Catálogo de publicaciones - libros

Climate has become one of the most topical issues over the last two to three decades. It has graduated from the status of obscure scientific debate to that of a global geopolitical issue. Climate itself is a sophisticated concept that is somewhat different to that used or discussed in everyday life. The basic nature of the globe’s climate is regulated by the global energy balance, as are the principal climate mechanisms. These in turn are modulated via the complex nonlinear interactions between the components that comprise the global climate system. These non-linear interactions generate an intense variability in climate that makes detection of small, secular trends in climate very difficult. The increase of carbon dioxide and surface temperatures is now being established as a fact, but the attribution of the temperature increase to carbon dioxide increases is a complex challenge. Due to constraints imposed by the current level of climate modeling technology we cannot perform crucial experiments in climate science. Accordingly we have to rely on a combination of numerical experiments, often with a considerable degree of parameterization of key climate processes and consensus among experts to reach provisional explanations concerning the causes, magnitude and intensity of climate change. Although the scientific research procedure is incremental in nature, the process of data collection, experimentation and verification of modeling outcomes, results in the steady accumulation of knowledge. It is this knowledge on which we rely for drawing conclusions about the state of the globe’s climate and that policy makers use in drawing up recommendations related to mitigation of and adaptation to climatic variability and change.

Extreme weather and climate events have wide ranging impacts on society as well as on biophysical systems. That society, on occasions, is unable to cope with extreme weather and climate events is concerning, especially as increases in the frequency and intensity of certain events are predicted by some global climate change projections. Extreme events come in many different shapes and sizes. The multitude of extreme event types has also led to a proliferation of definitions appropriate for different applications at different times and places.

Conceptually, climate change may lead to an alteration of extreme weather and climate events across Europe. Trends in time series of observed extreme weather and climate indices are suggestive of changes in the climatology of extreme events over Europe. This paper reviews theoretical approaches associated with the scientific assessment of extreme weather events.

It is only during the last five years that Canadian cities have begun to develop formal programs to protect the public’s health from the effects of summertime heat. Toronto’s (Ontario) Hot Weather Response Plan followed recommendations from advisory committees for seniors and for the homeless. The public health department was confronted with a rain-storm on the first day, in 1999, that it issued a heat alert. Toronto has since instituted a two-level alert and emergency response with action levels based on the estimation of mortality impacts through a synoptic model developed at the University of Delaware. Key to the program is media alerts and community partnerships to aid vulnerable people. Montreal’s (Quebec) approach has been to issue public advisories based on real and apparent temperature thresholds elaborated in collaboration with the Canadian Meteorological Service. Montreal has instituted a program of research and action designed to inform the population and to identify and mitigate population vulnerabilities in order to make residents more resistant to the effects on health of heat. Priority areas for health protection include hospitals and nursing homes, few of which are now air-conditioned; rather than retrofit air conditioning, relative air-cooling and air dehumidification have been proposed where feasible. In the community, local health centers target their vulnerable elderly clients requiring follow-up during heat waves based on the identification of factors such as dehydrating medications, social isolation, and lack of access to a nearby cooling room. A heat wave emergency response plan, based on the mobilization and updating of existing programs, is coordinated by civil defense authorities, advised by the city’s public health department.

As stated above, the Classification is designated for the purpose of medical screening and surveillance for the occupational lung diseases. However, the set of classification included in this book will give assistance also in clinical diagnosis of the occupational lung diseases. Wide application of the Classification is expected for further understanding of prevalence, prognosis and complications of the occupational lung diseases.

Recent advances in knowledge about the climate system have increased the ability of meteorologists to forecast extreme weather and climate events, such as floods and heatwaves. Public health agencies and authorities have had limited involvement in the development of early warning systems to take advantage of these forecasts to reduce the burden of disease associated with extreme events. Instead, public health has focused on surveillance and response activities to identify disease outbreaks following an extreme event. Although these systems are critical for detecting and investigating disease outbreaks, they are not designed for identifying and preventing many of the adverse health outcomes associated with extreme events. Designing and implementing effective disease prediction and preventions programs that incorporate advances in weather and climate forecasting have the potential to reduce illness, injury, and death. Critical components of an early warning system include the weather forecast, disease prediction models, and a response plan designed to pro-actively undertake activities to reduce projected adverse health outcomes. Because climate change may increase climate variability, early warning systems can both reduce current vulnerability to extreme events and increase the capacity to cope with a future that may be characterized by more frequent and more intense events.

A special feature of the future climatic change is the climate variability in particular the frequency and intensity of extreme conditions. Cold spells will remanin a problem within Europe even under the circumstances of climatic changes. With Britain’s predicted increase in environmental temperature by 2 °C during the next 50 years, seasonal mortality during the cold months of the year still will present the majority of excess mortality. Epidemiological evidence has indicated a causal relationship between mortality and cold weather. The most important diseases associated with cold-related excess mortality are ischaemic heart disease, cerebro-vascular disease and respiratory disease, especially influenza. Body cooling may offer a better explanation for the cold-related excess mortality than environmental temperature.

The goals of public health activities related to the health impact of cold extremes are to reduce premature deaths, the amount of disease and injuries, disease-produced discomfort, sickness and disability in the population. In order to evaluate the prevention of cold exposure-related excess mortality, we need the collaboration between health care, weather services and other officials to produce usable preventive action models. The definition of public health programmes aimed at preventing cold-related mortality needs further research. The prevention of cold injuries and illnesses is more the responsibility of health care providers and it requires practical information, education and professional support.

This paper discusses human thermoregulation and how this relates to health problems during exposure to climatic stress. The heat exchange of the body with the environment is described in terms of the heat balance equation which determines whether the body heats up, remains at stable temperature, or cools. Inside the body the thermoregulatory control aims at creating the right conditions of heat loss to keep the body temperature stable. In the heat the main effector mechanism for this is sweating. The heat balance is affected by air temperature, radiant temperature, humidity and wind speed as climatic parameters and by activity rate, clothing insulation, and sweat capacity as personal parameters. Heat tolerance is discussed in the light of personal characteristics (age, gender, fitness, acclimatisation, morphology and fat) indicating age and fitness as most important predictors. Heat related mortality and morbidity are strongly linked to age.

An unprecedented heat-wave struck France in early August 2003, associated to high levels of air pollution. The meteorological event was accompanied by an excess of mortality that started early and rose quickly. Between August 1st and 20th, the excess of deaths reached 14,802 cases in comparison to the average daily mortality in the 2000 – 2002 period. It represents +60 % of mortality for all causes. The observed excess of mortality first affected the elderly (+70 % for 75 years-old and more), but was also severe for the 45 – 74 year olds (+30 %). In all age groups, females mortality was 15 to 20 % higher than male. Almost the whole country was affected by the excess-mortality, however its intensity varied significantly from one region to another and was at a maximum in Paris and suburbs (+142 %). The excess mortality clearly increased with the duration of extreme temperatures. With regard to the location, the highest mortality rate affected nursing homes where the number of deaths observed was twice the expected number. Following the descriptive studies carried out immediately after the heat-wave, two case-control surveys were carried out. The first study was conducted to identify individual risk factors (way of life, medical history, self sufficiency) and environmental factors (housing) in elderly people living at home. The second one was conducted to identify individual risk factors (autonomy/handicap, medical condition, drug consumption) and environmental risk factors (number and quality of personnel available; facility size and characteristics; prevention plans and therapeutic protocols) for elderly residing in a nursing home. This survey was made in two parts: a “facility case-control study” and an “individual case-control study”. High levels of photochemical air pollution were associated to the heat-wave. A study was conducted to estimate the fraction attributable to ozone in the excess risks of mortality jointly related to temperature and ozone, and also to identify a decrease of expected mortality in the weeks following the heat-wave. In cities having experienced the highest excess risk of mortality (Paris, Lyon) the contribution of ozone was minor relative to temperature; the relative part of this air pollutant was higher but variable in cities where the excess risk of mortality was low. The study did not show a harvesting effect within the three weeks following the heat-wave. The French Heat-Wave National Plan, developed immediately after the 2003 event, includes a Heat Health Watch Warning System operating from 2004 and covering the whole country.

As stated above, the Classification is designated for the purpose of medical screening and surveillance for the occupational lung diseases. However, the set of classification included in this book will give assistance also in clinical diagnosis of the occupational lung diseases. Wide application of the Classification is expected for further understanding of prevalence, prognosis and complications of the occupational lung diseases.

We investigated the association of weather on daily mortality in Budapest, 1970 – 2000, with special regard to heat waves. Budapest has a continental climate and experiences extreme heat episodes. In the past 30 years, the minimum and maximum daily temperatures in Budapest has significantly increased, as well as daily variability in summer. A 5 °C increase in daily mean temperature above 18 °C increases the risk of total mortality by 10.6 % (95 % CI 9.7, 14.0). The effect of hot weather on cardiovascular mortality is even greater. Six heat episodes were identified from 1993 to 2000 using standardized methods. During each episode, a short term excess in mortality occurred. During the early June heatwave in 2000, excess mortality was greater than 50 % over the three day period. We conclude that temperature, especially heat waves, represent an important environmental burden on mortality in the residents of Budapest. Heat waves that occur early in the summer are particularly dangerous. There is a need to improve public health advice in order to reduce the burden of heat waves on human health in Hungary.