 Allora, molti grazie per l'invitazione del tipo. Sì, io sono Toglio, anche su behalf di Olivier Chanel, ma in realtà sono l'economista. Non sono davvero l'economista, quindi ho avuto qui il ruolo dell'epidemiologismo. L'epidemiologismo era davvero sviluppato. Il tuo era sviluppato, ma questo, c'è l'economia sanitaria, i biaidivarzi agricolti, quindi, non... Sì, penso che fico, soprattutto, a creare in mediterraneo e con altri. Non ho alcun conflitto di interesse. Voglio iniziare con il primo, che ha detto che il climato era buono. È un ipocratist. 2005 anni fa, ha capito che il climato era molto importante per l'economia, perché le persone che vivono, vengono con altri climati, possono sfruttare da diversi disease. E per lui, quello che ha observato, era che l'incidenza e la verità di diversi disease infecti erano cambiate, secondo il luogo. Quindi, come... Siamo riusciti a sapere di l'impacto del cambiamento del climato perché stiamo parlando di creare lungo. Voglio... Questo è una scuola in qualche modo, quindi è molto importante che andiamo ad underlare il tipo diverso di evidenza che abbiamo. Observazione di risorse con data che abbiamo collettato. In mio intervio, che alcuni persone non hanno lo stesso, è che non abbiamo abbastanza di qualità di qualità per fare cosa vogliamo fare, che è semplicemente per relare i cambiamenti climati o cosa ha prodotto per la città. La ricerca esperimentale, potete vedere alcune data, per esempio, per Polenze. È facile lavorare in alcune condizioni esperimentali. La modellina, siamo qui per questo. Possiamo avere un progetto, potete avere un assesimento di attenzione, e più recentemente, che è l'impasto reale, data mining e machine learning. Perché ho qualcosa. E machine learning, perché questo è quello che possiamo fare quando abbiamo un'altra data. Tu hai da discutere, ovviamente. Quindi, con Jean-François e anche con Eric, con François, abbiamo scritto a contribuire a questo libro che può essere appellato. Come vedete, è un accesso aperto. Questa è la regione mediterranea dei cambiamenti climati. Cosa? Sopre la dimensione. Ah, sì, è importante. È buono. Quindi, e hai tutti gli aspetti. La questione, ovviamente, per la regione mediterranea. Io credo che sei famiglia. In ogni caso, hai da essere famiglia con questi cambiamenti climati lungo, virtuali certi, sicuramente, per essere più confermati, perché non c'è una certezza. Perché non abbiamo abbastanza di data. Quindi, questo è un table classico. Tu puoi avere, per esempio, il primo linee è il fenomeno di trend di qualsiasi giorni più luci. Per esempio, una notte di qualsiasi regione, il secondo è qualsiasi giorni più luci, una notte di qualsiasi giorni più luci. E poi hai attuali cambiamenti. Sì, sono semplicemente, molto semplicemente, semplicemente che gli umani contributano a queste cambiamenti. E poi, il senario futuro, ovviamente, siamo molto interessati al senario usual, perché questo è quello che abbiamo avuto. Quindi, io avrò il dettaglio di queste varie variabili climatici trend, ma, ovviamente, sappiamo molto bene la temperatura. Questo è stato scelto da Giosso. La temperatura ha aumentato e questo è responsabile. Quindi, da un punto di vista dell'alto, i cambiamenti climatici possono avere un impatto direttamente, che vedremo, ledendosi ad un impatto dell'alto, ma possono avere anche un impatto indiretto, processi con cambiamenti fisici, cambiamenti biologici o cambiamenti per l'economia, l'economia, la struttura struttura. Questi, questi, questi, questi, questi, ovviamente, hanno un impatto sui social, economico, demografico, l'alto, molto molto con questa struttura, lo vedremo, e poi, ovviamente, sull'alto sistema, e poi, sull'alto impatto. Quindi, principalmente, l'effetto direttamente, cioè, l'effetto sull'alto, l'economia, la struttura struttura, l'infektione del controllo e la progettione del disastro. Sto andando a usare solo un esempio di questo rispetto, e l'effetto di l'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto sull'alto You have a 13 tons, okay? This is a very nice paper in the Lancet, reporting the exposure response association between temperature and the health effect of mortality. As you can see, you have a very often, except in some places, you curve. That means that you have that for very low temperature and that for very high temperature. And these, as a result, an increase of almost 80% of the mortality due to non-optimum temperature. When you go to very extreme cold and hot temperature, this was almost one percent. So one effect of a climate that is going to increase, obviously. Second effect, this was already mentioned by Joss, is the effect of pollution here. We worked the last year with the American Thoracic Society as a European Respiratory Society to define again what is an adverse effect of pollution. The criteria at this time were a little bit different. They were based on fatality, so having really the effect, persistence of fact, population risk, susceptibility, and medical functional significance. This is another open access journal that you can upload. And as you can see, obviously, when you inhale pollution, this goes in the lungs, but besides respiratory diseases, mortality, and morbidity that include COPD, pneumonia, lung cancer, et cetera, there are many other lung disease that can occur because of this pollution. Why? Because a very tiny particolar matter can go to the albueloi and then in the blood, from the blood to all the organs. So that you can see here, type one, type two diabetes, even insulin resistance, high blood pressure, ischemic diseases, stroke, neurological development, neurodegenerative diseases, cardiovascular diseases, myocardial infarction, et cetera, skin aging, and very, very important because the young generation of the future, there is a massive effect on premature birth, degrees, birth weight, the birth just like smoking a cigarette in utero. This is a very important effect, degrees of fetal growth, and that are also risk factor for asthma. So you see many health effect of which health pollution can be responsible. And this effect, still in this work, we want to see biological effect that you can assess taking by specimen, urine, blood, exhaled breath, and we so many. So, just to say obviously that under nutrition, diarrhea, somalaria, extreme weather event are huge killers. This is an example of a Katrina that killed only 2,000 people and say only because the other Nargis, Hurricane killed 138,000 people. So, a lot more. And obviously this means that we really need some broadcasting well down. We were talking about a storm, a dust storm. This can be also as it could be obviously well broadcast. Diarriva is related to a temperature in this paper in the Lancet. It will in Lima, Peru, diarrhea increase at 8% for every one degree temperature increase. So, another example. And just to underline that health impacts are fairly distributed. In some way you have a community admission of greenhouse gases. You know that very often these are from industrialized countries or new industrialized countries. And obviously WHO estimated per capital mortality is aware these sources are not of greenhouse gases are not present. So, I go to what I know because this is my medical background respiratory doctor. All this paper we wrote are also open access. I would like to underline that we start as a European Spiritual Society to produce a position paper on respiratory disease and then there was another paper produced with the allergy. And since then the last one was the World Asthma Organization. And this is very long but everything can be uploaded if you want to better explore this. So, coming back to the direct effect. These are due to temperature immediate rainfall and barometric pressure. And here all these events are mentioned in the paper. I have just a show except the last one. So, virtually certainly we know that we have more asthma and COPD morbidity with cold temperature. We have more COPD mortality with also cold temperature, sorry. And we have immediate that obviously boost asthma and allergic to rhinitis. Likely is an increase of asthma and rhinitis development. We call temperature and risk of asthma, rhinitis, morbidity with the drain because of humidity. To be further confirmed that was a very strange result is that you have more pneumothorax the opening of your lung with the hole because of barometric pressure. This was assessed at least in true study. More interesting is the effect of the climate changes on allergens. You know what you need to be allergic for like asthma, asthma, pollen, moles, air pollutants, respiratory infection. And here you have what I was already said we know that desertification is increasing, sunstorm also, wildfire because of the increase of the temperature and then obviously we have more people in towns and more industry in developing countries. And these are the origin of more ozone that is responsible for higher mortality and morbidity and more outdoor particular matter that obviously are both due to human activities and to natural phenomena. What we don't know still is removal by precipitation of a particular matter level, local level you will see why I'm saying that and also we don't know so much this pity about what is going on in indoor settings because we have some so some data Joseph provided so nice data so one simulation projection done by Australian colleagues saying that ozone related mortality for the person that asked how can we isolate climate from the rest this is a model taking into account all the other factor for 2060 we'll give 27% for a threshold exceeding so it's a lot in the increase of mortality obviously and the PM there are many many projections Joseph already showed that indicate an increase in all those in mortality obviously respiratory mortality and morbidity. For the indoor just I would like to underline that there is this paper on biomass in Europe last year position paper showing that 30% of fine PM in 2028 will be by for biomass burning overall in the northern country obviously and these has been related obviously to increase morbidity mortality even if some people are trying to really better study the projection this is from Carla Massimo Francesco Groups a very nice study party med where they made the separation between PM that were anthropogenic and PM that were from the desert and as you can see for all but overall for what I'm interested in the respiratory there is in the case of a mission a proper role of the desert PM compared to the anthropogenic PM there are not so many study that made the difference in general they are assessed inside in Europe I don't know if you know that we can take out from the final count because this is a natural cause we are not in responsible for that because in Europe exceeding values are fine I mean if the country go very often too high there is a fine to be paid and but if you have a natural phenomenon you can take out so now what is a very very important in the respiratory allergic and respiratory diseases the fact that we have increasing these allergens but actually they are not only allergens I want to insist on that also that moles and pollen when you have more foods more inundation you have moles proliferation proliferation moles are obviously allergens but they are also toxins they are also microbial, bio, sievo, latale, organica combined that's why you smell moldy when you enter in place where you have many moles and this has not really studied very much but changing temperature, humidity and also the origin of increased pollen production longer pollen season large distribution transport increase the potency of a airborne allergy this means that the pollen is more allergic also due to a pollution exposure and rainfall and plants I give you some examples first of all why do you have more pollets because look this is birch pollen rose here coming from Siberia because of a stronger wind so suddenly you have a pollen that you didn't have before this is why I'm saying more pollen secondly this has been published in science and then there are other papers since the a very first flowering of plants many plants 385 Q garden you know very nice place in near to London where advanced by five days for you this is not important for people that are allergic obviously these towns and may I say that in USA there are 50 million people that suffer from great fever which means a lot of cost because obviously and but you will see that this can become also asthma in some way 16% of this plant had 15 days in a decade in advance this has been confirmed by other study and other way to have new pollens is this is now this is hook green hook in 2100 era as shown that these plants will go up to France we have a genetic background that tell us whether we are allergic or not and to become allergic with clinical sinus intus so we need to meet the allergen if we live here we have allergic to hook we don't suffer from all college ok but here in 2100 we will suffer from that this is the same for many plants when you have more pollens you are also mon allergen this is the beginning of a new sensitization this clinical process you need to become allergic you have a development of allergy you have also early start of a release longer duration of exposure and also for symptoms that are more that become but this has also be complicated by the following that is I'm not going detail on all what you are seeing mainly there is other release then according to the kind of extrusion you can have an allergenic aerosol so in the air or absorption of allergen to pollen bound particles so probably quite complicated but figures help us look here this is a particle where you have an allergen that is tied up and here you have a pollen that has been modified by air pollution so what do you see you see that the actin that is the external part of the pollen is broken and you have all these things coming out and this is because there is a risk of asthma people are allergic have a nasal allergy because the pollen are big and stop in the nose then the pollen black and you have some very small submigrone particles that can go deep in the lung and that are responsible for pollenal asthma that is increasing actually we see more overall children and another effect of pollution that with the same number of pollens that is said the pollen count you have no allergen inside this is an example with CO2 this has been observed also with the zone and with other gases NO2 now a new phenomenon that is called thunderstorm probabilmente non l'avete visto quindi è buono quindi questo all the beginning nobody really noticed that and then some researchers started considering that when there is a thunderstorm there is an epidemic of asthma and mission and hospitalization and the last one was very bad 2016 nine death in Australia a country with a good medical system ok and obviously we have a more thunderstorm because of the climate changes that why I'm talking about I'm not going in detail but in epidemiology we use the hills criteria to see whether there is a causality between one effect one exposure and the health effect and most of the all the criteria were respected except the one that is the experimental one because we have some experiments might not enough what is an experiment? Do you have a guy? You put him in a chamber you have a ballast thunderstorm and so it's not really easy to do this is the phenomenon of thunderstorm just when the storm is coming the pollen are in some way go up because of the wind when they are close to the cloud they meet the humidity and they breaks because of the pollen this is the characteristic then also once again because of the climatic condition goes down where it meets people that are allergic but have only nauseal allergy and they start asthma and this is the phenomenon once again and you see once again that is broken all the sub micron particle when go out and this is what has been done by Kimmerz in Australia many years ago he said I take the with the pump the air and they see what is inside and they found so many broken pollens and allergens which is a proof of what I'm saying so now some projection this has been already said what will go into up to 2050 66% of the population will be in town this is another way to see what Joseph was saying he said the traffic is not so important but if you are only in town where traffic is important obviously you are a lot exposed to traffic and actually this is the situation you will see India will win with huge towns Karachi, Pakistan Tokyo is still a very big city but you know that Tokyo is diesel free since a while there are very nice data showing that it was you take out and you diminish mortality and morbidity I laugh a little bit saying that because of the Brexit Paris will be more important than London but I mean this is obviously a small detail so what is the consequence of a rapid branezio obviously traffic congestion so I'll take care as I said limited also we need to think about that there are some people that die of myocardial infarctus because the ambulance cannot go through that's I mean that there are no data on that at all but this has been taken to account more important pollution obviously is going up so adverse health effect psychological impact due to noise we do not start enough noise ma Carla ha studiato molto bene è buono e Carla e ovviamente caccia e vengono io vivo per te, questa è in Italia e Stefano Beni che descrive che è un giocatore un giocatore famoso in Italia che in il paese mette tutto non solo la poluzione perché c'era Argon Senon e poi tetraetilli, benzina molte spore, batteria anomeni spore epigenetoparasite etc etc etc so a town is really a lot of stuff that you meet that's sorry I wrote my but your name just but I mean this is a you very important study projecting what we will have in 2050 ok so a double mortality rate if we don't do anything can pollute have you ever think about the consequence of the internet so please switch off your computer 76 million tons of CO2 produced by internet in 2002 and now 830 million so really something important and I know that Jean-François they're going to show the same the conundrum as I call it of climate changes obviously I'm really interesting what is of interest for what I do so poll and pollution etc but very very important are also migration, conflict and general effect these leads me to talk about the fact that there are susceptible individuals we are a spiritual community elderly children a vulnerable individual leaving those living close to these factor sources there and obviously also the problem of migrants and refugees and migrants are almost 300,000 million people are not in their country they or their town they are elsewhere when you talk about the refugees this is wrong now I think the projection is 60 million and more and this means obviously in an inevitable spectrum at risk of physical nutrition and factual mental a conflictual situation to be talked about I'm skipping the agriculture because you said that very well and just talking about some cost to computer cost you need to take into account this very difficult scheme, this was provided by Olivier obviously and this concern mainly only air pollution so greenhouse is mainly and it's as you can see I think he is doing that in two days so but just to give you a panorama and the cost this has been published is that preliminary data we have a really to be kosho show that the potential 30% rise within next decade in medical cost for allergic disease asthma due to climate change so this is a small part of the whole ok and you know asthma cost billions of the same allergic anitis so we are going research challenge I think the just to be real as research I think that we have to mention the world expose and someone ask it here how can you really be sure that this is the issue and just a reply do you know this depends also on you yeah because of your background genetic your exposure etc. so mister why the from the international agency research council I have almost finished thank you said that to really understand an health outcomes we need to take it on count the totality of exposure individually subject to front conception to that even from pre conception because now we know have you heard about epigenetics so what happened in your grandmother it's you she smoke it you have a higher risk of asthma even if your mother your father didn't smoke come to see me if you want some about that and so really very important and for this ovviamente we need the good data and we need data that are recorded when they say good what does it mean it means standardize the data that can be compared collected in different places of the world that they can be collected so obviously to learn more you have to read me sorry no but this is a very recent paper we wrote on external esposome allergic disease inside that there is a lot of climate changes because climate changes this is an example what is the esposome you see you have external exposure in utero smoking chemical pollution etc. Then no specific external environment here you have your climate the climate all interact to modify your trascryptomy adutoms metabolomics proteomics what are the signals in your body and then through epigenetic genomics interactional you have the diseases and here you have an example you have your climate changes urbanization they impact on the pollution on change of temperature they go to eat and the allergen e depolluzione dp is the diesel particle and then they interact from outdoor as I just said with indoor because you open the windows but also because you simply meet the cat outdoors you have the hair on you you enter in your house and you think it's very clean etc. you are bringing the same for bacteria various etc. So interactional really important it's a finish so maybe the rain I go back to the beginning is changing there is a increase in temperature increase in night due point temperature increase in stream precipitation events the time that someone was talking about climate changes will likely increase a particular matter formation of ozone pollen moles certain population agree the risk from exposure to pollution and especially those with existing respiratory cardiovascular condition elderly, children, migrants, real refugees and public health awareness education coordinator mitigation obviously planning with agency can reduce this effect and I think I leave you on these without reading because this is a mainly what already said but before that an example of mitigation spider in Pakistan because of the fluid where they couldn't stay all up on the tree I think this is a really fantastic example of mitigation due spider web trap the pollens is a work of all it's everything inside Anisimaziano, is there any questions? Ah, yes, but it was in the title and they even prepared because I need to talk with you about the biodiversity hypothesis all these diseases are increasing because of biodiversity loss but I couldn't talk about everything Thank you Isabella This is obviously a very wide field for new research and what's your feeling on priorities on what should be done in the next couple of years, let's say So, as you probably have seen in my point of view there was a lot of clinical and actually but we need the research to better understand I think the it's difficult but the expo zone probably is my first priority I'm doing that, you know that I'm leading this project I'm trying and now we have a very nice environmental database with data on a pollution soil pollution, water pollution, drug consumption mainly All these stuff you see are collected in this database for Europe 28 countries Thank you for this nice talk Maybe I missed something when you present a nice research work comparing between anthropogenic dust and desert dust particles So can you re-explain us I mean the results I'm talking about the work done by Carla Yeah Anyway, you can see when you pump your user device to collect the particle matter you can see just as I said by Joss unfortunately we are not doing that all the time because it's expensive you can see the composition you can see many things so you can separate the the two kind of sources and then using nice models I don't know you are just on smoking? Probably yes, no? Yeah, so you can take out all the other risk factor for diseases you saw you can attribute the proper role of one particle compared to the other This has not been done so far It's an important issue Yes, thank you really for the presentation You reported data on the increase of molds bacteria in our samples related also to environmental climate changes but do you have also information of the changes of the communities of molds and bacteria and how this can be related to the allergic responses and so on? Very good question it was actually in the title and then because of 45 minutes talk obviously I had to change but this is what is called environmental microbiote so there are data obviously not so many that has assessed the evolution in same settings in 5 years for example it depends on the study so yes and one of the most important things is to look at what is called the diversity and why I'm really interested in it because for me this is the way of explaining why several chronic diseases are increasing you know the external microbiote is related your microbiote plurial not only the gut the lung, the nose and now very easy there is a poster Miriam has a poster over there and you do over there go to see it's very simple to explore the nose and it's very well correlated also with the lung and there is no invasive because the lung obviously the lung you have to go in or you can ask people to produce sputum but it's still something invasive the nose you can, you have a kit you take a little bit of your nasal fluid and so but to go back what have we saw also in our study in schools in Europe is a symphony study not yet publishes that according to the external microbiome so the number of bacteria, virus, allergens we had also variation in the microbiome, human microbiome overall in the symptoms and diseases but not all also a school performance because we can imagine although some internal parameter we are not assessing Thank you very much professor Nismain I know there are some other questions I'm sorry we have to move on but please keep that question for the coffee break just after there are two questions here and now, thank you and now we move to the presentation from professor Bernas Wingdo Bernas Wingdo è un medico doctor anche un medico doctor e è stato molto intervallo in produzione materiale per comprendere l'impatto climatico è un membro di l'academia medica l'academia medica oh, è il coffee break oh, sorry, sorry, sorry, sorry ok, Bernas, so I take it all over I take it all over, we start that again and now we have a coffee break we be we be back