%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67128 %T 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 %A Portela Dos Santos,Omar %A Alves,Paulo Jorge Pereira %A Verloo,Henk %+ Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, Chemin de l'Agasse 5, Sion, 1950, Switzerland, 41 786680125, omar.porteladossantos@hevs.ch %K climate change %K global warming %K emergency department %K emergency nursing %K sustainable care %K ecological medicine %K cardiopulmonary %K cardio health %K Valais %K Switzerland %K pilot study %K study protocol %K humanity %K air pollution %K impact %K comorbidities %K adults %K mixed methods design %K feasibility %K health promotion %K disease prevention %K acceptability %D 2025 %7 25.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 40132196 %R 10.2196/67128 %U https://www.researchprotocols.org/2025/1/e67128 %U https://doi.org/10.2196/67128 %U http://www.ncbi.nlm.nih.gov/pubmed/40132196 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65228 %T Digital Cognitive Behavioral Therapy–Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial %A Isaac,Fadia %A Klein,Britt %A Nguyen,Huy %A Watson,Shaun %A Kennedy,Gerard A %+ Institute of Health and Wellbeing, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia, 61 353276717, fadia.isaac@hotmail.com %K insomnia %K nightmares %K posttraumatic stress disorder %K PTSD %K wildfires %K cognitive behavioral therapy for insomnia %K CBTi %K exposure, relaxation, and rescripting therapy %K ERRT %K Sleep Best-i %K mobile health %K mHealth %K digital health %K computer %K eHealth %K bushfires %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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 × 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 %M 40085843 %R 10.2196/65228 %U https://humanfactors.jmir.org/2025/1/e65228 %U https://doi.org/10.2196/65228 %U http://www.ncbi.nlm.nih.gov/pubmed/40085843 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 7 %N %P e59790 %T Exploring the Knowledge, Attitudes, and Perceptions of Hospital Staff and Patients on Environmental Sustainability in the Operating Room: Quality Improvement Survey Study %A Stachura,Nicole Kasia %A Brar,Sukham K %A Davidson,Jacob %A Wilson,Claire A %A Dann,Celia %A Apostol,Mike %A Vecchio,John %A Bilodeau,Shannon %A Gunz,Anna %A Casas-Lopez,Diana Catalina %A Noppens,Ruediger %A Leslie,Ken %A Strychowsky,Julie E %+ Department of Otolaryngology-Head and Neck Surgery, Western University, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada, 1 519 685 8242, julie.strychowsky@lhsc.on.ca %K environmental sustainability %K sustainable healthcare %K operating room %K hospital %K recycling %K climate change %K global warming %K staff %K patient %K attitude %K opinion %K energy consumption %D 2024 %7 28.11.2024 %9 Original Paper %J JMIR Perioper Med %G English %X 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. %M 39608767 %R 10.2196/59790 %U https://periop.jmir.org/2024/1/e59790 %U https://doi.org/10.2196/59790 %U http://www.ncbi.nlm.nih.gov/pubmed/39608767 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58711 %T 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 %A Jordan,Arne %A Nothacker,Julia %A Paucke,Valentina %A Hager,Klaus Heinz %A Hueber,Susann %A Karimzadeh,Arian %A Kötter,Thomas %A Löffler,Christin %A Müller,Beate Sigrid %A Tajdar,Daniel %A Lühmann,Dagmar %A Scherer,Martin %A Schäfer,Ingmar %+ Institute and Outpatients Clinic of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany, 49 40 7410 52760, in.schaefer@uke.de %K climate change %K online survey %K open internet data %K climate %K environment %K rising temperature %K heatexposure %K chronic disease management %K epidemiology %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=–0.25, 95% CI –0.49 to –0.01, P=.04) and better self-reported protective behavior (β=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 (β=–0.39, 95% CI –0.54 to –0.23, P<.001) and higher somatosensory amplification (β=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 %M 39496153 %R 10.2196/58711 %U https://publichealth.jmir.org/2024/1/e58711 %U https://doi.org/10.2196/58711 %U http://www.ncbi.nlm.nih.gov/pubmed/39496153 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57948 %T Projections of Climate Change Impact on Acute Heat Illnesses in Taiwan: Case-Crossover Study %A Yang,Hsiao-Yu %A Wu,Chang-Fu %A Tsai,Kun-Hsien %K climate change %K global warming %K heat-related illness %K carbon reduction %K heat %K heat illness %K extreme heat %K Taiwan %K real time %K epidemic %K surveillance %K public health %K emergency department %K early warning system %K nonlinear model %K temperature %K socioeconomic %K environmental health %K heat stress %K environmental %K epidemiology %D 2024 %7 16.10.2024 %9 %J JMIR Public Health Surveill %G English %X 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 °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 °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. %R 10.2196/57948 %U https://publichealth.jmir.org/2024/1/e57948 %U https://doi.org/10.2196/57948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60147 %T Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study %A Polivka,Barbara %A Krueger,Kathryn %A Bimbi,Olivia %A Huntington-Moskos,Luz %A Nyenhuis,Sharmilee %A Cramer,Emily %A Eldeirawi,Kamal %+ School of Nursing, University of Kansas, 3901 Rainbow Blvd., School of Nursing, Kansas City, KS, 66160, United States, 1 9135881630, bpolivka@kumc.edu %K indoor air quality %K asthma %K real-time assessment %K EMA %K ecological momentary assessment %K mobile phone %K monitoring %K air quality %K real time %K spirometry %K acceptability %K usability %K residential toxins %K volatile organic compounds %K VOC %K adult %K female %K women %K college student %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39388233 %R 10.2196/60147 %U https://formative.jmir.org/2024/1/e60147 %U https://doi.org/10.2196/60147 %U http://www.ncbi.nlm.nih.gov/pubmed/39388233 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54687 %T Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors %A Iyengar,M Sriram %A Block Ngaybe,Maiya G %A Gonzalez,Myla %A Arora,Mona %+ University of Arizona College of Medicine, 475 North 5th Street, E967C, Phoenix, AZ, 85004, United States, 1 2817934733, msiyengar@arizona.edu %K health informatics %K data science %K climate change %K pandemics %K COVID-19 %K migrations %K mobile phone %D 2024 %7 12.8.2024 %9 Viewpoint %J Interact J Med Res %G English %X Climate change, local epidemics, future pandemics, and forced displacements pose significant public health threats worldwide. To cope successfully, people and communities are faced with the challenging task of developing resilience to these stressors. Our viewpoint is that the powerful capabilities of modern informatics technologies including artificial intelligence, biomedical and environmental sensors, augmented or virtual reality, data science, and other digital hardware or software, have great potential to promote, sustain, and support resilience in people and communities. However, there is no “one size fits all” solution for resilience. Solutions must match the specific effects of the stressor, cultural dimensions, social determinants of health, technology infrastructure, and many other factors. %M 39133540 %R 10.2196/54687 %U https://www.i-jmr.org/2024/1/e54687 %U https://doi.org/10.2196/54687 %U http://www.ncbi.nlm.nih.gov/pubmed/39133540 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e51883 %T 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 %A Chen,Yang %A Zhou,Lidan %A Zha,Yuanyi %A Wang,Yujin %A Wang,Kai %A Lu,Lvliang %A Guo,Pi %A Zhang,Qingying %K mortality burden %K nonaccidental deaths %K multivariate meta-analysis %K distributed lagged nonlinear mode %K attributable risk %K climate change %K human health %K association %K temperature %K mortality %K nonaccidental death %K spatial heterogeneity %K meteorological data %K temperature esposure %K heterogeneous %K spatial planning %K environmental temperature %K prefecture-level %K resource allocation %D 2024 %7 23.7.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/51883 %U https://publichealth.jmir.org/2024/1/e51883 %U https://doi.org/10.2196/51883 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54064 %T Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review %A Bhawra,Jasmin %A Elsahli,Nadine %A Patel,Jamin %+ CHANGE Research Lab, School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 553466, jasmin.bhawra@torontomu.ca %K climate change %K digital health %K ecoanxiety %K environmental hazards %K food security %K mental health %K scoping review %K smartphone apps %K digital apps %K mobile health %K mobile phone %D 2024 %7 23.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 39042453 %R 10.2196/54064 %U https://publichealth.jmir.org/2024/1/e54064 %U https://doi.org/10.2196/54064 %U http://www.ncbi.nlm.nih.gov/pubmed/39042453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54669 %T Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study %A Matzke,Ina %A Huhn,Sophie %A Koch,Mara %A Maggioni,Martina Anna %A Munga,Stephen %A Muma,Julius Okoth %A Odhiambo,Collins Ochieng %A Kwaro,Daniel %A Obor,David %A Bärnighausen,Till %A Dambach,Peter %A Barteit,Sandra %+ Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, 69120, Germany, 49 62215634030, barteit@uni-heidelberg.de %K wearables %K wearable %K tracker %K trackers %K climate %K Africa %K environment %K environmental %K heat %K weather %K exposure %K temperature %K rural %K fitness trackers %K climate change %K health %K heat %K sub-Saharan Africa %K Kenya %K outcome %K outcomes %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 38963698 %R 10.2196/54669 %U https://mhealth.jmir.org/2024/1/e54669 %U https://doi.org/10.2196/54669 %U http://www.ncbi.nlm.nih.gov/pubmed/38963698 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52221 %T Epidemic Characteristics and Meteorological Risk Factors of Hemorrhagic Fever With Renal Syndrome in 151 Cities in China From 2015 to 2021: Retrospective Analysis %A Luo,Yizhe %A Zhang,Longyao %A Xu,Yameng %A Kuai,Qiyuan %A Li,Wenhao %A Wu,Yifan %A Liu,Licheng %A Ren,Jiarong %A Zhang,Lingling %A Shi,Qiufang %A Liu,Xiaobo %A Tan,Weilong %+ Department of Epidemiology, School of Public Health, Nanjing Medical University, Meiyuan Xincun Street, Nanjing, 210002, China, 86 17384408593, njcdc@163.com %K China %K hemorrhagic fever with renal syndrome %K HFRS %K climate change %K meteorological factors %K distributed lag nonlinear model %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 ºC; relative risk [RR] 1.64, 95% CI 1.24-2.15) in the midtemperate zone, 0 months (28 ºC; RR 3.15, 95% CI 2.13-4.65) in the warm-temperate zone, and 0 months (4 ºC; 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. %M 38837197 %R 10.2196/52221 %U https://publichealth.jmir.org/2024/1/e52221 %U https://doi.org/10.2196/52221 %U http://www.ncbi.nlm.nih.gov/pubmed/38837197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53437 %T Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study %A Cummins,Mollie R %A Shishupal,Sukrut %A Wong,Bob %A Wan,Neng %A Han,Jiuying %A Johnny,Jace D %A Mhatre-Owens,Amy %A Gouripeddi,Ramkiran %A Ivanova,Julia %A Ong,Triton %A Soni,Hiral %A Barrera,Janelle %A Wilczewski,Hattie %A Welch,Brandon M %A Bunnell,Brian E %+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, United States, 1 8015859740, mollie.cummins@utah.edu %K air pollution %K environmental health %K telemedicine %K greenhouse gases %K clinical research informatics %K informatics %K data science %K telehealth %K eHealth %K travel %K air quality %K pollutant %K pollution %K polluted %K environment %K environmental %K greenhouse gas %K emissions %K retrospective %K observational %K United States %K USA %K North America %K North American %K cost %K costs %K economic %K economics %K saving %K savings %K finance %K financial %K finances %K CO2 %K carbon dioxide %K carbon footprint %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38536065 %R 10.2196/53437 %U https://www.jmir.org/2024/1/e53437 %U https://doi.org/10.2196/53437 %U http://www.ncbi.nlm.nih.gov/pubmed/38536065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56138 %T An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study %A Tourrette,Cédric %A Tostain,Jean-Baptiste %A Kozub,Eva %A Badreddine,Maha %A James,Julia %A Noraz,Aurore %A De Choudens,Charlotte %A Moulis,Lionel %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Montpellier University, INSERM, Campus Sante, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France, 33 684014834, francois.carbonnel@umontpellier.fr %K planetary health %K One Health %K medical education %K environmental health %K education %K e-learning %K general practitioner %K pilot study %K climate change %K training %K environmental %K e-learning module %K behavior change %K ecosystem %K questionnaire %K behavior %K self-assessment %K e-learning intervention %K environment %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X 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-Nîmes 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. %M 38743463 %R 10.2196/56138 %U https://formative.jmir.org/2024/1/e56138 %U https://doi.org/10.2196/56138 %U http://www.ncbi.nlm.nih.gov/pubmed/38743463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49929 %T Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review %A Ezeonu,Nwamaka Alexandra %A Hertelendy,Attila J %A Adu,Medard Kofi %A Kung,Janice Y %A Itanyi,Ijeoma Uchenna %A Dias,Raquel da Luz %A Agyapong,Belinda %A Hertelendy,Petra %A Ohanyido,Francis %A Agyapong,Vincent Israel Opoku %A Eboreime,Ejemai %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 9024732479, ejemai.eboreime@nshealth.ca %K mental health %K disasters %K mobile health %K mHealth %K application %K applications %K app %K apps %K smartphone %K stress %K psychological %K traumatic %K disaster %K disasters %K hazard %K hazards %K emergency %K psychological trauma %K mobile apps %K trauma %K scoping %K review methods %K review methodology %K mobile phone %D 2024 %7 17.4.2024 %9 Review %J J Med Internet Res %G English %X 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. %M 38520699 %R 10.2196/49929 %U https://www.jmir.org/2024/1/e49929 %U https://doi.org/10.2196/49929 %U http://www.ncbi.nlm.nih.gov/pubmed/38520699 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46980 %T Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study %A Koch,Mara %A Matzke,Ina %A Huhn,Sophie %A Sié,Ali %A Boudo,Valentin %A Compaoré,Guillaume %A Maggioni,Martina Anna %A Bunker,Aditi %A Bärnighausen,Till %A Dambach,Peter %A Barteit,Sandra %+ Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 5634030, barteit@uni-heidelberg.de %K wearable %K consumer-grade wearable %K sleep %K activity %K heart rate %K climate change %K heat %K rain %K weather %K sub-Saharan Africa %K global health %K public health %K mobile phone %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 °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 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °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. %M 37938879 %R 10.2196/46980 %U https://mhealth.jmir.org/2023/1/e46980 %U https://doi.org/10.2196/46980 %U http://www.ncbi.nlm.nih.gov/pubmed/37938879 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43712 %T Spatio-Temporal Analysis of Leptospirosis Hotspot Areas and Its Association With Hydroclimatic Factors in Selangor, Malaysia: Protocol for an Ecological Cross-sectional Study %A Ab Kadir,Muhammad Akram %A Abdul Manaf,Rosliza %A Mokhtar,Siti Aisah %A Ismail,Luthffi Idzhar %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 397692404, rosliza_abmanaf@upm.edu.my %K leptospirosis %K hotspot areas %K hydroclimatic factors %K Selangor %K geographical information system %K GIS %K predictive model %D 2023 %7 15.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37184897 %R 10.2196/43712 %U https://www.researchprotocols.org/2023/1/e43712 %U https://doi.org/10.2196/43712 %U http://www.ncbi.nlm.nih.gov/pubmed/37184897 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41627 %T Indigenous Food Systems Changes and Resiliency: Protocol for a Scoping Review %A Monteith,Hiliary %A Hiscock,Elizabeth Claire %A Sadeghi,Yasamin %A Smith,Emily V %A Mashford-Pringle,Angela %+ Department of Nutritional Sciences, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 4168869242, hiliary.monteith@gmail.com %K Indigenous %K food systems %K Indigenous health %K scoping review %K traditional foods %K colonization %K climate change %K pollution %K environment %D 2023 %7 21.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37083598 %R 10.2196/41627 %U https://www.researchprotocols.org/2023/1/e41627 %U https://doi.org/10.2196/41627 %U http://www.ncbi.nlm.nih.gov/pubmed/37083598 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42516 %T Nurses’ Perceptions of Climate Change: Protocol for a Scoping Review %A Diallo,Thierno %A Bérubé,Anouk %A Roberge,Martin %A Audate,Pierre-Paul %A Larente-Marcotte,Stéphanie %A Jobin,Édith %A Moubarak,Nisrine %A Guillaumie,Laurence %A Dupéré,Sophie %A Guichard,Anne %A Goupil-Sormany,Isabelle %+ Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, 1050, rue de la Médecine, Quebec, QC, G1V 0H6, Canada, 1 4186562131 ext 413488, bebs.diallo13@gmail.com %K perception %K climate change %K nurse %K scoping review %K review method %K environment %K nursing %K perspective %K search strategy %K global warming %K health care professional %D 2023 %7 11.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 36630170 %R 10.2196/42516 %U https://www.researchprotocols.org/2023/1/e42516 %U https://doi.org/10.2196/42516 %U http://www.ncbi.nlm.nih.gov/pubmed/36630170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e39532 %T Wearables for Measuring Health Effects of Climate Change–Induced Weather Extremes: Scoping Review %A Koch,Mara %A Matzke,Ina %A Huhn,Sophie %A Gunga,Hanns-Christian %A Maggioni,Martina Anna %A Munga,Stephen %A Obor,David %A Sié,Ali %A Boudo,Valentin %A Bunker,Aditi %A Dambach,Peter %A Bärnighausen,Till %A Barteit,Sandra %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 5634030, mara.koch@uni-heidelberg.de %K wearable %K consumer-grade wearables %K fitness trackers %K climate change %K heat %K global health %K public health %K review %K mobile phone %D 2022 %7 9.9.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X 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. %M 36083624 %R 10.2196/39532 %U https://mhealth.jmir.org/2022/9/e39532 %U https://doi.org/10.2196/39532 %U http://www.ncbi.nlm.nih.gov/pubmed/36083624 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34104 %T Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats %A Oetomo,Arlene %A Jalali,Niloofar %A Costa,Paula Dornhofer Paro %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada, 1 519 888 456 ext 41372, arlene.oetomo@uwaterloo.ca %K Internet of Things %K IoT %K heat waves %K public health %K smart home technology %K smart thermostats %K indoor temperature %K air conditioning %K heat alert response systems %K thermostat %K unsafe temperatures %K uHealth %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X 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°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. %M 35550317 %R 10.2196/34104 %U https://formative.jmir.org/2022/5/e34104 %U https://doi.org/10.2196/34104 %U http://www.ncbi.nlm.nih.gov/pubmed/35550317 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31389 %T The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness %A Bhawra,Jasmin %A Skinner,Kelly %A Favel,Duane %A Green,Brenda %A Coates,Ken %A Katapally,Tarun Reddy %+ Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, 101 Diefenbaker Place, Saskatoon, SK, S7N 5B8, Canada, 1 3065854544, jasmin.bhawra@usask.ca %K food security %K food sovereignty %K food equity %K mental health %K solastalgia %K climate change impacts %K climate change preparedness %K digital health %K digital dashboards %K Indigenous health %K mobile phone %D 2021 %7 15.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 Métis jurisdiction of Île-à-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 %M 34524106 %R 10.2196/31389 %U https://www.researchprotocols.org/2021/9/e31389 %U https://doi.org/10.2196/31389 %U http://www.ncbi.nlm.nih.gov/pubmed/34524106 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 11 %N 1 %P e9834 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2019 %7 ..2019 %9 %J Online J Public Health Inform %G English %X ObjectiveThis study aimed to explore the effects of El Niño and La Niña events on the timing of influenza A peak activity in European countries.IntroductionInfluenza causes a significant burden to the world every year. In the temperate zone, influenza usually prevalent in the winter season, however, it is hardly predictable when the influenza epidemic will begin and when the peak activity will come. Influenza has a peak in early winter sometimes and a peak in late winter in another year. However, it is not well known what determines these epidemics timing, and the global climate change is expected to influence the timing of influenza epidemics.MethodsThe weekly influenza surveillance data of 5 European countries (UK, Norway, Germany, Greece, and Italy) from January 2005 to July 2018 were retrieved from WHO FluNET database. UK and Norway are considered the northern part of Europe, otherwise Germany, Greece, and Italy are considered western southern part. The El Niño southern oscillation (ENSO) were retrieved from Korean Meteorological Administration. We used the definition of El Niño as the positive sea surface temperature anomalies (≥0.5 degree in Celcius), while La Niña events are negative anomalies (≤-0.5 degree) of 3 months moving average. The weeks with the highest activities of influenza A and B in each season were identified and coded as 1, 2, 3 if the peak appeared the 1st 2nd and 3rd week from the beginning of the year respectively. The influenza data of 2008/2009 and 2009/2010 were excluded from the analysis to eliminate the bias due to a pandemic influenza outbreak. We compared the means of these peak weeks according to the presence of the anomalies using the general linear model with Scheffe multiple comparison and Wilcoxon signed rank sum test.ResultsFrom January 2005 to July 2018, there were 3 El Niño and 5 La Niña events by the ENSO excluding 2009 El Niño. The influenza A peak activity was observed at 9th week (mean±SD, 8.7±4.8) from the beginning of the year in no anomaly event, but the peak appearance timing was significantly shortened to 6th week (6.2±2.7) and 5th week (5.1±3.9) when El Niño and La Niña events occurred, respectively (both p<0.05). Influenza A made the peak at usually 10th week (9.9±5.0) in northern 2 countries in no anomalies, but at 6th (6.4±3.9) week in any events of an anomaly in the surface sea temperature (p=0.072). In the southern 3 countries, influenza peaks were observed at 8th (7.9±4.8 ) week in usual without anomalies, but at 5th (5.0±3.3) week in El Niño or La Niña events (p=0.049).ConclusionsBoth El Niño and La Niña affect the timing of influenza A peak activity; the ENSO associated the early emergency of peak influenza activities in European countries.ReferencesFisman DN, et al. Impact of El Niño Southern Oscillation on infectious disease hospitalization risk in the United States. Proc Natl Acad Sci U S A. 2016; 113(51):14589-14594.Oluwole OSA. Seasonal Influenza Epidemics and El Niños. Front. Public Health 3:250.Zaraket H, et al. Association of early annual peak influenza activity with El Niño southern oscillation in Japan. Influenza andOther Respiratory Viruses 2008; 2(4): 127–130. %R 10.5210/ojphi.v11i1.9834 %U %U https://doi.org/10.5210/ojphi.v11i1.9834 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 10 %N 1 %P e8826 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2018 %7 ..2018 %9 %J Online J Public Health Inform %G English %X ObjectiveTo describe the differences in patient populations between those who seek care for heat exposure during the work week and those who seek care during the weekend.IntroductionAs global temperatures increase, so too does interest in the effect of climate change on the population’s health. 2016 represented the hottest year on record globally and well above the 20th century average in Virginia.1,2 With large-scale climate change comes an increase in severe weather patterns, including heat waves.3 Heat waves can have immense health impacts on a community, including heat stroke, heat exhaustion, and dehydration.Previous analyses of emergency department (ED) data indicate that certain populations – specifically males and rural residents – are more at risk for heat-related illness.4,5 None of these studies, however, looked for temporal relationships between the population seeking care and the day of the week. Syndromic surveillance data can be used to further describe those communities affected by heat exposure as well as identify any temporal patterns in visits.MethodsThe Virginia Department of Health (VDH) receives data from 148 EDs and urgent care centers (UCCs) as part of its syndromic surveillance program. During regular surveillance of a heat wave, it was observed that males made up a larger proportion of heat-related visits during the week than they did over the weekend. Data received on visits between January 1, 2015 and July 31, 2017 were used for a retrospective, cross-sectional analysis of demographic risk factors for heat-related illness. During this time frame, 6,739 visits were identified using the September 2016 Council for State and Territorial Epidemiologists (CSTE) syndrome definition for heat-related illness.6The effect of various demographics and visit factors on weekday heat exposure was measured using chi-squared tests. The variables in question included sex, race, ethnicity, rural vs. urban residence, and age group. Odds ratios, 95% confidence intervals, and p-values were reported for these analyses. Analyses were conducted using SAS 9.3 with a significance level of 0.05.ResultsOf the total 6,739 visits identified for heat-related illness, 4,782 (71.0%) occurred during the work week and 1,957 (29.0%) occurred on the weekend. The odds of seeking care for heat-related illness on a weekday were 1.84 times higher for males than for females, p < 0.001, 95% CI [1.65, 2.06]. Blacks or African Americans were more likely to seek care than whites during the work week with an odds ratio of 1.38, p < 0.001. 95% CI [1.20, 1.57]. Adults aged 18-64 years were more likely to seek care during the work week than both children aged 0-17 years (OR = 1.61, p < 0.001, 95% CI [1.37, 1.89]) and adults aged 65 years or older (OR = 1.36, p < 0.001, 95% CI [1.17, 1.58]). No significant relationship between ethnicity or rural vs. urban residence and work week visits for heat-related illness was observed.ConclusionsThe patient population that seeks care for heat-related illness differs between the work week and the weekend. These data suggest the presence of potential mediators or confounders that make males, blacks or African Americans, and adults aged 18-64 more likely to suffer from heat-related illness during the week. Collecting data on patients’ health behaviors, risk factors, and occupation could further elucidate this relationship. Syndromic surveillance, however, does not include the level of detail needed to investigate anything beyond basic demographics.With an increase in the intensity and frequency of heat waves on the horizon, the issue of heat-related illness is one of growing public health concern. Syndromic surveillance data can be used to describe patterns in the patient population most at risk. Public health action is then needed to protect these communities while further research explores the relationships in greater depth.References1 Nuccitelli, D. (2017, July 31). 2017 is so far the second-hottest year on record thanks to global warming. The Guardian. Retrieved from http://bit.ly/2vkPZpg2 Boyer, J. (2017, January 18). 2016 was the planet’s warmest year in modern records, but it wasn’t for Richmond or even Va. Richmond Times-Dispatch. Retrieved from http://bit.ly/2jptCKg3 Duffy, P. B. (2012, January 21). Increasing prevalence of extreme summer temperatures in the U.S. Climate Change, 111(2), 487-495. https://doi.org/10.1007/s10584-012-0396-64 Hess, J. J., Saha, S., & Luber, G. (2014 November). Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representatitve Sample. Environmental Health Perspectives 122(11), 1209. http://dx.doi.org.proxy.library.vcu.edu/10.1289/ehp.13067965 Sanchez, C. A., Thomas, K. E., Malilay, J., & Annest, J. L. (2010, January). Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001-2004. Family & Community Health 33(1), 3-10. doi:10.1097/FCH.0b013e3181c4e2fa6 Berisha, V., Braun, C. R., Cameron, L., Hoppe, B., Lane, K., Mamou, F., Menager, H., Roach, M., White, J. R., Wurster, J. (2016, September). Heat-Related Illness Syndrome Query: A Guidance Document for Implementing Heat-Related Illness Syndromic Surveillance in Public Health Practice. Retrieved from http://bit.ly/2w884aJ %R 10.5210/ojphi.v10i1.8826 %U %U https://doi.org/10.5210/ojphi.v10i1.8826 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 10 %N 1 %P e8829 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2018 %7 ..2018 %9 %J Online J Public Health Inform %G English %X ObjectiveUsing a syndromic surveillance system to understand the magnitude and risk factors related to heat-related illness (HRI) in Pinal County, AZ.IntroductionExtreme heat is a major cause of weather-related morbidity and mortality in the United States (US).1 HRI is the most frequent cause of environmental exposure-related injury treated in US emergency departments.2 More than 65,000 emergency room visits occur for acute HRI each summer nationwide.3 In Arizona, HRI accounts for an estimated 2,000 emergency room patients and 118 deaths each year.4 As heat-related illness becomes increasingly recognized as a public health issue, local health departments are tasked with building capacity to conduct enhanced surveillance of HRI in order to inform public health preparedness and response efforts. In Pinal County, understanding the magnitude and risk factors of HRI is important for informing prevention efforts as well as developing strategies to respond to extreme heat.MethodsTo gain a better understanding of the magnitude of HRI in Pinal County, historical cases were reviewed from hospital discharge data (HDD) from 2010-2016. Cases were included if the discharge record included any ICD codes consistent with HRI (ICD-9 codes 992 or ICD-10 codes T67 or X30) and if the patient’s county of residence was Pinal County. Recent HRI cases during the summer of 2017 were identified using the National Syndromic Surveillance Program BioSense Platform. The ESSENCE syndromic surveillance tool within the BioSense Platform includes data reported by local hospitals. This data can be used to detect abnormal activity for public health investigation. HRI cases were identified in ESSENCE based on ICD-10 codes and chief complaint terms according to a standardized algorithm developed by the Council of State and Territorial Epidemiologists.1 Both emergency department and admitted patients with a HRI were abstracted from HDD and ESSENCE. To assess HRI risk factors for the summer of 2017, a survey instrument was developed. Survey questions included the nature and location of the HRI incident, potential risk factors, and knowledge and awareness of HRI. Cases were identified in ESSENSE on a weekly basis from May 1, 2017-September 12, 2017, and follow up phone interviews were conducted with eligible cases. For HRI cases eligible for interview, three attempts were made to contact the patient by phone. Cases were excluded if the patient was incarcerated, deceased, or did not have a HRI upon medical record review. An exploratory analysis was performed for the data from HDD, ESSENCE, and interviews.ResultsPinal County Public Health Services District identified 1,321 HRI cases from 2010-2016, an average of 189 per year. Hospital discharge data suggest HRI cases are more likely to occur in males between the ages of 20-44 years old (27%). It is also notable that a sharp increase in HRI cases is observed each year in mid-to-late June, with an estimated 14% of annual cases occurring during the third week of June. Further analysis of HDD showed 31% of cases received medical treatment in Casa Grande in central Pinal County. Between May 1st and September 12th of 2017, 161 HRI cases were detected using ESSENCE. Of which 149 cases were determined to be HRI; 22 cases did not have contact information, and 4 cases were ineligible due to incarceration or death. A total of 31 HRI cases were interviewed out of the eligible 123 ESSENSE cases (25% response rate). Interview data indicated occupational exposure to extreme heat as a major risk factor for HRI. Additional risk factors reported during interviews included exposure to extreme heat while at home or traveling, although interview results are not representative due to a small sample size (n=31).ConclusionsSyndromic surveillance combined with interviews and a review of HDD provides an informative approach for monitoring and responding to HRI. Data suggest Pinal County should expect an increase in HRI cases by mid-June each year, typically coinciding with the first National Weather Service Extreme Heat Warning of the season. Preliminary results suggest that cases occur more frequently in working males ages 20-44 years old in occupations that expose workers to extreme heat conditions. Additional information is needed to assess risk factors for HRI among vulnerable populations in Pinal County who were not represented in this study, including individuals who are homeless, undocumented, elderly, or in correctional facilities. Future areas for improvement include improving the phone interview script to include English and Spanish language versions and performing medical record abstractions on all HRI cases. Enhanced syndromic surveillance is recommended to provide information on risk factors for HRI to inform prevention efforts in Pinal County.References1. Heat-Related Illness Syndrome Query: A Guidance Document For Implementing Heat-Related Illness Syndromic Surveillance in Public Health Practice. In: Epidemiologists CoSaT, ed. Vol 1.02016:1-12.2. Pillai SK, Noe RS, Murphy MW, et al. Heat illness: predictors of hospital admissions among emergency department visits-Georgia, 2002-2008. J Community Health. 2014;39(1):90-98.3. Centers for Disease Control and Prevention . Climate Change and Extreme Heat: What You Can Do to Prepare. 2016; Available from https://www.cdc.gov/climateandhealth/pubs/extreme-heat-guidebook.pdf4. Trends in Morbidity and Mortality from Exposure to Excessive Natural Heat in Arizona, 2012 report. In: Services ADoH, ed2012. %R 10.5210/ojphi.v10i1.8829 %U %U https://doi.org/10.5210/ojphi.v10i1.8829 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 10 %N 1 %P e8898 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2018 %7 ..2018 %9 %J Online J Public Health Inform %G English %X ObjectiveThe main aim of this work is to estimate the projected risks based on the incidence rate of natural foci infections and to expand the list of criteria for the characterization of natural foci of tick-borne infections.IntroductionThe epidemiological situation of natural foci of tick-borne infections (TBI) in Ukraine, as well as globally, is characterized by significant activation of processes due to global climate change, growing human-induced factor and shortcomings in the organization and running of epidemiological surveillance [1]. For the Western region of Ukraine, among all tick-borne zoonoses the most important are tick-borne viral encephalitis (TBVE), Lyme disease (LD), human granulocytic anaplasmosis (HGA) and some others [2-4]. Taking into account the increased incidence rate for these infections, we have developed baseline criteria (indicators of natural contamination of the main carriers and levels of the serum layer among the population in relation to the TBI pathogens in the endemic areas) to identify areas with different risk of contamination through GIS-technologies [5].MethodsEpi Info 7.1.1.14 software was used to analyze patient questionnaires with tick-borne infections (TBI) for 2010-2015. Prevalence maps of vector-borne infections were created by means of GIS technology using the QGIS 2.0.1. software to assess the risks of infection. Maps demonstrating the distribution of TBVE, LD and HGA were also developed based on contamination risk assessment criteria.ResultsRetrospective epidemiological analysis of incidence rates for TBVE, LD and HGA was conducted based on laboratory tests that were performed in the laboratory of vector-borne viral infections of the State Institution Lviv Research Institute of Epidemiology and Hygiene of the Ministry of Health of Ukraine. A direct correlation between the infection of I. ricinus, B. burgdorferi and LB (P <0.05) and infections of I. ricinus ticks, anaplasma and incidence of HGA (P <0.05) was established. However, this connection has not been confirmed for indicators with TBE.Data was obtained during the assessment of possible risks of tick-borne infections. For TBVE, the indicator of predicted risks based on the basic criteria was 60.3%, taking into account the cases of the disease. This was based on indicators of natural infection of the main carriers and the level of the serum layer among the population on the TBI activators in the endemic areas. The data obtained can be explained by the low level of morbidity and the detection of TBVE cases. The predicted risk for LD according to these criteria is 88.9%, due to the high level of clinical and laboratory diagnosis.As for the HGA, the predicted risk indicator reaches 66.7% due to the fact that the study of human anaplasmosis in Ukraine is at the initial level (the incidence rate and incidence are not included in the official reporting system).Taking into account the results obtained, it is advisable to supplement the list of criteria for determining the degree of activity of natural foci of tick-borne infections and the identification of areas with high risk of morbidity. These calculations were made by grouping statistical data (indicators) [5]. The reliability of the difference between the same indicators for individual zones was 95% (Table 1).ConclusionsTick-borne zoonoses are a serious problem for the public health system of the Western region of Ukraine. Extending the list of criteria for the characterization of natural foci of tick-borne infections will improve epidemiological surveillance and focus on key measures in high and medium-risk areas for the rational use of funds.References1. Nordberg M. Tick-Borne Infections in Humans. Aspects of immunopathogenesis, diagnosis and co-infections with Borrelia burgdorferi and Anaplasma phagocytophilum. Linköping University Medical Dissertations No.1315. Linköping, Sweden 2012.2. Morochkovsky R. Clinical characteristic of tick-borne encephalitis in Volhynia and optimization of treatment. Ternopil State Medical Academy I. Gorbachevsky Dissertations. Ternopil, Ukraine 2003.3. Zinchuk O. Lime borreliosis: Clinical and immunopathogenetic features and emergency preventive treatment. Lviv National Medical University D. Galitsky Dissertations. Lviv, Ukraine 2010.4. Ben I., Biletska H. Epidemiologic aspects of human granulocytic anaplasmosis in the Western region of Ukraine. Lik Sprava. 2015 Oct-Dec;(7-8).5. Ben I., Lozynsky I. Application of GIS-technologies for risk assessment of areas with tick-borne infections. Materials of the Regional Scientific Symposium within the framework of the concept of \"Unified Health\" and a review and Selection of scientific works with the support of CCDD in Ukraine. 2017 April 24-28, Kyiv. %R 10.5210/ojphi.v10i1.8898 %U %U https://doi.org/10.5210/ojphi.v10i1.8898 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 10 %N 1 %P e8957 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2018 %7 ..2018 %9 %J Online J Public Health Inform %G English %X ObjectiveUse ESSENCE to create a sustainable process for identifying ED and urgent care visits that may be related to harmful algal bloom exposure in Oregon.IntroductionHarmful algal blooms (HABs) consist of colonies of prokaryotic photosynthetic bacteria algae that can produce harmful toxins. The toxins produced by HABs are considered a One Health issue. HABs can occur in all types of water (fresh, brackish, and salt water) and are composed of cyanobacteria or microalgae. As the climate changes, so do many of the factors that contribute to the growth of HABs, which in turn, can increase the incidence of HAB-related illness in humans.There are three main pathways that HAB toxins can affect human health: dermal, gastrointestinal (GI), and neurological. Swimming in or consuming contaminated water and eating contaminated shellfish are ways to develop HAB-related illnesses. Contact with cells from a bloom while recreating can cause a rash on the body. Most commonly, HAB-related illnesses present with GI symptoms that resemble food poisoning and can affect the liver. Rarely, HABs that produce cyanotoxins can present with neurological symptoms.Issuing and lifting freshwater HAB advisories is within the preview of the Environmental Public Health section at the Oregon Public Health Division. However, most water bodies in the state are not monitored. Because of this, syndromic surveillance was considered as a potentially useful source of HAB exposure information, and the Oregon ESSENCE team was asked to develop a query to help monitor HAB-related complaints.MethodsPreliminary research was done on HABs and the associated health issues, and past advisories were examined to identify locations of interest. Next, keywords and symptoms were evaluated.Initially, the objective was to create a single query for HAB syndromic surveillance, but it became evident that multiple queries would have to be developed to fully encompass the various types of HAB-related illnesses: GI, neurological, and rash.Most commonly Oregon ESSENCE uses chief complaint and discharge diagnosis (CCDD) queries. However, the ICD-10 codes relating to HABs are not widely used, with only two occurrences since June 2015. It was determined that using the already established ESSENCE syndromes of Neuro, GI, and Rash would be most useful. To make the queries HAB-specific, an additional exposure element needed to be added. Exposures to HABs that are of interest occur in recreational freshwater sources. After running this query in the CCDD field, it was determined that the triage note field would yield better results. This is because this field often includes the patient’s verbatim complaints. This produced higher quality results, and a seasonal curve of cases could be seen in the historic data.Since the microcystin threshold for illness is significantly lower for pets; and a permanent HAB alert in southern Oregon was established after several dogs died from drinking contaminated water, tracking neurological cases that followed canine illness was investigated. A free-text triage note query was developed for patients mentioning dogs, and it was combined with the ESSENCE Neuro syndrome. After several attempts, it was clear that this would not be helpful for surveillance of HAB-related illnesses.Ultimately, four query configurations were developed to monitor HAB-related illness. Most importantly, a free-text recreational water query was developed to stand alone and then be paired with three distinct ESSENCE syndromes.Recreational water query text: (, (, ^ lake^ ,andnot, (, ^road^ ,or, ^rd^ ,or, ^sky^ ,or, ^oswego^ ,or, ^view^ ,) ,) ,or, ^swim^ ,or, (, ^ river ^ ,andnot, (, ^driver^, or, ^hood^ ,or, ^rd^ ,or, ^road^ ,or, ^three^ ,) ,) ,or, ^ boat^ ,) ,andnot, ^feels like^All queries were compiled into a myESSENCE page that could be shared for easy monitoring by all members of the team (Figure 1).ResultsThe ESSENCE team monitored the HAB myESSENCE page. The monitoring period for this project stretched from May to early August (MMWR weeks 19-31). Motoring was often informed by HAB alerts and required looking closely at individual visits. Over this time, the number of recreational water related visits varied, but the average was approximately 110 visits a week. This techniques also helped identify cases possibly related to unreported blooms. The months of June and July saw 15 specific cases that were potentially due to HAB exposure. These cases were highlighted and forwarded to Environmental Public Health for investigation.ConclusionsThis process helped refine the use of the triage note field when constructing keyword queries. While not all Oregon facilities provide triage notes, using specific terms allows ESSENCE users to search for words that may not be included in chief complaints. This is most be useful when searching for specific places or events. With further analysis, users can see what chief complaints are most likely to occur in conjunction with specific exposures. Moving forward, the development of a recreational water query has proven to be useful beyond the scope of this HAB project. Alternative versions of this query have been used in other contexts.ReferencesHarmful Algal Bloom (HAB)-Associated Illness. (2017, June 01). Retrieved August 01, 2017, from https://www.cdc.gov/habs/index.html %R 10.5210/ojphi.v10i1.8957 %U %U https://doi.org/10.5210/ojphi.v10i1.8957 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e135 %T Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps %A Sullivan,Rachel K %A Marsh,Samantha %A Halvarsson,Jakob %A Holdsworth,Michelle %A Waterlander,Wilma %A Poelman,Maartje P %A Salmond,Jennifer Ann %A Christian,Hayley %A Koh,Lenny SC %A Cade,Janet E %A Spence,John C %A Woodward,Alistair %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Geelong, Victoria,, Australia, 61 3 52271100, ralph.maddison@deakin.edu.au %K climate change %K noncommunicable diseases %K smartphone apps %K travel %K diet %K greenhouse gas emissions %K carbon footprint %K individual %K behavior change %D 2016 %7 19.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 27993762 %R 10.2196/mhealth.5931 %U http://mhealth.jmir.org/2016/4/e135/ %U https://doi.org/10.2196/mhealth.5931 %U http://www.ncbi.nlm.nih.gov/pubmed/27993762 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 6 %N 1 %P e5044 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2014 %7 ..2014 %9 %J Online J Public Health Inform %G English %X Uncertainty surrounding microbial fate and transport renders the assessment of climate change effects on waterborne pathogens complex and difficult to forecast. The objective of this study is to use watershed modeling to predict the impacts of future climate change and land management scenarios on microbial water quality. Preliminary findings suggest an increased risk to human health due to direct consequences of climate change. Results of watershed-scale microbial load modeling can inform the adoption of pollution control measures required to protect human health and aid development of new water policy. %R 10.5210/ojphi.v6i1.5044 %U %U https://doi.org/10.5210/ojphi.v6i1.5044