Bibliographie relative au coup de chaleur chez la personne âgée

Mise en ligne le 17 août 2003

dernière mise à jour le 23 juin 2005

Je présente ci-dessous des données de références dont la source la plus fréquente est la banque de données Medline.

A noter avant tout les deux ouvrages majeurs suivants permettant de mieux comprendre la catastrophe européenne de l'été 2003 :

Heat Wave. A social autopsy of disaster in Chicago d'Eric Klinenberg paru en 2002.

Canicules. La santé publique en question. Pr Lucien Abenhaim. Editions Fayard, France, paru en novembre 2003.

Précision pour la lecture des publications exprimées en degrés Fahrenheit :

Celsius vers Fahrenheit :
Fahrenheit = 32 + (9 / 5) x Celsius

Fahrenheit vers Celsius :
Celsius = (5 / 9) x (Fahrenheit - 32)


 Publication 1 :

MMWR Morb Mortal Wkly Rep. 1999 Jun 11;48(22):469-73.  

Erratum in:
    MMWR Morb Mortal Wkly Rep 2000 Jun 2;49(21):474.

Heat-related illnesses and deaths--Missouri, 1998, and United States, 1979-1996.

Although heat-related illness and death are readily preventable, exposure to
extremely high temperatures caused an annual average of 381 deaths in the United
States during 1979-1996. Basic behavioral and environmental precautions are
essential to preventing adverse health outcomes associated with sustained
periods of hot weather (daytime heat index of > or = 105 F [> or = 40.6 C] and a
nighttime minimum temperature of 80 F [26.7 C] persisting for at least 48
hours). This report describes four heat-related deaths that occurred in Missouri
during 1998, summarizes heat-related deaths in the United States during
1979-1996, describes risk factors associated with heat-related illness and
death, especially in susceptible populations (young and elderly, chronically
ill, and disabled persons), and recommends preventive measures.

PMID: 10428101 [PubMed - indexed for MEDLINE]

Publication 2 :

MMWR Morb Mortal Wkly Rep. 2003 Jul 4;52(26):610-3.  

Heat-related deaths--Chicago, Illinois, 1996-2001, and United States, 1979-1999.

Heat waves (i.e., >/=3 consecutive days of air temperatures >/=90 degrees F
[>/=32.2 degrees C]) are meteorologic events that contribute significantly to
heat-related deaths. Exposure to excessive heat can cause illness, injury, and
death. This report describes four cases of heat-related deaths, as reported by
the Office of the Medical Examiner, Cook County, Chicago, that occurred during
1996-2001; summarizes total heat-related deaths in Chicago during 1996-2001; and
compares the number of heat-related deaths during the 1995 and 1999 Chicago heat
waves. This report also summarizes trends in the United States during 1979-1999,
describes risk factors associated with heat-related deaths and symptoms, and
outlines preventive measures for heat-related illness, injury, and death.
Persons at risk for heat-related death should reduce strenuous outdoor
activities, drink water or nonalcoholic beverages frequently, and seek air

PMID: 12844077 [PubMed - indexed for MEDLINE]

Publication 3 :

Int J Hyperthermia. 2003 May-Jun;19(3):225-35.  

Cardiovascular responses to heat stress and their adverse consequences in
healthy and vulnerable human populations.

Donaldson GC, Keatinge WR, Saunders RD.

Medical Sciences Building, Queen Mary University of London, Mile End Road,
London E1 4NS, UK.

This paper reviews the basic thermoregulatory physiology of healthy people in
relation to hazards from external heat stress and internal heat loads generated
by physical exercise or radiofrequency (RF) radiation. In addition, members of
the population are identified who may be particularly vulnerable to the effects
of heat stress. These data are examined in relation to current international
guidance on occupational and public exposure to RF radiation. When body
temperature rises, heat balance of the body is normally restored by increased
blood flow to the skin and by sweating. These responses increase the work of the
heart and cause loss of salt and water from the body. They impair working
efficiency and can overload the heart and cause haemoconcentration, which can
lead to coronary and cerebral thrombosis, particularly in elderly people with
atheromatous arteries. These adverse effects of thermoregulatory adjustments
occur with even mild heat loads and account for the great majority of
heat-related illness and death. They are, therefore, particularly relevant to
determination of safe population exposures to additional sources of heat stress.
It is concluded that exposure to RF levels currently recommended as safe for the
general population, equivalent to heat loads of about one tenth basal metabolic
rate, could continue to be regarded as trivial in this context, but that
prolonged exposures of the general population to RF levels higher than that
could not be regarded as safe in all circumstances.

PMID: 12745969 [PubMed - in process]

Publication 4 :

Attention à certains médicaments qui seraient censés favoriser le coup de 
chaleur. Si l'on en croit la dernière édition du Harrison (Dinarello CA., Gelfand JA. Fièvre et hyperthermie; Section 2. Modifications de 
la température corporelle. Chapitre 17, pp 90-4. Harrison. Principes de Médecine 
Interne, 15ème Edition. Médecine-Sciences Flammarion. Edition française 2000), des médicaments favoriseraient le coup de chaleur, y compris chez des 
personnes ne faisant pas d'effort physique : il s'agit des antihistaminiques 
ayant des propriétés anticholinergiques, ainsi que des autres médicaments 
anticholinergiques, des antiparkinsonniens et des diurétiques.

Publication 5 :

Int Arch Occup Environ Health. 2002 Mar;75(3):163-70.  

Heat waves in Madrid 1986-1997: effects on the health of the elderly.

Diaz J, Jordan A, Garcia R, Lopez C, Alberdi JC, Hernandez E, Otero A.

Centro Universitario de Salud Publica de Madrid, Spain.

OBJECTIVE: The objective of this paper is to analyse and quantify the effects
exerted on summer mortality by extremes of heat, particularly among persons aged
65-74 and 75 years and over, groups in which mortality is higher. METHODS: The
study included the period from 1 January 1986 to 31 December 1997, for all
people aged over 65 years resident in Madrid, based on mortality due to all
causes except accidents (ICD-9 codes 1-799), and circulatory (390-459) and
respiratory (460-487) causes. Meteorological variables analysed were: daily
maximum temperature, daily minimum temperature and relative humidity. To control
the effect of air pollution on mortality we considered the daily mean values of
sulphur dioxide (SO2), total suspended particulate (TSP), nitric oxides (NOx),
nitrogen dioxide (NO2) and tropospheric ozone (O3). Univariate and multivariate
ARIMA models were used. Box-Jenkins pre-whitening was performed. RESULTS: The
results yielded by this study indicate a mortality increase up to 28.4% for
every degree the temperature rises above 36.5 degrees C, with particular effect
in women over the age of 75 years and circulatory-cause mortality. The first
heat wave that leads to the greatest effects on mortality, due to the higher
number of susceptible people and the duration of the heat wave, show an
exponential growth in mortality. Furthermore, low relative humidity enhances the
effects of high temperature, linking dryness to air pollutants, ozone in
particular. CONCLUSIONS: Since a warmer climate is predicted in the future, the
incidence of heat wave should increase, and more comprehensive measures, both
medical and social, should be adopted to prevent the effects of extreme heat on
the population, particularly the elderly.

PMID: 11954983 [PubMed - indexed for MEDLINE]

Publication 6 :

Int J Biometeorol. 2002 Aug;46(3):145-9. Epub 2002 Apr 25. 

Effects of extremely hot days on people older than 65 years in Seville (Spain)
from 1986 to 1997.

Diaz J, Garcia R, Velazquez de Castro F, Hernandez E, Lopez C, Otero A.

Centro Universitario de Salud Publica, C/General Oraa 39, 28006 Madrid, Spain.

The effects of heat waves on the population have been described by different
authors and a consistent relationship between mortality and temperature has been
found, especially in elderly subjects. The present paper studies this effect in
Seville, a city in the south of Spain, known for its climate of mild winters and
hot summers, when the temperature frequently exceeds 40 degrees C. This study
focuses on the summer months (June to September) for the years from 1986 to
1997. The relationships between total daily mortality and different specific
causes for persons older than 65 and 75 years, of each gender, were analysed.
Maximum daily temperature and relative humidity at 7.00 a.m. were introduced as
environmental variables. The possible confounding effect of different
atmospheric pollutants, particularly ozone, were considered. The methodology
employed was time series analysis using Box-Jenkins models with exogenous
variables. On the basis of dispersion diagrams, we defined extremely hot days as
those when the maximum daily temperature surpassed 41 degrees C. The ARIMA model
clearly shows the relationship between temperature and mortality. Mortality for
all causes increased up to 51% above the average in the group over 75 years for
each degree Celsius beyond 41 degrees C. The effect is more noticeable for
cardiovascular than for respiratory diseases, and more in women than in men.
Among the atmospheric pollutants, a relation was found between mortality and
concentrations of ozone, especially for men older than 75.

PMID: 12194008 [PubMed - indexed for MEDLINE]

Publication 7 :

Gac Sanit. 1997 Jul-Aug;11(4):164-70.  

[The effect of atmospheric variables on mortality due to respiratory and
cardiovascular diseases in those over 65 in the Community of Madrid]

[Article in Spanish]

Montero Rubio JC, Miron Perez IJ, Diaz Jimenez J, Alberdi Odriozola JC.

Centro Universitario de Salud Publica de Madrid.

OBJECTIVE: To investigate the influence of environmental variables on daily
mortality, due to respiratory and cardiovascular diseases, in the C.M. from 1986
to 1991. METHODOLOGY: The environmental and mortality variables are correlated
between cold and heat effects, checking the possible coincidence of models
between temperature and mortality by Box-Jenkins models. The filtered mortality
is correlated to the daily average temperatures, for 0-15 lags. RESULTS: The
minimum daily mortality is produced in an average temperature of 23.9 degrees.
There exists a correlation (p < 0.001) between cold temperature and all the
mortality causes in the 15 analysed lags. A correlation (p < 0.01) to vascular
diseases appears with hot temperature and, among them, with cerebrovascular
accidents (ACVA) in women for 0-3 lags. CONCLUSIONS: Cold temperatures increase
the mortality for all the analysed lags and causes. The heat produces immediate
effects on the mortality by ACVA in women.

PMID: 9378581 [PubMed - indexed for MEDLINE]

Publication 8 :

Publication 9 :

Environ Health Perspect. 2001 May;109(5):463-70.  

The impact of heat waves and cold spells on mortality rates in the Dutch

Huynen MM, Martens P, Schram D, Weijenberg MP, Kunst AE.

International Centre for Integrative Studies, Maastricht University, Maastricht,
The Netherlands.

We conducted the study described in this paper to investigate the impact of
ambient temperature on mortality in the Netherlands during 1979-1997, the impact
of heat waves and cold spells on mortality in particular, and the possibility of
any heat wave- or cold spell-induced forward displacement of mortality. We found
a V-like relationship between mortality and temperature, with an optimum
temperature value (e.g., average temperature with lowest mortality rate) of 16.5
degrees C for total mortality, cardiovascular mortality, respiratory mortality,
and mortality among those [Greater and equal to] 65 year of age. For mortality
due to malignant neoplasms and mortality in the youngest age group, the optimum
temperatures were 15.5 degrees C and 14.5 degrees C, respectively. For
temperatures above the optimum, mortality increased by 0.47, 1.86, 12.82, and
2.72% for malignant neoplasms, cardiovascular disease, respiratory diseases, and
total mortality, respectively, for each degree Celsius increase above the
optimum in the preceding month. For temperatures below the optimum, mortality
increased 0.22, 1.69, 5.15, and 1.37%, respectively, for each degree Celsius
decrease below the optimum in the preceding month. Mortality increased
significantly during all of the heat waves studied, and the elderly were most
effected by extreme heat. The heat waves led to increases in mortality due to
all of the selected causes, especially respiratory mortality. Average total
excess mortality during the heat waves studied was 12.1%, or 39.8 deaths/day.
The average excess mortality during the cold spells was 12.8% or 46.6
deaths/day, which was mostly attributable to the increase in cardiovascular
mortality and mortality among the elderly. The results concerning the forward
displacement of deaths due to heat waves were not conclusive. We found no
cold-induced forward displacement of deaths.

PMID: 11401757 [PubMed - indexed for MEDLINE]

Publication 10 :

Environ Health Perspect. 2001 May;109 Suppl 2:185-9.  

The potential impacts of climate variability and change on temperature-related
morbidity and mortality in the United States.

McGeehin MA, Mirabelli M.

Division of Environmental Hazards and Health Effects, National Center for
Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta,
Georgia, USA.

Heat and heat waves are projected to increase in severity and frequency with
increasing global mean temperatures. Studies in urban areas show an association
between increases in mortality and increases in heat, measured by maximum or
minimum temperature, heat index, and sometimes, other weather conditions. Health
effects associated with exposure to extreme and prolonged heat appear to be
related to environmental temperatures above those to which the population is
accustomed. Models of weather-mortality relationships indicate that populations
in northeastern and midwestern U.S. cities are likely to experience the greatest
number of illnesses and deaths in response to changes in summer temperature.
Physiologic and behavioral adaptations may reduce morbidity and mortality.
Within heat-sensitive regions, urban populations are the most vulnerable to
adverse heat-related health outcomes. The elderly, young children, the poor, and
people who are bedridden or are on certain medications are at particular risk.
Heat-related illnesses and deaths are largely preventable through behavioral
adaptations, including the use of air conditioning and increased fluid intake.
Overall death rates are higher in winter than in summer, and it is possible that
milder winters could reduce deaths in winter months. However, the relationship
between winter weather and mortality is difficult to interpret. Other adaptation
measures include heat emergency plans, warning systems, and illness management
plans. Research is needed to identify critical weather parameters, the
associations between heat and nonfatal illnesses, the evaluation of implemented
heat response plans, and the effectiveness of urban design in reducing heat

Publication Types:
    Review, Tutorial

PMID: 11359685 [PubMed - indexed for MEDLINE]

Publication 11 :

South Med J. 2002 Aug;95(8):799-802.  

Drug-associated heat stroke.

Martinez M, Devenport L, Saussy J, Martinez J.

Section of Emergency Medicine, Louisiana State University Medical Center, New
Orleans, USA.

During the June 1998 heat wave in New Orleans, 8 patients came to the emergency
department of a large public hospital over a 14-day period. They were
subsequently admitted to the intensive care unit with a diagnosis of heat
stroke. On each of these days, the ambient temperature exceeded 33.3 degrees C
(91.9 degrees F). Although the highest recorded temperature was only 35.6
degrees C (96 degrees F), the heat index reached a high of 44.5 degrees C (112
degrees F). Weather-related heat illnesses are well documented, but the reports
rarely address contributing medications or drugs. In this series, 6 patients
(75%) had been using medication or drugs known to induce or worsen hyperthermia.
A seventh patient had been prescribed a phenothiazine, but actual use could not
be established. An eighth patient had an unidentified agent detected on
toxicologic screening. The most common drug identified was cocaine. Other drugs
included diphenhydramine, tricyclic antidepressants, and phenothiazines. Six
patients (75%) had rhabdomyolysis; 3 of them also had disseminated intravascular
coagulation. There were 2 deaths, yielding a 25% mortality rate.

Publication Types:
    Review, Multicase

PMID: 12190212 [PubMed - indexed for MEDLINE]

Publication 12 :

Emerg Med Serv. 2003 Jul;32(7):34.  

Hot on the inside.

Weinmann M.

White Oak EMS, White Oak, PA, USA.

When a disease process becomes life-threatening, it is termed to be malignant.
Hyperthermia is a heat illness that arises from one of two basic causes: 1) the
body's normal thermoregulatory mechanisms are overwhelmed by the environment (an
exogenous heat load) or, more commonly, by excessive exercise in a
moderate-to-extreme environment (an endogenous heat load); or 2) failure of the
thermoregulatory mechanisms, such as those encountered in the elderly or
debilitated patient. Either cause can lead to heat illnesses such as heat
cramps, heat exhaustion or heatstroke. Heat cramps are brief, intermittent and
often severe muscular cramps that frequently occur in muscles fatigued by heavy
work or exercise. They are believed to be caused by a rapid change in the
extracellular fluid osmolarity resulting from sodium and water loss. Heat
exhaustion is a more severe form of heat illness characterized by minor changes
in mental status (poor judgment, irritability), dizziness, nausea and headache.
In severe cases, the patient may have an altered LOC. Just as with heat cramps,
profuse sweating is present. Removing the patient from the hot environment and
administering fluids will usually result in a rapid recovery. [table: see text]
Left untreated, heat exhaustion may progress to heatstroke. Heatstroke results
when there is a complete collapse of thermoregulatory mechanisms. This will lead
to a rise in body core temperature in excess of 105.8 degrees F (41 degrees C),
which will produce multisystem tissue damage and physiological collapse. Severe
cases can cause death. The patient in this case had an axillary temperature
taken and recorded at 101.4 degrees F. Typically, axillary temperatures are one
degree cooler than oral temperatures, which are one degree cooler than core
temperatures. This patient, then, had a core temperature of 103 degrees F or
higher. There are two types of heatstroke: classic and exertional. Classic
heatstroke occurs during periods of sustained high ambient temperatures and
humidity. Exertional heatstroke more often occurs in athletes, military
personnel and people who work strenuosly in the environment. In these
situations, endogenous heat accumulates more rapidly than the body can dissipate
it in the environment. Although sweating is usually absent in the classic form
of heatstroke, 50% of exertional heatstroke cases have persistent sweating as a
result of catecholamine release. The presence of sweating does not preclude the
diagnosis of heatstroke, and cessation of sweating is not the cause of it. As
the illness progresses, peripheral vasodilation occurs, resulting in hypotension
and shunting. As internal temperatures rise, myocardial contractility begins to
decrease, manifested by bradycardia and irritability of the myocardium. No
matter the age group, the presence of hypotension and decreased cardiac output
indicates a poor prognosis for the patient.

PMID: 12889421 [PubMed - in process]

Publication 13 :

 Am Fam Physician. 2002 Jun 1;65(11):2307-14.  

Comment in:
    Am Fam Physician. 2003 Apr 1;67(7):1439-40; author reply 1440.

Evaluation and treatment of heat-related illnesses.

Wexler RK.

Department of Family Medicine, Ohio State University College of Medicine and
Public Health, Columbus 43201, USA.

The body's ability to regulate core temperature depends on both host (internal)
and environmental (external) factors. Although athletes are commonly thought to
be most at risk for heat illnesses, children and the elderly are particularly
vulnerable. Heat cramps, which are caused by fluid and electrolyte imbalances,
are treated with massage, and fluid and electrolyte replacement. Heat exhaustion
occurs both as water- and sodium-depleted types, with associated symptoms such
as malaise, vomiting, and confusion. Treatment involves taking the affected
person to a cool environment and replacing fluids and electrolytes if needed. In
more serious cases, intravenous hydration may be necessary, although monitoring
of serum sodium levels is important to prevent cerebral edema. If not treated
promptly, heat exhaustion may evolve into heatstroke, a deadly form of heat
illness. Heatstroke occurs in classic and exertional forms and is present when
the core body temperature exceeds 40 degrees C (104 degrees F). The patient may
experience cardiac arrhythmias, rhabdomyolysis, serum chemistry abnormalities,
disseminated intravascular coagulation, and death. Heatstroke is a medical
emergency that should be treated immediately with temperature-lowering
techniques such as immersion in an ice bath or evaporative cooling. Fluid
resuscitation is important but should be closely monitored, and renal function
may need to be protected with mannitol and diuretics. It is important to be
vigilant for heat illnesses because they occur insidiously but progress rapidly.

Publication Types:
    Review, Tutorial

PMID: 12074531 [PubMed - indexed for MEDLINE]


Publication 14 :

Am Fam Physician. 2002 Jun 1;65(11):2307-14.  

Comment in:
    Am Fam Physician. 2003 Apr 1;67(7):1439-40; author reply 1440.

Evaluation and treatment of heat-related illnesses.

Wexler RK.

Department of Family Medicine, Ohio State University College of Medicine and
Public Health, Columbus 43201, USA.

The body's ability to regulate core temperature depends on both host (internal)
and environmental (external) factors. Although athletes are commonly thought to
be most at risk for heat illnesses, children and the elderly are particularly
vulnerable. Heat cramps, which are caused by fluid and electrolyte imbalances,
are treated with massage, and fluid and electrolyte replacement. Heat exhaustion
occurs both as water- and sodium-depleted types, with associated symptoms such
as malaise, vomiting, and confusion. Treatment involves taking the affected
person to a cool environment and replacing fluids and electrolytes if needed. In
more serious cases, intravenous hydration may be necessary, although monitoring
of serum sodium levels is important to prevent cerebral edema. If not treated
promptly, heat exhaustion may evolve into heatstroke, a deadly form of heat
illness. Heatstroke occurs in classic and exertional forms and is present when
the core body temperature exceeds 40 degrees C (104 degrees F). The patient may
experience cardiac arrhythmias, rhabdomyolysis, serum chemistry abnormalities,
disseminated intravascular coagulation, and death. Heatstroke is a medical
emergency that should be treated immediately with temperature-lowering
techniques such as immersion in an ice bath or evaporative cooling. Fluid
resuscitation is important but should be closely monitored, and renal function
may need to be protected with mannitol and diuretics. It is important to be
vigilant for heat illnesses because they occur insidiously but progress rapidly.

Publication Types:
    Review, Tutorial

PMID: 12074531 [PubMed - indexed for MEDLINE]

Publication 15 :

Cell Stress Chaperones. 2001 Apr;6(2):113-20.  

Presence of antibody against the inducible Hsp71 in patients with acute
heat-induced illness.

Wu T, Chen S, Xiao C, Wang C, Pan Q, Wang Z, Xie M, Mao Z, Wu Y, Tanguay RM.

Institute of Occupational Medicine, Tongji Medical College, Huazhong University
of Science and Technology, Wuhan, China.

Antibodies against heat shock or stress proteins (Hsps) have been reported in a
number of diseases in which they may be involved in the pathogenesis of the
disease or may be of use for prognosis. Heat-induced diseases, such as heat
cramps, heat exhaustion, or heat stroke, are frequent in hot working or living
environments. There are still few investigations on the presence and possible
significance of autoantibodies against Hsps in heat-induced illnesses. Using an
immunoblotting technique with recombinant human Hsps, we analyzed the presence
and titers of antibodies against Hsp60, Hsp71, and Hsp90alpha, and Hsp90beta in
a group of 42 young male patients who presented with acute heat-induced illness
during training. We also examined the presence of antibody against Hsp71 in a
second group of 57 patients with acute heat-induced illness and measured the
changes in titers of anti-Hsp71 antibodies in 9 patients hospitalized by
emergency physicians. In the first group of young persons exercising in a hot
environment, the occurrence of antibodies against Hsp71 and Hsp90alpha was
significantly higher among individuals with symptoms of heat-induced illness (P
< 0.05) than in the matched group of nonaffected exercising individuals.
Moreover titers of antibody against Hsp71 were higher in individuals of the
severe and mild heat-induced illness groups, the highest titer being found in
the most severe cases. The results from the second group of 57 heat-affected
patients exposed to extreme heat were similar. Again, patients with the more
severe heat-induced symptoms showed a significantly higher incidence of
antibodies to Hsp71 than controls and the titer of anti-Hsp71 was higher in the
severely affected group. Finally, in a study of 9 patients, it was observed that
the titer of anti-Hsp71 decreased during recovery from severe heat symptoms.
These results suggest that measurement of antibodies to Hsps may be useful in
assessing how individuals are responding to abnormal stress within their living
and working environment and may be used as one biomarker to evaluate their
susceptibility to heat-induced diseases.

PMID: 11599572 [PubMed - indexed for MEDLINE]

Publication 16 :

Am J Prev Med. 2002 May;22(4):221-7.  

Comment in:
    Am J Prev Med. 2002 May;22(4):328-9.

Heat-related mortality during a 1999 heat wave in Chicago.

Naughton MP, Henderson A, Mirabelli MC, Kaiser R, Wilhelm JL, Kieszak SM, Rubin
CH, McGeehin MA.

Epidemic Intelligence Service, Epidemiology Progam Office, and the National
Center for Environmental Health, Centers for Disease Control and Prevention,
Atlanta, GA 30333, USA.

BACKGROUND: During the summer of 1999, Chicago's second deadliest heat wave of
the decade resulted in at least 80 deaths. The high mortality, exceeded only by
a 1995 heat wave, provided the opportunity to investigate the risks associated
with heat-related deaths and to examine the effectiveness of targeted
heat-relieving interventions. METHODS: We conducted a case-control study to
determine risk factors for heat-related death. We collected demographic, health,
and behavior information for 63 case patients and 77
neighborhood-and-age-matched control subjects and generated odds ratios (ORs)
for each potential risk factor. RESULTS: Fifty-three percent of the case
patients were aged <65 years, and psychiatric illness was almost twice as common
in the younger than the older age group. In the multivariate analysis, the
strongest risk factors for heat-related death were living alone (OR=8.1; 95%
confidence interval [CI], 1.4-48.1) and not leaving home daily (OR=5.8; 95% CI,
1.5-22.0). The strongest protective factor was a working air conditioner
(OR=0.2; 95% CI, 0.1-0.7). Over half (53%) of the 80 decedents were seen or
spoken to on the day of or day before their deaths. CONCLUSIONS: A working air
conditioner is the strongest protective factor against heat-related death. The
relatively younger age of case patients in 1999 may be due to post-1995
interventions that focused on the elderly of Chicago. However, social isolation
and advanced age remain important risk factors. Individual social contacts and
educational messages targeted toward at-risk populations during heat waves may
decrease the number of deaths in these groups.

PMID: 11988377 [PubMed - indexed for MEDLINE]

Publication 17 :

Am J Public Health. 2002 May;92(5):830-3.  

Heat wave morbidity and mortality, Milwaukee, Wis, 1999 vs 1995: an improved

Weisskopf MG, Anderson HA, Foldy S, Hanrahan LP, Blair K, Torok TJ, Rumm PD.

Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease
Control and Prevention, Atlanta, Ga, USA.

OBJECTIVES: This study examined whether differences in heat alone, as opposed to
public health interventions or other factors, accounted for the reduction in
heat-related deaths and paramedic emergency medical service (EMS) runs between
1995 and 1999 during 2 heat waves occurring in Milwaukee, Wis. METHODS: Two
previously described prediction models were adapted to compare expected and
observed heat-related morbidity and mortality in 1999 based on the city's 1995
experience. RESULTS: Both models showed that heat-related deaths and EMS runs in
1999 were at least 49% lower than levels predicted by the 1995 relation between
heat and heat-related deaths or EMS runs. CONCLUSIONS: Reductions in
heat-related morbidity and mortality in 1999 were not attributable to
differences in heat levels alone. Changes in public health preparedness and
response may also have contributed to these reductions.

PMID: 11988455 [PubMed - indexed for MEDLINE]

Publication 18 :

Emerg Med (Fremantle). 2001 Mar;13(1):116-20.  

Hyperpyrexia in the emergency department.

McGugan EA.

Department of Emergency Medicine, Royal Brisbane Hospital, Queensland,

The differential diagnosis of the hyperpyrexic patient in the emergency
department is extensive. It includes sepsis, heat illness including heat stroke,
neuroleptic malignant syndrome, malignant hyperthermia, serotonin syndrome and
thyroid storm. Each of these possible diagnoses has distinguishing features that
may help to differentiate one from another. However, establishing the correct
diagnosis is a challenge in the setting of the obtunded emergency patient who
gives no history and where there may be limited access to any past medical or
drug history. This paper presents such a case and reviews the features of the
differential diagnoses and management of the hyperpyrexic patient.

Publication Types:
    Review, Tutorial

PMID: 11476402 [PubMed - indexed for MEDLINE]

Publication 19 :

Intensive Care Med. 2001 Apr;27(4):680-5.  

Acid-base alterations in heatstroke.

Bouchama A, De Vol EB.

Department of Medicine (MBC 46), King Faisal Specialist Hospital and Research
Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia.

OBJECTIVE: To analyze the acid-base balance during heatstroke. DESIGN:
Retrospective study. SETTING: Heatstroke Center, Makkah, Saudi Arabia. PATIENTS:
Hundred nine consecutive heatstroke patients (mean age 55 +/- 12 years) with
rectal temperature from 40 to 43.4 degrees C following exposure to hot weather.
INTERVENTION: Arterial blood gases collected prospectively and analyzed using
95% confidence limits established by controlled experimental studies. Severity
of heatstroke on admission assessed by Simplified Acute Physiology Score and
Organ System Failure score. RESULTS: Metabolic acidosis was the predominant
acid-base change followed by respiratory alkalosis (81 and 55% of the patients,
respectively). The prevalence of metabolic acidosis (but not respiratory
alkalosis) was significantly associated with the degree of hyperthermia: 63, 95
and 100% at 41, 42 and 43 degrees C, respectively (p < 0.0001). Patients with
metabolic acidosis had a large anion gap (24 +/- 5). Arterial partial pressure
of oxygen (PaO2), systolic blood pressure and Organ System Failure score were
similar with or without metabolic acidosis. Although the acute physiology score
was higher in patients with, than without, metabolic acidosis (15.7 +/- 3.7 vs
9.8 +/- 4.4, p < 0.001), there was no significant difference in neurologic
morbidity and mortality (7.9 vs 1.1%, 5.6 vs 0%, p = 0.776 and 0.581,
respectively). CONCLUSION: We conclude that metabolic acidosis is the
predominant response in heatstroke.

PMID: 11398693 [PubMed - indexed for MEDLINE]

Publication 20 :

Am J Forensic Med Pathol. 2001 Jun;22(2):196-9.  

An analysis of factors contributing to a series of deaths caused by exposure to
high environmental temperatures.

Green H, Gilbert J, James R, Byard RW.

Forensic Science Centre, Adelaide, Australia.

Autopsy reports at the Forensic Science Centre, Adelaide, South Australia, were
reviewed for the 8 years from January 1991 to December 1998 for cases with
unusual features in which deaths had been attributed to exposure to high
environmental temperatures. Amphetamine-related hyperpyrexial deaths, anesthetic
deaths caused by malignant hyperpyrexia, deaths of elderly incapacitated
individuals during heat waves, and deaths of children trapped in the back of
cars were excluded from the study. In 9 cases, where heat-related deaths had
occurred (age range 21 to 77 years; M:F = 8:1). Predisposing factors included
lack of familiarity with Australian environmental conditions, excessive
clothing, prolonged sun exposure, acute alcohol intoxication, obesity,
benztropine and trifluoperazine medication, and underlying dementia, alcoholic
liver disease, and possibly epilepsy.

PMID: 11394759 [PubMed - indexed for MEDLINE]

Publication 21 :

Heat related mortality in warm and cold regions of Europe: observational study

BMJ 2000;321:670-673 ( 16 September )

Editorial by Kalkstein

Publication 22 :

Harefuah. 1999 Jul;137(1-2):9-13, 88.  

[Severe heat stroke in an intensive care unit: course of the disease in the
intensive care unit, and early and subsequent treatment results]

[Article in Hebrew]

Halkin A, Lev D, Szold O, Bidermann P, Bulocnic S, Halpern P, Sorkine P.

Dept. of Medicine, Tel Aviv Medical Center.

During the August 1998 heat wave in Tel Aviv we admitted many patients for acute
heat-related illness; 6 had severe heat stroke and were admitted in critical
condition. We describe their clinical courses during the first 5 days of
hospitalization, including response to treatment and implications for future
management of this disorder. The mean APACHE II score of the 6 was 30 +/- 3.5
and mean Glasgow Coma Scale rating 3.5 +/- 0.5; they were in hypovolemic shock
and respiratory failure, necessitating mechanical ventilation. Despite early
effective therapy (core temperature in all was reduced to less than 39 degrees C
in less than 1 hour), there was 1 death (mortality 15%) and 4 required further
intensive care for life-threatening multiple organ failure. During severe heat
waves a significant number of referrals for acute heat-related illness must be
anticipated, possibly overwhelming admission capacity of regional intensive-care
units. Severe heat stroke complicated by multi-organ failure is not necessarily
related to prior physical activity. Although important in determining prognosis,
early treatment does not prevent severe complications. Mechanisms regulating
body heat may remain disturbed for days following early treatment and apparent
stabilization, mandating continued hospitalization.

PMID: 10959266 [PubMed - indexed for MEDLINE]

Publication 23 :

Am J Emerg Med. 2000 Jul;18(4):474-7.  

Heat stroke in a subtropical country.

How CK, Chern CH, Wang LM, Lee CH.

Emergency Department, Veterans General Hospital-Taipei, National Yang-Ming
University, Taiwan, ROC.

In Taiwan, a subtropical country without any history of heat waves, heat stroke
has been considered a rare disease. However, after seeing several cases of the
classic type of heat stroke at the end of the summer of 1998 (an unusual event)
we began to review and collect cases of suspected heat stroke (hyperthermia
(>40.6 degrees C) in the presence of altered mental status and anhidrosis) and
tried to explore the possible cause of this unusual phenomenon. Through a
emergency department (ED) chart review, case retraction from International
Classification of Diseases (ICD) code, and ED conferences, six patients were
found for the period from June to August (the hottest months in Taiwan) 1998. We
found that the most common comorbid conditions were hypertension (4/6) and
preexisting mental problems (3/6). All patients lived in the inner part of an
urban area, were middle class, and were not socially isolated. Most of our
patients felt unhealthy being exposed to the cold and avoided staying in
air-conditioned rooms. Laboratory abnormalities and clinical presentations,
except for a high fever and conscious change, seemed to be nonspecific. All
cases occurred during two periods of sustained hotter-than-average weather and,
to our surprise, we found that three episodes occurred around the day of the
highest weather temperature (38.1 degrees C). However, the higher temperatures
(around 30 degrees to 31 degrees C and 32 degrees to 33 degrees C) did not reach
the criteria of a heat wave. Compared with the other study, our patients seemed
to have initial worse outcomes. Because of special environment and social
factors, classic heat stroke may occur occasionally in subtropic regions,
without previous history of heat waves and where heat stroke rarely occurs,
during periods of the persistently high temperatures. Prevention of heat stroke
in an area with a low incidence includes early health organizations' issue of
advisories or warnings through the media and reminding or teaching emergency
physicians about heat stroke during sustained hot weather, especially when
record temperatures are set.

PMID: 10919543 [PubMed - indexed for MEDLINE]

Publication 24 :

Geriatr Nurs. 2000 Mar-Apr;21(2):70-7.  

Heat waves: their impact on the health of elders.

Worfolk JB.

Fitchburg State College, Fitchburg, Mass., USA.

A trend toward more hot and humid summers in the United States raises concern
for the health of our elderly population. Older adults are more vulnerable to
heat illness than younger people because of dysfunctional thermoregulatory
mechanisms, chronic dehydration, medications, and diseases involving the systems
that regulate body temperature. Heat exhaustion, if untreated, will lead to heat
stroke, which is fatal if body temperature is not quickly lowered, and research
shows that survivors may suffer long-term disabilities. Prevention requires
strong knowledge and application of measures necessary to keep elders healthy in
extreme heat. Should illness occur, careful monitoring and assessment will
ensure early detection and prompt treatment. This article provides information
for caregivers that will enable them to protect their patients from heat
illness. It also discusses age-related changes in the thermoregulatory system's
response to heat, risk factors, assessment criteria, preventive measures, and
first aid for victims of heat exhaustion and heat stroke.

Publication Types:
    Review, Tutorial

PMID: 10769330 [PubMed - indexed for MEDLINE]

Publication 25 :

Int J Biometeorol. 1999 Nov;43(3):124-7.  

Deaths from heat-stroke in Japan: 1968-1994.

Nakai S, Itoh T, Morimoto T.

Department of Physiology, Kyoto Prefectural University of Medicine, Japan.

Global warming is increasingly recognized as a threat to the survival of human
beings, because it could cause a serious increase in the occurrence of diseases
due to environmental heat during intermittent hot weather. To assess the direct
impact of extremely hot weather on human health, we investigated heat-related
deaths in Japan from 1968 through 1994, analyzing the data to determine the
distribution of the deaths by age and their correlation to the incidence of hot
days in summer. Vital Statistics of Japan, published by the Ministry of Health
and Welfare of Japan, was the source of the heat-related mortality data employed
in this study. Meteorological data were obtained from the District
Meteorological Observatories in Tokyo and Osaka, the two largest cities in
Japan. Heat-related deaths were most prone to occur on days with a peak daily
temperature above 38 degrees C, and the incidence of these deaths showed an
exponential dependence on the number of hot days. Thus, even a small rise in
atmospheric temperature may lead to a considerable increase in heat-related
mortality, indicating the importance of combating global warming. Furthermore,
half (50.1%) of the above-noted deaths occurred in children (4 years and under)
and the elderly (70 years and over) irrespective of gender, indicating the
vulnerability of these specific age groups to heat. Since a warmer climate is
predicted in the future, the incidence of heat waves will increase, and more
comprehensive measures, both medical and social, should be adopted for children
of 4 years and younger the elderly to prevent heat-related deaths in these age

PMID: 10639904 [PubMed - indexed for MEDLINE]

Publication 26 :

Environ Health Perspect. 1999 Nov;107(11):911-6.  

Temperature and air pollution as risk factors for heat stroke in Tokyo, July and
August 1980-1995.

Piver WT, Ando M, Ye F, Portier CJ.

National Institute of Environmental Health Sciences, Research Triangle Park,
North Carolina, USA.

Heat stroke is associated with prolonged exposures to high air temperatures that
usually occur in the summer months of July and August in Tokyo, Japan. Also
during July and August, residents of Tokyo are often exposed simultaneously to
high concentrations of air pollutants. To assess the impacts of these combined
exposures, daily numbers of heat stroke emergency transport cases/million
residents for Tokyo were stratified by gender and three groups: 0-14, 15-64; and
> 65 years of age, for the months of July and August in 1980-1995. A regression
model was constructed using daily maximum temperature (Tmax) and daily average
concentrations of NO2 and O3 as model covariates. Classification indices were
added to make it possible to compare the expected number of heat stroke cases by
age and gender. Lag times of 1-4 days in Tmax and air quality covariates and
terms to account for interactions between pairs of model covariates were also
included as additional risk factors. Generalized linear models (GLMs), assuming
a Poisson error structure for heat stroke emergency transport cases, were used
to determine which covariates were significant risk factors for heat stroke for
the three age groups of males and females. Same-day Tmax and concentrations of
NO2 were the most significant risk factors for heat stroke in all age groups of
males and females. The number of heat stroke emergency transport cases/million
residents was greater in males than in females in the same age groups. The
smallest number of heat stroke emergency transport cases/million residents
occurred for females 0-14 years of age and the greatest number of heat stroke
emergency transport cases/million residents occurred for males > 65 years of

PMID: 10544159 [PubMed - indexed for MEDLINE]


Publication 27 :

Ann Intern Med. 1998 Aug 1;129(3):173-81.



Near-fatal heat stroke during the 1995 heat wave in Chicago.

Dematte JE, O'Mara K, Buescher J, Whitney CG, Forsythe S, McNamee T, Adiga RB,
Ndukwu IM.

Michael Reese Hospital and Medical Center, University of Illinois at Chicago,
60521, USA.

BACKGROUND: In July 1995, Chicago sustained a heat wave that resulted in more
than 600 excess deaths, 3300 excess emergency department visits, and a
substantial number of intensive care unit admissions for near-fatal heat stroke.
OBJECTIVE: To describe the clinical features of patients admitted to an
intensive care unit with near-fatal classic heat stroke. Patients were followed
for 1 year to assess delayed functional outcome and mortality. DESIGN:
Observational study. SETTING: Intensive care units in the Chicago area.
PATIENTS: 58 patients admitted to the hospital from 12 July to 20 July 1995 who
met the case definition of classic heat stroke. MEASUREMENTS: The data
collection tool was designed to compile demographic and survival data and to
permit analysis of organ system function by abstracting data on physical
examination findings, electrocardiography and echocardiography results, fluid
resuscitation, radiography results, and laboratory findings. Data on functional
status at discharge and at 1 year were collected by using a modified Stanford
Health Assessment Questionnaire. RESULTS: Patients experienced multiorgan
dysfunction with neurologic impairment (100%), moderate to severe renal
insufficiency (53%), disseminated intravascular coagulation (45%), and the acute
respiratory distress syndrome (10%). Fifty-seven percent of patients had
evidence of infection on admission. In-hospital mortality was 21%. Most
survivors recovered near-normal renal, hematologic, and respiratory status, but
disability persisted, resulting in moderate to severe functional impairment in
33% of patients at hospital discharge. At 1 year, no patient had improved
functional status, and an additional 28% of patients had died. CONCLUSIONS:
Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high
percentage of patients had infection at presentation. A high mortality rate was
observed during acute hospitalization and at 1 year. In addition, substantial
functional impairment at discharge persisted 1 year. The degree of functional
disability correlated highly with survival at 1 year.

PMID: 9696724 [PubMed - indexed for MEDLINE]

Publication 28 :

Serum enzymes in heat stroke: prognostic implication


Publication 29 :

Thromb Haemost. 1996 Dec;76(6):909-15.  

Activation of coagulation and fibrinolysis in heatstroke.

Bouchama A, Bridey F, Hammami MM, Lacombe C, al-Shail E, al-Ohali Y, Combe F,
al-Sedairy S, de Prost D.

Department of Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.

Hemorrhagic diathesis and widespread microthrombosis are common in heatstroke.
To assess the early stages of coagulopathy in heatstroke, thrombin-antithrombin
III (TAT), fibrin monomers, plasmin-alpha 2-antiplasmin (PAP), plasminogen and
D-Dimer were measured in 16 heatstroke patients (means +/- SE rectal temperature
42.3 +/- 0.2 degrees C) pre- and postcooling and compared with 8 heatstressed
and 23 normal controls. Comparing heatstroke patients with normal controls, TAT,
fibrin monomers, PAP and D-Dimer were elevated to (median (range)) 16.5 (4-1000)
versus 3.5 (2-7.2) micrograms/l p < 0.001, 16 (4-113) versus 2 (2-9) nM p <
0.001; 3300 (1000-36500) versus 255 (136-462) micrograms/l p < 0.001 and 0.72
(0.22-64.8) versus 0.15 (0.05-0.25) microgram/ml p < 0.01 respectively.
Plasminogen decreased to 81% (34-106); PAP, TAT and D-Dimer correlated
significantly with hyperthermia (r = 0.577, p = 0.02; r = 0.635, p = 0.01; r =
0.76, p = 0.003). Postcooling PAP decreased to 545 (260-850) micrograms/l p <
0.005, TAT 10 (6-70) micrograms/l, and fibrin monomers 22 (18-86) nM remained
unchanged. Heatstressed controls showed mild but significant increase in all
markers. Activation of coagulation and fibrinolysis occurs early and is profound
and sustained in heatstroke. Cooling seems to attenuate the activation of
fibrinolysis only, however, this requires confirmation in a larger study

PMID: 8972010 [PubMed - indexed for MEDLINE]

Publication 30 :

Am J Forensic Med Pathol. 1996 Jun;17(2):106-8.  

Heat-related deaths in Philadelphia--1993.

Mirchandani HG, McDonald G, Hood IC, Fonseca C.

Medical Examiner's Office, Philadelphia, Pennsylvania 19104, USA.

A study of heat-related deaths associated with the 1993 heat wave in
Philadelphia, Pennsylvania, was conducted. Most of these deaths were in the
susceptible elderly with preexisting natural diseases who lived alone without
air conditioning in upstairs bedrooms with windows shut, thus creating an even
hotter environment. These excessive deaths under such conditions did not meet
the standard clinical criteria for hyperthermia because of varying postmortem
intervals. Therefore, the authors stress the utility of a postmortem definition
of heat-related death to better define the magnitude of health risk posed by hot
weather and warn public health and other agencies to take preventative measures.

Publication Types:
    Historical Article

PMID: 8727283 [PubMed - indexed for MEDLINE]

Publication 31 :

Remarque de l'auteur de ce site : la substance impliquée dans le résumé ci-dessous est l'oxybutinine. Cette substance est le principe actif de la spécialité française DITROPAN*., mais aussi de DRIPTANE* et ZARUR*. Cette publication renforce la prudence que nous devons avoir vis à vis des substances anticholinergiques.

Ann Pharmacother. 1996 Feb;30(2):144-7.  

Oxybutynin-induced heatstroke in an elderly patient.

Adubofour KO, Kajiwara GT, Goldberg CM, King-Angell JL.

Department of Medicine, Kaiser Permanente Medical Center, Fremont, CA 94555,

OBJECTIVE: To report an elderly patient with oxybutynin-induced heatstroke and
to remind clinicians of the possibility of drugs as an etiology of hyperthermia.
CASE SUMMARY: An elderly man was admitted to the emergency department in a
confused state. The day of admission was the hottest of the summer months in the
San Francisco area. Because his rectal temperature was 40 degrees C and his skin
was hot and dry, he was immediately packed in ice, given intravenous NaCl 0.9%,
and a cooling fan was used to aid in external cooling. The patient was taking
oxybutynin chloride, a drug with anticholinergic properties. The previous summer
he had been admitted with a rectal temperature of 41.1 degrees C. No infectious
etiology could be found. He was discharged in an improved state after a 48-hour
observation period. The drug was discontinued. DISCUSSION: It is important to
recognize heatstroke and institute prompt management because of the high
mortality associated with this thermoregulatory disorder. Prompt treatment
should consist of rapid cooling and vigorous cardiopulmonary support.
CONCLUSIONS: The possibility of drug-induced heatstroke should be investigated
in all patients admitted during the summer months with unexplained hyperthermia,
especially the elderly. To our knowledge this is the first reported case of
heatstroke associated with the use of oxybutynin.

PMID: 8835047 [PubMed - indexed for MEDLINE]

Publication 32 :

South Med J. 1995 Oct;88(10):1065-8.

Rhabdomyolysis and myoglobinuric acute renal failure associated with classic
heat stroke.

Tan W, Herzlich BC, Funaro R, Koutelos K, Pagala M, Amaladevi B, Grob D.

Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.

Classic heat stroke is a disorder of thermal regulation that predominantly
affects elderly patients during heat waves. In contrast to exertional heat
stroke, rhabdomyolysis and myoglobinuric acute renal failure are considered to
be unusual manifestations of classic heat stroke. We retrospectively reviewed
the charts of seven patients admitted to Maimonides Medical Center with classic
heat stroke over a 3-day period during a heat wave in July 1993. Three of these
patients with classic heat stroke had rhabdomyolysis, but no renal failure; two
completely recovered; and one had an ataxic gait disturbance. Three additional
patients had rhabdomyolysis and myoglobinuric acute renal failure; one of them
completely recovered, one survived with quadriplegia, and one died. Our findings
suggest that rhabdomyolysis and myoglobinuric acute renal failure are common
manifestations of classic heat stroke. Recognition of this complication warrants
rigorous hydration and alkalinization of the urine to prevent or attenuate
myoglobinuric acute renal failure.

PMID: 7481965 [PubMed - indexed for MEDLINE]

Publication 33 :

Am Fam Physician. 1994 Aug;50(2):389-96, 398.

Comment in:
    Am Fam Physician. 1995 Feb 1;51(2):352, 354.

Heat emergencies.

Bross MH, Nash BT Jr, Carlton FB Jr.

University of Mississippi Medical Center, Jackson.

Heat emergencies occur when the body is unable to adequately dissipate heat.
Hyperthermic patients should be cooled immediately with a lukewarm-water spray
and cool moving air. Patients with heat exhaustion respond well to
administration of intravenous fluids. Patients with heatstroke have a complete
loss of thermoregulation, a core temperature greater than 40.5 degrees C (105
degrees F) and impaired mental status. These critically ill patients must be
cooled quickly to 39 degrees C (102 degrees F) to avoid devastating
complications. Intensive care monitoring and support are indicated. To reduce
the risk of heat injury in hot weather, frail and elderly persons must maintain
hydration and may need to consider alternate living arrangements. Laborers,
athletes and military personnel benefit from gradual acclimation to the heat,
increased fluid intake, vapor-permeable clothing and frequent rest periods.

Publication Types:
    Review, Tutorial

PMID: 8042574 [PubMed - indexed for MEDLINE]

Publication 34 :

J Appl Physiol. 1991 Jul;71(1):328-32.

Mechanisms of hypophosphatemia in humans with heatstroke.

Bouchama A, Cafege A, Robertson W, al-Dossary S, el-Yazigi A.

Department of Medicine, King Faisal Specialist Hospital and Research Centre,
Riyadh, Saudi Arabia.

Hypophosphatemia is common in heatstroke, but little is known about its
mechanism. We investigated 10 consecutive patients with heatstroke (mean age 58
+/- 2 yr) whose mean rectal temperature at admission was 42.3 +/- 0.2 degrees C.
Eight patients presented with hypophosphatemia [0.48 +/- 0.08 mmol/l, normal
range (NR) 0.8-1.4 mmol/l], associated with increased fractional excretion of
phosphate (19.8 +/- 6.4%, NR 6-20%) relative to plasma phosphate levels and
reduced renal threshold for phosphate (0.55 +/- 0.08 mmol/l glomerular filtrate,
NR 0.8-1.4 mmol/l). Plasma parathyroid hormone (75.0 +/- 5 pmol/l) and calcium
(2.24 +/- 0.02 mmol/l) levels and fractional excretion of calcium were normal
(1.66 +/- 0.27%). There was no evidence of uricosuria or aminoaciduria, and only
one patient had glucosuria. Arterial carbon dioxide was decreased in eight
patients (28 +/- 1.1 Torr); however, none had elevated blood pH (7.35 +/- 0.02).
The results suggest that heatstroke-related hypophosphatemia is associated with
abnormal phosphaturia independent of the parathyroid hormone level, and there is
no evidence of tubular dysfunction.

PMID: 1917758 [PubMed - indexed for MEDLINE]

Publication 35 :

Med Clin (Barc). 1990 Apr 7;94(13):481-6.

[Classical heatstroke in Spain. Analysis of a series 78 cases]

[Article in Spanish]

Jimenez-Mejias ME, Montano Diaz M, Villalonga J, Bollain Tienda E, Lopez Pardo
F, Pineda JA, Gonzalez de la Puente MA.

Departamento de Medicina Interna, Hospital Universitario Virgen del Rocio,

Seventy-eight cases of classical heat stroke (HS) seen during the summer of 1988
and 1989 have been evaluated. The diagnosis was established on the basis of
classically accepted criteria (severe hyperthermia, impairment of the level of
consciousness, anhydrosis, exposure to high environmental temperature). 62.8% of
patients were females, with a mean age of 75 +/- 12.3 years. All patients had
predisposing factors and 57.7% was taking facilitating drugs. 86% of the
patients had 2 or more predisposing or facilitating factors. In 45 cases there
were prodromic features. The suspicion of HS was not raised in any of the
referring services. Hyperglycemia was present in 89.7% of cases, increased blood
urea in 85.9%, high creatine kinase in 74.3%, abnormal coagulation in 52.9%,
hypernatremia in 46.2%, hyponatremia in 37.2%, hypokalemia in 35.9%,
hyperkalemia in 23.1%, metabolic acidosis in 41.1% and respiratory alkalosis in
36.9%. Electrocardiogram was abnormal in 95.4%. 31 patients (39.7%) died. Death
was more common in patients with deep coma, shock, and higher blood urea levels.
The present study demonstrates the occurrence of this condition in our area.

PMID: 2355761 [PubMed - indexed for MEDLINE]

Publication 36 :

Br J Ophthalmol. 1989 Feb;73(2):100-5.  

Dehydrational crises: a major risk factor in blinding cataract.

Minassian DC, Mehra V, Verrey JD.

International Centre for Eye Health, Institute of Ophthalmology, London.

An earlier case control investigation has indicated a strong relationship
between dehydrational crises and risk of presenile cataract. A second
methodologically distinct case control study of risk factors in cataract has
been carried out in a population very different in terms of environmental and
sociocultural characteristics from the population investigated in the earlier
study in Central India. The results strongly confirm the findings from the first
study and indicate that an estimated 38% of blinding cataract may be
attributable to repeated dehydrational crises resulting from severe life
threatening diarrhoeal disease and/or heatstroke. The risk of blinding cataract
was strongly related to level of exposure to dehydrational crises in a
consistent and dose dependent manner, thus indicating a causal association. The
findings are discussed in relation to possible sources of bias in the study,
confounding in the data, and the steps that were taken to minimise their
undesirable effects.

PMID: 2930754 [PubMed - indexed for MEDLINE]

Publication 37 :

Neurology. 1987 Jun;37(6):1004-6.  

Neurologic manifestations of heatstroke at the Mecca pilgrimage.

Yaqub BA.

We analyzed the extent, pattern, and evolution of neurologic dysfunction in 87
patients with heatstroke at the Mecca pilgrimage. Disturbance of consciousness
and constricted pupils were seen in all patients. Deep coma, areflexia, and
absent brainstem reflexes were seen in 25 patients (29%). Automatic complex
movements (chewing, swallowing, and lip smacking) were seen in 17 patients
(30%). Body shivering during cooling occurred in six patients (7%). Recovery was
uncomplicated in 75 patients (87%). Two (2%) recovered but developed
pancerebellar syndrome. Ten patients (11%) died.

PMID: 3587616 [PubMed - indexed for MEDLINE]

Publication 38 :

Am J Emerg Med. 1986 Sep;4(5):394-8.  

Rapid cooling in classic heatstroke: effect on mortality rates.

Vicario SJ, Okabajue R, Haltom T.

The case records of 39 patients with classic (non-exertional) heatstroke
presenting to an urban emergency department were reviewed. Eight of 39 patients
died. Rapid cooling, defined as a rectal temperature of less than or equal to
38.9 degrees C (102 degrees F) within an hour of presentation, was achieved in
27 of 39 patients. Twelve patients had a temperature greater than or equal to
38.9 degrees C (102 degrees F) after one hour of treatment in the emergency
department. The rate of mortality in the rapid cooling group was four of 27
(15%), while in the delayed cooling group, the mortality rate was four of 12
(33%) (P = 0.18). Factors such as advanced age, hypotension, altered coagulation
status, and the necessity for endotracheal intubation on presentation dictated a
poor outcome despite successful cooling measures.

PMID: 3741557 [PubMed - indexed for MEDLINE]

Publication 39 :

South Med J. 1985 Jan;78(1):20-5.  

Classical heatstroke: clinical and laboratory assessment.

Tucker LE, Stanford J, Graves B, Swetnam J, Hamburger S, Anwar A.

We reviewed the clinical and laboratory characteristics of 34 patients who had
classical heatstroke during the Kansas City heat wave of 1980. The patients were
elderly, predominantly black, and of low socioeconomic class. Overall mortality
was 18%, with 9% of patients exhibiting severe residual neurologic deficit; 73%
had full recovery. Patients with coma, temperature greater than or equal to 108
F (42.2 C), severe hypotension, coagulopathy, and need for respiratory
assistance were at highest risk of death. Associated disease was common (67%),
with hypertension (32%), diabetes (21%), and alcoholism (21%) being most
frequent. Medications known to predispose to heatstroke were used by 56% of
patients. Hematologic abnormalities were nonspecific, and clinical evidence of
renal or hepatic failure was rare. Hyponatremia, hypokalemia, hypocalcemia,
hypomagnesemia, hypophosphatemia, and elevated levels of creatine phosphokinase
and glucose were frequent but did not correlate with outcome. The predominant
arterial blood gas abnormality was metabolic acidosis or a combined metabolic
acidosis and respiratory alkalosis.

PMID: 3966167 [PubMed - indexed for MEDLINE]

Publication 40 :

JAMA. 1982 Jun 25;247(24):3327-31.  

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

Jones TS, Liang AP, Kilbourne EM, Griffin MR, Patriarca PA, Wassilak SG, Mullan
RJ, Herrick RF, Donnell HD Jr, Choi K, Thacker SB.

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.

PMID: 7087075 [PubMed - indexed for MEDLINE]

Publication 41 :

J Appl Physiol. 1978 Jan;44(1):1-4.  

Age and sex difference in response to short exposure to extreme dry heat.

Shoenfeld Y, Udassin R, Shapiro Y, Ohri A, Sohar E.

Sixty volunteers, 33 males and 27 females (18-63 yr), were divided according to
age and sex. They were exposed for 10 min to extreme dry heat: 80-90 degrees C
dry bulb temperature and 3-4% relative humidity. Their rectal temperature, skin
temperature at eight different points, weight, and heart rate were recorded
prior to and immediately following the exposure. A mean rise of only 0.5 degrees
C in rectal temperature was recorded following exposure as compared to a mean
rise of 5.2 degrees C in mean weighted skin temperature (MWST). Female subjects
showed a significantly higher rise in MWST than the male subjects. Similarly, a
significantly higher rise in MWST was observed in elderly male subjects as
compared to the youngest male group (P less than 0.05). The differences in MWST
possibly resulted from differences in mean skin blood flow causing differences
in skin conductance. Large individual variation in heat response was recorded in
rectal temperature, as well as in weighted skin temperatures. The increase in
skin temperature during the first 10 min of exposure to extreme dry heat may
serve as an indicator for heat tolerance time, and may help predicting
heatstroke susceptible individuals.

PMID: 627489 [PubMed - indexed for MEDLINE]

Publication 42 :

A. Bouchama, E.B. De Vol . Acid-base alterations in heatstroke. Intensive Care Medicine

Publisher: Springer-Verlag Heidelberg

ISSN: 0342-4642

DOI: 10.1007/s001340100906

Issue: Volume 27, Number 4 / April 18, 2001

Pages: 680 - 685

A1 Department of Medicine (MBC 46), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
A2 Department of Biomedical Statistics and Scientific Computing, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia


Objective: To analyze the acid-base balance during heatstroke.

Design: Retrospective study.

Setting: Heatstroke Center, Makkah, Saudi Arabia.

Patients: Hundred nine consecutive heatstroke patients (mean age 55-12 years) with rectal temperature from 40 to 43.4°C following exposure to hot weather.

Intervention: Arterial blood gases collected prospectively and analyzed using 95% confidence limits established by controlled experimental studies. Severity of heatstroke on admission assessed by Simplified Acute Physiology Score and Organ System Failure score.

Results: Metabolic acidosis was the predominant acid-base change followed by respiratory alkalosis (81 and 55% of the patients, respectively). The prevalence of metabolic acidosis (but not respiratory alkalosis) was significantly associated with the degree of hyperthermia : 63, 95 and 100% at 41, 42 and 43°C, respectively (p<0.0001). Patients with metabolic acidosis had a large anion gap (24-5). Arterial partial pressure of oxygen (PaO2), systolic blood pressure and Organ System Failure score were similar with or without metabolic acidosis. Although the acute physiology score was higher in patients with, than without, metabolic acidosis (15.7-3.7 vs 9.8-4.4, p<0.001), there was no significant difference in neurologic morbidity and mortality (7.9 vs 1.1%, 5.6 vs 0%, p=0.776 and 0.581, respectively).

Conclusion: We conclude that metabolic acidosis is the predominant response in heatstroke.


Publication 43 :

Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL. 
Heat-related deaths during the July 1995 heat wave in Chicago. 
N Engl J Med. 1996 Jul 11;335(2):84-90.
Epidemic Intelligence Service, Centers for Disease Control and Prevention,
Atlanta, GA 30341-3724, USA.

BACKGROUND. During a record-setting heat wave in Chicago in July 1995, there
were at least 700 excess deaths, most of which were classified as heat-related.
We sought to determine who was at greatest risk for heat-related death. METHODS.
We conducted a case-control study in Chicago to identify risk factors associated
with heat-related death and death from cardiovascular causes from July 14
through July 17, 1995. Beginning on July 21, we interviewed 339 relatives,
neighbors, or friends of those who died and 339 controls matched to the case
subjects according to neighborhood and age. RESULTS. The risk of heat-related
death was increased for people with known medical problems who were confined to
bed (odds ratio as compared with those who were not confined to bed, 5.5) or who
were unable to care for themselves (odds ratio, 4.1). Also at increased risk
were those who did not leave home each day (odds ratio, 6.7), who lived alone
(odds ratio, 2.3), or who lived on the top floor of a building (odds ratio,
4.7). Having social contacts such as group activities or friends in the area was
protective. In a multivariate analysis, the strongest risk factors for
heat-related death were being confined to bed (odds ratio, 8.2) and living alone
(odds ratio, 2.3); the risk of death was reduced for people with working air
conditioners (odds ratio, 0.3) and those with access to transportation (odds
ratio, 0.3). Deaths classified as due to cardiovascular causes had risk factors
similar to those for heat-related death. CONCLUSIONS. In this study of the 1995
Chicago heat wave, those at greatest risk of dying from the heat were people
with medical illnesses who were socially isolated and did not have access to air
conditioning. In future heat emergencies, interventions directed to such persons
should reduce deaths related to the heat.

PMID: 8649494 [PubMed - indexed for MEDLINE]


Publication 44 :

Heat Wave: A Social Autopsy of Disaster in Chicago
de Klinenberg

En vente sur :

From the New England Journal of
Medicine, September 26, 2002
Like motorists who slow down
to stare at the aftermath of car crashes, most people are fascinated
by meteorologic disasters. The perils of weathering a hurricane, a
tsunami's destruction of property, and the human drama of a flood all
make for riveting tales of struggle and survival. Yet one kind of
weather-related catastrophe -- a deadly wave of heat and humidity --
seems not to get nearly the notice given the others, despite the fact
that it kills more than all the other kinds combined. Why heat waves
are such a quiet menace and how social conditions contributed to more
than 700 deaths during a week-long wave of unprecedented heat and
humidity in Chicago in 1995 are the focus of Heat Wave: A Social
Autopsy of Disaster in Chicago, written by sociologist Eric
Klinenberg. The term "social isolation" is usually applied
to those living in remote locations, but Klinenberg demonstrates that
this unfortunate condition also applies to thousands of people
(primarily senior citizens) in our nation's largest cities. And so it
was in 1995. Thousands of Chicago's elderly lived alone (many of them
in or near poverty), isolated in many ways and by many factors. When
the record-breaking heat and humidity arrived and stayed, these men
and women started dying, one at a time and quietly, behind closed,
locked doors. The immediate reasons were apparent. Many seniors did
not have air conditioning in their houses or apartments. Of those who
did have air conditioning, many chose not to use it, fearing utility
bills that they could not afford to pay. Fear of crime kept others
from leaving their homes to use free neighborhood "cooling
centers." Still other elderly Chicagoans knew, from a
physiological standpoint, that they were hot but were simply unaware
that they were in danger. Klinenberg shows in detail how the tragedy
was compounded by many factors and interests, including a public
health and medical establishment that did not anticipate the
magnitude of the looming danger and local news media that treated the
severe heat and humidity as little more than a novel topic for
lighthearted feature stories. The author also examines key
sociological factors relating to the elderly, including the perils of
"aging in place" while the surrounding environment changes;
the idealization and valuing of personal independence among seniors;
and differences between men and women in the establishment of
friendships and other interpersonal connections. Heat Wave is a
fascinating book, in part because the social conditions that led to
Chicago's 1995 tragedy still exist, for the most part, throughout our
nation and its aging population. People are still at risk. The book
is not without its flaws. Klinenberg strays from sociological
analysis and into a politicized attack when he examines the 1995
response of Mayor Richard M. Daley and his administration. He makes
far too much of the mayor's brief questioning of exactly what
constitutes a "heat-related death" -- a question, I might
add, that most of us had at the time. The author erroneously claims
that the response of the Daley administration was driven more by
public-relations damage control than by a desire to understand the
tragedy and prevent further deaths and that a report issued by the
Mayor's Commission on Extreme Weather Conditions was little more than
"spin," when it was in fact the product of careful
deliberation by leading figures in public health, medicine,
gerontology, meteorology, and other fields. Indeed, the report laid
the groundwork for Chicago's successful response to extreme weather,
which was credited with saving hundreds of lives in the summer of
1999. The report has been widely requested by and circulated to
public health planners throughout the nation. Other descriptions of
the mayoral response are similarly off-base. As a deputy commissioner
of the Health Department in 1995, I was there for every step of the
action, in front of the cameras and microphones and around the table
at meetings about emergency response. Klinenberg and his sources were
not there. Klinenberg also puts considerable emphasis on racial
disparities in the 1995 heat deaths. (The raw death totals indicate a
rough parity between mortality rates in the black and white
populations, but age-adjusted rates supplied by the author claim
otherwise.) In his biography posted on the Web site of Northwestern
University, where he teaches, Klinenberg notes his interest in the
exploration of "race as a principle of vision, division, and
domination." His focus on race is therefore understandable, but
many do not see race as the risk factor that he claims it is. Its
flaws aside, Heat Wave is a thought-provoking examination that
challenges everyone in medicine and public health to look beyond our
training to consider sociological conditions as risk factors. It
issues a call for all segments of the population to reestablish those
familial and social connections that we once seemed to have but now,
all too often, do not. John Wilhelm, M.D., M.P.H.

Publication 45 :

J Psychosoc Nurs Ment Health Serv. 1997 Jul;35(7):12-7.  

Heat stroke. Keeping your clients cool in the summer.

Batscha CL.

Health Care services, CASCAP, Inc., Cambridge, MA 02139, USA.

Persons with persistent, disabling mental illness have an increased risk of
heat-related illness. Mental health care providers must be aware of this risk,
and should be educated regarding detection and prevention. A high level of
awareness and monitoring for symptoms of heat-related illness is indicated
during the initial days of a heat wave. Health professionals must ensure that
consumers know about the risk of heat stroke and have a plan in place to deal
with hot weather. Plans must be practical, affordable, and take into account the
preferences, habits, and psychiatric symptoms of the individual who will carry
them out. Thoughtful planning and education can help reduce the risk of
heat-related illness in this vulnerable group.

PMID: 9243418 [PubMed - indexed for MEDLINE]

Publication 46 :

Encyclopaedia Universalis 2002, CD-ROM version 8. Item : thermogenèse.


Publication 47 :

INVS. Impact sanitaire de la vague de chaleur en France survenue en août 2003. Rapport d'étape - 29 août 2003. Institut de veille sanitaire :


Publication 48 :

Gaffin S, Gardner J, Flinn S. Cooling Methods for Heatstroke Victims. 18 April 2000 Annals of Internal Medicine Volume 132 Number 8, p 678.


Publication 49 :

Am J Epidemiol. 1976 Jun;103(6):565-75.  

Associations of coronary and stroke mortality with temperature and snowfall in
selected areas of the United States, 1962-1966.

Rogot E, Padgett SJ.

Daily temperatures and snowfall were related to coronary and stroke deaths in
selected standard metropolitan statistical areas for the 5-year period
1962-1966. Typically an inverse approximately linear pattern of coronary heart
disease (CHD) and of stroke mortality with temperature was seen over the greater
part of the temperature range, with mortality reaching a low for days with
average Fahrenheit temperatures in the 60's and 70's (15.6-26.6 C), and then
rising sharply at higher temperatures. Snowfall was found to be associated with
higher CHD and stroke mortality for a 5-, or 6-day period. Temperatures 1 and 2
days prior to death were also found to be associated with deaths from CHD and
stroke. Very hot days appeared to exert a cumulative effect upon mortality in
many of the areas.

Publication 50 :

Am J Epidemiol. 1993 Apr 1;137(7):701-5.  

Air pollution and emergency room admissions for chronic obstructive pulmonary
disease: a 5-year study.

Sunyer J, Saez M, Murillo C, Castellsague J, Martinez F, Anto JM.

Department d'Epidemiologia i Salut Publica, Universitat Autonoma de Barcelona,
Catalonia, Spain.

An association between sulfur dioxide levels in urban air and the daily number
of emergency room admissions for chronic obstructive pulmonary disease was
previously reported in Barcelona, Spain, for the period 1985-1986. The present
study assesses this association over a longer period of time, 1985-1989. This
made it possible to carry out separate analyses for the winter and summer
seasons and thus to control more adequately for weather and influenza epidemics.
An increase of 25 micrograms/m3 in sulfur dioxide (24-hour average) produced
adjusted changes of 6% and 9% in emergency room admissions for chronic
obstructive pulmonary disease during winter and summer, respectively. For black
smoke, a similar change was found during winter, although the change was smaller
in summer. The association of each pollutant with chronic obstructive pulmonary
disease admissions remained significant after control for the other pollutant.
The present findings support the conclusion that current levels of sulfur
dioxide and black smoke may have an effect on the respiratory health of
susceptible persons.

Publication 51 :

Environ Res. 1993 Jul;62(1):7-13.  

Particulate air pollution and chronic respiratory disease.

Schwartz J.

Department of Environmental Health Harvard School of Public Health, Boston,
Massachusetts 02115.

Chronic exposure to particulates has been associated with increased rates of
bronchitis and other respiratory ailments, with loss of lung function, and with
increased risk of lung cancer. Despite these findings, debate continues about
the adverse health effects of exposure to airborne particles at concentrations
often seen in urban areas. This issue was examined by looking at reported rates
of chronic respiratory illness by standardized questionnaire across 53 urban
areas in the United States. Diagnosis of respiratory illness by an examining
physician in the First National Health and Nutrition Examination Survey was also
considered as an outcome. After controlling for age, race, sex, and cigarette
smoking, annual average total suspended particulate concentrations (TSP) were
associated with increased risk of chronic bronchitis (odds ratio (OR) = 1.07,
95% confidence interval (CI) 1.02-1.12) and of a respiratory diagnosis by the
examining physician (OR = 1.06, 95% CI = 1.02-1.11). The odds ratios are for a
10 micrograms/m3 increase in TSP. When the analysis was restricted to never
smokers, the associations remained, with a slight increase in the relative odds
associated with airborne particles. Plots of the relative odds by quartiles of
TSP exposure, adjusting for covariates, showed dose-dependent increases in risk
with increasing exposure. The risk appeared to continue to concentrations below
the ambient air quality standard. Given the other recent findings of both acute
and chronic effects of particulate pollution, these associations are likely

Publication 52 :

Environ Res. 1995 Aug;70(2):105-13.

Temperature, ambient ozone levels, and mortality during summer 1994, in Belgium.

Sartor F, Snacken R, Demuth C, Walckiers D. Department of Epidemiology and Toxicology, Institute for Hygiene and Epidemiology, Brussels, Belgium.

The number of daily deaths, temperature, relative humidity, and 24-hr concentrations of main air pollutants observed during a heat wave (June 27-August 7, 1994) in Belgium were compared with those recorded before and after this heat wave. All these variables were averaged over the country. Expected mortality was calculated from daily deaths observed during the summers of 1985-1993. The influence of meteorological and air pollution variables on daily mortality was analyzed using generalized least-squares method. Mortality recorded during the heat wave was higher than expected: it increased by 9.4% in the age group 0-64 years (236 excess deaths; P < 0.001) and by 13.2% in the elderly (1168 excess deaths; P < 0.001). After the heat wave, mortality in the elderly was lower than expected (178 deficit deaths; P< 0.05); the net excess of mortality in the whole population amounted to 1226 deaths when accounting for this deficit. This increased mortality was associated with unusually high outdoor temperatures (range of daily mean: 15.3-27.5 degrees C) and elevated ozone levels (range of 24-hr concentration: 34.5-111.5 microg/m3). The duration of the ozone overexposure during the heat wave was also uncommon: half-hour concentrations of ozone exceeded, on an average, 100 microg/m3 for 8 consecutive hr. The number of daily deaths was mostly correlated with the mean daily temperature and 24-hr ozone concentration, both measured the day before. A synergy between temperature and ozone in their effects on mortality was also highlighted in both age groups. The product of the logarithm of temperature by the logarithm of ozone concentration, both measured the day before, contributed to 39.5% of the variance of the logarithm of daily deaths in elderly and to 4.5% in the age group 0-64 years. In conclusion, elevated outdoor temperatures combined with high ozone concentrations were assumed to be the likely cause of the important excess mortality observed in Belgium during the summer, 1994. PMID: 8674478 [PubMed - indexed for MEDLINE]


Publication 53 :

Int J Biometeorol. 1995 May;38(4):194-8.

The use of a complex thermohygrometric index in predicting adverse health effects in Athens.

Tselepidaki IG, Asimakopoulos DN, Katsouyanni K, Moustris C, Touloumi G, Pantazopoulou A. Laboratory of Meteorology, University of Athens, Greece.

Mortality and morbidity indices are known to depend on changes in meteorological conditions. In Athens, severe adverse health effects following extreme heat conditions have been reported. The usefulness has been investigated of the complex thermohygrometric index (THI), a simple index based on maximum daily temperature and relative humidity, in predicting the health effects of specific meteorological conditions. The values of THI were found to correlate well with more complex bioclimatic indices; the THI could successfully replace temperature and humidity in predicting the daily number of deaths through multiple linear regression modelling. Thus the introduction of THI levels more than 28.5 degrees C and between 26.5 and 28.5 degrees C, through dummy variables, in a regression model explained 40% of the variability in the number of deaths during the months of July and August. During days with THI values less than 26.5 degrees C the mean number of deaths was 33.5, compared to 41.8 when THI was between 26.5 and 28.5 degrees C. The daily number of deaths increased to 108.2 when THI exceeded 28.5 degrees C. From this study, the exact level of THI at which public health measures must be taken was not clear and more work is needed to identify it. However, given its simplicity, the use of THI for predicting meteorological conditions which are adverse to health would appear to be promising in preventive medicine and in health services planning. PMID: 7601552 [PubMed - indexed for MEDLINE]


Publication 54 :

Arch Environ Health. 1993 Jul-Aug;48(4):235-42.

Evidence for interaction between air pollution and high temperature in the causation of excess mortality.

Katsouyanni K, Pantazopoulou A, Touloumi G, Tselepidaki I, Moustris K, Asimakopoulos D, Poulopoulou G, Trichopoulos D. Department of Hygiene and Epidemiology, University of Athens, Medical School, Greece.

Studies have demonstrated repeatedly that air pollution in Athens is associated with a small but statistically significant increase in mortality. Extremely high air temperatures can also cause excess mortality. This study investigated whether air pollution and air temperature have synergistic effects on excess mortality in Athens. Data concerning the increased number of deaths in July 1987 (when a major "heat wave" hit Greece) were compared to the deaths in July of the 6 previous years. This comparison revealed a greater increase in the number of deaths in Athens (97%), compared to all other urban areas (33%) and to all non-urban areas (27%). Data on the daily levels of smoke, sulfur dioxide, and ozone; the number of deaths that occurred daily; and meteorological variables were collected for a 5-y period. The daily value of Thom's discomfort index was calculated. Multiple linear regression models were used to investigate main and interactive effects of air temperature and Thom's discomfort index and air pollution indices. The daily number of deaths increased by more than 40 when the mean 24-h air temperature exceeded 30 degrees C. The main effects of an air pollution index are not statistically significant, but the interaction between high levels of air pollution and high temperature (> or = 30 degrees C) are statistically significant (p < .05) for sulfur dioxide and are suggestive (p < .20) for ozone and smoke. Similar results were obtained when the discomfort index was used, instead of temperature in the models. PMID: 8357272 [PubMed - indexed for MEDLINE]


Publication 55 :

J Epidemiol Community Health. 1998 Aug;52(8):482-6. Comment in: J Epidemiol Community Health. 1999 Sep;53(9):591.

Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave.

Rooney C, McMichael AJ, Kovats RS, Coleman MP. Office for National Statistics, London.

STUDY OBJECTIVE: To assess the impact on mortality of the heatwave in England and Wales during July and August 1995 and to describe any difference in mortality impact between the Greater London urban population and the national population. DESIGN: Analysis of variation in daily mortality in England and Wales and in Greater London during a five day heatwave in July and August 1995, by age, sex, and cause. SETTING: England and Wales, and Greater London. MAIN RESULTS: An estimated 619 extra deaths (8.9% increase, approximate 95% confidence interval 6.4, 11.3%) were observed during this heatwave in England and Wales, relative to the expected number of deaths based on the 31-day moving average for that period. Excess deaths were apparent in all age groups, most noticeably in women and for deaths from respiratory and cerebrovascular disease. Using published daily mortality risk coefficients for air pollutants in London, it was estimated that up to 62% of the excess mortality in England and Wales during the heatwave may be attributable to concurrent increases in air pollution. In Greater London itself, where daytime temperatures were higher (and with lesser falls at night), mortality increased by 16.1% during the heatwave. Using the same risk coefficients to estimate the excess mortality apparently attributable to air pollution, more than 60% of the total excess in London was apparently attributable to the effects of heat. CONCLUSION: Analysis of this episode shows that exceptionally high temperatures in England and Wales, though rare, do cause increases in daily mortality. PMID: 9876358 [PubMed - indexed for MEDLINE]


Publication 56 :

Am J Public Health. 1997 Sep;87(9):1515-8.

Mortality in Chicago attributed to the July 1995 heat wave.

Whitman S, Good G, Donoghue ER, Benbow N, Shou W, Mou S. Epidemiology Program, Chicago Department of Public Health, IL 60604, USA.

OBJECTIVES: This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS: Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS: In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS: The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic. PMID: 9314806 [PubMed - indexed for MEDLINE]

Publication 57 :


Publication 58 :

Circulation. 2003 Aug 12;108(6):729-35. Epub 2003 Jul 28.

Impairment of thermoregulatory control of skin sympathetic nerve traffic in the elderly.

Grassi G, Seravalle G, Turri C, Bertinieri G, Dell'Oro R, Mancia G.

A propos du système nerveux autonome, Grassi (Grassi et al. 2003) étudie l'activité nerveuse sympathique cutanée (ANSC) chez 13 sujets jeunes, 12 d'âge moyen et 12 personnes âgées.  Il s'agit de mesurer, entre autres, la réponse à une variation de la température de la pièce de 8 degrés Celsius pendant 45 minutes. Les auteurs mettent en évidence une augmentation plus faible de l'ANSC chez les personnes âgées lors de l'exposition au froid. Par ailleurs, l'exposition à la chaleur induit une réduction de l'ANSC qui était significativement plus faible chez ces mêmes personnes. Comparées aux sujets jeunes, la variation de l'ANSC est réduite de 61% chez les personnes âgées lors du passage du froid au chaud. Une telle différence n'est pas observée lors d'un stimulus acoustique apte à provoquer une réaction émotionnelle. En conclusion, la diminution de l'adaptation nerveuse sympathique cutanée à la chaleur pourrait laisser supposer un trouble de la thermorégulation à ce niveau chez la personne âgée.

Publication 59 :

1: Swiss Med Wkly. 2005 Apr 2;135(13-14):200-5. 

Heat wave 2003 and mortality in Switzerland.

Grize L, Huss A, Thommen O, Schindler C, Braun-Fahrlander C.

Institute of Social and Preventive Medicine, University of Basel.

QUESTIONS UNDER STUDY: During June to August 2003, high temperatures were
reported across Europe including Switzerland. In many European countries,
particularly in France the heat wave was associated with an increase in
mortality. This is the first analysis investigating whether the high
temperatures during summer 2003 in Switzerland had a measurable impact on
mortality. METHODS: Daily data on all-cause mortality for the period January
1990 to December 2003, and meteorological data from 20 different stations for
the same period were analysed. Excess mortality for different age groups, gender
and geographic regions was calculated. Daily mortality and temperature in 2003
was correlated with lags of temperature up to 7 days. RESULTS: An estimated 7%
increase in all cause mortality occurred during June to August 2003. Excess
mortality was limited to the region north of the Alps, to inhabitants of cities
and suburban areas and was more pronounced among the elderly and the inhabitants
of Basel, Geneva and Lausanne. North of the Alps, deviations in daily mortality
were significantly correlated with deviations in maximum daily temperatures and
night temperatures. The combination of day temperature above 35 degrees C and
night temperatures above 20 degrees C predominantly occurred in Basel and Geneva
and might in part explain the regional differences in excess mortality.
CONCLUSIONS: As the number of elderly people in Switzerland continues to rise
and the occurrence of heat waves is predicted to increase as a consequence of
global warming, preventive programmes targeting susceptible populations during
heat waves are warranted.

Publication 60 :

Environ Res. 2005 Jul;98(3):390-9. Epub 2004 Dec 8. 

Epidemiologic study of mortality during the Summer 2003 heat wave in Italy.

Conti S, Meli P, Minelli G, Solimini R, Toccaceli V, Vichi M, Beltrano C, Perini

Bureau of Statistics, National Centre of Epidemiology, Surveillance and
Promotion of Health, Italian National Institute of Health (Istituto Superiore di
Sanita), Viale Regina Elena 299, 00161 Rome, Italy.

Introduction: It is widely recognized that extreme climatic conditions during
summer months may constitute a major public health threat. Owing to what is
called the "urban heat island effect," as well as to the consequences of heat
waves on health, individuals living in cities have an elevated risk of death
when temperature and humidity are high compared to those living in suburban and
rural areas. Studies on heat wave-related mortality have further demonstrated
that the greatest increases in mortality occur in the elderly. Following the
unusually hot summer of 2003 and the dramatic news from neighboring countries
such as France, the Italian Minister of Health requested the Istituto Superiore
di Sanita-Bureau of Statistics to undertake an epidemiologic study of mortality
in Italy during Summer 2003 to investigate whether there had been an excess of
deaths, with a particular focus on the elderly population. Materials and
methods: Communal offices, which maintain vital statistics, were asked for the
individual records of death of residents registered daily during the period 1
June-31 August 2003 and during the same period of 2002 for each of the 21
capitals of the Italian regions. As it was necessary to obtain mortality data
quickly from many municipalities and to make the analysis as soon as possible,
the method adopted was comparison of mortality counts during the heat wave with
figures observed during the same period of the previous year. Results: Compared
with 2002, between 1 June and 31 August 2003, there was an overall increase in
mortality of 3134 (from 20,564 to 23,698). The greatest increase was among the
elderly; 2876 deaths (92%) occurred among people aged 75 years and older, a more
than one-fifth increase (21.3%, from 13.517 to 16.393%). The highest increases
were observed in the northwestern cities, which are generally characterized by
cold weather, and in individuals 75 years and older: Turin (44.9%), Trento
(35.2%), Milan (30.6%), and Genoa (22.2%). Of note are also the increases
observed in two southern cities, L'Aquila (24.7%) and Potenza (25.4%), which are
located, respectively, at 700 and 800m above see level. For Bari and Campobasso,
both in the South, with a typically hot summer climate, the increase during the
last 15 days of August was 186.2 and 450%, respectively. Conclusions: The
relationship between mortality and discomfort due to climatic conditions as well
as the short lag time give a clear public health message: preventive, social,
and health care actions must be administered to the elderly and the frail to
avoid excess deaths during heat waves.

Publication 61 :

 Rev Prat. 2004 Jun 30;54(12):1298-304. 

[Disorders caused by prolonged exposure to heat]

[Article in French]

Lavallart B, Bourdon L, Gonthier R, Dab W.

Direction Generale de la Sante

France has suffered last summer an unprecedented heat wave that led to an
exceptional short-term surge of mortality. Cumulative deaths between August 1st
to 14th are estimated at 14,800. Epidemiological studies carried out by the
Institute de Veille Sanitaire will show the circumstances and risk factors
leading to heat-related pathologies. A literature review already shows the
principles of prevention, the circumstances of occurrences during similar past
heat waves, the risk factors and the principles of treatment. Prolonged exposure
to heat can be the initial cause of death, mainly in the elderly. The subject
thus dies of an overload of his natural defenses, unable to preserve his thermal
homeostasis. This is then a heat shock that reaches the central nervous system.
Heat shocks could kill every second patient and leads to severe neurological
sequel. During a heat wave, high temperatures can also trigger or worsen other
illnesses or be responsible for other so called heat-related syndromes. It is
crucially important to identify subjects at risk, situations of risk, and
preventive measures, knowing that heat shock leads 25% of patients to develop
multi-organ failure, even when appropriately treated.

Publication Types:
    Review, Tutorial

Publication 62 :

Rev Prat. 2004 Jun 30;54(12):1289-97. 

[The heat wave of August 2003: what happened?]

[Article in French]

Ledrans M, Pirard P, Tillaut H, Pascal M, Vandentorren S, Suzan F, Salines G, Le
Tertre A, Medina S, Maulpoix A, Berat B, Carre N, Ermanel C, Isnard H, Ravault
C, Delmas MC.

Institut de veille sanitaire, InVS, 12, rue du Val d'Osne, 94415 Saint-Maurice.

A heat wave of exceptional intensity occurred in France in August 2003, 2003 was
the warmest of the last 53 years in terms of minimal, maximal and average
temperatures, and in terms of duration. In addition, high temperatures and
sunshine, causing the emission of pollutants, significantly increased the
atmospheric ozone level. Some epidemiological studies were rapidly implemented
during the month of August in order to asses the health impact of this heat
wave. Excess mortality was estimated at about 14 800 additional deaths. This is
equivalent to a total mortality increase of 60% between August 1st and 20th,
2003 (Inserm survey). Almost the whole country was concerned by this
excess-mortality, even in locations where the number of very hot days remained
low. Excess-mortality clearly increased with the duration of extreme
temperatures. These studies also described the features of heat-related deaths.
They showed that the death toll was at its highest among seniors and suggested
that less autonomous or disabled or mentally ill people were more vulnerable.
So, they provided essential information for the setting up of an early warning
system in conjunction with emergency departments. The public health impact of
the Summer 2003 heat wave in various European countries was also assessed.
Different heat waves in term of intensity had occurred at different times in
many countries with each time deaths in excess. But, it does seem that France
was the most affected country. However, implementation of standardized methods
of data collection through all countries is necessary to afford further
comparisons. Collaborative studies will be conducted in this way. After theses
first descriptive studies, further etiologic studies on risk factors and
heat-related deaths were launched and are now in progress. Considering the
health impact of the heat wave, national health authorities decided to launch an
Heat Wave National Plan including a provisional Heat Watch Warning System (HWWS)
for 2004. Developed in collaboration with Meteo France, this HWWS is based upon
an analysis of historical daily mortality data and meteorological indicators in
14 French cities in order to define the best indicators and triggers. The public
health impact of the heat wave of August 2003 was major. This exceptional event
raises questions about anticipating phenomena which are difficult to predict.
The collaborative efforts which were developed and the group of actions and
studies which were implemented in a context of emergency are now useful for the
setting up of early warning strategies and thus efficient prevention.

Ecrire à l'auteur du site :Bernard Pradines