BACKGROUND:Public health is greatly affected by heatwaves, especially as a result of climate change. It is unclear whether heatwaves affect injury hospitalization, especially as developing countries facing the impact of climate change. OBJECTIVES:To assess the impact of heatwaves on injury-related hospitalization and the economic burden. METHODS:The daily hospitalizations and meteorological data from 2014 to 2019 were collected from 23 study sites in 11 meteorological geographic zones in China. We conducted a two-stage time series analysis based on a time-stratified case-crossover design, combined with DLNM to assess the association between heatwaves and daily injury hospitalization, and to further assess the regional and national economic losses resulting from hospitalization by calculating excess hospitalization costs (direct economic losses) and labor losses (indirect economic losses). To determine the vulnerable groups and areas, we also carried out stratified analyses by age, sex, and region. RESULTS:We found that 6.542% (95%CI: 3.939%, 9.008 %) of injury hospitalization were attributable to heatwaves during warm season (May to September) from 2014 to 2019. Approximately 361,447 injury hospitalizations were attributed to heatwaves each year in China, leading to an excess economic loss of 5.173 (95%CI: 3.104, 7.196) billion CNY, of which 3.114 (95%CI: 1.454, 4.720) billion CNY for males and 4.785 (95%CI: 3.203, 6.321) billion CNY for people aged 15-64 years. The attributable fraction (AF) of injury hospitalizations due to heatwaves was the highest in the plateau mountain climate zone, followed by the subtropical monsoon climate zone and the temperate monsoon climate zone. CONCLUSIONS:Heatwaves significantly increase the disease and economic burden of injury hospitalizations, and vary across populations and regions. Our findings implicate the necessity for targeted measures, including raising public awareness, improving healthcare infrastructure, and developing climate resilience policies, to reduce the threat of heatwaves to vulnerable populations and the associated disease and economic burden.

Identifying the factors that may impact intervention effectiveness of primary students is crucial for developing targeted intervention strategies on heatwave adaption. The purpose of the study was to assess how the family factors could affect the intervention effects of primary school students to adapt heatwave, using the data from a previously conducted primary school -based intervention study. The study recruited 648 students (9-13 years old) and their parents from two primary schools in Dongtai of Jiangsu province, China. From May to September 2017, a 5mon intervention for enhancing knowledge, attitude and practice (KAP) was implemented at the intervention school. The students' KAP scores and the family -related information were measured by designed self-administered questionnaires at intervention school and control school separately before and after intervention. The effects of the intervention were explored through the propensity score matching and difference -indifference method (PSM-DID), and stratified analysis were conducted by family factors. The overall KAP score increased by 2.391 (95% CI: 1.881, 2.902) after intervention, which shows that the intervention was effective. The students whose parents with higher school educational attainment, parents with employment, and household number <3 achieved significantly higher increment of KAP scores than their counterparts. Although students whose parents in marriage achieved higher score increasing than parents not in marriage, the difference was non -significant. Our findings indicated that parental education status, working status and the household size were the influence factors of heatwave adaption interventions for primary school students. Future interventions should take parental education status, working status and household size into account to improve the effectiveness of heatwave adaption intervention for primary school students.

It has been well documented that heatwaves are linked to elevated mortality and morbidity. However, the selection of optimal heatwave definitions for subsequent risk assessment has been inconsistent and there is no full picture of the effects of heatwaves with different intensities on economic losses due to mortality, which can provide important insights for public health considerations. Hence, we used a two-stage time series analysis, combined with values of statistical life (V-SL) based on the value of a statistical life year to assess the economic burden of deaths associated with heatwaves of different intensities and durations and to identify the vulnerable populations and regions. We further conducted stratified analyses by age, sex, and region. We found 2.9% (95%CI: 0.0%, 6.5%)-20.0% (95%CI: 2.9%, 34.2%) of V-SL were attributable to heatwaves, corresponding to attributable economic losses (AELs) of 2.20 (95%CI: 0.32, 3.77)-4.77 (95%CI: 1.53, 7.63) billion CNY. The economic burden of death was most sensitive to heatwave H99P_2D (99th percentile, at last 2 consecutive days), while H975P_2D (97.5th percentile, at last 2 consecutive days) caused the highest attributable economic losses. Females and elderly people aged >= 65 years were more sensitive. The AELs in the temperate zone and northern regions were larger than those in subtropical zone and southern regions during relatively low-intensity heatwaves, respectively. By contrast, the AELs in subtropical zone and southern regions were relatively higher than those in temperate zone and northern regions during relatively high-intensity heatwaves, respectively. The AELs were larger in urban areas than in rural areas. Tailored intervention strategies, primarily focusing on vulnerable populations and regions, should be formulated to reduce the economic loss due to heatwaves in the context of climate change.

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health. Exploring the association between temperature fluctuation and diseases, which has received relatively limited research attention, can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management. Therefore, this study aims to investigate the relationship between temperature change between neighboring days (TCN) and hospitalizations, identify diseases sensitive to extreme TCN, and evaluate the related disease burden. We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations. We first quantified site -specific associations between TCN and hospitalizations and then conducted metaanalysis to pool the results, to assess the relative risk of extreme TCN for susceptible diseases, and to estimate the related disease burden attributed to TCN. Stratified analyses were undertaken by age, sex, and disease type. Results showed that all -cause hospital admission was significantly linked to TCN. A negative TCN (below -1.9 degrees C) in the cool season and a positive TCN (above 1.0 degrees C) in the warm season increased the risk of hospitalization. People aged 15-64 years, men, and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season. People aged over 65 years, men, and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season. The attributable fraction to all -cause hospitalization from negative TCN in the cool season was 2.05% (95% CI: -0.90%, 4.53%) and from positive TCN in the warm season was 5.79% (95% CI: 2.98%, 8.31%). Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden. Our findings indicate that awareness of TCN and its health risks should be promoted and evidence -informed policies are needed to reduce the risk of TCN.

BACKGROUND:Many studies have shown that heatwaves are associated with an increased prevalence of urinary diseases. However, few national studies have been undertaken in China, and none have considered the associated economic losses. Such information would be useful for health authorities and medical service providers to improve their policy-making and medical resource allocation decisions.OBJECTIVES:To explore the association between heatwaves and hospital admissions for urinary diseases and assess the related medical costs and indirect economic losses in China from 2014 to 2019.METHODS:Daily meteorological and hospital admission data from 2014 to 2019 were collected from 23 study sites with different climatic characteristics in China. We assessed the heatwave-hospitalization associations and evaluated the location-specific attributable fractions (AFs) of urinary-related hospital admissions due to heatwaves by using a time-stratified case-crossover method with a distributed lag nonlinear model. We then pooled the AFs in a meta-analysis and estimated the national excess disease burden and associated economic losses. We also performed stratified analyses by sex, age, climate zone, and urinary disease subtype.RESULTS:A significant association between heatwaves and urinary-related hospital admissions was found with a relative risk of 1.090 (95 % confidence interval (CI): 1.050, 1.132). The pooled AF was 8.27 % (95%CI: 4.77 %, 11.63 %), indicating that heatwaves during the warm season (May to September) caused 248,364 urinary-related hospital admissions per year, with 2.42 (95%CI: 1.35, 3.45) billion CNY in economic losses, including 2.23 (95%CI: 1.29, 3.14) billion in direct losses and 0.19 (95%CI, 0.06, 0.31) billion in indirect losses, males, people aged 15-64 years, residents of temperate continental climate zones, and patients with urolithiasis were at higher risk.CONCLUSION:Tailored community health campaigns should be developed and implemented to reduce the adverse health effects and economic losses of heatwave-related urinary diseases, especially in the context of climate change.

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events, but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden. We collected daily data on climate, sociodemographic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March, 2014–2018. A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors. Twelve definitions of cold spells were used. Multi-meta regression analysis was applied to pool the impacts over different regions. Cold spells were significantly associated with all-cause mortality at lag 0–21 (CRR:1.38, 95%CI:1.21,1.57). In addition to respiratory diseases and circulatory system diseases, digestive, endocrine and nervous system diseases and injury were also affected by cold spells. The magnitude of the impacts of cold spells on mortality varied among the diseases investigated, with the highest risk estimate found for influenza and pneumonia (CRR: 2.00, 95%CI: 1.45, 2.76) and the lowest estimate found for injury (CRR: 1.26, 95%CI: 1.09,1.46). The fraction of all-cause mortality attributable to cold spells was 2.31% (95%CI: 0.90%, 3.46%). Among the regional differences, the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone, with attributable fractions of 2.85% (95%CI: 1.23%, 4.11%) and 3.36% (95%CI: 0.55%, 5.35%), respectively. Cold spells increased mortality from a range of diseases. Women, older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts. The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.

Background and aims: Earlier studies have reported inconsistent association between selenium (Se) and homo-cysteine (Hcy) levels, while no evidence could be found from Chinese population. To fill this gap, we investigated the association between blood Se and hyperhomocysteinemia (HHcy) of rural elderly population in China.Methods: A cross-sectional study on 1823 participants aged 65 and older from four Chinese rural counties was carried out in this study. Whole blood Se and serum Hcy concentrations were measured in fasting blood samples. Analysis of covariance and restricted cubic spline models were used to examine the association between Se and Hcy levels. Logistic regression models were used to evaluate the risk of prevalent HHcy among four Se quartile groups after adjusting for covariates.Results: For this sample, the mean blood Se concentration was 156.34 (74.65) mu g/L and the mean serum Hcy concentration was 17.25 (8.42) mu mol/L. A significant non-linear relationship was found between blood Se and serum Hcy, the association was inverse when blood Se was less than 97.404 mu g/L and greater than 156.919 mu g/L. Participants in the top three blood Se quartile groups had significantly lower risk of prevalent HHcy compared with the lowest quartile group. When defined as Hcy> 10 mu mol/L, the odds ratios and 95% confidence interval of HHcy were 0.600 (0.390, 0.924), 0.616 (0.398, 0.951) and 0.479 (0.314, 0.732) for Q2, Q3, and Q4 Se quartile groups compared with the Q1 group, respectively. When defined as Hcy >= 15 mu mol/L, the odds ratios and 95% confidence interval of HHcy were 0.833 (0.633, 1.098) and 0.827 (0.626, 1.092), 0.647 (0.489, 0.857) for Q2, Q3, and Q4 Se quartile groups compared with Q1 group.Conclusions: Our findings suggest that higher blood Se level could be a protective factor for HHcy in the elderly.

The number of swimming pools for infants and young children has been growing rapidly in China in recent years.How-ever,due to the lack of sanitary management norms or standards,there are hidden health and safety risks in baby swimming places.This paper introduces the current situation of the baby swimming industry,the characteristics of baby swimming places,and the existing health and safety problems,focusing discussion on the health design requirements,and sanitary quality requirements for water quality,indoor air,and public articles,as well as management requirements for baby swimming places,and also provide suggestions on sanita-tion management of baby swimming places.

Background: Evidence of the effectiveness of intervention against extreme heat remains unclear, especially among children, one of the vulnerable populations. This study aimed to evaluate the effectiveness of a primary school-based intervention program against heatwave and climate change in China to provide evidence for development of policies for adaptation to climate change. Methods: Two primary schools in Dongtai City, Jiangsu Province, China, were randomly selected as intervention and control schools (CTR registration number: ChiCTR2200056005). Health education was conducted at the intervention school to raise students’ awareness and capability to respond to extreme heat during May to September in 2017. Knowledge, attitude, and practice (KAP) of students and their parents at both schools were investigated by questionnaire surveys before and after intervention. The changes in KAP scores after intervention were evaluated using multivariable difference-in-difference (DID) analysis, controlling for age, sex, etc. Results: The scores of knowledge, attitude, and practice of students and their parents increased by 19.9% (95%CI: 16.3%, 23.6%) and 22.5% (95%CI: 17.8%, 27.1%); 9.60% (95%CI: 5.35%, 13.9%) and 7.22% (95%CI: 0.96%, 13.5%); and 9.94% (95%CI: 8.26%, 18.3%) and 5.22% (95%CI: 0.73%, 9.71%), respectively, after intervention. The KAP score changes of boys were slightly higher than those of girls. Older students had higher score changes than younger students. For parents, the higher the education level, the greater the score change, and change in scores was greater in females than in males. All the health education activities in the program were significantly correlated with the changes in KAP scores of primary school students after intervention, especially those curricula with interesting activities and experiential learning approaches. Conclusions: Heat and health education program in primary school was an effective approach to improve cognition and behavior for both students and their parents to better adapt to heatwaves and climate change. The successful experience can be generalized to respond to the increasing extreme weather/climate events in the context of climate change, such as heatwaves, and other emergent occasions or public health education, such as the control and prevention of COVID-19.

Background: Children are disproportionately affected by climate change while evidence regarding their adaptive behavior and relevant influencing factors is limited. Objectives: We attempted to investigate health-related adaptive behavior towards climate change for primary school children in China and explore potential influencing factors. Methods: We conducted a survey of 8322 primary school children in 12 cities across China. Knowledge, attitude, risk perception, and adaptive behavior scores for children were collected using a designed questionnaire. Weather exposures of cities were collected from 2014 to 2018. We applied a multiple linear regression and mixed-effect regression to assess the influencing factors of adaptive behavior. We also used the structural equation model (SEM) to validate the theoretical framework of adaptive behavior. Results: Most children (76.1%) were aware of climate change. They mainly get information from television, smartphones, and the Internet. A 1 score increase in knowledge, attitude, and risk perception was associated with 0.210, 0.386, and 0.160 increase in adaptive behavior scores, respectively. Females and children having air conditioners or heating systems at home were positively associated with adaptive behavior. Exposure to cold and rainstorms increased the adaptive behavior scores, while heat exposure had the opposite effects. The SEM showed that knowledge was positively associated with attitude and risk perception. Knowledge, attitude, and risk perception corresponded to 31.6%, 22.8%, and 26.1% changes of adaptive behavior, respectively. Conclusion: Most primary school children in China were aware of climate change. Knowledge, attitude, risk perception, cold, and rainstorm exposure were positively associated with health-related adaptive behavior towards climate change.

目的 探索隔日温差(temperature changes between neighboring days,TCN)对人群死亡的影响.方法 收集我国21个地区2014—2018年的每日气象因素数据、空气污染物数据和死因统计数据.运用分布滞后非线性模型(distributed lag non-linear model,DLNM)和多元Meta分析,估计不同季节的TCN对每日总死亡人数的影响.结果 研究显示,不同季节的TCN对每日总死亡人数均有显著影响,且阈值不同.冷季时,P95 TCN(升温)的14天累积相对危险度(CRR)为0.868(95％CI:0.794,0.948),而P 5(降温)对每日总死亡人数的影响没有统计学意义.暖季时,P 95 TCN(升温)的7天CRR为1.078(95％CI:1.009,1.152),而P 5(降温)的7天CRR为0.929(95％CI:0.889,0.971).冷季时,患有呼吸系统疾病人群更容易受到温度变化的不利影响.暖季时,循环系统疾病人群、女性和 ≥65岁人群对温度变化更为敏感.南北区域的分析显示,北方城市的人群对P 95 TCN的影响更加敏感.结论 不同季节的极端TCN与人群死亡的风险存在关联,冷季时升温可降低人群死亡风险,而暖季时升温可增加人群死亡风险,降温可降低人群死亡风险.健康促进策略应该考虑相邻两天之间的温度变化对人群死亡影响.

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.

Although the association between selenium (Se) and diabetes has been well-discussed in recent years, few studies have focused on the effects of long-term natural Se exposure and rarely concerned the effects of different Se biomarkers. To address this question, we carried out a 7-year longitudinal study on older adults aged over 65 and another cross-sectional study on middle-aged and older adults aged 40 and above from Chinese soil Se-deplete and Se-optimum areas. Cox proportional hazard models were used to evaluate the associations between nail Se levels and incidence risk of diabetes. Unconditional logistic regression models and analysis of variance models were used to examine the associations between serum Se levels and the prevalence risk of diabetes. The nail and serum Se levels were 0.47 ± 0.20 μg/g and 111.09 ± 55.01 μg/L for the two study populations, respectively. For both of the independent studies, higher Se levels were observed to be associated with a higher risk of diabetes and prediabetes. Compared with the Second nail Se quartile (Q2), the adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) of diabetes for Q1, Q3 and Q4 were 1.24(0.70, 2.21), 1.53(0.98, 2.39) and 1.31(0.76, 2.26), respectively, and the adjusted HRs (95 % CIs) of prediabetes were 1.47(0.77, 2.81), 1.38(0.83, 2.30), and 1.97(1.13, 3.44), respectively. Compared with the first serum Se quintile (Q1), the adjusted odds ratios (ORs) and 95 % CIs of diabetes for higher quintiles were 1.12(0.75, 1.66), 1.05(0.71, 1.57), 1.09(0.73, 1.62) and 1.51(1.02, 2.19), and the adjusted ORs (95 % CIs) of prediabetes were 1.27(0.77, 2.09), 1.70(1.05, 2.74), 1.94(1.21, 3.11) and 1.67(1.03, 2.71). Our findings consistently suggest that higher Se status is associated with a higher risk of diabetes in adults.

What is already known about this topic? In recent years, climate change may lead to an increase in cold spells in the middle latitudes, and there is a positive correlation between cold spells and population mortality. What is added by this report? The acute response period and the vulnerable population were identified under the optimal definition of cold spells, and the mortality burden caused by cold spells was estimated. What are the implications for public health practice? This research would provide evidence on the acute mortality effects of cold spells in southern China. Therefore, vulnerable populations, especially the elderly, should take timely measures to reduce the health damage caused by cold spells, especially in the first week after cold waves.

目的 探讨温度对林芝市臭氧所致门诊量的效应修饰作用.方法 收集2018—2019年林芝市人民医院的每日门诊资料以及林芝市逐日O3浓度资料和气象资料(日平均气温、平均相对湿度等),采用分布滞后非线性模型(DLNM)定量评估不同温度层内O3对人群门诊风险的影响.结果 低温时,O3每增加10μg/m3,每日总门诊量、非伤害门诊量的累计风险(CRR)分别增加53.8％(4.2％ ～126.9％)和59.1％(5.8％ ～139.2％).亚组分析结果显示,低温时,O3每增加10μg/m3,循环系统疾病、男性、女性、<14岁和14～65岁的年龄段人群门诊量的累积风险(CRR)分别增加152.1％(15.1％ ～451.9％)、58.3％(2.1％ ～145.5％)、49.2％(3.0％ ～116.1％)、39.6％(2.5％ ～90.3％)和61％(0.8％ ～157.1％).结论 林芝市日平均气温对O3所致人群门诊量的影响可能存在效应修饰作用,低温会加大O3所致门诊量的累积风险.

Background: There is limited evidence of effects and seasonal variation of temperature change on emergency department visits (EDVs). Objective: To investigate the association between diurnal temperature range (DTR), temperature change between neighboring days (TCN) and a comprehensive collection of cause-specific EDVs in China. Methods: We collected EDVs, weather, and air pollution data in 20 sites in China from 2014 to 2018. We applied a quasi-Poisson regression with distributed lag nonlinear model to evaluate DTR-and TCN-EDVs association. We used meta-analysis to pool site-specific estimates. We also conducted seasonal analysis and assess effects of modifiers. Results: A 1 ?C increase of DTR and TCN was associated with 0.29% [95% confidence interval (CI): 0.07%, 0.51%)] and 1.44% (95% CI: 0.93%, 1.96%) increase of total EDVs, respectively. People aged 18-44 were sensitive to DTR and TCN, while the elderly population was sensitive to TCN only in spring and autumn. In seasonal analysis, effects of temperature change on total EDVs were lower in summer. TCN increased risks of genitourinary diseases in summer, respiratory diseases in winter, injury in autumn, and mental diseases in spring. DTR increased the risk of respiratory diseases in autumn. Conclusion: Exposure to DTR and TCN was associated with elevated risk of EDVs but with great seasonal variations. Our results provided potential time and target populations for adaptive strategies and preventive measures.