Tag: Europe

Categories : Environmental EffectsTags :

Air Conditioning Kept Heat-related Deaths Down in Spain – for Those who Could Afford it

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Photo by Fandy Much

Air conditioning and heating systems have contributed considerably to reducing mortality linked to extreme temperatures in Spain, according to a new observational study. The findings, published in Environment International, provide valuable insights for designing policies to adapt to climate change.

Rising temperatures but lower mortality

Spain, like many parts of the world, has experienced rising temperatures in recent decades, with the average annual mean temperature increasing at an average rate of 0.36°C per decade.

The warming trend is even more pronounced in the summer months (0.40°C per decade). Surprisingly, this increase in temperature has coincided with a progressive reduction in mortality associated with heat.

In addition, cold-related mortality has also decreased.

“Understanding the factors that reduce susceptibility to extreme temperatures is crucial to inform health adaptation policies and to combat the negative effects of climate change,” says first author of the study, Hicham Achebak, researcher at ISGlobal and Inserm (France) and holder of a Marie Sklodowska-Curie Postdoctoral Fellowship from the European Commission.

Effective societal adaptations

In this study led by the Barcelona Institute for Global Health (ISGlobal), Achebak and colleagues analysed the demographic and socioeconomic factors behind the observed reduction in heat and cold-related mortality, despite rising temperatures.

They found that the increase in air conditioning (AC) prevalence in Spain was associated with a reduction in heat-related mortality, while the rise in heating prevalence was associated with a decrease in cold-related mortality.

Specifically, AC was found to be responsible for about 28.6% of the decline in deaths due to heat and 31.5% of the decrease in deaths due to extreme heat between the late 1980s and the early 2010s.

Heating systems contributed significantly, accounting for about 38.3% of the reduction in cold-related deaths and a substantial 50.8% decrease in extreme cold-related fatalities during the same period.

The decrease in mortality due to cold would have been larger had there not been a demographic shift towards a higher proportion of people aged over 65, who are more susceptible to cold temperatures.

The authors conclude that the reduction in heat-related mortality is largely the result of the country’s socioeconomic development over the study period, rather than specific interventions such as heat-wave warning systems.

Four decades of data

For the statistical analysis, the research team collected data on daily mortality (all causes) and weather (temperature and relative humidity) for 48 provinces in mainland Spain and the Balearic Islands, between January 1980 and December 2018.

These data were then linked to 14 indicators of context (demographic and socioeconomic variables such as housing, income and education) for these populations over the same period.

Implications for climate adaptation

The results of the study extend previous findings on heat-related mortality in Spain and underscore the importance of air conditioning and heating as effective adaptation measures to mitigate the effects of heat and cold.

“However, we observed large disparities in the presence of AC across provinces. AC is still unaffordable for many Spanish households,” says Achebak.

The authors also point out that the widespread use of AC could further contribute to global warming depending on the source of electricity generation, which is why other cooling strategies, such as expanding green and blue spaces in cities, are also needed.

“Our findings have important implications for the development of adaptation strategies to climate change. They also inform future projections of the impact of climate change on human health,” concludes Joan Ballester, ISGlobal researcher and study coordinator.

Source: Barcelona Institute for Global Health (ISGlobal)

Categories : Environmental EffectsTags :

Europe’s Heat-related Deaths in 2022 may Exceed 70 000

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Photo by Ketut Subiyanto

The burden of heat-related mortality during the summer of 2022 in Europe may have exceeded 70 000 deaths according to a study led by the Barcelona Institute for Global Health (ISGlobal). The authors of the study, published in The Lancet Regional Health – Europe, revised upwards initial estimates of the mortality associated with record temperatures in 2022 on the European continent.

In an earlier study, the same team used epidemiological models applied to weekly temperature and mortality data in 823 regions in 35 European countries and estimated the number of heat-related premature deaths in 2022 to be 62 862. In that study, the authors acknowledged that the use of weekly data would be expected to underestimate heat-related mortality, and pointed out that daily time-series data are required to accurately estimate the impact of high temperatures on mortality.

The objective of the new study was to develop a theoretical framework that could quantify the errors inherent to aggregated data, such as weekly and monthly temperature and mortality time-series. Models based on temporally aggregated data are useful because the data are available in real-time, allowing analysis of the health hazard within a few days. The researchers aggregated daily temperatures and mortality records from 147 regions in 16 European countries. They then analysed and compared the estimates of heat- and cold-related mortality by different levels of aggregation: daily, weekly, 2-weekly and monthly.

Analysis revealed differences in epidemiological estimates according to the time scale of aggregation. In particular, it was found that weekly, 2-weekly and monthly models underestimated the effects of heat and cold as compared to the daily model, and that the degree of underestimation increased with the length of the aggregation period. Specifically, for the period 1998–2004, the daily model estimated an annual cold and heat-related mortality of 290 104 and 39 434 premature deaths, respectively, while the weekly model underestimated these numbers by 8.56% and 21.56%, respectively.

“It is important to note that the differences were very small during periods of extreme cold and heat, such as the summer of 2003, when the underestimation by the weekly data model was only 4.62%,” explains Joan Ballester Claramunt, the ISGlobal researcher who leads the European Research Council’s EARLY-ADAPT project.

The team used this theoretical framework to revise the mortality burden attributed to the record temperatures experienced in 2022 in their earlier study. According to the calculations made using the new methodological approach, that study underestimated the heat-related mortality by 10.28%, which would mean that the actual heat-related mortality burden in 2022, estimated using the daily data model, was 70,066 deaths, and not 62,862 deaths as originally estimated.

Weekly data to analyse short-term effects of temperatures

“In general, we do not find models based on monthly aggregated data useful for estimating the short-term effects of ambient temperatures,” explains Ballester. “However, models based on weekly data do offer sufficient precision in mortality estimates to be useful in real-time practice in epidemiological surveillance and to inform public policies such as, for example, the activation of emergency plans for reducing the impact of heat waves and cold spells.”

It is an advantage in this area of research to be able to use weekly data since investigators often encounter bureaucratic obstacles that make it difficult or impossible to design large-scale epidemiological studies based on daily data. According to Ballester, when daily data is not available, the use of weekly data, which are easily accessible for Europe in real time, is a solution that can offer “a good approximation of the estimates obtained using the daily data model.”

Source: Barcelona Institute for Global Health (ISGlobal)

Categories : Diseases, Syndromes and ConditionsTags :

An ‘Epidemic’ of Sepsis in Southern Sweden

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Photo by Camilo Jimenez on Unsplash

A research team in Sweden has found that more than 4% of all hospital admissions in southern Sweden, also known as Skåne, are associated with sepsis. The results, published in JAMA Network Open, suggest that is a significantly under-diagnosed condition that can be likened to an epidemic.

In 2016, the researchers conducted an initial study where they revealed that sepsis is much more common than previously believed. The incidence turned out to be 750 adults per 100 000 individuals. In the latest study in the same region, the results showed that more than 4% of all hospitalisations involved the patient suffering from sepsis, and 20% of all sepsis patients died within three months.

“This makes sepsis as common as cancer with similar negative long-term consequences, and as deadly as an acute myocardial infarction. Among sepsis survivors, three-quarters also experience long-term complications such as heart attacks, kidney problems, and cognitive difficulties,” says Adam Linder, sepsis researcher and associate professor at the Departmentof infection medicine at Lund University, as well as a senior physician at Skåne University Hospital.

The European Sepsis Alliance has assigned the researchers with assessing how common sepsis is in the rest of Europe. Given the differing healthcare systems across countries, it wasn’t immediately clear how they should proceed to obtain accurate figures. Consequently, the researchers conducted a pilot study southern Sweden to determine if their methods were applicable to other European hospitals.

“Doctors classify patients using diagnostic codes. Since sepsis is a secondary diagnosis resulting from an infection, the condition is significantly underdiagnosed, as the primary disease often dictates the diagnostic code. This makes it challenging to find a way to accurately determine the number of sepsis cases,” says Lisa Mellhammar, sepsis researcher at Lund University and assistant senior physician at Skåne University Hospital.

The research showed that 7500 patients in southern Sweden were associated with sepsis in 2019, and the incidence increased to 6% during the COVID pandemic. However, even in the absence of COVID, the researchers believe that sepsis should be viewed as an epidemic.

The aim is to use the publication to influence the EU to establish a common surveillance system for sepsis. The team are in contact with authorities and researchers from around thirty European countries and hope that the research project can secure sufficient funding to start soon. There is no indication that the number of sepsis cases would be lower in other parts of Europe than in Sweden. In Swedish hospitals, only two percent of all sepsis patients are antibiotic-resistant, and the researchers speculate that the proportion of resistant cases is higher in many other European countries.

“Although sepsis care has improved in recent years, we need to enhance our diagnostic methods to identify patients earlier and develop alternative treatment methods beyond antibiotics to avoid resistance. Increasing awareness about sepsis among the public and decision-makers is crucial to ensure that resources are allocated appropriately,” concludes Adam Linder.

Source: Lund University

Categories : Diseases, Syndromes and ConditionsTags :

80 Cases of Monkeypox Reported in 12 Countries

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Close-up of monkeypox lesions on the arm and leg of a female child. Credit: Wikimedia Commons

On Friday, May 20, the World Health Organization has reported that there were 80 cases of monkeypox reported in 12 countries, but has not mentioned which countries those are. However, the National Institute for Communicable Diseases has not reported any cases in South Africa, though there has now been a case reported in Australia.

Update: as of 23 May, the NICD has reported that there are 145 cases in 15 countries, but confirms there are no local cases.

Normally endemic to certain countries where it resides in animal reservoirs, monkeypox is rarely encountered in countries outside those regions. The WHO notes that this is “atypical” for the zoonotic orthopoxvirus, which causes smallpox-like symptoms but with a lower mortality. European public health agencies have so far reported that the UK, Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden have seen cases. The first patient in the UK with the virus had returned from a trip to Nigeria, likely catching it there. Cases have been reported in the US and Canada.

The WHO advises that, “As monkeypox spreads through close contact, the response should focus on the people affected and their close contacts. People who closely interact with someone who is infectious are at greater risk for infection: this includes health workers, household members and sexual partners.”

At present, it is unclear why this unusual outbreak is happening now, especially amid the heightened vigilance of the COVID pandemic. One possibility is that some mutation is responsible, though there is little evidence at present to suggest a new variant is responsible.

Another explanation could be that this is simply a matter of the right place and time for the virus. It may also be easier for monkeypox to spread nowadays compared to when there was more widespread use of smallpox vaccine.

Source: BBC News

Categories : COVIDTags :

Netherlands and Ireland Suspend AstraZeneca Vaccine Over Blood Clots

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In the wake of reports from Norway of blood clots in people shortly after receiving the AstraZeneca vaccine, the Netherlands and Ireland have suspended its use.

The Dutch Health ministry on Sunday said that there was still no evidence of a direct link between the vaccine and possible adverse effects from Norway and Denmark, and there were no reported cases in the Netherlands.

“We can’t allow any doubts about the vaccine,” Dutch health minister Hugo de Jonge said. “We have to make sure everything is right, so it is wise to pause for now.”

Earlier on Sunday Ireland’s deputy chief medical officer, Dr Ronan Glynn, said that deployment of the AstraZeneca vaccine, which makes up 20% of the country’s 570 000 doses given so far, should be “temporarily deferred” with immediate effect as recommended by the country’s National Immunisation Advisory Committee (NIAC). However, he emphasised that there was no proof that blood clots had been caused by the vaccine.

The first blood clots were reported in Austria, and prompted a wave of concern, with Denmark suspending the AstraZeneca vaccine, along with the north of Italy. These latest cases in Norway resulted in three hospitalisations and one death.

The Norwegian Medicines Agency said the four people who had the AstraZeneca injection all had reduced numbers of blood platelets. It added: “People under the age of 50 who have received the AstraZeneca vaccine and feel increasingly unwell more than three days after vaccination, and who notice larger or smaller blue spots in the skin (skin haemorrhages) must consult a doctor or out-of-hours medical service as soon as possible.

“Similar incidents have been reported in other European countries, and the European Medicines Agency (EMA) is considering whether there may be an association with the coronavirus vaccines. So far, no conclusion has been reached.”

Professor Karina Butler, head of NIAC, said it was acting out of an abundance of caution but wanted a better understanding of this unanticipated cluster of “very serious” clotting events in younger people.

There were similarities to other cases reported elsewhere in Europe, she added. It was necessary to know “was there a possibility of a relationship with the vaccine, something which was rare but very serious and could have significant outcomes”, she said to Virgin Media News.

The agency did not yet know whether more blood clots were happening than expected in the population generally. “But they do seem to have clustered together at a level and in younger people – I mean less than 65 – where we wouldn’t necessarily have expected them to happen and thus the question was should we just pause until we get that information, because above all we want to maintain confidence in the vaccine programme so that people can feel that what they are getting is safe, that any serious safety signal is being thoroughly investigated,” she said. 

In a statement, Dr Glynn said: “It has not been concluded that there is any link between the Covid-19 vaccine AstraZeneca and these cases. However, acting on the precautionary principle, and pending receipt of further information, the NIAC has recommended the temporary deferral of the Covid-19 vaccine AstraZeneca vaccination programme in Ireland.”

Source: The Guardian