Friday, June 26, 2020

Tropical forest loss

New UD study shows that tropical forest loss is increased by large-scale land acquisitions

UNIVERSITY OF DELAWARE

IMAGE: UD ASSISTANT PROFESSOR KYLE DAVIS HAS PUBLISHED A NEW STUDY THAT LOOKS AT WHICH TYPES OF LARGE-SCALE LAND INVESTMENTS MAY BE ASSOCIATED WITH INCREASES IN TROPICAL DEFORESTATION. DAVIS IS PICTURED... view more

CREDIT: PHOTO COURTESY OF KYLE DAVIS

In recent years, there has been a rise in foreign and domestic large-scale land acquisitions--defined as being at least roughly one square mile--in Latin America, Asia, and Africa where investing countries and multinational investors take out long-term contracts to use the land for various enterprises.

In some cases, this leads to the creation of new jobs for local communities, and governments often welcome these investments as a means to promote the transfer of technologies and the inflow of capital. But the investments can also have adverse outcomes for local people, who rely on the acquired areas for food and income but have no legal claim to the land, and the environment-- as the land will likely need to be converted to serve its intended use.

An international group of researchers led by the University of Delaware's Kyle Davis has recently published a study in Nature Geoscience to see which types of large-scale land investments may be associated with increases in tropical deforestation. They found that investment types focusing on establishing new tree plantations -- where an area is cleared of existing trees and planted with a single tree species that is harvested for timber -- as well as plantations for producing palm oil and wood fiber, consistently had higher rates of forest loss than surrounding non-investment areas.

The study's findings show that large-scale land acquisitions can lead to elevated deforestation of tropical forests and highlight the role of local policies in the sustainable management of these ecosystems.

Analyzing land deals, forest cover

Researchers used a georeferenced database of more than 82,000 land deals -- covering 15 countries in Latin American, sub-Saharan Africa and Southeast Asia -- with global data on annual forest cover and loss between 2000 and 2018.

They found that since the start of the century, 76% of all large-scale land acquisitions in the Global South -- an emerging term which refers to the regions of Latin America, Asia, Africa and Oceania -- can be attributed to foreign land investment. These land acquisitions covered anywhere from 6% to 59% of a particular country's land area and 2% to 79% of its forests.

The information came from the Global Forest Watch database run by the World Resources Institute as well as other sources such as government ministries, which provides information for thousands of individual investments that show the exact area, boundary and intended use.

"This collection of datasets on individual land investments provided me with information on the exact area, boundary, and intended use of each deal. I then combined these data with satellite information on forest cover and forest loss to understand whether large-scale land investments are associated with increased rates of forest loss," said Davis, assistant professor in the Department of Geography and Spatial Sciences in UD's College of Earth, Ocean and Environment and the Department of Plant and Soil Sciences in UD's College of Agriculture and Natural Resources.

Environmentally damaging, globalized industries

With regards to the environmental damage done by oil palm, wood fiber and tree plantations, Davis said a lot of it has to do with the ways in which those products are grown.

"Investments to establish new oil palm or tree plantations seem to consistently have higher rates of forest loss, and that makes sense because basically, you have to completely clear the land in order to convert it to that intended use," said Davis. "If you want to establish a tree plantation or a palm oil plantation in place of natural vegetation, you've first got to cut down the forest."

For the other investment types, such as logging and mining, however, the results were much more mixed. Logging investments, in fact, served a small, protective role where the rates of forest loss in logging concessions were slightly lower than the rates of forest loss in surrounding, comparable areas. Davis attributed this to the specific requirements for the logging industry where only trees of a certain size or species can often be harvested.

These large-scale land acquisitions are now widespread across the planet, which was caused largely by rising globalization and the world's increasing interconnectedness.

"There's been a rapid increase in land investments in recent decades due to growing global demands for food, fuel, and fiber," said Davis.

He pointed to the global food crisis in 2008 when many import-reliant countries realized they were vulnerable to food or resource shortages. To help offset that vulnerability, they have pursued investments abroad to expand the pool of resources available to them in case another large-scale shock occurs.

Government information

Davis emphasized the importance for governments to provide detailed information on land investments, to ensure that these deals were carried out transparently and to allow researchers to objectively assess their effects.

He also said that by performing this comparison across different countries, it makes it possible to start identifying specific policies that are more effective in protecting forests.

"If you see deals in one country that aren't leading to enhanced forest loss but the same type of investment in another country is accelerating deforestation, then this suggests that there are opportunities to compare the policies in both places and leverage what's working in one country and adapt that to another context," said Davis. "But it also clearly shows that countries will inevitably experience deforestation should they seek to promote certain investments such as palm oil, wood fiber, and tree plantations, which we found were consistently associated with increased forest loss."

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75% of US workers can't work exclusively from home, face greater risks during pandemic

UNIVERSITY OF WASHINGTON

About three-quarters of U.S. workers, or 108 million people, are in jobs that cannot be done from home during a pandemic, putting these workers at increased risk of exposure to disease. This majority of workers are also at higher risk for other job disruptions such as layoffs, furloughs or hours reductions, a University of Washington study shows.

Such job disruptions can cause stress, anxiety and other mental health outcomes that could persist even as the United States reopens its economic and social life, said author Marissa Baker, an assistant professor in the UW Department of Environmental & Occupational Health Sciences.

These workers also represent some of the lowest paid workers in the U.S. workforce, Baker emphasized.

The remaining 25% of U.S. workers, or 35.6 million people, are in jobs that can be done at home. These jobs are typically in highly-paid occupational sectors such as finance, administration, computer, engineering and technology. Even as the economy begins to reopen, these workers will continue to be better shielded from exposure to the virus, reduced hours, furloughs or joblessness and have an increased ability to care for a child at home -- further growing the disparity between the top quarter of the workforce and the rest, the study found.

"This pandemic has really exacerbated existing vulnerabilities in American society, with workers most affected by the pandemic and stay-at-home orders being significantly lower paid and now also at increased risk for mental health outcomes associated with job insecurity and displacement, in addition to increased risk of exposure to COVID-19 if they keep going to work," said Baker.

"The most privileged workers will have a job that can be done at home, reducing their risk of exposure, and enabling them to continue to work even as office buildings were closed. Unfortunately, only a quarter of the U.S. workforce falls into this category. The fact that these are some of the highest paid workers in the U.S. is no surprise," Baker added.

In the study, published June 18 in the American Journal of Public Health, Baker examined 2018 Bureau of Labor Statistics data characterizing the importance of interacting with the public and the importance of using a computer at work to understand which workers could work from home during a pandemic event, and which workers would experience work disruptions due to COVID-19.

Using these two characteristics of work and how important they are in different types of jobs, Baker's analysis determined four main groups of occupations:

Work that relies on the use of computers but not as much on interaction with the public -- jobs in business and finance, software development, architecture, engineering and the sciences, for instance -- made up 25% of the workforce or 35.6 million workers. These workers had a median income of nearly $63,000.
Work that relies on both interaction with the public and computer use -- such as positions in management, healthcare, policing and education, most classified as essential during the pandemic -- comprised 36.4% of the workforce or 52.7 million workers. These workers had a median income of roughly $57,000.
Jobs in which interaction with the public and computer use are not important -- construction, maintenance, production, farming or forestry -- are 20.1% of the workforce or 29 million workers who make a median wage of $40,000.
Lastly, jobs in which computer work is not important but interacting with the public is -- retail, food and beauty services, protective services and delivery of goods -- were 18.9% of the workforce, or 27.4 million workers, with a median income of $32,000.

"The workers for whom computer use is not important at work but interactions with the public is are some of the lowest paid workers," Baker said. "And during this pandemic, they face compounding risks of exposure to COVID-19, job loss and adverse mental health outcomes associated with job loss."

As the economy reopens, some workers who have been unable to work at home but did continue to go to work during the pandemic -- such as some healthcare workers, security guards or bus drivers -- may now face layoffs as organizations adjust to reduced demand and economic pressures force layoffs, Baker explains. On the upside, workers in construction, manufacturing, production or freight transport who may have been laid off or furloughed during the pandemic will likely be some of the first industries to rebound and hire workers back.

However, the 18.9% of workers in occupations such as retail or food services, many of whom were laid off during the pandemic, may not have a job to go back to, further extending their job displacement and increasing adverse health effects associated with job loss. Those who are able to go back to work face a higher risk of exposure to the novel coronavirus still active in populations across the country.

Given the relationship between job insecurity or job displacement and mental health outcomes including stress, depression or anxiety, there could be a large burden of mental health outcomes among these workers.

"These results underscore the important role that work plays in public health. Workplace policies and practices enacted during a pandemic event or other public health emergency should aim to establish and maintain secure employment and living wages for all workers and consider both physical and mental health outcomes, even after the emergency subsides," Baker said.

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Baker's research was supported by the National Institute for Occupational Safety and Health under Federal Training Grant T42OH008433.

UK

Striking differences revealed in COVID-19 mortality between NHS trusts

UNIVERSITY OF CAMBRIDGE

Using data science techniques, the team revealed that the NHS trust in which a COVID-19 patient ended up in intensive care is as important, in terms of the risk of death, as the strongest patient-specific risk factors such as older age, immunosuppression or chronic heart/kidney disease. In the worst case, COVID-19 patients in the intensive care unit (ICU) of a particular NHS trust were over four times as likely to die in a given time period than COVID-19 patients in an average trust's ICU.

From the earliest days of the coronavirus pandemic, clinicians and scientists have been deciphering the risk factors that make someone with COVID-19 more likely to die. The uncovering of determinants of risk has allowed doctors to focus resources on the most vulnerable patients and has proved important in planning for the surge in demand for intensive care units created by the pandemic. It has also informed the public of which groups should take greater measures to shield or socially distance themselves. The new study is the first to reveal the extent to which ICU-patient location is a factor.

"COVID-19 has stretched most ICUs well beyond their normal capacity and necessitated them finding additional space, equipment and skilled staff - in an already stretched NHS - to deal with demand for highly specialist life-supporting therapies," says Dr Ercole. "It is possible that some hospitals found this harder either because they didn't have time to react or the necessary resources. It is crucial to understand the reasons for these between-centre differences as we plan our response to similar situations in the future: how and where to build capacity, and how to use what we have most effectively."

The peer-reviewed paper - "Between-centre differences for COVID-19 ICU mortality from early data in England" - is published in Intensive Care Medicine.

The analysis was carried out on anonymised data from the COVID-19 Hospitalisation in England Surveillance System (CHESS) dataset, supplied by Public Health England. The data were anonymised not only in terms of the patients but also in terms of the NHS trusts. The data covered 8 February to 22 May, during which there were 5062 ICU cases in 94 NHS trusts across England, with 1547 patient deaths and 1618 discharges from ICU.

The researchers call for urgent "comparative effectiveness research" to get to the bottom of these marked differences between NHS trusts. Knowledge gained in this direction could inform how ICUs are optimised and improve best practice in dealing with surges in COVID-19 cases in England, and perhaps beyond.

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Study: Air pollution major risk for cardiovascular disease regardless of country income

OREGON STATE UNIVERSITY

CORVALLIS, Ore. -- From low-income countries to high-income countries, long-term exposure to fine particulate outdoor air pollution is a major contributor to cardiovascular disease and death, a new Oregon State University study found.

But even small reductions in air pollution levels can result in a reduction of disease risk.

The study shows that countries don't have to immediately eradicate all air pollution to make a difference for people's health, said researcher Perry Hystad, an environmental epidemiologist in OSU's College of Public Health and Human Sciences. Hystad was the lead author on the international study, which also included fellow OSU public health researcher Andrew Larkin. Michael Brauer of the University of British Columbia was the senior author.

"If you reduce the concentration of outdoor air pollution, you're going to see benefits for cardiovascular disease," Hystad said. "Before this study, we were not sure if this was the case. Some studies suggested that at high concentration, as seen in many developing countries, levels would have to be reduced by very large amounts before health benefits would occur."

The massive study, published last week in The Lancet Planetary Health journal, used data from the long-running Prospective Urban Rural Epidemiology (PURE) study. For the current paper, researchers analyzed 157,436 adults between 35 and 70 years old in 21 countries from 2003-2018.

Overall, the study found a 5% increase in all cardiovascular events for every 10 microgram-per-cubic-meter increase in concentration of air pollutant particles under 2.5 microns in size (PM2.5). Factoring in the vast range of concentrations in PM2.5 recorded across the globe, that means 14% of all cardiovascular events documented in the study can be attributed to PM2.5 exposure.

"That's a big number," Hystad said. "That's a substantial portion of the cardiovascular disease burden."

The risks in low- and middle-income countries were mostly identical to the risks found in high-income countries.

The PURE study chose multiple countries from low, middle and high-income brackets to address a gap in existing research, as most air pollution studies have centered on people in high-income countries with relatively low concentrations of air pollution.

The current study looked at PM2.5 particles because they are small enough to be breathed deep into the lungs where they can cause chronic inflammation, Hystad said. These particles come from a range of combustion sources, including car engines, fireplaces and coal-fired power plants.

Researchers worked with a set of cardiovascular disease risk factors, including individual variables like smoking status, eating habits and pre-existing cardiovascular disease; and household factors like household wealth and use of dirty fuels for indoor cooking. Previous research in the PURE cohort found links between solid fuel use and kerosene use and cardiovascular disease. They also referenced geographical variables, including whether a person's location was rural or urban and general access to quality health care within each country.

In the data's 15-year period, in which participants were followed for roughly nine years each, 9,152 people had cardiovascular disease events, including 4,083 heart attacks and 4,139 strokes. There were 3,219 deaths attributed to cardiovascular disease.

The strongest association between air pollution exposure and health outcomes was for strokes. Hystad says a growing body of research finds that the risk of stroke is strongly impacted by exposure to PM2.5, especially at high concentrations.

Over the study's time frame, some countries' pollution levels improved, while some got worse, Hystad said. He pointed to the U.S.'s Clean Air Act of 1963 and how different air pollution levels are today compared to where they were in the 1970s.

"What I hope -- and this is actually what is happening -- is that developing countries can take these lessons and apply them and reduce the time it takes to achieve some of these air pollution reduction successes," he said. "Maybe instead of 30 years, you can do it in 10 years."

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The PURE study is led by Salim Yusuf at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences in Hamilton, Canada. The PURE-AIR study is led by Hystad and Brauer.

Machine learning has a flaw; it's gullible

Research shows how humans can shield machine learning from manipulation

UNIVERSITY OF MARYLAND

Machine learning (ML) - technology in which algorithms "learn" from existing patterns in data to conduct statistically driven predictions and facilitate decisions - has been found in multiple contexts to reveal bias. An example is Amazon.com coming under fire for a hiring algorithm that revealed gender and racial bias. Such biases often result from slanted training data or skewed algorithms.

And in other business contexts, there's another potential source of bias. It comes when outside individuals stand to benefit from bias predictions, and work to strategically alter the inputs. In other words, they're gaming the ML systems. A couple of the most common contexts are perhaps job applicants and people making a claim against their insurance. ML algorithms are built for these contexts. They can review resumes faster than any recruiter and comb through insurance claims faster than any human processor. But people who submit resumes and insurance claims have a strategic interest in getting positive outcomes - and some of them know how to outthink the algorithm.

Rajshree Agarwal and Evan Starr, researchers at the University of Maryland's Robert H. Smith School of Business worked with Prithwiraj Choudhury at Harvard Business School to set out to answer "Can ML correct for such strategic behavior?"

They found that two critical attributes of humans serve as important complements to machine learning in correcting for these biases. The more obvious one is vintage-specific skills, this ensures that humans have the ability to properly interface with machine learning so they can guide it appropriately. The other important attribute is domain-specific expertise, the knowledge that humans can provide machines on how to correct for the incompleteness of inputs.

Their work is forthcoming in Strategic Management Journal as "Machine Learning and Human Capital Complementarities: Experimental Evidence on Bias Mitigation."

Prior research in so-called "adversarial" ML looked closely at attempts to "trick" ML technologies, and generally concluded that it's extremely challenging to prepare the ML technology to account for every possible input and manipulation. In other words, ML is trickable.

What should firms do about it? Can they limit ML prediction bias? And, is there a role for humans to work with ML to do so? Agarwal, Choudhury and Starr honed their focus on patent examination, a context rife with potential trickery. "Patent examiners face a time-consuming challenge of accurately determining the novelty and nonobviousness of a patent application by sifting through ever-expanding amounts of 'prior art,'" or inventions that have come before, the researchers explain. It's challenging work.

Compounding the challenge: patent applicants are permitted by law to create hyphenated words and assign new meaning to existing words to describe their inventions. It's an opportunity, the researchers explain, for applicants to strategically write their applications in a strategic, ML-targeting way. The U.S. Patent and Trademark Office is generally wise to this. It has invited in ML technology that "reads" the text of applications, with the goal of spotting the most relevant prior art quicker and leading to more accurate decisions. "Although it is theoretically feasible for ML algorithms to continually learn and correct for ways that patent applicants attempt to manipulate the algorithm, the potential for patent applicants to dynamically update their writing strategies makes it practically impossible to train an ML algorithm to correct for this behavior," the researchers write.

In its study, the team conducted observational and experimental research. They found that patent language changes over time, making it highly challenging for any ML tool to operate perfectly on its own. The ML benefited strongly, they found, from human collaboration.

People with skills and knowledge accumulated through prior learning within a domain complement ML in mitigating bias stemming from applicant manipulation, the researchers found, because domain experts bring relevant outside information to correct for strategically altered inputs. And individuals with vintage-specific skills - skills and knowledge accumulated through prior familiarity of tasks with the technology - are better able to handle the complexities in ML technology interfaces.

They caution that although the provision of expert advice and vintage-specific human capital increases initial productivity, it remains unclear whether constant exposure and learning-by-doing by workers would cause the relative differences between the groups to grow or shrink over time. They encourage further research into the evolution in the productivity of all ML technologies, and their contingencies.

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The research drew the 2019 Best Conference Paper Award from the Strategic Management Society and won the Best Interdisciplinary Paper Award from the Strategic Human Capital Interest Group at Strategic Management Society 2019.

Those with IDD living in group homes more likely to die from COVID-19, study shows

SYRACUSE UNIVERSITY

Syracuse, N.Y. - A new study published recently in ScienceDirect by researchers from Syracuse University and SUNY Upstate Medical University shows that people with intellectual and developmental disabilities (IDD) living in residential group homes are more likely to be diagnosed with COVID-19 and die from the virus than those without IDD.

According to the researchers, the disparity is likely related to a higher prevalence of comorbid diseases among those with IDD, and/or a higher percentage of people with IDD living in congregate residential settings.

Their study, "COVID-19 Outcomes among People with Intellectual and Developmental Disability Living in Residential Group Homes in New York State," was published in the Disability and Health Journal. Utilizing data from the New York Disability Advocates (NYDA) and the New York State Department of Health COVID-19 Tracker, the study compared COVID-19 outcomes between 20,431 people with IDD who live in residential group homes in the state of New York to the overall outcomes for New York State.

"The rates of COVID-19 diagnosis and death were substantially higher for people with IDD living in residential group homes," said researcher Scott Landes, an associate professor of Sociology at Syracuse University's Maxwell School of Citizenship and Public Affairs and a research affiliate for the Lerner Center for Public Health Promotion. "This may partly be due to many individuals in this population having pre-existing health conditions that are associated with more severe COVID-19 outcomes.

"However, we are concerned that these severe outcomes may be more related to the current design of the IDD service system in the United States, in which states rely heavily on providing care in congregate settings with limited support and resources," Landes said. "This is proving deadly during the current pandemic."

The study was conducted by: Landes; two researchers from SUNY Upstate Medical Center in Syracuse, N.Y., Dr. Margaret Turk, SUNY Distinguished Service Professor of Physical Medicine & Rehabilitation, and Dr. Margaret Formica, associate professor of Public Health & Preventative Medicine and associate professor of urology; Katherine McDonald, professor and Chair of the Department of Public Health in the David B. Falk College of Sport and Human Dynamics at Syracuse University; and Dalton Stevens, a sociology PhD candidate at Syracuse University. Here is a more detailed look at their findings:

People with IDD living in residential group homes in New York State were at greater risk of severe COVID-19 outcomes:

* Case rates (a measure of the number of people diagnosed with COVID-19):

o 1,910 per 100,000 for New York State.

* Case-fatality (a measure of the proportion of death among those who contract the disease indicating disease severity):

o 7.9 percent for New York State.

* Mortality rate (a measure of the rate of death from a disease among a total population indicating burden of deaths due to a specific disease):

o 151 per 100,000 for New York State.

The study also examined each of these COVID-19 outcomes across regions of New York State. The differences in cases and mortality rate were confirmed across all regions of the state. However, case-fatality rate was only higher for people with IDD in and around the New York City region.

"The results of this present study reinforce our initial study that showed higher case-fatality rates among people with IDD using the TriNetX COVID-19 Research Network platform," researcher Dr. Margaret Turk said. "People with IDD are a poorly recognized and vulnerable group that does not often receive adequate attention within society in general, and within our healthcare system in particular. Further research is needed to determine the possible effects that access to - or quality of - medical care has on COVID-19 outcomes for this group."

Although U.S. states have been collecting data on COVID-19 outcomes among people with IDD served by the residential group home system, very few have publicly shared any of this data, and those that have shared data have done so sparingly.

Due to the increased severity of COVID-19 outcomes among people with IDD found in this study, the authors conclude that: "In order for us to have a full accounting of COVID-19 on the IDD population, or other vulnerable populations living in congregate settings, it is imperative that the entities that provide services for or monitor any segment of this population begin to openly share all relevant data they have on COVID-19 outcomes among people with IDD."

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Income, race are associated with disparities in access to green spaces

Study of two metro areas finds where parks, trees and other green spaces are located

OHIO STATE UNIVERSITY

COLUMBUS, Ohio - Access to green spaces in metro areas--parks, trails, even the tree cover in a neighborhood - is largely associated with income and race, new research indicates.

Researchers combined census-block-group demographic and socio-economic data with satellite imagery to analyze access to green spaces and vegetation in two metropolitan areas: Columbus, Ohio, and Atlanta, Georgia. Their study appears in the August issue of the journal Landscape and Urban Planning.

"Having close and convenient access to green spaces and vegetation within one's neighborhood can bring many ecological and health benefits," said Yujin Park, lead author of the study. Park recently completed her PhD in city and regional planning at The Ohio State University's Knowlton School of Architecture.

"These green resources should be available to anyone, and to any community, and we wanted to see whether this availability was affected by socioeconomic status, income, ethnicity or race."

Income and race may not have the same influence in all cities and counties, results show. Neighborhood location matters to what green space is available, the researchers found.

In the Columbus metropolitan area, a region of around 2 million people and 10 counties, access to green spaces is primarily influenced by income: Wealthier neighborhoods have greater access to parks, trees, greenways and sports fields. In the Atlanta metro area, a region of around 6 million people that covers 29 counties, access is significantly related to race.

Park said the researchers chose Atlanta and Columbus because they are similar in key measures including median incomes, urban core population densities, urban sprawl and car-dependency rates.

The researchers gathered data from both metropolitan areas by census block group from the 2010 U.S. Census and the 2014 Smart Location Database of the U.S. Environmental Protection Agency. They compared that data with four different geospatial datasets that show green spaces: National Land Cover Database (NLCD), Landsat Satellite imagery, OpenStreetMap and USA Parks from ESRI. Then, they analyzed accessibility to six different types of green spaces: vegetation biomass, tree canopies, parks, greenway trails, golf courses and sports fields, and a broad category of green open spaces that includes gardens, lawns, farms and fallow fields.

In Columbus, parks and greenways spanned the city, even reaching some poor neighborhoods. In Atlanta, mature trees covered more than half of the region.

The analysis showed that, in both cities, open green spaces inside the cities are concentrated in affluent, white suburbs near the center of the city.

Affluent suburban communities are also more likely to have access to a broad range of types of green space. In the Columbus area, for example, long-established, relatively affluent suburbs inside the city's beltway have access to both urban green trails and sports fields, as well as green lawns, trees and parks.

"There are very strong associations between community income levels and the density and diversity of green spaces available," Park said. "Affluent areas closer to the cities have a greater variety of choices in the green spaces available to them."

But in both regions, the data shows that less wealthy, racial-minority suburban and exurban communities outside the cities have little access to greenways and public parks. Therefore, disparities in access to green amenities may grow in these outskirt areas.

"Poorer urban communities are less likely to have access to trees and lawns. However, generally, communities in more-dense urban and downtown areas tend to have greater access to parks and green trails, thanks to historical park and trail investments in those areas," Park said. "Therefore, the efforts to increase and protect urban parks are very important, as they are the sources of green access for middle- to lower-income urban communities."

Jean-Michel Guldmann, professor emeritus of city and regional planning at Ohio State and the other author of this study, said future research could examine the quality of those green spaces.

"In the case of Atlanta, for example, there are many trees, but a lot of them are really old, and might not be well-cared-for," he said. "And some parks are not managed well and could feel unsafe to be in. The quality of urban parks can be another avenue for providing improved access."

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CONTACT: Yujin Park, park.2329@osu.edu Jean-Michel Guldmann, guldmann.1@osu.edu

Written by Laura Arenschield, arenschield.2@osu.edu

At height of COVID-19, nurses and doctors reported high levels of distress

COLUMBIA UNIVERSITY IRVING MEDICAL CENTER

NEW YORK, NY (June 23, 2020) -- During the height of the COVID-19 pandemic in New York City, health care workers on the front lines had high levels of acute stress, anxiety, and depression, a study by researchers at Columbia University Irving Medical Center and NewYork-Presbyterian has found.

Levels of stress, anxiety and depression were particularly high among those with the greatest amount of patient contact and interaction.

Among the findings:

More than half had high levels of acute stress.
Nearly half screened positive for depressive symptoms.
One-third had anxiety.
Most had insomnia symptoms and experienced loneliness.

The findings were published online in the journal General Hospital Psychiatry.

"This is the largest study in the United States to document the psychological impact among clinicians working on the front lines at the height of the NYC COVID-19 pandemic," says Marwah Abdalla, MD, assistant professor of medicine in the Center for Behavioral Cardiovascular Health at Columbia University, cardiac intensivist at NewYork-Presbyterian/Columbia University Irving Medical Center, and study leader.

"Our findings confirm what we suspected: Clinicians working in this environment experienced significant levels of acute stress and other psychological effects."

Nurses had highest stress levels

The researchers analyzed data from 657 clinicians at NewYork-Presbyterian/Columbia University Irving Medical Center who were screened for stress, anxiety, and depression symptoms between April 9 and April 24 during the peak of the pandemic in New York City. More than half (375) of respondents were nurses and advanced practice providers.

Overall, 57% of participants -- and 64% of nurses and advanced practice providers -- said they had experienced symptoms of acute stress, such as nightmares, an inability to stop thinking about COVID-19, a feeling of being constantly on guard, and numbness or detachment from people or their surroundings. Acute stress symptoms that persist for more than a month can lead to post-traumatic stress syndrome (PTSD).

Although the environment took a psychological toll on all healthcare workers, nurses were particularly affected. The different responsibilities of nurses may partly explain the higher rates of positive acute stress screens and other impacts, as nurses spend more time delivering direct patient care.

Nearly half (48%) of all participants screened positive for depressive symptoms and one-third (33%) for anxiety.

Loneliness was pervasive

Insomnia and loneliness were also pervasive in this group (71% and 65%, respectively). "These were essential workers who were still going to work and interacting with patients and colleagues throughout the day," Abdalla says, "so the high prevalence of loneliness is striking."

Three out of four participants were highly distressed about the possibility of transmitting COVID-19 to loved ones. Most were highly distressed about the need to maintain social distance from family and friends and a lack of control and uncertainty during the pandemic.

"The health care workers had the double burden of caring for patients with COVID-19 and worrying about the possibility of getting loved ones sick," says Abdalla. "The high prevalence of insomnia and loneliness among clinicians suggests that the acute stress of working in this environment was physically and emotionally exhausting and isolating, but we don't know yet if this stress will have long-term consequences, and if so, whether the feeling that they were doing something meaningful and purposeful helps insulate them from this stress."

Most engaged in stress-reducing behaviors

Most respondents reported the use of stress-reducing behaviors, most commonly physical exercise but also talk therapy, virtual support groups, and religious/spiritual practices. Most expressed interest in having access to an individual therapist.

"Our findings highlight the need to study the effectiveness of the wellness resources that were available to the health care workers during the study period and determine if additional resources may be needed to better protect them during the next health crisis that may arise in New York City," Abdalla says.

Abdalla and her colleagues are currently doing a follow-up survey to see if these clinicians' psychological symptoms, coping strategies, and sense of optimism change over time.

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More Information

The paper is titled, "Psychological Distress, Coping Behaviors, and Preferences for Support among New York Healthcare Workers during the COVID-19 Pandemic."

The other authors (all from NewYork-Presbyterian/Columbia University Irving Medical Center except where indicated) are Ari Shechter, Franchesca Diaz, Nathalie Moise, D. Edmund Anstey, Siqin Ye, Sachin Agarwal, Jeffrey L. Birk, Daniel Brodie, Diane E. Cannone, Bernard Chang, Jan Claassen, Talea Cornelius, Lilly Derby, Melissa Dong, Raymond C. Givens, Beth Hochman, Shunichi Homma, Ian M. Kronish, Sung A.J. Lee, Wilhelmina Manzano, Laurel E.S. Mayer, Cara L. McMurry, Vivek Moitra, Patrick Pham, LeRoy Rabbani, Reynaldo R. Rivera, Allan Schwartz, Joseph Schwartz (Stony Brook University, Stony Brook, NY), Peter Shapiro, Kaitlin Shaw, Alexandra M. Sullivan, Courtney Vose, Lauren Wasson, and Donald Edmondson.

Author funding includes grants from the American Heart Association, the Agency for Healthcare Research and Quality, and the National Institutes of Health (18AMFDP34380732, K23HL141682-01A1, R01HL146636-01A1, R01HL141494, R01HL146911, U24AG052175, P30AG064198, NHLBI R01HL132347, R01HL141811, R01HL146911, P30AG064198, R01-HL123368, R01-HL117832, R21 HL 145970).

The authors report no financial or other conflicts of interest.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.

Universal right to health could inspire people, organizations to make real change

BINGHAMTON UNIVERSITY

Acknowledging health as a universal human right could galvanize people and organizations to make major improvements in health worldwide, according to new research from faculty at Binghamton University, State University of New York.

"In the U.S., few people think that everyone has a right to health or universal health care. I think that if we commit to protecting everyone's rights to health, and think creatively about how to do so, we can help a lot of people," said Nicole Hassoun, professor of philosophy at Binghamton University, State University of New York.

The human right to health is important for protecting everyone's ability to live minimally good lives, in part, because it gives rise to what Hassoun calls the virtue of creative resolve - a fundamental commitment to overcoming apparent tragedy. That is, those committed to fulfilling the right often refuse to accept that doing so is impossible, and come up with creative ways of fulfilling the right, and act to fulfill it. Those who lead efforts to improve public health often exhibit the virtue.

"Consider how human rights advocates galvanized a global effort to extend access to essential medicines for HIV around the world," said Hassoun. "Activists simply refused to accept pharmaceutical companies' claim that it was impossible to lower prices and educated patients to demand access to treatment. Mass protests shifted public opinion and generic completion brought prices down from $12,000 per patient per year to $350. Similar efforts have transformed the global health landscape helping us eliminate smallpox and reduce the prevalence of many other devastating diseases."

Hassoun believes that the human right to health could guide national and international policy.

"Committing to fulfilling everyone's human right to health can help us overcome the need to ration: it can help us find the resources we need to fulfill the right when it seems that we lack them. It can help us criticize existing policies and support proposals for positive change," said Hassoun. "People need many things for health, but that is not a reason to reject the right. By fulfilling everyone's right to health, we may also fulfill many other rights (e.g. rights to clean water, education, and food). Moreover, the human right to health can require protecting public health with things like vaccines. Doing so is important for protecting communities as well as individuals."

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The paper, "The Human Right to Health: A Defense," was published in the Journal of Social Philosophy.

The Lancet Child & Adolescent Health: First Europe-wide study of children confirms COVID-19 predominately causes mild disease in children and fatalities are very rare

First multinational study of 582 children and adolescents with COVID-19 confirms majority of patients under 18 years old experience a mild disease and fatalities are extremely rare (4 deaths /582 patients, below 1%).

THE LANCET

Children with COVID-19 generally experience a mild disease and fatalities are very rare, according to a study of 582 patients from across Europe published today in The Lancet Child & Adolescent Health journal.

The study, which included children and adolescents aged from 3 days up to 18 years old, found that although the majority were admitted to hospital (62%, 363/582), fewer than one in ten patients required treatment in intensive care (8%, 48/582).

The researchers note that their study only involved patients who had sought medical help and been tested for COVID-19, and so milder cases would not have been included. They advise against extrapolating the numbers observed in their study to the wider population. However, they say their findings should be taken into consideration when planning for demand on intensive care services as the pandemic progresses.

Dr Marc Tebruegge, lead author from the UCL Great Ormond Street Institute of Child Health in London, UK, said: "Our study provides the most comprehensive overview of COVID-19 in children and adolescents to date. We were reassured to observe that the case fatality rate in our cohort was very low and it is likely to be substantially lower still, given that many children with mild disease would not have been brought to medical attention and therefore not included in this study. Overall, the vast majority of children and young people experience only mild disease. Nevertheless, a notable number of children do develop severe disease and require intensive care support, and this should be accounted for when planning and prioritising healthcare resources as the pandemic progresses." [1]

The study was carried out over a 3.5 week period from 1st to 24th April 2020, during the initial peak of the European COVID-19 pandemic. It involved 82 specialist healthcare institutions across 25 European countries. All of the 582 patients included in the study were confirmed to be infected with the SARS-CoV-2 virus by a PCR test. Only a quarter (25%, 145/582) had pre-existing medical conditions. This contrasts with adult studies where the proportion of patients with co-morbidities is typically far higher, but likely reflects that children have fewer chronic medical problems than adults overall in the general population, the authors say.

The researchers found that the most common symptom reported was fever (65%, 379/582). Around half of the patients had signs of upper respiratory tract infection (54%, 313/582) and a quarter had evidence of pneumonia (25%, 143/582). Gastrointestinal symptoms were reported in around a quarter of the children (22%, 128/582), 40 of whom did not have any respiratory symptoms. Some 92 children, most of whom were tested due to close contact with a known COVID-19 case, had no symptoms at all (16%, 92/582).

The vast majority of patients did not require oxygen or any other support to help them breathe at any stage (87%, 507/582). Only 25 children needed mechanical ventilation (4%, 25/582), but when they did need it, that support was typically required for a prolonged period, often for a week or more (range 1-34 days).

The number of patients receiving antiviral or immunomodulatory therapies were too low to draw conclusions about the efficacy of any of the treatments used. The authors say robust clinical trial data are urgently needed to help doctors make decisions regarding the best treatment strategy for children under their care.

Dr Florian Götzinger, from Wilhelminenspital in Vienna, Austria, said: "Although COVID-19 affects children less severely than adults overall, our study shows that there are severe cases in all age groups. Those who have pre-existing health issues and children under one month of age were more likely to be admitted to intensive care. Well-designed, randomised controlled studies on antiviral and immunomodulatory drugs in children are needed to enable evidence-based decisions regarding treatment for children with severe COVID-19." [1]

29 children were found to be infected with one or more additional respiratory viruses at the same time as SARS-CoV-2, such as cold or flu viruses. Of these, 24% required intensive care (7/29) compared with 7% of children with no additional viruses detected, (41/553).

Dr Begoña Santiago-Garcia, one of the lead authors from University Hospital Gregorio Marañón in Madrid, Spain, said: "This is the first study of children with COVID-19 to include data from multiple countries and multiple centres. Of note, we found that children in whom additional viruses were detected in the respiratory tract at the same time as SARS-CoV-2 were more likely to be admitted to intensive care. This could have important implications for the upcoming winter season, when cold and flu infections will be more common." [1]

Four patients died during the study period, two of whom had pre-existing medical conditions. All of the patients who died were older than 10 years of age. However, the overwhelming majority of patients were alive when the study closed (99%, 578/582) with only 25 (4%) still experiencing symptoms or needing support for their breathing.

At the time the study was conducted, testing capacity in many European countries was lower than demand, and so many children with COVID-19 and mild symptoms would not have been tested or diagnosed. Different countries were using different criteria to screen for the SARS-CoV-2 virus. Some were screening all children admitted to hospital while others were more selective in which patients were offered a test. This lack of standardisation makes it difficult to generalise the findings to the wider population, the authors say, but the true case fatality rate in children is likely substantially lower than that observed in this study (0.69%, 4/582).

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NOTES TO EDITORS

The study was carried out by the Paediatric Tuberculosis Network European Trials Group (ptbnet) COVID-19 Study Group, which comprises clinicians and researchers across 82 paediatric healthcare institutions in 25 European Countries. It was led by researchers at the UCL Great Ormond Street Institute of Child Health, London, UK; the Wilhelminenspital, the National Reference Centre for Childhood Tuberculosis, Vienna, Austria; and the University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid, Spain. Ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

[1] Quote direct from author and cannot be found in the text of the Article.

Peer reviewed / Observational / People

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