Abstract Background Current findings on the impact of weather conditions on osteoarthritis (OA) and rheumatoid arthritis (RA) are sparse and not conclusive. This study aimed to investigate the relationship between temperature change and OA/RA admission. Methods Daily OA/RA admission, meteorological data and pollutants from 1 January 2014 to 31 December 2017 in Hefei, China, were collected. We quantified the relationship between ambient temperature and OA/RA admission using a distributed lag nonlinear model (DLNM). Stratified analyses by gender and age were also examined. Results Temperature decrease was significantly associated with RA admission (25th percentile of temperature versus 50th percentile of temperature), with the acute and largest effect at current days lag (RR: 1.057, 95%CI: 1.005–1.111). However, no significant association between temperature and OA admission was observed. When conducting subgroup analyses by individual characteristics, we found that females and patients aged 41–65 years were more vulnerable to temperature decrease than males, patients aged 0–40 and ≧66 years, respectively. Conclusions This study suggested that temperature decrease was a risk factor for increases in RA admission. Females and patients aged 41–65 years were particularly vulnerable to the effect of temperature decrease.

目的 结合时间序列分析方法,探索危害儿童身心健康的疾病变化规律与趋势并提供政策建议.方法 采用分层整群抽样方法收集安徽省2013年-2017年住院患儿数据,利用卡方检验和构建自回归滑动平均混合模型,对儿童重点疾病谱进行变化分析和预测研究.结果 共纳入患儿849863例,男女比例为1.79:1;夏季患儿最多,有224150例,占26.4％;皖中地区患儿最多,有561749例,占66.1％;呼吸系统疾病患儿最多,有308492例.住院患儿疾病谱发生变化,呼吸系统疾病、消化系统疾病、新生儿疾病、伤害、传染性疾病患者数量排前5名,占74.2％,成为本地区影响儿童健康的主要问题.相关预测模型对上呼吸道感染、支气管炎和肺炎的短期预测效果较好.结论 呼吸系统疾病、消化系统疾病、新生儿疾病、伤害、传染性疾病是该地区影响儿童健康的主要问题,政府有关部门需针对儿童疾病谱的不同特征,结合时间序列分析等方法,科学预测评估,统筹规划,合理配置儿科医疗卫生资源.

目的 探索高温湿指数暴露与精神分裂症急性发作之间的关系.方法 收集2005年1月1日-2014年12月31日合肥每日气象和精神分裂症数据.使用分布滞后非线性模型(distributed lag non-linear model,DLNM)分析温湿指数对精神分裂症急性发作的影响.同时,探讨性别、年龄、婚姻状况和研究时期段对暴露效应所产生的修饰作用.结果 高温湿指数与精神分裂症急性发作存在相关,在滞后第2天的效应最大(RR=1.031,95％ CI:1.011～1.051,P＜O.05).按个体特征进行亚组分析时,发现年龄21～60岁、男性和已婚患者相对其他人群更易受到高温湿指数暴露的影响.此外,相比第1个五年(2005-2009年),第2个五年(2010-2014年)高温湿指数暴露的危害效应呈现下降趋势.结论 高温湿指数是精神分裂症急性发作的危险因素,21～ 60岁、男性和已婚患者更易受到高温湿指数的影响.

目的:了解抗击新冠疫情期间医务人员心理状况.方法:选取2020年2月3日-2月5日在安徽省立医院疫情防治一线医务人员共111名为调查对象,采用症状自评量表、焦虑自评量表和抑郁自评量表进行心理评估,并分析不同特征调查对象间差异.结果:111名调查对象在焦虑和恐怖因子评分高于中国常模.在人际关系敏感、敌对和偏执因子得分低于常模;SAS评分和SDS评分均高于常模.分组分析发现小于30岁、大专及以下、预检分诊/普通门诊和普通病房的医务人员更易出现抑郁状况.结论:抗击新冠肺炎疫情一线医务人员存在明显的焦虑和恐怖心理问题,应及时采取有针对性的干预措施.

Background Many studies have shown an association of childhood respiratory diseases with short-term temperature variability such as diurnal temperature range (DTR) and temperature change between two neighboring days (TCN). However, the impact of temperature variability on allergic rhinitis (AR) has not been investigated so far. This study sought to evaluate the short-term effect of temperature variability (i.e., TCN and DTR) on AR, as well as to identify vulnerable subpopulations. Method We collected daily data on emergency room visits and outpatients for AR and weather variables in Hefei, China during 2014–2016. A distributed lag non-linear model that controlled for long-term trend and seasonality, mean temperature, relative humidity, day of week was used to fit the associations of AR with DTR and TCN. Stratified analyses by age, sex and occupation were also performed. Results During the study period, there were a total of 53,538 cases and the average values of DTR and TCN were 8.4 °C (range: 1.0 °C to 21.2 °C) and 0 °C (range: − 12.2 °C to 5.9 °C), respectively. While we did not observe an adverse effect of DTR on AR, TCN was significantly associated with increased risk of AR. Specifically, a large temperature drop between two adjacent days (3.8 °C, 5th percentile of TCN) has a delayed and short-lasting effect on AR, with the estimated relative risk of 1.02 (95% confidence interval: 1.01 to 1.04) at lag 12. Moreover, boys and children older than 15 years seemed to be more vulnerable to the effect of TCN. Conclusions This study provided evidence of an adverse effect of large temperature drops between two adjacent days on childhood AR. Attention paid to boys and older children may help prevent AR attacks.

非故意伤害是指无意识、无目的造成的伤害,主要包括车祸、跌落、烧烫伤、中毒等12种伤害类型[1-2].非故意伤害因常见、多发、致残率高、后遗症多和年轻人高发等特点,已成为日益突出的公共卫生问题[2-4].尤其是刚进入小学的儿童活泼好动,对各种新鲜、刺激、危险的事物充满好奇,然而伤害预防知识匮乏、对外界致伤因素警惕性较低、防范意识较差,加之脱离家长看护等原因,使得小学生成为极易发生非故意伤害的高危人群[5-6].

Background: Short-term exposure to high level of ambient particulate matters (PM) concentrations has been linked with increased hospital admissions (HA) for schizophrenia. However, evidence is inconclusive about the added effect of mull-day exposure to high-level PM concentration on schizophrenia. This study aims to evaluate the durational effect of PM air pollution wave on schizophrenia. Method: Data on daily HA for schizophrenia, PM (PM2.5 and PM10) and meteorological variables over the period of 2014-2017 was collected in Jining, Shandong, China. Air pollution wave of PM was defined as 2 or 3 or >= 4 consecutive days with PM concentration >= 90th or >= 92.5th or >= 95th or >= 97.5th percentiles, respectively. A time-series Poisson regression model with duration as the variable of interest was used to evaluate the associations of PM air pollution wave with HA for schizophrenia. Results: A total of 14650 hospital admissions for schizophrenia were identified. Under various air pollution wave definitions, both PM2.5 and PM10, had significant adverse effects on schizophrenia HA. PM2.5 wave defined as >= 2 consecutive days with concentration >= 90th, >= 92.5th, >= 95th and 97.5th percentile was associated with 4.8% (2.0%-7.6%), 4.9% (1.9%-7.9%), 5.5% (2.0%-9.2%), and 7.6% (2.9%-12.6%) increase of HA for schizophrenia at lag 6. PM2.5 waves defined as >= 3 consecutive days with concentration >= 90th, >= 92.5th, >= 95th and >= 97.5th percentile respectively corresponded to 5.0% (2.3%-7.8%), 5.1% (1.9%-8.4%), 6.9% (3.0%-10.8%) and 12.0% (5.3%-19.1%) increases in HA for schizophrenia at lag 6. The most significant associations were observed on the sixth day in different lag models. Conclusions: PM air pollution wave was associated with increased risk of hospital admissions for schizophrenia, with stronger associations among married and female patients.

Background. The relationship between environmental factors and allergic rhinitis (AR) has become a focal point recently. However, few studies have investigated the adverse effects of both high relative humidity (RH) and low relative humidity. Moreover, the laged effect and disease burden of RH on AR were also neglected. Objectives: To explore the association of both high and low RH on daily AR hospital outpatients, and to quantify the corresponding disease burden attributable to RH. Methods: In our study, we define 95th as high RH and 5th as low RH. A distributed lag non-linear model (DLNM) combined with a Poisson generalized linear regression model were applied to analyze the relationship between RH and hospital outpatients for AR. All patients were retrieved from Anhui Provincial Children's Hospital (n = 37,221) from January 2015 to December 2016. Daily meteorological and air pollutant data were collected by Hefei Meteorological Bureau and Environmental Protection Agency. Subgroup analyses were conducted by gender and occupational groups. Results: Acute adverse effects of high and low RH on AR were explored respectively, with an increase of daily AR outpatients when encountered high and low RH. The low RH presented a risk effect at current day and lasted up to the eighth day. However, high RH began to appear a risk effect on the fourth day. Notably, the fraction of hospital outpatients attributable to low RH was 5.22% (95% CI: 1.92%, 8.33%) and high RH was 4.07% (95% CI: 1.13%, 7.30%) in the backward perspective. Additionally, male and students apparent to be more sensitive to the effects of low RH. Conclusion: This study suggests that both high and low RH are potential trigger for AR hospital outpatients in Hefei, China. Our studies might offer valuable messages to health practitioners and useful direction to decisions-makers respectively.

PURPOSE:We conducted the meta-analysis to respectively evaluate the risk of prenatal antibiotics use during specific trimesters (first, second, and third trimester) on childhood asthma or wheeze and to explore whether the association was biased by potential confounding. METHODS:The quality of included articles was assessed according to Newcastle-Ottawa Quality Assessment Scale and the Strengthening the Reporting of Observational Studies in Epidemiology. A random effects model was used to calculate pooled risk ratios and corresponding 95% confidence interval (CI), and publication bias was tested by Egger statistical test. RESULTS:Eight studies were included finally. We found a crude positive association of prenatal antibiotics use during each pregnancy trimester and risk of childhood asthma or wheeze with RRs of 1.28 (95% CI, 1.09-1.51) for the first trimester of pregnancy, 1.25 (95% CI, 1.02-1.52) for the second trimester, and 1.25 (95% CI, 1.05-1.49) for the third trimester. However, when considering potential factors of maternal infections and presence of siblings, the relationship for each trimester was insignificant. CONCLUSIONS:This systemic review and meta-analysis proposed a crude positive association between prenatal antibiotic use in every specific trimester and risk of childhood asthma or wheeze. However, adjustment for confounders decreased the relative risk estimates, supporting the concept that these associations are, at least in part, because of confounding by indication.

BACKGROUND:The relationship between ambient temperature, humidity and hand, foot, and mouth disease (HFMD) has been highlighted in East and Southeast Asia, which showed multiple different results. Therefore, our goal is to conduct a meta-analysis to further clarify this relationship and to quantify the size of these effects as well as the susceptible populations. METHODS:PubMed, Web of science, and Cochrane library were searched up to November 22, 2017 for articles analyzing the relationships between ambient temperature, humidity and incidence of HFMD. We assessed sources of heterogeneity by study design (temperature measure and exposed time resolution), population vulnerability (national income level and regional climate) and evaluated pooled effect estimates for the subgroups identified in the heterogeneity analysis. RESULTS:We identified 11 studies with 19 estimates of the relationship between ambient temperature, humidity and incidence of HFMD. It was found that per 1°C increase in the temperature and per 1% increase in the relative humidity were both significantly associated with increased incidence of HFMD (temperature: IRR, 1.05; 95% CI, 1.02-1.08; relative humidity: IRR, 1.01; 95% CI, 1.00-1.02). Subgroup analysis showed that people living in subtropical and middle income areas had a higher risk of incidence of HFMD. CONCLUSIONS:Ambient temperature and humidity may increase the incidence of HFMD in Asia-Pacific regions. Further studies are needed to clarify the relationship between ambient temperature, humidity and incidence of HFMD in various settings with distinct climate, socioeconomic, and demographic features.

Enterovirus 71 (EV71) is the main pathogen of hand‐foot‐mouth disease (HFMD) and causes several neurological complications. As new strains of EV71 are constantly discovered, it is important to understand the genomic characteristics of the viruses and the mechanism of virulence. Herein, we isolated five strains of EV71 from HFMD patients with or without neurovirulence and sequenced their whole genomes. We then performed whole genome sequence analysis of totally 36 EV71 strains. The phylogenetic analysis of the VP1 region revealed all five isolated strains are clustered into C4a of C4 subgenotype. In addition, by comparing the complete genome sequences of 36 strains, 253 variable amino acid positions were found, 14 of which were identified to be associated with neurovirulence (P < 0.05). Moreover, a similar pattern of amino acid variants combination was identified in four strains without neurovirulence, indicating this type of variant pattern might be associated with avirulence. The strains with neurovirulence appeared to be distinguished from those without neurovirulence by the variants in VP1 and P2 regions, implying VP1 and P2 are the important regions associated with neurovirulence. Indeed, 3‐D modeling of VP1 and P2 regions of non‐neurovirulent and neurovirulent strains revealed that the different variants resulted in different protein structures and amino acid composition of ligand binding site, which might account for their difference in neurovirulence. In summary, our study reveals 14 variable amino acid positions of VP1, P2 and P3 regions are related to the virulence and that mutations in the capsid proteins of EV71 might contribute to neurovirulence.

Background: The impacts of air pollution on asthma attacks have become a hotspot. Previous studies mainly focused on the developed countries or cities. There have been very limited studies in less-developed region to quantify the effects of air pollutants on asthma admissions in children. This study aims to assess the short-term impact of air pollutants on asthma hospital admissions for children in Hefei, China. Methods: Poisson generalized linear regression combined with distributed lag non-linear model (DLNM) were applied to investigate the effects of air pollutants on daily childhood hospital admissions of asthma from 2015 to 2016, controlling for meteorological factors. Subgroup analyses by sex and age were performed. Results: There were a total of 17,227 asthma admissions during 2015-2016. We found positive correlations between childhood asthma hospital visits and concentrations of NO2, O-3, PM10 and PM2.5. Significantly, NO2 exhibited robust positive correlations with cumulative effects 1.551 (95% CI: 1.306-1.841, lag0-3 days) in single-pollutant model and 1.580 (95% CI: 1.315-1.899, lag0-3 days) in multiple-pollutant model. Conclusions: Air pollutants had adverse effects on childhood asthma. NO2 presented the greatest effect, followed by PM2.5. Results will be important for health authority and guardians to realize the severity of air pollution on the increased risk of asthma, so as to develop relevant strategies and health interventions to meet the challenges of childhood asthma and reduce air pollution.

Background Acute bronchitis (AB) is one of the principal causes of childhood morbidity. Increasing number of studies has shown that air pollution is an important environmental contributor of respiratory disease. However, evidence so far is scarce regarding the effects of air pollution on childhood AB, and it also remains unclear how the risk of AB will change by season and age. Methods Data on hospital visits for AB in children, air pollution and meteorological factors from 1 January 2015 to 31 December 2016 were collected in Hefei, China. Time-series analysis was applied to assess the short-term effects of traffic-related air pollution on childhood AB outpatient visits. A Poisson generalised linear regression model combined with a distributed lag non-linear model was used to estimate the relationships, controlling for long-term trends, seasonal patterns, meteorological factors and other possible confounders. Results We found that an IQR increase in concentrations of nitrogen dioxide, particulate matter <2.5 µm and carbon monoxide significantly increased the daily hospital visits for childhood AB with 4-day cumulative effect estimates (relative risks: 1.03, 95% CI 1.01 to 1.05; 1.09, 95% CI 1.07 to 1.11; 1.07, 95% CI 1.05 to 1.09). Notably, the risk estimates during the cold season are pronounced; however, no significant association was observed during the warm season. Interestingly, children aged 6–14 years were more vulnerable to air pollutants than children aged less than 1 year and within 1–5 years. However, no gender difference was observed. Conclusion A significant association of traffic-related air pollution and increased department visits for childhood AB was observed, notably in school-age children and during the cold season.

Objective To investigate the effect of interleukin 23 receptor (IL-23R) on T helper cell 17 (Th17) call-mediated immune response in mycobacterium tuberculosis (TB) infection,and to explore the role of IL-23R in the pathogenesis of pulmonary tuberculosis.Methods 21 active lung tuberculosis (ATB) patients were enrolled in Beijing chest hospital from July to October in 2015,21 cases of latent tuberculosis infection (LTBI) and 21 healthy Healthy Donors (HD) were selected from Beijing Changping center for tuberculosis control and prevention from May to July in 2015.The peripheral blood mononuclear cells (PBMCs) were isolated and cultured.The expression of IL-23R mRNA in PBMCs was detected,IL-23 and IL-17A levels in the supernatant of PBMCs were measured.The expression of IL-23R mRNA in different groups and the effect of IL-23R expression on IL-17A level were analyzed.Results The expression of IL-23R mRNA in ATB group was lower than that in LTBI group (Z =-2.528,P =0.011),and in ATB group was higher than that in HD group (Z =-3.849,P ＜ 0.001).The expression of IL-17A in ATB group was lower than that in LTB group (t =2.238,P =0.031),and ATB group was higher than that in HD group (t =4.733,P ＜ 0.001).There was no significant difference in IL-23 level between the three groups (F =0.432,P =0.651).IL-23R mRNA expression was positively correlated with IL-17A level (rs =0.438,P =0.047).Conclusions The expression level of IL-23R in mycobacterium tuberculosis infection can regulate the immune response mediated by Th17 cells,which may affect the susceptibility and infection outcome of pulmonary tuberculosis.

Objective: To investigate the effect of humidex combined with mean temperature and relative humidity on the incidence of bacillary dysentery in Hefei. Methods: Daily counts of bacillary dysentery cases and weather data in Hefei were collected from January 1, 2006 to December 31, 2013. Then, the humidex was calculated from temperature and relative humidity. A Poisson generalized linear regression combined with distributed lag non-linear model was applied to analyze the relationship between humidex and the incidence of bacillary dysentery, after adjusting for long-term and seasonal trends, day of week and other weather confounders. Stratified analyses by gender, age and address were also conducted. Results: The risk of bacillary dysentery increased with the rise of humidex. The adverse effect of high humidex (90 percentile of humidex) appeared in 2-days lag and it was the largest at 4-days lag (RR=1.063, 95%CI: 1.037-1.090). Subgroup analyses indicated that all groups were affected by high humidex at lag 2-5 days. Conclusion: High humidex could significantly increase the risk of bacillary dysentery, and the lagged effects were observed.

Ambulance dispatch is a proxy of acute health outcomes, and growing epidemiological evidence documented its relation to extreme temperature events. Research, however, on short-term temperature change and ambulance dispatches is scarce. We aimed to investigate the effect of short-term temperature change on ambulance dispatches and potential modification by season. Daily data on ambulance dispatch and weather factors were collected in Huainan, a Chinese inland city from December 2011 through December 2013. A Poison generalized linear regression model combined with distributed lag nonlinear model was constructed to examine the association of temperature change between neighboring days (TCN) with ambulance dispatches. The effect modification by season was also examined. There were 48,700 ambulance attendances during the study period. A statistically significant association of TCN with ambulance dispatches was observed. Temperature rise between neighboring days (TCN > 0) was associated with elevated adverse risk of ambulance dispatches, and the effects appeared to be acute (lag0, on the current day) and could last for at least a week, while temperature drop between neighboring days (TCN < 0) had a protective effect. For a 1 °C increase of TCN at lag0 and lag06 (on the 7-day moving average), the risk of ambulance dispatches increased by 2 % (95 % CI 1–3 %) and 7 (95 % CI 1–13 %), respectively. Extreme TCN increase (95th percentile, 3.3 °C vs. 0 °C) at lag0 and lag05 was accompanied by 6 (95 % CI 3–8 %) and 27 % (95 % CI 12–44 %) increase in ambulance dispatches. Ambulance dispatches were more vulnerable to extremely great temperature rise in summer and autumn. TCN was adopted for the first time to quantify the impact of short-term temperature change on ambulance dispatches. Temperature drop between neighboring days (TCN < 0) had a protective effect on ambulance dispatches, while temperature rise between neighboring days (TCN > 0) could acutely trigger the increase in ambulance dispatches, and TCN effect differs by season.

Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025–1.135) and 1.159 (95 % CI 1.050–1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002–1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.

Hand, foot, and mouth disease (HFMD) is one of the most common communicable diseases in China, and current climate change had been recognized as a significant contributor. Nevertheless, no reliable models have been put forward to predict the dynamics of HFMD cases based on short-term weather variations. The present study aimed to examine the association between weather factors and HFMD, and to explore the accuracy of seasonal auto-regressive integrated moving average (SARIMA) model with local weather conditions in forecasting HFMD. Weather and HFMD data from 2009 to 2014 in Huainan, China, were used. Poisson regression model combined with a distributed lag non-linear model (DLNM) was applied to examine the relationship between weather factors and HFMD. The forecasting model for HFMD was performed by using the SARIMA model. The results showed that temperature rise was significantly associated with an elevated risk of HFMD. Yet, no correlations between relative humidity, barometric pressure and rainfall, and HFMD were observed. SARIMA models with temperature variable fitted HFMD data better than the model without it (sR (2) increased, while the BIC decreased), and the SARIMA (0, 1, 1)(0, 1, 0)(52) offered the best fit for HFMD data. In addition, compared with females and nursery children, males and scattered children may be more suitable for using SARIMA model to predict the number of HFMD cases and it has high precision. In conclusion, high temperature could increase the risk of contracting HFMD. SARIMA model with temperature variable can effectively improve its forecast accuracy, which can provide valuable information for the policy makers and public health to construct a best-fitting model and optimize HFMD prevention.

近年来,高校教师胜任力问题受到广泛关注,但大多通过定性研究而非实证定量研究来阐述自身观点,并且从学生视域研究医学院校教师胜任力的成果也不多见.采用问卷调查和行为事件访谈法确定教师胜任力要素,并在此基础上构建由7个因子组成的医学院校教师胜任力模型.此模型可为教师的聘用、培养及考核提供重要依据,从而提高教师的教学水平,进而达到提高教学质量的目的.

Background: Hand, foot and mouth disease (HFMD) is one of the major infectious diseases among children and remains a health threat, especially among Asian countries. Many epidemiologic studies suggested significant association of air temperature and humidity with childhood HFMD; however, evidence on the temperature effects on childhood HFMD in temperate cities is limited, and the interactive effects of temperature and humidity have not been studied yet.Methods: Daily counts of HFMD in children younger than 15 years of age and daily meteorologic variables during 2010 to 2012 were obtained in Hefei, China. A distributed lag nonlinear model was applied to estimate the potential nonlinear association between temperature and childhood HFMD. The interactive effects between temperature and humidity on childhood HFMD were also investigated.Results: Temperature rise was associated with higher risk of childhood HFMD. Within the incubation period of HFMD, temperature rise appeared to have the acute effects on childhood HFMD, and a 5 degrees C increase of temperature at lag 0-6 days was associated with 24.8% (95% confidence interval: 11.94%-39.10%) increase of childhood HFMD. Females and children of 0-4 years of agewere more vulnerable to temperature rise. Notably, there were obvious combined effects between temperature and humidity on childhood HFMD-the risk of childhood HFMD elevated at higher temperature and humidity level.Conclusions: This study provides evidence that temperature and humidity may jointly affect childhood HFMD, and such interactive impact needs to be considered when evaluating the temperature-childhood HFMD relationship.