Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study.

BACKGROUND: Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications. OBJECTIVE: Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy. METHODS: A time-stratified case-crossover design with conditional logistic regression was performed on ∼206,000 psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated. RESULTS: Each 5°C increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days. CONCLUSIONS: For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.

A Difference-In Difference Analysis of the South Carolina 2015 Extreme Floods and the Association with Maternal Health.

Research documenting the public health impacts of natural disasters often focuses on adults and children. Little research has examined the influence of extreme events, like floods, on maternal health, and less has examined the effect of disasters on maternal indicators like severe maternal morbidity (SMM) or unexpected outcomes of labor and delivery that result in significant short-or long-term consequences to a woman's health. The aim of this study is to identify the impacts of the 2015 flood events on maternal health outcomes in South Carolina, USA. We employ a quasi-experimental design using a difference-in-difference analysis with log-binomial regressions to evaluate maternal outcomes for impacted and control locations during the disaster event. Unlike previous studies, we extended our difference-in-difference analysis to include a trimester of exposure to assess the timing of flood exposure. We did not find evidence of statistically significant main effects on maternal health from the 2015 flood events related to preterm birth, gestational diabetes, mental disorders of pregnancy, depression, and generalized anxiety. However, we did find a statistically significant increase in SMM and low birth weight during the flood event for women in select trimester periods who were directly exposed. Our work provides new evidence on the effects of extreme flood events, like the 2015 floods, which can impact maternal health during specific exposure periods of pregnancy. Additional research is needed across other extreme weather events, as the unique context of the 2015 floods limits the generalizability of our findings.

Changing medical students' attitudes to and knowledge of deafness: a mixed methods study.

BACKGROUND AND AIM: Communication with healthcare professionals is challenging for those with hearing loss. This study aimed to determine the impact dedicated deaf awareness training could have on medical student's attitudes to and knowledge of deafness, and to explore ways of incorporating deaf awareness training into the core undergraduate medical curriculum. METHODS: A validated questionnaire was used to measure attitudes to and knowledge of deafness in those taking an optional deaf awareness and basic sign language module for second year medical students compared to students who took another module. Previous students on this module were also contacted and asked to complete the same questionnaire. Focus groups with these students explored ways to incorporate deaf awareness training into the core undergraduate medical curriculum. RESULTS: After completing the module, students had a more positive attitude to deaf individuals (p < 0.001), and higher knowledge scores (p = 0.027) in comparison to the control group. Examination of data revealed a significant negative association between years since undertaking the module and attitudes score (r = - 0.29, p = 0.04, n = 51), with no significant association for knowledge score (r = 0.22, p = 0.11, n = 52). Focus groups suggested integrating deaf awareness training into existing undergraduate communication skills teaching, with the inclusion of deaf tutors. CONCLUSIONS: This study indicates that incorporating a specialist module on deafness can improve attitudes to and knowledge of deafness. Importantly, this effect decreases over time, demonstrating the need for refresher training amongst junior doctors.