BACKGROUND: Individuals with mental disorders are often susceptible to the effects of extreme ambient temperatures. The aim of this study is to assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders in the Lisbon Metropolitan Area, Portugal. METHODS: To assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders (2008-2014), a quasi-Poisson generalized additive model combined with a distributed lag non-linear model was applied. The model was adjusted for day of the week, air pollution, relative humidity, time and seasonality. RESULTS: The number of hospital admissions for mental disorder during the study period was 30,139. Hospital admissions increase significantly with high temperatures on day of exposure, at lag 0-1 and at lag 0-2. Women are more vulnerable than men, and there was no difference between the age groups studied. CONCLUSIONS: The exposure to high temperatures should be considered a significant risk factor for mental disorders; therefore, patient management services may need to be strengthened when extreme high temperature alerts are given.

OBJECTIVE: The objective of this study was to investigate if high climate temperature could have a negative effect on behavioral and psychological symptoms of dementia (BPSD). DESIGN: We conducted a retrospective study. SETTING AND PATIENTS: Six patients discharged from the

OBJECTIVE: The goal of this study was to identify mental, behavioral, and cognitive disorders that may be triggered or exacerbated during heat waves, predisposing individuals to heat-related morbidity and mortality. DESIGN: Using health outcome data from Adelaide, South Australia, for 1993-2006, we estimated the effect of heat waves on hospital admissions and mortalities attributed to mental, behavioral, and cognitive disorders. We analyzed data using Poisson regression accounting for overdispersion and controlling for season and long-term trend, and we performed threshold analysis using hockey stick regression. RESULTS: Above a threshold of 26.7 degrees C, we observed a positive association between ambient temperature and hospital admissions for mental and behavioral disorders. Compared with non-heat-wave periods, hospital admissions increased by 7.3% during heat waves. Specific illnesses for which admissions increased included organic illnesses, including symptomatic mental disorders; dementia; mood (affective) disorders; neurotic, stress related, and somatoform disorders; disorders of psychological development; and senility. Mortalities attributed to mental and behavioral disorders increased during heat waves in the 65- to 74-year age group and in persons with schizophrenia, schizotypal, and delusional disorders. Dementia deaths increased in those up to 65 years of age. CONCLUSION: Our results suggest that episodes of extreme heat pose a salient risk to the health and well-being of the mentally ill. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: Improvements in the management and care of the mentally ill need to be addressed to avoid an increase in psychiatric morbidity and mortality as heat waves become more frequent.

BACKGROUND: A rarely investigated consequence of heat exposure is renal dysfunction resulting from dehydration and hyperthermia. Our study aims to quantify the relationship between exposure to extreme high temperatures and renal morbidity in South Australia. METHODS: Poisson regression accounting for over dispersion, seasonality and long-term trend was used to estimate the effect of heat waves on hospital admissions for renal disease, acute renal failure and renal dialysis over a 12-year period. Selected comorbidities were investigated as possible contributing risk factors. RESULTS: Admissions for renal disease and acute renal failure were increased during heat waves compared with non-heat wave periods with an incidence rate ratio of 1.100 [95% confidence intervals (CI) 1.003-1.206] and 1.255 (95% CI 1.037-1.519), respectively. Hospitalizations for dialysis showed no corresponding increase. Comorbid diabetes did not increase the risk of renal admission, however 'effects of heat and light' and 'exposure to excessive natural heat' (collectively termed effects of heat) were identified as risk factors. CONCLUSION: Our findings suggest that as heat waves become more frequent, the burden of renal morbidity may increase in susceptible individuals as an indirect consequence of global warming.

OBJECTIVE: The association between high temperature and mental disease has been the focus of several studies worldwide. However, no studies have focused on the mental disease burden attributable to hot temperature. Here, we aim to quantify the risk attributed to hot temperatures based on the exposure-lag-response relationship between temperature and mental diseases. METHOD: From data on daily temperature and emergency admissions (EA) for mental diseases collected from 6 major cities (Seoul, Incheon, Daejeon, Daegu, Busan, and Gwangju in South Korea) over a period of 11years (2003-2013), we estimated temperature-disease associations using a distributed lag non-linear model, and we pooled the data by city through multivariate meta-analysis. Cumulative relative risk and attributable risks were calculated for extreme hot temperatures, defined as the 99th percentile relative to the 50th percentile of temperatures. RESULTS: The strongest association between mental disease and high temperature was seen within a period of 0-4days of high temperature exposure. Our results reveal that 14.6% of EA for mental disease were due to extreme hot temperatures, and the elderly were more susceptible (19.1%). Specific mental diseases, including anxiety, dementia, schizophrenia, and depression, also showed significant risk attributed to hot temperatures. Of all EA for anxiety, 31.6% were attributed to extremely hot temperatures. CONCLUSIONS: High temperature was responsible for an attributable risk for mental disease, and the burden was higher in the elderly. This finding has important implications for designing appropriate public health policies to minimize the impact of high temperature on mental health.

Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as

We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel 0.1-2.7 additional kilometers for a one standard deviation increase in quality. Patients respond to both objective and subjective quality measures, suggesting that patient satisfaction scores may constitute important complements to clinical indicators when choosing provider.

This study examines the impact of ambient temperature on emotional well-being in the U.S. population aged 18+. The U.S. is an interesting test case because of its resources, technology and variation in climate across different areas, which also allows us to examine whether adaptation to different climates could weaken or even eliminate the impact of heat on well-being. Using survey responses from 1.9 million Americans over the period from 2008 to 2013, we estimate the effect of temperature on well-being from exogenous day-to-day temperature variation within respondents' area of residence and test whether this effect varies across areas with different climates. We find that increasing temperatures significantly reduce well-being. Compared to average daily temperatures in the 50-60 degrees F (10-16 degrees C) range, temperatures above 70 degrees F (21 degrees C) reduce positive emotions (e.g. joy, happiness), increase negative emotions (e.g. stress, anger), and increase fatigue (feeling tired, low energy). These effects are particularly strong among less educated and older Americans. However, there is no consistent evidence that heat effects on well-being differ across areas with mild and hot summers, suggesting limited variation in heat adaptation.

Sound mental health-a critical facet of human wellbeing-has the potential to be undermined by climate change. Few large-scale studies have empirically examined this hypothesis. Here, we show that short-term exposure to more extreme weather, multiyear warming, and tropical cyclone exposure each associate with worsened mental health. To do so, we couple meteorological and climatic data with reported mental health difficulties drawn from nearly 2 million randomly sampled US residents between 2002 and 2012. We find that shifting from monthly temperatures between 25 degrees C and 30 degrees C to >30 degrees C increases the probability of mental health difficulties by 0.5% points, that 1 degrees C of 5-year warming associates with a 2% point increase in the prevalence of mental health issues, and that exposure to Hurricane Katrina associates with a 4% point increase in this metric. Our analyses provide added quantitative support for the conclusion that environmental stressors produced by climate change pose threats to human mental health.

Although several empirical studies and systematic reviews have documented the mental health impacts of global climate change, the range of impacts has not been well understood. This review examines mental health impacts of three types of climate-related events: (1) acute events such as hurricanes, floods, and wildfires; (2) subacute or long-term changes such as drought and heat stress; and (3) the existential threat of long-lasting changes, including higher temperatures, rising sea levels and a permanently altered and potentially uninhabitable physical environment. The impacts represent both direct (i.e. heat stress) and indirect (i.e. economic loss, threats to health and well-being, displacement and forced migration, collective violence and civil conflict, and alienation from a degraded environment) consequences of global climate change.

BACKGROUND: Evidence for extreme ambient temperature effects on the risk of mental disorders (MDs) is limited. In this study, we evaluated the short-term effects of daily mean temperature on hospital admissions of MDs in Shanghai, China. METHODS: We obtained daily hospital admission data for MDs, daily meteorological and ambient pollution data in Shanghai from January 2008 to December 2015. Adjusted for time trend, air pollution, relative humidity and other confounders, a quasi-Poisson generalized additive model (GAM) combined with a distributed lag non-linear model (DLNM) was used to analyze the lag-exposure-response relationship between daily mean temperature and hospital admissions for MDs. RESULTS: Total daily hospital admissions for MDs during the study period were 93,971. With a reference of median temperature (18.3 degrees C), there was a significant positive association between the temperature above threshold (24.6 degrees C) and MD hospital admission visits at a lag of 0-1days. The relative risks of extreme hot temperatures (33.1 degrees C, 99% percentile) over the lag 0-1days compared to median temperature were 1.266 (95% confidence intervals: 1.074-1.493). No effect of cold weather on the hospital admissions for MDs was observed. CONCLUSIONS: This study suggests that extreme hot temperature poses significant risks on MD; health counseling and cooling measures should be considered for the susceptible population.

BACKGROUND: Mounting evidence demonstrates the relationship between high temperatures and adverse mental health outcomes. Yet, no study has examined the influence of temperature on crisis support-seeking behavior among youth in large urban areas. METHODS: Crisis Text Line (CTL) is a text messaging service that provides crisis interventions for support-seeking individuals for a range of mental-health outcomes in the United States. We applied a distributed lag non-linear modeling technique to assess the short-term impacts of daily maximum and minimum temperature on crisis-related events in four metropolitan locations in the USA. RESULTS: There were multiple positive associations in three of the four study locations that demonstrate crisis help-seeking behavior increased during anomalously warm conditions. CONCLUSIONS: This study suggests that there is a significant association between high minimum or maximum temperatures and crisis help-seeking behaviors in young adults and adolescents in urban areas in the United States.

Environmental temperature is known to correlate with schizophrenia, but little is known about the association with changes in temperature. This 12-year study aimed to evaluate the relationship between the mean daily range of ambient temperature and schizophrenia admissions in a national cohort of psychiatric inpatients in Taiwan. Meteorological data provided by the Central Weather Bureau of Taiwan were interpolated to create representative estimates. Psychiatric inpatient admissions in all hospitals with medical services enrolled in the current health care insurance system were retrieved from the 1996-2007 Psychiatric Inpatient Medical Claim dataset of the National Health Insurance Research Database. Generalized linear models with Poisson distributions were used to analyze the impact of mean diurnal change of temperature on schizophrenia admissions, controlling for internal correlations and demographic covariates. The daily temperature range varied between 1.7 degrees C and 12.1 degrees C (1st to 99th percentile). The relative risk of schizophrenia admission was significantly increased at a temperature range of 3.2 degrees C (10th percentile), and the maximum was at 12.1 degrees C (99th percentile); however, no such association was found with schizoaffective disorder. When restricted to the capital and largest city, the effects of temperature range were prominent and may correlate with temperature itself. The joint effect of temperature and temperature range was associated with elevated risk, particularly at cooler temperatures. A positive correlation was found between increasing temperature range and schizophrenia admissions. The increase in morbidity at high percentiles suggests that the increasing dynamics of temperature range are a valid reflection of risk, highlighting the need for precautionary action.

(sk) RMSE was 1.5 degrees C, with separate cycling and running giving RMSE of 1.4 degrees C and 1.6 degrees C, respectively, and no significant difference in residuals. Subjects' actual thermal sensation (ATS) votes displayed significant strong rank correlation with budget scores calculated using both measured and predicted (T) over bar (sk) (rs=0.507 and 0.517, respectively, P(sk) and T(c) validations, enables better application to a variety of outdoor spaces. This model can be used in future research studying linkages between thermal discomfort, subsequent decreases in physical activity, and negative health trends.]]>

OBJECTIVE: This study examined whether the number of emergency department visits for

BACKGROUND: Infectious diarrhea (ID) has exerted a severe disease burden on the world. The seasonal ID patterns suggest that meteorological factors (MFs) may influence ID incidence. The aim of this study was to evaluate the effect of MFs on ID, and to provide scientific evidence to the relevant health authorities for disease control and prevention. METHODS: Data from ID cases and daily MFs (including mean temperature, diurnal temperature range, relative humidity, precipitation, atmospheric pressure, and wind velocity) in Guangzhou, Southern China from 2006 to 2017 were collected. Using a distributed lag non-linear model approach, we assessed the relationship between MFs and ID incidence. RESULTS: Compared with the lowest ID risk values, low mean temperature, relative humidity, and precipitation were associated with an increased risk for ID, while higher diurnal temperature range and atmospheric pressure were also associated with increased risk. Maximum atmospheric pressure and minimum relative humidity had larger cumulative effects within 21 lag days, yielding relative risks of 133.11 (95% CI: 61.29-289.09) and 18.17 (14.42-22.89), respectively. The cumulative effect within 21 lag days of minimum temperature was higher than that from maximum temperature in all sub-populations. The cumulative effects of minimum temperature for men, teenagers, and young adults (10-29years) were higher than those for other populations. CONCLUSIONS: MFs should be considered when developing prevention and surveillance programs for ID. Special attention should be paid to vulnerable populations, such as teenagers and young adults.

BACKGROUND: The purpose of this study was to assess the effects of extreme ambient temperature on hospital emergency room visits (ER) related to mental and behavioral illnesses in Toronto, Canada. METHODS: A time series study was conducted using health and climatic data from 2002 to 2010 in Toronto, Canada. Relative risks (RRs) for increases in emergency room (ER) visits were estimated for specific mental and behavioral diseases (MBD) after exposure to hot and cold temperatures while using the 50th percentile of the daily mean temperature as reference. Poisson regression models using a distributed lag non-linear model (DLNM) were used. We adjusted for the effects of seasonality, humidity, day-of-the-week and outdoor air pollutants. RESULTS: We found a strong association between MBD ER visits and mean daily temperature at 28 degrees C. The association was strongest within a period of 0-4 days for exposure to hot temperatures. A 29% (RR=1.29, 95% CI 1.09-1.53) increase in MBD ER vists was observed over a cumulative period of 7 days after exposure to high ambient temperature (99th percentile vs. 50th percentile). Similar associations were reported for schizophrenia, mood, and neurotic disorers. No significant associations with cold temperatures were reported. LIMITATIONS: The ecological nature and the fact that only one city was investigated. CONCLUSIONS: Our findings suggest that extreme temperature poses a risk to the health and wellbeing for individuals with mental and behavior illnesses. Patient management and education may need to be improved as extreme temperatures may become more prevalent with climate change.

Patent data present a number of advantages compared to other alternative measures of innovation. This paper presents research on the use of environmentally relevant technology patent data using a comprehensive analysis method to analyze the development of green technology innovation in China in 1990-2015. From the analysis, it can be concluded that during the period of 2000-2015, China's environmental-related technology innovation made great progress and was at the forefront of green technology growth; in particular, the areas of water and wastewater treatment, solar photovoltaic (PV) energy, lighting, improvements related to bulk or fine chemicals or pharmaceuticals, electric vehicles, and other technologies made great achievements. These technologies are closely related to environmental policies, such as climate change mitigation and green industry transformation, for which China has been advocating for more than a decade. However, after analyzing China's green development, it was found that, although some of the indicators, environmental-related patents, and green developments have made great progress, complete reliance on green technology is far off in the future.

BACKGROUND: Diurnal temperature range (DTR), as an important index of climate change, has been increasingly used to evaluate the impacts of temperature variability on human health. However, little is known about the effects of DTR on schizophrenia. OBJECTIVE: The present study aims to examine the relationship between DTR and schizophrenia admissions, and further, to explore whether the association varied by individual characteristics and study periods. METHODS: A Poisson generalized linear regression combined with distributed lag non-linear model (DLNM) was applied to analyze daily DTR and schizophrenia data from Hefei, China during 2005 to 2014, after adjusting for long-term and seasonal trends, mean temperature, relative humidity and other confounding factors. RESULTS: An acute adverse effect of extremely high DTR on schizophrenia was observed, with a 2.7% (95% CI: 1.007-1.047) increase of daily schizophrenia admissions after exposure to extremely high DTR (95th percentile vs. 50th percentile). The risk for schizophrenia onset due to large DTR exposure increased from the first five years (2005-2009) to the second five years (2010-2014). Additionally, the patient aged 15-29 and 50-64years, male patients, patients born in spring/autumn, and married patients appeared to be more vulnerable to DTR effect. However, there was no significant association between moderately high DTR (75th percentile) and schizophrenia. CONCLUSIONS: This study suggests that extremely high DTR is a potential trigger for schizophrenia admissions in Hefei, China. Our findings may provide valuable information to decisions-makers and guidance to health practitioners.