Tag: environmental effects

Siblings of Autistic Children have Higher Risk of Autism

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Siblings of autistic children have a 20% chance of being autistic themselves – about seven times higher than the rate in infants with no autistic siblings, according to new research published in Pediatrics.

The study, by UC Davis MIND Institute distinguished professor Sally Ozonoff and the Baby Siblings Research Consortium, is based on a large, diverse group of families at research sites across the United States, Canada, and the United Kingdom. It confirms the same research group’s 2011 findings about the likelihood of autism in siblings, and adds news information suggesting it is more common, not less, in historically underrepresented groups.

Increasing autism rates prompt new study

“The rate of autism diagnosis in the general community has been steadily increasing since our previous paper was published,” Ozonoff explained. Ozonoff has studied the recurrence of autism in families for decades.

The latest estimates from the Centers for Disease Control and Prevention show that about 1 in 36 children has autism.  In 2011, the estimate was 1 in 68.

Ozonoff noted that there have also been changes in autism diagnostic criteria over the past decade. In addition, there is a growing awareness of autism in girls.

“So, it was important to understand if these had any impact on the likelihood of autism recurrence within a family,” she said.

The 2011 paper found a recurrence rate of 18.7%, while the new paper found a rate of 20.2% – a small but not significant increase.

“This should reassure providers who are counseling families and monitoring development. It should also help families plan for and support future children,” Ozonoff said.

A larger, more diverse study

The new study included data from 1605 infants at 18 research sites. All infants had an older autistic sibling.

“This study was much larger than the first and included more racially diverse participants,” Ozonoff said. The original study included 664 children.

Researchers followed the children from as early as six months of age for up to seven visits. Trained clinicians assessed the children for autism at age three using the Autism Diagnostic Observation Schedule (ADOS-2), a well-validated tool. The data were gathered from 2010 to 2019.

Sex of first autistic child, multiple autistic siblings key factors

Researchers found that the sex of the first autistic child influenced the likelihood that autism would recur within a family.

“If a family’s first autistic child was a girl, they were 50% more likely to have another child with autism than if their first autistic child was a boy,” Ozonoff said. “This points to genetic differences that increase recurrence likelihood in families who have an autistic daughter.”  

The researchers also found that a child with multiple autistic siblings has a higher chance of autism (37%) than a child with only one sibling on the spectrum (21%).

The sex of the infant was also associated with the likelihood of familial recurrence. If the later-born infant was a boy, they were almost twice as likely as a girl to be diagnosed themselves.

“The familial recurrence rate if the new baby was a boy was 25%, whereas it was 13% if the new baby was a girl,” Ozonoff explained. “This is in line with the fact that boys are diagnosed with autism about four times as often as girls in general.”

Race, maternal education level influence recurrence

The researchers found that race and the mother’s education level were likely factors as well. In non-white families, the recurrence rate was 25%. In white families, the recurrence rate was about 18%. In families where the mother had a high school education or less, recurrence was 32%. With some college, the rate was 25.5%, and with a college degree the rate was 19.7%. When the mother had a graduate degree, it dropped to 16.9%.

“These findings are new – and critical to replicate,” Ozonoff explained. “They do mirror the recent CDC findings that autism is more prevalent in children of historically underrepresented groups.” She noted that this reversed a longtime trend of lower prevalence in those groups. 

Most importantly, said Ozonoff, if these findings are replicated, they may indicate that there are social determinants of health that may lead to higher rates of autism in families. She emphasized that this study was not designed to answer those critical questions, and more research is needed.

Tracking outcomes

Unlike the first study, the researchers also tracked families who dropped out of the three-year study to see if their outcomes differed from those who did. “We wondered whether families who stayed in the study may have had children who were more affected — making them more worried about their development,” she explained.

That could have biased the estimates of recurrence to be higher than they really were. The current study showed that was not the case.

“So, now we have two large, independent studies that report familial recurrence in the same range,” Ozonoff said. “This reinforces how important it is that providers closely monitor the siblings of autistic children for delays in social development or communication. This is especially true in families who have reduced access to care, because early diagnosis and intervention are critical.”

Living Near Fracking Sites Increases Childhood Leukaemia Risk

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Children living near unconventional oil and gas (UOG) or ‘fracking’ developments at birth had a 2–3 times greater risk of leukaemia diagnoses between 2 and 7 years old, researchers have found.

Their study, published in the journal Environmental Health Perspectives, included nearly 2500 Pennsylvania children, 405 of whom were diagnosed with acute lymphoblastic leukaemia (ALL).

ALL arises from mutations to lymphoid immune cells. Although long-term survival rates are high, survivors may have long-term health risks and psychological issues. Unconventional oil and gas development, more commonly referred to as fracking (short for hydraulic fracturing), is a method for extracting gas and oil from shale rock. The process involves high-pressure injection of water, sand, and chemicals into bedrock to release oil or gas for extraction.

For communities living nearby, UOG development can pose a number of potential threats. As well as air pollution from vehicles and construction, there is also water pollution from hydraulic fracturing or spills of wastewater. Hundreds of chemicals have been reportedly used in UOG injection water or detected in wastewater, some of which are known or suspected carcinogens. The lack of data about this has given rise to concerns over the proximity of UOG to residential areas.

“Unconventional oil and gas development can both use and release chemicals that have been linked to cancer, so the potential for children living near UOG to be exposed to these chemical carcinogens is a major public health concern,” said the study’s senior author, Nicole Deziel, associate professor of epidemiology at the Yale School of Public Health.

“Studies of UOG exposure and cancer are extremely few in number. We set out to conduct a high-quality study to further investigate this potential relationship,” added Cassandra Clark, the study’s first author and a postdoctoral associate at the Yale Cancer Center. “Our results indicate that exposure to UOG may be an important risk factor for ALL, particularly for children exposed in utero.”

Oil and gas-related chemicals exposure could be through drinking water, the researchers found. The watershed, the zone from which a drinking water well serving their home would likely draw water, were compared with the distance from the home to the nearest of those UOG wells. UOG wells falling within the watershed area are expected to be more likely to impact the home’s drinking water supply, they said.

This work adds to a growing body of literature on UOG exposure and children’s health used to inform policy, such as setback distances (the required minimum distance between a private residence or other sensitive location and a UOG well). Current setback distances are the subject of much debate in the United States, with some calling for setback distances to be lengthened to more than 305m and as far as 1000m. The allowable setback in Pennsylvania, where the study was conducted, is 152m.

“Our findings of increased risk of ALL at distances of two kilometres or more from UOG operations, in conjunction with evidence from numerous other studies, suggest that existing setback distances, which may be as little as 150 feet (50m), are insufficiently protective of children’s health,” Clark said. “We hope that studies like ours are taken into account in the ongoing policy discussion around UOG setback distances.”

Source: Yale University

Greenspaces in Hospitals Calm Patients and Visitors

It can be stressful and time-consuming for patients and visitors to become accustomed to navigating large, unfamiliar hospitals, and so an architecture researcher tested a simple remedy: to let nature in with the use of indoor greenspaces and large windows.

Research conducted by West Virginia University’s associate professor Shan Jiang showed that introducing nature into large hospitals can humanise the institutional environment and reduce the stress of patients, visitors and healthcare providers.

Prof Jiang made use of immersive virtual environments for a controlled experiment that asked participants to complete various wayfinding tasks in a simulated hospital.

Though participants saw the same layout, one group encountered large windows and nature views among the corridor walls. The control group meanwhile saw solid walls without any daylight or views of nature, more like a typical modern hospital. Participants in the greenspace group used shorter time and walked less distance to complete wayfinding tasks.

“In terms of spatial orientation and wayfinding, window views of nature and small gardens can effectively break down the tedious interiors of large hospital blocks,” Prof Jiang said, “and serve as landmarks to aid people’s wayfinding and improve their spatial experience.”

In the greenspace group, participants’ mood states, particularly anger and confusion, were also found to be “significantly relieved”.

Prof Jiang’s findings are published in the Health Environments Research and Design Journal.

Based on prior research, it’s estimated that a patient or hospital visitor must go through at least seven steps in the wayfinding process to arrive at the final destination. WVU’s Center for Health Design cites wayfinding issues as an environmental stressor and a concerning topic in healthcare design.

Prof Jiang said that she was prompted to do the study by those factors, coupled with her own personal experiences (her family members have worked in healthcare) and others’ accounts of feeling lost in hospitals.

“Large hospitals can be visually welcoming but the functionality and internal circulation are indeed complex and confusing,” she said.

Greenspaces positioned at key decision points, such as main corridors or junctions, can help improve navigation.

With a background in landscape architecture, Jiang has been interested in the immediate surroundings of people in a smaller scope, particularly the indoor-outdoor relationship and the boundaries between architecture and landscapes.

Gardens and plants also tend to have strong therapeutic effects on people, she found.

“You may explain such therapeutic effects from multiple perspectives: people’s colour/hue preferences tend to range from blue to green, nature and plants are positive distractions that could restore people’s attentional fatigue, and human beings could have developed genetic preference of greenery from evolutionary perspectives,” Prof Jiang said. “All mechanisms together contribute to the positive experience when looking at gardens and nature views.”

Prof Jiang noted that many European hospitals have successfully integrated “hospital in a park” concepts. In the United States, the Lucile Packard Children’s Hospital Stanford in California has patios and window nooks in every patient room, and most rooms have direct views of a large healing garden, she said. The Alder Hey Children’s Hospital in the UK was literally built in a park.

Source: West Virginia University

Endocrine-disrupting Chemicals Present in Many Pregnancies

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Researchers in Europe have shown that up to 54% of pregnant women in Sweden were exposed to complex mixtures of endocrine-disrupting chemicals disruptive to brain development.

While current risk assessment tackles chemicals and their allowable exposures on an individual basis, these findings show the need to take mixtures into account for future risk assessment approaches. The study was published in Science.

A growing body of evidence has shown that industrially produced chemicals have endocrine disrupting properties and can thus be dangerous to human and animal health and development. A huge number of new compounds is released every year into the environment during the production of plastic derivatives and other goods.

While exposures for individual chemicals falls below thresholds, exposure to the same chemicals in complex mixtures can still impact human health. However, all current exposure thresholds, are based on chemicals being examined individually. Therefore, an alternative strategy needed to be tested, in which the actual mixtures measured in real life exposures could be tested as such in both the epidemiological and experimental setting. The EDC-MixRisk project set out to tackle this unmet need.

“The uniqueness of this comprehensive project is that we have linked population data with experimental studies, and then used this information to develop new methods for risk assessment of chemical mixtures,” said Carl-Gustaf Bornehag, professor at Karlstad University, Project Manager of the SELMA study.

The study was conducted in three steps:

  1. A mixture of chemicals in the blood and urine of pregnant women was identified in the Swedish pregnancy cohort SELMA, associated with delayed language development in children at 30 months. This critical mixture included a number of phthalates, bisphenol A, and perfluorinated chemicals.
  2. Experimental studies uncovered the molecular targets through which human-relevant levels of this mixture disrupted the regulation of endocrine circuits and of genes involved in autism and intellectual disability.
  3. The findings from the experimental studies were used to develop new principles for risk assessment of this mixture.

“It is striking that the findings in the experimental systems well reflected what we found in the epidemiological part, and that the effects could be demonstrated at normal exposure levels for humans,” said Joëlle Rüegg, professor of environmental toxicology at Uppsala University.

“Human brain organoids (advanced in vitro cultures that reproduce salient aspects of human brain development) afforded, for the first time, the opportunity to directly probe the molecular effects of this mixture on human brain tissue at stages matching those measured during pregnancy. Alongside other experimental systems and computational methods, we found that the mixture disrupts the regulation of genes linked to autism (one of whose hallmarks is language impairment), hinders the differentiation of neurons and alters thyroid hormone function in neural tissue,” said Giuseppe Testa, principal investigator of the EDC-MixRisk responsible for the human experimental modelling.

“One of the key hormonal pathways affected was thyroid hormone. Optimal levels of maternal thyroid hormone are needed in early pregnancy for brain growth and development, so it’s not surprising that there is an association with language delay as a function of prenatal exposure,” said Barbara Demeneix, professor of physiology and endocrinology at the Natural History Museum in Paris.

By combining these techniques, the researchers were able to show that 54% of children included in the SELMA study were at risk of delayed language development (at age 30 months) as they were prenatally exposed to a mixture of chemicals at levels that were above the levels predicted to impact neurodevelopment. Yet this risk fell below the exposure limits for individual chemicals.

Source: EURION Cluster

Tropical Areas Approaching Upper Limits for Survivable Heat

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Some people living in tropical regions are already living under conditions of heat stress that are approaching the upper limits of human survivability, a study has found.

In this study published in iScience, researchers noted that climate models used to predict heat conditions around the world are generally based on data from weather stations in relatively populated areas. Such data, they note, excludes conditions for people living in what they describe as informal settlements. To find out more about the conditions for people living in areas expected to be hit by the worst global warming effects, the researchers placed heat sensors in and around 100 houses in Makassar, Indonesia, a settlement in a tropical part of the country. The observed conditions are likely representative of many such settlements in the tropics, the researchers suggested.

Analysing the data, the researchers discovered that, during the rainy season, 80% of the sensors recorded temperatures in excess of established health thresholds. At such temperatures and humidity levels, adverse health impacts are said to be felt by people living there. In a few instances, they found that the sensors recorded temperatures that are believed to represent the upper limit of human survivability.

These findings are alarming for several reasons, they noted. For one, millions of people living in many parts of the world are already living under heat conditions that are harmful to their health. Another is the fact that many such people engage in physical labour for their livelihoods, and doing so in extreme heat can be fatal. Perhaps most alarming is the near certainty that conditions in such places are going to get worse as the planet continues to warm from fossil fuel burning and climate change. An analysis of the agreements reached at the COP26 summit found that the Earth was on course for a 2.4°C increase in temperature, well above the 1.5°C increase suggested by scientists to avoid the worst effects of climate change. For most such places, there are no relocation plans, and little chance that heat-mitigating technology such as air-conditioning will be installed. This suggests that a disaster of massive proportions is on the way.

Source: Phys.Org

High Altitude Protects against Stroke Risk

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While there are well-known common lifestyle and health factors that contribute to stroke risk, including smoking, high blood pressure, high cholesterol, and lack of physical activity, there is another overlooked factor that could also affect stroke risk – altitude.

Higher altitude means less oxygen availability, to which people living there have adapted. However, how this environment affects someone’s risk for stroke is still unclear. Anecdotal evidence suggests that short-term exposure to low oxygen can contribute to increased blood clotting and stroke risk, but the risk among people who permanently live at high altitude is not clear.

Researchers in Ecuador are in a unique position to explore these phenomena, as the presence of the Ecuadorian Andes means that people in the country live at a wide array of altitudes. Study lead author Esteban Ortiz-Prado, and Professor, Universidad de las Americas, explained:

“The main motivation of our work was to raise awareness of a problem that is very little explored. That is, more than 160 million people live above 2500 metres and there is very little information regarding epidemiological differences in terms of stroke at altitude. We wanted to contribute to new knowledge in this population that is often considered to be the same as the population living at sea level, and from a physiological point of view we are very different.”

The researchers drew on hospital records in Ecuador from between 2001 and 2017, and analysed rates of stroke hospitalisation and mortality among people who live at four different elevation ranges: low altitude (under 1500m), moderate altitude (1500­–2500m), high altitude (2500–3500m) and very high altitude (3500–5500m).

Analysis showed that people who lived at higher altitudes (above 2500m) tended to experience stroke at a later age compared with those at lower altitudes. Intriguingly, people who lived at higher altitudes had a lower stroke hospitalisation or mortality risk. This protective effect was greater between 2000 and 3500m, tapering off somewhat above 3500m. In South Africa, Johannesburg sits above 1700m altitude.

One explanation for this finding may be that people who live at high altitude have adapted to the low oxygen conditions, and more readily grow new blood vessels to help overcome stroke-related damage. They may also have a more developed vascular network in their brains that helps them to make the most of the oxygen they take in, but this could also protect them from the worst effects of stroke.

Source: Medical Xpress

Elevated Cancer Risk in 9/11 Responders 20 Years On

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Associations between responders exposed to toxins at the World Trade Center (WTC) collapse site and increased cancer risk continue to be observed 20 years after the tragic event.

Thousands of rescue workers and first responders were exposed to toxins (asbestos, polychlorinated biphenyls, benzene, dioxins) in the aftermath of the World Trade Center attacks on September 11, 2011. Two studies recently published in Occupational & Environmental Medicine reported on the cancer incidence rates among the WTC Health Program General Responder Cohort.

According to the first study, male New York City firefighters exposed to the WTC site had higher rates of all cancers 13% increase and a younger median age at diagnosis (55.6 vs 59.4 years) compared with male non-WTC-exposed firefighters.

The WTC-exposed firefighters had increased rates of a number of cancers, the highest of which was thyroid cancer (153%) reported Mayris Webber, DrPH, of the Bureau of Health Services at the Fire Department of the City of New York, and colleagues.

The second study from Charles Hall, PhD, of Albert Einstein College of Medicine in the Bronx, and colleagues, found that, beginning in 2007, rescue/recovery workers at the WTC site had a 24% increased risk for prostate cancer compared with the general population in New York State.

Webber and colleagues noted that all firefighters are repeatedly exposed to occupational hazards, including known carcinogens. Their 2016 study found no difference between WTC-exposed firefighters and a group of non-WTC-exposed firefighters from three other cities. The current study extended follow-up to allow for detection of cancers up to 15 years after WTC site exposure.

In this analysis of 10 786 WTC-exposed firefighters and 8813 non-WTC-exposed firefighters, prostate cancer was the most commonly diagnosed cancer among both groups.

In comparison to the US male population, all-cancer incidence among exposed firefighters was “higher than expected”, an increase of 9% even after adjustment for possible surveillance bias.

The researchers adjusted for earlier detection made possible through free screenings, but elevated rates persisted for all cancers (7%), prostate cancer (28%), non-Hodgkin lymphoma (21%), and thyroid cancer (111%).

Webber and colleagues acknowledged that assessment of cancer risk among WTC-exposed firefighters is complex, as “these firefighters were subject to carcinogenic exposures, while also enduring enormous physical and mental burdens related to the attacks.”

“Evidence is slowly accruing about cancer and other long latency illnesses in relation to WTC exposure, although much remains to be determined,” they added.

Research has shown a lag of 10 to 20 years from exposure to a carcinogen to prostate cancer diagnosis. While WTC exposure was known to be linked to prostate cancer risk among responders, the length of time between exposure and cancer diagnosis was unknown.

Among the 54 394 rescue/recovery workers in the study, 1120 prostate cancer cases were diagnosed from 2002 to 2015.

The median time from the attacks to a diagnosis was 9.4 years, with the majority (66%) of cases diagnosed from 2009 to 2015.

Higher screening rates among first responders may have contributed to the increased incidence of prostate cancer seen in the study, the researchers acknowledged.

Comparing the responders who arrived earliest to the site with those who arrived later revealed a positive, monotonic, dose-response association with the early (2002-2006) and late (2007-2015) periods.

“The increased hazard among those who responded to the disaster earliest or were caught in the dust cloud suggests that a high intensity of exposure may have played some role in premature oncogenesis,” Hall and colleagues wrote. “Our findings support the need for continued research evaluating the burden of prostate cancer in WTC responders.”

Source: MedPage Today

‘Uncomfortable’ Urban Spaces Result in Slower, Uncertain Walking

Stepping patterns become slower and more variable when a person is not comfortable with their environment, researchers have found.

The findings, published in PLoS One, shows that the perceived comfort of an environment, rather than it being natural or not, affects how people walk, with potential lessons for urban design.

Lead author Daria Burtan of Bristol’s School of Psychological Science said: “Measuring the changes of a person’s walking patterns through an environment allows us to understand their experienced comfort on a moment-to-moment basis.

“This is an important step toward being able to objectively quantify the impact of particular architectural designs on people’s wellbeing.”

Research has shown that spending time in green spaces such as parks helps improve attention spans, concentration and wellbeing, which can be shown by improvements in measured stepping patterns when walking in different environments.

Daria added: “As our cognitive faculties begin to decline in older age, the stepping patterns we make with our feet become slower and more variable, relative to when we are younger in the prime of our health. We found that the same thing happened when people walked toward images of urban and nature scenes they didn’t feel comfortable with – their stepping patterns became slower and more varied, relative to when they were looking at scenes they found comfortable and which they liked.

“Not only does this suggest that environments in which we feel comfortable and safe, place fewer processing demands on our brains; it demonstrates how measuring the real-time dynamics of our gait provides us with a powerful new tool for informing on the cognitive impacts of architecture and urban design.”

The researchers are now seeking to understand which psychological factors contribute to sensory discomfort.

Source: University of Bristol

Low-level Air Pollution Still Linked to Higher Mortality

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Long-term exposure to air pollution appears to still be linked to higher mortality despite the existence of air quality standards that restrict levels of pollution, suggests a study published online in The BMJ today.

Previous studies have found an association between long term exposure to outdoor air pollution such as those in the form of fine particles in the air (known as particulate matter or PM2.5) and nitrogen dioxide (NO2) and illness or mortality.

While air pollution concentrations have fallen substantially in Europe since the 1990s, it is unclear whether there still is a link between pollution and ill health or death at pollution levels under permitted levels.

Therefore, researchers set out to determine if there was an association between low levels of air pollution concentrations and natural and cause-specific deaths.

Low-level air pollution was defined as concentrations below current limits set by the European Union, US Environmental Protection Agency and the World Health Organization (WHO).

The researchers analysed data on eight groups of people within six European countries. Their study recruited participants in the 1990s or 2000s. Of the 325 367 participants who were followed up over an almost 20-year period, around 14.5% (47 131 people) died during the study period.

An increase of 5 µg/m3 (a concentration measure of particulate matter) in particulate matter (PM2.5) was associated with a 13% increase in natural deaths while the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6%. Associations with PM2.5 and NO2 were largely independent of each other.

Moreover, even at low to very low concentrations, associations with PM2.5, NO2, and black carbon remained significant. For people exposed to pollution levels below the US standard of 12 µg/m3, an increase of 5 µg/m3 in PM2.5 was associated with a 29.6% increase in natural deaths. People exposed to NO2at less than half the current EU standard of 40 µg/m3, a 10 µg/m3 increase in NO2 was associated with a 9.9% increase in natural deaths.

The study also has some limitations, the researchers said, such as the fact that it focused on exposure in 2010 which was towards the end of the follow-up period for most participants and, given falling air pollution, this measure might not exactly reflect the concentrations experienced during follow-up.

However, this was a large study from multiple European groups of people with detailed information provided. As such, the authors concluded: “Our study contributes to the evidence that outdoor air pollution is associated with mortality even at levels below the current European and North American standards and WHO guideline values.

“These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines and standards, and future assessments by the Global Burden of Disease [study].”

Source: The BMJ

Heat Waves Increase Aggression in Mental Health Wards

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According to a new study from Germany, heatwaves may increase aggressive patient behaviour in mental health wards.

Studies have shown an association between increased temperature and the incidence of violent crimes, accounting for about 10% of the variance in one study in Finland. This effect has also been seen within the context of American Football games, with more penalties for aggressive behaviour given for visiting teams on hotter days.

Researchers from ZfP Südwürttemberg and Ulm University in Germany drew on local weather data and incident reporting data to examine the impact of hot weather on mental health inpatient wards.

They discovered that there were an average of 15% more aggressive incidents on days over 30°C (9.7 per day) compared to days under 30°C (8.4 per day).

A clear relationship was also seen between the temperature of hot days (those over 30°C) and the number of aggressive incidents. As the temperature increased, the higher the rate of incidents, which reached a peak of 11.1 on the very hottest days (over 33.5°C).

The findings suggest that temperature is the cause of the increase in incidents, rather than another factor. No equivalent correlation was found between temperature on hot days and the use of restrictive practices by hospital staff.

Staff recorded aggressive incidents according to a standardised protocol, documenting the nature of the aggression (eg physical, verbal), the target (eg staff, patients), the impact and any subsequent measures taken.

The data for the study came from six German mental health hospitals and covered 13 years (2007-2019), 1007 beds and 164 435 admissions. Over this period, there were a total of 207 days over 30°C. All six hospitals were built according to modern building standards, but all lacked air-conditioning.

Lead author Dr Hans Knoblauch said: “The climate emergency means that many areas of the world could experience significantly more hot weather in the future.

“While more research into the mental health consequences is needed, these findings could have practical implications for mental healthcare, particularly around hospital design and architecture.”

His colleague, Professor Tilman Steinert, from Ulm University, commented: “These findings highlight an underappreciated impact of the climate emergency on mental health services. Increased aggression is an indicator of increased distress and an environment that is failing to help patients recover.

“Urgent action is now needed, to replicate the findings of this study using more measurements within mental health hospitals, to invest in those hospitals, and to tackle the climate crisis. Mental health patients deserve better.”

Source: EurekaAlert!

Journal information: Frank Eisele et al, Aggressive incidents in psychiatric hospitals on heat days, BJPsych Open (2021). DOI: 10.1192/bjo.2021.33