Heat exposure during outdoor activities in the US varies significantly by city, demography, and activity

Environmental heat is a growing public health concern in cities. Urbanization and global climate change threaten to exacerbate heat as an already significant environmental cause of human morbidity and mortality. Despite increasing risk, very little is known regarding determinants of outdoor urban heat exposure. To provide additional evidence for building community and national-scale resilience to extreme heat, we assess how US outdoor urban heat exposure varies by city, demography, and activity. We estimate outdoor urban heat exposure by pairing individual-level data from the American Time Use Survey (2004-2015) with corresponding meteorological data for 50 of the largest metropolitan statistical areas in the US. We also assess the intersection of activity intensity and heat exposure by pairing metabolic intensities with individual-level time-use data. We model an empirical relationship between demographic indicators and daily heat exposure with controls for spatiotemporal factors. We find higher outdoor heat exposure among the elderly and low-income individuals, and lower outdoor heat exposure in females, young adults, and those identifying as Black race. Traveling, lawn and garden care, and recreation are the most common outdoor activities to contribute to heat exposure. We also find individuals in cities with the most extreme temperatures do not necessarily have the highest outdoor heat exposure. The findings reveal large contrasts in outdoor heat exposure between different cities, demographic groups, and activities. Resolving the interplay between exposure, sensitivity, adaptive capacity, and behavior as determinants of heat-health risk will require advances in observational and modeling tools, especially at the individual scale.

Abortion training in Canadian obstetrics and gynecology residency programs

OBJECTIVE

To evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs.

STUDY DESIGN

Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures.

RESULTS

We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had "opt-in" abortion training, and half of the programs had "opt-out" abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency.

CONCLUSION

Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women.

IMPLICATIONS

Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty.

13,14-Dihydro-15-keto-prostaglandin F2 alpha in patients with urogenital tumors

13,14-Dihydro-15-keto-prostaglandin F2 alpha (13,14-DHK-PGF2 alpha) represents a stable product of degradation after pulmonary flow and it is shown to be reliably measured by radioimmunoassay. In patients with urogenital tumors, serum levels of 13,14-DHK-PGF2 alpha are distinctly elevated when compared to a control group. The rate of synthesis of this compound in urogenital tumors, however, appears to be different.