Emerging Roles of Health Care Providers to Mitigate Climate Change Impacts: A Perspective from East Harlem, New York

Professional associations of health care workers are issuing policy statements on climate change and health with greater frequency, calling on their members to act in their duty to protect and fulfill the right to health. These health care providers’ perceptions of their roles in the intersection of climate and health, however, have not been well-studied. This article presents results from a qualitative study using focus groups conducted with health care providers serving the low-income, ethnic minority population in East Harlem, New York. The focus groups sought to identify and explore providers’ perceived health threats of climate change, as well as their perceived role as frontline disseminators of information and detectors of disease for their patients. Extreme heat events were used to frame the discussion in each group. Three major themes emerged: 1) environmental awareness, 2) an “ecohealth” lens, and 3) heat and health vulnerability. The participants demonstrated their interest in playing a role in climate change adaptation by identifying at-risk patients and helping to tailor clinical care to better serve these individuals

Chronic Conditions and Pediatric Healthcare Utilization during Warm Weather Days in New York City

Background: While literature on the overall health burden of high temperature exposures on children continues to grow, little is known about whether children with chronic diseases are particularly vulnerable to the adverse health impacts of extreme heat. Methods: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to emergency department and hospitals during the warm months (May-September) from 2005 to 2011. We identified children with specific chronic diseases or conditions that plausibly enhance susceptibility to heat (i.e., asthma, obesity, cerebral palsy, cystic fibrosis, sickle cell disease, sickle cell trait, and mental health disorders). We also identified children with a complex chronic condition (CCC) defined using the Feudtner classification scheme. We used a time-stratified, case-crossover design and conditional logistic regression models, adjusted for mean daily relative humidity, to derive estimates of excess risk of pediatric admissions associated with daily maximum temperature (Tmax). Results: There were 2,480,556 pediatric cases in New York City during the study period; 90.8% (n = 2,252,550) occurred in emergency departments; chronic conditions appeared in 0.1% (sickle cell trait) up to 8.3% (asthma). The average Tmax was 80.3F (range 50F-104F). While we found an increase in overall pediatric admissions associated with Tmax, we found decreased risks among children with some specific categories of chronic conditions, including asthma, obesity, and mental health disorders. For children with CCC, temperature was associated with increased admissions when considering only the summer months. Conclusions: We found that children with chronic conditions show a complex pattern of risk of healthcare utilization. With further replication, our findings can help inform preparedness of the health system for prevention measures

Temperature and mental health–related emergency department and hospital encounters among children, adolescents and young adults

Abstract Aims We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults. Methods This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June–August) in New York City from 2005 to 2011 from patients of three age groups (6–11, 12–17 and 18–25 years). Using a distributed lag non-linear model over 0–5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations. Results In New York City, there were 82,982 mental health–related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health–related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13–1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09–1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04–1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature. Conclusions We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood

The Association of Tree Pollen Concentration Peaks and Allergy Medication Sales in New York City: 2003–2008

The impact of pollen exposure on population allergic illness is poorly characterized. We explore the association of tree pollen and over-the-counter daily allergy medication sales in the New York City metropolitan area. Dates of peak tree pollen (maple, oak, and birch) concentrations were identified from 2003 to 2008. Daily allergy medication sales reported to the city health department were analyzed as a function of the same-day and lagged tree pollen peak indicators, adjusting for season, year, temperature, and day of week. Significant associations were found between tree pollen peaks and allergy medication sales, with the strongest association at 2-day lag (excess sales of 28.7% (95% CI: 17.4–41.2) over the average sales during the study period). The cumulative effect over the 7-day period on and after the tree pollen peak dates was estimated to be 141.1% (95% CI: 79.4–224.1). In conclusion, tree pollen concentration peaks were followed by large increases in over-the-counter allergy medication sales

Search for resonances in the mass spectrum of muon pairs produced in association with b quark jets in proton-proton collisions at root 8 and 13 TeV

A search for resonances in the mass range 12-70 GeV produced in association with a b quark jet and a second jet, and decaying to a muon pair, is reported. The analysis is based on data from proton-proton collisions at center-of-mass energies of 8 and 13 TeV, collected with the CMS detector at the LHC and corresponding to integrated luminosities of 19.7 and 35.9 fb(-1), respectively. The search is carried out in two mutually exclusive event categories. Events in the first category are required to have a b quark jet in the central region (|| 2.4) and at least one jet in the forward region (|| > 2.4). Events in the second category are required to have two jets in the central region, at least one of which is identified as a b quark jet, no jets in the forward region, and low missing transverse momentum. An excess of events above the background near a dimuon mass of 28 GeV is observed in the 8 TeV data, corresponding to local significances of 4.2 and 2.9 standard deviations for the first and second event categories, respectively. A similar analysis conducted with the 13 TeV data results in a mild excess over the background in the first event category corresponding to a local significance of 2.0 standard deviations, while the second category results in a 1.4 standard deviation deficit. The fiducial cross section measurements and 95% confidence level upper limits on those for a resonance consistent with the 8 TeV excess are provided at both collision energies