Volume 30, Issue 4 (7-2020)                   JHNM 2020, 30(4): 224-232 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Borghei Y, Moghadamnia M T, Emami Sigaroudi A, Kazemnezhad Leili E. Relationship of Humidity and Atmospheric Pressure With the Risk of Out-of-hospital Cardiac Arrest. JHNM 2020; 30 (4) :224-232
URL: http://hnmj.gums.ac.ir/article-1-1475-en.html
1- Nursing (MSN), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
2- Assistant Professor, Department of Nursing (Medical- Surgical), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran , moghaddamnia92@gmail.com
3- Associate Professor (Community Health Nursing), Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
4- Associate Professor, Social Determinants of Health Research Center (SDHRC), Biostatistics, Guilan University of Medical Sciences, Rasht, Iran
Full-Text [PDF 544 kb]   (542 Downloads)     |   Abstract (HTML)  (1496 Views)
Full-Text:   (580 Views)
Introduction
ardiovascular diseases are the most common cause of death worldwide [1-3]. In Iran, the mortality rate due to cardiovascular diseases is 43% of the total deaths [4]. Out-of-hospital Cardiac Arrest occurs when a person’s heart suddenly stops pumping blood because of non-cardiac reasons at home, in public locations, ambulance, the emergency room, and at any location before hospital admission [5]. Acute coronary syndrome is an important risk factor for Out-of-hospital Cardiac Arrest [6-8]. The global prevalence of Out-of-hospital Cardiac Arrest is high and its mean survival rate is low (9.1%). The most important underlying cause of Out-of-hospital Cardiac Arrest which accounts for almost 70% of its occurrence is acute coronary syndrome [5]. 
Out-of-hospital Cardiac Arrest is associated with some of the patient’s characteristics, including age, gender, weight, medical and family history, smoking and pre-arrest activity, underlying diseases (e.g., diabetes mellitus, cardiovascular disease, hypertension), socio-economic status, race, and received emergency services [9, 10]. Environmental factors and climatic conditions can also be associated with the occurrence of heart disease but are not well known yet [11]. 
There is a complicated relationship between climate and human health consequences and it has been shown that different meteorological parameters conflict with each other at the same time [12, 13]. There is evidence of increasing global climate change and extreme weather events such as cold and heatwaves, and it is one of the most serious challenges worldwide [14-16]. According to the results of the Intergovernmental Panel on Climate Change in 2018, climatic conditions have become more variable compared to the past, creating phenomena such as large and long heatwaves, unpredictable climate changes, sudden cold spells, and extreme weather events such as floods and droughts [17]. According to the results of a study, 0.2% of annual mortality in the world is directly related to climate change [18]. 
Meteorological parameters and seasonal changes play a key role in the development of acute coronary syndrome. Studies have shown that weather conditions, air temperature, humidity, wind speed, and pressure affect the onset of acute coronary syndrome [19-21]. Although the survival rate after Out-of-hospital Cardiac Arrest has increased in recent years compared to the past, the chance of cardiopulmonary resuscitation (CPR) success is still low [10]. The results of a study showed that acute coronary syndrome occurs more often in summer when temperature and humidity levels are high and atmospheric pressure is low [22]. 
Humidity makes a person feel colder during the winter and feel warmer during the summer [23, 24]. Low relative humidity increases the viscosity of human blood which can be a risk factor for ischemic stroke [25]. In some cases, daily mortality with a focus on temperature has been reported as an independent predictor of humidity. A study examined the role of humidity in associations of high temperatures with mortality in several countries. Increased mortality at high humidity in cold temperatures was reported in 11 Chinese cities, but the association was lower at hot temperatures and high humidity. Moreover, a daily evaluation in the summer in three Swedish cities showed the detrimental effect of high humidity, especially at high temperatures in Stockholm, while there was an inverse relationship between humidity and mortality in summer in Valencia, Spain [26]. Abrignani et al. showed that humidity affects the number of hospital admissions in patients with acute myocardial infarction [27]. 
Lower relative humidity increases temperature-dependent cardiovascular mortality, with a 3.97% increase in cardiovascular mortality observed in the 5th and 25th percentiles of relative humidity [28]. Changes in atmospheric pressure may also affect and rupture atherosclerotic plaques [29]. Moreover, lowering atmospheric pressure can increase blood pressure by affecting the sympathetic nervous system and immune system, so atmospheric pressure is the main factor in climate change [30]. The findings of a study confirmed that in areas with high atmospheric pressure, the incidence of myocardial infarction was 7% higher than in areas with low atmospheric pressure [31]. An increase in atmospheric pressure along with a decrease in air temperature can increase hypoxia followed by vascular spasm [32]. 
The results of Plavcova et al. showed that the drop in atmospheric pressure in winter was significantly associated with an increase in the prevalence of cardiovascular diseases [33], while Houck showed no association between atmospheric pressure and the daily occurrence of acute myocardial infarction on the same day. However, one day after the change in atmospheric pressure, an increase in the incidence of acute myocardial infarction was reported. The rate of change in atmospheric pressure during autumn and winter is significantly associated with the daily occurrence of acute myocardial infarction [34].
Because of the high prevalence of cardiovascular diseases, nurses working in any place, including home, office, hospital, long-term care centers, or rehabilitation centers should be able to assess the cardiovascular system [35]. Preventing Out-of-hospital Cardiac Arrest requires a public health challenge [5], and it has turned into a major public health problem in the world [7]. A preventive measure is needed to reduce its mortality rate [12]. This preventive solution can be designed based on changes in meteorological parameters. This study aimed to determine the relationship between meteorological parameters (humidity and atmospheric pressure) with the prevalence of Out-of-hospital Cardiac Arrest and its outcome in a 3-year period (2016-2018).

Materials and Methods
This is an ecological time-series study. The study population consisted of patients with Out-of-hospital Cardiac Arrest referred to a governmental Hospital in Rasht City, Iran from 2016 to 2018 (n=463). Of them, 392 patients who met the inclusion criteria (those with the cardiac arrest diagnosed by the emergency medical staff or family, and had undergone CPR) were entered into the study. Those who lacked CPR a long time since cardiac arrest (according to the emergency physician) were excluded from the study. Information regarding the admission of patients was obtained from the only specialized cardiovascular hospital in Rasht, according to the CPR report card. 
This card contained the patient’s information, including first and last name, age, diagnosis, case number, treating physician, date and time of admission to the hospital, patient’s heart rhythm, and outcome of CPR. For each patient who underwent CPR, this form was completed and available in the hospital’s emergency department. Data related to meteorological variables, including maximum and minimum atmospheric pressure, average atmospheric pressure (in hPa), minimum and maximum humidity, and average daily humidity received from the Guilan Meteorological Organization in an Excel file. Since only one specific hospital form was used to collect data related to each CPR procedure and also meteorological data were used for meteorological parameters, there was no need for instrument validity and reliability. The nature of time-series studies conducted over a long period can control confounding variables in the study [36].
Accordingly, the 3-year study period of the present study controlled the factors affecting Out-of-hospital Cardiac Arrest . To estimate the effect of meteorological parameters, by considering nonlinear effects between these variables and also the delay effects of climate change, we used the package of Distributed Lag Non-Linear Models (DLNM) ver. 2.3.8 in R ver.3.5 software. Using this software, the relative chance of occurrence and consequence of Out-of-hospital Cardiac Arrest can be calculated for meteorological parameters such as humidity and atmospheric pressure. Since the effects of climate change may be delayed or interrupted according to previous studies, the 21st lag day was considered as the maximum delay time in this study. Most studies related to climate hazards and health that had evaluated the delayed effects of temperature changes on morbidity and mortality used the lag ranged 0-21 days after climate change [20].

Results
Out of 392 participants, 62.7% were male and 37.3% were female with Mean±SD age of 64.78±15.58 years. During the 3-year study period, the average atmospheric pressure was 1013.4 hPa ranged from 993.2 to 1041 hPa, and the average humidity was 81% ranged from 11% to 100% (Table 1).

 

Maximum humidity was observed in October 2016 and minimum humidity in January 2018; there were 19 unsuccessful CPR and 7 admissions due to Out-of-hospital Cardiac Arrest in October 2016, and 13 unsuccessful CPR and 12 admissions in January 2018. Maximum atmospheric pressure was observed in October 2016 and minimum atmospheric pressure in June 2018; there were 7 failed CPR and 11 admissions in October 2016, and 6 failed CPR and 6 admissions in June 2016.
 

The results showed a non-linear relationship between the humidity and admission rate of Out-of-hospital Cardiac Arrest patients (Figures 1 & 2). Low humidity was associated with an increase in the admission rate of Out-of-hospital Cardiac Arrest patients in lag days 0 to 10 (OR=1.54, 95%CI; 1.001-2.69, P=0.001). Also, 66% humidity in the lag day 0 had a protective effect on the admission rate (OR=0.35, 95% CI; 0.16-0.84, P=0.001); i.e. at this percentage, the lowest number of Out-of-hospital Cardiac Arrest cases occurred (Table 2). Moreover, lower humidity in the lag days 0 to 10 increased unsuccessful CPR in patients (OR=1.76, 95% CI; 1.006-3.79, P=0.001). At high humidity and longer delayed times, the rate of admission was significantly reduced. For example, at 95% level in the 21st lag day, humidity had a protective effect on the Out-of-hospital Cardiac Arrest occurrence (OR=0.51, 95% CI; 0.26-0.98, P=0.001).
 
 

The results showed a non-linear relationship between atmospheric pressure and the rate of admission in patients with Out-of-hospital Cardiac Arrest (Figures 3 & 4). Higher atmospheric pressure in the initial lag days (OR=1.16, 95% CI; 1.001-1.78, P=0.001) was associated with increased risk of Out-of-hospital Cardiac Arrest (Table 3), while in the lag days 4-20, it was associated with increased risk of failed CPR (OR=1.039, 95% CI; 1.005-1.91, P=0.001). On the other hand, lower atmospheric pressure showed reducing effects on the incidence of Out-of-hospital Cardiac Arrest . For example, the atmospheric pressure of 1015 hPa on the lag day 0 (same day as atmospheric pressure dropped) had a protective effect on the occurrence of Out-of-hospital Cardiac Arrest (OR=0.71, 95% CI; 0.53-0.96, P=0.001). Such a reducing effect was also observed on the CPR outcome at atmospheric pressure of 1004 hPa in the fifth lag day (OR=0.73, 95% CI: 0.55-0.96, P=0.001) indicating an increase in successful CPR. 
 

High atmospheric pressure on lag days 4-20 was associated with an increase in unsuccessful CPR in Out-of-hospital Cardiac Arrest patients. In women and age group of above 65 years, low atmospheric pressure in the initial lag days was associated with increased Out-of-hospital Cardiac Arrest cases, but in men and age group of under 65 years, high atmospheric pressure was related to increased Out-of-hospital Cardiac Arrest prevalence. Unsuccessful CPR at low atmospheric pressure was observed in women on lag days 10 to 15, and in the age group of > 65 years, it was reported in the initial lag days. In men and age group of above 65 years, high atmospheric pressure in the early lag days was associated with under failure of CPR. In all age and gender groups, low humidity was associated with increased failure of CPR and increased admission rate.
 



Discussion
The findings of this study showed that, in all patients, low humidity had an association with increased risk of Out-of-hospital Cardiac Arrest on lag days of 0-10. Our findings are in line with the findings of Hensel et al., who showed that the risk of Out-of-hospital Cardiac Arrest increased at a humidity level below 75% compared with levels above this percentage [11], but are against the results of Tobaldini et al. who reported that high humidity along with high temperature increased the prevalence of Out-of-hospital Cardiac Arrest , which could be very stressful for the cardiovascular system [8]. Because of low humidity increases blood viscosity and Guilan Province and Rasht City experience high humidity on most days, the physiological system of people living in this city may be less adapted to low humidity; therefore, it can increase the risk of Out-of-hospital Cardiac Arrest in this climate.
Lower humidity on lag days 0-10 also increased the unsuccessful CPR in all Out-of-hospital Cardiac Arrest patients, i.e. high humidity increases the success of CPR and reduces the risk of Out-of-hospital Cardiac Arrest . Our findings are consistent with Armstrong’s findings showed that a 23% increase in humidity was associated with a 1.1% decrease in mortality [26]. However, the findings of another study showed that a 10% increase in relative humidity was significantly associated with an increased incidence of Out-of-hospital Cardiac Arrest [30]. The difference in the duration of the study and also the individual and social differences of participants can be the reasons for this discrepancy.
Higher atmospheric pressure in the initial lag days increased hospital admission in Out-of-hospital Cardiac Arrest patients. A study has shown that low atmospheric pressure increases blood pressure through the sympathetic nervous system and the immune system. Therefore, atmospheric pressure is an important factor in climate change [30]. The findings of Ratajczak et al. study, conducted in a mild climate in Poland, show that among meteorological variables, only changes in atmospheric pressure have a potential effect on Out-of-hospital Cardiac Arrest occurrence [37]. Our findings are consistent with those of Hensel et al., who showed the possibility of reduced risk of Out-of-hospital Cardiac Arrest in moderate atmospheric pressure (1000 -1020 hPa), while the possibility of an increased risk in atmospheric pressure above 1020 hPa and below 1000 hPa [11].
High atmospheric pressure on lag days 4-20 increased the risk of unsuccessful CPR in Out-of-hospital Cardiac Arrest patients. According to Ou et al., increased mortality has been observed at extremely high atmospheric pressures (>1020 hPa) [28]. Low atmospheric pressure on lag day 5th had a protective effect on the outcome of CPR and increased the chance of its success. This finding is against Ou’s findings, which showed that low atmospheric pressure increases mortality due to cardiovascular disease [28]. Different climatic conditions of Rasht City, its proximity to the sea, and increased pressure can be the reasons for this discrepancy. In all age and gender groups, low humidity in the initial lag days increased the number of Out-of-hospital Cardiac Arrest cases. Ou et al. reported that the strongest effect of relative humidity reduction was observed in people over 75 years of age [28]. Low humidity also increased the risk of failed CPR in all age and gender groups.
In women and age group of >65 years, low atmospheric pressure in the initial lag days was associated with increased Out-of-hospital Cardiac Arrest cases, but in men and age group of <65 years, high atmospheric pressure increased the risk of Out-of-hospital Cardiac Arrest . This finding is consistent with Ratajczak’s findings, which showed that men were more likely to have Out-of-hospital Cardiac Arrest on consecutive days when atmospheric pressure was high, but in contrast to our findings, the prevalence of Out-of-hospital Cardiac Arrest in people under 65 years was high when the daily pressure change was lower [37]. According to Ou et al., women were more vulnerable than men to reduced atmospheric pressure and relative humidity. In their study, they found that patterns of age-based vulnerability would depend on behavioral and socio-economic differences between women and men in facing risks as well as their coping capacity. These differences in men and women in different ages may vary according to the patterns of injury in terms of age, behavioral, economic, and social differences between men and women, if exposed to hazards and other structures. [28].
The limitations of this study are its retrospective nature, the possible incorrect recording of data by the operator, as well as the fact that we only evaluated the patients referred to one hospital, and those who referred to private hospitals or clinics after cardiac arrest were not studied. Since the change in humidity and atmospheric pressure can be associated with the incidence of Out-of-hospital Cardiac Arrest , further studies are recommended to investigate its effects on respiratory diseases and their exacerbation.

Ethical Considerations
Compliance with ethical guidelines

This study approed by the Research Ethics Committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.1398.194).
Funding
This study was a part of the Master thesis of the first author, Yasaman Borghei, approved and financially supported by the Research Committee of Iran University of Medical Sciences.
Authors' contributions
Conceptualization: Yasaman Borghei, Mohammad Taghi Moghaddamnia, Abdolhossein Emami Sigaroudi; Draft preparation, resources, and investigation: Yasaman Borghei and Mohammad Taghi Moghaddamnia; Data analysis: Ehsan Kazemnejhad Leili, Yasaman Borghei, Mohammad Taghi Moghaddamnia and Abdolhossein Emami Sigaroudi; Editing and review: All authors.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to express their gratitude to the Guilan University of Medical Sciences, Cardiovascular Research Center, Emergency Department of Dr. Heshmat Hospital, Guilan Meteorological Organization in Rasht, Iran.


References
Phung D, Thai PK, Guo Y, Morawska L, Rutherford S, Chu C. Ambient temperature and risk of cardiovascular hospitalization: An updated systematic review and meta-analysis. Science of the Total Environment. 2016; 550:1084-102. [DOI:10.1016/j.scitotenv.2016.01.154] [PMID]
Lin YK, Chang CK, Wang YC, Ho TJ. Acute and prolonged adverse effects of temperature on mortality from cardiovascular diseases. PloS One. 2013; 8(12):e82678. [DOI:10.1371/journal.pone.0082678] [PMID] [PMCID]
Li M, Shaw BA, Zhang W, Vásquez E, Lin S. Impact of extremely hot days on emergency department visits for cardiovascular disease among older adults in New York State. International Journal of Environmental Research and Public Health. 2019; 16(12):2119. [DOI:10.3390/ijerph16122119] [PMID] [PMCID]
WHO. World Health Organization: Noncommunicable diseases country profiles 2018. 2018 [cited: 2018 May 5]; Available from: http://www.who.int.
Chen R, Li T, Cai J, Yan M, Zhao Z, Kan H. Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities. Journal of Epidemiology and Community Health. 2014; 68(12):1119-24. [DOI:10.1136/jech-2014-204012] [PMID]
Dahlquist M, Raza A, Bero-Bedada G, Hollenberg J, Lind T, Orsini N, et al. Short-term departures from an optimum ambient temperature are associated with increased risk of Out-of-hospital Cardiac Arrest. International Journal of Hygiene and Environmental Health. 2016; 219(4-5):389-97. [DOI:10.1016/j.ijheh.2016.03.005] [PMID]
Niu Y, Chen R, Liu C, Ran P, Chen A, Chen X, Kan H. The association between ambient temperature and Out-of-hospital Cardiac Arrest in Guangzhou, China. Science of the Total Environment. 2016; 572:114-8. [DOI:10.1016/j.scitotenv.2016.07.205] [PMID]
Tobaldini E, Iodice S, Bonora R, Bonzini M, Brambilla A, Sesana G, et al. Out-of-hospital Cardiac Arrests in a large metropolitan area: Synergistic effect of exposure to air particulates and high temperature. European Journal of Preventive Cardiology. 2020; 27(5):513-9. [DOI:10.1177/2047487319862063] [PMID]
Onozuka D, Hagihara A. Out-of-hospital Cardiac Arrest risk attributable to temperature in Japan. Scientific Reports. 2017; 7:39538. [DOI:10.1038/srep39538] [PMID] [PMCID]
Onozuka D, Hagihara A. Associations of day-to-day temperature change and diurnal temperature range with Out-of-hospital Cardiac Arrest. European Journal of Preventive Cardiology. 2017; 24(2):204-12. [DOI:10.1177/2047487316674818] [PMID]
Hensel M, Geppert D, Kersten JF, Stuhr M, Lorenz J, Wirtz S, Kerner T. Association between Weather-Related factors and cardiac arrest of presumed cardiac etiology: A prospective observational study based on out-of-hospital care data. Prehospital Emergency Care. 2018; 22(3):345-52. [DOI:10.1080/10903127.2017.1381790] [PMID]
Tanigawa-Sugihara K, Iwami T, Nishiyama C, Kitamura T, Goto M, Ando M, et al. Association between atmospheric conditions and occurrence of Out-of-hospital Cardiac Arrest. Circulation Journal. 2013; 77(8):2073-8. [DOI:10.1253/circj.CJ-13-0076] [PMID]
Fukuda T, Ohashi N, Doi K, Matsubara T, Kitsuta Y, Nakajima S, et al. Impact of seasonal temperature environment on the neurologic prognosis of Out-of-hospital Cardiac Arrest: A nationwide, population-based cohort study. Journal of Critical Care. 2014; 29(5):840-7. [DOI:10.1016/j.jcrc.2014.03.034] [PMID]
Yang J, Yin P, Zhou M, Ou CQ, Guo Y, Gasparrini A, et al. Cardiovascular mortality risk attributable to ambient temperature in China. Heart. 2015; 101(24):1966-72. [DOI:10.3390/ijerph120605918] [PMID] [PMCID]
Lee S, Lee E, Park MS, Kwon BY, Kim H, Jung DH, et al. Short-term effect of temperature on daily emergency visits for acute myocardial infarction with threshold temperatures. PLoS One. 2014; 9(4):e94070. [DOI:10.1371/journal.pone.0094070.s001]
Yang J, Ou CQ, Ding Y, Zhou YX, Chen PY. Daily temperature and mortality:A study of distributed lag non-linear effect and effect modification in Guangzhou. Environmental Health. 2012; 11(1):63. [DOI:10.1186/1476-069X-11-63] [PMID] [PMCID]
Yi W, Chan AP. Effects of temperature on mortality in Hong Kong: A time series analysis. International Journal of Biometeorology. 2015; 59(7):927-36. [DOI:10.1007/s00484-014-0895-4] [PMID]
Habib RR, El Zein K, Ghanawi J. Climate change and health research in the Eastern Mediterranean Region. EcoHealth. 2010; 7(2):156-75. [DOI:10.1007/s10393-010-0330-1] [PMID]
Tian Z, Li S, Zhang J, Jaakkola JJ, Guo Y. Ambient temperature and coronary heart disease mortality in Beijing, China: A time series study. Environmental Health. 2012; 11(1):56. [DOI:10.1186/1476-069X-11-56] [PMID] [PMCID]
Moghadamnia MT, Ardalan A, Mesdaghinia A, Keshtkar A, Naddafi K, Yekaninejad MS. Ambient temperature and cardiovascular mortality: A systematic review and meta-analysis. PeerJ. 2017; 5:e3574. [DOI:10.7717/peerj.3574] [PMID] [PMCID]
Guo Y, Li S, Zhang Y, Armstrong B, Jaakkola JJ, Tong S, Pan X. Extremely cold and hot temperatures increase the risk of ischaemic heart disease mortality: Epidemiological evidence from China. Heart. 2013; 99(3):195-203. [DOI:10.1136/heartjnl-2012-302518] [PMID]
Nia HS, Chan YH, Froelicher ES, Sharif SP, Yaghoobzadeh A, Jafari A, et al. Weather fluctuations: predictive factors in the prevalence of acute coronary syndrome. Health Promotion Perspectives. 2019; 9(2):123. [DOI:10.15171/hpp.2019.17] [PMID] [PMCID]
Moghadamnia MT, Ardalan A, Mesdaghinia A, Naddafi K, Yekaninejad MS. Association between apparent temperature and acute coronary syndrome admission in Rasht, Iran. Heart Asia. 2018; 10(2):e011068. [DOI:10.1136/heartasia-2018-011068] [PMID] [PMCID]
Moghadamnia MT, Ardalan A, Mesdaghinia A, Naddafi K, Yekaninejad MS. The effects of apparent temperature on cardiovascular mortality using a distributed lag nonlinear model analysis: 2005 to 2014. Asia Pacific Journal of Public Health. 2018; 30(4):361-8. [DOI:10.1177/1010539518768036] [PMID]
Rakers F, Schiffner R, Rupprecht S, Brandstädt A, Witte OW, Walther M, et al. Rapid weather changes are associated with increased ischemic stroke risk: A case-crossover study. European journal of epidemiology. 2016; 31(2):137-46. [DOI:10.1007/s10654-015-0060-3] [PMID]
Armstrong B, Sera F, Vicedo-Cabrera AM, Abrutzky R, Åström DO, Bell ML, et al. The role of humidity in associations of high temperature with mortality: A multicountry, multicity study. Environmental Health Perspectives. 2019; 127(9):097007. [DOI:10.1289/EHP5430.] [PMID] [PMCID]
Abrignani MG, Corrao S, Biondo GB, Renda N, Braschi A, Novo G, et al. Influence of climatic variables on acute myocardial infarction hospital admissions. International Journal of Cardiology. 2009; 137(2):123-9. [DOI:10.1016/j.ijcard.2008.06.036] [PMID]
Ou CQ, Jun YA, Ou QQ, Liu HZ, Lin GZ, Chen PY, et al. The impact of relative humidity and atmospheric pressure on mortality in Guangzhou, China. Biomedical and Environmental Sciences. 2014; 27(12):917-25. [DOI:10.3967/bes2014.132]
Gunes H, Kandis H, Saritas A, Dikici S, Buyukkaya R. The relationship between ischemic stroke and weather conditions in Duzce, Turkey. World Journal of Emergency Medicine. 2015; 6(3):207. [DOI:10.5847/wjem.j.1920-8642.2015.03.008] [PMID] [PMCID]
Charach G, Friedman I, Nochomovich H, Rogowski O, Charach L. Whether atmospheric pressure changes predict variations in blood pressure. Journal of Cardiology & Current Research. 2017; 9(4):00330. [DOI:10.15406/jccr.2017.09.00330]
Osterwalder R, Hunziker P, Pfisterer M, Radovanovic D, Urban P, Bertel O, et al. Bad weather-an important protective factor for myocardial infarction in Switzerland. An analysis from 5553 patients from the AMIS registry 1999-2002. European Heart Journal. 2004; 25:535.
Zunnunov ZR. Influence of meteopathogenic factors on population visits for emergency medical care. Therapeutic Archive. 2013; 85(9):11-7. https://ter-arkhiv.ru/0040-3660/article/view/31301
Plavcová E, Kyselý J. Effects of sudden air pressure changes on hospital admissions for cardiovascular diseases in Prague, 1994–2009. International Journal of Biometeorology. 2014; 58(6):1327-37. [DOI:10.1007/s00484-013-0735-y] [PMID]
Houck PD, Lethen JE, Riggs MW, Gantt DS, Dehmer GJ. Relation of atmospheric pressure changes and the occurrences of acute myocardial infarction and stroke. The American Journal of Cardiology. 2005; 96(1):45-51. [DOI:10.1016/j.amjcard.2005.02.042] [PMID]
Hinkle JL, Cheever KH. Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters Kluwer India: Lippincott Williams & Wilkins, Ltd; 2018.
Gasparrini A. Distributed lag linear and non-linear models in R: The package dlnm. Journal of Statistical Software. 2011; 43(8):1-20. [DOI:10.18637/jss.v043.i08] [PMID] [PMCID]
Ratajczak J, Łach P, Szczerbiński S, Paciorek P, Karłowska-Pik J, Ziemkiewicz B, et al. Atmospheric conditions and the occurrence of Out-of-hospital Cardiac Arrest in Poland—preliminary analysis of poorly understood phenomena. Medical Research Journal. 2018; 3(3):121-6. [DOI:10.5603/MRJ.a2018.0019]
Article Type : Research | Subject: General
Received: 2020/09/29 | Accepted: 2020/07/30 | Published: 2020/07/30

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.