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BACKGROUND: As the climate changes, it is crucial to focus not only on mitigation measures but also on building climate change resilience by developing efficient adaptation strategies. Although population adaptation is a major determinant of future climate-related health burden, it is not well accounted for in studies that project the health impact of climate change. We propose a methodological framework for temperature-related mortality that incorporates two simultaneous adaptation-sensitivity pathways: the physiological pathway, considering both heat adaptation and cold sensitivity, and the socioeconomic pathway, which is influenced by changes in future adaptive capacities. To demonstrate its utility we apply the framework to a case study mortality time-series dataset from Bavaria, Germany. METHODS: In this modelling framework, we used extrapolated location-specific and age-specific baseline exposure-response functions and propose different future scenarios of cold sensitivity and heat adaptation on the basis of varying slopes of these exposure-response functions. We also incorporated future socioeconomic adaptation in the exposure-response functions using projections of gross domestic product under the respective shared socioeconomic pathways. Future adaptable fractions, representing the deaths avoided under each of the future scenarios, are projected under combinations of two climate change scenarios (shared socioeconomic pathway [SSP]1-2.6 and SSP3-7.0) and the respective plausible population projection scenarios (SSP1 and SSP3), also incorporating the future changes in demographic age structure and mortality. The case study for this framework was done for five districts in Bavaria, for both total non-accidental mortality and cardiovascular disease mortality. The baseline data was obtained for the period 1990-2006, and the future period was defined as 2083-99. FINDINGS: In our Bavaria case study, average temperature was projected to increase by 2099 by an average of 1·1°C under SSP1-2.6 and by 4·1°C under SSP3-7.0. We observed the adaptable fraction to be largely influenced by socioeconomic adaptation for both total mortality and cardiovascular disease mortality, and for both climate change scenarios. For example, for total mortality, the highest adaptable fraction of 18·56% (95% empirical CI 10·77-23·67) was observed under the SSP1-2.6 future scenario, in the presence of socioeconomic adaptation and under the highest heat adaptation (10%) provided the cold sensitivity remains 0%. The cold adaptable fraction is lower than the heat adaptable fraction under all scenarios. In the absence of socioeconomic adaptation, population ageing will lead to higher temperature-related mortality. INTERPRETATION: Our developed framework helps to systematically understand the effectiveness of adaptation mechanisms. In the future, socioeconomic adaptation is estimated to play a major role in determining temperature-related excess mortality. Furthermore, cold sensitivity might outweigh heat adaptation in the majority of locations worldwide. Similarly, population ageing is projected to continue to determine future temperature-related mortality. FUNDING: EU Horizon 2020 (EXHAUSTION).

The report “Effects of Air Temperature Modified by Vulnerability Factors” was prepared as a milestone by researchers in the EU Project EXHAUSTION*. This report summarises the evidence on the interactive effects of high air temperature and various vulnerability factors, including the environmental, socio-economic, and individual behavioral factors on heart- and lung-related deaths and diseases (cardiopulmonary mortality and morbidity) across Europe. The study was conducted at the city, small-area (e.g., municipalities), and individual level. The findings show a greater vulnerability to heat for people living in urban areas with dense population, high air pollution levels, low coverage of green spaces, as well as areas with low Gross Domestic Product. Moreover, people with chronic pre-existing diseases and the elderly were found to be at greater risk. The findings highlight the urgent need to improve the urban environment as well as the health status and living conditions in European cities to contrast the impacts of heat and future climate change. This report alerts stakeholders and policymakers that targeted climate change adaptation measures need to be considered to protect vulnerable population and thereby increase European resilience to climate change.

The report “Effects of air Temperature on Cardiopulmonary Mortality and Morbidity in Europe” was prepared as a milestone of the EU Project EXHAUSTION. It summarizes the evidence on the effects of different levels and changes in ambient air temperature on cardiopulmonary (CPD) mortality and morbidity across Europe and puts a spotlight on the vulnerable and susceptible population. It can help stakeholders and policymakers to plan adaptation measures to protect the vulnerable and susceptible population and increase European resilience towards climate change and extreme weather events.

Background: Complex sexual and reproductive health interventions, such as sexuality education (SE), contain multiple components and activities, which often requires a comprehensive evaluation design and adaptation to a specific context. In this review, we synthetize available scientific literature on types of evaluation designs used for SE programs in low- and lower-middle-income countries. Methods: Two databases yielded 455 publications, from which 20 articles met the inclusion criteria. Narrative synthesis was used to summarize the findings. Evaluation approaches were compared to recommended evaluation frameworks. The quality of articles was assessed by using MMAT 2018. Results: A total of 15 interventions employed in 10 countries were evaluated in the 20 selected articles, with the quality of publications being moderate to high. Randomized controlled trial was the predominant study design, followed by quasi-experimental design. There were seven process evaluation studies, using mixed methods. Main outcomes reported were of public health or behavioral nature—condom use, sexual debut or delay, and number of sexual partners. By comparing evaluation designs to recommended frameworks, few studies fulfilled at least half of the criteria. Conclusions: Evaluations of SE are largely dominated by quantitative (quasi-)experimental designs and use of public health outcomes. To improve understanding of SE program effectiveness, it is important to assess the quality of the program development, its implementation, and its impact, using existing evaluation frameworks and recommendations.

(1) Background: Girls in low- and lower-middle income countries face challenges in menstrual health management (MHM), which impact their health and schooling. This might be exacerbated by refugee conditions. This study aimed at describing menstruation practices and experiences of adolescent girls in Nakivale refugee settlement in Southwestern Uganda. (2) Methods: We conducted a qualitative study from March to May 2018 and we intentionally selected participants to broadly represent different age groups and countries of origin. We conducted 28 semistructured interviews and two focus group discussions. Data were transcribed and translated into English. Analysis included data familiarization, manual coding, generation and refining of themes. (3) Results: Main findings included: (a) challenging social context with negative experiences during migration, family separation and scarcity of resources for livelihood within the settlement, (b) unfavorable menstruation experiences, including unpreparedness for menarche and lack of knowledge, limitations in activity and leisure, pain, school absenteeism and psychosocial effects, (c) menstrual practices, including use of unsuitable alternatives for MHM and poor health-seeking behavior. (4) Conclusions: A multipronged approach to MHM management is crucial, including comprehensive sexual education, enhancement of parent&ndash, adolescent communication, health sector partnership and support from NGOs to meet the tailored needs of adolescent girls.

Abstract The health effects of acute exposure to temperature extremes are established; those of long-term exposure only recently received attention. We performed a systematic review to assess the associations of long-term (>3 months) exposure to higher or lower temperature on total and cardiopulmonary mortality and morbidity, screening 3455 studies and selecting 34. The studies were classified in those observing associations within a population over years with changing annual temperature indices and those comparing areas with a different climate. We also assessed the risk of bias, adapting appropriately an instrument developed by the World Health Organization for air pollution. Studies reported that annual temperature indices for extremes and variability were associated with annual increases in mortality, indicating that effects of temperature extremes cannot be attributed only to short-term mortality displacement. Studies on cardiovascular mortality indicated stronger associations with cold rather than hot temperature, whilst those on respiratory outcomes reported effects of both heat and cold but were few and used diverse health outcomes. Interactions with air pollution were not generally assessed. The few studies investigating effect modification showed stronger effects among the elderly and those socially deprived. Comparisons of health outcome prevalence between areas reported lower blood pressure and a tendency for higher obesity in populations living in warmer climates. Our review indicated interesting associations between long-term exposure to unusual temperature levels in specific areas and differences in health outcomes and cardiovascular risk factors between geographical locations with different climate, but the number of studies by design and health outcome was small. Risk of bias was identified because of the use of crude exposure assessment and inadequate adjustment for confounding. More and better designed studies, including the investigation of effect modifiers, are needed.

Background: Bacillus genus have been found to produce antimicrobial polypeptides that have a remarkable capability to combat the current increasing problem of antibiotic resistance. The aim of this cross sectional study was to determine the proportion and pattern of distribution of antibiotic producing and non-producing species of Bacillus in soil and also to analyse the activity of the antibiotic producers. Methods: A total of 40 soil samples were collected from the wastelands of Kathmandu Valley and 121 isolates were studied from them. They were identified according to Bergey’s Manual. The antibiotic were extracted and the activity was analysed by agar- well diffusion method against the test organisms Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. Result: Bacillus subtilis species were found to be in highest number (17.3%) and Bacillus macerans (0.82%) in lowest number. 18.33% of Bacillus isolates were found to produce antibiotics. The highest number of antibiotic producing isolate was B. subtilis (40.09%) and the least was B. circulans (4.54%). The number of antibiotic producing bacteria were not found to be affected by moisture content of soil and pH change. Among the antibiotic producers, 63.63% produced antibiotic against Gram positive bacteria, 27.27% against Gram negative bacteria and B. alvei (9.09%) had a broad spectrum activity. Some colonies were even found to produce antibiotic with a greater potential than the conventional antibiotics. Conclusion: Based on property of soil, moist-neutral soil had the highest number of bacilli isolates and dry-acidic and moist-alkaline had least number of isolates. DOI: 10.21276/AABS.2017.1316

BACKGROUND: Substantial efforts are required to limit global warming to under 2 °C, with 1.5 °C as the target (Paris Agreement goal). We set out to project future temperature-related myocardial infarction (MI) events in Augsburg, Germany, at increases in warming of 1.5 °C, 2 °C, and 3 °C. METHODS: Using daily time series of MI cases and temperature projections under two climate scenarios, we projected changes in temperature-related MIs at different increases in warming, assuming no changes in population structure or level of adaptation. RESULTS: In a low-emission scenario that limits warming to below 2 °C throughout the 21st century, temperature-related MI cases will decrease slightly by –6 (confidence interval -60; 50) per decade at 1.5 °C of warming. In a high-emission scenario going beyond the Paris Agreement goals, temperature-related MI cases will increase by 18 (-64; 117) and 63 (-83; 257) per decade with warming of 2 °C and 3 °C, respectively. CONCLUSION: The future burden of temperature-related MI events in Augsburg at 2 °C and 3 °C of warming will be greater than at 1.5 °C. Fulfilling the Paris Agreement goal of limiting global warming to no more than 1.5 °C is therefore essential to avoid additional MI events due to climate change.

Tabulated results from the multinomial regression analysis for each of the individual covariates and the corresponding Relative Risk Ratioâ s (RRR), Confidence Intervals (CI) and p-values. (DOCX 16 kb)

Background Substantial efforts are required to limit global warming to under 2 °C, with 1.5 °C as the target (Paris Agreement goal). We set out to project future temperature-related myocardial infarction (MI) events in Augsburg, Germany, at increases in warming of 1.5 °C, 2 °C, and 3 °C. Methods Using daily time series of MI cases and temperature projections under two climate scenarios, we projected changes in temperature-related MIs at different increases in warming, assuming no changes in population structure or level of adaptation. Results In a low-emission scenario that limits warming to below 2 °C throughout the 21st century, temperature-related MI cases will decrease slightly by -6 (confidence interval -60; 50) per decade at 1.5 °C of warming. In a high-emission scenario going beyond the Paris Agreement goals, temperature-related MI cases will increase by 18 (-64; 117) and 63 (-83; 257) per decade with warming of 2 °C and 3 °C, respectively. Conclusion The future burden of temperature-related MI events in Augsburg at 2 °C and 3 °C of warming will be greater than at 1.5 °C. Fulfilling the Paris Agreement goal of limiting global warming to no more than 1.5 °C is therefore essential to avoid additional MI events due to climate change.

Background. Recent studies on temperature-related mortality burden generally found higher cold-related deaths than heat-related deaths. In the future, it is anticipated that global warming will, on one hand result in larger heat-related mortality but on the other hand lead to less cold-related mortality. Thus, it remains unclear whether the net change in temperature-related mortality burden will increase in the future under climate change. Objectives. We aimed to quantify the impact of climate change on heat-, cold-, and the total temperature-related (net change) mortality burden taking into account the future demographic changes across five districts in Bavaria, Germany by the end of the 21st century. Methods. We applied location-specific age-specific exposure-response functions (ERFs) to project the net change in temperature-related mortality burden during the future period 2083–2099 as compared to the baseline period 1990–2006. The projections were under different combinations of five climate change scenarios (assuming a constant climate, Representative Concentration Pathway [RCP] 2.6, RCP4.5, RCP6.0, and RCP8.5) and six population projection scenarios (assuming a constant population, Shared Socio-economic Pathway [SSP] 1, SSP2, SSP3, SSP4, and SSP5). Our projections were under the assumption of a constant vulnerability of the future population. We furthered compared the results with projections using location-specific overall all-age ERFs, i.e. not considering the age-effect and population aging. Results. The net temperature-related mortality for the total population was found to increase significantly under all scenarios of climate and population change with the highest total increments under SSP5-RCP8.5 by 19.61% (95% empirical CI (eCI): 11.78, 30.91). Under the same scenario for age ≥ 75, the increment was by 30.46% (95% eCI: 18.60, 47.74) and for age Conclusion. The elderly population (age ≥ 75), highly vulnerable to both heat and cold, is projected to be about four folds the younger population (age

Adolescent girls and young women are an overlooked group within conflict- or disaster-affected populations, and their sexual and reproductive health (SRH) needs are often neglected. Existing evidence shows that forced migration and human mobility make girls and women more vulnerable to poor SRH outcomes such as high risk sexual behaviors, lack of contraception use, STIs and HIV/AIDS. We performed a systematic literature review to explore knowledge, experiences and access to SRH services in this population group across the African continent. Two databases (PubMed and Web of Science) were searched and from 896 identified publications, 15 peer-reviewed articles published in English met the inclusion criteria for this review. These consisted of eight applied qualitative, five quantitative and two mixed-method study designs. The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT) using scores in percentages (0–100%). Available evidence indicates that knowledge of young women and girls regarding contraceptive methods, STIs and HIV/AIDS are limited. This population group often experiences gender-based and sexual violence and abuse. The access and availability of SRH services are often limited due to distances, costs and stigma. This review demonstrates that there is still a dearth of peer-reviewed literature on SRH related aspects among refugee, migrant and displaced girls and young women in Africa. The data disaggregation by sex and age should be emphasized for future research in this field.

Climate change, foreseen to cause adverse effects on human health, is an emerging global public health threat. Several studies have projected an increasing burden of health effects in the future as a result of global warming. Nevertheless, research in this field is comparatively young and so far there are no concrete answers about the future climate change related health impacts. This article discusses existing research gaps and introduces the EU project EXHAUSTION which aims to fill at least some of them.