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Park S, Hunter ES. Modeling the human placenta: in vitro applications in developmental and reproductive toxicology. Crit Rev Toxicol 2024; 54:431-464. [PMID: 39016688 DOI: 10.1080/10408444.2023.2295349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 07/18/2024]
Abstract
During its temporary tenure, the placenta has extensive and specialized functions that are critical for pre- and post-natal development. The consequences of chemical exposure in utero can have profound effects on the structure and function of pregnancy-associated tissues and the life-long health of the birthing person and their offspring. However, the toxicological importance and critical functions of the placenta to embryonic and fetal development and maturation have been understudied. This narrative will review early placental development in humans and highlight some in vitro models currently in use that are or can be applied to better understand placental processes underlying developmental toxicity due to in utero environmental exposures.
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Affiliation(s)
- Sarah Park
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
- Center for Computational Toxicology and Exposure, ORD, US EPA, Research Triangle Park, NC, USA
| | - Edward Sidney Hunter
- Center for Computational Toxicology and Exposure, ORD, US EPA, Research Triangle Park, NC, USA
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2
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Zachariah JP, Jone PN, Agbaje AO, Ryan HH, Trasande L, Perng W, Farzan SF. Environmental Exposures and Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1165-e1175. [PMID: 38618723 DOI: 10.1161/cir.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Environmental toxicants and pollutants are causes of adverse health consequences, including well-established associations between environmental exposures and cardiovascular diseases. Environmental degradation is widely prevalent and has a long latency period between exposure and health outcome, potentially placing a large number of individuals at risk of these health consequences. Emerging evidence suggests that environmental exposures in early life may be key risk factors for cardiovascular conditions across the life span. Children are a particularly sensitive population for the detrimental effects of environmental toxicants and pollutants given the long-term cumulative effects of early-life exposures on health outcomes, including congenital heart disease, acquired cardiac diseases, and accumulation of cardiovascular disease risk factors. This scientific statement highlights representative examples for each of these cardiovascular disease subtypes and their determinants, focusing specifically on the associations between climate change and congenital heart disease, airborne particulate matter and Kawasaki disease, blood lead levels and blood pressure, and endocrine-disrupting chemicals with cardiometabolic risk factors. Because children are particularly dependent on their caregivers to address their health concerns, this scientific statement highlights the need for clinicians, research scientists, and policymakers to focus more on the linkages of environmental exposures with cardiovascular conditions in children and adolescents.
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3
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Squires E, Whiting L, Petty J. Effects of climate change on the health of children and young people. Nurs Stand 2024; 39:60-65. [PMID: 38419409 DOI: 10.7748/ns.2024.e12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
The effects of climate change, such as air pollution and extreme heat events, can adversely affect the physical and mental health of children and young people at all ages. This article explores the effects of climate change on children and young people's development and explains the effects of air pollution and heatwaves on their health. The article also discusses how children and young people are knowledgeable and concerned about the effects of climate change and can offer new perspectives on addressing these effects. Finally, the authors consider the role of nurses in raising awareness of the adverse effects of climate change on children's health, incorporating climate change in their practice and promoting opportunities for children's involvement in healthcare decision-making, strategies and policy development.
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Affiliation(s)
- Eleanor Squires
- School of Health and Social Work, University of Hertfordshire, Hatfield, England
| | - Lisa Whiting
- research, School of Health and Social Work, University of Hertfordshire, Hatfield, England
| | - Julia Petty
- School of Health and Social Work, University of Hertfordshire, Hatfield, England
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4
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Lichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. Pulm Circ 2024; 14:e12394. [PMID: 38933180 PMCID: PMC11205889 DOI: 10.1002/pul2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.
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Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lena Reimann
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lucilla Piccari
- Department of Pulmonary MedicineHospital del MarBarcelonaSpain
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5
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Guo J, Ruan Y, Wang Y, Wang H, Ma S, Wan X, Zhou X, Tang Z, He Y, Zou Z, Li J. Maternal Exposure to Extreme Cold Events and Risk of Congenital Heart Defects: A Large Multicenter Study in China. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:3737-3746. [PMID: 38359432 DOI: 10.1021/acs.est.3c10306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Over the past decade, extreme temperature events have become more frequent and longer in duration. Previous studies on the association between extreme cold events (ECEs) and congenital heart defects (CHDs) are few and inconsistent. We conducted a national multicenter study in 1313 hospitals in 26 provinces in China and collected a total of 14 808 high CHD-risk participants from 2013 to 2021. We evaluated the ECEs experienced by each pregnant women during the embryonic period (3-8 weeks). The results indicated that ECEs experienced by pregnant women during the embryonic period were associated with the development of fetal CHD and were more strongly associated with some specific fetal CHD subtypes, such as pulmonary stenosis, pulmonary atresia, and tetralogy of Fallot. Of the CHD burden, 2.21% (95% CI: 1.43, 2.99%)-2.40% (95% CI: 1.26, 3.55%) of fetal CHD cases were attributable to ECEs during the embryonic period. Our findings emphasize the need to pay more attention to pregnant women whose embryonic period falls during the cold season to reduce cold spell detriments to newborns.
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Affiliation(s)
- Jianhui Guo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Yanping Ruan
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing 100029, People's Republic of China
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, People's Republic of China
| | - Yaqi Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Sheng Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Xiaoyu Wan
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Xiaoxue Zhou
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing 100029, People's Republic of China
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, People's Republic of China
| | - Ziqi Tang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Yihua He
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing 100029, People's Republic of China
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, People's Republic of China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People's Republic of China
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6
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Cerceo E, Saxer K, Grossman L, Shapley-Quinn K, Feldman-Winter L. The Climate Crisis and Breastfeeding: Opportunities for Resilience. J Hum Lact 2024; 40:33-50. [PMID: 38158719 DOI: 10.1177/08903344231216726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning.
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Affiliation(s)
- Elizabeth Cerceo
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Lauren Grossman
- General Internal Medicine and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Lori Feldman-Winter
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ, USA
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7
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Pandipati S, Leong M, Basu R, Abel D, Hayer S, Conry J. Climate change: Overview of risks to pregnant persons and their offspring. Semin Perinatol 2023; 47:151836. [PMID: 37863676 DOI: 10.1016/j.semperi.2023.151836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Climate change is one of the greatest challenges confronting humanity. Pregnant persons, their unborn children, and offspring are particularly vulnerable, as evidenced by adverse perinatal outcomes and increased rates of childhood illnesses. Environmental inequities compound the problem of maternal health inequities, and have given rise to the environmental justice movement. The International Federation of Gynecology and Obstetrics and other major medical societies have worked to heighten awareness and address the deleterious health effects of climate change and toxic environmental exposures. As part of routine prenatal, neonatal, and pediatric care, neonatal-perinatal care providers should incorporate discussions with their patients and families on potential harms and also identify actions to mitigate climate change effects on their health. This article provides clinicians with an overview of how climate change affects their patients, practical guidance in caring for them, and a frame setting of the articles to follow. Clinicians have a critical role to play, and the time to act is now.
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Affiliation(s)
- Santosh Pandipati
- Maternal-Fetal Medicine, Obstetrix of San Jose, e-Lōvu Health, United States.
| | - Melanie Leong
- Attending Neonatologist, Neonatal ECMO Services, The Regional Neonatal Center of Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, United States; Assistant Professor of Pediatrics, New York Medical College, United States
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California EPA, United States
| | - David Abel
- Maternal-Fetal Medicine, Oregon Health Sciences University, United States
| | - Sarena Hayer
- Obstetrics & Gynecology, Oregon Health Sciences University, United States
| | - Jeanne Conry
- International Federation of Gynecology and Obstetrics, United States
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Emont J, Wang M, Wright K. Health system decarbonization on obstetric and newborn units. Semin Perinatol 2023; 47:151844. [PMID: 37852893 DOI: 10.1016/j.semperi.2023.151844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
The healthcare industry makes up 4.6 % of greenhouse gas (GHS) emissions worldwide. Although it is not known what proportion of GHGs come from obstetric and newborn units, newborns and pregnant individuals are likely to face some of the largest consequences from climate change. We review the literature in the areas of decarbonization on labor and delivery (L&D) and neonatal units and describe innovations from the fields of surgery and anesthesia. Best practices for L&D include refining disposable equipment packs, decreasing the use of single-use medical devices, adequately triaging waste, and decreasing the use of potent anesthetic gases such as nitrous oxide and desflurane. In neonatal settings, similarly triaging waste and decreasing the use of plastics containing endocrine disrupting chemicals can lower the carbon and environmental footprint and improve neonatal health. Additionally, avoiding unnecessary cesarean deliveries and increasing breastfeeding practices are also likely to improve the carbon footprint of L&D and neonatal units.
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Affiliation(s)
- Jordan Emont
- Department of Obstetrics and Gynecology, Columbia University Medical Center - New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA.
| | - Melissa Wang
- Department of Obstetrics and Gynecology, Columbia University Medical Center - New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA
| | - Kelly Wright
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Martins RS, Poulikidis K, Razi SS, Latif MJ, Tafuri K, Bhora FY. From emissions to incisions and beyond: the repercussions of climate change on surgical disease in low- and-middle-income countries. BMC Surg 2023; 23:348. [PMID: 37974149 PMCID: PMC10655255 DOI: 10.1186/s12893-023-02260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
Climate change has far-reaching repercussions for surgical healthcare in low- and middle-income countries. Natural disasters cause injuries and infrastructural damage, while air pollution and global warming may increase surgical disease and predispose to worse outcomes. Socioeconomic ramifications further strain healthcare systems, highlighting the need for integrated climate and healthcare policies.
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Affiliation(s)
- Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America.
| | - Kostantinos Poulikidis
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America
| | - Syed Shahzad Razi
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America
| | - M Jawad Latif
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America
| | - Kyle Tafuri
- Hackensack Meridian Health Network, Nutley, NJ, 08820, United States of America
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network - Central Region, Edison, NJ, 08820, United States of America.
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Bragança J, Pinto R, Silva B, Marques N, Leitão HS, Fernandes MT. Charting the Path: Navigating Embryonic Development to Potentially Safeguard against Congenital Heart Defects. J Pers Med 2023; 13:1263. [PMID: 37623513 PMCID: PMC10455635 DOI: 10.3390/jpm13081263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Congenital heart diseases (CHDs) are structural or functional defects present at birth due to improper heart development. Current therapeutic approaches to treating severe CHDs are primarily palliative surgical interventions during the peri- or prenatal stages, when the heart has fully developed from faulty embryogenesis. However, earlier interventions during embryonic development have the potential for better outcomes, as demonstrated by fetal cardiac interventions performed in utero, which have shown improved neonatal and prenatal survival rates, as well as reduced lifelong morbidity. Extensive research on heart development has identified key steps, cellular players, and the intricate network of signaling pathways and transcription factors governing cardiogenesis. Additionally, some reports have indicated that certain adverse genetic and environmental conditions leading to heart malformations and embryonic death may be amendable through the activation of alternative mechanisms. This review first highlights key molecular and cellular processes involved in heart development. Subsequently, it explores the potential for future therapeutic strategies, targeting early embryonic stages, to prevent CHDs, through the delivery of biomolecules or exosomes to compensate for faulty cardiogenic mechanisms. Implementing such non-surgical interventions during early gestation may offer a prophylactic approach toward reducing the occurrence and severity of CHDs.
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Affiliation(s)
- José Bragança
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, 1400-038 Lisbon, Portugal
| | - Rute Pinto
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
| | - Bárbara Silva
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- PhD Program in Biomedical Sciences, Faculty of Medicine and Biomedical Sciences, Universidade do Algarve, 8005-139 Faro, Portugal
| | - Nuno Marques
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
| | - Helena S. Leitão
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
| | - Mónica T. Fernandes
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- School of Health, University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
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Chalupka SM, Latter A, Trombley J. Climate and Environmental Change: A Generation at Risk. MCN Am J Matern Child Nurs 2023; 48:181-187. [PMID: 36943828 DOI: 10.1097/nmc.0000000000000924] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT Climate and environmental changes have been described as the biggest global health threat of the 21st century, with the potential to cause immediate harm in early life with important lifelong effects, and important consequences for future generations. Pregnant women and children are increasingly being recognized as vulnerable populations in the context of climate change. The effects can be direct or indirect through heat stress, extreme weather events, and air pollution, potentially affecting both the immediate and long-term health of pregnant women and newborns through a broad range of mechanisms. Climate and environmental changes have wide-ranging effects on a woman's reproductive life including sexual maturation and fertility, pregnancy outcomes, lactation, breastfeeding, and menopause. A comprehensive overview of these impacts is presented as well as opportunities for interventions for nurses practicing in perinatal, neonatal, midwifery, and pediatric specialties.
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Rekha S, Nalini SJ, Bhuvana S, Kanmani S, Vidhya V. A Comprehensive Review on Hot Ambient Temperature and its Impacts on Adverse Pregnancy Outcomes. JOURNAL OF MOTHER AND CHILD 2023; 27:10-20. [PMID: 37368943 PMCID: PMC10298495 DOI: 10.34763/jmotherandchild.20232701.d-22-00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/18/2022] [Indexed: 06/29/2023]
Abstract
INTRODUCTION High workplace/ambient temperatures have been associated with Adverse Pregnancy Outcomes (APO). Millions of women working in developing nations suffer due to the rising temperatures caused by climate change. There are few pieces of research linking occupational heat stress to APO, and fresh evidence is required. METHODOLOGY We used databases including PubMed, Google Scholar, and Science Direct to search for research on high ambient/workplace temperatures and their effects. Original articles, newsletters, and book chapters were examined. The literature we analysed was categorised as follows: Heat, strain, and physical activity harming both mother and fetus. After categorising the literature, it was examined to identify the major results. RESULTS We found a definite association between heat stress and APOs such as miscarriages, premature birth, stillbirth, low birthweight, and congenital abnormalities in 23 research articles. Our work provides important information for future research into the biological mechanisms that create APOs and various prevention measures. CONCLUSION Our data suggest that temperature has long-term and short-term effects on maternal and fetal health. Though small in number, this study stressed the need for bigger cohort studies in tropical developing countries to create evidence for coordinated policies to safeguard pregnant women.
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Affiliation(s)
- Shanmugam Rekha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sirala Jagadeesh Nalini
- Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Srinivasan Bhuvana
- Department of Obstetrics and Gynecology, Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India
| | - S. Kanmani
- Centre for Environmental Studies, College of Engineering Guindy, Anna University, Chennai, Tamil Nadu, India
| | - Venugopal Vidhya
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Baharav Y, Nichols L, Wahal A, Gow O, Shickman K, Edwards M, Huffling K. The Impact of Extreme Heat Exposure on Pregnant People and Neonates: A State of the Science Review. J Midwifery Womens Health 2023; 68:324-332. [PMID: 37218676 DOI: 10.1111/jmwh.13502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023]
Abstract
The relationship between heat exposure and perinatal morbidity and mortality is of increasing concern as global temperatures rise and extreme heat events become more frequent and intense. Heat exposure can lead to a multitude of harmful outcomes for pregnant individuals and neonates, including hospitalization and death. This state of the science review explored the evidence on the associations between heat exposure and negative health outcomes during pregnancy and the neonatal period. Findings suggest that improving health care provider and patient awareness of heat-related risks and implementing specific interventions could mitigate adverse outcomes. Furthermore, public health and other policy interventions are needed to increase thermal comfort and reduce societal exposure to extreme heat and related risks. Early warning systems, medical alerts, provider and patient education, and increased access to health care and thermal comfort may improve pregnancy and early life health outcomes.
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Affiliation(s)
- Yuval Baharav
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Lilly Nichols
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Anya Wahal
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Owen Gow
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Kurt Shickman
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Maya Edwards
- Adrienne Arsht-Rockefeller Foundation Resilience Center, Atlantic Council, Washington, District of Columbia
| | - Katie Huffling
- Alliance of Nurses for Healthy Environments, Mount Rainier, Maryland
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14
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Wang M, Li L, Kang H, Xu H, Huang Q, Li N, Deng Y, Yu P, Liu Z. Maternal environmental, occupational, and urinary metabolite levels of benzene compounds and their association with congenital heart diseases in offspring: a case‒control study in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:66021-66032. [PMID: 37095212 PMCID: PMC10182929 DOI: 10.1007/s11356-023-27015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
The conclusions about the association of maternal pregnancy environment, occupation, and benzene compounds with fetal CHD are not entirely consistent. Eight hundred seven CHD cases and 1008 controls were included in this study. All occupations were classified and coded against the Occupational Classification Dictionary of the People's Republic of China (2015 version). Logistic regressions were used to explore the correlation among environmental factors, occupation types, and CHDs in offspring. We found that living near public facilities and having exposure to chemical reagents and hazardous substances were significant risk factors for CHDs in offspring. We found that offspring of mothers who worked in agriculture and similar work during pregnancy suffered from CHD. The risk of all CHDs in the offspring of pregnant women working in production manufacturing and related work was significantly higher than that in unemployed pregnant women, the risk was also observed in 4 subtypes of CHDs. We compared the concentrations of the five metabolite (MA, mHA, HA, PGA, and SPMA) levels of benzene compounds in the urine of mothers in case and control groups and found no significant differences. Our study suggests that maternal exposure during pregnancy and certain environmental and occupational conditions are risk factors for CHD in offspring, but did not support an association between concentrations of metabolites of benzene compounds in the urine of pregnant women and CHDs in their offspring.
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Affiliation(s)
- Meixian Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Lu Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Hong Kang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongmei Xu
- Department of Gynaecology and Obstetrics, Leshan People's Hospital, Leshan, 614003, China
| | - Qian Huang
- Department of Gynaecology and Obstetrics, Shehong People's Hospital, Shehong, 629299, China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ying Deng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhen Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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15
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Zhang Y, Sun F, Yuan K, Du Y, Wu L, Ge Y, Zhang Z, Sun S, Cao W. Ambient temperature and major structural anomalies: A retrospective study of over 2 million newborns. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 882:163613. [PMID: 37087019 DOI: 10.1016/j.scitotenv.2023.163613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/16/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Maternal exposure to ambient heat may be associated with congenital anomalies, but evidence is still limited. OBJECTIVES We aimed to estimate the association between maternal exposure to ambient heat during the 3-12 weeks post-conception (critical window of organogenesis) and risk of total and various diagnostic categories of major structural anomalies among live singleton births in the contiguous United States (US). METHODS We included data on 2,352,529 births with the first day of critical developmental windows falling within months of May through August from 2000 to 2004 across 525 US counties. We used a validated spatial-temporal model to estimate daily county-level population-weighted temperature. We used logistic regression to estimate the association between ambient temperature and risk of diagnostic categories of anomalies during the critical window after adjusting for individual and county-level factors. We conducted subgroup analysis to identify potential susceptible subpopulations. RESULTS A total of 29,188 anomalies (12.4 per 1000 births) were recorded during the study period. Maternal exposure to extreme heat (> 95th percentile) was associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies with an odds ratio (OR) of 1.05 (95 % CI: 1.00, 1.11), 1.17 (95 % CI: 1.01, 1.37), and 1.16 (95 % CI: 1.04, 1.29) compared with minimum morbidity temperature, respectively. The associations were homogeneous across subgroups defined by maternal age, maternal race/ethnicity, marital status, educational attainment, and parity, but were more pronounced among mothers residing in more socially vulnerable counties and births with multiple anomalies. CONCLUSIONS Among US live singleton births, maternal exposure to ambient heat may be associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies. We suggest additional research is carried out to better understand the relations between maternal heat exposure and congenital anomalies in the presence of global warming.
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Affiliation(s)
- Yangchang Zhang
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Kun Yuan
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Ying Du
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Lizhi Wu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou 310051, China
| | - Yang Ge
- School of Health Professions, University of Southern Mississippi, Hattiesburg 39402, MS, USA
| | - Zhenyu Zhang
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China.
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China.
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16
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Pandipati S, Abel DE. Anticipated impacts of climate change on women's health: A background primer. Int J Gynaecol Obstet 2023; 160:394-399. [PMID: 35953877 DOI: 10.1002/ijgo.14393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/27/2022] [Accepted: 08/10/2022] [Indexed: 01/20/2023]
Abstract
Due to human activities, atmospheric greenhouse gas levels have increased dramatically, leading to an increase in the global mean surface temperature by 1.1° Celsius. Unless we can achieve a significant reduction in emissions, the global mean surface temperature will continue to rise to a dangerous level. Adverse outcomes of this warming will include extreme weather events, a deterioration of food, water and air quality, decreased food security, and an increase in vector-borne infectious disease. Political and economic instability as well as mass population migration will result in reduced access to healthcare resources. Mitigation of and adaptation to climate change will be key determinants of humanity's survival in the face of this existential crisis. Women will be more adversely affected by climate change than men, and pregnant persons will be particularly vulnerable. Particular differential impacts on women include higher heat and particulate-related morbidity and mortality; pregnancy risks including preterm birth, fetal growth lag, hypertensive disorders; and mental health impacts. To prepare for the climate crisis, it is imperative for women's healthcare providers to assist their patients through political advocacy, provide family planning services, and focus on nutrition and lifestyle counseling.
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Affiliation(s)
- Santosh Pandipati
- Maternal-Fetal Medicine, Obstetrix of San Jose/Pediatrix Medical Group, Campbell, California, USA
| | - David E Abel
- Division of Perinatology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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17
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Moein Taghavi H, Eldeeb S. The adverse effects of climate change on congenital birth defects. Int J Gynaecol Obstet 2023; 160:447-448. [PMID: 36321221 DOI: 10.1002/ijgo.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Hossein Moein Taghavi
- Radiology Department, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sohayla Eldeeb
- Stanford University, Stanford University School of Medicine, Stanford, California, USA
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18
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Veenema RJ, Hoepner LA, Geer LA. Climate Change-Related Environmental Exposures and Perinatal and Maternal Health Outcomes in the U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1662. [PMID: 36767030 PMCID: PMC9914610 DOI: 10.3390/ijerph20031662] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Climate change poses one of the greatest risks to human health as air pollution increases, surface temperatures rise, and extreme weather events become more frequent. Environmental exposures related to climate change have a disproportionate effect on pregnant women through influencing food and water security, civil conflicts, extreme weather events, and the spread of disease. Our research team sought to identify the current peer-reviewed research on the effects of climate change-related environmental exposures on perinatal and maternal health in the United States. DESIGN AND METHODS A systematic literature review of publications identified through a comprehensive search of the PubMed and Web of Science databases was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. The initial search across both databases identified a combined total of 768 publications. We removed 126 duplicates and 1 quadruplet, and the remaining 639 publications were subjected to our pre-set inclusion and exclusion criteria. We excluded studies outside of the United States. A total of 39 studies met our inclusion criteria and were retained for thematic analysis. FINDINGS A total of 19 studies investigated the effect of either hot or cold temperature exposure on perinatal and maternal health outcomes. The effect of air pollution on perinatal outcomes was examined in five studies. A total of 19 studies evaluated the association between natural disasters (hurricanes, flash floods, and tropical cyclones) and perinatal and maternal health outcomes. High and low temperature extremes were found to negatively influence neonate and maternal health. Significant associations were found between air pollutant exposure and adverse pregnancy outcomes. Adverse pregnancy outcomes were linked to hurricanes, tropical cyclones, and flash floods. CONCLUSIONS This systematic review suggests that climate change-related environmental exposures, including extreme temperatures, air pollution, and natural disasters, are significantly associated with adverse perinatal and maternal health outcomes across the United States.
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19
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Neira M, Erguler K, Ahmady-Birgani H, Al-Hmoud ND, Fears R, Gogos C, Hobbhahn N, Koliou M, Kostrikis LG, Lelieveld J, Majeed A, Paz S, Rudich Y, Saad-Hussein A, Shaheen M, Tobias A, Christophides G. Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions. ENVIRONMENTAL RESEARCH 2023; 216:114537. [PMID: 36273599 PMCID: PMC9729515 DOI: 10.1016/j.envres.2022.114537] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 05/17/2023]
Abstract
Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.
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Affiliation(s)
- Marco Neira
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus.
| | - Kamil Erguler
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus
| | | | | | - Robin Fears
- European Academies Science Advisory Council (EASAC), Halle (Saale), Germany
| | | | - Nina Hobbhahn
- European Academies Science Advisory Council (EASAC), Halle (Saale), Germany
| | - Maria Koliou
- University of Cyprus Medical School, Nicosia, Cyprus
| | - Leondios G Kostrikis
- Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus; Cyprus Academy of Sciences, Letters, and Arts, Nicosia, Cyprus
| | - Jos Lelieveld
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus; Max Planck Institute for Chemistry, Mainz, Germany
| | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College London, London, United Kingdom
| | - Shlomit Paz
- Department of Geography and Environmental Studies, University of Haifa, Haifa, Israel
| | - Yinon Rudich
- Department of Earth and Planetary Sciences, The Weismann Institute of Science, Rehovot, Israel
| | - Amal Saad-Hussein
- Environment and Climate Change Research Institute, National Research Centre, Cairo, Egypt
| | - Mohammed Shaheen
- Damour for Community Development - Research Department, Palestine
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - George Christophides
- Climate and Atmosphere Research Center (CARE-C), The Cyprus Institute, Nicosia, Cyprus; Department of Life Sciences, Imperial College London, London, United Kingdom.
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20
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Requia WJ, Koutrakis P, Papatheodorou S. The association of maternal exposure to ambient temperature with low birth weight in term pregnancies varies by location: In Brazil, positive associations may occur only in the Amazon region. ENVIRONMENTAL RESEARCH 2022; 214:113923. [PMID: 35863440 DOI: 10.1016/j.envres.2022.113923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/20/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
Exposure to ambient temperature has been linked to adverse birth outcomes in several regions, including the USA, Australia, China, countries in the Middle East, and European countries. To date, no studies were performed in South America, a region with serious challenges related to climate change. Our investigation addresses this literature lack by examining the association between Low Birth Weight (LBW) and ambient temperature exposure in the largest county in South America, Brazil. We applied a nationwide case-control study design using a logistic regression model to estimate the odds ratio (OR) for LBW associated with ambient temperature during a specific trimester of pregnancy (1-3 trimester). Our sample size includes 5,790,713 birth records nationwide over 18 years (2001-2018), of which 264,967 infants were included in the model as cases of LBW, representing 4.6% of our total sample. We adjusted our model for several confounding variables, including weather factors, air pollution, seasonality, and SES variables at the individual level. Our findings indicate that North was the only region with positive and statistically significant associations in the primary analysis and most of the sensitivity analysis, which is the region where the Amazon is located. In this region, we estimated an increase of 5.16% (95%CI: 3.60; 6.74) in the odds of LBW per 1 °C increase in apparent temperature when the exposure occurred in the second trimester. Our results may be explained by the climate conditions in the Amazon region in the past years. A large body of literature indicates that the Amazon region has been facing serious climate challenges including issues related to policy, governance, and deforestation. Specifically, regarding deforestation, it is suggested that land use change and deforestation is projected to increase heat stress in the Amazon region, because of Amazon savannization, increasing the risk of heat stress exposure in Northern Brazil. Our study can assist public sectors and clinicians in mitigating the risk and vulnerability of the Amazonian population.
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Affiliation(s)
- Weeberb J Requia
- School of Public Policy and Government, Fundação Getúlio Vargas Brasília, Distrito Federal, Brazil.
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health Boston, Massachusetts, United States
| | - Stefania Papatheodorou
- Department of Environmental Health, Harvard TH Chan School of Public Health Boston, Massachusetts, United States
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21
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Puthota J, Alatorre A, Walsh S, Clemente JC, Malaspina D, Spicer J. Prenatal ambient temperature and risk for schizophrenia. Schizophr Res 2022; 247:67-83. [PMID: 34620533 PMCID: PMC8977400 DOI: 10.1016/j.schres.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We conducted a systematic review of the published literature to test the hypothesis that maternal exposure to extremes of ambient temperatures during pregnancy is associated with the risk for psychiatric disorders or congenital malformations in offspring, both of which are indicative of perturbations of fetal neurodevelopment. METHOD This study was conducted in accordance with the recommendations outlined in the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting proposal. Electronic databases (Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Ovid Global Health, Web of Science, and Cochrane Library) were searched. Four independent reviewers selected studies with the following criteria: (1) prenatal maternal ambient temperature exposure; (2) outcome of offspring psychiatric disorder or congenital defects; (3) empirical study; (4) full-length article, no conference presentations or abstracts. RESULTS Twenty-two studies met criteria and one was added from a reference list (n = 23). Of these, schizophrenia (n = 5), anorexia nervosa (n = 3) and congenital cardiovascular malformations (n = 6) studies were the most common. Each of these categories showed some evidence of association with an early pregnancy maternal ambient heat exposure effect, with other evidence for a late pregnancy cold effect. CONCLUSION Some evidence supports a role for early pregnancy maternal exposure to extreme ambient heat in the development of psychiatric disorders, but large-scale, prospective cohort data on individual births is essential. Optimal studies will be conducted in seasonally variable climates, accounting for actual maternal residence over the pregnancy and at parturition, local environmental temperature records, and appropriate covariates, similar to studies identified by this systematic review for congenital malformations.
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Affiliation(s)
| | - Andrea Alatorre
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America
| | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, United States of America
| | - Jose C Clemente
- Department of Genetics & Genomic Sciences, Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, United States of America
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience, Genetics & Genomics, Icahn School of Medicine at Mount Sinai, United States of America
| | - Julie Spicer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
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22
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Salehi F, Darmiani K, Nakhaee S, Zadeh AA, Javadmoosavi SY, Faghihi V, Mehrpour O. Comparison of Blood Lead Concentrations in Mothers of Children with Congenital Heart Disease and Mothers of Healthy Children. Biol Trace Elem Res 2022; 200:2001-2007. [PMID: 34231195 DOI: 10.1007/s12011-021-02813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
Congenital heart disease (CHD) is the most prevalent congenital defect that causes several problems for patients and their families and medical specialists. It is important to investigate CHD risk factors due to their significantly destructive load on society. This study aims to determine the association between maternal lead exposure and conceiving a child with CHD. This case-control study was performed on a total of 246 mothers in the pediatric clinic of Vali-e-Asr Hospital in Birjand, Iran. One hundred forty-six mothers with CHD children were defined as the case group, and 100 age-matched mothers with healthy children were considered the control group. All the mothers were between 20 and 40 years old, and their children were under the age of 6 months. Demographic data was collected from mothers using a well-designed questionnaire. In addition, all mothers were referred to the laboratory for measuring blood lead concentrations. The mean blood lead concentration (BLC) of mothers in the group of children with heart problems was 4.11 ± 10.02 with a median of 2.50 μg/dL and in the control group was 2.66 ± 2.06 with a median of 2.30 μg/dL. The Mann-Whitney test results showed that mothers' lead concentration in the group of children with heart problems was significantly higher than the control group (z = 2.13, p = 0.03). The chi-square test results showed that lead concentrations in the two groups were significantly different from each other (χ2 = 9.11, p = 0.01). The results of our study showed that mothers of children with CHD had higher blood concentrations than mothers of healthy children.
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Affiliation(s)
- Forod Salehi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Kimia Darmiani
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Sameneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadi Zadeh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Vahideh Faghihi
- Islamic Azad University, Science and Research Branch, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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23
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Simmons W, Lin S, Luben TJ, Sheridan SC, Langlois PH, Shaw GM, Reefhuis J, Romitti PA, Feldkamp ML, Nembhard WN, Desrosiers TA, Browne ML, Stingone JA. Modeling complex effects of exposure to particulate matter and extreme heat during pregnancy on congenital heart defects: A U.S. population-based case-control study in the National Birth Defects Prevention Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 808:152150. [PMID: 34864029 PMCID: PMC8758551 DOI: 10.1016/j.scitotenv.2021.152150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND/OBJECTIVE Research suggests gestational exposure to particulate matter ≤2.5 μm (PM2.5) and extreme heat may independently increase risk of birth defects. We investigated whether duration of gestational extreme heat exposure modifies associations between PM2.5 exposure and specific congenital heart defects (CHDs). We also explored nonlinear exposure-outcome relationships. METHODS We identified CHD case children (n = 2824) and non-malformed live-birth control children (n = 4033) from pregnancies ending between 1999 and 2007 in the National Birth Defects Prevention Study, a U.S. population-based multicenter case-control study. We assigned mothers 6-week averages of PM2.5 exposure during the cardiac critical period (postconceptional weeks 3-8) using the closest monitor within 50 km of maternal residence. We assigned a count of extreme heat days (EHDs, days above the 90th percentile of daily maximum temperature for year, season, and weather station) during this period using the closest weather station. Using generalized additive models, we explored logit-nonlinear exposure-outcome relationships, concluding logistic models were reasonable. We estimated joint effects of PM2.5 and EHDs on six CHDs using logistic regression models adjusted for mean dewpoint and maternal age, education, and race/ethnicity. We assessed multiplicative and additive effect modification. RESULTS Conditional on the highest observed EHD count (15) and at least one critical period day during spring/summer, each 5 μg/m3 increase in average PM2.5 exposure was significantly associated with perimembranous ventricular septal defects (VSDpm; OR: 1.54 [95% CI: 1.01, 2.41]). High EHD counts (8+) in the same population were positively, but non-significantly, associated with both overall septal defects and VSDpm. Null or inverse associations were observed for lower EHD counts. Multiplicative and additive effect modification estimates were consistently positive in all septal models. CONCLUSIONS Results provide limited evidence that duration of extreme heat exposure modifies the PM2.5-septal defects relationship. Future research with enhanced exposure assessment and modeling techniques could clarify these relationships.
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Affiliation(s)
- Will Simmons
- Department of Epidemiology, Columbia University, 722 West 168(th) Street, NY, New York 10032, USA
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, 1 University Place, Rensselaer, NY 12144, USA; Department of Environmental Health Sciences, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Thomas J Luben
- Office of Research and Development, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, RTP, NC 27711, USA
| | - Scott C Sheridan
- Department of Geography, Kent State University, 325 S. Lincoln Street, Kent, OH 44242, USA
| | - Peter H Langlois
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health, 1616 Guadalupe Street, Austin, TX 78701, USA
| | - Gary M Shaw
- Stanford School of Medicine, 453 Quarry Road, Stanford, CA 94305, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Paul A Romitti
- Department of Epidemiology, The University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Marcia L Feldkamp
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Wendy N Nembhard
- Departments of Pediatrics and Epidemiology, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA
| | - Tania A Desrosiers
- Department of Epidemiology, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Marilyn L Browne
- Department of Epidemiology and Biostatistics, University at Albany, 1 University Place, Rensselaer, NY 12144, USA; Birth Defects Registry, New York State Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University, 722 West 168(th) Street, NY, New York 10032, USA.
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Syed S, O’Sullivan TL, Phillips KP. Extreme Heat and Pregnancy Outcomes: A Scoping Review of the Epidemiological Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042412. [PMID: 35206601 PMCID: PMC8874707 DOI: 10.3390/ijerph19042412] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022]
Abstract
Background: Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a well-established teratogen in animal studies, with a growing body of literature suggesting human pregnancies are similarly at risk. Characterization of extreme heat as a pregnancy risk is problematic due to nonstandard definitions of heat waves, and variable study designs. To better focus future research in this area, we conducted a scoping review to assess the effects of extreme heat on pregnancy outcomes. Methods: A scoping review of epidemiological studies investigating gestational heat-exposure and published 2010 and 2020, was conducted with an emphasis on study design, gestational windows of sensitivity, adverse pregnancy outcomes and characterization of environmental temperatures. Results: A sample of 84 studies was identified, predominantly set in high-income countries. Preterm birth, birthweight, congenital anomalies and stillbirth were the most common pregnancy outcome variables. Studies reported race/ethnicity and/or socioeconomic variables, however these were not always emphasized in the analysis. Conclusion: Use of precise temperature data by most studies avoided pitfalls of imprecise, regional definitions of heat waves, however inconsistent study design, and exposure windows are a significant challenge to systematic evaluation of this literature. Despite the high risk of extreme heat events and limited mitigation strategies in the global south, there is a significant gap in the epidemiological literature from these regions. Greater consistency in study design and exposure windows would enhance the rigor of this field.
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Dalugoda Y, Kuppa J, Phung H, Rutherford S, Phung D. Effect of Elevated Ambient Temperature on Maternal, Foetal, and Neonatal Outcomes: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031771. [PMID: 35162797 PMCID: PMC8835067 DOI: 10.3390/ijerph19031771] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
This scoping review provides an overview of the published literature, identifies research gaps, and summarises the current evidence of the association between elevated ambient temperature exposure during pregnancy and adverse maternal, foetal, and neonatal outcomes. Following the PRISMA extension for scoping reviews reporting guidelines, a systematic search was conducted on CINAHL, PubMed, and Embase and included original articles published in the English language from 2015 to 2020 with no geographical limitations. A total of seventy-five studies were included, conducted across twenty-four countries, with a majority in the USA (n = 23) and China (n = 13). Study designs, temperature metrics, and exposure windows varied considerably across studies. Of the eighteen heat-associated adverse maternal, foetal, and neonatal outcomes identified, pre-term birth was the most common outcome (n = 30), followed by low birth weight (n = 11), stillbirth (n = 9), and gestational diabetes mellitus (n = 8). Overall, papers reported an increased risk with elevated temperature exposures. Less attention has been paid to relationships between heat and the diverse range of other adverse outcomes such as congenital anomalies and neonatal mortality. Further research on these less-reported outcomes is needed to improve understanding and the effect size of these relationships with elevated temperatures, which we know will be exacerbated by climate change.
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Affiliation(s)
- Yohani Dalugoda
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
- Correspondence:
| | - Jyothi Kuppa
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
| | - Hai Phung
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia; (J.K.); (H.P.); (S.R.)
| | - Dung Phung
- School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia;
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Abstract
PURPOSE OF REVIEW Climate change remains a major threat to the health and well-being of children globally. This article reviews the myriad health effects of climate change on children throughout their lives and discusses ways in which the general pediatrician can be an advocate for climate solutions. RECENT FINDINGS Rising atmospheric temperatures, increased air pollution, and destabilized weather patterns all lead to adverse health outcomes for children and adverse obstetric outcomes. However, the impact of climate change is not evenly distributed. Children living in poverty are more likely to be adversely impacted by the changing climate. SUMMARY Ongoing and emerging research suggests that children are particularly vulnerable to the effects of climate change. The primary care pediatrician is encouraged to see this irrefutable evidence as a call to action for advocacy on behalf of our patients and the planet.
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Affiliation(s)
- Nicola Brodie
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC
| | - Elizabeth A Silberholz
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Giudice LC, Llamas-Clark EF, DeNicola N, Pandipati S, Zlatnik MG, Decena DCD, Woodruff TJ, Conry JA. Climate change, women's health, and the role of obstetricians and gynecologists in leadership. Int J Gynaecol Obstet 2021; 155:345-356. [PMID: 34694628 PMCID: PMC9298078 DOI: 10.1002/ijgo.13958] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022]
Abstract
Climate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.
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Affiliation(s)
- Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Erlidia F Llamas-Clark
- Department of Obstetrics and Gynecology, Division of Ultrasound, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Nathaniel DeNicola
- Department of Obstetrics and Gynecology, Johns Hopkins Health System, Washington, District of Columbia, USA
| | - Santosh Pandipati
- Obstetrix Medical Group/Mednax (Maternal-Fetal Medicine), Campbell, California, USA
| | - Marya G Zlatnik
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
| | - Ditas Cristina D Decena
- Departments of Anatomy, Clinical Epidemiology and Public Health International, University of Santo Tomas, Manila, Philippines
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Environmental Research and Translation for Health (EaRTH) Center, University of California, San Francisco, San Francisco, California, USA
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Pacheco SE, Guidos G, Annesi-Maesano I, Pawankar R, Amato GD, Latour-Staffeld P, Urrutia-Pereira M, Kesic MJ, Hernandez ML. Climate Change and Global Issues in Allergy and Immunology. J Allergy Clin Immunol 2021; 148:1366-1377. [PMID: 34688774 DOI: 10.1016/j.jaci.2021.10.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
The steady increase in global temperatures, resulting from the combustion of fossil fuels and the accumulation of greenhouse gases (GHG), continues to destabilize all ecosystems worldwide. Although annual emissions must halve by 2030 and reach net-zero by 2050 to limit some of the most catastrophic impacts associated with a warming planet, the world's efforts to curb GHG emissions fall short of the commitments made in the 2015 Paris Agreement (1). To this effect, July 2021 was recently declared the hottest month ever recorded in 142 years (2). The ramifications of these changes on global temperatures are complex and further promote outdoor air pollution, pollen exposure, and extreme weather events. Besides worsening respiratory health, air pollution, promotes atopy and susceptibility to infections. The GHG effects on pollen affect the frequency and severity of asthma and allergic rhinitis. Changes in temperature, air pollution, and extreme weather events exert adverse multisystemic health effects and disproportionally affect disadvantaged and vulnerable populations. This article is an update for allergists and immunologists about the health impacts of climate change, already evident in our daily practices. It is also a call to action and advocacy, including integrating climate change-related mitigation, education, and adaptation measures to protect our patients and avert further injury to our planet.
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Affiliation(s)
- Susan E Pacheco
- Professor of Pediatrics, University of Texas McGovern Medical School, MSB3.228, Houston, Texas 77030.
| | - Guillermo Guidos
- Professor of Immunology, School of Medicine, ENMH, Instituto Politecnico Nacional, Mexico City
| | - Isabella Annesi-Maesano
- Deputy Director of Institute Desbrest of Epiddemioloy and Public Health, INSERM and Montpellier University, Montpellier, France
| | - Ruby Pawankar
- Professor, Division of Allergy, Dept. of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Gennaro D' Amato
- Fellow and Honorary member of EAACI, FAAAAI, FERS. , Chairman Committee World Allergy Organization on "Aerobiology, Climate change, Biodiversity and Allergy"; Division of Respiratory Diseases and Allergy, High Specialty Hospital A. Cardarelli, Naples
| | - Patricia Latour-Staffeld
- Allergy and Clinical Immunology, Distinguished Graduate Universidad Nacional Pedro Henriquez Ureña, Medical director of Centro Avanzado De Alergia y Asma Santo Domingo, President Latin American Society of Allergy, Asthma and Immunology, Associate Professor School of Medicine Universidad Nacional Pedro Henriquez Ureña, Dominican Republic
| | | | - Matthew J Kesic
- Campbell University, Physician Assistant Program, College of Pharmacy and Health Sciences, 4150 US HWY 421 South, Lillington, NC 27546
| | - Michelle L Hernandez
- Professor of Pediatrics Division of Allergy & Immunology Director, Clinical Research Unit, Children's Research Institute, UNC School of Medicine, 5008C Mary Ellen Jones Building, 116 Manning Drive, CB #7231 Chapel Hill, NC 27599-7231
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Nonmedical Determinants of Congenital Heart Diseases in Children from the Perspective of Mothers: A Qualitative Study in Iran. Cardiol Res Pract 2021; 2021:6647260. [PMID: 34447593 PMCID: PMC8384533 DOI: 10.1155/2021/6647260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. The objective of present study was to identify nonmedical determinants related to this abnormality from the mother's perspectives. Methods This research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. Results Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. Conclusions Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers' prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.
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Harville EW, Beitsch L, Uejio CK, Sherchan S, Lichtveld MY. Assessing the effects of disasters and their aftermath on pregnancy and infant outcomes: A conceptual model. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 62:102415. [PMID: 34336567 PMCID: PMC8318346 DOI: 10.1016/j.ijdrr.2021.102415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although many studies have examined broad patterns of effects on pregnancy and infant outcomes after disasters, the causes of adverse outcomes are not always clear. Disasters cause interrelated exposure to environmental pollutants, psychological stressors, and lack of health care, and interacts with other social determinants of health. This topical review examines the short- and long-term effects of disasters on pregnancy and how they are mediated by social, behavioral, and environmental effects. In the short term, disasters are associated with physical trauma, adverse environmental exposures, and unstable housing. In the longer term, disasters may lead to relocation, changes in family functioning, and negative economic effects. These aspects of disaster exposure, in turn, lead to lack of access to health care, increased stress and negative mental health outcomes, and negative behavioral changes, including smoking and substance use, poor nutrition, physical overexertion and limited activity, and reduction in breastfeeding. All of these factors interact with social determinants of health to worsen effects on the most vulnerable women, infants, and communities. Few interventions after disasters have been tested. With the increase in disasters due to climate change and the ongoing coronavirus pandemic, the models of effects of disasters and their human health consequences need increasing refinement, and, more importantly, should be applied to interventions that improve disaster prevention, mitigation, and response.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA
| | - Leslie Beitsch
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL
| | - Christopher K Uejio
- Department of Geography, College of Social Sciences and Public Policy, Florida State University, Tallahassee, FL
| | - Samendra Sherchan
- Department of Environmental Health Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA
| | - Maureen Y Lichtveld
- Professor and Chair, Department of Environmental Health Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA; Currently Dean and professor, Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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31
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Strzelecka I, Biedrzycka M, Karuga FF, Szmyd B, Batarowicz K, Respondek-Liberska M. Seasonality of Hypoplastic Left Heart Syndrome and Single Ventricle Heart in Poland in the Context of Air Pollution. J Clin Med 2021; 10:3207. [PMID: 34361990 PMCID: PMC8347882 DOI: 10.3390/jcm10153207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 01/17/2023] Open
Abstract
Hypoplastic left heart syndrome (HLHS) and single ventricle (SV) remain a significant cause of cardiac deaths occurring in the first week of life. Their pathogenesis and seasonal frequency are still unknown. Therefore, we attempt to look at the genesis of the HLHS and SV in the context of territorial distribution as well as seasonality. A total of 193 fetuses diagnosed with HLHS and 92 with SV were selected. The frequency was analyzed depending on the year, calendar month, quarter and season (fall-winter vs. spring-summer). The spatial distribution of HLHS and SV in Poland was analyzed. We observed a statistically significant overrepresentation of HLHS formation frequency in March: 27 (14.00%) in comparison to a monthly median of 15 (IQR: 13.75-16.25; p = 0.039), as well as a significantly higher frequency of HLHS in 2007-2009: 65 cases (33.68%) in comparison to the annual mean of 13.79 ± 6.36 (p < 0.001). We noted a higher frequency of SV among parous with the last menstrual period reported in the fall/winter season of 58 vs. 34 in the spring/summer season (p = 0.014). The performed analysis also revealed significant SV overrepresentation in 2008: 11 cases (12.00%) in comparison to the annual mean of 6.57 ± 2.71 (p = 0.016). Every single case of HLHS was observed when the concentration of benzo(a)pyrene and/or PM10 exceeded the acceptable/target level. Our research indicates that both the season and the level of pollution are significant factors affecting the health of parous women and their offspring. The reason why HLHS and SV develop more frequently at certain times of the year remains unclear, therefore research on this topic should be continued, as well as on the effects of PM10 and benzo(a)pyrene exposure.
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Affiliation(s)
- Iwona Strzelecka
- Department for Diagnoses and Prevention, Medical University of Lodz, 93-338 Łódź, Poland; (I.S.); (K.B.); (M.R.-L.)
| | - Małgorzata Biedrzycka
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland;
| | - Filip Franciszek Karuga
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland;
| | - Bartosz Szmyd
- Department of Pediatrics, Oncology, and Hematology, Medical University of Lodz, 91-738 Łódź, Poland;
| | - Katarzyna Batarowicz
- Department for Diagnoses and Prevention, Medical University of Lodz, 93-338 Łódź, Poland; (I.S.); (K.B.); (M.R.-L.)
| | - Maria Respondek-Liberska
- Department for Diagnoses and Prevention, Medical University of Lodz, 93-338 Łódź, Poland; (I.S.); (K.B.); (M.R.-L.)
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital, 93-338 Łódź, Poland
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Qu Y, Zhang W, Ryan I, Deng X, Dong G, Liu X, Lin S. Ambient extreme heat exposure in summer and transitional months and emergency department visits and hospital admissions due to pregnancy complications. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 777:146134. [PMID: 33689898 DOI: 10.1016/j.scitotenv.2021.146134] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Although extreme heat exposure (EHE) was reported to be associated with increased risks of multiple diseases, little is known about the effects of EHE on pregnancy complications. We examined the EHE-pregnancy complications associations by lag days, subtypes, sociodemographic characteristics, and areas in New York State (NYS). We conducted a case-crossover analysis to assess the EHE-pregnancy complications associations in summer (June-August) and transitional months (May and September). All emergency department (ED) visits and hospital admissions due to pregnancy complications (ICD 9 codes: 630-649) from 2005 to 2013 in NYS were included. Daily mean temperature > 90th percentile of the monthly mean temperature in each county was defined as an EHE. We used conditional logistic regression while controlling for other weather factors, air pollutants and holidays to assess the EHE-pregnancy complications associations. EHE was significantly associated with increased ED visits for pregnancy complications in summer (ORs ranged: 1.01-1.04 from lag days 0-5). There was also a significant and stronger association in transitional months (ORs ranged: 1.02-1.06, Lag 0). Furthermore, we found EHE affected multiple subtypes of pregnancy complications, including threatened/spontaneous abortion, renal diseases, infectious diseases, diabetes, and hypertension (ORs range: 1.13-1.90) during transitional months. A significant concentration response effect between the number of consecutive days of EHE and ED visits in summer (P for trend <0.001), ED visits in September (P for trend =0.03), and hospital admission in May (P for trend<0.001) due to pregnancy complications was observed, respectively. African Americans and residents in lower socioeconomic position (SEP) counties were more susceptible to the effects of EHE. In conclusion, we found an immediate and prolonged effect of EHE on pregnancy complications in summer and a stronger, immediate effect in transitional months. These effects were stronger in African Americans and counties with lower SEP. Earlier warnings regarding extreme heat are recommended to decrease pregnancy complications.
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Affiliation(s)
- Yanji Qu
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China; Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Wangjian Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Ian Ryan
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Xinlei Deng
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA
| | - Guanghui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Xiaoqing Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, Guangdong, China.
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, Albany, NY 12144, USA.
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Goshua A, Gomez J, Erny B, Burke M, Luby S, Sokolow S, LaBeaud AD, Auerbach P, Gisondi MA, Nadeau K. Addressing Climate Change and Its Effects on Human Health: A Call to Action for Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:324-328. [PMID: 33239537 DOI: 10.1097/acm.0000000000003861] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Human health is increasingly threatened by rapid and widespread changes in the environment and climate, including rising temperatures, air and water pollution, disease vector migration, floods, and droughts. In the United States, many medical schools, the American Medical Association, and the National Academy of Sciences have published calls for physicians and physicians-in-training to develop a basic knowledge of the science of climate change and an awareness of the associated health risks. The authors-all medical students and educators-argue for the expeditious redesign of medical school curricula to teach students to recognize, diagnose, and treat the many health conditions exacerbated by climate change as well as understand public health issues. In this Invited Commentary, the authors briefly review the health impacts of climate change, examine current climate change course offerings and proposals, and describe the rationale for promptly and comprehensively including climate science education in medical school curricula. Efforts in training physicians now will benefit those physicians' communities whose health will be impacted by a period of remarkable climate change. The bottom line is that the health effects of climate reality cannot be ignored, and people everywhere must adapt as quickly as possible.
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Affiliation(s)
- Anna Goshua
- A. Goshua is a second-year medical student, Stanford University School of Medicine, Stanford, California
| | - Jason Gomez
- J. Gomez is a second-year medical student, Stanford University School of Medicine, Stanford, California
| | - Barbara Erny
- B. Erny is medical liaison for international programs, American Society of Cataract and Refractive Surgery Foundation, Fairfax, Virginia, and a member, Environmental Health Committee, Physicians for Social Responsibility, Washington, DC
| | - Marshall Burke
- M. Burke is associate professor, Department of Earth System Science and Center on Food Security and the Environment, Stanford University, Stanford, California
| | - Stephen Luby
- S. Luby is professor of medicine and associate dean of global health research, Stanford University, Stanford, California
| | - Susanne Sokolow
- S. Sokolow is senior research scientist, Stanford Woods Institute for the Environment, Stanford University, Stanford, California
| | - A Desiree LaBeaud
- A.D. LaBeaud is professor of pediatrics, Stanford University School of Medicine, and a senior fellow, Stanford Woods Institute for the Environment, Stanford, California
| | - Paul Auerbach
- P. Auerbach is the Redlich Family Professor Emeritus, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael A Gisondi
- M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Stanford University, Stanford, California
| | - Kari Nadeau
- K. Nadeau is the Naddisy Family Foundation Professor of Allergy and director, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California
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A Comprehensive Assessment of the Associations Between Season of Conception and Birth Defects, Texas, 1999-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197120. [PMID: 33003294 PMCID: PMC7579376 DOI: 10.3390/ijerph17197120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/23/2022]
Abstract
Birth defects prevalence may vary seasonally, but previous studies have focused on a few commonly occurring phenotypes. We performed a phenome-wide association study (PheWAS) in order to evaluate the associations between season of conception and a broad range of birth defects. Date of conception was estimated for all livebirths and birth defect cases in Texas from 1999-2015 using data from vital records, provided by the Texas Department of State Health Services Center for Health Statistics. Birth defects diagnoses were obtained from the Texas Birth Defects Registry, a statewide, active surveillance system. We estimated prevalence ratios (PRs) for phenotypes with ≥50 cases according to conception in spring (March-May), summer (June-August) or fall (September-November) relative to winter (December-February), using Poisson regression. Season of conception was associated with 5% of birth defects studied in models adjusted for maternal age, education, race/ethnicity, and number of previous livebirths. Specifically, summer conception was associated with any monitored birth defect (PR 1.03, 95% CI 1.02-1.04) and five specific phenotypes, most notably Hirschsprung disease (PR 1.46, 95% CI 1.22-1.75). These findings suggest that seasonally variable exposures influence the development of several birth defects and may assist in identifying novel environmental risk factors.
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Monteblanco AD, Vanos JK. Community-based maternal health workers' perspectives on heat risk and safety: a pilot qualitative study. Health Care Women Int 2020; 42:657-677. [PMID: 32956026 DOI: 10.1080/07399332.2020.1803873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In this study the authors examined how maternal health workers (MHWs) perceive the health risks of extreme heat exposure to pregnant women and fetuses. The authors conducted interviews with 12 MHWs (including midwives and doulas) in El Paso, Texas. Using qualitative analysis, the researchers identified numerous themes. Although heat was not communicated as a major health risk, participants expressed some concern with growing heat exposure and communicated standard protective measures. While all participants were familiar with some heat illness symptoms, they were generally unaware of their clients' vulnerability. MHWs' minimal heat-risk knowledge leaves pregnant women and developing fetuses at risk of preventable harm.
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Affiliation(s)
- Adelle Dora Monteblanco
- Department of Sociology and Anthropology, Middle Tennessee State University, Murfreesboro, Tennessee, USA.,Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, Texas, USA
| | - Jennifer K Vanos
- School of Sustainability, Arizona State University, Tempe, Arizona, USA
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36
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Pacheco SE. Catastrophic effects of climate change on children's health start before birth. J Clin Invest 2020; 130:562-564. [PMID: 31929187 DOI: 10.1172/jci135005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Samuelson H, Baniassadi A, Lin A, Izaga González P, Brawley T, Narula T. Housing as a critical determinant of heat vulnerability and health. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 720:137296. [PMID: 32325550 DOI: 10.1016/j.scitotenv.2020.137296] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 06/11/2023]
Abstract
Municipalities use Heat Vulnerability Indices (HVIs) to quantify and map relative distribution of risks to human health in the event of a heatwave. These maps ostensibly allow public agencies to identify the highest-risk neighborhoods, and to concentrate emergency planning efforts and resources accordingly (e.g., to establish the locations of cooling centers). The method of constructing an HVI varies by municipality, but common inputs include demographic variables such as age and income - and to some extent, metrics such as land cover. However, taking demographic data as a proxy for heat vulnerability may provide an incomplete or inaccurate assessment of risk. A critical limitation in HVIs may be a lack of focus on housing characteristics and how they mediate indoor heat exposure. To provide an objective assessment of this limitation, we first reviewed HVIs in the literature and those published or commissioned by municipalities. We subsequently verified that most of these HVIs excluded housing factors. Next, to scope the potential consequences, we used physics-based simulations of housing prototypes (46,000 housing permutations per city) to estimate the variation in indoor heat exposure within high-vulnerability neighborhoods in Boston and Phoenix. The results show that by excluding building-level determinants of exposure, HVIs fail to capture important components of heat vulnerability. Moreover, we demonstrate how these maps currently overlook important nuances regarding the impact of building age and air conditioning functionality. Finally, we discuss the challenges of implementing housing stock characteristics in HVIs and propose methods for overcoming these challenges.
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Affiliation(s)
- Holly Samuelson
- Harvard Graduate School of Design, Department of Architecture, Cambridge, MA, USA.
| | - Amir Baniassadi
- Harvard Graduate School of Design, Department of Architecture, Cambridge, MA, USA
| | - Anne Lin
- Harvard Graduate School of Design, Department of Urban Planning and Design, Cambridge, MA, USA; Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA
| | - Pablo Izaga González
- Harvard Graduate School of Design, Department of Architecture, Cambridge, MA, USA
| | - Thomas Brawley
- University of California, College of Environmental Design, Berkeley, CA, USA; University of California, College of Natural Resources, Berkeley, CA, USA
| | - Tushar Narula
- University of California, College of Environmental Design, Berkeley, CA, USA
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Liang Y, Li X, Hu X, Wen B, Wang L, Wang C. A predictive model of offspring congenital heart disease based on maternal risk factors during pregnancy: a hospital based case-control study in Nanchong City. Int J Med Sci 2020; 17:3091-3097. [PMID: 33173430 PMCID: PMC7646101 DOI: 10.7150/ijms.48046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Based on epidemiological field data, this study was to develop a prediction model which can be used as a preliminary screening tool to identify pregnant women who were at high risk of offspring congenital heart disease (CHD) in Nanchong City, and be beneficial in guiding prenatal management and prevention. Methods: A total of 367 children with CHD and 367 children without congenital malformations aged 0 to 14 years old were recruited from the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital between March 2016 and November 2018. Using the SPSS 22.0 case-control matching module, the controls were matched to the cases at a rate of 1:1, according to the same gestational age of child (premature delivery or full-term), the maternal age of pregnancy (less than 1 year). 327 matched case-control pairs were analyzed by SPSS 22. Univariate and multivariate analysis were performed to find the important maternal influencing factors of offspring CHD. A logistic regression disease prediction model was constructed as the final predictors, and Hosmer-Lemeshow goodness of fit test and receiver operating characteristic (ROC) curve were used to evaluate the model. Results: 654 subjects (327 cases and 327 controls) were matched. The 25 variables were analysed. The logistic regression model established in this study was as follows: Logit(P)= -2.871+(0.686×respiratory infections)+(1.176×water pollution)+(1.019×adverse emotions during pregnancy) - (0.617×nutrition supplementation). The Hosmer-Lemeshow chi-square value was 7.208 (df = 6), with a nonsignificant p value of 0.302, which indicates that the model was well-fitted. The calibration plot showed good agreement between the bias-corrected prediction and the ideal reference line. Area under the ROC curve was 0.72 (95% CI: 0.681~0.759), which means that the predictive power of the model set fitted the data. Conclusion: In Nanchong city, more attention should be paid to mother who had a history of respiratory infections, exposure to polluted water, adverse emotions during pregnancy and nutritional deficiency. The risk model might be an effective tool for predicting of the risk of CHD in offspring by maternal experience during pregnancy, which can be used for clinical practise in Nanchong area.
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Affiliation(s)
- Yun Liang
- Department of Pediatric Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China; The first affiliated Hospital of Jinan University, Guangzhou, 510632, P.R. China
| | - Xiaoqin Li
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Xingsheng Hu
- Department of Cardiology, Nanchong Central Hospital, Nanchong, 637000, P.R. China; Department of Oncology, the second Xiangya Hospital of Central South University Changsha, Yuelu District, 410011, P.R. China (Current Address)
| | - Bing Wen
- Department of Cardiothoracic Surgery, Nanchong Central Hospital, Nanchong, 637000, P.R. China
| | - Liang Wang
- Department of Pediatric Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China; The first affiliated Hospital of Jinan University, Guangzhou, 510632, P.R. China
| | - Cheng Wang
- Department of Pediatric Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China; The first affiliated Hospital of Jinan University, Guangzhou, 510632, P.R. China
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Konkel L. Taking the Heat: Potential Fetal Health Effects of Hot Temperatures. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:102002. [PMID: 31652107 PMCID: PMC6910775 DOI: 10.1289/ehp6221] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Zhang W, Spero TL, Nolte CG, Garcia VC, Lin Z, Romitti PA, Shaw GM, Sheridan SC, Feldkamp ML, Woomert A, Hwang S, Fisher SC, Browne ML, Hao Y, Lin S. Projected Changes in Maternal Heat Exposure During Early Pregnancy and the Associated Congenital Heart Defect Burden in the United States. J Am Heart Assoc 2019; 8:e010995. [PMID: 30696385 PMCID: PMC6405581 DOI: 10.1161/jaha.118.010995] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/03/2018] [Indexed: 01/11/2023]
Abstract
Background More intense and longer-lasting heat events are expected in the United States as a consequence of climate change. This study aimed to project the potential changes in maternal heat exposure during early pregnancy (3-8 weeks post conception) and the associated burden of congenital heart defects ( CHD s) in the future. Methods and Results This study expanded on a prior nationwide case-control study that evaluated the association between CHD s and maternal heat exposure during early pregnancy in summer and spring. We defined multiple indicators of heat exposure, and applied published odds ratios obtained for the matching season of the baseline (1995-2005) into the projection period (2025-2035) to estimate potential changes in CHD burden throughout the United States. Increases in maternal heat exposure were projected across the United States and to be larger in the summer. The Midwest will potentially have the highest increase in summer maternal exposure to excessively hot days (3.42; 95% CI, 2.99-3.88 per pregnancy), heat event frequency (0.52; 95% CI, 0.44-0.60) and heat event duration (1.73; 95% CI, 1.49-1.97). We also found large increases in specific CHD subtypes during spring, including a 34.0% (95% CI, 4.9%-70.8%) increase in conotruncal CHD in the South and a 38.6% (95% CI , 9.9%-75.1%) increase in atrial septal defect in the Northeast. Conclusions Projected increases in maternal heat exposure could result in an increased CHD burden in certain seasons and regions of the United States.
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Affiliation(s)
- Wangjian Zhang
- Department of Medical Statistics and EpidemiologySchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
- Department of Environmental Health SciencesUniversity at Albany, State University of New YorkRensselaerNY
| | - Tanya L. Spero
- National Exposure Research LaboratoryU.S. Environmental Protection AgencyResearch Triangle ParkNC
| | - Christopher G. Nolte
- National Exposure Research LaboratoryU.S. Environmental Protection AgencyResearch Triangle ParkNC
| | - Valerie C. Garcia
- National Exposure Research LaboratoryU.S. Environmental Protection AgencyResearch Triangle ParkNC
| | - Ziqiang Lin
- Department of Environmental Health SciencesUniversity at Albany, State University of New YorkRensselaerNY
- Department of MathematicsUniversity at AlbanyNY
| | | | - Gary M. Shaw
- Stanford University School of MedicineStanfordCA
| | | | | | | | | | | | - Marilyn L. Browne
- Department of Epidemiology and BiostatisticsUniversity at Albany, State University of New YorkRensselaerNY
- New York State Department of HealthAlbanyNY
| | - Yuantao Hao
- Department of Medical Statistics and EpidemiologySchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Shao Lin
- Department of Environmental Health SciencesUniversity at Albany, State University of New YorkRensselaerNY
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