Clinical observations of the apparent clustering of daily stroke admissions to a regional hospital in an arid climate prompted our investigation of possible meteorologic factors associated with stroke admissions. Daily hospitalization and meteorologic data were studied for 895 patients with stroke admitted to Soroka Medical Center, Beer-Sheva, Israel, during 1981, 1982, and 1983. The average daily incidence of stroke was about twice as great on relatively warm days as on relatively cold ones. This increase may be explained by increases in thromboembolic mechanisms secondary to physiologic changes in response to heat. When heat waves are predicted, information on the added risk for stroke needs to be disseminated to both the population and to health care providers so preventive measures can be instituted. Special attention should be devoted to air conditioning and adequate consumption of liquids, and antiplatelet aggregation medication such as aspirin should be considered. (Stroke 1989;20:65-69) S troke is the third leading cause of death in Israel, as in other countries. 1 -5 Epidemiologic studies have confirmed a significant decline in the mortality rate from both cardiovascular disease and stroke over the past 20 years. 5 -9 Possible reasons include treatment of modifiable risk factors such as hypertension, cardiac diseases, hyperglycemia, and hypercholesterolemia. One of us observed for many years that stroke admissions to Soroka Medical Center appear to occur in clusters. On some days there are one or no admissions, and these days tend to be grouped; on other days or groups of days there are multiple admissions. In such a short period as a few days, risk factors such as age, sex, and heredity and variable disease risk factors such as hypertension, cardiac disease, and diabetes mellitus are unlikely to change. We looked for risk factors that could change over a period of hours to days and decided that meteorologic factors should be evaluated. This

We report on findings from a 2-year follow-up study of immigrants originating from exposed areas around the site of the 1986 Chernobyl accident matched with comparison subjects emigrating from other republics in the Confederation of Independent States. In the initial study of 708 immigrants, the samples were matched by age, gender, and year of immigration. We assessed two exposure groups-high and low-by estimating levels of ground cesium contamination from the International Atomic Energy Agency maps. We reinterviewed 520 immigrants from the first wave of data collection (a reinterview rate of 73%), 87 from high-exposure areas, 217 from lowexposure areas, and 216 comparison subjects. This study examined the prevalence of symptoms of posttraumatic stress disorder (PTSD), depression, somatization, anxiety, and physical effects (high blood pressure, acute symptoms, and chronic illness). The results obtained in the first wave conducted 8 years after the accident showed that psychological symptoms were significantly higher in exposed respondents than in the comparison group. During the second wave (10 years after the accident) we observed a decline in the prevalence of PTSD and related distress except for somatization, which remained at the same level. An association between exposure and high blood pressure was observed in the first wave of data, but was not still significant in the second wave of data collection. The proportion of those who reported three or more chronic health problems was 48.3% among the high-exposure group, 49.3% in the low-exposure group, and 30.6% in the comparison group (p=0.0003). The most commonly reported problems were heart disease, problems with vision or hearing, migraine headaches, problems with the lymphatic system, and arthritis. Based on the results, it was concluded that the Chernobyl accident was a powerful stressor, having a strong impact on both mental and physical health. Since all respondents were engaged in the process of acculturation and accommodation to a new country after emigration, it is encouraging that this study shows that levels of psychological distress are waning as the new immigrants are absorbed into Israeli society. However, there still remains some independent effect on health associated with the experience of the Chernobyl accident. -Environ Health Perspect 1 05(Suppl 6): 1545-1550 (1997)

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