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Background: The health effects of heat are well documented; however, limited information is available regarding the health risks of hot nights. Hot nights have become more common, increasing at a faster rate than hot days, making it urgent to understand the characteristics of the hot night risk. Objectives: We estimated the effects of hot nights on the cause- and location-specific mortality in a nationwide assessment over 43 y (1973-2015) using a unified analytical framework in the 47 prefectures of Japan. Methods: Hot nights were defined as days with a) minimum temperature [greater than or equal to]25[degrees]C (H[N.sub.25]) and b) minimum temperature [greater than or equal to]95th percentile (H[N.sub.95th]) for the prefecture. We conducted a time-series analysis using a two-stage approach during the hot night occurrence season (April-November). For each prefecture, we estimated associations between hot nights and mortality controlling for potential confounders including daily mean temperature. We then used a random-effects meta-analytic model to estimate the pooled cumulative association. Results: Overall, 24,721,226 deaths were included in this study. Nationally, all-cause mortality increased by 9%- 10% [H[N.sub.25] relative risk (RR) = 1.09, 95% confidence interval (CI): 1.08, 1.10; H[N.sub.95th] RR = 1.10, 95% CI: 1.09, 1.11] during hot nights in comparison with non hot nights. All 11 cause-specific mortalities were strongly associated with hot nights, and the corresponding associations appeared to be acute and lasted a few weeks, depending on the cause of death. The strength of the association between hot nights and mortality varied among prefectures. We found a higher mortality risk from hot nights in early summer in comparison with the late summer in all regions. Conclusions: Our findings support the evidence of mortality impacts from hot nights in excess of that explicable by daily mean temperature and have implications useful for establishing public health policy and research efforts estimating the health effects of climate change. https://doi.org/10.1289/EHP11444, Introduction Due to progressing global warming, the frequency and intensity of extreme heat events have increased, and hot days and nights are expected to be more frequent in the near [...]

The purpose of this study was to investigate five Japanese graduate (master's level) students' experiences in online courses in international development and peace through sport that used English as the medium of instruction. The study was situated in the framework of andragogy theory and used a descriptive-qualitative design using an in-depth, semistructured interview approach using online oral and written interviews. Three emergent themes were established. These recurrent themes were (a) learning online specialized content using English as a second language, (b) students' struggles in group projects through online education, and (c) students' opinions about the improvement of online education. To better support Japanese graduate students' online learning, this study encourages academic departments, administrators, and faculty to better design appropriate courses and online activities. This will contribute to a greater appreciation for the richness of sports development and peace and to increasing the availability of meaningful academic and social experiences for graduate students at Japanese universities. [ABSTRACT FROM AUTHOR]

Background: Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the risks of temperature on external causes of death. Objectives: We investigated the short-term associations between temperature and external causes of death and four specific categories (suicide, transport, falls, and drowning) in 47 prefectures of Japan from 1979 to 2015. Methods: We conducted a two-stage meta-regression analysis. First, we performed time-stratified case-crossover analyses with a distributed lag nonlinear model to examine the association between temperature and mortality due to external causes for each prefecture. We then used a multivariate meta-regression model to combine the association estimates across all prefectures in Japan. In addition, we performed stratified analyses for the associations by sex and age. Results: A total of 2,416,707 external causes of death were included in the study. We found a J-shaped exposure-response curve for all external causes of death, in which the risks increased for mild cold temperatures [20th percentile; relative risk (RR) = 1.09 (95% confidence interval [CI]: 1.05,1.12)] and extreme heat [99th percentile; RR= 1.24 (95% CI: 1.20, 1.29)] compared with those for minimum mortality temperature (MMT). However, the shapes of the exposure-response curves varied according to four subcategories. The risks of suicide and transport monotonically increased as temperature increased, with RRs of 1.35 (95% CI: 1.26, 1.45) and 1.60 (95% CI: 1.35, 1.90), respectively, for heat, whereas J- and U-shaped curves were observed for falls and drowning, with RRs of 1.14 (95% CI: 1.03,1.26) and 1.95 (95% CI: 1.70,2.23) forheatand 1.13 (95% CI: 1.02,1.26) and 2.33 (95% CI: 1.89,2.88) for cold, respectively, compared with those for cause-specific MMTs. The sex- and age-specific associations varied considerably depending on the specific causes. Discussion: Both low and high temperatures may be important drivers of increased risk of external causes of death. We suggest that preventive measures against external causes of death should be considered in adaptation policies. https://doi.org/10.1289/EHP9943, Introduction External causes of death are death caused by acute exposure to physical agents such as mechanical energy, heat, electricity, chemicals, and ionizing radiation and the broad categories include transport, [...]

Air pollution has been a severe issue in China. Exposure to PM2.5 has adverse health effects and causes economic losses. This study investigated the economic impact of exposure to PM2.5 pollution using monthly city-level data covering 88.5 million urban employees in 2016 and 2017. This study mainly focused on three expenditure indicators to measure the economic impact considering lower respiratory infections (LRIs), coronary heart disease (CHD), and stroke. The results show that a 10 µg/m3 increase in PM2.5 would cause total monthly expenses of LRIs, CHD, and stroke to increase by 0.226%, 0.237%, and 0.374%, respectively. We also found that LRI, CHD, and stroke hospital admissions increased significantly by 10%, 8.42%, and 5.64%, respectively. Furthermore, the total hospital stays of LRIs, CHDs, and strokes increased by 2.49%, 2. 51%, and 1.64%, respectively. Our findings also suggest heterogeneous impacts of PM2.5 exposures by sex and across regions, but no statistical evidence shows significant differences between the older and younger adult subgroups. Our results provide several policy implications for reducing unequal public health expenditures in overpolluted countries. [ABSTRACT FROM AUTHOR]

Background: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health effects of mitigation (HEM) actions can help policy makers prioritize investments based not only on mitigation potential but also on expected health benefits. To date, however, the wide range of incompatible approaches taken to developing and reporting HEM estimates has limited their comparability and usefulness to policymakers. Objective: The objective of this effort was to generate guidance for modeling studies on scoping, estimating, and reporting population health effects from climate change mitigation actions. Methods: An expert panel of HEM researchers was recruited to participate in developing guidance for conducting HEM studies. The primary literature and a synthesis of HEM studies were provided to the panel. Panel members then participated in a modified Delphi exercise to identify areas of consensus regarding HEM estimation. Finally, the panel met to review and discuss consensus findings, resolve remaining differences, and generate guidance regarding conducting HEM studies. Results: The panel generated a checklist of recommendations regarding stakeholder engagement: HEM modeling, including model structure, scope and scale, demographics, time horizons, counterfactuals, health response functions, and metrics; parameterization and reporting; approaches to uncertainty and sensitivity analysis; accounting for policy uptake; and discounting. Discussion: This checklist provides guidance for conducting and reporting HEM estimates to make them more comparable and useful for policymakers. Harmonization of HEM estimates has the potential to lead to advances in and improved synthesis of policy-relevant research that can inform evidence-based decision making and practice., Introduction In 2015, 196 countries outlined their Nationally Determined Contributions (NDCs) as part of the 2015 Paris Agreement of the United Nations Framework Convention on Climate Change (UNFCCC), with the [...]

A bicycle-sharing system (BSS) has been implemented in Seoul, South Korea to promote green transportation policy as a Sustainable Development Goal (SDG) to mitigate climate change, reduce traffic jams, and promote physical activity. However, the concentration of air pollutants in Seoul often exceeds the standards of the World Health Organization, thereby creating a conflict with SDG 3 (Health). Therefore, it is important to recognize the trade-offs between actions targeted at SDGs as they might offset each other. In this context, a primary concern is investigating how the behavior of BSS users regarding outdoor air pollution appears. This study explores the relationship between ambient air pollution and the behavior of BSS riders in Seoul. We conducted a time-series analysis of associations between particulate air pollution and participation in the BSS. We used generalized additive models, adjusted for mean temperature, humidity, rainfall, day of the week, long-term trends, and seasonality to construct an exposure–response relationship. We observed a nonlinear relationship between increasing air pollution and bicycle ridership. This study method can be used as a basis for similar analyses to investigate BSS policies in other cities. [ABSTRACT FROM AUTHOR]

Background: There is a growing concern that general anesthesia could increase the risk of dementia. However, the relationship between anesthesia and subsequent dementia is still undetermined.Objective: To determine whether the risk of dementia increases after exposure to general anesthesia.Methods: A population-based prospective cohort study analyzing the Korean National Health Insurance Service-National Sample Cohort database was conducted of all persons aged over 50 years (n = 219,423) from 1 January 2003 and 31 December 2013.Results: 44,956 in the general anesthesia group and 174,469 in the control group were followed for 12 years. The risk of dementia associated with previous exposure to general anesthesia was increased after adjusting for all covariates such as gender, age, health care visit frequency, and co-morbidities (Hazard ratio = 1.285, 95% confidence interval = 1.262-1.384, time-varying Cox hazard model). In addition, the number of anesthetic agents administered, the number of exposures to general anesthesia, the cumulative exposure time, and the organ category involved in surgery were associated with risk of dementia.Conclusion: In light of the increasing societal burden of dementia, careful surveillance for dementia and prevention guidelines for patients after general anesthesia are needed. [ABSTRACT FROM AUTHOR]

Previous epidemiological studies regarding mortality and particulate matter with an aerodynamic diameter of < 10 μm (PM 10 ) have considered only absolute concentrations of PM 10 as a risk factor. However, none have evaluated the durational effect of multi-day periods with high PM 10 concentrations. To evaluate the durational effect (i.e., number of days) of high PM 10 concentrations on mortality, we collected data regarding 3,662,749 deaths from 28 cities in Japan, South Korea, and China (1993–2009). Exposure was defined as consecutive days with daily PM 10 concentrations ≥ 75 μg/m 3 . A Poisson model was used with duration as the variable of interest, while controlling for daily PM 10 concentrations, meteorological variables, seasonal trends, and day of the week. The increase in mortality risk for each additional consecutive day with PM 10 concentrations ≥ 75 μg/m 3 was 0.68% in Japan (95% confidence interval [CI]: 0.35–1.01%), 0.48% in South Korea (95% CI: 0.30–0.66%), and 0.24% in China (95% CI: 0.14–0.33%). The annual average maximum number of consecutive days with high PM 10 in Japan (2.40 days), South Korea (6.96 days), and China (42.26 days) was associated with non-accidental death increases of 1.64% (95% CI: 1.31–1.98%), 3.37% (95% CI: 3.19–3.56%), and 10.43% (95% CI: 10.33–10.54%), respectively. These findings may facilitate the planning of public health interventions to minimize the health burden of air pollution. [ABSTRACT FROM AUTHOR]

The constituents and concentrations of pollutants, individual exposures, and biologic responses to air pollution may vary by season and meteorological conditions. However, evidence regarding seasonality of the acute effects of air pollution on mortality is limited and inconsistent. Herein, we examined seasonal patterns in the short-term associations of particulate matter (PM) smaller than 10 μm (PM 10 ) with daily mortality in 29 cities of three northeast Asian countries. Stratified time-series models were used to determine whether season altered the effect of PM 10 on mortality. This effect was first quantified within each season and at each location using a time-series model, after which city-specific estimates were pooled using a hierarchical Bayesian model. In all data sets, 3,675,348 non-accidental deaths were registered from 1993 to 2009. In Japan, a 10 μg/m 3 increase in PM 10 was significantly associated with increases in non-accidental mortality of 0.44% (95% confidence interval [CI]: 0.03%, 0.8%) in spring and 0.42% (0.02%, 0.82%) in fall. In South Korea, a 10 μg/m 3 increase in PM 10 was significantly associated with increases in non-accidental mortality of 0.51% (0.01%, 1.01%) in summer and 0.45% (0.03%, 0.87%) in fall, in cardiovascular disease mortality of 0.96% (0.29%, 1.63%) in fall, and in respiratory disease mortality of 1.57% (0.40%, 2.75%) in fall. In China, a 10 μg/m 3 increase in PM 10 was associated with increases in non-accidental mortality of 0.33% (0.01%, 0.66%) in summer and 0.41% (0.09%, 0.73%) in winter, in cardiovascular disease mortality of 0.41% (0.08%, 0.74%) in spring and 0.33% (0.02%, 0.64%) in winter, and in respiratory diseases mortality of 0.78% (0.27%, 1.30%) in winter. Our analyses suggest that the acute effect of particulate air pollution could vary seasonally and geographically. [ABSTRACT FROM AUTHOR]

Substantial epidemiologic literature has demonstrated the effects of air pollution and temperature on mortality. However, there is inconsistent evidence regarding the temperature modification effect on acute mortality due to air pollution. Herein, we investigated the effects of temperature on the relationship between air pollution and mortality due to non-accidental, cardiovascular, and respiratory death in seven cities in South Korea. We applied stratified time-series models to the data sets in order to examine whether the effects of particulate matter < 10 μm (PM 10 ) on mortality were modified by temperature. The effect of PM 10 on daily mortality was first quantified within different ranges of temperatures at each location using a time-series model, and then the estimates were pooled through a random-effects meta-analysis using the maximum likelihood method. From all the data sets, 828,787 non-accidental deaths were registered from 2000–2009. The highest overall risk between PM 10 and non-accidental or cardiovascular mortality was observed on extremely hot days (daily mean temperature: > 99th percentile) in individuals aged < 65 years. In those aged ≥ 65 years, the highest overall risk between PM 10 and non-accidental or cardiovascular mortality was observed on very hot days and not on extremely hot days (daily mean temperature: 95–99th percentile). There were strong harmful effects from PM 10 on non-accidental mortality with the highest temperature range (> 99th percentile) in men, with a very high temperature range (95–99th percentile) in women. Our findings showed that temperature can affect the relationship between the PM 10 levels and cause-specific mortality. Moreover, the differences were apparent after considering the age and sex groups. [ABSTRACT FROM AUTHOR]

• Climate mitigation generates co-benefits of air quality and public health. • An interdisciplinary multi-modeling approach was employed. • Health benefits of improved air quality could outweigh mitigation costs in South Korea. Climate change mitigation efforts to reduce greenhouse gas (GHG) emissions have associated costs, but there are also potential benefits from improved air quality, such as public health improvements and the associated cost savings. A multidisciplinary modeling approach can better assess the co-benefits from climate mitigation for human health and provide a justifiable basis for establishment of adequate climate change mitigation policies and public health actions. An integrated research framework was adopted by combining a computable general equilibrium model, an air quality model, and a health impact assessment model, to explore the long-term economic impacts of climate change mitigation in South Korea through 2050. Mitigation costs were further compared with health-related economic benefits under different socioeconomic and climate change mitigation scenarios. Achieving ambitious targets (i.e., stabilization of the radiative forcing level at 3.4 W/m2) would cost 1.3–8.5 billion USD in 2050, depending on varying carbon prices from different integrated assessment models. By contrast, achieving these same targets would reduce costs by 23 billion USD from the valuation of avoided premature mortality, 0.14 billion USD from health expenditures, and 0.38 billion USD from reduced lost work hours, demonstrating that health benefits alone noticeably offset the costs of cutting GHG emissions in South Korea. [ABSTRACT FROM AUTHOR]

Climate change, air pollution, and the rapidly aging population are important public health challenges. An understanding of air pollution impacts is imperative for preventing air-pollution-related deaths and illnesses, particularly in vulnerable subgroups such as the increasing population of older adults. To assess the effects of short-term air-pollution exposure on the elderly, we conducted a time-series analysis (1996–2015) of the associations between particulate matter with an aerodynamic diameter of <10 μm (PM10) and deaths among elderly residents of Seoul, South Korea, which has a rapidly aging population. We also investigated the synergistic effects of temperature and the lag structures of the effects by sex, cause of death, and season. A 10 μg/m3 rise in the 4-day moving average concentration of PM10 was associated with 0.31% (95% confidence interval (CI): 0.18% to 0.44%), 0.32% (95% CI: 0.09% to 0.55%), and 0.22% (95% CI: –0.23% to 0.66%) increases in non-accidental, cardiovascular, and respiratory mortalities, respectively. We found a significant and strong synergistic effect of PM10 concentration and ambient temperature on mortality in elderly people. PM10 posed an increased risk of non-accidental or cardiovascular mortality with increasing temperature, whereas the associated risk of respiratory death was highest on very cold days. The shape and length of the lag structure varied with the cause of death, sex, and season. Results indicate that elderly people exposed to PM10 are at increased risk of premature death. In the near future, these risks are likely to increase in step with the temperature rise associated with climate change and the continued population aging. Stronger emission controls will be needed to minimize the increased health risks associated with air pollution, especially in regions with high populations of elderly individuals. [ABSTRACT FROM AUTHOR]

Air pollution has been recently associated with suicide mortality. However, limited studies have examined possible effect modification of the association by various demographic and socioeconomic factors, despite their crucial roles on suicide risk. In 73,445 completed suicide cases from 26 South Korean cities from 2002 to 2013, we studied the association of suicide risk with exposure to particles <10 μm (PM 10 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), ozone (O 3 ), and carbon monoxide (CO), using a city-specific conditional logistic regression analysis with a case-crossover design. Random effects meta-analysis was used to pool the results. We considered a delayed effect of air pollution by constructing lags of up to 7 days. We explored effect modification by demographic and socioeconomic factors (sex, age, education level, job, and marital status) as well as place of death, method of suicide, and season, through stratified subgroup analyses. Among five pollutants, NO 2 showed the strongest association at immediate lags (percent change in odds ratio; PM 10 : 1.2% [95% CI, 0.2%, 2.3%]; NO 2 : 4.3% [95% CI, 1.9%, 6.7%]; SO 2 : 2.2% [95% CI, 0.7%, 3.8%]; O 3 : 1.5% [95% CI, −0.3%, 3.2%]; and CO: 2.4% [95% CI, 0.9%, 3.8%] per interquartile range increase at lag0). In subgroup analyses by socioeconomic factors, stronger associations were observed in the male sex, the elderly, those with lower education status, white-collar workers, and the married; the largest association was an 11.0% increase (95% CI, 4.1%, 18.4%) by NO 2 among white-collar workers. We add evidence of effect modification of the association between air pollution exposure and suicide risk by various demographic and socioeconomic factors. These findings can serve as the basis for suicide prevention strategies by providing information regarding susceptible subgroups. [ABSTRACT FROM AUTHOR]

Short-term associations between air pollution and mortality have been well reported in Japan, but the historical changes in mortality risk remain unknown. We examined temporal changes in the mortality risks associated with short-term exposure to four criteria air pollutants in selected Japanese cities. We collected daily mortality data for non-accidental causes (n = 5,748,206), cardiovascular (n = 1,938,743) and respiratory diseases (n = 777,266), and air pollutants (sulfur dioxide [SO 2 ], nitrogen dioxide [NO 2 ], suspended particulate matter [SPM], and oxidants [Ox]) in 10 cities from 1977 to 2015. We performed two-stage analysis with 5-year stratification to estimate the relative risk (RR) of mortality per 10-unit increase in the 2-day moving average of air pollutant concentrations. In the first stage, city-specific associations were assessed using a quasi-Poisson generalized linear regression model. In the second stage, city-specific estimates were pooled using a random-effects meta-analysis. Linear trend and ratio of relative risks (RRR) were computed to examine temporal changes. When stratifying the analysis by every 5 years, average concentrations in each sub-period decreased for SO 2 , NO 2 , and SPM (14.2–2.3 ppb, 29.4–17.5 ppb, 52.1–20.6 μg/m3, respectively) but increased for Ox (29.1–39.1 ppb) over the study period. We found evidence of a negative linear trend in the risk of cardiovascular mortality associated with SPM across sub-periods. However, the risks of non-accidental and respiratory mortality per 10-unit increase in SPM concentration were significantly higher in the most recent period than in the earliest period. Other gaseous pollutants did not show such temporal risk change. The risks posed by these pollutants were slightly to moderately heterogeneous in the different cities. The mortality risks associated with short-term exposure to SPM changed, with different trends by cause of death, in 10 cities over 39 years whereas the risks for other gaseous pollutants were relatively stable. [Display omitted] • Daily mortality risk related to air pollution was assessed in 10 Japanese cities. • Concentrations decreased for SO 2 , NO 2 , and SPM, but increased for Ox for 1977–2015. • A downward trend was found for cardiovascular mortality risk associated with SPM. • Non-accidental and respiratory mortality risk with SPM became greater recently. • Other gaseous pollutants indicated either decrease or non-significant risk change. [ABSTRACT FROM AUTHOR]

Background : Relatively little attention has been paid to the potential effects of rising temperatures on changes in human behavior that lead to health and social consequences, including aggression. This study investigated the association between ambient temperature and aggression using assault death data from Seoul, South Korea (1991-2020). Methods : We conducted a time-stratified case-crossover analysis based on conditional logistic regression to control for relevant covariates. The exposure-response curve was explored, and stratified analyses were conducted by season and sociodemographic characteristics. Results : The overall risk of assault deaths significantly increased by 1.4% per 1°C increase in ambient temperature. A positive curvilinear relationship was observed between ambient temperature and assault deaths, which flattened out at 23.6°C during the warm season. Furthermore, risk increases were higher in males, teenagers, and those with the least education. Conclusion : This study highlighted the importance of understanding the impact of rising temperatures on aggression in the context of climate change and public health., (Copyright ©2023, Yale Journal of Biology and Medicine.)

Background/aims: Race and ethnicity are important determinants when estimatingglomerular filtration rate (GFR). The Korean coefficients for the isotope dilution mass spectrometry (IDMS) Modification of Diet in Renal Disease (MDRD) Study equations were developed in 2010. However, the coefficients have not been validated. The aim of this study was to validate the performance of the Korean coefficients for the IDMS MDRD Study equations., Methods: Equation development and validation were performed in separate groups (development group, n = 147 from 2008 to 2009; validation group, n = 125 from 2010 to 2012). We compared the performance of the original IDMS MDRD equations and modified equations with Korean coefficients. Performance was assessed by comparing correlation coefficients, bias, and accuracy between estimated GFR and measured GFR, with systemic inulin clearance using a single injection method., Results: The Korean coefficients for the IDMS MDRD equations developed previously showed good performance in the validation group. The new Korean coefficients for the four- and six-variable IDMS MDRD equations using both the development and validation cohorts were 1.02046 and 0.97300, respectively. No significant difference was detected for the new Korean coefficients, in terms of estimating GFR, between the original and modified IDMS MDRD Study equations., Conclusions: The modified equations with Korean coefficients for the IDMS MDRD Study equations were not superior to the original equations for estimating GFR. Therefore, we recommend using the original IDMS MDRD Study equation without ethnic adjustment in the Korean population.