Modifiers of diurnal temperature range and mortality association in six Korean cities

Rapid temperature changes within a single day may be critical for populations vulnerable to thermal stress who have difficulty adjusting themselves behaviorally and physiologically. We hypothesized that diurnal temperature range (DTR) is associated with mortality, and that this association is modified by season and socioeconomic status (SES). We evaluated meteorological and mortality data from six metropolitan areas in Korea from 1992 to 2007. We applied generalized linear models (GLM) for quantifying the estimated effects of DTR on mortality after adjusting for mean temperature, dew point temperature, day of the week, and seasonal and long-term trends. Most areas showed a linear DTR–mortality relationship, with evidence of increasing mortality with increasing DTR. Deaths among the elderly (75 years or older), females, the less educated, and the non-hospital population were associated more strongly with DTR than with the corresponding categories. DTR was the greatest threat to vulnerable study populations, with greater influence in the fall season. DTR was found to be a predictor of mortality, and this relationship was modified by season and SES.     

Temperature modifies the health effects of particulate matter in Brisbane, Australia

A few epidemiological studies have examined whether there was an interactive effect between temperature and ambient particulate matter on cardiorespiratory morbidity and mortality, but the results were inconsistent. The present study used three time-series approaches to explore whether maximum temperature modified the impact of ambient particulate matter less than 10 μm in diameter (PM₁₀) on daily respiratory hospital admissions, cardiovascular hospital admissions, respiratory emergency visits, cardiovascular emergency visits, non-external cause mortality and cardiovascular mortality in Brisbane between 1996 and 2001. The analytical approaches included a bivariate response surface model, a non-stratification parametric model and a stratification parametric model. Results show that there existed a statistically significant interaction between PM₁₀ and temperature on most health outcomes at various lags. PM₁₀ exhibited more adverse health effects on warm days than cold days. The choice of the degree of freedom for smoothers to adjust for confounders and the selection of arbitrary cut-offs for temperature affected the interaction estimates to a certain extent, but did not change the overall conclusion. The results imply that it is important to control and reduce the emission of air particles in Brisbane, particularly when temperature increases.     

Lagged Effect of Diurnal Temperature Range on Mortality in a Subtropical Megacity of China

Background

Many studies have found extreme temperature can increase the risk of mortality. However, it is not clear whether extreme diurnal temperature range (DTR) is associated with daily disease-specific mortality, and how season might modify any association.

Objectives

To better understand the acute effect of DTR on mortality and identify whether season is a modifier of the DTR effect.

Methods

The distributed lag nonlinear model (DLNM) was applied to assess the non-linear and delayed effects of DTR on deaths (non-accidental mortality (NAD), cardiovascular disease (CVD), respiratory disease (RD) and cerebrovascular disease (CBD)) in the full year, the cold season and the warm season.

Results

A non-linear relationship was consistently found between extreme DTR and mortality. Immediate effects of extreme low DTR on all types of mortality were stronger than those of extreme high DTR in the full year. The cumulative effects of extreme DTRs increased with the increment of lag days for all types of mortality in cold season, and they were greater for extreme high DTRs than those of extreme low DTRs. In hot season, the cumulative effects for extreme low DTRs increased with the increment of lag days, but for extreme high DTR they reached maxima at a lag of 13 days for all types of mortality except for CBD(at lag6 days), and then decreased.

Conclusions

Our findings suggest that extreme DTR is an independent risk factor of daily mortality, and season is a modifier of the association of DTR with daily mortality.     

Does diurnal temperature range influence seasonal suicide mortality? Assessment of daily data of the Helsinki metropolitan area from 1973 to 2010

Several studies show a peak in suicide rates during springtime and suggest differences in the seasonal variation of suicides. However, the seasonal distribution of the temperature impact on suicide is less clear. This study investigated the relationship between diurnal temperature range (DTR) on suicide mortality. Daily temperature and suicide data for Helsinki were analyzed for the period of 1973–2010 inclusive. Overall, DTR reached its maximum during the spring from mid-April to mid-June, which is also the season with highest suicide mortality in the study region. Specifically, the seasonal timing and maxima for both DTR and suicides vary from year to year. Time series analysis of DTR and suicide records revealed a significant (P?<?0.01) correlation between the springtime DTR maxima and suicide rates for males. No similar association could be found for females. These results provide evidence that a higher springtime DTR could be linked statistically to a higher seasonal suicide rate each spring, whereas the exact timing of the DTR peak did not associate with the seasonal suicide rate. A possible mechanism behind the springtime association between the DTR and suicides originates from brown adipose tissue (BAT) over-activity. Activation of BAT through the winter improves cold tolerance at the cost of heat tolerance. This might trigger anxiety and psychomotor agitation, affecting mood in a negative way. As a hypothesis, the compromised heat tolerance is suggested to increase the risk of death from suicide.     

High-mortality days during the winter season: comparing meteorological conditions across 5 US cities

While the relationship between weather and human health has been studied from various perspectives, this study examines an alternative method of analysis by examining weather conditions on specific high-mortality days during the winter season. These high-mortality days, by definition, represent days with dramatic increases in mortality and the days with the highest mortality. By focusing solely on high-mortality days, this research examines the relationship between weather variables and mortality through a synoptic climatology, environment-to circulation approach. The atmospheric conditions during high-mortality days were compared to the days prior and the days not classified as high-mortality days. Similar patterns emerged across all five locations despite the spatial and temporal variability. Southern locations had a stronger relationship with temperature changes while northern locations showed a greater relationship to atmospheric pressure. Overall, all high-mortality days were associated with warmer temperatures, decreased pressure, and a greater likelihood of precipitation when compared to the previous subset of days. While the atmospheric conditions were consistent across all locations, the importance of the lag effect should not be overlooked as a contributing factor to mortality during the winter season. Through a variety of diverse, methodological approaches, future studies may build upon these results and explore in more detail the complex relationship between weather situations and the impact of short-term changes in weather and health outcomes.     

Spatial Modeling of Air Pollution in Studies of Its Short‐Term Health Effects

Summary In studies that estimate the short‐term effects of air pollution on health, daily measurements of pollution concentrations are often available from a number of monitoring locations within the study area. However, the health data are typically only available in the form of daily counts for the entire area, meaning that a corresponding single daily measure of pollution is required. The standard approach is to average the observed measurements at the monitoring locations, and use this in a log‐linear health model. However, as the pollution surface is spatially variable this simple summary is unlikely to be an accurate estimate of the average pollution concentration across the region, which may lead to bias in the resulting health effects. In this article, we propose an alternative approach that jointly models the pollution concentrations and their relationship with the health data using a Bayesian spatio‐temporal model. We compare this approach with the simple spatial average using a simulation study, by investigating the impact of spatial variation, monitor placement, and measurement error in the pollution data. An epidemiological study from Greater London is then presented, which estimates the relationship between respiratory mortality and four different pollutants.     

Dietary cholesterol and atherosclerosis

The perceived relationship between dietary cholesterol, plasma cholesterol and atherosclerosis is based on three lines of evidence: animal feeding studies, epidemiological surveys, and clinical trials. Over the past quarter century studies investigating the relationship between dietary cholesterol and atherosclerosis have raised questions regarding the contribution of dietary cholesterol to heart disease risk and the validity of dietary cholesterol restrictions based on these lines of evidence. Animal feeding studies have shown that for most species large doses of cholesterol are necessary to induce hypercholesterolemia and atherosclerosis, while for other species even small cholesterol intakes induce hypercholesterolemia. The species-to-species variability in the plasma cholesterol response to dietary cholesterol, and the distinctly different plasma lipoprotein profiles of most animal models make extrapolation of the data from animal feeding studies to human health extremely complicated and difficult to interpret. Epidemiological surveys often report positive relationships between cholesterol intakes and cardiovascular disease based on simple regression analyses; however, when multiple regression analyses account for the colinearity of dietary cholesterol and saturated fat calories, there is a null relationship between dietary cholesterol and coronary heart disease morbidity and mortality. An additional complication of epidemiological survey data is that dietary patterns high in animal products are often low in grains, fruits and vegetables which can contribute to increased risk of atherosclerosis. Clinical feeding studies show that a 100 mg/day change in dietary cholesterol will on average change the plasma total cholesterol level by 2.2-2.5 mg/dl, with a 1.9 mg/dl change in low density lipoprotein (LDL) cholesterol and a 0.4 mg/dl change in high density lipoprotein (HDL) cholesterol. Data indicate that dietary cholesterol has little effect on the plasma LDL:HDL ratio. Analysis of the available epidemiological and clinical data indicates that for the general population, dietary cholesterol makes no significant contribution to atherosclerosis and risk of cardiovascular disease.     

Effect of diurnal temperature range on cardiovascular markers in the elderly in Seoul, Korea

While diurnal temperature range (DTR) has been found to be a risk factor for mortality, evaluation of the underlying mechanisms involved in this association are lacking. To explain the association between DTR and health effects, we investigated how cardiovascular markers responded to DTR. Data was obtained from 560 participants who regularly attended a community elderly welfare center located in Seoul, Korea. Data collection was conducted a total of five times over a 3-year period beginning in August, 2008. We examined systolic and diastolic blood pressure (BP), heart rate (HR), and heart rate variability (HRV). Mixed-effects models and generalized additive mixed models were used to assess the relationship of DTR with BP, HR, and HRV. BP was not associated significantly with rapid temperature changes during the day. While HR was associated linearly with increments of DTR, the relationship between DTR and HRV showed nonlinear associations, or the presence of a cutoff around median DTR. At the cutoff level of DTR determined by an inflection point in the graph, standard deviation of normal-to-normal intervals (SDNN) and root mean square successive difference (RMSSD) were peaked, whereas the low frequency:high frequency (LF:HF) ratio was elevated with decreasing DTR below the cutoff level. The study demonstrated that HR increases with increasing temperature range during the day, and that HRV is reduced at small or large DTR, which suggests minimal cardiovascular stress around the median level of temperature range during the day.     

Temperature Changes between Neighboring Days and Mortality in Summer: A Distributed Lag Non-Linear Time Series Analysis

Background

Many studies have shown that high temperatures or heat waves were associated with mortality and morbidity. However, few studies have examined whether temperature changes between neighboring days have any significant impact on human health.

Method

A distributed lag non-linear model was employed to investigate the effect of temperature changes on mortality in summer during 2006–2010 in two subtropical Chinese cities. The temperature change was defined as the difference of the current day’s and the previous day’s mean temperature.

Results

We found non-linear effects of temperature changes between neighboring days in summer on mortality in both cities. Temperature increase was associated with increased mortality from non-accidental diseases and cardiovascular diseases, while temperature decrease had a protective effect on non-accidental mortality and cardiovascular mortality in both cities. Significant association between temperature changes and respiratory mortality was only found in Guangzhou.

Conclusion

This study suggests that temperature changes between neighboring days might be an alternative temperature indicator for studying temperature-mortality relationship.     

The impact of heat waves on children’s health: a systematic review

Young children are thought to be particularly sensitive to heat waves, but relatively less research attention has been paid to this field to date. A systematic review was conducted to elucidate the relationship between heat waves and children’s health. Literature published up to August 2012 were identified using the following MeSH terms and keywords: “heatwave”, “heat wave”, “child health”, “morbidity”, “hospital admission”, “emergency department visit”, “family practice”, “primary health care”, “death” and “mortality”. Of the 628 publications identified, 12 met the selection criteria. The existing literature does not consistently suggest that mortality among children increases significantly during heat waves, even though infants were associated with more heat-related deaths. Exposure to heat waves in the perinatal period may pose a threat to children’s health. Pediatric diseases or conditions associated with heat waves include renal disease, respiratory disease, electrolyte imbalance and fever. Future research should focus on how to develop a consistent definition of a heat wave from a children’s health perspective, identifying the best measure of children’s exposure to heat waves, exploring sensitive outcome measures to quantify the impact of heat waves on children, evaluating the possible impacts of heat waves on children’s birth outcomes, and understanding the differences in vulnerability to heat waves among children of different ages and from different income countries. Projection of the children’s disease burden caused by heat waves under climate change scenarios, and development of effective heat wave mitigation and adaptation strategies that incorporate other child protective health measures, are also strongly recommended.     

Changes in the association between summer temperature and mortality in Seoul, South Korea

The health impact of climate change depends on various conditions at any given time and place, as well as on the person. Temporal variations in the relationship between high temperature and mortality need to be explored in depth to explain how changes in the level of exposure and public health interventions modify the temperature–mortality relationship. We examined changes in the relationship between human mortality and temperature in Seoul, which has the highest population in South Korea, considering the change in population structure from 1993–2009. Poisson regression models were used to estimate short-term temperature-related mortality impacts. Temperature-related risks were divided into two “time periods” of approximately equal length (1993 and 1995–2000, and 2001–2009), and were also examined according to early summer and late summer. Temperature-related mortality in summer over the past 17 years has declined. These decreasing patterns were stronger for cardiovascular disease-related mortality than for all non-accidental deaths. The novel finding is that declines in temperature-related mortality were particularly noteworthy in late summer. Our results indicate that temperature-related mortality is decreasing in Seoul, particularly during late summer and, to a lesser extent, during early summer. This information would be useful for detailed public health preparedness for hot weather.     

Diurnal temperature range and mortality in Urmia,the Northwest of Iran

Diurnal Temperature Range (DTR) is a meteorological index which represents temperature variation within a day. This study assesses the impact of high and low values of DTR on mortality. Distributed Lag Non-linear Models combined with a quasi-Poisson regression model was used to assess the impact of DTR on cause, age and gender specific mortality, controlled for potential confounders such as long-term trend of daily mortality, day of week effect, holidays, mean temperature, humidity, wind speed and air pollutants. As the effect of DTR may vary between the hot season (from May to October) and cold season (from November to April of the next year), we conducted analyses separately for these two seasons. In high DTR values (all percentiles), the Cumulative Relative Risk (CRR) of Non-Accidental Death, Respiratory Death and Cardiovascular Death increased in the full year and hot season, and especially in lag (0−6) of the hot season. In the cold season and high DTR values (all percentiles), the CRR of Non-Accidental Death and Cardiovascular Death decreased, but the CRR of Respiratory Death increased. Although there was no clear significant effect in low DTR values. High values of DTR increase the risk of mortality, especially in the heat season, in Urmia, Iran.     

Clostridioides difficile infection and One Health: an equine perspective

Clostridioides (Clostridium) difficile presents a significant health risk to humans and animals. The complexity of the bacterial–host interaction affecting pathogenesis and disease development creates an ongoing challenge for epidemiological studies, control strategies and prevention planning. The recent emergence of human disease caused by strains of C. difficile found in animals adds to mounting evidence that C. difficile infection (CDI) may be a zoonosis. In equine populations, C. difficile is a known cause of diarrhoea and gastrointestinal inflammation, with considerable mortality and morbidity. This has a significant impact on both the well-being of the animal and, in the case of performance and production animals, it may have an adverse economic impact on relevant industries. While C. difficile is regularly isolated from horses, many questions remain regarding the impact of asymptomatic carriage as well as optimization of diagnosis, testing and treatment. This review provides an overview of our understanding of equine CDI while also identifying knowledge gaps and the need for a holistic One Health approach to a complicated issue.     

A hazard logit model analysis of covariates of childhood mortality in Matlab, Bangladesh.

In a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.     

Lycopene and heart health

Cardiovascular diseases (CVDs) are the leading causes of human morbidity and mortality in developed countries. Specific biomarkers in this context are markers of inflammation, lipid status, thrombosis and oxidative stress. One recommendation for CVD prevention is to increase consumption of fruits and vegetables as good sources of secondary plant products, e.g. carotenoids. This review aimed to show linkages between lycopene, one main carotenoid in the human diet, and prevention of heart diseases by looking for epidemiological data, results from in vitro experiments and results from in vivo studies (animal studies and human intervention trials). In addition, patents and products within the context of lycopene and CVD prevention will be discussed with a special emphasis on health claims. Epidemiological data, in vitro data and results from animal experiments partly showed promising preventive mechanisms of lycopene. In contrast, until now, human intervention studies mostly failed to show any CVD prevention. However, there is still an encouraging situation, giving hints for antioxidant as well as anti-inflammatory effects of lycopene. These mechanisms could be the background for cardio-protective effects of tomatoes and tomato products. In summary, there are a lot of investigations needed in the future to give reliable results to establish these CVD-preventive effects.     

Examining developmental plasticity in the skeletal system through a sensitive developmental windows framework

Developmental plasticity facilitates energetically costly but potentially fitness-enhancing adjustments to phenotypic trajectories in response to environmental stressors, and thus may significantly impact patterns of growth, morbidity, and mortality over the life course. Ongoing research into epigenetics and developmental biology indicate that the timing of stress exposures is a key factor when assessing their impact on developmental processes. Specifically, stress experienced within sensitive developmental windows (SDWs), discrete developmental periods characterized by heightened energy requirements and rapid growth, may alter the pace and tempo of growth in ways that significantly influence phenotypic development over both the short and long term. In human skeletal biology, efforts to assess how developmental environments shape health outcomes over the life course could be enhanced by incorporating the SDW concept into existing methodological approaches. The goal of this article is to outline an interpretive framework for identifying and interpreting evidence of developmental stress in the skeletal system using the SDW concept. This framework provides guidance for the identification of elements most likely to capture evidence of stress most relevant to a study's core research questions, the interpretation of developmental stress exhibited by those elements, and the relationship of skeletal indicators of stress to the demographic patterning of morbidity and mortality. Use of the SDW concept in skeletal biology has the potential to enrich traditional approaches to addressing developmental origins of health and disease hypotheses, by targeting periods in which individuals are most susceptible to stress and thus most likely to exhibit plasticity in response.     

The relationship between co-exposure to multiple heavy metals and liver damage

BackgroundThe impact of heavy metal exposure on human health has attracted widespread attention of researchers, and the impact of heavy metal exposure on liver function has also been confirmed, however, more attention is paid to the impact of single or two heavy metal exposures, and most epidemiological studies focus on heavy metal pollution areas. In this study, rural residents in non-heavy metal-contaminated areas in Northwest China were selected as the research objects to explore the comprehensive effects of co-exposure to multiple heavy metals on the liver, which can provide certain reference and support for related research.ObjectivesThis study used a Bayesian nuclear machine model (BKMR) to evaluate the relationship between exposure to heavy metal mixtures and indicators of liver function in a population in rural Northwest China.ResultsExposure to higher concentrations of metal mixtures was positively correlated with total bilirubin, direct bilirubin, and aspartate aminotransferase, and negatively correlated with alanine aminotransferase, with Pb contributing the most to indicators of liver function. We also observed a possible interaction of Cd with other heavy metals in the effect of heavy metal mixtures on DB levels.ConclusionsConcurrent exposure to higher concentrations of heavy metal mixtures (Cr, Co, Cd, and Pb) in rural China was associated with indicators representing poor liver function, of which the effect of lead on liver function should be focused. More prospective epidemiological studies and animal experiments need to be carried out to determine this relationship and possible mechanism.     

Environmental exposure and mitochondrial epigenetics: study design and analytical challenges

The environment can influence human health and disease in many harmful ways. Many epidemiological studies have been conducted with the aim of elucidating the association between environmental exposure and human disease at the molecular and pathological levels, and such associations can often be through induced epigenetic changes. One such mechanism for this is through environmental factors increasing oxidative stress in the cell, and this stress can subsequently lead to alterations in DNA molecules. The two cellular organelles that contain DNA are the nucleus and mitochondria, and the latter are particularly sensitive to oxidative stress, with mitochondrial functions often disrupted by increased stress. There has been a substantial increase over the past decade in the number of epigenetic studies investigating the impact of environmental exposures upon genomic DNA, but to date there has been insufficient attention paid to the impact upon mitochondrial epigenetics in studying human disease with exposure to environment. Here, in this review, we will discuss mitochondrial epigenetics with regard to epidemiological studies, with particular consideration given to study design and analytical challenges. Furthermore, we suggest future directions and perspectives in the field of mitochondrial epigenetic epidemiological studies.     

Beer and health: preventive effects of beer components on lifestyle-related diseases

It has been demonstrated that the light-to-moderate consumption of alcoholic beverages is associated with significant reductions in all-cause and particularly cardiovascular mortality. While the inverse association between red-wine consumption and cardiovascular risk is globally recognized as the French paradox, many epidemiological studies have concluded that beer and red wine are equally beneficial. Moderate alcohol intake improves lipoprotein metabolism and lowers cardiovascular mortality risk. The question now is whether additional health benefits associated with the non-alcohol components in beer may be expected. This article summarizes the results of the latest studies on the health benefits of beer while referring to our recent results, which demonstrate the preventive effects of beer and its components on lifestyle-related diseases. A series of studies using animal models have shown that beer may prevent carcinogenesis and osteoporosis; beer provides plasma with significant protection from oxidative stress; and isohumulones, the bitter substances derived from hops, may prevent and improve obesity and type-2 diabetes, improve lipid metabolism, and suppress atherosclerosis. Further studies are needed to clarify the components in addition to isohumulones that are responsible for these beneficial effects of beer, and the underlying mechanisms must be addressed.     

Health expectancy and the problem of substitute morbidity.

During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between ''living longer'' on the one hand and health-related ''quality of life'' on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so-called epidemiological transition in population health. The first one concerns the question of how--given the impressive changes--population health can be measured in an adequate and policy relevant present-day fashion. The second one is the so-called phenomenon of ''substitute morbidity and mortality'': more and more acute fatal diseases are replaced by non-fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease-specific expectations of interventions and asks for a shift to a ''total population health'' perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the ''dynamic equilibrium'' theory. In absolute numbers, however, the burden of disease will continue to increase with further ageing of the population.