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Dravid A, Sung WS, Song J, Dubey A, Eftekhar B. Subarachnoid Haemorrhage Incidence Pattern Analysis with Circular Statistics. Emerg Med Int 2024; 2024:6631990. [PMID: 38655008 PMCID: PMC11039014 DOI: 10.1155/2024/6631990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/27/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Knowledge about biological rhythms of diseases may not only help in understanding the pathophysiology of diseases but can also help health service policy makers and emergency department directors to allocate resources efficiently. Aneurysmal subarachnoid haemorrhage (SAH) has high rates of morbidity and mortality. The incidence of SAH has been attributed to patient-related factors such as characteristics of aneurysms, smoking, and hypertension. There are studies showing that the incidence of aneurysmal SAH appears to behave in periodic fashions over long time periods. However, there are inconsistencies in the literature regarding the impact of chronobiological factors such as circadian, seasonal, and lunar cycle factors on the occurrence of SAH. In this study, we focused on the analysis of a temporal pattern of SAH (infradian rhythms) with a novel approach using circular statistical methods. We aimed to see whether there is a circular pattern for the occurrence of SAH at all and if so, whether it can be related to known temporal patterns based on available literature. Our study did not support the notion that aneurysmal subarachnoid haemorrhages occur on any specific day in a cycle with specific lengths up to 365 days including specific weekdays, full moon, equinoxes, and solstices. Hence, we found no relationship between SAH incidence and timing. Study in larger populations using similar circular statistical methods is suggested.
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Affiliation(s)
- Ashish Dravid
- Department of Neurosurgery, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Wen-Shan Sung
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia
| | - Jeeuk Song
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia
| | - Arvind Dubey
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia
| | - Behzad Eftekhar
- Department of Neurosurgery, Nepean Hospital, The University of Sydney, Sydney, Australia
- Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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Uddin M, Nursetyo AA, Iqbal U, Nguyen PA, Jian WS, Li YC, Syed-Abdul S. Assessment of effects of moon phases on hospital outpatient visits: An observational national study. AIMS Public Health 2023; 10:324-332. [PMID: 37304591 PMCID: PMC10251051 DOI: 10.3934/publichealth.2023024] [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: 12/22/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives A vast amount of literature has been conducted for investigating the association of different lunar phases with human health; and it has mixed reviews for association and non-association of diseases with lunar phases. This study investigates the existence of any impact of moon phases on humans by exploring the difference in the rate of outpatient visits and type of diseases that prevail in either non-moon or moon phases. Methods We retrieved dates of non-moon and moon phases for eight years (1st January 2001-31st December 2008) from the timeanddate.com website for Taiwan. The study cohort consisted of 1 million people from Taiwan's National Health Insurance Research Database (NHIRD) followed over eight years (1st January 2001-31st December 2008). We used the two-tailed, paired-t-test to compare the significance of difference among outpatient visits for 1229 moon phase days and 1074 non-moon phase days by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from NHIRD records. Results We found 58 diseases that showed statistical differences in number of outpatient visits in the non-moon and moon phases. Conclusions The results of our study identified diseases that have significant variations during different lunar phases (non-moon and moon phases) for outpatient visits in the hospital. In order to fully understand the reality of the pervasive myth of lunar effects on human health, behaviors and diseases, more in-depth research investigations are required for providing comprehensive evidence covering all the factors, such as biological, psychological and environmental aspects.
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Affiliation(s)
- Mohy Uddin
- Research Quality Management Section, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | | | - Usman Iqbal
- Health ICT, Department of Health, Tasmania, Australia
- Global Health and Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Wen-Shan Jian
- School of Hospital Health care Administration, Taipei Medical University, Taiwan. No 250 Wu-Hsing Street, Taipei 110, Taiwan
| | - Yu-Chuan Li
- International Center for Health Information Technology, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan. No 250 Wu-Hsing Street, Taipei 110, Taiwan
- Research Center of Cancer Translational Medicine, Taipei Medical University, Taiwan
| | - Shabbir Syed-Abdul
- International Center for Health Information Technology, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan. No 250 Wu-Hsing Street, Taipei 110, Taiwan
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Zaręba K, Lasek-Bal A, Student S. The Influence of Selected Meteorological Factors on the Prevalence and Course of Stroke. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111216. [PMID: 34833434 PMCID: PMC8619234 DOI: 10.3390/medicina57111216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to evaluate the impact of weather factors on stroke parameters. Methods: This retrospective study analyzed the records of stroke patients concerning the influence of meteorological conditions and moon phases on stroke parameters. Results: The study group consisted of 402 patients aged between 20 and 102; women constituted 49.8% of the subjects. Ischaemic stroke was diagnosed in 90.5% of patients and hemorrhagic stroke was diagnosed in 9.5% of patients. The highest number of hospitalizations due to stroke was observed in January (48 events); the lowest number was observed in July (23 events). There was no statistically significant correlation between the meteorological parameters on the day of onset and the preceding day of stroke and the neurological status (NIHSS) of patients. Mean air temperature on the day of stroke and the day preceding stroke was significantly lower in the group of patients discharged with a very good functional status (≤2 points in modified Rankin scale (mRS)) compared to the patients with a bad functional status (>2 points in mRS); respectively: 7.98 ± 8.01 vs. 9.63 ± 7.78; p = 0.041 and 8.13 ± 7.72 vs. 9.70 ± 7.50; p = 0.048). Humidity above 75% on the day of stroke was found to be a factor for excellent functional state (RR 1.61; p = 0.016). The total anterior circulation infarcts (in comparison with stroke in the other localization) were more frequent (70%) during a third quarter moon (p = 0.011). The following parameters had a significant influence on the number of stroke cases in relation to autumn having the lowest number of onsets: mean temperature (OR 1.019 95% CI 1.014–1.024, p < 0.000), humidity (OR 1.028, CI 1.023–1.034, p < 0.0001), wind speed (OR 0.923, 95% CI 0.909–0.937, p < 0.0001), insolation (OR 0.885, 95% CI 0.869–0.902, p < 0.0001), precipitation (OR 0.914, 95% CI 0.884–0.946, p < 0.0001). Conclusion: Air humidity and air temperature on the day of stroke onset as well as air temperature on the day preceding stroke are important for the functional status of patients in the acute disease period. A combination of the following meteorological parameters: lowered mean temperature and low sunshine, high humidity and high wind speed all increase the risk of stroke during the winter period. High humidity combined with high precipitation, low wind speed and low sunshine in the autumn period are associated with the lowest stroke incidence risk. A possible relationship between phases of the moon and the incidence requires further investigation.
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Affiliation(s)
| | - Anetta Lasek-Bal
- Medical University of Silesia, 40-055 Katowice, Poland
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sebastian Student
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
- Biotechnology Center, Silesian University of Technology, 44-100 Gliwice, Poland
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Kuzmenko NV, Galagudza MM. Dependence of seasonal dynamics of hemorrhagic and ischemic strokes on the climate of a region: A meta-analysis. Int J Stroke 2021; 17:226-235. [PMID: 33724111 DOI: 10.1177/17474930211006296] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiovascular events occur more often in winter than in summer; however, the dependence of strokes on various meteorological factors remains unclear. AIMS The purpose of this meta-analysis was to determine the dependence of the circannual dynamics of hospitalizations for hemorrhagic stroke and ischemic stroke on seasonal fluctuations in meteorological factors. SUMMARY OF REVIEW AND CONCLUSIONS For our meta-analysis, we selected 20 and 26 publications examining the seasonal dynamics of hemorrhagic stroke and ischemic stroke, respectively . The meta-analysis showed that hemorrhagic stroke is less likely to occur in summer than in other seasons and does not depend on a region's climate. The seasonal dynamics of ischemic stroke are not clearly expressed and are determined by the characteristics of a region's climate. In a climate without pronounced seasonal dynamics of atmospheric pressure and in wet winters, the vector of ischemic stroke incidents will not be expressed or slightly shifted toward winter. Low atmospheric pressure in summer is associated with an increased likelihood of ischemic stroke during this season compared to winter. There was also a relation between ischemic stroke risk with high relative humidity and a significant decrease in ρO2 in summer, but there is not enough evidence regarding this association. We did not reveal dependence of the seasonal dynamics of strokes on the amplitude of annual fluctuations in air temperature.
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Affiliation(s)
- N V Kuzmenko
- Department for Experimental Physiology and Pharmacology, 123488Almazov National Medical Research Centre, St. Petersburg, Russia.,Laboratory of Biophysics of Blood Circulation, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - M M Galagudza
- Department for Experimental Physiology and Pharmacology, 123488Almazov National Medical Research Centre, St. Petersburg, Russia
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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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Wang RR, Hao Y, Guo H, Wang MQ, Han L, Zheng RY, He J, Wang ZR. Lunar cycle and psychiatric hospital admissions for schizophrenia: new findings from Henan province, China. Chronobiol Int 2020; 37:438-449. [PMID: 32252567 DOI: 10.1080/07420528.2019.1625054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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
| | - Hua Guo
- Department of psychiatry, The Psychiatric Hospital of Zhumadian, Zhumadian City, Henan province, China
| | - Meng-Qi Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ling Han
- 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
| | - Juan He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Ren Wang
- Psychiatry research center, Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
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Lowe M, Maidstone R, Poulton K, Worthington J, Durrington HJ, Ray DW, van Dellen D, Asderakis A, Blaikley J, Augustine T. Monthly variance in UK renal transplantation activity: a national retrospective cohort study. BMJ Open 2019; 9:e028786. [PMID: 31530596 PMCID: PMC6756352 DOI: 10.1136/bmjopen-2018-028786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify whether renal transplant activity varies in a reproducible manner across the year. DESIGN Retrospective cohort study using NHS Blood and Transplant data. SETTING All renal transplant centres in the UK. PARTICIPANTS A total of 24 270 patients who underwent renal transplantation between 2005 and 2014. PRIMARY OUTCOME Monthly transplant activity was analysed to see if transplant activity showed variation during the year. SECONDARY OUTCOME The number of organs rejected due to healthcare capacity was analysed to see if this affected transplantation rates. RESULTS Analysis of national transplant data revealed a reproducible yearly variance in transplant activity. This activity increased in late autumn and early winter (p=0.05) and could be attributed to increased rates of living (October and November) and deceased organ donation (November and December). An increase in deceased donation was attributed to a rise in donors following cerebrovascular accidents and hypoxic brain injury. Other causes of death (infections and road traffic accidents) were more seasonal in nature peaking in the winter or summer, respectively. Only 1.4% of transplants to intended recipients were redirected due to a lack of healthcare capacity, suggesting that capacity pressures in the National Health Service did not significantly affect transplant activity. CONCLUSION UK renal transplant activity peaks in late autumn/winter in contrast to other countries. Currently, healthcare capacity, though under strain, does not affect transplant activity; however, this may change if transplantation activity increases in line with national strategies as the spike in transplant activity coincides with peak activity in the national healthcare system.
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Affiliation(s)
- Marcus Lowe
- Transplantation Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
| | - Robert Maidstone
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Kay Poulton
- Transplantation Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Worthington
- Transplantation Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
| | - Hannah J Durrington
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - David W Ray
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - David van Dellen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Transplant and Endocrine Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - John Blaikley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Titus Augustine
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Transplant and Endocrine Surgery, Manchester University NHS Foundation Trust, Manchester, UK
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Seasonal variation in the occurrence of ischemic stroke: A meta-analysis. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2113-2130. [PMID: 30848411 DOI: 10.1007/s10653-019-00265-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/11/2019] [Indexed: 02/05/2023]
Abstract
Stroke was demonstrated to correlate with seasonal variation. However, the relevant studies were incongruous. To better understand the rules of seasonal impact on ischemic stroke (IS) patients, we performed this meta-analysis. We systematically searched relevant observational studies in Pubmed, Web of science and Embase from January 1, 1980, to November 1, 2017, in English. Patients included in this study were adults who suffered from IS. Stata version 12.0 software was used to pool useful data and calculate incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). We also performed heterogeneity and sensitivity analyses and evaluated publication bias. Thirty-three observational studies involving 234,196 participants were incorporated into the meta-analysis. Summer and December were regarded as reference, respectively. The IRRs were calculated showing: IRRWinter 1.05 (95% CI 1.04-1.07), IRRAutumn 1.03 (95% CI 1.02-1.04), IRRSpring 1.02 (95% CI 1.01-1.03). No obvious difference existed among 12 months. Stratified analyses on Köppen classification were also conducted. Between-study heterogeneity was discovered; however, predefined stratified analyses and meta-regression could not reduce this heterogeneity. Our meta-analysis has revealed very little seasonal variation in the overall study. Both cold and hot months may be high risky for IS after stratified by Köppen Climate Classification. Thus, a rationale to environmental setting of risky patient management could be provided. More studies with specific assessments are warranted for further comprehensive investigation.
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Affiliation(s)
- Ujjwal Chakraborty
- Life Science Division, Moulasole R.B. High School, Moulasole, Bankura, West Bengal, India
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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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Ruuskanen JO, Sipilä JOT, Rautava P, Kytö V. No association of moon phase with stroke occurrence. Chronobiol Int 2018; 35:1168-1174. [PMID: 29790788 DOI: 10.1080/07420528.2018.1465071] [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] [Indexed: 10/16/2022]
Abstract
Stroke occurrence shows strong correlations with sleep disorders and even subtle sleep disturbances have been shown to affect ischemic stroke (IS) occurrence. Chronobiology also exerts effects, like the morning surge in IS occurrence. Lunar cycles have also been shown to affect sleep and other physiological processes, but studies on moon phases and its possible association with occurrence of stroke are rare and nonconclusive. Therefore, we studied the effects of moon phases on stroke hospitalizations and in-hospital mortality nationwide in Finland in 2004-2014. All patients aged ≥18 years with IS or intracerebral hemorrhage (ICH) as primary discharge diagnosis were included. Daily number of admissions was treated as a response variable while moon phase, year and astronomical season were independent variables in Poisson regression modeling. We found no association between moon phases and stroke occurrence. The overall occurrence rates did not vary between different moon phases for IS or ICH (p = 0.61 or higher). There were no differences between moon phases in daily admission rates among men, women, young and old patients for any of the stroke subtypes. There was no difference in in-hospital mortality with regard to moon phase for IS or ICH overall (p = 0.19 or higher), nor in subgroup analyses. There were no significant interactions between moon phase and astronomical season for stroke occurrence or in-hospital mortality. To conclude, in this over a decade-long nationwide study including a total of 46 million person years of follow-up, we found no association between moon phases and occurrence or in-hospital mortality rates of IS or intracerebral hemorrhage.
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Affiliation(s)
- Jori O Ruuskanen
- a Division of Clinical Neurosciences , Turku University Hospital , Turku , Finland.,b Neurology , University of Turku , Turku , Finland
| | - Jussi O T Sipilä
- a Division of Clinical Neurosciences , Turku University Hospital , Turku , Finland.,b Neurology , University of Turku , Turku , Finland.,c Department of Neurology , Siun sote North Karelia Central Hospital , Joensuu , Finland
| | - Päivi Rautava
- d Clinical Research Center , Turku University Hospital , Turku , Finland.,e Department of Public Health , University of Turku , Turku , Finland
| | - Ville Kytö
- f Research Centre of Applied and Preventive Cardiovascular Medicine , University of Turku , Turku , Finland.,g Heart Center , Turku University Hospital , Turku , Finland
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Liu Y, Gong P, Wang M, Zhou J. Seasonal variation of admission severity and outcomes in ischemic stroke - a consecutive hospital-based stroke registry. Chronobiol Int 2018; 35:295-302. [PMID: 29372813 DOI: 10.1080/07420528.2017.1369430] [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] [Indexed: 10/18/2022]
Abstract
Different morbidities and mortalities of ischemic stroke may occur among seasons. For detecting the seasonal variations of severity after stroke onset and prognosis, we employed a retrospective analysis on a prospective regional hospital-based stroke registry and included a total of 1039 consecutive patients with onset date from January 2014 to December 2015. Patients were divided into four groups according to the onset seasons. Baseline characteristics, stroke subtypes, admission National Institute of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score in 90 d were recorded and compared. Ordinal logistic regression was used to evaluate the association of seasons and severity or outcomes. Higher proportion of cardiac embolisms appeared in spring and winter (p < 0.001). The median admission NIHSS score was 5 in spring, 3 in summer, 4 in fall and 4 in winter (p = 0.036). After 90 d from onset, 40.5% of patients in spring suffered poor outcome (mRS 3-6), while 24.6% in summer, 33.9% in fall and 40.1% in winter (p < 0.001). After adjusted for age, sex, stroke subtypes and other covariates, patients in spring and winter had 1.76 times (95%CI 1.14-2.70, p = 0.010) and 1.53 times (95%CI 1.08-2.18, p = 0.017) the risk of suffering higher severity category than patients in summer, respectively. Compared with summer group, risk of worse outcomes at 90 d increased to 2.30 times in spring (95%CI 1.53-3.45, p < 0.001), 1.57 times in fall (95%CI 1.14-2.16, p = 0.006) and 2.09 times in winter (95%CI 1.50-2.91, p < 0.001), respectively. In conclusion, onset seasons were associated with severity and outcomes in ischemic stroke, and patients admitted in spring and winter had more severity and worse outcomes than patients in summer.
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Affiliation(s)
- Yukai Liu
- a Department of Neurology , Nanjing First Hospital, Nanjing Medical University , Nanjing , P.R. China
| | - Pengyu Gong
- a Department of Neurology , Nanjing First Hospital, Nanjing Medical University , Nanjing , P.R. China
| | - Meng Wang
- a Department of Neurology , Nanjing First Hospital, Nanjing Medical University , Nanjing , P.R. China
| | - Junshan Zhou
- a Department of Neurology , Nanjing First Hospital, Nanjing Medical University , Nanjing , P.R. China
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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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Abstract
INTRODUCTION The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent. METHODS A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004-2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH). RESULTS The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality. CONCLUSIONS All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades. Key messages All major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer. Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype. The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982-1992.
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Affiliation(s)
- Jussi O T Sipilä
- a North Karelia Central Hospital , Joensuu , Finland.,b Division of Clinical Neurosciences , Turku University Hospital , Turku , Finland.,c Department of Neurology , University of Turku , Turku , Finland
| | - Jori O Ruuskanen
- d Turku University Hospital , Turku , Finland.,e Department of Neurology , University of Turku , Turku , Finland
| | - Tommi Kauko
- f Department of Biostatistics , University of Turku , Turku , Finland
| | - Päivi Rautava
- g Department of Public Health , University of Turku , Turku , Finland.,h Turku Clinical Research Centre, Turku University Hospital , Turku , Finland
| | - Ville Kytö
- i Heart Center, Turku University Hospital , Turku , Finland.,j Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku , Turku , Finland
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15
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Bunevicius A, Gendvilaite A, Deltuva VP, Tamasauskas A. The association between lunar phase and intracranial aneurysm rupture: Myth or reality? Own data and systematic review. BMC Neurol 2017; 17:99. [PMID: 28525979 PMCID: PMC5437543 DOI: 10.1186/s12883-017-0879-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/09/2017] [Indexed: 11/24/2022] Open
Abstract
Background It is a common belief in medical community that lunar phases have an impact on human health. A growing body of evidence indicates that lunar phases can predict the risk to develop acute neurological and vascular disorders. The goal of present report was to present our institution data and to perform systematic review of studies examining the association of intracranial aneurysm rupture with moon phases. Methods We identified all patients admitted to our department for ruptured intracranial aneurysms in a period between November, 2011 and December, 2014. Patients with a known aneurysm rupture date were included. Lunar phases were determined by dividing lunar month (29.5 days) into eight equal parts, i.e., new moon, waxing crescent, first quarter, waxing gibbous, full moon, waning gibbous, last quarter and waning crescent. A systematic literature review was undertaken to identify studies that evaluated the association of lunar phases with the incident of intracranial aneurysm rupture. Result One hundred and eighty-six patients (62 men and 124 women, median age 56 years) were admitted to our department for treatment of ruptured intracranial aneurysms. The rate of intracranial aneurysm rupture was equally distributed across all phases of the lunar cycle (X2 [7; 185] = 12.280, p = 0.092). We identified three studies that evaluated the association between incident intracranial aneurysm rupture and lunar phases with a total of 1483 patients. One study from Lebanon found that the incidence rate of intracranial aneurysm rupture was statistically significantly greater during the new moon phase (25% cases), relative to the other seven lunar phases (p < 0.001). Two subsequent studies from Austria and Germany in larger patient samples (n = 717 and n = 655, respectively) did not find an association between lunar phases and intracranial aneurysm rupture (p-values of 0.84 and 0.97, respectively). When analyzing all four studies together, we did not find an association between lunar phases and incidence of intracranial aneurysm rupture (X2 [1668; 7] = 2.080, p = 0.955). Conclusions Moon phases are not associated with incidence of intracranial aneurysm rupture. Studies investigating the association of intracranial aneurysm rupture with lunar illumination defined using more sensitive approaches are encouraged.
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Affiliation(s)
- Adomas Bunevicius
- Institute of Neurosciences, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50009, Kaunas, Lithuania. .,Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania.
| | - Agne Gendvilaite
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytenis Pranas Deltuva
- Institute of Neurosciences, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50009, Kaunas, Lithuania.,Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Arimantas Tamasauskas
- Institute of Neurosciences, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50009, Kaunas, Lithuania.,Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
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Reinberg A, Smolensky MH, Touitou Y. The full moon as a synchronizer of circa-monthly biological rhythms: Chronobiologic perspectives based on multidisciplinary naturalistic research. Chronobiol Int 2016; 33:465-79. [DOI: 10.3109/07420528.2016.1157083] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Alain Reinberg
- Unité de Chronobiologie, Fondation A de Rothschild, Paris cedex 19, France
| | - Michael H. Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Yvan Touitou
- Unité de Chronobiologie, Fondation A de Rothschild, Paris cedex 19, France
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