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Introduction. The most important risk factors for lung cancer are the tobacco smoking and residential radon exposure. The study of the interaction of smoking x radon as trigger factor for lung cancer morbidity in the Republic of Moldova was carried out. Material and methods. Data on tobacco smoking prevalence of the national study STEPS 2021, lung cancer morbidity data of 2012-2020 and data of radon measurements using RADTRAK2 during 2018-2021 were used. Data processing tools included summary statistics and cluster analysis. Results. The distribution of high radon values, the number of smokers and the lung cancer morbidity is uneven throughout the country. The formation of higher cluster combining all variables has proceeded by the formation of two clusters: 1. lung cancer incidence, lung cancer prevalence, number of total tobacco smokers, number of male smokers, number of female smokers, and number of urban smokers, 2. radon concentration and number of rural smokers. Conclusions. Study results demonstrate the leading role of tobacco smoking on morbidity among the adult population, regardless of gender in an urban environment with a rather low concentration of radon, and at the same time indicate the cumulative effect of smoking and increased radon concentration in rural areas due to the construction features of houses and lifestyle.

Background: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. Objectives: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality. Methods: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates. Results: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0–7 (0.9 °C). An IQR increase in inter-day TV0–7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0–7 and inter-day TV0–7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type. Conclusions: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.

Assessing the association between temperature frequency and mortality can provide insights into human adaptation to local ambient temperatures. We collected daily time-series data on mortality and temperature from 757 locations in 47 countries/regions during 1979–2020. We used a two-stage time series design to assess the association between temperature frequency and all-cause mortality. The results were pooled at the national, regional, and global levels. We observed a consistent decrease in the risk of mortality as the normalized frequency of temperature increases across the globe. The average increase in mortality risk comparing the 10th to 100th percentile of normalized frequency was 13.03% (95% CI: 12.17–13.91), with substantial regional differences (from 4.56% in Australia and New Zealand to 33.06% in South Europe). The highest increase in mortality was observed for high-income countries (13.58%, 95% CI: 12.56–14.61), followed by lower-middle-income countries (12.34%, 95% CI: 9.27–15.51). This study observed a declining risk of mortality associated with higher temperature frequency. Our findings suggest that populations can adapt to their local climate with frequent exposure, with the adapting ability varying geographically due to differences in climatic and socioeconomic characteristics.

Summary: Background: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000–19. Methods: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000–19. Temperature variability was calculated as the SD of the average of the same and previous days’ minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. Findings: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901–2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2–4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7–5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3–10·4), followed by Europe (4·4%, 2·2–5·6) and Africa (3·3, 1·9–4·6). Interpretation: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. Funding: Australian Research Council, Australian National Health & Medical Research Council.

This work presents the results from measurements of radon concentrations in primary and high school education institutions—including their gymnasiums—from the Chisinau municipality and various rayons from the central and southern part of the Republic of Moldova. In the research carried out during the years of 2013–2014 and 2021, there were 78 (29 + 49) premises included, respectively, and 149 and 23,805 investigations were performed using RTM-1642 (active measurements) and RadonEye+2 devices (passive measurements). The results show an essential variability for the studied radio-stressogenic factor, depending on the geological conditions of the location of the premises and the age of the building. Thus, during 2013–2014, the minimum concentration of radon detected was 26 Bq m−3, and the maximum detected was 607 Bq m−3. In 2021, the results denote an indicator variability in the range of 17.4–657.9 Bq m−3 for early education institutions, with an average value of 127.6 Bq m−3, and denote a range of 231.8–1129.3 Bq m−3, with an average value of 665.4 Bq m−3), for high school education institutions and their gymnasiums. The effective annual dose for the children in a classroom varies between an interval of 0.21–4.88 mSv y−1 (average 1.19 mSv y−1) and 0.14–9.08 mSv y−1 (average 1.29 mSv y−1) for the 2013–2014 and 2021 surveys, respectively.

Obiective. Expunerea rezidențială la radon este al doilea factor de risc al declanșării cancerului pulmonar pentru fumători și primul – pentru nefumătorii. Obținerea rezultatelor veridice în acest sens necesită efectuarea cercetărilor științifice epidemiologice pe scară largă, cu implicarea eșantioanelor adecvate de pacienți, dar aceste studii sunt foarte costisitoare. Problema studierii acțiunii radonului și a tutunului în declanșarea cancerului bronhopulmonar rămâne actuală. Analiza științifică a literaturii de specialitate a servit ca bază pentru inițierea dezvoltării unei metodologii de studiere a interacțiunii radon x fumat ca factor trigger în declanșarea cancerului bronhopulmonar la fumători din Republica Moldova. Material și metode. Experiența mondială privind metodologia studierii interacțiunii radon x fumat a fost examinată, utilizând rezultatele științifice a circa 30 de publicații pe site-urile ResearchGate, Pubmed, BioMedCentral, RSCI, CE Webgate, OMS, AIEA, etc. S-a efectuat sinteza abordărilor actuale ale dezvoltării și implementării metodelor de cercetare pentru elucidarea impactului interacțiunii radon x fumat asupra declanșării cancerului bronhopulmonar. Rezultate. Până în prezent, unele cercetări s-au axat pe studiul efectului expunerii sinergice la fumat/radon asupra apariției cancerului bronhopulmonar. O revizuire a literaturii în domeniu a demonstrat că principalele metode pentru studierea acestui fenomen sunt metodele caz-control și metodele sociologice prin sensibilizarea publicului. Combinând abordările studiate și luând ca bază experiența de succes a cercetărilor internaționale, a fost elaborată metodologia de estimare a interacțiunii radon x fumat asupra declanșării cancerului bronhopulmonar. Se propun două direcții de cercetare: (1) statistică, cu utilizarea datelor asupra fumătorilor în Republica Moldova, concentrația radonului în locuințe și indicatorii de morbiditate/mortalitate și (2) „caz-control”, cu utilizarea chestionarului în studiu pe termen lung în colaborare cu Institutul Oncologic. Concluzii. Dezvoltarea unei metodologii de studiu a influenței interacțiunii radon x fumat asupra declanșării cancerului bronhopulmonar va permite Sistemului de Sănătate Publică să elaboreze instrumentele de control/prevenire/diminuare a maladiei menționate.

Summary: Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% [6·19–10·47] were cold-related and 0·91% [0·56–1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. Funding: Australian Research Council and the Australian National Health and Medical Research Council.

Objectives. Review of international experience in creating and promoting programs for communicating the risk of radon exposure for public health in order to elaborate the appropriate approaches for our country in developing a program for communicating the risk of radon exposure. Material and methods. The scientific and practical sources from the countries of the European Region, Canada and the United States of America were used, which cover their national programs and policies for communicating the risk of radon exposure, recommended for implementation by EURATOM Directive 2013/59. Methods used - descriptive, analytical, synthetic. Results. The synthetic analysis of current sources summarizes the scientific evidence to substantiate political decisions and demonstrate the need for multilevel interventions. The key point of these policies is the need for a wider coverage of residents with information about the risk of radon exposure and how to reduce it. Efforts to improve public awareness have had some success in some countries, but it has also been found difficult to convince residents of the importance of radon control and forces them to take measures to mitigate the side effects. Conclusion. Public health policy in the area of radon risk should take into account the responsibility of the government and residents in addressing this issue.

Objectives. Climate change is a topic of major importance, discussed extensively by politicians, businessmen, environmentalists, society and the media. They take place in oceans, soil, open and closed environments. Climate change has many effects on health, and the health sector is one of the main links in the conduct of these clinical conditions. Doctors are specialists who could help raise public awareness of climate change and its impact on health. The aim of the study was focused on determining the link between high air temperatures and deaths from diseases of the circulatory system. Material and methods. A retrospective study was carried out, focusing on the estimation of general mortality and deaths from circulatory system diseases, using daily data on deaths and air temperature in Chișinău, during the summer 2001-2015. Results. The high temperatures during the summer, in the last 15 years (2001-2015), have increased the number of deaths in Chișinău. During high air temperatures, the main nosological groups of noncommunicable diseases, which represent in total over 70% of the causes of death, are neoplasms (C00-D48), diseases of the respiratory system (J00-J99), diseases of the circulatory system (I00-I99) and diseases of the digestive system (K00-K93). The largest contribution to total mortality (~50%) is circulatory system diseases. Conclusions. Weak but reliable statistical relationships have been established between high temperatures and deaths from circulatory system diseases.

Summary: Background: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions. Methods: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985–2015) and future (2020–99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk. Findings: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by −0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4–10·3% in 2090–99. Interpretation: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health. Funding: Korea Ministry of Environment.

An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010–2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (−0.92%p/°C) and Australia (−0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population. Keywords: Projection, Mortality, Climate change, Regional variation, Vulnerability

BackgroundHeatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited.Methods and findingsWe collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections.ConclusionsThis study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.

Objectives. The present study aimed to estimate the number of emergency ambulance call-outs during the very cold winter of 2009/2010 (December–February) with respect to the reference period of 2007-2010. Material and methods. As study material there were considered about 335 000 requests for emergency care in Chisinau, Republic of Moldova, and about 2 500 records of daily temperatures (mean, maximum and minimum) and wind speed from the Chisinau weather station. Quantitative estimation of the number of ambulance call-outs depending on the air temperature values was carried out using the statistical method of linear regression. Results and conclusions. Quantification of the health impact of the low temperatures recorded during the investigated period reveals that minimum diurnal temperatures have the greatest effect on the emergency ambulance call-outs increase: when the air temperature drops by 1°C, the number of total requests increases by 8 cases per day. According to nosology, the respiratory diseases correlate best with low maximum diurnal temperatures: a decrease by 1°C leads to an increase of 9 requests. The highest vulnerability to cold was recorded in the population aged 0-17 years. These findings could serve as a basis for elaboration and implementation of preventive targeting the vulnerable groups.

This work presents the results from measurements of radon concentrations in primary and high school education institutions—including their gymnasiums—from the Chisinau municipality and various rayons from the central and southern part of the Republic of Moldova. In the research carried out during the years of 2013–2014 and 2021, there were 78 (29 + 49) premises included, respectively, and 149 and 23,805 investigations were performed using RTM-1642 (active measurements) and RadonEye+2 devices (passive measurements). The results show an essential variability for the studied radio-stressogenic factor, depending on the geological conditions of the location of the premises and the age of the building. Thus, during 2013–2014, the minimum concentration of radon detected was 26 Bq m−3, and the maximum detected was 607 Bq m−3. In 2021, the results denote an indicator variability in the range of 17.4–657.9 Bq m−3 for early education institutions, with an average value of 127.6 Bq m−3, and denote a range of 231.8–1129.3 Bq m−3, with an average value of 665.4 Bq m−3), for high school education institutions and their gymnasiums. The effective annual dose for the children in a classroom varies between an interval of 0.21–4.88 mSv y−1 (average 1.19 mSv y−1) and 0.14–9.08 mSv y−1 (average 1.29 mSv y−1) for the 2013–2014 and 2021 surveys, respectively. [ABSTRACT FROM AUTHOR]

Background Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited. Methods and findings We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections. Conclusions This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change., Author(s): Yuming Guo 1,*, Antonio Gasparrini 2, Shanshan Li 1,*, Francesco Sera 2, Ana Maria Vicedo-Cabrera 2, Micheline de Sousa Zanotti Stagliorio Coelho 3,4, Paulo Hilario Nascimento Saldiva 3, Eric [...]