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Co-benefits of climate change mitigation for infectious disease control 减缓气候变化对传染病控制的共同效益。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-10-01 DOI: 10.1016/S2542-5196(24)00237-7
Jan C Semenza , Joacim Rocklöv
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引用次数: 0
Effect of heat stress in the first 1000 days of life on fetal and infant growth: a secondary analysis of the ENID randomised controlled trial 出生后 1000 天内的热应激对胎儿和婴儿生长的影响:ENID 随机对照试验的二次分析。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-10-01 DOI: 10.1016/S2542-5196(24)00208-0
Ana Bonell PhD , Prof Ana M Vicedo-Cabrera PhD , Giovenale Moirano PhD , Bakary Sonko BSc , David Jeffries PhD , Prof Sophie E Moore PhD , Prof Andy Haines F Med Sci , Prof Andrew M Prentice PhD , Prof Kris A Murray PhD
<div><h3>Background</h3><div>The intersecting crises of climate change, food insecurity, and undernutrition disproportionately affect children. Understanding the effect of heat on growth from conception to 2 years of age is important because of mortality and morbidity implications in the near term and over the life course.</div></div><div><h3>Methods</h3><div>In this secondary analysis, we used longitudinal pregnancy cohort data from the Early Nutrition and Immunity Development (ENID) randomised controlled trial in West Kiang, The Gambia, which occurred between Jan 20, 2010, and Feb 10, 2015. The ENID trial assessed micronutrient supplementation in the first 1000 days of life starting from 20 weeks’ gestation, during which anthropometric measurements were collected prospectively. We used multivariable linear regression to assess the effect of heat stress (defined by Universal Thermal Climate Index [UTCI]) on intrauterine growth restriction based on length-for-gestational age Z score (LGAZ), weight-for-gestational age Z score (WGAZ), and head circumference-for-gestational age Z score (HCGAZ) at birth, and assessed for effect modification of supplement intervention on the relationship between heat stress and infant anthropometry. We used multivariable, multilevel linear regression to evaluate the effect of heat stress on infant growth postnatally based on weight-for-height Z score (WHZ), weight-for-age Z score (WAZ), and height-for-age Z score (HAZ) from 0 to 2 years of age.</div></div><div><h3>Findings</h3><div>Complete data were available for 668 livebirth outcomes (329 [49%] female infants and 339 [51%] male infants). With each 1°C increase in mean daily maximum UTCI exposure, in the first trimester, we observed a reduction in WGAZ (–0·04 [95% CI –0·09 to 0·00]), whereas in the third trimester, we observed an increase in HCGAZ (0·06 [95% CI 0·00 to 0·12]), although 95% CIs included 0. Maternal protein-energy supplementation in the third trimester was associated with reduced WGAZ (–0·16 [–0·30 to –0·02]) with each 1°C increase in mean daily maximum UTCI exposure, while no effect of heat stress on WGAZ was found with either standard care (iron and folate) or multiple micronutrient supplementation. For the postnatal analysis, complete anthropometric data at 2 years were available for 645 infants (316 [49%] female infants and 329 [51%] male infants). Postnatally, heat stress effect varied by infant age, with infants aged 6–18 months being the most affected. In infants aged 12 months exposed to a mean daily UTCI of 30°C (preceding 90-day period) versus 25°C UTCI, we observed reductions in mean WHZ (–0·43 [95% CI –0·57 to –0·29]) and mean WAZ (–0·35 [95% CI –0·45 to –0·26]). We observed a marginal increase in HAZ with increasing heat stress exposure at age 6 months, but no effect at older ages.</div></div><div><h3>Interpretation</h3><div>Our results suggest that heat stress impacts prenatal and postnatal growth up to 2 years of age but sensitivity mig
背景:气候变化、粮食不安全和营养不良等危机相互交织,对儿童的影响尤为严重。了解热量对受孕至 2 岁儿童生长的影响非常重要,因为热量会在短期内和整个生命过程中对死亡率和发病率产生影响:在这项二次分析中,我们使用了来自冈比亚西基昂早期营养与免疫发展(ENID)随机对照试验的纵向孕期队列数据,该试验发生在 2010 年 1 月 20 日至 2015 年 2 月 10 日之间。ENID试验评估了从妊娠20周开始的生命最初1000天的微量营养素补充情况,在此期间对人体测量数据进行了前瞻性收集。我们采用多变量线性回归评估了热应激(以通用热气候指数[UTCI]定义)对宫内生长受限的影响,该影响基于出生时胎龄身长Z值(LGAZ)、胎龄体重Z值(WGAZ)和胎龄头围Z值(HCGAZ),并评估了补充剂干预对热应激与婴儿人体测量之间关系的影响修正。我们使用多变量、多层次线性回归法评估了热应激对婴儿出生后生长的影响,其依据是婴儿0至2岁期间的体重身高Z值(WHZ)、体重年龄Z值(WAZ)和身高年龄Z值(HAZ):668 名活产婴儿(329 名[49%]女婴和 339 名[51%]男婴)的完整数据。UTCI日平均最高暴露温度每升高1°C,在妊娠的前三个月,我们观察到WGAZ下降(-0-04 [95% CI -0-09 to 0-00]),而在妊娠的后三个月,我们观察到HCGAZ上升(0-06 [95% CI 0-00 to 0-12]),尽管95% CI包括0.5°C。母体在妊娠三个月内补充蛋白质能量与日平均最高UTCI暴露温度每升高1°C,WGAZ降低(-0-16 [-0-30 to -0-02])有关,而标准护理(铁和叶酸)或多种微量营养素补充均未发现热应激对WGAZ的影响。在产后分析中,645 名婴儿(316 名[49%]女婴和 329 名[51%]男婴)2 岁时的人体测量数据完整。产后热应激的影响因婴儿年龄而异,6-18 个月的婴儿受影响最大。在 12 个月大的婴儿中,暴露于 30°C 的日平均 UTCI(前 90 天期间)与 25°C 的 UTCI 相比,我们观察到平均 WHZ(-0-43 [95% CI -0-57 to -0-29])和平均 WAZ(-0-35 [95% CI -0-45 to -0-26])降低。我们观察到,在 6 个月大时,随着热应激暴露程度的增加,HAZ 略有增加,但在较大年龄时则没有影响:我们的研究结果表明,热应激会影响2岁以内的产前和产后生长,但敏感性可能因年龄而异。在地球迅速变暖的背景下,这些发现可能会对个人健康产生短期和长期影响,并对公共儿童健康产生近期和未来的影响:惠康基金会。
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引用次数: 0
Environmentally sustainable prescribing: recommendations for EU pharmaceutical legislation 环境可持续处方:欧盟药品立法建议。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-10-01 DOI: 10.1016/S2542-5196(24)00230-4
Joost D Piët , Amy Booth , Erik M Donker , Fabrizio de Ponti , Carlotta Lunghi , Elisabetta Poluzzi , Ben J A Janssen , SanYuMay Tun , Charlotte Bekker , Lorena Dima , João Costa , Mathilde Jalving , Thijs H Oude Munnink , Patricia M L A van den Bemt , Marc Labriffe , Tomás van Emden , Vera van Waardenburg , Robert Likic , Milan Richir , Michiel A van Agtmael , Jelle Tichelaar
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引用次数: 0
Correction to Lancet Planet Health 2022; 6: e243-56. 柳叶刀星球健康》2022;6:e243-56 更正。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-10 DOI: 10.1016/S2542-5196(24)00233-X
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引用次数: 0
Planetary Health and Disaster Risk Reduction: the Sendai Framework at its Midpoint 行星健康与减少灾害风险:仙台框架的中点。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00200-6
Liz Willetts
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引用次数: 0
Planetary Health Research Digest 行星健康研究摘要
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00211-0
Cahal McQuillan
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引用次数: 0
Risks of infectious disease hospitalisations in the aftermath of tropical cyclones: a multi-country time-series study 热带气旋过后传染病住院风险:多国时间序列研究
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00158-X
Wenzhong Huang MPH , Thomas Vogt PhD , Jinah Park MPH , Zhengyu Yang MPH , Prof Elizabeth A Ritchie PhD , Rongbin Xu PhD , Yiwen Zhang MPH , Prof Simon Hales PhD , Wenhua Yu MPH , Samuel Hundessa PhD , Christian Otto PhD , Pei Yu PhD , Yanming Liu PhD , Ke Ju MSc , Prof Eric Lavigne PhD , Tingting Ye MSc , Bo Wen MSc , Yao Wu MSc , Wissanupong Kliengchuay PhD , Prof Kraichat Tantrakarnapa PhD , Prof Yuming Guo PhD
<div><h3>Background</h3><p>The proportion of intense tropical cyclones is expected to increase in a changing climate. However, there is currently no consistent and comprehensive assessment of infectious disease risk following tropical cyclone exposure across countries and over decades. We aimed to explore the tropical cyclone-associated hospitalisation risks and burden for cause-specific infectious diseases on a multi-country scale.</p></div><div><h3>Methods</h3><p>Hospitalisation records for infectious diseases were collected from six countries and territories (Canada, South Korea, New Zealand, Taiwan, Thailand, and Viet Nam) during various periods between 2000 and 2019. The days with tropical cyclone-associated maximum sustained windspeeds of 34 knots or higher derived from a parametric wind field model were considered as tropical cyclone exposure days. The association of monthly infectious diseases hospitalisations and tropical cyclone exposure days was first examined at location level using a distributed lag non-linear quasi-Poisson regression model, and then pooled using a random-effects meta-analysis. The tropical cyclone-attributable number and fraction of infectious disease hospitalisations were also calculated.</p></div><div><h3>Findings</h3><p>Overall, 2·2 million people who were hospitalised for infectious diseases in 179 locations that had at least one tropical cyclone exposure day in the six countries and territories were included in the analysis. The elevated hospitalisation risks for infectious diseases associated with tropical cyclones tended to dissipate 2 months after the tropical cyclone exposure. Overall, each additional tropical cyclone day was associated with a 9% (cumulative relative risk 1·09 [95% CI 1·05–1·14]) increase in hospitalisations for all-cause infectious diseases, 13% (1·13 [1·05–1·21]) for intestinal infectious diseases, 14% (1·14 [1·05–1·23]) for sepsis, and 22% (1·22 [1·03–1·46]) for dengue during the 2 months after a tropical cyclone. Associations of tropical cyclones with hospitalisations for tuberculosis and malaria were not significant. In total, 0·72% (95% CI 0·40–1·01) of the hospitalisations for all-cause infectious diseases, 0·33% (0·15–0·49) for intestinal infectious diseases, 1·31% (0·57–1·95) for sepsis, and 0·63% (0·10–1·04) for dengue were attributable to tropical cyclone exposures. The attributable burdens were higher among young populations (aged ≤19 years) and male individuals compared with their counterparts, especially for intestinal infectious diseases. The heterogeneous spatiotemporal pattern was further revealed at the country and territory level—tropical cyclone-attributable fractions showed a decreasing trend in South Korea during the study period but an increasing trend in Viet Nam, Taiwan, and New Zealand.</p></div><div><h3>Interpretation</h3><p>Tropical cyclones were associated with persistent elevated hospitalisation risks of infectious diseases (particularly sepsis and intestinal i
背景在不断变化的气候中,强热带气旋的比例预计会增加。然而,目前还没有对不同国家和数十年来热带气旋造成的传染病风险进行一致而全面的评估。方法收集了六个国家和地区(加拿大、韩国、新西兰、台湾、泰国和越南)在 2000 年至 2019 年不同时期的传染病住院记录。根据参数风场模型得出的热带气旋相关最大持续风速达到或超过 34 节的日子被视为热带气旋暴露日。首先使用分布式滞后非线性准泊松回归模型在地点水平上检验每月传染病住院人数与热带气旋暴露日的关联,然后使用随机效应荟萃分析进行汇总。总的来说,在六个国家和地区中至少有一个热带气旋暴露日的 179 个地点中,有 200 万至 200 万人因传染病住院。与热带气旋相关的传染病住院风险升高往往会在热带气旋暴露 2 个月后消失。总体而言,在热带气旋发生后的 2 个月内,每增加一个热带气旋日,全因传染病的住院率就会增加 9%(累积相对风险 1-09 [95% CI 1-05-1-14]),肠道传染病的住院率增加 13% (1-13 [1-05-1-21]),败血症的住院率增加 14% (1-14 [1-05-1-23]),登革热的住院率增加 22% (1-22 [1-03-1-46])。热带气旋与肺结核和疟疾住院率的关系并不显著。总的来说,0-72%(95% CI 0-40-1-01)的全因传染病住院病例、0-33%(0-15-0-49)的肠道传染病住院病例、1-31%(0-57-1-95)的败血症住院病例和 0-63%(0-10-1-04)的登革热住院病例可归因于热带气旋。与同龄人相比,年轻人(年龄小于 19 岁)和男性的可归因负担更高,尤其是肠道传染病。在国家和地区层面,异质性时空模式进一步显现--在研究期间,韩国的热带气旋可归因比例呈下降趋势,而越南、台湾和新西兰则呈上升趋势。应根据热带气旋流行病学证据,针对不同人群、地区和传染病病因制定有针对性的干预措施,以应对不断增加的风险和负担。
{"title":"Risks of infectious disease hospitalisations in the aftermath of tropical cyclones: a multi-country time-series study","authors":"Wenzhong Huang MPH ,&nbsp;Thomas Vogt PhD ,&nbsp;Jinah Park MPH ,&nbsp;Zhengyu Yang MPH ,&nbsp;Prof Elizabeth A Ritchie PhD ,&nbsp;Rongbin Xu PhD ,&nbsp;Yiwen Zhang MPH ,&nbsp;Prof Simon Hales PhD ,&nbsp;Wenhua Yu MPH ,&nbsp;Samuel Hundessa PhD ,&nbsp;Christian Otto PhD ,&nbsp;Pei Yu PhD ,&nbsp;Yanming Liu PhD ,&nbsp;Ke Ju MSc ,&nbsp;Prof Eric Lavigne PhD ,&nbsp;Tingting Ye MSc ,&nbsp;Bo Wen MSc ,&nbsp;Yao Wu MSc ,&nbsp;Wissanupong Kliengchuay PhD ,&nbsp;Prof Kraichat Tantrakarnapa PhD ,&nbsp;Prof Yuming Guo PhD","doi":"10.1016/S2542-5196(24)00158-X","DOIUrl":"10.1016/S2542-5196(24)00158-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;The proportion of intense tropical cyclones is expected to increase in a changing climate. However, there is currently no consistent and comprehensive assessment of infectious disease risk following tropical cyclone exposure across countries and over decades. We aimed to explore the tropical cyclone-associated hospitalisation risks and burden for cause-specific infectious diseases on a multi-country scale.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Hospitalisation records for infectious diseases were collected from six countries and territories (Canada, South Korea, New Zealand, Taiwan, Thailand, and Viet Nam) during various periods between 2000 and 2019. The days with tropical cyclone-associated maximum sustained windspeeds of 34 knots or higher derived from a parametric wind field model were considered as tropical cyclone exposure days. The association of monthly infectious diseases hospitalisations and tropical cyclone exposure days was first examined at location level using a distributed lag non-linear quasi-Poisson regression model, and then pooled using a random-effects meta-analysis. The tropical cyclone-attributable number and fraction of infectious disease hospitalisations were also calculated.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;p&gt;Overall, 2·2 million people who were hospitalised for infectious diseases in 179 locations that had at least one tropical cyclone exposure day in the six countries and territories were included in the analysis. The elevated hospitalisation risks for infectious diseases associated with tropical cyclones tended to dissipate 2 months after the tropical cyclone exposure. Overall, each additional tropical cyclone day was associated with a 9% (cumulative relative risk 1·09 [95% CI 1·05–1·14]) increase in hospitalisations for all-cause infectious diseases, 13% (1·13 [1·05–1·21]) for intestinal infectious diseases, 14% (1·14 [1·05–1·23]) for sepsis, and 22% (1·22 [1·03–1·46]) for dengue during the 2 months after a tropical cyclone. Associations of tropical cyclones with hospitalisations for tuberculosis and malaria were not significant. In total, 0·72% (95% CI 0·40–1·01) of the hospitalisations for all-cause infectious diseases, 0·33% (0·15–0·49) for intestinal infectious diseases, 1·31% (0·57–1·95) for sepsis, and 0·63% (0·10–1·04) for dengue were attributable to tropical cyclone exposures. The attributable burdens were higher among young populations (aged ≤19 years) and male individuals compared with their counterparts, especially for intestinal infectious diseases. The heterogeneous spatiotemporal pattern was further revealed at the country and territory level—tropical cyclone-attributable fractions showed a decreasing trend in South Korea during the study period but an increasing trend in Viet Nam, Taiwan, and New Zealand.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;p&gt;Tropical cyclones were associated with persistent elevated hospitalisation risks of infectious diseases (particularly sepsis and intestinal i","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":null,"pages":null},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S254251962400158X/pdfft?md5=c66acccc85e54738fb04f31c3fe34225&pid=1-s2.0-S254251962400158X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond GDP: a review and conceptual framework for measuring sustainable and inclusive wellbeing 超越国内生产总值:衡量可持续和包容性福祉的审查和概念框架
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00147-5
Annegeke Jansen MSc , Ranran Wang PhD , Paul Behrens PhD , Rutger Hoekstra PhD

Policy making has long focused on economic growth as measured by gross domestic product (GDP), diverting attention from sustainable wellbeing for all. Despite high-quality proposals to go beyond GDP, their integration into policy and societal discourse remains limited. A new UN initiative, Valuing What Counts, provides an opportunity for establishing and institutionalising global measurement of metrics beyond GDP, a crucial step to enable a transition into a safe and just space for humanity. Here, we inform this process by consolidating 50 years of literature on Beyond GDP metrics, addressing three core challenges. First, we resolve the lack of interdisciplinary collaboration by integrating five scientific schools of thought in one measurement approach. Second, we alleviate confusion arising from numerous Beyond GDP alternatives, offering a structured analysis of 65 metrics, delineating their measurement objectives. Finally, we bridge the divide between scientific proposals and country-specific approaches. We unite country-specific needs with a standardised and interdisciplinary measurement approach, presenting a dashboard for sustainable and inclusive wellbeing.

长期以来,政策制定一直侧重于以国内生产总值(GDP)衡量的经济增长,从而转移了对全民可持续福祉的关注。尽管提出了超越 GDP 的高质量建议,但将其纳入政策和社会讨论的程度仍然有限。联合国的一项新倡议--"重视有价值的东西"--为建立超越 GDP 的全球衡量标准并使之制度化提供了一个机会,这是使人类过渡到安全和公正空间的关键一步。在此,我们通过整合 50 年来有关超越 GDP 的衡量标准的文献,为这一进程提供信息,并解决三个核心挑战。首先,我们通过将五大科学流派整合为一种衡量方法,解决了缺乏跨学科合作的问题。其次,我们对 65 个衡量标准进行了结构化分析,明确了它们的衡量目标,从而缓解了因众多超越 GDP 的替代方法而产生的混淆。最后,我们弥合了科学建议与国别方法之间的鸿沟。我们将各国的具体需求与标准化的跨学科衡量方法结合起来,为可持续和包容性福祉提供了一个仪表板。
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引用次数: 0
Planetary health learning objectives: foundational knowledge for global health education in an era of climate change 行星健康学习目标:气候变化时代全球健康教育的基础知识
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00167-0
Prof Kathryn H Jacobsen PhD , Prof Caryl E Waggett PhD , Pamela Berenbaum MSc , Brett R Bayles PhD , Gail L Carlson PhD , René English MBchB PhD , Carlos A Faerron Guzmán MD , Meredith L Gartin PhD , Prof Liz Grant PhD , Thomas L Henshaw PhD , Prof Lora L Iannotti PhD , Prof Philip J Landrigan MD , Nina Lansbury PhD , Prof Hao Li PhD , Prof Maureen Y Lichtveld MD , Ketrell L McWhorter PhD , Prof Jessica E Rettig PhD , Cecilia J Sorensen MD , Prof Eric J Wetzel PhD , Dawn Michele Whitehead PhD , Keith Martin MD

Planetary health is an emerging field that emphasises that humans depend on a healthy Earth for survival and, conversely, that the sustainability of Earth systems is dependent on human behaviours. In response to member demands for resources to support teaching and learning related to planetary health, the Consortium of Universities for Global Health (CUGH) convened a working group to develop a set of planetary health learning objectives (PHLOs) that would complement the existing ten CUGH global health learning objectives. The eight PHLOs feature Earth system changes, planetary boundaries, and climate change science; ecological systems and One Health; human health outcomes; risk assessment, vulnerability, and resilience; policy, governance, and laws (including the UN Framework Convention on Climate Change and the Paris Agreement); roles and responsibilities of governments, businesses, civil society organisations, other institutions, communities, and individuals for mitigation, adaptation, conservation, restoration, and sustainability; environmental ethics, human rights, and climate justice; and environmental literacy and communication. Educators who use the PHLOs as a foundation for teaching, curriculum design, and programme development related to the health–environment nexus will equip learners with a knowledge of planetary health science, interventions, and communication that is essential for future global health professionals.

行星健康是一个新兴领域,它强调人类的生存依赖于健康的地球,反之,地球系统的可持续性也依赖于人类的行为。为了满足成员对资源的需求,以支持与行星健康有关的教学,全球健康大学联盟(CUGH)召集了一个工作组,以制定一套行星健康学习目标(PHLOs),作为现有的十个全球健康大学联盟全球健康学习目标的补充。这八个 PHLOs 包括地球系统变化、地球边界和气候变化科学;生态系统和 "一体健康";人类健康成果;风险评估、脆弱性和复原力;政策、治理和法律(包括《联合国气候变化框架公约》和《巴黎协定》);政府、企业、民间社会组织、其他机构、社区和个人在减缓、适应、保护、恢复和可持续性方面的作用和责任;环境伦理、人权和气候正义;以及环境扫盲和交流。教育者如果将 PHLOs 作为与健康与环境关系相关的教学、课程设计和计划开发的基础,就能让学习者掌握行星健康科学、干预和交流方面的知识,这些知识对于未来的全球健康专业人员来说至关重要。
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引用次数: 0
Effects of ambient heat exposure on risk of all-cause mortality in children younger than 5 years in Africa: a pooled time-series analysis 环境热暴露对非洲 5 岁以下儿童全因死亡风险的影响:汇总时间序列分析。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00160-8
Chloe Brimicombe PhD , Katharina Wieser BSc , Tobias Monthaler BSc , Prof Debra Jackson PhD , Jeroen De Bont PhD , Prof Matthew F Chersich PhD , Prof Ilona M Otto PhD

Background

Reducing child mortality is a Sustainable Development Goal, and climate change constitutes numerous challenges for Africa. Previous research has shown an association between leading causes of child mortality and climate change. However, few studies have examined these effects in detail. We aimed to explore the effects of ambient heat on neonate, post-neonate, and child mortality rates.

Methods

For this pooled time-series analysis, health data were obtained from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Health and Demographic Surveillance System. We included data from 29 settlements from 13 countries across Africa, collected via monthly surveys from Jan 1, 1993, to Dec 31, 2016. Climate data were obtained from ERA5, collected from Jan 1, 1991, to Dec 31, 2019. We pooled these data for monthly mean daily maximum wet bulb globe temperature (WBGT) and downscaled to geolocations. Due to data heaping, we pooled our health data on a monthly temporal scale and a spatial scale into six different climate regions (ie, Sahel [ie, Burkina Faso and northern Ghana], Guinea [ie, southern Ghana, Côte d'Ivoire, and Nigeria], Senegal and The Gambia, eastern Africa [ie, Kenya, Malawi, Tanzania, Mozambique, and Uganda], South Africa, and Ethiopia). Our outcomes were neonate (ie, younger than 28 days), post-neonate (ie, aged 28 days to 1 year), and child (ie, older than 1 year and younger than 5 years) mortality. To assess the association between WBGT and monthly all-cause mortality, we used a time-series regression with a quasi-Poisson, polynomial-distributed lag model.

Findings

Between Jan 1, 1993, and Dec 31, 2016, there were 44 909 deaths in children younger than 5 years across the 29 sites in the 13 African countries: 10 078 neonates, 14 141 post-neonates, and 20 690 children. We observed differences in the association of heat with neonate, post-neonate, and child mortality by study region. For example, for Ethiopia, the relative risk ratio of mortality at the 95th percentile compared with median heat exposure during the study period was 1·14 (95% CI 1·06–1·23) for neonates, 0·99 (0·90–1·07) for post-neonates, and 0·79 (0·73–0·87) for children. Across the whole year, there was a significant increase in the relative risk of increased mortality for children in eastern Africa (relative risk 1·27, 95% CI 1·19–1·36) and Senegal and The Gambia (1·11, 1·04–1·18).

Interpretation

Our results show that the influence of extreme heat on mortality risk in children younger than 5 years varies by age group, region, and season. Future research should explore potentially informative ways to measure subtleties of heat stress and the factors contributing to vulnerability.

Funding

EU Horizons as part of the Heat Indicators for Global Health (HIGH) Horizons project.

背景:降低儿童死亡率是一项可持续发展目标,而气候变化给非洲带来了诸多挑战。以往的研究表明,儿童死亡的主要原因与气候变化有关。然而,很少有研究对这些影响进行详细研究。我们旨在探讨环境温度对新生儿、新生儿后期和儿童死亡率的影响:在这项汇总时间序列分析中,健康数据来自国际人口及其健康状况评估网络(INDEPTH)的健康与人口监测系统。我们纳入了来自非洲 13 个国家 29 个定居点的数据,这些数据是通过 1993 年 1 月 1 日至 2016 年 12 月 31 日的月度调查收集的。气候数据来自ERA5,收集时间为1991年1月1日至2019年12月31日。我们汇集了这些数据的月平均日最大湿球温度(WBGT),并对地理位置进行了降尺度处理。由于数据堆积,我们按月时间尺度和空间尺度将健康数据汇集到六个不同的气候区域(即萨赫勒[即布基纳法索和加纳北部]、几内亚[即加纳南部、科特迪瓦和尼日利亚]、塞内加尔和冈比亚、非洲东部[即肯尼亚、马拉维、坦桑尼亚、莫桑比克和乌干达]、南非和埃塞俄比亚)。我们的研究结果是新生儿(即小于 28 天)、新生儿后(即 28 天至 1 岁)和儿童(即 1 岁以上 5 岁以下)死亡率。为了评估 WBGT 与每月全因死亡率之间的关系,我们采用了准泊松、多项式分布滞后模型进行时间序列回归:1993年1月1日至2016年12月31日期间,13个非洲国家的29个地点共有44 909名5岁以下儿童死亡:其中新生儿 10 078 例,新生儿后 14 141 例,儿童 20 690 例。我们观察到,不同研究地区的高温与新生儿、新生儿后期和儿童死亡率的关系存在差异。例如,在埃塞俄比亚,与研究期间的热暴露中位数相比,第 95 百分位数的新生儿死亡率的相对风险比为 1-14 (95% CI 1-06-1-23),新生儿后死亡率的相对风险比为 0-99 (0-90-1-07),儿童死亡率的相对风险比为 0-79 (0-73-0-87)。从全年来看,东非(相对风险 1-27,95% CI 1-19-1-36)、塞内加尔和冈比亚(1-11,1-04-1-18)的儿童死亡率相对风险显著增加:我们的研究结果表明,极端高温对 5 岁以下儿童死亡风险的影响因年龄组、地区和季节而异。未来的研究应探索潜在的信息方法,以测量热应激的微妙性和导致脆弱性的因素:作为全球健康热指标(HIGH)地平线项目一部分的欧盟地平线项目。
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引用次数: 0
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Lancet Planetary Health
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