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There is growing evidence that air pollution plays a role in TB, but few studies have comprehensively included the six common air pollutants. Our objectives were to investigate the association between short-term exposure to six common air pollutants and the risk of tuberculosis outpatient visits in Fuyang, China, during the period 2015-2020. We combined the two models to explore the effects of exposure to six air pollutants on the risk of tuberculosis outpatient visits, including Poisson generalized linear regression model and distributed lag non-linear model (DLNM). We performed stratified analyses for season, gender and age. We used the lag-specific relative risks and cumulative relative risk obtained by increasing pollutant concentration by per 10 units to evaluate the connection between six air pollutants and TB, PM2.5 (RR=1.0018, 95%CI: 1.0004-1.0032, delay of 12 days) and (RR=1.0169,95%CI: 1.0007-1.0333, lag 0-16 days), SO2 were 0.9549 (95%CI: 0.9389-0.9712, lag 0 days) and 0.8212 (95%CI: 0.7351-0.9173, 0-20 days lag). Stratified analyses showed that seasonal differences had a greater impact on TB, and male more likely to develop TB than female, older people more likely to develop TB than younger people. Exposure to O3, CO, PM10, PM2.5, and NO2 increases the risk of TB outpatient visits, except SO2 reduces the risk. Male and elderly people should be protected. We need to pay more attention to the impact of seasonal effects on TB.

Background: The worldwide prevalence of eczema has continued to rise over the past decades.This has led to emphasis on the association between air pollution and eczema. This study investigated the relationship between daily exposure to air pollution and the number of eczema outpatient visits in Guangzhou with the overarching goal of providing novel insights on the interventions for eczema aggravation and prevention.Methods: Daily air pollution data, meteorological data, and number of eczema outpatients were obtained from 18th January 2013 to 31st December 2018 in Guangzhou. A generalized additive model with Poisson distribution was used to assess the association between the number of eczema outpatient visits and short-term exposure of PM2.5 and PM10. In addition, the effect of PM2.5 and PM10 by age (Results: A total of 293,343 eczema outpatient visits were recorded. The obtained results indicated that a 10μg/m3 increase of the same day/ lag 1 day/ lag 2 days PM2.5 was associated with increments of 2.33%(RR=1.0233, 95%CI: 1.0206-1.0260, PPP3 increase of PM10 was associated with eczema outpatients risk increments of 1.97%(RR=1.0197, 95%CI: 1.0177-1.0217, PPP2.5 exposure and eczema were observed at lag 0 day with the percent changes being 4.72% (95%CI, 4.18-5.28%, PPPConclusion: Short-term exposure of PM2.5 and PM10 increases the number of eczema outpatients especially among children and the elderly. This study has provided a further understanding of the relationship between air pollutants and eczema, which will benefit disease prevention and lower the health burden.

Short-term exposures to air pollution have been associated with various adverse health effects. In this study, we investigated the associations between ambient air pollutants with the number of hospital admissions and mortality from cardiovascular diseases (CVDs). This time series study was conducted in Tehran for the years 2014–2017 (1220 day). We collected the ambient air pollutant concentration data from the regulatory monitoring stations. The health data were obtained from the Ministry of Health and Medical Education. A distributed lag non-linear model (DLNM) was used for the analyses. Total CVDs and ischemic heart disease (IHD) admissions were associated with CO for each 1 mg/m3 increase at lags of 6 and 7 days. Also, there was a positive association between total CVDs (RR 1.01; 1.001 to 1.03), IHD (RR 1.04; 1.006 to 1.07), and cerebrovascular diseases (RR 1.03; 1.005 to 1.07) mortality with SO2 at a lag of 4 days. PM2.5 and PM10 were associated with cerebrovascular disease admissions in females aged 16–65 years and 16 years and younger for each 10 µg/m3 increase, respectively. Short-term exposure to SO2, NO2, and CO was associated with hospital admissions and mortality for CVDs, IHD, cerebrovascular diseases, and other cardiovascular diseases at different lags. Moreover, females were more affected by ambient air pollutants than males in terms of their burden of CVDs. Therefore, identifying the likely harmful effects of pollutants given their current concentrations requires the planning and implementation of strategies to reduce air pollution.

Temperature has been studied in relation to many health outcomes. However, few studies have explored its effect on the risk of hospital admission for rheumatoid arthritis (RA). A distributed lag non-linear model (DLNM) was used to analyze associations between mean temperature, diurnal temperature range (DTR), temperature change between neighboring days (TCN), and daily admissions for RA from 2015 to 2019 in Anqing, China. Subgroup analyses based on age, gender, rheumatoid factors, and admission route were performed. In total, 1456 patients with RA were hospitalized. Regarding the cumulative-lag effects of extreme cold temperature (5th percentile = 3℃), the risks of admissions for RA were increased and highest at lag 0–11 (RR = 2.68, 95% CI: 1.23–5.86). Exposing to low (5th percentile = 1.9℃) and high (95th percentile = 14.2℃) DTRs both had increased risks of RA admission, with highest RRs of 1.40 (95% CI: 1.03–1.91) and 1.24 (95% CI: 1.0–1.53) at lag 0 day, respectively. As for TCN, the marginal risk of admission in RA patients was found when exposed to high TCN (95th percentile = 2.9℃) with the largest single-day effect at lag 10 (RR = 1.11, 95% CI: 1.01–1.23). In subgroup analyses, females were more susceptible to extreme cold temperature, low and high DTRs, and high TCN. In regard to extreme cold temperature, significant risk of hospital admission in females only appeared at lag 2 (RR = 1.48, 95% CI: 1.02–2.15) and lag 0–2 (RR = 2.35, 95% CI: 1.11–4.95). It is clear that RA patients exposed to changing temperature may increase risks of admission. Supplementary Information The online version contains supplementary material available at 10.1007/s00484-021-02207-9.

Summary Background In the context of climate change and deforestation, Brazil is facing more frequent and unprecedented wildfires. Wildfire-related PM2·5 is associated with multiple adverse health outcomes; however, the magnitude of these associations in the Brazilian context is unclear. We aimed to estimate the association between daily exposure to wildfire-related PM2·5 and cause-specific hospital admission and attributable health burden in the Brazilian population using a nationwide dataset from 2000 to 2015. Methods In this nationwide time-series analysis, data for daily all-cause, cardiovascular, and respiratory hospital admissions were collected through the Brazilian Unified Health System from 1814 municipalities in Brazil between Jan 1, 2000, and Dec 31, 2015. Daily concentrations of wildfire-related PM2·5 were estimated using the 3D chemical transport model GEOS-Chem at a 2·0° latitude by 2·5° longitude resolution. A time-series analysis was fitted using quasi-Poisson regression to quantify municipality-specific effect estimates, which were then pooled at the regional and national levels using random-effects meta-analyses. Analyses were stratified by sex and ten age groups. The attributable fraction and attributable cases of hospital admissions due to wildfire-related PM2·5 were also calculated. Findings At the national level, a 10 μg/m3 increase in wildfire-related PM2·5 was associated with a 1·65% (95% CI 1·51–1·80) increase in all-cause hospital admissions, a 5·09% (4·73–5·44) increase in respiratory hospital admissions, and a 1·10% (0·78–1·42) increase in cardiovascular hospital admissions, over 0–1 days after the exposure. The effect estimates for all-cause hospital admission did not vary by sex, but were particularly high in children aged 4 years or younger (4·88% [95% CI 4·47–5·28]), children aged 5–9 years (2·33% [1·77–2·90]), and people aged 80 years and older (3·70% [3·20–4·20]) compared with other age groups. We estimated that 0·53% (95% CI 0·48–0·58) of all-cause hospital admissions were attributable to wildfire-related PM2·5, corresponding to 35 cases (95% CI 32–38) per 100 000 residents annually. The attributable rate was greatest for municipalities in the north, south, and central-west regions, and lowest in the northeast region. Results were consistent for all-cause and respiratory diseases across regions, but remained inconsistent for cardiovascular diseases. Interpretation Short-term exposure to wildfire-related PM2·5 was associated with increased risks of all-cause, respiratory, and cardiovascular hospital admissions, particularly among children (0–9 years) and older people (≥80 years). Greater attention should be paid to reducing exposure to wildfire smoke, particularly for the most susceptible populations. Funding Australian Research Council and Australian National Health and Medical Research Council.

Purpose Epidemic keratoconjunctivitis (EKC) is one of the most severe ocular viral infections. The aim of this interruptive time series study was to quantitatively evaluate the effectiveness of a hygienic EKC outbreak management concept developed in our ophthalmological department. Methods All patients with suspected EKC in the period from August to November 2018 were included in the study. Data were retrospectively collected from the patient’s medical documents and records. The disease was diagnosed clinically and confirmed by virus detection through polymerase chain reaction (PCR) from conjunctival swabs. With the beginning of the epidemic, an outbreak management plan was implemented to reduce the nosocomial spread. Results The outbreak lasted 77 days (20th August 2018 to 4th November 2018) and affected a total of 120 patients. This corresponds to a mean of 1.5 patients per outbreak day. The median age was 58 [1–92] years. Of all patients, 61 (50.8%) were female. Conjunctival swabs were collected in 100/120 (83.3%) cases, the adenovirus being detected in all positive smears (63/63, 100%). The implementation of our outbreak management plan reduced significantly the number of EKC cases per outbreak day and resulted in a reduction of the basic reproduction number by a factor of 2.2. Conclusion The detection of EKC together with the immediate implementation of hygienic outbreak measures can significantly reduce the spread of infection. The implementation of a strict outbreak management concept can significantly reduce the number of EKC cases, thus avoiding possible complications and therefore unnecessary health-related costs.

OBJECTIVES To analyse and map the leprosy risk areas in the state of Alagoas, an endemic region in the Northeastern Brazil, between 2001 and 2019. METHODS Ecological and time series study, using spatial analysis techniques. First, we analyse the epidemiological aspects of leprosy cases, using the data available in the Notifiable Diseases Information System; then, we used the segmented log-linear regression model to assess time trends. Spatial distribution was analysed by the Local Empirical Bayesian Estimator and by calculating the Global and Local Moran Index. Finally, spatiotemporal clusters were identified through scanning statistics, using the Kulldorf method of retrospective analysis. RESULTS We observed that Alagoas showed an average new case detection rate of 14.43/100,000 inhabitants between 2001 and 2019, being classified as highly endemic. The area of highest risk was the 9th health region (state hinterland), with increasing time trend (Annual Percentage Change/APC = 7.2; p-value < 0.05). Several clusters of high risk of leprosy transmission were verified in Alagoas, including the state capital and hinterland municipalities. CONCLUSIONS Our data indicate that active M. leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.

Background Patients with ankylosing spondylitis (AS) have reported that their pain becomes worse when the local weather changes. However, there is limited evidence verifying the short-term associations between meteorological factors and outpatient visits for patients with AS. Therefore, this study evaluates this possible association. Methods Meteorological data and data on daily AS outpatient visits to a general hospital in Hefei, China, from 2014 to 2019 were collected and analysed. Distributed lag nonlinear models and Poisson regression models were employed to determine the association between weather conditions and outpatient visits; the results were also stratified by gender and age. Results High relative humidity is significantly associated with all patient visits in lag 1 (RR = 1.113, 95% CI 1.021 to 1.213) and lag 7 days (RR = 1.115, 95% CI 1.014 to 1.227). A low relative risk to the nadir is observed in lag 4 days (RR = 0.920, 95% CI 0.862 to 0.983). Male and young patients ( Conclusions Our findings suggest a potential relationship between exposure to weather conditions and increased risk of AS outpatient visits. These results can aid hospitals in preparing for and managing hospital visits by AS patients when the local weather conditions change.

In the present study, we aim to evaluate the delayed and cumulative effect of ozone (O3) exposure on mumps in a megacity with high population density and high humidity. We took Chongqing, a megacity in Southwest China, as the research area and 2013–2017 as the research period. A total of 49,258 confirmed mumps cases were collected from 122 hospitals of Chongqing. We employed the distributed lag nonlinear models with quasi-Poisson link to investigate the relationship between prevalence of mumps and O3 exposure after adjusting for the effects of meteorological conditions. The results show that the effect of O3 exposure on mumps was mainly manifested in the lag of 0–7 days. The single-day ;lag effect was the most obvious on the 4th day, with the relative risk (RR) of mumps occurs of 1.006 (95% CI: 1.003–1.007) per 10 μg/m3 in the O3 exposure. The cumulative RR within 7 days was 1.025 (95% CI: 1.013–1.038). Our results suggest that O3 exposure can increase the risk of mumps infection, which fills the gap of relevant research in mountainous areas with high population density and high humidity. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-021-15473-2.

Schizophrenia (SCZ) hospital re-admissions constitute a serious disease burden worldwide. Some studies have reported an association between air pollutants and hospital admissions for SCZ. However, evidence is scarce regarding the effects of ambient particulate matter (PM) on SCZ hospital re-admissions, especially in coastal cities in China. The purpose of this study was to examine whether PM affects the risk of SCZ hospital re-admission in the coastal Chinese city of Qingdao. Daily SCZ hospital re-admissions, daily air pollutants, and meteorological factors from 2015 to 2019 were collected. A quasi-Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was applied to model the exposure-lag-response relationship between PM and SCZ hospital re-admissions. The relative risks (RRs) were estimated for an inter-quartile range (IQR) increase in PM concentrations. Subgroup analyses by age and gender were conducted to identify the vulnerable subgroups. There were 6220 SCZ hospital re-admissions during 2015-2019. The results revealed that PM, including PM10 (particles with an aerodynamic diameter ≤10 μm), PMc (particles >2.5 μm but

We aimed to investigate the association between air pollution concentration levels and hospital admissions for heart failure (HF) among older adults in metropolitan cities in South Korea. We used hospital admission data of 1.8 million older adults in seven metropolitan cities from 2008 to 2016, derived from the National Health Insurance Service of South Korea. Daily HF admission data were linked to air pollutants concentrations for the respective dates, including particulate matter less than 2.5 μm in size (PM2.5), 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone. We estimated the association between air pollutants and daily HF admissions using quasi-Poisson generalized additive models for each city. During the study period, 142,490 hospital admissions for HF were noted. Increases of 10 μg/m3 of PM2.5 and PM10, and 10 ppb of SO2, NO2, and CO were associated with an increased risk of HF admission by 0.93% ([95% confidence intervals 0.51–1.36], 0.55% [0.31–0.80], 6.04% [2.15–10.08], 1.10% [0.38–1.82], and 0.05% [0.01–0.09]), respectively, on the same day. Increases in mean exposure to PM2.5, PM10, and SO2 for 8 days from the concurrent day were also significantly associated with HF admissions. During the warm season, the risk of HF admissions increased shortly after an increase in PM2.5, whereas prolonged effects were observed during the cold season. Our study suggests the adverse effects of air pollution on HF. Moreover, the evidence of seasonality may help tailor protection guidelines for older adults.

Background: Some studies suggested 24-hour temperature change (TC24) was one of the potential risk factors for human health. However, evidence of the short-term effect of TC24 on outpatient and emergency department (O&ED) visits and hospitalizations for cause-specific cardiovascular diseases (CVDs) is still limited. Objective: To explore the short-term effects of TC24 on O&ED visits and hospitalizations for CVDs in northwest China which is an area with large temperature variation.Method: The O&ED visits records for CVDs of 3 general hospitals and the inpatient records for CVDs of 4 general hospitals were collected from January 1, 2013 to December 31, 2016, in Jinchang City, northwest China. Meteorological and air pollution data were also obtained during the same study period from local meteorological monitoring stations and environmental monitoring station, respectively. A generalized additive model (GAM) with Poisson regression was employed to analyze the effects of TC24 on O&ED visits and hospitalizations for CVDs. Results: V-shaped relationship were found between TC24 and O&ED visits and hospitalizations for CVDs including total CVD, hypertension, coronary heart disease (CHD) and stroke. Stratified analysis showed that men and patients over 65 years old were more susceptible to temperature changes. Whether heating may modify the effects of TC24 on O&ED visits and hospitalizations for CVDs.Conclusion: TC24 can affect the O&ED visits and hospitalizations for CVDs in this study. This study provides useful data for policy makers to better prepare local responses to the impact of changes in temperatures on population health.

Malnutrition in medical and surgical inpatients is an on-going problem. More-2-Eat (M2E) Phase 1 demonstrated that improved detection and treatment of hospital malnutrition could be embedded into routine practice using an intensive researcher-facilitated implementation process. Yet, spreading and sustaining new practices in diverse hospital cultures with minimal researcher support is unknown.To demonstrate that a scalable model of implementation can increase three key nutrition practices (admission screening; Subjective Global Assessment (SGA); and medication pass (MedPass) of oral nutritional supplement) in diverse acute care hospitals to detect and treat malnutrition in medical and surgical patients.Ten hospitals participated in this pretest post-test time series implementation study from across Canada, including 21 medical or surgical units (Phase 1 original units (n = 4), Phase 1 hospital new units (n = 9), Phase 2 new hospitals and units (n = 8)). The scalable implementation model included: training champions on implementation strategies and providing them with education resources for teams; creating a self-directed audit and feedback process; and providing mentorship. Standardized audits of all patients on the study unit on an audit day were completed bi-monthly to track nutrition care activities since admission. Bivariate comparisons were performed by time period (initial, mid-term and final audits). Run-charts depicted the trajectory of change and qualitatively compared to Phase 1.5158 patient charts were audited over the course of 18-months. Admission nutrition screening rates increased from 50% to 84% (p 0.0001). New Phase 1 units more readily implemented screening than Phase 2 sites, and the original Phase 1 units generally sustained screening practices from Phase 1. SGA was a sustained practice at Phase 1 hospitals including in new Phase 1 units. The new Phase 2 units improved completion of SGA but did not reach the levels of Phase 1 units (original or new). MedPass almost doubled over the time periods (7%-13% of all patients p 0.007). Other care practices significantly increased (e.g. volunteer mealtime assistance).Nutrition-care activities significantly increased in diverse hospital units with this scalable model. This heralds the transition from implementation research to sustained changes in routine practice. Screening, SGA, and MedPass can all be implemented, improve nutrition care for all patients, spread within an organization, and for the most part, sustained (and in the case of original Phase 1 units, for over 3 years) with champion leadership.

Background: Previous studies have mainly focused on the associations between air pollution and total respiratory disease mortality. However, evidence on the short-term effects of air pollution on chronic obstructive pulmonary disease (COPD) mortality is still not conclusive to date. The aim of this study was to investigate the short-term effects of ambient air pollution on COPD mortality in Wuhan China.Methods: Daily death numbers, concentrations of air pollutants (PM2.5, PM10, SO2, NO2, and O3) and meteorological characteristics in Wuhan between January 1, 2014 to December 31, 2019 were collected. Time-series analysis using generalized additive model was applied to evaluated the association between ambient air pollution and daily COPD mortality. Subgroup analysis by age (Results: During the study period, we observed a total of 16150 deaths(7.37 deaths per day) from COPD. The daily average concentrations of PM2.5, PM10, SO2, NO2 and O3 were 59.03, 90.48, 12.91, 48.84 and 91.77 µg/m3, respectively. In single pollutant model, for every increase of 10 µg/m3 in PM10, SO2, NO2 levels, COPD mortality increased by 0.581%(95CI:0.054%-1.111%), 4.316%(95CI:1.002%-7.738%) and 1.815%(95CI:0.523%-3.125%) at lag03, respectively. No significant associations were found for PM2.5 and O3. Subgroup analysis demonstrated that females were more susceptible to PM2.5, PM10, SO2 and NO2, in addition the concentrations of PM10, SO2 and NO2 were significantly associated with COPD mortality for older adults. In two-pollutant models, the significantly positive associations between SO2 as well as NO2 and COPD mortality remained after adjusting for PM2.5 or O3.Conclusions: Short-term exposure to PM10, SO2, and NO2 are significantly associated with a higher risk of COPD mortality. Female or elderly are more susceptible to air pollution. Further research is required to reveal the underlying mechanisms. The implementation of the environmental protection policy has become urgent.

Little is known about the influence of ambient fine particulate matter (PM2.5) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0-10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0-2 corresponded to a 0.64% (95% confidence interval: 0.55-0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m3 increase in PM2.5 concentrations on lag days 0-3 corresponded to a 0.82% (95% confidence interval: 0.67-0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations.

Objectives As the largest organ of the human body, the skin is the major exposure route of NO2. However, the evidence for a relationship between NO2 exposure and dermatologic diseases (DMs) is limited. This time-series study was conducted to assess the short-term effect of nitrogen dioxide (NO2) exposure on DMs outpatient visits in Xinxiang, China. Methods Daily recordings of NO2 concentrations, meteorological data, and the outpatient visits data for DMs were collected in Xinxiang from January 1st, 2015, to December 31st, 2018. The analysis method used was based on the generalized additive model (GAM) with quasi-Poisson regression to investigate the relationship between NO2 exposure and DMs outpatient visits. Several covariates, such as long-term trends, seasonality, and weather conditions were controlled. Results A total of 164,270 DMs outpatients were recorded. A 10 μg/m3 increase in NO2 concentrations during the period was associated with a 1.86% increase in DMs outpatient visits (95% confidence intervals [Cl]: 1.06–2.66%). The effect was stronger (around 6 times) in the cool seasons than in warmer seasons and younger patients (

Sex differences in the impact of exposure to air pollution have been reported previously and epidemiological studies indicate that fine particulate matter (PM2.5) effects on nonaccidental death are modified by sex; however, the results are not conclusive. To introduce a new method incorporating the monotone nonlinear relationship between PM2.5 and deaths to reveal the sex difference in the relationship, we illustrated the use of the constrained generalized additive model (CGAM) to investigate the sex difference in the effects of PM2.5 on nonaccidental deaths in Shanghai, China. Information on daily non-accidental deaths, air pollution, meteorological data, and smoking prevalence between 1 January 2012 and 31 December 2014 was obtained in Shanghai. The CGAM was used to assess the association of interaction between sex and daily PM2.5 concentrations with daily nonaccidental deaths, adjusting for weather type and smoking rate. A 2-week lag analysis was conducted as a sensitivity analysis. During the study period, the total number of non-accidental deaths in Shanghai was 336,379, with a daily mean of 163 deaths and 144 deaths for men and women, respectively. The average daily concentration of PM2.5 in Shanghai was 55.0 μg/m3 during the same time period. Women showed a lower risk for non-accidental death (risk ratio (RR) = 0.892, 95% confidence interval (CI): 0.802–0.993). Compared with men, the risk for nonaccidental death in relation to increasing PM2.5 concentration was smaller in women (RR = 0.998, 95% CI: 0.996–1.000, per 10 μg/m3 increase in PM2.5 concentration. The difference is consistent during the two lag weeks and more obvious when adjusting for the interaction between PM2.5 concentration and smoking prevalence. The effects of PM2.5 on daily nonaccidental death are different between men and women in Shanghai, China, and women tend to have a lower risk. The underlying mechanisms of the sex difference of PM2.5 effects on death need further investigation. The method displayed in the manuscript can be used for other environmental stressors as well.

Purpose This study examined the effect of EO diffusion in the clinical setting on nurses' mood. Design Interventional interrupted time series study with two data collection points: prior to, and in the second week of diffusion. Methods Self-report questionnaires measured the impact of EO diffusion on nurses' stress, depression, anxiety, distress, and mood. Three EOs (Citrus Bliss, Grapefruit, Wild Orange) were diffused in 2-week blocks, with a 1-week wash-out period. Descriptive statistics and paired sample t test were performed. Results A paired sample was returned for 39 participants. There were significant improvements after diffusion of Citrus Bliss for stress (mean difference [MD]: 2.58; 95% confidence interval [CI]: 0.82, 4.35), depression (MD: 1.83; 95% CI: 0.03, 3.64), distress (MD: 2.39; 95% CI: 0.58, 4.19) and mood (MD: 4.89; 95% CI: 0.52, 9.27). A large effect (Cohen's d effect >0.80) for depression and distress was observed for nurses who had previously used EOs and those with no reported external stressors. Conclusion Diffusion of citrus EOs in the clinical setting positively affected nurses' mood. Future studies could also explore effect for patients and visitors.

To evaluate the effects of gaseous pollutants (SO2, NO2) on non-accidental mortality of residents in Hefei city, we collected non-accidental deaths, air pollutants and meteorological data of Hefei city from 2014 to 2017. After controlling confounding factors with Poisson generalized additive model, we analyzed the relationship between air pollutants and non-accidental mortality and used subgroup analysis to identify susceptible groups. The number of non-accidental deaths during the study period was 42,116, with an average of 28.83 per day. The average concentrations of SO2 and NO2 were 16.08 μg/m3 and 39.10 μg/m3, respectively. In the single-pollutant model, every 10 μg/m3 increase in SO2 and NO2 concentrations was significantly associated with non-accidental mortality, and there was a significant lag effect. SO2 increased the risk of non-accidental death by 4.93% (95% CI: 1.94% ~ 8.00%) at lag0–3. In addition, male, the elderly, non-elderly and low-education people were more susceptible (P

Objective: To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average (SARIMA) models and Markov switching model (MSM). Methods: This descriptive study employed yearly and monthly data of 49 364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province, located in the center of Iran from January 2000 to December 2019. The data were provided by the leishmaniasis national surveillance system, the meteorological organization of Isfahan province, and Iranian Space Agency for vegetation information. The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics. Results: The minimum relative humidity, maximum relative humidity, minimum wind speed, and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags (P

Background: Visceral leishmaniasis in human (VLH) also known as kala-azar is a neglected disease of humans that mainly occurs in more than 50 countries mostly located in the Eastern Mediterranean and the Northern America. Objective: The purpose of this study was to determine the temporal patterns and predict of occurrence of VL in Ardabil Province, in northwestern Iran using autoregressive integrated moving average (ARIMA) models. Methods: This descriptive study employed yearly and monthly data of 602 cases of VLH in the province between January 2000 to December 2019, which was provided by the leishmaniasis national surveillance system. The monthly occurrences case constructed the ARIMA model of time-series model. The insignificance of the correlation in the lags of 12, 24 and 36 months, and Chi-square test showed the occurrence of VLH does not have a seasonal pattern. Eleven potential ARIMA models were examined for VLH cases. Finally, the best model was selected with the lower Akaike Information Criteria (AIC) and Bayesian information criterion (BIC) value. Then, the selected model was used to forecast frequency of monthly occurrences case. The forecasting precision was estimated by mean absolute percentage error (MAPE). Data analysis was performed using Stata14 and its package time series analysis. Results: ARIMA (5, 0, 1) model with AIC (25.7) and BIC (43.35) was selected. The MAPE value was 26.89% and the portmanteau test for white noise was (Q = 23.02, P = 0.98) for the residuals of the selected model showed that the data were fully modelled. The total cumulative VLH cases in the next 24 months' in Ardabil province predicted 14 cases (95% CI: 4-54 case). Conclusion: The ARIMA (5, 0, 1) model can be a useful tool to predict VLH cases as early warning system and the results are helpful for policy makers and primary care physicians in the readiness of public health problems before the outbreak of the disease.

Summary Background Exposure to temperature variability has been associated with increased risk of mortality and morbidity. We aimed to evaluate whether the association between short-term temperature variability and hospitalisation was affected by local socioeconomic level in Brazil. Methods In this time-series study, we collected city-level socioeconomic data, and daily hospitalisation and weather data from 1814 Brazilian cities between Jan 1, 2000, and Dec 31, 2015. All-cause and cause-specific hospitalisation data was from the Hospital Information System of the Unified Health System in Brazil. City-specific daily minimum and maximum temperatures came from a 0·25° × 0·25° Brazilian meteorological dataset. We represented city-specific socioeconomic level using literacy rate, urbanisation rate, average monthly household income per capita (using the 2000 and 2010 Brazilian census), and GDP per capita (using statistics from the Brazilian Institute of Geography and Statistics for 2000–15), and cities were categorised according to the 2015 World Bank standard. We used quasi-Poisson regression to do time-series analyses and obtain city-specific associations between temperature variability and hospitalisation. We pooled city-specific estimates according to different socioeconomic quartiles or levels using random-effect meta-analyses. Meta-regressions adjusting for demographic and climatic characteristics were used to evaluate the modification effect of city-level socioeconomic indicators on the association between temperature variability and hospitalisation. Findings We included a total of 147 959 243 hospitalisations (59·0% female) during the study period. Overall, we estimated that the hospitalisation risk due to every 1°C increase in the temperature variability in the current and previous day (TV0–1) increased by 0·52% (95% CI 0·50−0·55). For lower-middle-income cities, this risk was 0·63% (95% CI 0·58–0·69), for upper-middle-income cities it was 0·50% (0·47–0·53), and for high-income cities it was 0·39% (0·33–0·46). The socioeconomic inequality in vulnerability to TV0–1 was especially evident for people aged 0–19 years (effect estimate 1·21% [1·11–1·31] for lower-middle income vs 0·52% [0·41–0·63] for high income) and people aged 60 years or older (0·60% [0·50–0·70] vs 0·43% [0·31–0·56]), and for hospitalisation due to infectious diseases (1·62% [1·46–1·78] vs 0·56% [0·30–0·82]), respiratory diseases (1·32% [1·20–1·44] vs 0·55% [0·37–0·74]), and endocrine diseases (1·21% [0·99–1·43] vs 0·32% [0·02–0·62]). Interpretation People living in less developed cities in Brazil were more vulnerable to hospitalisation related to temperature variability. This disparity could exacerbate existing health and socioeconomic inequalities in Brazil, and it suggests that more attention should be paid to less developed areas to mitigate the adverse health effects of short-term temperature fluctuations. Funding None.

Changes in the preconception ambient temperature (PAT) can affect the gametogenesis, disturbing the development of the embryo, but the health risks of PAT on the developing fetus are still unclear. Here, based on the National Free Preconception Health Examination Project in the rural areas of Henan Province, we evaluate the effects of PAT on preterm birth (PTB). Data of 1,231,715 records from self-reported interviews, preconception physical examination, early gestation follow-up, and postpartum follow-up were collected from 1 January 2013 to 31 December 2016. Generalized additive models were used to assess the cumulative and lag effects of PAT upon PTB. The significant cumulative effects of mean temperature within 2 weeks and 3 weeks on the risk of PTB, especially upon late PTB (34–36 weeks) (P 90th percentile) within 2 weeks (RR = 1.470) and 3 weeks (RR = 1.375) before conception could increase the risk of PTB. After stratifying PTB, exposure to extreme heat within 2 weeks before conception can increase the risks of early (< 34 weeks) and late PTB (P < 0.05). Besides, exposure to extreme cold (< 10th percentile) within 3 weeks or longer before conception can elevate the risk of PTB, especially late PTB. The significant lag effects of temperature changes on the risk of early PTB (lag-8 days or earlier) were observed. In conclusion, the risk of PTB was susceptible to PAT changes within 2 weeks or longer before conception. Our findings provide (i) guidance for rural couples to make pregnancy plans and (ii) scientific evidence for the government to formulate policies to prevent PTB.

Background Avoidable hospitalizations (AHs) are defined as hospitalizations that could have been prevented through timely and effective services. AHs are, therefore, an indicator used to evaluate the access and effectiveness of primary health care services. Methods A retrospective time-series study spanning 8 years (2006-2013) was conducted to determine the relationship between AHs and gender, age, and access to primary health care physicians in rural areas in Tehran province, the capital of Iran. The total number of avoidable hospitalizations was 22,570; logistic regression was estimated for each year separately. Results Total hospitalizations and AHs increased during the study period, especially during the first 3 years of the study. AHs, as a percentage of total hospitalizations, did not change significantly throughout the study years. This value was 22.3% during the first year of study and varied between 17% and 19.6% from 2007 to 2013. No statistically significant relationship was seen between AH occurrence and access to a physician during the study years. Conclusion Increasing access to primary health care physicians cannot necessarily result in decreased AHs. Considering the factors influencing AHs while designing and implementing the family physicians program is important to achieve the expected results regarding the effectiveness of primary health care services.

This study aimed to study the relationship between air pollution and stroke (especially emergency stroke) in different regions and determine which air pollutant is the most significantly associated with stroke. The number of patients with emergency stroke, air pollutant data and related meteorological indicators were collected from December 2013 to May 2018 for large comprehensive hospitals in Chongqing. The generalized additive model was used to analyse the relationship between air pollution and emergency stroke. After analysis and adjusting for meteorological indicators and day-of-the-week effects, in the one-pollutant model, every 10 μg/m3 increase in ozone(O3) was associated with a 2.482% (95% CI 1.044%, 3.919%) change in emergency strokes within lag0. For males, every 10 μg/m3 increase of O3 contributed to a 0.77% percent greater change compared with females. For the group younger than 60 years, we observed a 1.14% increase in risk with every 10 μg/m3 increase in O3. The group with pre-existing hypertension had a 0.26% higher risk than the group with no pre-existing hypertension with every 10 μg/m3 increase in O3. In two-pollutant model, when O3 was combined with a 10 μg/m3 increase of NO2, it increased the most significant risk of emergency stroke by 0.22%. These findings suggest that short-term exposure to O3 within 0 days is associated with emergency outpatient strokes, and younger people (age

Background: The efficacy of rosella flowers as an antibacterial contains anthocyanin pigment which acts as an antioxidant, vitamins and minerals that are useful for the body so it needs to develop products other than drinks and food; one of them as herbal disinfectant for complete denture acrylic base. Objective: To determine the color stability of the complete denture base after cleaning with various concentrations of rosella flower extract. Method: This time series study with pre and post with control group design was carried out using 5 complete dentures cleaned with rosella flower extract toothpaste with a concentration of 2.5%, 5%, 10% and control, and assessed its color on the surface of the polished and intaglio surface. The value is processed into the formula ∆E * ab = [(∆L *) 2 + (∆a *) 2 + (∆b *) 2] 1/2 then analyzed using the Kolmorogrov test and t-test. Result: Rosella flower extract toothpaste at concentrations of 2.5%, 5%, and 10% did not show significant differences in color changes (p> 0.05). Conclusion: There were no significant differences in color changes at all concentrations after the acrylic base was cleaned with rosella flower extract.

Globally, fine particulate matter has been associated with several health problems including cancer. However, most studies focused mainly on lung cancer. Stomach and colorectal cancers play significant roles in increasing public health's cancer globally. This study focused on investigating a possible significant association between exposure to fine particulate matter (PM2.5) and mortality due to stomach and colorectal cancer in Xi'an from 2014 to 2016. Using time-series analysis, the study applied both single and multi-pollutant(s) approaches for investigations; PM2.5 was the pollutant of interest. Generalized additive model (GAM) was the core statistical method used with the addition of distributed lag model (DLM) to observe delayed effects. As a single pollutant, PM2.5 was significantly associated with stomach cancer mortality only RR (95%CI): 1.0003 (1.0001, 1.002). For the multi-pollutant analysis, PM2.5 combinations with NO2 were significantly associated with both stomach and colorectal cancer mortality RR (95%CI): 1.0103 (1.009, 1.021) and 1.054 (1.0324, 1.0667), respectively. Also, PM2.5 combination with O3 was significantly associated with colorectal cancer mortality, RR (95%CI): 1.0151 (1.0091, 1.0172), but no association was noted for combination with SO2. Though this study has reported significant associations, it will be beneficial for the public's health if more studies further investigate the relationship between exposure to PM2.5 and other cancer mortality.

Os óbitos femininos por agressão são ocasionados, muitas vezes, por indivíduos do sexo oposto, parceiros ou ex-parceiros das vítimas, havendo situações de abuso físico, sexual e psicológico. Neste trabalho, objetiva-se analisar a tendência temporal de mortalidade feminina por agressão e seus fatores no Brasil, de 2000 a 2017. Trata-se de um estudo de série temporal sobre mortalidade feminina por agressão, em todas as faixas etárias. Extraiu-se os dadosstema de Informação sobre Mortalidade, e as informações populacionais foram obtidas por meio do Instituto Brasileiro de Geografia e Estatística. Investigou-se as variáveis raça/cor de pele, idade, anos de estudo, local de ocorrência dos óbitos e o capítulo XX da CID-10, nas categorias com códigos de X-85 a Y-09 e Y-87. No período estudado, 75.113 mulheres morreram em decorrência de agressões. A maior parte delas tinha de 20 a 39 anos, autodeclaradas pardas (49,3%), com quatro a sete anos de estudo (27,7%), com óbito registrado com maior frequência em via pública e no domicílio (28,8% e 28,6%, respectivamente). No mesmo período, ocorreu um aumento na tendência da taxa de mortalidade feminina por agressão no Brasil (annual percent change – APC: 1,09; IC95%: 0,07;2,12). Houve aumento percentual nas agressões por queimaduras/fumaça (APC: 4,99; IC95%: 3,25;6,76), objeto cortante (APC: 3,07; IC95%: 1,72;4,43) e enforcamento e afogamento (APC: 1,96; IC95%: 0,71;3,23). Conclui-se que o aumento na tendência da mortalidade feminina por agressão em algumas regiões do país, especialmente entre mulheres jovens, mostra a necessidade de políticas públicas e sociais mais adequadas às especificidades das diferentes regiões do Brasil.

A partir dos 60 anos de vida, as chances de quedas aumentam significativamente. Estima-se que 30% dos idosos comunitários caem a cada ano, e metade desses de forma recorrente. O objetivo deste estudo foi analisar a tendência das internações hospitalares por quedas de idosos no Piauí, no período de 2010 a 2018. Trata-se de um estudo de séries temporais com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Utilizou-se o modelo de regressão linear de Prais-Winsten para análise de tendência. Ocorreram 14.286 internações por quedas de idosos, com maior ocorrência no sexo feminino (62%), na faixa de 60 a 69 anos (37,1%), sem especificação sobre o tipo de queda (73,6%). Observou-se tendência crescente na taxa de internação hospitalar para o sexo feminino (variação percentual anual – APC = 10,5% – IC95% 6,6; 14,4) e por quedas de um nível ao outro (APC = 10,6 – IC95% 0,6; 21,7). O coeficiente de letalidade apresentou tendência crescente para quedas ocorridas no mesmo nível (APC = 16,7 – IC95% 9,2; 24,8). Conclui-se que tanto a internação quanto a letalidade hospitalar por quedas de um nível a outro e do mesmo nível apresentaram tendência de aumento. Maior permanência e letalidade hospitalar foi observada nas regionais de saúde Cocais e Carnaubais.

To evaluate the effects of air pollutants on hospitalizations of elderly people for congestive heart failure (CHF) in the city of Sao Paulo, stratified by sex, exploring lag structures, from 2000 to 2013. Ecological time series study using information on hospitalization of elderly patients for CHF (ICD-10th: I50) obtained from DATASUS for the city of Sao Paulo. Information on O3, PM10, NO2, SO2, CO, temperature and humidity was obtained from CETESB. Descriptive analyses, Pearson correlation, and generalized linear Poisson regression model were applied to estimate the effects of pollutants. The interquartile variations of O3 (52.45 μg/m3), PM10 (24.28 μg/m3), NO2 (7.63 μg/m3), SO2 (50.22 μg/m3), and CO (1.28 ppm) were associated with increased hospitalizations for CHF. Air pollutants continue to be a factor that contributes to the increase in the number of hospitalizations due to CHF.

To assess YLL and mortality burden attributable to non-optimum ambient temperature, we collected mortality and environmental data from June 1, 2012 to December 30, 2017 in Shenzhen. We applied distributed lag nonlinear models with 21 days of lag to examine temperature-YLL and temperature-mortality associations, and calculated the attributable fractions of YLL and deaths for non-optimum temperature, including four subranges, mild cold, mild heat, extreme cold, and extreme heat. Cold and heat were distinguished by the optimum temperature, and each was separated into extreme and mild by cutoffs at 2.5th (12.2 °C) and 97.5th (30.4 °C) temperature percentile further. The optimum temperature was defined as the temperature that had minimum effect on YLL or mortality risk. The optimum temperature for non-accidental YLL was 24.5 °C, and for mortality it was 25.4 °C. Except for the population older than 65 years, the optimum temperature was generally lower in the YLL model than the mortality model. Of the total 61,576 non-accidental deaths and 1,350,835.7 YLL within the study period, 17.28% (95% empirical CI 9.42-25.14%) of YLL and 17.27% (12.70-21.34%) of mortality were attributable to non-optimum temperature. More YLL was caused by cold (10.14%, 3.94-16.36%) than by heat (7.14%, 0.47-13.88%). Mild cold (12.2-24.5 °C) was responsible for far more YLL (8.78%, 3.00-14.61%) than extreme cold (3.5-12.2 °C). As for cardiovascular deaths, only the fractions attributable to overall and cold temperature were significant, with mild cold contributing the largest fraction to YLL (16.31%, 6.85-25.82%) and mortality (16.08%, 9.77-21.22%). Most of the temperature-related YLL and mortality was attributable to mild but non-optimum weather, especially mild cold, while the YLL model implied a more prominent heat effect on premature death. Our findings can supply additional evidence from multiperspectives for health planners to define priorities and make targeted policies for mitigating the burden of adverse temperatures.

Suicide has been a subject of increasing concern and the toxicological and blood alcohol investigate in these victims is little studied. This study investigated the toxicological and blood alcohol profile of suicide victims in 27 municipalities in the extreme west of Santa Catarina. Aggregate time series study, with a survey of epidemiological data and analysis of expert reports by the Medical Legal Institute of all fatal victims of suicide, registered in the period between 2012 to 2016. Results: Males, aged 50-59 years, were the main victims and the hanging the main suicide method. The months of February and November, Sundays and the time of 08:00 to 11:59 were the moments of greater occurrences. Elevated levels of alcohol were observed in 23.97% of the victims and the main drugs found were benzodiazepines and tricyclic antidepressants. The results obtained in this study reinforce the concern regarding cases of suicide and an association between alcohol/drug use and suicidal practices. The data provide subsidies for elaboration and implementation of preventive actions. Professionals should be alert to signs of suicide, so that specialized help becomes a possible option, and is instrumental in reducing the number of suicides.

Under the background of global climate change, the present study aimed to evaluate the effects of daily mean temperature and diurnal temperature range (DTR) on the non-accidental mortality. Poisson generalized linear model (PGLM) combined with distributed lag non-linear model (DLNM) was used to evaluate these effects after adjusting the relative humidity and major air pollutants. All effects were presented as relative risk (RR), with 75th percentiles of daily mean temperature and DTR compare with their lowest RRs corresponding values. Daily mean temperature was associated with the non-accidental mortality with a U-shaped curve, and the non-accidental mortality increased by 1.8% (95% CI: 0.7~3.0%) when the temperature was 24.4 °C (20 °C as the reference). Additionally, the non-accidental mortality increased by 1.4% (95% CI: 0.1~2.7%) on lag6 day when DTR was 11.3 °C (7 °C as the reference). The elderly (≥ 65 years) were more susceptible to daily mean temperature and DTR, and females were more susceptible to high DTR effect than males. Our study provides evidence that daily mean temperature and DTR are significantly associated with non-accidental mortality and have delayed effects. Both females and elderly people are vulnerable to the potential adverse effects.

Atrial fibrillation (AF) is an important cardiovascular disease that causes a great burden of disease. However, there is limited evidence of a link between air pollution exposure and AF. This study aimed to explore the short-term association between air pollution and AF. We obtained daily hospitalization of AF in two major hospitals of Yancheng, China from May, 2015 to May, 2020. Generalized additive models with quasi-Poisson regression were used to assess the associations between six criteria air pollutants and AF hospitalization. We explored the lag patterns, and visualized the concentration-response relationships. The robustness of the association was tested by two-pollutant model, and we explored potential effect modification by age, sex and season. A total of 15,171 inpatients from two hospitals were collected in this study with an average daily count of eight patients. We observed consistent and significant associations between six air pollutants and AF on lag 0–4 days. A 10 ug/m3 increase in PM2.5 was associated with 2.81% (95%CI: 1.44%, 4.20%) changes in AF, and the effect estimate was 1.67% (95%CI: 0.77%, 2.59%) for PM10, 4.90% (95%CI: 1.69%, 8.22%) for NO2, 6.81% (95%CI: 0.46%, 13.57%) for SO2, 1.82% (95%CI: 0.60%, 3.06%) for O3; a 0.1 mg/m3 increase in CO was associated with 2.55% (95%CI: 0.91%, 4.21%) increments in AF. Associations of PM2.5 and PM10 were robust after adjusting for SO2, NO2, CO, and O3, but not vice versa. Female patients and those aged less 70 years had larger risk of AF associated with air pollution exposure. The concentration-response curves of the six pollutants were almost linear and increasing with no obvious thresholds. This time-series study in Yancheng demonstrated increased risk of AF and a delayed effect over lag 0–4 days. Our findings suggested need of prevention and protection against these environmental risk factors for AF in health departments.

Made available in DSpace on 2022-04-28T19:48:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) BACKGROUND: Exposure to air pollutants is associated with hospital admissions due to cardiovascular diseases and premature deaths. OBJECTIVE: To estimate years of life lost (YLL) due to premature deaths and their financial costs. DESIGN AND SETTING: Ecological time-series study carried out in São José dos Campos, Brazil, in 2016. METHODS: Data on deaths among residents of this city in 2016 were assessed to estimate the financial cost of premature deaths associated with air pollution. The diagnoses studied were ischemic heart disease, congestive heart failure and cerebrovascular disease, according to YLL. The fractions attributable to deaths associated with air pollutant exposure and to each potential year of life lost were calculated using negative binomial regression with lags of 0-7 days between exposure and outcome. Nitrogen dioxide, particulate matter (PM10) and ozone concentrations were included in the model and adjusted for temperature, hu-midity and seasonality. RESULTS: Exposure to particulate matter was significant at lag 3 days. There were 2177 hospitalizations over the study period, with 201 deaths (9.2%). Premature deaths led to 2035.69 years of life lost. A 10 μg/m³ increase in PM10 concentrations was correlated with 8.0% of the hospitalizations, which corresponded to 152.67 YLL (81.67 for males and 71.00 for females). The cost generated was approximately US$ 9.1 million in 2016. CONCLUSION: In this first study conducted in a medium-sized Brazilian city, using the YLL methodology, we identified an excess expense attributable to air pollution. Postgraduate Program on Mechanical Engineering Department of Energy São Paulo State University (UNESP) Postgraduate Program on Mechanical Engineering Department of Energy Universidade Estadual de São Paulo (UNESP) Postgraduate Program on Mechanical Engineering Department of Energy São Paulo State University (UNESP) Postgraduate Program on Mechanical Engineering Department of Energy Universidade Estadual de São Paulo (UNESP) FAPESP: 2019/12928-4

Background: The significant psychosocial morbidity experienced by cancer patients is often undetected and untreated. Despite international priority given to psychosocial care for cancer patients, implementation of psychosocial programs into routine cancer care is limited. We developed, implemented, and assessed the impact, acceptability, and cost of an integrated, patient-centered Psychosocial Assessment, Care and Treatment (PACT) model of care for cancer patients within a general hospital setting. Methods: A time series research design was implemented to test the PACT model of care, newly introduced in an Australian tertiary hospital. System-level impact on systematic distress screening and management was assessed through audit of the medical records of three cross-sectional samples of 141 patients, at baseline and at 12 and 24 months post-baseline. The impact of the model on patient experience and health care professionals’ (HCPs) knowledge and confidence was assessed via surveys. The acceptability of the intervention was assessed through HCP interviews at 24 months. The cost of the intervention was assessed by PACT staff recording the time spent on care provision, training, and intervention administration, and associated costs were calculated using staff payment rates adjusted for superannuation and leave. Results: Across the 24 months of implementation, formal distress screening increased from 0% at baseline to 29% of patients at 12 months and 31% of patients at 24 months, with an associated decrease in informal screening as formal screening increased. There was no notable change in distress management (ie, development of care plans) across the time period. Baseline patient experience was already high (mean score = 46.85/55) and did not change significantly over the course of the study. In both general and specific areas of addressing patient psychosocial concerns, HCP knowledge and confidence was moderate and remained largely unchanged over the course of the study. HCPs perceived the PACT model as highly beneficial and instrumental in bringing about significant changes to staff's knowledge, practices and awareness of psychosocial issues. The estimated total labor cost (including on-costs) was AUD$119,239 (over the 2 years); with a declining cost over the lifetime of the intervention reflecting the higher initial set-up costs. Conclusions: Although the PACT model was associated with an increase in distress screening, staff workloads, high turnover, and administrative barriers may have restricted the translation into distress management. Future research exploring effective avenues to engage staff at a management level and ensure that staff view distress management as a valuable component of their role may assist to embed strategies into the general hospital culture and lead to more sustainable changes.

Resumo O objetivo deste estudo é analisar a tendência de prematuridade no Brasil, entre 2012 e 2019, segundo características sociodemográficas, do pré-natal e parto. Trata-se de um estudo ecológico de série temporal, em que foram calculadas as proporções de prematuridade segundo as regiões do Brasil, idade materna, escolaridade materna, raça/cor, número de consultas pré-natal e tipo de parto, a partir dos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Sequencialmente, foram aplicados modelos de regressão polinomial para análise de tendência temporal. De 2012 a 2019, a proporção de prematuridade no Brasil apresentou tendência decrescente, variando de 10,87% a 9,95%, com a menor proporção em 2015, que foi de 9,77%. As mulheres na faixa etária de 45 anos ou mais e com 4 a 6 consultas de pré-natal apresentaram as maiores proporções de prematuridade para o período (14,88% a 17,92%) e com tendência crescente. Já as mulheres analfabetas e indígenas mostraram tendência decrescente para o período, apesar de terem as maiores proporções de prematuridade (15,75% a 11,74%). Há uma tendência decrescente de prematuridade no Brasil, especialmente em mulheres mais vulneráveis, entretanto, os serviços de saúde precisam melhorar o atendimento das mulheres com idade materna avançada e atrair aquelas com poucas consultas de pré-natal. Abstract The aim of this study is to analyze the trend of prematurity in Brazil from 2012 to 2019, according to sociodemographic, prenatal and childbirth characteristics. This is an ecological time series study, in which the proportions of prematurity were calculated according to the regions of Brazil, maternal age, maternal education, race/color, number of prenatal consultations and type of delivery from the data of Information System on Live Births (SINASC). Sequentially, polynomial regression models were applied to analyze time trends. From 2012 to 2019, the proportion of prematurity in Brazil showed a decreasing trend, ranging from 10.87% to 9.95%, with the lowest proportion in 2015, which was 9.77%. Women aged ≥ 45 years and with 4 to 6 prenatal consultations had the highest proportions of prematurity for the period (14.88% to 17.92%) and with an increasing trend. Illiterate and indigenous women, on the other hand, showed a decreasing trend for the period, despite having the highest proportions of prematurity (15.75% to 11.74%). There is a decreasing trend of prematurity in Brazil, especially in more vulnerable women. However, health services need to improve the care of women with an advanced maternal age and attract women with few prenatal consultations. Resumen El objetivo de este estudio es analizar la tendencia de la prematuridad en Brasil entre 2012 y 2019, según características sociodemográficas, prenatales y del parto. Se trata de un estudio ecológico de series temporales, en el que se calcularon las proporciones de prematuridad según las regiones de Brasil, la edad materna, la educación materna, la adscripción de etnia-raza, el número de consultas prenatales y el tipo de parto, a partir de los datos del Sistema de Información sobre Nacidos Vivos (SINASC). Para ello se aplicaron secuencialmente modelos de regresión polinomial para analizar las tendencias temporales. Desde 2012 hasta 2019, la proporción de prematuridad en Brasil mostró una tendencia decreciente, que va del 10,87 % al 9,95 %, con la proporción más baja en 2015, que fue de 9,77 %. Las mujeres de 45 años o más y con cuatro a seis consultas prenatales tuvieron las mayores proporciones de prematurez del período (14,88 % a 17,92 %) y con una tendencia creciente. Las mujeres analfabetas e indígenas, por su parte, mostraron una tendencia decreciente para el período, a pesar de tener las mayores proporciones de prematuridad (entre 15,75 % y 11,74 %). Existe una tendencia decreciente de la prematuridad en Brasil, especialmente entre las mujeres más vulnerables a pesar de lo cual los servicios de salud deben mejorar la atención de las mujeres con edad materna avanzada y atraer a mujeres con pocas consultas prenatales.

Background: There has been a recent worsening of air pollution in China, which poses a huge threat to public health by inducing and promoting circulatory and respiratory diseases. This study aimed to explore the association between the concentration of air pollution and daily internal medicine outpatient visits registered for the treatment of circulatory and respiratory symptoms in Zhoushan, China using a time-series method.Methods: We validated and acquired the daily internal medicine outpatient visits records between January 1, 2014, and December 31, 2019, from the Zhoushan Center for Disease Control and Prevention in Zhejiang, China. Further, we collected the daily average records of the ambient air pollutants from the Zhoushan Environmental Monitoring Centre within the same duration. A generalized additive model with the natural splines was constructed to explore the association between the ambient air pollutants and daily internal medicine outpatient visits. Further, we conducted a lag analysis by using the distributed lag non-linear model to estimate the time-delayed effects of the air pollutants on the daily internal medicine outpatient visits.Results: A total of 2,190,258 daily internal medicine outpatient visits with a mean of 202.4 visits per day were recorded. The non-linear relationships were found among particulate matter2.5 (PM2.5), sulfur dioxide (SO2), and the daily internal medicine outpatient visits. Overall, PM2.5 was positively correlated with the daily internal medicine outpatient visits. Both ozone (O3) and SO2 had significant delayed effects on the daily internal medical outpatient numbers; however, PM2.5 only showed a short-term risk.Conclusion: Short-term exposure to PM2.5 was associated with an increase in the daily internal medicine outpatient visits for circulatory and respiratory diseases/symptoms in Zhoushan, China. SO2 and O3 were shown to induce significant effects after a concentration-dependent time lag.

ObjectivesOur aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting.SettingAll English ambulance services, UK.DesignWe used a time series design analysing published monthly National Health Service staff sickness rates by gender, age, job role and region, comparing the 10 regional ambulance services in England between 2009 and 2018. Autoregressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) models were developed using Stata V.14.2 and trends displayed graphically.ParticipantsIndividual participant data were not available. The total number of full-time equivalent (FTE) days lost due to sickness absence (including non-working days) and total number of days available for work for each staff group and level were available. In line with The Data Protection Act, if the organisation had less than 330 FTE days available during the study period it was censored for analysis.ResultsA total of 1117 months of sickness absence rate data for all English ambulance services were included in the analysis. We found considerable variation in annual sickness absence rates between ambulance services and over the 10-year duration of the study in England. Across all the ambulance services the median days available were 1 336 888 with IQR of 548 796 and 73 346 median days lost due to sickness absence, with IQR of 30 551 days. Among clinical staff sickness absence varied seasonally with peaks in winter and falls over summer. The winter increases in sickness absence were largely predictable using seasonally adjusted (SARIMA) time series models.ConclusionSickness rates for clinical staff were found to vary considerably over time and by ambulance trust. Statistical models had sufficient predictive capability to help forecast sickness absence, enabling services to plan human resources more effectively at times of increased demand.

Background and aim: The introduction of direct oral anticoagulants (DOACs) has greatly changed the use of anticoagulant therapy in patients with non-valvular atrial fibrillation (Af). However, few studies have reported on the current state of anticoagulant therapy at the national level. This study aimed to examine changes in the proportions of oral anticoagulant (OAC) prescriptions (4 DOACs and a vitamin K antagonist: VKA) in patients with non-valvular Af aged ≥65 years, taking into consideration the risk of cerebral infarction and bleeding.Methods: Anticoagulant prescriptions in outpatients with Af were temporally analyzed using the nationwide claims database in Japan. The proportion of anticoagulants prescribed to Af patients aged ≥65 years was determined. Trends in anticoagulant prescriptions were examined according to cerebral infarction and bleeding risk.Results: The proportion of anticoagulant prescriptions for 12,076 Af patients aged ≥65 years in Japan increased from 41% in 2011 to 56% in 2015. The proportion of prescriptions for DOACs surpassed that of VKA. An increase in DOAC prescriptions was accompanied by an increase in the proportion of anticoagulant prescriptions in each group according to the CHA2DS2-VASc and HAS-BLED scores. The proportion of anticoagulant prescriptions for patients with a high risk of developing cerebral infarction and bleeding showed a marked increase.Conclusion: Trends in anticoagulant prescriptions in patients with non-valvular AfAf in Japan showed a marked increase in DOAC prescriptions. The widespread use of DOACs greatly changes the profiles of cerebral infarction and bleeding risks, which are related to the prescription of anticoagulant therapy in patients with non-valvular Af.

Background There are few studies focused on the correlations between ambient air pollution and abdominal pain, especially in emergency departments in China. Method: Daily data (from January 1, 2016 to December 31, 2018), including air pollution concentration (SO2, NO2, PM2.5, PM10, CO, and O3) and meteorological variables, for daily emergency room visits (ERVs) were collected in Wuhan, China. We conducted a time-series study to investigate the potential correlation between six ambient air pollutants and ERVs for abdominal pain and their effects, in different genders, ages and seasons. Results A total of 16,306 abdominal pain ERVs were identified during the study period. A 10-µg/m3 increase in concentration of SO2, NO2, PM2.5, PM10, CO, and O3 corresponded respectively to incremental increases in abdominal pain of 6.12% (95% confidence interval [CI]: -0.44-13.12), 1.65% (95%CI: -0.25-3.59), 1.12% (95%CI: -0.18-2.44), 0.38% (95%CI: -1.09-1.87), 9.87% (95%CI:3.14–17.05) and 1.11% (95%CI: 0.03–2.21). We observed significant correlations between CO and O3 and daily abdominal pain ERVs increase, and positive but insignificant correlations between the other pollutants and ERVs. The effects were stronger mainly for females (especially SO2 and O3) and younger people (especially CO and O3). The correlations of PM2.5 and PM10 were stronger in cool seasons, while the correlation of CO was stronger in warm seasons. Conclusion Our time-series study suggested that short-term exposure to air pollution (especially CO and O3) was positively correlated with ERVs for abdominal pain in Wuhan, China, and that their effects varied by season, gender and age. These data can add evidence on how air pollutants affect the human body, and may prompt hospitals to take specific precautions on polluted days and maintain order in emergency departments made busier due to the pollution.

Objectives: To investigate the extent to which temperature and influenza explained seasonality of mortality in Japan and to examine the association of the seasonality with prefecture-specific characteristics. Design: We conducted time-series analysis to estimate the seasonal amplitude before and after adjusting for temperature and/or influenza-like illness (ILI). Next, we applied linear mixed effect models to investigate the association of seasonal amplitudes with each indicator on prefecture-specific characteristics on climate, demographic and socioeconomic factors and adaptations. Setting: 47 prefectures in Japan Participants: Deaths for all-cause, circulatory, and respiratory disease between 1999 and 2015. Outcome measures: Peak-to-trough ratio (PTR, a measure of seasonal amplitude). Results: The nationwide unadjusted-PTRs for all-cause, circulatory and respiratory mortality were 1.29 (95% CIs: 1.28 to 1.31), 1.55 (95% CI: 1.52 to 1.57) and 1.45 (95% CI: 1.43 to 1.48), respectively. These PTRs reduced substantially after adjusting for temperature but very little after a separate adjustment for ILI. Furthermore, seasonal amplitudes varied between prefectures. However, there was no strong evidence for the associations of PTR with the indicators on prefecture-specific characteristics. Conclusions: Seasonality of mortality is primarily driven by temperature in Japan. The spatial variation in seasonal amplitudes was not associated with prefecture-specific characteristics. Although further investigations are required to confirm our findings, this study can help us gain a better understanding of the mechanisms underlying seasonality of mortality., BMJ Open, 11(7), art. no. e044876; 2021

This study analyzed the trend of leprosy indicators in Sergipe, between 2001 and 2015. It was a time series study that analyzed the trend for general detection coefficient, children under 15 years of age, and new cases with grade 2 disability. The joinpoint model was used. Two (2.6%) municipalities had an increasing trend in general detection coefficient, five (6.6%) had an increasing trend in detection rate in children under 15, and 19 (25.3%) had an increasing trend in detection coefficient of new leprosy cases with grade 2 disability. The findings suggest maintenance of the chain of transmission.

Cardiovascular disease represents a significant public health issue and places an immense burden on India's citizens, families, health systems, and the population. Predictive models provide structure and direction in anticipating future needs. This time-series study employed Box-Jenkins time series modeling to forecast 2030 prevalence and mortality rates of stroke, ischemic heart disease, and cardiovascular disease. The 2030 projected cardiovascular disease prevalence rate was predicted to increase to 5.26% (95% prediction interval, 5.19%-5.28%), with major contributors being stroke and ischemic heart disease. The authors propose increased investment across the continuum of care to efficaciously promote, prevent, and rehabilitate cardiovascular disease.

Purpose Nocturnal headaches among adolescents were reported to be increased with the development of modern technology. The purpose of this paper is to investigate the smartphone electromagnetic radiation related to nocturnal headaches among high school students. Design/methodology/approach The time series study of all 12,969 records from 145 high school students Chiang Mai Province was selected from the population in the first phase by setting criteria. The samples completed a headache diary utilizing a smartphone application. The smartphone output power (SOP) was measured and recorded by the smartphone application and transmitted by e-mail to a researcher. The smartphone use, sleep quality, anxiety and depression also were assessed. Data were analyzed using Generalized Estimating Equation adjusting for demographic data, smartphone use, and sleep quality and otherwise. Findings The resulted showed the prevalence of repeated headaches to be 13.4 percent, nocturnal headache only 5.3 percent and the strongest effect of day time SOP at a 1.80–1.99×10−5 mW range on nocturnal headaches (ORadj5.18; 95% CI: 3.44–7.81). Meanwhile, Lag_6 of daily SOP exposure produced a nocturnal headache effect in a reverse dose-response manner. Furthermore, the nocturnal headache also had the strongest association with age, internet use and device brand (ORadj2.33; 95% CI: 1.08–5.05, ORadj2.14; 95% CI: 1.07–4.2 and ORadj1.68; 95% CI: 1.1–2.4). Originality/value The electromagnetic radiation from a smartphone is the environmental variables influences on headache. The results suggested that there should be limited times for smartphone use and older age to start using a smartphone to prevent headache attacks at night.

China is among the countries with the worst air quality throughout the world. As PM2.5 was not included in the national air quality monitoring network before January 2013 in China, no study has investigated the associations of ambient PM2.5 and O3 with cardiovascular mortality in Hefei, China. In this time-series analysis, Poisson regression in generalized additive model was adopted to assess the associations between the air pollutants and cardiovascular mortality during the 2013–2015 in Hefei, China. The findings showed that the daily average level of PM2.5 and O3 was 77.8 μg/m3 and 60.1 μg/m3 in the study period, respectively. PM2.5 and O3 exposure tended to increase cardiovascular mortality, but the associations were statistically insignificant. Further stratified analyses by seasons showed that with every 10 μg/m3 increase of PM2.5 in the cold season (October–March), the risk of cardiovascular death increased by 0.22% (95% CI 0.05%, 0.39%); while every 10 μg/m3 increase of O3 in the warm season (April–September), the risk of cardiovascular death increased by 1.29% (95% CI 0.26%, 2.33%) on Lag0. Interestingly, stratified analysis by gender showed that the associations of PM2.5, but not O3 exposure, could significantly increase cardiovascular mortality in females, but not males. The findings of this study especially underscored the adverse associations of PM2.5 and O3 exposure with females in specific seasons. More studies are needed to verify our findings and further investigate the underlying mechanisms.