Analyzing the effects of drought at different time scales on cause-specific mortality in South Africa.

South Africa (SA) is highly vulnerable to the effects of drought on the environment, economy, and society. However, its effect on human health remains unclear. Understanding the mortality risk associated with different types of droughts in different population groups and by specific causes would help clarify the potential mechanisms involved. The study aims to comprehensively assess the effect of droughts of varying time scales on cause-specific mortality (all; infectious and parasitic; endocrine, nutritional, and metabolic; cardiovascular; respiratory) in SA (from 2009-2016) and identify more vulnerable profiles based on sex and age. We also evaluated the urbanicity and district-level socioeconomic deprivation as potential risk modifiers. We used a two-stage time-series study design, with the weekly standardized precipitation-evapotranspiration index (SPEI) calculated at 1, 6, 12, and 15 months of accumulation to identify droughts of different duration (SPEI1, 6, 12, 15, respectively). We applied a quasi-Poisson regression adjusted by mean temperature to assess the association between each type of drought and weekly mortality in all district municipalities of SA, and then pooled the estimates in a meta-regression model. We reported relative risks (RRs) for one unit increase of drought severity. Overall, we found a positive association between droughts (regardless the time scale) and all causes of death analyzed. The strongest associations were found for the drought events more prolonged (RR [95%CI]: 1.027 [1.018, 1.036] (SPEI1); 1.035 [1.021, 1.050] (SPEI6); 1.033 [1.008, 1.058] (SPEI12); 1.098 [1.068, 1.129] (SPEI15)) and respiratory mortality (RRs varied from 1.037 [1.021, 1.053] (SPEI1) to 1.189 [1.14, 1.241] (SPEI15)). An indication of greater vulnerability was found in younger adults for the shortest droughts, in older adults for medium-term and long-term droughts, and children for very long-term droughts. However, differences were not significant. Further evidence of the relevance of urbanicity and demographic and socioeconomic conditions as potential risk modifiers is needed.

Exploring the association between precipitation and hospital admission for mental disorders in Switzerland between 2009 and 2019.

While several studies proved the relationship between increasing temperatures and poor mental health, limited evidence exists on the effect of other weather factors, such as precipitation. This study assessed the impact of precipitation on hospital admissions for mental disorders in Switzerland between 2009-2019. We defined different precipitation events based on the duration (daily precipitation ≥1mm for 2, 3, or 4 days; PP.2/PP.3/PP.4) and intensity (≥90th percentile for 2 consecutive days; PEP90.2). First, we conducted aggregated time-stratified case-crossover analysis in eight main Swiss cities with distributed lag models to assess the association up to 3 days after the exposure. Then, we pooled the estimates in each city using a multivariate random effects meta-analysis for all hospital admissions and by subgroups (sex, age, diagnosis). Evidence of an association between precipitation and hospital admission for mental disorders was not found in Switzerland (PP.2: 1.003[0.978-1.029]; PP.3: 1.005[0.985-1.026]; PP.4: 0.994[0.960-1.030]; PEP90.2: 1.000[0.953-1.050]). Although the results were highly uncertain, we found an indication of increasing risks of hospital admission with increasing intensity of precipitation in warmer seasons (PP.2: 1.001[0.971-1.032] vs PEP90.2: 1.014[0.955-1.078]), while the risks of hospital admission slightly increased by the duration in colder season (PP.2: 1.009[0.981-1.039]; PP.3: 1.008[0.980-1.036]; PP.4: 1.017[0.956-1.081]). Overall, risks tend to be higher in people aged < 65 years. Duration of the events may influence more than intensity in females, while opposite patterns were observed in males. Risks tended to be larger but still uncertain for schizophrenia, mood disorders, and adult personality disorders. An indication of a negative association was found in neurotic disorders and null risks in the remaining groups. Although our findings did not show a clear association between precipitation and mental disorders, further research is required to clarify the role of precipitation and the potential implications of climate change and extreme precipitation events on mental health.

Heat-related first cardiovascular event incidence in the city of Madrid (Spain): Vulnerability assessment by demographic, socioeconomic, and health indicators.

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

Public Health Implications of Drought in a Climate Change Context: A Critical Review.

Extreme weather events are expected to increase due to climate change, which could pose an additional burden of morbidity and mortality. In recent decades, drought severity has increased in several regions around the world, affecting health by increasing the risk of water-, food-, and vector-borne diseases, malnutrition, cardiovascular and respiratory illness, mental health disorders, and mortality. Drought frequency and severity are expected to worsen across large regions as a result of a decrease in precipitation and an increase in temperature and atmospheric evaporative demand, posing a pressing challenge for public health. Variation in impacts among countries and communities is due to multiple factors, such as aging, socioeconomic status, access to health care, and gender, affecting population resilience. Integrative proactive action plans focused on risk management are required, and resources should be transferred to developing countries to reduce their vulnerability and risk.

Cytokine expression in the eye and brain of chickens following infection with a very virulent plus Marek's disease virus strain.

Cytokine transcripts were evaluated chronologically in the brain and in the eye of chickens infected with the very virulent plus Marek's disease virus (vv + MDV) strain 648A. Brain and eye samples were collected from chickens that were either suffering from transient paralysis (TP) (11 days post inoculation, dpi) or had completely recovered from TP but started developing clinical signs of persistent neurological disease (PND) (18-31 dpi). Results obtained from samples collected at 11 dpi are referred as EL (early lesions) and results obtained from samples collected at later times (18-31 dpi) are referred as LL (late lesions). Marked differences were found in the cytokine transcripts in brain and eye. While proinflammatory cytokines (IL-1ß, IL-8, IL-18), iNOS, IFN-α, IFN-γ, and IL-15 were upregulated in the brain during EL and LL, only IL-8 and IFN-γ were upregulated in the eye at both times (EL and LL). The two evaluated viral transcripts (gB and meq) were found in both eye and brain during EL and LL. Levels of the two viral transcripts evaluated were higher at LL than at EL in both brain and eye. No differences were found in any of the viral transcripts between eye and brain during EL. However, during the LL, the levels of meq transcripts were higher in the eye than in the brain. Our results suggest that MDV elicits different immune responses in the brain and in the eye of infected chickens. Because immune responses in the eye of chickens have been poorly studied, further studies on the pathogenesis of MDV in the eye could greatly contribute to our knowledge on the chicken eye immunity.

Quantification of the Effects of Droughts on Daily Mortality in Spain at Different Timescales at Regional and National Levels: A Meta-Analysis.

A performance assessment of two different indices (the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI)) for monitoring short-term and short-medium-term drought impacts on daily specific-cause mortality in Spain was conducted. To achieve a comprehensive, nationwide view, a meta-analysis was performed using a combination of provincial relative risks (RRs). Moreover, the subdivisions of Spain based on administrative, climatic, and demographic criteria to obtain the measures of combined risks were also taken into account. The results of the SPEI and SPI calculated at the same timescale were similar. Both showed that longer drought events produced greater RR values, for respiratory mortality. However, at the local administrative level, Galicia, Castilla-y-Leon, and Extremadura showed the greatest risk of daily mortality associated with drought episodes, with Andalucía, País Vasco, and other communities being notably impacted. Based on climatic regionalization, Northwest, Central, and Southern Spain were the regions most affected by different drought conditions for all analyzed causes of daily mortality, while the Mediterranean coastal region was less affected. Demographically, the regions with the highest proportion of people aged 65 years of age and over reflected the greatest risk of daily natural, circulatory, and respiratory mortality associated with drought episodes.

Effects of droughts on health: Diagnosis, repercussion, and adaptation in vulnerable regions under climate change. Challenges for future research.

There is little doubt about the effects of drought events on human health in the present climate. Projections of climate change indicate an increase in the occurrence and severity of droughts in the 21st century in a number of regions, thus it is likely that these types of hydrological extremes could have more of an impact if appropriate adaptation measures are not taken. The majority of studies on the effects of drought are focused on meteorological, agricultural, or hydrological contexts, but there are rather fewer assessments of the impacts of droughts on health. In particular, there have been hardly any attempts to compare different drought indices in order to identify and quantify the impacts of drought on health systems. In addition, rather better knowledge is needed on the mechanisms of vulnerability involved. In this paper, we attempt to describe the complexity of drought phenomena and the difficulty involved in quantifying the health risks linked to their occurrence. From an international perspective, we provide a brief review of the harmful effects of droughts on health in the context of climate change, as well as the vulnerability factors related to droughts. We make an assessment of aspects that have not yet been investigated, or which require further attention to be devoted to this topic. The principal aim of this paper is therefore to draw attention to the need to consider closely the relationship between drought indices and human health, in order to achieve a more fundamental understanding, and to propose specific courses or lines of action for future years, which could eventually be of use to healthcare providers and services.