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Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather

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Abstract

Hot days are increasingly common and are often associated with increased morbidity and mortality, especially in the elderly. Most heat-related illness and heat-related deaths are preventable. Medicines may accentuate the risk of dehydration and heat-related illness, especially in elderly people taking multiple medicines, through the following mechanisms: diuresis and electrolyte imbalance, sedation and cognitive impairment, changed thermoregulation, reduced thirst recognition, reduced sweat production, and hypotension and reduced cardiac output. Commonly used medicines that may significantly increase the risk include diuretics, especially when combined with an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), anticholinergics and psychotropics. Initiation of individualized preventive measures prior to the start of the hot weather season, which includes a review of the patient and their medicines to identify thermoregulatory issues, may reduce the risk of heat-related illness or death. © 2015 John Wiley & Sons Ltd.

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... The elderly are defined as persons aged over 75 years in this study, because this age group has been found to be particularly vulnerable to heat in Baden-Württemberg [13]. On the one hand, age subsumes many risk factors for suffering from heat such as pre-existing somatic and mental diseases, dependency on nursing care and intake of medication [11,[14][15][16]. A broad range of drugs have been identified to pose a threat in heatwaves because of interfering with the ability to adapt to heat (see Table 1). ...
... Table 1. Drugs associated with increased risks for heat health impacts (adapted from Westaway et al. [15]). ...
... As we noticed this throughout the data collection phase, we specified our question, asking for impacts on morbidity and mortality explicitly in the subsequent interviews. [15]: CVD in general [6], congestive heart failure [4], high blood pressure [4], arrhythmia [2], coronary heart disease [2], heart attack in patient history [1], stroke [1] Multi-morbidity [8] Dementia or other cognitive impairment [8] Respiratory diseases (RD) [6]: Chronic Obstructive Pulmonary Disease (COPD) [4], RD in general [2], asthma [1] Renal Disease [6] Diabetes [6] Psychiatric disorder, e.g., depression [2] Other impairments: Electrolyte imbalance [2], acute infections (esp. diarrheal disease) [3], chronic disease in general [2], adiposity [1], collapse in patient history [1], dehydration in patient history [1] Socioeconomic Factors [19/24] Social support and nursing care situation [14]: living alone without support [11], living alone in general [3], living alone or in care homes with insufficient support [2] Housing [7]: warm housing situation [4], impaired access to logistics [3] Social status [4]: low financial capacity [3], low education [1] Individual Factors [18/24] Age [16]: Old age [12], young age [4], old age as insufficient criteria [2] Male Sex [1] (weaker social network) Genetics [3] Intake of Medication [14/24] Cardiovascular medication [13]: antihypertensive medication in general [8], diuretics [9], betablocker [2], calcium antagonists [1], antiarrhythmic agents [1], Other medication [4]: antibiotics [1], antidiabetics [1], St. John's wort (photosensitivity) [1], nonprescribed medication (e.g., pain killers) [1]. ...
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Heat health impacts (HHI) on the elderly are a growing concern in the face of climate change and aging populations. General practitioners (GPs) have an important role in health care for the elderly. To inform the development of effective prevention measures, it is important to investigate GPs’ perceptions of HHI. Twenty four qualitative expert interviews were conducted with GPs and analyzed using the framework approach. GPs were generally aware of heat health impacts, focusing on cardiovascular morbidity and volume imbalances. Perceptions of mortality and for instance impacts on respiratory diseases or potentially risky drugs in heat waves partly diverged from findings in literature. GPs judged the current relevance of HHI differently depending on their attitudes towards: (i) sensitivity of the elderly, (ii) status of nursing care and (iii) heat exposure in Baden-Württemberg. Future relevance of HHI was perceived to be increasing by most GPs. The main cause identified for this was population aging, while impacts of climate change were judged as uncertain by many. GPs’ perceptions, partly diverging from literature, show that GPs’ knowledge and awareness on HHI and climate change needs to be strengthened. However, they also emphasize the need for more research on HHI in the ambulant health care setting. Furthermore, GPs perceptions suggest that strong nursing care and social networks for elderly are major elements of a climate resilient health system.
... Some classes of medications commonly used by older patients with chronic conditions may predispose these individuals to heat-related complications. These medications can sensitize a patient to heat by disrupting thermoregulatory responses that maintain core body temperature, either by interfering with cognitive processes or by directly disrupting autonomic mechanisms [11]. For instance, thermoregulation may be affected by numerous centrally-acting medications for neuropsychological disorders including antipsychotics, beta blockers, stimulants, and a broad array of medications with anticholinergic properties [11,12]. ...
... These medications can sensitize a patient to heat by disrupting thermoregulatory responses that maintain core body temperature, either by interfering with cognitive processes or by directly disrupting autonomic mechanisms [11]. For instance, thermoregulation may be affected by numerous centrally-acting medications for neuropsychological disorders including antipsychotics, beta blockers, stimulants, and a broad array of medications with anticholinergic properties [11,12]. Dehydration with or without concurrent electrolyte disturbance may also contribute to thermoregulatory failure, and medications that suppress thirst [13] and disrupt fluid balance such as angiotensin converting enzyme (ACE) inhibitors and diuretics, are commonly used by older patients [11,14] with chronic conditions. ...
... For instance, thermoregulation may be affected by numerous centrally-acting medications for neuropsychological disorders including antipsychotics, beta blockers, stimulants, and a broad array of medications with anticholinergic properties [11,12]. Dehydration with or without concurrent electrolyte disturbance may also contribute to thermoregulatory failure, and medications that suppress thirst [13] and disrupt fluid balance such as angiotensin converting enzyme (ACE) inhibitors and diuretics, are commonly used by older patients [11,14] with chronic conditions. Additionally, prior epidemiologic studies, mostly conducted in non-US samples or in the general population, support some of these hypotheses [15][16][17][18][19]. ...
Article
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Background Heatwaves kill more people than floods, tornadoes, and earthquakes combined and disproportionally affect older persons and those with chronic conditions. Commonly used medications for chronic conditions, e.g., diuretics, antipsychotics disrupt thermoregulation or fluid/electrolyte balance and may sensitive patients to heat. However, the effect of heat-sensitizing medications and their interactions with heatwaves are not well-quantified. We evaluated effects of potentially heat-sensitizing medications in vulnerable older patients. Methods US Medicare data were linked at the zip code level to climate data with surface air temperatures for June-August of 2007–2012. Patients were Medicare beneficiaries aged ≥65 years with chronic conditions including diabetes, dementia, and cardiovascular, lung, or kidney disease. Exposures were potentially heat-sensitizing medications including diuretics, anticholinergics, antipsychotics, beta blockers, stimulants, and anti-hypertensives. A heatwave was defined as ≥2 days above the 95 th percentile of historical zip code-specific surface air temperatures. We estimated associations of heat-sensitizing medications and heatwaves with heat-related hospitalization using self-controlled case series analysis. Results We identified 9,721 patients with at least one chronic condition and heat-related hospitalization; 42.1% of these patients experienced a heatwave. Heatwaves were associated with an increase in heat-related hospitalizations ranging from 21% (95% CI: 7% to 38%) to 33% (95% CI: 14% to 55%) across medication classes. Several drug classes were associated with moderately elevated risk of heat-related hospitalization in the absence of heatwaves, with rate ratios ranging from 1.16 (95% CI: 1.00 to 1.35) to 1.37 (95% CI: 1.14 to 1.66). We did not observe meaningful synergistic interactions between heatwaves and medications. Conclusions Older patients with chronic conditions may be at heightened risk for heat-related hospitalization due to the use of heat-sensitizing medications throughout the summer months, even in the absence of heatwaves. Further studies are needed to confirm these findings and also to understand the effect of milder and shorter heat exposure.
... This article reviews the current literature on drugassociated non-pyrogenic hyperthermia due to altered thermoregulation. In brief, the effects that drugs may have on thermoregulation are mainly achieved through the following [13][14][15]. ...
... Antipsychotic drugs potentially increase the hypothalamic temperature set point through their antidopaminergic activity. Anticholinergics, antipsychotics and tricyclic antidepressants can impair the ability to sweat by the inhibition of the muscarinic sweat glands [14]. Diuretics reduce blood pressure and can cause dehydration, with consequent reductions in peripheral blood flow [13]. ...
... Diuretics reduce blood pressure and can cause dehydration, with consequent reductions in peripheral blood flow [13]. Antihypertensives such as ACEI and angiotensin receptor blockers can also reduce thirst sense and fluid intake through diminished angiotensin II activity [14,29]. Beta-blockers can reduce heat loss by convection and conduction due to reduced blood flow to the skin [28]. ...
Article
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Purpose Hyperthermia occurs when heat accumulation surpasses the body’s ability for heat dissipation. Many drugs may affect thermoregulation. This narrative review aimed to provide an overview of the current literature concerning reports of drug-associated non-pyrogenic hyperthermia. Methods A comprehensive search was performed across 5 databases covering the period of inception to March 2019, for publications that reported hyperthermia associated with drug use. Studies that reported potential drug association with hyperthermia due to altered thermoregulatory mechanisms were included. Case reports of less than 3 cases were excluded, as well as hyperthermia due to other causes, such as hypersensitivity, malignant hyperthermia and neuroleptic malignant syndrome. The primary outcomes of interest were hospitalisation and mortality. Results The literature search initially identified a total of 2609 records. Based on full-text analysis, 11 articles met the inclusion criteria, of which there were 5 case-control studies, 2 case series and 4 retrospective analyses. Studies reported heat-related hospitalisations or emergency department presentations associated with the use of psychotropics (antipsychotics, antidepressants and anxiolytics), anticholinergics, antihistamines, diuretics, cardiovascular agents, non-steroidal anti-inflammatory drugs and anticoagulants. Psychotropic drugs were reported to be associated with increased heat-related mortality, other than through neuroleptic malignant syndrome, but findings varied among the studies. Conclusion Given the relative lack of publications, more research is necessary to study specific effects of drugs on body temperature and the likelihood of inducing non-pyrogenic hyperthermia. In particular, psychotropics, anticholinergics, diuretics and cardiovascular agents are of interest for future studies.
... Personal factors such as pre-existing medical conditions, obesity, certain medications, age, pregnancy, and lower levels of physical fitness, may increase the risk of HRI (Table 2). 40,41 As part of an employer's heat illness prevention program, pre-placement and periodic medical monitoring enable OEM providers to screen for these risk factors and educate workers or recommend interventions to reduce the risk. ...
... Medical conditions such as cardiovascular disease, diabetes, pulmonary disease, kidney disease, skin disorders, and infections increase the risk of HRIs and heat-related deaths. 11,12,40,41 Much of the evidence comes from observational studies of elderly individuals during heat waves. There is also some evidence from working populations. ...
... These age-related changes include slower sweat gland response to heat, lower plasma volume, decreased cardiac output, reduced blood flow to the skin, and diminished thirst drive. 40,41 Working for shorter intervals and taking longer breaks may be protective for older workers who are at risk for HRI because of these natural effects of aging. 14 Pregnant women have higher body temperatures and need more fluids to cool their core temperature. ...
Article
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High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.
... A further issue is whether environmental factors, for example, daily temperature and periods of extreme heat, might influence the associations between psychotropic use, hospital admissions, and outcomes. There is evidence, from case reports and experimental studies, that several psychotropics alter thermoregulation, [22][23][24][25] blood pressure control, [26][27][28] and sodium and water homeostasis. 29,30 Previous studies have also described the adverse effects of periods of extreme heat, that is, heat waves (HWs), in older adults, including an increased risk of hospitalization secondary to respiratory conditions, fluid and electrolyte disorders, and heat stroke. ...
... Psychotropics can adversely affect the homeostatic control of body temperature, blood pressure, and fluid and electrolyte balance. [22][23][24][25][26][27][28][29][30] Although this might occur with psychotropic overdose and intoxication, other factors such as age-related impairment in homeostatic capacity and extreme weather conditions, for example, HWs, might play a role. A case-control study reported that the use of antipsychotic or anxiolytic drugs was associated with increased risk of visiting the emergency department during an HW, because of heat stroke or hyperthermia. ...
Article
Purpose: The authors investigated whether the use of psychotropics and environmental temperature on admission influence hospital length of stay (LOS) and mortality in older medical patients. Methods: Clinical and demographic characteristics, Charlson Comorbidity Index, use of psychotropic and nonpsychotropic drugs, hospital LOS, and mortality were retrospectively collected in medical patients 65 years and older (n = 382) admitted to a metropolitan teaching hospital during 5 consecutive heat waves (HWs) between 2007 and 2009. Patients admitted either before or after each HW, matched for HW period, age, and admission day of the week, served as controls (non-HW, n = 1339). Results: Total number of psychotropic and nonpsychotropic drugs, Charlson Comorbidity Index, comorbidities, number of daily admissions, LOS, and mortality were similar in the HW and non-HW groups. After adjusting for clinical and demographic confounders, competing risks regression showed that psychotropic use, particularly antipsychotics, predicted increased LOS during non-HW (subdistribution hazard ratio: 95% CI, 0.82, 0.72-0.94; P = 0.003) but not HW (subdistribution hazard ratio: 95% CI, 0.89, 0.69-1.14; P = 0.36) periods. The effect of psychotropics on LOS during normal weather conditions was particularly evident in the old-old subgroup (difference [SE] in coefficients between non-HW and HW periods: -0.52 [0.25], P = 0.036 in patients >80 years; 0.11 [0.19], P = 0.54, in patients 65-80 years). By contrast, psychotropics did not predict hospital mortality during non-HW or HW periods. Conclusions: Psychotropic use on admission, particularly antipsychotics, predicted hospital LOS, but not mortality, in older medical patients, particularly those older than 80 years, during normal environmental temperature. However, there was no effect of psychotropics on LOS during extreme heat.
... This difference is essentially due to the possibility of adapting to the conditions of the thermal environment, which differs from one patient to another, and indeed, some patients simultaneously suffer from multiple (Table 5). This could also be explained by the drugs taken by patients, which may increase the risk of dehydration and heat-related diseases by the following mechanisms: thermoregulation, diuresis, and electrolyte imbalance, sedation and cognitive impairment, hypotension, and reduced cardiac output [28]. Age-related diseases are the most critical issues affecting the thermal comfort requirements of patients. ...
... This difference is essentially due to the possibility of adapting to the conditions of the thermal environment, which differs from one patient to another, and indeed, some patients simultaneously suffer from multiple illnesses (Table 5). This could also be explained by the drugs taken by patients, which may increase the risk of dehydration and heat-related diseases by the following mechanisms: thermoregulation, diuresis, and electrolyte imbalance, sedation and cognitive impairment, hypotension, and reduced cardiac output [28]. Age-related diseases are the most critical issues affecting the thermal comfort requirements of patients. ...
Article
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This paper investigates adaptive thermal comfort during summer in medical residences that are located in the French city of Troyes and managed by the Association of Parents of Disabled Children (APEI). Thermal comfort in these buildings is evaluated using subjective measurements and objective physical parameters. The thermal sensations of respondents were determined by questionnaires, while thermal comfort was estimated using the predicted mean vote (PMV) model. Indoor environmental parameters (relative humidity, mean radiant temperature, air temperature, and air velocity) were measured using a thermal environment sensor during the summer period in July and August 2018. A good correlation was found between operative temperature, mean radiant temperature, and PMV. The neutral temperature was determined by linear regression analysis of the operative temperature and Fanger’s PMV model. The obtained neutral temperature is 23.7 °C. Based on the datasets and questionnaires, the adaptive coefficient α representing patients’ capacity to adapt to heat was found to be 1.261. A strong correlation was also observed between the sequential thermal index n(t) and the adaptive temperature. Finally, a new empirical model of adaptive temperature was developed using the data collected from a longitudinal survey in four residential buildings of APEI in summer, and the obtained adaptive temperature is 25.0 °C with upper and lower limits of 24.7 °C and 25.4 °C.
... High atmospheric temperature can increase risk of mortality caused by cardiovascular, respiratory, and other ailments, suggesting the existence of multiple biological pathways (Anderson and Bell, 2009;Gasparrini et al., 2012;Gasparrini et al., 2015), and heatwaves lead to dehydration, hyperthermia, heat exhaustion, heatstroke, complications of delirium, and exacerbation of a pre-existing illness (Åström et al., 2011;Fouillet et al., 2006;Westaway et al., 2015). Meanwhile, social isolation is associated with loneliness, stress (Cacioppo and Hawkley, 2003;Steptoe et al., 2004), and lack of physical activity (Robins et al., 2018) or independent living (Russell et al., 1997). ...
... Further, social T isolation can increase blood pressure (Cacioppo et al., 2002;Grant et al., 2009), cholesterol and cortisol awakening responses to stress (Grant et al., 2009), impairment of immune function (Pressman et al., 2005), and eventually cardiovascular morbidity and mortality (Grant et al., 2009). Thus, heat-related deaths most often occur in vulnerable elderly people living at home alone who lack social support and do not call for assistance (Basu and Ostro, 2008;Bouchama et al., 2007;Westaway et al., 2015). ...
Article
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Although several studies have reported that social isolation is one of the important health risk factors in the elderly population living in urban areas, its effects on vulnerability to heatwaves have been studied relatively less than climatic and other socio-economic factors. Thus, we investigated the association between social isolation levels and heatwave-related mortality risk in the elderly population in 119 urban administrative districts in Korea, using a time-series multi-city dataset (2008–2017). We used a two-stage analysis. In the first stage, we estimated the heatwave-related mortality risk in the elderly population (age ≥ 65) for each district using a time-series regression with a distributed lag model. Subsequently, in the second stage, we applied meta-regressions to pool the estimates across all the districts and estimate the association between social isolation variables and heatwave-related mortality risk. Our findings showed that higher social gathering and mutual aid levels were associated with lower heatwave-related mortality risk. Further, the lower percentage of single elderly households living in detached houses was also related to higher heatwave-related mortality risk. The associations were generally more evident in males compared to females. Our findings suggest that vulnerability to heatwave-related mortality among the urban, city-dwelling, elderly population may be amplified by higher isolation indicators.
... There have been numerous studies from Australia, Canada, Israel and other countries examining the association between high ambient temperatures and hospitalizations related to MBDs indicating an increased risk of temperature related-deaths and hospitalizations, especially among those with dementia and schizophrenia [18][19][20][21]. Additionally, there is mounting evidence that certain medications used to treat MBDs can exacerbate effects on individuals using psychotropic and cardiovascular medications when exposed to extreme heat [22,23]. In contrast, there have been fewer studies from the United States examining these associations and those that exist have been limited to specific heat events or smaller case studies [24][25][26]. ...
... While we were not able to evaluate the use or the number of medications prescribed, the use of illicit and prescribed medications may account for MBD hospitalizations with concurrent HRI. Elderly patients on antipsychotics for dementia and others being treated for various mental health conditions may also be taking multiple medications to treat underlying health issues, which could also affect the thermoregulatory response [23]. While these effects may not be apparent during cooler seasons, healthcare practitioners may need to evaluate the use of certain medications among patients suffering from MBDs during summer months and monitor them closely during periods of excessive heat. ...
Article
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Background Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States. Objective To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis. Methods This study uses hospitalization data from the Nationwide Inpatient Sample (2001–2010). Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR) were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI. Results Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06), African Americans (RR, 1.16), Native Americans (RR, 1.70), uninsured (RR, 1.92), and those 40 years and older, compared to MBD hospitalizations alone. Conclusions Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies.
... Due to physiological changes because of aging, dehydration is more common in the older individual. These changes include debilitation of renal function, low total body water, and lower thirst sensation (29). ...
Article
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Introduction To mitigate morbidity, mortality, and impacts of heat-related illnesses (HRIs) on health, it was vital to implement a comprehensive framework for HRI prevention and control. A recognized tool from the field of trauma prevention known as the Haddon matrix was applied. The matrix states that any event is affected by three factors: host, agent, and environment. In addition, another recognized tool known as the combined model was used in this study. The combined model is a three-dimensional model that includes the idea for the three axes of Haddon's matrix with the methodology of the community risk reduction (CRR) model. Aim of the study To identify the environmental and individual risk factors of HRIs based on the Haddon matrix and the recommended prevention strategies by the CRR tool by using the combined model. Methodology An extensive literature review was conducted to assess all the risk factors associated with HRI, as well as preventive measures. Then the Haddon matrix was used to structure, separating human factors from technical and environmental details and timing. After that, the combined model was used to set all responses and mitigation measures for each element obtained from the Haddon matrix tool. Conclusion Projected increases in heat stress over the globe require the formulation and implementation of evidence-based HRI mitigation and preventive measures. In this study, we implemented the combined model that was utilized as a systematic strategy for the more theoretical framework of Haddon's matrix. Using the Haddon matrix to determine the HRI risk factors and the combined model to mitigate its impact was practical and helpful in planning, preparedness, and mitigating the HRIs during Hajj, provided a broad approach equivalent to the Swiss cheese model, and would facilitate an informed decision.
... A number of factors affecting per se renal function, e.g., specific co-morbidities and non-TW nephrotoxic drugs, should be accounted for when investigating associations between the TW and in-hospital AKI. Periods of extreme heat might also influence these associations by promoting fluid loss through perspiration, dehydration, and pre-renal failure [9,10,12]. Notably, pre-renal failure is considered the main mechanism underlying TW-mediated AKI [7]. ...
Article
Introduction: We investigated whether the concomitant use of diuretics, non-steroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (triple whammy, TW) predicts in-hospital acute kidney injury (AKI) and whether admission during recorded periods of extreme heat influences this association. Methods: We retrospectively collected data on patient characteristics and use of TW/non-TW drugs on admission, AKI (increase in serum creatinine ≥ 27 µmol/l either within the first 48 h of admission or throughout hospitalization, primary outcome), length of stay (LOS), and mortality (secondary outcomes) in medical patients ≥65 years admitted (1) during five consecutive heat waves (HWs) between 2007 and 2009 (n = 382) or (2) either before or after each HW, matched for HW period, age, and admission day of the week (non-HW, controls, n = 1339). Results: Number of TW and non-TW drugs, co-morbidities, number of daily admissions, incidence of in-hospital AKI, LOS, and mortality were similar in the HW and non-HW groups. After adjusting for clinical and demographic confounders, logistic regression showed that TW use did not predict AKI within 48 h of admission either during non-HW periods (OR 0.79, 95% CI 0.34-1.83, P = 0.58) or during HWs (OR 1.02, 95% CI 0.21-2.97, P = 0.97). Similar results were observed when AKI was captured throughout hospitalization. TW use did not predict LOS or mortality irrespective of environmental temperature on admission. Conclusions: TW use on admission did not predict in-hospital AKI, LOS, or mortality in older medical patients admitted either during periods of normal environmental temperature or during HWs.
... 23. Certain health conditions and common prescription medications, including psychotropics, interfere with the body's capacity to regulate temperature (Westaway et al., 2015). This is a concern given the high number of comorbid physical and mental health conditions prevalent among jail populations; In 2020, approximately 45-52% of people detained in New York City jails on any given day were flagged for a potential mental health problem or need for treatment (Rempel, 2020). ...
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The U.S. criminal legal system contributes to the oppression and harm of marginalized groups, calling into question ethical governance. The front end of this system, specifically bail and pretrial justice, exploits opportunities for resource generation and social control as a major driver of incarceration, yet receives limited attention in public administration or ethics. Disproportionate punishment and collateral penalties associated with bail and pretrial justice are causes and consequences of structural racism and administrative dysfunction. Excessive bail as a poverty penalty incurs risks to health, safety, financial security, and constitutional presumptions and protections. In light of civil and constitutional rights concerns, bail and pretrial-associated philanthropic solutions have proliferated. This article provides background on bail and pretrial justice policies and politics; outlines evidence of related consequences; describes select reform efforts and philanthropic tools, including the charitable bail organization The Bail Project; and contextualizes bail and pretrial justice within a public values framework, which centers social equity and incorporates critical race theory alongside politics and public ethics of care. Upholding the Constitution and the law, strengthening social equity, and ensuring procedural due process are core tenets of good governance, yet anathema to the current bail and pretrial justice system, which is a critical public ethics concern.
... Healthy elderly adults (aged 65+), have lower cardiac outputs, blood circulation and skin blood flow when compared to younger patients (Kenney and Munce, 2003;Minson et al., 1998), making thermoregulation through circulatory means less efficient. Furthermore, specific medications that are more common in the elderly can increase the risk of dehydration and subsequent heat-related illness (NIOSH, 2016;Westaway et al., 2015). Psychological drugs such as antidepressants and antipsychotics can alter central thermoregulation by impairing sweating (Beyer et al., 2017) and have a significantly increased prevalence in the elderly (aged 60+) (Pratt et al., 2017). ...
Article
Projections show that Earth's climate will continue to warm concurrent with increases in the percentage of the world's elderly population. With an understanding that the body's resilience to the heat degrades as it ages, these coupled phenomena point to serious concerns of heat-related mortality in growing elderly populations. As many of the people in this age cohort choose to live in managed long-term care facilities, it's imperative that outdoor spaces of these communities be made thermally comfortable so that connections with nature and the promotion of non-sedentary activities are maintained. Studies have shown that simply being outside has a positive impact on a broad range of the psychosocial well-being of older adults. However, these spaces must be designed to afford accessibility, safety, and aesthetically pleasing experiences so that they are taken full advantage of. Here, we employ an integrative review to link ideas from the disciplines of climate science, health and physiology, and landscape architecture to explain the connections between heat, increased morbidity and mortality in aging adults, existing gaps in thermal comfort models, and key strategies in the development of useable, comfortable outdoor spaces for older adults. Integrative reviews allow for new frameworks or perspectives on a subject to be introduced. Uncovering the synergy of these three knowledge bases can contribute to guiding microclimatic research, design practitioners, and care providers as they seek safe, comfortable and inviting outdoor spaces for aging adults.
... Due to physiological changes because of aging, dehydration is more common in the older individual. These changes include debilitation of renal function, low total body water, and lower thirst sensation (29). ...
Article
Introduction: To mitigate morbidity, mortality, and impacts of heat-related illnesses (HRIs) on health, it was vital to implement a comprehensive framework for HRI prevention and control. A recognized tool from the field of trauma prevention known as the Haddon matrix was applied. The matrix states that any event is a ected by three factors: host, agent, and environment. In addition, another recognized tool known as the combined model was used in this study. The combined model is a three-dimensional model that includes the idea for the three axes of Haddon's matrix with the methodology of the community risk reduction (CRR) model. Aim of the study: To identify the environmental and individual risk factors of HRIs based on the Haddon matrix and the recommended prevention strategies by the CRR tool by using the combined model. Methodology: An extensive literature review was conducted to assess all the risk factors associated with HRI, as well as preventive measures. Then the Haddon matrix was used to structure, separating human factors from technical and environmental details and timing. After that, the combined model was used to set all responses and mitigation measures for each element obtained from the Haddon matrix tool. Conclusion: Projected increases in heat stress over the globe require the formulation and implementation of evidence-based HRI mitigation and preventive measures. In this study, we implemented the combined model that was utilized as a systematic strategy for the more theoretical framework of Haddon's matrix. Using the Haddon matrix to determine the HRI risk factors and the combined model to mitigate its impact was practical and helpful in planning, preparedness, and mitigating the HRIs during Hajj, provided a broad approach equivalent to the Swiss cheese model, and would facilitate an informed decision.
... (Level -V; Strength -C; Panel Agreement -strong) Rationale: These medications include alpha-agonists (e.g., tizanidine, clonidine), narcotics, oxybutynin, gabapentin, and antidepressants that are norepinephrine-and serotonin reuptake inhibitors (Adubofour et al., 1996;Cuddy, 2004;Kameyama et al., 1986;Menard & Hahn, 1991;Westaway et al., 2015). Although the effects of these medications are not well understood, their effects on thermoregulation are usually dose dependent. ...
... ;Blachère et al. (2011);Westaway et al. (2015). ...
Article
More frequent and intense periods of extreme heat (heatwaves) represent the most direct challenge to human health posed by climate change. Older adults are particularly vulnerable, especially those with common age-associated chronic health conditions (e.g., cardiovascular disease, hypertension, obesity, type 2 diabetes, chronic kidney disease). In parallel, the global population is aging and age-associated disease rates are on the rise. Impairments in the physiological responses tasked with maintaining homeostasis during heat exposure have long been thought to contribute to increased risk of health disorders in older adults during heatwaves. As such, a comprehensive overview of the provisional links between age-related physiological dysfunction and elevated risk of heat-related injury in older adults would be of great value to healthcare officials and policy makers concerned with protecting heat-vulnerable sectors of the population from the adverse health impacts of heatwaves. In this narrative review, we therefore summarize our current understanding of the physiological mechanisms by which aging impairs the regulation of body temperature, hemodynamic stability and hydration status. We then examine how these impairments may contribute to acute pathophysiological events common during heatwaves (e.g., heatstroke, major adverse cardiovascular events, acute kidney injury) and discuss how age-associated chronic health conditions may exacerbate those impairments. Finally, we briefly consider the importance of physiological research in the development of climate-health programs aimed at protecting heat-vulnerable individuals.
... These medications include alpha-agonists (e.g., tizanidine, clonidine), narcotics, oxybutynin, gabapentin, and antidepressants that are norepinephrine and serotonin reuptake inhibitors (Adubofour et al., 1996;Cuddy, 2004;Kameyama et al., 1986;Menard & Hahn, 1991;Westaway et al., 2015). Although the effects of these medications are not well understood, their effects on thermoregulation are usually dose dependent. ...
... The PMV-PPD model requires two personal factors-metabolic rate and clothing insulation-and four environmental factors-air temperature, radiant temperature, air velocity, and humidity [11]. When patients take medications that affect their thermoregulatory system [12], the predictability of comfort ratings may be less reliable. Therefore, thermal adaptation can play a key role in evaluating the thermal sensation of patients. ...
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The thermal comfort requirements of disabled people in healthcare buildings are an important research topic that concerns a specific population with medical conditions impacted by the indoor environment. This paper experimentally investigated adaptive thermal comfort in buildings belonging to the Association of Parents of Disabled Children, located in the city of Troyes, France, during the winter season. Thermal comfort was evaluated using subjective measurements and objective physical parameters. The thermal sensations of respondents were determined by questionnaires adapted to their disability. Indoor environmental parameters such as relative humidity, mean radiant temperature, air temperature, and air velocity were measured using a thermal microclimate station during winter in February and March 2020. The main results indicated a strong correlation between operative temperature, predicted mean vote, and adaptive predicted mean vote, with the adaptive temperature estimated at around 21.65 °C. These findings highlighted the need to propose an adaptive thermal comfort strategy. Thus, a new adaptive model of the predicted mean vote was proposed and discussed, with a focus on the relationship between patient sensations and the thermal environment.
... The T wb,crit values in this study are applicable to young, healthy individuals meaning that the current risk to more vulnerable populations is even higher than previously thought. Notably, the elderly are at increased risk due to decreased thermoeffector responsiveness to heat stress (19,20), medication-induced degradation of body cooling capacity (21), and biobehavioral alterations, which further inhibit heat tolerance (22). This has been realized in excess deaths among the elderly during the 1995 Chicago, USA (23) and 2003 European (24) heatwaves in addition to many others. ...
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A wet-bulb temperature of 35°C has been theorized to be the limit to human adaptability to extreme heat, a growing concern in the face of continued and predicted accelerated climate change. While this theorized threshold is based in physiological principles it has not been tested using empirical data. This study examined the critical wet-bulb temperature (T wb, crit ) at which heat stress becomes uncompensable in young, healthy adults performing tasks at modest metabolic rates mimicking basic activities of daily life. Across six experimentally determined environmental limits, no subject's T wb, crit reached the 35°C limit and all means were significantly lower than the theoretical 35°C threshold. Mean T wb, crit values were relatively constant across 36-40°C humid environments and averaged 30.55±0.98 °C but progressively decreased (higher deviation from 35°C) in hotter, dry ambient environments. T wb, crit was significantly associated with mean skin temperature (and a faster warming rate of the skin) due to larger increases in dry heat gain in the hot-dry environments. As sweat rates did not significantly differ among experimental environments, evaporative cooling was outpaced by dry heat gain in hot-dry conditions, causing larger deviations from the theoretical 35°C adaptability threshold. In summary, a wet-bulb temperature threshold cannot be applied to human adaptability across all climatic conditions and where appropriate (high humidity), that threshold is well below 35°C.
... For example, some medications, including diuretics, anticholinergics, and psychotropics, may increase an individual's risk of suffering heat-related illness. 50 In these cases, prescribers should consider alternative medications, appropriately counsel patients about heat risks, and screen for risk factors such as lack of access to cooling or outdoor work. Support for this body of work may come from the Health Resources and Services Administration (HRSA), given the disproportionate health burdens on the most disadvantaged (for example, integrate a climate lens into HRSA's Health Center Program, aimed at providing primary care in medically underserved areas). ...
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Climate change increasingly threatens the ability of the US health care system to deliver safe, effective, and efficient care to the American people. The existing health care system has key vulnerabilities that will grow more problematic as the effects of climate change on Americans' lives become stronger. Thus, health care policy makers must integrate a climate lens as they develop health system interventions. Applying a climate lens means assessing climate change-driven health risks and integrating them into policies and other actions to improve the nation's health. This lens can be applied to rethinking how to take a more population-based approach to health care delivery, prioritize health care system decarbonization and resilience, adapt data infrastructure, develop a climate-ready workforce, and pay for care. Our recommendations outline how to include climate-informed assessments into health care decision making and health policy, ultimately leading to a more resilient and equitable health care system that is better able to meet the needs of patients today and in the future.
... Diuretics can increase urination and perspiration and contribute to dehydration, especially when combined with antipsychotics and other medicines that reduce thirst sensation and otherwise affect thermoregulation. 35 A study during a 2003 heat wave in France found that heat-related illness patients prescribed anticholinergics, anti-psychotics, and anxiolytics were more likely to be seen in the emergency room compared to community controls prescribed other medications. The study also found that diuretic use was associated with increased risk of death. ...
Technical Report
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This document is intended to give a summary of extreme heat, the health burden of heat exposure, the impacts of climate change, and components and effectiveness of heat response plans with a focus on relevant peer-reviewed literature and existing heat response plans. Resources and examples of successful implementation and potential collaborative efforts are included.
... Dalam hal memilih orang yang akan bekerja di dapur, pemeriksaan kesehatan awal harus termasuk ke dalam tahapan seleksinya. Hal ini dilakukan untuk mengetahui faktor pribadi yang sekiranya dapat meningkatkan risiko terkena Heat-Related Illness seperti kondisi kesehatan sebelum memulai kerja di dapur, tingkat kebugaran fisik, riwayat obat-obatan yang diminum, hingga status kehamilan (Westaway K et al, 2015;Leyk, 2019). Adapun beberapa penyakit yang dapat meningkatkan risiko terkena Heat-Related Illness bagi para pekerja dapur di antaranya adalah penyakit kardiovaskular, diabetes, paru, ginjal, kulit, dan infeksi (Leon L R et al, 2015;Tustin et al, 2018). ...
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Kitchen workers are exposed to a lot of hazard and risk, including heat stress. Therefore, we are interested to make a paper about what are the risks of being exposed by heat stress for kitchen workers and how to prevent further injuries. This paper are made for the completion of our final project and has not been reviewed.
... The data sets we used were limited to those from experiments in which healthy subjects performed two types of activity (walking on a treadmill and cycling) in environmental conditions varying between 20 and 40°C at 40% or 50% relative humidity. Under real-world conditions, however, men and women differing in many factors [e.g., age, body composition, fitness level, presence or absence of an illness that can induce heat injury (11,55,57), acclimation level, clothing, and hydration status] perform free-ranging activities of varying intensity. Studies that systematically vary several of the aforementioned factors and include subjects with T c values well within the zone of clinical relevance could further serve to validate our model. ...
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A rising core body temperature (Tc) during strenuous physical activity is a leading indicator of heat-injury risk. Hence, a system that can estimate Tc in real time and provide early warning of an impending temperature rise may enable proactive interventions to reduce the risk of heat injuries. However, real-time field assessment of Tc requires impractical invasive technologies. To address this problem, we developed a mathematical model that describes the relationships between Tc and non-invasive measurements of an individual's physical activity, heart rate, and skin temperature, and two environmental variables (ambient temperature and relative humidity). A Kalman filter adapts the model parameters to each individual and provides real-time personalized Tc estimates. Using data from three distinct studies, comprising 166 subjects who performed treadmill and cycle ergometer tasks under different experimental conditions, we assessed model performance via the root mean squared error (RMSE). The individualized model yielded an overall average RMSE of 0.33{degree sign}C [standard deviation (SD) = 0.18], allowing us to reach the same conclusions in each study as those obtained using the Tc measurements. Furthermore, for 22 unique subjects whose Tc exceeded 38.5{degree sign}C, a potential lower core body temperature limit of clinical relevance, the average RMSE decreased to 0.25{degree sign}C (SD = 0.20). Importantly, these results remained robust in the presence of simulated real-world operational conditions, yielding no more than 16% worse RMSEs when measurements were missing (40%) or laden with added noise. Hence, the individualized model provides a practical means to develop an early warning system for reducing heat-injury risk.
... Furthermore, with aging, thermoregulation is slowed making some medications, such as diuretics, antihypertensives (e.g., ACE inhibitors, angiotensin II receptor blockers), and psy-chiatric medications, a greater risk to older adults during heat waves. When new medications, including over-thecounter medications, are added, the risk of heat-related problems, such as dehydration and delirium, can be amplifi ed (Fick, 2018;Fick, Steis, Mion, & Walls, 2011;Westaway et al., 2015). For example, the risk of lithium toxicity is increased when older adults take lithium carbonate during heat waves (Roxane Laboratories Inc., 2011). ...
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Older adults have unique health risks related to climate change. This commentary addresses the health impacts of climate change for older adults, identifies gaps in gerontological nursing research, and highlights areas for research to address the significant gap in nursing science. Climate risks of extreme weather events, such as heat, rain, flooding, and wildfires, as well as poor air quality, vector-borne diseases, interruptions of services, and treatment plans all place older adults at risk of experiencing greater morbidity and early mortality. Despite these risks, there is a gap in nursing research related to climate change and aging. Nurse scientists can address this gap with an interdisciplinary approach. There are climate resources and theoretical frameworks to support scientific inquiry. Funding sources must be made available to assure rigorous scholarship of climate-related health impacts for older adults. Gerontological nurse researchers must build capacity to address climate change and health. [Research in Gerontological Nursing, 13(1), 6-12.].
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We tested the hypotheses that older adults with cardiovascular co-morbidities will demonstrate greater changes in body temperature and exaggerated changes in blood pressure before initiating thermal behavior. We studied twelve healthy younger adults (Younger, 25±4 y) and six older adults (‘At Risk’, 67±4 y) taking prescription medications for at least two of the following conditions: hypertension, type II diabetes, hypercholesterolemia. Subjects underwent a 90-min test in which they voluntarily moved between cool (18.1±1.8°C, RH: 29±5%) and warm (40.2±0.3°C, RH: 20±0%) rooms when they felt ‘too cool’ (C→W) or ‘too warm’ (W→C). Mean skin and intestinal temperatures and blood pressure were measured. Data were analyzed as a change from pretest baseline. Changes in mean skin temperature were not different between groups at C→W (Younger: +0.2±0.8°C, ‘At Risk’: +0.7±1.8°C, P = 0.51) or W→C (Younger: +2.7±0.6°C, ‘At Risk’: +2.9±1.9°C, P = 0.53). Changes in intestinal temperature were not different at C→W (Younger: 0.0±0.1°C, ‘At Risk’: +0.1±0.2, P = 0.11), but differed at W→C (-0.1±0.2°C vs. +0.1±0.3°C, P = 0.02). Systolic pressure at C→W increased (Younger: +10±9 mmHg, ‘At Risk’: +24±17 mmHg) and at W→C decreased (Younger: -4±13 mmHg, ‘At Risk’: -23±19 mmHg) to a greater extent in ‘At Risk’ (P≤0.05). Differences were also apparent for diastolic pressure at C→W (Younger: -2±4 mmHg, ‘At Risk’: +17±23 mmHg, P<0.01), but not at W→C (Younger Y: +4±13 mmHg, ‘At Risk’: -1±6 mmHg, P = 0.29). Despite little evidence for differential control of thermal behavior, the initiation of behavior in ‘at risk’ older adults is preceded by exaggerated blood pressure responses.
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Heat waves increase the morbidity and mortality in Germany, particularly of older patients in need of care. Due to climate change the number of heat waves in Germany will increase threefold by the end of the century. In addition, the proportion of patients at risk will grow due to demographic change. Therefore, the Government and the Federal States have developed recommendations for heat action plans, in which the medical profession should also participate in the prevention of heat-related damage to health. Physicians and their team should first become acquainted with the topic. In addition, they should inform patients at risk and their relatives of the risks and preventive measures. In the summer a critical check of drugs is also needed because medications impair cooling mechanisms in heat waves, the pharmacokinetics can change and unwanted side effects of drugs occur more frequently. Lastly, due to their central position in the healthcare system, physicians should participate in the coordination of a good nursing care and intensification of social contacts during heat waves.
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What is known and objective: Hyperthermia occurs when heat accumulation surpasses the body's ability for heat dissipation. Many drugs can affect thermoregulation through mechanisms including altering the neurotransmitters that cause increased heat production or decreased heat loss and may, therefore, be associated with hyperthermia. This study aimed to examine hospitalizations and emergency department (ED) presentations due to hyperthermia and to investigate the potential association with drug therapy. Methods: A retrospective analysis of ED presentations and hospitalizations due to hyperthermia in all four major hospitals in Tasmania, Australia, between July 2010 and December 2018 was performed. Data of patients aged ≥18 years were extracted from the hospital digital medical records and analysed for the prevalence, trends and various potential risk factors for hyperthermia, such as age, environmental temperature and drug therapy. Results: This study included 224 patients. The data illustrated a trend with time, albeit not statistically significant, towards increasing hospital presentations due to hyperthermia. Antiepileptics (P = .03) and furosemide (P = .04) were the most frequently used drugs in patients with primary hyperthermia. The high use of levothyroxine in the study population (6.7%) stood out compared with the estimated national average (2.1%). Various drug classes associated with hyperthermia were used significantly more in the age group ≥60 years, suggesting polypharmacy in the elderly as a contributing factor for hyperthermia. What is new and conclusion: This study reports a possible association of some drugs, particularly diuretics (furosemide), antiepileptics and levothyroxine, with hyperthermia. Healthcare professionals should be aware of the increasing prevalence of hyperthermia and the possible involvement of drugs.
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Our climate is changing. These changes have an impact on health, especially in vulnerable populations such as older adults. Many older adults lack the physical, cognitive, social, and economic resources to avoid and/or mitigate the effects of exposure to extreme weather events. The purpose of the current article is to help nurses understand climate change and how that relates to the need for specific interventions to support climate adaptation for the older adult population. A model of exposure, contact to stressors, and adaptive capacity are used to address the health needs of older adults in the face of climate change. Gaps in nursing knowledge, resources for nurses, and a proposed agenda for research and practice in climate change are offered. Gerontological nurses are in an important position to lessen the harm of climate change in older adults through practice, research, and policy. [Journal of Gerontological Nursing, 45(11), 21-29.].
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Background: With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses. Methods: A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included. Results: Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes. Conclusion: Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatization, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.
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Hittegolven komen in Nederland steeds vaker voor. Ouderen lopen een groter risico op dehydratie bij langdurig warm weer, zeker als ze diuretica gebruiken. Heeft het zin om diuretica bij kwetsbare ouderen te stoppen om dehydratie bij hitte te voorkomen? Huisarts Antoinette van Zijl zocht het uit. Haar conclusie: tijdelijk stoppen met diuretica lijkt zinvol.
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Objective: The aim of this study was to describe risk factors for heat-related illness (HRI) in U.S. workers. Methods: We reviewed a subset of HRI enforcement investigations conducted by the Occupational Safety and Health Administration (OSHA) from 2011 through 2016. We assessed characteristics of the workers, employers, and events. We stratified cases by severity to assess whether risk factors were more prevalent in fatal HRIs. Results: We analyzed 38 investigations involving 66 HRIs. Many workers had predisposing medical conditions or used predisposing medications. Comorbidities were more prevalent in workers who died. Most (73%) fatal HRIs occurred during the first week on the job. Common clinical findings in heat stroke cases included multiorgan failure, muscle breakdown, and systemic inflammation. Conclusion: Severe HRI is more likely when personal susceptibilities coexist with work-related and environmental risk factors. Almost all HRIs occur when employers do not adhere to preventive guidelines.
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Despite being the most essential nutrient, water is commonly forgotten in the fields of pharmacy and nutrition. Hydration status is determined by water balance (the difference between water input and output). Hypohydration or negative water balance is affected by numerous factors, either internal (i.e., a lack of thirst sensation) or external (e.g., polypharmacy or chronic consumption of certain drugs). However, to date, research on the interaction between hydration status and drugs/excipients has been scarce. Drugs may trigger the appearance of hypohydration by means of the increase of water elimination through either diarrhea, urine or sweat; a decrease in thirst sensation or appetite; or the alteration of central thermoregulation. On the other hand, pharmaceutical excipients induce alterations in hydration status by decreasing the gastrointestinal transit time or increasing the gastrointestinal tract rate or intestinal permeability. In the present review, we evaluate studies that focus on the effects of drugs/excipients on hydration status. These studies support the aim of monitoring the hydration status in patients, mainly in those population segments with a higher risk, to avoid complications and associated pathologies, which are key axes in both pharmaceutical care and the field of nutrition.
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Global warming, provoked by the greenhouse effect of high levels of atmospheric gases, and most notably of carbon dioxide and methane, directly threatens human health and survival. Individuals vary in their capacity to tolerate episodes of extreme heat. Because skin is the organ tasked with heat dissipation, it is important for dermatologists to be versed in the physiology of cutaneous heat dissipation and cognizant of those clinical settings in which skin’s thermoregulatory responses may be impaired. When the external temperature is lower than that of the skin, it releases internal heat through direct thermal exchange with the environment -- a process that is aided by an expansion of cutaneous blood flow and by eccrine sweating. Cooling through the evaporation of sweat is effective even when the external temperature exceeds that of skin. Many factors, including environmental, physiological (such as age and gender), and pathological (such as pre-existing illnesses, disorders of eccrine function, and medications) considerations, impact skin’s capacity to thermoregulate. Identification of individuals at increased risk for heat-related morbidity and mortality will become increasingly important in the care of patients.
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We studied the possibility of using artificial intelligence (AI) passive microwave radiometry (MWR) for the diagnostics of venous diseases. MWR measures non-invasive microwave emission (internal temperature) from human body 4 cm deep. The method has been used for early diagnostics in cancer, back pain, brain, COVID-19 pneumonia, and other diseases. In this paper, an AI model based on MWR data is proposed. The model was used to predict the disease state of phlebology patients. We have used MWR and infrared (skin temperature) data of the lower extremities to design a feature space and construct a classification algorithm. Our method has a sensitivity above 0.8 and a specificity above 0.7. At the same time, our method provides an advisory outcome in terms which are understandable for clinicians.
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Importance: There is a large body of epidemiologic evidence that heat is associated with increased risk of mortality. One of the most effective strategies to mitigate the effects of heat is through air conditioning (AC); Texas regulates the internal temperature of jails to stay between 65 and 85 °F degrees, but these same standards do not apply to state and private prisons. Objective: To analyze whether heat during warm months is associated with an increased risk of mortality in Texas prisons without AC. Design, setting, and participants: This case-crossover study included individuals who died in Texas prisons between 2001 and 2019. The association of heat in warm months with mortality in Texas prisons with and without AC was estimated. Data analysis was conducted from January to April 2022. Exposures: Increasing daily heat index above 85 °F and extreme heat days (days above the 90th percentile heat index for the prison location). Main outcomes and measures: Daily mortality in Texas prisons. Results: There were 2083 and 1381 deaths in prisons without and with AC, respectively, during warm months from 2001 to 2019. Most of the deceased were male (3339 of 3464 [96%]) and the median (IQR) age at death was 54 (45-62) years. A 1-degree increase above 85 °F heat index and an extreme heat day were associated with a 0.7% (95% CI, 0.1%-1.3%) and a 15.1% (95% CI, 1.3%-30.8%) increase in the risk of mortality in prisons without AC, respectively. Approximately 13% of mortality or 271 deaths may be attributable to extreme heat during warm months between 2001 to 2019 in Texas prison facilities without AC. In prisons with AC, a negative percentage change in mortality risk was observed, although the 95% CI crossed zero (percentage change in mortality risk: -0.6%; 95% CI, -1.6% to 0.5%). The estimates in prisons without AC were statistically different than the estimates in prisons with AC (P = .05). Conclusions and relevance: This study found an average of 14 deaths per year between 2001 to 2019 were associated with heat in Texas prisons without AC vs no deaths associated with heat in prisons with AC. Adopting an AC policy in Texas prisons may be important for protecting the health of one of our most vulnerable populations.
Chapter
The global urban population has grown rapidly during the last decades. Currently, more than 4 billion people around the world live in urban areas. Consequently, the natural environments are destroyed due to the escalating demands for urban infrastructure. One of the most calamitous effects of urbanization is the complex and multilayered local phenomenon of urban heat island (UHI) which is a consequence of the prevailing weather conditions and the characteristics of urban cities. Therefore, the urban overheating has become an important issue of public health for both developing and developed countries. Indeed, urban residents suffer from the elevated ambient temperature during day and night. As well as they suffer from unseasonal hot weather conditions and meteorological hazards such as extreme weather events and heat waves. In general, higher outdoor and indoor air temperatures have direct impact on human’s health and well-being. Specifically, they can cause heat stress, sleep disorders and cardiovascular and cardiorespiratory diseases. The purpose of the present chapter is to present a comprehensive review about the existing literature with reference to the impact of urban overheating on heat-related morbidity. Moreover, this chapter aims to examine the indirect effects of high ambient temperature on urban systems to evaluate their impacts on the overall environmental quality of cities and public health.KeywordsPublic healthIndoor temperatureOutdoor temperatureUHIWell-beingMitigation approach
Article
Background Maternal exposure to weather-related extreme heat events (EHEs) has been associated with congenital heart defects (CHDs) in offspring. Certain medications may affect an individual's physiologic responses to EHEs. We evaluated whether thermoregulation-related medications modified associations between maternal EHE exposure and CHDs. Methods We linked geocoded residence data from the U.S. National Birth Defects Prevention Study, a population-based case-control study, to summertime EHE exposures. An EHE was defined using the 90th percentile of daily maximum temperature (EHE90) for each of six climate regions during postconceptional weeks 3–8. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between EHE90 and the risk of CHDs were estimated by strata of maternal thermoregulation-related medication use and climate region. Interaction effects were evaluated on multiplicative and additive scales. Results Over 45% of participants reported thermoregulation-related medication use during the critical period of cardiogenesis. Overall, these medications did not significantly modify the association between EHEs and CHDs. Still, medications that alter central thermoregulation increased aORs (95% CI) of EHE90 from 0.73 (0.41, 1.30) among non-users to 5.09 (1.20, 21.67) among users in the Southwest region, U.S. This effect modification was statistically significant on the multiplicative (P = 0.03) and additive scales, with an interaction contrast ratio (95% CI) of 1.64 (0.26, 3.02). Conclusion No significant interaction was found for the maternal use of thermoregulation-related medications with EHEs on CHDs in general, while medications altering central thermoregulation significantly modified the association between EHEs and CHDs in Southwest U.S. This finding deserves further research.
Article
As the body's most direct interface with the environment, cutaneous health is especially vulnerable to climatic factors. Anthropogenic-induced climatic change continues to accelerate, increasing the probability and severity of extreme weather events (EWE). In this review, we examine the dermatological manifestations related to EWE, such as floods, wildfires, and extreme heat. To improve awareness among dermatologists and other clinicians, the English language scientific literature was searched to identify articles linking climate change, extreme weather events, and skin manifestations. Common themes include propagation of infection and vector-borne diseases, exacerbation of underlying inflammatory conditions, and psychodermatologic implications. Secondary effects of natural disasters such as population migration, inadequate sanitation and hygiene infrastructure, and limited access to healthcare services increase the risk of climate-related skin disease. Extreme weather events also disproportionately affect certain demographic and geographic populations and exacerbate underlying disparities in marginalized populations. Improving extreme weather-related dermatological health outcomes requires a comprehensive approach in clinical practice, research endeavors, and public policy interventions with particular attention to disproportionate impacts on vulnerable populations.
Article
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Purpose of Review Climate change has manifested itself in multiple environmental hazards to human health. Older adults and those living with cardiovascular diseases are particularly susceptible to poor outcomes due to unique social, economic, and physiologic vulnerabilities. This review aims to summarize those vulnerabilities and the resultant impacts of climate-mediated disasters on the heart health of the aging population. Recent Findings Analyses incorporating a wide variety of environmental data sources have identified increases in cardiovascular risk factors, hospitalizations, and mortality from intensified air pollution, wildfires, heat waves, extreme weather events, rising sea levels, and pandemic disease. Older adults, especially those of low socioeconomic status or belonging to ethnic minority groups, bear a disproportionate health burden from these hazards. Summary The worldwide trends responsible for global warming continue to worsen climate change–mediated natural disasters. As such, additional investigation will be necessary to develop personal and policy-level interventions to protect the cardiovascular wellbeing of our aging population.
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Objectives: To adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes. Methods: An expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS. Results: Similar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete. Conclusions: Prehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.
Chapter
Globally, heat waves account for dramatic increases in mortality and morbidity; however, there is increasing awareness that day-to-day increases in temperature contribute to a significant risk of heat-related morbidity and mortality (HRMM) that over one or more warm seasons may exceed the public health burden of heat waves. Climate change has already and will continue to increase both average ambient temperatures and the frequency and intensity of excursions above those averages (i.e., heat waves or extreme heat events) and will thereby lead directly and indirectly to amplification of the risk of HRMM. This chapter provides a brief synopsis of our current knowledge about thermoregulation, thermotolerance, and the pathophysiology of heat stroke, and the multiple determinants of health and illness that influence the risk of HRMM and that collectively define vulnerability. A particular focus is on two vulnerable populations, older adults and children. An Environmental Health Multiple-Determinants Model of Vulnerability is presented as a conceptual framework to integrate that knowledge, with the intent of providing a tool that can facilitate compilation and translation of the information to interventions and adaptation strategies relevant at the individual level and/or subpopulation and population levels and at one or more geopolitical scales in developing and/or developed nations. Three overarching strategies for HRMM risk reduction are discussed, including Extreme Heat Event and Warm Season Heat Preparedness and Response Action Plans, Promote Good Health and Access to Quality Healthcare (reduces risk and increases resiliency), and Reduce/Manage Potential Exposure(s) (individual, community) to Ambient Heat and Other Physical Environmental Stressors. A key focus of this chapter is on integration and translation of knowledge.
Despite the urgency of the climate crisis and mounting evidence linking climate change to child health harms, pediatricians do not routinely engage with climate change in the office. Each primary care visit offers opportunities to screen for and support children burdened with risks to health that are increasingly intense due to climate change. Routine promotion of healthy behaviors also aligns with some needed—and powerful—solutions to the climate crisis. For some patients, including those engaged in athletics, those with asthma and allergies, or those with complex healthcare needs, preparedness for environmental risks and disasters worsened by climate change is a critical component of disease prevention and management. For all patients, anticipatory guidance topics that are already mainstays of pediatric best practices are related closely to needed guidance to keep children safe and promote health in the setting of compounding risks due to climate change. By considering climate change in routine care, pediatricians will be updating practice to align with evidence-based literature and better serving patients. This article provides a framework for pediatricians to provide climate-informed primary care during the structure of pediatric well child and other visits.
Article
Background Heatwaves are known to increase mortality. However, there is a need for more quantitative information on factors affecting sensitivity to the adverse health effects, particularly in countries with cool summer temperatures. Objectives We evaluated mortality risk related to heatwave days in Finland. Risk was examined by age, sex, cause of death, and place of death, including health and social care facilities and homes. Mortality was also analysed for different patient subgroups in healthcare facilities. Methods Heatwaves were defined as periods when the daily average temperature exceeded the 90th percentile of that from May to August in 2000–2014 for ≥4 days. In addition to all heatwave days, risk was analysed for short (4–5 days) and long (≥10 days) heatwaves. Mortality analyses were based on linking registry data on i) daily non-accidental and cause-specific mortality and ii) admissions to a health or social care facility. Statistical analyses were conducted using generalised estimating equations for longitudinal data analysis, assuming a Poisson distribution for the daily mortality count. Results During all heatwave days, mortality increased among those aged 65–74 years (6.7%, 95% confidence interval 2.9–10.8%) and ≥75 years (12.8%, 95% CI 9.8–15.9%). Mortality increased in both sexes, but the risk was higher in women. Positive associations were observed for deaths due to respiratory diseases, renal diseases, mental and behavioural disorders, diseases of the nervous system, and cardiovascular diseases. Overall, effects were stronger for long than short heatwaves. During all heatwave days, mortality increased in healthcare facilities in outpatients (26.9%, 95% CI 17.3–37.2%) and inpatients. Among inpatients, the risk was higher in long-term inpatients (stay in ward > 30 days, 13.1%, 95% CI 8.6–17.7%) than others (5.8%, 95% CI 2.7–9.0%). At homes, mortality increased by 8.1% (95% CI 1.9–14.6%). Elevated risk estimates were also detected for social care facilities. Conclusions In Finland, a cold-climate Northern country, heatwaves increase mortality risk significantly among the elderly. Women are more susceptible than men, and many chronic diseases are important risk factors. To reduce heatwave-related deaths, preparedness should be improved particularly in hospital and healthcare centre wards, where the most vulnerable are long-term inpatients. However, measures are also needed to protect the elderly at home and in social care facilities, especially during prolonged hot periods.
Article
In the past decade, the inevitable increase in temperature has caused Malaysia to experience more extreme heat events, and yet very little research has been dedicated in exploring the heat-related vulnerability of exposed population. In this study, the extreme heat vulnerability index (EHVI) has been evaluated to identify the most vulnerable districts to extreme heat events. We evaluated exposure, population sensitivity and adaptive capacity from sociodemographic and remote sensing data. We have applied multivariate analysis on 13 indicators for every 87 districts to elucidate the extreme heat vulnerability in Peninsular Malaysia. The EHVI was generated by summing up the normalized extreme heat exposure scores and factor scores from the multivariate analysis. Our findings clarify that the most vulnerable populations are confined in the urban and northern region of Peninsular Malaysia. The source of vulnerability varied between both regions, with urbanization and population density increase the vulnerability in urban areas, high heat exposure and sensitive population are the dominant factors of vulnerability in the northern region. These findings are valuable in identifying districts vulnerable to extreme heat and help regulatory body; in designing effective adaptation and preparedness strategies to increase the population resilience towards extreme heat.
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Der aktuelle Versorgungs-Report geht der Frage nach, welche Auswirkungen der Klimawandel auf unsere Gesundheit hat und welche Konsequenzen sich daraus für die medizinische Versorgung in Deutschland ergeben. Dabei bringt er die unterschiedlichen Perspektiven von Umweltepidemiologie, Medizin und Gesundheitspolitik zusammen. Expertinnen und Experten analysieren in insgesamt 16 Fachbeiträgen den Einfluss des Klimawandels auf Erkrankungshäufigkeiten, gefährdete Bevölkerungsgruppen und Infrastrukturen der Gesundheitsversorgung. Der Report verfolgt das Ziel, aktuelle wissenschaftliche Erkenntnisse für die Versorgungspraxis aufzubereiten und so zu einer stärkeren Sensibilisierung für die gesundheitlichen Folgen des Klimawandels in der Gesellschaft beizutragen. Dargelegt werden: - klimawissenschaftliche Grundlagen und Gesundheitsfolgen der Klimaveränderungen - versorgungsbezogene Analysen zu bedeutsamen Gesundheitsrisiken und Präventionsempfehlungen - Verhalten der Bevölkerung auf Basis einer aktuellen deutschlandweiten Befragung - Anpassungsbedarf auf infrastrukturell-organisatorischer Ebene Der Teil „Daten und Analysen“ informiert umfassend über die Häufigkeit von Erkrankungen und Behandlungen in Deutschland.
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Dans un contexte d’accroissement de la vulnérabilité des êtres humains et des sociétés humaines face au dérèglement climatique et à l’effondrement de la biodiversité, il devient indispensable de mener une réflexion approfondie sur les liens complexes qu’entretiennent l’environnement et notre santé. Appréhender un sujet aussi multidimensionnel nécessite de s’ouvrir à différentes perspectives. En effet, si nous voulons apprendre à prendre soin et à soigner autrement, en tenant compte de ce que l’on nomme «l’interdépendance du vivant», nous devons prêter attention aux connaissances apportées par les sciences humaines et sociales, les sciences de l’environnement, les sciences de l’ingénierie ou encore les sciences de la santé. Ce livre écrit par quelque 70 autrices et auteurs d’horizons disciplinaires différents et revu indépendamment par plus de 30 expertes et experts est une invitation à aller voir au-delà de son propre champ professionnel. Il s’adresse à toutes les personnes soucieuses de trouver quelques clés de compréhension pour penser la santé dans l’environnement et entamer une nécessaire transformation socioécologique des services de santé.
Article
Aim: To test the hypothesis that severe acute poisoning by alcohol and drugs is more frequent at higher rather than at lower ambient temperatures. Method: This was a prospective observational study performed in a prehospital setting under marine west coast climate conditions. Data from the Emergency Medical Service in Hamburg (Germany) and data from the local weather station were evaluated over a 5-year period. Temperature data were obtained and matched with the associated rescue mission data which were divided into the following groups: 1) alcohol poisoning, 2) opioid poisoning, 3) poisoning by sedatives/hypnotics, multiple drugs, volatile solvents, and other psychoactive substances. Lowess-Regression analysis was performed to assess the relationship between ambient temperature and frequency of severe acute poisoning. Additionally, three temperature-ranges were defined in order to compare them with each other with regard to frequency of severe poisoning (<10 °C vs. 10-20 °C vs. >20 °C). The severity of emergencies was assessed using the National Advisory Committee for Aeronautics (NACA) scoring system. Results: In 1,535 patients severe acute alcohol or drug poisoning associated with loss of consciousness, hypotension, and impaired respiratory function was treated (alcohol: n=604; opioids: n=295; sedatives/hypnotics/multiple drugs: n=636). Compared to mild temperatures (10-20°C), the frequency of poisoning increased in all three groups at higher temperatures and decreased at lower temperatures (p<0.01). No significant correlation was found between severity of emergencies and temperature. Conclusions: Our results suggest a continuously increasing probability of occurrence of severe acute poisoning by alcohol and drugs with rising temperature.
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Climate change and desertification is a global problem, and Turkey and the Middle East region are among the mostly affected areas of the world. By the end of this century, Turkey and the Middle East region are expected to have an increased mean temperature about 3–5 °C and a 20–40% decline in precipitation. The Intergovernmental Panel on Climate Change (IPPC) warns that desertification is likely to become irreversible, if the environment becomes drier and the soil becomes further degraded through erosion and compaction. According to United Nations Environment Program (UNEP), most of areas in Turkey are under desertification and/or high potential for desertification and only small parts of the areas in Turkey are non-risky places. Climate models predict a hotter, drier, and less predictable climate for the Middle East region, and degradation and desertification are expected to accelerate due to global warming. Climate change and desertification is acting as a risk for water loss, decline in agriculture, and loss of biodiversity. Climate change has a negative impact on human health by indirect effects including air, water, and food supplies and by direct effects especially on elderly, children, and chronically ill population. This chapter examines the potential impacts of climate change and desertification on the environmental parameters and human health in Turkey and the Middle East.
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Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as “threat multipliers,” especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.
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The increase in the frequency of very hot weather that is a predicted consequence of climate change poses an emerging threat to public health. Extreme heat can be harmful to the health of older persons who are known to be amongst the most vulnerable in the community. This study aimed to investigate factors influencing the ability of older persons to adapt to hot conditions, and barriers to adaptation. A qualitative study was conducted in Adelaide, Australia, involving focus groups and interviews with stakeholders including key personnel involved in aged care, community services, government sectors, emergency services and policy making. Findings revealed a broad range of factors that underpin the heat-susceptibility of the aged. These were categorized into four broad themes relating to: physiology and an age-related decline in health; socioeconomic factors, particularly those influencing air conditioning use; psychological issues including fears and anxieties about extreme heat; and adaptive strategies that could be identified as both enablers and barriers. As a consequence, the ability and willingness to undertake behavior change during heatwaves can therefore be affected in older persons. Additionally, understanding the control panels on modern air conditioners can present challenges for the aged. Improving heat-health knowledge and addressing the social and economic concerns of the older population will assist in minimizing heat-related morbidity and mortality in a warming climate.
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Extreme heatwaves occurred in Adelaide, South Australia, in the summers of 2008 and 2009. Both heatwaves were unique in terms of their duration (15 days and 13 days respectively), and the 2009 heatwave was also remarkable in its intensity with a maximum temperature reaching 45.7 °C. It is of interest to compare the health impacts of these two unprecedented heatwaves with those of previous heatwaves in Adelaide. Using case-series analysis, daily morbidity and mortality rates during heatwaves (≥ 35 °C for three or more days) occurring in 2008 and 2009 and previous heatwaves occurring between 1993 and 2008 were compared with rates during all non-heatwave days (1 October to 31 March). Incidence rate ratios (IRRs) were established for ambulance call-outs, hospital admissions, emergency department presentations and mortality. Dose response effects of heatwave duration and intensity were examined. Ambulance call-outs during the extreme 2008 and 2009 events were increased by 10% and 16% respectively compared to 4.4% during previous heatwaves. Overall increases in hospital and emergency settings were marginal, except for emergency department presentations in 2008, but increases in specific health categories were observed. Renal morbidity in the elderly was increased during both heatwaves. During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves. In 2009, marked increases in ischaemic heart disease were seen in the 15-64 year age group. Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected. Significant dose-response relationships were observed for heatwave duration (ambulance, hospital and emergency setting) and intensity (ambulance and mortality). While only incremental increases in morbidity and mortality above previous findings occurred in 2008, health impacts of the 2009 heatwave stand out. These findings send a signal that the intense and long 2009 heatwave may have exceeded the capacity of the population to cope. It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.
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Because of the increasing concerns about climate change and deadly heatwaves in the past, the health effects of hot weather are fast becoming a global public health challenge for the 21st century. Some cities across the world have introduced public health protection measures, with the timely provision of appropriate home-based prevention advice to the general public being the most crucial point of intervention. In this Review, we report current epidemiological and physiological evidence about the range of health effects associated with hot weather, and draw attention to the interplay between climate factors, human susceptibility, and adaptation measures that contribute to heat burdens. We focus on the evidence base for the most commonly provided heat-protection advice, and make recommendations about the optimum clinical and public health practice that are expected to reduce health problems associated with current and future hot weather.
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This review examines recent evidence on mortality from elevated ambient temperature for studies published from January 2001 to December 2008. PubMed was used to search for the following keywords: temperature, apparent temperature, heat, heat index, and mortality. The search was limited to the English language and epidemiologic studies. Studies that reported mortality counts or excess deaths following heat waves were excluded so that the focus remained on general ambient temperature and mortality in a variety of locations. Studies focusing on cold temperature effects were also excluded. Thirty-six total studies were presented in three tables: 1) elevated ambient temperature and mortality; 2) air pollutants as confounders and/or effect modifiers of the elevated ambient temperature and mortality association; and 3) vulnerable subgroups of the elevated ambient temperature-mortality association. The evidence suggests that particulate matter with less than 10 um in aerodynamic diameter and ozone may confound the association, while ozone was an effect modifier in the warmer months in some locations. Nonetheless, the independent effect of temperature and mortality was withheld. Elevated temperature was associated with increased risk for those dying from cardiovascular, respiratory, cerebrovascular, and some specific cardiovascular diseases, such as ischemic heart disease, congestive heart failure, and myocardial infarction. Vulnerable subgroups also included: Black racial/ethnic group, women, those with lower socioeconomic status, and several age groups, particularly the elderly over 65 years of age as well as infants and young children. Many of these outcomes and vulnerable subgroups have only been identified in recent studies and varied by location and study population. Thus, region-specific policies, especially in urban areas, are vital to the mitigation of heat-related deaths.
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Scientists haven predicted that extremes in climate are likely to increase in frequency and severity.(1) These changes may have a direct impact on population health, as heat waves can exceed the physiological adaptive capacity of vulnerable population groups. Individuals over the age of 60 years are consistently the most vulnerable,(2-4) with 82%-92% of excess mortality occurring in this group.(5) Risks for heat-related illness or injuries are compounded for people with obesity,(6,7) cardiovascular disease,(8-10) respiratory disease(8-10) and diabetes mellitus.(4,8,9) These conditions decrease the body's ability to adapt to changes in environmental conditions.(11) When people must perform physical work in the heat, the occurrence of heat-related morbidity and mortality is likely to be more frequent.(12) Although these trends in heat-related morbidity and mortality are evident, there has been little research to explain the causes of increased susceptibility within vulnerable populations. In this review, we describe the effects of heat on human physiology and the factors that increase the risk of heat stress. The methods used in preparing this review are summarized in Box 1 and are described in greater detail in Appendix 1 (available at www.cmaj.ca/cgi/content/full/cmaj.081050/DC1).
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Translate the available knowledge on ageing and dehydration into main messages for clinical practice. Older people are more susceptible to dehydration than younger people. This is partly due to lack of thirst sensation and changes in the water and sodium balance that naturally occur as people age. It is also, to some degree, attributable to the fact that elderly people, both those living at home and those living in institutions, often have various impairments, disabilities and/or handicaps (comorbidity). They also tend to use numerous drugs and medication for these illnesses (polypharmacy). Multimorbidity and polypharmacy often overstress the normal age-related physiological changes in the water and sodium balance and therefore increase elderly people's risk of dehydration,especially during intercurrent infections or warm weather. Elderly people, whether they are living on their own or in an institution, and especially elderly people that can no longer take care of themselves because of cognitive, sensory, motor and/or ADL impairments, need extra help to stay hydrated. The most important strategy is simply a matter of ensuring that elderly people consume a sufficient amount of fluids (at least 1.7 liters every 24 hours). Additional strategies include making healthy drinks and water easily available and accessible at all times and reminding and encouraging the elderly to consume these fluids. Elderly people should not be encouraged to consume large amounts of fluids at once but rather small amounts throughout the day. When the recommended fluid intake cannot, for whatever reason, be realized, fluids can be administered via catheter or by hypodermoclysis. In more specific and severe cases, fluids can be administered intravenously. The prevention, signaling and treatment of dehydration in the elderly is an important multidisciplinary endeavor. Formal and informal care providers need to continuously be aware of the risk factors and signs of dehydration in the elderly, especially during periods of very warm weather and when older people are ill. Standard professional care for high risk patients is imperative.
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Most projections of climate change suggest an increased frequency of heatwaves in England over coming decades; older people are at particular risk. This could result in substantial mortality and morbidity. To determine elderly people's knowledge and perceptions of heat-related risks to health, and of protective behaviours. Semi-structured interviews: 73 men and women, 72-94 years, living in their own homes in London and Norwich, UK. Few respondents considered themselves either old or at risk from the effects of heat, even though many had some form of relevant chronic illness; they did recognize that some medical conditions might increase risks in others. Most reported that they had taken appropriate steps to reduce the effects of heat. Some respondents considered it appropriate for the government to take responsibility for protecting vulnerable people, but many thought state intervention was unnecessary, intrusive and unlikely to be effective. Respondents were more positive about the value of appropriately disseminated advice and solutions by communities themselves. The Heatwave Plan should consider giving greater emphasis to a population-based information strategy, using innovative information dissemination methods to increase awareness of vulnerability to heat among the elderly and to ensure clarity about behaviour modification measures.
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From August 1st to 20th, 2003, the mean maximum temperature in France exceeded the seasonal norm by 11-12 degrees C on nine consecutive days. A major increase in mortality was then observed, which main epidemiological features are described herein. The number of deaths observed from August to November 2003 in France was compared to those expected on the basis of the mortality rates observed from 2000 to 2002 and the 2003 population estimates. From August 1st to 20th, 2003, 15,000 excess deaths were observed. From 35 years age, the excess mortality was marked and increased with age. It was 15% higher in women than in men of comparable age as of age 45 years. Excess mortality at home and in retirement institutions was greater than that in hospitals. The mortality of widowed, single and divorced subjects was greater than that of married people. Deaths directly related to heat, heatstroke, hyperthermia and dehydration increased massively. Cardiovascular diseases, ill-defined morbid disorders, respiratory diseases and nervous system diseases also markedly contributed to the excess mortality. The geographic variations in mortality showed a clear age-dependent relationship with the number of very hot days. No harvesting effect was observed. Heat waves must be considered as a threat to European populations living in climates that are currently temperate. While the elderly and people living alone are particularly vulnerable to heat waves, no segment of the population may be considered protected from the risks associated with heat waves.
Article
The human sweating response is subject to the influence of diverse classes of drugs. Some act centrally at the hypothalamus or at spinal thermoregulatory centres, while others act at sympathetic ganglia or at the eccrine-neuroeffector junction. Pharmacological disturbances of sweating have broad clinical implications. Drugs that induce hyperhidrosis, or sweating in excess of that needed to maintain thermoregulation, can cause patient discomfort and embarrassment, and include cholinesterase inhibitors, selective serotonin reuptake inhibitors, opioids and tricyclic antidepressants. Drugs that induce hypohidrosis, or deficient sweating, can increase the risk of heat exhaustion or heat stroke and include antimuscarinic anticholinergic agents, carbonic anhydrase inhibitors and tricyclic antidepressants. As acetylcholine is the principal neuroeccrine mediator, anhidrosis is one of the clinical hallmarks by which acute anticholinergic toxicity may be recognized. The symptom of dry mouth often accompanies the less apparent symptom of hypohidrosis because the muscarinic M3 acetylcholine receptor type predominates at both sweat and salivary glands. Management options include dose reduction, drug substitution or discontinuation. When compelling medical indications require continuation of a drug causing hyperhidrosis, the addition of a pharmacological agent to suppress sweating can help to reduce symptoms. When hypohidrotic drugs must be continued, deficient sweating can be managed by avoiding situations of heat stress and cooling the skin with externally applied water. The availability of clinical tests for the assessment of sudomotor dysfunction in neurological disease has enhanced recognition of the complex effects of drugs on sweating. Advances in the understanding of drug-induced anhidrosis have also enlarged the therapeutic repertoire of effective treatments for hyperhidrosis.
Article
BACKGROUND Heatwaves are increasing in frequency, intensity and duration, and are associated with an increase in mortality and morbidity, particularly in the very young and the very old. Concurrently, the Australian population is aging, with the prediction that by 2036 approximately 27% of Australians will be aged over 65 years. OBJECTIVE This article reviews the evidence on heat related health risk and discusses the role of the general practitioner in reducing morbidity in older people as a result of heatwaves. DISCUSSION Heatwaves are associated with increased mortality and morbidity in people aged over 65 years, and more so in those aged over 75 years. Older people are more vulnerable to the effects of extreme heat through a range of physiological and physical factors. As key providers of healthcare to older people, GPs play a crucial role in identifying those at risk and implementing strategies to minimise the risks of mortality and morbidity during periods of extreme heat.
Article
Heatwaves cause illness and death, and are likely to become more severe and frequent in the future. This study has investigated the awareness, knowledge and practices of health professionals and care providers regarding heatwaves and health of older clients, in order to inform harm minimisation strategies for Victoria, Australia. An electronic survey of personnel of six health profession and care provider groups that support the health of older people living in the community was conducted in Victoria, Australia, in 2008. Descriptive statistics were derived through quantitative analysis. Survey respondents showed a high level of awareness that heatwaves can be harmful for older people. Gaps in knowledge were identified regarding thermoregulation, risk factors, heat-related illness, and the use of fans. Few organisations had existing heatwave response plans, and responses to heatwaves were mostly reactive and opportunistic. Despite a broad level of understanding of the dangers of heatwaves, an opportunistic, reactive approach by health profession and carer personnel, in conjunction with gaps in knowledge, leaves older people in Victoria at risk of preventable harm from extreme hot weather.
Article
The association between ambient temperature and mortality has been established worldwide, including the authors' prior study in California. Here, they examined cause-specific mortality, age, race/ethnicity, gender, and educational level to identify subgroups vulnerable to high ambient temperature. They obtained data on nine California counties from May through September of 1999-2003 from the National Climatic Data Center (countywide weather) and the California Department of Health Services (individual mortality). Using a time-stratified case-crossover approach, they obtained county-specific estimates of mortality, which were combined in meta-analyses. A total of 231,676 nonaccidental deaths were included. Each 10 degrees F (approximately 4.7 degrees C) increase in mean daily apparent temperature corresponded to a 2.6% (95% confidence interval (CI): 1.3, 3.9) increase for cardiovascular mortality, with the most significant risk found for ischemic heart disease. Elevated risks were also found for persons at least 65 years of age (2.2%, 95% CI: 0.04, 4.0), infants 1 year of age or less (4.9%, 95% CI: -1.8, 11.6), and the Black racial/ethnic group (4.9%, 95% CI: 2.0, 7.9). No differences were found by gender or educational level. To prevent the mortality associated with ambient temperature, persons with cardiovascular disease, the elderly, infants, and Blacks among others should be targeted.
Article
To identify risk factors associated with heatstroke, a case-control study in St Louis and Kansas City, Mo, was conducted during July and August 1980. Questionnaire data were gathered for 156 persons with heatstroke (severe heat illness with documented hyperthermia) and 462 control subjects matched by age, sex, and neighborhood of residence. A stepwise linear logistic regression procedure was used to identify factors significantly associated with heatstroke. Alcoholism, living on the higher floors of multistory buildings, and using major tranquilizers (phenothiazines, butyrophenones, or thioxanthenes) were factors associated with increased risk. Factors associated with decreased risk were using home air conditioning, spending more time in air-conditioned places, and living in a residence well shaded by trees and shrubs. Being able to care for oneself, characteristically undertaking vigorous physical activity, but reducing such activity during the heat, and taking extra liquid were also associated with decreased risk. Our findings also suggest effective preventive measures. During a heat wave, the greatest attention should be directed toward high-risk groups, and relief efforts should include measures shown to be associated with reduced risk. (JAMA 1982;247:3332-3336)
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