The effect of improving the thermal quality of cold housing on blood pressure and general health: a research note.

OBJECTIVE: To examine the effect of improving the thermal quality of housing on blood pressure (BP) and general health. DESIGN: A before and after study comparing the changes of the intervention with controls. SETTING: Four blocks of flats in the Easthall area of Easterhouse in Glasgow. PARTICIPANTS: Residents of the four blocks who agreed to participate. INTERVENTION: Two blocks of flats were upgraded from being cold, damp and mouldy to being comfortably warm, dry and mould free throughout. MAIN OUTCOME MEASURES: Changes in BP, general health and financial status. RESULTS: In the intervention subjects, systolic and diastolic blood pressures fell very significantly (p<0.000). There was also an improvement in general health as reported subjectively, and as indicated by a reduction in the use of medication and in hospital admissions. In addition, there was a markedly reduced expenditure on heating costs and other previous expenses. There were no changes in the control subjects in any of these measures. CONCLUSION: Improving the thermal quality of housing to eliminate damp and mould and produce a comfortable temperature throughout the house has a major impact on the health of the residents. There are also financial benefits for the residents, and indirectly for the NHS.

Accidental hypothermia.

Hypothermia and its management are examined and logical explanations are given for discarding many traditional views. Hypothermia is classified according to physiological changes, and a practical approach is suggested for management.

The cause of death after rescue.

It is recognized that some people die from hypothermia even though they are alive and uninjured when rescued. The traditional explanation is that this is due to ventricular fibrillation resulting from the afterdrop of core temperature. This hypothesis was based on inadequate measurement and failure to consider the physiology of cold. It should now be discarded. Most deaths after rescue occur through an imbalance between the active vascular capacity and the circulating fluid volume i.e. relative hypovolaemia or fluid overload. The actual mechanism in any individual case depends both on the history of the cooling and the method of rewarming used. Some deaths will however occur due to continued cooling of the body or to ventricular fibrillation precipitated by rough handling.

The role of cold in ischaemic heart disease: a review.

A review of the literature suggests that the geographical and social class distribution of ischaemic heart disease (IHD) could be partly explained by variations in degrees of cold exposure, which includes wind and rain as well as temperature, with frequent exposure to cold being more harmful than steady exposure. Blood pressure (BP) and serum cholesterol are raised in response to acute and chronic exposure to cold. Smoking and cold produce similar physiological changes which increase the risk of IHD, while regular exercise blunts the physiological effects of cold and other stresses. There are many acute responses to cold which could trigger a myocardial infarction (MI) and therefore cold is probably a major precipitating factor in many cases of MI. Public health measures to improve domestic housing and the working environment may produce a significant impact on the incidence of IHD.

Hypothesis: temperature recommendations for elderly people: are we wrong?

By concentrating housing recommendations purely on temperature, particularly of the living room, the medical profession may be doing a disservice to the elderly and may be causing increased numbers of cold-related deaths through attempting to reduce the far fewer cases of hypothermia. The best advice may be to avoid having one room significantly warmer than the rest of the house, to prewarm the bed and bedroom at night, to wear adequate clothing, eat adequate food, and take some exercise.

Hypothermia and cold.

Hypothermia is defined and classified, and the physiology of temperature regulation summarized; fluid balance and the phenomenon of symptomless cooling are considered in more detail. The symptoms and signs of hypothermia are charted, with cautions, and the problems considered of making any diagnosis, including that of death, in hypothermic patients. Recommendations for treatment are complicated by the possible presence of other factors including drowning and the so-called 'diving reflex' phenomenon. There are many methods of rewarming and all are safe if used with intensive care monitoring. However, for field use by the rescue services there are only three practical methods. The traditional explanation of why survivors die after rescue is discarded with an alternative proposed. Since hypothermia is not numerically the most important cause of cold-related deaths, the other dangers are considered. Finally caution is advised when interpreting published papers on hypothermia.