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Sleep disorders attract increasing concerns. However, the evidence of the association between ambient air pollution and sleep disorders is limited. Therefore, our aim was to determine the association between short-term air pollution exposure and outpatient visits for sleep disorders in Xi'an, the largest city in Northwest China. Baseline outpatient data of daily sleep disorders between 2011 and 2013 were collected. Quasi-Poisson distribution was applied by adjusting the day of the week and weather conditions. A total of 49,282 sleep disorder outpatient visits were recorded. The most significant association between air pollutants and outpatient visits was observed on concurrent day: per 10 μg/m

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder associated with high mortality and morbidity. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and AF attacks. This study aimed to explore the association between short-term ambient nitrogen dioxide (NO

Type 2 diabetes (T2DM) as a non-communicable disease imposes heavy disease burdens on society. Limited studies have been conducted to assess the effects of short-term air pollution exposure on T2DM, especially in Asian regions. Our research aimed to determine the association between short-term exposure to ambient nitrogen dioxide (NO

Ambient carbon monoxide (CO) is associated with bronchitis morbidity, but there is no evidence concerning its correlation with hospitalization costs for bronchitis patients. This study aimed to investigate the relationship between short-term ambient CO exposure and hospitalization costs for bronchitis patients in Chongqing, China. Baseline data for 3162 hospitalized bronchitis patients from November 2013 to December 2019 were collected. Multiple linear regression analysis was used to determine the association, delayed and cumulative, between short-term CO exposure and hospitalization costs. Additionally, subgroup analyses were performed by gender, age, season, and comorbidity. Positive association between CO and hospitalization costs for bronchitis patients was observed. The strongest association was observed at lag 015 days, with per 1 mg/m

Depression is known to be one of the most common mental disorders raising global concerns. However, evidence regarding the association between short-term air pollution exposure and risk of development of depression is limited. The aim of this was to assess the relationship between short-term ambient air pollution exposure and depression in outpatient visits in Xi'an, a northwestern Chinese metropolis. Data for air pollutants including particulate matter (PM

Anxiety, a common and devastating mental disorder, has raised widespread interests. The impacts of air pollution on physical health are well known, whereas few studies have explored the association of atmospheric pollution, especially short-term air pollution exposure, with the risk of anxiety disorders. In addition, there are increasing concerns in emerging evidence supporting a possible etiological link. Therefore, our aim was to evaluate the relationship between short-term exposure to atmospheric pollutants and anxiety outpatient visits in Xi'an, a city of northwestern China and a metropolis with relatively heavy air pollution. We collected the data of both daily outpatient visits and daily air pollution (SO2, NO2, and PM10) between January 1, 2010 and January 31, 2016 (2222 days). To clarify the association between short-term ambient atmospheric pollution exposure and anxiety outpatient visits, an over-dispersed Poisson generalized additive model was applied by adjusting the day of the week and weather conditions (including temperature, humidity, sunlight hours, and rainfalls). Positive association between gaseous air pollutants (SO2 and NO2) and anxiety daily outpatient visits was observed. Moreover, the largest estimated values of both SO2 and NO2 were evidence at lag 03 (4-day moving average lag), with 10 μg/m3 increase corresponded to the increase of outpatient anxiety visits at 4.11% (95% CI: 2.15%, 6.06%) for SO2 and 3.97% (95% CI: 1.90%, 6.06%) for NO2. However, there was no differences in susceptibility to air pollutants between different genders as well as different ages. Taken together, short-term exposure to ambient air pollutants, especially gaseous air pollutants (NO2 and SO2), can be related to higher risk of anxiety outpatient visits.

Schizophrenia is a devastating neuropsychiatric disorder with increasing concern. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and schizophrenia attacks. This study aimed to investigate the associations between short-term air pollution exposure and schizophrenia outpatient visits based on a time-series study performed in China. Daily data of schizophrenia outpatient admissions and air pollution from 1 October 2010 to 31 December 2013 were collected in Xi'an, a heavily-polluted city in China. We utilized a time-series Poisson regression model to examine the associations between short-term air pollution and schizophrenia outpatient visits with different lag days. A total of 34,865 outpatient-visits for schizophrenia were identified. A 10 μg/m3 increase of PM10, SO2, and NO2 concentrations corresponded to 0.289% (95% Cl: 0.118%, 0.460%), 1.374% (95% Cl: 0.723%, 2.025%), and 1.881% (95% Cl: 0.957%, 2.805%) elevation in outpatient-visits for schizophrenia at lag 0, and the associations appeared to be stronger, although not statistically significantly, in females and in middle and older age adults (40 and over). The most significant associations were observed on the concurrent day in different lag models. In conclusion, short-term exposure to ambient air pollution (PM10, SO2, and NO2) can be associated with increased risk of daily outpatient visits for schizophrenia, which may contribute to the further understanding of the potential adverse effects of air pollution in schizophrenia and other neuropsychiatric disorders.

Air pollution is a risk factor for type 2 diabetes (T2D), exerting heavy economic burden on both individuals and societies. However, there is no apparent report regarding the influence of air pollutants such as particulate matter (PM

Human papillomavirus (HPV) infections are common sexually-transmitted diseases among reproductive-aged women with increasing concern. Until now, there are no prior study about the association between HPV infections and ambient air pollution. This study aimed to explore the relationship between short-term exposure to ambient pollutants and daily outpatient visits for HPV infections in China. Data of daily outpatient visits for HPV infections were obtained from January 1, 2014 to December 31, 2018 (1826 days). Over-dispersed Poisson generalized additive models were applied by adjusting weather conditions and day of the week. We identified a total of 39,746 cases for HPV infections. A 10 μg/m3 increase of PM10, PM2.5, SO2, and NO2 or a 0.1 mg/m3 rise of CO in concurrent day (lag 0) concentrations was related to an elevation of 0.822% (95% Cl: 0.282%, 1.36%), 1.05% (95% Cl: 0.280%, 1.81%), 5.72% (95% Cl: 1.79%, 9.65%), 5.02% (95% Cl: 3.45%, 6.60%), and 2.40% (95% Cl: 1.43%, 3.37%) in daily outpatient-visits for HPV infections, respectively. The association was more significant in those women aged 41 or over. As for 10 μg/m3 increase of O3, a −1.33% (95% Cl: −2.13%, −0.530%) change was observed on the lag 03 and such effects appeared to be more obvious in the aged 18–40 group. Our results provided the first evidence that short-term exposure to ambient pollutants was related to, which may be indirectly, the increased risk of HPV infections while O3 may act as a “protective” factor.

Menstrual disorders are common diseases among reproductive-aged women with increasing concerns. Until now, there have been limited studies about the association between menstrual disorders and air pollution. This study aimed to investigate the association between short-term (concurrent day and within 1 week prior) ambient air pollution exposure and menstrual disorder outpatient visits in Xi'an, a metropolis in northwestern China. Daily baseline outpatient data of menstrual disorders from January 1, 2010 to February 18, 2016 (2239 days) were obtained. An over-dispersed Poisson generalized additive model was applied to discover the relationship between short-term air pollution exposure and the number of menstrual disorder outpatient visits by adjusting the day of the week and weather conditions. A total of 51,893 outpatient visits for menstrual disorders were recorded. A 10 μg/m3 increase of PM10 and NO2 concentrations corresponded to 0.236% (95% Cl: 0.075%, 0.397%) and 2.173% (95% Cl: 0.990%, 3.357%) elevations in outpatient-visits for menstrual disorders at lag 7 and lag 01 (concurrent day and previous 1 day), respectively. The association was more significant in young females (18–29 years) and there was no obvious association observed between SO2 and menstrual disorder outpatient visits. This is the first evidence that short-term exposure to ambient air pollution can be associated with an increased risk of menstrual disorder attacks. The results of our study may help to establish more comprehensive understanding of the health effects of ambient air pollution on menstrual disorders and other reproductive diseases.

Carbon monoxide (CO) is a well-known “toxic gas”. It represents a toxic inhalation hazard at high concentration and is commonly found in polluted air. However, a series of recent studies have suggested that low concentration of CO can also produce protective functions. This study was performed to investigate the association between ambient CO exposure and vaginitis outpatient visits. Daily baseline outpatient data of vaginitis from January 1, 2013 to December 31, 2015 were obtained from Xi'an, a heavily-polluted metropolis in China. The over-dispersed Poisson generalized additive model was applied to discover the relations between short-term ambient CO exposure and the number of vaginitis outpatient visits by adjusting day of the week and weather conditions. A total of 16,825 outpatient hospital visits for vaginitis were recorded. The mean daily concentration of carbon monoxide (CO) was well below Chinese and WHO guidelines. During the study period, increased levels of ambient CO was associated with reduced outpatient-visits through concurrent to lag 5 days, and the most significant association was evidenced at lag 05. A 0.1 mg/m3 increase in daily average CO at lag 05 corresponded to −1.25% (95%CI: −1.85%, −0.65%) change in outpatient-visits for vaginitis. Moreover, the association was more significant in those women aged 20–29 years. After adjustment for PM10, PM2.5, SO2, and NO2, and O3, the negative associations of CO with vaginitis kept significant, suggesting relative stability of effect estimates. In summary, this is the first evidence that increased ambient CO exposure can be related to reduced daily outpatient visits for vaginitis. The results of our study may not only help to establish more comprehensive understanding of the health effects of ambient air on vaginitis and other gynecological diseases, but also provide a clue to new potential interventions.

The correlation between enteritis, a common digestive disease, and exposure to ambient air pollutants has not been examined in a comprehensive manner. The aim of this study was to determine whether an association between short-term air pollution exposure and outpatient visits for enteritis in Xi'an, China, occurred using a time-series investigation. Daily baseline data from January 1, 2013, to December 31, 2015, were obtained. The overdispersed Poisson generalized additive model was used to analyze the association between air pollutant levels and frequency of enteritis. A total of 12,815 outpatient hospital visits for enteritis were identified. A 10-µg/m3 increase in average concentrations of particulate matter (PM)10, PM2.5, nitrogen dioxide (NO2), and sulfur dioxide (SO2), and a 0.1-mg/m3 rise of carbon monoxide (CO) were associated with a significantly elevated number of outpatient visits for enteritis on concurrent days, while ozone (O3) did not markedly affect the frequency of enteritis clinical visits. There were no significant positive effects between two-pollutant and single-pollutant models. Lag models showed that the most prominent responses occurred on concurrent days. Confounding factors of gender and age played a significant role in the observations. Taken together, data indicate that air pollution may result in enhanced occurrence of enteritis attack.

The data concerning the association between environmental pollution and epilepsy attacks are limited. The aim of this study was to explore the association between acute air pollution exposure and epilepsy attack.A hospital record-based study was carried out in Xi'an, a heavily-polluted metropolis in China. Daily baseline data were obtained. Time-series Poisson regression models were applied to analyze the association between air pollution and epilepsy.A 10 μg/m3 increase of NO2, SO2, and O3 concentrations corresponded to 3.17% (95%Cl: 1.41%, 4.93%), 3.55% (95%Cl: 1.93%, 5.18%), and -0.84% (95%Cl: -1.58%, 0.09%) increase in outpatient-visits for epilepsy on the concurrent days, which were significantly influenced by sex and age. The effects of NO2 and SO2 would be stronger when adjusted for PM2.5. As for O3, a -1.14% (95%Cl: -1.90%, -0.39%) decrease was evidenced when adjusted for NO2. The lag models showed that the most significant effects were evidenced on concurrent days.We discovered previously undocumented relationships between short-term air pollution exposure and epilepsy: while NO2 and SO2 were positively associated with outpatient-visits of epilepsy, O3 might be associated with reduced risk.

Food safety is an important public health problem for the entire world, especially developing countries. Food safety incidents in China in the recent years have threatened the health of the Chinese citizens.[1] Many products, including chicken, pork, beef and rice and so on, were found to be unsafe for consumption. Vegetables tainted with pesticides, pork tainted with clenbuterol, fish treated with cancer-causing antimicrobials, eggs colored with industrial dye, fake liquor that could induce blindness or death, exploding watermelons, and recycled “drainage oil” containing carcinogens and traces of aflatoxin have been put on the people's daily dining table.[2,3] The outcome was outrage across the country. Public confidence in the food industry plummeted. People turned pale at the mention of “food”. Some people even started to plant vegetables in their own house.[4] In all these incidents, the most cases with the most cause for concern are those involving infant formula foods. Almost 10 years ago, there was a milk incident at Fuyang, Anhui Province. At least 13 infants were dead due to ingesting the fake infant formula that was short of nutrients.[5] At that time, more than 20 persons were sentenced to serve in prison for periods varying from 6 months to 8 years.[6] Four years later, a even more serious scandal involving infant formula broke out. In 2008, the famous “Sanlu” branded baby formula was found to contain high concentrations of melamine, a chemical that can cause serious lithiasis in the urinary system. According to the official Chinese data submitted to the World Health Organization, the maximum concentration of melamine in Sanlu's baby formula was as high as 4700 mg/kg[7] while the safe limit released later was 1.0 mg/kg. Many other well-known brands were also found to have the same problem. It has been reported that about 300 000 babies became ill, with at least six deaths, due to the formation of kidney stones and other complications caused by toxic baby formulas.[8] Even after these issues came to light, infant formulas with numerous health problems continued to be discovered. In 2011, a large milk producer said that excessive toxin levels had been found in its milk because of moldy cattle feed. In 2012, another large producer recalled formula tainted with mercury.[9] These incidents have understandably provoked nationwide panic among Chinese parents. Because of worrying about the safety of Chinese milk powders, they are now buying up infant milk powder everywhere outside of China that they can get it.[10] On March 1, 2013, the Hong Kong government carried out the revised Import and Export Regulations policy, which includes a specific provision for the allowed quantity of baby formula powder for children less than 36 months of age. This provision was written because infant formula was in short supply in some areas of Hong Kong.[11] According to this provision, a person at least 16 years of age can only carry up to two cans, or 1.8 kg (about 3.97 lbs.), of baby formula out of Hong Kong. Violators may face fines of up to HK$500 000 (about $64 500) and up to two years in jail.[12] On March 2, 25 people had already been arrested for attempting to take baby formula powder beyond the specified limit outside the borders of Hong Kong. Since then, even more people have been arrested, and the total number of these arrested milk powder “smugglers” reportedly exceeded the number of heroin carriers detained at the border of Hong Kong in 2012. On March 6, Liang Zhenying, Chief Executive of Hong Kong Special Administrative Region, stated that the deficient infant formula powder supply in Hong Kong had been corrected.[13] Due to the stringent restrictions, the sales volume of baby formulas in Hong Kong plummeted significantly only two months after the regulation was implemented.[14] On September 24, Mr. Gao Yongwen, chief of the Hong Kong Food and Health Bureau, declared that the Hong Kong government would soon begin stress tests on the city's supplies of baby formula on the National Day holiday on October 1.[15] The results of the tests would determine whether the restrictions on mainland purchases could be lifted within a short time. This caused Hong Kong mothers grow concerned at the possibility of outside buyers again depleting the Hong Kong supply of baby formula. The later declaration released October 13, 2013 suggested that previously declared limit would not be lifted in the near future.[16] In response to the problems of toxic and unsafe food, the Chinese Government has taken a series of measures to manage the situation for food in general and baby formula. In 2009, the new food safety law went into effect and the State Council Food Safety Commission, composing of three vice premiers and more minister-level officials, was established in 2010 to help enforce it. The new specified standards for infant formula are listed in the Table. The Chinese government also enforced much stricter regulations, as evidenced by the large number of food safety cases brought to the judicial system. Additionally, the local government in Hohhot has decided to set up a national laboratory to monitor products of Mengniu and Yili, China's two dairy giants. Furthermore, the government will increase investment and encourage private capital in building grazing land and dairy farms to ensure milk quality from the source.[17] Table New and revised food safety regulations implemented since 2009 More recently in March 2013, a new ministry-level administration, the General Administration of Food and Drug, was established in order to boost people's confidence in the quality of the nation's food. This new administration replaced the old State Food and Drug Administration and is responsible for supervising food and drug safety during processes of production, circulation and consumption. Additionally, the new national health and family planning commission is now responsible for assessing food safety risks and formulating food safety standards.[18] It is only with strict, ongoing oversight and swift response that the Chinese food industry can begin to regain the trust of the Chinese people. People often view food and diet as essential needs, and place food safety as a top priority. However, there is dissatisfaction in the Chinese people given the current situation of food safety. There are several causes for the emerging food contamination. Firstly, environmental pollution, including air, water and soil pollution, is an increasing problem in China. With the pollution in the environment becoming more and more serious, the probability of the pollutants entering foods also increase, thereby raising concerns over food safety.[19] Secondly, the management of the food market in China needs to be further improved. For example, in many Chinese cities, food sales are always conducted through roadside markets, most of which have inadequate labeling on foods and lack information on potential risk factors, which can lead to decreased consumer confidence.[20] The core problems for achieving food safety in China, however, are interest and responsibility of the government. Measures should be implemented to ensure the safety of the food. The government has carried out many regulations, but in the future, relevant governmental departments, merchants companies, and all of us should collaborate in order to implement the regulations more strictly and thoroughly to ensure food safety in China.

Background and purpose The data concerning the association between environmental pollution and epilepsy attacks are limited. The aim of this study was to explore the association between acute air pollution exposure and epilepsy attack. Methods A hospital record-based study was carried out in Xi’an, a heavily-polluted metropolis in China. Daily baseline data were obtained. Time-series Poisson regression models were applied to analyze the association between air pollution and epilepsy. Results A 10 μg/m3 increase of NO2, SO2, and O3 concentrations corresponded to 3.17% (95%Cl: 1.41%, 4.93%), 3.55% (95%Cl: 1.93%, 5.18%), and -0.84% (95%Cl: -1.58%, 0.09%) increase in outpatient-visits for epilepsy on the concurrent days, which were significantly influenced by sex and age. The effects of NO2 and SO2 would be stronger when adjusted for PM2.5. As for O3, a -1.14% (95%Cl: -1.90%, -0.39%) decrease was evidenced when adjusted for NO2. The lag models showed that the most significant effects were evidenced on concurrent days. Conclusions We discovered previously undocumented relationships between short-term air pollution exposure and epilepsy: while NO2 and SO2 were positively associated with outpatient-visits of epilepsy, O3 might be associated with reduced risk.