[show abstract][hide abstract] ABSTRACT: Heat waves and air pollution are both associated with increased mortality. Their joint effects are less well understood.
We explored the role of air pollution in modifying the effects of heat waves on mortality, within the EuroHEAT project. Daily mortality, meteorologic, and air pollution data from nine European cities for the years 1990-2004 were assembled. We defined heat waves by taking both intensity and duration into account. The city-specific effects of heat wave episodes were estimated using generalized estimating equation models, adjusting for potential confounders with and without inclusion of air pollutants (particles, ozone, nitrogen dioxide, sulphur dioxide, carbon monoxide). To investigate effect modification, we introduced an interaction term between heat waves and each single pollutant in the models. Random effects meta-analysis was used to summarize the city-specific results.
The increase in the number of daily deaths during heat wave episodes was 54% higher on high ozone days compared with low, among people age 75-84 years. The heat wave effect on high PM10 days was increased by 36% and 106% in the 75-84 year and 85+ year age groups, respectively. A similar pattern was observed for effects on cardiovascular mortality. Effect modification was less evident for respiratory mortality, although the heat wave effect itself was greater for this cause of death. The heat wave effect was smaller (15-30%) after adjustment for ozone or PM10.
The heat wave effect on mortality was larger during high ozone or high PM10 days. When assessing the effect of heat waves on mortality, lack of adjustment for ozone and especially PM10 overestimates effect parameters. This bias has implications for public health policy.
[show abstract][hide abstract] ABSTRACT: The change of ambient temperature plays a key role in determining the run of the annual Lyme season. Our aim was to explain the apparent contradiction between the annual unimodal Lyme borreliosis incidence and the bimodal Ixodes ricinus tick activity run – both observed in Hungary – by distinguishing the temperature dependent seasonal human and tick activity, the temperature independent factors, and the multiplicative effect of human outdoor activity in summer holiday, using data from Hungary in the period of 1998-2012. This separation was verified by modeling the Lyme incidence based on the separated factors, and comparing the run of the observed and modeled incidence. We demonstrated the bimodality of tick season by using the originally unimodal Lyme incidence data. To model the outdoor human activity the amount of camping guest nights was used, which showed an irregular run from mid-June to September. The human outdoor activity showed a similar exponential correlation with ambient temperature to that the relative incidence did. It was proved that summer holiday has great influence on Lyme incidence.
International Journal of Environmental Health Research 07/2013; · 1.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: The Patient!s Hayfever Diary (PHD – www.pollendiary.com) is a free
web-based service for people suffering from pollen allergy that is currently used in 13 European countries and exists in 10 lan- guages. PHD users report their pollen- induced symptoms and medication use on a daily basis. PHD users also enter their geographical location so that their symp- toms can be compared with pollen levels recorded at the nearest pollen-monitoring station in the European Aeroallergen Net- work (https://ean.polleninfo.eu/Ean/). This allows users to identify aeroallergens that they are likely to have been exposed to, and for research into thresholds of aeroal- lergens (i.e. the number of pollen grains per cubic metre of air necessary for causing symptoms).
Method: Daily PHD symptom scores and corresponding pollen data for 2009–2012 were analysed. The number of registered PHD users was 26 002. The total number of points related to ocular, nasal and respi- ratory symptoms and medication use ran- ged from 0 (no symptoms) to 26. PHD users were said to be ‘allergic’ if their symptom scores were correlated with levels of a particular pollen type. A symptom score of 15 was deemed to be ‘high’. Results: Analysis of symptom scores entered into PHD from different biogeo- graphical areas confirms the hypothesis that sufferers inhabiting areas with higher atmospheric concentrations of certain pol- len types have a higher tolerance. For example, when comparing symptom scores and atmospheric concentrations of ragweed pollen, it was found that Serbian users required a much higher pollen load to reach a ‘high’ symptom score than Aus- trian users.
Conclusion: The pollen count is considered to be a proxy for exposure to aeroaller- gens. Threshold values are important for sufferers because they can use them to manage symptoms and interpret pollen count information. This knowledge is also useful for general practitioners and aller- gists as it provides corroborative evidence for diagnosis. PHD is the key to solving the perpetual discussion about thresholds for aeroallergens. We emphasize that the thresholds for alerts vary from region to region. Our goal is for pan-European cov- erage of PHD. The data from which will be used to compile European threshold maps for allergy-relevant airborne parti- cles. On this premise a smartphone appli- cation that can provide ‘personalised pollen information’ will be published in March 2013.
[show abstract][hide abstract] ABSTRACT: The increase of Lyme borreliosis (LB) can be expected due to climate change, while the distribution of the disease and annual activity of the vector and host animals depend on several factors of the environment. The presented study aimed to assess expressly the spring season temperature dependence on the incidence of LB in Hungary. The weekly LB data were obtained from the National Epidemiologic and Surveillance System for a period of 13 years - 1998-2010. Daily temperature data were derived from the European Climate Assessment and Dataset. The association was studied at national level, descriptive statistics and linear regression models were applied. A significant increasing trend was observed in the mean temperature of the analysed years (0.052°C per year). The annual LB incidence doubled during the 13 year period. The incidence rates of the periods 1998-2001 and 2007-2010 were 11.1 resp. 17.0 per 100,000. The start of a steep increase in weekly LB incidence (0.1 per 100,000) shifted significantly by 3 weeks earlier, the start date of spring showed similar trend (p=0.0041). LB incidence increased more steadily in spring than in summer, with 79% of the increase being reported during weeks 15-28, with maximum rates of increase occurring in weeks 23-25. The trend was significant between the weeks 15-28. In the warmer years with 19.02°C mean temperature in May and June, the LB incidence curve reached the annual peak 2-3 weeks earlier, and the descending phase of the curve started earlier than in the colder years with 17.06°C of the same period.
Annals of agricultural and environmental medicine: AAEM 06/2013; 20(2):245-51. · 3.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract. Our study intended to explore the potential distributionshif of Phlebotomusariasi, P. neglectus,
P. perfiliewi, P. perniciosus, and P. tobbi, and some other sandfly species: P. papatasi, P. sergenti, and P.
similis. We used climate envelope modeling (CEM) method to determine the ecological requirements of
the species and to model the potential distribution for three periods (1961-1990, 2011-2040, and 2041-
2070). We found that by the end of the 2060’s the Southern UK, Germany, entire France and also the
western part of Poland can be colonized by sandfly species, mostly by P. ariasi and P. pernicosus. P.
ariasishowe the greatest potential northward expansion, from 49°N to 59°N. For all of the studied sand
fly species the entire Mediterranean Basin, the Balkan Peninsula, the Carpathian Basin, and northern
coastline of the Black Sea are potentially suitable. The length of the predicted active period of the vectors
will increase with one or two months.
Keywords: leishmaniasis, climate change, Phlebotomus, potential distribution, climate envelope model
Applied Ecology and Environmental Research 01/2013; 11(2):189-208. · 0.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: SUMMARY Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the 'summarized' approach, data across countries were summarized and analysed as one overall country. In the 'stratified' approach, heterogeneities between countries were taken into account. Pooling using the 'stratified' approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.
Epidemiology and Infection 11/2012; · 2.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper aims to address some gaps in current knowledge by studying temporal and spatial variations
in Artemisia pollen counts (2000–2009) at 13 sites located in different biogeographical areas of Central
and Eastern Europe. Analysis showed that start dates of Artemisia pollen seasons are greatly dependent
on temperature during June and July, with hot summer temperatures having a tendency to delay summer
flowering. However, this relationship is not linear and the rate at which seasons become later increases
when mean minimum June–July temperatures reach a threshold of about 13 ◦C. No explanation for variations
in pollen season intensity could be found. The geographical location or amount of urbanisation did
not influence, either positively or negatively, the seasonal pollen index. Second peaks in Artemisia pollen
seasons can be described as the pollen seasons of late flowering Artemisia species, and mainly occurred in the geographical area south of the Carpathian Mountains. These second peaks can significantly influence the seasonal pollen index, contributing over 50% to the season’s total Artemisia pollen recorded at one site.
Agricultural and Forest Meteorology 01/2012; 160(160):48-59. · 3.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: A progressive global increase in the burden of allergic diseases has affected the industrialized world over the last half century and has been reported in the literature. The clinical evidence reveals a general increase in both incidence and prevalence of respiratory diseases, such as allergic rhinitis (common hay fever) and asthma. Such phenomena may be related not only to air pollution and changes in lifestyle, but also to an actual increase in airborne quantities of allergenic pollen. Experimental enhancements of carbon dioxide (CO[Formula: see text]) have demonstrated changes in pollen amount and allergenicity, but this has rarely been shown in the wider environment. The present analysis of a continental-scale pollen data set reveals an increasing trend in the yearly amount of airborne pollen for many taxa in Europe, which is more pronounced in urban than semi-rural/rural areas. Climate change may contribute to these changes, however increased temperatures do not appear to be a major influencing factor. Instead, we suggest the anthropogenic rise of atmospheric CO[Formula: see text] levels may be influential.
PLoS ONE 01/2012; 7(4):e34076. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper aims to address some gaps in current knowledge by studying temporal and spatial variations in Artemisia pollen counts (2000-2009) at 13 sites located in different biogeographical areas of Central and Eastern Europe. Analysis showed that start dates of Artemisia pollen seasons are greatly dependent on temperature during June and July, with hot summer temperatures having a tendency to delay summer flowering. However, this relationship is not linear and the rate at which seasons become later increases when mean minimum June-July temperatures reach a threshold of about 13 degrees C. No explanation for variations in pollen season intensity could be found. The geographical location or amount of urbanisation did not influence, either positively or negatively, the seasonal pollen index. Second peaks in Artemisia pollen seasons can be described as the pollen seasons of late flowering Artemisia species, and mainly occurred in the geographical area south of the Carpathian Mountains. These second peaks can significantly influence the seasonal pollen index, contributing over 50% to the season's total Artemisia pollen recorded at one site. (C) 2012 Elsevier B.V. All rights reserved
Agricultural and Forest Meteorology 01/2012; 160:48-59. · 3.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2012; 17(14). · 5.49 Impact Factor
[show abstract][hide abstract] ABSTRACT: Recently, research focus has returned to amenable mortality to health care, despite the decreasing trend, as it remains a significant contributor to social and economic loss due to premature death. This article assesses the trends of amenable mortality over time and, its spatial inequalities with respect to deprivation, in Hungary.
An ecological analysis of mortality amenable to health care was carried out using smoothed indirectly standardized mortality ratios, calculated by full hierarchical Bayesian methods, at municipality level. The association between the spatial distribution of amenable mortality and deprivation was also assessed using a Hungarian specific deprivation index.
Trends of mortality amenable to health care were characterized by a decreasing pattern across the studied period, 1996-2008. Areas of significantly high risk of amenable mortality were identified in the North-eastern, Eastern and South-western parts of Hungary. A statistically significant association was found between amenable mortality and deprivation status in both genders. After correcting for bias due to socio-economic confounders, the patterns of areas with excess risks significantly changed.
Differences in deprivation alone cannot explain the spatial distribution of mortality amenable to health care. This study highlights the importance of exploring other factors (e.g. health-care system and individual life style) beyond socio-economic status, which affect health inequalities particularly for health policy makers, who are responsible for the mitigation of health disparities.
The European Journal of Public Health 09/2011; 22(5):620-4. · 2.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Studies of the relationships between low socio-economic status and impaired lung function were conducted mainly in Western European countries and North America. East-West differences remain unexplored. Associations between parental education and lung function were explored using data on 24,010 school-children from eight cross-sectional studies conducted in North America, Western and Eastern Europe. Parental education was defined as low and high using country-specific classifications. Country-specific estimates of effects of low parental education on volume and flow parameters were obtained using linear and logistic regression, controlling for early life and other individual risk factors. Meta-regressions were used for assessment of heterogeneity between country-specific estimates. The association between low parental education and lung function was not consistent across the countries, but showed a more pronounced inverse gradient in the Western countries. The most consistent decrease associated with low parental education was found for peak expiratory flow (PEF), ranging from -2.80 to -1.14%, with statistically significant associations in five out of eight countries. The mean odds ratio for low PEF (<75% of predicted) was 1.34 (95% CI 1.06-1.70) after all adjustments. Although social gradients were attenuated after adjusting for known risk factors, these risk factors could not completely explain the social gradient in lung function.
European Journal of Epidemiology 09/2010; 26(1):45-54. · 5.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: We present here a simple methodology for calculating species inventories for allergenic pollen that can be used by atmospheric transport models. Ragweed (Ambrosia) species distribution or infection level on the Pannonian Plain has been used as an example of how the methodology can be used. The Pannonian Plain is one of the three main regions in Europe recognized as being polluted by Ambrosia. The methodology relies on spatial variations in annual Ambrosia pollen counts, knowledge on ragweed ecology and detailed land cover information. The results of this analysis showed that some of the highest mean annual ragweed pollen concentrations were witnessed around Kecskemét in central Hungary and Novi Sad in northern Serbia. These areas are also the areas with the highest density of Ambrosia habitats. The resulting inventory can be entered into atmospheric transport models in combination with other components such as a phenological model and a model for daily pollen release, in order to simulate the movement of ragweed pollen from the Pannonian Plain. The methodology is likely to be generally applicable for creating inventories of species distribution of allergenic plants. The main requirement is availability of: detailed land cover information; pollen indexes; a list of the most important habitats; and a region of interest that is mainly influenced by local sources.
Agricultural and Forest Meteorology 08/2010; 150:1203-1210. · 3.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: An association between health and socio-economic status is well known. Based on international and national studies, the aims of this study were to develop a multi-dimensional index at the municipality level, to provide information about socio-economic deprivation in Hungary and to investigate the association between socio-economic status and the spatial distribution of premature mortality due to diseases of the circulatory system. Seven municipality level socio-economic indicators were used from the National Information System of Spatial Development (income, low qualification, unemployment, one-parent families, large families, density of housing and car ownership). After normalisation and standardisation, indicator weights were evaluated using factor analysis. A risk analysis study was conducted using the Rapid Inquiry Facility software to evaluate the association between deprivation and the spatial distribution of premature mortality due to diseases of the circulatory system for the years 1998-2004. Areas of significantly high deprivation were identified in the northeastern, eastern and southwestern parts of Hungary. A statistically significant association was found between premature cardiovascular mortality and deprivation status in both genders. The Deprivation Index is the first composite index at the municipality level in Hungary and includes key factors that affect socio-economic status. The identified association highlighted the fact that inequalities in socio-economic status may reflect the spatial distribution of health status in a population. The results can be used to inform prevention strategies and help plan local health promotion programs aimed at reducing health inequalities.
Social Science [?] Medicine 02/2010; 70(9):1342-9. · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.
Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated.
The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions.
Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.
Environmental Health 01/2010; 9:37. · 2.71 Impact Factor