Mortality and displaced mortality during heat waves in the Czech Republic

The aims of this study were to assess impacts of hot summer periods on mortality in the Czech Republic and to quantify the size of the short-term displacement effect which resulted in lower than expected mortality after heat waves. The analysis covered the period 1982–2000 when several extraordinarily hot summers occurred in central Europe. Daily total all-cause mortality and mortality due to cardiovascular diseases (CVD) in the entire population of the Czech Republic (approximately 10 million inhabitants) were examined. The daily death counts were standardized to account for the long-term decline in mortality and the seasonal and weekly cycles. Heat-related mortality is better expressed if 1-day lag after temperature is considered compared to the unlagged relationship. With the 1-day lag, both excess total mortality and excess CVD mortality were positive during all 17 heat waves, and in 14 (12) heat waves the increase in total (CVD) mortality was statistically significant (P=0.05). The mean relative rise in total mortality during heat waves was 13%. The response was greater in females than males and similar regardless of whether total or CVD mortality was used. The largest relative increases, exceeding 20% in both total and CVD mortality, were associated with heat waves which occurred in early summer (the first half of July 1984 and June 1994). The mortality displacement effect played an important role since mortality tended to be lower than expected after hot periods. The mean net mortality change due to heat waves was estimated to be about a 1% increase in the number of deaths. The large relative increases during some heat waves were particularly noteworthy since the study (in contrast to most analyses of the heat stress/mortality relationship) was not restricted to an urban area and/or an elderly population.     

Decreased impacts of the 2003 heat waves on mortality in the Czech Republic: an improved response?

The paper examines impacts on mortality of heat waves in 2003, the hottest summer on record in the Czech Republic, and compares them with previous similar events. While most summer heat waves over the period since 1986 were associated with significantly elevated mortality, this was not the case for three out of the four heat waves in 2003. The relatively weak mortality response was particularly noteworthy for the most severe heat wave which occurred in the first 10 days of August 2003 and resulted in enormous excess mortality in some western European countries. A mortality displacement effect and short-term adaptation to heat contributed to the reduced mortality impacts of the heat waves that followed after previous relatively warm periods. However, the decreased mortality response of the 2003 heat waves compared to previous heat waves in the 1990s is also likely to have arisen from positive health-care and other socio-economic changes in the post-communist central European region over the past decade, as well as a better public awareness of heat-related risks due to enhanced media coverage and regular biometeorological forecast and warnings.     

Evaluation of the plan for surveillance and controlling of the effects of heat waves in Madrid

This paper presents evaluation of a plan for surveillance of and controlling the effects of heat-related mortality (PSCEHW), implemented in Madrid in 2004 through a time series analysis conducted with ARIMA modeling. From the public health point of view, prevention plans should be implemented as adaptive measures to heat waves. In 2003, the impact attributable to the heat wave was an increase in mortality per °C of 22.39 %. All heat waves since 2003 have been of lower intensity, and yet, in 2005 there was a heat wave of lower intensity that had a greater impact, i.e. an increase in mortality per °C of 45.71 %. With the methodology used here, we cannot say whether implementation of PSCEHW has resulted in a decrease of mortality attributable to high temperatures in the city of Madrid.     

The impact of heat,cold, and heat waves on hospital admissions in eight cities in Korea

Although the impact of temperature on mortality is well documented, relatively fewer studies have evaluated the associations of temperature with morbidity outcomes such as hospital admissions, and most studies were conducted in North America or Europe. We evaluated weather and hospital admissions including specific causes (allergic disease, asthma, selected respiratory disease, and cardiovascular disease) in eight major cities in Korea from 2003 to 2008. We also explored potential effect modification by individual characteristics such as sex and age. We used hierarchical modeling to first estimate city-specific associations between heat, cold, or heat waves and hospitalizations, and then estimated overall effects. Stratified analyses were performed by cause of hospitalization, sex, and age (0–14, 15–64, 65–74, and ≥75 years). Cardiovascular hospitalizations were significantly associated with high temperature, whereas hospitalizations for allergic disease, asthma, and selected respiratory disease were significantly associated with low temperature. The overall heat effect for cardiovascular hospitalization was a 4.5 % (95 % confidence interval 0.7, 8.5 %) increase in risk comparing hospitalizations at 25 to 15 °C. For cold effect, the overall increase in risk of hospitalizations comparing 2 with 15 °C was 50.5 (13.7, 99.2 %), 43.6 (8.9, 89.5 %), and 53.6 % (9.8, 114.9 %) for allergic disease, asthma, and selected respiratory disease, respectively. We did not find statistically significant effects of heat waves compared with nonheat wave days. Our results suggest susceptible populations such as women and younger persons. Our findings provide suggestive evidence that both high and low ambient temperatures are associated with the risk of hospital admissions, particularly in women or younger person, in Korea.     

A simple indicator to rapidly assess the short-term impact of heat waves on mortality within the French heat warning system

We propose a simple method to provide a rapid and robust estimate of the short-term impacts of heat waves on mortality, to be used for communication within a heat warning system. The excess mortality during a heat wave is defined as the difference between the observed mortality over the period and the observed mortality over the same period during the N preceding years. This method was tested on 19 French cities between 1973 and 2007. In six cities, we compared the excess mortality to that obtained using a modelling of the temperature-mortality relationship. There was a good agreement between the excess mortalities estimated by the simple indicator and by the models. Major differences were observed during the most extreme heat waves, in 1983 and 2003, and after the implementation of the heat prevention plan in 2006. Excluding these events, the mean difference between the estimates obtained by the two methods was of 13 deaths [1:45]. A comparison of mortality with the previous years provides a simple estimate of the mortality impact of heat waves. It can be used to provide early and reliable information to stakeholders of the heat prevention plan, and to select heat waves that should be further investigated.     

Heat stress and mortality in Lisbon part I. model construction and validation

Global climate change will have direct impacts on human health, including increased mortality due to heat stress and heat waves. An empirical-statistical model for heat stress is constructed for the city of Lisbon using the June-August months of the observational period 1980-1998. The model uses the regression of an aggregate dose-response relationship between maximum temperature and excess heat-related deaths, based on the difference between observed and expected deaths. The model is validated by correlation and residual analysis. The mean annual heat-related mortality for the period 1980-1998 was between 5.4 and 6 deaths per 100,000 depending on the method used to calculate expected deaths. Both validation methods show that the model has a moderate to high accuracy in modelling heat-related deaths compared to the observed record.     

A comparative analysis of heat waves and associated mortality in St. Louis, Missouri – 1980 and 1995

 This research investigates heat-related mortality during the 1980 and 1995 heat waves in St. Louis, Missouri. St. Louis has a long history of extreme summer weather, and heat-related mortality is a public health concern. Heat waves are defined as days with apparent temperatures exceeding 40.6°C (105°F). The study uses a multivariate analysis to investigate the relationship between mortality and heat wave intensity, duration, and timing within the summer season. The heat wave of 1980 was more severe and had higher associated mortality than that of 1995. To learn if changing population characteristics, in addition to weather conditions, contributed to this difference, changes in population vulnerability between 1980 and 1995 are evaluated under simulated heat wave conditions. The findings show that St. Louis remains at risk of heat wave mortality. In addition, there is evidence that vulnerability has increased despite increased air-conditioning penetration and public health interventions. Received: 12 August 1997 / Revised: 12 January 1998 / Accepted: 13 February 1998     

A simple heat alert system for Melbourne,Australia

A simple heat alert system, based solely on predicted maximum and minimum daily temperatures, has been developed for the city of Melbourne in southeast Australia. The system is based upon a demonstration that, when mean daily temperature exceeds a threshold of 30°C (mean of today’s maximum temperature and tonight’s minimum temperature), the average daily mortality of people aged 65 years or more is about 15–17% greater than usual. Similar numbers of excess deaths also occur when daily minimum temperatures exceed 24°C (increases of 19–21% over expected death rate), so a heat alert system based solely on this widely available weather forecast variable is also feasible. No strong signal of excess heat-related deaths appears when the data are stratified using daily maximum temperatures. This may be because in Melbourne some days with very high maximum temperatures will be affected by the passage of cool changes and cold fronts in the afternoon, leading to a rapid drop in temperature (i.e., some days with high maximum temperatures will not continue to be hot throughout the day and into the evening). A single day with temperatures exceeding the thresholds noted above is sufficient to cause this increase in mortality, rather than requiring an extended heat wave. The increased daily mortality does not appear to represent a short-term advancement of mortality.     

Heat- and cold-stress effects on cardiovascular mortality and morbidity among urban and rural populations in the Czech Republic

Several studies have examined the relationship of high and low air temperatures to cardiovascular mortality in the Czech Republic. Much less is understood about heat-/cold-related cardiovascular morbidity and possible regional differences. This paper compares the effects of warm and cold days on excess mortality and morbidity for cardiovascular diseases (CVDs) in the city of Prague and a rural region of southern Bohemia during 1994–2009. Population size and age structure are similar in the two regions. The results are evaluated for selected population groups (men and women). Excess mortality (number of deaths) and morbidity (number of hospital admissions) were determined as differences between observed and expected daily values, the latter being adjusted for long-term changes, annual and weekly cycles, and epidemics of influenza/acute respiratory infections. Generally higher relative excess CVD mortality on warm days than on cold days was identified in both regions. In contrast to mortality, weak excess CVD morbidity was observed for both warm and cold days. Different responses of individual CVDs to heat versus cold stress may be caused by the different nature of each CVD and different physiological processes induced by heat or cold stress. The slight differences between Prague and southern Bohemia in response to heat versus cold stress suggest the possible influence of environmental and socioeconomic factors such as the effects of urban heat island and exposure to air pollution, lifestyle differences, and divergence in population structure, which may result in differing vulnerability of urban versus rural population to temperature extremes.     

Excess mortality and morbidity during the July 2006 heat wave in Porto, Portugal

The purpose of this study was to understand the effects of the July 2006 heat wave through the use of the heat index, in mortality (all causes) and morbidity (all causes, respiratory and circulatory diseases) in general, and in people over 74 years and by gender, in Porto. In this paper, the Poisson generalized additive regression model was used to estimate the impact of apparent temperature (heat index) and daily mortality and morbidity during the July 2006 heat wave. Daily mortality, morbidity and heat index were correlated with lags of apparent temperature up to 7 days using Pearson correlation. For a 1°C increase in mean apparent temperature we observed a 2.7 % (95 % CI: 1.7–3.6 %) increase in mortality (all cause), a 1.7 % (95 % CI: 0.6–2.9 %) increase in respiratory morbidity, a 2.2 % (95 % CI: 0.4–4.1 %) increase in respiratory morbidity in women, a 5.4 % (95%CI: 1.1–6.6 %) increase in chronic obstructive pulmonary morbidity, and a 7.5 % (95 % CI: 1.3–14.1 %) increase in chronic obstructive pulmonary morbidity in women, for the entire population. For people?≥?75 years, our results showed a 3.3 % increase (95 % CI: 1.7–5.0 %) in respiratory morbidity, a 2.7 % (95 % CI: 0.4–5.1 %) increase in respiratory morbidity in men, a 3.9 % (95 %CI: 1.6–6.3 %) increase in respiratory morbidity in women, a 7.0 % (95 % CI: 1.1–13.2 %) in chronic obstructive pulmonary disease, and a 9.0 % (95 % CI: 0.3–18.5 %) in chronic obstructive pulmonary disease in women. The use of heat index in a Mediterranean tempered climate enabled the identification of the effects of the July 2006 heat wave in mortality due to all causes and in respiratory morbidity of the general population, as well as in respiratory morbidity of individuals with more than 74 years of age.     

Excess deaths during the 2004 heatwave in Brisbane, Australia

The paper examines whether there was an excess of deaths and the relative role of temperature and ozone in a heatwave during 7–26 February 2004 in Brisbane, Australia, a subtropical city accustomed to warm weather. The data on daily counts of deaths from cardiovascular disease and non-external causes, meteorological conditions, and air pollution in Brisbane from 1 January 2001 to 31 October 2004 were supplied by the Australian Bureau of Statistics, Australian Bureau of Meteorology, and Queensland Environmental Protection Agency, respectively. The relationship between temperature and mortality was analysed using a Poisson time series regression model with smoothing splines to control for nonlinear effects of confounding factors. The highest temperature recorded in the 2004 heatwave was 42°C compared with the highest recorded temperature of 34°C during the same periods of 2001–2003. There was a significant relationship between exposure to heat and excess deaths in the 2004 heatwave [estimated increase in non-external deaths: 75 ([95% confidence interval, CI: 11–138; cardiovascular deaths: 41 (95% CI: −2 to 84)]. There was no apparent evidence of substantial short-term mortality displacement. The excess deaths were mainly attributed to temperature but exposure to ozone also contributed to these deaths.     

Genome‐wide SNP analysis reveals an increase in adaptive genetic variation through selective breeding of coral

Marine heat waves are increasing in magnitude, duration, and frequency as a result of climate change and are the principal global driver of mortality in reef‐building corals. Resilience‐based genetic management may increase coral heat tolerance, but it is unclear how temperature responses are regulated at the genome level and thus how corals may adapt to warming naturally or through selective breeding. Here we combine phenotypic, pedigree, and genomic marker data from colonies sourced from a warm reef on the Great Barrier Reef reproductively crossed with conspecific colonies from a cooler reef to produce combinations of warm purebreds and warm‐cool hybrid larvae and juveniles. Interpopulation breeding created significantly greater genetic diversity across the coral genome compared to breeding between populations and maintained diversity in key regions associated with heat tolerance and fitness. High‐density genome‐wide scans of single nucleotide polymorphisms (SNPs) identified alleles significantly associated with larval families reared at 27.5°C (87–2,224 loci), including loci putatively associated with proteins involved in responses to heat stress (cell membrane formation, metabolism, and immune responses). Underlying genetics of these families explained 43% of PCoA multilocus variation in survival, growth, and bleaching responses at 27.5°C and 31°C at the juvenile stage. Genetic marker contribution to total variation in fitness traits (narrow‐sense heritability) was high for survival but not for growth and bleaching in juveniles, with heritability of these traits being higher at 31°C relative to 27.5°C. While based on only a limited number of crosses, the mechanistic understanding presented here demonstrates that allele frequencies are affected by one generation of selective breeding, key information for the assessments of genetic intervention feasibility and modelling of reef futures.     

The rôle of butterfly wings in regulation of body temperature

Free and unnarcotized butterflies in a vertical basking position were exposed to radiation from a halogen lamp. Warming rate and equilibrium excess temperatures were recorded by means of microthermistors on the cuticle. Living, dead, and dried specimens were irradiated partly and totally. If the wings are shaded, the excess body temperature is reduced by about 30 per cent. The major portion of the heat transferred from the wing to the body originates from 15 per cent of the wing surface nearest to the body. There is no significant difference in excess thoracic temperatures of living and freshly dead specimens. After drying, the body temperature level rises about 1·4 to 2·2°C, remaining almost constant between 15°C (not radiated) and 37°C (radiated). The influence of air convection was tested with dried specimens under varying spatial orientation, keeping incident radiation constant. In an approximately horizontal position the heat arising from the wing increases to about 40 per cent by accumulation of warm air under the wing base. The ecological implications of heat supply by the wings and adaptive significance of wing pattern are discussed with respect to different modes of heat transport     

The impact of the 2008 cold spell on mortality in Shanghai, China

No prior studies in China have investigated the health impact of cold spell. In Shanghai, we defined the cold spell as a period of at least seven consecutive days with daily temperature below the third percentile during the study period (2001–2009). Between January 2001 and December 2009, we identified a cold spell between January 27 and February 3, 2008 in Shanghai. We investigated the impact of cold spell on mortality of the residents living in the nine urban districts of Shanghai. We calculated the excess deaths and rate ratios (RRs) during the cold spell and compared these data with a winter reference period (January 6–9, and February 28 to March 2). The number of excess deaths during the cold spell period was 153 in our study population. The cold spell caused a short-term increase in total mortality of 13 % (95 % CI: 7–19 %). The impact was statistically significant for cardiovascular mortality (RR?=?1.21, 95 % CI: 1.12–1.31), but not for respiratory mortality (RR?=?1.14, 95 % CI: 0.98–1.32). For total mortality, gender did not make a statistically significant difference for the cold spell impact. Cold spell had a significant impact on mortality in elderly people (over 65 years), but not in other age groups. Conclusively, our analysis showed that the 2008 cold spell had a substantial effect on mortality in Shanghai. Public health programs should be tailored to prevent cold-spell-related health problems in the city.     

Heat tolerance of early developmental stages of glacier foreland species in the growth chamber and in the field

In glacier forelands, seeds readily germinate, however, a high proportion of seedlings die shortly after their appearance. We hypothesized that besides drought, frost and missing safe sites, heat on the ground surface could be one of the major threats for seedlings. The heat strain in different ground strata was assessed from 2007 to 2010. The heat tolerance (LT₅₀) of eleven alpine species from different successional stages was tested considering imbibed (G1) and germinated seeds (G2) as well as seedlings (G3). Additionally, the heat hardening capacity of seedlings was determined in the field. Across all species, LT₅₀ decreased significantly by 9 K from G1 (55 °C) to G3 (46 °C), similarly in all species of the successional stages. Field-grown seedlings had mostly an increased LT₅₀ (2K). Intraspecifically, LT₅₀ of seedlings varied between 40.6 and 52.5 °C. Along the chronosequence, LT₅₀ in G1 was similar, but was higher in G2 and G3 of early successional species. The highest temperatures occurred at 0–0.5 cm in air (mean/absolute maximum: 42.6/54.1 °C) posing a significant heat injury risk for seedlings when under water shortage transpirational cooling is prevented. Below small stones (0–0.5 cm), maxima were 4 K lower, indicating heat safer microsites. Maxima >30 °C occurred at 32.3, >40 °C at 6.2 %. Interannually, 2010 was the hottest year with heat exceeding LT₅₀ at all microsites (0–0.5 cm). Temperature maxima on sandy surfaces were lower than on microsites with gravel (diameter <5–10 mm). The hot summer of 2010 may be a small foretaste of in future more severe and frequent heat waves. Ground surface temperature maxima at the pioneer stage are already now critical for heat survival and may partly explain the high seedling mortality recognized on recently deglaciated terrain.     

LNA mediated in situ hybridization of miR171 and miR397a in leaf and ambient root tissues revealed expressional homogeneity in response to shoot heat shock in Arabidopsis thaliana

MicroRNAs (miRNAs) are endogenous non-protein coding RNA molecules of approximately 21 nucleotides in length capable of modulating gene expression in animals and plants. The role of miRNA based gene regulation has been proved in several pathways including in plant growth, development and stress response. In this study miR171 and miR397a were tested for their expression pattern under different heat shock regimes in shoot and root tissues of Arabidopsis thaliana using Locked Nucleic Acid (LNA) mediated in situ hybridization. With an increase in temperature across 35 °C, 40 °C and 45 °C there was a corresponding increased up-regulation of miR171 in leaf tissues compared to ambient temperature. Similarly, an unambiguous elevated expression of miR171 within increase in duration of exposure at each temperature regime across 1 h, 2 h and 3 h was noticed in comparison to ambient control leaf tissue. On the other hand, miR397a, which expressed at ambient control conditions, got down-regulated both with increase in heat and exposure regime in leaf tissues. Both miRNAs expressed in control ambient root tissues. Maintaining the root zone temperature at ambient conditions, upon imposing heat shock regime to shoot system, miR171 recorded corresponding increased up-regulation as indicated by the intensity of in situ hybridization, while miR397a got down-regulated. Given the differential homogeneity in expression pattern of both miRNA in leaf and root tissues experiencing heat shock regimes, possibilities of movement of heat shock induced signals to root tissues seem to be obvious.     

Acclimation responses to temperature vary with vertical stratification: implications for vulnerability of soil‐dwelling species to extreme temperature events

The occurrence of summer heat waves is predicted to increase in amplitude and frequency in the near future, but the consequences of such extreme events are largely unknown, especially for belowground organisms. Soil organisms usually exhibit strong vertical stratification, resulting in more frequent exposure to extreme temperatures for surface‐dwelling species than for soil‐dwelling species. Therefore soil‐dwelling species are expected to have poor acclimation responses to cope with temperature changes. We used five species of surface‐dwelling and four species of soil‐dwelling Collembola that habituate different depths in the soil. We tested for differences in tolerance to extreme temperatures after acclimation to warm and cold conditions. We also tested for differences in acclimation of the underlying physiology by looking at changes in membrane lipid composition. Chill coma recovery time, heat knockdown time and fatty acid profiles were determined after 1 week of acclimation to either 5 or 20 °C. Our results showed that surface‐dwelling Collembola better maintained increased heat tolerance across acclimation temperatures, but no such response was found for cold tolerance. Concordantly, four of the five surface‐dwelling Collembola showed up to fourfold changes in relative abundance of fatty acids after 1 week of acclimation, whereas none of the soil‐dwelling species showed a significant adjustment in fatty acid composition. Strong physiological responses to temperature fluctuations may have become redundant in soil‐dwelling species due to the relative thermal stability of their subterranean habitat. Based on the results of the four species studied, we expect that unless soil‐dwelling species can temporarily retreat to avoid extreme temperatures, the predicted increase in heat waves under climatic change renders these soil‐dwelling species more vulnerable to extinction than species with better physiological capabilities. Being able to act under a larger thermal range is probably costly and could reduce maximum performance at the optimal temperature.     

Synthetic heat at mild temperatures

"Synthetic heat", also known as the heat grill illusion, occurs when contact with spatially adjacent warm and cold stimuli produce a sensation of "heat". This phenomenon has been explained as a painful perception that occurs when warm stimulation inhibits cold-sensitive neurons in the spinothalamic tract (STT), which in turn unmasks activity in the pain pathway caused by stimulation of C-polymodal nociceptors (CPNs). The "unmasking model" was tested in experiment 1 by combining warm (35-40°C) and cool ( &#83 27°C) stimuli that were too mild to stimulate CPNs. After discovering that these temperatures produced nonpainful heat, experiment 2 was designed to determine whether heat could be induced when near-threshold cooling was paired with mild warmth, and whether lowering the base temperature for cooling would increase the noxious (burning, stinging) components of heat for fixed cooling steps of 1-3°C. Cooling by just 1°C from a base temperature of 33°C led to reports of heat on more than 1/3 of trials, and cooling by just 3°C evoked heat on 75% of trials. Lowering the base temperature to 31 or 29°C increased reports of heat and burning but did not produce significant reports of pain. Perception of nonpainful heat at such mild temperatures indicates either that cold-sensitive nociceptors with thresholds very similar to cold fibers innervate hairy skin in humans, or that heat can result from integration of warm fiber and cold fiber activity, perhaps via convergence on nonspecific (e.g., WDR) neurons in the STT.     

Short-term effects of extreme hot summer temperatures on total daily mortality in Barcelona, Spain

The summer of 2003 was exceptionally hot, leading to an excess of mortality in Europe. Here, we assess the short-term effects of extreme hot summer temperatures on total daily mortality in Barcelona (Spain). Daily mortality from burial records, maximum temperature, relative humidity and photochemical pollutants, were collected for the period 1999–2003. Data was analysed using Poisson regression with generalised additive models. Mortality shows a considerable increase when maximum temperatures are over a threshold temperature of 30.5°C. The risk of death associated with an increase of 1°C above the threshold was 6%, 7% and 5% after 1, 2 and 3 days, respectively. Exposure to extreme hot temperatures leads to an significant increase in mortality.