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BackgroundThe substantial health damage attributed to heat waves, along with their increasing intensity and frequency in the context of global warming, highlights the importance of exploring the health effects of heat waves. ObjectiveTo calculate the excess heat stroke cases during heat waves in the summer of 2013—2023 in Shanghai, analyze the association between heat waves and heat stroke, and to further explore the modifying effects of heat wave characteristics on heat stroke. MethodsUsing a retrospective ecological study design, data on heat stroke cases were collected from the heat stroke case reporting system of the Chinese Center for Disease Control and Prevention, and concurrent meteorological data from Xujiahui Meteorological Station. A heat wave was defined as at least 3 consecutive days with daily maximum temperature meeting or exceeding 35 ℃ in this study, excess heat stroke cases related to heat waves were assessed as the difference between the numbers of heat stroke cases observed on a given day and the corresponding 31 d (15 d before and after that day) moving average, and statistical analyses using generalized linear model based on time series study were performed to assess the impact of heat waves on heat stroke. ResultsOverall 25 heat waves during the study period were observed, leading to a total of estimated 792.6 extra heat stroke cases. The risk of heat stroke significantly increased during heat waves (RR=2.60, 95%CI: 2.08, 3.26), but no statistically significant differences in heat wave effects were observed among different genders, ages, or regions. In terms of the timing of heat waves, the risk of heat stroke was highest during the first heat wave (RR=3.58, 95%CI: 2.82, 4.55), which was significantly higher than that during the second heat wave (RR=2.19, 95%CI: 1.66, 2.90), and no significant effect was observed during the third or subsequent heat waves. The impact of heat waves on heat stroke persisted for more than 4 d, with the risk higher on the fourth day and beyond (RR=2.95, 95%CI: 2.28, 3.83), significantly higher than on the first day of heat wave (RR=1.74, 95%CI: 1.18, 2.56). ConclusionHeat waves had a substantial effect on heat stroke in Shanghai from 2013 to 2023, and special attention need to be paid to heat waves with early onset and long duration.

BackgroundThe Qingcaosha Reservoir is facing issues of algal blooms and eutrophication, and the resulting increase in the level of chlorination disinfection by-products in the water has been a major concern. ObjectiveTo evaluate the impact of "Algae Monitoring and Control Program in Qingcaosha Reservoir" (hereinafter referred to as the program) on the control of trihalomethanes (THMs) in conventional finished water. MethodsFrom 2011 to 2019, water samples were collected from the Lujiazui Water Plant once per season, one sample each time, and the concentrations of four THMs (trichloromethane, dichlorobromomethane, monochlorodibromomethane, and tribromomethane) were measured in the samples. Using 2014 when the program was implemented as a cut-off point, the entire study period was divided into two phases: pre-implementation (2011–2013) and post-implementation(2014–2019). Segmented linear regression with interrupted time series analysis was applied to assess the concentrations and trends of THMs in the finished water before and after the program launch. ResultsThe concentration of total THMs in finished water increased by 1.561 µg·L−1 (P=0.010) for each season of time extension before launching the program. The change in the concentration of total THMs in finished water was not statistically significant after the program launch, but the THMs concentration showed a decreasing trend as the slope was −0.626 (P=0.001). From 2017 until the end of 2019, the average concentration of THMs in finished water of Lujiazui Water Plant dropped to 10 μg·L−1 or less.ConclusionsThe algae and eutrophication control measures in Qingcaosha Reservoir have achieved good results, controlling THMs in finished water at a low level, and the trend of THMs has changed from a yearly increase pattern before the program to a yearly decrease pattern after the program.

BackgroundHeat stroke is a severe heat-related illness, and it is necessary to explain in depth the effect of high temperature on heat stroke in the context of global warming. ObjectiveTo describe the epidemiological characteristics of reported heat stroke cases in Shanghai from 2013 to 2022, analyze the influence of daily mean temperature threshold on heat stroke, and identify susceptible populations, so as to provide data support for the development of relevant social and public policies. MethodsData from case reports on heat stroke were collected in Shanghai from 2013 to 2022. Heat stroke associated daily mean temperature threshold, lag effects, and susceptible populations were estimated using piecewise regression model and distributed lag non-linear model. ResultsAmong the 3479 cases reported from June to August of 2013—2022 in Shanghai, the male-to-female ratio was 3.34. A positive association between daily mean temperature and heat stroke was found, the association was strongest on the day of exposure and persisted until lag day 2, with an estimated threshold at 33.1 ℃. Using the median value of daily mean temperature as the reference value (28.1 ℃), the peak cumulative effect of extreme high temperature (33.1 ℃) appeared at lag 0-2 days with a relative risk (RR) value and its 95%CI of 25.32 (17.49-36.64) for all included cases; the RRs for male and female were 26.33 (17.78, 38.98) and 25.20 (12.52, 50.72), respectively, and no statistically significant difference was found between sexes (P＞0.05); the RRs were much greater in population aged 45-64 years (25.17, 95%CI: 15.54, 40.78) and 65 years and above (76.98, 95%CI: 34.80, 170.30), significantly higher than the values in those aged 16-44 years (20.22, 95%CI: 12.22, 33.44) (P＜0.05); urban areas showed a greater RR (49.09, 95%CI: 19.60, 122.95) than rural areas (23.65, 95%CI: 16.13, 34.67) (P＜0.05). ConclusionHigh temperature is significantly associated with heat stroke cases reported in Shanghai, with a threshold of 33.1℃ for daily mean temperature. The middle-aged and elderly adults and urban residents are more vulnerable to heat stress than those younger and living in rural areas.

BackgroundNon-occupational carbon monoxide (CO) poisoning is a public health problem that seriously affect people’s health and lives. ObjectiveTo describe the prevalence of non-occupational CO poisoning during 2007—2018 in Shanghai, analyze its epidemiological characteristics and potential influencing factors, and explore effective prevention and control measures. MethodsDaily reported non-occupational CO poisoning cases and meteorological factors from 2007 to 2018 were collected in Shanghai, epidemiological characteristics were analyzed by descriptive epidemiology methods, and a distributed lag nonlinear model was used to assess the association between temperature and non-occupational CO poisoning. ResultsA total of 2264 non-occupational CO poisoning events and 3866 cases from 2007 to 2018 were reported in Shanghai, including 59 death cases. More than half of the poisoning cases were female (56.3%), and young adults accounted for more cases than any other age group (54.8%). The poisoning events mainly occurred in winter (from December to next February); however, cases reported in summer increased in recent years. The peak period of the events was from 20:00 to 24:00. Households (85.2%) and restaurants (8.0%) were the common places of non-occupational CO poisoning events, and the main cause was improper use of gas water heater (36.9%). A nonlinear curve was found between daily average temperature of current day and the occurrence of non-occupational CO poisoning. Temperature was negatively associated with the risk of non-occupational CO poisoning when the temperature was lower than 9.6 ℃, while a positive association was found during 9.7-26.0 ℃. ConclusionWinter is a high season for non-occupational CO poisoning in Shanghai, rising cases reported in summer is also worthy of attention. Supervision should be strengthened to ban sales of unqualified gas water heaters, and health education on CO poisoning prevention and control should be conducted through multiple channels, in order to reduce the incidence of CO poisoning.

BackgroundNitrosamines (NAms) are highly carcinogenic and frequently detected in drinking water systems in China, indicating potential human health risk through drinking water.ObjectiveTo analyze the distribution of NAms in drinking water in Shanghai and to evaluate relevant human health risk.MethodsA total of 94 samples of source water and 120 samples of finished water were collected in February (dry period) and August (wet period) of 2021 from 30 drinking water plants in Shanghai, and eight NAms were quantitatively analyzed by gas chromatography tandem mass spectrometry after solid phase extraction. Cancer risks for different age groups caused by NAms exposure through water were evaluated using Monte Carlo probabilistic method and carcinogens risk assessment model recommended by the United States Environmental Protection Agency.ResultsThe concentrations of total NAms in source and finished water were 12.56-65.86 ng·L−1 and 8.52-57.38 ng·L−1, respectively. The average concentration of total NAms was higher in source water (33.50 ng·L−1) than in finished water (22.07 ng·L−1, P

Coronavirus Disease 2019 (COVID-19) has caused a pandemic globally since its outbreak in 2019. As an important port city with prosperous foreign trade, Shanghai has been under severe pressure to prevent the input of COVID-19. With this in mind, solid policies and measures have always been taken in Shanghai to control the input of COVID-19 strictly. In March 2022, the SARS-CoV-2 Omicron variant swept Shanghai, and then the home office order was rapidly carried out in most of the districts. This article focuses on quantifying the changes in concentrations of PM10 and PM2.5 in Shanghai after implementing the home office order and exploring the spatial-distribution characteristics and time trend of the impact of the home office order on airborne particulate matters (PMs) through an interrupted-time-series (ITS) analysis. This study found that PM10 and PM2.5 decreased by 31.40 μg/m3 (p = 0.028) and 10.33 μg/m3 (p = 0.276), respectively, with the fastest decrease speed in the first 10 days of the home office order. Meanwhile, the changes in PM concentrations in eastern areas such as Fengxian District and Chongming District are less than those in central and western areas of Shanghai. Therefore, it can be concluded that implementing the home office order for 10 days could effectively cut down PM concentrations, and the reduction values can be affected by spatial difference and time factor.

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.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.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.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.