| 31. |
- Guo, Yuming, et al.
(författare)
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Quantifying excess deaths related to heatwaves under climate change scenarios : A multicountry time series modelling study
- 2018
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 15:7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited.METHODS AND FINDINGS: We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections.CONCLUSIONS: This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.
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| 32. |
- Kühnel, Line, et al.
(författare)
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Disease Progression in Multiple System Atrophy—Novel Modeling Framework and Predictive Factors
- 2022
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Ingår i: Movement Disorders. - : Wiley. - 0885-3185 .- 1531-8257. ; 37:8, s. 1719-1727
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiple system atrophy (MSA) is a rare and aggressive neurodegenerative disease that typically leads to death 6 to 10 years after symptom onset. The rapid evolution renders it crucial to understand the general disease progression and factors affecting the disease course. Objectives: The aims of this study were to develop a novel disease-progression model to estimate a population-level MSA progression trajectory and predict patient-specific continuous disease stages describing the degree of progress into the disease. Methods: The disease-progression model estimated a population-level progression trajectory of subscales of the Unified MSA Rating Scale and the Unified Parkinson's Disease Rating Scale using patients in the European MSA natural history study. The predicted disease continuum was validated via multiple analyses based on reported anchor points, and the effect of MSA subtype on the rate of disease progression was evaluated. Results: The predicted disease continuum spanned approximately 6 years, with an estimated average duration of 51 months for a patient with global disability score 0 to reach the highest level of 4. The predicted continuous disease stages were shown to be correlated with time of symptom onset and predictive of survival time. MSA motor subtype was found to significantly affect disease progression, with MSA-parkinsonian (MSA-P) type patients having an accelerated rate of progression. Conclusions: The proposed modeling framework introduces a new method of analyzing and interpreting the progression of MSA. It can provide new insights and opportunities for investigating covariate effects on the rate of progression and provide well-founded predictions of patient-level future progressions.
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| 33. |
- Norén, Erika, et al.
(författare)
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Tidstrender för urinhalter av bekämpningsmedelsrester hos unga män – Resultat från fyra undersökningar mellan 2000 - 2013
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The increased use of synthetic chemicals in society poses possible harmful risks for the environment and human health. There are difficulties in predicting and evaluating consequences and effects of long-time exposure of different chemicals. Biomonitoring is one way to observe the level of exposure in the human population.Agricultural pesticides are a widely used group of chemicals to which we are mainly exposed by occupation or by diet. Long-term exposure to pesticides might have a negative impact on human health, especially in children and foetuses, due to genotoxic, neurotoxic and endocrine disrupting characteristics of many pesticides.This study focuses on the exposure assessment of 14 different metabolites from about 20 pesticides in urinary samples. The pesticides and their biomarkers of exposure included in the analysis were the fungicides thiabendazole (OH-T), pyrimetanil (OH-P), tebuconazole (TEB-OH), mancozeb and several ethylenebisdithiocarbamates (ETU), propineb (PTU), the insecticides chlorpyrifos (TCP), some pyrethroid insecticides, which have the same corresponding biomarkers (3-PBA, DCCA), and some specific pyrethroid biomarkers (4F-3-PBA, CFCA), the herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) and 2-methyl-4-chlorophenoxyacetic acid (MCPA) and the growth regulators chlormequat (CCC) and mepiquat (MQ). The samples were collected years 2000, 2004, 2009 and 2013 from young men in the enrolment for military service in the south of Sweden. The last year of measurement (2013) both young men and women in upper secondary school were included. All samples were analysed in 2016 with liquid chromatography-tandem mass spectrometry (LC/MS/MS). The emphasis of the statistical analysis was temporal trends between the years 2000 and 2013.The highest concentrations were found for TCP and CCC in all samples from all four years. In general, the concentrations were below the levels seen in previous studies of other Swedish populations.The only increasing trend near significance was that for TCP, although the increasing gradient was fairly low ( = 0,28). The concentrations of CCC decreased over the years, but not statistically significantly so. The biomarkers 3-PBA, 2,4-D, DCCA and MQ were detected above the limit of detection (LOD), but in fairly low concentrations in the majority of samples and without significant trends. The remaining residues were mainly below the LOD and could not be further statistically analysed.
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| 34. |
- Norlin, Jenny M., et al.
(författare)
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Clinical Impression of Severity Index for Parkinson's Disease and Its Association to Health-Related Quality of Life
- 2022
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Ingår i: Movement Disorders Clinical Practice. - : John Wiley and Sons Ltd. - 2330-1619.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD) is a simple tool that can easily be used in clinical practice. Few studies have investigated the relationship between health-related quality of life and the CISI-PD. Objective : To analyze the association of CISI-PD scores with those of generic (EQ-5D-5L) and Parkinson's disease (PD) disease-specific (Parkinson's Disease Questionnaire–8 [PDQ-8]) health-related quality of life assessments. Methods : Persons with idiopathic PD in the Swedish Parkinson's Disease registry with simultaneous registrations of CISI-PD and EQ-5D-5L and/or PDQ-8 were included. Correlations with EQ-5D dimensions were analyzed. The relationships between the CISI-PD, EQ-5D-5L, and PDQ-8 were estimated by linear mixed models with random intercept. Results : In the Swedish Parkinson's Disease registry, 3511 registrations, among 2168 persons, fulfilled the inclusion criteria. The dimensions self-care, mobility, and usual activities correlated moderately with the CISI-PD (rs = 0.60, rs = 0.54, rs = 0.57). Weak correlations were found for anxiety/depression and pain/discomfort (rs = 0.39, rs = 0.29) (P values < 0.001). The fitted model included the CISI-PD, age, sex, and time since diagnosis. The CISI-PD had a statistically significant impact on the EQ-5D and PDQ-8 (P values < 0.001). Conclusions : The CISI-PD provides a moderate correlation with the EQ-5D and could possibly be useful as a basis for defining health states in future health economic models and serving as outcomes in managed entry agreements. Nonetheless, the limitation of capturing nonmotor symptoms of the disease remains a shortcoming of clinical instruments, including the CISI-PD.
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| 35. |
- Odhiambo Sewe, Maquins, et al.
(författare)
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Estimated Effect of Temperature on Years of Life Lost : A Retrospective Time-Series Study of Low-, Middle-, and High-Income Regions
- 2018
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Ingår i: Journal of Environmental Health Perspectives. - : Public Health Services, US Dept of Health and Human Services. - 0091-6765 .- 1552-9924. ; 126:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Numerous studies have reported a strong association between temperature and mortality. Additional insights can be gained from investigating the effects of temperature on years of life lost (YLL), considering the life expectancy at the time of death.OBJECTIVES: The goal of this work was to assess the association between temperature and YLL at seven low-, middle-, and high-income sites.METHODS: We obtained meteorological and population data for at least nine years from four Health and Demographic Surveillance Sites in Kenya (western Kenya, Nairobi), Burkina Faso (Nouna), and India (Vadu), as well as data from cities in the United States (Philadelphia, Phoenix) and Sweden (Stockholm). A distributed lag nonlinear model was used to estimate the association of daily maximum temperature and daily YLL, lagged 0-14 d. The reference value was set for each site at the temperature with the lowest YLL.RESULTS: Generally, YLL increased with higher temperature, starting day 0. In Nouna, the hottest location, with a minimum YLL temperature at the first percentile, YLL increased consistently with higher temperatures. In Vadu, YLL increased in association with heat, whereas in Nairobi, YLL increased in association with both low and high temperatures. Associations with cold and heat were evident for Phoenix (stronger for heat), Stockholm, and Philadelphia (both stronger for cold). Patterns of associations with mortality were generally similar to those with YLL.CONCLUSIONS: Both high and low temperatures are associated with YLL in high-, middle-, and low-income countries. Policy guidance and health adaptation measures might be improved with more comprehensive indicators of the health burden of high and low temperatures such as YLL.
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| 36. |
- Orru, Hans, et al.
(författare)
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Increases in external cause mortality due to high and low temperatures : evidence from northeastern Europe
- 2017
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Ingår i: International journal of biometeorology. - : Springer Science and Business Media LLC. - 0020-7128 .- 1432-1254. ; 61:5, s. 963-966
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00-Y99) and maximum temperatures over the period 1997-2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1-3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14-1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03-1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.
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| 37. |
- Oudin Åström, Daniel, et al.
(författare)
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Attributing mortality from extreme temperatures to climate change in Stockholm, Sweden
- 2013
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Ingår i: Nature Climate Change. - : Nature Publishing Group. - 1758-678X .- 1758-6798. ; 3:12, s. 1050-1054
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Tidskriftsartikel (refereegranskat)abstract
- A changing climate is increasing the frequency, intensity, duration and spatial extent of heat waves. These changes are associated with increased human mortality during heat extremes. At the other end of the temperature scale, it has been widely speculated that cold-related mortality could decrease in a warmer world. We aim to answer a key question; the extent to which mortality due to temperature extremes in Stockholm, Sweden during 1980–2009 can be attributed to climate change that has occurred since our reference period (1900–1929). Mortality from heat extremes in 1980–2009 was double what would have occurred without climate change. Although temperature shifted towards warmer temperatures in the winter season, cold extremes occurred more frequently, contributing to a small increase of mortality during the winter months. No evidence was found for adaptation over 1980–2009.
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| 38. |
- Oudin Åström, Daniel, et al.
(författare)
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Evolution of Minimum Mortality Temperature in Stockholm, Sweden, 1901-2009
- 2016
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Ingår i: Journal of Environmental Health Perspectives. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 124:6, s. 740-744
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The mortality impacts of hot and cold temperatures have been thoroughly documented, with most locations reporting a U-shaped relationship with a minimum mortality temperature (MMT) at which mortality is lowest. How MMT may have evolved over past decades as global mean surface temperature increased has not been thoroughly explored.OBJECTIVE: We used observations of daily mean temperatures to investigate whether MMT changed in Stockholm, Sweden, from the beginning of the 20th century until 2009.METHODS: Daily mortality and temperature data for the period 1901-2009 in Stockholm, Sweden were used to model the temperature-mortality relationship. We estimated MMT using distributed lag non-linear Poisson regression models considering lags up to 21 days of daily mean temperature as the exposure variable. To avoid large influences on the MMT from intra and inter annual climatic variability, we estimated MMT based on 30-year periods. Further, we investigated whether there were trends in the absolute value of the MMT and the relative value of the MMT (the corresponding percentile of the same day temperature distribution) over the study period.RESULTS: Our findings suggest that both the absolute MMT and the relative MMT increased in Stockholm, Sweden over the course of the last century.CONCLUSIONS: The increase in MMT over the course of the last century suggests autonomous adaptation within the context of the large epidemiological, demographical and societal changes that occurred. Whether the rate of increase will be sustained with climate change is an open question.
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| 39. |
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| 40. |
- Oudin Åström, Daniel, et al.
(författare)
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Investigating changes in mortality attributable to heat and cold in Stockholm, Sweden
- 2018
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Ingår i: International journal of biometeorology. - : Springer Science and Business Media LLC. - 0020-7128 .- 1432-1254. ; 62:9, s. 1777-1780
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Tidskriftsartikel (refereegranskat)abstract
- Projections of temperature-related mortality rely upon exposure-response relationships using recent data. Analyzing long historical data and trends may extend knowledge of past and present impacts that may provide additional insight and improve future scenarios. We collected daily mean temperatures and daily all-cause mortality for the period 1901-2013 for Stockholm County, Sweden, and calculated the total attributable fraction of mortality due to non-optimal temperatures and quantified the contribution of cold and heat. Total mortality attributable to non-optimal temperatures varied between periods and cold consistently had a larger impact on mortality than heat. Cold-related attributable fraction (AF) remained stable over time whereas heat-related AF decreased. AF on cold days remained stable over time, which may indicate that mortality during colder months may not decline as temperatures increase in the future. More research is needed to enhance estimates of burdens related to cold and heat in the future.
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