Changes in cold-related mortalities between 1995 and 2016 in South East England.

OBJECTIVE: The aim of the study was to examine trends in cold-related mortalities between 1995 and 2016. STUDY DESIGN: This is a longitudinal mortality study. METHODS: For men and women aged 65-74 years or those older than 85 years in South East England, the relationship between daily mortality (deaths per million population) and outdoor temperatures below 18 °C, with allowance for influenza epidemics, was assessed by linear regression on an annual basis. The regression coefficients were expressed as a percentage of the mortality at 18 °C to adjust for changes in mortality through health care. Trends in 'specific' cold-related mortalities were then examined over two periods, 1977-1994 and 1995-2016. RESULTS: In contrast to the early period, annual trends in cold-related specific mortalities showed no decline between 1995 and 2016. 'Specific' cold-related mortality of women, but not men, in the age group older than 85 years showed a significant increase over the 1995-2016 period, which was different from the trend over the earlier period (P < 0.01). CONCLUSION: Despite state-funded benefits to help alleviate fuel poverty and public health advice, very elderly women appear to be at increasing risk of cold-related mortality-greater help may be necessary.

Coincidence of pollen season with the first fetal trimester together with early pet exposure is associated with sensitization to cat and dog allergens in early childhood: A Finnish population-based study.

BACKGROUND: Children whose 11th fetal week falls in pollen season (spring) reportedly have an increased risk of sensitization to food allergens. No such finding has been reported for pet allergens. OBJECTIVE: The aim of the study was to (i) evaluate the incidence of pet (dog and cat) sensitization according to the season of the 11th fetal week and (ii) whether the association between pet exposure and respective sensitization is modified by the coincidence of the 11th fetal week with pollen season. METHODS: The study population comprised all children (born between 2001 and 2006) in the province of South Karelia, Finland (N = 5920). Their data of immunoglobulin E antibodies and skin prick tests to pet allergens (N = 538) were collected from patient records and linked with questionnaire data on pet exposure. RESULTS: The seasonal incidence peak of cat sensitization was observed in children whose 11th fetal week occurred in June (7.4%) and that of dog sensitization in April (3.8%) and June (4.7%). The relative rate (RR) for cat sensitization was 2.92 (95% CI 1.40-6.08) in children with cat exposure alone, 8.53 (4.07-17.86) in children with cat and fetal pollen exposures and 0.61 (0.20-1.83) in children exposed to pollen alone, compared with children without these exposures. The respective RRs for dog sensitization were 2.17 (1.13-4.19), 4.40 (2.19-8.83) and 1.65 (0.77-3.53). CONCLUSIONS AND CLINICAL RELEVANCE: Coincidence of the first fetal trimester with pollen season strengthens the association between pet exposure and respective sensitization. Pollen exposure at early pregnancy may deviate immune system towards Th2-type reactivity promoting development of specific allergy in case allergen exposure occurred. Therefore, primary prevention of allergic diseases may need to begin during early pregnancy.

Association between adolescent sport activities and lumbar disk degeneration among young adults.

The relationship between different sport activities and lumbar intervertebral disk degeneration (DD) is largely unknown. We evaluated whether adolescent participation in different sports is associated with lumbar DD in a population-based birth cohort of young adults. A total of 558 young adults (325 females and 233 males) underwent magnetic resonance imaging (MRI, 1.5-T scanner). A DD sum score, based on the Pfirrmann grading, was calculated for all lumbar levels. The sum score was categorized into no DD, 1, 2, or at least 3. Participation in different sport activities was self-reported by postal surveys at 16, 18, and 19 years, and three groups were formed based on participation frequency in 11 sports: (a) highly active (at least twice a week), (b) moderately active (2-4 times a month), and (c) inactive (maximum once a month). Cumulative odds ratios (COR) and their 95% confidence intervals (CI) were obtained for each sport by ordinal logistic regression, adjusting for gender, body mass index, age, socioeconomic status, smoking, and other sports. Highly active participation in jogging/running and swimming was associated with a higher DD sum score (COR: 3.0; 95% CI: 1.4-6.3 and 5.0; 1.7-15.2, respectively) compared to inactive participation, whereas highly active participation in skating showed low COR. In conclusion, running and swimming at least twice a week in early adulthood are potentially associated with lumbar DD. Follow-up studies with MRI are needed to show whether frequent exposure to running or swimming has further effect on the integrity of lumbar intervertebral disks.

Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland.

OBJECTIVES: To study the role of distance in public primary health service use in rural and urban local residential areas (1 km² grids) among the young adults of the Northern Finland Birth Cohort 1966 (N = 4503). STUDY DESIGN: Cross-sectional study of a cohort born in Northern Finland in 1966. METHODS: Use of local health centres was surveyed by postal questionnaire in 1997, and distance from study subjects' home to health centre was calculated along road network. The crude and adjusted incidence rate ratios (IRR) and their 95% confidence intervals were calculated for distance, predisposing and illness-level variables. Distance-related health inequity indices were calculated. RESULTS: The IRRs indicated 1.5-fold higher rate of health centre visits among subjects living farther than 10 km compared to subjects living within 2 km from health centre in urban areas. In rural areas, IRRs indicated no significant association with distance and health centre use. No distance-related inequity in the use of health centre services was found. CONCLUSIONS: Distance does not seem to be major barrier in health service use among these 31-year old adults. However, closer study of some groups, such as the rural unemployed, might be valuable.

Prevalence of cold-related musculoskeletal pain according to self-reported threshold temperature among the Finnish adult population.

BACKGROUND: Exposure to cold reportedly increases musculoskeletal pains. We assessed the prevalence of such pain and self-reported threshold temperature (TT) at which the pain emerges. METHODS: A random sample of 6591 people in Finland, aged 25-74 years, answered a questionnaire on repeated cold-related musculoskeletal pain (CMP) and its TT. The response rate was 64%. We used quantile regression to quantify the effects of personal characteristics and region of residence on TT at various locations of its distribution. RESULTS: Of the participants, 1892 (30%) experienced CMP in at least one body site and 1692 reported TT. Ten percent of the participants who perceived CMP did so at -2 °C, 50% at -14 °C and 90% at -23 °C. Residence in the South elevated TT by 1-6 °C compared with residence in the North, depending on the proportion of participants reporting CMP at various temperatures. Joint disorders increased TT at milder temperatures, at which only 10% of all participants perceived CMP, whereas back disorders did so mainly at lower temperatures, at which 70% were affected. Overweight was associated with a 2 °C lower TT, and physical inactivity with a 1 °C higher TT, and TT increased by 1 °C per 10-year increase in age. The greatest model-estimated difference in median TT between subgroups was 12 °C. CONCLUSIONS: People suffering from musculoskeletal disorders and those living in the warmer areas of Finland need special advice to protect themselves against the cold. Our study provides preliminary information to support such advice.

Psychosocial and lifestyle correlates of musculoskeletal pain patterns in adolescence: a 2-year follow-up study.

BACKGROUND: The prevalence of musculoskeletal (MS) pain has been increasing among adolescents in the last decades. This may be related to either adverse changes in lifestyle and/or the psychosocial environment. Our study analysed the psychosocial and lifestyle correlates of musculoskeletal pain progression in adolescence. METHODS: The study was based on the 1986 Northern Finland Birth Cohort and included 1773 adolescents at the ages of 16 to 18. Latent class analysis was applied to find the homogeneous profiles of MS pains in four body areas (neck, shoulder, low back and limb). We analysed the associations between time spent in sedentary activities and sleeping, physical activity level, body mass index, alcohol consumption, smoking, and emotional and behavioural factors at 16 years, and belonging to pain clusters at 16 and 18 years. RESULTS: We found an association between a higher probability of MS pains between 16 and 18 years and increasing emotional and behavioural problems in both genders. Among boys, a high likelihood of MS pains during follow-up was also associated with a long time spent sitting and insufficient sleeping time. Among girls, alcohol consumption associated with high pain probability. MS pains already co-occur to a large extent in their early course. CONCLUSIONS: The strong overlap of emotional and behavioural problems and MS pains in adolescence requires awareness in both research and clinical work.

Caesarean section and allergic manifestations: insufficient evidence of association found in population-based study of children aged 1 to 4 years.

AIM: To provide evidence on the association between caesarean section and allergic manifestations in an unselected child population. METHODS: Research focused on all children aged from one to 4 years (N = 4779), born between April 2001 and March 2005 and living in the province of South Karelia, Finland. They were identified from the nationwide population register. Questionnaire data on 3181 participants were individually merged with allergy test results (skin prick tests, IgE antibodies and open food challenges) from all patient records. RESULTS: Compared with vaginal delivery, the adjusted relative incidence of positive allergy tests (with 95% confidence intervals, CI) in children born by caesarean section was 1.14 (0.79, 1.65) for food, 1.16 (0.66, 2.05) for animals, 0.94 (0.46, 1.92) for pollen and 1.19 (0.87, 1.63) for any allergens. The corresponding adjusted prevalence odds ratios (with 95% CI) of physician-diagnosed allergic manifestations were 1.15 (0.80, 1.63) for food allergy, 0.90 (0.47, 1.59) for pollen allergy or hay fever, 1.00 (0.75, 1.31) for atopic eczema, 0.96 (0.53, 1.65) for asthma and 1.08 (0.85, 1.38) for any allergic manifestation. CONCLUSION: Insufficient evidence was found in our population for any association between birth by caesarean section and allergic manifestations. Further evidence from unselected populations, with longer follow-up periods, is needed.

Cold-related symptoms among the healthy and sick of the general population: National FINRISK Study data, 2002.

OBJECTIVE: To determine the prevalence of cold-related symptoms among the general population, especially people with pre-existing diseases. STUDY DESIGN: Six thousand nine hundred and fifty-one men and women aged 25-74 years, who had participated in the National FINRISK 2002 Study, filled in a questionnaire on cold-related symptoms. METHODS: Age-specific and age-adjusted prevalence figures for cold-related symptoms were calculated. The symptoms were regressed for gender, age, region of residence, industry, self-reported disease and smoking. RESULTS: Five percent of the subjects reported chest pain or arrhythmia in the cold, and higher prevalence figures were found for respiratory (men 26%/women 31%) and musculoskeletal symptoms (31%/28%). The prevalence of cold-related cardiovascular symptoms was particularly high among subjects with coronary heart disease (33%/46%) or cardiac insufficiency (25%/40%), as was the prevalence of respiratory symptoms among asthmatics (69%/78%) and subjects with chronic bronchitis (66%/77%). The symptoms increased with age, were more common in colder areas than milder areas, and were more common in those engaged in agricultural work than those engaged in industry or services. Cold-related cardiovascular and respiratory symptoms were more common among women than men. The regression-adjusted contributions (percentage points) to various cold-related symptoms were 2-45% for lung disease, 7-9% for cardiovascular disease, 3-15% for joint or back disease and 6-13% for mental disease. CONCLUSIONS: Large proportions of people living in the north, particularly those with pre-existing medical conditions, experience cardiovascular, respiratory or musculoskeletal symptoms in the cold. Since the symptoms may predict future morbidity and mortality, a strategy is needed to reduce the cold-related health risks of the entire population.

Cardiorespiratory fitness of finnish adolescents.

We evaluated the accuracy of a submaximal cycle ergometer test to assess cardiorespiratory fitness in adolescents and provided population-based reference values. In a health study of the Northern Finland birth cohort born in 1985 - 1986 (NFBC 1986), cardiorespiratory fitness of 5375 males and females aged 15 to 16 years was measured by a submaximal cycle ergometer test by using a two-stage exercise protocol designed for this survey. A total of 4903 subjects performed two work stages. Maximal workload and peak oxygen consumption were calculated on the basis of heart rate responses by the WHO extrapolation method. An additional 472 subjects were able to finish only one work stage. For them, peak oxygen uptake was calculated by the Astrand nomogram. To evaluate the accuracy of submaximal testing, a validation sample of 90 subjects carried out both a submaximal test and a maximal cycle ergometer test with direct measurement of peak oxygen uptake. The WHO method proved to estimate peak oxygen uptake with reasonable accuracy. The Astrand nomogram method overestimated peak oxygen uptake considerably, and therefore a new single-stage regression method was applied to calculate maximal workload and peak oxygen consumption. Reference values of cardiorespiratory fitness were provided for 2690 males and 2685 females aged 15 to 16 years.

Body mass index and weight change from adolescence into adulthood, waist-to-hip ratio and perceived work ability among young adults.

OBJECTIVES: To study how body mass index (BMI, kg/m2) at 14 and 31 years (y) changes in BMI between 14 and 31 y, and waist-to-hip ratio (WHR) at 31 y are associated with poor perceived working ability at 31 y. DESIGN AND SUBJECTS: A population-based cohort, originally 11637 people, born in Northern Finland in 1966 was resurveyed at 14 and 31 y. MEASUREMENTS: Perceived work ability (measured by modified work ability index, WAI), BMI, WHR, alcohol intake, smoking, basic education and work history were recorded at 31 y and BMI also at 14 y. RESULTS: Low WAI (15% of lowest values) at 31 y showed a U-shaped association with BMI at 14 y, and also with BMI at 31 y, except in obese males. Low WAI similarly had a U-shaped association with WHR, but in males only, while in females, the probability of low WAI increased almost linearly with WHR. Low WAI was more common among smokers and people with a low level of education. The pattern for alcohol intake was more equivocal, with a nonsignificant finding in males and an almost linear decrease of low WAI with increasing alcohol intake in females. CONCLUSIONS: Work ability, health habits and anthropometric measures should be evaluated regularly in young workers, and preventive measures against diseases leading to premature retirement should be taken in time, for example by the occupational health-care service.

Cardiorespiratory fitness of males and females of northern Finland birth cohort of 1966 at age 31.

This study aimed to measure cardiorespiratory fitness of about 9000 males and females at age 31, to produce the reference values and relate them to the level of physical activity and body mass index (BMI). Study population was the Northern Finland birth cohort of 1966. At age 31, 8786 persons responded to a postal inquiry including questions about physical activity and 5497 of them also performed a step test. A sample of 123 persons performed a maximal exercise test with direct measurement of peak oxygen uptake (VO(2peak)). This was done to develop VO(2peak) prediction models on the basis of heart rate after a step test, BMI and frequency of brisk physical activity. These models were used to calculate VO(2peak) for the whole study population. Mean VO(2peak) +/- standard deviation was 43.0 +/- 4.6 ml.kg(-1).min(-1) in 4071 males and 34.3 +/- 4.3 ml.kg(-1).min(-1) in 4367 females. A graded dose-response relationship was observed in males and females between the frequency of participation in brisk exercise and VO(2peak). Similar dose-response relationship was also observed in overweight and obese persons, although the level of VO(2peak) was lower in persons with increased BMI. At age 31, very low levels of VO(2peak) seemed to be associated with a combination of infrequent participation in brisk exercise and increased BMI. These reference values can be used in the interpretation of fitness test results and in physical activity counselling.

Change in the level of physical activity from adolescence into adulthood and obesity at the age of 31 years.

OBJECTIVE: To evaluate how a change in the level of leisure-time physical activity from adolescence into adulthood is associated with overall and abdominal obesity at the age of 31 y. DESIGN: Prospective follow-up study of Northern Finland birth cohort of 1966. SUBJECTS: In all, a population of 2834 males and 2872 females aged 31 y was studied. MEASUREMENTS: At the age of 31 y, overweight was defined as a body mass index (BMI) of 25.0-29.9 kg/m(2) and obesity as a BMI of 30.0 kg/m(2) or more. The cutoff points of waist circumference for mild and severe abdominal obesity were 94.0 and 102.0 cm in males and 80.0 and 88.0 cm in females. The change in the level of physical activity (at least moderately active vs inactive) was evaluated by inquiries conducted at the ages of 14 and 31 y. The odds ratios (OR) and their 95% confidence intervals (CI) obtained from logistic regression were adjusted for maternal BMI before pregnancy, BMI at the age of 14 y, alcohol intake, occupational physical activity, smoking, and, in the case of females, for parity at age 31 y. RESULTS: Becoming inactive during the transition from adolescence to adulthood was associated with overall overweight in males (OR 1.49, CI 1.18-1.89), overall obesity in males (OR 1.53, CI 0.99-2.37) and females (OR 1.51, CI 0.94-2.44), and with severe abdominal obesity in females (OR 1.80, CI 1.13-2.86). Being persistently inactive from adolescence to adulthood was associated with mild abdominal obesity in males (OR 1.83, CI 1.13-2.95), but not with other obesity measures in either gender after adjustment for confounding factors. CONCLUSIONS: Becoming inactive during the transition from adolescence to adulthood is related to overall obesity in both genders, and to severe abdominal obesity in females at the age of 31 y. The results emphasize the role of continued physical activity from adolescence into adulthood in the prevention of adult obesity.

Changes in summer temperature and heat-related mortality since 1971 in North Carolina, South Finland, and Southeast England.

Three climatically diverse regions were studied to determine the impact of temperature change on heat-related mortality from 1971 to 1997. Median regressions showed that May-August temperatures in North Carolina rose by 1.0 degrees C (95% CL 0.0-2.0 degrees C) from 23.5 degrees C (74.3 degrees F), were unchanged in South Finland at 13.5 degrees C (56.3 degrees F), and rose in Southeast England 2.1 degrees C (0.3-4.0 degrees C) from 14.9 degrees C (58.8 degrees F). After determining for each region the daily temperature (as a 3 degrees C band) at which the mortality was the lowest, annual heat-related mortality was obtained as excess mortality per million at temperatures above this. Annual heat-related mortality per million (among the population at risk, aged 55+) fell in North Carolina by 212 (59-365) from 228 (140-317) to only 16 (not significant, NS); fell in South Finland by 282 (66-500) from 382 (257-507) to 99 (NS); and fell in Southeast England by 2.4 (NS) from 111 (41-180) to 108 (41-176). The falls in North Carolina and South Finland remained significant after allowances were made for changes in age, sex, and baseline mortality. Increased air conditioning probably explains the virtual disappearance of heat-related mortality in the hottest region, North Carolina, despite warmer summers. Other lifestyle changes associated with increasing prosperity probably explain the favorable trends in the cooler regions.

Small-area variation in mortality in the city of Oulu, Finland, during the period 1978--1995.

The aim of the present work was to explore small-area differences in mortality from all causes among males and females within the city of Oulu during the period 1978--1995 and to identify areas where mortality has been persistently high or low. Analyses carried out using Geographical Information System techniques with geo-referenced mortality data produced at a resolution of 1 x 1 km showed significant regional variations in mortality within the city. The differences were wide enough to suggest variations of several years in longevity, and were probably indicative of marked variations in the incidences of diseases. Observed mortality differences may reflect the influence of the rapidly changing urban structure and consequent health effects based on selection, lifestyles, work exposures and deprivation.

Serum lipid levels and M/L55 allele distribution of HDL paraoxonase gene in Saami and Finnish men.

Paraoxonase (PON) is an antioxidative enzyme, which eliminates lipid peroxides. The mutation in codon 55 of PON1 gene causes a change of methionine (M-allele) to leucine (L-allele) and influences PON activity. The Saami are a population living in the northern part of Fennoscandia. In previous studies their death rate from coronary artery disease (CAD) was found to be low. We compared PON M/L55 allele frequencies of 68 Saami and 68 Finnish men and related the PON genotypes to plasma lipid levels and to the levels of autoantibodies against oxidized LDL. The M/L55 genotypes were determined by PCR and restriction enzyme digestion. ELISA was used to measure antibodies against oxidized LDL. The L- and M-allele frequencies were 64% and 36% in Saami population and 64% and 36% in Finnish men, respectively (p = NS, Fisher's exact test). There were also no significant differences in plasma lipid levels or in antibody levels against oxidized LDL between PON genotypes or between Saami and Finnish men. Our results indicate that the PON M/L55 genotype is not associated with plasma lipid levels or the levels of autoantibodies against oxidized LDL in these populations. The Saami men have the same PON M/L55 allele distribution as the Finnish men and the PON genotype might thus not be one factor protecting Saami against CAD.

Outdoor clothing: its relationship to geography, climate, behaviour and cold-related mortality in Europe.

It has been suggested, that the inhabitants of northern European regions, who experience little cold-related mortality, protect themselves outdoors by wearing more clothing, at the same temperature, than people living in southern regions where such mortality is high. Outdoor clothing data were collected in eight regions from 6583 people divided by sex and age group (50-59 and 65-74 years). Across Europe, the total clothing worn (as assessed by dry thermal insulation and numbers of items or layers) increased significantly with cold, wind, less physical activity and longer periods outdoors. Men wore 0.14 clo (1 clo = 0.115 m2 K W-1) more than women and the older people wore 0.05 clo more than the younger group (both P < 0.001). After allowance for these factors, regional differences in insulation and item number were correlated (r = -0.74, P = 0.037; r = -0.74, P = 0.036 respectively), but not those in clothing layers (r = -0.21; P = 0.61), with indices of cold-related mortality. Cold weather most increased the wearing of gloves, scarves and hats. The geographical variation in the wearing of these three together items more closely matched that in cold-related mortality (r = -0.89, P = 0.003). A possible explanation for this may be that they protect the head and hands, where stimulation by cold greatly increases peripheral vasoconstriction causing a rise in blood pressure that procedure haemoconcentration and raised cardiovascular risk.

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

OBJECTIVES: To assess heat related mortalities in relation to climate within Europe. DESIGN: Observational population study. SETTING: North Finland, south Finland, Baden-Württemberg, Netherlands, London, north Italy, and Athens. SUBJECTS: People aged 65-74. MAIN OUTCOME MEASURES: Mortalities at temperatures above, below, and within each region's temperature band of minimum mortality. RESULTS: Mortality was lowest at 14.3-17.3 degrees C in north Finland but at 22.7-25.7 degrees C in Athens. Overall the 3 degrees C minimum mortality temperature bands were significantly higher in regions with higher than lower mean summer temperatures (P=0.027). This was not due to regional differences in wind speeds, humidity, or rain. As a result, regions with hot summers did not have significantly higher annual heat related mortality per million population than cold regions at temperatures above these bands. Mean annual heat related mortalities were 304 (95% confidence interval 126 to 482) in North Finland, 445 (59 to 831) in Athens, and 40 (13 to 68) in London. Cold related mortalities were 2457 (1130 to 3786), 2533 (965 to 4101), and 3129 (2319 to 3939) respectively. CONCLUSIONS: Populations in Europe have adjusted successfully to mean summer temperatures ranging from 13.5 degrees C to 24.1 degrees C, and can be expected to adjust to global warming predicted for the next half century with little sustained increase in heat related mortality. Active measures to accelerate adjustment to hot weather could minimise temporary rises in heat related mortality, and measures to maintain protection against cold in winter could permit substantial reductions in overall mortality as temperatures rise.

Winter mortality in relation to climate.

We report further details of the Eurowinter survey of cold related mortalities and protective measures against cold in seven regions of Europe, and review these with other evidence on the relationship of winter mortality to climate. Data for the oldest subject group studied, aged 65-74, showed that in this vulnerable group, high levels of protection against indoor and outdoor cold at given outdoor temperatures were found mainly in countries with cold winters, and were associated with low levels of excess mortality at a given level of outdoor cold. Regions such as London that had poor protection against cold and/or high baseline mortalities had higher levels of winter excess mortality than expected for the coldness of their winters.

Seasonal variation of deaths in Finland--is it still diminishing?

The seasonal variation of deaths in Finland during the period 1961-1995, and its possible diminution over time was examined on a daily and monthly basis. The daily pattern of deaths over the year was asymmetric, with a very steep rise in December (peak on December 26), a slow rise in late winter and spring, a secondary rise in June (peak on June 24) and a trough in late August. The December peak was 26% higher than the August trough and showed no diminution over the period studied. The second peak in June was 12% higher than the annual minimum and was particularly pronounced in deaths from ischaemic heart disease and among people dying at ages 35 to 64 years. The winter excess in all natural mortality was estimated to be 7.4% of all annual deaths, and it showed some diminution over time, from 8.4% in 1961 to 6.3% in 1995, mainly because of the steeper decline in mortality in late winter in the 1980s and 1990s compared with the previous periods.

Dependence of cold-related coronary and respiratory symptoms on age and exposure to cold.

Cold causes cardiopulmonary stress often perceived as shortness of breath or chest pain, and causes exacerbation of these symptoms in persons suffering heart or lung disease. We investigated the prevalence of these symptoms and their association with sex, age and cold exposure in a population-based sample of 1,785 persons who lived in three areas of Finland. The exposure to cold was measured by the annual number cold days (mean daily temperature below 0 degree C) in the resident locality and weekly hours spent in the cold in winter. Shortness of breath was 25% and chest pain 52% more common in females than in males, and their prevalence increased by 24% and 77%, respectively, for every 10 years of age. The prevalence of shortness of breath increased by 5% and chest pain by 6% for every 10 cold days in the resident locality, and by 6% and 7% for every 10 hours spent in the cold, respectively. We suggest that environmental cold, measured by the number of cold days throughout the year and weekly hours spent in the cold, may provoke cardiopulmonary symptoms independent of sex and age.