A nationwide analysis of the outcomes in hospitalized patients with atrial fibrillation and temperature-related illnesses.

OBJECTIVES: The authors evaluated mortality and indices of cost of care among inpatients with Atrial Fibrillation (AF) and a diagnosis of a Temperature-Related Illness (TRI). The authors also assessed trends in the prevalence of TRIs among AF hospitalizations. METHODS: In this cross-sectional study, the authors used discharge data from the Nationwide Inpatient Sample (NIS) collected between January 2005 and September 2015 to identify patients with a diagnosis of AF and TRI. Outcomes of interest included in-hospital mortality, invasive mechanical ventilation, hospital length of stay, and cost of hospitalization. RESULTS: A total of 37,933 encounters were included. The median age was 79 years. Males were slightly overrepresented relative to females (54.2% vs. 45.8%, respectively). Although Blacks were only 6.6% of the cohort, they represented 12.2% of the TRI cases. Compared to non-TRI-related hospitalizations, a diagnosis of a TRI was associated with an increased likelihood of invasive mechanical ventilation (16.5% vs. 4.1%, p < 0.001), longer length-of-stay (5 vs. 4 days, p < 0.001), higher cost of care (10,082 vs. 8,607, in US dollars p < 0.001), and increased mortality (18.6% vs. 5.1%, p < 0.001). Compared to non-TRI, cold-related illness portends higher odds of mortality 4.68, 95% Confidence Interval (4.35-5.04), p < 0.001, and heat-related illness was associated with less odds of mortality, but this was not statistically significant 0.77 (0.57-1.03), p = 0.88. CONCLUSION: The occurrence of TRI among hospitalized AF patients is small but there is an increasing trend in the prevalence, which more than doubled over the decade in this study. Individuals with AF who are admitted with a TRI face significantly poorer outcomes than those admitted without a TRI including higher mortality. Cold-related illness is associated with higher odds of mortality. Further research is required to elucidate the pathogenic mechanisms underlying these findings and identify strategies to prevent TRIs in AF patients.

A nationwide analysis of the outcomes in hospitalized patients with atrial fibrillation and temperature-related illnesses

Abstract Objectives The authors evaluated mortality and indices of cost of care among inpatients with Atrial Fibrillation (AF) and a diagnosis of a Temperature-Related Illness (TRI). The authors also assessed trends in the prevalence of TRIs among AF hospitalizations. Methods In this cross-sectional study, the authors used discharge data from the Nationwide Inpatient Sample (NIS) collected between January 2005 and September 2015 to identify patients with a diagnosis of AF and TRI. Outcomes of interest included in-hospital mortality, invasive mechanical ventilation, hospital length of stay, and cost of hospitalization. Results A total of 37,933 encounters were included. The median age was 79 years. Males were slightly overrepresented relative to females (54.2% vs. 45.8%, respectively). Although Blacks were only 6.6% of the cohort, they represented 12.2% of the TRI cases. Compared to non-TRI-related hospitalizations, a diagnosis of a TRI was associated with an increased likelihood of invasive mechanical ventilation (16.5% vs. 4.1%, p< 0.001), longer length-of-stay (5 vs. 4 days, p <0.001), higher cost of care (10,082 vs. 8,607, in US dollars p <0.001), and increased mortality (18.6% vs. 5.1%, p <0.001). Compared to non-TRI, cold-related illness portends higher odds of mortality 4.68, 95% Confidence Interval (4.35-5.04), p <0.001, and heat-related illness was associated with less odds of mortality, but this was not statistically significant 0.77 (0.57-1.03), p= 0.88. Conclusion The occurrence of TRI among hospitalized AF patients is small but there is an increasing trend in the prevalence, which more than doubled over the decade in this study. Individuals with AF who are admitted with a TRI face significantly poorer outcomes than those admitted without a TRI including higher mortality. Cold-related illness is associated with higher odds of mortality. Further research is required to elucidate the pathogenic mechanisms underlying these findings and identify strategies to prevent TRIs in AF patients.

Heat stress risk among New York City public school kitchen workers: a quantitative exposure assessment.

Despite the known human health risks associated with excessive heat exposure, particularly in occupational settings, data describing potential heat exposures in school kitchens is scarce, and no published studies to date have performed a quantitative heat exposure assessment for workers employed in this setting. The purpose of this study was to quantify the extent of heat stress in New York City public school kitchens and to assess potential risk of heat-related illness and/or acute injury. Full-shift indoor Wet Bulb Globe Temperature (WBGT) indices, as well as indoor CO2 and CO concentrations were measured for ten school kitchens. A quantitative exposure assessment for three metabolic work-rate scenarios (light, moderate, heavy) was performed in accordance with the Occupational Safety and Health Administration's (OSHA) Heat Hazard Assessment methodology. The overall mean indoor WBGT index for all ten sites was approximately 25.0 °C (77.0 °F; Standard Deviation [SD] = 2.0 °C). Regarding the estimated Action Limit, 10% of school kitchens sampled exceeded this recommended limit for the light work-rate scenario; 60% of schools exceeded this limit for the moderate work-rate scenario; and 80% of schools exceeded this limit for the heavy work-rate scenario. For the Threshold Limit Value (TLV), none of the kitchens exceeded this limit for the light or moderate work-rate scenarios; 30% of kitchens were in excess of this limit for the heavy work-rate scenario. Mean full-shift CO2 and CO air concentrations ranged from 435-911 ppm (mean = 648; SD = 158) and 0.0-3.2 ppm (mean = 0.9; SD = 0.9), respectively. The data collected in the current study suggest that kitchen staff employed in New York City public schools may be exposed to excessive indoor heat levels. Adequate work-rest schedules should be implemented for kitchen workers, in addition to other feasible engineering and administrative controls to mitigate potential risk of heat-related illness and/or acute injury.

Extreme heat and occupational heat illnesses in South Australia, 2001-2010.

OBJECTIVES: This study aims to examine the epidemiological characteristics of occupational heat illnesses in South Australia, to quantify the association between ambient temperature and occupational heat illnesses, and to investigate the impact of heatwaves on occupational heat illnesses. METHODS: Workers' compensation claims data and weather data were obtained from SafeWork South Australia and the Bureau of Meteorology, respectively, for 2001-2010. Time series analysis with generalised estimation equation models and linear spline functions was used to quantify the temperature-heat illness claims association. A case-crossover design was applied to investigate the impact of heatwaves on occupational heat illnesses. RESULTS: There were 306 heat illness claims during the study period, with an incidence rate of 4.5 per 100,000 employees. The overall risk of occupational heat illness was positively associated with maximum temperature (Tmax), especially when Tmax was over the threshold of 35.5 °C. One degree increase of Tmax was associated with a 12.7% (incidence rate ratio 1.127, 95% CI 1.067 to 1.190) increase of occupational heat illness claims. During heatwave periods, the risk of occupational heat illness was about 4-7 times higher than that of non-heatwave periods. CONCLUSIONS: There is a need to develop or refine current heat-related regulations and guidelines to minimise the risk of occupational heat illnesses in vulnerable workers in a warming climate.