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Background: Atrial fibrillation (AF) is highly prevalent in the population, yet the factors contributing to AF events in susceptible individuals remain partially understood. The potential relationship between meteorological factors and AF, particularly with abnormal electrocardiograph (ECG) repolarization, has not been adequately studied. This case-crossover study aims to investigate the association between meteorological factors and daily hospital visits for AF with abnormal ECG repolarization in Shanghai, China. Methods: The study cohort comprised 10,325 patients with ECG-confirmed AF who sought treatment at Shanghai Sixth People's Hospital between 2015 and 2018. Meteorological and air pollutant concentration data were matched with the patient records. Using a case-crossover design, we analyzed the association between meteorological factors and the daily count of hospital visitors for AF with abnormal ECG repolarization at our AF center. Lag analysis models were applied to examine the temporal relationship between meteorological factors and AF events. Results: The analysis revealed statistically significant associations between AF occurrence and specific meteorological factors. AF events were significantly associated with average atmospheric pressure (lag 0 day, OR 0.9901, 95% CI 0.9825–0.9977, P < 0.05), average temperature (lag 1 day, OR 0.9890, 95% CI 0.9789–0.9992, P < 0.05), daily pressure range (lag 7 days, OR 1.0195, 95% CI 1.0079–1.0312, P < 0.01), and daily temperature range (lag 5 days, OR 1.0208, 95% CI 1.0087–1.0331, P < 0.01). Moreover, a significant correlation was observed between daily pressure range and daily temperature range with AF patients, particularly those with abnormal ECG repolarization, as evident in the case-crossover analysis. Conclusion: This study highlights a significant correlation between meteorological factors and daily hospital visits for AF accompanied by abnormal ECG repolarization in Shanghai, China. In addition, AF patients with abnormal ECG repolarization were found to be more vulnerable to rapid daily changes in pressure and temperature compared to AF patients without such repolarization abnormalities. [ABSTRACT FROM AUTHOR]

Background: Childhood atopic dermatitis (AD) is an inflammatory skin disease which sometimes predisposes to allergies. Environmental factors (low humidity, irritants, etc.) are prominent causative triggers of AD.Objectives: This study aims to explore the effects of both meteorological factors and air pollutants on childhood AD, and the modification effects by season in Shanghai, China.Methods: Quasi-Poisson generalized linear regression model, combined with a distributed lag nonlinear model was used to examine the nonlinear and lagged effects of environmental factors on childhood AD from 2009 to 2017 in Shanghai. We also performed a season-stratified analysis to determine the modification effects of environmental exposure by season on childhood AD.Results: There were 1,043,240 outpatient visits for childhood AD in total, at 3 major pediatric hospitals. Low temperature and relative humidity (RH), and high daily temperature difference (DTD) and air pollutants (i.e., NO2) increased the relative risks (RRs) of outpatient visits for childhood AD in the whole year. In the cold season, an increased risk of outpatient visits for childhood AD was associated with low RH (RR 2.26, 95% CI 1.69-3.02) and high NO2 (1.11, 95% CI 1.06-1.17). In the warm season, outpatient visits for childhood AD were associated with low temperature (3.49, 95% CI 3.22-3.77), low RH (1.89, 95% CI 1.74-2.06), high DTD (1.41, 95% CI 1.31-1.53), and high NO2 (1.05, 95% CI 1.03-1.06).Conclusions: This study suggests that environmental exposure may be a key trigger for outpatient visits for childhood AD with apparent seasonal effects. Tailored preventive strategies to avoid environmental triggers of childhood AD should be developed. [ABSTRACT FROM AUTHOR]

Background: Childhood asthma and allergic diseases are a significant global problem. There are inconsistent findings on the associations of delivery mode, the number of children in the household and breastfeeding with childhood asthma and allergic diseases. We assessed these associations and examined whether breastfeeding modified the effects of neonatal and familial risk factors on childhood asthma and allergic diseases.Methods: A population-based cross-sectional study was conducted in Shanghai, China. A total of 17 primary schools were randomly selected from 13 districts of Shanghai in this study. The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma and allergic diseases. Multivariable logistic regression models were used to evaluate the associations between neonatal and familial factors and childhood asthma and allergic diseases, and to examine the modification effects of breastfeeding on the associations assessed.Results: Of 10,464 primary school children aged 6-11 years, the overall prevalence of childhood asthma, allergic rhinitis, urticaria, food allergy and drug allergy was 13.9, 22.7, 15.3, 8.1 and 4.6%, respectively. Male sex, high socioeconomic status, cesarean section delivery, only one child in the household and having family history of allergy were associated with increased odds ratio (OR) of childhood asthma and allergic diseases while longer breastfeeding duration (> 6 months) was inversely associated with these diseases. Longer breastfeeding duration also attenuated the OR of neonatal and familial risk factors on childhood asthma and allergic diseases. For instance, the adjusted OR of childhood asthma in the group of vaginal delivery and breastfeeding duration > 6 months was lowest (0.78, 95% confidence interval: 0.66, 0.92).Conclusions: Longer breastfeeding duration was inversely associated with childhood asthma and allergic diseases, and also reduced the OR of neonatal and familial risk factors on these diseases. Giving the prevalence of childhood asthma and allergic diseases is rapidly rising across the globe, these findings may have important clinical and public health implications. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to perform an exposure assessment of PM2.5 (particulate matter less than 2.5μm in aerodynamic diameter) among children and to explore the potential sources of exposure from both indoor and outdoor environments. Methods: In terms of real-time exposure measurements of PM2.5, we collected data from 57 children aged 8–12 years (9.64 ± 0.93 years) in two schools in Shanghai, China. Simultaneously, questionnaire surveys and time-activity diaries were used to estimate the environment at home and daily time-activity patterns in order to estimate the exposure dose of PM2.5 in these children. Principle component regression analysis was used to explore the influence of potential sources of PM2.5 exposure. Results: All the median personal exposure and microenvironment PM2.5 concentrations greatly exceeded the daily 24-h PM2.5 Ambient Air Quality Standards of China, the USA, and the World Health Organization (WHO). The median Etotal (the sum of the PM2.5 exposure levels in different microenvironment and fractional time) of all students was 3014.13 (μg.h)/m3. The concentration of time-weighted average (TWA) exposure of all students was 137.01 μg/m3. The median TWA exposure level during the on-campus period (135.81 μg/m3) was significantly higher than the off-campus period (115.50 μg/m3, P = 0.013 < 0.05). Besides ambient air pollution and meteorological conditions, storey height of the classroom and mode of transportation to school were significantly correlated with children’s daily PM2.5 exposure. Conclusions: Children in the two selected schools were exposed to high concentrations of PM2.5 in winter of 2013 in Shanghai. Their personal PM2.5 exposure was mainly associated with ambient air conditions, storey height of the classroom, and children’s transportation mode to school. [ABSTRACT FROM AUTHOR]

Severe air pollution events still occur frequently in Shanghai. In order to predict when Shanghai air quality satisfies the National Ambient Air Quality Standards of China (NAAQSC) and identify potential source areas of criteria air pollutants for the regional joint prevention and control of air pollution, concentration data of PM 2.5 , PM 10 , SO 2 , NO 2 and O 3 were collected in 2014–2022 at fourteen monitoring sites across Shanghai and surrounding areas. A first – order rate equation with harmonic regression analysis was employed for time series analysis and concentration prediction. Decreasing concentrations were observed widely over all sites except O 3 and NO 2. It is very likely that the secondary NAAQSC standards for PM x , and SO 2 would be met by 2025 and O 3 and NO 2 would likely become the critical pollutants that determine air quality level after 2025. Regional transport was predominant for PM x and SO 2 pollution. A 3D – CWT multisite joint location method was developed to identify their potential source areas at different spatial resolutions. Weighting function correction was assigned via information entropy of endpoint numbers in each cell. A probabilistic parameter WI PSA was proposed to quantify and normalize the probability that grid cells are source areas in order to achieve fourteen – site joint location, and it was comparable and compatible at different spatial resolutions. Potential source areas of PM 2.5 and PM 10 were similar, including Henan, Shandong, Hebei and Anhui, while origin domains of SO 2 mainly covered Henan and Hebei. In all seasons, air pollution that was transported to Shanghai (i.e., PM x and SO 2) originated mainly from the North China Plain; the contribution of marine sources was neglectable. [Display omitted] • Declining concentrations of PM x and SO 2 were observed widely in Shanghai. • Local secondary standards for PM x and SO 2 would likely be met by 2025. • Regional transport was predominant for PM x and SO 2 pollution. • 3D-CWT multisite joint location identified accurately their potential source areas. • In all seasons Shanghai PM pollution originated mainly from the North China Plain. [ABSTRACT FROM AUTHOR]

Inconsistent evidence exists about whether exposure to greenspace benefits childhood asthma. Previous studies have only focused on residential or school greenspace, and no research has combined greenspace exposures at both homes and schools to determine their link with childhood asthma. A population-based cross-sectional study was conducted among 16,605 children during 2019 in Shanghai, China. Self-reported questionnaires were used to collect information on childhood asthma and demographic, socioeconomic and behavioural factors. Environmental data including ambient temperature, particulate matter with aerodynamic diameter less than 1 µm (PM 1), enhanced vegetation index (EVI), and normalized difference vegetation index (NDVI) were collected from satellite data. Binomial generalized linear models with a logit link were carried out to evaluate the association between greenspace exposure and children's asthma, as well as the effect modifiers. An interquartile range increment of whole greenspace (NDVI 500 , NDVI 250 , EVI 500 , and EVI 250) exposure was associated with a reduced odds ratio of children's asthma (0.88, 95% CI: 0.78, 0.99; 0.89, 95% CI: 0.79, 1.01; 0.87, 95% CI: 0.77, 0.99; and 0.88, 95% CI: 0.78, 0.99, respectively) after controlling potential confounders. Low temperature, low PM 1 , males, vaginal delivery, suburban/rural area, and without family history of allergy appeared to enhance the greenspace-asthma association. Increased greenspace exposure was associated with a lower risk of childhood asthma, and the association was modified by a range of socio-environmental factors. These findings add to the body of evidence on the benefits of biodiversity and supporting the promotion of urban greenspace to protect children's health. • It's the first study on whole greenspace near home and school and children's asthma. • Higher greenspace exposure was associated with lower risks of childhood asthma. • A range of socio-environmental factors modified the greenspace-asthma association. [ABSTRACT FROM AUTHOR]

Atmospheric deposition of polycyclic aromatic hydrocarbons (PAHs) onto soil threatens terrestrial ecosystem. To locate potential source areas geographically, a total of 139 atmospheric bulk deposition samples were collected during 2012–2019 at eight sites in Shanghai and its surrounding areas. A multisite joint location method was developed for the first time to locate potential source areas of atmospheric PAHs based on an enhanced three dimensional concentration weighted trajectory model. The method considered spatial and temporal variations of atmospheric boundary layer height and homogenized all results over the eight sites via geometric mean. Regional transport was an important contributor of PAH atmospheric deposition while massive local emissions may disturb the identification of potential source areas. Northwesterly winds were associated with elevated deposition fluxes. Potential source areas were identified by the multisite joint location method and included Hebei, Tianjin, Shandong and Jiangsu to the north, and Anhui to the west of Shanghai. PM and SO 2 data from the national ground monitoring stations confirmed the identified source areas of deposited PAHs in Shanghai. [Display omitted] • Significant declining trends of PAH deposition fluxes were observed in Shanghai. • Local emission accounted for 25–73% of the total deposition fluxes. • Regional transport from the northern and western parts of China had a great impact. • A multisite joint location method is proposed to screen emission areas of PAHs. • It provides an evidence to support effectiveness of the Clean Air Action of China. [ABSTRACT FROM AUTHOR]

No prior studies in China have investigated the health impact of cold spell. In Shanghai, we defined the cold spell as a period of at least seven consecutive days with daily temperature below the third percentile during the study period (2001-2009). Between January 2001 and December 2009, we identified a cold spell between January 27 and February 3, 2008 in Shanghai. We investigated the impact of cold spell on mortality of the residents living in the nine urban districts of Shanghai. We calculated the excess deaths and rate ratios (RRs) during the cold spell and compared these data with a winter reference period (January 6-9, and February 28 to March 2). The number of excess deaths during the cold spell period was 153 in our study population. The cold spell caused a short-term increase in total mortality of 13 % (95 % CI: 7-19 %). The impact was statistically significant for cardiovascular mortality (RR = 1.21, 95 % CI: 1.12-1.31), but not for respiratory mortality (RR = 1.14, 95 % CI: 0.98-1.32). For total mortality, gender did not make a statistically significant difference for the cold spell impact. Cold spell had a significant impact on mortality in elderly people (over 65 years), but not in other age groups. Conclusively, our analysis showed that the 2008 cold spell had a substantial effect on mortality in Shanghai. Public health programs should be tailored to prevent cold-spell-related health problems in the city. [ABSTRACT FROM AUTHOR]

Abstract: This study was designed to assess the association between visibility and air quality, and to determine whether the variations in daily mortality were associated with fluctuations in visibility levels in Shanghai, China. Mortality data were extracted from the death certificates, provided by Shanghai Municipal Center of Disease Control and Prevention, and visibility data were obtained from Shanghai Municipal Bureau of Meteorology. Air quality data (PM10, PM2.5, PM10–2.5, SO2, NO2 and O3) were obtained from Shanghai Environmental Monitoring Center. Generalized additive model (GAM) with penalized splines was used to analyze the mortality, visibility, air pollution, and covariate data. Among various pollutants, PM2.5 showed strongest correlation with visibility. Visibility, together with humidity, was found appropriate in predicting PM2.5 (R-squared: 0.64) and PM10 (R-squared: 0.62). Decreased visibility was significantly associated with elevated death rates from all causes and from cardiovascular disease in Shanghai; one inter-quartile range (8 km) decrease in visibility corresponded to 2.17% (95%CI: 0.46%, 3.85%), 3.36% (95%CI: 0.96%, 5.70%), and 3.02% (95%CI: −1.32%, 7.17%) increase of total, cardiovascular and respiratory mortality, respectively. The effect estimates using predicted PM2.5 and PM10 concentrations were similar to those assessed using actual concentrations. This is the first study in Mainland China assessing the association between visibility and adverse health outcomes. Our findings suggest the possibility of using visibility as a surrogate of air quality in health research in developing countries where air pollution data might be scarce and not routinely monitored. [Copyright &y& Elsevier]

Various factors can modify the health effects of temperature. Prior findings about modifiers are inconsistent, and such studies have been conducted mostly in developed countries. We conducted a time-series analysis to examine the modifying effect of gender, age and education on the association between temperature and daily mortality in Shanghai, China, using 4 years (2001-2004) of daily data. A natural spline model was used to analyze the data. Elderly subjects were found to be more vulnerable to temperature health effects compared with younger people. We observed no significant modifying effect of gender or education level. These findings may provide useful information for local governments seeking to take steps to protect vulnerable sub-populations. [ABSTRACT FROM AUTHOR]

The integrated wind risk warning model for rail transport presented has four elements: Background wind data, a wind field model, a vulnerability model, and a risk model. Background wind data uses observations in this study. Using the wind field model with effective surface roughness lengths, the background wind data are interpolated to a 30-m resolution grid. In the vulnerability model, the aerodynamic characteristics of railway vehicles are analyzed with CFD (Computational Fluid Dynamics) modelling. In the risk model, the maximum value of three aerodynamic forces is used as the criteria to evaluate rail safety and to quantify the risk level under extremely windy weather. The full model is tested for the Shanghai Metro Line 16 using wind conditions during Typhoon Chan-hom. The proposed approach enables quick quantification of real-time safety risk levels during typhoon landfall, providing sophisticated warning information for rail vehicle operation safety. [ABSTRACT FROM AUTHOR]

Abstract: No prior studies exist in Mainland China examining the association of outdoor air pollution with hospital admissions. In this study, we conducted a time-series analysis to examine the association of outdoor air pollutants (PM10, SO2, and NO2) with both total and cause-specific hospital admission in Shanghai, using three years of daily data (2005–2007). Hospital admission and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Natural spline model was used to analyze the data. We found outdoor air pollution was associated with increased risk of total and cardiovascular hospital admission in Shanghai. The effect estimates of air pollutants varied by lag (L) structures of pollutants’ concentrations. For lag 5, a 10μg/m3 increase in concentration of PM10, SO2 and NO2 corresponded to 0.18% (95% CI: −0.15%, 0.52%), 0.63% (95% CI: 0.03%, 1.23%), and 0.99% (95% CI: 0.10%, 1.88%) increase of total hospital admission; and 0.23% (95% CI: −0.03%, 0.48%), 0.65% (95% CI: 0.19%, 1.12%), and 0.80% (95% CI: 0.10%, 1.49%) increase of cardiovascular hospital admission. The associations appeared to be more evident in the cool season (from November to April) than in the warm season (from May to October). We found significant effects of gaseous pollutants (SO2 and NO2) after adjustment for PM10. Our analyses provide the first evidence in China that the current air pollution level has an effect on hospital admission and strengthen the rationale for further limiting air pollution levels in Shanghai. [Copyright &y& Elsevier]

Abstract: Few studies exist in China examining the association of ambient air pollution with morbidity outcomes. We conducted a time-series analysis to examine the association of outdoor air pollutants (PM10, SO2, and NO2) with hospital outpatient and emergency room visits in Shanghai, China, using 3years of daily data (2005–2007). Hospital and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Using a natural spline model, we examined effect of air pollutants with different lag structures including both single-day lag and multi-day lag. We examined effects of air pollution for the warm season (from April to September) and cool season (from October to March) separately. We found outdoor air pollution (SO2 and NO2) was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. The effect estimates varied for different lag structures of pollutants’ concentrations. For lag 3, a 10μg/m3 increase in concentration of PM10, SO2 and NO2 corresponded to 0.11% (95%CI: −0.03%, 0.26%), 0.34% (95%CI: 0.06%, 0.61%) and 0.55% (95%CI: 0.14%, 0.97%) increase of outpatient visit; and 0.01% (95%CI: −0.09%, 0.10%), 0.17% (95%CI: 0.00%, 0.35%) and 0.08% (95%CI: −0.18%, 0.33%) increase of emergency room visit. The associations appeared to be more evident in the cool season than in the warm season. In conclusion, short-term exposure to outdoor air pollution was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. Our analyses provide evidence that the current air pollution level has an adverse health effect and strengthen the rationale for further limiting air pollution levels in the city. [Copyright &y& Elsevier]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

There has been increasing interest in identifying the adverse effects of ambient environmental factors on asthma exacerbations (AE), but season-stratified effects of meteorological factors on childhood asthma remain unclear. We explored the season-stratified effects of meteorological factors on childhood AE in Shanghai, China. Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to examine the lagged and nonlinear effects of meteorological factors on childhood AE after adjustment for putative confounders. We also performed a season-stratified analysis to determine whether the season modified the relationship between meteorological factors and childhood AE. There were 23,103 emergency department visits (EDVs) for childhood AE, including 15,466 boys and 7637 girls during 2008–2017. Most meteorological factors (e.g., temperature, diurnal temperature range (DTR), relative humidity (RH) and wind speed (WS)) were significantly associated with EDVs for childhood AE, even after adjustment for the confounding effects of air pollutants. In the whole year, extreme cold, moderate heat, higher DTR, lower RH and WS increased the relative risk (RR) for childhood AE. In the cold season, lower RH and wind speed increased the risks of childhood AE (RR lag0-28 for the 5th percentile (p5) of RH: 9.744, 95% CI: 3.567, 26.616; RR lag0-28 for the p5 of wind speed: 10.671, 95% CI: 1.096, 103.879). In the warm season, higher temperature and DTR, lower RH and WS increased the RR for childhood AE (RR lag0-5 for the p95 of temperature: 1.871, 95% CI: 1.246, 2.810; RR lag0-2 for the p95 of DTR: 1.146, 95% CI: 1.010, 1.300; RR lag0-5 for the p5 of RH: 1.931, 95% CI: 1.191, 3.128; RR lag0-2 for the p5 of WS: 1.311, 95% CI: 1.005, 1.709). Extreme meteorological factors appeared to be triggers of EDVs for childhood AE in Shanghai and the effects modified by season. These findings provide evidence for developing season-specific and tailored strategies to prevent and control childhood AE. • Extreme meteorological conditions increased emergency department visits for childhood asthma. • The effects of meteorological factors on childhood asthma were markedly seasonal and lagged. • There was a "U" type of association between maximum and mean temperatures and risk for childhood asthma. • Non-optimal temperature, humidity, diurnal temperature range and wind speed were potential triggers of childhood asthma. [ABSTRACT FROM AUTHOR]