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The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015–2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran’s Indices and retrospective space–time scan statistics were used in spatial and space–time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (−46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (−54.70%), North (−49.97%), and Northeast (−44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics.

The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015–2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran's Indices and retrospective space–time scan statistics were used in spatial and space–time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (−46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (−54.70%), North (−49.97%), and Northeast (−44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics. [ABSTRACT FROM AUTHOR]

Abstract Objectives: to analyze neonatal deaths according to avoidability and to analyze the temporal trend of neonatal mortality rate (NMR) in Niterói/RJ, 2012-2022. Methods: ecological time series study. Data from Sistema de Informação sobre Nascidos Vivos and Sistema de Informação sobre Mortalidade. NMRs were calculated according to maternal and neonatal variables and trends were estimated using the joinpoint regression. Results: the annual number of live births (LB) fell, with a decreasing trend among adolescents and those with low education level. Of the 324 deaths, most occurred early (0-6 days), by preventable causes in 68.6%, predominating those reducible by adequate care during pregnancy. The overall NMR remained stable, ranging from 4.2 to 6/1,000 LB, being higher at the extremes of maternal age (12.7 and 8.6/1,000 LB in 2022, adolescents and over 35 years old, respectively), in low education level mothers (27.6/1,000 LB in 2022), in neonates 2,500g, and for avoidable causes. Conclusions: the high proportion of preventable causes reveals the reduction potential. There was inequality in NMR and its trend, demanding more equitable health actions.

Xue Wang,1,* Chenghua Gao,2,* Yuan Xia,1 Xiaoqian Xu,1 Lehui Li,1 Yan Liu,1 Xing Yao,3 Ning Cao,1 Zichao Li,1 Xin Fang1 1Public Health College, Inner Mongolia Medical University, Hohhot, People’s Republic of China; 2School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, People’s Republic of China; 3Infection Control Department, Inner Mongolia People’s Hospital, Hohhot, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xin Fang, Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of China, Tel +86 18686066179, Email 18686066179@163.comObjective: There is limited evidence that atmospheric pollutants are associated with the number of allergic rhinitis (AR) visits. This study aimed to investigate the relationship between atmospheric pollutants and meteorological factors and the number of daily visits for AR in Hohhot City, providing a theoretical basis for further research on the effects of atmospheric pollutants on AR.Methods: Microsoft Excel 2016 was used to collect and organize the AR outpatient consultation data, air pollution and meteorological data in Hohhot City during 2018– 2020, and the data were descriptively analyzed and Spearman correlation test was performed using SPSS22.0; A generalized additive model was built in R4.2.3 to analyze the effect of air pollution on the number of AR visits and its lagged and cumulative effects, while the robustness of the model was tested using a two-pollutant analysis. Finally, we analyzed the effects of the interaction of temperature, relative humidity and pollutants on the number of AR visits.Results: The daily average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3 in Hohhot during 2018– 2020 were 38.1 μg/m3, 83.3 μg/m3, 36.1 μg/m3, 15.1 μg/m3, 14.2 mg/m3, and 99.95 μg/m3, respectively, with the concentrations of PM2.5 and PM10 exceeding the secondary limit of the national standard. The results of the generalized additive model analysis showed that the RR and 95% CI of the effect of each 10 μg/m3 increase in pollutant concentration (1 mg/m3 increase in CO) on the number of AR outpatient clinics were 1.008 (1.001– 1.016), 1.002 (1– 1.005), 1.072 (1.033– 1.113), 1.020 (1007– 1.034), 1.033 (1.014– 1.052), 0.987 (0.9804– 0.9936).Conclusion: Short-term exposure to PM2.5, PM10, SO2, NO2, and CO was significantly associated with an increase in AR clinic visits, and short-term exposure to O3 was significantly associated with a decrease in allergic rhinitis clinic visits.Keywords: allergic rhinitis, air pollutants, time series study, interaction effect

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Evidence suggests a possible association between ambient air pollutants and oral diseases. Nevertheless, information regarding the relationship between air pollutants and pulpitis is scarce and inconclusive. In view of this, the present study aimed to investigate the relationship between short-term exposure to air pollution and outpatient visits for pulpitis. Daily data on outpatient visits for pulpitis, air pollutants, and meteorological data in Hefei, China, was collected from January 1, 2015 to December 31, 2021. The association between exposure to air pollutants and pulpitis outpatient visits was evaluated using distributed lag non-linear model (DLNM) and a generalized linear model (GLM). Furthermore, stratified analyses were performed by gender, age and season. A total of 93,324 records of outpatient visits for pulpitis were included in this study. The results showed that exposure to NO2, PM2.5, and CO were positively correlated with an increased risk of pulpitis outpatient visits. Each 10 μg/m3 increase in NO2 and PM2.5 concentration, at lag 0–2 day, was associated with a 2.4% (relative risk (RR) = 1.024, 95% confidence interval (CI): 1.014–1.035) and 0.5% (RR = 1.005, 95% CI: 1.000–1.010) increase in pulpitis outpatient visits, respectively. With a 1 mg/m3 increase in CO concentration, the risk of pulpitis outpatient visits increased by 9.1% (RR = 1.091, 95% CI: 1.031–1.154, lag 0–1 day). Intriguingly, exposure to O3 was associated with a decreased risk of pulpitis outpatient visits (RR = 0.990, 95% CI: 0.984–0.995, lag 0–5 day). Subgroup analysis revealed that in the warm season, exposure to PM2.5, O3, and CO was related with a significantly higher outpatient risk of pulpitis than in the cold season. Additionally, the influence of PM2.5 and CO exposure at age < 65 years was significantly stronger than at age ≥ 65 years. In conclusion, exposure to ambient NO2, PM2.5, and CO is associated with an increase in pulpitis outpatient visits in Hefei, China. Conversely, exposure to O3 reduces the risk of outpatient visits for pulpitis. Age and season are effect modifiers of these associations. [ABSTRACT FROM AUTHOR]

Abstract Objective: to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. Methods: this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. Results: of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). Conclusion: incidence trend was stable in the state of Maranhão and falling in São Luís.

Ambient air pollution remains one of the most important risk factors for health outcomes. In recent years, there has been a growing number of research linking particulate matter (PM) exposure with adverse health effects, especially on cardiovascular and respiratory systems. The objective of this review is to examine the range and nature of studies on time series analysis of health outcomes affected by PM2.5 across a broad research area. A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping review framework through a strategic search of PubMed and ScienceDirect online databases for articles from January 2016 to January 2021. Articles were first screened by their titles and abstracts. Then two reviewers independently reviewed and evaluated the full text of the remaining articles for eligibility. Of the 407 potentially relevant studies, 138 articles were included for final analysis. There was an increasing trend in publications from 2016 to 2019 but a decreasing trend in the year 2020. Most studies were conducted in Eastern and South-Eastern Asia (69.6%), Europe and Northern America (14.5%) and Latin America and the Caribbean (8.7%), with the majority coming from high- and upper-middle-income countries (95.6%). The main methodology used was Generalized Additive Model (GAM) with Poisson distribution (74.6%). Morbidity was the most common health outcome studied (60.1%), with vulnerable groups (64.5%) often included. The association between PM2.5 and health effects was stronger for respiratory diseases compared to cardiovascular diseases. In short-term studies (less than 7 years), respiratory diseases showed higher risks compared to cardiovascular. However, in long-term studies (7 years and more), cardiovascular showed higher risks. [ABSTRACT FROM AUTHOR]

The associations of air pollution and meteorological factors with the outpatient visits of urticaria remain poorly studied. This study aimed to assess the association between air pollution, meteorological factors, and daily outpatient visits for urticaria in Shijiazhuang, China, during 2014–2019. Daily recordings of air pollutant concentrations, meteorological data, and outpatient visits data for urticaria were collected during the 6 years. Descriptive research methods were used to describe the distribution characteristics and demographic features of urticaria. A combination of the generalized linear regression model (GLM) and distribution lag nonlinear model (DLNM) was used to evaluate the lag association between environmental factors and daily outpatient visits for urticaria. Stratified analyses by gender (male; female) and age (< 18 years; 18–39 years; > 39 years) were further conducted. The dose–response relationship between daily urticaria visits and CO, NO2, O3, temperature, and relative humidity was nonlinear. High concentrations of CO, NO2, O3, and high temperatures increased the risk of urticaria outpatient visits. The maximum cumulative association of high concentrations of CO, NO2, and O3 was lag 0–14 days (CO: RR = 1.10, 95%CI: 1.06, 1.31; NO2: RR = 1.09, 95%CI: 1.01, 1.08; O3: RR = 1.16, 95%CI: 1.08, 1.25), and high temperatures was lag 0–7 days (RR = 1.27, 95%CI: 1.14, 1.41). Low concentrations of NO2, O3, and high humidity, on the other hand, act as protective factors for urticaria outpatient. The maximum cumulative association of low concentrations of NO2 was the 0-day lag (RR = 0.97, 95%CI: 0.95, 0.99), O3 was lag 0–5 days (RR = 0.94, 95%CI: 0.88, 0.99), and high humidity was lag 0–10 days (RR = 0.93, 95%CI: 0.89, 0.98). Stratified analyses showed that the risk of urticaria outpatient visits was higher for the males and in the < 18 years age group. In conclusion, we found that the development of urticaria in Shijiazhuang has a distinct seasonal and cyclical nature. Air pollutants and meteorological factors had varying degrees of influence on the risk of urticaria outpatient visits. This study provides indirect evidence for a link between air pollution, meteorological factors, and urticaria outpatient visits. [ABSTRACT FROM AUTHOR]

ObjectivePrevious epidemiological studies have shown that both long-term and short-term exposure to fine particulate matters (PM2.5) were associated with the morbidity and mortality of circulatory system diseases (CSD). However, the impact of PM2.5 on CSD remains inconclusive. This study aimed to investigate the associations between PM2.5 and circulatory system diseases in Ganzhou.MethodsWe conducted this time series study to explore the association between ambient PM2.5 exposure and daily hospital admissions for CSD from 2016 to 2020 in Ganzhou by using generalized additive models (GAMs). Stratified analyses were also performed by gender, age, and season.ResultsBased on 201,799 hospitalized cases, significant and positive associations were found between short-term PM2.5 exposure and hospital admissions for CSD, including total CSD, hypertension, coronary heart disease (CHD), cerebrovascular disease (CEVD), heart failure (HF), and arrhythmia. Each 10 μg/m3 increase in PM2.5 concentrations was associated with a 2.588% (95% confidence interval [CI], 1.161%–4.035%), 2.773% (95% CI, 1.246%–4.324%), 2.865% (95% CI, 0.786%–4.893%), 1.691% (95% CI, 0.239%–3.165%), 4.173% (95% CI, 1.988%–6.404%) and 1.496% (95% CI, 0.030%–2.983%) increment in hospitalizations for total CSD, hypertension, CHD, CEVD, HF, and arrhythmia, respectively. As PM2.5 concentrations rise, the hospitalizations for arrhythmia showed a slow upward trend, while other CSD increased sharply at high PM2.5 levels. In subgroup analyses, the impacts of PM2.5 on hospitalizations for CSD were not materially changed, although the females had higher risks of hypertension, HF, and arrhythmia. The relationships between PM2.5 exposure and hospitalizations for CSD were more significant among individuals aged ≤65 years, except for arrhythmia. PM2.5 had stronger effects on total CSD, hypertension, CEVD, HF, and arrhythmia during cold seasons.ConclusionPM2.5 exposure was positively associated with daily hospital admissions for CSD, which might provide informative insight on adverse effects of PM2.5.

BackgroundAmbient carbon monoxide (CO) exposure is associated with increased mortality and hospitalization risk for total respiratory diseases. However, evidence on the risk of hospitalization for specific respiratory diseases from ambient CO exposure is limited.MethodsData on daily hospitalizations for respiratory diseases, air pollutants, and meteorological factors from January 2016 to December 2020 were collected in Ganzhou, China. A generalized additive model with the quasi-Poisson link and lag structures was used to estimate the associations between ambient CO concentration and hospitalizations of total respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), and influenza-pneumonia. Possible confounding co-pollutants and effect modification by gender, age, and season were considered.ResultsA total of 72,430 hospitalized cases of respiratory diseases were recorded. Significant positive exposure–response relationships were observed between ambient CO exposure and hospitalization risk from respiratory diseases. For each 1 mg/m3 increase in CO concentration (lag0–2), hospitalizations for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia increased by 13.56 (95% CI: 6.76%, 20.79%), 17.74 (95% CI: 1.34%, 36.8%), 12.45 (95% CI: 2.91%, 22.87%), 41.25 (95% CI: 18.19%, 68.81%), and 13.5% (95% CI: 3.41%, 24.56%), respectively. In addition, the associations of ambient CO with hospitalizations for total respiratory diseases and influenza-pneumonia were stronger during the warm season, while women were more susceptible to ambient CO exposure-associated hospitalizations for asthma and LRTI (all P < 0.05).ConclusionIn brief, significant positive exposure–response relationships were found between ambient CO exposure and hospitalization risk for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia. Effect modification by season and gender was found in ambient CO exposure-associated respiratory hospitalizations.

Background: Many studies have shown that various kinds of diseases were associated with the variation of ambient temperature. However, there’s only a scrap of evidence paying attention to the link between temperature and skin diseases, and no relevant national research was performed in China. Objective: This study aimed to quantify the effect of heat on skin diseases and identify the vulnerable populations and areas in China. Methods: Daily meteorological data, air pollutant data and outpatient data were collected from in 18 sites of China during 2014–2018. A time-series study with distributed lag nonlinear model and multivariate meta-analysis was applied to analyze the site-specific and pooled associations between daily mean temperature and daily outpatient visits of skin diseases by using the data of warm season (from June to September). Stratified analysis by age, sex and climate zones and subtypes of skin diseases were also conducted. Results: We found a positive linear relationship between the ambient temperature and risk of skin diseases, with a 1.25% (95%CI: 0.34%, 2.16%) increase of risk of outpatient visits for each 1 °C increase in daily mean temperature during the warm season. In general, groups aged 18–44 years, males and people living in temperate climate regions were more susceptible to high temperature. Immune dysfunction including dermatitis and eczema were heat-sensitive skin diseases. Conclusions: Our findings suggested that people should take notice of heat-related skin diseases and also provided some references about related health burden for strategy-makers. Targeted measures for vulnerable populations need to be taken to reduce disease burden, including monitoring and early warning systems, and sun-protection measures.

NASA GIOVANNI is an advanced technology of remote sensing system. It is able to provide with Earth Science information within only a few minutes. The focus of this study is to obtain a reliable information via NASA GIOVANNI regarding the temperature trend in Penang Island, Malaysia, from year 2016 to 2018 and to verify the validity and reliability of the data obtained from NASA GIOVANNI and therefore being able to replace with the conventional method of using AccuWeather. From the system, MODIS Aqua is selected as it is the most suitable satellite among others to capture the temperature reading at the desired area. The data obtained from AccuWeather are mostly accurate and clear even though there are several limitations regarding the parameter involved as it is quite general. Meanwhile the temperature data obtained from NASA GIOVANNI are more specific and detailed as it consists of several parameters. For example, NASA GIOVANNI can access the sea surface and land surface temperature for the desired location. Apart from that, NASA GIOVANNI also able to separate between daytime and nighttime temperature data. After obtaining both data from NASA GIOVANNI and AccuWeather, an effective comparison is made via cross validation or to be exact, linear regression. From the graph of linear regression, R-Squared value can be calculated and hence can determine the correlation of both data. From the R-Squared calculations, the values calculated are 0.75 for year 2016, 0.65 for year 2017 and 0.71 for year 2018. According to the R-Squared value, it is concluded that the temperature data from NASA GIOVANNI is having a positive and strong correlation with AccuWeather as the values are exceeding 0.5 for each year. Therefore, the temperature data via NASA GIOVANNI is possible to be obtained and that the obtained temperature data are almost as accurate as AccuWeather. [ABSTRACT FROM AUTHOR]

Summary: Background: Data reporting the number of births given by women resident in Vienna for each week between 1999 and 2019, and the duration (in weeks) of their pregnancies, were used to estimate the week of conception. When preliminary examinations detected cyclical patterns for births and conceptions, a series of Poisson regressions for births and conceptions were performed to assess whether these cycles could be associated with lunar or solar phases. Methods: To that end 2 sine-cosine functions, 1 with a wavelength of 1 year (365.25 days) and 1 with a wavelength of 29.529 days, the latter resembling the average length of a lunar cycle, were constructed. In addition, also average weekly temperatures were included in the models. Results: Same week temperature was a strong non-linear predictor for both births and conceptions. Extreme temperatures, especially hot temperatures, increased the number of births while the numbers of successful conceptions were decreased by extreme temperatures. Regarding annual variation in conceptions, the lowest values were found in May and the highest in late autumn and early winter. Therefore, the highest numbers of births are observed in the summer. As per lunar variations, the highest numbers of conceptions occurred at the full moon and the highest numbers of births at the waxing crescent to first quarter moon. Discussion: The latter results should be treated with caution, as they are not hypothesis driven. Furthermore, literature reports on this topic are conflicting. Nevertheless, these findings will be useful in further analyses examining air pollution effects. [ABSTRACT FROM AUTHOR]

Short-term exposure to PM 2.5 or O 3 can increase mortality risk; however, limited studies have evaluated their interaction. A multicity time series study was conducted to investigate the synergistic effect of PM 2.5 and O 3 on mortality in China, using mortality data and high-resolution pollutant predictions from 272 cities in 2013-2015. Generalized additive models were applied to estimate associations of PM 2.5 and O 3 with mortality. Modification and interaction effects were explored by stratified analyses and synergistic indexes. Deaths attributable to PM 2.5 and O 3 were evaluated with or without modification of the other pollutant. The risk of total nonaccidental mortality increased by 0.70% for each 10 μg/m 3 increase in PM 2.5 when O 3 levels were high, compared to 0.12% at low O 3 levels. The effect of O 3 on total nonaccidental mortality at high PM 2.5 levels (1.26%) was also significantly higher than that at low PM 2.5 levels (0.59%). Similar patterns were observed for cardiovascular or respiratory diseases. The relative excess risk of interaction and synergy index of PM 2.5 and O 3 on nonaccidental mortality were 0.69% and 1.31 with statistical significance, respectively. Nonaccidental deaths attributable to short-term exposure of PM 2.5 or O 3 when considering modification of the other pollutant were 28% and 31% higher than those without considering modification, respectively. Our results found synergistic effects of short-term coexposure to PM 2.5 and O 3 on mortality and suggested underestimations of attributable risks without considering their synergistic effects.

ABSTRACT Background: We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019. Methods: A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran’s index to check for autocorrelation. Results: A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation. Conclusions: In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).

The topic of inflammatory bowel disease (IBD) has attracted more and more attention. Accumulating evidence suggests that exposure to air pollutants is associated with IBD, yet the results are inconsistent and study about daily exposure is few. This study evaluated the association between daily air pollution and IBD in Hefei, China. Daily IBD admission data were obtained from two hospitals in Hefei from January 1, 2019, to December 31, 2019. Daily concentrations of major air pollutants were provided by the Hefei Environmental Protection Bureau. Meteorological data were collected from China Meteorological Data Network. Distributed lag nonlinear model (DLNM) considering both the lag effects of exposure factors and nonlinear relationship of exposure-reaction was used to assess the effect of daily air pollutants exposure on IBD admission. During the study period, totally 886 cases of IBD were recruited, including 313 cases of ulcerative colitis (UC) and 573 cases of Crohn's disease (CD). The findings showed PM2.5, O3, and CO exposure significantly increased the risk of IBD. Mean concentrations of PM2.5, O3, and CO in Hefei were 43.85ug/m3, 100.78ug/m3, and 0.76 mg/m3, respectively. Each increase of 10 mg/m3 in PM2.5/O3 and 0.1 mg/m3 in CO increased the risk of IBD. The strongest effects of these three pollutants on IBD were observed in lag2-lag3 (RR = 1.037, 95% CI: 1.005–1.070%), lag3 (RR = 1.020, 95% CI: 1.002–1.038%), and lag2 (RR = 1.036, 95% CI: 1.003–1.071%), respectively. In warm seasons, PM2.5, O3, and CO had a stronger effect increased the risk of IBD, which were observed in lag2 (RR = 1.104, 95% CI: 1.032–1.181%), lag2 and lag5 (RR = 1.023, 95% CI: 1.002–1.044%; RR = 1.036, 95% CI: 1.004–1.069%), and lag2 (RR = 1.071, 95% CI: 1.012–1.133%), respectively. Air pollutant (PM2.5, O3, and CO) exposure could increase the risk of IBD, while the most susceptibility seasons for the exposure were mainly in warm seasons. The results of this study suggest that air pollutants increase the risk of IBD patients in Hefei, China, providing a basis for developing countries to improve effective prevention of IBD, and a potential opportunity to avoid part of the risk of the onset or recurrence of IBD. This study contributes to the knowledge of the association between air pollution and IBD, but the associations need to be verified by further studies. [ABSTRACT FROM AUTHOR]

Previous studies demonstrated that short-term exposure to gaseous pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3)) had a greater adverse effect on cardiovascular disease. However, little evidence exists regarding the synergy between gaseous pollutants and cardiovascular disease (CVD). Therefore, we aimed to estimate the effect of individual gaseous pollutants on hospital admissions for CVD and to explore the possible synergistic effects between gaseous pollutants. Daily hospitalization counts for CVD were collected from January 1, 2014, to December 31, 2015. We also collected daily time series on gaseous pollutants from the Environment of the People's Republic of China, including NO2, SO2, and O3. We used distributed lag nonlinear models (DLNMs) to assess the association of individual gaseous pollutants on CVD hospitalization, after controlling for seasonality, day of the week, public holidays, and weather variables. Then, we explored the variability across age and sex groups. In addition, we analyzed the synergistic effects between gaseous pollutants on CVD. Extremely low NO2 and SO2 increase the risk of CVD in all subgroup at lag 7 days. The greatest effect of high concentration of SO2 was observed in male and the elderly (≥ 65 years) at lag 3 days. Greater effects of high concentration of O3 were more pronounced in the young (< 65 years) and female at lag 3 days, while the effect of low concentration of O3 was greater in male and the young (< 65 years) at lag 0 day. We found a synergistic effect between NO2 and SO2 for CVD, as well as between SO2 and O3. The synergistic effects of NO2 and SO2 on CVD were stronger in the elderly (≥ 65) and female. The female was sensitive to synergistic effects of SO2-O3 and NO2-O3. Interestingly, we found that there was a risk of CVD in the susceptible population even for gaseous pollutant concentrations below the National Environmental Quality Standard. The synergy between NO2 and SO2 was significantly associated with cardiovascular disease hospitalization in the elderly (≥ 65). This study provides evidence for the synergistic effect of gaseous pollutants on hospital admissions for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objective: To analyze the trend of epidemiological and operational indicators of leprosy in the state of Tocantins, Brazil, from 2001 to 2020. Methodology: This is a population-based ecological study, with temporal analysis of new leprosy cases based on Poisson regression by inflection points (Joinpoints), using secondary data reported between 2001 and 2020. Results: A total of 24.413 cases were reported. The overall detection coefficient showed four temporal trends. The Médio Norte Araguaia, Cerrado Tocantins Araguaia and Ilha do Bananal regions showed a significant downward trend in the AAPC (3.1%, 4.6% and 5.3%, respectively). Only the Amor Perfeito region showed a significant growth trend of 2.7%. In the evaluation of the Annual Percent Change (APC), the Bico do Papagaio region had a significant increase of 12.1% between 2001 and 2008 and a significant decrease of 10.3% between 2008 and 2020. In the Capim Dourado region, the APC had a significant decrease of 6.3% between 2001 and 2013 and a significant increase of 34.5% between 2013 and 2018. Conclusion: Leprosy remains in high magnitude in Tocantins, indicating active transmission, late diagnosis, heterogeneous trend in case detection in the eight health regions and persistence of hyperendemicity, requiring strengthening of surveillance measures. [ABSTRACT FROM AUTHOR]

Some studies suggested that 24-h 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. The aim of this study is 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. 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 station 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. 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. The estimates in non-heating months were higher than in full year. 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 temperature on population health. [ABSTRACT FROM AUTHOR]

Accumulating evidence witnesses the negative influence of air pollution on human health, but the relationship between air pollution and premature babies has been inconsistent. In this study, the association between weekly average concentration of air pollutants and preterm birth (PTB) was conducted in Xuzhou, a heavy industry city, in China. We constructed a distributed lag non-linear model (DLNM), an ecological study, to access the associations between ambient air pollutants and PTB in this study. Totally, 5408 premature babies were included, and the weekly average levels of PM2.5, PM10, SO2, NO2, O3, and CO were 61.24, 110.21, 22.55, 40.55, 104.45, and 1.04 mg/m3, respectively. We found that PM2.5, PM10, SO2, and NO2 significantly increased the risk of PTB, and the susceptibility windows of these contaminants were the second trimester and third trimester (from 12 to 29 weeks). Every 10 μg/m3 increase of PM2.5, PM10, SO2, and NO2, the greatest relative risk (RR) values and 95% confidence interval (CI) on PTB were 1.0075 [95% CI, 1.0019–1.0131], 1.0053 [95% CI, 1.0014–1.0092], 1.0203 [95% CI, 1.0030–1.0379], and 1.0170 [95% CI, 1.0052–1.0289] in lag 16th, 18th, 19th, and 20th gestational weeks, respectively. No significant influence of O3 and CO were found on preterm birth. Subgroup analysis showed that the risk of premature delivery was higher for younger pregnant women and in warm season. This finding shows that prenatal exposure to ambient air pollutants is associated with preterm birth, and there existed an exposure window period. [ABSTRACT FROM AUTHOR]

Background: It is still unclear about the association between ambient air pollution and attack risk of acute myocardial infarction (AMI) in South China. This study assessed the effects of short-term exposure to ambient air pollutants on hospital admission of AMI in Guangzhou, South China. Materials and methods: We obtained the information on 19,622 hospital admissions of AMI from the Guangzhou Cardiovascular and Cerebrovascular Disease Event Surveillance System during the years from 2014 to 2017. Daily concentrations of air pollution data on particulate matter < 2.5 μm in diameter (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) were available from the Daily Quality Report of the Guangzhou Environmental Protection Bureau during the study period. The effects of air pollution exposure on the risk of AMI hospital admission were assessed using Poisson generalized additive models. Risk estimates were reported as the percent increase in daily hospital admissions of AMI for an interquartile range (IQR) increment in air pollution concentrations. Results: On average, there were 13 hospital admissions of AMI each day. After controlling for the pollutants, including PM2.5, SO2, and O3, and other time-varying factors, a 21.26-μg/m3 increment in the 2-day moving average of same-day and previous-day NO2 concentrations was statistically linked to an increase of 6.38% [95% confidence interval (CI): 1.33%, 11.67%] of AMI hospital admissions. Additionally, per IQR increment in the 2-day moving average exposure of same-day and previous-day NO2 pollutant levels was linked to a 7.85% (95% CI: 1.19%, 14.95%) increase of AMI hospital admissions among people aged above 65 years old. An effect modification of risk by gender was found, suggesting that females were more susceptible to the exposure to NO2 pollutant. Conclusions: A statistical association between NO2 exposure and AMI attack risk is identified, which can provide insight into the planning of clinical services for AMI. [ABSTRACT FROM AUTHOR]

The work presents the results of short-term health effects assessment of particulate matter (PM) in Warsaw, the capital of Poland. The influence of three PM fractions, PM10 (particles of aerodynamic diameter < 10 μm), PM2.5 (particles of aerodynamic diameter < 2.5 μm), and PMc (coarse fraction of diameter between 2.5 and 10 μm), modeled by the CALMET/CALPUFF system, has been studied in the period of 2013–2014. Six population health endpoints; daily counts of all-cause (ALL), cardiovascular (CV), and respiratory (RS) death cases; and ALL, CV, and RS hospital admissions were investigated with the use of statistical time series analysis via nonparametric generalized additive model (GAM) approach. The results show that PM2.5 increases the relative risk (RR) of ALL premature deaths by 0.7% per 10 μg/m3, as well as of CV mortality by 0.9%. PM10 exposures reveal the largest influence on mortality in a 2-day lag: 0.3% for all causes and 0.4% for CV causes, while for RS causes only in the elderly group (above 65 years, 1.4%) and for males (2.1%). The risk of hospitalizations increases with elevated PMc levels by 2.5%, 2.1%, and 4.6% for ALL, CV, and RS hospital admissions, respectively. The results suggest that the research on PM impact on health should concentrate more on attempts to assign specific health outcomes to PM originating from different types of sources, characterized by different granulation, as well as physical and chemical properties of emitted particles. [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of legislative changes to the New South Wales (NSW) workers' compensation scheme on injured workers access to benefits, insurer claim processing and work disability duration.Methods: Population-based interrupted time series study of workers' compensation claims made in NSW 2 years before and after legislative amendment in June 2012. Outcomes included incidence of accepted claims per 100 000 workers, the median and 75th percentile insurer decision time in days, and the median and 75th percentile of work disability duration in weeks. Effects were assessed relative to a comparator of seven other Australian workers' compensation jurisdictions.Results: n=1 069 231 accepted workers' compensation claims were analysed. Claiming in NSW fell 15.3% following legislative reform, equivalent to 46.6 fewer claims per 100 000 covered workers per month. This effect was greater in time loss claims (17.3%) than medical-only claims (10.3%). Across models, there were consistent trend increases in insurer decision time. Median work disability duration increased following the legislative reform.Conclusions: The observed reduction in access to benefits was consistent with the policy objective of improving the financial sustainability of the compensation scheme. However, this was accompanied by changes in other markers of performance that were unintended, and are suggestive of adverse health consequences of the reform. This study demonstrates the need for care in reform of workers' compensation scheme policy. [ABSTRACT FROM AUTHOR]

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Abstract Background Although numerous studies have demonstrated that the criteria air pollutants increased the risk of exacerbation of chronic obstructive pulmonary disease (COPD), few have explored the effects of ambient benzene and toluene on COPD. Objective This study aimed to evaluate the short-term effects of ambient benzene and toluene on emergency COPD (eCOPD) hospitalizations. Methods We obtained daily mean and maximum concentrations of benzene and toluene during April 1, 2011 - December 31, 2014 from the Hong Kong Environmental Protection Department, and daily counts of eCOPD hospitalizations from the Hospital Authority. Generalized additive distributed lag models were used to estimate the percentage excess risk (ER%) of eCOPD hospitalizations per interquartile range (IQR) increase in ambient benzene and toluene. Results The ER% estimates of eCOPD hospitalizations post cumulative exposure of up to two days were 2.62% (95%CI: 0.17% to 5.13%) and 1.42% (0.16% to 2.69%), for per IQR increase of daily mean benzene (1.4 μg/m3) and toluene (4.6 μg/m3), respectively. People below the age of 65 had a significantly higher risk of eCOPD hospitalizations associated with daily maximum toluene than the elderly. Conclusions Ambient benzene and toluene might be environmental stressors for acute exacerbations of COPD in the Hong Kong population. Graphical abstract Unlabelled Image Highlights • Evidence of ambient benzene and toluene on COPD is insufficient. • We performed generalized additive distributed lag model to assess short-term effects of ambient benzene and toluene on emergency COPD hospitalizations. • We observed cumulative effects of daily mean benzene and toluene on emergency COPD hospitalizations up to two days. • The relation of daily maximum toluene on emergency COPD hospitalizations was stronger in the younger people. [ABSTRACT FROM AUTHOR]

Abstract Background Numerous epidemiological studies have indicated the adverse cardiovascular effects of air pollution on heart failure (HF) risk. However, little data are available directly evaluating the association of ambient volatile organic compounds (VOCs) with HF risk. We aimed to estimate the short-term effects of ambient VOCs on HF emergency hospitalizations in Hong Kong and to evaluate whether the associations were modified by sex and age. Methods We collected the daily VOCs concentrations from the Hong Kong Environmental Protection Department between April 2011 to December 2014. HF emergency hospital admission data were obtained from the Hospital Authority of Hong Kong. Generalized additive model (GAM) integrated with the distributed lag model (DLM) was used to estimate the excess risks of HF emergency hospitalizations with ambient concentrations of each VOCs groups – alkane, alkene, alkyne, benzene and substituted benzene. Results We observed short-term effects of alkyne and benzene on an increased risk of HF emergency hospitalizations. The cumulative effect over 0–6 lag days (dlm 0-6) for an IQR increment of alkyne (1.17 ppb) was associated with 4.2% (95% CI: 1.18%–7.26%) increases of HF emergency hospitalizations, while the corresponding effect estimate over dlm 0-2 for benzene per IQR (0.43 ppb) was 2.7% (95% CI: 0.39%–5.04%). Each VOCs groups was significantly associated with HF emergency hospitalizations in men. Conclusions Ambient volatile organic compounds, particularly alkyne and benzene, were associated with increased risks of heart failure in the Hong Kong population. Graphical abstract Image 1 Highlights • Evidence on health effects of ambient VOCs on heart failure is insufficient. • Generalized additive distributed lag model were used to estimate effects of VOCs. • We observed short-term effects of alkyne and benzene on HF hospitalizations. • Health impacts of VOCs on HF were stronger in men. [ABSTRACT FROM AUTHOR]

Background While numerous studies worldwide have evaluated the short-term associations of fine and coarse particulate matter (PM) air pollution with mortality and morbidity, these studies may be susceptible to short-term harvesting effect. We aimed to investigate the short-term association between mortality and PM with aerodynamic diameter less than 2.5 μm (PM 2.5 ) and those between 2.5 and 10 μm (PMc) within a month prior to death, and assess the mortality displacement by PM 2.5 and PMc among elderly population in Hong Kong. Methods We obtained air pollution data from January 2011 to December 2015 from Environmental Protection Department, and daily cause-specific mortality data from Census and Statistical Department of Hong Kong. We performed generalized additive distributed lag model to examine the acute, delayed and long-lasting effects of PM 2.5 and PMc within one month on mortality. Results We observed a statistically significant association of PM 2.5 and PMc exposure over lags 0–6 days with all natural mortality and cardio-respiratory mortality. The overall cumulative effect of PM 2.5 over 0–30 lag days was 3.44% (95% CI: 0.30–6.67%) increase in all natural mortality and 6.90% (95% CI: 0.58–13.61%) increase of circulatory mortality, which suggested the absence of mortality displacement by PM 2.5 . On the other hand, no significant cumulative association with mortality was found for PMc over 0–30 lag exposure window, and thus mortality displacement by PMc cannot be ruled out. Findings remained robust in various sensitivity analyses. Conclusions We found adverse effect of both PM 2.5 and PMc exposure within one week prior to death. While there was no evidence of mortality displacement in the association of PM 2.5 exposure over one month prior with all natural and circulatory mortality, mortality displacement by PMc cannot be ruled out. PM 2.5 may contribute more to the longer term effect of particulate matter than PMc. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the risk factors of the daily mortality associated with air pollution causing acute lower respiratory tract infections. Methods: We applied a short time series analysis to the air pollution record, meteorological data and 133 non-accidental death data in Shengyang, China, in 2013-2015. After controlling the seasonality, day of week and weather conditions, the group employed an over-dispersed Possion generalized addictive model to discuss the associations among different variables, then performed the stratified analysis according to age, gender, and season. Results: Mean concentrations of particulate matter with aerodynamic diameters of < 10 μm (PM10) and < 2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) were 122.4, 74.8, 79.4, 47.7, and 86.2 μg/m3, respectively. An increase of 10 μg/m3 in the 8-day moving average concentrations of PM10, PM2.5, SO2, NO2, and O3 corresponded to 0.18% (95% confidence interval [CI]: 0.10%, 0.26%), 0.21% (95% CI: 0.11%, 0.31%), 0.16% (95% CI: 0.04%, 0.30%), 0.43% (95% CI: 0.07%, 0.90%), and 0.10% (95% CI: -0.08%, 0.31%) increase in the daily mortality. The effects of air pollution lasted 9 days (lag 0-8), and they were more statistically significant in the elderly than in other age groups. Conclusion: These findings clarified the burden of air pollution on the morbidity of acute lower respiratory tract infections and emphasized the urgency of the control and prevention of air pollution and respiratory diseases in China.

Background Numerous epidemiological and experimental studies have demonstrated the detrimental effects of the criteria air pollutants on population health, including particulate matters, ozone, and nitrogen dioxide. However, evidence on health effects of benzene, toluene, ethylbenzene, and xylene (BTEX in short) is insufficient. Objectives The present study aimed to assess the exposure-lag-response relations of ambient BTEX components with cardiorespiratory mortality in Hong Kong population. Methods Daily BTEX concentrations from April 2011 to December 2014 were collected from the Hong Kong Environmental Protection Department. Cause-specific mortality records were obtained from the Census and Statistics Department of Hong Kong. Generalized additive model (GAM) integrated with a distributed lag model (DLM) was used to estimate the excess risks of cardiorespiratory mortality associated with the cumulative exposure to benzene and TEX (toluene, ethylbenzene and xylene combined) over 0–9 lag days, while adjusting for time trend, seasonality, weather conditions and calendar effects. Results We observed the delayed and distributed lag effects of BTEX components on circulatory mortality. The cumulative exposures over 0–9 lag days for IQR increments of benzene (1.4 μg/m 3 ) and TEX (7.9 μg/m 3 ) were associated with 5.8% (95%CI: 1.0% to 10.8%) and 3.5% (95%CI: 1.0% to 6.1%) increases in circulatory mortality, respectively. The effect estimates of benzene and TEX were more delayed than that of PM 2.5 . We didn't observe any significant association of BTEX exposure on total and respiratory deaths. Conclusions Short-term elevations in ambient BTEX concentrations may trigger circulatory mortality in Hong Kong population. [ABSTRACT FROM AUTHOR]

Background Chronic obstructive pulmonary disease (COPD) has become the fourth-leading cause of death. The association between air pollution and years of life lost (YLL) caused by COPD is currently a hot topic; however, few studies have been published regarding COPD YLL around the world, especially in China, a highly polluted area. Aim We investigated the exposure-response association between ambient particulate matter with an aerodynamic diameter of less than 10 μm (PM 10 ) and COPD YLL. Methods We applied a generalized additive model (GAM) to estimate the short-term effects of PM 10 on COPD YLL and mortality from 2002 to 2010 in Tianjin. Results The annual mean concentration of PM 10 was 111.6 μg/m 3 . An increase in PM 10 was significantly associated with daily YLL and mortality in a single pollutant model. A 10 μg/m 3 increase in the two-day moving average of PM 10 was associated with the maximum YLL increment of 0.30 (95% confidence interval: 0.06, 0.54) person-years and an excess risk (ER) of mortality of 0.60% (0.20%, 1.01%). For YLL increases, the association is stronger in elderly (0.27 (0.06, 0.48), the cumulative effect) populations than in younger populations. Conclusions An increment of COPD YLL is associated with an increased PM 10 concentration. Elderly groups are more susceptible to air pollution. Strict air pollutant emission control is needed to protect public health. [ABSTRACT FROM AUTHOR]