water potential (Ψ), gas exchange (photosynthesis A net and stomatal conductance g s ), canopy temperature (T can ), and heat tolerance (leaf critical temperature T crit and thermal safety margins TSM, i.e., the difference between maximum T can and T crit ) in three oak species in forests along a latitudinal gradient (Quercus petraea in Switzerland, Quercus ilex in France, and Quercus coccifera in Spain) throughout the growing season. Gas exchange and Ψ of all species were strongly reduced by increased air temperature (T air ) and soil drying, resulting in stomatal closure and inhibition of photosynthesis in Q. ilex and Q. coccifera when T air surpassed 30°C and soil moisture dropped below 14%. Across all seasons, T can was mainly above T air but increased strongly (up to 10°C > T air ) when A net was null or negative. Although trees endured extreme T air (up to 42°C), positive TSM were maintained during the growing season due to high T crit in all species (average T crit of 54.7°C) and possibly stomatal decoupling (i.e., A net  ≤0 while g s  >0). Indeed, Q. ilex and Q. coccifera trees maintained low but positive g s (despite null A net ), decreasing Ψ passed embolism thresholds. This may have prevented T can from rising above T crit during extreme heat. Overall, our work highlighted that the mechanisms behind heat tolerance and leaf temperature regulation in oak trees include a combination of high evaporative cooling, large heat tolerance limits, and stomatal decoupling. These processes must be considered to accurately predict plant damages, survival, and mortality during extreme heatwaves., (© 2024 The Author(s). Global Change Biology published by John Wiley & Sons Ltd.)

Mediterranean lakes are facing heightened exposure to multiple stressors, such as intensified Saharan dust deposition, temperature increases and fluctuations linked to heatwaves. However, the combined impact of dust and water temperature on the microbial community in freshwater ecosystems remains underexplored. To assess the interactive effect of dust deposition and temperature on aquatic microbes (heterotrophic bacteria and phytoplankton), a combination of field mesocosm experiments covering a dust gradient (five levels, 0-320 mg L -1 ), and paired laboratory microcosms with increased temperature at two levels (constant and fluctuating high temperature) were conducted in a high mountain lake in the Spanish Sierra Nevada, at three points in time throughout the ice-free period. Heterotrophic bacterial production (HBP) increased with dust load regardless of the temperature regime. However, temperature regime affected the magnitude and nature of the interactive Dust×T effect on HBP. Specifically, constant and fluctuating high temperature showed opposing interactive effects in the short term that became additive over time. The relationships between HBP and predictor variables (soluble reactive phosphorus (SRP), excreted organic carbon (EOC), and heterotrophic bacterial abundance (HBA)), coupled with an evaluation of the mechanistic variable photosynthetic carbon use efficiency by bacteria (%CUEb), revealed that bacteria depended on primary production in nearly all treatments when dust was added. The %CUEb increased with dust load in the control temperature treatment, but it was highest at intermediate dust loads under both constant and fluctuating high temperatures. Overall, our results suggest that while dust addition alone strengthens algae-bacteria coupling, high temperatures lead to decoupling in the long term at intermediate dust loads, potentially impacting ecosystem function., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

We introduce the thermosurvey dataset, a comprehensive collection focusing on the thermal comfort, heat-related experiences, health, socioeconomic status, and perceptions of older adults (aged 65 and over) in Warsaw and Madrid. The two cities differ greatly in their heat experiences, but due to climate change, both face increasing temperatures. The study aimed to understand how heat affects cities' older adult population and how we can better adapt to rising temperatures. We call the study a thermosurvey because it connects traditional survey data with temperature and humidity measurements done before, after and during the interview, offering a holistic view of the participants' thermal environments. The dataset can be used to better understand thermal comfort, the interplay of health and heat experiences, and the relationship between experiences and climate change views. We hope our data will enable scholars to analyse the impact of climate change on older adults and to develop strategies to help them adapt to a warming climate., (© 2024. The Author(s).)

Climate change and population ageing are converging challenges that are expected to significantly worsen the health impacts of high temperatures. We aimed to remeasure the implications of ageing for heat-related mortality by comparing time trends based on chronological age (number of years already lived) with those derived from the application of state-of-the-art demographic methodology which better captures the dynamics of evolving longevity: prospective age (number of years still to be lived). We conducted a nationwide time-series analysis of 13 regions in Spain over 1980-2018 using all-cause mortality microdata for people aged 65+ and annual life tables from the Spanish National Institute of Statistics, and daily mean temperatures from E-OBS. Based on confounder-adjusted quasi-Poisson regression with distributed lag non-linear models and multivariate meta-analysis in moving 15-year timeslices, we assessed sex-specific changes in absolute risk and impacts for heat-related mortality at extreme and moderate temperatures, for chronological and prospective age groups. In the conventional chronological age analysis, absolute risk fell over the study period (e.g. females, extreme heat: -54%; moderate heat: -23%); after accounting for rising longevity, the prospective age analysis, however, found a smaller decline in risk for extreme heat (-15%) and a rise for moderate heat (+46%). Additionally, while the chronological age analysis suggested a shift in mortality towards higher ages, the prospective age analysis showed that over the study period, people of largely the same (prospective) age were impacted. Further, the prospective age analysis revealed excess risk in females (compared to males) rose from 20% to 27% for extreme heat, and from 40% to 70% for moderate heat. Assessing the implications of ageing using a prospective age perspective showed the urgency of re-doubling risk reduction efforts, including accelerating healthy ageing programs that incorporate climate considerations. The age patterns of impacts suggested that such actions have the potential to mitigate ageing-related heat-health threats to generate climate change-ready, healthy societies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Heat waves pose a substantial and increasing risk to public health. Heat health early warning systems (HHEWSs) and response plans are increasingly being adopted to alert people to the health risks posed by days of extreme heat and recommend protective behaviors. However, evidence regarding the effectiveness of HHEWSs remains limited. We examined the impact of heat wave naming on heat-related beliefs and behaviors to ascertain the potential effectiveness of heat wave naming as a heat health risk communication and management tool. Specifically, we surveyed members of the public exposed to the proMETEO Sevilla HHEWS messaging campaign which in the summer of 2022 applied a name to heat waves considered to pose the greatest risk to public health. During the heat season we evaluated, the proMETEO Sevilla HHEWS campaign applied a name to one heat wave, heat wave "Zoe". Our analysis of the post-survey of 2022 adults indicated that the 6% of participants who recalled the name Zoe unaided reported greater engagement in heat wave safety behaviors and more positive beliefs about naming heat waves and their local governments' heat wave response. These results provide initial evidence for potential utility in naming heat waves as part of HHEWSs and HAPs., (© 2024. The Author(s).)

Background: A number of studies have reported reductions in mortality risk due to heat and cold over time. However, questions remain about the drivers of these adaptation processes to ambient temperatures. We aimed to analyse the demographic and socioeconomic drivers of the downward trends in vulnerability to heat- and cold-related mortality observed in Spain during recent decades (1980-2018)., Methods: We collected data on all-cause mortality, temperature and relevant contextual indicators for 48 provinces in mainland Spain and the Balearic Islands between Jan 1, 1980, and Dec 31, 2018. Fourteen contextual indicators were analysed representing ageing, isolation, urbanicity, heating, air conditioning (AC), house antiquity and ownership, education, life expectancy, macroeconomics, socioeconomics, and health investment. The statistical analysis was separately performed for the range of months mostly causing heat- (June-September) and cold- (October-May) related mortality. We first applied a quasi-Poisson generalised linear regression in combination with distributed lag non-linear models (DLNM) to estimate province-specific temperature-mortality associations for different periods, and then we fitted univariable and multivariable multilevel spatiotemporal meta-regression models to evaluate the effect modification of the contextual characteristics on heat- and cold-related mortality risks over time., Findings: The average annual mean temperature has risen at an average rate of 0·36 °C per decade in Spain over 1980-2012, although the increase in temperature has been more pronounced in summer (0·40 °C per decade in June-September) than during the rest of the year (0·33 °C per decade). This warming has been observed, however, in parallel with a progressive reduction in the mortality risk associated to both hot and cold temperatures. We found independent associations for AC with heat-related mortality, and heating with cold-related mortality. AC was responsible for about 28·6% (31·5%) of the decrease in deaths due to heat (extreme heat) between 1989 and 1993 and 2009-2013, and heating for about 38·3% (50·8%) of the reductions in deaths due to cold (extreme cold) temperatures. Ageing (ie, proportion of population over 64 years) attenuated the decrease in cold-related mortality., Interpretation: AC and heating are effective societal adaptive measures to heat and cold temperatures. This evidence holds important implications for climate change health adaptation policies, and for the projections of climate change impacts on human health., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Nowadays, the measurement of heat stress indices is of principal importance due to the escalating impact of global warming. As temperatures continue to rise, the well-being and health of individuals are increasingly at risk, which can lead to a detrimental effect on human performance and behavior. Hence, monitoring and assessing heat stress indices have become necessary for ensuring the safety and comfort of individuals. Thermal comfort indices, such as wet-bulb globe temperature (WBGT), Tropical Summer Index (TSI), and Predicted Heat Strain (PHS), as well as parameters like mean radiant temperature (MRT), are typically used for assessing and controlling heat stress conditions in working and urban environments. Therefore, measurement and monitoring of these parameters should be obtained for any environment in which people are constantly exposed. Modern cities collect and publish this relevant information following the Smart City concept. To monitor large cities, cost-effective solutions must be developed. This work presents the results of a Heat Stress Monitoring (HSM) system prototype network tested in the Benicalap-Ciutat Fallera district in Valencia, Spain. The scope of this work is to design, commission, and test a low-cost prototype that is able to measure heat stress indices. The Heat Stress Monitoring system comprises a central unit or receiver and several transmitters communicating via radiofrequency. The transmitter accurately measures wind speed, air temperature, relative humidity, atmospheric pressure, solar irradiation, and black globe temperature. The receiver has a 4G modem that sends the data to an SQL database in the cloud. The devices were tested over one year, showing that radio data transmission is reliable up to 700 m from the receiver. The system's power supply, composed of a Photovoltaic panel and Lithium-ion batteries, provided off-grid capabilities to the transmitter, with a tested backup autonomy of up to 36 days per charge. Then, indicators such as WBGT, TSI, and MRT were successfully estimated using the data collected by the devices. The material cost of a 12-point network is around EUR 2430 with a competitive price of EUR 190 per device.

Environmental epidemiology studies require models of multiple exposures to adjust for co-exposure and explore interactions. We estimated spatiotemporal exposure to surface air temperature and pollution (PM 2.5 , PM 10 , NO 2 , O 3 ) at high spatiotemporal resolution (daily, 250 m) for 2018-2020 in Catalonia. Innovations include the use of TROPOMI products, a data split for remote sensing gap-filling evaluation, estimation of prediction uncertainty, and use of explainable machine learning. We compiled meteorological and air quality station measurements, climate and atmospheric composition reanalyses, remote sensing products, and other spatiotemporal data. We performed gap-filling of remotely-sensed products using Random Forest (RF) models and validated them using Out-Of-Bag (OOB) samples and a structured data split. The exposure modelling workflow consisted of: 1) PM 2.5 station imputation with PM 10 data; 2) quantile RF (QRF) model fitting; and 3) geostatistical residual spatial interpolation. Prediction uncertainty was estimated using QRF. SHAP values were used to examine variable importance and the fitted relationships. Model performance was assessed via nested CV at the station level. Evaluation of the gap-filling models using the structured split showed error underestimation when using OOB. Temperature models had the best performance (R 2 =0.98) followed by the gaseous air pollutants (R 2 =0.81 for NO 2 and 0.86 for O 3 ), while the performance of the PM 2.5 and PM 10 models was lower (R 2 =0.57 and 0.63 respectively). Predicted exposure patterns captured urban heat island effects, dust advection events, and NO 2 hotspots. SHAP values estimated a high importance of TROPOMI tropospheric NO 2 columns in PM and NO 2 models, and confirmed that the fitted associations conformed to prior knowledge. Our work highlights the importance of correctly validating gap-filling models and the potential of TROPOMI measurements. Moderate performance in PM models can be partly explained by the poor station coverage. Our exposure estimates can be used in epidemiological studies potentially accounting for exposure uncertainty., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Heat stroke is a significant cause of mortality in response to high summer temperatures. There is limited evidence on the pattern and magnitude of the association between temperature and heat stroke mortality. We examined this association in Spain, using data from a 27-year follow-up period., Methods: We used a space-time-stratified case-crossover design. We analyzed data using conditional quasi-Poisson regression with distributed lag nonlinear models., Results: Spain recorded a total of 285 heat stroke deaths between 1990 and 2016. Heat stroke deaths occurred in 6% of the days in the summer months. The mean temperature was, on average, 5 °C higher on days when a heat stroke was recorded than on days without heat stroke deaths. The overall relative risk was 1.74 (95% confidence interval = 1.54, 1.96) for a 1 °C rise in mean temperature above the threshold of 16 °C, at which a heat stroke death was first recorded. We observed lagged effects as long as 10 days., Conclusions: Although heat stroke represents a small fraction of total heat-attributable mortality during the summer, it is strongly associated with high temperatures, providing an immediately visible warning of heat-related risk., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Urban heat islands (UHIs) have become an especially relevant phenomenon as a consequence of global warming and the growing proportion of people living in cities. The health impacts that are sometimes attributed to the rise in temperature generated in an UHI are not always adequately justified. The objective is to analyse what effect UHIs have on maximum (Tmax) and minimum daily temperatures (Tmin) recorded in urban and non-urban observatories, and quantify the impact on morbidity and mortality during heat waves in Spain's five cities. Data were collected on natural-cause daily mortality and unscheduled emergency hospital admissions (ICD-10: A00-R99) registered in these 5 cities across the period 2014-2018. We analysed daily Tmax and Tmin values at urban and non-urban observatories in these cities, and quantified the impact of Tmax and Tmin values during heat waves in each of these cities, using GLM models that included Tmax only, Tmin only, and both. We controlled for air pollution and other meteorological variables, as well as for seasonalities, trend and the autoregressive nature of the series. The UHI effect was observed in Tmin but not in Tmax, and proved to be greater in coastal cities than in inland and more densely populated cities. The UHI value in relation to the mean Tmin in the summer months ranged from 1.2 °C in Murcia to 4.1 °C in Valencia (difference between urban/non-urban observatories). The modelling process showed that, while a statistically significant association (p < 0.05) was observed in inland cities with Tmax for mortality and hospital admissions in heat waves, in coastal cities the association was obtained with Tmin, and the only impact in this case was the UHI effect on morbidity and mortality. No generalisations can be made about the impact of UHI on morbidity and mortality among the exposed population in cities. Studies on a local scale are called for, since it is local factors that determine whether the UHI effect will have a greater or lesser impact on health during heat-wave events., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Studies which analyse the joint effect of acoustic or chemical air pollution variables and different meteorological variables on neuroendocrine disease are practically nonexistent. This study therefore sought to analyse the impact of air pollutants and environmental meteorological variables on daily unscheduled admissions due to endocrine and metabolic diseases in the Madrid Region from January 01, 2013 to December 31, 2018., Material and Methods: We conducted a longitudinal, retrospective, ecological study of daily time series analysed by Poisson regression, with emergency neuroendocrine-disease admissions in the Madrid Region as the dependent variable. The independent variables were: mean daily concentrations of PM 10 , PM 2.5 , NO 2 and O 3 ; acoustic pollution; maximum and minimum daily temperatures; hours of sunlight; relative humidity; wind speed; and air pressure above sea level. Estimators of the statistically significant variables were used to calculate the relative risks (RRs)., Results: A statistically significant association was found between the increase in temperatures in heat waves, RR: 1.123 95% CI (1.001-1.018), and the number of emergency admissions, making it the main risk factor. An association between a decrease in sunlight and an increase in hospital admissions, RR: 1.005 95% CI (1.002 1.008), was likewise observed. Similarly, ozone, in the form of mean daily concentrations in excess of 44 μg/m 3 , had an impact on admissions due to neuroendocrine disease, RR: 1.010 95% CI (1.007-1.035). The breakdown by sex showed that in the case of women, NO 2 was also a risk factor, RR: 1.021 95% CI (1.007-1.035)., Conclusion: The results obtained in this study serve to identify risk factors for this disease, such as extreme temperatures in heat waves, O 3 or NO 2 . The robust association found between the decrease in sunlight and increase in hospital admissions due to neuroendocrine disease serves to spotlight an environmental factor which has received scant attention in public health until now., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Over 70,000 excess deaths occurred in Europe during the summer of 2003. The resulting societal awareness led to the design and implementation of adaptation strategies to protect at-risk populations. We aimed to quantify heat-related mortality burden during the summer of 2022, the hottest season on record in Europe. We analyzed the Eurostat mortality database, which includes 45,184,044 counts of death from 823 contiguous regions in 35 European countries, representing the whole population of over 543 million people. We estimated 61,672 (95% confidence interval (CI) = 37,643-86,807) heat-related deaths in Europe between 30 May and 4 September 2022. Italy (18,010 deaths; 95% CI = 13,793-22,225), Spain (11,324; 95% CI = 7,908-14,880) and Germany (8,173; 95% CI = 5,374-11,018) had the highest summer heat-related mortality numbers, while Italy (295 deaths per million, 95% CI = 226-364), Greece (280, 95% CI = 201-355), Spain (237, 95% CI = 166-312) and Portugal (211, 95% CI = 162-255) had the highest heat-related mortality rates. Relative to population, we estimated 56% more heat-related deaths in women than men, with higher rates in men aged 0-64 (+41%) and 65-79 (+14%) years, and in women aged 80+ years (+27%). Our results call for a reevaluation and strengthening of existing heat surveillance platforms, prevention plans and long-term adaptation strategies., (© 2023. The Author(s).)

While climate change and population ageing are expected to increase the exposure and vulnerability to extreme heat events, there is emerging evidence suggesting that social inequalities would additionally magnify the projected health impacts. However, limited evidence exists on how social determinants modify heat-related cardiovascular morbidity. This study aims to explore the association between heat and the incidence of first acute cardiovascular event (CVE) in adults in Madrid between 2015 and 2018, and to assess how social context and other individual characteristics modify the estimated association. We performed a case-crossover study using the individual information collected from electronic medical records of 6514 adults aged 40-75 living in Madrid city that suffered a first CVE during summer (June-September) between 2015 and 2018. We applied conditional logistic regression with a distributed lag non-linear model to analyse the heat-CVE association. Estimates were expressed as Odds Ratio (OR) for extreme heat (at 97.5th percentile of daily maximum temperature distribution), compared to the minimum risk temperature. We performed stratified analyses by specific diagnosis, sex, age (40-64, 65-75), country of origin, area-level deprivation, and presence of comorbidities. Overall, the risk of suffering CVE increased by 15.3% (OR: 1.153 [95%CI 1.010-1.317]) during extreme heat. Males were particularly more affected (1.248, [1.059-1.471]), vs 1.039 [0.810-1.331] in females), and non-Spanish population (1.869 [1.28-2.728]), vs 1.084 [0.940-1.250] in Spanish). Similar estimates were found by age groups. We observed a dose-response pattern across deprivation levels, with larger risks in populations with higher deprivation (1.228 [1.031-1.462]) and almost null association in the lowest deprivation group (1.062 [0.836-1.349]). No clear patterns of larger vulnerability were found by presence of comorbidity. We found that heat unequally increased the risk of suffering CVE in adults in Madrid, affecting mainly males and deprived populations. Local measures should pay special attention to vulnerable populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people)., Methods: We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z -score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z -scores using the Pearson correlation coefficient ( R 2 )., Results: During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z -scores of temperature and all-cause deaths was 3 days and R 2 = 0.86, while between ILI and all-cause deaths was 22 days and R 2 = 0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021., Conclusion: Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Coma, Pino, Mora, Fina, Perramon, Prats, Medina, Planella, Mompart, Mendioroz and Cabezas.)

There is worldwide concern about how climate change -which involves rising temperatures- may increase the risk of contracting and developing diseases, reducing the quality of life. This study provides new research that takes into account parameters such as land surface temperature (LST), surface urban heat island (SUHI), urban hotspot (UHS), air pollution (SO 2 , NO 2 , CO, O 3 and aerosols), the normalized difference vegetation index (NDVI), the normalized difference building index (NDBI) and the proportion of vegetation (PV) that allows evaluating environmental quality and establishes mitigation measures in future urban developments that could improve the quality of life of a given population. With the help of Sentinel 3 and 5P satellite images, we studied these variables in the context of Granada (Spain) during the year 2021 to assess how they may affect the risk of developing diseases (stomach, colorectal, lung, prostate and bladder cancer, dementia, cerebrovascular disease, liver disease and suicide). The results, corroborated by the statistical analysis using the Data Panel technique, indicate that the variables LST, SUHI and daytime UHS, NO 2 , SO 2 and NDBI have important positive correlations above 99% (p value: 0.000) with an excess risk of developing these diseases. Hence, the importance of this study for the formulation of healthy policies in cities and future research that minimizes the excess risk of diseases., (© 2023. The Author(s).)

Climate change is currently regarded as the greatest global threat to human health, and its health-related consequences take different forms according to age, sex, socioeconomic level, and type of territory. The aim of this study is to ascertain the differences in vulnerability and the heat-adaptation process through the minimum mortality temperature (MMT) among the Spanish population aged ≥65 years by territorial classification. A retrospective, longitudinal, ecological time-series study, using provincial data on daily mortality and maximum daily temperature across the period 1983-2018, was performed, differentiating between urban and nonurban populations. The MMTs in the study period were higher for the ≥65-year age group in urban provinces, with a mean value of 29.6 °C (95%CI 29.2-30.0) versus 28.1 °C (95%CI 27.7-28.5) in nonurban provinces. This difference was statistically significant ( p < 0.05). In terms of adaptation levels, higher average values were obtained for nonurban areas, with values of 0.12 (95%CI -0.13-0.37), than for urban areas, with values of 0.09 (95%CI -0.27-0.45), though this difference was not statistically significant ( p < 0.05). These findings may contribute to better planning by making it possible to implement more specific public health prevention plans. Lastly, they highlight the need to conduct studies on heat-adaptation processes, taking into account various differential factors, such as age and territory.

The objective of this study was to characterize radon concentrations registered in the Radiological Surveillance Network of the Basque country in relation to local meteorological parameters, and to determine its behaviour under heatwave events. For this purpose, radon measurements and meteorological parameters from June 2012 to June 2015 were analysed at two sites, Bilbao and Vitoria (northern Spain), in a region characterized by complex orography, causing large temporal and spatial variability in meteorological conditions. Yearly, seasonal, and diurnal cycle differences and similarities were investigated at both sites. The temporal evolution of radon concentration was analysed at both sites during the two heatwave periods officially identified by the State Meteorological Agency (8-11 August 2012 and 17-23 August 2012). The analysis revealed two different patterns of radon concentrations, in terms of both time and intensity, under this synoptic pattern, making it also possible to identify regional transport channels of radon concentrations between the two sites. This set of results evidences the adequate position of both stations to represent the spatial and temporal evolution of radiological variables continuously in this region.

In the current climate change scenario, heat waves have become one of the most concerning extreme climatic events, both because of their implications for human health and the economy, and because of their increase in intensity and frequency in recent decades. This work presents for the first time a climatological analysis of heat waves in the Iberian Peninsula and Balearic Archipelago (IPB) using the Excess Heat Factor index (EHF). This index considers the factor of intensity and the acclimatization process of human body in the study of heat waves. We focused on the intensity (also called severity), duration, frequency and spatial extension of heat waves in the IPB in the 1950-2020 period. The exceptional heat wave of August 2018 was approached in a similar way to further explore the usefulness of the EHF index. We found that the EHF index identified heat wave conditions 2 days earlier than indices that used only maximum temperatures. Results showed a significant increase in intensity, duration, frequency and spatial extension of heat waves for the whole IPB for 1950-2020 period. The average extent of heat waves increased by 4.0% per decade and the maximum extent by 4.1% per decade. This trend suggested a significant increase in human exposure, droughts, fire risk and energy demand in this region in the last decades., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Although adaptation to continuously rising ambient temperatures is an emerging topic and has been widely studied at a global scale, detailed analysis of the joint indicators for long-term adaptation in Spain are scarce. This study aims to explore temporal variations of the minimum mortality temperature and mortality burden from heat and cold between 1979 and 2018., Methods: We collected individual all-cause mortality and climate reanalysis data for 4 decades at a daily time step. To estimate the temperature-mortality association for each decade, we fitted a quasi-Poisson time-series regression model using a distributed lag non-linear model with 21 days of lag, controlling for trends and day of the week. We also calculated attributable mortality fractions by age and sex for heat and cold, defined as temperatures above and below the optimum temperature, which corresponds to the minimum mortality in each period., Results: We analysed over 14 million deaths registered in Spain between 1979 and 2018. The optimum temperature estimated at a nationwide scale declined from 21 °C in 1979-1988 to 16 °C in 1999-2008, and raised to 18 °C in 2009-2018. The mortality burden from moderate cold showed a 3-fold reduction down to 2.4% in 2009-2018. Since 1988-1999, the mortality risk attributable to moderate (extreme) heat reduced from 0.9% (0.8%) to 0.6% (0.5%). The mortality risk due to heat in women was almost 2 times larger than in men, and did not decrease over time., Conclusion: Despite the progressively warmer temperatures in Spain, we observed a persistent flattening of the exposure-response curves, which marked an expansion of the uncertainty range of the optimal temperatures. Adaptation has been produced to some extent in a non-uniform manner with a substantial decrease in cold-related mortality, while for heat it became more apparent in the most recent decade only., (© 2023. The Author(s).)

The capacity for adaptation to climate change is limited, and the elderly rank high among the most exposed population groups. To date, few studies have addressed the issue of heat adaptation, and little is known about the long-term effects of exposure to heat. One indicator that allows the ascertainment of a population's level of adaptation to heat is the minimum mortality temperature (MMT), which links temperature and daily mortality. The aim of this study was to ascertain, firstly, adaptation to heat among persons aged ≥ 65 years across the period 1983 to 2018 through analysis of the MMT; and secondly, the trend in such adaptation to heat over time with respect to the total population. A retrospective longitudinal ecological time series study was conducted, using data on daily mortality and maximum daily temperature across the study period. Over time, the MMT was highest among elderly people, with a value of 28.6 °C (95%CI 28.3-28.9) versus 28.2 °C (95%CI 27.83-28.51) for the total population, though this difference was not statistically significant. A total of 62% of Spanish provinces included populations of elderly people that had adapted to heat during the study period. In general, elderly persons' level of adaptation registered an average value of 0.11 (°C/decade).

Background: In Spain, two synoptic-scale conditions influence heat wave formation. The first involves advection of warm and dry air masses carrying dust of Saharan origin (North African Dust (NAF) = 1). The second entails anticyclonic stagnation with high insolation and stability (NAF) = 0). Some studies show that the meteorological origin of these heat waves may affect their impact on morbidity and mortality., Objective: To determine whether the impact of heat waves on health outcomes in Madrid (Spain) during 2013-2018 varied by synoptic-scale condition., Methodology: Outcome data consist of daily mortality and daily hospital emergency admissions (morbidity) for natural, circulatory, and respiratory causes. Predictors include daily maximum and minimum temperatures and daily mean concentrations of NO 2 , PM 10 , PM 2.5 , NO 2 , and O 3 . Analyses adjust for insolation, relative humidity, and wind speed. Generalized linear models were performed with Poisson link between the variables controlling for trend, seasonality, and auto-regression in the series. Relative Risks (RR) and Attributable Risks (AR) were determined. The RRs for mortality attributable to high temperatures were similar regardless of NAF status. For hospital admissions, however, the RRs for hot days with NAF = 0 are higher than for days with NAF = 1. We also found that atmospheric pollutants worsen morbidity and mortality, especially PM 10 concentrations when NAF = 1 and O 3 concentrations when NAF = 0., Results: The effect of heat waves on morbidity and mortality depends on the synoptic situation. The impact is greater under anticyclonic stagnation conditions than under Saharan dust advection. Further, the health impact of pollutants such as PM 10 and O 3 varies according to the synoptic situation., Conclusions: Based on these findings, we strongly recommend prevention plans to include data on the meteorological situation originating the heat wave, on a synoptic-scale, as well as comprehensive preventive measures against the compounding effect of high temperatures and pollution., Competing Interests: Declaration of competing interest The researchers declare that they have no conflict of interest that would compromise the independence of this research work. The views expressed by the authors are not necessarily those of the institutions they are affiliated with., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Although there are currently alternative treatments to the long-term use of oral corticosteroids (OCS) in severe asthma, recent studies show excessive use depending on geography and differences in medical practice. The objective of the study was to describe the differences in OCS use for severe asthma across the Spanish geography., Methods: This is a real-world study using existing databases (year 2019): longitudinal patient database (EMR), based on electronic medical records, and database of pharmacological consumption (Sell-in) in basic healthcare areas. With EMR, the percentage of OCS prescriptions corresponding to patients with severe asthma (ICD-9 "asthma" and prescription of biological treatment and/or high dose of inhaled corticosteroids/long-acting inhaled β2 agonists) was calculated. This percentage was transferred to the OCS consumption of each basic healthcare area as reported in the Sell-in database and a national heat map was created. The estimation of OCS use in patients with severe asthma per 100,000 inhabitants for each region was calculated by grouping basic healthcare areas and the mean OCS use per patient for different regions in Spain was also estimated., Results: Patients with severe asthma in Spain were mostly female (69.6%), with a mean age (SD) of 57.6 years (18.01). Median time (Pc25-Pc75) since asthma diagnosis was 83.1 months (34.65-131.56). Of all patients with OCS prescriptions in 2019 identified in EMR, 4.4% corresponded to patients with severe asthma. Regions with the highest OCS use were Asturias, Andalucía, and Galicia, whereas those with the lowest use were Navarra, Baleares, Madrid and País Vasco. The mean OCS use per patient with severe asthma in 2019 throughout Spain was 1099.85 mg per patient, ranging from 782.99 mg in Navarra to 1432.64 in Asturias., Conclusions: There are geographical differences between Spanish regions with respect to the use of OCS in patients with severe asthma. The national mean consumption of OCS per patient with severe asthma and year is above the limits that indicate good asthma control., (© 2023. The Author(s).)

Background: Some studies have documented that cold or hot ambient temperatures increase the risk of motor vehicle crashes. However, the number of existing studies is still limited, especially for the effects of cold., Objectives: To estimate the relationship between ambient temperatures and risk of motor vehicle crashes in Spain, and to estimate the same association when restricting to those crashes with driver performance-associated factors (namely distraction, fatigue, sleepiness or disease)., Methods: We used data for the period 1993-2013. We conducted a time series analysis controlling for seasonality and trends and using the distributed lag nonlinear model framework to estimate nonlinear and delayed effects of up to 7 days. Analyses were conducted at the province level and combined using multivariate meta-analysis., Results: The study included 1,908,460 motor vehicle crashes, 37% of them with associated driver performance factors. The overall analysis showed that the risk of crashes increased almost linearly with temperature. The estimates of the cumulative effect of lags 0-7 when comparing the 99th percentile and the first percentile of temperature produced a relative risk (RR) of 1.15 (95% confidence interval (CI): 1.11, 1.20). The estimates were slightly higher when analyses were restricted to crashes with driver performance-associated factors (RR: 1.23, 95% CI: 1.17, 1.30). In some provinces that reached temperatures below 0 °C, an increased risk with cold temperatures was also observed. An added effect of both cold spell and heat wave periods was found only in the analysis of crashes with driver performance-associated factors (cold spells, RR: 1.029, 95% CI: 1.005, 1.053; heat waves, RR: 1.020, 95% CI: 1.002, 1.039)., Conclusions: The increase of temperature increased the risk of motor vehicle crashes in Spain. Measures aimed at reducing the influence of heat on the risk of motor vehicle crashes can have important benefits for public health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

In Spain the average temperature has increased by 1.7 °C since pre-industrial times. There has been an increase in heat waves both in terms of frequency and intensity, with a clear impact in terms of population health. The effect of heat waves on daily mortality presents important territorial differences. Gender also affects these impacts, as a determinant that conditions social inequalities in health. There is evidence that women may be more susceptible to extreme heat than men, although there are relatively few studies that analyze differences in the vulnerability and adaptation to heat by sex. This could be related to physiological causes. On the other hand, one of the indicators used to measure vulnerability to heat in a population and its adaptation is the minimum mortality temperature (MMT) and its temporal evolution. The aim of this study was to analyze the values of MMT in men and women and its temporal evolution during the 1983-2018 period in Spain's provinces. An ecological, longitudinal retrospective study was carried out of time series data, based on maximum daily temperature and daily mortality data corresponding to the study period. Using cubic and quadratic fits between daily mortality rates and the temperature, the minimum values of these functions were determined, which allowed for determining MMT values. Furthermore, we used an improved methodology that provided for the estimation of missing MMT values when polynomial fits were inexistent. This analysis was carried out for each year. Later, based on the annual values of MMT, a linear fit was carried out to determine the rate of evolution of MMT for men and for women at the province level. Average MMT for all of Spain's provinces was 29.4 °C in the case of men and 28.7 °C in the case of women. The MMT for men was greater than that of women in 86 percent of the total provinces analyzed, which indicates greater vulnerability among women. In terms of the rate of variation in MMT during the period analyzed, that of men was 0.39 °C/decade, compared to 0.53 °C/decade for women, indicating greater adaptation to heat among women, compared to men. The differences found between men and women were statistically significant. At the province level, the results show great heterogeneity. Studies carried out at the local level are needed to provide knowledge about those factors that can explain these differences at the province level, and to allow for incorporating a gender perspective in the implementation of measures for adaptation to high temperatures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

In contrast to research on heat waves, there are no studies in recent years that analyze the temporal evolution of threshold temperatures (Tthreshold) for extremely cold days (ECD). It is unknown whether threshold temperatures have increased more quickly than the minimum daily temperature (Tmin) in recent years. The objective of this study was to analyze the temporal evolution of the minimum daily temperature (Tmin) in a group of Spanish provinces and compare it with the evolution of threshold temperatures. An ecological, retrospective time series study was carried out using daily observations between January 1, 1983 and December 31, 2018 (36 years) in 10 provinces that are representative of the different climate territories in Spain. For each representative observatory in each province, the values of Tmin were obtained for the winter months (November-March). The value of Tthreshold was determined for each province and each year, using dispersion diagrams for the pre-whitened series, with daily mortality due to natural causes displayed on the Y axis (CIEX: A00-R99) and Tmin grouped by 10 degree intervals on the X axis. To determine the temporal evolution of Tmin and Tthreshold for each province, linear models were fitted, with time as the independent variable. During the winter months, Tmin increased at an average rate of 0.2 °C/decade (IC95: 0.1-0.3), while Tthreshold remained practically constant during the period, at 0.1 °C/decade (IC95% -0.1 0.3). These values are much lower than those obtained in the case of heat, both in terms of the evolution of maximum daily temperature and that of Tthreshold. In conclusion, the fact that this trend has been maintained across time in a scenario of climate change, with a slow increase in minimum daily temperatures and constant values of Threshold, suggests a decrease in the number of ECD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Under the influence of climate change, environmental exposure to heat and pollution grows, exacerbated by extreme events, increasing the risk of mortality in vulnerable areas. We aimed to evaluate the present (2000-2019) and future effects of heat on the burden of cardiovascular (in people aged 45 years or older), respiratory (in people aged 60 years or older) and all-cause (in people aged 1 year or more) diseases in capitals of the Legal Amazon (Brazil)., Methods: An ecological study was conducted to initially estimate, for the period 2000-2019, the relative risk (RR) of exposure-response related to the effects of temperature on years of life potentially lost (YLL) using the generalized linear regression model (GLM), combined with the distributed non-linear lag model (DLNM); and the fractions of YLL attributable to heat from the prospective perspective (forward). Subsequently, the results were estimated in the baseline period (1970-2005) and projected into the future in the specific levels of warming and periods: 1.5 ºC (2010-2039), 2 ºC (2040-2069) and 4 ºC (2070-2099), considering the temperature data from the WCRP CORDEX regional climate model in RCP8.5 scenario., Results: The RR of YLL increased significantly in the capitals due to exposure to heat and marked thermal amplitudes between 2000-2019, with the major effects on respiratory diseases in Río Blanco (14%), due to all causes in Manaus (12%) and cardiovascular in Cuiabá (9%). Compared with the baseline period, the period 2040-2069 showed the largest increase (10.40 times) in the fraction of the number of YLL attributable to heat in the region, with the predominance of cardiovascular diseases. The findings were not completely conclusive, the low precision of the estimated confidence intervals did not show the significance of the negative effect of heat., Conclusions: Regardless of its significance, heat increases the risk of years of life lost in the short and medium term. The results support the need to include climate change mitigation and adaptation measures as public health protection policies., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This paper presents a device used to measure and register temperature for long-term subsoil measurements in boreholes. The borehole of this study is located in Gijón (Asturias, Spain). The measurements were made through two fixed sets of sensors coupled to the geothermal pipe, constituting two independent installations: (a) a commercial device called "Hobo", which uses TMCx-HD-specific sensors based on resistors with variable resistance; and (b) a device built by this research group, which uses DS12B20 Maxim sensors, a bus 1-wire, and a recording device based on a conventional Arduino board. Temperature was registered every 5 min across several years. These measurements were used to thermally characterize the subsoil, determining the apparent thermal diffusivity, and to study the thermo-hydrogeology of the Lower Jurassic Gijón's formation made of Liassic limestones and dolomites. This work is part of the Q-Thermie group's research called "Shallow Thermal Energy".

The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: There is currently little knowledge and few published works on the subject of vulnerability to heat in rural environments at the country level. Therefore, the objective of this study was to determine whether rural areas are more vulnerable to extreme heat than urban areas in Spain. This study aimed to analyze whether a pattern of vulnerability depends on contextual, environmental, demographic, economic and housing variables., Methods: An ecological, longitudinal and retrospective study was carried out based on time series data between January 01, 2000 and December 31, 2013 in 42 geographic areas in 10 provinces in Spain. We first analyzed the functional relationship between the mortality rate per million inhabitants and maximum daily temperature (Tmax). We then determined the summer temperature threshold (Pthreshold) (June-September) at which increases in mortality are produced that are attributable to heat. In a second phase, based on Pthreshold, a vulnerability variable was calculated, and its distribution was analyzed using mixed linear models from the Poisson family (link = log). In these models, the dependent variable was vulnerability, and the independent variables were exposure to high temperatures, aridity of the climate, deprivation index, percentage of people over age 65, rurality index, percentage of housing built prior to 1980 and condition of dwellings., Results: Rurality was a protective factor, and vulnerability in urban areas was six times greater. In contrast, risk factors included aridity (RR = 5.89 (2.26 15.36)), living in cool summer zones (2.69 (1.23, 5.91)), poverty (4.05 (1.91 8.59)) and the percentage of dysfunctional housing (1.13 (1.04 1.24))., Conclusions: Rural areas are less vulnerable to extreme heat than the urban areas analyzed. Also, population groups with worse working conditions and higher percentages of dwellings in poor conditions are more vulnerable., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Although future climate is predicted to have more extreme heat conditions, the available evidence on the impact of these conditions on pregnancy length is very scarce and inconclusive. Objectives: We investigated the impact of maternal short-term exposure to extreme ambient heat on the length of pregnancy. Methods: This study was based on a cohort of births that occurred in a major university hospital in Barcelona during 2001-2005. Three indicators of extreme heat conditions based on 1-day exposure to an unusually high heat-humidity index were applied. Each mother was assigned the measures made by the meteorological station closest to maternal residential postcodes. A two-stage analysis was developed to quantify the change in pregnancy length after maternal exposure to extreme heat conditions adjusted for a range of covariates. The second step was repeated for lags 0 (delivery date) to 6 days. Results: We included data from 7,585 pregnant women in our analysis. We estimated a 5-day reduction in average gestational age at delivery after an unusually high heat-humidity index on the day before delivery. Conclusion: Extreme heat was associated with a reduction in the average gestational age of children delivered the next day, suggesting an immediate effect of this exposure on pregnant women. Further studies are required to confirm our findings in different settings. [ABSTRACT FROM AUTHOR]

Background: The increased risk of mortality during periods of high and low temperatures has been well established. However, most of the studies used daily counts of deaths or hospitalisations as health outcomes, although they are the ones at the top of the health impact pyramid reflecting only a limited proportion of patients with the most severe cases., Objectives: This study evaluates the relationship between short-term exposure to the daily mean temperature and medication prescribed for the respiratory system in five Spanish cities., Methods: We fitted time series regression models to cause-specific medical prescriptions, including different respiratory subgroups and age groups. We included a distributed lag non-linear model with lags up to 14 days for daily mean temperature. City-specific associations were summarised as overall-cumulative exposure-response curves., Results: We found a positive association between cause-specific medical prescriptions and daily mean temperature with a non-linear inverted J- or V-shaped relationship in most cities. Between 0.3% and 0.6% of all respiratory prescriptions were attributed to cold for Madrid, Zaragoza and Pamplona, while in cities with only cold effects the attributable fractions were estimated as 19.2% for Murcia and 13.5% for Santander. Heat effects in Madrid, Zaragoza and Pamplona showed higher fractions between 8.7% and 17.2%. The estimated costs are in general higher for heat effects, showing annual values ranging between €191,905 and €311,076 for heat per 100,000 persons., Conclusions: This study provides novel evidence of the effects of the thermal environment on the prescription of medication for respiratory disorders in Spain, showing that low and high temperatures lead to an increase in the number of such prescriptions. The consumption of medication can reflect exposure to the environment with a lesser degree of severity in terms of morbidity., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to analyze at the level of Spain's 52 provinces province level the temporal evolution of minimum mortality temperatures (MMT) from 1983 to 2018, in order to determine whether the increase in MMT would be sufficient to compensate for the increase in environmental temperatures in Spain for the period. It also aimed to analyze whether the rate of evolution of MMT would be sufficient, were it to remain constant, to compensate for the predicted increase in temperatures in an unfavorable (RCP 8.5) emissions scenario for the time horizon 2051-2100. The independent variable was made up of maximum daily temperature data (Tmax) for the summer months in the reference observatories of each province for the 1983-2018 period. The dependent variable was daily mortality rate due to natural causes (ICD 10: A00-R99). For each year and province, MMT was determined using a quadratic or cubic fit (p < 0.05). Based on the annual MMT values, a linear fit was carried out that allowed for determining the time evolution of MMT. These values were compared with the evolution of Tmax registered in each observatory during the 1983-2018 analyzed period and with the predicted values of Tmax obtained for an RCP8.5 scenario for the period 2051-2100. The rate of global variance in Tmax in the summer months in Spain during the 1983-2018 period was 0.41 °C/decade, while MMT across the whole country increased at a rate of 0.64 °C/decade. Variations in the provinces were heterogeneous. For the 2051-2100 time horizon, there was predicted increase in Tmax values of 0.66 °C/decade, with marked geographical differences. Although at the global level it is possible to speak of adaptation, the heterogeneities among the provinces suggest that the local level measures are needed in order to facilitate adaptation in those areas where it is not occurring., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Due to global warming, the search for new sources for heat tolerance and the identification of genes involved in this process has become an important challenge as of today. The main objective of the current research was to verify whether the heat tolerance determined in controlled greenhouse experiments could be a good predictor of the agronomic performance in field cultivation under climatic high temperature stress., Results: Tomato accessions were grown in greenhouse under three temperature regimes: control (T1), moderate (T2) and extreme heat stress (T3). Reproductive traits (flower and fruit number and fruit set) were used to define heat tolerance. In a first screening, heat tolerance was evaluated in 219 tomato accessions. A total of 51 accessions were identified as being potentially heat tolerant. Among those, 28 accessions, together with 10 accessions from Italy (7) and Bulgaria (3), selected for their heat tolerance in the field in parallel experiments, were re-evaluated at three temperature treatments. Sixteen tomato accessions showed a significant heat tolerance at T3, including five wild species, two traditional cultivars and four commercial varieties, one accession from Bulgaria and four from Italy. The 15 most promising accessions for heat tolerance were assayed in field trials in Italy and Bulgaria, confirming the good performance of most of them at high temperatures. Finally, a differential gene expression analysis in pre-anthesis (ovary) and post-anthesis (developing fruit) under heat stress among pairs of contrasting genotypes (tolerant and sensitive from traditional and modern groups) showed that the major differential responses were produced in post-anthesis fruit. The response of the sensitive genotypes included the induction of HSP genes, whereas the tolerant genotype response included the induction of genes involved in the regulation of hormones or enzymes such as abscisic acid and transferases., Conclusions: The high temperature tolerance of fifteen tomato accessions observed in controlled greenhouse experiments were confirmed in agronomic field experiments providing new sources of heat tolerance that could be incorporated into breeding programs. A DEG analysis showed the complex response of tomato to heat and deciphered the different mechanisms activated in sensitive and tolerant tomato accessions under heat stress., (© 2021. The Author(s).)

Objective: To investigate reported extreme temperature-related catastrophic events and associated mortality on the European continent including the Russian Federation., Design: Cross-sectional respecting Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria., Settings: Data source: Emergency Events Database (EM-DAT)., Participants: Search criteria: location-European continent including Russian Federation, time-years 1988 until 2019 (close of database 12 July 2019), catastrophic events-extreme temperatures., Primary Outcome Measures: Numbers of heat waves, cold waves, severe winter conditions and associated number of deaths, overall, and per country and year, respecting STROBE criteria., Results: The most frequent type of the 243 events recorded in EM-DAT were cold waves (54.7%). However, cold waves and severe winter conditions only accounted for 6460 deaths (4.5%), while heat waves were associated with 137 533 deaths (95.5%). The five most severe heat waves in 2003, 2006, 2010, 2013 and 2015 were associated with a total of 135 089 deaths. The most severe heat waves were geographically distributed over the Russian Federation (2010), as well as France, Italy, Spain and Germany, each in 2003., Conclusion: Although cold waves are more frequently reported in EM-DAT, heat waves are the major cause for temperature-related deaths. In order to better protect the public, it is important to address resiliency and vulnerability of populations at risk and age groups., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Occupational heat exposure can provoke health problems that increase the risk of certain diseases and affect workers' ability to maintain healthy and productive lives. This study investigates the effects of occupational heat stress on workers' physiological strain and labor productivity, as well as examining multiple interventions to mitigate the problem., Methods: We monitored 518 full work-shifts obtained from 238 experienced and acclimatized individuals who work in key industrial sectors located in Cyprus, Greece, Qatar, and Spain. Continuous core body temperature, mean skin temperature, heart rate, and labor productivity were collected from the beginning to the end of all work-shifts., Results: In workplaces where self-pacing is not feasible or very limited, we found that occupational heat stress is associated with the heat strain experienced by workers. Strategies focusing on hydration, work-rest cycles, and ventilated clothing were able to mitigate the physiological heat strain experienced by workers. Increasing mechanization enhanced labor productivity without increasing workers' physiological strain., Conclusions: Empowering laborers to self-pace is the basis of heat mitigation, while tailored strategies focusing on hydration, work-rest cycles, ventilated garments, and mechanization can further reduce the physiological heat strain experienced by workers under certain conditions.

Background: The link between heat exposure and adverse health outcomes in workers is well documented and a growing body of epidemiological evidence from various countries suggests that extreme heat may also contribute to increased risk of occupational injuries (OI). Previously, there have been no comparative reviews assessing the risk of OI due to extreme heat within a wide range of global climate zones. The present review therefore aims to summarise the existing epidemiological evidence on the impact of extreme heat (hot temperatures and heatwaves (HW)) on OI in different climate zones and to assess the individual risk factors associated with workers and workplace that contribute to heat-associated OI risks., Methods: A systematic review of published peer-reviewed articles that assessed the effects of extreme heat on OI among non-military workers was undertaken using three databases (PubMed, Embase and Scopus) without temporal or geographical limits from database inception until July 2020. Extreme heat exposure was assessed in terms of hot temperatures and HW periods. For hot temperatures, the effect estimates were converted to relative risks (RR) associated with 1 °C increase in temperature above reference values, while for HW, effect estimates were RR comparing heatwave with non-heatwave periods. The patterns of heat associated OI risk were investigated in different climate zones (according to Köppen Geiger classification) based on the study locations and were estimated using random-effects meta-analysis models. Subgroup analyses according to workers' characteristics (e.g. gender, age group, experience), nature of work (e.g. physical demands, location of work i.e. indoor/outdoor) and workplace characteristics (e.g. industries, business size) were also conducted., Results: A total of 24 studies published between 2005 and 2020 were included in the review. Among these, 22 studies met the eligibility criteria, representing almost 22 million OI across six countries (Australia, Canada, China, Italy, Spain, and USA) and were included in the meta-analysis. The pooled results suggested that the overall risk of OI increased by 1% (RR 1.010, 95% CI: 1.009-1.011) for 1 °C increase in temperature above reference values and 17.4% (RR 1.174, 95% CI: 1.057-1.291) during HW. Among different climate zones, the highest risk of OI during hot temperatures was identified in Humid Subtropical Climates (RR 1.017, 95% CI: 1.014-1.020) followed by Oceanic (RR 1.010, 95% CI: 1.008-1.012) and Hot Mediterranean Climates (RR 1.009, 95% CI: 1.008-1.011). Similarly, Oceanic (RR 1.218, 95% CI: 1.093-1.343) and Humid Subtropical Climates (RR 1.213, 95% CI: 0.995-1.431) had the highest risk of OI during HW periods. No studies assessing the risk of OI in Tropical regions were found. The effects of hot temperatures on the risk of OI were acute with a lag effect of 1-2 days in all climate zones. Young workers (age < 35 years), male workers and workers in agriculture, forestry or fishing, construction and manufacturing industries were at high risk of OI during hot temperatures. Further young workers (age < 35 years), male workers and those working in electricity, gas and water and manufacturing industries were found to be at high risk of OI during HW., Conclusions: This review strengthens the evidence on the risk of heat-associated OI in different climate zones. The risk of OI associated with extreme heat is not evenly distributed and is dependent on underlying climatic conditions, workers' attributes, the nature of work and workplace characteristics. The differences in the risk of OI across different climate zones and worker subgroups warrant further investigation along with the development of climate and work-specific intervention strategies., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Mechanisms linking occupational heat exposure with chronic diseases have been proposed. However, evidence on occupational heat exposure and cancer risk is limited., Methods: We evaluated occupational heat exposure and female breast cancer risk in a large Spanish case-control study. We enrolled 1,738 breast cancer cases and 1,910 frequency-matched population controls. A Spanish job-exposure matrix, MatEmEsp, was used to assign estimates of the proportion of workers exposed ( P ≥ 25% for at least 1 year) and work time with heat stress (wet bulb globe temperature ISO 7243) for each occupation. We used three exposure indices: ever versus never exposed, lifetime cumulative exposure, and duration of exposure (years). We estimated ORs and 95% confidence intervals (CI), applying a lag period of 5 years and adjusting for potential confounders., Results: Ever occupational heat exposure was associated with a moderate but statistically significant higher risk of breast cancer (OR 1.22; 95% CI, 1.01-1.46), with significant trends across categories of lifetime cumulative exposure and duration ( P trend = 0.01 and 0.03, respectively). Stronger associations were found for hormone receptor-positive disease (OR ever exposure = 1.38; 95% CI, 1.12-1.67). We found no confounding effects from multiple other common occupational exposures; however, results attenuated with adjustment for occupational detergent exposure., Conclusions: This study provides some evidence of an association between occupational heat exposure and female breast cancer risk., Impact: Our results contribute substantially to the scientific literature. Further investigations are needed considering multiple occupational exposures., (©2020 American Association for Cancer Research.)

Heat waves are expected to increase in duration and frequency, impacting coastal ecosystems, especially intertidal organisms living near their thermal tolerance limits. Sedentary infaunal species are limited to some extent in escapes from sudden temperature changes, rather modifications to their physiology and behaviour are expected. This may lead to strong ecological and economic impacts on commercial bivalve species, such as Venerupis corrugata, Ruditapes decussatus, the introduced Ruditapes philippinarum and Cerastoderma edule, the most relevant in NW Spain. We investigated lethal and sublethal effects of heat during low tide on these species in the laboratory. Summer temperatures experienced within field, shallow sediments at approximately 2 cm depth i.e. 20 °C (control), 27 °C, 32 °C, and 37 °C, were replicated during four consecutive days and the diffusion of heat at the burrowing depth of each species was estimated; temperature exposure was expressed as degree hours above 22 °C. After two days of tidal exposure, C. edule and V. corrugata suffered significant mortalities, and also the most dramatic decrease in scope for growth (SFG) as well as reduction in burrowing activity. After four days under stress, all species had negative SFG. On recovery, species showed compensation at longer exposures, particularly C. edule. These effects of temperature on mortality, growth potential and burrowing ability may increase the time to achieve commercial size and exposure to predation. Particularly, V. corrugata, with a center of distribution lower in the intertidal and subtidal, and C. edule, shallower in the sediment, may be the most affected. Clearly the intensity and frequency of heat waves will affect these key species in the intertidal sediment flats changing ecosystem functioning and fisheries management strategies., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Climate change is a severe public health challenge. Understanding to what extent fatal and non-fatal consequences of specific diseases are associated with temperature may help to improve the effectiveness of preventive public health efforts. This study examines the effects of temperature on deaths and hospital admissions by cardiovascular and respiratory diseases, empathizing the difference between mortality and morbidity., Methods: Daily counts for mortality and hospital admissions by cardiovascular and respiratory diseases were collected for the 52 provincial capital cities in Spain, between 1990 and 2014. The association with temperature in each city was investigated by means of distributed lag non-linear models using quasi-Poisson regression. City-specific exposure-response curves were pooled by multivariate random-effects meta-analysis to obtain countrywide risk estimates of mortality and hospitalizations due to heat and cold, and attributable fractions were computed., Results: Heat and cold exposure were identified to be associated with increased risk of cardiovascular and respiratory mortality. Heat was not found to have an impact on hospital admissions. The estimated fraction of mortality attributable to cold was of greater magnitude in hospitalizations (17.5% for cardiovascular and 12.5% for respiratory diseases) compared to deaths (9% and 2.7%, respectively)., Conclusions: There were noteworthy differences between temperature-related mortality and hospital admissions regarding cardiovascular and respiratory diseases, hence reinforcing the convenience of cause-specific measures to prevent temperature-related deaths., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The increase in the frequency and intensity of heat waves is one of the most unquestionable effects of climate change. Therefore, the progressive increase in maximum temperatures will have a clear incidence on the increase in mortality, especially in countries that are vulnerable due to geographical location or their socioeconomic characteristics. Different research studies show that the mortality attributable to heat is decreasing globally, and research is centred on future scenarios. One way of detecting the existence of a lesser impact of heat is through the increase in the so-called temperature of minimum mortality (TMM). The objective of this study is to determine the temporal evolution of TMM in two Spanish provinces (Seville and Madrid) during the 1983-2018 period and to evaluate whether the rate of adaptation to heat is appropriate. We used the gross rate of daily mortality due to natural causes (CIEX: A00-R99) and the maximum daily temperature (°C) to determine the quinquennial TMM using dispersion diagrams and realizing fit using quadratic and cubic curvilinear estimation. The same analysis was carried out at the annual level, by fitting an equation to the line of TMM for each province, whose slope, if significant (p < 0.05) represents the annual rate of variation in TMM. The results observed in this quinquennial analysis showed that the TMM is higher in Seville than in Madrid and that it is higher among men than women in the two provinces. Furthermore, there was an increase in TMM in all of the quinquennium and a clear decrease in the final period. At the annual level, the linear fit was significant for Madrid for the whole population and corresponds to an increase in the TMM of 0.58 °C per decade. For Seville the linear fits were significant and the slopes of the fitted lines was 1.1 °C/decade. Both Madrid and Seville are adapting to the increase in temperatures observed over the past 36 years, and women are the group that is more susceptible to heat, compared to men. The implementation of improvements and evaluation of prevention plans to address the impact of heat waves should continue in order to ensure adequate adaptation in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction and objectives . The increase in mortality and hospital admissions associated with high and low temperatures is well established. However, less is known about the influence of extreme ambient temperature conditions on cardiovascular ambulance dispatches. This study seeks to evaluate the effects of minimum and maximum daily temperatures on cardiovascular morbidity in the cities of Vigo and A Coruña in North-West Spain, using emergency medical calls during the period 2005-2017. Methods. For the purposes of analysis, we employed a quasi-Poisson time series regression model, within a distributed non-linear lag model by exposure variable and city. The relative risks of cold- and heat-related calls were estimated for each city and temperature model. Results. A total of 70,537 calls were evaluated, most of which were associated with low maximum and minimum temperatures on cold days in both cities. At maximum temperatures, significant cold-related effects were observed at lags of 3-6 days in Vigo and 5-11 days in A Coruña. At minimum temperatures, cold-related effects registered a similar pattern in both cities, with significant relative risks at lags of 4 to 12 days in A Coruña. Heat-related effects did not display a clearly significant pattern. Conclusions. An increase in cardiovascular morbidity is observed with moderately low temperatures without extremes being required to establish an effect. Public health prevention plans and warning systems should consider including moderate temperature range in the prevention of cardiovascular morbidity.

Species' range edges are expanding to both warmer and cooler regions. Yet, no studies directly compared the changes in range-limiting traits within the same species during both types of range expansions. To increase our mechanistic understanding of range expansions, it is crucial to disentangle the contributions of plastic and genetic changes in these traits. The aim of this study was to test for plastic and evolutionary changes in heat tolerance, life history, and behavior, and compare these during range expansions toward warmer and cooler regions. Using laboratory experiments we reconstructed the thermal performance curves (TPCurves) of larval life history (survival, growth, and development rates) and larval heat tolerance (CTmax) across two recent range expansions from the core populations in southern France toward a warmer (southeastern Spain) and a cooler (northwestern Spain) region in Europe by the damselfly Ischnura elegans. First-generation larvae from field-collected mothers were reared across a range of temperatures (16°-28°C) in incubators. The range expansion to the warmer region was associated with the evolution of a greater ability to cope with high temperatures (increased mean and thermal plasticity of CTmax), faster development, and, in part, a faster growth, indicating a higher time constraints caused by a shorter time frame available for larval development associated with a transition to a greater voltinism. Our results thereby support the emerging pattern that plasticity in heat tolerance alone is inadequate to adapt to new thermal regimes. The range expansion to the cooler region was associated with faster growth indicating countergradient variation without a change in CTmax. The evolution of a faster growth rate during both range expansions could be explained by a greater digestive efficiency rather than an increased food intake. Our results highlight that range expansions to warmer and cooler regions can result in similar evolutionary changes in the TPCurves for life history, and no opposite changes in heat tolerance., (© 2020 by the Ecological Society of America.)

Background: The study of almond fat stability is essential from a quality control perspective meanly because, in most of the cases, almonds are sold skinned and thermally treated. In this work an alternative method to Rancimat test based on attenuated total reflectance-Fourier-transform infrared (ATR-FTIR) spectrometry was adapted for checking the induced degradation at 75 °C of seven almond oil cultivars, three of the top Californian producing varieties, and, four traditional cultivars harvested in Spain., Results: The thermal oil degradation evolution was followed by measuring the changes in the absorbance of the selected FTIR spectra bands (3470, 3006, 1730, 1630, 988 and 970 cm -1 ). A first-order kinetic behaviour was observed, after an induction time in all bands., Conclusions: Kinetic coefficients and induction times were easily obtained as the absorbance values (from difference spectra) fitted to pseudo-first-order kinetics after the induction time. Principal component analysis was applied to the kinetic parameters to visualize which variables could be useful to classify the almond cultivars based on their resistance to thermal oxidation processes. It was found that selecting only the induction times corresponding to the bands 3470, 3006, 1630 and 970 cm -1 a separate classification of the Californian cultivars from the Spanish ones was possible. Finally, a linear discriminant analysis was assayed using only the four induction times previously selected. Validated classification and correct in 100% of the cases was obtained for all the samples based on their Spanish or Californian origin. © 2020 Society of Chemical Industry., (© 2020 Society of Chemical Industry.)

In ants, social thermal regulation is the collective maintenance of a nest temperature that is optimal for individual colony members. In the thermophilic ant Aphaenogaster iberica, two key behaviours regulate nest temperature: seasonal nest relocation and variable nest depth. Outside the nest, foragers must adapt their activity to avoid temperatures that exceed their thermal limits. It has been suggested that social thermal regulation constrains physiological and morphological thermal adaptations at the individual level. We tested this hypothesis by examining the foraging rhythms of six populations of A. iberica, which were found at different elevations (from 100 to 2,000 m) in the Sierra Nevada mountain range of southern Spain. We tested the thermal resistance of individuals from these populations under controlled conditions. Janzen's climatic variability hypothesis (CVH) states that greater climatic variability should select for organisms with broader temperature tolerances. We found that the A. iberica population at 1,300 m experienced the most extreme temperatures and that ants from this population had the highest heat tolerance (LT50 = 57.55°C). These results support CVH's validity at microclimatic scales, such as the one represented by the elevational gradient in this study. Aphaenogaster iberica maintains colony food intake levels across different elevations and mean daily temperatures by shifting its rhythm of activity. This efficient colony-level thermal regulation and the significant differences in individual heat tolerance that we observed among the populations suggest that behaviourally controlled thermal regulation does not constrain individual physiological adaptations for coping with extreme temperatures., (© 2020 British Ecological Society.)

Background: The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2)., Methods: A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N = 6011) and 2018 (N = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results., Results: Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use., Conclusion: This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: To investigate if an intensive rehabilitation programme, including intensive exercise and patient education, for young adults with inflammatory arthritis, conducted in a warm climate, has long-term effects on general health status compared with usual care., Design: Open randomized controlled trial., Patients: A total of 64 patients with inflammatory arthritis, aged 20-35 years., Methods: Patients underwent randomized allocation to an intensive 17-day rehabilitation programme in a warm climate (intervention group) or to usual care with no structured rehabilitation (control group). The primary outcomes were physical function, assessed by the "30-second Sit to Stand test"(30sSTS), and coping, measured by the "Effective Musculoskeletal Consumer Scale" (EC17)., Results: A total of 64 patients (mean age 27.5 years, 62.5% female) were randomized. Thirty out of 32 patients completed the intervention. At 12-month follow-up, 7 patients were lost to follow-up; 4 from the intervention group and 3 from the control group. The intervention group showed significant improvement in the physical function test at 3 months; estimated mean difference (95% confidence interval): 5.5 (2.8-8.1), 6 months 3.6 (0.4-6.8) and 12 months 4.0 (0.0-7.9), compared with the control group. There were no differences in coping between the 2 groups at 3, 6 or 12 months., Conclusion: Rehabilitation in a warm climate improves physical functioning, but not coping, in young adults with inflammatory arthritis.

Hospitals need to prepare large amounts of domestic hot water (DHW) to develop their healthcare activity. The aim of this work was to analyse potential savings that can be achieved by installing solar thermal energy for production of domestic hot water in the hospitals of Extremadura (Spain). For this purpose, 25 hospitals between 533 and 87,118 m 2 and between 15 and 529 beds were studied, three solar factor scenarios were simulated (0.70, 0.75 and 0.80) and the necessary investment and corresponding economic and environmental savings were calculated. Better economic results and energy ratios for 70% of solar contribution were obtained. These results show an average payback of 4.74 years (SD = 0.26) reaching 4.29 kWh/€ per year (SD = 0.20). Undertaking an investment of 674,423 €, 2,895,416 kWh/year of thermal energy could be generated with which to save both 145,933 € and 638 tons of CO 2 per year. It was statistically demonstrated the priority of carrying out an installation with a solar factor of 70%, investing preferably in hospitals in Cáceres over those in Badajoz, especially in the public sector with more than 300 beds. These findings will provide hospital managers with useful information to make decisions on future investments.

Background: Most studies use temperature observation data from weather stations near the analyzed region or city as the reference point for the exposure-response association. Climatic reanalysis data sets have already been used for climate studies, but are not yet used routinely in environmental epidemiology., Methods: We compared the mortality-temperature association using weather station temperature and ERA-5 reanalysis data for the 52 provincial capital cities in Spain, using time-series regression with distributed lag non-linear models., Results: The shape of temperature distribution is very close between the weather station and ERA-5 reanalysis data (correlation from 0.90 to 0.99). The overall cumulative exposure-response curves are very similar in their shape and risks estimates for cold and heat effects, although risk estimates for ERA-5 were slightly lower than for weather station temperature., Conclusions: Reanalysis data allow the estimation of the health effects of temperature, even in areas located far from weather stations or without any available., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Temperature is one of the main factors governing the growth of microorganisms. The aim of the present study was to provide temperature conditions representative of the food products stored in domestic refrigerators and to assess the impact of the temperature (fluctuation) on the shelf-life of refrigerated cooked meat products, from the safety and the spoilage point of view. The analysis of the time-temperature profiles recorded from 160 domestic refrigerators of households from small (28%) and large (72%) municipalities in Catalonia (Spain) showed that the 24 h-mean temperature could be described by a normal distribution (mean = 5.4 °C, standard deviation = 2.3 °C) with a mean value within the upper limit of the appropriate storage temperature of refrigerated products (i.e. ≤6 °C). The impact of door openings or day and night was not significant. Temperature distribution showed differences depending on the season, being higher in the cold season than in the warm one. Noteworthy, refrigerators of elderly (≥ 65 years old) households showed a higher percentage of time at temperatures >8 °C in comparison with those of the general population. Overall, the 75th percentile of the distribution of the 24 h-mean temperature values was 6.7 °C. This study can be used as a scientific evidence of the consumer storage stage when food business operators or laboratories conduct shelf-life studies. According to the simulation of the growth of Listeria monocytogenes and lactic acid bacteria in cooked meat products, risk scenarios were identified in which the critical level of the pathogen could be reached before lactic acid bacteria achieved the spoilage level. The fluctuation of the refrigerator temperature ranged from 0.5 up to 12.2 °C within the 24 h-profile. The assessment of the safety of cooked meat products stored at constant temperature or under different time-temperature profiles showed that both the mean and the fluctuation of the profile had an impact on the shelf-life, which was higher at low temperatures. The improvement of the household refrigerated storage would be an effective way to increase food safety of refrigerated ready-to-eat food., (Copyright © 2019 Elsevier Ltd. All rights reserved.)