this study evaluated the association between the risk of events requiring ambulance services and the ambient temperature and particulate matter of 2.5 μm (pM 2.5 ) and 10 μm (pM 10 ) for populations living in subtropical Taiwan. We used a distributed lag nonlinear model with a quasi-Poisson function to assess the roles of ambient temperature, PM 10 and pM 2.5 in the use of ambulance services for respiratory distress, coma and unconsciousness, chest pain, lying down in public, headaches/dizziness/vertigo/ fainting/syncope and out-of-hospital cardiac arrest (OHCA). The relative risk (RR) and 95% confidence interval (CI) of each specific event were calculated in association with the ambient conditions. In general, the events that required ambulance services had a V-shaped or J-shaped association with the temperature, where the risks were higher at extreme temperatures. The RR of each event was significant when the patients were exposed to temperatures in the 5 th percentile (<15 °C); patients with OHCA had the highest adjusted RR of 1.61 (95% CI = 1.47-1.77). The risks were also significant for coma/ unconsciousness, headaches/dizziness/vertigo/fainting/syncope, and OHCA but not for respiratory distress, chest pain and lying down in public, after exposure to the 99 th percentile temperatures of >30 °C. The risks for use of ambulance services increased with PM exposure and were significant for events of respiratory distress, chest pain and OHCA after exposure to the 99 th percentile pM 2.5 after controlling for temperatures. Events requiring ambulance services were more likely to occur when the ambient temperature was low than when it was high for the population on the subtropical island of Taiwan. The association of the risk of events requiring ambulance services with PM were not as strong as the association with low temperatures.The increased frequency and intensity of extreme climate events are important public health concerns 1 . Studies have reported that ambient temperature and air pollution are important factors with significant impacts associated with various morbidities and mortalities [2][3][4] . The associations between mortality and the temperature have been characterized by U-shaped, V-shaped and J-shaped curves 5,6 , with mortality increasing at extremely cold and/or extremely hot temperatures 7,8 . Studies have also found that the risk of emergency room visits for out-of-hospital cardiac arrest (OHCA) was greater in cold seasons than in hot seasons 9-11 . In Taiwan, the cumulative 6-day relative risk of emergency room visits for OHCA reaches 1.73 when the mean temperature is 14 °C in comparison to when it is >27 °C after controlling for air pollution 12 .Climate conditions have important impacts on the transport and dispersion of air pollutants. The role of pollutants in health impacts may thus vary with climate conditions 13 . However, studies may emphasize the impacts of air pollution rather than temperature on health, especially for respiratory diseases. One study that used the Danish Diet, Cancer, ...

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Background This study investigated risks of mortality from and morbidity (emergency room visits (ERVs) and outpatient visits) of asthma and chronic obstructive pulmonary disease (COPD) associated with extreme temperatures, fine particulate matter (PM2.5), and ozone (O3) by sex, and age, from 2005 to 2016 in 6 metropolitan cities in Taiwan. Methods The distributed lag non-linear model was employed to assess age (0–18, 19–39, 40–64, and 65 years and above), sex-cause-specific deaths, ERVs, and outpatient visits associated with extreme high (99th percentile) and low (5th percentile) temperatures and PM2.5 and O3 concentrations at 90th percentile. Random-effects meta-analysis was adopted to investigate cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) for the whole studied areas. Results Only the mortality risk of COPD in the elderly men was significantly associated with the extreme low temperatures. Exposure to the 90th percentile PM2.5 was associated with outpatient visits for asthma in 0–18 years old boys [RR = 1.15 (95% CI: 1.09–1.22)]. Meanwhile, significant elevation of ERVs of asthma for females aged 40–64 years was associated with exposure to ozone, with the highest RR of 1.21 (95% CI: 1.05–1.39). Conclusions This study identified vulnerable subpopulations who were at risk to extreme events associated with ambient environments deserving further evaluation for adaptation.

Treatment cost and quality of domestic water are highly correlated with raw water quality in reservoirs. This study aims to identify the key factors that influence the trophic state levels and correlations among Carlson trophic state index (CTSI) levels, water quality parameters and weather factors in four major reservoirs in Taiwan from 2000 to 2017. Weather (e.g., air temperature, relative humidity, total precipitation, sunlight percentage and cloud cover) and water quality parameters (e.g., pH, chemical oxygen demand, suspended solids (SS), ammonia, total hardness, nitrate, nitrite and water temperature) were included in the principal component analysis and absolute principal component score models to evaluate the main governing factors of the trophic state levels (e.g., CTSI). SS were washed out by precipitation, thereby influencing the reservoir transparency tremendously and contributing over 50% to the CTSI level in eutrophicated reservoirs (e.g., the Shihmen and Chengchinghu Reservoirs). CTSI levels in the mesotrophic reservoir (e.g., Liyutan Reservoir) had strong correlation with chlorophyll-a and total phosphorus. Results show that rainfall/weather factors were the key driving factors that affected the CTSI levels in Taiwan eutrophicated reservoirs, indicating the need to consider basin management and the impacts of extreme precipitation in reservoir management and future policymaking.

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