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This study aimed to identify and evaluate the short-term and lag effects of environmental factors on asthma hospitalizations in different regions. The ecological study on asthma is performed in three regions of Guangxi, China, that are distinctly different in geography and climate. We used distributed lag non-linear models to investigate the exposure-response-lag relationship between meteorological factors, air pollutants, and asthma hospital admissions across the three regions during 2015 (January 1 to December 31). Cold was an important meteorological factor affecting asthma. At lag 0, the relative risk (RR; 23°C as reference) of cold in the Northwest, Northeast, and South was 1.10 (10°C), 1.14 (8°C), and 1.30 (11°C), respectively. NO 2 was identified as the most important air pollutant affecting asthma. The RR of asthma hospitalization increased by 10.9% (at lag 4), 8.1% (at lag 0), and 4.2% (at lag 2) for every 10 μg/m3 increase in NO 2 concentration in the Northwest, Northeast, and South, respectively. In the three regions of Guangxi, there were differences in the dominant factors affecting asthma hospitalizations. Differences in geography can inform governments as to how to prepare the healthcare system to meet the expected peaks. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the correlation between environmental PM2.5 and heart failure (HF) hospitalization in Lanzhou. China. Method: The correlation between atmospheric PM, 5 and HF hospitalization was evaluated using a distributed lag nonlinear model. Result: During the study period, 16,122 HF patients were hospitalized. The average concentration of PM2.5 is 45.24 µg/m³. PM2.5 was positively correlated with HIT hospitalization with single lag (lagO) and cumulative lag (lagO], lag02, lag03). The maximum lag effect is estimated to occur in lag03, and with the PM2.5 concentration increasing by 10 µg/m³, HF hospitalization risk increased by 1.023 (95% confidence interval. 1.006-1.039). The risk of hospitalization for HF in the male group, the age group 65 years or older, and the cold season was statistically significant and more positively correlated. Conclusion: PM2.5 exposure increases the risk of HF admission in Lanzhou. [ABSTRACT FROM AUTHOR]

The effect of ambient temperature on health continues to draw more and more attention with the global warming. Bacillary dysentery (BD) is a major global environmental health issue and affected by temperature and other environmental variables. In the current study, we evaluated the effect of temperature on the incidence of BD from January 1st, 2008 to December 31st, 2011 in Jiayuguan, a temperate continental arid climate city in the Hexi Corridor of northwest China. A distributed lag non-linear model (DLNM) was performed to evaluate the lag effect of temperature on BD up to 30 days. Results showed the risk of BD increased with temperature significantly, especially after 8 °C. The maximum risk of BD was observed at extreme high temperature (29 °C). The effect of temperature on BD risk was significantly divided into short-term effect at lag 5 days and long-term effect at lag 30 days. Age ≤ 15 years were most affected by high temperature. The maximum cumulative risk for lag 30 days (25.8, 95% CIs: 11.8–50.1) was observed at 29 °C. Age ≤ 15 years and females showed short-term effect at lag 5 days and long-term effect at lag 30 days, while age > 15 years and males showed acute short-term effect at lag 0 and light long-term effect at lag 16 days. [ABSTRACT FROM AUTHOR]

To explore the etiology of risk factors and quantify the mortality differences in systemic lupus erythematosus (SLE) patients with different initial disease activity. The Jiangsu Lupus database was established by collecting medical records from first-hospitalized SLE patients during 1999–2009 from 26 centers in Jiangsu province, China, and their survival status every five years. The initial SLEDAI scores [high (>12) vs. low–moderate (≤12)] differences in mortality attributable to risk factors were quantified using population attributable fraction (PAF), relative attributable risk (RAR) and adjusted relative risk (ARR). Among 2446 SLE patients, 83 and 176 deaths were observed in the low–moderate and high activity groups, with mortality rates of 7.7 and 14.0 per 1000 person years, respectively. Anemia was the leading contributor to mortality, with PAFs of 40.4 and 37.5 in the low–moderate and high activity groups, respectively, and explained 23.2% of the mortality differences with an ARR of 1.66 between the two groups. Cardiopulmonary involvement caused the highest PAFs in the low–moderate (20.5%) and high activity (13.6%) groups, explaining 18.3% of the mortality differences. The combination of anemia and cardiopulmonary involvement had the highest RAR, causing 39.8% of the mortality differences (ARR = 1.52) between the two groups. In addition, hypoalbuminemia and a decrease in the creatinine clearance rate accounted for 20–30% of deaths and explained 10–20% of the mortality differences between the two groups, while antimalarial drug nonuse accounted for about 35% of deaths and explained 3.6% of the mortality differences. Anemia, cardiopulmonary involvement and hypoalbuminemia may cause substantial mortality differences across disease activity states, suggesting additional strategies beyond disease activity assessment to monitor SLE outcomes. [ABSTRACT FROM AUTHOR]

Indoor radon exposure is thought to be associated with adverse health effect as lung cancer. Lung cancer incidences in China have been the highest worldwide during the past two decades. It is important to quantitively address indoor radon exposure and its health effect, especially in countries like China. In this paper, we have conducted a meta‐analysis based on indoor radon and its health effect studies from a systematic review between 2000 and 2020. A total of 8 studies were included for lung cancer. We found that the relative risk (RR) was 1.01 (95% CI: 1.01–1.02) per 10 Bq/m3 increase of indoor radon for lung cancer in China. The subgroup analysis found no significant difference between the conclusions from the studies from China and other regions. The health effect of indoor radon exposure is relatively consistent for the low‐exposure and high‐exposure groups in the subgroup analysis. With a better understanding of exposure level of indoor radon, the outcomes and conclusions of this study will provide supports for next phase of researches on estimation of environmental burden of disease by indoor radon exposures in countries like China. [ABSTRACT FROM AUTHOR]

Background: The transmission and fatal risk of severe fever with thrombocytopenia syndrome (SFTS), an emerging infectious disease first discovered in China in 2009, still needed further quantification. This research aimed to analyze the SFTS clusters and assess the transmission and mortality risk for SFTS. Methods: Both epidemiological investigation and case reports regarding SFTS clusters in China during 2011–2021 were obtained from the Public Health Emergency Information Management System of the Chinese Center for Disease Control and Prevention Information System. The transmission risk was evaluated by using the secondary attack rate (SAR) and relative risk (RR). Mortality risk factors were analyzed using a logistic regression model. Results: There were 35 SFTS clusters during 2011–2021 involving 118 patients with a fatality rate of 22.0%. The number of clusters annually increased seasonally from April to September. The clusters mainly occurred in Anhui (16 clusters) and Shandong provinces (8 clusters). The SAR through contact with blood or bloody fluids was much higher than that through contact with non-bloody fluids (50.6% vs 3.0%; χ2 = 210.97, P < 0.05), with an RR of 16.61 [95% confidence interval (CI): 10.23–26.97]. There was a statistically significant difference in the SAR between exposure to the blood of a deceased person during burial preparation and exposure to the living patients' blood (66.7% vs 34.5%; χ2 = 6.40, P < 0.05), with an RR of 1.93 (95% CI: 1.11–3.37). The mortality risk factors were a long interval from onset to diagnosis [odds ratio (OR) = 1.385), 95% CI: 1.083–1.772, P = 0.009) and advanced age (OR: 1.095, 95% CI: 1.031–1.163, P = 0.01). Conclusions: The SFTS clusters showed a high mortality rate and resulted in a high SAR. Contact with a bleeding corpse was associated with a higher infection risk, compared with contacting the blood from living patients. It is important to promote early detection and appropriate case management of patients with SFTS, as well as improved handling of their corpses, to prevent further transmission and mortality. [ABSTRACT FROM AUTHOR]

Epidemiological studies found that exposure to air pollution increases cardiovascular hospitalizations. However, studies on rural-urban differences in associations between hospitalizations for cardiovascular diseases and air pollution are limited. The generalized linear model (GLM) was applied to investigate the associations between cardiovascular hospitalizations and air pollution (SO2, NO2, PM2.5, PM10, CO, and O3) in Guangxi, southwest China, in 2015 (January 1–December 31). The relative risk of pollutants (SO2, NO2) on cardiovascular hospital admissions was significantly different between urban and rural areas. The effect of SO2 on cardiovascular hospitalizations was higher in urban areas than in rural areas at lag0 to lag3 and cumulative lag01 to lag03. In urban areas, there were positive associations between NO2 and cardiovascular hospitalizations at lag0, lag1 and cumulative lag01, lag02. In contrast, the effect of NO2 on cardiovascular hospitalizations was not significant in rural areas. Urban residents were more sensitive than rural residents to SO2 and NO2. Subgroup analyses showed statistically significant differences between rural and urban areas in the association between SO2 and NO2 and cardiovascular hospitalizations for males. For age groups, people aged ≥ 65 years appeared to be more vulnerable to SO2 and NO2 in urban areas. The effects of PM2.5 PM10, CO, and O3 on cardiovascular hospitalizations were consistently negative for all groups. Our findings indicated that there were rural-urban differences in associations between cardiovascular hospitalizations and air pollutants. In rural areas, the risk of cardiovascular hospitalizations was mainly influenced by SO2. Therefore, we expect to pay attention to protecting people from air pollution, particularly for those aged ≥ 65 years in urban areas. [ABSTRACT FROM AUTHOR]

Previous studies have reported that daily average temperature is connected with respiratory diseases (RD), but proof is limited for the influence of the extreme low temperature on RD in Lanzhou, a northwestern China of temperate area. Generalized additive model (GAM) was built in this work to describe the relationship between daily mean temperature and RD in Lanzhou, China from 2012 to 2017. The results indicated that the exposure–response curve was inverse J-shaped, showing the lower the temperature, the larger the relative risk (RR). The RR of daily emergency room (ER) admissions in P5 extreme low temperature (the temperature below the fifth percentile, etc.) was larger than that in P10. The P5 extreme low temperature has the strongest effect at lag 0, and the RRs were 1.043 (95% CI: 1.030, 1.055) for the total, 1.031 (95% CI: 1.015, 1.046) for males and 1.058 (95% CI: 1.039, 1.077) for females. For different age groups, the largest RRs were 1.026 (95% CI: 1.013, 1.039) for the children (age < 16 years) at lag 5, 1.057 (95% CI: 1.030, 1.085) for the young adults (aged 16–45 years), 1.060 (95% CI: 1.023, 1.099) for the middle-aged (aged 46–60 years) and 1.121 (95% CI: 1.077, 1.166) for the elderly group of age > 60 years. Meanwhile, females and the elderly were more vulnerable to extreme temperature. The results could strengthen the scientific evidence of effects of extreme low temperature on RD in temperate areas. [ABSTRACT FROM AUTHOR]

Background: Angina is a crucial risk signal for cardiovascular disease. However, few studies have evaluated the effects of ambient air pollution exposure on angina., Objective: We aimed to explore the short-term effects of air pollution on hospitalization for angina and its lag effects., Methods: We collected data on air pollutant concentrations and angina hospitalizations from 2013 to 2020. Distributed lag nonlinear model (DLNM) was used to evaluate the short-term effects of air pollutants on angina hospitalization under different lag structures. Stratified analysis by sex, age and season was obtained., Results: A total of 39,110 cases of angina hospitalization were included in the study. The results showed a significant positive correlation between PM 2.5 , SO 2 , NO 2 , and CO and angina hospitalization. Their maximum harmful effects were observed at lag0-7 (RR = 1.042; 95% CI: 1.017, 1.068), lag0-3 (RR = 1.067; 95% CI: 1.005, 1.133), lag0-6 (RR = 1.078; 95% CI: 1.041, 1.117), and lag0-6 (RR = 1.244; 95% CI: 1.109, 1.397), respectively. PM 10 did not have an overall risk effect on angina hospitalization, but it did have a risk effect on women and the elderly. O 3 was significantly negatively correlated with angina hospitalization, with the most pronounced effect observed at lag0-6 (RR = 0.960; 95% CI: 0.940, 0.982). Stratified analysis results showed that women and the elderly were more susceptible to pollutants, and the adverse effects of pollutants were stronger in the cold season., Conclusion: Short-term exposure to PM 2.5 , SO 2 , NO 2 , and CO increases the risk of hospitalization for angina., (© 2024. The Author(s).)

BACKGROUND: The potential role of occupational exposures in the development of nasopharyngeal carcinoma (NPC) remains unclear, particularly in high‐incidence areas. METHODS: The authors conducted a population‐based case‐control study, consisting of 2514 incident NPC cases and 2586 randomly selected population controls, in southern China from 2010 to 2014. Occupational history and other covariates were self‐reported using a questionnaire. Multivariate logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the risk of NPC associated with occupational exposures. Restricted cubic splines were used to evaluate potentially nonlinear duration‐response relations. RESULTS: Individuals who had exposure to occupational dusts (OR, 1.45; 95% CI, 1.26‐1.68), chemical vapors (OR, 1.37; 95% CI, 1.17‐1.61), exhausts/smokes (OR, 1.42; 95% CI, 1.25‐1.60), or acids/alkalis (OR, 1.56; 95% CI, 1.30‐1.89) in the workplace had an increased NPC risk compared with those who were unexposed. Risk estimates for all 4 categories of occupational exposures appeared to linearly increase with increasing duration. Within these categories, occupational exposure to 14 subtypes of agents conferred significantly higher risks of NPC, with ORs ranging from 1.30 to 2.29, including dust from metals, textiles, cement, or coal; vapor from formaldehyde, organic solvents, or dyes; exhaust or smoke from diesel, firewood, asphalt/tar, vehicles, or welding; and sulfuric acid, hydrochloric acid, nitric acid, and concentrated alkali/ammonia. CONCLUSIONS: Occupational exposures to dusts, chemical vapors, exhausts/smokes, or acids/alkalis are associated with an excess risk of NPC. If the current results are causal, then the amelioration of workplace conditions might alleviate the burden of NPC in endemic areas. LAY SUMMARY: The role of occupational exposures in the development of nasopharyngeal carcinoma (NPC) remains unclear, particularly in high‐incidence areas.The authors conducted a population‐based study with 2514 incident NPC cases and 2586 population controls in southern China and observed that occupational exposures were associated with an increased risk of NPC.Duration‐response trends were observed with increasing duration of exposure.These findings provide new evidence supporting an etiologic role of occupational exposures for NPC in a high‐incidence region. Occupational exposures are associated with an increased risk of nasopharyngeal carcinoma, and the association is primarily driven by 14 subtypes of occupational agents. Duration‐response trends are observed with increasing duration of exposure. [ABSTRACT FROM AUTHOR]

Stroke is the first leading cause of death in China, and low fruit intake is suggested to be one of the most important risk factors for stroke mortality. However, the trends of stroke mortality attributable to low fruit intake remain unclear in China. Therefore, this study aimed to investigate the long-term trends of stroke mortality attributable to low fruit intake by sex in China during 1990–2017. Data were obtained from the Global Burden of Disease 2017 study; the annual percentage change (APC) and average annual percentage change (AAPC) were estimated by joinpoint regression analysis, and the net age, period, and cohort effects were estimated using the age–period–cohort model with an intrinsic estimator algorithm (APC-IE). The crude mortality rates (CMRs) increased for males and decreased for females from 1990 to 2017. The age-standardized mortality rates (ASMRs) for both males and females showed consecutive significant declines from 1990 to 2017. By APC analysis, substantially increasing age effects were presented from 25 to 79 years for both sexes. The independent period and cohort effects progressively decreased during the entire period for both sexes, with a faster decrease for females than for males. Males and elder groups were the high-risk population for stroke mortality caused by low fruit intake. Although the mortality risk showed a decreasing trend, the fruit intake was still low for the Chinese population. Therefore, effective strategies and global awareness are essential to improve the current situation of low fruit intake, thereby preventing and reducing the stroke mortality risk caused by low fruit intake in China. [ABSTRACT FROM AUTHOR]

INTRODUCTION The All Causes of Death Surveillance (ACDS) system was used to measure smoking-attributed mortality by inserting questions on smoking on death certificates. Smoking status information of the deceased has been routinely collected in death certificates since 2010. We describe a death registry-based case-control study using smoking and cause-of-death data for the period 2010--15. METHODS From 2010, three questions about the smoking status of the deceased were inserted in a revised death certificate: 1) Smoking status (current smoker, quit smoking, never smoker); 2) Number of cigarettes per day smoked; and 3) Number of years of smoking. A data-accuracy survey of 1788 telephone interviews of the family of the deceased was also conducted. Smoking habits (current/ex-smoker vs non-smoker) were compared in study cases (persons who died of lung cancer and other diseases known to be caused by smoking) and the controls (never smokers). Multivariate logistic regression analysis was conducted to estimate relative risks, RR (odds ratios) for smoking-attributed mortality, for lung cancer and all causes of death related to smoking, adjusted for 5-year interval age groups, education, marital status, and year of death. RESULTS During the study period (2010--15), the annual crude death reporting rates ranged from 6.5‰ to 7.0‰. The reporting rates of smoking status, smoking history and the number of cigarettes smoked daily were 95.5%, 98.6% and 98.6%, respectively. Compared to never smokers, the RR of ever smoking in males was 1.38 (95% CI: 1.33--1.43) for all causes of smoking-related deaths and 3.07 (95% CI: 2.91--3.24) for lung cancer, while in females the values were 1.46 (95% CI: 1.39--1.54) for all causes of smoking-related deaths and 4.07 (95% CI: 3.81--4.35) for lung cancer. The results in Tianjin are in accord with published results from previous studies. CONCLUSIONS Levels and trends in smoking attributed mortality can be measured at low cost by using the stable, complete and effective ACDS system in Tianjin. [ABSTRACT FROM AUTHOR]

Background: Meteorological factors play an important role in human health. Clarifying the occurrence of dog and cat bites (DCBs) under different meteorological conditions can provide key insights into the prevention of DCBs. Therefore, the objective of the study was to explore the relationship between meteorological factors and DCBs and to provide caution to avoid the incidents that may occur by DCBs., Methods: In this study, data on meteorological factors and cases of DCBs were retrospectively collected at the Shanghai Climate Center and Jinshan Hospital of Fudan University, respectively, in 2016-2020. The distributed lag non-linear and time series model (DLNM) were used to examine the effect of meteorological elements on daily hospital visits due to DCBs., Results: A total of 26,857 DCBs were collected ranging from 1 to 39 cases per day. The relationship between ambient temperature and DCBs was J-shaped. DCBs were positively correlated with daily mean temperature (rs = 0.588, P  < 0.01). The relative risk (RR) of DCBs was associated with high temperature (RR = 1.450; 95% CI [1.220-1.722]). Female was more susceptible to high temperature than male. High temperature increased the risk of DCBs., Conclusions: The extremely high temperature increased the risk of injuries caused by DCBs, particularly for females. These data may help to develop public health strategies for potentially avoiding the occurrence of DCBs., Competing Interests: The authors declare there are no competing interests., (©2024 Pang et al.)

There has been a gap regarding current knowledge of the effect of PM on pulmonary TB, such as the exposure-time-response between them. This study aimed to explore the distributed lag effects of particulate matter (PM) on active pulmonary tuberculosis (TB) and identify the vulnerable groups. A generalized additive mixed model combined with a distributed lag non-linear model was applied to quantify the association between PM and active pulmonary TB with adjustment for potential confounders. Relative risk (RR) and cumulative RR with 95% confidence interval (CI) were calculated to quantify the exposure-time-response. A total of 16,486 cases of active pulmonary TB were notified. Results suggested that a unit 10 µg/m 3 increase of daily PM 2.5 concentration was positively associated with active pulmonary TB morbidity at 36-115 lag day and RR reached maximum at 66 lag day (1.0076; 95%CI, 1.0031-1.0122), and the cumulative RR was 2.1940 (95%CI, 1.2292-3.9161). For PM 10 , this association was significantly positive at 73-117 lag day, and RR reached maximum at 100 lag day (1.0036; 95%CI, 1.0003-1.0067), and the cumulative RR was not significant. This study provides evidence that PM significantly associate with active pulmonary TB. Vulnerability to PM 2.5 was identified in male, female, 0-18 ages, 19-64 ages, workers, and students. Our findings have significant implications for developing local strategies to prevent and reduce health impact in PM polluted areas., (© 2023. The Author(s) under exclusive licence to International Society of Biometeorology.)

Objective: Short-term air pollution exposure is correlated with childhood acute upper respiratory infections (AURI) hospitalizations. We surveyed the relationship between AURI hospitalizations and air pollutant concentrations in children aged 0-14 years from 1 January 2014 to 31 December 2019 in Lanzhou City., Methods: We collected both data on air pollutant concentrations and children's AURI hospitalizations during the study period. Distributional lagged nonlinear models were adopted to assess the short-term effects of air pollutants on children's AURI hospitalizations. We also performed subgroup analysis and sensitivity analysis., Results: A total of 15,881 children were hospitalized for AURI during the study period. The results showed that for each 10 µg/m 3 increase in PM 2.5 , SO 2 , and NO 2 concentrations at lag0-6, the relative risk (RR) values for children hospitalized for AURI were RR = 1.0247 (95% CI: 1.0092,1.0405), RR = 1.0928 (95% CI: 1.0562, 1.1308), and RR = 1.0715 (95% CI: 1.0495, 1.0940), respectively. PM 10 was significantly associated with AURI hospitalization in children only at lag0, RR = 1.0028 (95% CI: 1.0000, 1.0056)., Conclusion: Short-term exposures to PM 2.5 , PM 10 , SO 2 , and NO 2 all increase the risk of AURI hospitalization in children variously., (© 2023 Wiley Periodicals LLC.)

Abstract This study investigates the urban-rural and sex differences in the increased risks of the ten most common cancers in China related to high PM 2.5 concentration in the southeastern side of Hu line. Pearson correlation coefficient is estimated to reveal how the cancers closely associated with PM 2.5 long-term exposure. Then linear regression is conducted to evaluate sex- and area-specific increased risks of those cancers from high level PM 2.5 long-term exposure. The major finding is with the increase of every 10 μg/m3 of annual mean PM 2.5 concentration, the increase of relative risks for lung cancer incidence and mortality are 15% and 23% for males, and 22% and 24% for females in rural area. For urban area, the increase of relative risk for ovarian cancer incidence is 9% for females, while that for prostatic cancer increases 17% for males. For leukemia, the increase of relative risks for incidence and mortality are 22% and 19% for females in rural area, while in urban area the increase of relative risk for mortality is 9% for males and for incidence is 6% for females. It is also found that with increased PM 2.5 exposure, the risks for ovarian and prostatic cancer rise significantly in urban area, while risks for lung cancer and leukemia rise significantly in rural area. The results demonstrate the higher risks for lung cancer and leukemia with increased PM 2.5 exposure are more significant for female. This study also suggests that the carcinogenic effects of PM 2.5 have obvious sex and urban-rural differences. Highlights • Increased risks for lung, ovarian, prostate cancers and leukemia are closely associated with increased PM 2.5 exposure (Short version: Lung/ovarian/prostate cancer and leukemia are closely related with increased PM 2.5). • PM 2.5 significantly impacts the risks for lung cancer and leukemia in rural area. • PM 2.5 significantly impacts the risks for prostate and ovarian cancers in urban area. • Females are at higher risks for lung cancer and leukemia due to elevated PM 2.5 [ABSTRACT FROM AUTHOR]

Abstract Objectives This study aimed to determine the relative risks of addiction to the Internet, online gaming and online social networking of college students in six Asian countries/regions (Singapore, Hong Kong [HK]/Macau, China, South Korea, Taiwan and Japan) compared with students in the United States (US). It also explored the relative risks of depression and anxiety symptoms among students with Internet-related addictions from these countries/regions. Study design This is a cross-sectional survey. Methods A convenience sample of 8067 college students aged between 18 and 30 years was recruited from seven countries/regions. Students completed a survey about their use of the Internet, online gaming and online social networking as well as the presence of depression and anxiety symptoms. Results For all students, the overall prevalence rates were 8.9% for Internet use addiction, 19.0% for online gaming addiction and 33.1% for online social networking addiction. Compared with the US students, Asian students showed higher risks of online social networking addiction but displayed lower risks of online gaming addiction (with the exception of students from HK/Macau). Chinese and Japanese students also showed higher risks of Internet addiction compared with the US students. In general, addicted Asian students were at higher risks of depression than the addicted US students, especially among Asian students who were addicted to online gaming. Addicted Asian students were at lower risks of anxiety than the addicted US students, especially among Asian students who were addicted to online social networking, and addicted students from HK/Macau and Japan were more likely to have higher relative risks of depression. Conclusions There are country/regional differences in the risks of Internet-related addictions and psychiatric symptoms. It is suggested that country/region-specific health education programmes regarding Internet-related addictions are warranted to maximise the efficiency of prevention and intervention. These programmes should attempt to tackle not only problematic Internet-related behaviours but also mood disturbances among college students. Highlights • Asian students showed higher risks of online social networking addiction than the US students. • Asian students showed lower risks of online gaming addiction than the US students. • HK/Macau and Japanese students with social networking addiction had higher risks of depression than their US counterparts. • Asian students (Except Singapore and Taiwan) with gaming addiction had higher risks of depression than their US counterparts. • HK/Macau students with Internet addiction had higher risks of depression and anxiety than their US counterparts. [ABSTRACT FROM AUTHOR]

China is now experiencing major public health challenges caused by air pollution. Few studies have quantified the dynamics of air pollution and its impact on the risk of respiratory infection. We conducted an integrated data analysis to quantify the association among air quality index (AQI), meteorological variables and respiratory infection risk in Shaanxi province of China in the period of November 15th, 2010 to November 14th, 2016. Our analysis illustrated a statistically significantly positive correlation between the number of influenza-like illness (ILI) cases and AQI, and the respiratory infection risk has increased progressively with increased AQI with a time lag of 0–3 days. We also developed mathematical models for the AQI trend and respiratory infection dynamics, incorporating AQI-dependent incidence and AQI-based behaviour change interventions. Our combined data and modelling analysis estimated the basic reproduction number for the respiratory infection during the studying period to be 2.4076, higher than the basic reproduction number of the 2009 pandemic influenza in the same province. Our modelling-based simulations concluded that, in terms of respiratory infection risk reduction, the persistent control of emission in the China's blue-sky programme is much more effective than substantial social-economic interventions implemented only during the smog days. [ABSTRACT FROM AUTHOR]

Background: Short-term exposure to air pollution is associated with acute lower respiratory infections (ALRI) in children. We investigated the relationship between hospitalization for ALRI in children and air pollutant concentrations from January 1, 2014 to December 31, 2020 in Lanzhou City., Methods: We collected data on air pollutant concentrations and children's hospitalization data during the study period. A time series regression analysis was used to assess the short-term effects of air pollutants on ALRI in children, and subgroup analyses and sensitivity analyses were performed., Results: A total of 51,206 children with ALRI were studied, including 40,126 cases of pneumonia and 11,080 cases of bronchiolitis. The results of the study revealed that PM 2.5 , PM 10 , SO 2 and NO 2 were significantly associated with hospitalization for ALRI in children aged 0-14 years. For each 10 µg/m 3 increase in air pollutant concentration in lag0-7, the relative risk of ALRI hospitalization in children due to PM 2.5 , PM 10 , SO 2 and NO 2 increased by 1.089 (95%CI:1.075, 1.103), 1.018 (95%CI:1.014, 1.021), 1.186 (95%CI:1.154. 1.219) and 1.149 (95%CI:1.130, 1.168), respectively., Conclusions: PM 2.5 , PM 10 , SO 2 and NO 2 short-term exposures were positively associated with ALRI, pneumonia and bronchiolitis hospitalizations in Lanzhou, China. Local governments should make efforts to improve urban ambient air quality conditions to reduce hospitalization rates for childhood respiratory diseases., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Temperature is closely associated with respiratory disease (RD) in children, but few studies have examined whether the relationship between ambient temperature and RD in children changed after the COVID-19 epidemic. The aim of this study was to assess the relationship between temperature and RD in children after the COVID-19 epidemic in Guangzhou, China. We used a distributed lag nonlinear model to compare the relationship between temperature and RD among children in Guangzhou from 2018 to 2022. The results showed an S-shaped relationship between temperature and RD in the post-COVID-19 period with a reference minimum risk at a temperature of 21 °C and an increasing relative risk (RR) at extremely low temperature (ELT) and extremely high temperature (EHT). The highest RR associated with EHT was 1.935 (95% confidence interval [CI]: 1.314-2.850) at a lag of 0-14 days. The on-the-day lag effects were found to be strongest at the lag 0 day of EHT with a RR of 1.167 (95% CI: 1.021-1.334). Furthermore, each 1 °C increase in post-COVID-19 temperature increased the risk of RD by 8.2% (95% CI: 1.044-1.121). Our study provides evidence that the relationship between temperature and RD in children in Guangzhou changed after the COVID-19 epidemic, and high temperature is more likely to cause RD in children. Relevant government departments and parents should understand the relationship between temperature and RD in children and develop new preventive measures., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: We seek to investigate the joint effects of age and body mass index (BMI) on the incident hypertension subtypes among Chinese adults during 1989-2011.Methods: We investigated the Incidence rates (IRs, per 100person-years) of hypertension subtypes, adjusted relative risks (RRs) and population attributable risk percent (PAR%) of BMI for hypertension, and clarified the age-specific effect of BMI on incident hypertension utilizing a dynamic cohort study from the China Health and Nutrition Survey (CHNS) 1989-2011.Results: Normotensive participants (n=53,028) at baseline were included, with mean age was 41.7 (95% CI, 41.6-41.7)years old. During a total of 118,694person years (average was 6.38years) of follow-up, a total of 5208 incident cases of hypertension were documented. The IRs of hypertension were 4.4 (95% CI, 4.3-4.5), which increased gradually by age and BMI (Ptrend<0.001). Compared with those with BMI<22kg/m(2), the RR of hypertension was 3.13 (95% CI, 2.84-3.45) in the group with BMI≥28kg/m(2). The PAR% (BMI>22 vs. BMI<22) for hypertension in Chinese population was 32% (95% CI, 29-34%). Similar trends were observed in all age and BMI groups for both isolated systolic hypertension and systolic-diastolic hypertension, which were mainly affected by age. In contrast, the peak IR of isolated diastolic hypertension was observed in participants aged 30-49years with higher BMIs.Conclusions: The PAR% (IR of BP≥140/90 or treatment for BMI>22 vs. IR for BMI<22) of elevated body weight for hypertension was 32% in Chinese population. [ABSTRACT FROM AUTHOR]

Objective: To explore factors affecting the incidence of ectopic pregnancy (EP) in assisted reproductive technology (ART).Design: A retrospective cohort study on the incidence of EPs in IVF/intracytoplasmic sperm injection (ICSI) and IUI cycles from June 2009 to August 2015. Age of patients, tubal factor infertility, type of cycle (fresh or thawed), embryo being transferred (cleavage embryo or blastocyst), and number of embryos transferred were analyzed to explore their relationship with the incidence of EP.Setting: Teaching hospital.Patient(s): A total of 18,432 pregnancies resulting from ART treatment were retrospectively analyzed.Intervention(s): None.Main Outcome Measure(s): Ectopic pregnancy rate.Result(s): For IVF/ICSI cycles, the incidence of EP was different between cycles transferred with cleavage embryo and blastocyst (3.45% vs. 2.47%). In multivariate logistic regression analysis, tubal infertility was associated with EP (adjusted odds ratio 1.716, 95% confidence interval 1.444-2.039). For IUI cycles, EP was significantly higher in stimulated cycles compared with natural cycles (2.62% vs. 0.99%). The EP rate in cycles with sperm from donor and husband was 1.08% and 3.54%, respectively. However, when patients were stratified according to tubal infertility, the EP rate increased with level of peak estrogen. In thawed embryo transfer cycles, the EP rate was lower in blastocyst transfer cycles and in cycles transferred with fewer embryos.Conclusion(s): Irrespective of tubal infertility, for fresh IVF/ICSI cycles the rate of EP is positively associated with ovarian stimulation; for thawed IVF/ICSI cycles, blastocyst transfer or transfer with fewer embryos reduces the EP rate. In IUI cycles, EP is associated with sperm source. [ABSTRACT FROM AUTHOR]

Exposures to ambient fine particulate matter (PM 2.5 ) and cold ambient temperatures have been identified as important risk factors in contributing towards the global mortality from chronic obstructive pulmonary disease (COPD). Despite China currently being the country with the largest population in the world, previous relative risk (RR) models have considered little or no information from the ambient air pollution related cohort studies in the country. This likely provides a less accurate picture of the trend in air pollution attributable mortality in the country over time. A novel relative risk model called pollutant-temperature exposure (PTE) model is proposed to estimate the RR attributable to the combined effect of air pollution and ambient temperature in a population. In this paper, the pollutant concentration-response curve was extrapolated from the cohort studies in China, whereas the temperature response curve was extracted from a study in Yangtze River Delta (YRD) region. The performance of the PTE model was compared with the integrated exposure-response (IER) model using the data of YRD region, which revealed that the estimated relative risks of the PTE model were noticeably higher than the IER model during the winter season. Furthermore, the predictive ability of the PTE model was validated using actual data of Ningbo city, which showed that the estimated RR using the PTE model with 1-month moving average data showed a good result with the trend of actual COPD mortality, indicated by a lower root mean square error (RMSE = 0.956). By considering the combined effect of ambient air pollutant and ambient temperature, the PTE model is expected to provide more accurate relative risk estimates for the regions with high levels of ambient PM 2.5 and seasonal variation of ambient temperature., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Most of the studies are focused on influenza and meteorological factors for influenza. There are still few studies focused on the relationship between pollution factors and influenza, and the results are not consistent. This study conducted distributed lag nonlinear model and attributable risk on the relationship between influenza and pollution factors, aiming to quantify the association and provide a basis for the prevention of influenza and the formulation of relevant policies. Environmental data in Shijiazhuang from 2014 to 2019, as well as the data on hospital-confirmed influenza, were collected. When the concentration of PM 2.5 was the highest (621 μg/m 3 ), the relative risk was the highest (RR: 2.39, 95% CI: 1.10-5.17). For extremely high concentration PM 2.5 (348 μg/m 3 ), analysis of cumulative lag effect showed statistical significance from cumulative lag0-1 to lag0-6 day, and the minimum cumulative lag effect appeared in lag0-2 (RR: 0.760, 95% CI: 0.655-0.882). In terms of ozone, the RR value was 2.28(1.19,4.38), when O 3 concentration was 310 μg/m 3 , and the RR was 1.65(1.26,2.15), when O 3 concentration was 0 μg/m 3 . The RR of this lag effect increased with the increase of lag days, and reached the maximum at lag0-7 days, RR and 95% CI of slightly low concentration and extremely high concentration were 1.217(1.108,1.337) and 1.440(1.012,2.047), respectively. Stratified analysis showed that there was little difference in gender, but in different age groups, the cumulative lag effect of these two pollutants on influenza was significantly different. Our study found a non-linear relationship between two pollutants and influenza; slightly low concentrations were more associated with contaminant-related influenza. Health workers should encourage patients to get the influenza vaccine and wear masks when going out during flu seasons., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

It is well-established that exposure to non-optimum temperatures adversely affects public health, with the negative impact varying with latitude, as well as various climatic and population characteristics. This work aims to assess the relationship between ambient temperature and mortality from cardiorespiratory diseases in Eastern Macedonia and Thrace, in Northern Greece. For this, a standard time-series over-dispersed Poisson regression was fit, along with a distributed lag nonlinear model (DLNM), using a maximum lag of 21 days, to capture the non-linear and delayed temperature-related effects. A U-shaped relationship was found between temperature and cardiorespiratory mortality for the overall population and various subgroups and the minimum mortality temperature was observed around the 65th percentile of the temperature distribution. Exposure to extremely high temperatures was found to put the highest risk of cardiorespiratory mortality in all cases, except for females which were found to be more sensitive to extreme cold. It is remarkable that the highest burden of temperature-related mortality was attributed to moderate temperatures and primarily to moderate cold. The elderly were found to be particularly susceptible to both cold and hot thermal stress. These results provide new evidence on the health response of the population to low and high temperatures and could be useful to local authorities and policy-makers for developing interventions and prevention strategies for reducing the adverse impact of ambient temperature.

Aims: The aims of this study are to investigate injury mortality in children aged 1-4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008. Methods: The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1-4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008. Results: During the 9-year study period, the injury mortality rates for children aged 1-4 years declined significantly by an average of 5.4% each year ( P < 0.001; 95% confidence interval (CI): 3.6-7.0%) overall in China, with a decrease of 4.8% ( P < 0.001; 95% CI: 2.5-7.1%) and 9.9% ( P < 0.001; 95% CI: 4.9-14.7%) in rural and urban areas, respectively. The proportion of injury-related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year ( P < 0.001; 95% CI: 2.6-8.0%) and 6.1% ( P < 0.001; 95% CI: 2.7-9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury-related deaths in children aged 1-4 years. Conclusion: Childhood injury is still the leading cause of death in children aged 1-4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury. [ABSTRACT FROM AUTHOR]

Occupational and experimental studies have revealed the organs most affected by dimethylformamide (DMF) are liver and gastrointestinal tract. However, few studies have focused on the potential effect of outdoor pollution of DMF. This study examined the health risk of hospitalization due to digestive system disease by time series studies in a case city Longwan, China. The urine metabolite of DMF was correlated well with DMF exposure concentration (EC). A 101.0-μg/m3 (interquartile range) increase in the two-day moving average of DMF EC was associated with a 1.10 (1.01 ˜ 1.20), 1.22 (1.10 ˜ 1.35), and 1.05 (0.90 ˜ 1.22) increase in hospitalization for total digestive system diseases, liver disease, and gastrointestinal tract disease, respectively. The exposure-dose response between DMF and the relative risk of liver disease was linear only below 350 μg/m3. These findings highlight a previously unrecognized health problem related to VOCs released into the outdoor environment. [Copyright &y& Elsevier]

Older people are main susceptible group affected by non-optimal temperature. The aim of the study was to determine how mortality of older people with different ages are affected by temperatures. For this study, we collected data of all-cause death of 256,037 people aged between 65 and 104 years of age from a prefecture located in the north subtropical area with most serious aging rate in 2000, 2010 and 2020 in China. A distributed lag nonlinear model under different age groups was used to estimate non-optimal temperature associations to mortality. The results revealed: (1) With increasing age, older people were more likely to die during moderate low temperature, the proportion of attributable fraction of moderate low temperature in all temperature gradually increased with age. (2) Moderate low temperature could be divided into two parts, the lower part caused most death at age 65-79 and the higher part was not so dangerous, while for age 80+, preventive actions should be taken for both parts. (3) A leveling-off and deceleration phenomenon was observed at age 95-99 for low temperature, but not 100-104, it may be virtually a consequence of "harvesting effect" in that susceptible and common people have died before age 95, it was coincidence with mortality deceleration at extreme old ages found by demographic scholars over the past 200 years. (4) Heat wave had much higher relative risk than cold spell compared with moderate high and low temperature because of steeper slope of relative risk at the period of moderate-extreme conversion of high temperature, the older people should pay more attention to weather with moderate-extreme conversion of high temperature. Furthermore, our findings could help improve the understanding of non-optimal temperature on health of older people and support the development of response strategies for different seasons at different ages., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To examine trends in the major causes and rates of neonatal infection-associated mortality (NIMRs) in different geographical regions in China from 2003 to 2008. Methods: Neonatal mortality data collected from the Chinese National Women and Children's Health Surveillance Network were analyzed. Results: The NIMRs declined. Pneumonia, sepsis and diarrhea were the top three infections that caused neonatal deaths. Compared to the coastal region, the relative risk (RR) of NIMRs in the remote and inland regions declined from 5.52 (95% CI: 4.05-7.52) and 2.37 (95% CI: 1.72-3.25) during 2003-2005 to 3.45 (95% CI: 2.58-4.61) and 1.72 (95% CI: 1.28-2.31) during 2006-2008, respectively. Once again, compared to the coastal region, the risk of pneumonia-specific mortality had significant regional disparities during 2006-2008 with a RR of 3.82 (95% CI: 2.74-5.32) in the remote region and 2.01 (95% CI: 1.44-2.80) in the inland region. The NIMRs in the remote region was characterized by more home deliveries and non-healthcare seeking behavior prior to death than the coastal region. Conclusions: Infection is still one of the main causes of neonatal mortality in China. Although the NIMRs have been declining, disparities concerning neonatal infection-associated and pneumonia-specific neonatal morality still exist. Approaches for reducing mortality of neonatal infections will efficiently decrease total neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Birth Defects are a series of diseases that seriously affect children's health. Birth defects are generally caused by several interrelated factors. The aims of the article is to estimate the prevalence rate and types of birth defects in Inner Mongolia, China, to compare socio-demographic characteristics among the children with birth defects and to analyze the association between risk factors and birth defects. Methods: Data used in this study were obtained through baseline survey of Inner Mongolia Birth Defects Program, a population-based survey conducted from 2005 to 2008. The survey used cluster sampling method in all 12 administrative districts of Inner Mongolia. Sampling size is calculated according to local population size at a certain percentage. All live births, stillbirths and abortions born from October 2005 to September 2008, whose families lived in Inner Mongolia at least one year, were included. The cases of birth defects were diagnosed by the clinical doctors according to their experiences with further laboratory tests if needed. The inclusion criteria of the cases that had already dead were decided according to death records available at local cites. We calculated prevalence rate and 95% confidence intervals of different groups. Outcome variable was the occurrence of birth defects and associations between risk factors and birth defects were analyzed by using Poisson regression analysis. Results: 976 children with birth defects were diagnosed. The prevalence rate of birth defects was 156.1 per 10000 births (95%CI: 146.3-165.8). The prevalence rate of neural tube defect (20.1 per 10000 births) including anencephaly (6.9 per 10000), spina bifida (10.6 per 10000), and encephalocele (2.7 per 10000) was the highest, followed by congenital heart disease (17.1 per 10000). The relative risk (RR) for maternal age less than 25 was 2.22 (95%CI: 2.05,2.41). The RR of the ethnic Mongols was lower than Han Chinese (RR: 0.84; 95%CI: 0.80-0.89). The RR of the third and second pregnancy was significantly higher than the first pregnancy while a slight difference between the second and the first pregnancy was also found. Alcohol drinking of mothers, familial inheritance and living area were also found to be related to the occurrence of the birth defects.Conclusions: Relatively higher birth defect rates were found in Inner Mongolia. This study found that maternal age less than 25, alcohol drinking, familiar inheritance, lower education level of mothers, times of pregnancies and living in rural areas may increase the risk of birth defects. Ethnic Mongols were less likely to have birth defects than Han Chinese. [ABSTRACT FROM AUTHOR]

Objective To estimate the relative risks of dyslipidemia, hypertension, diabetes mellitus, and metabolic syndromes among overweight and obese Chinese children compared with their normal weight counterparts. Methods Overweight and obesity were defined by age- and sex-specific BMI classification reference for Chinese children and adolescents. Pediatric metabolic syndrome (MetS) and each risk factor for MetS were defined using the criteria for US adolescents. Definition of hyper-TC, LDL, and dyslipidemia for adults was applied as well. General linear model factor analysis and chi-square test were used to compare the difference in metabolic indicators among normal weight, overweight, and obese groups. Multiple logistic regression analysis was performed to estimate the odds ratio of metabolic abnormalities between obesity, overweight, and normal weight children, after adjustment for living area, family economic level, age, sex, and dally exercise time and TV watching time, as well as different dietary indices in the model. Results Significant increases in blood lipids, glucose, and blood pressure were found among overweight and obese children as compared with their counterparts with normal weight. By applying WGOC-recommended BMI classification, the risks for hypertriglyceridemia, low HDL and dyslipidemia among overweight children were 1.9, 1.4, and 1.5 times, and was 3.3, 1.5, and 1.8 times among obese groups compared to their counterparts with normal weight after adjustment for age, sex, region, socioeconomic status, physical activity, and dietary intakes. The overweight and obese children (15-17.9 years) had a high-risk of developing hypertension, which was 2.3 and 2.9 times higher than their counterparts with normal weight. Above 90% obese adolescents had abdominal obesity, while less than 1% normal weight ones had abdominal obesity. No obese adolescents were free from any risk factors for MetS, while 36.9% of normal weight adolescents were from the risk factors. 83.3% obese boys and all obese girls had metabolic syndrome, while only 15.5% normal weight boys and 18.8% normal weight girls had metabolic syndrome. Four risk factors for metabolic syndrome were found in 8.3% obese boys while none in normal weight boys and girls. The prevalence of MetS among normal weight, overweight, and obesity groups was 1.5%, 18.3%, and 38.1% respectively. Conclusion The cardiovascular disease (CVD) risk factors are clustered in obese Chinese children. Our observations strongly suggest that efforts should be made to prevent the onset of overweight and its associated diseases during early childhood. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies have explored the impact of meteorological factors on the epidemic of COVID-19, their relationship remains controversial and needs to be clarified., Methods: We assessed the risk effect of various meteorological factors on COVID-19 infection using the distributed lag nonlinear model, based on related data from July 1, 2020, to June 30, 2021, in eight countries, including Portugal, Greece, Egypt, South Africa, Paraguay, Uruguay, South Korea, and Japan, which are in Europe, Africa, South America, and Asia, respectively. We also explored associations between COVID-19 prevalence and individual meteorological factors by the Spearman's rank correlation test., Results: There were significant non-linear relationships between both temperature and relative humidity and COVID-19 prevalence. In the countries located in the Northern Hemisphere with similar latitudes, the risk of COVID-19 infection was the highest at temperature below 5 ℃. In the countries located in the Southern Hemisphere with similar latitudes, their highest infection risk occurred at around 15 ℃. Nevertheless, in most countries, high temperature showed no significant association with reduced risk of COVID-19 infection. The effect pattern of relative humidity on COVID-19 depended on the range of its variation in countries. Overall, low relative humidity was correlated with increased risk of COVID-19 infection, while the high risk of infection at extremely high relative humidity could occur in some countries. In addition, relative humidity had a longer lag effect on COVID-19 than temperature., Conclusions: The effects of meteorological factors on COVID-19 prevalence are nonlinear and hysteretic. Although low temperature and relative humidity may lower the risk of COVID-19, high temperature or relative humidity could also be associated with a high prevalence of COVID-19 in some regions., (© 2022. The Author(s).)

Objectives: Short-term temperature variability (TV) is associated with the exacerbation of asthma, but little is known about the relative effects of intra- and inter-day TV. We aimed to assess the relative impacts of intra- and inter-day TV on childhood asthma and to explore the modification effects by season., Methods: A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was adopted to evaluate the nonlinear and lagged effects of TV on childhood asthma in Shanghai from 2009 to 2017. Intra- and inter-day TV was measured with diurnal temperature range (DTR) and temperature changes between neighboring days (TCN), respectively., Results: Increased DTR was associated with the elevated relative risk (RR) of daily outpatient visits for childhood asthma (DOVCA) in both the whole year (RR lag0-14 for the 99th percentile: 1.264, 95% confidence interval (CI): 1.052, 1.518) and cold season (RR lag0-12 for the 99th percentile: 1.411, 95% CI: 1.053, 1.889). Higher TCN in the warm season was associated with the increased RR of DOVCA (RR lag0-14 for the 99th percentile: 2.964, 95% CI: 1.636, 5.373). The number and fraction of DOVCA attributed to an interquartile range (IQR) increase of TCN were higher than those attributed to DTR in both the whole year period and warm season. However, the number and fraction of DOVCA attributed to an IQR increase of DTR were greater than those attributed to TCN in the cold season., Conclusions: Our results provide novel evidence that both intra- and inter-day TV might be a trigger of childhood asthma. Higher DTR appeared to have greater impacts on childhood asthma in the cold season while an increase in TCN seemed to have bigger effects in the warm season., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Growing studies have shown that high temperature is a potential risk factor of schizophrenia occurrence. Therefore, elaborate analysis of different temperature exposure patterns, such as cumulative heat exposure within a time period and transient exposure at a particular time point, is of important public health significance. This study aims to utilize hourly temperature data to better capture the effects of cumulative and transient heat exposures on schizophrenia during the warm season in Hefei, China. We included the daily mean temperature and daily schizophrenia hospitalizations into the distributed lag non-linear model (DLNM) to simulate the exposure-response curve and determine the heat threshold (19.4 °C). We calculated and applied a novel indicator-daily excess hourly heat (DEHH)-to examine the effects of cumulative heat exposure over a day on schizophrenia hospitalizations. Temperature measurements at each time point were also incorporated in the DLNM as independent exposure indicators to analyze the impact of transient heat exposure on schizophrenia. Each increment of interquartile range (IQR) in DEHH was associated with elevated risk of schizophrenia hospitalizations from lag 1 (RR = 1.036, 95% confidence interval (CI): 1.016, 1.057) to lag 4 (RR = 1.025, 95% CI: 1.005, 1.046). Men and people over 40 years old were more susceptible to DEHH. Besides, we found a greater risk of heat-related schizophrenia hospitalizations between 0 a.m. and 6 a.m. This study revealed the adverse effects of accumulated and transient heat exposures on schizophrenia hospitalizations. Our findings need to be further tested in other regions with distinct regional features., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Climate change is a crucial cause of health issues, as reported in many studies. Temperature is one of the important factors related to extreme weather. Chiang Mai, the center of the north of Thailand, is also affected by temperature changes that have led to many outpatient visits. Better information will help the health service to be well-prepared. This research applied typical meteorological data and solar radiation into the distributed lag nonlinear model and a quasi-Poisson regression model. The "hot effect" and "cold effect" on outpatient visits caused by respiratory diseases, dermatophytosis, and intestinal infectious diseases in a public Chiang Mai hospital between January 2015 and December 2019 were then investigated. Of the 185,202 cases, results showed that all of the diseases mentioned had more than 10% of relative risk (RR) in cold effects. However, the RR of dermatophytosis was found to be 114%, a very high risk. In the case of hot effects, the patients of the age 19-29 have relatively high RR over 20% for respiratory diseases and dermatophytosis. It was also observed that cold effects lasted longer than hot effects., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Recently, particulate matter pollution has been worsening, which has been affecting the asthma visits in children. In this study, we assessed the short-term effects of PM 10 and PM 2.5 on asthma visits in children in Shanghai, China from January 1, 2009 and December 31, 2010, using a generalized additive model. We controlled the confounding factors, such as long-term trends, week day effect, and weather elements. The lag effects of different age subgroups (≤ 2 yr, 3-5 yr, and 6-18 yr subgroups) were performed. The results showed significant effects of PM 10 and PM 2.5 on asthma visits in children, though the seasonal lags varied for the three age subgroups. In general, the effect of PM 2.5 on asthma visits in children was stronger and more acute than that of PM 10 . PM 2.5 showed the highest relative risk of 1.192 at lag 0 day in summer; and PM 10 showed the highest relative risk of 1.073 at lag 3 day in autumn. Overall, particulate matter pollution showed a greater effect on relatively younger children. In particular, the ≤ 2 yr subgroup showed the highest seasonal relative risk of PM 10 . Especially, seasonal relative risk of PM 10 in autumn for the ≤ 2 yr subgroup was much higher than that for the other two subgroups. The 3-5 yr and 6-18 yr subgroups showed the highest seasonal relative risk of PM 2.5 in summer and winter, respectively. But the pediatric visits data we obtained cannot reflect the true prevalence of asthma and multiple visits. Thus, selection bias may exist in our analysis., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: We conducted a distributed lag non-linear time series analysis to quantify the association between air pollution and scarlet fever in Qingdao city during 2014-2018., Methods: A distributed lag non-linear model (DLNM) combined with a generalized additive mixed model (GAMM) was applied to quantify the distributed lag effects of air pollutions on scarlet fever, with daily incidence of scarlet fever as the dependent variable and air pollutions as the independent variable adjusted for potential confounders., Results: A total of 6316 cases of scarlet fever were notified, and there were 376 days occurring air pollution during the study period. Scarlet fever was significantly associated with air pollutions at a lag of 7 days with different relative risk (RR) of air pollution degrees [1.172, 95% confidence interval (CI): 1.038-1.323 in mild air pollution; 1.374, 95% CI 1.078-1.749 in moderate air pollution; 1.610, 95% CI 1.163-2.314 in severe air pollution; 1.887, 95% CI 1.163-3.061 in most severe air pollution]., Conclusions: Our findings show that air pollution is positively associated with scarlet fever in Qingdao, and the risk of scarlet fever could be increased along with the degrees of air pollution. It contributes to developing strategies to prevent and reduce health impact from scarlet fever and other non-vaccine-preventable respiratory infectious diseases in air polluted areas., (© 2021. The Author(s).)

Objective: To evaluate the impact of a colorectal cancer (CRC) risk predicting system on CRC mortality rates., Method: An organized population screening program targeted at all the subjects (n = 102,076) at age 40-74 in nine towns of Jiashan county, China was conducted from 2007 to 2012. All of the screening participants were first triaged into high-risk & low-risk groups by a questionnaire and two fecal immunuochemical tests, only the high-risk subjects were subject to colonocopy. The screening participants were surveyed death caused by CRC for a total of six years after the enrollment. The CRC mortality in subgroups of the screening population was analyzed., Results: A total of 82,184 (80.51 % of the targeted population) screening participants were identified. CRC death were recorded for 142 subjects (28.819 per 10 5 person-years). The age-adjusted relative risk(RR) of CRC death in the high-risk subjects (n = 12862, 84.48 per 10 5 person-years) was 3.92 (95 % CI = 2.81-5.49) compared with the low-risk subjects (n = 69322, 18.52 per 10 5 person-years). In the high-risk group, the age-adjusted RR of CRC death for those accepted colonoscopies (51.44 per 10 5 person-years) compared with those refused colonoscopies (187.94 per 10 5 person-years, P < 0.0001) was 0.34 (95 % CI = 0.21-0.56). The first three years after screening has seen the largest difference of CRC death hazard in both comparing groups., Conclusion: The high-risk subjects triaged by the risk predicting system have a higher CRC mortality rate than the low-risk subjects, especially in the first three years after screening. Refusal of colonoscopy is risky behavior for the high-risk subject., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To compare the risk of liver-related adverse drug reactions (ADRs) in children and adults., Study Design: A case/non-case analysis on spontaneous reports based on the China National Adverse Drug Reactions Monitoring System database were conducted, focusing on events of liver-related ADRs in children younger than 14 years of age. Both the relative risk of liver-related ADRs in children vs entire population and the risk stratification in children were expressed as a measure of disproportionality using the reporting odds ratio (ROR)., Results: There were 1206 cases of pediatric liver-related ADRs identified from 2012 to 2016, accounting for 2.82% of the entire population. The greatest ROR values in children from 0 to 14 years vs the entire population were observed for analgesics (3.97, 95% CI 3.27-4.81), respiratory (2.60, 95% CI 1.04-6.43), antineoplastic (2.29, 95% CI 2.02-2.58), immunomodulatory (1.91, 95% CI 1.44-2.53), and antimicrobial agents (1.47, 95% CI 1.33-1.63). Notably, infants aged 0-1 years showed significantly greater risk (3.14, 95% CI 2.85-3.48) of liver-related ADRs than the other age groups of children. For infants, analgesics (3.21, 95% CI 2.20-4.66) and antimicrobials (3.15, 95% CI 2.50-3.97) agents were found to have the greatest adjusted RORs than other drug categories. The highest RORs were found for meropenem, amoxicillin, fluconazole, vancomycin, cefaclor, and ceftazidime in the antimicrobial agents for infants., Conclusions: Children are sensitive to liver-related ADRs caused by several specific drug categories, and infants are the most sensitive., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Understanding the association between floods and bacillary dysentery (BD) incidence is necessary for us to assess the health risk of extreme weather events. This study aims at exploring the association between floods and daily bacillary dysentery cases in main urban areas of Chongqing between 2005 and 2016 as well as evaluating the attributable risk from floods., Methods: The association between floods and daily bacillary dysentery cases was evaluated by using distributed lag non-linear model, controlling for meteorological factors, long-term trend, seasonality, and day of week. The fraction and number of bacillary dysentery cases attributable to floods was calculated. Subgroup analyses were conducted to explore the association across age, gender, and occupation., Results: After controlling the impact of temperature, precipitation, relative humidity, long-term trend, and seasonality, a significant lag effect of floods on bacillary dysentery cases was found at 0-day, 3-day, and 4-day lag, and the cumulative relative risk (CRR) over a 7-lag day period was 1.393 (95%CI 1.216-1.596). Male had higher risk than female. People under 5 years old and people aged 15-64 years old had significantly higher risk. Students, workers, and children had significantly higher risk. During the study period, based on 7-lag days, the attributable fraction of bacillary dysentery cases due to floods was 1.10% and the attributable number was 497 persons., Conclusions: This study confirms that floods can increase the risk of bacillary dysentery incidence in main urban areas of Chongqing within an accurate time scale, the risk of bacillary dysentery caused by floods is still serious. The key population includes male, people under 5 years old, students, workers, and children. Considering the lag effect of floods on bacillary dysentery, the government and public health emergency departments should advance to the emergency health response in order to minimize the potential risk of floods on public.

Introduction: The relative risk (RR) of long-term exposure to PM 2.5 in lung cancer mortality (LCM) may vary spatially in China. However, previous studies applying global regression have been unable to capture such variation. We aimed to employ a geographically weighted Poisson regression (GWPR) to estimate the RRs of LCM among the elderly (≥65 years) related to long-term exposure to PM 2.5 and the LCM attributable to PM 2.5 at the county level in China., Methods: We obtained annual LCM in the elderly between 2013 and 2015 from the National Death Surveillance. We linked annual mean concentrations of PM 2.5 between 2000 and 2004 with LCM using GWPR model at 148 counties across mainland China, adjusting for smoking and socioeconomic covariates. We used county-specific GWPR models to estimate annual average LCM in the elderly between 2013 and 2015 attributable to PM 2.5 exposure between 2000 and 2004., Results: The magnitude of the association between long-term exposure to PM 2.5 and LCM varied with county. The median of county-specific RRs of LCM among elderly men and women was 1.52 (range: 0.90, 2.40) and 1.49 (range: 0.88, 2.56) for each 10 μg/m 3 increment in PM 2.5 , respectively. The RRs were positively significant (P < 0.05) at 95% (140/148) of counties among both elderly men and women. Higher RRs of PM 2.5 among elderly men were located at Southwest and South China, and higher RRs among elderly women were located at Northwest, Southwest, and South China. There were 99,967 and 54,457 lung cancer deaths among elderly men and women that could be attributed to PM 2.5 , with the attributable fractions of 31.4% and 33.8%, respectively., Conclusions: The relative importance of long-term exposure to PM 2.5 in LCM differed by county. The results could help the government design tailored and efficient interventions. More stringent PM 2.5 control is urgently needed to reduce LCM in China., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Accidents in high-danger industries in China occur frequently and cause loss of life, injuries, and economic loss. One of the most important reasons causing severe safety situations is the lack of knowledge on macro industry risk in the practice and academic field in China. In order to solve this problem, the method to calculate group risk and individual risk, concerning risk aversion, is discussed, selected, and improved. The group risks and individual risks of five high-danger industries from 2004 to 2016 are calculated. Relative risk indices between five high-danger industries during the 11 th and 12 th Five-Year Guideline for National Economic and Social Development (FYP) are determined. The results show that there are some differences between group risk and individual risk of high-danger industries. The reasons for differences and the connections with published interventions are discussed. Through discussion, two different ways to reduce group risk and individual risk are identified, which could help supervisors inspect the actual effectiveness of safety policies, measures, and interventions and choose a better way to reduce risk and ensure work safety in industries.

According to the requirements of the Healthy China Program, reasonable assessment of residents' health risks and economic loss caused by urban air pollution is of great significance for environmental health policy planning. Based on the data of PM 2.5 concentration, population density, and urbanization level of 338 Chinese cities in the year of 2015, the epidemiological relative risk (RR) was adopted to estimate the negative health effects caused by exposure to PM 2.5 . Meanwhile, the Value of Statistical Life (VSL) and Cost of Illness (COI) methods were used to calculate economic loss. The results show that PM 2.5 pollution remains serious in 2015, which brings about many people suffering from all kinds of fearful health problems especially premature death and related diseases. The mortality and morbidity increase dramatically, and the total direct economic loss related to PM 2.5 pollution in 2015 was 1.846 trillion yuan, accounting for 2.73% of total annual GDP. In addition, there was a strong correlation between urbanization level and health risks as well as economic loss, which implies that people who live in highly urbanized cities may face more severe health and economic losses. Furthermore, 338 cities were divided into four categories based on urbanization level and economic loss, of which the key areas (type D) were the regions where an increase in monitoring and governance is most needed. In the process of urbanization, policy makers should pay more attention to health costs and regional differentiated management, as well as promote the construction of healthy cities more widely.

Recent epidemiological studies pointed out that air pollution has a significant impact on pediatric asthma. Shanghai is one of the biggest cities in China, and the short-term effect of atmospheric particulate matter on the incidence of pediatric asthma has become a hot topic. From January 1, 2009, to December 31, 2010, we used daily measurements of pollutant concentrations, daily weather data, and daily records of pediatric asthma hospital visits from local authorities to evaluate the short-term effect of air pollution on pediatric asthma incidence in Shanghai, China. We used a generalized additive model (GAM) in the analysis, and the controlled confounding factors include long-term trends, day-of-the-week effects, and weather elements. We divided the entire study group into different age-subgroups. In addition, we took a variety of lag models into consideration. The results showed a strong connection between concentrations of fine particulate matter (PM 2.5 ) and pediatric asthma hospital visits from 2009 to 2010 in Shanghai, China. For the entire study group, the greatest relative risk (RR) of PM 2.5 on pediatric asthma hospital visits was 1.060 on a lag of 4 days. As for the three different age-subgroups, the greatest RR of PM 2.5 on pediatric asthma hospital visits was 1.061 (at a lag of 5 days), 1.071 (at a lag of 4 days), and 1.052 (at a lag of 2 days), for the under-2-year-olds, 3-to-5-year-olds, and the 6-to-18-year-olds, respectively. The overall short-term effect of PM 2.5 on pediatric asthma hospital visits was relatively stronger in younger children. Within the year, we detected the strongest seasonal effect of PM 2.5 on pediatric asthma hospital visits in Summer. When adding other air pollutants in the analysis model, RR of PM 2.5 on pediatric asthma hospital visits would be increased.

Background: Evidence on the potential roles that dietary patterns play in the risk of preeclampsia remains limited., Objective: To examine the associations between dietary patterns during pregnancy and the risk of preeclampsia., Study Design: We analyzed data from a cluster randomized controlled trial among 987 healthy pregnant women in three rural counties in northwestern China. Maternal diet during the whole pregnancy was assessed using a 107-item food frequency questionnaire with proportion size administered before delivery. Principal component factor analysis with varimax rotation was used to identify common dietary patterns. Preeclampsia was diagnosed by trained clinicians and recorded in delivery records., Results: Nineteen participants (1.9%) were diagnosed with preeclampsia. Gestational hypertension and proteinuria were only weakly correlated with each other (Kappa = 0.06): 10.7% participants with gestational hypertension only, 8.8% with proteinuria only, 1.9% with both, and 78.6% with neither. Five common dietary patterns were identified: vegetable, meat, fruit, snack, and wheat staple patterns. After adjusting for calories, other dietary pattern scores and baseline blood pressure, a higher vegetable pattern scores was associated with lower risk of preeclampsia (P for trend = 0.041; the highest vs lowest quartile, adjusted relative risk = 0.20 [95% confidence interval, 0.04-0.98]). A similar association was also observed for the risk of proteinuria (P for trend = 0.015): the highest vs lowest quartiles of the vegetable pattern score, adjusted relative risk = 0.44 (95% confidence interval, 0.24-0.80). The other four pattern scores were not associated with preeclampsia., Conclusions: Adherence to vegetable dietary pattern may be associated with the lower risk of preeclampsia, possibly through reducing development of proteinuria. The original full study was registered at clinicaltrials.gov as NCT02537392., (Copyright © 2019 International Society for the Study of Hypertension in Pregnancy. All rights reserved.)

Objectives: This study aims to estimate the impact of heatwaves from July 2010 to October 2012 on daily outpatient visits for respiratory disease (RD) in Cangnan, China and identify vulnerable populations., Methods: The definition of heatwave was a period at least 3 consecutive days with maximum temperature exceeding 35 °C in this study. A time-stratified case-crossover design was conducted to examine the relationship between heatwaves and outpatient visits for RD. Patient data for the period from 2010 to 2012 were collected from the Third People's Hospital of Cangnan and daily meteorological data for the same period were collected from the China Meteorological Data Service Center. Data regarding the air pollution index (API), a composite indicator of air pollution, were collected from the Data Center of the Chinese Ministry of Environmental Protection. RD were identified based on the 10th revision International Classification of Diseases (ICD-10) codes (J00-J99). A conditional Poisson regression model was applied to examine the heatwave-RD association using the Relative Risk (RR) while adjusting for meteorological and air pollution factors including temperature, rainfall, wind speed, pressure, humidity, sunshine hours and API., Results: During the study period, 4 heatwaves occurred and a total of 1732 outpatient visits for RD were reported. Heatwaves increased the frequency of RD outpatient visits and the highest RR of total RD was 1.155% and 95% Confidence Intervals (95% CI) was 1.084-1.232 at Lag 0. For subcategories, heatwaves increased the risk of infectious RD (Lag 0: RR =1.182, 95% CI: 1.106-1.263) and decreased the risk of non-infectious RD ((Lag 6: RR =0.750, 95% CI: 0.568-0.990). Moreover, heatwaves showed adverse effects on acute upper respiratory infection (Lag 0: RR =1.306, 95% CI: 1.177-1.450). The RR of outpatient visits for RD was statistically significant in females (Lag 0: RR =1.161, 95% CI: 1.046-1.298), males (Lag 4: RR =1.161, 95% CI: 1.096-1.261), young people aged 4-17 years (Lag 0: RR =1.741, 95% CI: 1.524-1.990) and elders aged 65 years or older (Lag 5: RR =1.412, 95% CI: 1.111-1.794) during heatwaves., Conclusions: Heatwaves had a significant harmful impact on daily outpatient visits for RD in Cangnan, especially for vulnerable population identified. These results can be used not only to strengthen the health education and protection of these vulnerable populations, but also to assist relevant organizations with developing intervention programmes and improving disease prevention and community care., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This study discusses the changes in the daily average concentrations of the main air pollutants, such as PM 10 , PM 2.5 , O 3 , and NO 2 , in Shanghai, and the effects of air pollution on cold in Shanghai. For this study, data on air pollutants, meteorological factors, and the number of daily hospital visits from cold in Shanghai were collected from January 1, 2008 to December 31, 2010. Using the time series Poisson semi-parametric generalized additive model, and controlling for the long-term trend, "week" effect, and meteorological factors by smoothing the spline function, the exposure-response relationship between air pollution and human health in Shanghai was analyzed. The study sets up the model according to age, evaluating the impact and the lag effect of air pollution on the number of daily hospital visits. Results show that when PM 10 , NO 2 , O 3 , and PM 2.5 increase by an IQR, the relative risk of cold disease is 1.0240 (1.0233-1.0246), 1.0206 (1.0201-1.0212), 0.9393 (0.9384-0.9402), and 1.0080 (1.0069-1.0086), and when PM 10 , NO 2 , O 3 , and PM 2.5 increase by 10 μg·m -3 , the daily hospital visits increase by 0.5%, 1.0%, -2.0%, and 0.2%. In the multi-polluted model, the results of NO 2 and PM 2.5 are basically lower compared to the results of the single-pollutant model, the results of PM 10 and O 3 are higher. Air pollution in Shanghai has an impact on the incidence of cold disease.

Objectives: Zhengzhou, Kaifeng and Xinxiang, the cities in the north central region of Henan Province, suffered from many times floods from 2004 to 2009. We focused on dysentery disease consequences of floods and examined the association between floods and the morbidity of dysentery, based on a longitudinal data., Methods: A generalized additive mixed model was conducted to examine the relationship between the monthly morbidity of dysentery and floods from 2004 to 2009 in the study areas. The relative risks (RRs) of the floods risk on the morbidity of dysentery were estimated in each city and the whole region., Results: The RRs on dysentery were 11.47 (95% CI: 8.67-15.33), 1.35 (95% CI: 1.23-3.90) and 2.75 (95% CI: 1.36-4.85) in Kaifeng, Xinxiang and Zhengzhou, respectively. The RR on dysentery in the whole region was 1.66 (95% CI: 1.52-1.82)., Conclusions: Our study confirms that flooding has significantly increased the risk of dysentery in the study areas. Additionally, we observed that a sudden and severe flooding can contribute more risk to the morbidity of dysentery than a persistent and moderate flooding. Our findings have significant implications for developing strategies to prevent and reduce health impact of floods., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Migrant workers now represent an increasing percentage of workers in Korea, but few studies have evaluated work-related health risks in this population. In this study, we explored the relative risk of occupational injuries and diseases in migrant workers compared with native Korean workers., Method: An analysis of work-related injuries and diseases among migrant workers in Korea during 2005-2007 was conducted in each industrial subsector using nationwide data., Results: Risks of fatal and non-fatal occupational injuries for migrant workers were considerably higher than their Korean counterparts. The industry-adjusted standard mortality ratios of fatal occupational injuries were 1.89 (1.45-2.47), 2.29 (1.81-2.88), and 1.73 (1.36-2.22) for 2005, 2006, and 2007, respectively., Conclusions: A greater proportion of migrant workers is exposed to higher risks of occupational safety and health issues than their Korean counterparts, demonstrating that the occupational safety and health of migrant workers requires more attention than that of Korean workers., (© 2014 Wiley Periodicals, Inc.)

Background: Xinxiang, a city in Henan Province, suffered from frequent floods due to persistent and heavy precipitation from 2004 to 2010. In the same period, dysentery was a common public health problem in Xinxiang, with the proportion of reported cases being the third highest among all the notified infectious diseases., Objectives: We focused on dysentery disease consequences of different degrees of floods and examined the association between floods and the morbidity of dysentery on the basis of longitudinal data during the study period., Design: A time-series Poisson regression model was conducted to examine the relationship between 10 times different degrees of floods and the monthly morbidity of dysentery from 2004 to 2010 in Xinxiang. Relative risks (RRs) of moderate and severe floods on the morbidity of dysentery were calculated in this paper. In addition, we estimated the attributable contributions of moderate and severe floods to the morbidity of dysentery., Results: A total of 7591 cases of dysentery were notified in Xinxiang during the study period. The effect of floods on dysentery was shown with a 0-month lag. Regression analysis showed that the risk of moderate and severe floods on the morbidity of dysentery was 1.55 (95% CI: 1.42-1.670) and 1.74 (95% CI: 1.56-1.94), respectively. The attributable risk proportions (ARPs) of moderate and severe floods to the morbidity of dysentery were 35.53 and 42.48%, respectively., Conclusions: This study confirms that floods have significantly increased the risk of dysentery in the study area. In addition, severe floods have a higher proportional contribution to the morbidity of dysentery than moderate floods. Public health action should be taken to avoid and control a potential risk of dysentery epidemics after floods.