Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis

Extent: 9p.BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.Monika Nitschke, Graeme R. Tucker, Alana L. Hansen, Susan Williams, Ying Zhang and Peng B

Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension

BACKGROUND: Hypertension is common among patients with Alzheimer disease. Because this group has been excluded from hypertension trials, evidence regarding safety of treatment is lacking. This secondary analysis of a randomized controlled trial assessed whether antihypertensive treatment increases the prevalence of orthostatic hypotension (OH) in patients with Alzheimer disease. METHODS AND RESULTS: Four hundred seventy‐seven patients with mild‐to‐moderate Alzheimer disease were randomized to the calcium‐channel blocker nilvadipine 8 mg/day or placebo for 78 weeks. Presence of OH (blood pressure drop ≥20/≥10 mm Hg after 1 minute of standing) and OH‐related adverse events (dizziness, syncope, falls, and fractures) was determined at 7 follow‐up visits. Mean age of the study population was 72.2±8.2 years and mean Mini‐Mental State Examination score was 20.4±3.8. Baseline blood pressure was 137.8±14.0/77.0±8.6 mm Hg. Grade I hypertension was present in 53.4% (n=255). After 13 weeks, blood pressure had fallen by −7.8/−3.9 mm Hg for nilvadipine and by −0.4/−0.8 mm Hg for placebo (P<0.001). Across the 78‐week intervention period, there was no difference between groups in the proportion of patients with OH at a study visit (odds ratio [95% CI]=1.1 [0.8–1.5], P=0.62), nor in the proportion of visits where a patient met criteria for OH, corrected for number of visits (7.7±13.8% versus 7.3±11.6%). OH‐related adverse events were not more often reported in the intervention group compared with placebo. Results were similar for those with baseline hypertension. CONCLUSIONS: This study suggests that initiation of a low dose of antihypertensive treatment does not significantly increase the risk of OH in patients with mild‐to‐moderate Alzheimer disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02017340

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health:Wealthy nations must do much more, much faster

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