Journal Article Annotations
2023, 1st Quarter
Annotations by Mary Burke, MD
During the extreme heat event (EHE) of 2021, the authors found increased mortality for those with schizophrenia, depression, substance use disorder, chronic kidney disease, and those with three or more chronic diseases.
Strength and weaknesses:
The authors used a large data base that had been set up during the COVID pandemic to track deaths in the single-payor, British Columbia health system. The health system had alerted clinicians early during the EHE of the risk for mortality, such that deaths were reported in a more timely way than prior studies. The authors note: “First, this is a case-only study comparing individuals who died during the EHE with those who died before the EHE. The reported effect estimates cannot be interpreted as risk and protective factors as could be done for a case-control study comparing EHE deaths with EHE survivors. Instead, an increased odds ratio indicates that the prevalence of a specific condition was higher among those who died during the EHE compared with those who died during more typical summer conditions.” They also note data limitations using typical weather periods as comparators compared to case-control series. They note that increased heat worsens air pollution, such that some deaths might be attributable to the latter.
We will continue to see increased risk in our patients due to extreme heat events. Schizophrenic patients are especially vulnerable not only related to their medications, which impair thermoregulation, but also due to comorbid chronic illnesses and their higher risk of social or economic disadvantage.
Global plastic manufacturing—from feedstock to disposal and the many ways that plastics enter the environment—are destructive to both the environment and also human health. This easy-to-use online publication describes the health and psychiatric impact of microplastics on health. It can be read in discrete sections, so it is not overwhelming. Harms are especially common among laborers and those living in industrialized areas; these persons are often from minority or marginalized communities. Infants and children are especially vulnerable to neurodevelopmental effects. However, the ubiquity of microplastics in our water and food means that all humans are exposed. This easy-to-use online publication can be read in discrete sections, so it is not overwhelming.
Strength and weaknesses:
This comprehensive synthesis of the literature is directed to health care professionals. It is led by one of the most important leaders in pediatric environmental health, who early in his career recognized the risk of lead poisoning to brain development and forced changes in safety standards.
Non-communicable diseases are common in most countries, including the United States. We continue to learn about the role that environmental toxins play in many of these diseases, and as physicians we are called upon to detect exposures among our patients. We must be especially attentive to the risk among children. Secondly, while the field of medicine has benefited greatly from plastics (as the authors acknowledge), it is time for hospitals and clinics to rethink what we use and how we manage our waste. Those who have leverage with hospital administrators can learn more about how to reduce the environmental footprint of their institutions at Healthcare Without Harm, a global organization: https://noharm.org/ .
Using maps of air pollution (air quality index and particulate matter 2.5, which has been demonstrated to worsen mental health through inflammatory pathways), the authors demonstrate that locations with worse and sustained air pollution have higher rates of internet queries regarding mental health on Baidu (the largest Chinese search engine).
Strength and weaknesses:
The authors did extensive analysis to filter out other weather-related phenomena. However, their data rests on the assumption that Baidu searches accurately reflect mental health complaints. They used online consultation to doctors to validate their numbers, but again this approach assumes that all residents use the internet in similar ways.
Multiple studies have shown the relationship of pollution, and particularly PM 2.5, to anxiety, depression and developmental disorders. C-L psychiatrists can provide psychoeducation on the use of masks during periods of worsened air quality, and to help patients plan ahead if they live in areas with frequent periods of pollution It may be helpful to patients to understand that there are external, physical contributions to worsening symptoms, especially if they have concrete steps to mitigate them. These can include having N95 masks available when outside, and using an air filter when inside. play a role in psychiatric symptom exacerbation.