The Effects of Climate Change on Health Care

Global Warming is a growing issue in every type of community, and the cause of this increase in temperature has been proven to be from human-generated greenhouse gas emissions. These emissions come from things such as the burning of fossil fuels when driving a car. The increased temperature of the globe has lead to heat waves, a decline in air quality, increased sea levels, and more recurrent major storms, including floods and wildfires. This, in effect, is causing a decline in the quality of the air humans breath, the food they eat, the water they drink, and the places they live. This has been shown to lead to more health problems, including infections from floodwater, respiratory conditions like asthma from the dirty air, heat exhaustion, and an increase in mental illness from the stress of all of these changes and the events that come with them. In addition, there has been an increase in heart, lung, and kidney diseases, which leads to an increase in medications prescribed for these illnesses. Certain mediations, however, are not helpful to patients because they interfere with the body’s ability to regulate its temperature, which is critical during this time of global climate change. These medications include antihistamines, stimulants, and antipsychotic medications.

It has also been shown that medical providers have a great impact with making these facts known to the public, and showing them how global warming really does directly affect them. Some ways that providers can do this is by encouraging biking and walking instead of driving to not only cut down on emissions, but to get patients exercising and improving their health. In addition, they can counsel patients with asthma and other serious conditions to make sure they are being adherent to their medications and give them tips on how to keep their conditions in check during these times of stress for their body.

JAMA. 2016;315(3):239-240.

I agree with the findings of this article, because health care providers are an unlikely, yet very useful source of information and support for people in many situations, including during climate changes or times of disaster. Most people don’t listen to the advocates for a “greener” planet, or don’t take them seriously, but if health care providers join the movement, it can definitely make the population more aware of the serious effects of global warming and what it can do to their health. Do you know someone whose health is being affected because of the events associated with increasing global temperatures? Or, after reading this article, do you now realize that someone you know is at greater risk for adverse health effects due to global warming?

Potential Risks to Mother and Fetus with Use of Psychotropic Medications

Chisolm and Payne conducted a literature review to summarize the known and unknown risks of using psychotropic drugs during pregnancy. 15% of pregnant women have a psychiatric illness and 10% to 13% of fetuses are exposed to a psychotropic medication. Studies showed that many women relapsed if their medications were discontinued during pregnancy. It was found that most classes of psychotropic drugs are relatively safe to the fetus during pregnancy. A risk-benefit analysis should be conducted to determine if the risks associated with the drug or untreated psychiatric disorder are worse.

CYP1A2 enzymes are down-regulated in pregnant women so medications such as olanzapine and clozapine require a lower dose. Additionally, these medications have an increased risk for maternal weight gain, increased infant birth weight, and gestational diabetes, so ultrasound monitoring of fetal size may be beneficial in late pregnancy. High potency first generation antipsychotics are recommended over low potency first generation antipsychotics to minimize maternal anticholinergic, hypotensive, and antihistamine effects. Second generation antipsychotics are no safer than first generation antipsychotics and may have an increased risk of high infant birth weight and hypoglycemia.

There is still an inadequate amount of literature on the safety of antipsychotic use in pregnant women. Focus should be emphasized on drug management during pregnancy, including before and after delivery. The psychotropic medications should not be suddenly discontinued, and a comprehensive treatment plan should be developed for women to ensure quality and safe care to the mother and developing fetus.

BMJ. doi: http://dx.doi.org/10.1136/bmj.h5918 (published 20 Jan. 2016).

There is still not enough evidence to completely decide which antipsychotics are safe during pregnancy. What other medications could potentially be safe during pregnancy but are often discontinued due to a lack of research? And why?