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Hao T, Wang X, Han S, Yao Q, Ding J. Investigating the impact of weather on stroke in summer. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02724-3. [PMID: 38913080 DOI: 10.1007/s00484-024-02724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/15/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
The objective of this study is to explore how changes in weather contribute to an increase in hospital admissions for stroke in summer. We collected 96,509 cases of stroke hospitalization data in Tianjin from 2016 to 2022 summer, along with corresponding meteorological data. The generalized additive model and distributed lag nonlinear model were used to analyze the lag and cumulative effects of temperature on stroke hospitalization. The research results show both the cold effect and the heat effect in summer would increase the risk of hospitalization. The effect of daily maximum temperature on stroke hospitalization was immediate when the temperature was higher, and delayed when the temperature was lower. However, the risk of stroke hospitalization increased more significantly with increasing temperature than with decreasing temperature. In the presence of one or more of the following three weather changes: sharp temperature increase, sharp temperature decrease, continuous high temperature, the daily number of stroke inpatients were higher than the average in the same period. 83% of the Inpatient-heavy events within the study period were caused by a combination of dramatic temperature changes and continuous high temperatures. In 48% of Inpatient-heavy events, continuous high temperature weather above 30℃ for at least 4 consecutive days were observed. And 55% of high temperature weather was accompanied by high humidity. When the daily relative humidity was greater than 70% and the daily maximum temperature was between 26 and 28℃ or more than 34℃, or the daily maximum temperature changes over 10℃ within 48 h, the number of daily inpatients was more than 1.2 times of the average daily inpatients. More attention should be paid to the combined effects of continuous high temperature and sudden temperature changes in summer stroke prevention.
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Affiliation(s)
- Tianyi Hao
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| | - Xiaojia Wang
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| | - Suqin Han
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China.
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China.
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China.
| | - Qing Yao
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
| | - Jing Ding
- Tianjin Environmental Meteorological Center, Tianjin, 300074, China
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research, Tianjin, 300074, China
- Tianjin Interdisciplinary Innovation Centre for Health and Meteorology, Tianjin, 300074, China
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Bücke P, Henkes H, Arnold G, Herting B, Jüttler E, Klötzsch C, Lindner A, Mauz U, Niehaus L, Reinhard M, Waibel S, Horvath T, Bäzner H, Aguilar Pérez M. Seasonal patterns and associations in the incidence of acute ischemic stroke requiring mechanical thrombectomy. Eur J Neurol 2021; 28:2229-2237. [PMID: 33738909 PMCID: PMC9290541 DOI: 10.1111/ene.14832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
Background In order to identify risk periods with an increased demand in technical and human resources, we tried to determine patterns and associations in the incidence of acute ischemic stroke due to embolic large vessel occlusions (eLVO) requiring mechanical thrombectomy (MT). Methods We conducted a time series analysis over a 9‐year period (2010–2018) based on observational data in order to detect seasonal patterns in the incidence of MT due to eLVO (n = 2628 patients). In a series of sequential negative binominal regression models, we aimed to detect further associations (e.g., temperature, atmospheric pressure, air pollution). Results There was a 6‐month seasonal pattern in the incidence of MT due to eLVO (p = 0.024) peaking in March and September. Colder overall temperature was associated with an increase in MT due to eLVO (average marginal effect [AME], [95% CI]: −0.15 [−0.30–0.0001]; p = 0.05; per °C). A current increase in the average monthly temperature was associated with a higher incidence of MT due to eLVO (0.34 [0.11–0.56]; p = 0.003). Atmospheric pressure was positively correlated with MT due to eLVO (0.38 [0.13–0.64]; p = 0.003; per hectopascal [hPa]). We could detect no causal correlation between air pollutants and MT due to eLVO. Conclusions Our data suggest a 6‐month seasonal pattern in the incidence of MT due to eLVO peaking in spring and early autumn. This might be attributed to two different factors: (1) a current temperature rise (comparing the average monthly temperature in consecutive months) and (2) colder overall temperature. These results could help to identify risk periods requiring an adaptation in local infrastructure.
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Affiliation(s)
- Philipp Bücke
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland.,Neurological Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Guy Arnold
- Neurological Clinic, Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Birgit Herting
- Neurological Clinic, Diakonie-Klinikum Schwäbisch Hall, Schwäbisch Hall, Germany
| | - Eric Jüttler
- Neurological Clinic, Ostalb-Klinikum Aalen, Aalen, Germany
| | - Christof Klötzsch
- Neurological Clinic, Hegau-Bodensee-Klinikum Singen, Singen, Germany
| | - Alfred Lindner
- Neurological Clinic, Marienhospital Stuttgart, Stuttgart, Germany
| | - Uwe Mauz
- Neurological Clinic, MEDIUS Klinik Kirchheim, Kirchheim, Germany
| | - Ludwig Niehaus
- Neurological Clinic, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Matthias Reinhard
- Clinic for Neurology and Clinical Neurophysiology, Klinikum Esslingen, Esslingen, Germany
| | - Stefan Waibel
- Center for Internal Medicine, Stauferklinikum Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Thomas Horvath
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
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Ding J, Zhou D, Shang S, Pan L, Ya J, Ding Y, Ji X, Meng R. Impact of seasonal variations on the first ischemic events in patients with moyamoya disease. Clin Neurol Neurosurg 2018; 173:65-69. [PMID: 30089245 DOI: 10.1016/j.clineuro.2018.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/16/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This retrospective study aimed to explore the impact of seasonal variations on the first ischemic events in patients with moyamoya disease (MMD). PATIENTS AND METHODS Based on the first-time ischemic event occurrence, 113 patients, including 84 with cerebral infarction and 29 with transient ischemic attack, who were diagnosed with ischemic MMD were divided into four groups: spring (March-May), summer (June-August), autumn (September-November) and winter (December-February). The incidence of cerebral infarction was considered as the primary parameter. The impact of seasonal variations on the occurrence of cerebral infarction was analyzed by Poisson regression model and seasonal analysis. RESULTS When summer was set as the reference, patients in summer were more significantly susceptible to develop cerebral infarction as compared with spring (IRR, 0.529, 95%CI, 0.299-0.937, p = 0.03), autumn (IRR, 0.441, 95%CI, 0.240-0.810, p < 0.01) and winter (0.500, 95%CI, 0.279-0.895, p = 0.02). The seasonality of the time series in summer (1.231) was substantially higher than that in the other three seasons (-0.269 in spring, -0.656 in autumn and -0.306 in winter). No discrepancy in either NIHSS or mRS scores at admission was observed among the four seasons. CONCLUSION Patients with MMD may be more vulnerable to cerebral infarction in summer compared with the other three seasons, and seasonal onset of cerebral infarction does not seem to be associated with the severity of neurological disability at admission.
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Affiliation(s)
- Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Shuling Shang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Department of Neurology, Tangshan Union Medical College Hospital, Tangshan, 063000, China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, 48201, USA
| | - Xunming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Ikefuti PV, Barrozo LV, Braga ALF. Mean air temperature as a risk factor for stroke mortality in São Paulo, Brazil. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1535-1542. [PMID: 29802502 DOI: 10.1007/s00484-018-1554-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
In Brazil, chronic diseases account for the largest percentage of all deaths among men and women. Among the cardiovascular diseases, stroke is the leading cause of death, accounting for 10% of all deaths. We evaluated associations between stroke and mean air temperature using recorded mortality data and meteorological station data from 2002 to 2011. A time series analysis was applied to 55,633 mortality cases. Ischemic and hemorrhagic strokes (IS and HS, respectively) were divided to test different impact on which subgroup. Poisson regression with distributed lag non-linear model was used and adjusted for seasonality, pollutants, humidity, and days of the week. HS mortality was associated with low mean temperatures for men relative risk (RR) = 2.43 (95% CI, 1.12-5.28) and women RR = 1.39 (95% CI, 1.03-1.86). RR of IS mortality was not significant using a 21-day lag window. Analyzing the lag response separately, we observed that the effect of temperature is acute in stroke mortality (higher risk among lags 0-5). However, for IS, higher mean temperatures were significant for this subtype with more than 15-day lag. Our findings showed that mean air temperature is associated with stroke mortality in the city of São Paulo for men and women and IS and HS may have different triggers. Further studies are needed to evaluate physiologic differences between these two subtypes of stroke.
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Affiliation(s)
- Priscilla V Ikefuti
- Department of Geography, School of Philosophy, Literature and Human Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 338. Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Ligia V Barrozo
- Department of Geography, School of Philosophy, Literature and Human Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 338. Cidade Universitária, São Paulo, 05508-000, Brazil.
| | - Alfésio L F Braga
- Department of Pathology, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, São Paulo, 01246-903, Brazil
- Collective Health Graduate Program, Catholic University of Santos, Av. Conselheiro Nébias, 300, Santos, 11015-002, São Paulo, Brazil
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Meadows KL, Silver GM. The Effects of Various Weather Conditions as a Potential Ischemic Stroke Trigger in Dogs. Vet Sci 2017; 4:vetsci4040056. [PMID: 29144407 PMCID: PMC5753636 DOI: 10.3390/vetsci4040056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
Stroke is the fifth leading cause of death in the United States, and is the leading cause of serious, long-term disability worldwide. There are at least 795,000 new or recurrent strokes each year, and approximately 85% of all stroke occurrences are ischemic. Unfortunately, companion animals are also at risk for ischemic stroke. Although the exact incidence of ischemic stroke in companion animals is unknown, some studies, and the veterinary information network (VIN), report that approximately 3% of neurological case referrals are due to a stroke. There is a long list of predisposing factors associated with the risk of ischemic stroke in both humans and canines; however, these factors do not explain why a stroke happens at a particular time on a particular day. Our understanding of these potential stroke “triggers” is limited, and the effect of transient environmental exposures may be one such “trigger”. The present study investigated the extent to which the natural occurrence of canine ischemic stroke was related to the weather conditions in the time-period immediately preceding the onset of stroke. The results of the present study demonstrated that the change in weather conditions could be a potential stroke trigger, with the strokes evaluated occurring after periods of rapid, large fluctuations in weather conditions. There are currently no epidemiological data on the seasonal variability of ischemic stroke in dogs, and determining whether canine stroke parallels human stroke would further validate the use of companion dogs as an appropriate naturally occurring model.
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Affiliation(s)
- Kristy L Meadows
- Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Rd., Grafton, MA 01536, USA.
| | - Gena M Silver
- Massachusetts Veterinary Referral Hospital, 20 Cabot Rd., Woburn, MA 01801, USA.
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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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Gomes J, Damasceno A, Carrilho C, Lobo V, Lopes H, Madede T, Pravinrai P, Silva-Matos C, Diogo D, Azevedo A, Lunet N. Triggering of stroke by ambient temperature variation: a case-crossover study in Maputo, Mozambique. Clin Neurol Neurosurg 2014; 129:72-7. [PMID: 25559679 DOI: 10.1016/j.clineuro.2014.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The effect of ambient temperature as a stroke trigger is likely to differ by type of stroke and to depend on non-transient exposures that influence the risk of this outcome. We aimed to quantify the association between ambient temperature variation and stroke, according to clinical characteristics of the events, and other risk factors for stroke. METHODS We conducted a case-crossover study based on a 1-year registry of the hospital admissions due to newly occurring ischemic and hemorrhagic stroke events in Maputo, Mozambique's capital city (N=593). The case-period was defined as the 7 days before the stroke event, which was compared to two control periods (14-21 days and 21-28 days before the event). We computed humidity- and precipitation-adjusted odds ratios (OR) and 95% confidence intervals (95%CI) using conditional logistic regression. RESULTS An association between minimum temperature declines higher than 2.4 °C in any two consecutive days in the previous week and the occurrence of stroke was observed only for first events (OR=1.43, 95%CI: 1.15-1.76). Stronger and statistically significant associations were observed for hemorrhagic stroke (OR=1.50, 95%CI: 1.07-2.09) and among subjects not exposed to risk factors, including smoking, high serum cholesterol or atrial fibrillation. No differences in the effect of temperature were found according to the patients' vital status 28 days after the event. CONCLUSIONS First stroke events, especially of the hemorrhagic type, were triggered by declines in the minimum temperature between consecutive days of the preceding week.
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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 (ISPUP), 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 (ISPUP), 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 (ISPUP), Porto, Portugal
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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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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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Mostofsky E, Wilker EH, Schwartz J, Zanobetti A, Gold DR, Wellenius GA, Mittleman MA. Short-term changes in ambient temperature and risk of ischemic stroke. Cerebrovasc Dis Extra 2014; 4:9-18. [PMID: 24575110 PMCID: PMC3934677 DOI: 10.1159/000357352] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Despite consistent evidence of a higher short-term risk of cardiovascular mortality associated with ambient temperature, there have been discrepant findings on the association between temperature and ischemic stroke. Moreover, few studies have considered potential confounding by ambient fine particulate matter air pollution <2.5 μm in diameter (PM2.5) and none have examined the impact of temperature changes on stroke in the subsequent hours rather than days. The aim of this study was to evaluate whether changes in temperature trigger an ischemic stroke in the following hours and days and whether humid days are particularly harmful. Methods We reviewed the medical records of 1,705 patients residing in the metropolitan region of Boston, Mass., USA, who were hospitalized with neurologist-confirmed ischemic stroke, and we abstracted data on the time of symptom onset and clinical characteristics. We obtained hourly meteorological data from the National Weather Service station and hourly PM2.5 data from the Harvard ambient monitoring station. We used the time-stratified case-crossover design to assess the association between ischemic stroke and apparent temperature averaged over 1-7 days prior to stroke onset adjusting for PM2.5. We assessed whether differences in apparent temperature trigger a stroke within shorter time periods by examining the association between stroke onset and apparent temperature levels averaged in 2-hour increments prior to stroke onset (0-2 h through 36-38 h). We tested whether the association varied by health characteristics or by PM2.5, ozone or relative humidity. Results The incidence rate ratio of ischemic stroke was 1.09 (95% confidence interval 1.01-1.18) following a 5°C decrement in average apparent temperature over the 2 days preceding symptom onset. The higher risk associated with cooler temperatures peaked in the first 14-34 h. There was no statistically significant difference in the association between temperature and ischemic stroke across seasons. The risk of ischemic stroke was not meaningfully different across subgroups of patients defined by health characteristics. The association between ischemic stroke and ambient temperature was stronger on days with higher levels of relative humidity. Conclusions Lower temperatures are associated with a higher risk of ischemic stroke onset in both warm and cool seasons, and the risk is higher on days with higher levels of relative humidity. Based on this study and the body of literature on ambient temperature and cardiovascular events, identifying methods for mitigating cardiovascular risk may be warranted.
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Affiliation(s)
- Elizabeth Mostofsky
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA ; Department of Epidemiology, Harvard School of Public Health, Boston, Mass., USA
| | - Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA
| | - Joel Schwartz
- Department of Epidemiology, Harvard School of Public Health, Boston, Mass., USA ; Department of Environmental Health, Harvard School of Public Health, Boston, Mass., USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, Boston, Mass., USA
| | - Diane R Gold
- Department of Environmental Health, Harvard School of Public Health, Boston, Mass., USA ; Department of Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass., USA
| | - Gregory A Wellenius
- Department of Epidemiology, School of Public Health, Brown University, Providence, R.I., USA
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA ; Department of Epidemiology, Harvard School of Public Health, Boston, Mass., USA
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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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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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Pellitteri PK. The Role of Intraoperative Measurement of Parathyroid Hormone in Parathyroid Surgery. ACTA ACUST UNITED AC 2008; 70:319-30. [DOI: 10.1159/000149835] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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