Objective:To study the relationship between emergency department visits for unintentional injuries and air pollutants in four cities in Shandong Province, China (2019-2022). Methods:From 2019 to 2022, the data on air pollutants and unintentional injury emergency department visits were extracted from four cities in Shandong Province (Dezhou, Jinan, Zibo, and Heze). We used the dynamic factor model (DFM) to determine the trend of emergency visits and the distributed lag nonlinear model (DLNM) to analyze the lag effect of air pollutants on these visits. We also conducted a meta-analysis to summarize the impact estimates of air pollutants on emergency visits. Results:The dynamic factor model showed that from 2019 to 2022, the number of emergency visits for unintentional injuries in the four cities in Shandong Province was cyclical, with the highest number of emergency visits in summer every year. PM2.5, PM10, CO, SO2, NO2, and O3 exhibited single-day lag effects on emergency visits for unintentional injuries, with the highest risk observed at Lag4, Lag5, Lag4, Lag3, Lag1, and Lag3, respectively. The corresponding relative risks (RRs) and 95% confidence intervals (CIs) were 1.014(1.007, 1.021), 1.015(1.006, 1.023), 1.085(1.038, 1.134), 1.036(1.013, 1.060), 1.121(1.069, 1.175), and 1.084(1.052, 1.116). Additionally, PM2.5, PM10, CO, SO2, NO2, and O3 demonstrated cumulative lag effects, with the highest risk observed at Lag07, Lag07, Lag06, Lag05, Lag06, and Lag05, respectively. The RRs (95% CIs) were 1.058(1.033, 1.083), 1.037(1.003, 1.072), 1.468(1.244, 1.733), 1.099(1.039, 1.161), 1.221(1.097, 1.359), and 1.227(1.138, 1.323). Conclusion:Emergency visits for unintentional injuries in the four cities exhibited an annual cyclical pattern, with the peak occurring in summer. Exposure to high concentrations of air pollutants increased the risk of unintentional injuries, with distinct effects observed across different pollutants, each exhibiting specific single-day and cumulative lag effects.

Platelets are an able regulator of CD4+ T cell immunity. Herein, the mechanisms underlying platelet-regulated effector responses of naïve CD4+ T (Tn) cells were investigated. Platelet–Tn cell co-cultures of human cells, genetically modified murine models, and high-throughput bioinformatic analyses were combined to elucidate molecular mechanisms of platelet-dependent regulation. Platelets exerted sophisticated regulation on effector responses of type 1, 2, and 17 T helper (Th1/Th2/Th17) and regulatory T (Treg) cells, in time-, concentration-, and organ-dependent manners and with close cooperation of transforming growth factor β (TGFβ) and platelet factor 4 (PF4). PF4 at low concentrations reinforced TGFβ signaling by heteromerizing with type III TGFβ receptor (TGFBRIII), and subsequently enhanced TGFBRII expression and TGFβ signaling. High-concentration PF4 had, however, opposite effects by directly binding to TGFBRII, blocking TGFβ–TGFBRII ligation, and thus inhibiting TGFβ signaling. Furthermore, platelet depletion markedly hampered Treg and Th17 responses in the spleen but not in the lymph nodes, blockade of platelet–Tn cell contact diminished platelet effects, while spleen injection of PF4-immobilized microparticles in PF4-deficient mice mimicked platelet effects, suggesting the importance of direct platelet–Tn contact and platelet-bound PF4 for the optimal regulatory effects by platelets. Platelets exert context-dependent regulations on effector responses of Tn cells via PF4-TGFβ duet, suggesting new possibilities of platelet-targeted interventions of T cell immunity.

目的 通过R软件实现分布滞后非线性模型(distributed lag non-linear model,DLNM)与多元meta分析的两阶段分析.方法 通过1个时间序列数据实例研究介绍利用R软件实现DLNM与多元meta分析2阶段分析的具体步骤.结果 DLNM与多元meta分析的两阶段分析可以在R软件中实现.结论 R软件可灵活方便地构建DLNM以及实现多元meta分析,在环境流行病学中可广泛应用.

目的 了解我国甲乙类传染病的流行病学特征和发病趋势,为制定此类疾病的针对性防治措施提供依据.方法 通过描述性流行病学方法,对2008—2018年我国甲乙类法定传染病的流行特征进行探讨.结果 2008—2018年我国甲乙类传染病的发病率呈整体下降趋势(χ2=7.422,P=0.006),死亡率呈明显上升趋势(χ2=8.096,P=0.004);2008—2018年11年间病毒性肝炎和肺结核发病率一直稳居发病顺位前两位,发病率显著高于其它类型传染病;四种不同传播途径甲乙类传染病的发病率顺位为:血源传播及性传染病(整体呈上升趋势,χ2=4.478,P=0.034)、呼吸道传染病(整体呈下降趋势,χ2=8.943,P=0.003)、肠道传染病(整体呈下降趋势,χ2=9.848,P=0.002)、自然疫源及虫媒传染病(整体呈下降趋势,χ2=0.207,P=0.649).结论 目前我国部分法定甲乙类传染病发病率依然呈现上升趋势,死亡率整体亦呈现上升趋势,且新发传染病不断出现,甲乙类传染病的防控依然是我国的一项重大公共卫生问题,相关部门应该采取措施进行防控.

Abstract Background The effects of extreme temperature on infectious diseases are complex and far-reaching. There are few studies to access the relationship of pulmonary tuberculosis (PTB) with extreme temperature. The study aimed to identify whether there was association between extreme temperature and the reported morbidity of PTB in Shandong Province, China, from 2005 to 2016. Methods A generalized additive model (GAM) was firstly conducted to evaluate the relationship between daily reported incidence rate of PTB and extreme temperature events in the prefecture-level cities. Then, the effect estimates were pooled using meta-analysis at the provincial level. The fixed-effect model or random-effect model was selected based on the result of heterogeneity test. Results Among the 446,016 PTB reported cases, the majority of reported cases occurred in spring. The higher reported incidence rate areas were located in Liaocheng, Taian, Linyi and Heze. Extreme low temperature had an impact on the reported incidence of PTB in only one prefecture-level city, i.e., Binzhou (RR = 0.903, 95% CI: 0.817–0.999). While, extreme high temperature was found to have a positive effect on reported morbidity of PTB in Binzhou (RR = 0.924, 95% CI: 0.856–0.997) and Weihai (RR = 0.910, 95% CI: 0.843–0.982). Meta-analysis showed that extreme high temperature was associated with a decreased risk of PTB (RR = 0.982, 95% CI: 0.966–0.998). However, extreme low temperature was no relationship with the reported incidence of PTB. Conclusion Our findings are suggested that extreme high temperature has significantly decreased the risk of PTB at the provincial levels. The findings have implications for developing strategies to response to climate change.

Background: Little comprehensive information on overall epidemic trend of respiratory infectious diseases is available in Shandong Province, China. This study aimed to determine the spatiotemporal distribution and epidemic characteristics of respiratory infectious diseases. Methods: Time series was firstly performed to describe the temporal distribution feature of respiratory infectious diseases during 2005-2014 in Shandong Province. GIS Natural Breaks (Jenks) was applied to divide the average annual incidence of respiratory infectious diseases into five grades. Spatial empirical Bayesian smoothed risk maps and excess risk maps were further used to investigate spatial patterns of respiratory infectious diseases. Global and local Moran’s I statistics were used to measure the spatial autocorrelation. Spatial-temporal scanning was used to detect spatiotemporal clusters and identify high-risk locations. Results: A total of 537,506 cases of respiratory infectious diseases were reported in Shandong province during 2005-2014. The morbidity of respiratory infectious diseases had obvious seasonality with high morbidity in winter and spring. Local Moran’s I analysis showed that there were 5, 23, 24, 4, 20, 8, 14, 10 and 7 high-risk counties determined for influenza A (H1N1), measles, tuberculosis, meningococcal meningitis, pertussis, scarlet fever, influenza, mumps and rubella, respectively. The spatial-temporal clustering analysis determined that the most likely cluster of influenza A (H1N1), measles, tuberculosis, meningococcal meningitis, pertussis, scarlet fever, influenza, mumps and rubella included 74, 66, 58, 56, 22, 64, 2, 75 and 56 counties, and the time frame was November 2009, March 2008, January 2007, February 2005, July 2007, December 2011, November 2009, June 2012 and May 2005, respectively. Conclusions: There were obvious spatiotemporal clusters of respiratory infectious diseases in Shandong during 2005–2014. More attention should be paid to the epidemiological and spatiotemporal characteristics of respiratory infectious diseases to establish new strategies for its control.

目的 对高校《医学统计学》课程实训教学改革方式进行初步探索,为全面提升课程教学质量提供理论指导.方法 以我校2018年春开设《医学统计学》课程的本科学生(共44个班级)共计1097人作为研究对象,采用分层整群抽样方法抽取试验组(22个班),其余班级内的学生作为对照组(22个班).试验组采取新实训教学方式,对照组采取传统实训教学方式,应用路径分析法探讨实训教学改革的效果.结果 学习兴趣(直接效应=0.31)、课程满意度(直接效应=0.11)、实训考核成绩(直接效应=0.21)可对教学质量产生直接影响;专业(直接效应=0.18,间接效应=0.12)、课程认知(直接效应=0.30,间接效应=0.19)、实训方法(直接效应=0.18,间接效应=0.32)可通过直接和间接作用共同影响教学质量.结论 多种因素可影响《医学统计学》课程的教学质量,其中实训方法的改革影响最显著.在以后的课程教授过程中,应着重从提高学生学习兴趣、课程认知度及课程满意度,尤其是进行实训教学方式改革方面着手以提高教学质量.

This study aimed to examine the association between floods and the morbidity of acute hemorrhagic conjunctivitis (AHC) in Mengshan, China. Relying on the longitudinal data, a generalized additive model (GAM) was applied to quantify the relationship between the morbidity of AHC and floods from 2005 to 2012, controlling for other meteorological variables. Years lived with disability (YLDs) and attributable YLDs were used as the measure of the burden of AHC because of the floods. Multivariable analysis showed that floods were significantly associated with an increased risk of the morbidity of AHC (rate ratio [RR] = 2.136, 95% CI: 2.109-2.163). The total YLDs per 1,000 in Mengshan was 0.2001, although the value in females was higher than that in males (0.2351 versus 0.1686). The YLD per 1,000 of AHC in Mengshan was highest between the ages of 5 and 14 years (0.6530), followed by the age of 0-4 years (0.3325). The attributable YLD per 1,000 of AHC due to the floods in Mengshan was 0.0434 (95% CI: 0.0425-0.0442). Our study confirms that floods have significantly increased the risks of AHC in the selected study area. Females and youngsters may be the vulnerable populations to develop the flood-related disease.

本研究旨在了解医学类本科生自主学习能力现状,分析相关影响因素的作用.研究结果显示,学习目标、课外活动频率、兼职情况及对所学专业态度直接影响大学生自主学习能力;学习动机、教师教学模式及性别可通过直接和间接作用共同影响学生自主学习能力.

目的 分析2008-2018年大连市5岁以下儿童主要死亡原因和变化趋势,为减少儿童死亡,保护儿童健康、制定儿童生存、发展以及保护战略措施提供询证依据.方法 按照《中国5岁以下儿童死亡监测方案》和《辽宁省5岁以下儿童死亡监测方案》执行,对2008-2018年大连市5岁以下儿童死亡监测数据进行回顾性统计分析.结果 2008-2018年度大连市新生儿、婴儿及5岁以下儿童死亡率均呈波浪式下降趋势,婴儿死亡率城市与农村比较差异无统计学意义(P＞0.05),1～4岁儿童死亡率近年来城乡差异不明显;早产低出生体质量、其他先天异常、先天性心脏病、出生窒息及其他新生儿病等成为影响大连市婴儿主要死因;其他肿瘤、交通意外、先天性心脏病、其他神经系统疾病及白血病为1～4岁儿童死亡的主要原因.5岁以下儿童死亡大多进行住院治疗,死亡地点为医院与家中的比例相差不大.结论 早产低出生体质量儿和出生缺陷儿是婴儿死亡干预的重点对象,对1～4岁儿童加强安全教育是降低儿童死亡的重要举措.

目的 了解山东省某医学高校学生对气候变化与健康关系的认知现况,探讨医学生对气候变化是否采取应对措施的影响因素.方法 选取山东某医科大学为调查现场,采取分层整群抽样方式抽取研究对象1486人进行问卷调查,调查内容包括一般人口学特征、对气候变化的了解及态度、应对气候变化的行为变化.结果 9.1％医学生对气候变化不了解或非常不了解,有9.4％医学生不确定气候变化正在发生的说法,不过有83.2％医学生认为通过改变个人行为将对气候变化产生影响.对气候变化的了解情况影响因素是居住地;是否赞同气候变化正在发生和是否信任媒体的报道是影响医学生对气候变化担心程度的主要因素;应对气候变化的行为变化影响因素是获取气候变化的信息渠道和是否信任媒体报道;多因素分析显示同意个人行为对气候变化产生影响(OR=1.345,95％CI:1.138～1.588)、认为权威机构正采取措施应对气候变化(OR=1.336,95％CI:1.111～1.607)、相信媒体对气候变化的报道(OR=1.239,95％CI:1.011～1.518)、对于气候变化对人类影响很乐观(OR=1.330,95％CI:1.144～1.546)的医学生更加愿意参加应对气候变化的环保行动.结论 医学生对气候变化的了解情况较好,但仍需要学校、社会加大对气候变化的教育,针对各方面的影响因素制定与实施相关措施.

Background: Given that more frequent and intensive extreme heat events have been projected based on climate change modeling, it is of significance to have a better understanding of the association between heat waves and mental illnesses. This study aimed to explore the effects of heat waves on daily hospital visits for mental illness in the summer of 2010 in Jinan, China. Methods: A symmetric bidirectional case-crossover study was firstly conducted to determine the relationship between daily hospital visits for mental illness and heat waves in Jinan in 2010. Multifactor logistic regression analysis was then used to analyze the influencing factors for daily hospital visits for mental illness during the heat wave periods. Results: Multivariable analysis showed that the heat wave events were associated with an increased risk of mental illness. The largest odds ratios (ORs) of the heat waves for daily hospital visits for mental illness were 2.231 (95% confidence interval (CI): 1.436–3.466) at a 3-day lag, 2.836 (95% CI: 1.776–4.525) at a 2-day lag, 3.178 (95% CI: 1.995–5.064) at a 3-day lag, and 2.988 (95% CI: 2.158–4.140) at a 2-day lag for the first, second, third, and fourth heat waves, respectively. The elderly, urban residents, outdoor workers, and singles may be high-risk populations for developing heat wave-related mental illness. Conclusions: Our study has supported that there is a positive association between heat waves and hospital visits for mental illness in the study site. Age, home address, occupation, and marital status were associated with daily hospital visits for mental illness during the heat wave periods.

BACKGROUND:Flood-related damage can be very severe and include health effects. Among those health impacts, infectious diseases still represent a significant public health problem in China. However, there have been few studies on the identification of the spectrum of infectious diseases associated with floods in one area. This study aimed to quantitatively identify sensitive infectious diseases associated with floods in Guangxi, China. METHODS:A time-trend ecological design was conducted. A descriptive analysis was first performed to exclude infectious diseases with low incidence from 2005 to 2012 in ten study sites of Guangxi. The Wilcoxon rank-sum test was applied to examine the difference in the ten-day attack rate of infectious diseases between the exposure and control periods with different lagged effects. Negative binomial, zero-inflated Poisson and zero-inflated negative binomial models were used to examine the relationship and odd ratios (ORs) of the risk of floods on infectious diseases of preliminary screening. RESULTS:A total of 417,271 infectious diseases were notified. There were 11 infectious diseases associated with floods in the preliminary screening process for flood-sensitive infectious diseases. The strongest effect was shown with a 0-9 ten-day lag in different infectious diseases. Multivariate analysis showed that floods were significantly associated with an increased the risk of bacillary dysentery (odds ratio (OR) = 1.268, 95% confidence interval (CI): 1.072-1.500), acute haemorrhagic conjunctivitis (AHC, OR = 3.230, 95% CI: 1.976-5.280), influenza A (H1N1) (OR = 1.808, 95% CI: 1.721-1.901), tuberculosis (OR = 1.200, 95% CI: 1.036-1.391), influenza (OR = 2.614, 95% CI: 1.476-4.629), Japanese encephalitis (OR = 2.334, 95% CI: 1.119-4.865), and leptospirosis (OR = 1.138, 95% CI: 1.075-1.205), respectively. CONCLUSION:The spectrum of infectious diseases which are associated with floods are bacillary dysentery, AHC, influenza A (H1N1), tuberculosis, influenza, Japanese encephalitis and leptospirosis in Guangxi. Floods can result in differently increased risk of these diseases, and public health action should be taken to control a potential risk of these diseases after floods.

Primary immune thrombocytopenia (ITP) is a serious medical disorder that has the potential for maternal and fetal mortality. Corticosteroids, intravenous immunoglobulin, or both are the first-line treatments for ITP in pregnancy, but choices are limited if patients fail to respond. Recombinant human thrombopoietin (rhTPO) has been proved effective and safe in management of chronic ITP. However, the efficacy and safety of rhTPO for pregnant ITP patients still need to be explored. Here we developed an ideal murine model that simulated human ITP in pregnancy and evaluated the efficacy and safety of rhTPO in management of ITP in pregnancy. Model mice were subcutaneously administered with 0, 150, 1,500 and 15,000 U/kg rhTPO for 14 days. Significant higher platelet counts were noted in rhTPO-treated groups on Day 7, 10 and 14. On Day 20, half the maternal mice were sacrificed. Frequencies of Tregs in CD4+ T cells in rhTPO-treated groups were statistically higher than control. Significant higher plasma levels of TGF-β1 were observed in rhTPO-treated groups than control. There was no significant abnormality in gross or visceral examination of fetuses. The remaining half maternal mice and their pups were observed for at least three weeks to assess vital signs. No abnormal signs were noted. Furthermore, we investigated the underlying mechanisms. Results showed that Tregs were negative for c-Mpl and rhTPO had no direct effect on Tregs. Additionally, the Treg frequency in splenic CD4+ T cells in LY2109761-treated model mice was statistically lower than control. Thus, rhTPO may be a safe and effective option for treatment of pregnant ITP patients.

目的 评价威海市气象干旱与风疹发病风险的关系.方法 采用时间序列方法,基于分布滞后非线性模型对2005—2013年威海市风疹发病数据及同期干旱数据、气象数据进行回归分析.分析气象干旱对风疹发病影响的即时效应与滞后效应.结果 威海市9年期间共计发病526人,年均发病率为2.18/10万.分布滞后非线性模型结果显示气象干旱对风疹发病的影响呈非线性关系,气象干旱在滞后2旬和3旬时,气象干旱导致的风疹发病增加,其RR值分别为1.11(95％CI:1.04～1.19)和1.10(95％CI:1.04～1.16);在滞后2～3旬时,其累计RR值最大(RR=1.09),但无统计学意义(P>0.05).结论 气象干旱对风疹的发病影响存在着滞后性,可导致风疹发病风险增加.

目的 分析2014-2018年大连市5岁以下儿童死亡情况,为进一步控制和降低大连市5岁以下儿童的死亡率提供科学依据.方法 利用妇幼保健机构为中心的三级儿童死亡报告监测系统收集2014-2018年大连市5岁以下儿童的死亡数据,采用卡方检验分析死亡率及构成比的差异,采用年度变化百分比(APC)评价死亡率的年度变化趋势,对死亡率几何均数的拟合直线斜率进行t检验.结果 2014-2018年,大连市婴儿死亡率和5岁以下儿童死亡率呈现下降趋势(P<0.05),APC分别为-6.01％及-5.16％,而新生儿死亡率和1～4岁儿童死亡率下降趋势不明显(P>0.05);不同季度5岁以下儿童的死亡率比较,仅2016年不同季度的5岁以下儿童死亡率差异有统计学意义(P<0.05).2014-2018年大连市婴儿死因顺位前5位依次为:早产低出生体质量、其他先天异常、其他新生儿病、先天性心脏病、出生窒息,其构成比分别为16.44％,13.79％,12.30％,11.26％及10.69％,死因顺位前5位导致死亡数占婴儿死亡总数的比例为64.48％;1～4岁儿童死因顺位前5位依次为:其他肿瘤、交通意外、其他神经系统疾病、意外跌落、白血病,其构成比分别为16.46％,14.77％,11.81％,7.59％及7.17％,死因顺位前5位导致的死亡数占1～4岁儿童死亡总数的比例为57.80％;5岁以下儿童死因顺位前5位依次为:早产低出生体质量、其他先天异常、先天性心脏病、其他新生儿病、出生窒息,其构成比分别为12.92％,11.38％,10.12％,9.67％及8.40％,死因顺位前5位导致死亡数占婴儿死亡总数的比例为52.49％.结论 近年来,大连市5岁以下儿童死亡率呈降低趋势,但仍然要重视儿童生命质量监测,加强围产期保健,预防出生缺陷,重视儿童安全教育,加大先心病政府救助宣传力度,以进一步降低儿童死亡率.

暴雨洪涝已成为世界范围内频繁发生的自然灾害之一.20世纪以来,伴随全球气候的巨大变化,多种极端气候事件出现的频率及强度均与之增大/强,其中包括暴雨洪涝.在暴雨洪涝效应期,灾区居住条件恶劣、洁净水源及服务设施匮乏,为多种疾病的流行及播散提供了适宜条件.大量研究显示,暴雨洪涝会对人类身体健康造成严重危害,且这种危害在未来相当长的时期内将持续存在.基于文献回顾,从暴雨洪涝与人类健康关系的研究现状、研究方法学以及研究方向等方面进行了综述,从而为认识和应对暴雨洪涝灾害的健康风险提供理论依据.

Caffeic acid is an antioxidant commonly used to promote hematopoiesis and hemostasis. However, little is known about its systemic safety profile in reproduction and development. Here, we focused on the reproductive and developmental toxicity of caffeic acid in F0 female mice and F1 offspring. In the three-segment study, the F0 female mice were continuously exposed to 0, 0.15, 5 or 150 mg/kg/day of caffeic acid by gavage. We found that 5 mg/kg/day and 150 mg/kg/day of caffeic acid affected implantation of embryos when administered before gestation day 6. In addition, 150 mg/kg/day of caffeic acid affected fetal weight gain. No maternal toxicity, fetal teratogenesis or post-natal effects on pup development were observed. The no-observed-adverse-effect-level was 0.15 mg/kg/day for pregnant mice under the conditions of this study.

BACKGROUND:Understanding the potential links between floods and infectious diarrhea is important under the context of climate change. However, little is known about the risk of infectious diarrhea after floods and what factors could modify these effects in China. OBJECTIVES:This study aims to quantitatively examine the relationship between floods and infectious diarrhea and their effect modifiers. METHODS:Weekly number of infectious diarrhea cases from 2004 to 2011 during flood season in Hunan province were supplied by the National Notifiable Disease Surveillance System. Flood and meteorological data over the same period were obtained. A two-stage model was used to estimate a provincial average association and their effect modifiers between floods and infectious diarrhea, accounting for other confounders. RESULTS:A total of 134,571 cases of infectious diarrhea were notified from 2004 to 2011. After controlling for seasonality, long-term trends, and meteorological factors, floods were significantly associated with infectious diarrhea in the provincial level with a cumulative RR of 1.22 (95% CI: 1.05, 1.43) with a lagged effect of 0-1 week. Geographic locations and economic levels were identified as effect modifiers, with a higher impact of floods on infectious diarrhea in the western and regions with a low economic level of Hunan. CONCLUSIONS:Our study provides strong evidence of a positive association between floods and infectious diarrhea in the study area. Local control strategies for public health should be taken in time to prevent and reduce the risk of infectious diarrhea after floods, especially for the vulnerable regions identified.

Many researchers have been studying the influence of floods on intestinal infection in recent years. This study aimed to project the future disease burden of bacillary dysentery associated with floods in Guangxi, China. Relying on the longitudinal data, a generalized additive mixed model was applied to quantify the relationship between the monthly morbidity of bacillary dysentery and floods with two severity levels from 2004 to 2010, controlling for other meteorological variables. Years Lived with Disability (YLDs) was used as the measure of the burden of bacillary dysentery in the future of Guangxi, China. According to the generalized additive mixed model, the relative risks (RR) of moderate and severe floods on the morbidity of bacillary dysentery were 1.17 (95% CI: 1.03-1.33) and 1.39 (95% CI: 1.14-1.70), respectively. The regression analysis also indicated that the flood duration was negatively associated with the morbidity of bacillary dysentery (with RR: 0.63, 95% CI: 0.44-0.90). Considering the effects of floods only, compared with the YLDs in 2010, increasing flood events may lead to a 4.0% increase in the YLDs for bacillary dysentery by 2020, 2100, 0.0% by 2050, and an 8.0% increase by 2030 in Guangxi, if other factors remain constant. Considering all potential changes include floods, temperature and population size, the YLDs for bacillary dysentery may increase by up to 16.0% by 2020, 20.0% by 2030, 2050, and 0.0% by 2100, compared to that in 2010 under the moderate flood scenario; Under the severe flood scenario, the YLDs for bacillary dysentery may increase by up to 16.0% by 2020, 20.0% by 2030, 2050, and 4.0% by 2100.