Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Hess JJ[original query] |
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Short term physician visits and medication prescriptions for allergic disease associated with seasonal tree, grass, and weed pollen exposure across the United States
Saha S , Vaidyanathan A , Lo F , Brown C , Hess JJ . Environ Health 2021 20 (1) 85 BACKGROUND: While year-round exposure to pollen is linked to a large burden of allergic diseases, location-specific risk information on pollen types and allergy outcomes are limited. We characterize the relationship between acute exposure to tree, grass and weed pollen taxa and two allergy outcomes (allergic rhinitis physician visit and prescription allergy medication fill) across 28 metropolitan statistical areas (MSA) in the United States. METHODS: We obtained daily pollen data from National Allergy Bureau (NAB) monitors at these 28 MSAs for 2008-2015. We revised the NAB guidelines to classify taxa-specific pollen severity each day. Daily information on allergic rhinitis and prescribed allergy medications for individuals with employer-based health insurance from the IBM MarketScan Research database for these MSAs. We combined the daily pollen and health data for each MSA into a longitudinal dataset. We conducted a MSA-specific conditional quasi-Poisson regression analysis to assess how different levels of pollen concentration impact the health outcomes, controlling for local air pollution, meteorology and Influenza-like illness (ILI). We used a random effects meta-analysis to produce an overall risk estimate for each pollen type and health outcome. RESULTS: The seasonal distribution of pollen taxa and associated health impacts varied across the MSAs. Relative risk of allergic rhinitis visits increased as concentrations increased for all pollen types; relative risk of medication fills increased for tree and weed pollen only. We observed an increase in health risk even on days with moderate levels of pollen concentration. 7-day average concentration of pollen had stronger association with the health outcomes compared to the same-day measure. Controlling for air pollution and ILI had little impact on effect estimates. CONCLUSION: This analysis expands the catalogue of associations between different pollen taxa and allergy-related outcomes across multiple MSAs. The effect estimates we present can be used to project the burden of allergic disease in specific locations in the future as well inform patients with allergies on impending pollen exposure. |
A systematic review of the effects of temperature and precipitation on pollen concentrations and season timing, and implications for human health
Schramm PJ , Brown CL , Saha S , Conlon KC , Manangan AP , Bell JE , Hess JJ . Int J Biometeorol 2021 65 (10) 1615-1628 Climate and weather directly impact plant phenology, affecting airborne pollen. The objective of this systematic review is to examine the impacts of meteorological variables on airborne pollen concentrations and pollen season timing. Using PRISMA methodology, we reviewed literature that assessed whether there was a relationship between local temperature and precipitation and measured airborne pollen. The search strategy included terms related to pollen, trends or measurements, and season timing. For inclusion, studies must have conducted a correlation analysis of at least 5 years of airborne pollen data to local meteorological data and report quantitative results. Data from peer-reviewed articles were extracted on the correlations between seven pollen indicators (main pollen season start date, end date, peak date, and length, annual pollen integral, average daily pollen concentration, and peak pollen concentration), and two meteorological variables (temperature and precipitation). Ninety-three articles were included in the analysis out of 9,679 articles screened. Overall, warmer temperatures correlated with earlier and longer pollen seasons and higher pollen concentrations. Precipitation had varying effects on pollen concentration and pollen season timing indicators. Increased precipitation may have a short-term effect causing low pollen concentrations potentially due to "wash out" effect. Long-term effects of precipitation varied for trees and weeds and had a positive correlation with grass pollen levels. With increases in temperature due to climate change, pollen seasons for some taxa in some regions may start earlier, last longer, and be more intense, which may be associated with adverse health impacts, as pollen exposure has well-known health effects in sensitized individuals. |
An evidence-based public health approach to climate change adaptation
Hess JJ , Eidson M , Tlumak JE , Raab KK , Luber G . Environ Health Perspect 2014 122 (11) 1177-86 BACKGROUND: Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. OBJECTIVES: To review the literature on evidence-based public health (EBPH), determine whether it can be applied to climate change adaptation, and consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. METHODS: We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. DISCUSSION: A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors limit application currently, including lack of higher level evidence of intervention efficacy and lack of guidelines for reporting climate change health impact projections. To enhance the evidence base there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This has implications for funders, researchers, journal editors, practitioners, and policymakers. CONCLUSIONS: The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders. |
Building resilience against climate effects - a novel framework to facilitate climate readiness in public health agencies
Marinucci GD , Luber G , Uejio CK , Saha S , Hess JJ . Int J Environ Res Public Health 2014 11 (6) 6433-58 Climate change is anticipated to have several adverse health impacts. Managing these risks to public health requires an iterative approach. As with many risk management strategies related to climate change, using modeling to project impacts, engaging a wide range of stakeholders, and regularly updating models and risk management plans with new information-hallmarks of adaptive management-are considered central tenets of effective public health adaptation. The Centers for Disease Control and Prevention has developed a framework, entitled Building Resilience Against Climate Effects, or BRACE, to facilitate this process for public health agencies. Its five steps are laid out here. Following the steps laid out in BRACE will enable an agency to use the best available science to project likely climate change health impacts in a given jurisdiction and prioritize interventions. Adopting BRACE will also reinforce public health's established commitment to evidence-based practice and institutional learning, both of which will be central to successfully engaging the significant new challenges that climate change presents. |
Summertime acute heat illness in U.S. emergency departments from 2006 through 2010: analysis of a nationally representative sample
Hess JJ , Saha S , Luber G . Environ Health Perspect 2014 122 (11) 1209-15 BACKGROUND: Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits. OBJECTIVE: To describe acute heat illness visits to US EDs from 2006-2010 and identify factors associated with hospital admission or death-in-the-ED. METHODS: We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006-10, defining cases as ED visits from May-September with any heat illness diagnosis (ICD-9-CM 992.0-992.9). We correlated visit rates and temperature anomalies analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR). RESULTS: There were 326,497 (95% CI: 308,372-344,658) cases, with 287,875 (88.2%) treated-and-released, 38,392 (11.8%) admitted, and 230 (0.07%) died-in-the-ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (correlation coefficient 0.90, p=0.037). Treat-and-release rates were highest for younger adults (26.2/100,000/year), while hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (78.7-120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death-in-the-ED were higher among elders, males, urban and low income residents, and those with chronic conditions. CONCLUSIONS: Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death-in-the-ED. Chronic disease burden exponentially increased this risk. |
Public health and climate change adaptation at the federal level: one agency's response to Executive Order 13514
Hess JJ , Schramm PJ , Luber G . Am J Public Health 2014 104 (3) e22-30 Climate change will likely have adverse human health effects that require federal agency involvement in adaptation activities. In 2009, President Obama issued Executive Order 13514, Federal Leadership in Environmental, Energy, and Economic Performance. The order required federal agencies to develop and implement climate change adaptation plans. The Centers for Disease Control and Prevention (CDC), as part of a larger Department of Health and Human Services response to climate change, is developing such plans. We provide background on Executive Orders, outline tenets of climate change adaptation, discuss public health adaptation planning at both the Department of Health and Human Services and the CDC, and outline possible future CDC efforts. We also consider how these activities may be better integrated with other adaptation activities that manage emerging health threats posed by climate change. |
Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience
Hess JJ , McDowell JZ , Luber G . Environ Health Perspect 2012 120 (2) 171-9 BACKGROUND: Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems. OBJECTIVES: We explored possible explanations for the lack of work on adaptive capacity, outline climate-health challenges that may lie outside public health's coping range, and consider changes in practice that could increase public health's adaptive capacity. METHODS: We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity. DISCUSSION: There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health's adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting. CONCLUSIONS: Increasing public health capacity will be necessary for certain climate-health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change. |
Urban form and extreme heat events: are sprawling cities more vulnerable to climate change than compact cities?
Stone B , Hess JJ , Frumkin H . Environ Health Perspect 2010 118 (10) 1425-1428 BACKGROUND: Extreme heat events (EHEs) are increasing in frequency in large U.S. cities and are responsible for a greater annual number of climate-related fatalities, on average, than any other form of extreme weather. In addition, low-density, sprawling patterns of urban development have been associated with enhanced surface temperatures in urbanized areas. OBJECTIVES: In this study. we examined the association between urban form at the level of the metropolitan region and the frequency of EHEs over a five-decade period. METHODS: We employed a widely published sprawl index to measure the association between urban form in 2000 and the mean annual rate of change in EHEs between 1956 and 2005. RESULTS: We found that the rate of increase in the annual number of EHEs between 1956 and 2005 in the most sprawling metropolitan regions was more than double the rate of increase observed in the most compact metropolitan regions. CONCLUSIONS: The design and management of land use in metropolitan regions may offer an important tool for adapting to the heat-related health effects associated with ongoing climate change. |
Climate change and emergency medicine: impacts and opportunities
Hess JJ , Heilpern KL , Davis TE , Frumkin H . Acad Emerg Med 2009 16 (8) 782-94 There is scientific consensus that the climate is changing, that human activity plays a major role, and that the changes will continue through this century. Expert consensus holds that significant health effects are very likely. Public health and health care systems must understand these impacts to properly pursue preparedness and prevention activities. All of medicine will very likely be affected, and certain medical specialties are likely to be more significantly burdened based on their clinical activity, ease of public access, public health roles, and energy use profiles. These specialties have been called on to consider the likely impacts on their patients and practice and to prepare their practitioners. Emergency medicine (EM), with its focus on urgent and emergent ambulatory care, role as a safety-net provider, urban concentration, and broad-based clinical mission, will very likely experience a significant rise in demand for its services over and above current annual increases. Clinically, EM will see amplification of weather-related disease patterns and shifts in disease distribution. In EM's prehospital care and disaster response activities, both emergency medical services (EMS) activity and disaster medical assistance team (DMAT) deployment activities will likely increase. EM's public health roles, including disaster preparedness, emergency department (ED)-based surveillance, and safety-net care, are likely to face increasing demands, along with pressures to improve fuel efficiency and reduce greenhouse gas emissions. Finally, EM's roles in ED and hospital management, particularly related to building and purchasing, are likely to be impacted by efforts to reduce greenhouse gas emissions and enhance energy efficiency. Climate change thus presents multiple clinical and public health challenges to EM, but also creates numerous opportunities for research, education, and leadership on an emerging health issue of global scope. |
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