Keeping Cool as the Climate Heats Up

If you’ve stepped outside lately, you’ve likely noticed that after a slow start here in the Northeast, summer is starting to sizzle across the U.S (and the Northern Hemisphere). The Pacific Northwest experienced an unprecedented “heat dome” in May, Canada has gotten so hot that it’s literally on fire, and currently the Southwest has been baking in the triple-digits going on several weeks now. Europe and Asia have also been dealt significant heat waves this year, with parts of China reaching triple digits for weeks on end early this season. The seven (7) hottest days on earth in the past 100,000+ years were all in July 2023!

Learn More about Extreme Heat

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A Climate Emergency

According to IPCC Sixth Assessment Report, in the last 170 years, humans have caused the global temperature to increase to the highest level in the last 2,000 years. The current multi-century period is the warmest in the past 100,000 years. The temperature in the years 2011-2020 was 1.09°C higher than in 1859-1890 (pre-industrial baseline). The temperature on land rose by 1.59°C while over the ocean it rose only by 0.88°C. Since 1950, the number of cold days and nights has decreased, and the number of warm days and nights has increased.

Between climate change fueled extreme weather and a shift into an El Niño climate pattern, 2023 is already breking records and could quite possibly cause the earth to breach the 1.5°C target that was set for in the Paris Agreement. In May 2023, the World Meteorological Organization (WMO) announced that there is a 66% chance that the earth will breach the target in the next five years.

A Crisis of the Extremes

Many people think climate change simply mainly means warmer temperatures. But temperature rise is only the beginning of the story. Because the Earth is a system, where everything is connected, changes in one area can influence changes in all others.

Climate change is causing the weather around the world to get more extreme, and scientists are increasingly able to pinpoint exactly how the weather is changing as the Earth heats up.

Higher temperatures mean warmer and more volatile seas, which lead to higher sea levels and more moisture evaporating into the atmosphere. The more moisture in the air, along with more volatile seas, leads to more intense and extreme storms.

In areas prone to drought, higher temperatures means more moisture evaporating from the land (leading to lakes, rivers, and streams drying up). Less precipitation on these areas leads to drought, which in turn cascades into risks for wildfires and ecosystem destruction.

Health Impacts of Extreme Heat

As climate change worsens, more frequent and longer-lasting extreme heat waves will increase people’s vulnerability to heat-related health impacts; especially among the elderly, the very young, the impoverished, and those living with chronic illnesses.

The Low Down on Low Temperatures

One of the biggest drivers of heat-related health impacts is not the high temperatures, but rather the low temperatures. When temperatures drop at night, it allows our bodies and our environment to cool off and recover from the day’s intensity. With the most recent heat waves, the low temperatures are not dropping like they would in decades past, leading to people being unable to sufficiently cool their homes and their bodies, especially in regions and among populations that lack air conditioning.

“Urban Heat islands”

In cities such as New York, “urban heat islands” (where heat is trapped at the surface due to population and infrastructure density) make surface temperatures between 2-5°F warmer than the less urban areas around them. This is especially concerning for the poor, the elderly, and the homeless.

Heat-Related Death & Disease

Heat-related deaths usually result from heat stroke and related conditions, but also from cardiovascular disease, respiratory disease, and cerebrovascular disease. Heat waves are also associated with increased hospital admissions for cardiovascular, kidney, and respiratory disorders.

Pollution & Air Quality

Heat waves often lead to poor air quality. The extreme heat and stagnant air during a heat wave increases the amount of ozone pollution and particulate pollution. Drought conditions can also occur during a heat wave, meaning that soils are very dry. Drought conditions on top of heat waves can also increase the risk and spread of wildfire, that in turn increases the particulate air pollution. Exposure to air pollution can affect everyone’s health. When we breathe in air pollutants, they can enter our bloodstream and contribute to coughing or itchy eyes and cause or worsen many respiratory and lung diseases (eg. asthma, COPD, and lung cancers), leading to hospitalizations, or even premature death.

Extreme Heat and Medications

Some commonly prescribed and over-the-counter drugs and medications can increase sensitivity to heat and sun exposure.

Photosensitivity

Some medicines contain ingredients that may cause photosensitivity — a chemically induced change in the skin. Photosensitivity makes a person sensitive to sunlight and can cause sunburn-like symptoms, a rash or other unwanted side effects. Below are the types of medications that can potentially cause photosensitivity:

  • Antibiotics
  • Antifungals
  • Antihistamines
  • Cholesterol lowering drugs
  • Diuretics
  • Non-steroidal anti-inflammatory drugs
  • Oral contraceptives and estrogens
  • Phenothiazines
  • Psoralens
  • Retinoids
  • Sulfonamides
  • Sulfonylureas for type 2 diabetes
  • Alpha-hydroxy acids in cosmetics

Thermoregulation

Other medications can directly interact with internal body regulation, such as decreasing the amount of sweat produced or the amount of fluids in the body, disrupting blood flow to the skin, and disrupting the hypothalamus. These can all potentially cause heat intolerance or overheating. Additionally, some of these same medications can also cause decreased thirst, which can increase the risk of dehydration in extreme heat. The main classes of drugs that disrupt thermoregulation are:

  • Antihistamines and Decongestants
  • Beta-Blockers
  • Diuretics
  • Psychotropic and psychiatric medications

Climate Change & Extreme Heat Resources

Data and Trackers

Heat & Health Tracker – The CDC’s Heat & Health Tracker provides local heat and health information so communities can better prepare for and respond to extreme heat events. Use the search on the right to explore how extreme heat affects your county, populations who are at risk, and response resources.

AirNow – AirNow reports air quality using the official U.S. Air Quality Index (AQI), a color-coded index designed to communicate whether air quality is healthy or unhealthy for you. When you know the AQI in your area, you can take steps to protect your health.

CDC National Environmental Public Health Tracking Network — At the local, state, and national levels, the Tracking Program uses a network of people and information systems to deliver a core set of health, exposure, and hazards data, information summaries, and tools to enable analysis, visualization and reporting of insights drawn from data.

Be Ready, Be Safe

Extreme Heat — Ready.gov is a National public service campaign designed to educate and empower the American people to prepare for, respond to and mitigate emergencies, including natural and man-made disasters. The goal of the campaign is to promote preparedness through public involvement.

Extreme Heat Safety — Learn how to stay safe during a heat wave and how to treat heat-related illness like heat exhaustion from the American Red Cross.

Tips for Preventing Heat-Related Illness – Tips from the National Center for Environmental Health; stay cool, stay hydrated, stay informed.

Protecting Vulnerable Groups from Extreme Heat — Information and resources for specific populations that are disproportionately affected by extreme heat: older adults, infants and children, chronically ill, low income, athletes, and outdoor workers.

Heat Safety Tips and Resources — The National Weather Service Safety Information page is designed to prepare you for excessive heat events, describe what to do during a an excessive heat wave, and inform you about the health dangers of heat. You also will find educational materials and fun  games and activities to help educate children about the dangers of heat. 

For even more news, information, resources, and policy on climate change, the climate crisis, and the intersectionality of health, climate, and humanity, take a look at our Climate Crisis LibGuide.

Pubmed Filters that are MeSH

In PubMed you can use Filters (sometimes referred to as Limits), located on the left hand side of the search results screen to limit your search by certain criteria. The Filters fall into several categories, such as Article Types, Article Language, etc. Some are visible on the search results screen by default, and some can be found and made visible for the future use when clicking Additional Filters button.

The Filters are efficient and handy tools for refining a search, adding desired criteria to your search terms, thus significantly increasing search precision.

However, users may not be aware of the fact that most of the Filters are, in fact, MeSH (Medical Subject Headings) terms set up as clickable Filters but functioning as MeSH terms behind the scenes. For example, if you apply a Clinical Trial Filter, your move will be translated by PubMed as adding a search term “clinical trial”[Publication Type] to your search strategy with an “AND” Boolean Operator, e.g. cancer AND “clinical trial”[Publication Type], Publication Type is a category in the MeSH tree.

Of course, if you are a proficient searcher you can type “clinical trial”[pt], instead of clicking the Filter button which just supports refining your search in an easy and visual way.

Filters are a great feature, however there is a caveat. When you apply a Filter that is a MeSH, your search will automatically be limited to Medline portion of Pubmed. Pubmed is comprised of Medline, as well as many open access articles (mostly coming from Pubmed Central) not indexed for Medline.

To efficiently search Pubmed in it’s entirety, you must construct your search strategy as a combination of MeSH and keywords. MeSH are assigned only to Medline references and there is some lag time in this process. When applying Filters that are based on MeSH to your search it will not retrieve these references only found outside of Medline, as well as some recent Medline references not yet assigned MeSH.

In other words, by using such Filters you limit your search results to Medline only (excluding some very recent references not yet assigned MeSH) instead of getting all Pubmed search results.

The Filter categories that are MeSH terms include:

  • Article Type (publication type)
  • Species
  • Sex
  • Age

These filters should be used with caution.

The non-MeSH Filters are safe to use in any search, including:

  • Text Availability
  • Associated Data
  • Publication Date
  • Article Language

In conclusion, it is possible to combine applying Filters with using appropriate search terms if you aim at limiting your search by some criteria, yet searching all of PubMed, but as this requires search proficiency it would be best to get assistance at your Library.


Shedding Light on PRISMA

Systematic reviews (as well as other comprehensive evidence-based practice syntheses such as meta-analyses, scoping reviews, and living reviews) have in recent years become a buzzword in scientific publishing. However, many clinicians and researchers are unaware of the amount of time and effort these reviews require, and are not prepared for the process ahead.

The MSK Library’s Systematic Review Service provides resources and support for teams conducting comprehensive evidence-based reviews. One of the most important aspects of any comprehensive review is understanding, at minimum, what needs to be included. Thankfully, there are multiple tools and guidelines to assist you, including PRISMA.

What is PRISMA?

PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses, to assist authors in improving the quality of their reviews.

PRISMA stands for: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

The guidelines were originally developed in 2009, and included a statement and an explanation published in a variety of biomedical journals (including JAMA, NEJM, Lancet, and BMJ). Beginning in 2017 an international team updated the PRISMA guidelines to continue to reflect the changing nature of scientific communication. PRISMA 2020 was initially released as a preprint in September 2020 and published in March 2021 in the Journal of Clinical Epidemiology, and reprinted in a number of other journals to disseminate it widely. The PRISMA 2020 Statement consists of a 27-item checklist and a flow diagram.

There are a few components to PRISMA that provide different information and are used for different things.

The PRISMA Checklist

The PRISMA 2020 statement includes a 27-item checklist that addresses the introduction, methods, results and discussion sections of a systematic review report. An expanded checklist is also available that provides detailed information and recommendations about how to properly report each item, as found in the Explanation and Elaboration paper.

The PRISMA Flow Diagram

The PRISMA 2020 flow diagram shows the flow of information through the different phases of a systematic review. It outlines the number of records identified, included and excluded, and the reasons for exclusions.

PRISMA 2020 includes four different flow diagram templates based on the type of review and the sources used to identify studies:

  • new systematic reviews, includes searches of only databases and registers
  • updated systematic reviews, includes searches of only databases and registers
  • new systematic reviews, includes searches of databases and registers, plus other sources
  • updated systematic reviews, includes searches of databases and registers, plus other sources

PRISMA Extensions

Since 2015, a variety of extensions of the PRISMA Statement have been developed to facilitate the reporting of different types or aspects of systematic reviews, including:

Using PRISMA: Do This, Not That

PRISMA is a reporting guideline, not a how-to guideline. It is only designed to assist you in how to write up (aka report) the review process.

If you are reporting a systematic review, scoping review, meta-analysis, etc using PRISMA, you can describe it in your methods section like this:

  • “this review is reported according to PRISMA”
  • “we followed the PRISMA Statement to report this review”

These are examples of descriptions should NOT be used when writing up your review:

  • “we conducted the search according to PRISMA”
  • “the review conducted in accordance with PRISMA”

PRISMA-S: Reporting Literature Searches

The latest installment of PRISMA extensions is the PRISMA-S, an extension published in 2021, which is a 16-item checklist used to complement the PRISMA 2020 checklist and flow diagram, that focuses specifically on what needs to be included when reporting the literature search strategies for your review. Again, this is now a how-to, and your methods section should not describe your literature searches as conducted using PRISMA-S. Rather, it details what information should be included when writing up or reporting your review.

Some of the details that PRISMA-S recommends including in your write-up (either in the methods section or supplemental appendices) are:

  • database name and platform (eg. MEDLINE database on the Ovid platform)
  • full search strategies for every database and register included
  • other sources or methods used to identify studies (hand searching, author contacts, grey literature, etc.)
  • any limits, filters, or restrictions used or put into the searches
  • dates of all searches and updates
  • process and software used to manage citations, including removing duplicates (EndNote, Covidence, Distiller SR, etc.)

The Future of PRISMA

The following PRISMA extensions are in development in collaboration with the PRISMA group: