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Danh N, Ho C, Ford E, Zhang J, Hong H, Reid C, Xu D. Association between ambient temperature and stroke risk in high-risk populations: a systematic review. Front Neurol 2024; 14:1323224. [PMID: 38259643 PMCID: PMC10801432 DOI: 10.3389/fneur.2023.1323224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background Significant associations exist between ambient temperature and stroke risk, but results in high cardiovascular risk populations are lacking. This systemic review summarised current evidence on ambient temperature and overall stroke risk in a high cardiovascular risk population. Methods We performed a systematic literature search across MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and GEOBASE, from inception to 3 July 2023, to identify all population-based studies. Eligible studies screened by independent reviewers recruited individuals aged 18 years and over, where minimum 80% of participants had a high cerebral vascular disease (CVD) risk profile. The primary outcomes are stroke morbidity and mortality, while the secondary outcomes are morbidity and mortality of ischaemic stroke (IS), intracranial cerebral haemorrhage (ICH), and subarachnoid haemorrhage (SH). Results The database searches identified 9,025 articles. After removing duplicates, 7,647 articles were screened in title and abstract to identify 380 articles for full-text screening. After the full-text screening of 380 articles by two independent reviewers, 23 articles were included in the review. Conclusion The evidence for an association between ambient temperature and stroke incidence is that lower temperatures were more likely to increase morbidity and mortality risk of both haemorrhagic and ischaemic stroke in older people. Conversely, higher ambient temperature is significantly associated with intracranial haemorrhage risk, but decreased risk with IS. Higher and lower ambient temperatures consistently increase stroke risks in patients with comorbidities of congestive heart failure and dyslipidaemia. This evidence implies the need to establish clinical guidelines for preventive intervention in patients with high stroke risks during extreme ambient temperatures.
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Affiliation(s)
- Nathan Danh
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Chau Ho
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Emily Ford
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Jian Zhang
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hua Hong
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Christopher Reid
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dan Xu
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Ramos-Pachón A, Rodríguez-Luna D, Martí-Fàbregas J, Millán M, Bustamante A, Martínez-Sánchez M, Serena J, Terceño M, Vera-Cáceres C, Camps-Renom P, Prats-Sánchez L, Rodríguez-Villatoro N, Cardona-Portela P, Urra X, Solà S, del Mar Escudero M, Salvat-Plana M, Ribó M, Abilleira S, Pérez de la Ossa N, Silva Y. Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage: A Secondary Analysis of the RACECAT Randomized Clinical Trial. JAMA Neurol 2023; 80:1028-1036. [PMID: 37603325 PMCID: PMC10442788 DOI: 10.1001/jamaneurol.2023.2754] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 08/22/2023]
Abstract
Importance Prehospital transfer protocols are based on rapid access to reperfusion therapies for patients with ischemic stroke. The effect of different protocols among patients receiving a final diagnosis of intracerebral hemorrhage (ICH) is unknown. Objective To determine the effect of direct transport to an endovascular treatment (EVT)-capable stroke center vs transport to the nearest local stroke center. Design, Setting, and Participants This was a prespecified secondary analysis of RACECAT, a multicenter, population-based, cluster-randomized clinical trial conducted from March 2017 to June 2020 in Catalonia, Spain. Patients were evaluated by a blinded end point assessment. All consecutive patients suspected of experiencing a large vessel occlusion stroke (Rapid Arterial Occlusion Evaluation Scale [RACE] score in the field >4 on a scale of 0 to 9, with lower to higher stroke severity) with final diagnosis of ICH were included. A total of 1401 patients were enrolled in RACECAT with suspicion of large vessel occlusion stroke. The current analysis was conducted in October 2022. Intervention Direct transport to an EVT-capable stroke center (n = 137) or to the closest local stroke center (n = 165). Main Outcomes and Measures The primary outcome was tested using cumulative ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI of the shift analysis of disability at 90 days as assessed by the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) in the intention-to-treat population. Secondary outcomes, included 90-day mortality, death or severe functional dependency, early neurological deterioration, early mortality, ICH volume and enlargement, rate of neurosurgical treatment, rate of clinical complications during initial transport, and rate of adverse events until day 5. Results Of 1401 patients enrolled, 1099 were excluded from this analysis (32 rejected informed consent, 920 had ischemic stroke, 29 had transient ischemic attack, 12 had subarachnoid hemorrhage, and 106 had stroke mimic). Thus, 302 patients were included (204 [67.5%] men; mean [SD] age 71.7 [12.8] years; and median [IQR] RACE score, 7 [6-8]). For the primary outcome, direct transfer to an EVT-capable stroke center (mean [SD] mRS score, 4.93 [1.38]) resulted in worse functional outcome at 90 days compared with transfer to the nearest local stroke center (mean [SD] mRS score, 4.66 [1.39]; adjusted common OR, 0.63; 95% CI, 0.41-0.96). Direct transfer to an EVT-capable stroke center also suggested potentially higher 90-day mortality compared with transfer to the nearest local stroke center (67 of 137 [48.9%] vs 62 of 165 [37.6%]; adjusted hazard ratio, 1.40; 95% CI, 0.99-1.99). The rates of medical complications during the initial transfer (30 of 137 [22.6%] vs 9 of 165 patients [5.6%]; adjusted OR, 5.29; 95% CI, 2.38-11.73) and in-hospital pneumonia (49 of 137 patients [35.8%] vs 29 of 165 patients [17.6%]; OR, 2.61; 95% CI, 1.53-4.44) were higher in the EVT-capable stroke center group. Conclusions and Relevance In this secondary analysis of the RACECAT randomized clinical trial, bypassing the closest stroke center resulted in reduced chances of functional independence at 90 days for patients who received a final diagnosis of ICH. Trial Registration ClinicalTrials.gov Identifier: NCT02795962.
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Affiliation(s)
- Anna Ramos-Pachón
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Mònica Millán
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Alejandro Bustamante
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Marina Martínez-Sánchez
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Joaquín Serena
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | - Mikel Terceño
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Pere Cardona-Portela
- Stroke Unit, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
| | - Xabier Urra
- Stroke Unit, Hospital Clínic, and August Pi i Sunyer Biomedical Research Institute Barcelona, Barcelona, Spain
| | - Silvia Solà
- Sistema d’Emergències Mèdiques, Barcelona, Spain
| | | | - Mercè Salvat-Plana
- Catalan Stroke Program, Agency for Health Quality and Assessment of Catalonia, and CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Sònia Abilleira
- Catalan Stroke Program, Agency for Health Quality and Assessment of Catalonia, and CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Yolanda Silva
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
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Gao S, Yang T, Zhang X, Li G, Qin Y, Zhang X, Li J, Yang S, Yin M, Zhao J, Wei N, Zhao J, Li L, Li H, Yue X, Zhang W, Jia X, Fan Y, Liu H. A longitudinal study on the effect of extreme temperature on non-accidental deaths in Hulunbuir City based on DLNM model. Int Arch Occup Environ Health 2023; 96:1009-1014. [PMID: 37269342 PMCID: PMC10361884 DOI: 10.1007/s00420-023-01986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the frequency and effect of extreme temperature on the non-accidental death rate in Hulunbuir, a Chinese ice city. METHODS From 2014 to 2018, mortality data of residents residing in Hulunbuir City were collected. The lag and cumulative effects of extreme temperature conditions on non-accidental death and respiratory and circulatory diseases were analyzed by distributed lag non-linear models (DLNM). RESULTS The risk of death was the highest during high-temperature conditions, the RR value was 1.111 (95% CI 1.031 ~ 1.198). The effect was severe and acute. The risk of death during extreme low-temperature conditions peaked on the fifth day, (RR 1.057; 95% CI 1.012 ~ 1.112), then decreased and was maintained for 12 days. The cumulative RR value was 1.289 (95% CI 1.045 ~ 1.589). Heat significantly influenced the incidence of non-accidental death in both men (RR 1.187; 95% CI 1.059-1.331) and women (RR 1.252; 95% CI 1.085-1.445). CONCLUSIONS Regardless of the temperature effect, the risk of death in the elderly group (≥ 65 years) was significantly higher than that of the young group (0-64 years). High-temperature and low-temperature conditions can contribute to the increased number of deaths in Hulunbei. While high-temperature has an acute effect, low-temperature has a lagging effect. Elderly and women, as well as people with circulatory diseases, are more sensitive to extreme temperatures.
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Affiliation(s)
- Sheng Gao
- Institute of Artificial Intelligence, School of Electrical and Information Engineering, Hunan University, Changsha, 410000, People's Republic of China
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Tian Yang
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Xiuhong Zhang
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Guofeng Li
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Yuhan Qin
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Xiangnan Zhang
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Jing Li
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Shengmei Yang
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Minghui Yin
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Jufang Zhao
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Nana Wei
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Jing Zhao
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Li Li
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China
| | - Huan Li
- Inner Mongolia Medical University, Hohhot, 010107, People's Republic of China
| | - Xuanzhi Yue
- Inner Mongolia Medical University, Hohhot, 010107, People's Republic of China
| | - Wenyu Zhang
- Inner Mongolia Medical University, Hohhot, 010107, People's Republic of China
| | - Xinrui Jia
- Inner Mongolia Medical University, Hohhot, 010107, People's Republic of China
| | - Yaochun Fan
- Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, 010070, People's Republic of China.
| | - Hongli Liu
- Institute of Artificial Intelligence, School of Electrical and Information Engineering, Hunan University, Changsha, 410000, People's Republic of China.
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Wang P, Cheng S, Song W, Li Y, Liu J, Zhao Q, Luo S. Daily Meteorological Parameters Influence the Risk of Intracerebral Hemorrhage in a Subtropical Monsoon Basin Climate. Risk Manag Healthc Policy 2021; 14:4833-4841. [PMID: 34916860 PMCID: PMC8667755 DOI: 10.2147/rmhp.s331314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose The correlation between meteorological parameters and intracerebral hemorrhage (ICH) occurrence is controversial. Our research explored the effect of daily meteorological parameters on ICH risk in a subtropical monsoon basin climate. Methods We retrospectively analyzed patients with ICH in a teaching hospital. Daily meteorological parameters including temperature (TEM), atmospheric pressure (PRE), relative humidity (RHU), and sunshine duration (SSD) were collected, with the diurnal variation (daily maximum minus minimum) and day-to-day variation (average of the day minus the previous day) calculated to represent their fluctuation. We adopted a time-stratified case-crossover approach and selected conditional logistic regression to explore the effect of meteorological parameters on ICH risk. The influence of monthly mean temperature proceeded via stratified analysis. Air pollutants were gathered as covariates. Results Our study included 1052 eligible cases with ICH. In a single-factor model, the risk of ICH decreased by 5.9% (P<0.001) for each 1°C higher of the daily mean TEM, and the risk increased by 2.4% (P=0.002) for each 1hPa higher of the daily mean PRE. Prolongation of daily SSD inhibited the risk of ICH, and OR was 0.959 (P=0.007). The risk was raised by 7.5% (P=0.0496) with a 1°C increment of day-to-day variation of TEM. In a two-factor model, the effect of daily mean TEM or daily SSD on ICH risk was still statistically significant after adjusting another factor. The influence of meteorological parameters on ICH risk continued in cold months but disappeared in warm months after stratified analysis. Conclusion This research indicates daily TEM and SSD had an inverse correlation to ICH risk in a subtropical monsoon basin climate. They were independent when adjusted by another factor. Daily PRE and day-to-day TEM variation were positively related to ICH risk. The correlation of daily meteorological factors on ICH risk was affected by the monthly thermal background.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Shuwen Cheng
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Weizheng Song
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Yaxin Li
- West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Jia Liu
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Qiang Zhao
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Shuang Luo
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
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van Etten ES, Kaushik K, Jolink WMT, Koemans EA, Ekker MS, Rasing I, Voigt S, Schreuder FHBM, Cannegieter SC, Rinkel GJE, Lijfering WM, Klijn CJM, Wermer MJH. Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study. Stroke 2021; 53:1692-1699. [PMID: 34911344 DOI: 10.1161/strokeaha.121.036233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset. METHODS We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors. RESULTS We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8-3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3-6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2-19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7-60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8-55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4-63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6-37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1-95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7-6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9-4.2). CONCLUSIONS We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.
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Affiliation(s)
- Ellis S van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Kanishk Kaushik
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Wilmar M T Jolink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Emma A Koemans
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Merel S Ekker
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Ingeborg Rasing
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Suzanne C Cannegieter
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, the Netherlands. (S.C.C.)
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.)
| | - Willem M Lijfering
- Department of Epidemiology, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.).,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands. (S.C.C., W.M.L.)
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (W.M.T.J., G.J.E.R., C.J.M.K.).,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (M.S.E., F.H.B.M.S., C.J.M.K.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (E.S.v.E., K.K., E.A.K., I.R., S.V., M.J.H.W.)
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Wang P, Luo S, Cheng S, Li Y, Song W. Optimal Antihypertensive Medication Adherence Reduces the Effect of Ambient Temperature on Intracerebral Hemorrhage Occurrence: A Case-Crossover Study. Patient Prefer Adherence 2021; 15:2489-2496. [PMID: 34795476 PMCID: PMC8592395 DOI: 10.2147/ppa.s341259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE The role of antihypertensive medication adherence in reducing the effect of ambient temperature (TEM) on intracerebral hemorrhage (ICH) pathogenesis is unclear. We aimed to study the influence of ambient TEM on the ICH occurrence in hypertensive patients with different medication adherence. METHODS We enrolled consecutive ICH patients with a definite history of hypertension in a teaching hospital over a period of six years. Medication adherence was calculated using the proportion of prescription days covered (PDC) to antihypertensive mediation in the last month before the ICH attack. Optimal medication adherence (OMA) was the PDC > 80%, and non-optimal medication adherence (non-OMA) was ≤80%. Daily ambient TEM and its variation were collected as the explanatory variables, and dominant air pollutants were gathered as covariates. We adopted a time-stratified case-crossover approach to minimize individual confounders. Conditional logistic regression was conducted to calculate the odds ratio (OR) of daily ambient TEM on ICH occurrence. RESULTS We recruited a total of 474 patients in this study. The number of participants with OMA and non-OMA was 249 and 225. Daily mean and max TEM in lag0 to lag2, as well as daily min TEM in lag0 to lag1, were significantly related to ICH onset in all enrolled patients and non-OMA cases. However, only daily TEM in lag0 was meaningfully associated with ICH onset in the OMA cases. The risk of ICH in OMA patients, respectively, changed by 7.9% (OR = 0.921, [0.861, 0.985]) or 6.3% (OR = 0.937, [0.882, 0.995]) when daily mean or max TEM was altered by 1°C in lag0, but the change raised by 10.4% (OR = 0.896, [0.836, 0.960]) or 7.5% (OR = 0.925, [0.868, 0.986]) in non-OMA patients. And the risk varied (OR = 0.933, [0.882, 0.988]) only in non-OMA patients when daily min TEM was altered by 1°C in lag1. CONCLUSION Our results indicate that OMA to antihypertensive drugs reduces the influence of ambient TEM on ICH occurrence in hypertensive patients.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, Chengdu Fifth People’s Hospital/Affiliated Chengdu No.5 People’s Hospital of Chengdu University of TCM, Chengdu, People’s Republic of China
| | - Shuang Luo
- Department of Neurosurgery, Chengdu Fifth People’s Hospital/Affiliated Chengdu No.5 People’s Hospital of Chengdu University of TCM, Chengdu, People’s Republic of China
| | - Shuwen Cheng
- Department of Neurosurgery, Chengdu Fifth People’s Hospital/Affiliated Chengdu No.5 People’s Hospital of Chengdu University of TCM, Chengdu, People’s Republic of China
| | - Yaxin Li
- West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, People’s Republic of China
| | - Weizheng Song
- Department of Neurosurgery, Chengdu Fifth People’s Hospital/Affiliated Chengdu No.5 People’s Hospital of Chengdu University of TCM, Chengdu, People’s Republic of China
- Correspondence: Weizheng Song Department of Neurosurgery, Chengdu Fifth People’s Hospital/Affiliated Chengdu No.5 People’s Hospital of Chengdu University of TCM, Chengdu, 611130, People’s Republic of China Tel/Fax +86 28 82726171 Email
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Cazin I, Rossegger E, Guedes de la Cruz G, Griesser T, Schlögl S. Recent Advances in Functional Polymers Containing Coumarin Chromophores. Polymers (Basel) 2020; 13:E56. [PMID: 33375724 PMCID: PMC7794725 DOI: 10.3390/polym13010056] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
Natural and synthetic coumarin derivatives have gained increased attention in the design of functional polymers and polymer networks due to their unique optical, biological, and photochemical properties. This review provides a comprehensive overview over recent developments in macromolecular architecture and mainly covers examples from the literature published from 2004 to 2020. Along with a discussion on coumarin and its photochemical properties, we focus on polymers containing coumarin as a nonreactive moiety as well as polymer systems exploiting the dimerization and/or reversible nature of the [2πs + 2πs] cycloaddition reaction. Coumarin moieties undergo a reversible [2πs + 2πs] cycloaddition reaction upon irradiation with specific wavelengths in the UV region, which is applied to impart intrinsic healability, shape-memory, and reversible properties into polymers. In addition, coumarin chromophores are able to dimerize under the exposure to direct sunlight, which is a promising route for the synthesis and cross-linking of polymer systems under "green" and environment-friendly conditions. Along with the chemistry and design of coumarin functional polymers, we highlight various future application fields of coumarin containing polymers involving tissue engineering, drug delivery systems, soft robotics, or 4D printing applications.
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Affiliation(s)
- Ines Cazin
- Polymer Competence Center Leoben GmbH, Roseggerstrasse 12, 8700 Leoben, Austria; (I.C.); (E.R.)
| | - Elisabeth Rossegger
- Polymer Competence Center Leoben GmbH, Roseggerstrasse 12, 8700 Leoben, Austria; (I.C.); (E.R.)
| | - Gema Guedes de la Cruz
- Department Polymer Engineering and Science, Institute Chemistry of Polymeric Materials, Montanuniversitaet Leoben, Otto Glöckel-Strasse 2, 8700 Leoben, Austria; (G.G.d.l.C.); (T.G.)
| | - Thomas Griesser
- Department Polymer Engineering and Science, Institute Chemistry of Polymeric Materials, Montanuniversitaet Leoben, Otto Glöckel-Strasse 2, 8700 Leoben, Austria; (G.G.d.l.C.); (T.G.)
| | - Sandra Schlögl
- Polymer Competence Center Leoben GmbH, Roseggerstrasse 12, 8700 Leoben, Austria; (I.C.); (E.R.)
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8
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Aaron S, Lakshmanan J, Sudarsanam TD, Benjamin K, Durairaj J, Mathew V, Sivadasan A, Prabhakar AT, Keshava SKN, Mannam PR, Kirubakaran P, Muliyil J, Alexander M. Cerebral Venous Thrombosis, Seasonal Trends, and Climatic Influence: A Region-SpecificStudy. Ann Indian Acad Neurol 2019; 23:522-527. [PMID: 33223671 PMCID: PMC7657288 DOI: 10.4103/aian.aian_409_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose: Studies looking at seasonal variation on cerebral venous thrombosis (CVT) are few with conflicting conclusions. In this region-specific study, we looked for climatic influence and seasonal trends on the incidence of CVT. Methods: Imaging proven adult CVT cases treated over a period of 18 years from a specific geographical location with similar seasons and climatic conditions were studied. Metrological parameters prepared using 30 years of data was used. Quantum geographical information system (QGIS software) and SPSS v 22 were used for patient plotting and analysis. Results: Total of 970 cases were studied. The incidence was significantly higher in summer 411 (42.3%) compared with autumn 317 (32.7%) and winter 242 (25.05); P = 0.038. This trend was consistent across all the 18 years in time series analysis. Mean age was 33.5 years (range 18–88 years). A significant majority 673 (69.4%) were below 40 years of age; P = 0.012. Females constituted 394 (40.6%) of cases. Postpartum CVT cases constituted 237 (30%). Interaction analysis showed younger age (<40 years) were more vulnerable for CVT in summer; P = 0.009. There was no seasonal influence on postpartum CVT. Apart for a weak positive correlation between rain fall (r = 0.18, P < 0.01); humidity and cloud cover was not influencing the incidence. Conclusions: Higher ambient temperatures were consistently associated with higher incidence of CVT. This is the largest region-specific study on CVT in the world. These results may be applicable to other regions with similar climatic conditions.
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Affiliation(s)
- Sanjith Aaron
- Department of Neurology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jeyaseelan Lakshmanan
- Department of Biostatistics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Thambu D Sudarsanam
- Department of General Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Kenneth Benjamin
- Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jothilakshmi Durairaj
- Department of Biostatistics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Department of Neurology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Ajith Sivadasan
- Department of Neurology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - A T Prabhakar
- Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Shyam Kumar N Keshava
- Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Pavitra R Mannam
- Department of Radiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Prabhu Kirubakaran
- Department of Neurology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jayaprakash Muliyil
- Department of Community Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Department of Neurology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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9
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Polcaro-Pichet S, Kosatsky T, Potter BJ, Bilodeau-Bertrand M, Auger N. Effects of cold temperature and snowfall on stroke mortality: A case-crossover analysis. ENVIRONMENT INTERNATIONAL 2019; 126:89-95. [PMID: 30784804 DOI: 10.1016/j.envint.2019.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND We sought to determine if cold temperature and snowfall are independently associated with stroke mortality, and whether effects differ between hemorrhagic and ischemic stroke. MATERIALS AND METHODS We conducted a case-crossover study of 13,201 stroke deaths utilizing weather records between the months of November and April for Quebec, Canada from 1981 to 2015. We compared exposure to cold temperature and snowfall with controls days when stroke death did not occur. We computed odds ratios (OR) and 95% confidence intervals (CI) for the association of minimum temperature and duration of snowfall with stroke, adjusted for change in barometric pressure and relative humidity. RESULTS The likelihood of mortality the day following exposure to cold temperature was elevated for hemorrhagic stroke in men, independent of snowfall. Relative to 0 °C, a temperature of -20 °C was associated with 1.17 times the odds of hemorrhagic stroke death (95% CI 1.04-1.32). An independent effect of snowfall was also present in men, with 12 h of snowfall associated with 1.12 times the odds of hemorrhagic stroke death (95% CI 1.00-1.24) compared with no snowfall. There was no evidence of an increased risk in women. Cold temperature and snowfall were not associated with ischemic stroke death in either men or women. CONCLUSION Our results suggest that cold temperature and snowfall are independent risk factors for death from hemorrhagic stroke in men. These findings imply that interventions to prevent fatal hemorrhagic stroke during winter should include both cold temperature exposure and snowfall in men.
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Affiliation(s)
- Sara Polcaro-Pichet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Tom Kosatsky
- National Collaborating Centre for Environmental Health, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Brian J Potter
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Cardiology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | | | - Nathalie Auger
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
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10
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Ross ME, Vicedo-Cabrera AM, Kopp RE, Song L, Goldfarb DS, Pulido J, Warner S, Furth SL, Tasian GE. Assessment of the combination of temperature and relative humidity on kidney stone presentations. ENVIRONMENTAL RESEARCH 2018; 162:97-105. [PMID: 29289860 PMCID: PMC5811384 DOI: 10.1016/j.envres.2017.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 06/01/2023]
Abstract
Temperature and relative humidity have opposing effects on evaporative water loss, the likely mediator of the temperature-dependence of nephrolithiasis. However, prior studies considered only dry-bulb temperatures when estimating the temperature-dependence of nephrolithiasis. We used distributed lag non-linear models and repeated 10-fold cross-validation to determine the daily temperature metric and corresponding adjustment for relative humidity that most accurately predicted kidney stone presentations during hot and cold periods in South Carolina from 1997 to 2015. We examined three metrics for wet-bulb temperatures and heat index, both of which measure the combination of temperature and humidity, and for dry-bulb temperatures: (1) daytime mean temperature; (2) 24-h mean temperature; and (3) most extreme 24-h temperature. For models using dry-bulb temperatures, we considered four treatments of relative humidity. Among 188,531 patients who presented with kidney stones, 24-h wet bulb temperature best predicted kidney stone presentation during summer. Mean cross-validated residuals were generally lower in summer for wet-bulb temperatures and heat index than the corresponding dry-bulb temperature metric, regardless of type of adjustment for relative humidity. Those dry-bulb models that additionally adjusted for relative humidity had higher mean residuals than other temperature metrics. The relative risk of kidney stone presentations at the 99th percentile of each temperature metric compared to the respective median temperature in summer months differed by temperature metric and relative humidity adjustment, and ranged from an excess risk of 8-14%. All metrics performed similarly in winter. The combination of temperature and relative humidity determine the risk of kidney stone presentations, particularly during periods of high heat and humidity. These results suggest that metrics that measure moist heat stress should be used to estimate the temperature-dependence of kidney stone presentations, but that the particular metric is relatively unimportant.
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Affiliation(s)
- Michelle E Ross
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Ana M Vicedo-Cabrera
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, England WC1E 7HT, United Kingdom.
| | - Robert E Kopp
- Department of Earth and Planetary Sciences and Institute of Earth, Ocean & Atmospheric Sciences, Rutgers University; New Brunswick, NJ 08901, USA.
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - David S Goldfarb
- Division of Nephrology, New York University School of Medicine, New York, New York 10016, USA.
| | - Jose Pulido
- Department of Surgery, Division of Urology; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Steven Warner
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Susan L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Surgery, Division of Urology; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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11
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Ha S, Nguyen K, Liu D, Männistö T, Nobles C, Sherman S, Mendola P. Ambient temperature and risk of cardiovascular events at labor and delivery: A case-crossover study. ENVIRONMENTAL RESEARCH 2017; 159:622-628. [PMID: 28926807 PMCID: PMC5624535 DOI: 10.1016/j.envres.2017.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/06/2017] [Accepted: 09/09/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND Extreme ambient temperatures are linked to cardiac events in the general population, but this relationship is unclear among pregnant women. We estimated the associations and attributable risk between ambient temperature and the risk of cardiovascular event at labor/delivery, and investigated whether these associations vary by maternal race/ethnicity. METHODS We identified 680 women with singleton deliveries affected by cardiovascular events across 12 US sites (2002-2008). Average daily temperature during the week before, delivery day, and each of the seven days before delivery was estimated for each woman. In a case-crossover analysis, exposures during these hazard periods were compared to two control periods before and after delivery using conditional logistic regression adjusted for other environmental factors. RESULTS During the cold season (October-April), 1°C lower during the week prior to delivery was associated with a 4% (95% CI: 1-7%) increased risk of having a labor/delivery affected by cardiovascular events including cardiac arrest and stroke. During the warm season (May-September), 1°C higher during the week prior was associated with a 7% (95% CI: 3-12%) increased risk. These risks translated to 13.4 and 23.9 excess events per 100,000 singleton deliveries during the cold and warm season, respectively. During the warm season, the risks were more pronounced on days closer to delivery and Black women appeared to be more susceptible to the same temperature increase. CONCLUSION Small changes in temperature appear to affect the risk of having cardiovascular events at labor/delivery. Black women had a differentially higher warm season risk. These findings merit further investigation.
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Affiliation(s)
- Sandie Ha
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, 6710B Rockledge Drive Room 3119, MSC 7004 Bethesda, Rockville, MD, USA; School of Social Sciences, Humanties and Arts, University of California, Merced, CA, USA
| | - Kelly Nguyen
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, 6710B Rockledge Drive Room 3119, MSC 7004 Bethesda, Rockville, MD, USA; San Diego State University, San Diego, CA, USA; Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Danping Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, NICHD, Rockville, MD, USA
| | - Tuija Männistö
- Northern Finland Laboratory Centre NordLab, Oulu, Finland; Department of Clinical Chemistry, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; National Institute for Health and Welfare, Oulu, Finland
| | - Carrie Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, 6710B Rockledge Drive Room 3119, MSC 7004 Bethesda, Rockville, MD, USA
| | | | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, NICHD, 6710B Rockledge Drive Room 3119, MSC 7004 Bethesda, Rockville, MD, USA.
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Abstract
Case-crossover design is a variation of case-control design that it employs persons' history periods as controls. Case-crossover design can be viewed as the hybrid of case-control study and crossover design. Characteristic confounding that is constant within one person can be well controlled with this method. The relative risk and odds ratio, as well as their 95% confidence intervals (CIs), can be estimated using Cochran-Mantel-Haenszel method. R codes for the calculation are provided in the main text. Readers may adapt these codes to their own task. Conditional logistic regression model is another way to estimate odds ratio of the exposure. Furthermore, it allows for incorporation of other time-varying covariates that are not constant within subjects. The model fitting per se is not technically difficult because there is well developed statistical package. However, it is challenging to convert original dataset obtained from case report form to that suitable to be passed to clogit() function. R code for this task is provided and explained in the text.
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Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
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