Does Ethnic Diversity Impact on Risk Perceptions, Preparedness, and Management of Heat Waves?
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ABSTRACT:
SUBMITTER: Siman-Tov M
PROVIDER: S-EPMC8365166 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundHeat waves have been linked with an increase in mortality, but the associated risk has been only partly characterized.MethodsWe examined this association by decomposing the risk for temperature into a "main effect" due to independent effects of daily high temperatures, and an "added" effect due to sustained duration of heat during waves, using data from 108 communities in the United States during 1987-2000. We adopted different definitions of heat-wave days on the basis of combinations of temperature thresholds and days of duration. The main effect was estimated through distributed lag nonlinear functions of temperature, which account for nonlinear delayed effects and short-time harvesting. We defined the main effect as the relative risk between the median city-specific temperature during heat-wave days and the 75th percentile of the year-round distribution. The added effect was defined first using a simple indicator, and then a function of consecutive heat-wave days. City-specific main and added effects were pooled through univariate and multivariate meta-analytic techniques.ResultsThe added wave effect was small (0.2%-2.8% excess relative risk, depending on wave definition) compared with the main effect (4.9%-8.0%), and was apparent only after 4 consecutive heat-wave days.ConclusionsMost of the excess risk with heat waves in the United States can be simply summarized as the independent effects of individual days' temperatures. A smaller added effect arises in heat waves lasting more than 4 days.
| S-EPMC3324776 | biostudies-literature
Project description:The overarching goal of this paper is to shed light on the human influence on the changing patterns of heat waves in India using the Heat Wave Magnitude Index daily (HWMId). The HWMId obtained from the observational data sets shows a large increase in the heat waves during the past decades. Investigating the effects of natural (e.g., solar variations and volcanic forcings) and anthropogenic (e.g., greenhouse gas emissions, anthropogenic, land use, and land cover) forcings revealed that the anthropogenic factors have cause a two-fold increase in the occurrence probability of severe heat waves in central and mid-southern India during twentieth century. The spatial distribution of maximum HWMId values under natural and all forcings (including anthropogenic) indicates that in most places human activities have increases the frequency, duration and intensity of extreme heat waves. Under the Representative Concentration Pathway (RCP) 4.5, the risk of heat waves is projected to increase tenfold during the twenty-first century. More than ~ 70% of the land areas in India is projected to be influenced by heat waves with magnitudes greater than 9. Furthermore, we find a significant relationship between heat waves and deficits in precipitation. Results show that concurrent heat waves and droughts are projected to increase in most places in India during the twenty-first century.
| S-EPMC8885895 | biostudies-literature
Project description:Heat waves have been linked to increases in emergency-related morbidity, but more research is needed on the demographic and disease-specific aspects of these morbidities. Using a case-crossover approach, over 700,000 daily emergency department hospital admissions in Charlottesville, Virginia, U.S.A. from 2005⁻2016 are compared between warm season heat wave and non-heat wave periods. Heat waves are defined based on the exceedance, for at least three consecutive days, of two apparent temperature thresholds (35 °C and 37 °C) that account for 3 and 6% of the period of record. Total admissions and admissions for whites, blacks, males, females, and 20⁻49 years old are significantly elevated during heat waves, as are admissions related to a variety of diagnostic categories, including diabetes, pregnancy complications, and injuries and poisoning. Evidence that heat waves raise emergency department admissions across numerous demographic and disease categories suggests that heat exerts comorbidity influences that extend beyond the more well-studied direct relationships such as heat strokes and cardiac arrest.
| S-EPMC6068980 | biostudies-literature
Project description:Heat waves are associated with increased mortality, however, few studies have examined the added effect of heat waves. Moreover, there is limited evidence for the influence of different heat wave definitions (HWs) on cardiovascular mortality in Beijing, the capital of China. The aim of this study was to find the best HW definitions for cardiovascular mortality, and we examined the effect modification by an individual characteristic on cardiovascular mortality in Beijing, a typical northern city in China. We applied a Poisson generalized additive approach to estimate the differences in cardiovascular mortality during heat waves (using 12 HWs) compared with non-heat-wave days in Beijing from 2006 to 2009. We also validated the model fit by checking the residuals to ensure that the autocorrelation was successfully removed. In addition, the effect modifications by individual characteristics were explored in different HWs. Our results showed that the associations between heat waves and cardiovascular mortality differed from different HWs. HWs using the 93th percentile of the daily average temperature (27.7 °C) and a duration ?5 days had the greatest risk, with an increase of 18% (95% confidence interval (CI): 6%, 31%) in the overall population, 24% (95% CI: 10%, 39%) in an older group (ages ?65 years), and 22% (95% CI: 3%, 44%) in a female group. The added effect of heat waves was apparent after 5 consecutive heat wave days for the overall population and the older group. Females and the elderly were at higher risk than males and younger subjects (ages <65 years). Our findings suggest that heat wave definitions play a significant role in the relationship between heat wave and cardiovascular mortality. Using a suitable definition may have implications for designing local heat early warning systems and protecting the susceptible populations during heat waves.
| S-EPMC5036765 | biostudies-literature
Project description:BackgroundGraduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical-legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy.MethodsAnonymous electronic surveys were sent to attending surgeons and residents of all Accreditation Council for Graduate Medical Education accredited programs during the 2017-2018 academic year. Seventy-two integrated and 42 independent plastic surgery programs were surveyed. Analysis of responses was performed using the Fisher exact and chi-square tests.ResultsThere were 158 attending surgeon and 129 resident responses. The resident and attending surgeon response rates were 11.7% and 16.8%, respectively. Eighty-seven percent of residents felt their operative experience within residency prepared them for practice. Residents felt least prepared in aesthetics and pediatrics/craniofacial surgery. Attending surgeons perceived that they provided residents graduated autonomy throughout residency. Residents identified the complexity of a procedure, attending surgeon supervision, and time constraints as the largest factors influencing resident autonomy. Attending surgeons noted patient safety as the largest deterrent to autonomy.ConclusionsIn our study, a majority of plastic surgery residents were found to feel prepared for practice after residency; however, preparedness gaps within training still exist in aesthetic and craniomaxillofacial surgery. Plastic surgery programs must work to develop training programs that simultaneously promote resident autonomy, while prioritizing patient safety, and maintaining productivity and financial well-being.
| S-EPMC7647638 | biostudies-literature
Project description:Although physiological responses to the thermal environment are most frequently investigated using constant temperatures, the incorporation of thermal variability can allow for a more accurate prediction of how thermally sensitive species respond to a rapidly changing climate. In species with temperature-dependent sex determination (TSD), developmental responses to incubation temperature are mediated by several genes involved in gonadal differentiation. Kdm6b and Dmrt1 respond to cool incubation temperatures and are associated with testis development, while FoxL2 and Cyp19A1 respond to warm incubation temperatures and are associated with ovary development. Using fluctuating incubation temperatures, we designed two studies, one investigating how conflicting thermal cues affect the timing of commitment to gonadal development, and another investigating the rapid molecular responses to conflicting thermal cues in the red-eared slider turtle (Trachemys scripta). Using gene expression as a proxy of timing of commitment to gonadal fate, results from the first study show that exposure to high amounts of conflicting thermal cues during development delays commitment to gonadal fate. Results from the second study show that Kdm6b splice variants exhibit differential responses to early heat wave exposure, but rapidly (within 2 days) recover to pre-exposure levels after the heat wave. Despite changes in the expression of Kdm6b splice variants, there was no effect on Dmrt1 expression. Collectively, these findings demonstrate how short exposures to heat early in development can change how embryos respond to heat later in development.
| S-EPMC10560553 | biostudies-literature
Project description:Purpose The purpose of this study was to assess the self-perceived preparedness of incoming postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) ophthalmology interns/residents to carry out core competencies in ophthalmology. Methods An online survey was created using the Survey Monkey survey platform and distributed to all ophthalmology resident applicants to the Bascom Palmer Eye Institute from the 2021 to 2022 and 2022 to 2023 application cycles. The survey contained questions pertaining to demographics, prior ophthalmic experience, online resources that were used to prepare for ophthalmology, and self-perceived preparedness to carry out key clinical skills in ophthalmology. Results A total of 170 responses were obtained (16.1% response rate). Of those, 119 (70%) were incoming PGY1 interns and 51 (30%) were incoming PGY2 residents for the 2022 to 2023 academic year. Most respondents (90.6%, n = 154) reported that their ophthalmology residency was affiliated with an integrated ophthalmology intern year. Incoming PGY2s moderately agreed with the statement that they felt as prepared to see patients in ophthalmology as they do in other surgical subspecialties, whereas incoming PGY1s only mildly agreed with that statement ( p = 0.003). Both incoming PGY1s and PGY2s felt most prepared to obtain histories relating to basic ophthalmic complaints and felt least prepared to read and interpret ophthalmic imaging studies. The most popular online resources used by respondents in order of popularity were EyeGuru (35.2%, n = 60), EyeWiki (32.9%, n = 56), Tim Root/OphthoBook (26.5%, n = 45), American Academy of Ophthalmology (13.5%, n = 23), and EyeRounds/University of Iowa (13.5%, n = 23). Conclusion A major challenge in integrating ophthalmic education into the medical school curricula is the gradual shift toward shorter preclinical curricula. However, having a core foundation of ophthalmic knowledge is critical for incoming ophthalmology residents to be able to maximize their specialty-specific training. Integrated ophthalmology intern years likely play a significant role in the increased self-efficacy of incoming PGY2s compared with incoming PGY1s. Adopting nontraditional teaching methods like flipped classroom learning, utilizing online medical education resources, and continuing to increase ophthalmology exposure during PGY1 year may better prepare incoming PGY2s to operate independently in ophthalmology settings.
| S-EPMC10730283 | biostudies-literature
Project description:BackgroundFamily Healthware™, a tool developed by the CDC, is a self-administered web-based family history tool that assesses familial risk for six diseases (coronary heart disease; stroke; diabetes; and colon, breast, and ovarian cancers) and provides personalized prevention messages based on risk. The Family Healthware Impact Trial (FHITr) set out to examine the clinical utility of presenting personalized preventive messages tailored to family history risk for improving health behaviors.PurposeThe purpose of this study was to examine the impact of Family Healthware on modifying disease risk perceptions, particularly among those who initially underestimated their risk for certain diseases.DesignA total of 3786 patients were enrolled in a cluster-randomized trial to evaluate the clinical utility of Family Healthware.Setting/participantsParticipants were recruited from 41 primary care practices among 13 states between 2005 and 2007.Main outcome measuresPerceived risk for each disease was assessed at baseline and 6-month follow-up using a single-item comparative risk question. Analyses were completed in March 2012.ResultsCompared to controls, Family Healthware increased risk perceptions among those who underestimated their risk for heart disease (15% vs 9%, p<0.005); stroke (11% vs 8%, p<0.05); diabetes (18% vs 11%, p<0.05); and colon cancer (17% vs 10%, p=0.05) but not breast or ovarian cancers. The majority of underestimators did not shift in their disease risk perceptions.ConclusionsFamily Healthware was effective at increasing disease risk perceptions, particularly for metabolic conditions, among those who underestimated their risk. Results from this study also demonstrate the relatively resistant nature of risk perceptions.Trial registrationThis study is registered at clinicaltrials.govNCT00164658.
| S-EPMC3448124 | biostudies-literature
Project description:This study aimed to assess the impacts of heat waves during the summer of 2015 on mortality in the Czech Republic and to compare them with those of heat waves back to the previous record-breaking summer of 1994. We analyzed daily natural-cause mortality across the country's entire population. A mortality baseline was determined using generalized additive models adjusted for long-term trends, seasonal and weekly cycles, and identified heat waves. Mortality deviations from the baseline were calculated to quantify excess mortality during heat waves, defined as periods of at least three consecutive days with mean daily temperature higher than the 95th percentile of annual distribution. The summer of 2015 was record-breaking in the total duration of heat waves as well as their total heat load. Consequently, the impact of the major heat wave in 2015 on the increase in excess mortality relative to the baseline was greater than during the previous record-breaking heat wave in 1994 (265% vs. 240%). Excess mortality was comparable among the younger age group (0-64 years) and the elderly (65+ years) in the 1994 major heat wave while it was significantly larger among the elderly in 2015. The results suggest that the total heat load of a heat wave needs to be considered when assessing its impact on mortality, as the cumulative excess heat factor explains the magnitude of excess mortality during a heat wave better than other characteristics such as duration or average daily mean temperature during the heat wave. Comparison of the mortality impacts of the 2015 and 1994 major heat waves suggests that the recently reported decline in overall heat-related mortality in Central Europe has abated and simple extrapolation of the trend would lead to biased conclusions even for the near future. Further research is needed toward understanding the additional mitigation measures required to prevent heat-related mortality in the Czech Republic and elsewhere.
| S-EPMC5750980 | biostudies-literature
Project description:Understanding how weather impacts health is critical, especially under a changing climate; however, relatively few studies have investigated subtropical regions. We examined how mortality in São Paulo, Brazil, is affected by cold, heat, and heat waves over 14.5 years (1996-2010). We used over-dispersed generalized linear modeling to estimate heat- and cold-related mortality, and Bayesian hierarchical modeling to estimate overall effects and modification by heat wave characteristics (intensity, duration, and timing in season). Stratified analyses were performed by cause of death and individual characteristics (sex, age, education, marital status, and place of death). Cold effects on mortality appeared higher than heat effects in this subtropical city with moderate climatic conditions. Heat was associated with respiratory mortality and cold with cardiovascular mortality. Risk of total mortality was 6.1% (95% confidence interval 4.7, 7.6%) higher at the 99th percentile of temperature than the 90th percentile (heat effect) and 8.6% (6.2, 11.1%) higher at the 1st compared to the 10th percentile (cold effect). Risks were higher for females and those with no education for heat effect, and males for cold effect. Older persons, widows, and non-hospital deaths had higher mortality risks for heat and cold. Mortality during heat waves was higher than on non-heat wave days for total, cardiovascular, and respiratory mortality. Our findings indicate that mortality in São Paulo is associated with both cold and heat and that some subpopulations are more vulnerable.
| S-EPMC4644507 | biostudies-literature