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      Changes in mortalities and hospital admissions associated with holidays and respiratory illness: implications for medical services

      research-article
      , MA MB BChir PhD FRCP 1 , , , BA PhD 2
      Journal of Evaluation in Clinical Practice
      Blackwell Science Ltd
      coronary, elective, emergency, hospital admissions, mortality, respiratory

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          Abstract

          Rationale and objectives  To see whether net mortalities increase during and after reductions in medical services, either at average weekends, or at Christmas when pressure from illness is unusually high.

          Methods  (1) Paired t‐tests to compare mean daily deaths and hospital admissions during and after weekends (Saturday–Tuesday) with means for the week, in south‐east England; (2) Linear regressions to see whether trends of daily deaths change when admissions are reduced at Christmas.

          Results  Neither mean daily all‐cause, respiratory or ischaemic heart deaths exceeded weekly averages during weekends, or during Saturday–Monday or Saturday–Tuesday, despite falls in daily elective and daily emergency hospital admissions at weekends that averaged 61–72% and 14–22%, respectively. During 19–24 December, daily deaths were above annual means, respiratory deaths by 49% (29, 1–58), but elective admissions fell and although emergency admissions tended to rise, total admissions rose only for respiratory disease, and only by 33% (376, −47 to 799). On Christmas Day (25 December), even emergency admissions fell sharply below previous trends, respiratory emergency admissions by 18% ( P < 0.01). Respiratory deaths alone then immediately increased ( P < 0.01) above trend, by 5.9% (5.8 deaths/day) on 26 December and by 12.9% (12.9) on 27 December.

          Conclusions  No adverse effect on mortality was apparent within 2 days from reduction in medical services at weekends. However, respiratory deaths accelerated sharply after reduction in elective and emergency admissions at Christmas, when rates of infection and mortality from respiratory disease were high. Implications for medical services during respiratory epidemics are discussed.

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          Most cited references19

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          Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe

          (1997)
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            Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: factors in mortality from coronary and cerebral thrombosis in winter.

            Six hours of mild surface cooling in moving air at 24 degrees C with little fall in core temperature (0.4 degree C) increased the packed cell volume by 7% and increased the platelet count and usually the mean platelet volume to produce a 15% increase in the fraction of plasma volume occupied by platelets. Little of these increases occurred in the first hour. Whole blood viscosity increased by 21%; plasma viscosity usually increased, and arterial pressure rose on average from 126/69 to 138/87 mm Hg. Plasma cholesterol concentration increased, in both high and low density lipoprotein fractions, but values of total lipoprotein and lipoprotein fractions were unchanged. The increases in platelets, red cells, and viscosity associated with normal thermoregulatory adjustments to mild surface cooling provide a probable explanation for rapid increases in coronary and cerebral thrombosis in cold weather. The raised arterial pressure and possibly cholesterol concentration may contribute to slower components of the increased thrombosis.
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              Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: winter infections and death from cardiovascular disease.

              There are approximately 20,000 excess deaths from cardiovascular disease each winter in England and Wales. The reasons for the excess have not been fully elucidated. For one year, we studied 96 men and women aged 65-74 living in their own homes in order to examine seasonal variation in plasma fibrinogen and factor VII clotting activity (FVIIc), and to investigate relationships with infection and other cardiovascular-disease risk factors. Both fibrinogen and FVIIc plasma values were greater in winter with estimated winter-summer differences (confidence intervals) of 0.13 (0.05-0.20) g/L for fibrinogen and 4.2 (1.2-7.1)% of standard for FVIIc. These differences could account for 15% and 9% increases in ischaemic heart disease risk in winter respectively. After adjustment for confounding by season, fibrinogen was strongly related to neutrophil count (p < 0.0001), C-reactive protein (p < 0.0001), alpha 1-antichymotrypsin (p < 0.0001), and self-reported cough (p < 0.0001) and coryza (p = 0.0004), but not to ambient temperature. Therefore, we suggest that seasonal variation in fibrinogen might be induced by winter respiratory infections via activation of the acute phase response. Seasonal variations in the cardiovascular risk factors fibrinogen and FVIIc provide further possible explanations for the marked seasonal variation in death from ischaemic heart disease and stroke in the elderly.
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                Author and article information

                Journal
                J Eval Clin Pract
                J Eval Clin Pract
                10.1111/(ISSN)1365-2753
                JEP
                Journal of Evaluation in Clinical Practice
                Blackwell Science Ltd (Oxford, UK )
                1356-1294
                1365-2753
                03 May 2005
                June 2005
                : 11
                : 3 ( doiID: 10.1111/jep.2005.11.issue-3 )
                : 275-281
                Affiliations
                [ 1 ]Professor Emeritus, Queen Mary College, London, UK
                [ 2 ]Lecturer, Bart's and the London, Queen Mary's School of Medicine and Dentistry, University of London, UK
                Author notes
                [*] [* ]Professor W.R. Keatinge 
Medical Sciences Building 
Queen Mary College 
Mile End Road 
London E1 4NS 
UK 
E‐mail: w.r.keatinge@ 123456qmul.ac.uk
                Article
                JEP533
                10.1111/j.1365-2753.2005.00533.x
                7159119
                15869557
                30c3ee93-6e2e-4d20-afb0-17e916338570

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Page count
                links-crossref: 0, links-pubmed: 0, Figures: 2, Tables: 2, Equations: 0, References: 21, Pages: 7, Words: 3560
                Categories
                Original Articles
                Custom metadata
                2.0
                June 2005
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

                Medicine
                coronary,elective,emergency,hospital admissions,mortality,respiratory
                Medicine
                coronary, elective, emergency, hospital admissions, mortality, respiratory

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