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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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Koo GPY, Zheng H, Aik JCL, Tan BYQ, Sharma VK, Sia CH, Ong MEH, Ho AFW. Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4979. [PMID: 36981888 PMCID: PMC10049712 DOI: 10.3390/ijerph20064979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from 2010 to 2015 with similar rainfall, temperature, wind speed, and Pollutant Standards Index (PSI) using k-means clustering. Three distinct clusters were formed 'Cluster 1' containing high wind speed, 'Cluster 2' having high rainfall, and 'Cluster 3' having high temperatures and PSI. We aggregated the number of AIS episodes over the same period with the clusters and analysed their association using a conditional Poisson regression in a time-stratified case-crossover design. Comparing the three clusters, Cluster 3 had the highest AIS occurrence (IRR 1.09; 95% confidence interval (CI) 1.05-1.13), with no significant difference between Clusters 1 and 2. Subgroup analyses in Cluster 3 showed that AIS risk was amplified in the elderly (≥65 years old), non-smokers, and those without a history of ischaemic heart disease/atrial fibrillation/vascular heart disease/peripheral vascular disease. In conclusion, we found that AIS incidence may be higher on days with higher temperatures and PSI. These findings have important public health implications for AIS prevention and health services delivery during at-risk days, such as during the seasonal transboundary haze.
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Affiliation(s)
| | - Huili Zheng
- National Registry of Diseases Officer, Health Promotion Board, Singapore 168937, Singapore
| | - Joel C. L. Aik
- Environmental Epidemiology and Toxicology Division, Environmental Health Institute, National Environment Agency, Singapore 228231, Singapore
- Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Y. Q. Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ching Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Marcus E. H. Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Andrew F. W. Ho
- Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Centre of Population Health Research and Implementation, SingHealth Regional Health System, Singapore 168753, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
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3
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He F, Wei J, Dong Y, Liu C, Zhao K, Peng W, Lu Z, Zhang B, Xue F, Guo X, Jia X. Associations of ambient temperature with mortality for ischemic and hemorrhagic stroke and the modification effects of greenness in Shandong Province, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158046. [PMID: 35987239 DOI: 10.1016/j.scitotenv.2022.158046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence is scant on the relative and attributable contributions of ambient temperature on stroke subtypes mortality. Few studies have examined modification effects of multiple greenness indicators on such contributions, especially in China. We quantified the associations between ambient temperature and overall, ischemic, and hemorrhagic stroke mortality; further examined whether the associations were modified by greenness. METHODS We conducted a multicenter time-series analysis from January 1, 2013 to December 31, 2019. we adopted a distributed lag non-linear model to evaluate county-specific temperature-stroke mortality associations. We then applied a random-effects meta-analysis to pool county-specific effects. Attributable mortality was calculated for cold and heat, defined as temperatures below and above the minimum mortality temperature (MMT). Finally, We conducted a multivariate meta-regression to determine associations between greenness and stroke mortality risks for cold and heat, using normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) as quantitative indicators of greenness exposure. RESULTS In the study period, 138,749 deaths from total stroke were reported: 86,873 ischemic and 51,876 hemorrhagic stroke. We observed significant W-shaped relationships between temperature and stroke mortality, with substantial differences among counties and regions. With MMT as the temperature threshold, 17.16 % (95 % empirical CI, 13.38 %-19.75 %) of overall, 20.05 % (95 % eCI, 16.46 %-22.70 %) of ischemic, and 12.55 % (95 % eCI, 5.59 %-16.24 %) of hemorrhagic stroke mortality were attributable to non-optimum temperature (combining cold and heat), more mortality was caused by cold (14.94 %; 95 % eCI, 11.57 %-17.34 %) than by heat (2.22 %; 95 % eCI, 1.54 %-2.72 %). Higher levels of NDVI, SAVI and EVI were related to mitigated effects of non-optimum temperatures-especially heat. CONCLUSIONS Exposure to non-optimum temperatures aggravated stroke mortality risks; increasing greenness could alleviate that risks. This evidence has important implications for local communities in developing adaptive strategies to minimize the health consequences of adverse temperatures.
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Affiliation(s)
- Fenfen He
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Yilin Dong
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Chao Liu
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Ke Zhao
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Wenjia Peng
- School of Public Health, Fudan University, Shanghai, China
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Healthcare Big Data Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, China.
| | - Xianjie Jia
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China.
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Martinaitiene D, Raskauskiene N. Effects of Changes in Seasonal Weather Patterns on the Subjective Well-Being in Patients with CAD Enrolled in Cardiac Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094997. [PMID: 35564392 PMCID: PMC9099623 DOI: 10.3390/ijerph19094997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023]
Abstract
Objective: We examined whether seasonal and monthly variations exist in the subjective well-being of weather-sensitive patients with coronary artery disease (CAD) during cardiac rehabilitation. Methods: In this cross-sectional study, 865 patients (30% female, age 60 ± 9) were recruited within 2−3 weeks of treatment for acute coronary syndrome and during cardiac rehabilitation. The patients completed the Palanga self-assessment diary for weather sensitivity (PSAD-WS) daily, for an average of 15.5 days. PSAD-WS is an 11-item (general) three-factor (psychological, cardiac, and physical symptoms) questionnaire used to assess weather sensitivity in CAD patients. Weather data were recorded using the weather station “Vantage Pro2 Plus”. Continuous data were recorded eight times each day for the weather parameters and the averages of the data were linked to the respondents’ same-day diary results. Results: Weather-sensitive (WS) patients were found to be more sensitive to seasonal changes than patients who were not WS, and they were more likely to experience psychological symptoms. August (summer), December (winter), and March (spring) had the highest numbers of cardiac symptoms (all p < 0.001). In summary, peaks of symptoms appeared more frequently during the transition from one season to the next. Conclusion: This study extends the knowledge about the impact of atmospheric variables on the general well-being of weather-sensitive CAD patients during cardiac rehabilitation.
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Wang R, Tian J, Li L, Liu X, Leng M, Ye Z, Li G. Relationship between diurnal temperature range and emergency ambulance dispatches due to stroke in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:153037. [PMID: 35031377 DOI: 10.1016/j.scitotenv.2022.153037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The evidence between diurnal temperature range (DTR) and stroke remains controversial and sparse. We aimed to assess the relationship between DTR and emergency ambulance dispatches (EADs) due to stroke, and to explore whether there were effect modifications to the relationship. METHODS A Quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the relationship between DTR and EADs for stroke between January 1st 2011 and June 30th 2018 in Guangzhou, China. We estimated the effects of the low DTR and high DTR (defined as DTR below and above 10 °C respectively) on EADs. The effects of minimum, maximum, 5th, 25th, 50th, 75th, and 95th percentiles of DTR compared with the DTR of 10 °C were also analyzed. RESULTS A total of 20,275 EADs for stroke were included for analyses, among which 17,556 EADs were used in the model further adjusted for age and sex. A quasi-U-shaped relationship between DTR and EADs over lag0-2 days was observed. For the low DTR, per 1 °C decrease in DTR was significantly associated with an increase of 2.64% (RR = 1.03, 95% CI: 1.01-1.04) for EADs, while per 1 °C increase for the high DTR was non-significantly related with an increased risk of EADs (RR = 1.01, 95% CI: 0.90-1.13). Significant effects of the 5th and 25th percentiles of DTR on EADs were found when compared with the DTR of 10 °C. No significant effect modifications by age, sex or season were found to the association between DTR and EADs. CONCLUSIONS We found a quasi-U-shaped relationship between DTR and EADs due to stroke in this study, while age, sex or season did not significantly modify the association between DTR and EADs. More high-quality evidence is needed to further explore and validate the relationship between DTR and stroke.
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Affiliation(s)
- Ruoting Wang
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Junzhang Tian
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Likang Li
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xintong Liu
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meifang Leng
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zebing Ye
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
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Vaičiulis V, Venclovienė J, Kačienė G, Tamošiūnas A, Kiznys D, Lukšienė D, Radišauskas R. Association between El Niño-Southern Oscillation events and stroke: a case-crossover study in Kaunas city, Lithuania, 2000-2015. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:769-779. [PMID: 35094109 PMCID: PMC8948119 DOI: 10.1007/s00484-021-02235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 05/20/2023]
Abstract
The aim of this study was to determine the association between the daily number of cases of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients aged 25-64 years and the El Niño-Southern Oscillation (ENSO) events during 2000-2015. As an indicator of the effect of the ENSO, the monthly NIÑO 3.4 index (Equatorial Pacific Sea Surface Temperature) was used. During the 5844-day study period, 5600 cases of stroke (3170 (56.61%) in men and 2430 (43.39%) in women) were analyzed. Of these, 4354 (77.8%) cases were IS, and 1041 (18.6%) cases were HS. In 3496 (62.2%) cases, stroke occurred in the age group of 55-64 years. In the analysis, we used the following categories of the ENSO events: strong La Niña, moderate La Niña, moderate El Niño, and strong El Niño. The effect of the ENSO was examined by using the multivariate Poisson regression adjusting for weather variables. The highest risk of both strokes (BS) was observed on days of strong and moderate La Niña (rate ratio (RR) 1.27, 95% CI 1.13-1.42) and RR = 1.15 (1.07-1.23), respectively), while the risk for IS was the highest on days of moderate El Niño (RR = 1.11(1.02-1.20)). A lower risk for BS was found on days of strong El Niño (RR = 0.77(0.62-0.97)). We found that ENSO events affected the occurrence of BS and IS in all age groups, and the strongest effect was observed among females. The results of this study provide new evidence that ENSO events may affect the risk of stroke, especially the risk of IS.
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Affiliation(s)
- Vidmantas Vaičiulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania.
- Health Research Institute, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania.
| | - Jonė Venclovienė
- Department of Environmental Sciences, Vytautas Magnus University, Donelaičio St. 58, 44248, Kaunas, Lithuania
- Institute of Cardiology, Laboratory of Clinical Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
| | - Giedrė Kačienė
- Department of Environmental Sciences, Vytautas Magnus University, Donelaičio St. 58, 44248, Kaunas, Lithuania
| | - Abdonas Tamošiūnas
- Institute of Cardiology, Laboratory of Population Studies, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania
| | - Deividas Kiznys
- Department of Environmental Sciences, Vytautas Magnus University, Donelaičio St. 58, 44248, Kaunas, Lithuania
| | - Dalia Lukšienė
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania
- Institute of Cardiology, Laboratory of Population Studies, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
| | - Ričardas Radišauskas
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilžės St. 18, 47181, Kaunas, Lithuania
- Institute of Cardiology, Laboratory of Population Studies, Lithuanian University of Health Sciences, Sukileliu St. 15, 50103, Kaunas, Lithuania
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7
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Tomasović S, Sremec J, Košćak Lukač J, Sičaja G, Bačić Baronica K, Ostojić V, Raifi Z, Tomić Sremec N, Plačko-Vršnak D, Srnec L, Mikec K. Weather patterns and occurrence of epileptic seizures. BMC Neurol 2022; 22:33. [PMID: 35062900 PMCID: PMC8780718 DOI: 10.1186/s12883-021-02535-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background The results of various studies that have so far evaluated the influence of meteorological conditions on seizures are often divergent. No studies have been performed so far that evaluate the possible correlation between the occurrence of seizure-related events, surface and upper level atmospheric conditions and biometeorological forecasts. The aim of this study is to investigate those interactions. Methods Records of “Sveti Duh” University hospital, Zagreb, Croatia between January 2016 and May 2020 were analysed in order to determine number of patients per day who were assessed through Emergency room because of a recent epileptic seizure. The dates were assessed for surface and upper level atmospheric conditions and biometeorological forecasts. Analyses of these factors were performed for two consecutive days preceding that day, the day of seizure, as well as for the following day. Data was analysed using chi-squared test, Mann-Whitney U-test or Kruskal-Wallis test (with Conover’s test for post-hoc analyses), depending on variable type. Additionaly, logistic regression was used to study effects of variables on seizure occurrence. Statistical significance was set to p < 0.05. Results Results showed significant difference between the numbers of patients with seizure depending on upper level type on the following day. We also observed fewer daily patients with seizures when the synoptic situation on the following day was high pressure field then when it was low pressure or non-gradient pressure field (observed just during the colder part of the year), which was supported in our regression analyses. A greater frequency of seizures was observed if the biometerological prognosis was deemed unfavourable on the following day. Furthermore, our results showed significantly larger proportion of days with seizure patients in warmer, than in colder days of the year. Conclusions All of the analyzed weather-related parameters seem to be associated with daily numbers of seizures on the previous day. The reason behind this phenomenon is uncertain; however, the results indicate that weather patterns have a certain influence on patients with epilepsy, but are not yet fully understood or adequately appreciated.
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Abstract
Climate change is one of the biggest challenges humanity is facing in the 21st century. Two recognized sequelae of climate change are global warming and air pollution. The gradual increase in ambient temperature, coupled with elevated pollution levels have a devastating effect on our health, potentially contributing to the increased rate and severity of numerous neurological disorders. The main aim of this review paper is to shed some light on the association between the phenomena of global warming and air pollution, and two of the most common and debilitating neurological conditions: stroke and neurodegenerative disorders. Extreme ambient temperatures induce neurological impairment and increase stroke incidence and mortality. Global warming does not participate in the etiology of neurodegenerative disorders, but it exacerbates symptoms of dementia, Alzheimer's disease (AD) and Parkinson's Disease (PD). A very close link exists between accumulated levels of air pollutants (principally particulate matter), and the incidence of ischemic rather than hemorrhagic strokes. People exposed to air pollutants have a higher risk of developing dementia and AD, but not PD. Oxidative stress, changes in cardiovascular and cerebrovascular haemodynamics, excitotoxicity, microglial activation, and cellular apoptosis, all play a central role in the overlap of the effect of climate change on neurological disorders. The complex interactions between global warming and air pollution, and their intricate effect on the nervous system, imply that future policies aimed to mitigate climate change must address these two challenges in unison.
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Affiliation(s)
- Christian Zammit
- Anatomy Department, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Natalia Torzhenskaya
- Anatomy Department, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | | | - Jean Calleja Agius
- Anatomy Department, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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9
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Gulcebi MI, Bartolini E, Lee O, Lisgaras CP, Onat F, Mifsud J, Striano P, Vezzani A, Hildebrand MS, Jimenez-Jimenez D, Junck L, Lewis-Smith D, Scheffer IE, Thijs RD, Zuberi SM, Blenkinsop S, Fowler HJ, Foley A, Sisodiya SM, Berkovic S, Cavalleri G, Correa DJ, Martins Custodio H, Galovic M, Guerrini R, Henshall D, Howard O, Hughes K, Katsarou A, Koeleman BP, Krause R, Lowenstein D, Mandelenaki D, Marini C, O'Brien TJ, Pace A, De Palma L, Perucca P, Pitkänen A, Quinn F, Selmer KK, Steward CA, Swanborough N, Thijs R, Tittensor P, Trivisano M, Weckhuysen S, Zara F. Climate change and epilepsy: Insights from clinical and basic science studies. Epilepsy Behav 2021; 116:107791. [PMID: 33578223 PMCID: PMC9386889 DOI: 10.1016/j.yebeh.2021.107791] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 12/23/2022]
Abstract
Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.
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Affiliation(s)
- Medine I. Gulcebi
- Department of Medical Pharmacology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Omay Lee
- Department of Neurology and Clinical Neurophysiology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Christos Panagiotis Lisgaras
- New York University Langone Health, 100 First Ave., New York, NY 10016, USA; The Nathan S. Kline Institute for Psychiatric Research, Center for Dementia Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962, USA.
| | - Filiz Onat
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey,Department of Medical Pharmacology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, University of Malta, Msida MSD2040, Malta.
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, DINOGMI-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, IRCCS “Giannina Gaslini” Institute, Genova, Italy
| | - Annamaria Vezzani
- Laboratory of Experimental Neurology, Department of Neuroscience, IRCCS 'Mario Negri' Institute for Pharmacological Research, Milan, Italy.
| | - Michael S. Hildebrand
- Department of Medicine (Austin Health), University of Melbourne, and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Diego Jimenez-Jimenez
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK and Chalfont Centre for Epilepsy, Bucks, UK.
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Ingrid E. Scheffer
- University of Melbourne, Austin Health and Royal Children’s Hospital, Florey Institute and Murdoch Children’s Research Institute, Melbourne, Australia
| | - Roland D. Thijs
- Department of Neurology, Leiden University Medical Centre (LUMC), PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Sameer M. Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children & Institute of Health & Wellbeing, University of Glasgow, Fraser of Allander Neurosciences Unit, Royal Hospital for Children, UK
| | | | - Hayley J. Fowler
- Centre for Earth Systems Engineering Research, School of Engineering, Newcastle University, UK
| | - Aideen Foley
- Department of Geography, Birkbeck College University of London, London, UK.
| | - Epilepsy Climate Change ConsortiumBalestriniSimonaaaBerkovicSamuelabCavalleriGianpieroacCorreaDaniel JoséadMartins CustodioHelenaaeGalovicMarianafGuerriniRenzoagHenshallDavidahHowardOlgaaiHughesKelvinajKatsarouAnnaakKoelemanBobby P.C.alKrauseRolandamLowensteinDanielanMandelenakiDespoinaaoMariniCarlaapO’BrienTerence J.aqPaceAdrianarDe PalmaLucaasPeruccaPieroatPitkänenAslaauQuinnFinolaavSelmerKaja KristineawStewardCharles A.axSwanboroughNicolaayThijsRolandazTittensorPhilbaTrivisanoMarinabbWeckhuysenSarahbcZaraFedericobdDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UKEpilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin 2, Ireland; The FutureNeuro Research Centre, Dublin 2, IrelandSaul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, 1410 Pelham Parkway South, K-312, Bronx, NY 10461, USADepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Bucks, UKUniversity Hospital Zurich, SwitzerlandDepartment of Child Neurology and Psychiatry, University of Pisa and IRCCS Fondazione Stella Maris, 56018 Calambrone, Pisa, ItalyFutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin D02 YN77, IrelandUCB Pharma Ltd, Slough, UKDravet Syndrome UK, UKLaboratory of Developmental Epilepsy, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USAUniversity Medical Center, Utrecht, The NetherlandsLuxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, LuxembourgDepartment of Neurology, University of California, San Francisco, CA, USADepartment of Pediatric Neurology, Queen Fabiola Children’s University Hospital, Brussels, Brussels Capital Region, BelgiumNeuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, ItalyMelbourne Brain Centre, Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, AustraliaGozo General Hospital, MaltaNeurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyDepartment of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, AustraliaA.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FIN-70211 Kuopio, FinlandILAE-IBE Congress Secretariat, Dublin, IrelandNational Centre for Rare Epilepsy-related Disorders, Oslo University Hospital, Oslo, Norway; Department of Medical Genetics, Oslo University Hospital, University of Oslo, Oslo, NorwayCongenica Ltd, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1DR, UK; Wellcome Sanger InstituteWellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UKEpilepsy Society, Bucks, UKStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UKRoyal Wolverhampton NHS Trust, Wolverhampton, UKRare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, ItalyNeurogenetics Group, Center for Molecular Neurology, VIB, University of Antwerp, Antwerp 2610, BelgiumUnit of Medical Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK and Chalfont Centre for Epilepsy, Bucks, UK,Corresponding author at: Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
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Qi X, Wang Z, Xia X, Xue J, Gu Y, Han S, Yao Q, Cai Z, Wang X, Wang L, Leng SX, Li X. The effects of heatwaves and cold spells on patients admitted with acute ischemic stroke. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:309. [PMID: 33708936 PMCID: PMC7944308 DOI: 10.21037/atm-20-4256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background This study aimed to explore the effects of heatwaves and cold spells on blood pressure, thrombus formation, and systemic inflammation at admission in patients with ischemic stroke. Methods Data of patients with ischemic stroke who were admitted to the Second Hospital of Tianjin Medical University between May 2014 and March 2019 were reviewed, along with meteorological data from the same time period. A total of 806 clinically confirmed patients with ischemic stroke (34–97 years old) were included in the final analysis. Heatwaves and cold spells were defined as ≥2 consecutive days with average temperature >95th percentile (May–August) and <5th percentile (November–March), respectively. Coagulation parameters, inflammation indices, blood pressure, and neurological impairment were evaluated within 24 hours of admission. General linear and logistic regression models were created to investigate the relationships of heatwaves and cold spells with the examination results of patients with ischemic stroke at admission. Results After adjustment for potential environmental confounders, heatwaves were positively associated with high systolic blood pressure (SBP) (β=8.693, P=0.019), diastolic blood pressure (DBP) (β=3.665, P=0.040), reduced thrombin time (TT) (β=−0.642, P=0.027), and activated partial thromboplastin time (APTT) (β=−1.572, P=0.027) in ischemic stroke patients at admission. Cold spells were positively associated with high SBP (β=5.277, P=0.028), DBP (β=4.672, P=0.012), fibrinogen (β=0.315, P=0.011), globulin (β=1.523, P=0.011), and reduced TT (β=−0.784, P<0.001) and APTT (β=−1.062, P=0.024). Cold spells were also associated with a higher risk of respiratory infection [odds ratio (OR) =2.677, P=0.001]. Conclusions Exposure to heatwaves or cold spells was associated with blood pressure and coagulation at admission in patients with ischemic stroke. Cold spells also resulted in higher levels of inflammation. These findings suggest that changes in coagulation, blood pressure, and inflammation may be the potential biological mechanisms underlying the cerebrovascular effects of exposure to extreme temperatures.
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Affiliation(s)
- Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhongyan Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Juanjuan Xue
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yumeng Gu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Suqin Han
- Tianjin Environmental Meteorology Center, Tianjin, China
| | - Qing Yao
- Tianjin Environmental Meteorology Center, Tianjin, China
| | - Ziying Cai
- Tianjin Environmental Meteorology Center, Tianjin, China
| | - Xiaojia Wang
- Tianjin Environmental Meteorology Center, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Li L, Huang S, Duan Y, Liu P, Lei L, Tian Y, Xiang M, Peng J, Cheng J, Yin P. Effect of ambient temperature on stroke onset: a time-series analysis between 2003 and 2014 in Shenzhen, China. Occup Environ Med 2021; 78:oemed-2020-106985. [PMID: 33509904 DOI: 10.1136/oemed-2020-106985] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evidence on the relationship between ambient temperature and morbidity of different stroke subtypes in China is limited. This study aimed to assess the influence of ambient temperature on stroke risk in Shenzhen, China. METHODS From 1 January 2003 to 31 December 2014, 114 552 stroke cases in Shenzhen were collected. A generalised additive model with quasi-Poisson regression combined with a distributed lag non-linear model was applied to evaluate the temperature effects on stroke subtypes. Furthermore, this study explored the variability of the effects across sex, age and education. RESULTS The immediate heat effects on ischaemic stroke (IS) and the persistent effects of ambient temperature on intracerebral haemorrhage (ICH) were significant. Overall, the cold-related relative risks (RRs) of IS, ICH and subarachnoid haemorrhage (SAH) were 1.02 (0.97-1.07), 1.16 (1.04-1.30) and 1.12 (0.61-2.04), whereas the heat-related RRs were 1.00 (0.97-1.04), 0.80 (0.73-0.88) and 1.05 (0.63-1.78), respectively. For IS, a weakly beneficial cold effect was found among men while a detrimental heat effect among both men and women, the elderly and higher-educated population at lag0. However, regarding ICH, the temperature effects in men, the young and higher-educated population are stronger at lag0-4, lag0-7 as cold reveals threat and heat reveals protection. CONCLUSION Responses of diverse stroke subtypes to ambient temperature varied. Effective measures should be taken to increase public awareness about the effects of ambient temperature on stroke attack and to educate the public about self-protection.
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Affiliation(s)
- Lei Li
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Suli Huang
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Peiyi Liu
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
- Department of Occupational and Environment Health, Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lin Lei
- Department of Chronic Disease Prevention and Treatment, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yuchen Tian
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Ming Xiang
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
| | - Ji Peng
- Department of Chronic Disease Prevention and Treatment, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Jinquan Cheng
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, Huazhong University of Science and Technology Tongji Medical College School of Public Health, Wuhan, Hubei, China
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Wang RR, Hao Y, Chen J, Wang MQ, Zheng RY, Shi LS, He J. Sex differences in the effects of the moon on ischemic stroke incidence: new findings from Beijing, China. Chronobiol Int 2020; 37:935-945. [PMID: 32654529 DOI: 10.1080/07420528.2019.1696811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Stroke is a major cause of death and disability in China, and no therapies have proven effective to prevent it. Popular belief holds that the lunar cycle affects human physiology, behavior, and health. The aim of our study is to determine whether the lunar cycle impacts the incidence of stroke subtypes [intracerebral hemorrhage (ICH), transient ischemic attack (TIA) and ischemic stroke (IS)]. We retrospectively extracted the discharge registry data of all patients with first-ever acute stroke hospitalized in the affiliated hospital of Beijing University of Traditional Chinese Medicine during 2002-2015. The onset times of stroke were assigned to four primary lunar phases based on NASA definitions. Chi-square tests and multiple logistic regression analyses were used to estimate the association between the lunar cycle and stroke incidence with adjustment for age, sex and season. A total of 5,965 patients with stroke (4,909 admissions for ischemic stroke IS, 754 admissions for ICH, and 302 admissions for TIA) were evaluated in our study. Subgroup analysis indicated that the admission rates of different sexes for IS tended to have opposite variation during the four moon phases. More female patients were admitted during the new moon than in the first and third quarters, while fewer male patients were admitted during the new moon than in the first and third quarters (χ2 = 15.589, P = .001). Multiple logistic regression analyses revealed that men were more likely to be admitted for IS in the first quarter than during the new moon (odds ratio [OR] = 1.252, 95% confidence interval [CI] = 1.076-1.456) (P = .004), and a corresponding trend was also identified for the third quarter (OR = 1.235, 95% CI = 1.062-1.437) (P = .006). No significant gender differences were shown in ICH or TIA. No sex difference is obvious during the full moon. Moon phases seem to affect both genders, but in very different ways. It seems that the new moon is a protective factor for male ischemic stroke patients and a risk factor for female ones. Woman tends to be more vulnerable than ever at the new moon, so deserves more attention and care. The mechanisms underlying this observation are worth studying further.
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Affiliation(s)
- Ran-Ran Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Yu Hao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Jian Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Meng-Qi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Ruo-Yun Zheng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Ling-Sheng Shi
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
| | - Juan He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine , Beijing, China
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Royé D, Zarrabeitia MT, Riancho J, Santurtún A. A time series analysis of the relationship between apparent temperature, air pollutants and ischemic stroke in Madrid, Spain. ENVIRONMENTAL RESEARCH 2019; 173:349-358. [PMID: 30953949 DOI: 10.1016/j.envres.2019.03.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 05/04/2023]
Abstract
The understanding of the role of environment on the pathogenesis of stroke is gaining importance in the context of climate change. This study analyzes the temporal pattern of ischemic stroke (IS) in Madrid, Spain, during a 13-year period (2001-2013), and the relationship between ischemic stroke (admissions and deaths) incidence and environmental factors on a daily scale by using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of air pollutants and Apparent Temperature (AT), a biometeorological index which represents human thermal comfort on IS, a lag non-linear model was fitted in a generalized additive model. The mortality rate followed a downward trend over the studied period, however admission rates progressively increased. Our results show that both increases and decreases in AT had a marked relationship with IS deaths, while hospital admissions were only associated with low AT. When analyzing the cumulative effects (for lag 0-14 days), with an AT of 1.7 °C (percentile 5%) a RR of 1.20 (95% CI, 1.05-1.37) for IS mortality and a RR of 1.09 (95% CI, 0.91-1.29) for morbidity is estimated. Concerning gender differences, men show higher risks of mortality in low temperatures and women in high temperatures. No significant relationship was found between air pollutant concentrations and IS morbi-mortality, but this result must be interpreted with caution, since there are strong spatial fluctuations of the former between nearby geographical areas that make it difficult to perform correlation analyses.
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Affiliation(s)
- Dominic Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Geography, University of Porto, Porto, Portugal; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - María T Zarrabeitia
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | - Javier Riancho
- Department of Neurology, Hospital Sierrallana-Instituto de Investigación Sanitaria (IDIVAL), Centro Investigación Biomédica en Red Enfermedades (CIBERNED), Santander, Spain
| | - Ana Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain.
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Knezovic M, Pintaric S, Jelavic MM, Kes VB, Nesek V, Bogovic S, Cvetkovic B, Pintaric H. The role of weather conditions and normal level of air pollution in appearance of stroke in the region of Southeast Europe. Acta Neurol Belg 2018; 118:267-275. [PMID: 29478214 DOI: 10.1007/s13760-018-0885-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
We investigated correlation between the normal level of air pollution, weather conditions and stroke occurrence in the region of Southeast Europe with a humid continental climate. This retrospective study included 1963 patients, 1712 (87.2%) with ischemic (IS) and 251 (12.8%) with hemorrhagic stroke (HS) admitted to emergency department. The number of patients, values of weather condition (meteorological parameters) [air temperature (°C), atmospheric pressure (kPa), relative humidity (%)] and concentrations of air pollutants [particulate matter (PM10), nitrogen dioxide (NO2), ozone (O3)], were recorded and evaluated for each season (spring, summer, autumn, winter) during 2 years (July 2008-June 2010). The highest rate of IS was observed during spring (28.9%) (p = 0.0002) and HS in winter (33.9%) (p = 0.0006). We have found negative Spearman's correlations (after Bonferroni adjustment for the multiple correlations) of the number of males with values of relative humidity (%) (day 0, rho = - 0.15), the total number of strokes (day 2, rho = - 0.12), females (day 2, rho = - 0.12) and IS (day 2, rho = - 0.13) with concentrations of PM10 (µg/m3), as well as negative correlations of the number of females (day 2, rho = - 0.12) and IS (day 2, rho = - 0.12) with concentrations of NO2 (µg/m3) (for all p < 0.002). In winter, the number of HS (day 0, rho = 0.25, p = 0.001) positively correlated with concentrations of O3 (µg/m3). The appearance of stroke has seasonal variations, with the highest rates during spring and winter. Positive correlation between the number of HS and values of O3 requires an additional reduction of the legally permitted pollutants concentrations.
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Poznanska A, Wojtyniak B, Chwojnicki K, Lewtak K, Rubikowska B, Seroka W. Cerebrovascular diseases in Poland-inconsistent seasonal patterns of hospitalisation and mortality. Eur J Public Health 2018; 28:376-381. [PMID: 29020302 DOI: 10.1093/eurpub/ckx133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background A seasonal variation in the incidence of cerebrovascular diseases still remains inconsistently evidenced. Herein, we analyse the monthly patterns of two health phenomena: hospital admissions and deaths due to these diseases. Methods We identified 69 511 cases of hospital admissions and 14 956 deaths due to cerebrovascular diseases (ICD10: I60-I69 and G45) among the inhabitants of five Polish voivodeship capitals in 2004-13. The method of time series analysis (exponential smoothing with linear trend and monthly additive seasonality) was applied to calculate the monthly specific seasonal indices. The monthly variation in an in-hospital fatality and nonhospital deaths were also analysed. Results A summer season reduction in number of cases was observed for hospital admissions and deaths. Interestingly, the winter season effect is much more complex, mainly due to the contribution of December, when a high mortality is accompanied by a substantial decrease in the hospitalisation level. This unique discrepancy was observed for all the studied cities. Moreover, this month is characterised by a notably high in-hospital fatality. However, neither the number of non-hospital deaths nor the average length of hospital stay or the kind of hospitalised diseases evidenced that cerebrovascular problems were more serious in December than in any other month. Conclusion The obtained results confirmed a seasonal variation in cerebrovascular diseases among the inhabitants of Polish cities. Habitual and administrative limitations in hospital activities observed every December do not seem indifferent from the patient health's perspective since they may lead to a low hospitalisation level and a high in-hospital fatality.
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Affiliation(s)
- Anna Poznanska
- Centre for Monitoring and Analyses of Population Health Status, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Bogdan Wojtyniak
- Centre for Monitoring and Analyses of Population Health Status, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Kamil Chwojnicki
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Lewtak
- Department of Health Promotion and Postgraduate Education, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Barbara Rubikowska
- Centre for Monitoring and Analyses of Population Health Status, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Wojciech Seroka
- Centre for Monitoring and Analyses of Population Health Status, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
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Jin H, Xu Z, Li Y, Xu J, Shan H, Feng X, Xie Y, Bian K, Qin D. Seasonal variation of stroke incidence in Wujin, a city in southeast China. Health Sci Rep 2018; 1:e29. [PMID: 30623065 PMCID: PMC6266434 DOI: 10.1002/hsr2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/14/2017] [Accepted: 01/22/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate seasonal variations in stroke incidence in a city in southeast China. METHODS First-ever stroke in residents aged 20 or older in Wujin city was reported by local physicians between January 2006 and December 2007. All reported stroke cases were checked with the city-wide health insurance system. Fatal cases were checked with the household registry system. The annualized stroke incidences were calculated for each month and each season. The stroke incidence was compared among seasons, with spring as a reference. RESULTS Wujin city had an adult (≥20 y old) population of 1 278 020 in 2010. A total of 2319 stroke cases, 1217 male and 1102 female, were reported in 2006 and 2007. The raw annual incidence of stroke was 90.7/100 000 (95% CI: 82.1-94.5). Stroke incidence was highest in September (125.2/100 000; 95% CI = 109.4-139.3) and lowest in January (78.8/100 000; 95% CI = 69.1-93.2). Stroke incidence was highest in autumn (OR = 1.18, 95% CI: 1.05-1.32, P < .001, compared with spring). Autumn also had the highest incidences of ischemic stroke (OR = 1.22, 95% CI: 1.06-1.40). CONCLUSIONS Stroke incidence showed monthly and seasonal variations in southeast China. Autumn had the highest incidences of both ischemic stroke and cerebral hemorrhage.
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Affiliation(s)
- Huafeng Jin
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Zhiliang Xu
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Yunyan Li
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Jiaping Xu
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Hongmei Shan
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Xiaoli Feng
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Yan Xie
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Keyu Bian
- Department of NeurologyWujing Traditional Chinese Medicine HospitalChangzhouJiangsu ProvinceChina
| | - Dong Qin
- Chang Zhou Meteorological BureauChang ZhouJiangsu ProvinceChina
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Li T, Horton RM, Bader DA, Liu F, Sun Q, Kinney PL. Long-term projections of temperature-related mortality risks for ischemic stroke, hemorrhagic stroke, and acute ischemic heart disease under changing climate in Beijing, China. ENVIRONMENT INTERNATIONAL 2018; 112:1-9. [PMID: 29241068 DOI: 10.1016/j.envint.2017.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 11/15/2017] [Accepted: 12/04/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Changing climates have been causing variations in the number of global ischemic heart disease and stroke incidences, and will continue to affect disease occurrence in the future. OBJECTIVES To project temperature-related mortality for acute ischemic heart disease, and ischemic and hemorrhagic stroke with concomitant climate warming. METHODS We estimated the exposure-response relationship between daily cause-specific mortality and daily mean temperature in Beijing. We utilized outputs from 31 downscaled climate models and two representative concentration pathways (RCPs) for the 2020s, 2050s, and 2080s. This strategy was used to estimate future net temperature along with heat- and cold-related deaths. The results for predicted temperature-related deaths were subsequently contrasted with the baseline period. RESULTS In the 2080s, using the RCP8.5 and no population variation scenarios, the net total number of annual temperature-related deaths exhibited a median value of 637 (with a range across models of 434-874) for ischemic stroke; this is an increase of approximately 100% compared with the 1980s. The median number of projected annual temperature-related deaths was 660 (with a range across models of 580-745) for hemorrhagic stroke (virtually no change compared with the 1980s), and 1683 (with a range across models of 1351-2002) for acute ischemic heart disease (a slight increase of approximately 20% compared with the 1980s). In the 2080s, the monthly death projection for hemorrhagic stroke and acute ischemic heart disease showed that the largest absolute changes occurred in summer and winter while the largest absolute changes for ischemic stroke occurred in summer. CONCLUSIONS We projected that the temperature-related mortality associated with ischemic stroke will increase dramatically due to climate warming. However, projected temperature-related mortality pertaining to acute ischemic heart disease and hemorrhagic stroke should remain relatively stable over time.
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Affiliation(s)
- Tiantian Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Radley M Horton
- Center for Climate Systems Research, Columbia University, New York, USA
| | - Daniel A Bader
- Center for Climate Systems Research, Columbia University, New York, USA
| | - Fangchao Liu
- Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College,China
| | - Qinghua Sun
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, USA
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Reis J. Environmental Risk Factors for Stroke and Cardiovascular Disease. ENCYCLOPEDIA OF CARDIOVASCULAR RESEARCH AND MEDICINE 2018. [PMCID: PMC7150018 DOI: 10.1016/b978-0-12-809657-4.64111-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Besides the classical individual stroke risk factors a new class has appeared, the environmental risk factors. After a review of the evidences demonstrating that air pollution is a potent risk factor (Part 1), we propose an update of other physical, chemical, and biological factors, now considered as risk factors (Part 2). One of the challenges is to precise their specific roles as they can be combined in their noxious impacts (traffic air pollution + noise + weather + infections). This knowledge has practical consequences; From now on, medical advices cannot be limited to individual recommendations but must also deal with environmental public health issues.
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Lavados PM, Olavarría VV, Hoffmeister L. Ambient Temperature and Stroke Risk. Stroke 2018; 49:255-261. [DOI: 10.1161/strokeaha.117.017838] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/30/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Pablo M. Lavados
- From the Departamento de Neurología y Psiquiatría (P.M.L., V.V.O.) y Departamento de Paciente Crítico (V.V.O.), Unidad de Neurología Vascular, Servicio de Neurología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Chile; Departamento de Ciencias Neurológicas, Universidad de Chile, Santiago (P.M.L.); and Escuela de Salud Pública, Facultad de Ciencias, Universidad Mayor, Santiago, Chile (L.H.)
| | - Verónica V. Olavarría
- From the Departamento de Neurología y Psiquiatría (P.M.L., V.V.O.) y Departamento de Paciente Crítico (V.V.O.), Unidad de Neurología Vascular, Servicio de Neurología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Chile; Departamento de Ciencias Neurológicas, Universidad de Chile, Santiago (P.M.L.); and Escuela de Salud Pública, Facultad de Ciencias, Universidad Mayor, Santiago, Chile (L.H.)
| | - Lorena Hoffmeister
- From the Departamento de Neurología y Psiquiatría (P.M.L., V.V.O.) y Departamento de Paciente Crítico (V.V.O.), Unidad de Neurología Vascular, Servicio de Neurología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Chile; Departamento de Ciencias Neurológicas, Universidad de Chile, Santiago (P.M.L.); and Escuela de Salud Pública, Facultad de Ciencias, Universidad Mayor, Santiago, Chile (L.H.)
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Association of ischemic and hemorrhagic strokes hospital admission with extreme temperature in Nanchang, China—A case-crossover study. J Clin Neurosci 2017. [DOI: 10.1016/j.jocn.2017.04.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tamasauskiene L, Rastenyte D, Radisauskas R, Tamosiunas A, Tamasauskas D, Vaiciulis V, Kranciukaite-Butylkiniene D, Milinaviciene E. Relationship of meteorological factors and acute stroke events in Kaunas (Lithuania) in 2000-2010. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:9286-9293. [PMID: 28229384 DOI: 10.1007/s11356-017-8590-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 02/06/2017] [Indexed: 06/06/2023]
Abstract
Some researchers have hypothesised that meteorological factors may have an impact on acute cerebrovascular diseases. The aim of this study was to determine an impact of some meteorological factors on occurrence of acute cerebrovascular events in the middle-aged Kaunas population. Kaunas stroke register data were used. Data on meteorological factors for the time period from 2000 to 2010 were obtained from the Lithuanian Hydrometeorological Service Kaunas Meteorological Station. We analysed 4038 cases with stroke. Ischemic strokes composed 80.4% and haemorrhagic strokes-19.6%. According to Poisson regression analysis, significant negative correlation between ischemic, haemorrhagic and all types of stroke and ambient air temperature was found (β coefficient - 0.007, -0.016, -0.009, p < 0.001, respectively). Results of ARIMA showed that ambient temperature of the day of stroke onset was associated with the occurrence of ischemic, haemorrhagic and all types of stroke: when temperature was lower, the risk of stroke was higher (-0.006, -0.003, -0.009, p < 0.001, respectively). Low temperature on the event day and 1 and 2 days before the event was associated with higher incidence of haemorrhagic stroke in women. Low ambient temperature on the event day increased incidence of haemorrhagic stroke in subjects 55-64 years. High wind speed on the event day was associated with higher incidence of ischemic stroke in older subjects. Meteorological factors may have some impact on the risk of acute cerebrovascular events. Health care providers should focus on preventive measures, which can reduce these risks.
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Affiliation(s)
- Laura Tamasauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009, Kaunas, Lithuania.
| | - Daiva Rastenyte
- Department of Neurology, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Av. 15, LT-50161, Kaunas, Lithuania
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, LT-47181, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Av. 15, LT-50161, Kaunas, Lithuania
| | - Domantas Tamasauskas
- Department of Neurosurgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, LT-50009, Kaunas, Lithuania
| | - Vidmantas Vaiciulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, LT-47181, Kaunas, Lithuania
| | | | - Egle Milinaviciene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu Av. 15, LT-50161, Kaunas, Lithuania
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Ambient Temperature and Stroke Occurrence: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070698. [PMID: 27420077 PMCID: PMC4962239 DOI: 10.3390/ijerph13070698] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 01/03/2023]
Abstract
Biologically plausible associations exist between climatic conditions and stroke risk, but study results are inconsistent. We aimed to summarize current evidence on ambient temperature and overall stroke occurrence, and by age, sex, and variation of temperature. We performed a systematic literature search across MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and GEOBASE, from inception to 16 October 2015 to identify all population-based observational studies. Where possible, data were pooled for meta-analysis with Odds ratios (OR) and corresponding 95% confidence intervals (CI) by means of the random effects meta-analysis. We included 21 studies with a total of 476,511 patients. The data were varied as indicated by significant heterogeneity across studies for both ischemic stroke (IS) and intracerebral hemorrhage (ICH). Pooled OR (95% CI) in every 1 degree Celsius increase in ambient temperature was significant for ICH 0.97 (0.94–1.00), but not for IS 1.00 (0.99–1.01) and subarachnoid hemorrhage (SAH) 1.00 (0.98–1.01). Meta-analysis was not possible for the pre-specified subgroup analyses by age, sex, and variation of temperature. Change in temperature over the previous 24 h appeared to be more important than absolute temperature in relation to the risk of stroke, especially in relation to the risk of ICH. Older age appeared to increase vulnerability to low temperature for both IS and ICH. To conclude, this review shows that lower mean ambient temperature is significantly associated with the risk of ICH, but not with IS and SAH. Larger temperature changes were associated with higher stroke rates in the elderly.
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Air Pressure, Humidity and Stroke Occurrence: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070675. [PMID: 27399733 PMCID: PMC4962216 DOI: 10.3390/ijerph13070675] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/04/2016] [Accepted: 06/08/2016] [Indexed: 01/10/2023]
Abstract
Background/Aims: An influence of climate upon stroke risk is biologically plausible and supported by epidemiological evidence. We aimed to determine whether air pressure (AP) and humidity are associated with hospital stroke admission. Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and GEOBASE, from inception to 16 October 2015 to identify relevant population-based observational studies. Where possible, data were pooled for meta-analysis with odds ratios (OR) and corresponding 95% confidence intervals (CI) by means of the random-effect method. Results: We included 11 studies with a total of 314,385 patients. The effect of AP was varied across studies for ischemic stroke (IS) and subarachnoid haemorrhage (SAH). Pooled ORs (95%CI) associated with 1 hPa increase in AP for the risk of IS, intracerebral hemorrhage (ICH) and SAH were 1.00 (0.99–1.01), 1.01 (0.99–1.02) and 1.02 (0.97–1.07) respectively. The pooled ORs (95%CI) associated with 1 percent increase in humidity for the risk of IS and ICH were 1.00 (1.00–1.01) and 1.00 (0.99–1.01) respectively. Conclusion: This review shows that there is no evidence of a relationship between AP or humidity and the occurrence of hospital admission for stroke. Further research is needed to clarify the extent and nature of any relationship between AP, humidity and stroke in different geographical areas.
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Meng G, Tan Y, Fang M, Yang H, Liu X, Zhao Y. Meteorological Factors Related to Emergency Admission of Elderly Stroke Patients in Shanghai: Analysis with a Multilayer Perceptron Neural Network. Med Sci Monit 2015; 21:3600-7. [PMID: 26590182 PMCID: PMC4662240 DOI: 10.12659/msm.895334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to predict the emergency admission of elderly stroke patients in Shanghai by using a multilayer perceptron (MLP) neural network. Material/Methods Patients (>60 years) with first-ever stroke registered in the Emergency Center of Neurology Department, Shanghai Tenth People’s Hospital, from January 2012 to June 2014 were enrolled into the present study. Daily climate records were obtained from the National Meteorological Office. MLP was used to model the daily emergency admission into the neurology department with meteorological factors such as wind level, weather type, daily maximum temperature, lowest temperature, average temperature, and absolute temperature difference. The relationships of meteorological factors with the emergency admission due to stroke were analyzed in an MLP model. Results In 886 days, 2180 first-onset elderly stroke patients were enrolled, and the average number of stroke patients was 2.46 per day. MLP was used to establish a model for the prediction of dates with low stroke admission (≤4) and those with high stroke admission (≥5). For the days with low stroke admission, the absolute temperature difference accounted for 40.7% of admissions, while for the days with high stroke admission, the weather types accounted for 73.3%. Conclusions Outdoor temperature and related meteorological parameters are associated with stroke attack. The absolute temperature difference and the weather types have adverse effects on stroke. Further study is needed to determine if other meteorological factors such as pollutants also play important roles in stroke attack.
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Affiliation(s)
- Guilin Meng
- Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai, China (mainland)
| | - Yan Tan
- Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai, China (mainland)
| | - Min Fang
- Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai, China (mainland)
| | - Hongyan Yang
- Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai, China (mainland)
| | - Xueyuan Liu
- Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai, China (mainland)
| | - Yanxin Zhao
- Department of Neurology, Tenth People's Hospital, Tongji University, Shanghai, China (mainland)
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Folyovich A, Biczó D, Al-Muhanna N, Béres-Molnár AK, Fejős Á, Pintér Á, Bereczki D, Fischer A, Vadasdi K, Pintér F. Anomalous equivalent potential temperature: an atmospheric feature predicting days with higher risk for fatal outcome in acute ischemic stroke-a preliminary study. ENVIRONMENTAL MONITORING AND ASSESSMENT 2015; 187:547. [PMID: 26233665 DOI: 10.1007/s10661-015-4722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/01/2015] [Indexed: 06/04/2023]
Abstract
Acute stroke is a life-threatening condition. Fatal outcome is related to risk factors, some of these affected by climatic changes. Forecasting potentially harmful atmospheric processes may therefore be of practical importance in the acute care of stroke patients. We analyzed the history of all patients with acute ischemic stroke (N = 184) confirmed by neuroimaging including those who died (N = 35, 15 males) at our hospital department in the winter months of 2009. Patient data were anonymized, and the human meteorologists were only aware of patients' age, gender, and exact time of death. Of the meteorological parameters, equivalent potential temperature (EPT) has been chosen for analysis. EPT is generally used for forecasting thunderstorms, but in the case of synoptic scale airflow (10(6) m), it is suitable for characterizing the air mass inflowing from different regions. The behavior of measured EPT values was compared to the climatic (30 years) averages. We developed meteorological criteria for anomalous periods of EPT and tested if such periods are associated with higher rate of fatal outcome. The duration of anomalous and non-anomalous periods was nearly equal during the studied 3 months. Stroke onset distributed similarly between anomalous and non-anomalous days; however, of the 35 deaths, 27 occurred during anomalous periods: on average, 0.56 deaths occurred on anomalous days and 0.19 on non-anomalous days. Winter periods meeting the criteria of anomalous EPT may have a significant adverse human-meteorological impact on the outcome in acute ischemic stroke.
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Affiliation(s)
- András Folyovich
- Department of Neurology and Stroke Center, Szent János Hospital, Budapest, Hungary
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26
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Rapid weather changes are associated with increased ischemic stroke risk: a case-crossover study. Eur J Epidemiol 2015; 31:137-46. [DOI: 10.1007/s10654-015-0060-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Çevik Y, Doğan NÖ, Daş M, Ahmedali A, Kul S, Bayram H. The association between weather conditions and stroke admissions in Turkey. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2015; 59:899-905. [PMID: 25145443 DOI: 10.1007/s00484-014-0890-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 06/03/2023]
Abstract
Although several factors such as cigarette smoking, blood pressure, diabetes, obesity, hypercholesterolemia, physical inactivity and dietary factors have been well documented to increase the risk for stroke, there are conflicting data about the role of meteorological variables in the etiology of stroke. We conducted a retrospective study to investigate the association between weather patterns, including daily temperature, humidity, wind speed, and air pressure, and stroke admissions to the Emergency Department of Atatürk Training and Research Hospital in Ankara, Turkey, between January 2009 and April 2010. Generalized additive models with logistic link function were used to investigate the relationship between predictors and days with and without stroke admission at lags 0-4. A total of 373 stroke patients were admitted to the emergency department (ED) between January 2009 and April 2010. Of patients, 297 had ischemic stroke (IS), 34 hemorrhagic stroke (HS), and 42 subarachnoidal hemorrhage (SAH). Although we did not find any association between overall admissions due to stroke and meteorological parameters, univariable analysis indicated that there were significantly more SAH cases on days with lower daily mean temperatures of 8.79 ± 8.75 °C as compared to relatively mild days with higher temperatures (mean temperature = 11.89 ± 7.94 °C, p = 0.021). The multivariable analysis demonstrated that admissions due to SAH increased on days with lower daily mean temperatures for the same day (lag 0; odds ratio (OR) [95% confidence interval (95% CI)] = 0.93 [0.89-0.98], p = 0.004) and lag 1 (OR [95% CI] =0.76 [0.67-0.86], p = 0.001). Furthermore, the wind speed at both lag 1 (OR [95% CI] = 1.63 [1.27-2.09], p = 0.001) and lag 3 (OR [95% CI] = 1.43 [1.12-1.81], p = 0.004) increased admissions due to HS, respectively. In conclusion, our study demonstrated that there was an association between ED admissions due to SAH and HS and weather conditions suggesting that meteorological variables may, at least in part, play as risk factors for intracranial hemorrhages.
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Affiliation(s)
- Yunsur Çevik
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
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Abstract
Following a heat wave in January 2014 in Adelaide, state capital of South Australia, we asked the question whether extreme heat was associated with an increase in stroke incidence. We found in the literature that the association between stroke presentation to hospital and meteorological factors has long been a topic of debate and subject to numerous studies. The literature indicated that an association between heat waves and an increase in admissions for stroke was unlikely in Australia and the United States. We suggest that it may be inappropriate to generalize this conclusion to other countries and rural areas. In view of the global climate change debate, we suggest that prospective studies be focused in developing countries and rural areas to assess the real impact of extreme heat on respective populations to better inform stroke physicians and health policy makers.
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Affiliation(s)
- Fiona Chan
- Stroke Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Meteorological Variables Associated with Stroke. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:597106. [PMID: 27379326 PMCID: PMC4897103 DOI: 10.1155/2014/597106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 11/24/2022]
Abstract
To elucidate relationships between meteorological variables and incidence of stroke, we studied patients diagnosed with stroke after presenting to the emergency department (May 1, 2010–August 8, 2011). Patient demographics and medical data were reviewed retrospectively with regional meteorological data. Across 467 days, 134 stroke events were recorded on 114 days. On stroke days, maximum temperature (max T) and atmospheric pressure (AP) combined were a significant predictor of stroke (max T odds ratio (OR) = 1.014, 95% confidence interval (CI) = 1.003–1.026, and P = 0.04; AP: OR = 1.033, 95% CI = 0.997–1.071, and P = 0.02). When the patient could identify the hour of the stroke, average temperature (avg T) was significantly higher than nonstroke hours (18.2°C versus 16.16°C, P = 0.04). Daily fluctuations in AP and avg T also had significant effects on stroke incidence (AP: OR = 0.629, 95% CI = 0.512–0.773, and P = 0.0001; avg T OR = 1.1399, 95% CI = 1.218–606, and P = 0.0001). Patient age, stroke history, body mass index, ethnicity, and sex were further contributors to stroke risk. Temperature, atmospheric pressure, and certain physiological conditions likely play roles in weather-related stroke susceptibility. The mechanisms driving these associations are not fully understood.
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Ma W, Chen R, Kan H. Temperature-related mortality in 17 large Chinese cities: how heat and cold affect mortality in China. ENVIRONMENTAL RESEARCH 2014; 134:127-33. [PMID: 25127523 DOI: 10.1016/j.envres.2014.07.007] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 06/18/2014] [Accepted: 07/15/2014] [Indexed: 05/07/2023]
Abstract
Few multicity studies have been conducted to investigate the acute health effects of cold and hot temperatures in China. We aimed to examine the relationship between temperature and daily mortality in 17 large Chinese cities. We first calculated city-specific effect of temperature using time-series regression models combined with distributed lag nonlinear models; then we pooled the city-specific estimates with the Bayesian hierarchical models. The cold effects lasted longer than the hot effects. For the cold effects, a 1 °C decrease from the 25th to 1st percentiles of temperature over lags 0-14 days was associated with increases of 1.69% [95% posterior intervals (PI): 1.01%, 2.36%], 2.49% (95% PI: 1.53%, 3.46%) and 1.60% (95% PI: 0.32%, 2.87%) in total, cardiovascular and respiratory mortality, respectively. For the hot effects, a 1 °C increase from the 75th to 99th percentiles of temperature was associated with corresponding increases of 2.83% (95% PI: 1.42%, 4.24%), 3.02% (95% PI: 1.33%, 4.71%) and 4.64% (95% PI: 1.96%, 7.31%). The latitudes, number of air conditioning per household and disposable income per capita were significant modifiers for cold effects; the proportion of the elderly was a significant modifier for hot effects. This largest epidemiological study of temperature to date in China suggested that both cold and hot temperatures were associated with increased mortality. Our findings may have important implications for the public health policies in China.
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Affiliation(s)
- Wenjuan Ma
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, & Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, & Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, Shanghai, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, & Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, Shanghai, China.
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Shaposhnikov D, Revich B, Gurfinkel Y, Naumova E. The influence of meteorological and geomagnetic factors on acute myocardial infarction and brain stroke in Moscow, Russia. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:799-808. [PMID: 23700198 DOI: 10.1007/s00484-013-0660-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
Evidence of the impact of air temperature and pressure on cardiovascular morbidity is still quite limited and controversial, and even less is known about the potential influence of geomagnetic activity. The objective of this study was to assess impacts of air temperature, barometric pressure and geomagnetic activity on hospitalizations with myocardial infarctions and brain strokes. We studied 2,833 myocardial infarctions and 1,096 brain strokes registered in two Moscow hospitals between 1992 and 2005. Daily event rates were linked with meteorological and geomagnetic conditions, using generalized linear model with controls for day of the week, seasonal and long-term trends. The number of myocardial infarctions decreased with temperature, displayed a U-shaped relationship with pressure and variations in pressure, and increased with geomagnetic activity. The number of strokes increased with temperature, daily temperature range and geomagnetic activity. Detrimental effects on strokes of low pressure and falling pressure were observed. Relative risks of infarctions and strokes during geomagnetic storms were 1.29 (95% CI 1.19-1.40) and 1.25 (1.10-1.42), respectively. The number of strokes doubled during cold spells. The influence of barometric pressure on hospitalizations was relatively greater than the influence of geomagnetic activity, and the influence of temperature was greater than the influence of pressure. Brain strokes were more sensitive to inclement weather than myocardial infarctions. This paper provides quantitative estimates of the expected increases in hospital admissions on the worst days and can help to develop preventive health plans for cardiovascular diseases.
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Affiliation(s)
- Dmitry Shaposhnikov
- Environmental Health Laboratory, Institute of Forecasting, Russian Academy of Sciences, Moscow, Russian Federation,
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32
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The role of cold stress in predicting extra cardiovascular and respiratory admissions. Int J Cardiol 2014; 172:e109-10. [PMID: 24438927 DOI: 10.1016/j.ijcard.2013.12.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 11/22/2022]
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Wang Q, Gao C, Wang H, Lang L, Yue T, Lin H. Ischemic stroke hospital admission associated with ambient temperature in Jinan, China. PLoS One 2013; 8:e80381. [PMID: 24260379 PMCID: PMC3833907 DOI: 10.1371/journal.pone.0080381] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study estimated the effects of ambient temperature and relative humidity on hospital admissions for ischemic stroke during 1990-2009 in Jinan, China. METHODS To account for possible delayed effects and harvesting effect, we examined the impact of meteorological factors up to 30 days before each admission using a distributed lag non-linear model; we controlled for season, long-term trend, day of week and public holidays in the analysis. Stratified analyses were also done for summer and winter. RESULTS A total of 1,908 ischemic stroke hospital admissions were observed between 1990 and 2009. We found a strong non-linear acute effect of daily temperatures on ischemic stroke hospital admission. With the mean temperature 15°C as the reference, the relative risk (RR) was 1.43 (95% confidence interval (CI): 1.10-1.85) for 0°C daily temperature on the same day, and 0.43 (95% CI: 0.31-0.59) for 30°C daily temperature on the same day, respectively. The effect of ambient temperature was similar in summer and winter. No significant association was observed between relative humidity and ischemic stroke hospitalization. CONCLUSIONS Low temperature might be a risk factor for ischemic stroke, and high temperature might be protective factor of ischemic stroke occurrence in Jinan, China.
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Affiliation(s)
- Qinzhou Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Cuilian Gao
- Qilu Hospital of Shandong University, Jinan, China
| | | | - Lingling Lang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Tao Yue
- Cadre Health Care Department, Zibo Center Hospital, Zibo, China
| | - Hualiang Lin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Al Mamun M, Rumana N, Specogna AV, Turin TC. Studying effects of weather parameters on acute stroke: considering the contribution of "risk factors" and "triggering factors" together. J Stroke Cerebrovasc Dis 2013; 23:194-5. [PMID: 23968712 DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Mohammad Al Mamun
- Department of Public Health, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Tabuk, Kingdom of Saudi Arabia.
| | - Nahid Rumana
- Sleep Center, Foothills Medical Center, Alberta Health Services, Calgary, Alberta, Canada
| | - Adrian V Specogna
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tanvir C Turin
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chen R, Wang C, Meng X, Chen H, Thach TQ, Wong CM, Kan H. Both low and high temperature may increase the risk of stroke mortality. Neurology 2013; 81:1064-70. [PMID: 23946311 DOI: 10.1212/wnl.0b013e3182a4a43c] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine temperature in relation to stroke mortality in a multicity time series study in China. METHODS We obtained data on daily temperature and mortality from 8 large cities in China. We used quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on stroke mortality across multiple days, adjusting for long-term and seasonal trends, day of the week, air pollution, and relative humidity. We applied the Bayesian hierarchical model to pool city-specific effect estimates. RESULTS Both cold and hot temperatures were associated with increased risk of stroke mortality. The potential effect of cold temperature might last more than 2 weeks. The pooled relative risks of extreme cold (first percentile of temperature) and cold (10th percentile of temperature) temperatures over lags 0-14 days were 1.39 (95% posterior intervals [PI] 1.18-1.64) and 1.11 (95% PI 1.06-1.17), compared with the 25th percentile of temperature. In contrast, the effect of hot temperature was more immediate. The relative risks of stroke mortality over lags 0-3 days were 1.06 (95% PI 1.02-1.10) for extreme hot temperature (99th percentile of temperature) and 1.14 (95% PI 1.05-1.24) for hot temperature (90th percentile of temperature), compared with the 75th percentile of temperature. CONCLUSIONS This study showed that both cold and hot temperatures were associated with increased risk of stroke mortality in China. Our findings may have important implications for stroke prevention in China.
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Affiliation(s)
- Renjie Chen
- From the School of Public Health, Key Lab of Public Health Safety of the Ministry of Education (R.C., C.W., X.M., H.K.), Research Institute for the Changing Global Environment and Fudan Tyndall Centre (R.C., C.W., X.M., H.K.), and Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP) (R.C., C.W., X.M., H.K.), Fudan University, Shanghai, China; Epidemiology Branch (H.C.), National Institute of Environmental Health Science, National Institutes of Health, Research Triangle Park, NC; and Department of Community Medicine (T.Q.T., C.-M.W.), School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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The effects of heat stress and its effect modifiers on stroke hospitalizations in Allegheny County, Pennsylvania. Int Arch Occup Environ Health 2013; 87:557-65. [PMID: 23897226 DOI: 10.1007/s00420-013-0897-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/17/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE Heat has been known to increase the risk of many health endpoints. However, few studies have examined its effects on stroke. The objective of this case-crossover study is to investigate the effects of high heat and its effect modifiers on the risk of stroke hospitalization in Allegheny County, Pennsylvania. METHODS We obtained data on first stroke hospitalizations among adults ages 65 and older and daily meteorological information during warm seasons (May-September) from 1994 to 2000 in Allegheny County, Pennsylvania. Using conditional multiple logistic regressions, the effects of heat days (any day with a temperature greater than the 95th percentile) and heat wave days (at least two continuous heat days) on the risk of stroke hospitalization were investigated. The potential interactions between high heat and age, type of stroke, and gender were also examined. RESULTS Heat day and heat wave at lag-2 day were significantly associated with an increased risk for stroke hospitalization (OR 1.121, 95 % CI 1.013-1.242; OR 1.173, 95 % CI 1.047-1.315, respectively) after adjusting for important covariates. In addition, having two or more heat wave days within the 4 day window prior to the event was also significantly associated with an increased risk (OR 1.119, 95 % CI 1.004, 1.246) compared to having no heat wave days during the period. The effect of high heat on stroke was more significant for ischemic stroke, men, and subjects ages 80 years or older. CONCLUSIONS Our study suggests that high heat may have adverse effects on stroke and that some subgroups may be particularly susceptible to heat.
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Gomes J, Damasceno A, Carrilho C, Lobo V, Lopes H, Madede T, Pravinrai P, Silva-Matos C, Diogo D, Azevedo A, Lunet N. The effect of season and temperature variation on hospital admissions for incident stroke events in Maputo, Mozambique. J Stroke Cerebrovasc Dis 2013; 23:271-7. [PMID: 23523200 DOI: 10.1016/j.jstrokecerebrovasdis.2013.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Identifying locale-specific patterns regarding the variation in stroke incidence throughout the year and with atmospheric temperature may be useful to the organization of stroke care, especially in low-resource settings. GOAL We aimed to describe the variation in the incidence of stroke hospitalizations across seasons and with short-term temperature variation, in Maputo, Mozambique. METHODS Between August 1, 2005, and July 31, 2006, we identified 651 stroke events in Maputo dwellers, according to the World Health Organization's STEPwise approach. The day of symptom onset was defined as the index date. We computed crude and adjusted (humidity, precipitation and temperature) incidence rate ratios (IRRs) and 95% confidence intervals (CIs) with Poisson regression. RESULTS Stroke incidence did not vary significantly with season (dry versus wet: crude IRR = .98, 95% CI: .84-1.15), atmospheric temperature at the index date, or average atmospheric temperature in the preceding 2 weeks. The incidence rates of stroke were approximately 30% higher when in the previous 10 days there was a decline in the minimum temperature greater than or equal to 3 °C between any 2 consecutive days (variation in minimum temperature -5.1 to -3.0 versus -2.3 to -.4, adjusted IRR = 1.31, 95% CI: 1.09-1.57). No significant associations were observed according to the variation in maximum temperatures. CONCLUSIONS Sudden declines in the minimum temperatures were associated with a higher incidence of stroke hospitalizations in Maputo. This provides important information for prediction of periods of higher hospital affluence because of stroke and to understand the mechanisms underlying the triggering of a stroke event.
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Affiliation(s)
- Joana Gomes
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health-University of Porto, Porto, Portugal.
| | - Albertino Damasceno
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Vitória Lobo
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hélder Lopes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Pius Pravinrai
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Silva-Matos
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Domingos Diogo
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ana Azevedo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health-University of Porto, Porto, Portugal
| | - Nuno Lunet
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health-University of Porto, Porto, Portugal
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Lim YH, Kim H, Hong YC. Variation in mortality of ischemic and hemorrhagic strokes in relation to high temperature. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2013; 57:145-53. [PMID: 22527757 DOI: 10.1007/s00484-012-0542-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/25/2012] [Accepted: 03/26/2012] [Indexed: 05/15/2023]
Abstract
Outdoor temperature has been reported to have a significant influence on the seasonal variations of stroke mortality, but few studies have investigated the effect of high temperature on the mortality of ischemic and hemorrhagic strokes. The main study goal was to examine the effect of temperature, particularly high temperature, on ischemic and hemorrhagic strokes. We investigated the association between outdoor temperature and stroke mortality in four metropolitan cities in Korea during 1992-2007. We used time series analysis of the age-adjusted mortality rate for ischemic and hemorrhagic stroke deaths by using generalized additive and generalized linear models, and estimated the percentage change of mortality rate associated with a 1°C increase of mean temperature. The temperature-responses for the hemorrhagic and ischemic stroke mortality differed, particularly in the range of high temperature. The estimated percentage change of ischemic stroke mortality above a threshold temperature was 5.4 % (95 % CI, 3.9-6.9 %) in Seoul, 4.1 % (95 % CI, 1.6-6.6 %) in Incheon, 2.3 % (-0.2 to 5.0 %) in Daegu and 3.6 % (0.7-6.6 %) in Busan, after controlling for daily mean humidity, mean air pressure, day of the week, season, and year. Additional adjustment of air pollution concentrations in the model did not change the effects. Hemorrhagic stroke mortality risk significantly decreased with increasing temperature without a threshold in the four cities after adjusting for confounders. These findings suggest that the mortality of hemorrhagic and ischemic strokes show different patterns in relation to outdoor temperature. High temperature was harmful for ischemic stroke but not for hemorrhagic stroke. The risk of high temperature to ischemic stroke did not differ by age or gender.
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Affiliation(s)
- Youn-Hee Lim
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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Kräuchi K, Gompper B, Hauenstein D, Flammer J, Pflüger M, Studerus E, Schötzau A, Orgül S. Diurnal Blood Pressure Variations Are Associated with Changes in Distal–Proximal Skin Temperature Gradient. Chronobiol Int 2012; 29:1273-83. [DOI: 10.3109/07420528.2012.719961] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goggins WB, Woo J, Ho S, Chan EYY, Chau PH. Weather, season, and daily stroke admissions in Hong Kong. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2012; 56:865-72. [PMID: 21915799 DOI: 10.1007/s00484-011-0491-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 05/24/2023]
Abstract
Previous studies examining daily temperature and stroke incidence have given conflicting results. We undertook this retrospective study of all stroke admissions in those aged 35 years old and above to Hong Kong public hospitals from 1999 through 2006 in order to better understand the effects of meteorological conditions on stroke risk in a subtropical setting. We used Poisson Generalized Additive Models with daily hemorrhagic (HS) and ischemic stroke (IS) counts separately as outcomes, and daily mean temperature, humidity, solar radiation, rainfall, air pressure, pollutants, flu consultation rates, day of week, holidays, time trend and seasonality as predictors. Lagged effects of temperature, humidity and pollutants were also considered. A total of 23,457 HS and 107,505 IS admissions were analyzed. Mean daily temperature had a strong, consistent, negative linear association with HS admissions over the range (8.2-31.8°C) observed. A 1°C lower average temperature over the same day and previous 4 days (lags 0-4) being associated with a 2.7% (95% CI: 2.0-3.4%, P < .0.0001) higher admission rate after controlling for other variables. This association was stronger among older subjects and females. Higher lag 0-4 average change in air pressure from previous day was modestly associated with higher HS risk. The association between IS and temperature was weaker and apparent only below 22°C, with a 1°C lower average temperature (lags 0-13) below this threshold being associated with a 1.6% (95% CI:1.0-2.2%, P < 0.0001) higher IS admission rate. Pollutant levels were not associated with HS or IS. Future studies should examine HS and IS risk separately.
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Affiliation(s)
- William B Goggins
- Division of Biostatistics, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Mücke S, Grotemeyer KH, Stahlhut L, Husstedt IW, Evers S. The influence of fluid intake on stroke recurrence — A prospective study. J Neurol Sci 2012; 315:82-5. [DOI: 10.1016/j.jns.2011.11.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/08/2011] [Accepted: 11/10/2011] [Indexed: 12/01/2022]
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Tang ZY, Zhu QY, Xu LJ, Deng LY, Zeng Y, Ding WJ, Huang W. Artificial cold wave-induced cerebral infarction in rats with carotid atherosclerosis. J Mol Neurosci 2012; 47:278-85. [PMID: 22415353 DOI: 10.1007/s12031-012-9735-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 02/24/2012] [Indexed: 12/18/2022]
Abstract
To investigate the effects of cold on blood pressure, serum endothelin-1 content, serum nitric oxide content, and morbidity of cerebral infarction, as well as assess the therapeutic effect of nimodipine. A total of 200 rats were initially assigned to a normal group (n = 10), sham group (n = 10), and carotid atherosclerosis group (n = 180), and subsequently the animals in the carotid atherosclerosis group were randomly assigned to three groups: non-cold (n = 59), cold treatment (n = 58), and nimodipine (n = 58). Rats in the cold and nimodipine groups experienced an artificial cold wave. The temperature was set at 22°C for 12 h (7:00 am to 7:00 pm) and then at 4°C for another 12 h (7:00 pm to 7:00 am), representing a cycle. The animals underwent three cycles of cold. Rats in the nimodipine group were treated with nimodipine and those in the cold group with given an equal volume of intragastric normal saline for 3 days. Hematoxylin and eosin staining showed features of carotid atherosclerosis in all animals. Blood pressure fluctuated with alteration of temperature. A temperature decrease was accompanied by an increase of blood pressure and elevation of serum levels of endothelium-1 and nitric oxide. In addition, although nimodipine could prevent the cold-induced increase of blood pressure and elevation of serum endothelium-1 and nitric oxide levels, it had no effect on blood pressure fluctuation or morbidity of cerebral infarction. The results suggest that dramatic variation in temperature is one of the main causes of cold-induced fluctuation of blood pressure.
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Affiliation(s)
- Zhen-Yu Tang
- Department of neurology, the Second Hospital Affiliated to Nanchang University, Nanchang, 330006, China.
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Hori A, Hashizume M, Tsuda Y, Tsukahara T, Nomiyama T. Effects of weather variability and air pollutants on emergency admissions for cardiovascular and cerebrovascular diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2012; 22:416-430. [PMID: 22384943 DOI: 10.1080/09603123.2011.650155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We examined the effect of ambient temperature, air pressure and air pollutants on daily emergency admissions by identifying the cause of admission for each type of stroke and cardiovascular disease using generalized linear Poisson regression models allowing for overdispersion, and controlling for seasonal and inter-annual variations, days of the week and public holidays, levels of influenza and respiratory syncytial viruses. Every 1°C decrease in mean temperature was associated with an increase in the daily number of emergency admissions by 7.83% (95% CI 2.06-13.25) for acute coronary syndrome (ACS) and heart failure, by 35.57% (95% CI 15.59-59.02) for intracerebral haemorrhage (ICH) and by 11.71% (95% CI 4.1-19.89) for cerebral infarction. An increase of emergency admissions due to ICH (3.25% (95% CI 0.94-5.51)), heart failure (3.56% (95% CI 1.09-5.96)) was observed at every 1 hPa decrease in air pressure from the previous days. We found stronger detrimental effect of cold on stroke than cardiovascular disease.
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Affiliation(s)
- Aya Hori
- Department of Preventive Medicine and Public Health , Shinshu University School of Medicine, Matsumoto, Japan.
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Hennerici MG. Report of the 20th European Stroke Conference, Hamburg, May 24-27, 2011. Cerebrovasc Dis 2011; 32:589-613. [PMID: 22134359 DOI: 10.1159/000334176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- M G Hennerici
- Department of Neurology, UMM, University of Heidelberg, Mannheim, Germany
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Wichmann J, Andersen ZJ, Ketzel M, Ellermann T, Loft S. Apparent temperature and cause-specific mortality in Copenhagen, Denmark: a case-crossover analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:3712-27. [PMID: 22016711 PMCID: PMC3194112 DOI: 10.3390/ijerph8093712] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 08/22/2011] [Accepted: 09/05/2011] [Indexed: 11/30/2022]
Abstract
Temperature, a key climate change indicator, is expected to increase substantially in the Northern Hemisphere, with potentially grave implications for human health. This study is the first to investigate the association between the daily 3-hour maximum apparent temperature (Tappmax), and respiratory, cardiovascular and cerebrovascular mortality in Copenhagen (1999–2006) using a case-crossover design. Susceptibility was investigated for age, sex, socio-economic status and place of death. For an inter-quartile range (7 °C) increase in Tappmax, an inverse association was found with cardiovascular mortality (−7% 95% CI −13%; −1%) and none with respiratory and cerebrovascular mortality. In the cold period all associations were inverse, although insignificant.
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Affiliation(s)
- Janine Wichmann
- Section of Environmental Health, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen DK-1014, Denmark; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +45-353-27622; Fax: +45-353-27686
| | - Zorana Jovanovic Andersen
- Institute of Cancer Epidemiology, Danish Cancer Society, 49 Strandboulevarden, Copenhagen DK-2100, Denmark; E-Mail:
| | - Matthias Ketzel
- Department of Environmental Sciences, Aarhus University, Frederiksborgvej 399, Roskilde DK-4000, Denmark; E-Mails: (M.K.); (T.E.)
| | - Thomas Ellermann
- Department of Environmental Sciences, Aarhus University, Frederiksborgvej 399, Roskilde DK-4000, Denmark; E-Mails: (M.K.); (T.E.)
| | - Steffen Loft
- Section of Environmental Health, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen DK-1014, Denmark; E-Mail:
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Shiue I, Matzarakis A. When stroke epidemiology meets weather and climate: a heat exposure index from human biometeorology. Int J Stroke 2011; 6:176. [PMID: 21371283 DOI: 10.1111/j.1747-4949.2010.00576.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morabito M, Crisci A, Vallorani R, Modesti PA, Gensini GF, Orlandini S. Innovative Approaches Helpful to Enhance Knowledge on Weather-Related Stroke Events Over a Wide Geographical Area and a Large Population. Stroke 2011; 42:593-600. [DOI: 10.1161/strokeaha.110.602037] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Results on the effect of weather on stroke occurrences are still confusing and controversial. The aim of this study was to retrospectively investigate in Tuscany (central Italy) the weather-related stroke events through the use of an innovative source of weather data (Reanalysis) together with an original statistical approach to quantify the prompt/delayed health effects of both cold and heat exposures.
Methods—
Daily stroke hospitalizations and meteorologic data from the Reanalysis 2 Achieve were obtained for the period 1997 to 2007. Generalized linear and additive models and an innovative modeling approach, the constrained segmented distributed lag model, were applied.
Results—
Both daily averages and day-to-day changes of air temperature and geopotential height (a measure that approximates the mean surface pressure) were selected as independent predictors of all stroke occurrences. In particular, a 5°C temperature decrease was associated with 16.5% increase of primary intracerebral hemorrhage of people ≥65 years of age. A general short-term cold effect on hospitalizations limited to 1 week after exposure was observed and, for the first time, a clear harvesting effect (deficit of hospitalization) for cold-related primary intracerebral hemorrhage was described. Day-to-day changes of meteorologic parameters disclosed characteristic U- and J-shaped relationships with stroke occurrences.
Conclusions—
Thanks to the intrinsic characteristic of Reanalysis, these results might simply be implemented in an operative forecast system regarding weather-related stroke events with the aim to develop preventive health plans.
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Affiliation(s)
- Marco Morabito
- From the Interdepartmental Centre of Bioclimatology (M.M., P.A.M., G.F.G., S.O.), University of Florence, Firenze, Italy; the Institute of Biometeorology (A.C., R.V.), National Research Council, Firenze, Italy; Clinica Medica and Cardiologia (P.A.M., G.F.G.), University of Florence, Firenze, Italy; and Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Pozzolatico, Italy (G.F.G., P.A.M.)
| | - Alfonso Crisci
- From the Interdepartmental Centre of Bioclimatology (M.M., P.A.M., G.F.G., S.O.), University of Florence, Firenze, Italy; the Institute of Biometeorology (A.C., R.V.), National Research Council, Firenze, Italy; Clinica Medica and Cardiologia (P.A.M., G.F.G.), University of Florence, Firenze, Italy; and Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Pozzolatico, Italy (G.F.G., P.A.M.)
| | - Roberto Vallorani
- From the Interdepartmental Centre of Bioclimatology (M.M., P.A.M., G.F.G., S.O.), University of Florence, Firenze, Italy; the Institute of Biometeorology (A.C., R.V.), National Research Council, Firenze, Italy; Clinica Medica and Cardiologia (P.A.M., G.F.G.), University of Florence, Firenze, Italy; and Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Pozzolatico, Italy (G.F.G., P.A.M.)
| | - Pietro Amedeo Modesti
- From the Interdepartmental Centre of Bioclimatology (M.M., P.A.M., G.F.G., S.O.), University of Florence, Firenze, Italy; the Institute of Biometeorology (A.C., R.V.), National Research Council, Firenze, Italy; Clinica Medica and Cardiologia (P.A.M., G.F.G.), University of Florence, Firenze, Italy; and Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Pozzolatico, Italy (G.F.G., P.A.M.)
| | - Gian Franco Gensini
- From the Interdepartmental Centre of Bioclimatology (M.M., P.A.M., G.F.G., S.O.), University of Florence, Firenze, Italy; the Institute of Biometeorology (A.C., R.V.), National Research Council, Firenze, Italy; Clinica Medica and Cardiologia (P.A.M., G.F.G.), University of Florence, Firenze, Italy; and Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Pozzolatico, Italy (G.F.G., P.A.M.)
| | - Simone Orlandini
- From the Interdepartmental Centre of Bioclimatology (M.M., P.A.M., G.F.G., S.O.), University of Florence, Firenze, Italy; the Institute of Biometeorology (A.C., R.V.), National Research Council, Firenze, Italy; Clinica Medica and Cardiologia (P.A.M., G.F.G.), University of Florence, Firenze, Italy; and Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Pozzolatico, Italy (G.F.G., P.A.M.)
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Shiue I. Under the weather with stroke before more data emerge. Int J Stroke 2011; 6:90; author reply 90. [PMID: 21205248 DOI: 10.1111/j.1747-4949.2010.00546.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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