Temporal trends in temperature-related mortality and evidence for maladaptation to heat and cold in the Eastern Mediterranean region.

The eastern Mediterranean region is characterized by rising temperature trends exceeding the corresponding global averages and is considered a climate change hot-spot. Although previous studies have thoroughly investigated the impact of extreme heat and cold on human mortality and morbidity, both for the current and future climate change scenarios, the temporal trends in temperature-related mortality or the potential historical adaptation to heat and cold extremes has never been studied in this region. This study focuses on cardiovascular mortality and assesses the temporal evolution of the Minimum Mortality Temperature (MMT), as well as the disease-specific cold- and heat-attributable fraction of mortality in three typical eastern Mediterranean environments (Athens, Thessaloniki and Cyprus). Data on daily cardiovascular mortality (ICD-10 code: I00-I99) and meteorological parameters were available between 1999 and 2019 for Athens, 1999 to 2018 for Thessaloniki and 2004 to 2019 for Cyprus. Estimation of cardiovascular MMT and mortality fractions relied on time-series Poisson regressions with distributed lag nonlinear models (DLNM) controlling for seasonal and long-term trends, performed over a series of rolling sub-periods at each site. The results indicated that in Athens, the MMT decreased from 23 °C (67.5th percentile) in 1999-2007 to 21.8 °C (62nd percentile) in 2011-2019, while in Cyprus the MMT decreased from 26.3 °C (79th percentile) in 2004-2012 to 23.9 °C (66.5th percentile) in 2011-2019. In Thessaloniki, the decrease in MMT was rather negligible. In all regions under study, the fractions of mortality attributed to both cold and heat followed an upward trend throughout the years. In conclusion, the demonstrated increase in cold attributable fraction and the decreasing temporal trend of MMT across the examined sites are suggestive of maladaptation to extreme temperatures in regions with warm climate and highlight the need for relevant public health policies and interventions.

The influence of weather types over northern Greece on respiratory and cardio-vascular mortality.

Extreme ambient temperatures are well-known for their adverse impact on public health, in the form of increased mortality and morbidity due to respiratory and cardio-vascular diseases. However, to capture the total impact of weather on cause-specific mortality/morbidity, the synoptic atmospheric conditions over the region under study need to be taken into account. The objective of this work is to identify weather types over Thessaloniki, Greece, statistically associated with mortality from circulatory and respiratory diseases, in an attempt to holistically determine the impact of weather on cause-specific mortality in the region. For this purpose, we employed datasets from the NCEP/NCAR Reanalysis comprising intrinsic daily data, gridded at a resolution of 2.5°×2.5° and covering a 41-year period (1980-2020). The first set used contains data of 500 hPa and 1,000 hPa geopotential heights for the main geographical domain of the Mediterranean region (30°N-45°N, 10°Ε-35°E). The second set comprises meteorological variables (2 m temperature, specific humidity, 2 m zonal and 2 m meridional wind and total cloud cover) for a geographical domain of north Greece (40.95°Ν, 22.50°Ε-26.25°E). We applied a combination of principal components analysis (PCA) as a dimensionality reduction tool and k-means cluster analysis (CA) in order to group days with homogeneous synoptic meteorological parameters. The derived weather types were statistically correlated with respiratory and mortality data for the time-period 1999-2018. It was concluded that the most fatal conditions for public health in Thessaloniki were associated with weather types bringing low/extremely low ambient temperature over north Greece.

Anatomy of the atmospheric emissions from the transport sector in Greece: trends and challenges.

Emissions of atmospheric pollutants are well-known for their adverse effects on air quality and public health. Additionally, GHG emissions are responsible for the so called "Radiating Forcing" leading to climate change and degradation of ecosystem services. In this work, we analyze the annual emission trends of various air pollutants, including GHGs, from all 4 sectors of transport (roads, aviation, navigation, and railway) in Greece during the 28-year period between 1990 and 2017, in order to examine the confounding dynamics among external forces, such as the major fiscal recession of 2008, and the GHG/pollutant emissions in the country. The analysis is performed with a suite of statistical tools consisting of bivariate correlation analysis, Mann-Kendall test, Sen's slope estimation, and Joinpoint regression analysis, in order to thoroughly study the trends of emissions. It is found that all transport sectors (except for the railway) show a significant increase in their emissions, despite the fiscal recession of 2008 that temporarily decelerated all aspects of economic activity in the country. Given the major share of transport in GHG emissions (37%) and air pollution in urban centers, it is essential that the road sector adapts to the new challenges, by means of switching to low-emission technologies and electromobilization. The same applies for the navigation and aviation sectors, which are known pillars of the tourist industry in the country.

The Impact of Ambient Temperature on Cardiorespiratory Mortality in Northern Greece.

It is well-established that exposure to non-optimum temperatures adversely affects public health, with the negative impact varying with latitude, as well as various climatic and population characteristics. This work aims to assess the relationship between ambient temperature and mortality from cardiorespiratory diseases in Eastern Macedonia and Thrace, in Northern Greece. For this, a standard time-series over-dispersed Poisson regression was fit, along with a distributed lag nonlinear model (DLNM), using a maximum lag of 21 days, to capture the non-linear and delayed temperature-related effects. A U-shaped relationship was found between temperature and cardiorespiratory mortality for the overall population and various subgroups and the minimum mortality temperature was observed around the 65th percentile of the temperature distribution. Exposure to extremely high temperatures was found to put the highest risk of cardiorespiratory mortality in all cases, except for females which were found to be more sensitive to extreme cold. It is remarkable that the highest burden of temperature-related mortality was attributed to moderate temperatures and primarily to moderate cold. The elderly were found to be particularly susceptible to both cold and hot thermal stress. These results provide new evidence on the health response of the population to low and high temperatures and could be useful to local authorities and policy-makers for developing interventions and prevention strategies for reducing the adverse impact of ambient temperature.

Heat-related mortality under climate change and the impact of adaptation through air conditioning: A case study from Thessaloniki, Greece.

Climate change is expected to increase heat-related mortality across the world. Health Impact Assessment (HIA) studies are used to quantify the impact of higher temperatures, taking into account the effect of population adaptation. Although air-conditioning (AC) is one of the main drivers of technological adaptation to heat, the health impacts associated with AC-induced air pollution have not been examined in detail. This study uses the city of Thessaloniki, Greece as a case study and aims to estimate the future heat-related mortality, the residential cooling demand, and the adaptation trade-off between averted heat-related and increased air pollution cardiorespiratory mortality. Using temperature and population projections under different Coupled Model Intercomparison Project Phase 6 (CIMP6) Shared Socioeconomic Pathways scenarios (SSPs), a HIA model was developed for the future heat and air pollution cardiorespiratory mortality. Counterfactual scenarios of either black carbon (BC) or natural gas (NG) being the fuel source for electricity generation were included in the HIA. The results indicate that the heat-related cardiorespiratory mortality in Thessaloniki will increase and the excess of annual heat-related deaths in 2080-2099 will range from 2.4 (95% CI: 0.0-20.9) under SSP1-2.6 to 433.7 (95% CI: 66.9-1070) under SSP5-8.5. Population adaptation will attenuate the heat-related mortality, although the latter may be counterbalanced by the higher air pollution-related mortality due to increased AC, especially under moderate SSP scenarios and coal-fired power plants. Future studies examining the health effects of warmer temperatures need to account for the impact of both adaptation and increased penetration and use of AC.

From inequitable to sustainable e-waste processing for reduction of impact on human health and the environment.

Recycling of electric and electronic waste products (e-waste) which amounted to more than 50 million metric tonnes per year worldwide is a massive and global operation. Unfortunately, an estimated 70-80% of this waste has not been properly managed because the waste went from developed to low-income countries to be dumped into landfills or informally recycled. Such recycling has been carried out either directly on landfill sites or in small, often family-run recycling shops without much regulations or oversights. The process traditionally involved manual dismantling, cleaning with hazardous solvents, burning and melting on open fires, etc., which would generate a variety of toxic substances and exposure/hazards to applicators, family members, proximate residents and the environment. The situation clearly calls for global responsibility to reduce the impact on human health and the environment, especially in developing countries where poor residents have been shouldering the hazardous burden. On the other hand, formal e-waste recycling has been mainly conducted in small scales in industrialized countries. Whether the latter process would impose less risk to populations and environment has not been determined yet. Therefore, the main objectives of this review are: 1. to address current trends and emerging threats of not only informal but also formal e-waste management practices, and 2. to propose adequate measures and interventions. A major recommendation is to conduct independent surveillance of compliance with e-waste trading and processing according to the Basel Ban Amendment. The recycling industry needs to be carefully evaluated by joint effort from international agencies, producing industries and other stakeholders to develop better processes. Subsequent transition to more sustainable and equitable e-waste management solutions should result in more effective use of natural resources, and in prevention of adverse effects on health and the environment.

Identifying patterns of airborne pollen distribution using a synoptic climatology approach.

Understanding the mechanisms of pollen release and dispersion in the atmosphere is of high importance, not only for getting an insight on the patterns of movement of these biological particles that are necessary for plants' reproduction, but also because exposure to airborne pollen is a major concern for respiratory allergies worldwide. In this work, a synoptic circulation-to-environment classification method was adopted to elucidate the relationship between distinct atmospheric patterns and pollen levels for the 11 most abundant but also allergenic taxa in Thessaloniki, Greece, for the 15-year period 1987-2001. It was found that the NW1 depressional weather type is associated with the "low winter pollen season" and high levels of pollen from Carpinus spp., Corylus spp., Cupressaceae, Platanus spp., Pinaceae, Quercus spp. and Urticaceae. In contrast, the SW1 cyclonic type is linked to the "high spring-summer pollen season" and high levels of pollen from Oleaceae and Urticaceae. On the other hand, anticyclonic weather is associated with the "summer-autumn pollen season" and high levels of Poaceae and Chenopodiaceae pollen in the atmosphere. Regional transport of Alnus pollen is linked to a strong high-pressure system centered over Italy, giving light NE winds over northern Greece. These findings shed light to the synoptic climatology of airborne pollen in Thessaloniki and could feed early-warning systems for alerting vulnerable groups of the allergic population.

Correction to: Weather patterns and all-cause mortality in England, UK.

The original article was published with an erroneous rendering of Eq. 2 in the article's Methodology section.

Weather patterns and all-cause mortality in England, UK.

Cold- and heat-related mortality poses significant public health concerns worldwide. Although there are numerous studies dealing with the association between extreme ambient temperature and mortality, only a small number adopt a synoptic climatological approach in order to understand the nature of weather systems that precipitate increases in cold- or heat-related mortality. In this paper, the Lamb Weather Type synoptic classification is used to examine the relationship between daily mortality and weather patterns across nine regions of England. Analysis results revealed that the population in England is more susceptible to cold weather. Furthermore, it was found that the Easterly weather types are the most hazardous for public health all-year-long; however, during the cold period, the results are more evident and spatially homogenous. Nevertheless, it is noteworthy that the most dangerous weather conditions are not always associated with extreme (high or low) temperatures, a finding which points to the complexity of weather-related health effects and highlights the importance of a synoptic climatological approach in elucidating the relationship between temperature and mortality.

3-year noise monitoring and strategic noise mapping in an extended motorway.

It is well known that the quality of the acoustic environment is very often degraded by major environmental interventions such as extended motorways. Considering this, the European Union has imposed relevant legislation on its member states to monitor these environmental changes/interventions and to develop strategic noise maps and action plans, in order to protect the natural and human environment. Egnatia Odos is a major motorway that crosses northern Greece and connects the country with the main European Motorway network. In the present work, the results of an extended traffic noise measuring campaign at selected sections of the Egnatia motorway are presented, together with the strategic noise maps and calculations of the population exposure. It was concluded that, although the noise levels in the countryside were low, in the suburban areas near the city of Thessaloniki the traffic noise was reported high during both the day and night. However, the extent of the traffic noise issue was found considerably greater during night-time. The number of exceedances was rather limited, though a considerable amount of population (11.5% and 5.4% during the day and night, respectively) seems to be affected by relatively high noise levels, highlighting the importance of traffic noise monitoring.

The effect of ambient air temperature on cardiovascular and respiratory mortality in Thessaloniki, Greece.

OBJECTIVES: There is a growing body of evidence linking ambient air temperature and adverse health effects, in the form of hospitalization or even increased mortality mainly due to respiratory and cardio/cerebro-vascular illnesses. In the present study, we examine the association between high ambient air temperature and cardiovascular as well as respiratory mortality for the population of the greater area of Thessaloniki, Greece, taking into account the role of particulate pollution as a potential confounder. METHODS: A mixed Poisson regression model, using a quasi-likelihood function to account for potential over-dispersion in the outcome distribution given covariates, was combined with distributed lag non-linear models, to estimate the non-linear and lag patterns in the association between mortality and daily mean temperature from 1999 to 2012. RESULTS: A direct heat effect was found, as the mortality risk increased sharply above the temperature threshold of 33 °C, suggesting a significant effect of high temperatures on mortality on the same and next day of the heat events (lags 0-1) which was retained for a week, whereas a harvesting effect was noticed for the following days. Cardiovascular and respiratory mortality risk increased by 4.4% (95% CI 2.7%-6.1%) and 5.9% (95% CI 1.8%-10.3%) respectively on the same and following day of a heat event, whereas the risk dropped steeply in the following days. Particulate matter did not confound the association between high temperature and mortality in this population. CONCLUSION: There is a significant association between mortality and hot temperatures in Thessaloniki, Greece. Reduction in exposure to increased temperatures, as part of prevention measures and strategies, should be considered for vulnerable subpopulations.

Strategic Noise Maps and Action Plans for the reduction of population exposure in a Mediterranean port city.

One of the major environmental problems in contemporary societies is noise pollution, as it is well-known that noise adversely affects both the physiological and the psychological human health and well-being. This paper presents the development of Strategic Noise Maps and Action Plans for the "agglomeration of Piraeus", an area with >15% of the total population and almost 12% of the total area of the "Athenian - Piraeus conurbation". In Piraeus different noise sources, such as the railway, port activities, the road network, industrial and logistic activities etc., in combination with mixed land uses, dense urban canopy characteristics, residential areas adjacent to major road arterials etc. create a complicated noise environment that causes annoyance to the population. For this study, a campaign of 55 24-hour noise measurements was carried out and a series of 200 traffic counts were used for the estimation of traffic characteristics. Annual road traffic data were derived from a validated traffic model, while vessel, rail and industrial activity data were obtained from the service operators and in-situ surveys. The aforementioned noise/traffic measurements were used to calibrate a complex geographical model of the urban canopy and the noise sources layout. Strategic Noise Maps were then developed, along with estimations of the population exposure and DALYs lost from environmental noise per source. Action Plans including intervention measures aiming at the reduction of noise pollution in the area were then proposed. It was found that when implementing the interventions proposed both the noise levels and the exposure of population were significantly reduced, highlighting the importance of exposure reduction, especially for the vulnerable subpopulations, through prevention measures and strategies.

Environmental monitoring and risk assessment of pesticide residues in surface waters of the Louros River (N.W. Greece).

Estuarine environments are being constantly stressed by new sources of pollution (e.g. pesticides) derived from activities of industry and intensive agriculture. The present study aims at quantify pesticides of three different categories (fungicides, herbicides and insecticides) in the Louros River (Epirus region, North-Western Greece). A monitoring study of 34 compounds was carried out in surface river waters from June 2011 until May 2012. Seven water sampling stations were established and 35 water samples were collected. A solid-phase extraction (SPE) method coupled with gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS), depending on the compound, was developed and validated. During the monitoring study 25 pesticides were detected (13 herbicides, 9 insecticides, 3 fungicides). The most commonly encountered pesticides were quizalofop-ethyl, trifluralin and pendimethaline. Tebufenpyrad was found in all sampling stations and seasons, with the highest concentrations of 0.330 µg/L at Tsopeli Lagoon exceeding the rather low concentrations reported nationwide. Regarding the environmental risk due to the presence of target compounds in surface waters, this was estimated by calculating risk quotients (RQs) for different aquatic organisms (algae, zooplankton and fish). The results denoted a possible threat for the aquatic environment, rendering in this way the RQ method as a useful screening tool. In any case, further extensive study is needed for acetochlor, pirimiphos-methyl, endosulfan-a and azinphos-ethyl in order to better correlate their occurrence and potential toxic effects in aquatic life and humans.

Assessment of the toxic potential of rainwater precipitation: First evidence from a case study in three Greek cities.

Considering the necessity to monitor rainwater quality and the limited existing data regarding wet precipitations' toxic potential, the toxic potential of rainwater (RW) samples collected in three cities of Western Greece (Corfu, Agrinion and Patras) during May, October, November, and December of 2014 were investigated. The relationship of the adverse effects obtained, against cytokinesis block micronucleus (CBMN) and Vibrio fischeri bioluminescence (Microtox) assays with the physicochemical characteristics, the heavy metal concentration levels of rainwater samples and the meteorological parameters governing the climatic conditions in each region, were studied in detail. All samples showed pH values in the range of 5.37-7.17, high concentrations of ΝΗ4+ and the presence of SO42- and NO3-. The metals Al, Mn, Fe, Co, Ni, Cu, Zn, As, Sb, Cd, were detected in most of the samples, with maximum concentrations ranging from 0.16 µg L-1 (for Co) to 86.6 µg L-1 (for Fe). The CBMN assay showed statistically significant rainwater cytotoxic activity at 5% (v/v) concentration in all cities during all months studied and at 10% (v/v) in Agrinion and Corfu in May. No genotoxic effect was induced at 5% (v/v) concentration of rainwater, except for Corfu city during November, whereas 10% (v/v) of rainwater led to statistically significant increase in micronuclei frequencies in all three cities. The highest (100%) and the lowest (14%) inhibitory effect exhibited by the rainwater in the Vibrio test were noticed at Corfu city during May and December, respectively. Considering the inter-relations obtained among the abiotic and biotic variables measured in all cases, conductivity, SO42-, NH4+, and total metal burden could be related with both CBMN and Microtox assays data, regardless of the site- and month-specific differences. The multidisciplinary approach presented here showed that the physicochemical profile of rainwater precipitation could be significantly related with the induction of adverse effects on biota.

Heat-related mortality in Cyprus for current and future climate scenarios.

Extreme temperatures have long been associated with adverse health impacts, ranging from minor illness, to increased hospitalizations and mortality. Heat-related mortality during summer months is likely to become an increasing public health problem in future due to the effects of climate change. We performed a health impact assessment for heat-related mortality for the warm months of April-September for the years 2004 to 2009 inclusive, for the city of Nicosia and for Cyprus as a whole, based on separately derived exposure-response functions. We further estimated the potential future heat-related mortality by including climate projections for southern Europe, which suggest changes in temperature of between 1°C and 5°C over the next century. There were 32 heat-related deaths per year in Cyprus over the study period. When adding the projected increase in temperature due to climate change, there was a substantial increase in mortality: for a 1°C increase in temperature, heat related mortality in Cyprus was estimated to double to 64 per year, and for a 5°C increase, heat-related mortality was expected to be 8 times the baseline rate for the warm season (281 compared with 32). This analysis highlights the importance of preparing for potential health impacts due to heat in Cyprus, particularly under a changing climate.

Forecasting hourly PM(10) concentration in Cyprus through artificial neural networks and multiple regression models: implications to local environmental management.

In the present work, two types of artificial neural network (NN) models using the multilayer perceptron (MLP) and the radial basis function (RBF) techniques, as well as a model based on principal component regression analysis (PCRA), are employed to forecast hourly PM(10) concentrations in four urban areas (Larnaca, Limassol, Nicosia and Paphos) in Cyprus. The model development is based on a variety of meteorological and pollutant parameters corresponding to the 2-year period between July 2006 and June 2008, and the model evaluation is achieved through the use of a series of well-established evaluation instruments and methodologies. The evaluation reveals that the MLP NN models display the best forecasting performance with R (2) values ranging between 0.65 and 0.76, whereas the RBF NNs and the PCRA models reveal a rather weak performance with R (2) values between 0.37-0.43 and 0.33-0.38, respectively. The derived MLP models are also used to forecast Saharan dust episodes with remarkable success (probability of detection ranging between 0.68 and 0.71). On the whole, the analysis shows that the models introduced here could provide local authorities with reliable and precise predictions and alarms about air quality if used on an operational basis.