Pregnant Women Have a Higher Risk of Delivering Early on Unseasonably Hot Days
By Alan Barreca
About a quarter of children in the U.S. are born two to three weeks before their due date, which qualifies them as "early term." Pregnancies typically last 40 weeks, so you might think that being born two to three weeks early wouldn't matter.
But, children born just two or three weeks early are at slightly higher risks of respiratory problems, like asthma, later in childhood. About 1 in 10 children in the U.S. are born more than three weeks before their due date, which qualifies them as "preterm" and puts them at higher risks for much worse outcomes.
Hot weather is one potential risk factor in early deliveries because heat exposure can increase the mother's level of oxytocin, a hormone that regulates delivery. Despite the plausible link, questions remain about the number of deliveries affected by hot weather every year in the U.S. or if hot weather accelerates the timing of delivery by hours, days or weeks.
I'm an economist who has spent much of my decade-long career investigating how weather affects human health, with a focus on child and maternal health. I got started down this career path in 2008 because I wanted to understand why infant health is much worse today in hotter parts of the U.S., like Louisiana. Now, I work on these issues to help identify unknown health-related threats from climate change.
New Evidence on Temperature and Delivery Risk
My latest work with Jessamyn Schaller at Claremont McKenna, published in the Dec. 2, 2019 issue of Nature Climate Change, focuses on the effect of hot weather on early deliveries. We compiled 56 million birth records from the U.S. over the 1969-1988 time period. We then matched the recorded county of birth to daily weather data to see if hot weather does, in fact, lead to earlier deliveries.
But, there were two data challenges we needed to overcome.
First, hotter places have other problems, many of which aren't related to the climate. More people in Mississippi, for example, do not have health insurance.
To get around this challenge, we analyzed time periods with unpredictably hot weather, which we define as an excess of days with maximum temperatures of 90 degrees Fahrenheit (32 degrees Celsius) or higher for a given county and time of year. This approach controls for slow-moving societal changes that affect infant health independent of the weather, like access to health care.
Second, measuring pregnancy duration (or what obstetricians call gestational length) is difficult. Pregnancies technically begin on the start of the last menstrual period prior to conception. Some mothers might recall this date, but the data suggest that there's a lot of guessing going on, either on the hospital's or the mother's side.
Here's where our study gets creative. We tested for shifts in the timing of deliveries. Take a hypothetical example: We might observe 10 more births than average in DeKalb County, Georgia, one of many counties in our data, on an unusually hot day for that time of year. Supposing the hot weather caused those births to occur two days early, we should observe 10 fewer births than average for DeKalb County two days later after the hot weather subsides. With this approach, we only need data on weather and birth dates, and not the start date of the pregnancy.
Our estimates imply that about 5% more children are born on unpredictably hot 90 degree-plus Fahrenheit days than would be expected. In total, hot weather caused about 25,000 babies each year to be born earlier than they would have otherwise in the U.S. The average loss is about six days of gestation. But, the losses were potentially as large as two weeks for some births.
Lessons for Climate Change
This isn't the first study to consider how weather might influence fetal health. A number of studies look at preterm delivery (less than 37 weeks gestation), although using very small samples. Our creative approach and large dataset enabled us to calculate weather-related reductions in gestational lengths across the entire U.S.
Unfortunately, we can't give the specific reason why hot weather causes earlier deliveries. It may or may not be because hot weather increases oxytocin and induces labor. And, it's not clear how much worse off these children will be as they grow into adulthood for being born a little early, especially since we can't tell whether the births qualify as preterm or early term. But, one recent study did find that fetal exposure to hot weather has lasting impacts into adulthood.
The risks for women delivering early are likely to increase in the coming years with climate change. Of course, the exact reductions in gestational length are difficult to predict because it's unclear what our future world is going to look like once 90 degree-plus F (32 degree-plus C) days become much more frequent.
But, to give you a sense of the magnitude, we predicted that more hot weather from climate change would induce about 42,000 additional deliveries annually in the U.S. by the end of century. That's more than 1 in every 100 births.
Air conditioning is likely to be an important solution, and is something we see in our data. But, without using greener air conditioners and renewable energy sources it will make climate change worse.
Given air conditioning is costly, climate change is likely to not only be a threat to child health, but would also put a financial strain on many households' tight budgets.
Alan Barreca is an associate professor of environmental economics at the University of California, Los Angeles.
Disclosure statement: Alan Barreca received funding to conduct this research from the California Strategic Growth Council.
Reposted with permission from The Conversation.
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By Arkilaus Kladit
My name is Arkilaus Kladit. I'm from the Knasaimos-Tehit tribe in South Sorong Regency, West Papua Province, Indonesia. For decades my tribe has been fighting to protect our forests from outsiders who want to log it or clear it for palm oil. For my people, the forest is our mother and our best friend. Everything we need to survive comes from the forest: food, medicines, building materials, and there are many sacred sites in the forest.
Map of the Knasaimos traditional lands.
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By Farah Aqel
Overthinkers are people who are buried in their own obsessive thoughts. Imagine being in a large maze where each turn leads into an even deeper and knottier tangle of catastrophic, distressing events — that is what it feels like to them when they think about the issues that confront them.
Ruminating<p>According to the late Susan Nolen-Hoeksema, a professor of psychology at Yale University, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796420/" target="_blank">ruminating</a> involves replaying a problem over and over in your mind. We ruminate by obsessing over our thoughts and thinking repetitively about various aspects of a past situation.</p><p>It usually involves regret, self-loathing and self-blaming. Rumination is associated with the development of depression, anxiety and eating disorders. </p><p>People prone to such patterns of thought may, for example, overanalyze every single detail of a relationship that breaks up. They often blame themselves for what has happened and are overcome with regret, with typical thoughts being: </p><p>- I should have been more patient and more supportive. </p><p>- I have lost the most perfect partner ever. </p><p>- No one will love me again.</p>
Worrying<p>Worrying is wanting to predict the future. It involves negative thoughts about things that might and might not happen.</p><p>- They'll not like me in the interview; they'll not give me the job. </p><p>- I haven't heard back from other employers. How long will I be unemployed?</p><p>These thoughts are energy-draining and distressing. They could happen to anyone under stress. But when you reach the point where your thoughts and worrying are preventing you from doing what you want to do — from living your life to the fullest — then you should take action.</p>
Catch Yourself Overthinking<p>Reuben Berger, a psychotherapist at the university hospital in the western German city of Bonn, recommends several practical steps that you could employ in your daily routine when you catch yourself worrying or ruminating.</p><p>One effective remedy, says Berger, is the <a href="https://www.uofmhealth.org/health-library/uf9938" target="_blank">thought-stopping technique.</a></p><p>"When the negative thoughts come or ruminations start, you say to yourself: 'Stop!,'" he says, adding that it is more effective when you actually say the word out loud.</p><p>He even recommends having a rubber band around your wrist to ping against yourself while saying the word. Adding a visual component by imagining a stop sign also makes the technique more powerful, he says.</p><p>The main idea here is conditioning yourself to stop the loop of worrying (making future predictions) or rumination (obsessing over past events).</p><p>Berger says the technique could take up to two weeks to take effect and that it needs to be practiced every day. "Consistency is very important," he says. </p>
Thoughts Are Just Thoughts<p>Another way of dealing with negative thoughts often used in modern therapy is realizing that thoughts aren't facts, says Berger.</p><p>He says it is important when we think something to ask: Is that real? Did that really happen? What is the worst thing that could happen?</p><p>Flight anxiety is one example where untrue thoughts are accepted as facts. Although air travel is the safest way to get around, people suffering from fear of flying accept their thoughts and fears as reality, then act upon them by refusing to fly.</p>
Mindfulness<p>Berger also recommends the use of mindfulness techniques, in which attention is paid to experiences in the moment without judging them, as a way of reducing worrying.</p><p>"Mindfulness helps you to distance yourself from your thoughts and to be more present in the moment," he says.</p><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432145/#R2" target="_blank">Several studies</a> have shown that mindfulness has a positive impact on reducing stress-related behaviors such as rumination and worrying, as focusing on the moment makes anxiety about other problems impossible.</p><p>Mindfulness can be practiced during routine activities by paying attention to your body and your surroundings. For instance, when you leave for work in the morning, you can focus on sensing the breeze, listen attentively to birds, feel the gravel under your feet and monitor your breath. </p>
Trick Your Brain Into Happiness<p>People plagued by obsessive thoughts do not always choose healthy ways like mindfulness to distract from them, however.</p><p> Dr. Edward Selby, a psychologist at Florida state university, has shown in a study that people try to avoid rumination by engaging in a range of uncontrolled behaviors, such as binge eating and substance abuse.</p><p>But he says that a much better way to overcome such distress is by distraction and shifting attention away from problems that are obsessing us.</p><p>There are many activities that can be used to distract from rumination, he says, and people should choose the one that works best for them. Here are some examples:</p><p>- Listen to music</p><p>- Read a book</p><p>- Take a hot shower</p><p>- Dance or exercise </p><p>- Talk to a friend (not about the problem)</p><p>- Watch a movie</p><p>- Mindfulness meditation</p>
Changing the Perception of Events<p>The way people perceive a situation largely influences their emotions and behavior. It is not the situation itself that determines how they feel, but rather the way they interpret it.</p><p>Reframing negative thoughts can lead to positive emotions and, subsequently, healthier behaviors — including a reduction in damaging overthinking and worrying.</p><p>Cognitive behavioral therapy (CBT) is currently a gold standard in psychotherapy. CBT aims to change the way people think and act. It largely involves challenging unhelpful beliefs or attitudes such as overgeneralization — thinking "I always fail at public speaking" when you have had one bad experience in front of an audience, for example — or "catastrophization," i.e., imagining the worst possible outcome to a situation. </p><p>A psychotherapist can teach people how to implement such thought-changing techniques into their lives. Techniques vary depending on their issues and goals.</p>
Solutions Are at Hand<p>Try to find ways of avoiding worrying, rumination and overthinking that make you feel most comfortable.</p><p>Incorporating any routine in your life when you're stressed isn't an easy task, but you can do it! If you feel overwhelmed, you can always seek professional help. </p><p><em>If you are suffering from serious emotional strain or suicidal thoughts, do not hesitate to seek professional help. You can find information on where to find such help, no matter where you live in the world, <a href="https://www.befrienders.org/" target="_blank">at this website.</a></em></p>
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By Michael Baker, Amanda Kvalsvig and Nick Wilson
On Sunday, New Zealand marked 100 days without community transmission of COVID-19.
Deaths From COVID-19 Per Million Population<img lazy-loadable="true" src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU0ODIyOS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0MjkzMDc1OX0.7Yp1h1hokihlMJUurDukGmq-Y8NJB0V-07O1ukEjGt0/img.png?width=980" id="0fe6a" class="rm-shortcode" data-rm-shortcode-id="6bce85a610aee18e2f4f1c1caca7b8a0" data-rm-shortcode-name="rebelmouse-image" />
<div id="77fff" class="rm-shortcode" data-rm-shortcode-id="ce7b34f8986d3d36bee5d4d83ac0822c"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1292270210238447616" data-partner="rebelmouse"><div style="margin:1em 0">COVID-19 Update There are no new cases of COVID-19 to report in New Zealand today. It has been 100 days since t… https://t.co/Cz55ixGZUz</div> — Unite against COVID-19 (@Unite against COVID-19)<a href="https://twitter.com/covid19nz/statuses/1292270210238447616">1596936201.0</a></blockquote></div>
Getting Through the Pandemic<p>We have gained a much better understanding of COVID-19 over the past eight months. Without effective control measures, it is likely to continue to spread globally for many months to years, ultimately infecting billions and killing millions. The proportion of infected people who die appears to be <a href="https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v4" target="_blank">slightly below 1%</a>.</p><p>This infection also causes serious <a href="https://www.bmj.com/content/370/bmj.m2815" target="_blank">long-term consequences</a> for some survivors. The largest uncertainties involve <a href="https://www.nature.com/articles/d41586-020-02278-5" target="_blank">immunity to this virus</a>, whether it can develop from exposure to infection or vaccines, and if it is long-lasting. The potential for treatment with antivirals and other therapeutics is also still uncertain.</p><p>This knowledge reinforces the huge benefits of sustaining elimination. We know that if New Zealand were to experience widespread COVID-19 transmission, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310086/" target="_blank">impact on Māori and Pasifika populations</a> could be catastrophic.</p><p>We have previously described critical measures to get us through this period, including the use of fabric face masks, improving contact tracing with suitable digital tools, applying a science-based approach to border management, and the need for a dedicated national public health agency.</p><p>Maintaining elimination depends on adopting a highly strategic approach to risk management. This approach involves choosing an optimal mix of interventions and using resources in the most efficient way to keep the risk of COVID-19 outbreaks at a consistently low level. Several measures can contribute to this goal over the next few months, while also allowing incremental increases in international travel:</p><ul><li>resurgence planning for a border-control failure and outbreaks of various sizes, with state-of-the-art contact tracing and an upgraded alert level system</li><li>ensuring all New Zealanders own a <a href="https://www.nzma.org.nz/journal-articles/mass-masking-an-alternative-to-a-second-lockdown-in-aotearoa" target="_blank">re-useable fabric face mask</a> with their <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12354409" target="_blank">use built into the alert level system</a></li><li>conducting exercises and simulations to test outbreak management procedures, possibly including "mass masking days" to engage the public in the response</li><li>carefully exploring processes to allow <a href="https://blogs.otago.ac.nz/pubhealthexpert/2020/06/16/preventing-outbreaks-of-covid-19-in-nz-associated-with-air-travel-from-australia-new-modelling-study-of-alternatives-to-quarantine/" target="_blank">quarantine-free travel</a> between jurisdictions free of COVID-19, notably various Pacific Islands, Tasmania and Taiwan (which may require digital tracking of arriving travellers for the first few weeks)</li><li>planning for carefully managed inbound travel by key long-term visitor groups such as tertiary students who would generally still need managed quarantine.</li></ul>
Building Back Better<p>New Zealand cannot change the reality of the global COVID-19 pandemic. But it can leverage possible benefits.</p><p>We should conduct an <a href="https://blogs.otago.ac.nz/pubhealthexpert/2020/06/11/five-key-reasons-why-nz-should-have-an-official-inquiry-into-the-response-to-the-covid-19-pandemic/" target="_blank">official inquiry into the COVID-19 response</a> so we learn everything we possibly can to improve our response capacity for future events.</p><p>We also need to establish a specialized national public health agency to <a href="https://blogs.otago.ac.nz/pubhealthexpert/2017/12/20/the-havelock-north-drinking-water-inquiry-a-wake-up-call-to-rebuild-public-health-in-new-zealand/" target="_blank">manage serious threats to public health</a> and provide critical mass to <a href="https://blogs.otago.ac.nz/pubhealthexpert/2020/02/05/a-preventable-measles-epidemic-lessons-for-reforming-public-health-in-nz/" target="_blank">advance public health generally</a>. Such an agency appears to have been a key factor in the success of Taiwan, which avoided a costly lockdown entirely.</p><p>Business as usual should not be an option for the recovery phase. A recent <a href="https://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=12353555" target="_blank">Massey University survey</a> suggests seven out of ten New Zealanders support a green recovery approach.</p><p>New Zealand's elimination of COVID-19 has drawn attention worldwide, with a description just <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2025203" target="_blank">published</a> in the New England Journal of Medicine. We support a rejuvenated World Health Organization that can provide improved global leadership for pandemic prevention and control, including greater use of an elimination approach to combat COVID-19.</p>
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