Short-term effect of ambient temperature change on the risk of tuberculosis admissions: Assessments of two exposure metrics.

BACKGROUND: Although the effects of seasonal variations and ambient temperature on the incidence of tuberculosis (TB) have been well documented, it is still unknown whether ambient temperature change is an independent risk factor for TB. The aim of this study was to assess the association between ambient temperature change and the risk of TB admissions. METHOD: A distributed lag non-linear model (DLNM) combined with Poisson generalized linear regression model was performed to assess the association between ambient temperature change and the risk of TB admissions from 2014 to 2018 in Hefei, China. Two temperature change metrics including temperature change between neighboring days (TCN) and diurnal temperature range (DTR) were used to assess the effects of temperature change exposure. Subgroup analyses were performed by gender, age and season. Besides, the attributable risk was calculated to evaluated the public health significance. RESULTS: The overall exposure-response curves suggested that there were statistically significant associations between two temperature change metrics and the risk of TB admissions. The maximum lag-specific relative risk (RR) of TB admissions was 1.088 (95%CI: 1.012-1.171, lag 4 day) for exposing to large temperature drop (TCN= -4 °C) in winter. Besides, the overall cumulative risk of TB admissions increased continuously and peaked at a lag of 7 days (RR=1.350, 95%CI: 1.120-1.628). Subgroup analysis suggested that exposure to large temperature drop had an adverse effect on TB admissions among males, females and adults. Similarly, large level of DTR exposure (DTR=15 °C) in spring also increased the risk of TB admissions on lag 0 day (RR=1.039, 95%CI: 1.016-1.063), and the cumulative RRs peaked at a lag of 1 days (RR=1.029, 95%CI: 1.012-1.047). We also found that females and elderly people were more vulnerable to the large level of DTR exposure. Additionally, the assessment of attributable risk suggested that taking target measures for the upcoming large temperature drop (b-AF = 4.17%, 95% eCI: 1.24%, 7.22%, b-AN = 1195) may achieve great public health benefits for TB prevention. CONCLUSION: This study suggests that ambient temperature change is associated with the risk of TB admissions. Besides, TCN may be a better predictor for the TB prevention and public health.

Association between short-term exposure to ambient air pollutants and the risk of tuberculosis outpatient visits: A time-series study in Hefei, China.

BACKGROUND: The current evidence has presented mixed results between air pollutants exposure and the progression of tuberculosis (TB). The purpose of this study was to explore the association between short-term exposure to air pollutants and the risk of TB outpatient visits in Hefei, China. METHODS: Time-series analysis was used to assess the effect of short-term exposure to ambient air pollutants on the risk of TB outpatient visits. A Poisson generalized linear regression model combined with a distributed lag non-linear model (DLNM) was applied to explore the association. The effects of different gender (male, female), age (≤65 years old, >65 years old) and season (cold season, warm season) on the risk of TB were investigated by stratified analysis. Sensitivity analyses were conducted to test the robustness of our findings. RESULTS: A total of 22,749 active TB cases were identified from November 1, 2013 to December 31, 2018 in Hefei. The overall exposure-response curve showed that the concentration of particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5) and nitrogen dioxide (NO2) exposure were positively correlated with the risk of TB outpatient visits, while ozone (O3) and sulfur dioxide (SO2) exposure were negatively correlated with the risk of TB outpatient visits. The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits were 1.057 [95%CI: 1.002-1.115, lag 3 day] and 1.559 (95%CI: 1.057-2.300, lag 13 days) for each 10 µg/m³ increase in PM2.5; 1.026 (95% CI: 1.008-1.044, lag 0 day) and 1.559 (95%CI: 1.057-2.300, lag 07 days) for each 10 µg/m³ increase in NO2; 0.866 (95% CI: 0.801-0.935, lag 5 day) and 0.852 (95%CI: 1.01-1.11, lag 0-14 days) for each 10 µg/m³ increase in SO2 in the single-pollutant model. There was only a negative association between O3 exposure and the cumulative risk of TB outpatient visits (RR = 0.960, 95%CI: 0.936-0.984, lag 07 days). Stratified analyses showed that the effects of SO2 and O3 exposure were different between warm and cold seasons. The effect of NO2 exposure remained statistically significant in male, younger, and cold season subgroups. Besides, elderly people are more susceptible to PM2.5 exposure. CONCLUSION: This study suggests that exposure to PM2.5, NO2, SO2, and O3 are associated with the risk of TB outpatient visits. Seasonal variation may have a greater impact on the risk of TB outpatient visits compared with gender and age.

Human epidemiological evidence about the association between air pollution exposure and gestational diabetes mellitus: Systematic review and meta-analysis.

BACKGROUND: Previous studies have shown that ambient air pollution exposure can increase the risk of type 2 diabetes mellitus (T2DM) significantly. In consideration of the common underlying pathophysiologic mechanisms, exposure to air pollution may also increase the risk of gestational diabetes mellitus (GDM), but the current evidence was inconsistent and has not well been systematically reviewed. Our goal was to perform a systematic review and meta-analysis assessing the association between air pollution exposure and GDM. METHODS: An extensive literature search was conducted in selected electronic databases for related human epidemiological studies published in English language. Summary effect estimates were calculated using random-effect models for a) risk per unit increase in continuous air pollutant concentration and b) risk of high versus low exposure level in individual study if each exposure that had been examined in ≥2 studies. We evaluated the heterogeneity using Cochran's Q test and quantified it by I2 statistic. Publication bias was also evaluated through the funnel plot when sufficient number of studies are available. RESULTS: A total of 11 studies evaluating the association between GDM and exposure to air pollution were identified finally. The summary odds ratio (OR) for incidence of GDM following a 10 µg/m3 increase in PM2.5 exposure during the second trimester was 1.04 (95% Confidence Interval (CI): 1.01, 1.09) and in NOx during the first trimester was 1.03 (95%CI: 1.00, 1.07) per 10 ppb increase, while for high versus low SO2 exposure during the second trimester was 1.25 (95%CI: 1.02, 1.53). High heterogeneity among study-specific results in majority of the analyses were observed, and attributed to different exposure assessment methods, populations, study locations, and covariates adjustment. Publication bias cannot be excluded because of the inclusion of small number of studies. CONCLUSIONS: The present study supports the evidence that air pollution exposure increases the risk the GDM, albeit the existence of high heterogeneity. Further studies are necessary to elaborate the suggestive associations. These results are of public health significance since worsening air pollution in developing countries has been expected to increase the risk of GDM development.

Association between ambient air pollution and Parkinson's disease: Systematic review and meta-analysis.

Air pollution has been evaluated as a possible risk factor for Parkinson's disease (PD), but, the present results are inconsistent and have not been combined. We performed a systematic review and meta-analysis to estimate the association between long-term exposure to ambient air pollution and PD, given the nature of disease etiology. A total of 10 studies were identified by searching Web of Science, Science Direct, and PubMed before October 2017. We found a significantly increased risk of PD with 10 parts per billion (ppb) increase in nitrogen oxides (NOx) exposure (relative risk (RR) = 1.06; 95% confidence interval (CI): 1.04, 1.09). The pooled RR for the association between carbon monoxide (CO) exposure, 1 parts per million (ppm) increment, and the risk of PD was 1.65 (95% CI: 1.10, 2.48). The pooled RRs for the association between nitrogen dioxide (NO2) and ozone (O3) exposure per 1 ppb increment, and the risk of PD were 1.01 (95% CI: 1.00, 1.03) and 1.01 (95% CI: 1.00, 1.02), respectively. There was a significant heterogeneity in the meta-analysis for fine particulate matter (PM2.5), NO2, sulfur dioxide (SO2), and CO. We concluded that NO2, NOx, CO and O3 exposure were associated with an increased risk of PD, although there is high risk of bias. The dose-response effects evaluated by high-quality studies are needed. Researches should be expanded to low- and/or middle- income countries where indoor and outdoor air pollution are high. CAPSULE: Long-term exposure to ambient NO2, NOx, CO and O3 can increase the risk of Parkinson's disease.

Associations of telomere length in risk and recurrence of prostate cancer: A meta-analysis.

Over the past decades, there is an increasing number of association studies of telomere length (TL) and the risk and recurrence of prostate cancer (PCa), but the results are inconsistent. Hence, we identify the relevant studies published in English on or before 10 January 2019 conducting a literature review in the electronic databases including PubMed, EMBASE and Cochrane Library. Twelve studies (with 19 data sets) were included in this meta-analysis, five of which were associated with risk assessment, six of which reported recurrence of PCa and one of which included them. Our meta-analysis demonstrated a positive association of shorter telomeres in patients with PCa, but without statistical significance (OR, 1.23; 95% CI: 0.91-1.66). Shorter telomeres in stroma (OR, 2.40; 95% CI: 1.61-3.56) and epithelium (OR, 1.70; 95% CI: 1.33-2.16) were positively correlated with PCa, but in leucocyte (OR, 0.81; 95% CI: 0.73-0.91) had negative association with PCa. Furthermore, two studies combined yielded a pooled OR of 2.87 (95% CI: 1.22-6.76) for the association between shorter TL and metastasis. These results are novel and give further strength to formulate eligible individualising treatment and surveillance strategies.

Pre-Pregnancy Health Status and Risk of Preterm Birth: A Large, Chinese, Rural, Population-Based Study.

The aim of this study was to estimate the incidence of preterm birth (PTB) and identify maternal risk factors before pregnancy in rural China, and to determine their population-attributable fractions (PAFs). A prospectively population-based study was conducted in the city of Fuyang, China. Surveillance locations were randomly selected by cluster sampling based on administrative areas and geographic characteristics. Data were collected through interview questionnaires and medical examination records from the participants, then follow-up until discharge, fetus death, or at a maximum of 6 weeks postpartum, whichever came first. We used logistic regression analysis to identify the associated factors. PAFs were also estimated to examine the impact of risk factors. The incidence of PTB was 3.86% in this study. Multivariate analyses showed that risk factors for PTB were economic pressure (aOR=2.98, 95% CI, 2.40-3.71), hypertension (aOR=3.45, 95% CI, 2.23-5.36), hypoglycemia (aOR=2.07, 95% CI, 1.58, 2.72), hyperglycemia (aOR=1.69, 95% CI, 1.09, 2.62), serum creatinine (<44 µmol/L) (aOR=1.78, 95% CI, 1.13-2.40), hypothyroidism (aOR=1.37, 95% CI, 1.06-1.78), positivity for anti-CMV IgM (aOR=2.57, 95% CI, 1.21-5.45), multiple pregnancy (aOR=3.35, 95% CI, 1.87-6.00), and parity (≥3 times) (aOR=1.67, 95% CI, 1.05-2.64). Economic pressure was the most significant contributor (11.57%), while parity was the lowest (0.10%). This study demonstrated the relatively high burden of PTBs in a rural Chinese area. A broader focus on the risk factors prior to pregnancy amenable to interventions of women may reduce the incidence of PTB.

Associations between hypospadias, cryptorchidism and anogenital distance: Systematic review and meta-analysis.

Hypospadias and cryptorchidism are potential manifestations of testicular dysgenesis syndrome (TDS) at birth. Anogenital distance (AGD) has been presumed as an indicator related to endocrine disruptors proposed as one of the pathogenetic mechanisms underlying male reproductive disorders. In humans, recent studies have correlated AGD in boys to testicular anomalies. However, the associations between hypospadias, cryptorchidism and AGD remain inconsistent and have not been combined. Hence, we conducted a meta-analysis to assess gradations in the severity of the endocrine disruption in cryptorchidism or hypospadias by using AGD. A total of 2,119 boys from five birth cohort studies and two cross-sectional studies were subjected to meta-analysis. Random-effect model was used to calculate the standardised mean difference (SMD) of AGD. Our results reveal that boys with hypospadias or cryptorchidism have shorter AGD ([SMD, -2.63; 95% CI, -4.65 to -0.62] and [SMD, -0.69; 95% CI, -1.36 to -0.02]) respectively. There was no indication of a publication bias either from the result of Egger's test or Begg's test for hypospadias and cryptorchidism.

Risk factors for spontaneous abortion from a prevention perspective in rural China: a population-based follow-up study.

OBJECTIVES: We conducted this study to investigate the risk factors for spontaneous abortion among rural Chinese women. METHODS: Risk factors prior to pregnancy associated with spontaneous abortion were identified among 17,248 rural women enrolled in a prospective population-based follow-up study. The risk of spontaneous abortion was estimated with odds ratio (OR) and 95% confidence interval (CI) for several factors. A nonconditional logistic regression analysis was then performed to identify the independently associated factors. RESULTS: The total sample of this study population consisted of 17,248 pregnant women including 921 of them whose pregnancies resulted in spontaneous abortion and the incidence of spontaneous abortion was 5.04%. After the adjustment of confounding factors, menarche age, serum creatinine, family genetic diseases or maternal congenital defects was associated with an increased risk of spontaneous abortion while folic acid supplementation reduced the risk among rural Chinese women. CONCLUSIONS: The findings of our study suggest that multiple modifiable factors may increase the risk of spontaneous abortion which may help relevant departments better to guide detailed effectively prevention strategies toward spontaneous abortion to improve the reproductive quality of rural population. Further studies are required to elaborate these risk factors for spontaneous abortion.

Large for gestational age and macrosomia in pregnancies without gestational diabetes mellitus.

Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18-45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44-80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible.

Elevated parathyroid hormone levels and cognitive function: A systematic review.

OBJECTIVE: To systematically estimate the association between elevated parathyroid hormone (PTH) levels and cognitive function. METHODS: This review was conducted on ten papers identified through database searches from inception to 31 October 2018. The quality of studies was assessed using the Downs and Black checklist. RESULTS: There is a low volume of data reporting on the impact of elevated PTH levels on cognitive impairment. The quality of the identified studies ranged from poor (37 %) to good (76 %). Although the results from studies were mixed, one cross-sectional study and one prospective study suggested a link between elevated PTH levels and a decrease in the Mini-Mental State Examination (MMSE) score. Three cross-sectional studies that assessed other cognitive domain in specific domains, such as language, memory and executive function provided mixed results for an association between elevated PTH levels and cognitive function. Two studies showed mixed evidence for a link between elevated PTH levels and poor executive function. One prospective study, one cross-sectional study and three case-control studies provide mixed evidence for an association between higher PTH levels and Alzheimer´s disease (AD). Two studies showed limited evidence for an association between elevated PTH levels and vascular dementia. CONCLUSION: This review presented that the level of evidence available to support an association between elevated PTH levels and cognitive function was generally weak and inconsistent. Future studies with more better methodological quality are needed.

Maternal air pollution exposure and congenital heart defects in offspring: A systematic review and meta-analysis.

BACKGROUND: Congenital heart defects (CHDs) has a multifactorial causation with a strong genetic component and many environmental triggers. Emerging body of empirical studies suggest that air pollution is an important contributor to the development of CHDs, however, there still remains some controversy over the current evidence, and to the authors' knowledge, no studies have reviewed the most recent evidence. OBJECTIVES: We performed a systematic review and meta-analysis of epidemiological literature to investigate the relationship between maternal air pollution exposure and CHDs risk in offspring. The presence of heterogeneity and publication bias across available studies were also examined. METHODS: An extensive literature search of epidemiological studies pertaining to air pollution and CHDs, published in English language, until August 1, 2019 was conducted. Summary risk estimates of pollution-outcome combinations were calculated for i) risk per specific increment of concentration and ii) risk at high versus low exposure level in each study using fixed-effect model or random-effects model. RESULTS: A total of 26 studies were finally included. In the meta-analyses, high versus low carbon monoxide (CO) exposure was associated with an increased risk of tetralogy of Fallot [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.04-1.41], yet particulate matter ≤ 5 µm (PM2.5) exposure was marginally associated with it. Increased risk of atrial septal defects (ASDs) was found for each 10 µg/m3 and 10 ppb increment in particulate matter ≤ 10 µm (PM10) and ozone (O3) exposure, respectively (OR = 1.04, 95% CI: 1.00-1.09; OR = 1.09, 95% CI: 1.02-1.17). Categorical nitrogen dioxide (NO2) exposure was associated with an increased risk of coarctation of the aorta (OR for high versus low = 1.14, 95% CI: 1.02-1.26). Analyses for other combinations yielded none statistically significant associations. Sensitive analyses showed similar findings. CONCLUSIONS: The summary effect estimates from this study suggest statistically significant associations between increased risk of specific CHDs subtypes and PM2.5, PM10, NO2, CO, and O3 exposures. Further studies, especially conducted in developing countries, with improvements in exposure assessing, outcome harmonizing, and mechanistic understanding are needed to elaborate the suggestive associations.

Longitudinal trajectory of vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis during pregnancy as well as the impact on pregnancy outcomes: a preliminary study.

Objectives: The aims of this study were to describe the course of vulvovaginal candidiasis (VVC), trichomoniasis, and bacterial vaginosis (BV) in pregnancy and to explore the association between these longitudinal changes and pregnancy outcomes. Methods: A total of 793 pregnant women were enrolled at the first trimester of pregnancy and were followed prospectively twice at the second and third trimester. VVC, trichomoniasis, and BV were evaluated at each trimester of pregnancy. Results were evaluated for trends of these three diseases and the association between these changes of trends and pregnancy outcomes. Results: The trend of negative at all three time points was dominant for all three diseases compared with trend of positive throughout pregnancy was the most rare. In addition, for VVC, a trend toward positive can't be ignored (7.5%). However, for BV, the distribution of other three trends (trend negative, trend positive, status random) were basically the same. Different trends of these three diseases were not associated with adverse pregnancy outcomes, with the exception of women who had a trend of BV positive throughout pregnancy were more likely to suffer from amniotic fluid infection (AFI) compared with women who were negative at all three time points (p = .016, OR: 17.29, 95% CI: 1.70-175.54). Conclusions: In this population, the trend of negative throughout pregnancy was dominant for all three diseases compared with few women were positive across their pregnancy. BV may be associated with AFI during pregnancy.

The prevalence and risk factors of menstrual pain of married women in Anhui Province, China.

PURPOSE: To investigate the prevalence and the associated risk factors for menstrual pain in a sample of rural married women of reproductive age in Anhui Province of China. METHODS: A cross-sectional study was conducted among married women (n = 14,828) aged 18-45 years. Data were collected through self-reported questionnaires. Mann Whitney U, Kruskal-Walls H tests and ordinal logistic regression models were used to analyze the data. RESULTS: The prevalence of no, moderate, severe menstrual pain was 80.1%, 18.7%, 1.2%, respectively. Lower educational level, lower stress level and earlier age at menarche were protective factors for menstrual pain while women with longer duration of menstrual flow tended to have menstrual pain. Compared to women with a normal body mass index (BMI), significantly higher odds of reporting menstrual pain were detected for women who were lower BMI or higher BMI. Age, length of menstrual cycle, blood type, anemia and previous pregnancy were not significantly associated with dysmenorrhea after controlling for potential confounding factors. CONCLUSIONS: There is high prevalence of dysmenorrhea among women in China. Our results suggest that reduction of stress and maintaining a normal BMI may be important for women to have pain-free periods.

The association between prenatal bisphenol A exposure and birth weight: a meta-analysis.

The association between prenatal BPA exposure and birth weight is controversial. Here, a meta-analysis was performed to estimate the association between prenatal BPA exposure and birth weight. We searched literature addressing the association of interest in relevant databases. Data were independently extracted and analyzed using partial regression coefficient (ß) and/or odds ratio (OR) and their 95% confidence intervals (CIs). We identified 140 references and included 8 studies. Based on the results of meta-analysis, the association between prenatal BPA exposure and continuous birth weight was estimated to be 4.42 g (95% CI: -8.83 to 17.67 g) when comparing the highest vs. the lowest BPA concentration. Findings from this study indicated that prenatal BPA exposure was not statistically associated with continuous birth weight. However, more evidence, based on large prospective cohort studies, is required to provide conclusive evidence on whether or not prenatal BPA exposure is associated with birth weight.