BACKGROUND:Exposure to heat extremes is associated with higher rates of mortality, morbidity and healthcare costs. In the context of population ageing and climate change, which is expected to make extreme heat events more intense, frequent, prolonged, and widespread, understanding their health impacts on older adults is crucial for informing targeted interventions. METHODS:This systematic review and meta-analysis searched PubMed, Embase, Web of Science, Scopus, CINAHL, and AgeLine for studies published between January 1, 1990, and March 15, 2025.Original research articles assessing morbidity, mortality, and healthcare costs among older adults during periods of high temperatures or heatwaves were included.Eligible studies used observational designs, such as time series, case-crossover, or case time-series, comparing risks across different exposures or time periods. Reviews, commentaries, grey literature, animal studies, and studies not focused on temperature as the primary exposure were excluded. Risk estimates were extracted from published studies. A random-effects meta-analysis was conducted to pool relative risks of morbidity and mortality, focusing on specific disease categories according to ICD-10 codes, climate zones, and demographic factors. The certainty and strength of the evidence were assessed following the Navigation Guide systematic review methodology framework. The study protocol was registered with PROSPERO (CRD42023423311). RESULTS:Out of 21,610 identified studies, 623 were eligible, spanning six continents and 305 locations classified by Köppen climate zones. Of these, 578 were included in the meta-analysis, 43 in a supplementary meta-analysis, and four on healthcare costs were narratively synthesised. A 1°C temperature rise was associated with higher morbidity (RR 1.016 [CI95% 1.012-1.019]) and mortality (RR 1.022 [CI95% 1.020-1.024]) among older people. The highest morbidity risks were linked to heat-related illnesses, external causes and endocrine diseases, and in tropical climates. Mortality risk was highest for intentional self-harm and external causes, chronic obstructive pulmonary disease (COPD), and in Mediterranean climates, with the strongest overall impact on those aged ≥ 85 years. Heatwaves increased morbidity (RR 1.189 [CI95% 1.146-1.233]), particularly for heat-related illnesses and external causes, with the highest overall risk seen in adults aged 75-84 and in subtropical climates. Mortality also rose (RR 1.117 [CI95% 1.105-1.129]), especially for cerebrovascular, endocrine and respiratory diseases, with the greatest overall risks found in tropical climates and among individuals aged ≥ 85 years. Despite the limited number of studies on healthcare costs they showed significant increases in costs during heat exposure for emergency department presentations, respiratory and ureter calculus hospitalisations. There was high heterogeneity with morbidity (high temperatures: I2 = 84.1%; heatwaves: I2 = 97.6%), whilst for mortality, there was no observed heterogeneity with high temperatures (I2 = 0.0%) and moderate heterogeneity with heatwaves (I2 = 72.2%).The strength of evidence was rated as "sufficient" for an association between heat exposure and increased mortality and morbidity in older adults, and "limited" for healthcare costs. CONCLUSION:This review highlights the critical impact of heat exposure on the health of older adults, particularly in different climate zones, and indicates a potential increase in healthcare costs associated with this risk. With the global rise in temperatures and ageing populations, heat-related health risks will continue to increase. Effective, evidence-based interventions, such as tailored heat health action plans that consider individual risk factors, local resources, climatic characteristics and healthcare infrastructure, are crucial to minimise these risks.

BACKGROUND:To project the future disease burden of dengue fever in Fujian Province by accounting for anticipated changes in climate and population, and to inform the development of targeted and effective dengue prevention and control strategies as well as public health interventions; METHODS: We applied a distributed lag nonlinear model (DLNM) calibrated using locally acquired dengue cases from 2015 to 2019 and linked it to future temperature projections from four global climate models under three Shared Socioeconomic Pathways (SSP1-2.6, SSP2-4.5, and SSP5-8.5). These projections were integrated with population scenarios to estimate the temperature-attributable dengue burden through 2099; RESULTS: Dengue risk increased across all scenarios. By 2090-2099, heat exposure (referenced to 18 °C) was associated with a 1.68-fold higher excess risk of dengue fever (95% CI: 1.01-1.89) under SSP1-2.6, 1.50-fold higher (1.38-1.64) under SSP2-4.5, and 1.74-fold higher (1.59-1.88) under SSP5-8.5. Notably, the moderate-emission scenario (SSP2-4.5) yielded a lower risk than both low- and high-emission pathways, reflecting the nonlinear temperature-dengue relationship in this transitional transmission region; CONCLUSIONS: The burden of dengue fever in Fujian Province is projected to increase under all climate change scenarios examined. These findings underscore the need of proactive and climate-informed public health planning to mitigate the growing dengue risk associated with global warming.

Although meteorological factors are connected with severe fever with thrombocytopenia syndrome (SFTS) incidence, available findings have been inconsistent. This study was performed to systematically evaluate the correlation between meteorological factors and SFTS incidence. We performed a thorough literature search in PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases from databases initiatives to November 30, 2024. Literature was searched for correlation between meteorological factors and SFTS incidence. Two researchers screened the retrieved literature based on exclusion and inclusion criteria. Finally, data extraction and quality evaluation were carried out for the included literature, and meta-analysis was executed applying the R package (4.4.1). A total of 404 relevant literature were retrieved, and 12 studies were enrolled in the meta-analysis. Both average temperature (rs=0.73, 95

Air pollution is a significant global health challenge, particularly for respiratory diseases (RD) and cardiovascular diseases (CVD). This study examines the links between ambient air pollutants and mortality from these diseases in the Shandong Peninsula urban cluster, China (including Jinan, Qingdao, Weifang, Zibo, Yantai, Weihai, Rizhao, and Dongying). Daily data on air pollutants, meteorological parameters, and RD and CVD mortality were collected from the eight cities. A distributed lag non-linear model with quasi-Poisson regression was used to assess both single-day and cumulative lag effects of pollutants on mortality in each city. A meta-analysis investigated the combined effects of air pollutants on mortality. The results suggest significant relative risks (RR) for PM2.5, PM10, and NO2 in Jinan, Zibo, and Qingdao concerning RD and CVD mortality. In contrast, Rizhao, Weihai, Weifang, Dongying, and Yantai did not achieve statistical significance. The meta-analysis reveals that, with a cumulative lag of 7 days, the effects of PM2.5, PM10, and NO2 significantly influence mortality. The estimated RRs for RD were 0.88 (0.84, 0.93) for PM2.5, 0.92 (0.88, 0.96) for PM10, and 0.72 (0.64, 0.81) for NO2, respectively. For CVD, the RRs were 0.92 (0.89, 0.95), 0.95 (0.92, 0.98), and 0.83 (0.74, 0.93). Notably, the Qtest showed significant heterogeneity in the effects across different cities, while SO2 generally did not exhibit significant effects. These findings confirm the links between air pollution and mortality from RD and CVD diseases in specific cities and across the Shandong Peninsula, highlighting the urgent need for locally tailored public health policies.

Background:Previous studies have focused on the effects of air pollution on lung function in children with respiratory diseases, and there is insufficient evidence on healthy children. This cross-sectional study therefore aimed to investigate the relationship between air pollutants and lung function in healthy children. Methods:We collected lung function measurements between December 2016 and December 2020 from a total of 780 healthy children aged 7-11 years old in an elementary school in Jinan City. Air pollutant data, including particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) and ≤10 µm (PM10), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3), were collected from the nearest monitoring stations to the school. Multiple linear regression models were developed to assess the relationship between pollutants and children's lung function indices. Results:Increasing pollutant concentrations were associated with decreases in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), forced expiratory flow at 25% (FEF25) and forced expiratory flow at 75% (FEF75). In addition, this effect had a lag effect and a cumulative lag effect, especially at lag 3 d, with significant decreases in FEV1 and PEF. Specifically, for every 10 µg/m3 increase in the concentrations of PM2.5, PM10, SO2, NO2, and CO, the FEV1 decreased by 1.05 mL [95% confidence interval (CI): -2.02, -0.08], 1.18 mL (95% CI: -1.94, -0.42), 4.96 mL (95% CI: -8.08, -1.84), 4.94 mL (95% CI: -7.59, -2.28), and 0.11 mL (95% CI: -0.20, -0.01), respectively. For every 10 µg/m3 increase in PM10, SO2, NO2, and CO, PEF decreased by 3.80 mL (95% CI: -6.51, -1.08), 16.73 mL (95% CI: -27.83, -5.63), 17 mL (95% CI: -26.44, -7.55), and 0.39 mL (95% CI: -0.72, -0.05), respectively. Boys' lung function was more sensitive to pollutants than girls'. Conclusions:Short-term exposure to air pollutants is harmful to children's health and appropriate protective measures should be taken to minimize the adverse effects of air pollution on children's health.

Objective To assess health equity in the Yangtze River region to improve understanding of the correlation between hand, foot, and mouth disease (HFMD) and socioeconomic factors. Methods From 2014-2016, data on HFMD incidence, population statistics, economic indicators, and meteorology from 26 cities along the Yangtze River were analyzed. A multi-city random-effects meta-analysis was performed to study the relationship between temperature and HFMD transmission, and health equity was assessed with respect to socio-economic impact. Results Over the study period, 919,458 HFMD cases were reported, with Shanghai (162,303) having the highest incidence and Tongling (5,513) having the lowest. Males were more commonly affected (male-to-female ratio, 1.49:1). The exposure-response relationship had an M-shaped curve, with two HFMD peaks occurring at 4 degrees C and 26 degrees C. The relative risk had two peaks at 1.30 degrees C (1.834, 95% CI: 1.204-2.794) and 31.4 degrees C (1.143, 95% CI: 0.901-1.451), forming an M shape, with the first peak higher than the second. The most significant impact of temperature on HFMD was observed between-2 degrees C and 18.1 degrees C. The concentration index (0.2463) indicated moderate concentration differences, whereas the Theil index (0.0418) showed low inequality in distribution. Conclusion The incidence of HFMD varied across cities, particularly with changes in temperature. Economically prosperous areas showed higher risks, indicating disparities. Targeted interventions in these areas are crucial for mitigating the risk of HFMD.

The composition of particulate matter (PM) in poultry farms differs significantly from that of atmospheric PM as there is a higher concentration of microbes on farms. To assess the health effects of PM from poultry farms on pregnant animals, we collected PM from duck houses using a particulate sampler, processed it via centrifugation and vacuum concentration, and subsequently exposed the mice to airborne PM at 0.48 mg/m3 (i.e., low concentration group) and 1.92 mg/m3 (i.e., high concentration group) on the fifth day of pregnancy. After exposure until the twentieth day of pregnancy or spontaneous delivery, mice were euthanized for sampling. The effects of PM from duck houses on the pregnancy toxicity of mice were analyzed using histopathological analysis, enzyme-linked immunosorbent assay, and quantitative real-time polymerase chain reaction (qPCR). The results showed that exposure to PM had adverse effects on pregnant mice that reduced their feed intake in both groups. Microscopic lesions were observed in the lungs and placentas of pregnant mice, and the lesions worsened with increased PM concentrations, as shown by alveolar wall thickening, the infiltration of inflammatory cells in pulmonary interstitium, congestion, edema, and cellular degeneration of placenta. In pregnant mice in the high concentration group, exposure to PM significantly increased the expression of inflammatory cytokines in the lungs and placentas, caused oxidative stress, and decreased estrogen level in the blood. Exposure to PM also resulted in the reduced litter sizes of pregnant mice and shorter body and tail lengths in the fetuses delivered. Beyond that, exposure to PM significantly downregulated the levels of antioxidant factor superoxide dismutase and neurotrophic factor Ngf in the brains of fetuses. Collectively, exposure to a high concentration of PM by inhalation among pregnant mice caused significant pregnancy toxicity that led to abnormal fetal development due to inflammatory damage and oxidative stress. These findings established a foundation for future studies on the underlying mechanisms of pregnancy toxicity induced by exposure to PM.

Infectious serositis is a common disease caused by Riemerella anatipestifer (R. anatipestifer) in ducks, characterized by respiratory distress, septicemia, and neurological symptoms. In this study, 1,020 samples (brain and liver) were collected from ducks with suspected R. anatipestifer infection from March 2020 to March 2022 in Shandong Province, of which 171 R. anatipestifer strains were identified by PCR and isolation culture. The serotype of all strains was analyzed, and 74 strains were subjected to drug sensitivity tests and drug resistance genes detection. The results showed that the overall prevalence rate of R. anatipestifer in Shandong Province was 16.7% (171/1,020), with most strains coming from brain samples of ducklings under 3-mo old collected from September to December each year. Histopathological examination showed that heart vessels of the diseased duck were highly dilated and filled with red blood cells, with obvious fibrin exudates outside the pericardium, and fatty degeneration of liver cells. There were 45 strains of serotype 1, 45 strains of serotype 2, 2 strains of serotype 4, 33 strains of serotype 6, 44 strains of serotype 7, and 2 strains of serotype 10. The minimum inhibitory concentration (MIC) of 10 common antibiotics against 74 representative strains was determined by the agar dilution method. It was found that 74 strains had the most severe resistance to gentamicin (77%) and fully susceptible to ceftriaxone, but the 81.1% isolated strains were multidrug resistant. Resistance genes testing of 74 R. anatipestifers showed that tetracycline resistance gene tet X had the highest detection rate of 95.9%, followed by macrolide resistance gene ermF with 77%, and the rate of β-lactam resistance gene blaTEM is the lowest (10.8%). The animal experiment of 4 R. anatipestifer strains with different serotypes showed that they had strong pathogenicity to 7-day-old ducklings, which could cause nervous symptoms, and the mortality rate was 58% to 70%. The autopsy showed obvious pathological changes. These findings of this study on R. anatipestifer will help us to understand the latest prevalence, drug resistance characteristics, and pathogenicity of R. anatipestifer in Shandong, China, and provide a scientific guide for the treatment and control of the disease.

Background Global COVID-19 vaccination programs effectively contain the fast spread of the SARS-CoV-2. Characteristic the immunity status of returned populations will favor for understanding the achievement of herd immunity and long-term management of COVID-19 in China. Methods Returning travellers were recruited from 7 quarantine stations in Guangzhou, China. The immunity statuses of participants were determined through Competitive ELISA, Micro-Neutralization Assay and Enzyme-Linked FluoroSpot Assay. Results A total of 272 subjects were involved in questionnaire survey, in which 235 (86.4%) were returning ex-patriot Chinese and 37 (13.6%) were foreigners. Blood and throat swabs specimens were collected from each of 108 returning ex-patriot Chinese. The neutralizing antibody against SARS-CoV-2 was detected in ~90% of returning ex-patriot Chinese, either in the primary or the homologous and heterologous booster vaccination group. The serum NAb titers of them were significantly decreased against SARS-CoV-2 Omicron BA.5, BF.7, BQ.1 and XBB.1 compare with prototype virus. However, memory T cell responses including specific IFN-γ and IL-2 were no differences in either group. Smoking, drinking, SARS-CoV-2 infection, COVID-19 vaccination, and the time interval between last vaccination and the sampling were independent influencing factors for NAb titers against prototype SARS-CoV-2 and variants of concerns. The dose of vaccination was the unique common influencing factor for Omicron variants. Conclusions The herd immunity was established in returning ex-patriot Chinese who exposure to the complicated infection and vaccination circumstance. Domestic residents will benefit from booster of COVID-19 vaccines either in homologous and heterologous vaccination after re-opening of China, as well as breakthrough infection.

目的 分析2014-2016年山东省各县手足口的分布及时空聚集性,为提高山东省手足口病防治工作的高效性、针对性提供理论依据.方法 首先对每个年份的疫情分布进行描述性分析,并使用了空间自相关、热点分析(Geti-Ord)、时空扫描分析以研究手足口病的时空聚集性.结果 全局空间自相关结果(MoranⅠ均大于0)提示存在聚集性;局部空间自相关和热点分析均提示鲁中、鲁西北存在局部聚集性;时空扫描得出2014-2016年间的多级聚集性区域,其中一级聚集区(RR=1.33,LLR=2045.94)和二级聚集区(RR=2.43,LLR=1321.5)包含鲁中、西北的44个区县,并且主要于温度回暖的月份出现.结论 山东省手足口病发病率存在时空聚集性.今后的防治工作、医疗资源配置应更加针对人口流动大的地区以及气候回暖的高风险季节.

Background Global COVID-19 vaccination programs effectively contain the fast spread of the SARS-CoV-2. Characteristic the immunity status of returned populations will favor for understanding the achievement of herd immunity and long-term management of COVID-19 in China. Methods Returning travellers were recruited from 7 quarantine stations in Guangzhou, China. The immunity statuses of participants were determined through Competitive ELISA, Micro-Neutralization Assay and Enzyme-Linked FluoroSpot Assay. Results A total of 272 subjects were involved in questionnaire survey, in which 235 (86.4%) were returning ex-patriot Chinese and 37 (13.6%) were foreigners. Blood and throat swabs specimens were collected from each of 108 returning ex-patriot Chinese. The neutralizing antibody against SARS-CoV-2 was detected in ~90% of returning ex-patriot Chinese, either in the primary or the homologous and heterologous booster vaccination group. The serum NAb titers of them were significantly decreased against SARS-CoV-2 Omicron BA.5, BF.7, BQ.1 and XBB.1 compare with prototype virus. However, memory T cell responses including specific IFN-γ and IL-2 were no differences in either group. Smoking, drinking, SARS-CoV-2 infection, COVID-19 vaccination, and the time interval between last vaccination and the sampling were independent influencing factors for NAb titers against prototype SARS-CoV-2 and variants of concerns. The dose of vaccination was the unique common influencing factor for Omicron variants. Conclusions The herd immunity was established in returning ex-patriot Chinese who exposure to the complicated infection and vaccination circumstance. Domestic residents will benefit from booster of COVID-19 vaccines either in homologous and heterologous vaccination after re-opening of China, as well as breakthrough infection.

To explore the frequency and effect of extreme temperature on the non-accidental death rate in Hulunbuir, a Chinese ice city. From 2014 to 2018, mortality data of residents residing in Hulunbuir City were collected. The lag and cumulative effects of extreme temperature conditions on non-accidental death and respiratory and circulatory diseases were analyzed by distributed lag non-linear models (DLNM). The risk of death was the highest during high-temperature conditions, the RR value was 1.111 (95

Objective: The objective of this review is to explore the role of information technology in the construction and management of modern hospitals, and how to use information technology to promote the development and management of hospitals. Methods: The relevant medical information and data at home and abroad were collected from the Internet, and the actual situation of the hospital, the diagnosis, treatment and management of outpatients were compared and analyzed to compare the role of medical information in hospital development. Results: After the effective implementation of medical information in the hospital, the technical level and efficiency of diagnosis, treatment and management technology in the hospital were obviously improved, so that patients could see a doctor more conveniently, and doctors and nurses could have a higher level of diagnosis and treatment. Conclusions: The use of medical information can significantly improve the overall management level of the hospital, make it more convenient for patients to see a doctor, and improve the construction and management of modern hospitals, which is of great significance to the improvement of the level of medical technology.

BACKGROUND:Avian hepatitis E virus (HEV) is the pathogenic agent of big liver and spleen disease (BLS) and of hepatitis-splenomegaly syndrome (HSS) in chickens, which have caused economic losses to the poultry industry in China. In this study, 18 samples of BLS chickens were collected to reveal the molecular epidemiological characteristics of avian HEV in the province of Shandong, China.RESULTS:Gross and microscopic lesions of clinical samples were observed; then, virology detection and genetic analysis of avian HEV were performed. The results showed that there was significant swelling and rupture in the liver and that the spleen was enlarged. Microscopic lesions demonstrated obvious hemorrhage in the liver, with infiltration of heterophilic granulocytes, lymphocytes, and macrophages, as well as the reduction of lymphocytes in the spleen. Eleven of the 18 samples were positive for avian HEV, with a positive rate of 61.11%. More importantly, all avian HEV-positive samples were mixed infections: among these, the mixed infections of avian HEV and chicken infectious anemia virus (CIAV) and avian HEV and fowl adenovirus (FAdV) were the most common. Furthermore, the genetic evolution analysis showed that all avian HEV strains obtained here did not belong to the reported 4 genotypes, thus constituting a potential novel genotype.CONCLUSIONS:These results of this study further enrich the epidemiological data on avian HEV in Shandong, prove the genetic diversity of avian HEV in China, and uncover the complex mixed infections of avian HEV clinical samples.

Polluting biomass fuel use has adverse effects on human health, but there are limited studies exploring the association between biomass fuel use and undernutrition in adult and child population. The study aims to investigate the association between biomass fuel use and undernutrition status of adults and children under 5 years of age in low and middle income countries (LMICs). Data were from the Demographic and Health Surveys in 14 LMICs. The main exposure variable was type of fuel the household mainly used for cooking. Linear regression models and Modified Poisson regression models with robust error variance in consideration of complex survey design were used to estimate the association between type of fuel used for cooking and the outcomes of interest. Personal and household data were collected by questionnaire, and anthropometry data were collected by measurement with a standardised protocol. A total of 532 987 households were included in the analysis, and the majority of households (63.9%) used high polluting fuels. For women, use of high polluting fuels lead to a 0.66 kg m(-2) (95% CI: -0.74, -0.58) decrease in BMI and a 10% (95% CI: 7%, 13%) higher risk of underweight. For men, high polluting fuels lead to a 0.63 kg m(-2) (95% CI: -0.88, -0.38) decrease in BMI and a 11% (95% CI: 5%, 18%) higher risk of underweight. For children, high polluting fuels resulted in a 0.16 (95% CI: -0.20, -0.11), 0.17 (95% CI: -0.22, -0.11), and 0.09 (95% CI: -0.14, -0.04) unit decrease in weight-for-age, height-for-age, and weight-for-height z scores, respectively; high polluting fuel use can lead to a 10% (95% CI: 3%, 18%) higher risk of underweight and a 13% (95% CI: 7%, 19%) higher risk of stunting, respectively. Effective interventions should be adopted by policymakers to accelerate the transition of polluting fuels to cleaner energy in LMICs.

Chronic obstructive pulmonary disease （COPD）,which is characterized by a long-term, irreversible airway limitation and persistent respiratory symptoms, is common and preventable. Several studies have suggested that particulate matter is associated with the prevalence of COPD and the risk of mortality. At the same time,

A Correction to this paper has been published: https://doi.org/10.1038/s41467-021-22487-4

The COVID-19 is a major global health event that has changed people's lives and behaviors.As a fragile and sensitive area with high population density and poor living conditions in the city, collective housing is also an important construction area for future urban renewal.In the process of the spread of the new crown epidemic, the collective housing has exposed a series of weaknesses such as difficult community management, inconvenience of life, and insufficient outdoor space.Therefore, the update and transformation of the outdoor environment of the collective housing combined with the concept of public health is a problem that must be considered at present.This article combines the practice of renewal and transformation of the X community in Chaoyang District, Beijing, combined with survey methods such as questionnaires, interviews, and observations, combined with the needs of residents and the practical experience of the grassroots management unit, and carried out an overall renewal design of the external space environment of the collective housing.The epidemic is combined with the division of functional layout, refined design of outdoor activity space to ensure safe distance, and increased shared smart facilities to improve the quality of the outdoor environment of collective residences and strengthen community resilience; to achieve communication and sharing, epidemic prevention and control on the basis of ensuring safe social distance outdoor sports and other functions.In this way, the ability of collective housing to prevent, identify, and dispose of urban risks will be improved, and will provide residents with a better and livable community life.

Under the background of digital economy, technological diversification and R&D internationalization are important strategic choices for eMNCs, represented by China, to seek advanced technological resources and create competitive advantages. This paper takes China’s listed MNCs from 2009 to 2019 as the research object and applies a non-equilibrium panel negative binomial fixed effect regression to investigate the impact mechanism of technological diversification of China’s MNCs on enterprise innovation performance and the moderating effect of overseas R&D networks. Results show that the related technological diversification of MNCs has a significant positive impact, and the unrelated technological diversification and their innovation performance are in inverted U-shaped relationship; overseas R&D networks have significant moderating effect while the breadth and depth of the moderating effect are not the same; significant differences exist in the moderating effect of overseas R&D networks due to the heterogeneity of institutional development levels among regions in China.