Fifi is a vascular neurologist and neuroendovascular surgeon.

The world endured its hottest summer on record in 2024, and the transition to fall brought devastation from multiple hurricanes in the U.S. The growing effects of climate change are widespread and becoming more severe. Now, new research is making it apparent that my field of neurointerventional surgery must confront the growing and deadly link between climate change and an increase in stroke.
Just last month, the latest stroke update from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study in The Lancet Neurology reported that “rises in ambient temperature (including heatwaves) and climate change are associated with increased stroke morbidity and mortality.”
Earlier this year, another study published in Neurology found that, in 2019, more than half a million people died due to strokes that were linked to extreme temperatures (including both extreme highs and lows). From the study, “Globally, low temperature (deaths 474,002, 95% UI 355,077–606,537; DALYs 8,357,198, 95% UI 6,186,217–10,801,911) contributed more to stroke deaths and DALYs [disability-adjusted life years] than high temperature (deaths 48,030, 95% UI 5,630–104,370; DALYs 1,089,329, 95% UI 112,690–2,375,345) in 2019.”
While research on the climate change-stroke connection focuses mostly on extreme temperatures and air pollution, we know that service disruptions due to other extreme weather events — like the hurricanes and flooding that caused so much devastation in the Southeastern U.S. — will ultimately lead to treatment delays and a potential increase in death and disability from stroke. In fact, in preparation for the extreme effects of Hurricane Milton, first responders were forced to suspend answering 911 calls.
As with so many health issues, the poorer a patient is, the more vulnerable they are. In these studies, the connection between climate change and stroke mortality was stronger in low-income countries than high-income countries. Moreover, emerging research at the intersection of environmental justice and medicine is shedding light on comparable injustices being experienced here in the U.S., further exacerbating serious health disparities in stroke care.
Specifically, research released at the Society of NeuroInterventional Surgery’s annual meeting this summer found that worsening air quality and temperature extremes in the U.S. are linked to increased stroke burden, especially among those with lower incomes and a lack of health resources.
Researchers found that stroke prevalence was higher in areas with higher climate vulnerability scores, especially in the Southeast and the Midwest. Across the entire country, stroke incidence was 1.5 times higher in areas with the highest climate vulnerability scores (in the top 10th percentile in the Climate Vulnerability Index) compared to areas with lower scores (in the 50th percentile). Rural areas were especially likely to have high levels of combined climate vulnerability and stroke prevalence.
What this growing body of research makes clear is climate change is altering what it means to be “at risk” for a stroke. And to best serve potential patients, the fields of stroke and neurointerventional medicine and public health need to adapt our approach to stroke care.
Today, much of the public-facing stroke messaging is focused on prevention, and while stroke prevention is important, stroke education cannot end there. Focusing on risk factors alone can leave those who fall outside of the “high-risk” category unprepared. Plus, now we know the risk factors are shifting. Strokes affect people of all ages, including children, as well as those who have a healthy diet and have no family history of stroke.
The authors of the GBD stroke study conclude, “In summary, our study findings continue to point out that currently used stroke prevention strategies are not sufficiently effective to halt, let alone reduce, the fast-growing stroke burden.”
I agree. We need to approach the reduction of the global stroke burden from multiple angles.
A common barrier to better care is that many people are unfamiliar with stroke symptoms. According to a recent omnibus survey, around two-thirds of adults (63%) say they would know if they were having a stroke, but only 16% of adults can correctly identify common stroke symptoms, and around 1 in 10 (11%) get all these common symptoms incorrect.
Healthcare providers need to share the BE FAST acronym with every patient. It is a critical tool to assess stroke symptoms: Balance loss, Eyesight changes, Facial drooping, Arm weakness, Speech difficulty, Time to call 911.
The survey also found that less than half of American adults would call 911 for a stroke. That statistic points to a huge gap in public understanding, one that can be the difference between life and death.
Nearly 2 million brain cells die every minute a severe stroke goes untreated. The longer a patient’s treatment is delayed, the greater the impact of a stroke, including the potential for severe disability and death. Yet, not realizing it’s time-sensitive, too many people drive themselves to the hospital or have a family member or friend drive them instead of calling 911. Our patients need to understand that even one, “mild” symptom of stroke is a reason to call 911.
So many of us feel powerless to mitigate the effects of climate change, but stroke is one place where public education can increase quality of life and survival. As we continue to learn more about the influence of climate change on stroke, we can take action now to reduce stroke death and disability by emphasizing to our patients, our loved ones, and the American public at large that stroke can happen to anyone at any age. Knowing BE FAST and seeking emergency treatment options immediately will save lives and reduce disability.
Johanna Fifi, MD, is a neuroendovascular surgeon at Mount Sinai Hospital in New York City and the president of the Society of NeuroInterventional Surgery. She serves as a professor of Neurosurgery, Neurology, and Radiology at the Icahn School of Medicine at Mount Sinai and is the director of the Pediatric Neuroendovascular Program, associate director of the Cerebrovascular Center, and co-director of the Neuroendovascular Surgery Fellowship Program.

Disclosures
Fifi is a consultant for Medtronic, Cerenovus, Stryker, MIVI, and Microvention. She owns stock in Imperative Care.

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A teenager in British Columbia was hospitalized in critical condition with the disease, and officials were working to find out how the person was exposed to the virus.A teenager was hospitalized and in critical condition after contracting bird flu, in what Canadian officials said on Tuesday was the country’s first known case of the virus being transmitted to a human.Health officials in British Columbia were investigating how the teenager came down with the disease despite having no known links to poultry farms, the most common sites where bird flu has been detected in Canada.The virus, called H5N1, is a low risk to the public, health officials said, because it does not spread easily between people. But prolonged outbreaks, such as a cluster in U.S. dairy cattle can increase the chances of the virus mutating and spreading.There have been 46 cases of people contracting the virus in the United States, according to the Centers for Disease Control and Prevention, nearly all of them farm workers. Most cases have been mild.About 36 people who came into contact with the young person in Canada have tested negative for the virus and were offered a preventative course of antiviral medication, Dr. Bonnie Henry, British Columbia’s health officer, said at a news conference on Tuesday. Pets also tested negative.Bird flu, or avian influenza, has not broken out in Canadian dairy farms, but at least two dozen poultry farms have detected the virus since October 2024, officials said.Officials are making painstaking efforts to track down the source of the viral exposure in British Columbia.“There is a very real possibility that we may not ever determine the source, but at this point, we have a number of leads that we’re following,” Dr. Henry said. “We will be tracking down everyone because this is such a rare event.”Officials would not disclose the age or gender of the teenager, but said the person was in critical condition and receiving treatment at the B.C. Children’s Hospital in Vancouver after being admitted on Friday.About a week before that, the teenager went to a hospital emergency room complaining of respiratory symptoms, and had pink eye, fever and a cough. The teenager was sent home at the time and did not attend school before being admitted to the hospital, Dr. Henry said.There has only been one other case, in 2014, of bird flu in a Canadian citizen. Experts say they believe that person contracted the virus during a trip to China, where H5N1 was first discovered about two decades ago. That Canadian later died.British Columbia has warned members of the public to avoid handling dead birds or allowing pets near them.Poultry farmers were also warned to take caution.“People who are raising ducks and chickens and other domestic fowl are advised to keep their flocks indoors, as these birds are spreading their avian flu viruses up and down North America,” said Dr. Brian Ward, a professor at McGill University in Montreal who researches infectious diseases.

The decline in U.S. drug overdose deaths appears to have continued this year, giving experts hope the nation is seeing sustained improvement in the persistent epidemic.
There were about 97,000 overdose deaths in the 12-month period that ended June 30, according to provisional CDC data released Wednesday. That’s down 14% from the estimated 113,000 for the previous 12-month period.
“This is a pretty stunning and rapid reversal of drug overdose mortality numbers,” said Brandon Marshall, PhD, a Brown University researcher who studies overdose trends.
Overdose death rates began steadily climbing in the 1990s because of opioid painkillers, followed by waves of deaths led by other opioids like heroin and — more recently — illicit fentanyl. Provisional data had indicated a slight decline for 2023, and the tally released Wednesday showed that the downward trend has kept going.
Of course, there have been moments in the last several years when U.S. overdose deaths seemed to have plateaued or even started to go down, only to rise again, Marshall noted.
“This seems to be substantial and sustained,” Marshall said. “I think there’s real reason for hope here.”
Experts aren’t certain about the reasons for the decline, but they cite a combination of possible factors.
One is COVID-19. In the worst days of the pandemic, addiction treatment was hard to get and people were socially isolated — with no one around to help if they overdosed.
“During the pandemic we saw such a meteoric rise in drug overdose deaths that it’s only natural we would see a decrease,” said Farida Ahmad, MPH, of the CDC’s National Center for Health Statistics.
Still, overdose deaths are well above what they were at the beginning of the COVID-19 pandemic.
The recent numbers could represent the fruition of years of efforts to increase the availability of the overdose-reversing drug naloxone (Narcan), and addiction treatments such as buprenorphine, said Erin Winstanley, PhD, a University of Pittsburgh professor who researches drug overdose trends.
Marshall said such efforts likely are being aided by money from settlements of opioid-related lawsuits, brought by state, local, and Native American governments against drugmakers, wholesalers, and pharmacies. Settlement funds have been rolling out to small towns and big cities across the U.S., and some have started spending the money on naloxone and other measures.
Some experts have wondered about changes in the drug supply. Xylazine, a sedative, has been increasingly detected in illegally manufactured fentanyl, and experts are sorting out exactly how it’s affecting overdoses.
In the latest CDC data, overdose death reports are down in 45 states. Increases occurred in Alaska, Nevada, Oregon, Utah, and Washington.
The most dramatic decreases were seen in North Carolina and Ohio, but CDC officials voiced a note of caution. Some jurisdictions have had lags in getting death records to federal statisticians — particularly North Carolina, where death investigations have slowed because of understaffing at the state medical examiner’s office. The CDC made estimates to try to account for incomplete death records, but the decline in some places may ultimately turn out not to be as dramatic as initial numbers suggest.
Another limitation of the provisional data is that it doesn’t detail what’s happening in different groups of people. Recent research noted the overdose deaths in Black and Native Americans have been growing disproportionately larger.
“We really need more data from the CDC to learn whether these declines are being experienced in all racial ethnic subgroups,” Marshall said.

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In the years before the introduction of respiratory syncytial virus (RSV) vaccines, the virus was linked with substantial hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths among adults, according to a cross-sectional analysis of CDC data.
Adjusted analysis showed estimated RSV-associated hospitalization rates ranging from 48.9 per 100,000 adults during the 2016-2017 respiratory season to 76.2 per 100,000 in 2017-2018, reported researchers led by Fiona Havers, MD, MHS, of CDC’s National Center for Immunizations and Respiratory Diseases in Atlanta.
Estimated hospitalization rates were highest among adults ages 75 and older, ranging from 244.7 per 100,000 in 2022-2023 to 411.4 per 100,000 in 2017-2018, findings in JAMA Network Open indicated.
In addition, annual estimates of RSV-associated ICU admissions ranged from 24,400 to 34,900 for the 2016-2017 and 2017-2018 seasons, respectively, while estimated annual in-hospital deaths ranged from 4,680 in 2018-2019 to 8,620 in 2017-2018.
“These findings validated RSV as a substantial contributor to respiratory illness and hospitalization among adults, especially older adults,” Havers and colleagues wrote, noting that up to 136,000 estimated annual hospitalizations occurred among those 65 years or older.
Researchers used data from the CDC’s RSV Hospitalization Surveillance Network (RSV-NET) to arrive at their estimates. From the database, they identified a total of 16,575 laboratory-confirmed RSV-associated hospitalizations from the 2016-2017 to the 2022-2023 respiratory virus seasons. To estimate RSV burden, Havers and colleagues used adjustment multipliers to correct for the relatively low proportion of adults who were actually tested for RSV while hospitalized, as well as test sensitivity.
Of note, RSV severity “appeared to be comparable to or possibly more than the severity of influenza and SARS-CoV-2” in hospitalized adults. In the study, about 19% of adults hospitalized with RSV required ICU care and 4.3% died in the hospital. In comparison, CDC data from the 2021-2022 season found that 15.5% of hospitalized adults with COVID-19 required ICU admission and 4.6% died, and 13.3% of patients hospitalized for the flu were admitted to the ICU and 4.6% died, they explained.
Also, estimates of RSV-associated hospitalizations in older adults were comparable to the burden of influenza-associated hospitalizations during milder influenza seasons.
Hospital deaths associated with RSV were highest among those ages 75 or older, at 5.8%. From the 2016-2017 respiratory season through the 2022-2023 seasons, adults 75 and older accounted for 45.6% of the hospitalizations, 38.6% of the ICU admissions, and 58.7% of the in-hospital deaths associated with RSV.
Deaths due to RSV were probably underestimated because the analysis did not include deaths after hospital discharge, Havers and colleagues noted.
The first-ever RSV vaccine (Arexvy) received FDA approval in May 2023, followed by approval of a second vaccine (Abrysvo) in June 2023. An mRNA RSV vaccine (mResvia) was approved earlier this year as well. CDC recommendations now say that all adults ages 75 and older should receive a single dose of an RSV vaccine, as should those ages 60 to 74 years who are at increased risk of severe RSV disease.
“Given the large numbers of potentially vaccine-preventable hospitalizations and deaths associated with RSV, increasing vaccine coverage among adults at highest risk could reduce associated hospitalizations and severe clinical outcomes,” the authors wrote.
Atypical patterns of RSV circulation occurred during the COVID pandemic. Lower hospitalization rates were observed during 2020-2021 and 2021-2022, whereas increased circulation and an earlier peak occurred during 2022-2023.
On average, only 43.5% of the hospitalized adults with acute respiratory illness whose data was included in the RSV-NET catchment were tested for RSV. During 2016-2017, RSV testing was performed in 30.4% of adults ages 18-49 years with acute respiratory illness, 33.1% in those ages 50-64 years, 31.5% for those ages 65-74 years, and just 27.7% of those ages 75 and older. During the 2022-2023 season, these proportions increased to 56.1%, 61.2%, and 61.6% for those age groups, respectively.
Clinicians frequently don’t test for RSV in hospitalized adults with respiratory illness because of limited awareness of RSV as an important pathogen and because results do not generally change disease management, the study authors noted. Importantly, standard tests for RSV are now recognized to have lower sensitivity than previously thought.
The analysis had several limitations, including that RSV-NET data may not be generalizable to the entire country. Also, assumptions used in the adjustment analysis may have overestimated or underestimated the burden of RSV disease.

Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

Disclosures
The study was funded by grants from the CDC Emerging Infections Program and the Council of State and Territorial Epidemiologists.Havers and co-authors reported relationships with the study funders, state health departments, and other governmental agencies.

Primary Source
JAMA Network Open
Source Reference: Havers FP, et al “Burden of respiratory syncytial virus-associated hospitalizations in US adults, October 2016 to September 2023” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.44756.

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Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Alzheimer’s Researcher Faces Scrutiny
Berislav Zlokovic, MD, PhD, a prominent Alzheimer’s researcher and the head of a major neuroscience institute at the University of Southern California (USC), was placed on an indefinite leave of absence, according to a Science investigation.
A USC official declined to clarify why Zlokovic was placed on leave, but Science noted that he has faced scrutiny since its 2023 investigation revealed evidence of scientific misconduct.
Science also found that a planned clinical trial for a stroke drug candidate that Zlokovic helped develop was formally canceled by the company that sponsored the $30 million study. The NIH reportedly required USC return nearly $2 million in funding that was meant for the trial as well.
Zlokovic’s leave was announced by Carolyn Meltzer, dean of the USC Keck School of Medicine, in an October 22 email to the school’s faculty, according to the investigation. Zlokovic also stepped down as the head of the Zilkha Neurogenetic Institute, the Department of Physiology & Neuroscience, and as co-director of USC’s federally funded Alzheimer’s Disease Research Center.
The earlier Science investigation cited a large dossier that showed image manipulation in dozens of articles co-authored by Zlokovic. Several of those studies involved an experimental drug that reportedly reduced brain damage in people who suffered ischemic strokes. However, the investigation uncovered evidence that this drug may have an increased risk of death in trial participants.
Science reported that Zlokovic could not be reached for comment about his leave of absence.
Opioid Recovery Community Rejects Addiction Medicines
The addiction recovery community, led by groups like Narcotics Anonymous, has continued to reject addiction medications like buprenorphine or methadone despite evidence of their life-saving potential, according to a STAT investigation.
Thousands of organizations that claim to support those struggling with opioid addiction are very hostile to these effective addiction medications, the investigation found.
Individuals who have participated in Narcotics Anonymous or been residents of detox facilities and rehab centers described a culture that rejected medical consensus around addiction medicine and attempted to silence anyone who dissented, according to STAT.
For example, residents of recovery housing programs have been evicted for taking methadone or buprenorphine, STAT reported. Similarly, individuals seeking to enter rehab and detox facilities are only admitted if they are not taking those medications or if they agree to wean off of them quickly.
Many in the addiction recovery community see methadone or buprenorphine as mind-altering drugs that are no better than heroin or fentanyl. Leaders of addiction recovery support groups will tell individuals taking those medications that they aren’t “clean” yet.
Meanwhile, there is limited evidence that those support groups offer effective recovery support, according to the investigation.
Idaho Lags Behind Nation in Coroner’s Investigations
Due to a lack of regulations and undertrained, publicly elected coroners, Idaho has the nation’s lowest autopsy rate for child deaths attributed to unnatural or unknown causes, according to ProPublica.
While some states hire licensed forensic pathologists to be county medical examiners, Idaho elects coroners who often do not have a medical degree, or even any formal training in the field, ProPublica reported. Although many other states follow this practice, ProPublica found that Idaho also lacks other regulations, such as a professional oversight board, requirements for autopsies for unexpected or unexplained child deaths, or even funding to conduct services like body transportation.
According to the investigation, one of the few existing requirements is that newly elected coroners must attend “coroner’s school” in their first year, and continue to accrue 24 hours of training every 2 years. However, there are no penalties for failing to comply. ProPublica found that 1 in 4 coroners in Idaho have repeatedly fallen short of those requirements.
As a result, just 49% of those unnatural or unknown deaths were autopsied in Idaho from 2018 through 2022, which was far below the national average of 79%, according to a review by the state.
One county coroner profiled in the story, Rick Taylor, reportedly only works part-time despite earning more than $95,000 a year. Taylor has come under scrutiny in the state for failing to properly handle cases, including those involving unexpected or unexplained child deaths.
In one case, he reportedly declined to perform an autopsy on a newborn who was pronounced dead within minutes of arriving at the local hospital. Other officials in the state believed Taylor’s handling of the case fell short of a coroner’s expected responsibilities, ProPublica reported.

Michael DePeau-Wilson is a reporter on MedPage Today’s enterprise & investigative team. He covers psychiatry, long covid, and infectious diseases, among other relevant U.S. clinical news. Follow

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New research suggests symptoms of the disorder may be less severe in those with a demanding schedule.In high school, Sophie Didier started falling behind. She found it difficult to concentrate on her schoolwork, felt restless in class and often got in trouble for talking too much.“I had a teacher that used to give me suckers so that I would shut up,” she said.At 15, a doctor diagnosed her with attention deficit hyperactivity disorder. Medication helped, but she discovered that having a demanding schedule was also important. In both high school and college, her grades improved when she was juggling lacrosse and other extracurricular activities with her classes. Being so busy forced her to stick to a routine.“I felt more organized then,” recalled Ms. Didier, now 24 and living in Kansas City, Mo. “Like I had a better handle on things.”Research has shown that A.D.H.D. symptoms can change over time, improving and then worsening again or vice versa. And according to a recently published study, having additional responsibilities and obligations is associated with periods of milder A.D.H.D. This might mean that staying busy had been beneficial, researchers said. It could also just mean that people with milder symptoms had been able to handle more demands, they added.Oftentimes, people with A.D.H.D. “seem to do best when there’s an urgent deadline or when the stakes are high,” said Margaret Sibley, who is a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle and who led the study.The study, published online in October in the Journal of Clinical Psychiatry, tracked 483 patients in the United States and Canada who each had a combination of inattentive and hyperactive-impulsive A.D.H.D. symptoms. The researchers followed the participants for 16 years, starting at an average age of 8. They found that about three-quarters of the patients experienced fluctuations in their symptoms, generally beginning around age 12, which included either a full or partial remission of symptoms.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The fashion industry “should be concerned” by a trend back to using more skinny models, the editorial director of British Vogue has said.

BBC/Brijesh PatelA man whose wife died after a drain was mistakenly left in her abdomen for 21 hours has condemned the increased use of physician associates (PAs) within the National Health Service.