No abstract

We report a measurable effect of atmospheric conditions upon stroke incidence in a temperate climate.

WINNING ABSTRACT: Many COPD sufferers find that their symptoms become worse during colder weather, which can lead to an exacerbation resulting in hospital admission. This study investigates different measures of cold, assessing which most strongly relate to COPD admissions and whether they can be used to forecast risk of exacerbation.COPD admissions (ICD10 J40-J44) for the five Strategic Health Authorities (SHAs) in London and corresponding meteorological data were extracted for October-March 1997-2003. Correlations and regressions were used to compare the effects on admissions of: N daily mean, maximum and minimum temperature; N significant drops in temperature; N weekly average maximum temperature; N ''cumulative cold'', summing the number of degrees the daily maximum temperature was below a threshold across a week; N different windchill indices.All measures of cold showed significant negative correlations with COPD admissions. Daily relationships were weaker than weekly ones (R5 -0.19, p,0.001 for daily maximum temperature, R5 -0.36, p,0.001 for weekly average maximum temperature) but are most significant with an 8-day lag. Windchill had the strongest correlation with one-week lag (R5 -0.397, p,0.001) accounting for 20% of the variation in admissions. ''Cumulative cold'' is also significant at p,0.001, ranging from R50.28 for a 3uC threshold to R50.36 for 18uC.Cold measures explain sufficient variation in COPD hospital admissions to be used in a forecast model of risk of exacerbation. The Met Office uses such a model in a health forecasting and anticipatory care service in England.

Patients with no previous admissions have lower individual risk, but contribute to a high overall utilisation of health care resources and should be targeted to prevent admissions. Focusing upon high-risk patients (frequent attenders or more severe) may only reduce a small proportion of admissions, and therefore clinicians should ensure that all COPD patients receive appropriate therapy to reduce risk of exacerbations.

SummaryThe Parchmore Partnership, London, audited 11 evidence-based criteria relating to patient knowledge and COPD morbidity during December 2004 to March 2005 using questionnaires and practice records. 32 patients with moderate to severe COPD participated, and during the project they received information and extra care. Patient knowledge and clinical indicators showed significant improvements. Crown

No abstract

The incidence of extreme weather conditions is expected to rise over the next 50 years. The population of older and frail people is also expected to rise. Many of these older people will suffer from heart failure. Heat waves present special problems to patients in heart failure and the professionals who care for them. This article identifies lapses in the knowledge base relating to advice for patients in heart failure in the areas of lifestyle modification, medication and assessment. It also identifies the policy conclusions which have emerged from the analysis of heat waves which have occurred in the past and how these conclusions may be shaped to meet the needs of heart failure patients during conditions of extreme heat.