Heatwaves, biodiversity and health in times of climate change

array:22 ["pii" => "S0021755724001335" "issn" => "00217557" "doi" => "10.1016/j.jped.2024.10.002" "estado" => "S100" "fechaPublicacion" => "2024-10-31" "aid" => "1337" "copyright" => "Sociedade Brasileira de Pediatria" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 0 "subdocumento" => "rev" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:16 [ "pii" => "S0021755724001323" "issn" => "00217557" "doi" => "10.1016/j.jped.2024.09.004" "estado" => "S100" "fechaPublicacion" => "2024-11-01" "aid" => "1336" "documento" => "article" "crossmark" => 0 "subdocumento" => "rev" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Review article" "titulo" => "Environmental pollution and cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Denise Bousfield da Silva, Mara Albonei Dudeque Pianovski, Neviçolino Pereira de Carvalho Filho" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Denise Bousfield da" "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "Mara Albonei Dudeque" "apellidos" => "Pianovski" ] 2 => array:2 [ "nombre" => "Neviçolino Pereira de" "apellidos" => "Carvalho Filho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755724001323?idApp=UINPBA000049" "url" => "/00217557/unassign/S0021755724001323/v1_202411010423/en/main.assets" ] "itemAnterior" => array:16 [ "pii" => "S0021755724000937" "issn" => "00217557" "doi" => "10.1016/j.jped.2024.06.011" "estado" => "S200" "fechaPublicacion" => "2024-08-14" "aid" => "1309" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Prenatal diagnosis of critical congenital heart disease associated with lower postpartum depressive symptoms: a case-control study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1614 "Ancho" => 3000 "Tamanyo" => 109374 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flowchart of data collection process." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniela R. Vieira, Patrícia P. Ruschel, Márcia M. Schmidt, Paulo Zielinsky" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Daniela R." "apellidos" => "Vieira" ] 1 => array:2 [ "nombre" => "Patrícia P." "apellidos" => "Ruschel" ] 2 => array:2 [ "nombre" => "Márcia M." "apellidos" => "Schmidt" ] 3 => array:2 [ "nombre" => "Paulo" "apellidos" => "Zielinsky" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755724000937?idApp=UINPBA000049" "url" => "/00217557/unassign/S0021755724000937/v1_202408161126/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Review article" "titulo" => "Heatwaves, biodiversity and health in times of climate change" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Marcelo de Paula Corrêa" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Marcelo de Paula" "apellidos" => "Corrêa" "email" => array:1 [ 0 => "mpcorrea@unifei.edu.br" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto de Recursos Naturais, Universidade Federal de Itajubá, Itajubá, MG, Brazil" "identificador" => "aff0001" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1774 "Ancho" => 2167 "Tamanyo" => 384478 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Relative variation (%) of the average maximum temperatures in relation to the year 1950 (solid lines). The dashed lines show the trend curve through linear regression of the data. Data source: World Bank.<a class="elsevierStyleCrossRef" href="#bib0022">22</a>" ] ] ] "textoCompleto" => "IntroductionHeatwaves (HWs) can be defined as periods in which high temperatures accumulate over a sequence of days and nights considered exceptionally warm. There is no formal definition of the minimum time period or temperatures required to constitute a HW. For instance, the National Weather Service of the United States of America (USA) defines HW as a period of abnormally warm weather lasting at least two days or more, and with either high or low humidity.<a class="elsevierStyleCrossRef" href="#bib0001">1</a> In Europe, EuroHEAT, a project coordinated by the Regional Office of the World Health Organization (WHO), provides a more technical definition: “HW is a period in which the apparent maximum and minimum temperatures are above the 90th percentile of the monthly distribution for at least two days”.<a class="elsevierStyleCrossRef" href="#bib0002">2</a> There are also other related terminologies that can help indicate hot spells, such as the tropical nights index, defined as the annual number of days with a minimum nighttime temperature of at least 20 °C.<a class="elsevierStyleCrossRef" href="#bib0003">3</a> In Brazil, the National Institute of Meteorology (INMET) adopts the recommendation of the World Meteorological Organization (WMO), which defines HW as the period of five or more consecutive days during which the maximum daily temperature exceeds the average maximum temperature by at least 5 °C.<a class="elsevierStyleCrossRef" href="#bib0004">4</a>,<a class="elsevierStyleCrossRef" href="#bib0005">5</a>HWs are associated with increased risks in different sectors of society, mainly affecting the economy and health. Among the main effects are the increase in hospitalizations and human mortality, the duration and intensity of droughts, worsening water quality, forest fires and smoke, energy shortages, and agricultural losses, among others. The impact of HWs on mortality and morbidity affects all age groups. However, overall, children and the elderly are the most affected, in addition to people with specific medical conditions, particularly those suffering from cardiovascular and respiratory diseases.<a class="elsevierStyleCrossRef" href="#bib0006">6</a> Recent studies carried out in Brazil show an association between the increased risk of mortality from different causes and the occurrence and intensity of HWs.<a class="elsevierStyleCrossRef" href="#bib0007">7</a>,<a class="elsevierStyleCrossRef" href="#bib0008">8</a>The frequency and intensity of HWs have been increasing across the globe since the 1950s and there is scientific consensus that this trend is associated with climate change.<a class="elsevierStyleCrossRef" href="#bib0009">9</a> These studies also converge on a finding of concern, indicating that the survival limit in several regions of the planet may be reached by the end of the 21st century due to the fatal combination of rising temperatures and extremes, positive or negative, of humidity.<a class="elsevierStyleCrossRef" href="#bib0010">10</a> Human actions that are harmful to the environment, such as deforestation, contribute to the phenomenon of intensification in all regions of Brazil. For instance, the occurrence of more intense HWs in the Amazon in the last decade occurred during extreme droughts in the region and is associated with the reduction of the original forest area.<a class="elsevierStyleCrossRef" href="#bib0011">11</a> This increase in HW episodes has also been recorded in recent decades throughout South America. In Brazil, in particular, a substantial contribution of persistent dry conditions to HW episodes has been observed, highlighting the vulnerability of the region to climate change.<a class="elsevierStyleCrossRef" href="#bib0012">12</a>This article presents a brief overview of the most recent studies on the relationship between the occurrence of HWs, their relationship with biodiversity and their impacts on human health, especially on more vulnerable groups, such as children and adolescents. It is expected that this scientific review, although brief, will contribute to greater awareness on the subject, the development of preventive actions and the faster and more efficient identification to respond to medical emergencies that occur during such climatic episodes. Furthermore, the strengthening of knowledge about the dangers associated with HWs should always be seen as an incentive for the development of more interdisciplinary studies among researchers in the atmospheric and health sciences.Distribution, frequency and intensity of heat waves and their relationship with climate changeThe year 2023 was the warmest year ever recorded in history.<a class="elsevierStyleCrossRef" href="#bib0013">13</a> This claim is corroborated by meteorological records dating back to the 1850s and the reconstruction of a 2000-year time series using mathematical models.<a class="elsevierStyleCrossRef" href="#bib0014">14</a> This record has also been confirmed by indirect evidence, such as studies of ice cores in Antarctica, indicating that it is possibly the warmest year in the last 100,000 years.<a class="elsevierStyleCrossRef" href="#bib0015">15</a> Since its start, 2023 has also been a year of heat extremes occurring simultaneously in different parts of the world. For example, temperatures in some parts of Brazil exceeded 40 °C in mid-September, while much of Australia recorded temperatures 16 °C higher than normal ones. It is important to note that these high temperatures, and their early arrival in early spring, are consistent with projections made in previous studies. This increase in the occurrence of large-scale simultaneous extreme heat seasons is largely related to changes in atmospheric circulation due to global warming.<a class="elsevierStyleCrossRef" href="#bib0016">16</a>HWs are expected to become more frequent, persistent and intense in almost all inhabited regions. These episodes are expected to accompany both soil drying trends, especially in mid-latitudes, as well as occurrences of humid HWs in other regions of the planet, such as in southern Asia, for example. These climate extremes also impact ecosystems and biodiversity through a greater predisposition to the occurrence of forest fires, commonly observed in Brazil, parts of South America, Australia, and the USA, among other countries.<a class="elsevierStyleCrossRef" href="#bib0017">17</a>The consistency of these results is corroborated by studies that use a different range of analyses, databases and models, but whose results converge towards a future of changes in the severity, duration and frequency of HWs due to climate change. These projections indicate a strong impact on the most populous cities on the planet this century, as increases of between 3.4 and 6.6 °C in temperatures and HWs lasting between 4 and 10 days are expected. Even cities further away from the tropical and subtropical regions are expected to experience significant warming. For instance, Paris is expected to experience one of the most significant increases in the severity of HWs, with increases of 3.4 °C in HWs lasting 5 days and 1.7 °C in longer HWs lasting around 10 days.<a class="elsevierStyleCrossRef" href="#bib0018">18</a>In South America, a study of 191 HW episodes observed in the region showed that approximately 47% of these hot spells were observed in the east and southeast of the continent; that is, within Brazilian territory. The hottest area, which extends from the northeast to the southwest of South America, stood out for its higher frequencies of intense HW episodes; and, across the continent, there was a significant increase in the intensity and persistence of HWs between 1979 and 2019.<a class="elsevierStyleCrossRef" href="#bib0019">19</a> There is also significant evidence that HWs are becoming increasingly associated with droughts in northeastern and southeastern Brazil, in the Amazon and in the Pantanal.<a class="elsevierStyleCrossRef" href="#bib0020">20</a> In a study carried out in the state of São Paulo, with observations of HWs occurring between 2000 and 2020, the average temperature of the HWs was approximately 35 °C, with an average duration of 5.3 days. It is important to note that 92% of these extreme events occurred between the springs and summers of the second decade of the studied period, that is, between 2010 and 2020.<a class="elsevierStyleCrossRef" href="#bib0021">21</a><a class="elsevierStyleCrossRef" href="#fig0001">Figures 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a> illustrate this trend of increasing temperatures, by showing the variation, in relation to the year 1950, of the average annual maximum temperatures (Tmáx‾) in four Brazilian states (<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>)<a class="elsevierStyleCrossRef" href="#bib0022">22</a> and of the number of days in the year (NT>25) in the which maximum temperatures exceeded 25 °C (<a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a>).<a class="elsevierStyleCrossRef" href="#bib0022">22</a> The relative differences (RD) depicted in the graphs were calculated as follows:<elsevierMultimedia ident="ueqn0001"></elsevierMultimedia><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia>Where x represents and NT>25 in <a class="elsevierStyleCrossRef" href="#fig0001">Figures 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>, respectively.Note that, in both figures, the linear regression curves of the time series (dashed lines) show a statistically significant increasing trend, (p-value < 0.001), both of and NT>25 between 1950 and 2020. That is, the average maximum temperatures increased between the mid-20th century and the beginning of this century in all regions of the country, with a greater increase in these temperatures in the southeast region of Brazil (blue and red curves). In parallel, the number of days with maximum temperatures above 25 °C increased between 20 and 30% in the south and southeast regions, therefore being a strong indication of the increase in the frequency and intensity of HWs in these regions. <a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a> does not show data for the state of Pernambuco, as there was no significant increase in NT>25, since the maximum temperatures in the region were already above 25 °C for most of the year in 1950.It is important to emphasize that the increases in the occurrence and intensity of HWs in Brazil are also closely related to cyclical phenomena involving positive or negative variations in the average temperatures of the Pacific Ocean. For example, the Pacific Decadal Oscillation (PDO) and El Niño-Southern Oscillation (ENSO) are capable of modulating HWs in different regions of Brazil and the world. The PDO and ENSO are similar phenomena but with distinct temporal variations. While the former has a climate variation lasting about one or two decades, ENSO usually lasts between six and 18 months.<a class="elsevierStyleCrossRef" href="#bib0023">23</a>,<a class="elsevierStyleCrossRef" href="#bib0024">24</a> The southern region of Brazil generally has a greater number of HWs during the warm phase of the PDO (increase in surface temperatures of the Pacific Ocean), while HWs were more frequent in the southeast and midwest regions during the cold phase of the phenomenon and, therefore, related to the decrease in temperatures in the Pacific. Moreover, in the southern part of Brazil, the intensity and persistence of HWs did not change significantly between the two phases of the PDO, but the events have clearly been more intense and persistent in the cold phase.<a class="elsevierStyleCrossRef" href="#bib0025">25</a>Heat waves and children's and adolescents’ healthFrom pregnancy to old age, humans are exposed to the harmful effects of HWs. During pregnancy, these effects are mainly associated with the capacity for thermoregulation and physiological changes, with a consequent increase in the future burden of chronic diseases, both in mothers and their infants.<a class="elsevierStyleCrossRef" href="#bib0026">26</a> Furthermore, the HWs and the record droughts recently observed in southeastern Brazil have resulted in an increase in fetal mortality and preterm births.<a class="elsevierStyleCrossRef" href="#bib0020">20</a> Another study carried out in the country, involving a broad information database from more than 160 million inhabitants, indicated a positive association between the occurrence of HWs and the number of hospitalizations at any age. Regarding mortality, the evidence suggests a greater relationship between HWs and deaths caused by respiratory problems than by cardiovascular causes. Women and the elderly constitute the most vulnerable groups,<a class="elsevierStyleCrossRef" href="#bib0007">7</a> whereas men seem to be more susceptible to dying from ischemic stroke during HW episodes.<a class="elsevierStyleCrossRef" href="#bib0008">8</a>In parallel, the number of hospital admissions due to perinatal conditions was most strongly associated with HWs.<a class="elsevierStyleCrossRef" href="#bib0027">27</a> There is scientific consensus that young children (< 5 years) and elderly individuals (> 65 years), as well as those with chronic or cardiopulmonary diseases, are more vulnerable to HWs, regardless of socioeconomic or geographic factors. Regarding the geographic factor, the tropical regions of the planet stand out, since the increase in temperature during the HWs, and due to climate change, has reached physiological tolerance limits and may become recurrent in the future.<a class="elsevierStyleCrossRef" href="#bib0028">28</a> In addition to the risk of death, daily life under high temperatures reduces labor productivity, increases the risk of injuries and illnesses and, even if indirectly, is associated with an increase in the number of violent crimes, sexual assaults and homicides.<a class="elsevierStyleCrossRef" href="#bib0029">29</a>,<a class="elsevierStyleCrossRef" href="#bib0030">30</a>These problems are further aggravated by the regional socioeconomic context, especially in a country marked by great social inequalities. In the first two decades of this century, approximately 50,000 deaths were attributed to the increasing number of HWs in Brazil, which represents more than 20 times the number of deaths related to landslides in the same period. This excess heat-related mortality tended to be greater in the poorest regions of the country, i.e., north, northeast and midwest regions, with a greater emphasis on people with lower educational levels, among blacks and brown people and, as already noted, among women and the elderly.<a class="elsevierStyleCrossRef" href="#bib0031">31</a> There is an increasing number of recent publications reinforcing the inseparable nature of social vulnerability aspects in the assessment of the relationship between mortality in children under five years of age and climate change. After all, aggregating all-cause mortality results across multiple seasons and climate zones can be misleading about nuances in response to heat exposure.<a class="elsevierStyleCrossRef" href="#bib0032">32</a>In the case of children and adolescents, excessive heat increases the risk of sudden infant death syndrome (SIDS), mental health problems, fluid and electrolyte imbalance, heatstroke fever, and the occurrence of infectious, respiratory, renal, and cardiac diseases.<a class="elsevierStyleCrossRef" href="#bib0033">33</a>,<a class="elsevierStyleCrossRef" href="#bib0034">34</a> Among infants, more deaths are reported during periods of HWs, but conclusive evidence on the direct relationship between these periods of heat and infant mortality is still lacking.<a class="elsevierStyleCrossRef" href="#bib0035">35</a> However, such mortality may also be indirectly affected by HWs, as studies show that deaths by drowning among the elderly<a class="elsevierStyleCrossRef" href="#bib0036">36</a> and children between five and 14 years of age increase by more than 10% during episodes of prolonged heat.<a class="elsevierStyleCrossRef" href="#bib0037">37</a><a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>, adapted from Hicks et al. (2023),<a class="elsevierStyleCrossRef" href="#bib0038">38</a> depicts a summary of the health risks associated with heat exposure.<a class="elsevierStyleCrossRef" href="#bib0039">39</a>,<a class="elsevierStyleCrossRef" href="#bib0040">40</a><elsevierMultimedia ident="tbl0001"></elsevierMultimedia>It is important to note that, among the several health risks depicted in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>, the potential risk of death associated with heatstroke stands out, in addition to implications that can result in insufficient vital organ function, such as the heart, liver and kidneys. Another highlight is the association of heat exposure with the worsening of skin rashes and common chronic diseases, such as asthma.Final considerationsHWs emerge as a growing climate phenomenon and a cause for concern, associated with climate change and environmental degradation. The increase in the frequency and intensity of HWs, as evidenced by historical data and future projections, has direct and severe consequences for public health and biodiversity. Vulnerable groups, such as children, the elderly, and people with pre-existing health conditions, are particularly affected, showing an increase in mortality and hospitalization rates. The intersection between the effects of HWs and socioeconomic factors further aggravates these problems, exposing the social inequalities that permeate the response to these extreme climate events.In this scenario, raising awareness and the implementation of preventive measures are essential to attenuate the impacts of HWs. It is imperative that there be a joint effort between researchers from different disciplines, in addition to effective public policies that address both public health and environmental protection. Promoting interdisciplinary studies and adopting strategies to deal with the consequences of HWs are essential to ensure the safety and well-being of the populations, especially in vulnerable regions. Only through integrated actions will it be possible to face the challenges imposed by HWs and their effects on society. In common, most of the studies cited in this article reinforce the need for more in-depth research on the effects of climate change on health, especially pediatric health, including the establishment of new guidelines for protective factors that take into account subgroups of individuals who are more vulnerable.Author's contributionStudy design, data collection and writing of the manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres2287634" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Data source" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Data summary" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1902435" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0002" "titulo" => "Distribution, frequency and intensity of heat waves and their relationship with climate change" ] 4 => array:2 [ "identificador" => "sec0003" "titulo" => "Heat waves and children's and adolescents’ health" ] 5 => array:2 [ "identificador" => "sec0004" "titulo" => "Final considerations" ] 6 => array:2 [ "identificador" => "sec0005" "titulo" => "Author's contribution" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-09-19" "fechaAceptado" => "2024-10-02" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1902435" "palabras" => array:5 [ 0 => "Climate change" 1 => "Public health" 2 => "Social vulnerability" 3 => "Infant mortality" 4 => "Preventive policies" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesThis article discusses heatwaves (HWs), their definitions, and increasing frequencies associated with climate change, as well as their effects on human health, especially on children and vulnerable groups. It emphasizes the need for interdisciplinary studies to better understand the effects of HWs and preventive actions to mitigate the effects caused by this phenomenon. Data sourceThe data were obtained from recent studies, conducted in Brazil and abroad, on the impacts of HWs. The figures were attained with data provided by the Climate Change Knowledge Portal. Data summaryHWs are periods of extreme heat, modulated by climate phenomena such as El Niño and the Pacific Decadal Oscillations. The frequency and intensity of HWs have increased since the 1950s, driven by climate change. HWs affect public health by increasing the risk of mortality from respiratory and cardiovascular diseases. Children are more vulnerable to problems such as fever caused by heatstroke, respiratory and kidney infections, as well as risks such as sudden infant death syndrome. Almost half of the HW episodes observed in South America in this century occurred in Brazil, mainly in socioeconomically vulnerable regions. ConclusionsThe increase in the number of HWs is a direct consequence of climate change and has severe impacts on public health and biodiversity. Vulnerable groups suffer more from these phenomena, and social inequalities aggravate the problems. It is essential to promote awareness, implement effective public policies and encourage interdisciplinary research to mitigate the effects of HWs on society." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Data source" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Data summary" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "Institution or service to which the study is linked for indexing at Index Medicus/MEDLINE: Instituto de Recursos Naturais – Universidade Federal de Itajubá- Itajubá MG- Brazil." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1774 "Ancho" => 2167 "Tamanyo" => 384478 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Relative variation (%) of the average maximum temperatures in relation to the year 1950 (solid lines). The dashed lines show the trend curve through linear regression of the data. Data source: World Bank.<a class="elsevierStyleCrossRef" href="#bib0022">22</a>" ] ] 1 => array:8 [ "identificador" => "fig0002" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1752 "Ancho" => 2167 "Tamanyo" => 345910 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Relative variation (%) in the number of days in the year in which maximum temperatures exceeded 25 °C in relation to the year 1950 (solid lines). The dashed lines show the trend curve through linear regression of the data. Data source: World Bank.<a class="elsevierStyleCrossRef" href="#bib0022">22</a>" ] ] 2 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Issue \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Problem \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Severity \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Signs \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0006"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Prevention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0007"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0008"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="left" valign="top">Thermoregulation<a class="elsevierStyleCrossRef" href="#bib0039">39</a></td><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Heat stress \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Discomfort \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Normal vital signs \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0013"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="left" valign="top">Limit heat exposureSeek cool or air-conditioned shelterEnsure adequate hydrationAvoid strenuous exerciseInfants, young children, and adolescent athletes are at greatest risk and should be carefully monitored.</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Cool, hydrated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Heat exhaustion \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Thirst, headache, weakness, dizziness, syncope, vomiting, dehydration \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Body temperature < 40 °CTachycardia, hypotensionThere is no dysfunction of the central nervous system or end organs \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Cooling down, resting \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Heat stroke \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Serious, life-threatening \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Neurological dysfunction, altered mental status, hematemesis, hematochezia, purpuric rash, and other symptoms of heat exhaustion \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Body temperature > 40 °CHeart, liver and/or kidney failure, hypotension, arrhythmia, pupillary changes, tetany \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Emergency medical careImmediate cold water immersionContinuous coolingVentilatory supportManage end-organ damage \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Loss of fluids and electrolytes \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Dehydration \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Variable \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Thirst \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Normal vital signs \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Maintain adequate fluid intake \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Adequate fluid and electrolyte intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top">Burns</td><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Sunburn \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Variable \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Erythema, heat, pain, swelling, blisters \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Mainly superficial \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Avoid sun exposureUse sunscreen \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Prevention: shade, clothing coverage, use of sunscreen \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Thermal burn \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Variable \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Erythema, heat, pain, blisters, paleness, or no pain are warning signs of a full-thickness burn. \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Superficial, partial or full-thickness burn \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Check surfaces that may be hot before exposing children \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Prevention: Check hot surfaces, including sand and pavement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="left" valign="top">Other issues</td><a name="en0051"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Asthma exacerbation \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Variable \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Shortness of breath, coughing, wheezing \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Respiratory effort, hypoxemia \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Avoid extreme heat, always have relief medication available \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Asthma management<a class="elsevierStyleCrossRef" href="#bib0040">40</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Heat rash \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Erythematous skin rash (may be pruritic) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Heat rash, common in babies \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Stay in a cool environment, avoid overdressing babies and children \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Light and cool clothes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Edema \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Swelling of the hands and feet \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Dependent edema \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Stay in a cool environment \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Cool and elevate affected areas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Muscle cramps associated with exercise \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">“Heat cramps” can occur with high-intensity exercise in heat or cold environmentThey are more common with lack of physical conditioning, dehydration or poor acclimatization \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Normal vital signs \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Avoid strenuous or unusual exercise on hot days and in unfamiliar climatesEnsure adequate hydration \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Rest, hydration, cooling down and stretching \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3709001.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Health risks associated with heat exposure (adapted from Hicks et al.<a class="elsevierStyleCrossRef" href="#bib0038">38</a>)." ] ] 3 => array:5 [ "identificador" => "ueqn0001" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "RD[%]=100×(xi−x1950x1950)" "Fichero" => "STRIPIN_si2.jpeg" "Tamanyo" => 189 "Alto" => 36 "Ancho" => 178 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Weather Service. During a heat wave. [Accessed em 19 Set 2024]. Disponível em: <a target="_blank" href="https://www.weather.gov/safety/heat-during">https://www.weather.gov/safety/heat-during</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EuroHEAT: Improving Public Health Responses to Extreme weather/heat-waves: Summary For Policy-Makers" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "World Health Organization (WHO). Regional Office for Europe" "etal" => false ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2009" "editorial" => "World Health Organization. Regional Office for Europe" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://iris.who.int/handle/10665/107934" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Crespi A., Terzi S., Cocuccioni S., Zebisch M., Berckmans J., Füssel H.-.M. Climate-related hazard indices for Europe. European Topic Centre on Climate Change impacts, Vulnerability and Adaptation. (ETC/CCA) Technical Paper 2020/1. 2020;64p. <a target="_blank" href="http://doi.org/10.25424/cmcc/climate_related_hazard_indices_europe_2020">https://doi.org/10.25424/cmcc/climate_related_hazard_indices_europe_2020</a>." ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Meteorological Organization. Heatwave. [Accessed em 19 Set 2024]. Disponível em: <a target="_blank" href="https://wmo.int/topics/heatwave">https://wmo.int/topics/heatwave</a>." ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Nacional de Meteorologia. Glossário de termos técnicos. [Accessed em 19 Set 2024]. Disponível em: <a target="_blank" href="https://portal.inmet.gov.br/glossario/glossario#O">https://portal.inmet.gov.br/glossario/glossario#O</a>." ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of heatwaves on mortality and morbidity and the associated vulnerability factors: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.S. Arsad" 1 => "R. Hod" 2 => "N. Ahmad" 3 => "R. Ismail" 4 => "N. Mohamed" 5 => "M. Baharom" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Environ Res Pub Health" "fecha" => "2022" "volumen" => "19" "paginaInicial" => "16356" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of heat waves on cardiovascular and respiratory mortality in Rio de Janeiro, Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.H. Silveira" 1 => "T.R. Cortes" 2 => "M.L. Bell" 3 => "W.L. Junger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "PLoS ONE." "fecha" => "2023" "volumen" => "18" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of heat waves and cold spells on cause-specific mortality in the city of São Paulo, Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.L. Moraes" 1 => "R. Almendra" 2 => "L.V. Barrozo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Int J Hyg Environ Health" "fecha" => "2022" "volumen" => "239" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2023: summary for Policymakers" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Core Writing Team" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.59327/IPCC/AR6-9789291691647.001" "LibroEditado" => array:5 [ "editores" => "H.Lee, J.Romero" "titulo" => "Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel On Climate Change" "paginaInicial" => "1" "paginaFinal" => "34" "serieFecha" => "2023" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heat waves: a hot topic in climate change research" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Marx" 1 => "R. Haunschild" 2 => "L. Bornmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00704-021-03758-y" "Revista" => array:6 [ "tituloSerie" => "Theor Appl Climatol" "fecha" => "2021" "volumen" => "146" "paginaInicial" => "781" "paginaFinal" => "800" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34493886" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0011" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The most extreme heat waves in Amazonia happened under extreme dryness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.F. Costa" 1 => "H.B. Gomes" 2 => "M.C.L. Silva" 3 => "L. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clim Dyn" "fecha" => "2022" "volumen" => "59" "paginaInicial" => "281" "paginaFinal" => "295" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0012" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent increasing frequency of compound summer drought and heatwaves in Southeast Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.L. Geirinhas" 1 => "A. Russo" 2 => "R. Libonati" 3 => "P.M. Sousa" 4 => "D.G. Miralles" 5 => "R.M. Trigo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Environ Res Lett" "fecha" => "2021" "volumen" => "16" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0013" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Bardan R. NASA analysis confirms 2023 as warmest year on record. [Accessed em 19 Set 2024]. Disponível em: <a target="_blank" href="https://www.nasa.gov/news-release/nasa-analysis-confirms-2023-as-warmest-year-on-record">https://www.nasa.gov/news-release/nasa-analysis-confirms-2023-as-warmest-year-on-record</a>." ] ] ] 13 => array:3 [ "identificador" => "bib0014" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2023 summer warmth unparalleled over the past 2,000 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Esper" 1 => "M. Torbenson" 2 => "U. Büntgen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41586-024-07512-y" "Revista" => array:6 [ "tituloSerie" => "Nature" "fecha" => "2024" "volumen" => "631" "paginaInicial" => "94" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38744323" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0015" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2023: weather and climate extremes hitting the globe with emerging features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Zhang" 1 => "R. Clark" 2 => "T. Zhou" 3 => "L. Li" 4 => "C. Li" 5 => "J. Rivera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Atmos Sci" "fecha" => "2024" "volumen" => "41" "paginaInicial" => "1001" "paginaFinal" => "1016" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0016" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observed and projected shifts in hot extremes' season in the Eastern Mediterranean" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Founda" 1 => "K.V. Varotsos" 2 => "F. Pierros" 3 => "C. Giannakopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Global Planet Change" "fecha" => "2019" "volumen" => "175" "paginaInicial" => "190" "paginaFinal" => "200" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0017" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction and projection of heatwaves" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.I. Domeisen" 1 => "E.A. Eltahir" 2 => "E.M. Fischer" 3 => "R. Knutti" 4 => "S.E. Perkins-Kirkpatrick" 5 => "C. Schär" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nat Rev Earth Environ" "fecha" => "2023" "volumen" => "4" "paginaInicial" => "36" "paginaFinal" => "50" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0018" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Future changes in heatwave severity, duration and frequency due to climate change for the most populous cities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.J. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Weather Clim Extrem" "fecha" => "2020" "volumen" => "30" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0019" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Climatology of heatwaves in South America identified through ERA5 reanalysis data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.R. de Araújo" 1 => "A. Frassoni" 2 => "L.F. Sapucci" 3 => "D. Bitencourt" 4 => "F.A. de Brito Neto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Climatol" "fecha" => "2022" "volumen" => "42" "paginaInicial" => "9430" "paginaFinal" => "9448" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0020" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drought–heatwave nexus in Brazil and related impacts on health and fires: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Libonati" 1 => "J.L. Geirinhas" 2 => "P.S. Silva" 3 => "D. Monteiro dos Santos" 4 => "J.A. Rodrigues" 5 => "A. Russo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/nyas.14887" "Revista" => array:6 [ "tituloSerie" => "Ann NY Acad Sci" "fecha" => "2022" "volumen" => "1517" "paginaInicial" => "44" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36052446" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0021" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heat waves in São Paulo State, Brazil: intensity, duration, spatial scope, and atmospheric characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Valverde" 1 => "M.B. Rosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Climatol" "fecha" => "2023" "volumen" => "43" "paginaInicial" => "3782" "paginaFinal" => "3798" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0022" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Bank. Climate change knowledge portal. [Accessed em 19 Set 2024]. Disponível em: <a target="_blank" href="https://climateknowledgeportal.worldbank.org/">https://climateknowledgeportal.worldbank.org/</a>." ] ] ] 22 => array:3 [ "identificador" => "bib0023" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pacific decadal oscillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.J. Mantua" 1 => "S.R. Hare" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Oceanog" "fecha" => "2002" "volumen" => "58" "paginaInicial" => "35" "paginaFinal" => "44" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0024" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seasonal-to-decadal prediction of El Niño-Southern Oscillation and Pacific Decadal Oscillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Choi" 1 => "S.W Son" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clim Atmos Sci" "fecha" => "2022" "volumen" => "5" "paginaInicial" => "29" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0025" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization and spatial coverage of heat waves in subtropical Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.C. Reis" 1 => "N.T. Boiaski" 2 => "S.E. Ferraz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Atmos" "fecha" => "2019" "volumen" => "10" "paginaInicial" => "284" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0026" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extreme heat exposure in pregnancy and risk for preterm birth, low birth weight and stillbirths" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Böckmann" 1 => "M.F. Chersich" 2 => "M.D. Pham" 3 => "A. Areal" 4 => "M.M. Haghighi" 5 => "A. Manyuchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Eur J Pub Health" "fecha" => "2020" "paginaInicial" => "30" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0027" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between heatwaves and risk of hospitalization in Brazil: a nationwide time series study between 2000 and 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Q. Zhao" 1 => "S. Li" 2 => "M.S. Coelho" 3 => "P.H. Saldiva" 4 => "K. Hu" 5 => "R.R. Huxley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "PLoS Med" "fecha" => "2019" "volumen" => "16" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0028" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hot weather and heat extremes: health risks" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.L. Ebi" 1 => "A. Capon" 2 => "P. Berry" 3 => "C. Broderick" 4 => "R. de Dear" 5 => "G. Havenith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(21)01208-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2021" "volumen" => "398" "paginaInicial" => "698" "paginaFinal" => "708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34419205" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0029" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Murder nature: weather and violent crime in rural Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.W. Ishak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "World Develop" "fecha" => "2022" "volumen" => "157" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0030" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interpersonal violence associated with hot weather" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Mahendran" 1 => "R. Xu" 2 => "S. Li" 3 => "S Guo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2021" "volumen" => "5" "paginaInicial" => "571" "paginaFinal" => "572" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0031" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Monteiro dos Santos" 1 => "R. Libonati" 2 => "B.N. Garcia" 3 => "J.L. Geirinhas" 4 => "B.B. Salvi" 5 => "E. Lima e Silva" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "PLoS One" "fecha" => "2024" "volumen" => "19" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0032" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of ambient heat exposure on risk of all-cause mortality in children younger than 5 years in Africa: a pooled time-series analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Brimicombe" 1 => "K. Wieser" 2 => "T. Monthaler" 3 => "D. Jackson" 4 => "J. de Bont" 5 => "M.F. Chersich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet Planet Health" "fecha" => "2024" "volumen" => "8" "paginaInicial" => "640" "paginaFinal" => "646" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0033" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperthermia and heat stress as risk factors for sudden infant death syndrome: a narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Bach" 1 => "J.-P. Libert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Front Pediatr" "fecha" => "2022" "volumen" => "10" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0034" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased temperatures and child health outcomes: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Faurie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Eur J Pub Health" "fecha" => "2023" "paginaInicial" => "33" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0035" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of heat waves on children's health: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Z. Xu" 1 => "P.E. Sheffield" 2 => "H. Su" 3 => "X. Wang" 4 => "Y. Bi" 5 => "S. Tong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00484-013-0655-x" "Revista" => array:6 [ "tituloSerie" => "Int J Biometeorol" "fecha" => "2014" "volumen" => "58" "paginaInicial" => "239" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23525899" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0036" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Examining the relationship between heatwaves and fatal drowning: a case study from Queensland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.E. Peden" 1 => "H.M. Mason" 2 => "J.C. King" 3 => "R.C. Franklin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ip-2023-044938" "Revista" => array:6 [ "tituloSerie" => "Australia Inj Prev" "fecha" => "2024" "volumen" => "30" "paginaInicial" => "7" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37678903" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0037" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association of heatwave with drowning mortality in five provinces of China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Huang" 1 => "Z. Li" 2 => "J. Hu" 3 => "S. Zhu" 4 => "W. Gong" 5 => "C. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Sci Total Environm" "fecha" => "2023" "volumen" => "903" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0038" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Too hot! Preventing, recognizing and managing heat injury in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Hicks" 1 => "L. Komar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/pch/pxac092" "Revista" => array:6 [ "tituloSerie" => "Paediatr Child Health" "fecha" => "2022" "volumen" => "28" "paginaInicial" => "72" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37151923" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0039" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Tanen D. Distúrbios causados pelo calor. Manuais MSD, 2023. [Accessed em 19 Set 2024]. Disponível em:<a target="_blank" href="https://www.msdmanuals.com/pt-br/casa/les%C3%B5es-e-envenenamentos/dist%C3%BArbios-causados-pelo-calor">https://www.msdmanuals.com/pt-br/casa/les%C3%B5es-e-envenenamentos/dist%C3%BArbios-causados-pelo-calor</a>." ] ] ] 39 => array:3 [ "identificador" => "bib0040" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guia Prático De Gestão Da Asma Nos Cuidados De Saúde Primários (atualização 2022)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Vicente" 1 => "R. Costa" 2 => "L. Alves" 3 => "N. Pina" 4 => "J.C. Sousa" 5 => "J. Ramires" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2022" "paginaInicial" => "52" "editorial" => "Springer Healthcare Ibérica S.L." ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://apmgf.pt/wp-content/uploads/2024/01/guia-pratico-de-gestao-da-asma.pdf" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/unassign/S0021755724001335/v1_202410310622/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/00217557/unassign/S0021755724001335/v1_202410310622/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755724001335?idApp=UINPBA000049"]

Statistics

Review article

Marcelo de Paula Corrêa

Instituto de Recursos Naturais, Universidade Federal de Itajubá, Itajubá, MG, Brazil

Read

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:22 [
  "pii" => "S0021755724001335"
  "issn" => "00217557"
  "doi" => "10.1016/j.jped.2024.10.002"
  "estado" => "S100"
  "fechaPublicacion" => "2024-10-31"
  "aid" => "1337"
  "copyright" => "Sociedade Brasileira de Pediatria"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "rev"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:16 [
    "pii" => "S0021755724001323"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2024.09.004"
    "estado" => "S100"
    "fechaPublicacion" => "2024-11-01"
    "aid" => "1336"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "rev"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
      "titulo" => "Environmental pollution and cancer"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Denise Bousfield da Silva, Mara Albonei Dudeque Pianovski, Nevi&#231;olino Pereira de Carvalho Filho"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Denise Bousfield da"
              "apellidos" => "Silva"
            ]
            1 => array:2 [
              "nombre" => "Mara Albonei Dudeque"
              "apellidos" => "Pianovski"
            ]
            2 => array:2 [
              "nombre" => "Nevi&#231;olino Pereira de"
              "apellidos" => "Carvalho Filho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755724001323?idApp=UINPBA000049"
    "url" => "/00217557/unassign/S0021755724001323/v1_202411010423/en/main.assets"
  ]
  "itemAnterior" => array:16 [
    "pii" => "S0021755724000937"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2024.06.011"
    "estado" => "S200"
    "fechaPublicacion" => "2024-08-14"
    "aid" => "1309"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Prenatal diagnosis of critical congenital heart disease associated with lower postpartum depressive symptoms&#58; a case-control study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0001"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1614
              "Ancho" => 3000
              "Tamanyo" => 109374
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "alt0001"
              "detalle" => "Fig "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Flowchart of data collection process&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Daniela R&#46; Vieira, Patr&#237;cia P&#46; Ruschel, M&#225;rcia M&#46; Schmidt, Paulo Zielinsky"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Daniela R&#46;"
              "apellidos" => "Vieira"
            ]
            1 => array:2 [
              "nombre" => "Patr&#237;cia P&#46;"
              "apellidos" => "Ruschel"
            ]
            2 => array:2 [
              "nombre" => "M&#225;rcia M&#46;"
              "apellidos" => "Schmidt"
            ]
            3 => array:2 [
              "nombre" => "Paulo"
              "apellidos" => "Zielinsky"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755724000937?idApp=UINPBA000049"
    "url" => "/00217557/unassign/S0021755724000937/v1_202408161126/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
    "titulo" => "Heatwaves&#44; biodiversity and health in times of climate change"
    "tieneTextoCompleto" => true
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Marcelo de Paula Corr&#234;a"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Marcelo de Paula"
            "apellidos" => "Corr&#234;a"
            "email" => array:1 [
              0 => "mpcorrea@unifei.edu.br"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Instituto de Recursos Naturais&#44; Universidade Federal de Itajub&#225;&#44; Itajub&#225;&#44; MG&#44; Brazil"
            "identificador" => "aff0001"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1774
            "Ancho" => 2167
            "Tamanyo" => 384478
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Relative variation &#40;&#37;&#41; of the average maximum temperatures in relation to the year 1950 &#40;solid lines&#41;&#46; The dashed lines show the trend curve through linear regression of the data&#46; Data source&#58; World Bank&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a></p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Heatwaves &#40;HWs&#41; can be defined as periods in which high temperatures accumulate over a sequence of days and nights considered exceptionally warm&#46; There is no formal definition of the minimum time period or temperatures required to constitute a HW&#46; For instance&#44; the National Weather Service of the United States of America &#40;USA&#41; defines HW as a period of abnormally warm weather lasting at least two days or more&#44; and with either high or low humidity&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> In Europe&#44; EuroHEAT&#44; a project coordinated by the Regional Office of the World Health Organization &#40;WHO&#41;&#44; provides a more technical definition&#58; &#8220;HW is a period in which the apparent maximum and minimum temperatures are above the 90th percentile of the monthly distribution for at least two days&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> There are also other related terminologies that can help indicate hot spells&#44; such as the tropical nights index&#44; defined as the annual number of days with a minimum nighttime temperature of at least 20&#8239;&#176;C&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> In Brazil&#44; the National Institute of Meteorology &#40;INMET&#41; adopts the recommendation of the World Meteorological Organization &#40;WMO&#41;&#44; which defines HW as the period of five or more consecutive days during which the maximum daily temperature exceeds the average maximum temperature by at least 5&#8239;&#176;C&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">HWs are associated with increased risks in different sectors of society&#44; mainly affecting the economy and health&#46; Among the main effects are the increase in hospitalizations and human mortality&#44; the duration and intensity of droughts&#44; worsening water quality&#44; forest fires and smoke&#44; energy shortages&#44; and agricultural losses&#44; among others&#46; The impact of HWs on mortality and morbidity affects all age groups&#46; However&#44; overall&#44; children and the elderly are the most affected&#44; in addition to people with specific medical conditions&#44; particularly those suffering from cardiovascular and respiratory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Recent studies carried out in Brazil show an association between the increased risk of mortality from different causes and the occurrence and intensity of HWs&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">The frequency and intensity of HWs have been increasing across the globe since the 1950s and there is scientific consensus that this trend is associated with climate change&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> These studies also converge on a finding of concern&#44; indicating that the survival limit in several regions of the planet may be reached by the end of the 21st century due to the fatal combination of rising temperatures and extremes&#44; positive or negative&#44; of humidity&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Human actions that are harmful to the environment&#44; such as deforestation&#44; contribute to the phenomenon of intensification in all regions of Brazil&#46; For instance&#44; the occurrence of more intense HWs in the Amazon in the last decade occurred during extreme droughts in the region and is associated with the reduction of the original forest area&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> This increase in HW episodes has also been recorded in recent decades throughout South America&#46; In Brazil&#44; in particular&#44; a substantial contribution of persistent dry conditions to HW episodes has been observed&#44; highlighting the vulnerability of the region to climate change&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">This article presents a brief overview of the most recent studies on the relationship between the occurrence of HWs&#44; their relationship with biodiversity and their impacts on human health&#44; especially on more vulnerable groups&#44; such as children and adolescents&#46; It is expected that this scientific review&#44; although brief&#44; will contribute to greater awareness on the subject&#44; the development of preventive actions and the faster and more efficient identification to respond to medical emergencies that occur during such climatic episodes&#46; Furthermore&#44; the strengthening of knowledge about the dangers associated with HWs should always be seen as an incentive for the development of more interdisciplinary studies among researchers in the atmospheric and health sciences&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Distribution&#44; frequency and intensity of heat waves and their relationship with climate change</span><p id="para0010" class="elsevierStylePara elsevierViewall">The year 2023 was the warmest year ever recorded in history&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> This claim is corroborated by meteorological records dating back to the 1850s and the reconstruction of a 2000-year time series using mathematical models&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> This record has also been confirmed by indirect evidence&#44; such as studies of ice cores in Antarctica&#44; indicating that it is possibly the warmest year in the last 100&#44;000 years&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Since its start&#44; 2023 has also been a year of heat extremes occurring simultaneously in different parts of the world&#46; For example&#44; temperatures in some parts of Brazil exceeded 40&#8239;&#176;C in mid-September&#44; while much of Australia recorded temperatures 16&#8239;&#176;C higher than normal ones&#46; It is important to note that these high temperatures&#44; and their early arrival in early spring&#44; are consistent with projections made in previous studies&#46; This increase in the occurrence of large-scale simultaneous extreme heat seasons is largely related to changes in atmospheric circulation due to global warming&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">HWs are expected to become more frequent&#44; persistent and intense in almost all inhabited regions&#46; These episodes are expected to accompany both soil drying trends&#44; especially in mid-latitudes&#44; as well as occurrences of humid HWs in other regions of the planet&#44; such as in southern Asia&#44; for example&#46; These climate extremes also impact ecosystems and biodiversity through a greater predisposition to the occurrence of forest fires&#44; commonly observed in Brazil&#44; parts of South America&#44; Australia&#44; and the USA&#44; among other countries&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">The consistency of these results is corroborated by studies that use a different range of analyses&#44; databases and models&#44; but whose results converge towards a future of changes in the severity&#44; duration and frequency of HWs due to climate change&#46; These projections indicate a strong impact on the most populous cities on the planet this century&#44; as increases of between 3&#46;4 and 6&#46;6&#8239;&#176;C in temperatures and HWs lasting between 4 and 10 days are expected&#46; Even cities further away from the tropical and subtropical regions are expected to experience significant warming&#46; For instance&#44; Paris is expected to experience one of the most significant increases in the severity of HWs&#44; with increases of 3&#46;4&#8239;&#176;C in HWs lasting 5 days and 1&#46;7&#8239;&#176;C in longer HWs lasting around 10 days&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0013" class="elsevierStylePara elsevierViewall">In South America&#44; a study of 191 HW episodes observed in the region showed that approximately 47&#37; of these hot spells were observed in the east and southeast of the continent&#59; that is&#44; within Brazilian territory&#46; The hottest area&#44; which extends from the northeast to the southwest of South America&#44; stood out for its higher frequencies of intense HW episodes&#59; and&#44; across the continent&#44; there was a significant increase in the intensity and persistence of HWs between 1979 and 2019&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> There is also significant evidence that HWs are becoming increasingly associated with droughts in northeastern and southeastern Brazil&#44; in the Amazon and in the Pantanal&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> In a study carried out in the state of S&#227;o Paulo&#44; with observations of HWs occurring between 2000 and 2020&#44; the average temperature of the HWs was approximately 35&#8239;&#176;C&#44; with an average duration of 5&#46;3 days&#46; It is important to note that 92&#37; of these extreme events occurred between the springs and summers of the second decade of the studied period&#44; that is&#44; between 2010 and 2020&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0014" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0001">Figures 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a> illustrate this trend of increasing temperatures&#44; by showing the variation&#44; in relation to the year 1950&#44; of the average annual maximum temperatures &#40;Tm&#225;x&#8254;&#41; in four Brazilian states &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> and of the number of days in the year &#40;N<span class="elsevierStyleInf">T&#62;25</span>&#41; in the which maximum temperatures exceeded 25&#8239;&#176;C &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The relative differences &#40;RD&#41; depicted in the graphs were calculated as follows&#58;<elsevierMultimedia ident="ueqn0001"></elsevierMultimedia></p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0015" class="elsevierStylePara elsevierViewall">Where x represents and N<span class="elsevierStyleInf">T&#62;25</span> in <a class="elsevierStyleCrossRef" href="#fig0001">Figures 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#44; respectively&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">Note that&#44; in both figures&#44; the linear regression curves of the time series &#40;dashed lines&#41; show a statistically significant increasing trend&#44; &#40;<span class="elsevierStyleItalic">p</span>-value &#60; 0&#46;001&#41;&#44; both of and N<span class="elsevierStyleInf">T&#62;25</span> between 1950 and 2020&#46; That is&#44; the average maximum temperatures increased between the mid-20th century and the beginning of this century in all regions of the country&#44; with a greater increase in these temperatures in the southeast region of Brazil &#40;blue and red curves&#41;&#46; In parallel&#44; the number of days with maximum temperatures above 25&#8239;&#176;C increased between 20 and 30&#37; in the south and southeast regions&#44; therefore being a strong indication of the increase in the frequency and intensity of HWs in these regions&#46; <a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a> does not show data for the state of Pernambuco&#44; as there was no significant increase in N<span class="elsevierStyleInf">T&#62;25</span>&#44; since the maximum temperatures in the region were already above 25&#8239;&#176;C for most of the year in 1950&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">It is important to emphasize that the increases in the occurrence and intensity of HWs in Brazil are also closely related to cyclical phenomena involving positive or negative variations in the average temperatures of the Pacific Ocean&#46; For example&#44; the Pacific Decadal Oscillation &#40;PDO&#41; and El Ni&#241;o-Southern Oscillation &#40;ENSO&#41; are capable of modulating HWs in different regions of Brazil and the world&#46; The PDO and ENSO are similar phenomena but with distinct temporal variations&#46; While the former has a climate variation lasting about one or two decades&#44; ENSO usually lasts between six and 18 months&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> The southern region of Brazil generally has a greater number of HWs during the warm phase of the PDO &#40;increase in surface temperatures of the Pacific Ocean&#41;&#44; while HWs were more frequent in the southeast and midwest regions during the cold phase of the phenomenon and&#44; therefore&#44; related to the decrease in temperatures in the Pacific&#46; Moreover&#44; in the southern part of Brazil&#44; the intensity and persistence of HWs did not change significantly between the two phases of the PDO&#44; but the events have clearly been more intense and persistent in the cold phase&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Heat waves and children&#39;s and adolescents&#8217; health</span><p id="para0018" class="elsevierStylePara elsevierViewall">From pregnancy to old age&#44; humans are exposed to the harmful effects of HWs&#46; During pregnancy&#44; these effects are mainly associated with the capacity for thermoregulation and physiological changes&#44; with a consequent increase in the future burden of chronic diseases&#44; both in mothers and their infants&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Furthermore&#44; the HWs and the record droughts recently observed in southeastern Brazil have resulted in an increase in fetal mortality and preterm births&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Another study carried out in the country&#44; involving a broad information database from more than 160 million inhabitants&#44; indicated a positive association between the occurrence of HWs and the number of hospitalizations at any age&#46; Regarding mortality&#44; the evidence suggests a greater relationship between HWs and deaths caused by respiratory problems than by cardiovascular causes&#46; Women and the elderly constitute the most vulnerable groups&#44;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> whereas men seem to be more susceptible to dying from ischemic stroke during HW episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0019" class="elsevierStylePara elsevierViewall">In parallel&#44; the number of hospital admissions due to perinatal conditions was most strongly associated with HWs&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> There is scientific consensus that young children &#40;&#60; 5 years&#41; and elderly individuals &#40;&#62; 65 years&#41;&#44; as well as those with chronic or cardiopulmonary diseases&#44; are more vulnerable to HWs&#44; regardless of socioeconomic or geographic factors&#46; Regarding the geographic factor&#44; the tropical regions of the planet stand out&#44; since the increase in temperature during the HWs&#44; and due to climate change&#44; has reached physiological tolerance limits and may become recurrent in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> In addition to the risk of death&#44; daily life under high temperatures reduces labor productivity&#44; increases the risk of injuries and illnesses and&#44; even if indirectly&#44; is associated with an increase in the number of violent crimes&#44; sexual assaults and homicides&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a></p><p id="para0020" class="elsevierStylePara elsevierViewall">These problems are further aggravated by the regional socioeconomic context&#44; especially in a country marked by great social inequalities&#46; In the first two decades of this century&#44; approximately 50&#44;000 deaths were attributed to the increasing number of HWs in Brazil&#44; which represents more than 20 times the number of deaths related to landslides in the same period&#46; This excess heat-related mortality tended to be greater in the poorest regions of the country&#44; i&#46;e&#46;&#44; north&#44; northeast and midwest regions&#44; with a greater emphasis on people with lower educational levels&#44; among blacks and brown people and&#44; as already noted&#44; among women and the elderly&#46;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> There is an increasing number of recent publications reinforcing the inseparable nature of social vulnerability aspects in the assessment of the relationship between mortality in children under five years of age and climate change&#46; After all&#44; aggregating all-cause mortality results across multiple seasons and climate zones can be misleading about nuances in response to heat exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a></p><p id="para0021" class="elsevierStylePara elsevierViewall">In the case of children and adolescents&#44; excessive heat increases the risk of sudden infant death syndrome &#40;SIDS&#41;&#44; mental health problems&#44; fluid and electrolyte imbalance&#44; heatstroke fever&#44; and the occurrence of infectious&#44; respiratory&#44; renal&#44; and cardiac diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> Among infants&#44; more deaths are reported during periods of HWs&#44; but conclusive evidence on the direct relationship between these periods of heat and infant mortality is still lacking&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> However&#44; such mortality may also be indirectly affected by HWs&#44; as studies show that deaths by drowning among the elderly<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> and children between five and 14 years of age increase by more than 10&#37; during episodes of prolonged heat&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a><a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#44; adapted from Hicks et al&#46; &#40;2023&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> depicts a summary of the health risks associated with heat exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a></p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0022" class="elsevierStylePara elsevierViewall">It is important to note that&#44; among the several health risks depicted in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#44; the potential risk of death associated with heatstroke stands out&#44; in addition to implications that can result in insufficient vital organ function&#44; such as the heart&#44; liver and kidneys&#46; Another highlight is the association of heat exposure with the worsening of skin rashes and common chronic diseases&#44; such as asthma&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Final considerations</span><p id="para0023" class="elsevierStylePara elsevierViewall">HWs emerge as a growing climate phenomenon and a cause for concern&#44; associated with climate change and environmental degradation&#46; The increase in the frequency and intensity of HWs&#44; as evidenced by historical data and future projections&#44; has direct and severe consequences for public health and biodiversity&#46; Vulnerable groups&#44; such as children&#44; the elderly&#44; and people with pre-existing health conditions&#44; are particularly affected&#44; showing an increase in mortality and hospitalization rates&#46; The intersection between the effects of HWs and socioeconomic factors further aggravates these problems&#44; exposing the social inequalities that permeate the response to these extreme climate events&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">In this scenario&#44; raising awareness and the implementation of preventive measures are essential to attenuate the impacts of HWs&#46; It is imperative that there be a joint effort between researchers from different disciplines&#44; in addition to effective public policies that address both public health and environmental protection&#46; Promoting interdisciplinary studies and adopting strategies to deal with the consequences of HWs are essential to ensure the safety and well-being of the populations&#44; especially in vulnerable regions&#46; Only through integrated actions will it be possible to face the challenges imposed by HWs and their effects on society&#46; In common&#44; most of the studies cited in this article reinforce the need for more in-depth research on the effects of climate change on health&#44; especially pediatric health&#44; including the establishment of new guidelines for protective factors that take into account subgroups of individuals who are more vulnerable&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Author&#39;s contribution</span><p id="para0025" class="elsevierStylePara elsevierViewall">Study design&#44; data collection and writing of the manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:8 [
        0 => array:3 [
          "identificador" => "xres2287634"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abss0001"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abss0002"
              "titulo" => "Data source"
            ]
            2 => array:2 [
              "identificador" => "abss0003"
              "titulo" => "Data summary"
            ]
            3 => array:2 [
              "identificador" => "abss0004"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1902435"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0001"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0002"
          "titulo" => "Distribution&#44; frequency and intensity of heat waves and their relationship with climate change"
        ]
        4 => array:2 [
          "identificador" => "sec0003"
          "titulo" => "Heat waves and children&#39;s and adolescents&#8217; health"
        ]
        5 => array:2 [
          "identificador" => "sec0004"
          "titulo" => "Final considerations"
        ]
        6 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Author&#39;s contribution"
        ]
        7 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-09-19"
    "fechaAceptado" => "2024-10-02"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1902435"
          "palabras" => array:5 [
            0 => "Climate change"
            1 => "Public health"
            2 => "Social vulnerability"
            3 => "Infant mortality"
            4 => "Preventive policies"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objectives</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">This article discusses heatwaves &#40;HWs&#41;&#44; their definitions&#44; and increasing frequencies associated with climate change&#44; as well as their effects on human health&#44; especially on children and vulnerable groups&#46; It emphasizes the need for interdisciplinary studies to better understand the effects of HWs and preventive actions to mitigate the effects caused by this phenomenon&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Data source</span><p id="spara005" class="elsevierStyleSimplePara elsevierViewall">The data were obtained from recent studies&#44; conducted in Brazil and abroad&#44; on the impacts of HWs&#46; The figures were attained with data provided by the Climate Change Knowledge Portal&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Data summary</span><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">HWs are periods of extreme heat&#44; modulated by climate phenomena such as <span class="elsevierStyleItalic">El Ni&#241;o</span> and the Pacific Decadal Oscillations&#46; The frequency and intensity of HWs have increased since the 1950s&#44; driven by climate change&#46; HWs affect public health by increasing the risk of mortality from respiratory and cardiovascular diseases&#46; Children are more vulnerable to problems such as fever caused by heatstroke&#44; respiratory and kidney infections&#44; as well as risks such as sudden infant death syndrome&#46; Almost half of the HW episodes observed in South America in this century occurred in Brazil&#44; mainly in socioeconomically vulnerable regions&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">The increase in the number of HWs is a direct consequence of climate change and has severe impacts on public health and biodiversity&#46; Vulnerable groups suffer more from these phenomena&#44; and social inequalities aggravate the problems&#46; It is essential to promote awareness&#44; implement effective public policies and encourage interdisciplinary research to mitigate the effects of HWs on society&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0001"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abss0002"
            "titulo" => "Data source"
          ]
          2 => array:2 [
            "identificador" => "abss0003"
            "titulo" => "Data summary"
          ]
          3 => array:2 [
            "identificador" => "abss0004"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:1 [
        "nota" => "<p class="elsevierStyleNotepara" id="notep0001">Institution or service to which the study is linked for indexing at Index Medicus&#47;MEDLINE&#58; Instituto de Recursos Naturais &#8211; Universidade Federal de Itajub&#225;- Itajub&#225; MG- Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1774
            "Ancho" => 2167
            "Tamanyo" => 384478
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Relative variation &#40;&#37;&#41; of the average maximum temperatures in relation to the year 1950 &#40;solid lines&#41;&#46; The dashed lines show the trend curve through linear regression of the data&#46; Data source&#58; World Bank&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a></p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0002"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1752
            "Ancho" => 2167
            "Tamanyo" => 345910
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Relative variation &#40;&#37;&#41; in the number of days in the year in which maximum temperatures exceeded 25&#8239;&#176;C in relation to the year 1950 &#40;solid lines&#41;&#46; The dashed lines show the trend curve through linear regression of the data&#46; Data source&#58; World Bank&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a></p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Issue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Prevention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0007"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0008"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="left" valign="top">Thermoregulation<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a></td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Heat stress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Discomfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Normal vital signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="left" valign="top">Limit heat exposureSeek cool or air-conditioned shelterEnsure adequate hydrationAvoid strenuous exerciseInfants&#44; young children&#44; and adolescent athletes are at greatest risk and should be carefully monitored&#46;</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cool&#44; hydrated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Heat exhaustion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Thirst&#44; headache&#44; weakness&#44; dizziness&#44; syncope&#44; vomiting&#44; dehydration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Body temperature &#60; 40&#8239;&#176;CTachycardia&#44; hypotensionThere is no dysfunction of the central nervous system or end organs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cooling down&#44; resting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Heat stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Serious&#44; life-threatening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Neurological dysfunction&#44; altered mental status&#44; hematemesis&#44; hematochezia&#44; purpuric rash&#44; and other symptoms of heat exhaustion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Body temperature &#62; 40&#8239;&#176;CHeart&#44; liver and&#47;or kidney failure&#44; hypotension&#44; arrhythmia&#44; pupillary changes&#44; tetany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Emergency medical careImmediate cold water immersionContinuous coolingVentilatory supportManage end-organ damage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Loss of fluids and electrolytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Dehydration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Thirst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Normal vital signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Maintain adequate fluid intake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Adequate fluid and electrolyte intake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top">Burns</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Sunburn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Erythema&#44; heat&#44; pain&#44; swelling&#44; blisters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mainly superficial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Avoid sun exposureUse sunscreen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Prevention&#58; shade&#44; clothing coverage&#44; use of sunscreen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Thermal burn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Erythema&#44; heat&#44; pain&#44; blisters&#44; paleness&#44; or no pain are warning signs of a full-thickness burn&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Superficial&#44; partial or full-thickness burn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Check surfaces that may be hot before exposing children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Prevention&#58; Check hot surfaces&#44; including sand and pavement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="left" valign="top">Other issues</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Asthma exacerbation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Shortness of breath&#44; coughing&#44; wheezing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Respiratory effort&#44; hypoxemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Avoid extreme heat&#44; always have relief medication available&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Asthma management<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Heat rash&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Erythematous skin rash &#40;may be pruritic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Heat rash&#44; common in babies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Stay in a cool environment&#44; avoid overdressing babies and children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Light and cool clothes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Swelling of the hands and feet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Dependent edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Stay in a cool environment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cool and elevate affected areas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Muscle cramps associated with exercise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8220;Heat cramps&#8221; can occur with high-intensity exercise in heat or cold environmentThey are more common with lack of physical conditioning&#44; dehydration or poor acclimatization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Normal vital signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Avoid strenuous or unusual exercise on hot days and in unfamiliar climatesEnsure adequate hydration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Rest&#44; hydration&#44; cooling down and stretching&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3709001.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Health risks associated with heat exposure &#40;adapted from Hicks et al&#46;<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a>&#41;&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "ueqn0001"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:5 [
          "Matematica" => "RD&#91;&#37;&#93;&#61;100&#215;&#40;xi&#8722;x1950x1950&#41;"
          "Fichero" => "STRIPIN_si2.jpeg"
          "Tamanyo" => 189
          "Alto" => 36
          "Ancho" => 178
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Weather Service&#46; During a heat wave&#46; &#91;Accessed em 19 Set 2024&#93;&#46; Dispon&#237;vel em&#58; <a target="_blank" href="https://www.weather.gov/safety/heat-during">https&#58;&#47;&#47;www&#46;weather&#46;gov&#47;safety&#47;heat-during</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EuroHEAT&#58; Improving Public Health Responses to Extreme weather&#47;heat-waves&#58; Summary For Policy-Makers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "World Health Organization &#40;WHO&#41;&#46; Regional Office for Europe"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2009"
                        "editorial" => "World Health Organization&#46; Regional Office for Europe"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;iris&#46;who&#46;int&#47;handle&#47;10665&#47;107934"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0003"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Crespi A&#46;&#44; Terzi S&#46;&#44; Cocuccioni S&#46;&#44; Zebisch M&#46;&#44; Berckmans J&#46;&#44; F&#252;ssel H&#46;-&#46;M&#46; Climate-related hazard indices for Europe&#46; European Topic Centre on Climate Change impacts&#44; Vulnerability and Adaptation&#46; &#40;ETC&#47;CCA&#41; Technical Paper 2020&#47;1&#46; 2020&#59;64p&#46; <a target="_blank" href="http://doi.org/10.25424/cmcc/climate_related_hazard_indices_europe_2020">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;25424&#47;cmcc&#47;climate&#95;related&#95;hazard&#95;indices&#95;europe&#95;2020</a>&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0004"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Meteorological Organization&#46; Heatwave&#46; &#91;Accessed em 19 Set 2024&#93;&#46; Dispon&#237;vel em&#58; <a target="_blank" href="https://wmo.int/topics/heatwave">https&#58;&#47;&#47;wmo&#46;int&#47;topics&#47;heatwave</a>&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Meteorologia&#46; Gloss&#225;rio de termos t&#233;cnicos&#46; &#91;Accessed em 19 Set 2024&#93;&#46; Dispon&#237;vel em&#58; <a target="_blank" href="https://portal.inmet.gov.br/glossario/glossario#O">https&#58;&#47;&#47;portal&#46;inmet&#46;gov&#46;br&#47;glossario&#47;glossario&#35;O</a>&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0006"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of heatwaves on mortality and morbidity and the associated vulnerability factors&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;S&#46; Arsad"
                            1 => "R&#46; Hod"
                            2 => "N&#46; Ahmad"
                            3 => "R&#46; Ismail"
                            4 => "N&#46; Mohamed"
                            5 => "M&#46; Baharom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Environ Res Pub Health"
                        "fecha" => "2022"
                        "volumen" => "19"
                        "paginaInicial" => "16356"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0007"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of heat waves on cardiovascular and respiratory mortality in Rio de Janeiro&#44; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46;H&#46; Silveira"
                            1 => "T&#46;R&#46; Cortes"
                            2 => "M&#46;L&#46; Bell"
                            3 => "W&#46;L&#46; Junger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "PLoS ONE&#46;"
                        "fecha" => "2023"
                        "volumen" => "18"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0008"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of heat waves and cold spells on cause-specific mortality in the city of S&#227;o Paulo&#44; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;L&#46; Moraes"
                            1 => "R&#46; Almendra"
                            2 => "L&#46;V&#46; Barrozo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Int J Hyg Environ Health"
                        "fecha" => "2022"
                        "volumen" => "239"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0009"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2023&#58; summary for Policymakers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Core Writing Team"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.59327/IPCC/AR6-9789291691647.001"
                      "LibroEditado" => array:5 [
                        "editores" => "H&#46;Lee, J&#46;Romero"
                        "titulo" => "Climate Change 2023&#58; Synthesis Report&#46; Contribution of Working Groups I&#44; II and III to the Sixth Assessment Report of the Intergovernmental Panel On Climate Change"
                        "paginaInicial" => "1"
                        "paginaFinal" => "34"
                        "serieFecha" => "2023"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heat waves&#58; a hot topic in climate change research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46; Marx"
                            1 => "R&#46; Haunschild"
                            2 => "L&#46; Bornmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00704-021-03758-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Theor Appl Climatol"
                        "fecha" => "2021"
                        "volumen" => "146"
                        "paginaInicial" => "781"
                        "paginaFinal" => "800"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34493886"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0011"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The most extreme heat waves in Amazonia happened under extreme dryness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;F&#46; Costa"
                            1 => "H&#46;B&#46; Gomes"
                            2 => "M&#46;C&#46;L&#46; Silva"
                            3 => "L&#46; Zhou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clim Dyn"
                        "fecha" => "2022"
                        "volumen" => "59"
                        "paginaInicial" => "281"
                        "paginaFinal" => "295"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0012"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recent increasing frequency of compound summer drought and heatwaves in Southeast Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Geirinhas"
                            1 => "A&#46; Russo"
                            2 => "R&#46; Libonati"
                            3 => "P&#46;M&#46; Sousa"
                            4 => "D&#46;G&#46; Miralles"
                            5 => "R&#46;M&#46; Trigo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Environ Res Lett"
                        "fecha" => "2021"
                        "volumen" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0013"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Bardan R&#46; NASA analysis confirms 2023 as warmest year on record&#46; &#91;Accessed em 19 Set 2024&#93;&#46; Dispon&#237;vel em&#58; <a target="_blank" href="https://www.nasa.gov/news-release/nasa-analysis-confirms-2023-as-warmest-year-on-record">https&#58;&#47;&#47;www&#46;nasa&#46;gov&#47;news-release&#47;nasa-analysis-confirms-2023-as-warmest-year-on-record</a>&#46;"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0014"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2023 summer warmth unparalleled over the past 2&#44;000 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Esper"
                            1 => "M&#46; Torbenson"
                            2 => "U&#46; B&#252;ntgen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41586-024-07512-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2024"
                        "volumen" => "631"
                        "paginaInicial" => "94"
                        "paginaFinal" => "97"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38744323"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2023&#58; weather and climate extremes hitting the globe with emerging features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Zhang"
                            1 => "R&#46; Clark"
                            2 => "T&#46; Zhou"
                            3 => "L&#46; Li"
                            4 => "C&#46; Li"
                            5 => "J&#46; Rivera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Atmos Sci"
                        "fecha" => "2024"
                        "volumen" => "41"
                        "paginaInicial" => "1001"
                        "paginaFinal" => "1016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0016"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Observed and projected shifts in hot extremes&#39; season in the Eastern Mediterranean"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Founda"
                            1 => "K&#46;V&#46; Varotsos"
                            2 => "F&#46; Pierros"
                            3 => "C&#46; Giannakopoulos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Global Planet Change"
                        "fecha" => "2019"
                        "volumen" => "175"
                        "paginaInicial" => "190"
                        "paginaFinal" => "200"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0017"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction and projection of heatwaves"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;I&#46; Domeisen"
                            1 => "E&#46;A&#46; Eltahir"
                            2 => "E&#46;M&#46; Fischer"
                            3 => "R&#46; Knutti"
                            4 => "S&#46;E&#46; Perkins-Kirkpatrick"
                            5 => "C&#46; Sch&#228;r"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nat Rev Earth Environ"
                        "fecha" => "2023"
                        "volumen" => "4"
                        "paginaInicial" => "36"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0018"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Future changes in heatwave severity&#44; duration and frequency due to climate change for the most populous cities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;J&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Weather Clim Extrem"
                        "fecha" => "2020"
                        "volumen" => "30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0019"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Climatology of heatwaves in South America identified through ERA5 reanalysis data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;R&#46; de Ara&#250;jo"
                            1 => "A&#46; Frassoni"
                            2 => "L&#46;F&#46; Sapucci"
                            3 => "D&#46; Bitencourt"
                            4 => "F&#46;A&#46; de Brito Neto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Climatol"
                        "fecha" => "2022"
                        "volumen" => "42"
                        "paginaInicial" => "9430"
                        "paginaFinal" => "9448"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drought&#8211;heatwave nexus in Brazil and related impacts on health and fires&#58; a comprehensive review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Libonati"
                            1 => "J&#46;L&#46; Geirinhas"
                            2 => "P&#46;S&#46; Silva"
                            3 => "D&#46; Monteiro dos Santos"
                            4 => "J&#46;A&#46; Rodrigues"
                            5 => "A&#46; Russo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/nyas.14887"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann NY Acad Sci"
                        "fecha" => "2022"
                        "volumen" => "1517"
                        "paginaInicial" => "44"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36052446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0021"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heat waves in S&#227;o Paulo State&#44; Brazil&#58; intensity&#44; duration&#44; spatial scope&#44; and atmospheric characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; Valverde"
                            1 => "M&#46;B&#46; Rosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Climatol"
                        "fecha" => "2023"
                        "volumen" => "43"
                        "paginaInicial" => "3782"
                        "paginaFinal" => "3798"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0022"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Bank&#46; Climate change knowledge portal&#46; &#91;Accessed em 19 Set 2024&#93;&#46; Dispon&#237;vel em&#58; <a target="_blank" href="https://climateknowledgeportal.worldbank.org/">https&#58;&#47;&#47;climateknowledgeportal&#46;worldbank&#46;org&#47;</a>&#46;"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0023"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pacific decadal oscillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;J&#46; Mantua"
                            1 => "S&#46;R&#46; Hare"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Oceanog"
                        "fecha" => "2002"
                        "volumen" => "58"
                        "paginaInicial" => "35"
                        "paginaFinal" => "44"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0024"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seasonal-to-decadal prediction of El Ni&#241;o-Southern Oscillation and Pacific Decadal Oscillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Choi"
                            1 => "S&#46;W Son"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Clim Atmos Sci"
                        "fecha" => "2022"
                        "volumen" => "5"
                        "paginaInicial" => "29"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization and spatial coverage of heat waves in subtropical Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;C&#46; Reis"
                            1 => "N&#46;T&#46; Boiaski"
                            2 => "S&#46;E&#46; Ferraz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Atmos"
                        "fecha" => "2019"
                        "volumen" => "10"
                        "paginaInicial" => "284"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0026"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extreme heat exposure in pregnancy and risk for preterm birth&#44; low birth weight and stillbirths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; B&#246;ckmann"
                            1 => "M&#46;F&#46; Chersich"
                            2 => "M&#46;D&#46; Pham"
                            3 => "A&#46; Areal"
                            4 => "M&#46;M&#46; Haghighi"
                            5 => "A&#46; Manyuchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Eur J Pub Health"
                        "fecha" => "2020"
                        "paginaInicial" => "30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0027"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association between heatwaves and risk of hospitalization in Brazil&#58; a nationwide time series study between 2000 and 2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Q&#46; Zhao"
                            1 => "S&#46; Li"
                            2 => "M&#46;S&#46; Coelho"
                            3 => "P&#46;H&#46; Saldiva"
                            4 => "K&#46; Hu"
                            5 => "R&#46;R&#46; Huxley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "PLoS Med"
                        "fecha" => "2019"
                        "volumen" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0028"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hot weather and heat extremes&#58; health risks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;L&#46; Ebi"
                            1 => "A&#46; Capon"
                            2 => "P&#46; Berry"
                            3 => "C&#46; Broderick"
                            4 => "R&#46; de Dear"
                            5 => "G&#46; Havenith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(21)01208-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2021"
                        "volumen" => "398"
                        "paginaInicial" => "698"
                        "paginaFinal" => "708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34419205"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0029"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Murder nature&#58; weather and violent crime in rural Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;W&#46; Ishak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "World Develop"
                        "fecha" => "2022"
                        "volumen" => "157"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interpersonal violence associated with hot weather"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Mahendran"
                            1 => "R&#46; Xu"
                            2 => "S&#46; Li"
                            3 => "S Guo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2021"
                        "volumen" => "5"
                        "paginaInicial" => "571"
                        "paginaFinal" => "572"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0031"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Monteiro dos Santos"
                            1 => "R&#46; Libonati"
                            2 => "B&#46;N&#46; Garcia"
                            3 => "J&#46;L&#46; Geirinhas"
                            4 => "B&#46;B&#46; Salvi"
                            5 => "E&#46; Lima e Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2024"
                        "volumen" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0032"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of ambient heat exposure on risk of all-cause mortality in children younger than 5 years in Africa&#58; a pooled time-series analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Brimicombe"
                            1 => "K&#46; Wieser"
                            2 => "T&#46; Monthaler"
                            3 => "D&#46; Jackson"
                            4 => "J&#46; de Bont"
                            5 => "M&#46;F&#46; Chersich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Planet Health"
                        "fecha" => "2024"
                        "volumen" => "8"
                        "paginaInicial" => "640"
                        "paginaFinal" => "646"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0033"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperthermia and heat stress as risk factors for sudden infant death syndrome&#58; a narrative review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Bach"
                            1 => "J&#46;-P&#46; Libert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Front Pediatr"
                        "fecha" => "2022"
                        "volumen" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0034"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased temperatures and child health outcomes&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Faurie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Eur J Pub Health"
                        "fecha" => "2023"
                        "paginaInicial" => "33"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of heat waves on children&#39;s health&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Z&#46; Xu"
                            1 => "P&#46;E&#46; Sheffield"
                            2 => "H&#46; Su"
                            3 => "X&#46; Wang"
                            4 => "Y&#46; Bi"
                            5 => "S&#46; Tong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00484-013-0655-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Biometeorol"
                        "fecha" => "2014"
                        "volumen" => "58"
                        "paginaInicial" => "239"
                        "paginaFinal" => "247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23525899"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0036"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Examining the relationship between heatwaves and fatal drowning&#58; a case study from Queensland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;E&#46; Peden"
                            1 => "H&#46;M&#46; Mason"
                            2 => "J&#46;C&#46; King"
                            3 => "R&#46;C&#46; Franklin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ip-2023-044938"
                      "Revista" => array:6 [
                        "tituloSerie" => "Australia Inj Prev"
                        "fecha" => "2024"
                        "volumen" => "30"
                        "paginaInicial" => "7"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37678903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0037"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association of heatwave with drowning mortality in five provinces of China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Huang"
                            1 => "Z&#46; Li"
                            2 => "J&#46; Hu"
                            3 => "S&#46; Zhu"
                            4 => "W&#46; Gong"
                            5 => "C&#46; Zhou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Sci Total Environm"
                        "fecha" => "2023"
                        "volumen" => "903"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0038"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Too hot&#33; Preventing&#44; recognizing and managing heat injury in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Hicks"
                            1 => "L&#46; Komar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/pch/pxac092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Child Health"
                        "fecha" => "2022"
                        "volumen" => "28"
                        "paginaInicial" => "72"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37151923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0039"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Tanen D&#46; Dist&#250;rbios causados pelo calor&#46; Manuais MSD&#44; 2023&#46; &#91;Accessed em 19 Set 2024&#93;&#46; Dispon&#237;vel em&#58;<a target="_blank" href="https://www.msdmanuals.com/pt-br/casa/les%C3%B5es-e-envenenamentos/dist%C3%BArbios-causados-pelo-calor">https&#58;&#47;&#47;www&#46;msdmanuals&#46;com&#47;pt-br&#47;casa&#47;les&#37;C3&#37;B5es-e-envenenamentos&#47;dist&#37;C3&#37;BArbios-causados-pelo-calor</a>&#46;"
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guia Pr&#225;tico De Gest&#227;o Da Asma Nos Cuidados De Sa&#250;de Prim&#225;rios &#40;atualiza&#231;&#227;o 2022&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Vicente"
                            1 => "R&#46; Costa"
                            2 => "L&#46; Alves"
                            3 => "N&#46; Pina"
                            4 => "J&#46;C&#46; Sousa"
                            5 => "J&#46; Ramires"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2022"
                        "paginaInicial" => "52"
                        "editorial" => "Springer Healthcare Ib&#233;rica S&#46;L&#46;"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;apmgf&#46;pt&#47;wp-content&#47;uploads&#47;2024&#47;01&#47;guia-pratico-de-gestao-da-asma&#46;pdf"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00217557/unassign/S0021755724001335/v1_202410310622/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/00217557/unassign/S0021755724001335/v1_202410310622/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755724001335?idApp=UINPBA000049"
]

Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2024.10.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	13	21	34
2024 October	4	4	8

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter