BACKGROUND:in environmental epidemiology, critical appraisal of evidence across studies and quantitative synthesis is crucial to inform public health, but it is challenged by the heterogeneity in exposure assessment methods. Even when assessing the same exposure, different studies frequently report risk estimates using varying categorical exposure intervals, making it difficult to compare and synthetize findings quantitatively. Advanced meta-analytical methodologies capable of harmonizing different exposure categorizations and effect estimates are crucial for generating flexible, policy-relevant, and locally applicable evidence that can be used in Health Impact Assessments of the disease burden related to environmental exposures and of the potential impact of mitigation measures. OBJECTIVES:to present a transparent and reproducible approach for harmonizing diverse categorical risk estimates (based on differently defined categories) into a per-unit continuous effect estimate, thereby including them in meta-analyses. The method is exemplified through a practical application. METHODS:the method involves three steps: 1. estimating the midpoint of each exposure category and calculating category-specific per-unit continuous beta coefficients from categorical effect estimates; 2. deriving a study-specific continuous effect estimate as a weighted average of these beta coefficients; 3. calculating the uncertainty (i.e., confidence intervals) of the resulting estimate. This approach assumes linearity of risk within categories and independence of category-specific estimates. The method was illustrated through a practical application to the dataset reported by Mataloni et al. (2016), with the aim of deriving a continuous hazard risk associated with a 1 ng/m³ increase in H2S exposure. Method robustness was assessed by comparing results with the true continuous effect and with those deriving from previously published pooling methods that overcome some limitations, including the absence of risk modelling across categories and covariance estimation. The effect of different definitions of central category exposures was also examined. RESULTS:the proposed method was applied in cases where the same exposure (e.g., H2S) was examined across studies for a given health outcome, but varying exposure intervals. A sample calculation is provided, along with an R script and corresponding Excel formulas. The method appears to provide an unbiased estimation of the 'true' continuous effect and obtained results comparable with other more complex methods both in terms of point and interval estimates pooled across categories and was robust to different central category exposures definitions. CONCLUSIONS:the proposed method provides a practical and replicable approach for converting categorical risk estimates into continuous effect estimates, enabling the harmonization of heterogeneous exposure categories across studies. This allows comparability and enables to carry out meta-analyses even in settings with a limited evidence base, where the addition of a single study can meaningfully contribute to the pooled estimate. The method helps overcome a frequent source of heterogeneity in environmental epidemiology, enhancing the robustness, precision, and interpretability of meta-analytical results. Applying methods such as the one here presented to systematic reviews and meta-analyses in the field of environmental epidemiology - where commonly potential effects of exposures are highly uncertain, as in the case of municipal solid waste disposal sites - more valid and robust estimates of the effects of specific environmental exposures can be obtained, therefore providing a stronger evidence base to inform public health decision-making.

This umbrella review synthesises evidence on the unequal health impacts of climate change-related extreme events using an explicit equity-oriented framework. Following PRISMA guidelines, 28 systematic reviews were identified that assessed the health effects of high temperatures, wildfires, floods, droughts, and mixed extreme weather events. Eligibility required reviews to report effect estimates stratified by at least one PROGRESS-Plus dimension, including place of residence, race/ethnicity, occupation, gender, age, religion, education, socio-economic position, social capital, or pre-existing health conditions. Across climate hazards and health outcomes, consistent evidence of differential impacts across PROGRESS-Plus factors was observed. Age and gender were the most frequently examined modifiers, while socio-economic disadvantage, ethnicity, rural residence, and chronic conditions further intensified vulnerability. PROGRESS-Plus not only highlighted vulnerable groups but also provides a framework for guiding policy and intervention design, ensuring that climate-health strategies are equity-sensitive, context-specific, and aimed at addressing structural drivers of disparities rather than only stratifying outcomes.

Abstract Background Farmworkers are at risk for heat-related illnesses (HRI) due to intensifying heat exposure resulting from climate change. Migrant farmworkers might be at further increased risk due to limited control over workplace conditions and language and cultural barriers. This systematic literature review and meta-analysis aims to assess the global prevalence of self-reported heat-related illnesses among migrant farmworkers. Methods We searched five databases for peer-reviewed literature and additional sources to capture grey literature in any language up to October 2024. Studies providing self-reported heat-related symptoms among migrant farmworkers were included. A random effects model was used to calculate the pooled proportion of individual and combined heat-related health outcomes. Separate pooled estimates were included for each symptom as well as the number of symptoms. Risk of bias was assessed using the JBI quality assessment tool. Results Seventeen papers were included, including data from 2966 migrant farmworkers. The pooled proportion for having at least one HRI symptom was 52% (95%CI 39–65) and 21% (95%CI 4–44) reported at least three HRI symptoms. Heterogeneity was high across all pooled estimates (I² ranging from 83% to 99%). The most common symptoms were extreme sweating (46%), weakness (45%), and headache (36%). No differences were found between internal and international migrants nor between studies asking about HRI symptoms experienced in a short-term (e.g., the past week) versus longer periods. Discussion and conclusion Migrant farmworkers reported a high proportion of HRI symptoms. Standardized HRI symptom questionnaires and physiological monitoring can aid in early detection to prevent more serious health issues, allow comparison across settings, and support interventions to mitigate heat-related occupational health risks.

BACKGROUND:public health aims to promote a health-centred approach in all policies, even in adaptation and mitigation policies for climate change. OBJECTIVES:to provide a critical summary on legislations, policies and case studies at international, national and local level and to assess the implementation of the "health lens", in support of researchers and workers on environment and health. DESIGN:document review on legislations, policies and case studies, focusing on mitigation of urban health island and sustainable mobility. METHODS:a policy and legislation review was carried out from institutional websites at European and local level. Sustainable urban mobility plans (SUMP) and energy and climate action plans (SECAP) were retrieved for the cities included in the Climactions project (Genoa, Turin, Bologna, Rome, Bari, Palermo) from local authorities' websites. Best practices of urban heat island mitigation and sustainable mobility were searched from European platforms (Climate adapt, Urban mobility observatory -- ELTIS, EIT Urban Mobility) to obtain a critical picture of adaptation and mitigation options in cities. RESULTS:the review shows a large number of legislations, plans, and programmes on adaptation and mitigation both at European and Italian level with a gap between planned and actually implemented actions also due to the lack of dedicated economic resources. There is also an inequal level of implementation among Italian regions, with some criticalities, for example, in the citizen participatory process within the strategic environmental assessment of SUMPs, SECAPs, and adaptation plans. At the local level, in the last decade, several best practices of urban heat island mitigation and sustainable mobility were experienced in different sectors including new urban green space infrastructures, albedo enhancement measures, car-pooling apps, incentives to active mobility, temporary streets liberation, and a combination of measures within adaptation plans such as London Climate Action Plan and Barcelona Superblock programme. Only few measures were health centred embedding public health into urban planning (e.g., the London plan based on the 'healthy streets' approach) suggesting health benefits for the population. CONCLUSIONS:the recent increase in regulations and policies at European and national level is not paralleled by real progresses in climate actions, despite the constant growth of annual emissions. Therefore, there is the need to accelerate the fossil fuel emission mitigation while promoting adaptation to be ready to counteract actual and future climate related risks. Health workers such as paediatricians, family doctors, epidemiologists can advocate the transition and support the citizens and youth engagement in climate-related decision making.

OBJECTIVES:to identify environmental, socioeconomic, and territorial characteristics in five urban areas (Turin, Bologna, Rome, Bari, Palermo) and to identify areas characterized by high environmental and socioeconomic vulnerability. DESIGN:geographical study. SETTING AND PARTICIPANTS:study domain on five Italian cities, each city was characterized at the urban-area level. MAIN OUTCOME MEASURES:for each urban area or neighbourhood, multiple spatial indicators were constructed concerning the main environmental (air pollution, urbanisation, temperature, altitude and presence of rivers and watercourses, greenery, road and rail networks), and socioeconomic (deprivation index) aspects. These characteristics have been synthesised into a composite indicator with a geographically weighted principal component analysis in order to characterise environmental and socioeconomic vulnerability in a single measure that can be more easily interpreted compared to a set of individual indicators. RESULTS:the involved cities have numerous databases suitable for mapping the main environmental and socioeconomic characteristics. Turin is the most populous of these cities and the one which has the highest average daily PM10 value (29.7±1.4 µg/m3). Together with Palermo, it is the city with the highest density of local roads. Data on residential land cover show a South-North gradient, from 50% in Palermo and Bari to 24,5% in Rome. Low-density residential areas prevail in all cities. The synthetic value of the indicator captures the spatial variability of the territory, highlighting the areas of greatest urban vulnerability in each city under study. Bologna and Roma are the cities with the highest percentage of residents in the high environmental, climate, and socioeconomic vulnerability level, respectively 38% and 29%, while Bari and Palermo show the highest fraction of population living in low vulnerability areas. CONCLUSIONS:in this study, five Italian cities were characterised from an environmental, socioeconomic, and spatial perspective. Furthermore, through the use of a synthetic indicator of socioeconomic environmental exposure, the most vulnerable areas were identified. This indicator provides immediate and effective information to support policies to protect health and combat environmental and social risk factors in the area.

OBJECTIVES:to estimate CO2 emissions for different commuting modes before, during, and after the COVID-19 lockdown, and define scenarios to assess their impact on the environment and health. DESIGN:cross-sectional study using data retrieved from a survey. SETTING AND PARTICIPANTS:the study included anonymous participation from both researchers involved in the Climactions project and the general population; the questionnaire was made available through social media. Information was gathered on the transportation modes used to commute, the distance travelled and travel times before, during, and after the COVID-19 emergency, and proposals for actions/solutions to enhance sustainable commuting in urban areas. MAIN OUTCOME MEASURES:the amount of CO2 emissions due to different commuting modes during various stages of the pandemic was estimated based on vehicle-specific emission coefficients provided by the European Environmental Agency, taking into account the average number of passengers per vehicle. Sustainable commuting scenarios were also proposed, including active transportation (walking, cycling, etcetera). RESULTS:the online questionnaire was filled-in by 2,904 persons, predominantly women (62.3%) and residents in Northern Italy (44.6%). Over 80% of the respondents were aged over 40 (0.7% <25 years). On average, the distance travelled on a daily commute was 23.6 km (median: 13 km), with longer distances in the Southern Regions (average: 38.2 km, median: 20 km). The average per-capita CO2 emissions were 2 kg per day in the pre-pandemic situation. The reduction in commuting during lockdown periods led to a significant decrease in estimated CO2 emissions, with an average per capita reduction of about 100 grams per day. From September 2020, the increase in smart working among respondents still allowed for a reduction in estimated CO2 levels, despite an increase in emissions from private vehicle use (1.5 kg per capita per day). Considering sustainable scenarios, a 15-minute walk during the daily commute would lead to a reduction in estimated CO2 levels of up to 0.7 kg per capita per day. Regarding the statement that "improving air quality in cities and reducing greenhouse gas emissions are useful actions to combat climate change", 94% of respondents strongly agreed. CONCLUSIONS:in Italy, road transport accounts for approximately 25% of the total CO2 emissions. The lockdown provided a natural scenario for reducing emissions in urban areas, and the implementation of smart working was associated with a decrease in CO2 emissions due to reduced commuting. However, it is crucial to promote sustainable and active transportation modes for daily commuting such as walking and cycling, also considering the significant health co-benefits.

OBJECTIVES:to quantify the impact of heat on mortality, in terms of heat attributable deaths in 6 Italian cities included in the CCM Climactions project (Turin, Genoa, Bologna, Rome, Bari, Palermo) and to estimate the potential health co-benefits by considering temperature reduction scenarios in urban areas proposed in the project case studies in terms of urban nature-based solutions measures and albedo variation of impervious surfaces. DESIGN:city-specific time series models and impact assessment. SETTING AND PARTICIPANTS:daily mortality counts and average temperature data in six Italian cities (Turin, Genoa, Bologna, Rome, Bari, Palermo) included in the CCM CLIMACTIONS project Main outcome measures: overall mortality. Non-linear distributed lag models were used to estimate risk and attributable deaths for increments between the 75th and the 99th percentiles of the mean temperature distribution (lag 0-3) over the period 2006-2015. To estimate the benefits of the intervention scenarios proposed in Climactions to reduce temperatures in urban areas, the deaths attributable to heat with and without this reduction were calculated and the difference between the two estimates corresponds to the potential change in the impact due to scenario measures introduced. RESULTS:the study reports a reduction in heat attributable deaths between 25% and 35% and between 40% and 60% in all cities, respectively, for the two scenarios of average temperature mitigation equal to 1.3°C and 2°C. CONCLUSIONS:although only referring to simulation scenarios, the study provides further evidence of how urban nature-based solutions and the variation in the albedo of surfaces can be beneficial at an urban level both for the environment and populations health, supporting the implementation of climate change adaptation measures.

Migrant and ethnic minority (MEM) outdoor workers might be at increased risk for heat-related illnesses (HRI), due to environmental exposures, heavy physical work, limited control over workplace conditions and language and cultural barriers. This review aims to synthesize the literature on health impacts of occupational heat exposure among MEM outdoor workers, including risk factors, heat-related perception and behaviour and healthcare utilization. Seventy-six publications were included. Most were conducted in the US, where the weighted prevalence for at least one HRI symptom was 48.8

Municipal solid waste incinerators (MSWIs) are widely used for waste management. However, the health effects of their emissions remain uncertain, needing further investigation and monitoring of the potential risks associated with such exposure. The aim of this study is to update and synthesize evidence on the health effects of residential exposure to MSWIs. A systematic review with meta-analysis was conducted following PRISMA guidelines. The systematic search in MEDLINE, EMBASE, and Web of Science (April 2025), using specific search strategies, identified observational studies reporting quantitative estimates on the association between long term residential exposure to MSWIs and health outcomes. Study quality was assessed using the Navigation Guide tool. A narrative synthesis was conducted for all outcomes. When possible, a random-effects meta-analysis was performed and Higgins I2 was used to summarize heterogeneity. For the overall body of evidence, heatmaps were used to visually represent the direction of the associations (positive, negative or lack of association) stratified by study quality. Out of 3,273 records identified, 51 studies were included. The most frequently investigated outcomes were congenital anomalies, pregnancy outcomes, cardiovascular and respiratory diseases, and cancers. The narrative synthesis suggests a weak association for hospitalizations due to cardiovascular and respiratory diseases in high-quality studies and a potential increased risk for non-Hodgkin lymphoma, based on low-quality evidence. The meta-analysis confirms a slight increased risk for respiratory diseases (HR 1.02; 95

The adoption of diets that minimize both their environmental impacts and weight excess in children would be a major co-benefit for climate change mitigation. We evaluated the relationship between child diet-related environmental impact and anthropometric characteristics in an Italian birth cohort. The study involved 2127 children of the Piccolipiù birth cohort. At 4 years, their diet in the previous two months was assessed through a questionnaire, from which we derived individual: (i) diet-related daily greenhouse gas emissions (GHGE), (ii) land use (LU), (iii) adherence to the Mediterranean Diet (MD) and (iv) red meat consumption. We related these variables with overweight and obesity, waist circumference, and height at 4 years using regression models adjusted for a priori selected confounders. Diet-related GHGE and LU had a positive weak association with overweight and obesity, with an odds ratio (OR) for the fourth vs. second quartile of 1.30 for both GHGE (95% confidence intervals –CI–: 0.96; 1.77) and LU (95% CI: 0.96–1.76). Both OR estimates increased after adjustment for energy intake. GHGE and LU were not associated with height, with the exception of shorter children in the first quartile. A high vs. low MD adherence was associated with an increase in height Z-score of 0.11 (95% CI 0.01; 0.21). No association was found for red meat consumption. These results suggest that lowering the impact of high environmental impact diets may have, if anything, beneficial effects on child obesity, overweight, and height, with pro-MD patterns playing an important role.

In urban areas, environmental exposures to air pollution, extreme temperatures and noise as well as socio-economic inequalities are amplified. Urban green spaces offer dual benefits: they help mitigate climate change and improve public health by fostering connection to nature, reducing noise and air pollution, mitigating the urban heat island effect, and promoting physical activity. Within the 2023 "Cobenefici di Salute ed equità a supporto dei piani di risposta ai cambiamenti climatici in Italia" project funded by the Ministry of Health, we identified health indicators to assess climate action co-benefits, including those on cardiovascular disease mortality and morbidity, birth outcomes and mental health. An increase of 0.1 in the Normalized Difference Vegetation Index (NDVI) was found to be associated with a 3% reduction in cardiovascular mortality rates (95% CI: -4% to -1%). Such estimates will be applied in health impact assessment studies to help guide effective climate adaptation and public health strategies.

Background: Urban areas are disproportionately affected by multiple pressures from overbuilding, traffic, air pollution, and heat waves that often interact and are interconnected in producing health effects. A new synthetic tool to summarize environmental and climatic vulnerability has been introduced for the city of Rome, Italy, to provide the basis for environmental and health policies.Methods: From a literature overview and based on the availability of data, several macro-dimensions were identified on 1,461 grid cells with a width of 1 km2 in Rome: land use, roads and traffic-related exposure, green space data, soil sealing, air pollution (PM2.5, PM10, NO2, C6H6, SO2), urban heat island intensity. The Geographically Weighted Principal Component Analysis (GWPCA) method was performed to produce a composite spatial indicator to describe and interpret each spatial feature by integrating all environmental dimensions. The method of natural breaks was used to define the risk classes. A bivariate map of environmental and social vulnerability was described.Results: The first three components explained most of the variation in the data structure with an average of 78.2% of the total percentage of variance (PTV) explained by the GWPCA, with air pollution and soil sealing contributing most in the first component; green space in the second component; road and traffic density and SO2 in the third component. 56% of the population lives in areas with high or very high levels of environmental and climatic vulnerability, showing a periphery-centre trend, inverse to the deprivation index. Conclusions: A new environmental and climatic vulnerability indicator for the city of Rome was able to identify the areas and population at risk in the city, and can be integrated with other vulnerability dimensions, such as social deprivation, providing the basis for risk stratification of the population and for the design of policies to address environmental, climatic and social injustice.

Abstract Background This study, conducted as part of the European ENBEL project (Horizon 2020), aims at synthesising the scientific evidence on heat health preventive measures targeting vulnerable populations, considering other environmental co-exposures, such as air pollution, wildfires and droughts. Methods A scoping review was performed on Medline and Embase (Ovid) through search terms on clinical and social vulnerabilities, health outcomes (morbidity, mortality, hospitalisation), heatwaves, droughts, air pollution, wildfires, and preventive measures. Records in English published between 2000 and 2023 were included and screened according to PRISMA guidelines. Results 8608 records were retrieved, 5895 of which screened after duplicate removal. 51 were included in the qualitative synthesis. The interventions, mainly targeting workers (from agriculture, healthcare, waste management, firefighting and military sectors) and school athletes, were the most evaluated preventive measures. The role of hydration, rest in the shade, cooling cloths and food, and acclimatisation procedures were highlighted for both groups. On the other hand, local prevention plans, mainly from high-income Countries, focused on the elderly, adults in poor health conditions, homeless and institutionalised people. The implemented measures concentrate on cooling interventions, provision of health care and social services, education and information campaigns. Regarding co-exposures, a study on prevention for firefighters and one on the implementation of Clean Air Centres in California for people vulnerable to heat and smoke were retrieved. A search of the grey literature will be performed to avoid publication bias. Conclusions There is still limited evidence on the effectiveness of preventive measures aimed at protecting vulnerable subgroups from heat-related health effects. The present findings can help orient the public health agenda and research priorities on climate changes adaptation measures. Key messages • Heatwaves are more frequent due to climate change, putting vulnerable population at risk. Developing plans and programs aimed at reducing negative health outcomes related to heat should be a priority. • Hydration, rest, and acclimatization procedures reduce heat-related illnesses in workers and athletes. Local prevention plans for the elderly show the role of education and information.

OBJECTIVES:to describe studies that evaluated the screening programmes implemented in the school during the COVID-19 pandemic.DESIGN:a systematic literature review was conducted according to the PRISMA 2020 Guidelines. Studies published until December 2021 were included. The methodological quality of the studies was assessed with validated scales. Study selection, data extraction, and quality assessment were carried out by two authors independently.SETTING AND PARTICIPANTS:teachers and students belonging to schools of all levels, including universities.MAIN OUTCOMES MEASURES:a. transmission-related outcomes (such as the number or proportion of cases, cumulative frequency, incidence); b. feasibility/acceptability of the screening strategies; c. socioeconomic outcomes (such as testing cost, number of days spent in school, quarantine).RESULTS:after having removed duplicate articles, 2,822 records were retrieved. Thirty-six studies were included (15 used an observational design and 21 modelling study). Regarding the former, the methodological quality has been rated as high in 2 studies, intermediate in 6 and low in 2; in the remaining ones, it was not evaluated because only descriptive. Screenings were quite different in terms of school study population, types of tests used, methods of submission and analysis, and level of incidence in the community at the time of implementation. Outcome indicators were also varied, a heterogeneity that, on the one hand, did not allow for meta-analysis of results and, on the other, allowed for testing the performance of the screenings in very different settings. All of the field studies claim that the screenings reduced SARS-CoV-2 exposure and infection among children, adolescents, and college students, curbing at-school transmission and helping to reduce the number of closing school days. Studies that evaluated the cost of the intervention emphasized its cost-effectiveness, while those that focused on the acceptability of the instrument showed a preference among children, adolescents, and parents for minimally invasive, self-administered tests with high sensitivity and lower frequency of repetition. Simulation-based studies are mostly based on compartmental and agent-based models. Their quality is quite high methodologically, although uncertainty quantification and external validation, aimed at verifying the model ability to reproduce observed data, are lacking in many cases. The contexts to which the simulations refer are all school-based, although 7 studies consider residential situations, which are poorly suited to the Italian context. All simulation-based models indicate the importance of planning repeated testing on asymptomatic individuals to limit contagion. However, the costs of these procedures can be high unless assessments are spaced out or pool testing procedures are used. Obtaining high student adherence to the screening programme is extremely important to maximize results.CONCLUSIONS:school-based screenings, especially when combined with other preventive measures, have been important public health tools to contain infections during COVID-19 waves and to ensure children's and adolescents' right to education and to prevent the fallout in physical and mental health (with strong equity consequences) associated with school closures.

Introduction While there is consistent evidence on the effects of heat on workers' health and safety, the evidence on the resulting social and economic impacts is still limited. A scoping literature review was carried out to update the knowledge about social and economic impacts related to workplace heat exposure. Methods The literature search was conducted in two bibliographic databases (Web of Science and PubMed), to select publications from 2010 to April 2022. Results A total of 89 studies were included in the qualitative synthesis (32 field studies, 8 studies estimating healthcare-related costs, and 49 economic studies). Overall, consistent evidence of the socioeconomic impacts of heat exposure in the workplace emerges. Actual productivity losses at the global level are nearly 10% and are expected to increase up to 30–40% under the worst climate change scenario by the end of the century. Vulnerable regions are mainly low-latitude and low- and middle-income countries with a greater proportion of outdoor workers but include also areas from developed countries such as southern Europe. The most affected sectors are agriculture and construction. There is limited evidence regarding the role of cooling measures and changes in the work/rest schedule in mitigating heat-related productivity loss. Conclusion The available evidence highlights the need for strengthening prevention efforts to enhance workers' awareness and resilience toward occupational heat exposure, particularly in low- and middle-income countries but also in some areas of developed countries where an increase in frequency and intensity of heat waves is expected under future climate change scenarios.

Objectives: to estimate the impact of daily exposure to ex-treme air temperatures (heat and cold) on cause-specific mortality in Italy and to evaluate the differences in the asso-ciation between urban, suburban and rural municipalities. Design: time series analyses with two-stage approach were applied: in the first stage, multiple Poisson regression mod-els and distributed lag non-linear models (DLNM) were used to define the association between temperature and mortal-ity; in the second one, meta-analytic results were obtained by adopting BLUP (Best Linear Unbiased Prediction) coefficients at provincial level, which were then used to estimate the At-tributable Fractions of cause-specific deaths.Setting and participants:cause-specific deaths from 2006 to 2015 in Italy have been analysed by region and overall.Main outcome measures: 5,648,299 total deaths included. Fractions (and relative 95% empirical confidence interval) of deaths attributable to increases from 75th to 99th percentiles of temperature, for heat, and decreases from 25th to 1st per-centile, for cold.Results: the overall impact of air temperature on cause- specific mortality is higher for heat than for cold. When con-sidering heat, the attributable fraction is higher for diseases of the central nervous system (3.6% 95% CI 1.9-4.9) and mental health disease (3.1% 95% CI 1.7-4.4), while consid-ering cold, ischemic disease (1.3% 95% CI 1.1-1.6) and dia-betes (1.3% 95% CI 0.7-1.8) showed the greater impact. By urbanization level, similar impacts were found for cold tem-perature, while for heat there was an indication of higher vulnerability in rural areas emerged Conclusions: results are relevant for the implementation and promotion of preventive measures according to cli-mate change related increase in temperature. The available evidence can provide the basis to identify vulnerable areas and population subgroups to which address current and fu-ture heat and cold adaptation plans in Italy