Using real-time syndromic surveillance to assess the health impact of the 2013 heatwave in England.

Heatwaves are a seasonal threat to public health. During July 2013 England experienced a heatwave; we used a suite of syndromic surveillance systems to monitor the impact of the heatwave. Significant increases in heatstroke and sunstroke were observed during 7-10 July 2013. Syndromic surveillance provided an innovative and effective service, supporting heatwave planning and providing early warning of the impact of extreme heat thereby improving the public health response to heatwaves.

Syndromic surveillance use to detect the early effects of heat-waves: an analysis of NHS direct data in England.

OBJECTIVES: To investigate the effects of high ambient temperatures, including the summer 2003 heat-episode, on NHS Direct usage and its suitability as a surveillance tool in heat health warning systems. METHODS: Analyses of data on calls to NHS Direct in English Regions in the period Dec 2001-May 2004. Outcomes were daily rates of all symptomatic calls, and daily proportion of calls for selected causes (fever, vomiting, difficulty breathing, heat/sun-stroke) RESULTS: Total calls were moderately increased as environmental temperature increased; this effect was greatest in calls for young children and for fever. Total calls were moderately elevated during two summer heat episodes in 2003: calls specifically for heat/sun stroke increased acutely in response to these episodes. No association was apparent between environmental temperature and proportion of calls for vomiting and difficulty breathing. CONCLUSIONS: Calls to NHS Direct are sensitive to daily temperatures and extreme weather. NHS Direct is timely and has great potential in health surveillance. Calls for heat- and sun-stroke are now routinely monitored as part of the UK Heat-wave plan

Municipal heat wave response plans.

Approximately 400 people die from extreme heat each year in the United States, and the risk of heat waves may increase as a result of global climate change. Despite the risk of heat-related morbidity and mortality, many cities lack written heat response plans. In a review of plans from 18 cities at risk for heat-related mortality, we found that many cities had inadequate or no heat response plans. This is an important area for further investigation and government attention.

Cáncer basocelular en área costera y valles interiores: IV Región / Basal cell cancer in coast area and interior valleys: IV region

Se presentan 277 pacientes portadores de cáncer basocelular primarios tratados entre 1989 y 1998. Se analiza retrospectivamente su comportamiento epidemiológico comparando la incidencia y tasa de morbilidad en la planicie costera y las zonas altas de los valles interiores. Además se describe y compara la incidencia de radiación UVB en las dos áreas. La insolación UVB media acumulada mensual de los valles interiores casi duplica la del área costera siguiendo un ritmo estacional más alto en el verano y más bajo en el invierno. La comparación de dos zonas que se diferencian en altitud y humedad relativa ambiental muestra una diferencia de incidencia y de tasa de morbilidad de cáncer basocelular, siendo aquellas más elevadas en el área de mayor insolación ultravioleta, correspondiente a los valles interiores. En conclusión, la incidencia de CBC en la IV región de Chile duplica los valores medios de incidencia de grandes series internacionales, por otra parte, el riesgo relativo de desarrollar la enfermedad es hasta un 44 por ciento mayor para los habitantes de los valles interiores (RR=1,44 en 1998) y, por último, la tasa de morbilidad es uniformemente mayor en el área de mayor insolación UVB

Epidemiology of heat illnesses during the Makkah Pilgrimages in Saudi Arabia.

A review of the literature shows that our knowledge of the epidemiology of heat illnesses on a global and regional level is still lacking. Until now most of the information has come from the experience of European armies in hot environments. Recently increased interest has been shown following the epidemics of heat illnesses affecting civil communities in the United States. Of great importance and unique for the study of heat illness is the start of the hot cycle of the Makkah Pilgrimage which will continue for the next 15-16 years. Approximately two million people, the majority of whom are at great risk, will be exposed to the extremes of hot weather in May-September. Thousands of heat stroke cases are expected to occur. In this paper the conditions prevailing during the annual Makkah Pilgrimage are described as well as a review of the epidemiological and clinical findings observed by the author during the pilgrimages of 1980/81 when 176 cases and 467 cases of Heat Stroke were seen and treated respectively and a new physiological method of treatment of heat stroke which proved very successful in clinical field trials was introduced.

Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, Mo.

The morbidity and mortality associated with the 1980 heat wave in St Louis and Kansas City, Mo, were assessed retrospectively. Heat-related illness and deaths were identified by review of death certificates and hospital, emergency room, and medical examiners' records in the two cities. Data from the July 1980 heat wave were compared with data from July 1978 and 1979, when there were no heat waves. Deaths from all causes in July 1980 increased by 57% and 64% in St Louis and Kansas City, respectively, but only 10% in the predominantly rural areas of Missouri. About one of every 1,000 residents of the two cities was hospitalized for or died of heat-related illness. Incidence rates (per 100,000) of heatstroke, defined as severe heat illness with documented hyperthermia, were 26.5 and 17.6 for St Louis and Kansas City, respectively. No heatstroke cases occurred in July 1979. Heatstroke rates were ten to 12 times higher for persons aged 65 years or older than for those younger than 65 years. The ratios of age-adjusted heatstroke rates were approximately 3:1 for nonwhite v white persons and about 6:1 for low v high socioeconomic status. Public health preventive measures in future heat waves should be directed toward the urban poor, the elderly, and persons of other-than-white races.

Risk factors for heatstroke. A case-control study.

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.