@Article{info:doi/10.2196/67128,
author="Portela Dos Santos, Omar
and Alves, Pereira Paulo Jorge
and Verloo, Henk",
title="Exploring Climate Change's Impact on the Cardiopulmonary Health of Adults Living in the Canton of Valais, Switzerland: Protocol for a Development and Usability Pilot Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="25",
volume="14",
pages="e67128",
keywords="climate change",
keywords="global warming",
keywords="emergency department",
keywords="emergency nursing",
keywords="sustainable care",
keywords="ecological medicine",
keywords="cardiopulmonary",
keywords="cardio health",
keywords="Valais",
keywords="Switzerland",
keywords="pilot study",
keywords="study protocol",
keywords="humanity",
keywords="air pollution",
keywords="impact",
keywords="comorbidities",
keywords="adults",
keywords="mixed methods design",
keywords="feasibility",
keywords="health promotion",
keywords="disease prevention",
keywords="acceptability",
abstract="Background: Climate change is affecting public health and well-being. In 2016, Swiss emergency departments (EDs) treated 1,722,000 cases, with 4718 daily admissions. In 2023, the ED of Sion Regional Hospital recorded 75,000 consultations. The links between climate change and health are complex, necessitating urgent research on its impact on cardiopulmonary health in Valais, Switzerland. Raising awareness among frontline professionals is crucial for developing health promotion and disease prevention strategies. Objective: This study explores the preliminary effects of climate change on cardiopulmonary health in Valais and assesses adult patients' knowledge of its health consequences. Findings will inform adaptations in patient care, health promotion, and disease prevention at Sion Hospital's ED. The feasibility of patient selection and data collection will also be evaluated. Methods: Using a convergent, parallel, mixed methods design, data will be collected from September 21, 2024, to September 20, 2025, with a target sample of 60 patients. The quantitative phase will examine patient recruitment feasibility, consultation reasons, and triage levels, correlating them with climate variables (temperature, nitrogen dioxide, particulate matter, sulfur dioxide, and ozone). It will also analyze sociodemographic profiles. The qualitative phase will explore patients' knowledge of climate change and its potential links to their ED visits. The feasibility and acceptability of the study process will be assessed. The protocol follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Extension for Pilot and Feasibility Trials. Results: Data collection started on September 21, 2024, following the approval by the ethical commission. Data collection will take place over 1 year, until September 20, 2025. Conclusions: This study will test the feasibility of a larger investigation and examine potential associations between Valais' changing microclimate and population health. Findings will establish patient profiles and explore their perceptions and knowledge of climate change, informing future health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/67128 ",
doi="10.2196/67128",
url="https://www.researchprotocols.org/2025/1/e67128"
}


@Article{info:doi/10.2196/65228,
author="Isaac, Fadia
and Klein, Britt
and Nguyen, Huy
and Watson, Shaun
and Kennedy, A. Gerard",
title="Digital Cognitive Behavioral Therapy--Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="14",
volume="12",
pages="e65228",
keywords="insomnia",
keywords="nightmares",
keywords="posttraumatic stress disorder",
keywords="PTSD",
keywords="wildfires",
keywords="cognitive behavioral therapy for insomnia",
keywords="CBTi",
keywords="exposure, relaxation, and rescripting therapy",
keywords="ERRT",
keywords="Sleep Best-i",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="computer",
keywords="eHealth",
keywords="bushfires",
abstract="Background: Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. Objective: This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Methods: Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ?8 on the Insomnia Severity Index, a score of ?3 on the Nightmare Disorder Index, or a score of ?31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53\%) or the waitlist control group (n=14, 47\%) in a sequential manner. Participants' ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63\% (19/30) female and 37\% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder--7, the Patient Health Questionnaire--9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Results: Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention's effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition {\texttimes} time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire--9. No changes were detected on the Generalized Anxiety Disorder--7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. Conclusions: The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054 ",
doi="10.2196/65228",
url="https://humanfactors.jmir.org/2025/1/e65228"
}


@Article{info:doi/10.2196/59790,
author="Stachura, Kasia Nicole
and Brar, K. Sukham
and Davidson, Jacob
and Wilson, A. Claire
and Dann, Celia
and Apostol, Mike
and Vecchio, John
and Bilodeau, Shannon
and Gunz, Anna
and Casas-Lopez, Catalina Diana
and Noppens, Ruediger
and Leslie, Ken
and Strychowsky, E. Julie",
title="Exploring the Knowledge, Attitudes, and Perceptions of Hospital Staff and Patients on Environmental Sustainability in the Operating Room: Quality Improvement Survey Study",
journal="JMIR Perioper Med",
year="2024",
month="Nov",
day="28",
volume="7",
pages="e59790",
keywords="environmental sustainability",
keywords="sustainable healthcare",
keywords="operating room",
keywords="hospital",
keywords="recycling",
keywords="climate change",
keywords="global warming",
keywords="staff",
keywords="patient",
keywords="attitude",
keywords="opinion",
keywords="energy consumption",
abstract="Background: In Canada, the health care system has been estimated to generate 33 million metric tons of greenhouse gas emissions annually. Health care systems, specifically operating rooms (ORs), are significant contributors to greenhouse gas emissions, using 3 to 6 times more energy than the hospital's average unit. Objective: This quality improvement study aimed to investigate the knowledge, attitudes, and perceptions of staff members and patients on sustainability in the OR, as well as identify opportunities for initiatives and barriers to implementation. Methods: A total of 2 surveys were developed, consisting of 27 questions for staff members and 22 questions for patients and caregivers. Topics included demographics, knowledge and attitudes regarding environmental sustainability, opportunities for initiatives, and perceived barriers. Multiple-choice, Likert-scale, and open-ended questions were used. Results: A total of 174 staff members and 37 patients participated. The majority (152/174, 88\%) of staff members had received no and minimal training on sustainability, while 93\% (162/174) cited practicing sustainability at work as moderately to extremely important. Among patients and caregivers, 54\% (20/37) often or always noticed when a hospital is being eco-friendly. Both staff members and patients agreed that improving sustainability would boost satisfaction (125/174, 71.8\% and 22/37, 59.4\%, respectively) and hospital reputation (22/37, 59.4\% and 25/37, 69.5\%, respectively). The staff members' highest-rated environmental initiatives included transitioning to reusables, education, and improved energy consumption, while patients prioritized increased nature, improved food sourcing, and education. Perceived barriers to these initiatives included cost, lack of education, and lack of incentives. Conclusions: Staff members and patients and caregivers in a large academic health care center acknowledge the significance of environmental sustainability in the OR. While they do not perceive a direct impact on patient care, they anticipate positive effects on satisfaction and hospital reputation. Aligning initiatives with staff members and patient and caregiver preferences can help drive meaningful change within the OR and beyond. ",
doi="10.2196/59790",
url="https://periop.jmir.org/2024/1/e59790"
}


@Article{info:doi/10.2196/58711,
author="Jordan, Arne
and Nothacker, Julia
and Paucke, Valentina
and Hager, Heinz Klaus
and Hueber, Susann
and Karimzadeh, Arian
and K{\"o}tter, Thomas
and L{\"o}ffler, Christin
and M{\"u}ller, Sigrid Beate
and Tajdar, Daniel
and L{\"u}hmann, Dagmar
and Scherer, Martin
and Sch{\"a}fer, Ingmar",
title="Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="4",
volume="10",
pages="e58711",
keywords="climate change",
keywords="online survey",
keywords="open internet data",
keywords="climate",
keywords="environment",
keywords="rising temperature",
keywords="heatexposure",
keywords="chronic disease management",
keywords="epidemiology",
abstract="Background: As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients' issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. Objective: This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. Methods: We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Results: Of the 291 eligible patients, 61 (21.0\%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51\%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38\%) and diabetes mellitus (n=20, 33\%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9\%) and shortness of breath (142/294 observations, 48.3\%). Compared with temperatures of 27{\textdegree}C or lower, a heat index between over 27{\textdegree}C and 32{\textdegree}C ($\beta$=1.02, 95\% CI 0.08-1.96, P=.03) and over 32{\textdegree}C ($\beta$=1.35, 95\% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy ($\beta$=--0.25, 95\% CI --0.49 to --0.01, P=.04) and better self-reported protective behavior ($\beta$=0.65, 95\% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy ($\beta$=--0.39, 95\% CI --0.54 to --0.23, P<.001) and higher somatosensory amplification ($\beta$=0.18, 95\% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Conclusions: Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. Trial Registration: ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163 ",
doi="10.2196/58711",
url="https://publichealth.jmir.org/2024/1/e58711"
}


@Article{info:doi/10.2196/57948,
author="Yang, Hsiao-Yu
and Wu, Chang-Fu
and Tsai, Kun-Hsien",
title="Projections of Climate Change Impact on Acute Heat Illnesses in Taiwan: Case-Crossover Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="16",
volume="10",
pages="e57948",
keywords="climate change",
keywords="global warming",
keywords="heat-related illness",
keywords="carbon reduction",
keywords="heat",
keywords="heat illness",
keywords="extreme heat",
keywords="Taiwan",
keywords="real time",
keywords="epidemic",
keywords="surveillance",
keywords="public health",
keywords="emergency department",
keywords="early warning system",
keywords="nonlinear model",
keywords="temperature",
keywords="socioeconomic",
keywords="environmental health",
keywords="heat stress",
keywords="environmental",
keywords="epidemiology",
abstract="Background: With global warming, the number of days with extreme heat is expected to increase and may cause more acute heat illnesses. While decreasing emissions may mitigate the climate impacts, its effectiveness in reducing acute heat illnesses remains uncertain. Taiwan has established a real-time epidemic surveillance and early warning system to monitor acute heat illnesses since January 1, 2011. Predicting the number of acute heat illnesses requires forecasting temperature changes that are influenced by adaptation policies. Objective: The aim of this study was to estimate the changes in the number of acute heat illnesses under different adaptation policies. Methods: We obtained the numbers of acute heat illnesses in Taiwan from January 2011 to July 2023 using emergency department visit data from the real-time epidemic surveillance and early warning system. We used segmented linear regression to identify the join point as a nonoptimal temperature threshold. We projected the temperature distribution and excess acute heat illnesses through the end of the century when Taiwan adopts the ``Sustainability (shared socioeconomic pathways 1?2.6 [SSP1-2.6]),'' ``Middle of the road (SSP2-4.5),'' ``Regional rivalry (SSP3-7.0),'' and ``Fossil-fueled development (SSP5-8.5)'' scenarios. Distributed lag nonlinear models were used to analyze the attributable number (AN) and attributable fraction (AF) of acute heat illnesses caused by nonoptimal temperature. Results: We enrolled a total of 28,661 patients with a mean age of 44.5 (SD 15.3) years up to July 2023, of whom 21,619 (75.4\%) were male patients. The nonoptimal temperature was 27 {\textdegree}C. The relative risk of acute heat illnesses with a 1-degree increase in mean temperature was 1.71 (95\% CI 1.63-1.79). In the SSP5-8.5 worst-case scenario, the mean temperature was projected to rise by +5.8 {\textdegree}C (SD 0.26), with the AN and AF of acute heat illnesses above nonoptimal temperature being 19,021 (95\% CI 2249?35,792) and 89.9\% (95\% CI 89.3\%?90.5\%) by 2090?2099. However, if Taiwan adopts the Sustainability SSP1-2.6 scenario, the AN and AF of acute heat illnesses due to nonoptimal temperature will be reduced to 12,468 (95\% CI 3233?21,704) and 62.1\% (95\% CI 61.2?63.1). Conclusions: Adopting sustainable development policies can help mitigate the risk of acute heat illnesses caused by global warming. ",
doi="10.2196/57948",
url="https://publichealth.jmir.org/2024/1/e57948"
}


@Article{info:doi/10.2196/60147,
author="Polivka, Barbara
and Krueger, Kathryn
and Bimbi, Olivia
and Huntington-Moskos, Luz
and Nyenhuis, Sharmilee
and Cramer, Emily
and Eldeirawi, Kamal",
title="Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="10",
volume="8",
pages="e60147",
keywords="indoor air quality",
keywords="asthma",
keywords="real-time assessment",
keywords="EMA",
keywords="ecological momentary assessment",
keywords="mobile phone",
keywords="monitoring",
keywords="air quality",
keywords="real time",
keywords="spirometry",
keywords="acceptability",
keywords="usability",
keywords="residential toxins",
keywords="volatile organic compounds",
keywords="VOC",
keywords="adult",
keywords="female",
keywords="women",
keywords="college student",
abstract="Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90\%), White (n=26, 67\%), college graduates (n=25, 66\%), and residing in a single-family home (n=30, 75\%). Most indicated that the air quality monitor (n=23, 58\%), the EMA (n=20, 50\%), and the spirometer (n=17, 43\%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. ",
doi="10.2196/60147",
url="https://formative.jmir.org/2024/1/e60147"
}


@Article{info:doi/10.2196/54687,
author="Iyengar, Sriram M.
and Block Ngaybe, G. Maiya
and Gonzalez, Myla
and Arora, Mona",
title="Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="12",
volume="13",
pages="e54687",
keywords="health informatics",
keywords="data science",
keywords="climate change",
keywords="pandemics",
keywords="COVID-19",
keywords="migrations",
keywords="mobile phone",
doi="10.2196/54687",
url="https://www.i-jmr.org/2024/1/e54687",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133540"
}


@Article{info:doi/10.2196/51883,
author="Chen, Yang
and Zhou, Lidan
and Zha, Yuanyi
and Wang, Yujin
and Wang, Kai
and Lu, Lvliang
and Guo, Pi
and Zhang, Qingying",
title="Impact of Ambient Temperature on Mortality Burden and Spatial Heterogeneity in 16 Prefecture-Level Cities of a Low-Latitude Plateau Area in Yunnan Province: Time-Series Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="23",
volume="10",
pages="e51883",
keywords="mortality burden",
keywords="nonaccidental deaths",
keywords="multivariate meta-analysis",
keywords="distributed lagged nonlinear mode",
keywords="attributable risk",
keywords="climate change",
keywords="human health",
keywords="association",
keywords="temperature",
keywords="mortality",
keywords="nonaccidental death",
keywords="spatial heterogeneity",
keywords="meteorological data",
keywords="temperature esposure",
keywords="heterogeneous",
keywords="spatial planning",
keywords="environmental temperature",
keywords="prefecture-level",
keywords="resource allocation",
abstract="Background: The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography. Objectives: This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions. Methods: We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors. Results: The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0?21 days on YLL for nonaccidental deaths were 403.16 (95\% empirical confidence interval [eCI] 148.14?615.18) and 247.83 (95\% eCI 45.73?418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45\% (95\% eCI 3.73\%?10.38\%). Cold temperature was responsible for most of the mortality burden (4.61\%, 95\% eCI 1.70?7.04), whereas the burden due to heat was 2.84\% (95\% eCI 0.58?4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (\%) for mean temperature was 13.97\% (95\% eCI 6.70?14.02) for heart disease, 11.12\% (95\% eCI 2.52?16.82) for respiratory disease, 10.85\% (95\% eCI 6.70?14.02) for cardiovascular disease, and 10.13\% (95\% eCI 6.03?13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71\% vs 4.54\%). Furthermore, we found 48.2\% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7\%) among urban characteristics. Conclusions: This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention. ",
doi="10.2196/51883",
url="https://publichealth.jmir.org/2024/1/e51883"
}


@Article{info:doi/10.2196/54064,
author="Bhawra, Jasmin
and Elsahli, Nadine
and Patel, Jamin",
title="Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="23",
volume="10",
pages="e54064",
keywords="climate change",
keywords="digital health",
keywords="ecoanxiety",
keywords="environmental hazards",
keywords="food security",
keywords="mental health",
keywords="scoping review",
keywords="smartphone apps",
keywords="digital apps",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people's way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. Objective: This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. Methods: A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. Results: From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50\%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50\%) assessed climate change--related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36\%), knowledge databases (n=5, 36\%), data collection and analysis (n=3, 21\%), gamification (n=1, 7\%), and educational resources (n=2, 14\%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7\%), collaborative (n=1, 7\%), and cocreative (n=1, 7\%) approaches, to ensure the relevance and use of digital apps. Conclusions: Most digital apps identified provided a service to citizens to either prevent adverse climate change--related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions. ",
doi="10.2196/54064",
url="https://publichealth.jmir.org/2024/1/e54064"
}


@Article{info:doi/10.2196/54669,
author="Matzke, Ina
and Huhn, Sophie
and Koch, Mara
and Maggioni, Anna Martina
and Munga, Stephen
and Muma, Okoth Julius
and Odhiambo, Ochieng Collins
and Kwaro, Daniel
and Obor, David
and B{\"a}rnighausen, Till
and Dambach, Peter
and Barteit, Sandra",
title="Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="4",
volume="12",
pages="e54669",
keywords="wearables",
keywords="wearable",
keywords="tracker",
keywords="trackers",
keywords="climate",
keywords="Africa",
keywords="environment",
keywords="environmental",
keywords="heat",
keywords="weather",
keywords="exposure",
keywords="temperature",
keywords="rural",
keywords="fitness trackers",
keywords="climate change",
keywords="health",
keywords="sub-Saharan Africa",
keywords="Kenya",
keywords="outcome",
keywords="outcomes",
abstract="Background: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. Objective: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. Methods: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. Results: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1\%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8\%) out of 204 days. Despite 10 (21\%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6\%, SD 21.3\% and mean 86.1\%, SD 18.9\%, respectively), but low for heart rate (mean 7\%, SD 14\%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2\% (SD 24.5\%) completeness. Conclusions: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change. ",
doi="10.2196/54669",
url="https://mhealth.jmir.org/2024/1/e54669",
url="http://www.ncbi.nlm.nih.gov/pubmed/38963698"
}


@Article{info:doi/10.2196/52221,
author="Luo, Yizhe
and Zhang, Longyao
and Xu, Yameng
and Kuai, Qiyuan
and Li, Wenhao
and Wu, Yifan
and Liu, Licheng
and Ren, Jiarong
and Zhang, Lingling
and Shi, Qiufang
and Liu, Xiaobo
and Tan, Weilong",
title="Epidemic Characteristics and Meteorological Risk Factors of Hemorrhagic Fever With Renal Syndrome in 151 Cities in China From 2015 to 2021: Retrospective Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="5",
volume="10",
pages="e52221",
keywords="China",
keywords="hemorrhagic fever with renal syndrome",
keywords="HFRS",
keywords="climate change",
keywords="meteorological factors",
keywords="distributed lag nonlinear model",
abstract="Background: Hemorrhagic fever with renal syndrome (HFRS) continues to pose a significant public health threat to the population in China. Previous epidemiological evidence indicates that HFRS is climate sensitive and influenced by meteorological factors. However, past studies either focused on too-narrow geographical regions or investigated time periods that were too early. There is an urgent need for a comprehensive analysis to interpret the epidemiological patterns of meteorological factors affecting the incidence of HFRS across diverse climate zones. Objective: In this study, we aimed to describe the overall epidemic characteristics of HFRS and explore the linkage between monthly HFRS cases and meteorological factors at different climate levels in China. Methods: The reported HFRS cases and meteorological data were collected from 151 cities in China during the period from 2015 to 2021. We conducted a 3-stage analysis, adopting a distributed lag nonlinear model and a generalized additive model to estimate the interactions and marginal effects of meteorological factors on HFRS. Results: This study included a total of 63,180 cases of HFRS; the epidemic trends showed seasonal fluctuations, with patterns varying across different climate zones. Temperature had the greatest impact on the incidence of HFRS, with the maximum hysteresis effects being at 1 month (--19 {\textordmasculine}C; relative risk [RR] 1.64, 95\% CI 1.24-2.15) in the midtemperate zone, 0 months (28 {\textordmasculine}C; RR 3.15, 95\% CI 2.13-4.65) in the warm-temperate zone, and 0 months (4 {\textordmasculine}C; RR 1.72, 95\% CI 1.31-2.25) in the subtropical zone. Interactions were discovered between the average temperature, relative humidity, and precipitation in different temperature zones. Moreover, the influence of precipitation and relative humidity on the incidence of HFRS had different characteristics under different temperature layers. The hysteresis effect of meteorological factors did not end after an epidemic season, but gradually weakened in the following 1 or 2 seasons. Conclusions: Weather variability, especially low temperature, plays an important role in epidemics of HFRS in China. A long hysteresis effect indicates the necessity of continuous intervention following an HFRS epidemic. This finding can help public health departments guide the prevention and control of HFRS and develop strategies to cope with the impacts of climate change in specific regions. ",
doi="10.2196/52221",
url="https://publichealth.jmir.org/2024/1/e52221",
url="http://www.ncbi.nlm.nih.gov/pubmed/38837197"
}


@Article{info:doi/10.2196/53437,
author="Cummins, R. Mollie
and Shishupal, Sukrut
and Wong, Bob
and Wan, Neng
and Han, Jiuying
and Johnny, D. Jace
and Mhatre-Owens, Amy
and Gouripeddi, Ramkiran
and Ivanova, Julia
and Ong, Triton
and Soni, Hiral
and Barrera, Janelle
and Wilczewski, Hattie
and Welch, M. Brandon
and Bunnell, E. Brian",
title="Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="15",
volume="26",
pages="e53437",
keywords="air pollution",
keywords="environmental health",
keywords="telemedicine",
keywords="greenhouse gases",
keywords="clinical research informatics",
keywords="informatics",
keywords="data science",
keywords="telehealth",
keywords="eHealth",
keywords="travel",
keywords="air quality",
keywords="pollutant",
keywords="pollution",
keywords="polluted",
keywords="environment",
keywords="environmental",
keywords="greenhouse gas",
keywords="emissions",
keywords="retrospective",
keywords="observational",
keywords="United States",
keywords="USA",
keywords="North America",
keywords="North American",
keywords="cost",
keywords="costs",
keywords="economic",
keywords="economics",
keywords="saving",
keywords="savings",
keywords="finance",
keywords="financial",
keywords="finances",
keywords="CO2",
keywords="carbon dioxide",
keywords="carbon footprint",
abstract="Background: Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. Objective: This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. Methods: We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. Results: The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. Conclusions: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint. ",
doi="10.2196/53437",
url="https://www.jmir.org/2024/1/e53437",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536065"
}


@Article{info:doi/10.2196/56138,
author="Tourrette, C{\'e}dric
and Tostain, Jean-Baptiste
and Kozub, Eva
and Badreddine, Maha
and James, Julia
and Noraz, Aurore
and De Choudens, Charlotte
and Moulis, Lionel
and Duflos, Claire
and Carbonnel, Francois",
title="An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="14",
volume="8",
pages="e56138",
keywords="planetary health",
keywords="One Health",
keywords="medical education",
keywords="environmental health",
keywords="education",
keywords="e-learning",
keywords="general practitioner",
keywords="pilot study",
keywords="climate change",
keywords="training",
keywords="environmental",
keywords="e-learning module",
keywords="behavior change",
keywords="ecosystem",
keywords="questionnaire",
keywords="behavior",
keywords="self-assessment",
keywords="e-learning intervention",
keywords="environment",
abstract="Background: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ?65 years will increase by 1540\%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23\% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-N{\^i}mes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. Objective: The objective of this study was to assess the impact of the e-learning module on participants' knowledge and behavior change. Methods: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. Results: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55\%). The mean scores for participants' pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). Conclusions: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice. ",
doi="10.2196/56138",
url="https://formative.jmir.org/2024/1/e56138",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743463"
}


@Article{info:doi/10.2196/49929,
author="Ezeonu, Alexandra Nwamaka
and Hertelendy, J. Attila
and Adu, Kofi Medard
and Kung, Y. Janice
and Itanyi, Uchenna Ijeoma
and Dias, Luz Raquel da
and Agyapong, Belinda
and Hertelendy, Petra
and Ohanyido, Francis
and Agyapong, Opoku Vincent Israel
and Eboreime, Ejemai",
title="Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="17",
volume="26",
pages="e49929",
keywords="mental health",
keywords="disasters",
keywords="mobile health",
keywords="mHealth",
keywords="application",
keywords="applications",
keywords="app",
keywords="apps",
keywords="smartphone",
keywords="stress",
keywords="psychological",
keywords="traumatic",
keywords="disaster",
keywords="hazard",
keywords="hazards",
keywords="emergency",
keywords="psychological trauma",
keywords="mobile apps",
keywords="trauma",
keywords="scoping",
keywords="review methods",
keywords="review methodology",
keywords="mobile phone",
abstract="Background: Disasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management. Objective: This scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature. Methods: We identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: Of the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps' use as either the primary or secondary outcome. Conclusions: A limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards. ",
doi="10.2196/49929",
url="https://www.jmir.org/2024/1/e49929",
url="http://www.ncbi.nlm.nih.gov/pubmed/38520699"
}


@Article{info:doi/10.2196/46980,
author="Koch, Mara
and Matzke, Ina
and Huhn, Sophie
and Si{\'e}, Ali
and Boudo, Valentin
and Compaor{\'e}, Guillaume
and Maggioni, Anna Martina
and Bunker, Aditi
and B{\"a}rnighausen, Till
and Dambach, Peter
and Barteit, Sandra",
title="Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Nov",
day="8",
volume="11",
pages="e46980",
keywords="wearable",
keywords="consumer-grade wearable",
keywords="sleep",
keywords="activity",
keywords="heart rate",
keywords="climate change",
keywords="heat",
keywords="rain",
keywords="weather",
keywords="sub-Saharan Africa",
keywords="global health",
keywords="public health",
keywords="mobile phone",
abstract="Background: Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. Objective: The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. Methods: Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. Results: Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ?25 {\textdegree}C. Many participants (55/137, 40.1\%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1\%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 {\textdegree}C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 {\textdegree}C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. Conclusions: During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities. ",
doi="10.2196/46980",
url="https://mhealth.jmir.org/2023/1/e46980",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938879"
}


@Article{info:doi/10.2196/43712,
author="Ab Kadir, Akram Muhammad
and Abdul Manaf, Rosliza
and Mokhtar, Aisah Siti
and Ismail, Idzhar Luthffi",
title="Spatio-Temporal Analysis of Leptospirosis Hotspot Areas and Its Association With Hydroclimatic Factors in Selangor, Malaysia: Protocol for an Ecological Cross-sectional Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="15",
volume="12",
pages="e43712",
keywords="leptospirosis",
keywords="hotspot areas",
keywords="hydroclimatic factors",
keywords="Selangor",
keywords="geographical information system",
keywords="GIS",
keywords="predictive model",
abstract="Background: Leptospirosis is considered a neglected zoonotic disease in temperate regions but an endemic disease in countries with tropical climates such as South America, Southern Asia, and Southeast Asia. There has been an increase in leptospirosis incidence in Malaysia from 1.45 to 25.94 cases per 100,000 population between 2005 and 2014. With increasing incidence in Selangor, Malaysia, and frequent climate change dynamics, a study on the disease hotspot areas and their association with the hydroclimatic factors would further enhance disease surveillance and public health interventions. Objective: This study aims to examine the association between the spatio-temporal distribution of leptospirosis hotspot areas from 2011 to 2019 with the hydroclimatic factors in Selangor using the geographical information system and remote sensing techniques to develop a leptospirosis hotspot predictive model. Methods: This will be an ecological cross-sectional study with geographical information system and remote sensing mapping and analysis concerning leptospirosis using secondary data. Leptospirosis cases in Selangor from January 2011 to December 2019 shall be obtained from the Selangor State Health Department. Laboratory-confirmed cases with data on the possible source of infection would be identified and georeferenced according to their longitude and latitudes. Topographic data consisting of subdistrict boundaries and the distribution of rivers in Selangor will be obtained from the Department of Survey and Mapping. The ArcGIS Pro software will be used to evaluate the clustering of the cases and mapped using the Getis-Ord Gi* tool. The satellite images for rainfall and land surface temperature will be acquired from the Giovanni National Aeronautics and Space Administration EarthData website and processed to obtain the average monthly values in millimeters and degrees Celsius. Meanwhile, the average monthly river hydrometric levels will be obtained from the Department of Drainage and Irrigation. Data are then inputted as thematic layers and in the ArcGIS software for further analysis. The artificial neural network analysis in artificial intelligence Phyton software will then be used to obtain the leptospirosis hotspot predictive model. Results: This research was funded as of November 2022. Data collection, processing, and analysis commenced in December 2022, and the results of the study are expected to be published by the end of 2024. The leptospirosis distribution and clusters may be significantly associated with the hydroclimatic factors of rainfall, land surface temperature, and the river hydrometric level. Conclusions: This study will explore the associations of leptospirosis hotspot areas with the hydroclimatic factors in Selangor and subsequently the development of a leptospirosis predictive model. The constructed predictive model could potentially be used to design and enhance public health initiatives for disease prevention. International Registered Report Identifier (IRRID): PRR1-10.2196/43712 ",
doi="10.2196/43712",
url="https://www.researchprotocols.org/2023/1/e43712",
url="http://www.ncbi.nlm.nih.gov/pubmed/37184897"
}


@Article{info:doi/10.2196/41627,
author="Monteith, Hiliary
and Hiscock, Claire Elizabeth
and Sadeghi, Yasamin
and Smith, V. Emily
and Mashford-Pringle, Angela",
title="Indigenous Food Systems Changes and Resiliency: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="21",
volume="12",
pages="e41627",
keywords="Indigenous",
keywords="food systems",
keywords="Indigenous health",
keywords="scoping review",
keywords="traditional foods",
keywords="colonization",
keywords="climate change",
keywords="pollution",
keywords="environment",
abstract="Background: Indigenous food systems (IFS) consider the complex relationships and connections between land, animals, plants, water, and people. These food systems may differ between regions, Indigenous cultures, and history; however, given the similar colonial histories and policies influencing Indigenous groups in Canada, the United States, Australia, and Aotearoa (New Zealand), the IFS changes and responses in these regions may follow similar trends. Climate change and pollution continue to impact the environment in catastrophic ways, and this, in turn, impacts IFS. However, to date, there has been no review of the literature on IFS, how they are changing, and how communities are responding to these changes. Objective: In this scoping review, we will summarize primary research in Canada, the United States, Australia, and Aotearoa related to IFS addressing the following questions: (1) What changes are IFS experiencing in the context of climate change and pollution? (2) What actions have been taken in response to IFS changes? (3) What are the characteristics of IFS research in peer-reviewed academic literature? Methods: We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews and the Joanna Briggs Institute reviewer's manual to inform the review process. MEDLINE, SCOPUS, International Bibliography of the Social Sciences, Sociological Abstracts, and the Bibliography of Native North Americans are the databases included in this review search. All screening and extraction have been supported by Covidence software (Veritas Health Innovation) with 2 independent reviewers conducting the abstract and full-text screening. We will map concepts and themes related to the research questions to contribute to the understanding of IFS within the academic literature and provide a narrative review of the outcomes. Results: The electronic database searches for this review were conducted in May 2021. Screening and full-text review were initially completed in the winter of 2022. We are currently in the process of compiling results and aim to share findings in 2023. Conclusions: This review will provide valuable insight into current IFS needs by summarizing the peer-reviewed literature on how IFS are changing because of climate change and pollution and how communities are responding to these changes. The results of this review will be shared with Indigenous communities, through academic publications, community conversations, and conference presentations. Trial Registration: OSF Registries osf.io/xrj87; https://osf.io/xrj87 International Registered Report Identifier (IRRID): RR1-10.2196/41627 ",
doi="10.2196/41627",
url="https://www.researchprotocols.org/2023/1/e41627",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083598"
}


@Article{info:doi/10.2196/42516,
author="Diallo, Thierno
and B{\'e}rub{\'e}, Anouk
and Roberge, Martin
and Audate, Pierre-Paul
and Larente-Marcotte, St{\'e}phanie
and Jobin, {\'E}dith
and Moubarak, Nisrine
and Guillaumie, Laurence
and Dup{\'e}r{\'e}, Sophie
and Guichard, Anne
and Goupil-Sormany, Isabelle",
title="Nurses' Perceptions of Climate Change: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="11",
volume="12",
pages="e42516",
keywords="perception",
keywords="climate change",
keywords="nurse",
keywords="scoping review",
keywords="review method",
keywords="environment",
keywords="nursing",
keywords="perspective",
keywords="search strategy",
keywords="global warming",
keywords="health care professional",
abstract="Background: Climate change is a major threat to human health. Nurses are in contact with patients suffering from the effects of climate change in their daily work. Therefore, they need to be involved in combating it at both the individual and collective levels. However, there is still very little known about nurses' perception of climate change and their role toward it. A few recent studies have embarked on the process of examining the perceptions of these health professionals relative to climate change, but no exploratory review of the literature has been conducted on nurses' perception of this phenomenon. Objective: The purpose of this protocol is to develop a research strategy for an exploratory review of the literature focused on identifying nurses' perceptions of climate change. Methods: Firstly, with the help of a specialized librarian, we defined keywords and their combinations, using an iterative process, to develop a documentary search strategy. This strategy was tested in the following four bibliographic databases: MEDLINE (PubMed), CINAHL, Embase, and Web of Science. A search of the grey literature will also be conducted to supplement the results of the bibliographic database search. The next step will be for 2 members of the research team to carry out a 2-stage selection process using the web-based systematic review software Covidence. They will carry out this selection process independently, with the aim of identifying relevant studies that meet the inclusion criteria for our exploratory review. Finally, data on year of publication, authors, geographic area, article type, study objectives, methodology, and key findings will be extracted from selected articles for analysis. The data will be analyzed by the research team based on an in-depth examination of the findings and will be directed toward answering the research question and fulfilling the study's objective. Results: The results will help in defining nurses' perceptions of climate change more clearly as well as the role they can play and what they need to be able to bring forward solutions to this phenomenon. The findings should also serve to guide the health sector and nursing faculty's interventions aimed at preparing health professionals to act on the potential threats associated with climate change. Conclusions: The preliminary search suggests a possible gap between the importance of the nursing role in addressing the health impacts of climate change and the nurses' lack of knowledge and awareness on this matter. The results will allow for raising nurses' awareness of their role in the fight against climate change and the ways to address its health effects. This study will also open up new research perspectives on how to equip nurses to better integrate response to climate change issues into their professional practice. International Registered Report Identifier (IRRID): DERR1-10.2196/42516 ",
doi="10.2196/42516",
url="https://www.researchprotocols.org/2023/1/e42516",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630170"
}


@Article{info:doi/10.2196/39532,
author="Koch, Mara
and Matzke, Ina
and Huhn, Sophie
and Gunga, Hanns-Christian
and Maggioni, Anna Martina
and Munga, Stephen
and Obor, David
and Si{\'e}, Ali
and Boudo, Valentin
and Bunker, Aditi
and Dambach, Peter
and B{\"a}rnighausen, Till
and Barteit, Sandra",
title="Wearables for Measuring Health Effects of Climate Change--Induced Weather Extremes: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="9",
volume="10",
number="9",
pages="e39532",
keywords="wearable",
keywords="consumer-grade wearables",
keywords="fitness trackers",
keywords="climate change",
keywords="heat",
keywords="global health",
keywords="public health",
keywords="review",
keywords="mobile phone",
abstract="Background: Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecological momentary assessment, and some studies have used wearables in the field of climate change and health. However, these studies vary in study design, demographics, and outcome variables, and existing research has not been mapped. Objective: In this review, we aimed to map existing research on wearables used to detect direct health impacts and individual exposure during climate change--induced weather extremes, such as heat waves or wildfires. Methods: We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and systematically searched 6 databases (PubMed [MEDLINE], IEEE Xplore, CINAHL [EBSCOhost], WoS, Scopus, Ovid [MEDLINE], and Google Scholar). The search yielded 1871 results. Abstracts and full texts were screened by 2 reviewers (MK and IM) independently using the inclusion and exclusion criteria. The inclusion criteria comprised studies published since 2010 that used off-the-shelf wearables that were neither invasive nor obtrusive to the user in the setting of climate change--related weather extremes. Data were charted using a structured form, and the study outcomes were narratively synthesized. Results: The review included 55,284 study participants using wearables in 53 studies. Most studies were conducted in upper--middle-income and high-income countries (50/53, 94\%) in urban environments (25/53, 47\%) or in a climatic chamber (19/53, 36\%) and assessed the health effects of heat exposure (52/53, 98\%). The majority reported adverse health effects of heat exposure on sleep, physical activity, and heart rate. The remaining studies assessed occupational heat stress or compared individual- and area-level heat exposure. In total, 26\% (14/53) of studies determined that all examined wearables were valid and reliable for measuring health parameters during heat exposure when compared with standard methods. Conclusions: Wearables have been used successfully in large-scale research to measure the health implications of climate change--related weather extremes. More research is needed in low-income countries and vulnerable populations with pre-existing conditions. In addition, further research could focus on the health impacts of other climate change--related conditions and the effectiveness of adaptation measures at the individual level to such weather extremes. ",
doi="10.2196/39532",
url="https://mhealth.jmir.org/2022/9/e39532",
url="http://www.ncbi.nlm.nih.gov/pubmed/36083624"
}


@Article{info:doi/10.2196/34104,
author="Oetomo, Arlene
and Jalali, Niloofar
and Costa, Paro Paula Dornhofer
and Morita, Pelegrini Plinio",
title="Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats",
journal="JMIR Form Res",
year="2022",
month="May",
day="12",
volume="6",
number="5",
pages="e34104",
keywords="Internet of Things",
keywords="IoT",
keywords="heat waves",
keywords="public health",
keywords="smart home technology",
keywords="smart thermostats",
keywords="indoor temperature",
keywords="air conditioning",
keywords="heat alert response systems",
keywords="thermostat",
keywords="unsafe temperatures",
keywords="uHealth",
abstract="Background: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. Objective: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26{\textdegree}C. Methods: We used secondary data---indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non--air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. Results: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non--heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non--air conditioned houses. Conclusions: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses. ",
doi="10.2196/34104",
url="https://formative.jmir.org/2022/5/e34104",
url="http://www.ncbi.nlm.nih.gov/pubmed/35550317"
}


@Article{info:doi/10.2196/31389,
author="Bhawra, Jasmin
and Skinner, Kelly
and Favel, Duane
and Green, Brenda
and Coates, Ken
and Katapally, Reddy Tarun",
title="The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="15",
volume="10",
number="9",
pages="e31389",
keywords="food security",
keywords="food sovereignty",
keywords="food equity",
keywords="mental health",
keywords="solastalgia",
keywords="climate change impacts",
keywords="climate change preparedness",
keywords="digital health",
keywords="digital dashboards",
keywords="Indigenous health",
keywords="mobile phone",
abstract="Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change--related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change--related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic M{\'e}tis jurisdiction of {\^I}le-{\`a}-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples' self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 ",
doi="10.2196/31389",
url="https://www.researchprotocols.org/2021/9/e31389",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524106"
}


@Article{info:doi/10.5210/ojphi.v11i1.9834,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="1",
pages="e9834",
doi="10.5210/ojphi.v11i1.9834",
url=""
}


@Article{info:doi/10.5210/ojphi.v10i1.8826,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2018",
volume="10",
number="1",
pages="e8826",
doi="10.5210/ojphi.v10i1.8826",
url=""
}


@Article{info:doi/10.5210/ojphi.v10i1.8829,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2018",
volume="10",
number="1",
pages="e8829",
doi="10.5210/ojphi.v10i1.8829",
url=""
}


@Article{info:doi/10.5210/ojphi.v10i1.8898,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2018",
volume="10",
number="1",
pages="e8898",
doi="10.5210/ojphi.v10i1.8898",
url=""
}


@Article{info:doi/10.5210/ojphi.v10i1.8957,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2018",
volume="10",
number="1",
pages="e8957",
doi="10.5210/ojphi.v10i1.8957",
url=""
}


@Article{info:doi/10.2196/mhealth.5931,
author="Sullivan, K. Rachel
and Marsh, Samantha
and Halvarsson, Jakob
and Holdsworth, Michelle
and Waterlander, Wilma
and Poelman, P. Maartje
and Salmond, Ann Jennifer
and Christian, Hayley
and Koh, SC Lenny
and Cade, E. Janet
and Spence, C. John
and Woodward, Alistair
and Maddison, Ralph",
title="Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Dec",
day="19",
volume="4",
number="4",
pages="e135",
keywords="climate change",
keywords="noncommunicable diseases",
keywords="smartphone apps",
keywords="travel",
keywords="diet",
keywords="greenhouse gas emissions",
keywords="carbon footprint",
keywords="individual",
keywords="behavior change",
abstract="Background: Climate change and the burden of noncommunicable diseases are major global challenges. Opportunities exist to investigate health and climate change co-benefits through a shift from motorized to active transport (walking and cycling) and a shift in dietary patterns away from a globalized diet to reduced consumption of meat and energy dense foods. Given the ubiquitous use and proliferation of smartphone apps, an opportunity exists to use this technology to capture individual travel and dietary behavior and the associated impact on the environment and health. Objective: The objective of the study is to identify, describe the features, and rate the quality of existing smartphone apps which capture personal travel and dietary behavior and simultaneously estimate the carbon cost and potential health consequences of these actions. Methods: The Google Play and Apple App Stores were searched between October 19 and November 6, 2015, and a secondary Google search using the apps filter was conducted between August 8 and September 18, 2016. Eligible apps were required to estimate the carbon cost of personal behaviors with the potential to include features to maximize health outcomes. The quality of included apps was assessed by 2 researchers using the Mobile Application Rating Scale (MARS). Results: Out of 7213 results, 40 apps were identified and rated. Multiple travel-related apps were identified, however no apps solely focused on the carbon impact or health consequences of dietary behavior. None of the rated apps provided sufficient information on the health consequences of travel and dietary behavior. Some apps included features to maximize participant engagement and encourage behavior change towards reduced greenhouse gas emissions. Most apps were rated as acceptable quality as determined by the MARS; 1 was of poor quality and 10 apps were of good quality. Interrater reliability of the 2 evaluators was excellent (ICC=0.94, 95\% CI 0.87-0.97). Conclusions: Existing apps capturing travel and dietary behavior and the associated health and environmental impact are of mixed quality. Most apps do not include all desirable features or provide sufficient health information. Further research is needed to determine the potential of smartphone apps to evoke behavior change resulting in climate change and health co-benefits. ",
doi="10.2196/mhealth.5931",
url="http://mhealth.jmir.org/2016/4/e135/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27993762"
}


@Article{info:doi/10.5210/ojphi.v6i1.5044,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2014",
volume="6",
number="1",
pages="e5044",
doi="10.5210/ojphi.v6i1.5044",
url=""
}