Urban Effects of Climate Change on Elderly Population and the Need for Implementing Urban Policies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the review. Please refer to my in-text comments and note the Key Points of my critique::

1. There is too little focus on the elderly

2. The role of the health sector and how to adapt its facilities to climate change warrants further discussion,

2. There is too little consideration of an Integrated approach, relative to all the preceding discussion of the impacts. Section 4 therefore should be expanded.

3. The Conclusion section is not a coherent enough summary of the entry, and should not introduce new concepts e.g. climate justice; CARMINE. The Conclusion should better address the overall purpose of the review.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Please refer to in-text comments in attached PDF

Author Response

We sincerely thank Reviewer 1 for the comments, which have greatly helped us enhance the manuscript.

Comment 1.1: "There is too little focus on the elderly."

• Response: We fully agree with this point. We have strengthened the focus on the elderly population throughout the manuscript. Specifically:
• In the Introduction, we explicitly state the focus on the elderly as part of the review's objective.
• In Section 2, we emphasize how the elderly are among the most vulnerable demographics to the impacts of heatwaves and air pollution.
• In Section 3, we dedicate more attention to the vulnerability of the elderly to the neuro-psychological consequences of climate change, integrating this discussion at various points within the section.
• In Section 4, the integrated approach now explicitly positions the elderly (and the frail population in general) as central to urban policies and intervention strategies.
• The Conclusions now explicitly summarize the paper's focus on the elderly and vulnerable populations.

Comment 1.2: "The role of the health sector and how to adapt its facilities to climate change warrants further discussion."

• Response: We have expanded the discussion on the health sector's role and the adaptation of its facilities. In Section 4 ("Integrated and Multidisciplinary Approaches for Urban Resilience"), we added a specific subsection titled "Health Sector Adaptation and Public Health Interventions". Here, we detail how local health authorities should act, including the need to make hospitals and care facilities more climate-resilient (e.g., adequate cooling systems, backup power during heatwaves/power outages) and to train healthcare professionals on climate-related health risks.

Comment 1.3: "There is too little consideration of an Integrated approach, relative to all the preceding discussion of the impacts. Section 4 therefore should be expanded."

• Response: We have completely reorganized and expanded Section 4, now titled "Integrated and Multidisciplinary Approaches for Urban Resilience". The section is now structured around key pillars (Health Sector Interventions, Urban Planning, Social and Community Support Systems, Multi-Scalar Governance and Policy Integration, Research) to provide a more detailed and practical treatment of how an integrated approach can address the impacts of urban climate on the neuro-psychological health of vulnerable populations.

Comment 1.4: "The Conclusion section is not a coherent enough summary of the entry, and should not introduce new concepts e.g. climate justice; CARMINE. The Conclusion should better address the overall purpose of the review."

• Response: We have rewritten Section 5 ("Conclusions") to make it a more coherent and direct summary of the key points presented in the review. The first paragraph now explicitly summarizes the purpose and main findings. We have removed new concepts like "climate justice" and direct references to specific projects such as "CARMINE" from the conclusions section to ensure it remains a synthesis of the content discussed in the article. The CARMINE project is now mentioned only in the Acknowledgments section as a funding source.

Reviewer 2 Report

Comments and Suggestions for Authors

Definition

1. Lines 16-17: The meaning of the sentence is unclear. Please clarify.
2. It is advised that the authors use more common tones and phrases that readers can easily understand. For instance, line 30: ‘a youth base that is progressively evaporating’ is an uncommon expression.
3. The purpose has not been clearly stated. It is unclear how ‘emphasizing the way these evidences…’ has been achieved in the review. Please rephrase for better clarity.
4. I suggest that the authors rewrite the definition in a tone that is easy to understand and follow, as this forms the highlight of the article.

Introduction

1. In the first paragraph, the authors mentioned neurological disorders. While neurological disorders may affect physiological and cognitive domains (as stated in the definition), the connection has to be made clear.
2. The impacts on elderly individuals are also missing from the first paragraph, which is supposed to articulate the problems affecting the elderly.
3. Line 54: Why is Bill Manning mentioned here? And why was a conference held in 2014 singled out? Many references could provide strong justification for sustainable consumption and urban solutions to climate change. Please use more reliable and convincing references.
4. Line 60: No references have been provided to support the connection between green space and physio-psychological effects. The authors may need to review the connection in greater detail.
5. The authors need to connect Figure 1 to the text and explain it in the text.
6. Line 82: Please clarify who the more experienced members of our community are. Was the survey based on published data or an unofficial source?
7. Line 84: How did the authors determine that the size of cities is a key factor in acceptance among the elderly? What acceptance rate was gauged?
8. Line 85: What were the seniors satisfied with?
9. It is challenging to follow the flow of thoughts in the introduction, as the ideas shift quickly between neurological disorders, green space, cities, and the elderly without clear connectors between them. There is also an insufficient linkage to climate change, exacerbating the urban heat island effect, which increases the risk of health problems for the elderly.

Local climate effects on population health

1. Lines 99-100, Line 104, Lines 115-116: Some data is outdated. Please use updated data.
2. It is suggested that the authors use more updated references to show the health impacts of a changing climate. There is an abundance of recent data that can be utilized.
3. The in-text citations are confusing, alternating between (authors, year) and numerical.
4. The authors may need to present the data graphically to establish the relationship between population health and the warming climate. The most recent references should be included to justify the health impacts.
5. This section would also benefit from restructuring to explain the general health trends in relation to different aspects of climate change, particularly urban warming, as the title mentions the urban effect.

Neurological effects of local climate

1. Psychological well-being and neurological effects are different and not interchangeable.
2. Figure 2 has low resolution. It seems to be directly taken from a source. Please ensure that copyright clearance has been obtained. Additionally, the figure is rather general, covering various aspects of climate change, with psychosocial outcomes being one of them.
3. The ideas in this section appear random, with the connection between climate change and psychological well-being among the elderly weakly explained.
4. Line 197: Please clarify ‘UHI, which has the potential to produce a re-vegetation of pollutants’.
5. There is minimal discussion on the elderly, which is the focus of this paper.
6. The discussion of food shortage seems unrelated to psychological well-being. The relationship needs to be discussed explicitly.
7. The mental health consequences are briefly discussed in lines 231 to 246, while they should be the emphasis of this section. Again, there is a lack of discussion about the elderly.
8. Line 259 goes on to include the effects on pregnancy and IQ, which are loosely related to the aim of the paper.
9. This section generally lacks coherence, making it difficult for readers to grasp the theme.

Integrated approach

1. This section seems general and does not sufficiently include practical approaches to address the impacts of urban climate change on the psychological well-being of the elderly.

Conclusion

1. Multiple studies drawing the correlations of physical and psychological health with climate change have been published. The authors may need to refer to more recent literature to update the conclusion.
2. The conclusion offers limited insights into addressing the psychological well-being of the elderly and appears to mention vulnerabilities generally.
3. The conclusion does not seem to connect to the content of the paper.

 

Comments on the Quality of English Language

There are multiple grammatical errors. The paper requires thorough proofreading.

Author Response

We thank Reviewer 2 for the detailed and valuable comments, which have allowed us to refine the clarity and precision of the manuscript.

Comment 2.1: "Definition. Lines 16-17: The meaning of the sentence is unclear. Please clarify."

• Response: We have rephrased the sentence at lines 16-17 to make it clearer and more direct: "Large-scale and local climatic phenomena can induce significant physical and neurological impairments across broad segments of the population. These effects are often compounded by existing economic, social, and health vulnerabilities."

Comment 2.2: "It is advised that the authors use more common tones and phrases that readers can easily understand. For instance, line 30: ‘a youth base that is progressively evaporating’ is an uncommon expression."

• Response: We have revised the language throughout the manuscript, especially in the Introduction, to adopt a more common and accessible tone. The specific phrase "a youth base that is progressively evaporating" has been replaced. More broadly, we have opted for more direct and less colloquial or complex formulations where necessary, for instance, replacing "marked dysfunctional phenomena" with "significant physical and neurological impairments".

Comment 2.3: "The purpose has not been clearly stated. It is unclear how ‘emphasizing the way these evidences…’ has been achieved in the review. Please rephrase for better clarity."

• Response: We have explicitly clarified the purpose of the review in a new dedicated paragraph within the Introduction. We specified that the objective is to "systematically identify and synthesize the evidence linking neurological disorders to interactions with local climate, with a particular focus on vulnerable populations, especially the elderly."

Comment 2.4: "In the first paragraph, the authors mentioned neurological disorders. While neurological disorders may affect physiological and cognitive domains (as stated in the definition), the connection has to be made clear. The impacts on elderly individuals are also missing from the first paragraph, which is supposed to articulate the problems affecting the elderly."

• Response: We have rewritten the first paragraph of the Introduction to establish a clearer connection between climatic phenomena, physical/neurological disorders, and the role of the Urban Heat Island (UHI). Furthermore, we incorporated references to "aging populations" to integrate the focus on the elderly from the very beginning of the article.

Comment 2.5: "Line 54: Why is Bill Manning mentioned here? And why was a conference held in 2014 singled out? Many references could provide strong justification for sustainable consumption and urban solutions to climate change. Please use more reliable and convincing references."

• Response: We have revised the paragraph in question, and Bill Manning  was not already mentioned. We have strengthened the section by emphasizing the need for integration between scientific knowledge and management for urban climate resilience.

Comment 2.6: "Line 60: No references have been provided to support the connection between green space and physio-psychological effects. The authors may need to review the connection in greater detail."

• Response: We acknowledge the lack of references at this point. We have added references to indicate the need to insert pertinent scientific references that support the connection between green spaces and physio-psychological effects.

Comment 2.7: "The authors need to connect Figure 1 to the text and explain it in the text."

• Response: We have explicitly integrated Figure 1 into the text. We added a paragraph before its appearance explaining the relevance of SDG#11 and its objectives, directly linking it to the creation of healthier and more resilient urban environments. The figure is now mentioned both before and after its discussion.

Comment 2.8: "Line 82: Please clarify who the more experienced members of our community are. Was the survey based on published data or an unofficial source? Line 84: How did the authors determine that the size of cities is a key factor in acceptance among the elderly? What acceptance rate was gauged? Line 85: What were the seniors satisfied with?"

• Response: We have reformulated the paragraph to clarify these points. We specified that "more experienced members of our community" refers to "older adults" and that the data comes from the European Commission's 2023 report on the quality of life in European cities, clarifying that this is a published and official source. The discussion on "city size as a key factor" has been made more explicit, indicating the satisfaction percentage and what it refers to.

Comment 2.9: "It is challenging to follow the flow of thoughts in the introduction, as the ideas shift quickly between neurological disorders, green space, cities, and the elderly without clear connectors between them. There is also an insufficient linkage to climate change, exacerbating the urban heat island effect, which increases the risk of health problems for the elderly."

• Response: We have completely restructured the Introduction to improve its coherence and logical flow. We have included clearer connectors between the concepts of neurological disorders, urban climate, green spaces, and the elderly population. Furthermore, we have strengthened the explicit link between climate change, the Urban Heat Island (UHI) effect, and the increased health risks, particularly for the elderly, from the very first paragraphs.

Comment 2.10: "Local climate effects on population health. Lines 99-100, Line 104, Lines 115-116: Some data is outdated. Please use updated data. It is suggested that the authors use more updated references to show the health impacts of a changing climate. There is an abundance of recent data that can be utilized."

• Response: We have updated the data and implemented it with more recent references in Section 2. We have inserted references to indicate where more current data and studies need to be inserted to strengthen the claims.

Comment 2.11: "The in-text citations are confusing, alternating between (authors, year) and numerical."

• Response: We have noted this inconsistency. In the modifications made to the manuscript, we have aimed to standardize the citation style. Upon final submission, we will ensure that the entire manuscript adheres to a single citation style consistently.

Comment 2.12: "The authors may need to present the data graphically to establish the relationship between population health and the warming climate. The most recent references should be included to justify the health impacts."

• Response: We welcome this suggestion. We have inserted a graphical figure to visually illustrate the increase in heat-related mortality by age groups (the figure is under CC BY-NC-ND 4.0)

Comment 2.13: "This section would also benefit from restructuring to explain the general health trends in relation to different aspects of climate change, particularly urban warming, as the title mentions the urban effect."

• Response: We have restructured Section 2 to improve the flow and emphasis on the urban effect of climate warming. The section now proceeds from the general context of air pollution to the specific impacts of heatwaves, with a strengthened focus on the urban microclimate and the Urban Heat Island (UHI) effect.

Comment 2.14: "Neurological effects of local climate. Psychological well-being and neurological effects are different and not interchangeable."

• Response: We have added a specific paragraph at the beginning of Section 3 to clarify the distinction between "psychological well-being" and "neurological effects," while also highlighting their close interconnections and their link to climatic impacts.

Comment 2.15: "Figure 2 has low resolution. It seems to be directly taken from a source. Please ensure that copyright clearance has been obtained. Additionally, the figure is rather general, covering various aspects of climate change, with psychosocial outcomes being one of them."

• Response: We have noted the concerns regarding Figure 2. We have implement to manuscript with a high resolution figure modified by Cremonini after Corvalan et al. We agree the figure covers various aspects related to climate change, is our intention to try to link the issue also with the problems of city regeneration, often approached in strictly disciplinary way and to highlight that the psychosocial ones are part of this frame.

Comment 2.16: "The ideas in this section appear random, with the connection between climate change and psychological well-being among the elderly weakly explained."

• Response: As mentioned, the entire Section 3 has been restructured to improve the coherence and logical flow of ideas. We have strengthened the explanation of the link between climate change, environmental stressors, and psychological and neurological well-being, with a specific emphasis on the vulnerability of the elderly.

Comment 2.17: "Line 197: Please clarify ‘UHI, which has the potential to produce a re-vegetation of pollutants’."

• Response: We have identified and clarified this phrase. We have rephrased the concept to indicate that UHI "can exacerbate the entrapment and concentration of pollutants within the city fabric," as "re-vegetation of pollutants" appeared to be an unclear or incorrect terminology.

Comment 2.18: "There is minimal discussion on the elderly, which is the focus of this paper."

• Response: We have significantly increased the discussion on the elderly population within Section 3. We have highlighted the elderly as a highly vulnerable demographic and discussed the exacerbating factors that increase their susceptibility to climate-related mental and neurological health impacts. This point has been reinforced throughout the section to align with the overall focus of the article.

Comment 2.19: "The discussion of food shortage seems unrelated to psychological well-being. The relationship needs to be discussed explicitly."

• Response: We have expanded the discussion on food shortage in Section 3 to explicitly link it to psychological well-being and neurological problems. We have clarified that droughts impact agricultural production and livelihoods, leading to economic insecurity and poverty, which are risk factors for mental illnesses, and that malnutrition can cause developmental delays/degradation on both mental and neurological problems.

Comment 2.20: "The mental health consequences are briefly discussed in lines 231 to 246, while they should be the emphasis of this section. Again, there is a lack of discussion about the elderly."

• Response: We have strengthened and expanded the discussion on the direct mental health consequences (stress, anxiety, PTSD, depression, suicidal ideation) in Section 3, making it a focal point of the section. We have also integrated the discussion on the increased vulnerability of the elderly to these consequences at various points within the section.

Comment 2.21: "Line 259 goes on to include the effects on pregnancy and IQ, which are loosely related to the aim of the paper."

• Response: We have revised this section. While acknowledging that these specific examples (pregnancy, childhood IQ) might deviate slightly from the primary focus on the elderly, we have retained them to illustrate the broad and pervasive range of neurological and cognitive impacts of extreme heat, demonstrating the breadth of the general problem. We have added a sentence clarifying this justification.

Comment 2.22: "This section generally lacks coherence, making it difficult for readers to grasp the theme."

• Response: As mentioned, the entire Section 3 has been restructured to improve its coherence and logical flow, with particular attention to the connection between urban climate, neurological/psychological effects, and the elderly population.

Comment 2.23: "Integrated approach. This section seems general and does not sufficiently include practical approaches to address the impacts of urban climate change on the psychological well-being of the elderly."

• Response: We have significantly expanded and reorganized Section 4 ("Integrated and Multidisciplinary Approaches for Urban Resilience") to make it much more practical and detailed. It now includes specific pillars and concrete examples of approaches to address the impacts of climate change on the health and psychological well-being of the elderly and frail populations.

Comment 2.24: "Conclusion. Multiple studies drawing the correlations of physical and psychological health with climate change have been published. The authors may need to refer to more recent literature to update the conclusion. The conclusion offers limited insights into addressing the psychological well-being of the elderly and appears to mention vulnerabilities generally. The conclusion does not seem to connect to the content of the paper."

• Response: We have completely rewritten Section 5 ("Conclusions") to make it a coherent and focused summary. It now explicitly summarizes the review's purpose, the main findings regarding the impact of urban climate on the neuro-psychological health of the elderly, and the importance of an integrated approach. The conclusions now reiterate the key concepts discussed in the body of the text and do not introduce new arguments. The literature update has been carried out in the relevant sections of the manuscript, ensuring that the conclusions reflect the synthesis of the most current evidence presented.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Please language check future submissions

Comments for author File: Comments.pdf

Comments on the Quality of English Language

There are numerous basic grammar errors in the Abstract - and some elsewhere that I have corrected

Author Response

Please language check future submissions

There are numerous basic grammar errors in the Abstract - and some elsewhere that I have corrected

Response: We would like to thank the reviewer very much for the thorough corrections made throughout the article. We hope we have correctly understood all the suggestions he highlighted.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have made an effort to address the comments, leading to substantial improvement of the manuscript. However, there are still minor suggestions, as indicated in the following:

1. There are still minor grammatical errors as below. The authors are advised to proofread the manuscript again.
   1. Line 31 – ‘Nature Based Solutions’ should be ‘Nature-based solutions’
   2. Line 33 – ‘given in’ should be ‘given’
   3. Line 33 – ‘current of’ should be ‘current or’
   4. Line 35 – ‘Century’ should be ‘century’
   5. Line 39 – ‘remaining’ should be ‘remains’
   6. Line 42 – ‘lake’ should be ‘lack’
   7. Line 43 – ‘main lead’ is incorrect
   8. Line 126 – ‘as become’ should be ‘has become’
2. Line 163 – Inconsistent styles of in-text citation are still observed, for instance, it suffices to put Kalkstein et al. [19] without indicating the year.
3. Line 202 – The section does not seem to indicate that heatwave affected women and people with medical history more, nor is this shown in Figure 2. Please revise the remark and explain Figure 2.
4. Figure 2 is of low resolution. Please provide a clearer one.
5. Lines 235 and 246: The link between psychological well-being and neurological effects does not appear convincing. The authors need to enhance the explanation of the connection. Additionally, the section does not really discuss the neurological effects, i.e., damage to the nervous system, and the use of this term should be removed or replaced. The authors did not explain the impacts of climate change on psychological well-being in detail before moving on to the other effects, like respiratory illnesses and re-entrapment of pollutants, whose relation to mental well-being has not been discussed in detail.
6. The discussion on vulnerability should be moved to a new dedicated section/subsection rather than being combined with the section on psychological effects.
7. Line 328: The authors explain heat waves here, but their impacts have already been discussed in an earlier section. This makes the explanation repetitive or incoherent. Please put all discussions related to heat waves and elevated temperatures under one section. Please structure the discussion based on the types of climate events and types of impacts, so that it is easier for readers to follow.
8. A large part of Section 4 is dedicated to the definition of disability. Please make the discussion more balanced and clarify how the law contributes to urban resilience against climate change.
9. Line 458: The conclusion suggests air pollution related to climate change exacerbates psychological impacts, but this has not been discussed in detail. Please explain how climate change makes air pollution worse and how this worsening air pollution leads to greater psychological impacts.
10. Line 471: The authors use the word ‘psychiatric’ here, which is not equivalent to ‘psychological’. Please adopt a consistent term, namely ‘psychological’.
11. The manuscript would benefit from better structuring, so that it is easier for the readers to follow the idea.

 

 

Author Response

Comment 1: The authors have made an effort to address the comments, leading to substantial improvement of the manuscript. However, there are still minor suggestions, as indicated in the following:

1. There are still minor grammatical errors as below. The authors are advised to proofread the manuscript again.
1. Line 31 – ‘Nature Based Solutions’ should be ‘Nature-based solutions’
2. Line 33 – ‘given in’ should be ‘given’
3. Line 33 – ‘current of’ should be ‘current or’
4. Line 35 – ‘Century’ should be ‘century’
5. Line 39 – ‘remaining’ should be ‘remains’
6. Line 42 – ‘lake’ should be ‘lack’
7. Line 43 – ‘main lead’ is incorrect
8. Line 126 – ‘as become’ should be ‘has become’

Response 1: Thank you very much, we replaced accordingly

 

Comment 2: Line 163 – Inconsistent styles of in-text citation are still observed, for instance, it suffices to put Kalkstein et al. [19] without indicating the year.

Response 2: We modified accordingly

Comment 3: Line 202 – The section does not seem to indicate that heatwave affected women and people with medical history more, nor is this shown in Figure 2. Please revise the remark and explain Figure 2.

Response3 : We fully agree with the first comment, so we have deleted the sentence referring to women and people with a more complex medical history, and added the sentence highlighted in green at the beginning of Chapter 2: 'As pointed out by Masselot et al. [17], a cumulative exposure-response relationship has been identified for different age groups, with a tendency for the relative risk to increase with age." We have also moved Figure 2 immediately after this new sentence. We hope that the new sentence will make Figure 2 more explicative.

Comment 4: Figure 2 is of low resolution. Please provide a clearer one.

Response 4: Figure 2 is high resolution, downloaded from the article that made it available. We assume that the version of the article sent to you may have a low resolution to reduce the size of the download.

 

Comment 5: Lines 235 and 246: The link between psychological well-being and neurological effects does not appear convincing. The authors need to enhance the explanation of the connection. Additionally, the section does not really discuss the neurological effects, i.e., damage to the nervous system, and the use of this term should be removed or replaced. The authors did not explain the impacts of climate change on psychological well-being in detail before moving on to the other effects, like respiratory illnesses and re-entrapment of pollutants, whose relation to mental well-being has not been discussed in detail.

Response 5: To emphasise the connection between psychological well-being and neurological effects, we added the phrase “studies have reported significant associations between well-being and various areas of the brain [25]”, which refers to a new article added to the bibliography that provides an important overview of the connection between psychological well-being and neurological effects. Regarding the two references that originally referred to the WHO, we have retained only one, expanding the reference to another article already cited above (see reference 8).

 

Comment 6: The discussion on vulnerability should be moved to a new dedicated section/subsection rather than being combined with the section on psychological effects.

Response 6 : The aim of this work is to show how climate change and general and psychological vulnerabilities are closely related. If we separate them, even methodologically, we risk losing the systemic vision that we want to express and that is represented in Figure 3. We have therefore decided not to follow the reviewer's interesting suggestion because of our aim is to stress this systemic vision that should be taken into account in the urban policies.

 

Comment 7: Line 328: The authors explain heat waves here, but their impacts have already been discussed in an earlier section. This makes the explanation repetitive or incoherent. Please put all discussions related to heat waves and elevated temperatures under one section. Please structure the discussion based on the types of climate events and types of impacts, so that it is easier for readers to follow.

Response 7: We have moved the sentence ‘Heat waves are peaks of high temperature that last for several days and exceed typical seasonal temperatures. This phenomenon is related to climate change, as their frequency and intensity have increased. The frequency and intensity of heat waves are extreme events related to climate change, with a regional effect.’ to the beginning of paragraph 2. It is highlighted in green.

 

Comment 8: A large part of Section 4 is dedicated to the definition of disability. Please make the discussion more balanced and clarify how the law contributes to urban resilience against climate change.

Response 8: We have added the following lines to clarify the link between mobility impairment and exposure time to heat waves: “Mobility impairment can impede an individual's ability to navigate the city and fulfil their needs and desires. These difficulties result in increased exposure time and, consequently, heightened climate risk for individuals with disabilities. It is therefore imperative that specific policies are implemented to mitigate the urban environment, with a view to reducing the relative risk to people with disabilities by decreasing their exposure to high temperatures. One such measure might be the creation of more shaded areas”.

Comment 9: Line 458: The conclusion suggests air pollution related to climate change exacerbates psychological impacts, but this has not been discussed in detail. Please explain how climate change makes air pollution worse and how this worsening air pollution leads to greater psychological impacts.

Response 9: At the beginning of Chapter 2, we explained the dynamic linking rising temperatures to deteriorating air quality, adding the following sentence: :” The relationship between heat waves and a worsened air quality is explained by the fact that the urban structure responds to a higher enthalpy content (heat accumulated in materials) of the city, causing a high degree of mixing of pollutants emitted into the environment and, in fact, trapping them inside it for long periods of time.”.

Comment 10: Line 471: The authors use the word ‘psychiatric’ here, which is not equivalent to ‘psychological’. Please adopt a consistent term, namely ‘psychological’.

Response 10: we replaced “psychiatric illnesses” with “neurological disorders”.

 

Comment 11: The manuscript would benefit from better structuring, so that it is easier for the readers to follow the idea.

Response 11: We hope that our changes have been useful in meeting the reviewer's opinion and making the article easier to read.