The effect of heterogeneous severe drought on all-cause and cardiovascular mortality in the Northern Rockies and Plains of the United States

Drought is a distinct and complicated climate hazard that regularly leads to severe economic impacts. Changes in the frequency and occurrence of drought due to anthropogenic climate change can lead to new and unanticipated outcomes. To better prepare for health outcomes, more research is needed to develop methodologies to understand potential consequences. This study suggests a new methodology for assessing the impact of monthly severe drought exposure on mortality in the Northern Rockies and Plains of the United States from 2000 to 2018. A two-stage model with the power prior approach was applied to integrate heterogeneous severe drought pattern and estimate overall risk ratios of all-cause and cardiovascular mortality related to multiple drought indices (the US Drought Monitor, 6- and 12-month Standardized Precipitation-Evapotranspiration Index, 6- and 12 month Evaporative Demand Drought Index). Under severe drought, the risk ratios of all-cause mortality are 1.050 (95 % Cr: 1.031 to 1.071, USDM), 1.041 (95 % Cr: 1.022 to 1.060, 6-SPEI), 1.009 (95 % Cr: 0.989 to 1.031, 12SPEI), 1.045 (95 % Cr: 1.022 to 1.067, 6-EDDI), and 1.035 (95 % Cr: 1.009 to 1.062, 12-EDDI); cardiovascular mortality are 1.057 (95 % Cr: 1.023 to 1.091, USDM), 1.028 (95 % Cr: 0.998 to 1.059, 6-SPEI), 1.005 (95 % Cr: 0.973 to 1.040, 12-SPEI), 1.042 (95 % Cr: 1.005 to 1.080, 6-EDDI), and 1.004 (95 % Cr: 0.959 to 1.049, 12-EDDI). Our results showed that (i) a model with properly accounted for heterogeneous exposure pattern had greater risk ratios if statistically significant; (ii) a mid-term (6-month) severe drought had higher risk ratios compared to longer-term (12-month) drought; and (iii) different severe droughts affect populations in a different way. These results expand the existing knowledge of drought relationship to increasing mortality in the United States. The findings from this study highlight the need for communities and policymakers to establish effective drought-prevention initiatives in this region.

Impacts of compounding drought and heatwave events on child mental health: insights from a spatial clustering analysis

BACKGROUND

Concurrent heatwave and drought events may have larger health impacts than each event separately; however, no US-based studies have examined differential mental health impacts of compound drought and heatwave events in pediatric populations.

OBJECTIVE

To examine the spatial patterns of mood disorders and suicide-related emergency department (ED) visits in children during heatwave, drought, and compound heatwave and drought events. We tested whether the occurrence of compound heatwave and drought events have a synergistic (multiplicative) effect on the risk of mental health related outcomes in children as compared to the additive effect of each individual climate hazard. Lastly, we identified household and community-level determinants of geographic variability of high psychiatric burden.

METHODS

Daily counts of psychiatric ED visits in North Carolina from 2016 to 2019 (May to Sept) for pediatric populations were aggregated at the county scale. Bernoulli cluster analyses identified high-risk spatial clusters of psychiatric morbidity during heatwave, drought, or compound heatwave and drought periods. Multivariate adaptive regression models examined the individual importance of household and community-level determinants in predicting high-risk clustering of mood disorders or suicidality across the three climate threats.

RESULTS

Results showed significant spatial clustering of suicide and mood disorder risks in children during heatwave, drought, and compound event periods. Periods of drought were associated with the highest likelihood of spatial clustering for suicide and mood disorders, where the risk of an ED visit was 4.48 and 6.32 times higher, respectively, compared to non-drought periods. Compounding events were associated with a threefold increase in both suicide and mood disorder-related ED visits. Community and household vulnerability factors that most contributed to spatial clustering varied across climate hazards, but consistent determinants included residential segregation, green space availability, low English proficiency, overcrowding, no broadband access, no vehicle access, housing vacancy, and availability of housing units.

CONCLUSION

Findings advance understanding on the locations of vulnerable pediatric populations who are disproportionately exposed to compounding climate stressors and identify community resilience factors to target in public health adaptation strategies.

The Association between Drought Exposure and Respiratory-Related Mortality in the United States from 2000 to 2018

Climate change has brought increasing attention to the assessment of health risks associated with climate and extreme events. Drought is a complex climate phenomenon that has been increasing in frequency and severity both locally and globally due to climate change. However, the health risks of drought are often overlooked, especially in places such as the United States, as the pathways to health impacts are complex and indirect. This study aims to conduct a comprehensive assessment of the effects of monthly drought exposure on respiratory mortality for NOAA climate regions in the United States from 2000 to 2018. A two-stage model was applied to estimate the location-specific and overall effects of respiratory risk associated with two different drought indices over two timescales (the US Drought Monitor and the 6-month and 12-month Evaporative Demand Drought Index). During moderate and severe drought exposure, respiratory mortality risk ratio in the general population increased up to 6.0% (95% Cr: 4.8 to 7.2) in the Northeast, 9.0% (95% Cr: 4.9 to 13.3) in the Northern Rockies and Plains, 5.2% (95% Cr: 3.9 to 6.5) in the Ohio Valley, 3.5% (95% Cr: 1.9 to 5.0) in the Southeast, and 15.9% (95% Cr: 10.8 to 20.4) in the Upper Midwest. Our results showed that age, ethnicity, sex (both male and female), and urbanicity (both metro and non-metro) resulted in more affected population subgroups in certain climate regions. The magnitude and direction of respiratory risk ratio differed across NOAA climate regions. These results demonstrate a need for policymakers and communities to develop more effective strategies to mitigate the effects of drought across regions.

Short-term effects of specific humidity and temperature on COVID-19 morbidity in select US cities

Little is known about the environmental conditions that drive the spatiotemporal patterns of SARS-CoV-2. Preliminary research suggests an association with meteorological parameters. However, the relationship with temperature and humidity is not yet apparent for COVID-19 cases in US cities first impacted. The objective of this study is to evaluate the association between COVID-19 cases and meteorological parameters in select US cities. A case-crossover design with a distributed lag nonlinear model was used to evaluate the contribution of ambient temperature and specific humidity on COVID-19 cases in select US cities. The case-crossover examines each COVID case as its own control at different time periods (before and after transmission occurred). We modeled the effect of temperature and humidity on COVID-19 transmission using a lag period of 7 days. A subset of 8 cities were evaluated for the relationship with meteorological parameters and 5 cities were evaluated in detail. Short-term exposure to humidity was positively associated with COVID-19 transmission in 4 cities. The associations were small with 3 out of 4 cities exhibiting higher COVID19 transmission with specific humidity that ranged from 6 to 9 g/kg. Our results suggest that weather should be considered in infectious disease modeling efforts. Future work is needed over a longer time period and across different locations to clearly establish the weather-COVID19 relationship.

Treatment of locally advanced thyroid carcinoma with combination doxorubicin and radiation therapy

Since 1979, 41 patients with locally advanced thyroid cancers have been prospectively treated in our institution according to a combination regimen of low-dose Adriamycin (doxorubicin) and external-beam radiation therapy. Two types of treatment regimen were used depending on tumor histologic type. Group 1 patients with well-differentiated papillary, follicular, or mixed type tumor (n = 22) received the combined regimen consisting of once weekly administration of Adriamycin (10 mg/m2) before radiation therapy (RT). Radiation therapy was carried out with a daily dose of 200 cGy for 5 days per week to a total tumor dose of 5600 cGy. Group 2 patients with anaplastic giant and spindle cell carcinoma of the thyroid (n = 19) received the combined regimen, consisting of once weekly administration of Adriamycin (10 mg/m2) before hyperfractionated RT. Radiation therapy was carried out with a fractional dose of 160 cGy per treatment twice a day for 3 days per week to a total dose of 5760 cGy in 40 days. Initial complete tumor response rates in the group 1 and 2 were 91% and 84%, respectively. Local tumor control rates at 2 years after combined therapy were 77% and 68%, respectively. The median survival time was 4 years for group 1 and 1 year for group 2. There was no disproportionately enhanced normal tissue morbidity seen with this combined approach. Patients in group 1 have a good quality of life, once the local disease is under control due to the indolent course of the disease. On the contrary, most patients in group 2 promptly developed distant metastases and died from the disease.

Thyroid cancer

Thyroid cancer encompasses some forms that practically have no identifiable mortality to one of the most lethal soft tissue cancers known. Because of this variation, a knowledge of the role that age, histology, and extent of disease play in establishing a prognosis is necessary to provide a rational therapeutic program. Younger patients (under age 40) with differentiated cancer, even those with lymph node metastases, should not be overtreated with extensive surgery and 131I or external beam therapy because the prognosis in these patients is so extremely good. Thyroid hormone suppression is probably adequate therapy for patients in this group after obvious disease has been resected. Recurrences can usually be effectively treated with 131I. On the other hand, older patients should be treated more aggressively, especially with the routine use of 131I ablation and therapy after resection of disease. Radiation therapy as described for recurrent disease should be considered at an early point and should be used immediately once the diagnosis of anaplastic cancer has been established. Finally, patience and observation alone should be considered a good therapeutic alternative, for example, in hypercalcitoninemic patients with medullary cancer that has been apparently adequately resected. Repeat operations in these patients fail to eliminate elevated serum calcitonin levels in the majority of cases, and the patients may live for many years with a good quality of life.

Treatment of anaplastic giant and spindle cell carcinoma of the thyroid gland with combination Adriamycin and radiation therapy. A new approach

The authors have devised a new treatment regimen consisting of combination Adriamycin and hyperfractionated radiation therapy for the treatment of anaplastic giant and spindle cell carcinoma of the thyroid gland. The regimen consists of a once weekly administration of low-dose Adriamycin (doxorubicin) (10 mg/m2) and hyperfractionated radiation therapy. The radiation therapy is carried out with fractional dose of 160 rad per treatment twice a day for three days per week. The total tumor dose is 5760 rad delivered in 40 days. Since 1979, nine patients underwent the foregoing combination treatment regimen. Eight of nine achieved complete tumor regression in the primary treated area and six remained free of disease in the neck until time of death or last follow-up. There was no disproportionately enhanced normal tissue morbidity seen with this combined approach. If an effective systemic treatment regimen can be devised for anaplastic carcinoma of the thyroid, the present Adriamycin and hyperfractionated radiation therapy may be capable of achieving improved survival time.

Combination adriamycin and radiation therapy for locally advanced carcinoma of the thyroid gland

We have devised a new treatment regimen consisting of combination adriamycin and radiation therapy for the treatment of locally advanced differentiated carcinoma of the thyroid gland. The regimen consists of a once weekly administration of low dose adriamycin (10 mg/m2) and radiation therapy. The radiation therapy is carried out with a fractional dose of 200 rad per treatment, five times per week, for 5 1/2 weeks. Since 1979, eight patients underwent the combination treatment regimen and seven out of eight achieved complete tumor regression in the primary treated area. There was no disproportionately enhanced normal tissue morbidity seen with this approach.

Bone scans in bone metastases from functioning thyroid carcinoma

Sixty percent of differentiated thyroid carcinoma bone metastases identified by local radioactive iodide uptake and radiographic changes were negative in the bone scans. Another 20% of the bony metastases showed only a minimal increased uptake of bone imaging radionuclides. It is concluded that the bone scan is not a useful tool in the work-up for metastatic thyroid cancer.