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Shi L, Wang B, Wu Q, Yang J, Wang L, Wan D, Wang Y, Feng Z, Zhang W, Li L, Wang W, Chen J, Ai X, Zheng J, Zhang Z, He M. Heatstroke: a multicenter study in Southwestern China. Front Public Health 2024; 12:1349753. [PMID: 38699425 PMCID: PMC11064700 DOI: 10.3389/fpubh.2024.1349753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Background An increase in Heatstroke cases occurred in southwest China in 2022 due to factors like global warming, abnormal temperature rise, insufficient power supply, and other contributing factors. This resulted in a notable rise in Heatstroke patients experiencing varying degrees of organ dysfunction. This descriptive study aims to analyze the epidemiology and clinical outcomes of Heatstroke patients in the ICU, providing support for standardized diagnosis and treatment, ultimately enhancing the prognosis of Heatstroke. Methods A retrospective, multicenter, descriptive analysis was conducted on Heatstroke patients admitted to ICUs across 83 hospitals in southwest China. Electronic medical records were utilized for data collection, encompassing various aspects such as epidemiological factors, onset symptoms, complications, laboratory data, concurrent infections, treatments, and patient outcomes. Results The dataset primarily comprised classic heatstroke, with 477 males (55% of total). The patient population had a median age of 72 years (range: 63-80 years). The most common initial symptoms were fever, mental or behavioral abnormalities, and fainting. ICU treatment involved respiratory support, antibiotics, sedatives, and other interventions. Among the 700 ICU admissions, 213 patients had no infection, while 487 were diagnosed with infection, predominantly lower respiratory tract infection. Patients presenting with neurological symptoms initially (n = 715) exhibited higher ICU mortality risk compared to those without neurological symptoms (n = 104), with an odds ratio of 2.382 (95% CI 1.665, 4.870) (p = 0.017). Conclusion In 2022, the majority of Heatstroke patients in southwest China experienced classical Heatstroke, with many acquiring infections upon admission to the ICU. Moreover, Heatstroke can result in diverse complications.
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Affiliation(s)
- Lvyuan Shi
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lietao Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dingyuan Wan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yucong Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhongxue Feng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Wei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Li Li
- Department of Critical Care Medicine, The Second People's Hospital of Neijiang City, Neijiang, Sichuan, China
| | - Wenhu Wang
- Department of Critical Care Medicine, Zizhong County People's Hospital, Neijiang, Sichuan, China
| | - Jun Chen
- Department of Critical Care Medicine, The People's Hospital of Jianyang City, Jianyang, Sichuan, China
| | - Xiaohua Ai
- Department of Critical Care Medicine, The People's Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Jianwei Zheng
- Department of Critical Care Medicine, Hejiang People's Hospital, Luzhou, Sichuan, China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Stearns RL, Hosokawa Y, Belval LN, Martin DG, Huggins RA, Jardine JF, Casa DJ. Exertional Heat Stroke Survival at the Falmouth Road Race: 180 New Cases With Expanded Analysis. J Athl Train 2024; 59:304-309. [PMID: 37655801 PMCID: PMC10976335 DOI: 10.4085/1062-6050-0065.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
CONTEXT A high number of exertional heat stroke (EHS) cases occur during the Falmouth Road Race. OBJECTIVES To extend previous analyses of EHS cases during the Falmouth Road Race by assessing or describing (1) EHS and heat exhaustion (HE) incidence rates, (2) EHS outcomes as they relate to survival, (3) the effect of the environment on these outcomes, and (4) how this influences medical provider planning and preparedness. DESIGN Descriptive epidemiologic study. SETTING Falmouth Road Race. PATIENTS OR OTHER PARTICIPANTS Patients with EHS or HE admitted to the medical tent. MAIN OUTCOME MEASURE(S) We obtained 8 years (2012 to 2019) of Falmouth Road Race anonymous EHS and HE medical records. Meteorologic data were collected and analyzed to evaluate the effect of environmental conditions on the heat illness incidence (exertional heat illness [EHI] = EHS + HE). The EHS treatment and outcomes (ie, cooling time, survival, and discharge outcome), number of HE patients, and wet bulb globe temperature (WBGT) for each race were analyzed. RESULTS A total of 180 EHS and 239 HE cases were identified. Overall incidence rates per 1000 participants were 2.07 for EHS and 2.76 for HE. The EHI incidence rate was 4.83 per 1000 participants. Of the 180 EHS cases, 100% survived, and 20% were transported to the emergency department. The WBGT was strongly correlated with the incidence of both EHS (r2 = 0.904, P = .026) and EHI (r2 = 0.912, P = .023). CONCLUSIONS This is the second-largest civilian database of EHS cases reported. When combined with the previous dataset of EHS survivors from this race, it amounts to 454 EHS cases resulting in 100% survival. The WBGT remained a strong predictor of EHS and EHI cases. These findings support 100% survival from EHS when patients over a wide range of ages and sexes are treated with cold-water immersion.
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Affiliation(s)
- Rebecca L. Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | | | - David G. Martin
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Robert A. Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - John F. Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Gossack-Keenan K, Yeom DS, Kanu J, Hau JP, Rosychuk RJ, Clark D, Bola R, Tze C, Niosco C, Emery H, Yeung P, Hohl CM. Heatstroke presentations to urban hospitals during BC's extreme heat event: lessons for the future. CAN J EMERG MED 2024; 26:111-118. [PMID: 38153655 PMCID: PMC10861625 DOI: 10.1007/s43678-023-00622-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/07/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC's 2021 heat dome. METHODS We conducted a review of consecutive adults presenting to 7 hospitals in BC's Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality. RESULTS Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3). INTERPRETATION Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.
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Affiliation(s)
- Kira Gossack-Keenan
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Medicine, Diamond Health Care Centre, 11th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - David Seonguk Yeom
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Josephine Kanu
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | | | - Dylan Clark
- Climate Institute Canada, Vancouver, BC, Canada
| | - Rajan Bola
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Caris Tze
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Niosco
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hayley Emery
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Phillip Yeung
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada
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Wang YC, Jin XY, Lei Z, Liu XJ, Liu Y, Zhang BG, Gong J, Wang LT, Shi LY, Wan DY, Fu X, Wang LP, Ma AJ, Cheng YS, Yang J, He M, Jin XD, Kang Y, Wang B, Zhang ZW, Wu Q. Gastrointestinal manifestations of critical ill heatstroke patients and their associations with outcomes: A multicentre, retrospective, observational study. World J Gastroenterol 2024; 30:346-366. [PMID: 38313238 PMCID: PMC10835541 DOI: 10.3748/wjg.v30.i4.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/17/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Extreme heat exposure is a growing health problem, and the effects of heat on the gastrointestinal (GI) tract is unknown. This study aimed to assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes. AIM To assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes. METHODS Patients admitted to the intensive care unit (ICU) due to heatstroke were included from 83 centres. Patient history, laboratory results, and clinically relevant outcomes were recorded at ICU admission and daily until up to day 15, ICU discharge, or death. GI symptoms, including nausea/vomiting, diarrhoea, flatulence, and bloody stools, were recorded. The characteristics of patients with heatstroke concomitant with GI symptoms were described. Multivariable regression analyses were performed to determine significant predictors of GI symptoms. RESULTS A total of 713 patients were included in the final analysis, of whom 132 (18.5%) patients had at least one GI symptom during their ICU stay, while 26 (3.6%) suffered from more than one symptom. Patients with GI symptoms had a significantly higher ICU stay compared with those without. The mortality of patients who had two or more GI symptoms simultaneously was significantly higher than that in those with one GI symptom. Multivariable logistic regression analysis revealed that older patients with a lower GCS score on admission were more likely to experience GI symptoms. CONCLUSION The GI manifestations of heatstroke are common and appear to impact clinically relevant hospitalization outcomes.
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Affiliation(s)
- Yu-Cong Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin-Yang Jin
- School of Pharmacy, Macau University of Science and Technology, Macau 999078, China
| | - Zheng Lei
- Department of Critical Care Medicine, The First People's Hospital of Ziyang City, Ziyang 641399, Sichuan Province, China
| | - Xiao-Jiao Liu
- Department of Critical Care Medicine, The First People's Hospital of Guanghan City, Chengdu 618399, Sichuan Province, China
| | - Yu Liu
- Department of Critical Care Medicine, Lezhi County Traditional Chinese Medicine Hospital, Chengdu 641599, Sichuan Province, China
| | - Bang-Guo Zhang
- Department of Critical Care Medicine, Chengdu Qingbaijiang District People's Hospital, Chengdu 610399, Sichuan Province, China
| | - Jian Gong
- Department of Critical Care Medicine, Ziyang People's Hospital, Chengdu 641399, Sichuan Province, China
| | - Lie-Tao Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lv-Yuan Shi
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ding-Yuan Wan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Fu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lu-Ping Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ai-Jia Ma
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Song Cheng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Dong Jin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhong-Wei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Fujimoto M, Hayashi K, Nishiura H. Possible adaptation measures for climate change in preventing heatstroke among older adults in Japan. Front Public Health 2023; 11:1184963. [PMID: 37808973 PMCID: PMC10556232 DOI: 10.3389/fpubh.2023.1184963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Heatstroke mortality is highest among older adults aged 65 years and older, and the risk is even doubled among those aged 75 years and older. The incidence of heatstroke is expected to increase in the future with elevated temperatures owing to climate change. In the context of a super-aged society, we examined possible adaptation measures in Japan that could prevent heatstroke among older people using an epidemiological survey combined with mathematical modeling. Methods To identify possible interventions, we conducted a cross-sectional survey, collecting information on heatstroke episodes from 2018 to 2019 among people aged 75 years and older. Responses were analyzed from 576 participants, and propensity score matching was used to adjust for measurable confounders and used to estimate the effect sizes associated with variables that constitute possible interventions. Subsequently, a weather-driven statistical model was used to predict heatstroke-related ambulance transports. We projected the incidence of heatstroke-related transports until the year 2100, with and without adaptation measures. Results The risk factor with the greatest odds ratio (OR) of heatstroke among older adults was living alone (OR 2.5, 95% confidence interval: 1.2-5.4). Other possible risk factors included an inability to drink water independently and the absence of air conditioning. Using three climate change scenarios, a more than 30% increase in the incidence of heatstroke-related ambulance transports was anticipated for representative concentration pathways (RCP) 4.5 and 8.5, as compared with a carbon-neutral scenario. Given 30% reduction in single living, a 15% reduction in the incidence of heatstroke is expected. Given 70% improvement in all three risk factors, a 40% reduction in the incidence can be expected. Conclusion Possible adaptation measures include providing support for older adults living alone, for those who have an inability to drink water and for those without air conditioning. To be comparable to carbon neutrality, future climate change under RCP 2.6 requires achieving a 30% relative reduction in all three identified risks at least from 2060; under RCP 4.5, a 70% reduction from 2050 at the latest is needed. In the case of RCP 8.5, the goal of heatstroke-related transports approaching RCP 1.9 cannot be achieved.
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Oka K, Honda Y, Hui Phung VL, Hijioka Y. Potential effect of heat adaptation on association between number of heatstroke patients transported by ambulance and wet bulb globe temperature in Japan. Environ Res 2023; 216:114666. [PMID: 36328225 DOI: 10.1016/j.envres.2022.114666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
This study analyzed the association between heatstroke incidence and daily maximum wet bulb globe temperature (WBGT) for all 47 prefectures in Japan by age group and severity using time-series analysis, controlling for confounders, such as seasonality and long-term trends. With the obtained association, the relative risk between the reference WBGT (defined as the value at which heatstroke starts to increase) and the daily maximum WBGT at 30 °C (RRwbgt30) of each prefecture were calculated. For the heatstroke data, the daily number of heatstroke patients transported by ambulance at the prefecture level, provided by the Fire and Disaster Management Agency, was utilized. The analysis was conducted for age groups of 7-17 y, 18-64 y, and ≥65 y, and for severity of Deceased, Severe, Moderate (combined as DSM), and Mild. The analysis period was set from May 1 to September 30, 2015-2019. Finally, the correlation between RRwbgt30 and the average daily maximum WBGT during the analysis period (aveWBGTms) of each prefecture was analyzed to examine the regionality of heatstroke incidence. The result showed that RRwbgt30 is negatively correlated with aveWBGTms for the age group 18-64 y and ≥65 y (except for the age group 7-17 y) and for severity. The natural logarithm of the RRwbgt30 of all 47 prefectures ranged from 2.0 to 8.2 for the age group 7-17 y, 1.1 to 4.0 for the age group 18-64 y, 1.8 to 6.0 for the age group ≥65 y, and 1.0 to 3.6 for DSM, and 0.9 to 4.0 for Mild. This regionality can be attributed to the effects of heat adaptation, where people in hotter regions are accustomed to implementing measures against hot environments and are more heat acclimatized than people in cooler regions.
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Affiliation(s)
- Kazutaka Oka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan.
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Vera Ling Hui Phung
- Center for Climate Change Adaptation, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Yasuaki Hijioka
- Center for Climate Change Adaptation, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
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Lien TC, Tabata T. Regional incidence risk of heat stroke in elderly individuals considering population, household structure, and local industrial sector. Sci Total Environ 2022; 853:158548. [PMID: 36096227 DOI: 10.1016/j.scitotenv.2022.158548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
This study aims to clarify the regional characteristics of heat stroke incidence patterns inside and outside residences among the elderly from the perspective of working and living conditions. The study area comprised 41 municipalities belonging to Hyogo Prefecture in Japan. Based on information on heat stroke emergency medical evacuees in each municipality from 2011 to 2020, the regional differences in the incidence risk of heat stroke were analyzed. The results revealed that the number of cases and the proportion of males and females among them were related to the demographic structure of each municipality. A grouping analysis was conducted to classify the characteristics of each municipality based on the relationship between the incidence risk of heat stroke and the industrial structure. A factor analysis and binomial logistic regression analysis were also conducted to investigate the effect of demographic structure on the incidence risk of heat stroke. The results indicate that the incidence risk of heat stroke is correlated with industrial and demographic structures, and the risk is likely to vary regionally.
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Affiliation(s)
- Tzu-Chen Lien
- Graduate School of Human Development and Environment, Kobe University, Japan
| | - Tomohiro Tabata
- Graduate School of Human Development and Environment, Kobe University, Japan.
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Nakamura D, Kinoshita H, Asada K, Arimitsu T, Yasumatsu M, Ishiwata T. Trends in ambulance dispatches related to heat illness from 2010 to 2019: An ecological study. PLoS One 2022; 17:e0275641. [PMID: 36342929 PMCID: PMC9639828 DOI: 10.1371/journal.pone.0275641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
Heatstroke is a serious heat-related illness that can even cause death. Heat alert systems play an important role in reducing the number of patients experiencing heat illness, as they encourage preventive actions such as the use of air conditioning, hydration, or other strategies. However, to date, the Japanese hazard classification has not considered seasonal and regional variations, despite clear differences in meteorological conditions across different regions in Japan. Moreover, several studies have reported a difference in thermoregulation between older and younger adults, implying that the hazard classification should also consider age differences. This study examined the relationship between the number of ambulance dispatches related to heat illness (ADRHI) and the Japanese heat hazard classification from 2010 to 2019, focusing on monthly and regional differences. Data from 47 prefectures during the 10-year period were collected and analyzed. ADRHI and wet bulb globe temperature (WBGT) data were collected from Japan’s Ministry of Internal Affairs and Communications and the Ministry of the Environment Heat Illness Prevention Information website, respectively. The findings showed a significant relationship between ADRHI and WBGTmax (p < 0.05, r = 0.74). ADRHI per 100,000 people showed significant differences across months. The post hoc test detected the first steep increase in ADRHI at a WBGTmax of 23°C than at 22°C in June, and at a WBGTmax of 26°C, 27°C, and 25°C in July, August, and September, respectively. Moreover, the first significant increase in ADRHI per 100,000 people at WBGTmax differed across each region, at a WBGTmax of 24°C in Hokkaido-Tohoku, 25°C in Kanto, Kansai, and Chugoku, 26°C in Chubu, 27°C in Shikoku, and 28°C in Kyushu-Okinawa. Further, Poisson regression analysis revealed that the relative risks differed across each region and month. These results imply that the hazard classification should be adjusted according to region and month in Japan.
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Affiliation(s)
- Daisuke Nakamura
- Weathernews Inc., Makuhari Techno Garden, Chiba, Japan
- Rikkyo Research Institute of Wellness, Rikkyo University, Tokyo, Japan
- Physical Fitness Project, Japan Football Association (JFA), Tokyo, Japan
- * E-mail:
| | | | - Kazuo Asada
- Weathernews Inc., Makuhari Techno Garden, Chiba, Japan
| | - Takuma Arimitsu
- Faculty of Health Care, Department of Human Health, Hachinohe Gakuin University, Aomori, Japan
| | - Mikinobu Yasumatsu
- Rikkyo Research Institute of Wellness, Rikkyo University, Tokyo, Japan
- Physical Fitness Project, Japan Football Association (JFA), Tokyo, Japan
- Department of Sport and Wellness, Rikkyo University, Saitama, Japan
| | - Takayuki Ishiwata
- Rikkyo Research Institute of Wellness, Rikkyo University, Tokyo, Japan
- Department of Sport and Wellness, Rikkyo University, Saitama, Japan
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Weng SF, Zhu DX, Lin DF, Zhang LZ, Zhang M, Zhang NX. [Investigation on occupational injury of sanitation workers in Shenzhen City]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:500-503. [PMID: 35915939 DOI: 10.3760/cma.j.cn121094-20210629-00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To understand the occurrence of occupational injuries among sanitation workers in Shenzhen, and provide a scientific basis for the prevention of occupational injuries among sanitation workers. Methods: From May to November 2020, a cluster sampling method was used to select some street sanitation workers in Shenzhen to conduct a questionnaire survey. A total of 2200 questionnaires were recovered, of which 2167 were valid (98.5% effective recovery rate) . The socio-demographic data, length of service, type of work and occurrence of occupational injuries of sanitation workers were collected, and the distribution characteristics of occupational injuries and their relationship with factors such as type of work were analyzed. Results: Among the 2167 sanitation workers, 240 (11.1%) had experienced occupational injuries. The most common occupational injuries among sanitation workers were sharp injury, heat stroke and motor vehicle traffic accident, with the incidence rates of 6.1% (133/2167) , 2.4% (53/2167) and 1.7% (36/2167) respectively. There were statistically significant differences in the distribution of occupational injuries among sanitation workers with different lengths of work and types of work (P<0.05) . The incidence of occupational injury among sanitation workers with more than 5 years of service was significantly higher than that of workers with less than 5 years of service (P<0.05) . The incidence of sharp injury among garbage sorting and transportation personnel was higher (7.9%, 21/265) , the incidence of heat stroke among manual cleaners was higher (3.1%, 42/1366) , and the incidence of motor vehicle traffic accident among mechanized cleaners was higher (5.4%, 10/184) . Conclusion: There are many cases of occupational injuries among sanitation workers in Shenzhen. Targeted measures should be taken to prevent the occurrence of different types of work and different types of occupational injuries, and to improve the occupational health level of sanitation workers.
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Affiliation(s)
- S F Weng
- Occupational Hazard Assessment Institute of Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - D X Zhu
- Comprehensive Management Department of Occupational Health of Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - D F Lin
- Occupational Hazard Assessment Institute of Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - L Z Zhang
- Comprehensive Management Department of Occupational Health of Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - M Zhang
- Comprehensive Management Department of Occupational Health of Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - N X Zhang
- Executive Office of Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
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Hatakeyama K, Seposo X. Heatstroke-related ambulance dispatch risk before and during COVID-19 pandemic: Subgroup analysis by age, severity, and incident place. Sci Total Environ 2022; 821:153310. [PMID: 35085629 PMCID: PMC8784651 DOI: 10.1016/j.scitotenv.2022.153310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In summer 2020 under the COVID-19 pandemic, the Ministry of Health, Labour and Welfare has made public warnings that specific preventive measures such as maskwearing and stay-at-home orders, may increase heatstroke risk. In our previous work, we found a lower risk of heatstroke-related ambulance dispatches (HSAD) during the COVID-19 period, however, it is uncertain whether similar risk reductions can be observed in different vulnerable subgroups. This study aimed to determine the HSAD risk during the COVID-19 pandemic by age, severity, and incident place subgroups. METHOD A summer-specific (June-September), time-series analysis was performed, using daily HSAD and meteorological data from 47 Japanese prefectures from 2017 to 2020. A two-stage analysis was applied to determine the association between HSAD and COVID-19 pandemic, adjusting for maximum temperature, humidity, seasonality, and relevant temporal adjustments. A generalized linear model was utilized in the first stage to estimate the prefecture-specific effect estimates. Thereafter, a fixed effect meta-analysis in the second stage was implemented to pool the first stage estimates. Subsequently, subgroup analysis via an interaction by age, severity, and incident place was used to analyze the HSAD risk among subgroups. RESULTS A total of 274,031 HSAD cases was recorded across 47 Japanese prefectures. The average total number of HSAD in the pre-COVID-19 period was 69,721, meanwhile, the COVID-19 period was 64,869. Highest reductions in the risks was particularly observed in the young category (ratio of relative risk (RRR) = 0.54, 95% Confidential Interval (CI): 0.51, 0.57) compared to the elderly category. Whereas highest increment in the risks were observed in severe/death (RRR = 1.25, 95% CI: 1.13, 1.37) compared to the mild category. CONCLUSION COVID-19 situation exhibited a non-uniform change in the HSAD risk for all subgroups, with the magnitude of the risks varying by age, severity, and incident place.
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Affiliation(s)
- Koya Hatakeyama
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Xerxes Seposo
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan.
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11
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Williams V, Oh GT. Update: Heat illness, active component, U.S. Armed Forces, 2021. MSMR 2022; 29:8-14. [PMID: 35608520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In 2021, there were 488 incident cases of heat stroke and 1,864 incident cases of heat exhaustion among active component service members of the U.S. Armed Forces. The unadjusted annual rates of incident heat stroke and heat exhaustion peaked in 2018 and then declined in 2019 and 2020. Between 2020 and 2021, the rate of incident heat stroke was relatively stable (0.37 cases per 1,000 person-years [p-yrs]) while the rate of heat exhaustion increased slightly (1.40 cases per 1,000 p-yrs). In 2021, subgroup-specific rates of incident heat stroke and heat exhaustion were highest among male service members, those less than 20 years old, Marine Corps and Army members, recruit trainees, and those in combat-specific occupations. During 2017–2021, a total of 312 heat illnesses were documented among service members in the U.S. Central Command (CENTCOM) area of responsibility (AOR); 6.4% (n=20) were diagnosed as heat stroke. Commanders, small unit leaders, training cadre, and supporting medical personnel must ensure that the military members whom they supervise and support are informed about the risks, preventive countermeasures, early signs and symptoms, and first-responder actions related to heat illnesses.
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12
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DeGroot D, Henderson K, O'Connor F. Exertional heat illness at Fort Benning, GA: Unique insights from the Army Heat Center. MSMR 2022; 29:2-7. [PMID: 35608507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Army Heat Center at Fort Benning, GA was established to identify and disseminate best practices for the prevention, field care, evacuation, hospital care, and return to duty of exertional heat casualties. During the 2017-2021 surveillance period, there were 1,911 heat casualties treated at Ft. Benning's Martin Army Community Hospital. Most patients were junior enlisted and officer personnel who were engaged in initial entry training. Heat exhaustion, heat injury, heat stroke, and hyponatremia accounted for 52.6%, 18.4%, 18.2%, and 2.0% of total heat illnesses, respectively. The annual proportion of heat casualties that were due to heat exhaustion rose steadily during the surveillance period, reaching 77.7% in 2021, while the incidence of heat injury and heat stroke did not increase during this period. Data are presented on the occurrence of clusters of heat illness, the association of cases of heat stroke with arduous physical activities, and the seasonal variation in incidence of heat illnesses. It is important that unit leaders and trainers understand the risk factors for heat illness among those being trained and that early first aid measures be employed in the field (especially rapid cooling).
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13
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Fisher JD, Shah AP, Norozian F. Clinical Spectrum of Pediatric Heat Illness and Heatstroke in a North American Desert Climate. Pediatr Emerg Care 2022; 38:e891-e893. [PMID: 33848093 DOI: 10.1097/pec.0000000000002438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The spectrum of historical features and clinical presentations of heat illness and heatstroke in the pediatric population has received limited focus in the emergency medicine literature. The majority of published cases involve children trapped in closed spaces and adolescent athletes undergoing high-intensity training regimens in geographical regions with moderately high ambient temperatures and high humidity. There has been less research on the potential impact of extreme temperatures and radiant heat that are the hallmarks of the US southwest region. We performed a retrospective review of pediatric heat illness at our facility located in a North American desert climate.
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Affiliation(s)
- Jay D Fisher
- From the Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV
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14
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Merchant RK, Grundstein A, Yeargin S, Emerson D. Exertional heat illnesses in marching band artists: a case series. Int J Biometeorol 2021; 65:2181-2188. [PMID: 34424411 DOI: 10.1007/s00484-021-02183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Marching band (MB) artists frequently spend many hours engaged in outdoor physical activity. Anecdotal evidence and small studies have indicated that MB artists do experience heat-related health problems. Yet, unlike athletes, military personnel, or workers, there is very little research on heat-related hazards among this unique population. Here, we seek to understand the incidence and circumstances under which exertional heat illnesses (EHIs) occur among MB artists over a 31-year period (1990-2020) across the USA. Using an on-line news dataset, we identified 34 separate events and at least 393 total EHIs. Heat syncope (~ 55%) and heat exhaustion (~ 44%) comprised the majority of EHIs, although a small number of exertional heat stroke cases were also reported. EHIs were reported in all types of MB activities with ~ 32% during rehearsal, ~ 29% during parades, ~ 21% during competition, and ~ 15% during a performance. Also, the vast majority of events occurred with high school (~ 88%) marching bands. Finally, EHIs overwhelmingly occurred when the weather was unusually hot by local conditions. In light of these findings, we emphasize the need for MB specific heat polices that incorporate weather-based activity modification, acclimatization, education about EHIs, and access to on-site medical professionals.
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Affiliation(s)
- Rashawn K Merchant
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA, 30602, USA
| | - Andrew Grundstein
- Department of Geography, University of Georgia, Athens, GA, 30602, USA.
| | - Susan Yeargin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Dawn Emerson
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, 66160, USA
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15
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Breslow RG, Collins JE, Troyanos C, Cohen MC, D'Hemecourt P, Dyer KS, Baggish A. Exertional Heat Stroke at the Boston Marathon: Demographics and the Environment. Med Sci Sports Exerc 2021; 53:1818-1825. [PMID: 33756522 DOI: 10.1249/mss.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to assess associations between exertional heat stroke (EHS) and sex, age, prior performance, and environmental conditions, and report on resources needed for EHS cases at the Boston Marathon. METHODS We analyzed participant characteristics, environmental data, and EHS medical encounters during the 2015-2019 Boston Marathon races. RESULTS Among 136,161 starters, there was an incidence of 3.7 EHS cases per 10,000 starters (95% confidence interval, 2.8-4.9), representing 0.5% of all medical encounters. There were significant associations between sex and age (P < 0.0001), sex and start wave (P < 0.0001), and age group and start wave (P < 0.0001). Sex was not significantly associated with increased EHS incidence; however, age younger than 30 yr and assignment to the first two start waves were. All cases occurred at races with average wet bulb globe temperatures of 17°C-20°C. There was a linear correlation between EHS incidence and greater increases in wet bulb globe temperature from start to peak (R2 = 0.7688). A majority of cases (37; 72.5%) were race finishers; nonfinishers all presented after mile 18. Most were triaged 3-4 h after starting, and all were treated with ice water immersion. Treatment times were prolonged (mean (SD), 78.1 (47.5) min; range, 15-190 min); 29.4% (15 cases) developed posttreatment hypothermia, and 35.3% (18 cases) were given intravenous fluids. Most (31 cases; 64.6%) were discharged directly, although 16 cases (33.3%) required hospital transport. There were no fatalities. CONCLUSIONS Younger and faster runners are at higher risk for EHS at the Boston Marathon. Greater increases in heat stress from start to peak during a marathon may exacerbate risk. EHS encounters comprise a small percentage of race-day medical encounters but require extensive resources and warrant risk mitigation efforts.
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Affiliation(s)
| | | | | | | | | | - K Sophia Dyer
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
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16
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Toosty NT, Hagishima A, Tanaka KI. Heat health risk assessment analysing heatstroke patients in Fukuoka City, Japan. PLoS One 2021; 16:e0253011. [PMID: 34153053 PMCID: PMC8216561 DOI: 10.1371/journal.pone.0253011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Climate change, as a defining issue of the current time, is causing severe heat-related illness in the context of extremely hot weather conditions. In Japan, the remarkable temperature increase in summer caused by an urban heat island and climate change has become a threat to public health in recent years. Methods This study aimed to determine the potential risk factors for heatstroke by analysing data extracted from the records of emergency transport to the hospital due to heatstroke in Fukuoka City, Japan. In this regard, a negative binomial regression model was used to account for overdispersion in the data. Age-structure analyses of heatstroke patients were also embodied to identify the sub-population of Fukuoka City with the highest susceptibility. Results The daily maximum temperature and wet-bulb globe temperature (WBGT), along with differences in both the mean temperature and time-weighted temperature from those of the consecutive past days were detected as significant risk factors for heatstroke. Results indicated that there was a positive association between the resulting risk factors and the probability of heatstroke occurrence. The elderly of Fukuoka City aged 70 years or older were found to be the most vulnerable to heatstroke. Most of the aforementioned risk factors also encountered significant and positive associations with the risk of heatstroke occurrence for the group with highest susceptibility. Conclusion These results can provide insights for health professionals and stakeholders in designing their strategies to reduce heatstroke patients and to secure the emergency transport systems in summer.
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Affiliation(s)
- Nishat Tasnim Toosty
- Energy and Environmental Engineering, Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga-koen, Kasuga-shi, Fukuoka, Japan
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
| | - Aya Hagishima
- Energy and Environmental Engineering, Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga-koen, Kasuga-shi, Fukuoka, Japan
- Faculty of Engineering Sciences, Kyushu University, Kasuga-koen, Kasuga-shi, Fukuoka, Japan
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17
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Hatakeyama K, Ota J, Takahashi Y, Kawamitsu S, Seposo X. Effect of the COVID-19 pandemic on heatstroke-related ambulance dispatch in the 47 prefectures of Japan. Sci Total Environ 2021; 768:145176. [PMID: 33736302 PMCID: PMC9752559 DOI: 10.1016/j.scitotenv.2021.145176] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 05/24/2023]
Abstract
In 2020, Coronavirus disease 2019 (COVID-19) pandemic has brought a huge impact in daily life and has prompted people to take preventive measures. In the summertime, however, the Japanese government has cautioned that some COVID-19 pandemic conditions may affect the risk to heatstroke. This study investigated how the COVID-19 pandemic setting affected heatstroke-related ambulance dispatches (HSAD). Daily HSAD data and relevant weather parameters from June to September from 2016 to 2020 of 47 prefectures in Japan were obtained from the Fire and Disaster Management Agency (FDMA) database. A binary variable representing COVID-19 impact was created, whereby years 2016 to 2019 were coded as 0, while 2020 as 1. We employed a two-stage analysis in elucidating the impact of COVID-19 pandemic on HSAD. Firstly, we regressed HSAD with the COVID-19 binary variable after adjusting for relevant covariates to obtain prefecture-specific effect estimates. Prefecture-specific estimates were subsequently pooled via random effects meta-analysis in generating the pooled estimate. Pooled Relative Risk (RR) of HSAD during the COVID-19 pandemic was 0.78 (95% Confidential Interval [CI], 0.75-0.82). We found an overall statistically significant decrease in HSAD risk during the COVID-19 pandemic in Japan. Specifically, the decrease in the risk of HSAD may be linked to the COVID-19 precautionary measures such as stay-home request and availability of alternative consultation services, which may have decreased the direct exposure of the population to extreme heat.
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Affiliation(s)
- Koya Hatakeyama
- International Health Development Course, Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Junko Ota
- International Health Development Course, Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Yoshiko Takahashi
- International Health Development Course, Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Saki Kawamitsu
- International Health Development Course, Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Xerxes Seposo
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan.
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18
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Kaewput W, Thongprayoon C, Petnak T, Cato LD, Chewcharat A, Boonpheng B, Bathini T, Vallabhajosyula S, Cheungpasitporn W. Inpatient burden and mortality of heatstroke in the United States. Int J Clin Pract 2021; 75:e13837. [PMID: 33202077 DOI: 10.1111/ijcp.13837] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilisation of hospitalisation for heatstroke in the United States. Additionally, this study aimed to explore factors associated with in-hospital mortalities of heatstroke. METHODS The 2003-2014 National Inpatient Sample database was used to identify hospitalised patients with a principal diagnosis of heatstroke. The inpatient prevalence, clinical characteristics, in-hospital treatments, outcomes, length of hospital stay, and hospitalisation cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. RESULTS A total of 3372 patients were primarily admitted for heatstroke, accounting for an overall inpatient prevalence of heatstroke amongst hospitalised patients of 36.3 cases per 1 000 000 admissions in the United States with an increasing trend during the study period (P < .001). Age 40-59 was the most prevalent age group. During the hospital stay, 20% required mechanical ventilation, and 2% received renal replacement therapy. Rhabdomyolysis was the most common complication. Renal failure was the most common end-organ failure, followed by neurological, respiratory, metabolic, hematologic, circulatory, and liver systems. The in-hospital mortality rate of heatstroke hospitalisation was 5% with a decreasing trend during the study period (P < .001). The presence of end-organ failure was associated with increased in-hospital mortality, whereas more recent years of hospitalisation was associated with decreased in-hospital mortality. The median length of hospital stay was 2 days. The median hospitalisation cost was $17 372. CONCLUSION The inpatient prevalence of heatstroke in the United States increased, while the in-hospital mortality of heatstroke decreased.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Liam D Cato
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tuscon, AZ, USA
| | | | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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19
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Otani S, Funaki Ishizu S, Masumoto T, Amano H, Kurozawa Y. The Effect of Minimum and Maximum Air Temperatures in the Summer on Heat Stroke in Japan: A Time-Stratified Case-Crossover Study. Int J Environ Res Public Health 2021; 18:ijerph18041632. [PMID: 33572074 PMCID: PMC7915318 DOI: 10.3390/ijerph18041632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/23/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
An increase in the global surface temperature and changes in urban morphologies are associated with increased heat stress especially in urban areas. This can be one of the contributing factors underlying an increase in heat strokes. We examined the impact of summer minimum air temperatures, which often represent nighttime temperatures, as well as a maximum temperature on a heat stroke. We collected data from the records of daily ambulance transports for heat strokes and meteorological data for July and August of 2017–2019 in the Tottori Prefecture, Japan. A time-stratified case-crossover design was used to determine the association of maximum/minimum air temperatures and the incidence of heat strokes. We used a logistic regression to identify factors associated with the severity of heat strokes. A total of 1108 cases were identified with 373 (33.7%) calls originating in the home (of these, 59.8% were the age of ≥ 75). A total of 65.8% of cases under the age of 18 were related to exercise. Days with a minimum temperature ≥ 25 °C had an odds ratio (95% confidence interval) of 3.77 (2.19, 6.51) for the incidence of an exercise-related heat stroke (reference: days with a minimum temperature < 23 °C). The odds ratio for a heat stroke occurring at home or for calls for an ambulance to the home was 6.75 (4.47, 10.20). The severity of the heat stroke was associated with older age but not with air temperature. Minimum and maximum air temperatures may be associated with the incidence of heat strokes and in particular the former with non-exertional heat strokes.
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Affiliation(s)
- Shinji Otani
- International Platform for Dryland Research and Education, Tottori University, Tottori 680-0001, Japan
- Correspondence: ; Tel.: +81-857-30-6317
| | - Satomi Funaki Ishizu
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan; (S.F.I.); (T.M.); (H.A.); (Y.K.)
| | - Toshio Masumoto
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan; (S.F.I.); (T.M.); (H.A.); (Y.K.)
| | - Hiroki Amano
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan; (S.F.I.); (T.M.); (H.A.); (Y.K.)
| | - Youichi Kurozawa
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan; (S.F.I.); (T.M.); (H.A.); (Y.K.)
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20
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Chambers SN, McMahan B, Bongers CCWG. Developing a geospatial measure of change in core temperature for migrating persons in the Mexico-U.S. border region. Spat Spatiotemporal Epidemiol 2020; 35:100363. [PMID: 33138953 DOI: 10.1016/j.sste.2020.100363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/20/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
Although heat exposure is the leading cause of mortality for undocumented immigrants attempting to traverse the Mexico-U.S. border, there has been little work in quantifying risk. Therefore, our study aims to develop a methodology projecting increase in core temperature over time and space for migrants in Southern Arizona using spatial analysis and remote sensing in combination with the heat balance equation-adapting physiological formulae to a multi-step geospatial model using local climate conditions, terrain, and body specifics. We sought to quantitatively compare the results by demographic categories of age and sex and qualitatively compare them to known terrestrial conditions and prior studies of those conditions. We demonstrated a more detailed measure of risk for migrants than those used most recently: energy expenditure and terrain ruggedness. Our study not only gives a better understanding of the 'funnel effect' mechanisms, but also provides an opportunity for relief and rescue operations.
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Affiliation(s)
- Samuel N Chambers
- School of Geography, Development & Environment, The University of Arizona, 1064 E Lowell Street, PO Box 210137 Tucson, AZ 85721, USA.
| | - Ben McMahan
- Climate Assessment for the Southwest (CLIMAS) and Bureau of Applied Research in Anthropology (BARA), The University of Arizona, Tucson, Arizona, USA
| | - Coen C W G Bongers
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, The Netherlands
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21
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Alele F, Malau-Aduli B, Malau-Aduli A, Crowe M. Systematic review of gender differences in the epidemiology and risk factors of exertional heat illness and heat tolerance in the armed forces. BMJ Open 2020; 10:e031825. [PMID: 32265238 PMCID: PMC7245403 DOI: 10.1136/bmjopen-2019-031825] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 02/06/2020] [Accepted: 03/04/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This review aimed to describe the epidemiology of all heat-related illnesses in women compared with men in the armed forces and to identify gender-specific risk factors and differences in heat tolerance. DESIGN A systematic review of multiple databases (MEDLINE, Emcare, CINAHL, PsycINFO, Informit and Scopus) was conducted from the inception of the databases to 1 April 2019 using the preferred reporting items for systematic review and meta-analysis guidelines. ELIGIBILITY CRITERIA All relevant studies investigating and comparing heat illness and heat tolerance in women and men in the armed forces were included in the review. RESULTS Twenty-four studies were included in the systematic review. The incidence of heat stroke in women ranged from 0.10 to 0.26 per 1000 person-years, while the incidence of heat stroke ranged from 0.22 to 0.48 per 1000 person-years in men. The incidence of other heat illnesses in women compared with men ranged from 1.30 to 2.89 per 1000 person-years versus 0.98 to 1.98 per 1000 person-years. The limited evidence suggests that women had a greater risk of exertional heat illness compared with men. Other gender-specific risk factors were slower run times and body mass index. Although there was a higher proportion of women who were heat intolerant compared with men, this finding needs to be interpreted with caution due to the limited evidence. CONCLUSION The findings of this review suggest that men experienced a slightly higher incidence of heat stroke than women in the armed forces. In addition, the limited available evidence suggests that a higher proportion of women were heat intolerant and being a female was associated with a greater risk of exertional heat illnesses. Given the limited evidence available, further research is required to investigate the influence of gender differences on heat intolerance and heat illness.
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Affiliation(s)
- Faith Alele
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Aduli Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Melissa Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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22
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Donham BP, Frankfurt SB, Cartier RA, O'Hara SM, Sieg VC. Low Incidence of Death and Renal Failure in United States Military Service Members Hospitalized with Exertional Heat Stroke: A Retrospective Cohort Study. Mil Med 2020; 185:362-367. [PMID: 32074343 DOI: 10.1093/milmed/usz214] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION The goal of the current study was to characterize the rate and estimate associated mortality and morbidity of exertional heat stroke (EHS) in U.S. military service members. MATERIALS AND METHODS The current study was a retrospective cohort medical chart review study of all active-duty U.S. military service members, hospitalized with EHS at any MTF in the world between January1, 2007 and July 1, 2014. Enrolled patients were identified by altered mental status and elevated temperatures associated with physical exercise. RESULTS Out of 607 service members with an International Classification of Disease code indicating any type of heat injury, 48 service members met inclusion criteria for EHS. Core temperature was M = 105.8°F (41°C), standard deviation = 1.43, 90% were diagnosed with EHS prior to hospitalization, and 71% received prehospital cooling. Meantime to normothermia post-hospitalization was 56 minutes (standard deviation = 79.28). Acute kidney injury was diagnosed in 40% of patients although none developed hyperkalemia or required dialysis. Disseminated intravascular coagulation was rare (4%, n = 2) and overall observed mortality was very low (2%, n = 1). CONCLUSION EHS is aggressively identified and treated in U.S. Military Treatment Facilities. Mortality and morbidity were strikingly low.
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Affiliation(s)
- Benjamin P Donham
- Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave, Fort Hood, TX 76544
| | - Sheila B Frankfurt
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX 76711
| | - Rudolph A Cartier
- Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave, Fort Hood, TX 76544
| | - Sean M O'Hara
- Department of Emergency Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr, TX 78234
| | - Vanessa C Sieg
- Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave, Fort Hood, TX 76544
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Knoll JM, Knight LR, Quiroz D, Popat SM, Pederson TG, Morton-Gonzaba N. Variation in Clinical Presentations and Outcomes of Heat Stroke Victims in the Mass-Casualty Setting. J Emerg Med 2019; 57:866-870. [PMID: 31606230 DOI: 10.1016/j.jemermed.2019.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/18/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immigrants crossing the Southern U.S. border are particularly susceptible to heat illness. We review 3 patients from a heat-related mass-casualty incident with variations in heat stroke presentation, course, and outcome. CASE REPORT On July 23, 2017, emergency medical services responded to a trafficking-related mass-casualty incident in San Antonio, Texas, involving 39 migrants found inside an abandoned tractor trailer without air conditioning who had been trafficked from Laredo, Texas. Three victims exhibiting heat stroke symptoms were taken to the ED of a large academic teaching hospital. Patient 1 was a 42-year-old man who presented with seizing, vomiting, and a core temperature of 38.8°C (101.8°F). His 54-day hospital course was notable for 2 cardiac arrests, disseminated intravascular coagulation, prolonged lactic acidosis, and residual kidney disease. Patient 2 was a 32-year-old man who presented to the emergency department intubated in the field with a core temperature of 40.7°C (105.3°F). His 60-day hospital course was notable for disseminated intravascular coagulation, severely elevated troponin, prolonged lactic acidosis, and stroke. Patient 3 was a 20-year-old man who presented with seizing and decorticate posturing, with a core temperature of 40.5°C (104.9°F). His 6-day hospital course was notable for rapid clinical improvement and full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians will encounter heat stroke victims. Our patients were exposed to an identical environment, and while each patient was otherwise healthy and differed significantly only in age, they exhibited a diversity of heat stroke presentations and sequelae. Treatment prioritizes cooling, but rapid deterioration requires intensive treatment of multiorgan failure.
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Affiliation(s)
- Judith M Knoll
- Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Lorelle R Knight
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas
| | - Devin Quiroz
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas
| | - Shyam M Popat
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas
| | - Thomas G Pederson
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas
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Knapik JJ, Epstein Y. Exertional Heat Stroke: Pathophysiology, Epidemiology, Diagnosis, Treatment, and Prevention. J Spec Oper Med 2019; 19:108-116. [PMID: 31201762 DOI: 10.55460/5p2q-1mbq] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2019] [Indexed: 11/09/2022]
Abstract
Temperature increases due to climate changes and operations expected to be conducted in hot environments make heat-related injuries a major medical concern for the military. The most serious of heat-related injuries is exertional heat stroke (EHS). EHS generally occurs when health individual perform physical activity in hot environments and the balance between body heat production and heat dissipation is upset resulting in excessive body heat storage. Blood flow to the skin is increased to assist in dissipating heat while gut blood flow is considerably reduced, and this increases the permeability of the gastrointestinal mucosa. Toxic materials from gut bacteria leak through the gastrointestinal mucosa into the central circulation triggering an inflammatory response, disseminated intravascular coagulation (DIC), multiorgan failure, and vascular collapse. In addition, high heat directly damages cellular proteins resulting in cellular death. In the United States military, the overall incidence of clinically diagnosed heat stroke from 1998 to 2017 was (mean ± standard deviation) 2.7 ± 0.5 cases/10,000 Soldier-years and outpatient rates rose over this period. The cornerstone of EHS diagnosis is recognition of central nervous dysfunction (ataxia, loss of balance, convulsions, irrational behavior, unusual behavior, inappropriate comments, collapse, and loss of consciousness) and a body core temperature (obtained with a rectal thermometer) usually >40.5°C (105°F). The gold standard treatment is whole body cold water immersion. In the field where water immersion is not available it may be necessary to use ice packs or very cold, wet towels placed over as much of the body as possible before transportation of the victim to higher levels of medical care. The key to prevention of EHS and other heat-related injuries is proper heat acclimation, understanding work/rest cycles, proper hydration during activity, and assuring that physical activity is matched to the Soldiers' fitness levels. Also, certain dietary supplements (DSs) may have effects on energy expenditure, gastrointestinal function, and thermoregulation that should be considered and understood. In many cases over-motivation is a major risk factor. Commanders and trainers should be alert to any change in the Soldier's behavior. Proper attention to these factors should considerably reduce the incidence of EHS.
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Liss A, Naumova EN. Heatwaves and hospitalizations due to hyperthermia in defined climate regions in the conterminous USA. Environ Monit Assess 2019; 191:394. [PMID: 31254102 DOI: 10.1007/s10661-019-7412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/20/2019] [Indexed: 05/21/2023]
Abstract
Heatwaves are one of the deadliest natural disasters that occur annually with thousands of people seeking medical attention. The spatio-temporal synchronization between peaks in disease manifestation and high temperature provides important insights into the seasonal timing of the heatwave and the response it may cause with respect to emergence, severity, and duration. The objectives of this study are to examine the association between hospitalizations due to heat stroke in older adults and heat in the United States (US) and explore synchronization with respect to heatwave sequence, time of arrival, and regional climate. Three large data sets were utilized: daily hospitalization records of the US elderly between 1991 and 2006, annual demographic summaries on Medicare beneficiaries maintained by the Centers for Medicare and Medicaid Services (CMS), and nationwide daily meteorological observations. We modeled seasonal fluctuations in health outcomes, such as the timing and intensity of the seasonal peak in hospitalizations using refined harmonic GLM for eight climatically similar regions. During the 16-year study period, there were 40,019 heat-related hospitalizations (HRH) in the conterminous US. The rates of HRH varied substantially across eight climatic regions: with the highest rate of 7.05 cases per million residents observed in areas with temperate arid summers and winters (TaTa) and the lowest rate of 0.67-in areas with cold moderately dry summers and arid winters (CdCa), where summer temperatures are about 18.3 °C and 12.1 °C, respectively. We detected 400 heatwaves defined as any day when the night time temperature is above its 90th percentile for the current and previous nights. The first seasonal heatwave in a season resulted in 4274 hospitalizations over 342 heatwave-days: 34.3% of 12,442 hospitalizations occurred in 26% of 1308 heatwave-days. The relative risks of increased HRH associated with the first and second heatwaves were 10.4 (95%CI: 8.5; 12.3) and 11.4 (95%CI: 9.6; 13.3), respectively, indicating the disproportional effects of early heatwave arrivals. The seasonal spike in heat stroke hospitalizations in regions with relatively similar annual temperatures, e.g. in areas with temperate moderately dry summers and winters (TdTa: 12.8 °C) and (TaTa: 11.1 °C) ranged between 4.5 (95%CI: 3.3; 5.5) and 11.0 (95%CI: 8.2; 14.9) cases per million residents, respectively, indicating substantial regional differences. The differences in heat-related hospitalizations and response to heatwaves are substantial among older adults residing in different climate regions of the conterminous US. The disproportionally high response to the early seasonal heatwave deserves special attention, especially in the context of prevention and decision support frameworks.
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Affiliation(s)
- Alexander Liss
- Department of Civil and Environmental Engineering, Tufts University, School of Engineering, Medford, MA, 02155, USA
| | - Elena N Naumova
- Department of Civil and Environmental Engineering, Tufts University, School of Engineering, Medford, MA, 02155, USA.
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA.
- Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, 02155, USA.
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Update: Heat illness, active component, U.S. Armed Forces, 2018. MSMR 2019; 26:15-20. [PMID: 31026173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2018, there were 578 incident diagnoses of heat stroke and 2,214 incident diagnoses of heat exhaustion among active component service members. The overall crude incidence rates of heat stroke and heat exhaustion diagnoses were 0.45 cases and 1.71 cases per 1,000 person-years, respectively. In 2018, subgroup-specific rates of incident heat stroke diagnoses were highest among males and service members less than 20 years old, Asian/Pacific Islanders, Marine Corps and Army members, recruit trainees, and those in combatspecific occupations. Subgroup-specific incidence rates of heat exhaustion diagnoses in 2018 were notably higher among service members less than 20 years old, Asian/Pacific Islanders, Army and Marine Corps members, recruit trainees, and service members in combat-specific occupations. During 2014- 2018, a total of 325 heat illnesses were documented among service members in Iraq and Afghanistan; 8.6% (n=28) were diagnosed as heat stroke. Commanders, small unit leaders, training cadre, and supporting medical personnel must ensure that the military members whom they supervise and support are informed about the risks, preventive countermeasures, early signs and symptoms, and first-responder actions related to heat illnesses.
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Wang Y, Song Q, Du Y, Wang J, Zhou J, Du Z, Li T. A random forest model to predict heatstroke occurrence for heatwave in China. Sci Total Environ 2019; 650:3048-3053. [PMID: 30373081 DOI: 10.1016/j.scitotenv.2018.09.369] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/08/2018] [Accepted: 09/30/2018] [Indexed: 06/08/2023]
Abstract
Extreme heat events have recently become more frequent and represent an increasing risk of damage to public health. However, the existing prediction of heatwave related health effects has limited representativeness and verification. Our study addressed the prediction of heatstroke occurrences based on three years' data of typical cities of hot temperature in China, and examined the importance ranks of model parameters including meteorological and socioeconomic status (SES) factors. The results show that meteorological factors contributed the most to model estimation of the parameters evaluated, and SES parameters, such as the search index, were also important indicators of heatstroke prediction. The model had a satisfying performance compared to traditional linear regression models. The model established in our study can be further applied to extreme weather-related impact research and reduce economic loss due to public health expenses.
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Affiliation(s)
- Yanwen Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Qingqing Song
- Peking University School of Public Health, Beijing 100191, China
| | - Yanjun Du
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jiaonan Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jinhui Zhou
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Zonghao Du
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Tiantian Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China.
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Tseng MF, Chou CL, Chung CH, Chien WC, Chen YK, Yang HC, Chu P. Association between heat stroke and ischemic heart disease: A national longitudinal cohort study in Taiwan. Eur J Intern Med 2019; 59:97-103. [PMID: 30297250 DOI: 10.1016/j.ejim.2018.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 12/16/2022]
Abstract
The purpose of this study is to determine the relationship between heat stroke and ischemic heart disease (IHD), in a nationwide population using a longitudinal approach. We retrospectively examined the data from the National Health Insurance Research Database (NHIRD) in Taiwan, for patients examined between 2000 and 2013. In total, 628 patients with a heat stroke episode were enrolled and matched with 1256 patients without any history of a heat stroke episode by propensity score matching at a ratio of 1:2. The mean follow-up years of the heat stroke group was 11.89 years and the mean follow up of the control group was 11.51 years. An association between heat stroke episodes and IHD (log-rank p < .001) was found in a univariate cox regression analysis. After multivariate adjustment, age, comorbidities (hypertension, diabetes, stroke), and lower insurance premiums were associated with IHD events in patients who had a heat stroke. IHD was independently associated with heat stroke following cox multivariate regression analysis and patients with a heat stroke episode had a higher incidence of IHD events compared to those without any heat stroke episode (2598.41/105 person-years vs. 1286.14/105 person-years, adjusted hazard ratio 3.527, 95% CI: 2.078-4.032, p < .001). The onset of IHD in patients who suffered a heat stroke was earlier than in those without a heat stroke episode (2.08 ± 3.45 vs. 3.61 ± 3.25 years, p < .001). In conclusion, clinicians should be aware about evaluating the IHD risk following a heat stroke episode in a patient.
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Affiliation(s)
- Min-Feng Tseng
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chu-Lin Chou
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Medical Research, Ping-Tung Christian Hospital, Ping-Tung, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.
| | - Ying-Kai Chen
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Chien Yang
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Pauling Chu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Center for the Prevention and Treatment of Heat Stroke, Tri-Service General Hospital, Taipei, Taiwan.
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Hosokawa Y, Adams WM, Belval LN, Davis RJ, Huggins RA, Jardine JF, Katch RK, Stearns RL, Casa DJ. Exertional heat illness incidence and on-site medical team preparedness in warm weather. Int J Biometeorol 2018; 62:1147-1153. [PMID: 29594509 DOI: 10.1007/s00484-018-1517-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGTA) and Liljegren (WBGTL) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGTA or WBGTL. One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGTA explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGTL explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGTA and WBGTL on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.
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Affiliation(s)
- Yuri Hosokawa
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA.
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA.
| | - William M Adams
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of North Carolina at Greensboro, 1408 Walker Avenue, 237 Coleman Building, Greensboro, NC, 27412, USA
| | - Luke N Belval
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - Robert J Davis
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Falmouth Road Race, P.O. Box 732, Falmouth, MA, 02541-0732, USA
| | - Robert A Huggins
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - John F Jardine
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Falmouth Road Race, P.O. Box 732, Falmouth, MA, 02541-0732, USA
| | - Rachel K Katch
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - Rebecca L Stearns
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
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Hayashida K, Kondo Y, Hifumi T, Shimazaki J, Oda Y, Shiraishi S, Fukuda T, Sasaki J, Shimizu K. A novel early risk assessment tool for detecting clinical outcomes in patients with heat-related illness (J-ERATO score): Development and validation in independent cohorts in Japan. PLoS One 2018; 13:e0197032. [PMID: 29742138 PMCID: PMC5942769 DOI: 10.1371/journal.pone.0197032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We sought to develop a novel risk assessment tool to predict the clinical outcomes after heat-related illness. METHODS Prospective, multicenter observational study. Patients who transferred to emergency hospitals in Japan with heat-related illness were registered. The sample was divided into two parts: 60% to construct the score and 40% to validate it. A binary logistic regression model was used to predict hospital admission as a primary outcome. The resulting model was transformed into a scoring system. RESULTS A total of 3,001 eligible patients were analyzed. There was no difference in variables between development and validation cohorts. Based on the result of a logistic regression model in the development phase (n = 1,805), the J-ERATO score was defined as the sum of the six binary components in the prehospital setting (respiratory rate≥22 /min, Glasgow coma scale<15, systolic blood pressure≤100 mmHg, heart rate≥100 bpm, body temperature≥38°C, and age≥65 y), for a total score ranging from 0 to 6. In the validation phase (n = 1,196), the score had excellent discrimination (C-statistic 0.84; 95% CI 0.79-0.89, p<0.0001) and calibration (P>0.2 by Hosmer-Lemeshow test). The observed proportion of hospital admission increased with increasing J-ERATO score (score = 0, 5.0%; score = 1, 15.0%; score = 2, 24.6%; score = 3, 38.6%; score = 4, 68.0%; score = 5, 85.2%; score = 6, 96.4%). Multivariate analyses showed that the J-ERATO score was an independent positive predictor of hospital admission (adjusted OR, 2.43; 95% CI, 2.06-2.87; P<0.001), intensive care unit (ICU) admission (3.73; 2.95-4.72; P<0.001) and in-hospital mortality (1.65; 1.18-2.32; P = 0.004). CONCLUSIONS The J-ERATO score is simply assessed and can facilitate the identification of patients with higher risk of heat-related hospitalization. This scoring system is also significantly associated with the higher likelihood of ICU admission and in-hospital mortality after heat-related hospitalization.
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Affiliation(s)
- Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yutaka Kondo
- Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Junya Shimazaki
- Advanced Medical Emergency and Critical Care Center, Osaka University Hospital, Osaka, Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | | | - Tatsuma Fukuda
- Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Armed Forces Health Surveillance Branch. Update: Heat illness, active component, U.S. Armed Forces, 2017. MSMR 2018; 25:6-12. [PMID: 29696983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
OBJECTIVES To improve heat-related illness surveillance, we evaluated and refined North Carolina's heat syndrome case definition. METHODS We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. RESULTS The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: "heat ex" (n = 1674, 41.8%), "overheat" (n = 646, 16.1%), "too hot" (n = 594, 14.8%), and "heatstroke" (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: "burn," "grease," "liquid," "oil," "radiator," "antifreeze," "hot tub," "hot spring," and "sauna." After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P < .001). CONCLUSIONS Revising the heat syndrome case definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.
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Affiliation(s)
- Laurel Harduar Morano
- 1 Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna E Waller
- 1 Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Li Y, Li C, Luo S, He J, Cheng Y, Jin Y. Impacts of extremely high temperature and heatwave on heatstroke in Chongqing, China. Environ Sci Pollut Res Int 2017; 24:8534-8540. [PMID: 28191617 DOI: 10.1007/s11356-017-8457-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
Few studies have reported the quantitative association between heat and heatstroke (HS) occurrence, particularly in China. The aim of this study was to quantitatively assess the association between high temperature/heatwave and HS occurrence in Chongqing. The daily HS data from 2009 to 2013 of Chongqing were extracted from Chongqing Center for Disease Control and Prevention. A Zero-inflated Poisson regression model (ZIP) with a logistic distribution was used to quantitatively analyze the impacts of the daily maximum temperature (Tmax) over the threshold on HS occurrence by gender, age, and severity of HS, after controlling for covariates including day of the week (DOW), relative humidity, and daily temperature range. Lag effects up to 10 days were analyzed. Heatwave intensity, which was classified into four levels according to the quartile of its values, was calculated by Tmax multiplied the duration of a heatwave. The excess risk of HS during heatwave with different intensity was analyzed. The Tmax threshold for HS was 34 °C in Chongqing. After adjusting for potential confounders, strong associations and age-specific lag effects between Tmax and daily HS occurrence were observed. The impacts of Tmax on total HS lasted for 7 days (lag0-6), with the highest excess risk (ER) value of 30.5% (95% CI 23.6 and 37.8%) on lag0 with each 1 °C increment in Tmax over the threshold. A slightly stronger temperature-HS association was detected in male compared to female. The population over 65 years had the highest ER and the younger adults aged 19-35 and 35-55 years also showed significant heat-HS associations. The number of daily cases increased with the increasing of duration of heatwave and the peak value occurred on the eleventh day of the heatwave. The excess risk of HS during the heatwave with 1 to 4 level of intensity increased by 2.54, 2.97, 5.61, and 11.3 times, respectively, as compared with that of non-heatwave. Extreme heat is becoming a huge threat to public health due to the strong temperature-HS associations in Chongqing. Climate change with increasing temperatures may make the situation worse. Our results can provide reference for developing and improving relevant public health strategies and early extreme weather and health warning system to prevent and reduce the health risks due to extreme weather and climate change in Chongqing.
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Affiliation(s)
- Yonghong Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Beijing, 100021, China
| | - Chengcheng Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Beijing, 100021, China
| | - Shuquan Luo
- Chongqing Center for Disease Control and Prevention, Chongqing, 404000, China
| | - Jinyu He
- Chongqing Center for Disease Control and Prevention, Chongqing, 404000, China
| | - Yibin Cheng
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Beijing, 100021, China
| | - Yinlong Jin
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 7 Panjiayuan Nanli, Beijing, 100021, China.
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Phung D, Chu C, Rutherford S, Nguyen HLT, Do CM, Huang C. Heatwave and risk of hospitalization: A multi-province study in Vietnam. Environ Pollut 2017; 220:597-607. [PMID: 27743790 DOI: 10.1016/j.envpol.2016.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 05/24/2023]
Abstract
The effects of heatwaves on morbidity in developing and tropical countries have not been well explored. The purpose of this study was to examine the relationship between heatwaves and hospitalization and the potential influence of socio-economic factors on this relationship in Vietnam. Generalized Linear Models (GLM) with Poisson family and Distributed Lag Models (DLM) were applied to evaluate the effect of heatwaves for each province (province-level effect). A random-effects meta-analysis was applied to calculate the pooled estimates (country-level effects) for 'all causes', infectious, cardiovascular, and respiratory admissions queried by lag days, regions, sex, and ages. We used random-effects meta-regression to explore the potential influence of socio-economic factors on the relationship between heatwaves and hospitalization. The size of province-level effects varied across provinces. The pooled estimates show that heatwaves were significantly associated with a 2.5% (95%CI: 0.8-4.3) and 3.8% (95%CI, 1.5-6.2) increase in all causes and infectious admissions at lag 0. Cardiovascular and respiratory admissions (0.8%, 95%CI: -1.6-3.3; 2.2%, 95%CI: -0.7-5.2) were not significantly increased after a heatwave event. The risk of hospitalization due to heatwaves was higher in the North than in the South for all causes (5.4%, 95%CI: -0.1-11.5 versus 1.3%, 95%CI: 0.1-2.6), infectious (11.2%, 95%CI: 3.1-19.9 versus 3.2%, 95%CI: 0.7-5.7), cardiovascular (7.5%, 95%CI: 1.1-14.4 versus -1.2%, 95%CI: -2.6-2.3), and respiratory diseases (2.7%, 95%CI: -5.4-11.5 versus 2.1%, 95%CI: -0.8-1.2). A non-significant influence of socio-economic factors on the relationship between heatwave and hospitalization was observed. This study provides important evidence and suggests implications for the projected impacts of climate change related extreme weather. Climate change adaptation programs of the health sector should be developed to protect residents from the effects of extreme weather events such as heatwaves in Vietnam.
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Affiliation(s)
- Dung Phung
- Centre for Environment and Population Health, Griffith University, Australia; Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, China.
| | - Cordia Chu
- Centre for Environment and Population Health, Griffith University, Australia
| | - Shannon Rutherford
- Centre for Environment and Population Health, Griffith University, Australia
| | | | - Cuong Manh Do
- Health Environment Management Agency, Vietnam Ministry of Health, Viet Nam
| | - Cunrui Huang
- Centre for Environment and Population Health, Griffith University, Australia; Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, China.
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Padalino B, Raidal SL, Hall E, Knight P, Celi P, Jeffcott L, Muscatello G. A Survey on Transport Management Practices Associated with Injuries and Health Problems in Horses. PLoS One 2016; 11:e0162371. [PMID: 27588689 PMCID: PMC5010189 DOI: 10.1371/journal.pone.0162371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/22/2016] [Indexed: 11/19/2022] Open
Abstract
An online survey was conducted to determine associations between transport management and transport-related injuries and diseases in horses in Australia. The survey was composed of three sections: respondents' demographic information, transport management strategies or procedures (before, during and after transportation) and transport diseases experienced in the previous two year period. Univariate and multivariate modelling was performed exploring associations between variables (respondents' details and transport management strategies) and the following transport-related diseases as outcomes: traumatic injuries, diarrhoea, heat stroke, muscular problems, laminitis, transport pneumonia and colic. The survey generated 797 responses. Traumatic injuries were the most common transport-related problem, with a reported incidence of 45.0%. Younger respondents (<40 years old) caring for large numbers of horses (>30 in a week) were more likely to report transport-related injuries. Injury risk was also linked to the use of protections and tranquilizers prior to transport, and checking horses after the journey. Diarrhoea (20.0%) and heat stroke (10.5%) were reported more by amateur than professional horse carers. Increased risk of heat stroke was linked to the restriction of hay and water prior to transportation. Muscular problems (13.0%) appeared to be exacerbated when horse health was not assessed before journey; whilst the risk of laminitis (2.9%) was around three fold greater when post transport recovery strategies were not applied. Associations were made between transport pneumonia (9.2%) and duration of journey, and with activity (horses involved in racing at greater risk). No associations were seen between the incidence of colic (10.3%) and the variables examined. Study findings should be interpreted with caution as they represent participant perceptions and recall. Nevertheless, results support many current recommendations for safe transportation of horses. They also highlight the need to further investigate many of identified management factors to refine existing policies and practices in equine transportation.
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Affiliation(s)
- Barbara Padalino
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, Camden, New South Wales, Australia
- Department of Veterinary Medicine, The University of Bari, Bari, Italy
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Sharanne L. Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Evelyn Hall
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, Camden, New South Wales, Australia
| | - Peter Knight
- Discipline of Biomedical Science, School of Medical Sciences, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Pietro Celi
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, Camden, New South Wales, Australia
| | - Leo Jeffcott
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, Camden, New South Wales, Australia
| | - Gary Muscatello
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, Camden, New South Wales, Australia
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Wang Y, Bobb JF, Papi B, Wang Y, Kosheleva A, Di Q, Schwartz JD, Dominici F. Heat stroke admissions during heat waves in 1,916 US counties for the period from 1999 to 2010 and their effect modifiers. Environ Health 2016; 15:83. [PMID: 27503399 PMCID: PMC4977899 DOI: 10.1186/s12940-016-0167-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/27/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND Heat stroke is a serious heat-related illness, especially among older adults. However, little is known regarding the spatiotemporal variation of heat stroke admissions during heat waves and what factors modify the adverse effects. METHODS We conducted a large-scale national study among 23.5 million Medicare fee-for-service beneficiaries per year residing in 1,916 US counties during 1999-2010. Heat wave days, defined as a period of at least two consecutive days with temperatures exceeding the 97th percentile of that county's temperatures, were matched to non-heat wave days by county and week. We fitted random-effects Poisson regression models to estimate the relative risk (RR) of heat stroke admissions on a heat wave day as compared to a matched non-heat wave day. A variety of effect modifiers were tested including individual-level covariates, community-level covariates, meteorological conditions, and the intensity and duration of the heat wave event. RESULTS The RR declined substantially from 71.0 (21.3-236.2) in 1999 to 3.5 (1.9-6.5) in 2010, and was highest in the northeast and lowest in the west north central regions of the US. We found a lower RR among counties with higher central air conditioning (AC) prevalence. More severe and longer-lasting heat waves had higher RRs. CONCLUSIONS Heat stroke hospitalizations associated with heat waves declined dramatically over time, indicating increased resilience to extreme heat among older adults. Considerable risks, however, still remain through 2010, which could be addressed through public health interventions at a regional scale to further increase central AC and monitoring heat waves.
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Affiliation(s)
- Yan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215 USA
| | - Jennifer F. Bobb
- Biostatistics Unit, Group Health Research Institute, 1730 Minor Ave #1600, Seattle, WA 98101 USA
| | - Bianca Papi
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Anna Kosheleva
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215 USA
| | - Qian Di
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215 USA
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215 USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
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Wang H, Shan N, Qin X, Lou Y, Li H. [Pathogenesis and advance in epidemiology of heat stroke]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015; 27:702-704. [PMID: 26255024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Hongping Wang
- Department of Critical Care Medicine, 401st Hospital in Jinan Military Region of PLA, Qingdao 266071, Shandong, China
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Strimel WJ, O'Riordan MJ. Sudden cardiac arrest in long distance races: considering the full context. J Am Coll Cardiol 2015; 65:407-408. [PMID: 25634847 DOI: 10.1016/j.jacc.2014.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
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Chen Z, Qiao Z, Wang D. [Epidemiological analysis of heat stroke from 2009 to 2013 in Wuhan, China]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2015; 33:260-262. [PMID: 26506772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Zhang K, Chen TH, Begley CE. Impact of the 2011 heat wave on mortality and emergency department visits in Houston, Texas. Environ Health 2015; 14:11. [PMID: 25627975 PMCID: PMC4417210 DOI: 10.1186/1476-069x-14-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/05/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Heat waves have been linked to increased risk of mortality and morbidity, and are projected to increase in frequency and intensity in a changing climate. Houston and other areas in Texas experienced an exceptional heat wave in the summer of 2011 producing the hottest August on record. This study aims to assess the health-related impact of this heat wave. METHODS Distributed lag models were used to estimate associations between the 2011 heat wave and all-cause mortality and emergency department (ED) visits from May 1 through September 30 for the five-year period 2007-2011. The 2011 heat wave is defined as a continuous period from August 2 through 30, 2011 according to the heat advisories issued by the local National Weather Service office, and is included in the models as a dummy variable. We compared the estimated excess risk among the models with and without adjustment of continuous temperature and ozone. RESULTS The 2011 heat wave in Houston was associated with a 3.6% excess risk in ED visits (95% CI: 0.6%, 6.6%) and 0.6% increase in mortality risk (95% CI: -5.5%, 7.1%). The elderly over 65 years of age were at the greatest risk in ED visits. These patterns are consistent across different heat-wave definitions, and results are similar when adjusting for continuous temperature and ozone. CONCLUSIONS The 2011 heat wave in Houston had a substantial impact on ED visits and no significant impact on mortality. Our findings provide insights into local heat-wave and health preparations and interventions.
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Affiliation(s)
- Kai Zhang
- />Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030 USA
| | - Tsun-Hsuan Chen
- />Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030 USA
| | - Charles E Begley
- />Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas USA
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Abstract
IMPORTANCE Heat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases. OBJECTIVES To identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. DESIGN, SETTING, AND POPULATION Matched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data. EXPOSURES Heat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non-heat wave periods by county and week. MAIN OUTCOMES AND MEASURES Daily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach. RESULTS Risks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non-heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12-1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06-1.23) for renal failure, 1.10 (95% CI, 1.04-1.16) for urinary tract infections, 1.06 (95% CI, 1.00-1.11) for septicemia, and 2.54 (95% CI, 2.14-3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22-0.46) excess admissions per 100,000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12-0.39) for renal failure, 0.24 (95% CI, 0.09-0.39) for urinary tract infections, 0.21 (95% CI, 0.01-0.41) for septicemia, and 0.16 (95% CI, 0.10-0.22) for heat stroke. For fluid and electrolyte disorders and heat stroke, the risk of hospitalization increased during more intense and longer-lasting heat wave periods (P < .05). Risks were generally highest on the heat wave day but remained elevated for up to 5 subsequent days. CONCLUSIONS AND RELEVANCE Among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. However, the absolute risk increase was small and of uncertain clinical importance.
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Affiliation(s)
- Jennifer F Bobb
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Ziad Obermeyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yun Wang
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Francesca Dominici
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
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Elliot AJ, Bone A, Morbey R, Hughes HE, Harcourt S, Smith S, Loveridge P, Green HK, Pebody R, Andrews N, Murray V, Catchpole M, Bickler G, McCloskey B, Smith G. Using real-time syndromic surveillance to assess the health impact of the 2013 heatwave in England. Environ Res 2014; 135:31-6. [PMID: 25262071 DOI: 10.1016/j.envres.2014.08.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/20/2014] [Accepted: 08/23/2014] [Indexed: 05/12/2023]
Abstract
Heatwaves are a seasonal threat to public health. During July 2013 England experienced a heatwave; we used a suite of syndromic surveillance systems to monitor the impact of the heatwave. Significant increases in heatstroke and sunstroke were observed during 7-10 July 2013. Syndromic surveillance provided an innovative and effective service, supporting heatwave planning and providing early warning of the impact of extreme heat thereby improving the public health response to heatwaves.
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Affiliation(s)
- Alex J Elliot
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK.
| | - Angie Bone
- Extreme Events and Health Protection, Public Health England, London SE1 8UG, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK
| | - Helen E Hughes
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK
| | - Sally Harcourt
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK
| | - Sue Smith
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK
| | - Paul Loveridge
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK
| | - Helen K Green
- Respiratory Diseases Department, Public Health England, London NW9 5EQ, UK
| | - Richard Pebody
- Respiratory Diseases Department, Public Health England, London NW9 5EQ, UK
| | - Nick Andrews
- Statistics and Modelling Economics Department, Public Health England, London NW9 5HT, UK
| | - Virginia Murray
- Extreme Events and Health Protection, Public Health England, London SE1 8UG, UK
| | - Mike Catchpole
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5HT, UK
| | - Graham Bickler
- Operations Centre, Public Health England, Horsham RH12 1XA, UK
| | | | - Gillian Smith
- Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK
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Kim SH, Jo SN, Myung HN, Jang JY. The effect of pre-existing medical conditions on heat stroke during hot weather in South Korea. Environ Res 2014; 133:246-252. [PMID: 24981822 DOI: 10.1016/j.envres.2014.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/31/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Heat stroke contributes considerably to morbidity and mortality in hot weather, but it is unclear whether pre-existing medical conditions increase the risk of heat stroke. The purpose of this study was to assess the association between heat stroke and pre-existing medical conditions in South Korea. METHODS A case-control study was conducted using data from a nationwide surveillance system for heat illnesses in 2012. Individuals with heat stroke were identified and compared to control subjects with mild heat illness such as heat exhaustion, heat edema, heat cramps, and heat syncope. Categories of pre-existing medical conditions included cardio/cerebrovascular disease, respiratory disease, neuropsychiatric disorder, and diabetes mellitus. Associations between heat stroke and pre-existing medical conditions were assessed by multivariate logistic regression analyses. RESULTS Of 968 eligible patients, 178 (18.4%) presented with heat stroke. Patients with pre-existing medical conditions were relatively greater in the heat stroke group than in the control group (40.4% and 23.9%, respectively). Neuropsychiatric disorder was associated with an increased odds of heat stroke after adjustment for covariates (adjusted odds ratio, 7.69; 95% CI, 4.06-14.54). There were no significant relationships between heat stroke and other medical conditions (cardio/cerebrovascular disease: 0.66, 0.40-1.06; respiratory disease: 1.44, 0.35-5.89; diabetes mellitus: 1.16, 0.58-2.34). CONCLUSIONS Pre-existing neuropsychiatric disorder was associated with an increased risk of heat stroke. National strategies and clinical guidance for such patients should be initiated to prevent fatal events.
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Affiliation(s)
- Si-Heon Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, San-5 Wonchon-dong, Youngtong-gu, Suwon, South Korea; Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osongsaengmyeong2-ro, Osong-eup, Cheongwon-gun, Chungbuk, South Korea
| | - Soo-Nam Jo
- Climate Change Adaptation Task Force, Korea Centers for Disease Control and Prevention, Osongsaengmyeong2-ro, Osong-eup, Cheongwon-gun, Chungbuk, South Korea
| | - Hyung-Nam Myung
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, San-5 Wonchon-dong, Youngtong-gu, Suwon, South Korea
| | - Jae-Yeon Jang
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, San-5 Wonchon-dong, Youngtong-gu, Suwon, South Korea.
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Ng CFS, Ueda K, Ono M, Nitta H, Takami A. Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan. Int J Biometeorol 2014; 58:941-8. [PMID: 23700200 DOI: 10.1007/s00484-013-0677-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 05/13/2023]
Abstract
Despite rising concern on the impact of heat on human health, the risk of high summer temperature on heatstroke-related emergency dispatches is not well understood in Japan. A time-series study was conducted to examine the association between apparent temperature and daily heatstroke-related ambulance dispatches (HSAD) within the Kanto area of Japan. A total of 12,907 HSAD occurring from 2000 to 2009 in five major cities-Saitama, Chiba, Tokyo, Kawasaki, and Yokohama-were analyzed. Generalized additive models and zero-inflated Poisson regressions were used to estimate the effects of daily maximum three-hour apparent temperature (AT) on dispatch frequency from May to September, with adjustment for seasonality, long-term trend, weekends, and public holidays. Linear and non-linear exposure effects were considered. Effects on days when AT first exceeded its summer median were also investigated. City-specific estimates were combined using random effects meta-analyses. Exposure-response relationship was found to be fairly linear. Significant risk increase began from 21 °C with a combined relative risk (RR) of 1.22 (95% confidence interval, 1.03-1.44), increasing to 1.49 (1.42-1.57) at peak AT. When linear exposure was assumed, combined RR was 1.43 (1.37-1.50) per degree Celsius increment. Overall association was significant the first few times when median AT was initially exceeded in a particular warm season. More than two-thirds of these initial hot days were in June, implying the harmful effect of initial warming as the season changed. Risk increase that began early at the fairly mild perceived temperature implies the need for early precaution.
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Affiliation(s)
- Chris Fook Sheng Ng
- Environmental Epidemiology Section, Center for Environmental Health Sciences, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan,
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Armed Forces Health Surveillance Center (AFHSC). Update: Heat injuries, active component, U.S. Armed Forces, 2013. MSMR 2014; 21:10-3. [PMID: 24684615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The number of active component service members treated for heat stroke in 2013 (n=324) was the lowest since 2010 (n=321). Incidence rates of heat stroke were higher among males, those younger than 20 years of age, Asian/Pacific Islanders, Marine Corps and Army members, recruit trainees, and service members in combat-specific occupations, compared to their respective counterparts. Fewer service members were treated for "other heat injuries" in 2013 (n=1,701) than in any other year of the 5-year surveillance period. In addition, there were fewer reportable medical events, ambulatory encounters, and hospitalizations for "other heat injuries" in 2013 than in any of the prior 4 years. The incidence rate of "other heat injuries" was higher among females than males and 304 percent higher among recruit trainees than among other enlisted members or officers. During 2009-2013, a total of 909 heat injury events occurred in Iraq/Afghanistan; 6.4 percent (n=58) of those events were due to heat stroke.
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Tate RC, Selde W. Heat trap. How to treat vehicular hyperthermia in children. JEMS 2013; 38:36-42. [PMID: 24159737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Zhang Y, Nitschke M, Bi P. Risk factors for direct heat-related hospitalization during the 2009 Adelaide heatwave: a case crossover study. Sci Total Environ 2013; 442:1-5. [PMID: 23168533 DOI: 10.1016/j.scitotenv.2012.10.042] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/25/2012] [Accepted: 10/09/2012] [Indexed: 05/09/2023]
Abstract
Adelaide experienced an extreme and prolonged 13 days heatwave in summer 2009. The health impacts of this heatwave included an almost 14-fold increase in direct heat-related hospital admissions. This study aims to investigate the risk factors for this extra health burden. A case crossover study was conducted in metropolitan Adelaide to compare the characteristics of patients from the heatwave (exposure) period and non-heatwave (control) periods before and after. Direct heat-related hospitalizations were identified based on the ICD-10 codes (X30, T67, and E86). Patients' data, including age, gender, indicators of health status, living conditions and socio-economic status, were collected from the South Australian Department of Health and patients' case-notes from seven major Adelaide hospitals. Multivariate logistic regression model was used to estimate the odd ratios (OR) and the 95% confidence intervals (CI). Results indicate that living at residential aged care (OR=0.41, 95% CI: 0.15-0.70) and having higher number of co-morbidities (OR=0.89, 95% CI: 0.83-0.95) reduced the risk of hospital admission for direct heat-related illnesses during the heatwave, while having renal problems (OR=1.72, 95% CI: 1.07-2.94), reporting a fall prior to hospitalization (OR=2.04, 95% CI: 1.10-3.77), receiving assistance from community (OR=2.31, 95% CI: 1.24-4.30), living alone (OR=2.41, 95% CI: 1.32-4.40), socio-economic disadvantage (OR=2.10, 95% CI: 1.09-4.04) and no private health insurance (OR=1.82, 95% CI: 1.05-3.16) increased the risk. In conclusion, the people most at risk during the 2009 heatwave in Adelaide were those who lived alone, received help from community services, with co-existing renal problems or a risk of falls, and with a lower socio-economic status. Findings will assist in refining heat-health response systems and developing intervention programmes.
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Affiliation(s)
- Ying Zhang
- School of Population Health and Clinical Practice, The University of Adelaide, Adelaide, SA 5005, Australia.
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Kondo M, Ono M, Nakazawa K, Kayaba M, Minakuchi E, Sugimoto K, Honda Y. Population at high-risk of indoor heatstroke: the usage of cooling appliances among urban elderlies in Japan. Environ Health Prev Med 2012; 18:251-7. [PMID: 23160849 DOI: 10.1007/s12199-012-0313-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 10/09/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Heatstroke due to a heat wave during the summer is one of the commonly known health impacts of climate change in Japan. The elderly are particularly at high-risk of developing indoor heatstroke with poor prognosis. This study aims to describe the population among elderlies at high-risk of indoor heatstroke by focusing on the usage of cooling appliances. METHODS We conducted a web-based household survey in eight urban areas during the winter season of 2011. Households with a person aged 65 and over were selected as samples from panel members of a research firm, and the oldest member of the household was queried about his/her usage of cooling appliances. The population at high-risk of indoor heatstroke is defined as the elderly staying in a room without cooling appliances, or not using the installed cooling appliances, or turning the cooling appliances on only when the room temperature is above 28 °C. RESULTS 15.4 and 19.1 % of the elderlies living in urban areas of Japan are identified as at high-risk of indoor heatstroke during activity time and sleeping time, respectively, according to the definition of high-risk of indoor heatstroke in this study. CONCLUSIONS These figures are not negligible since the consequences of heatstroke are grave, but its risk can be eliminated by an appropriate usage of cooling appliances. The preventive interventions are needed to protect the elderlies at high-risk of heatstroke.
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Affiliation(s)
- Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Pumchandh N, Tedsana V, Ngow S, Rangsin R, Aimpun P, Mungthin M, Srilennawat N. Monitoring of the bed time body temperature and body weight to prevent the occurrence of heat stroke in the Royal Thai Army recruits, Lopburi Province, Thailand. J Med Assoc Thai 2012; 95 Suppl 5:S1-S5. [PMID: 22934437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Heat stroke is still an important health problem in Thai army recruits. The authors aimed to evaluate a new method for preventing heat stroke in the newly army recruits during basic training in May-June 2006, by monitoring the bed time body temperature and body weight. MATERIAL AND METHOD One thousand one hundred and fifteen recruits from five army units in Lopburi Province, Thailand were enrolled in the present study. Standardized questionnaire was used for data collection including unit information, personal information, environmental information and daily activity information. Bed time body temperature and body weight were recorded daily. Anyone who had a body temperature > 37.8 degrees C or body weight lossing > 10% in 24 h had to stop training until these indicators were normal. RESULTS There was no incidence of heat stroke in these army units during this training period. There were 191 recruits who had a body temperature > 37.8 degrees C. The mean duration of the fever was 3.3 +/- 3.3 days. The incidence of fever was 21.4 per 100 persons-month. There were 30 recruits with the body weight lossing > 10%. The duration of body weight loss was one day. Analyzed by mixed model using STATA program, there was statistically significant difference of the body temperature (p < 0.001) but not the body weight (p = 0.644) among the period of time. CONCLUSION This monitoring of the bed time body temperature and body weight seems to be effective for the prevention of the occurrence of heat stroke because there was no case of heat stroke in the present study. However, further large-scale study with a control group should be performed.
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Affiliation(s)
- Norawee Pumchandh
- The Medical Platoon of the 1st Battalion of the 31st Infantry Regiment, the King's Guard, Lopburi, Thailand.
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Laaidi K, Zeghnoun A, Dousset B, Bretin P, Vandentorren S, Giraudet E, Beaudeau P. The impact of heat islands on mortality in Paris during the August 2003 heat wave. Environ Health Perspect 2012; 120:254-9. [PMID: 21885383 PMCID: PMC3279432 DOI: 10.1289/ehp.1103532] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 09/01/2011] [Indexed: 05/05/2023]
Abstract
BACKGROUND Heat waves have a drastic impact on urban populations, which could increase with climate change. OBJECTIVES We evaluated new indicators of elderly people's exposure to heat in Paris, from a public health prevention perspective, using satellite thermal images. METHODS We used a time series of 61 images from the satellites of the National Oceanic and Atmospheric Administration's (NOAA) Advanced Very High Resolution Radiometer (AVHRR) taken from 1 to 13 August 2003 to produce thermal indicators of minimum, maximum, and mean surface temperatures and diurnal temperature amplitude, with different lags between the meteorological data and the health impact. Health data came from a case-control study involving 241 people ≥ 65 years of age who died in the city of Paris or the nearby suburban area of Val-de-Marne during the August 2003 heat wave, and 241 controls who were matched to cases on age, sex, and residential zone. For each person, we integrated the thermal indicators in a conditional logistic regression model, adjusted for age and other potential confounders. We computed odds ratios (ORs) comparing the 90th and 50th percentiles of the temperature differences between cases and controls for various indicators. RESULTS Mortality risk was significantly associated with exposure for two indicators: minimum temperatures averaged for 1-13 August [for a 0.41°C increase, OR = 2.17; 95% confidence interval (CI): 1.14, 4.16] and minimum temperature averaged on the day of death and the 6 preceding days (for a 0.51°C increase: OR = 2.24; 95% CI: 1.03, 4.87). CONCLUSIONS Our results support the influence of night temperatures on the health impact of heat waves in urban areas. Urban heat exposure indicators based on satellite imagery have the potential to identify areas with higher risk of death, which could inform intervention decisions by key stakeholders.
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Affiliation(s)
- Karine Laaidi
- Institut de veille sanitaire, Département Santé Environnement, Saint-Maurice, France.
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