Identifying joint impacts of sun radiation, temperature, humidity, and rain duration on triggering mental disorders using a high-resolution weather monitoring system.

BACKGROUND: Mental disorders (MDs) are behavioral or mental patterns that cause significant distress or impairment of personal functioning. Previously, temperature has been linked to MDs, but most studies suffered from exposure misclassification due to limited monitoring sites. We aimed to assess whether multiple meteorological factors could jointly trigger MD-related emergency department (ED) visits in warm season, using a highly dense weather monitoring system. METHODS: We conducted a time-stratified, case-crossover study. MDs-related ED visits (primary diagnosis) from May-October 2017-2018 were obtained from New York State (NYS) discharge database. We obtained solar radiation (SR), relative humidity (RH), temperature, heat index (HI), and rainfall from Mesonet, a real-time monitoring system spaced about 17 miles (126 stations) across NYS. We used conditional logistic regression to assess the weather-MD associations. RESULTS: For each interquartile range (IQR) increase, both SR (excess risk (ER): 4.9%, 95% CI: 3.2-6.7%) and RH (ER: 4.0%, 95% CI: 2.6-5.4%) showed the largest risk for MD-related ED visits at lag 0-9 days. While temperature presented a short-term risk (highest ER at lag 0-2 days: 3.7%, 95% CI: 2.5-4.9%), HI increased risk over a two-week period (ER range: 3.7-4.5%), and rainfall hours showed an inverse association with MDs (ER: -0.5%, 95% CI: 0.9-(-0.1)%). Additionally, we observed stronger association of SR, RH, temperature, and HI in September and October. Combination of high SR, RH, and temperature displayed the largest increase in MDs (ER: 7.49%, 95% CI: 3.95-11.15%). The weather-MD association was stronger for psychoactive substance usage, mood disorders, adult behavior disorders, males, Hispanics, African Americans, individuals aged 46-65, or Medicare patients. CONCLUSIONS: Hot and humid weather, especially the joint effect of high sun radiation, temperature and relative humidity showed the highest risk of MD diseases. We found stronger weather-MD associations in summer transitional months, males, and minority groups. These findings also need further confirmation.

How neighborhood environment modified the effects of power outages on multiple health outcomes in New York state?

Background: Although power outage (PO) is one of the most important consequences of increasing weather extremes and the health impact of POs has been reported previously, studies on the neighborhood environment underlying the population vulnerability in such situations are limited. This study aimed to identify dominant neighborhood environmental predictors which modified the impact of POs on multiple health outcomes in New York State. Methods: We applied a two-stage approach. In the first stage, we used time series analysis to determine the impact of POs (versus non-PO periods) on multiple health outcomes in each power operating division in New York State, 2001-2013. In the second stage, we classified divisions as risk-elevated and non-elevated, then developed predictive models for the elevation status based on 36 neighborhood environmental factors using random forest and gradient boosted trees. Results: Consistent across different outcomes, we found predictors representing greater urbanization, particularly, the proportion of residents having access to public transportation (importance ranging from 4.9-15.6%), population density (3.3-16.1%), per capita income (2.3-10.7%), and the density of public infrastructure (0.8-8.5%), were associated with a higher possibility of risk elevation following power outages. Additionally, the percent of minority (-6.3-27.9%) and those with limited English (2.2-8.1%), the percent of sandy soil (6.5-11.8%), and average soil temperature (3.0-15.7%) were also dominant predictors for multiple outcomes. Spatial hotspots of vulnerability generally were located surrounding New York City and in the northwest, the pattern of which was consistent with socioeconomic status. Conclusion: Population vulnerability during power outages was dominated by neighborhood environmental factors representing greater urbanization.

Power Outage: An Ignored Risk Factor for COPD Exacerbations.

BACKGROUND: COPD is the third leading cause of death in the United States, with 16 million Americans currently experiencing difficulty with breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations. RESEARCH QUESTION: The goal of this study was to determine how power outages affect COPD exacerbations. STUDY DESIGN AND METHODS: Using distributed lag nonlinear models controlling for time-varying confounders, the hospitalization rate during a power outage was compared vs non-outage periods to determine the rate ratio (RR) for COPD and its subtypes at each of 0 to 6 lag days in New York State from 2001 to 2013. Stratified analyses were conducted according to sociodemographic characteristics, season, and clinical severity; changes were investigated in numerous critical medical indicators, including length of stay, hospital cost, the number of comorbidities, and therapeutic procedures between the two periods. RESULTS: The RR of COPD hospitalization following power outages ranged from 1.03 to 1.39 across lag days. The risk was strongest at lag0 and lag1 days and lasted significantly for 7 days. Associations were stronger for the subgroup with acute bronchitis (RR, 1.08-1.69) than for cases of acute exacerbation (RR, 1.03-1.40). Compared with non-outage periods, the outage period was observed to be $4.67 thousand greater in hospital cost and 1.38 greater in the number of comorbidities per case. The average cost (or number of comorbidities) was elevated in all groups stratified according to cost (or number of comorbidities). In contrast, changes in the average length of stay (-0.43 day) and the average number of therapeutic procedures (-0.09) were subtle. INTERPRETATION: Power outages were associated with a significantly elevated rate of COPD hospitalization, as well as greater costs and number of comorbidities. The average cost and number of comorbidities were elevated in all clinical severity groups.

The general use of outdoor warning sirens: a preliminary survey of emergency managers.

With more direct, personal warning systems becoming popular, the continued maintenance of older warning systems, such as outdoor warning sirens, may be jeopardized as emergency managers (EMs) seek to optimize their limited budgets. However, the extent to which sirens are embedded into the American landscape and culture argues against their removal. To better quantify the distribution and use of outdoor warning sirens, an international survey of EMs was conducted to learn more about where siren systems are deployed and how they are operated. Approximately 593 respondents started the 31 question survey with 383 completing it. Questions were asked regarding siren network size, alternative warning systems, siren use and capabilities, and testing. For those without sirens, a series of questions were asked for why sirens were not used. In general, a lack of perceived threat, high costs, and large geographic area kept some jurisdictions from installing sirens. Of those that operate siren networks, half of networks are small (≤10 sirens), while a small percentage of jurisdictions (6.3 percent) operate very large networks (>100). A large majority of respondents expected to maintain or expand their networks within the next 5 years. Three-quarters of respondents use additional warning systems. Nearly half of respondents use sirens for nonweather applications, and nearly two-thirds have the capability to use multiple sound alerts. Overall, sirens remain a popular tool for warning on a variety of local hazards though how the sirens are operated and tested vary widely by jurisdiction.