The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon "Lekima" : In Jinan, China.

BACKGROUND: Studies had suggested increased risk of death of residents was associated with typhoons, particularly coastal regions. However, these findings ignored the impact of inland typhoons on the health of residents, especially the indirect death risk caused by typhoons. This study aimed to investigate the acute death risk of residents during inland typhoon Lekima in Jinan, further identify vulnerable populations and areas. METHODS: We selected the daily death from 11 to 27th August 2019 in Jinan as case period, and conducted a time-stratified case-crossover design to match the contemporaneous data from 2016 to 2018 as control period. We used the generalized linear Poisson models to estimate the related effects of death risk during typhoon Lekima and lag days. RESULTS: During the Lekima typhoon month, there were 3,366 deaths occurred in Jinan. Compared to unexposed periods, the acute death risk of non-accidental diseases (especially circulatory diseases), female and the older adults increased significantly in the second week after the typhoon. The maximum significant effect of circulatory disease deaths, female and older adult deaths were appeared on lag9, lag9, and lag13 respectively. And the typhoon-associated RR were 1.19 (95%CI:1.05,1.34), 1.28 (95%CI:1.08,1.52), and 1.22 (95%CI:1.06,1.42) respectively. The acute death risk of residents living in TQ and CQ increased significantly on Lag2 and Lag6 after the typhoon, respectively, while those living in LX, LC, HY, JY, and SH occurred from Lag 8 to Lag 13 after the typhoon. LC lasted the longest days. CONCLUSIONS: Typhoons would increase the vulnerability of residents living in Jinan which mainly occurred from the seventh day after the typhoon. Residents suffering from non-accidental diseases (circulatory diseases), female and the older adults were more vulnerable. The vulnerability of TQ and CQ occurred on Lag2 and Lag6 after typhoon Lekima, respectively, and the other areas except ZQ and PY occurred from Lag 8 to Lag 13. LC lasted the longest duration. Our findings emphasized the importance of the emergency response, which would help policymakers to identify vulnerable regions and populations accurately during typhoons and formulate the emergency response plan.

The joint effect of cumulative doses for outdoor air pollutants exposure in early life on asthma and wheezing among young children.

BACKGROUND: Constrained by no proper way to assess cumulative exposure, the joint effect of air pollution cumulative exposure doses on childhood asthma and wheezing (AW) was not understood. OBJECTIVE: To assess the association between cumulative exposure to multiple air pollutants in early life and childhood AW. METHODS: We designed a nested case-control study based on the birth cohort in Jinan City. Children with AW followed up within 2 years after birth were treated as cases, and non-cases in this cohort were treated as the control source population, and the propensity score matching method was used to match each case to 5 controls. We calculated the individual cumulative outdoor exposure doses for each period using an inverse distance weighted model, alongside the complex Simpson's formula, accounting for outdoor time and respiratory volume. The Least absolute shrinkage and selection operator (Lasso) regression was performed to screen for covariates. To analyze the joint effects of pollutants, we employed the weighted quantile sum (WQS) regression model in conjunction with conditional logistic regression. RESULTS: 84 cases and 420 controls were included in this study. The odds ratio (OR) with 95% confidence interval (CI) of the impact of cumulative exposure (mg/m3) after birth on childhood AW was 1.78 (1.15-2.74) for SO2, 1.69 (1.11-2.57) for NO2, and 1.65 (1.09-2.52) for PM2.5, respectively. Furthermore, with each 25th percentile increase in the WQS index, the overall risk of cumulative doses for six pollutants exposure after birth on AW increased by an adjusted OR of 1.10 (1.03, 1.18), and SO2, PM2.5, and NO2 contributed the most to the WQS index. However, no statistically significant association was found between cumulative exposure to all pollutants before birth and childhood AW. CONCLUSIONS: There was a joint effect of the cumulative exposure dose of outdoor air pollutants after birth on AW in children aged 0-2 years. And traffic-related pollutants (SO2, PM2.5, and NO2) make a greater contribution to the joint effect.

SRSF3 alleviates ischemic cerebral infarction damage by activating PI3K/Akt pathway.

Ischemic cerebral infarction is one of cerebrovascular diseases with high incidence, disability rate and mortality globally, and neuronal cell apoptosis is a crucial cause of brain injury during cerebral infarction. A middle cerebral artery occlusion (MCAO) model was built in Sprague-Dawley (SD) rats to simulate ischemic cerebral infarction. An in vitro model of ischemic cerebral infarction was constructed in BV2 cells with the treatment of oxygen-glucose deprivation (OGD). The role and mechanism of serine/arginine-rich splicing factor 3 (SRSF3) in ischemic cerebral infarction were investigated both in animal and cell models. The expression of SRSF3 was downregulated in MCAO-treated rats. Overexpression of SRSF3 reduced the neurological scores, brain water content and infarct volume in MCAO-induced rats. Increased apoptosis neurons accompanied with the abnormal expressions of apoptosis-related proteins in MCAO-induced rats were revised with the upregulation of SRSF3. Also, a diminished cell viability, and elevated apoptosis rate were indicated in OGD-induced BV2 cells, which were reversed with the overexpression of SRSF3. Besides, OGD induced an enhancement in the relative protein expression of programmed cell death protein 4 (PDCD4), and a reduction in the relative expression of p-PI3K/PI3K and p-AKT/AKT, which were inverted with the upregulation of SRSF3 in BV2 cells. Overexpression of PDCD4 abolished the role of SRSF3 in cell viability, apoptosis rate and the level of PI3K/AKT pathway in OGD-induced BV2 cells. SRSF3 improved ischemic cerebral infarction via PDCD4 in vivo and in vitro, which was closely associated with PI3K/AKT signaling pathway.

A life course approach to asthma and wheezing among young children caused by ozone: A prospective birth cohort in northern China.

BACKGROUND: Given differences in vulnerability of children in early life, a life course approach to asthma and wheezing (AW) in young children caused by ozone (O3) is not fully understood. METHODS: We conducted a birth cohort in Jinan, China from 2018 to 2021 to elucidate the onset model of childhood AW due to O3 exposure. An inverse distance weighted model was used for individual exposure assessment. The time-dependent Cox proportional-hazard model and logistic model were used to investigate the effects of O3 exposure on AW. Principal component analysis, interaction analysis, and distributed lag model were used to analyze the life course approach. RESULTS: The cumulative incidence rate for AW among 6501 children aged 2 was 1.4%. A high level of O3 was related to AW (HR: 2.10, 95% CI: 1.31, 3.37). Only O3 exposure after birth was associated with AW, with an OR of 1.82 (1.08, 3.12), after adjusting for the effect before birth. Furthermore, adjusting for other air pollutants, the HR for the individual effect of high O3 exposure on AW was 2.44 (1.53, 3.89). Interestingly, P values for interactions for O3 and the principal components of other pollutants, as well as the characteristic variable of open windows were less than 0.1. Moreover, an increase in the IQR of O3 exposure at the 31st to 37th weeks before birth and the 1st to 105th weeks after birth was associated with an increase in the HRs for AW. CONCLUSIONS: High-level of O3 exposure after birth could lead to AW among young children. Importantly, the AW onset model may include the risk factors accumulation and the sensitive period model. Specifically, there are two sensitive windows in early life, and the correlated insults between the high level of O3 and other pollutants as well as open windows in the asthma-inducing effect.

Extreme cold weather and circulatory diseases of older adults: A time-stratified case-crossover study in jinan, China.

OBJECTIVES: We aimed to investigate the acute effect of extreme cold weather on circulatory disease mortality of older adults in Jinan, with individual and regional-scale characteristics as subgroup analyses to further identify vulnerable populations. METHODS: This study contained the death data of Jinan from 2011 to 2020 (Nov-Mar). A time-stratified case-crossover method was used to estimate the effects of extreme cold weather and lags 0-8 days, controlling for holiday and relative humidity. To evaluate the impact of different durations and thresholds of extreme cold weather, we considered 4 cold day and 12 cold wave definitions RESULTS: Our results showed an increase in circulatory disease deaths under several definitions. The number of older adults died of circulatory diseases totaled 92,119 during the study period. In the definitions of cold day, the maximum significant effect ranging from 1.08 (95% CI: 1.03,1.14) to 1.13 (95% CI: 1.04,1.24) and appeared on Lag5 or Lag6. In the definitions of cold wave, the maximum significant effect ranging from 1.07 (95% CI: 1.02, 1.12) to 1.14 (95% CI: 1.03, 1.25). The cold effect is mainly attributable to cold day rather than an added effect related to the duration. Our research confirmed that extreme cold weather had a stronger impact on women [maximum effects with an OR of 1.21 (95% CI: 1.08, 1.36) in P1, 1.19 (95% CI: 1.05, 1.36) in M12)], and the effect gradient increased with age. CONCLUSIONS: Our findings support the evidence on the impact of extreme cold weather on circulatory disease mortality and provide a basis for policymakers to select target groups to develop policies and reduce the public health burden.

Non-linear relationships and interactions of meteorological factors on mumps in Jinan, China.

Although vaccination is available, mumps remains a public health concern in many countries including China. Previous studies have indicated the impact of meteorological factors and mumps, but findings vary across different regions with limited evidence to inform local public health responses. We aim to examine the impacts of meteorological variables on mumps in Jinan, a temperate city of China, and explore the interactions of temperature with humidity or wind speed. Weekly meteorological data and notified cases of mumps in Jinan were collected for 2014-2018. Regression analyses using the generalized additive model were performed with considerations of multicollinearity, lag effects, school holidays, long-term trend, and seasonality. A stratification model was applied to investigate the interaction. We found a non-linear relationship between weekly mean temperature and the number of cases. Between 1.2 and 24.5 °C, the excess risk (ER) of mumps for a 1 °C increase in weekly mean temperature was 3.08% (95% CI 1.32 to 4.87%) at 0-week lag. The lagged effects could last for 3 weeks. There were interactions between mean temperature and relative humidity or wind speed. The effect of mean temperature was enhanced in days with low relative humidity or high wind speed. This study suggests that temperature is positively associated with mumps cases with thresholds in the temperate city of China, and the effect can be modified by relative humidity and wind speed and is independent of vaccine coverage. Findings could be integrated into current early warning systems of mumps in order to protect people's health from the risk of changing climate.

Associations between Personal PM2.5 Elemental Constituents and Decline of Kidney Function in Older Individuals: the China BAPE Study.

Long-term exposure to fine particulate matter (PM2.5) is associated with kidney dysfunction. However, few studies have investigated acute effects of PM2.5 elemental constituents on renal function. We evaluated associations between personal PM2.5 and its elemental constituents and kidney function, assessed by an estimated glomerular filtration rate (eGFR) in Biomarkers of Air Pollutants Exposure in the Chinese aged 60-69 study. Seventy one older individuals were visited monthly between September 2018 and January 2019. Each participant wore a PM2.5 monitor for 72 h, responded to a questionnaire, and underwent a physical examination with blood sampling. Linear mixed-effect models were used to estimate associations between personal PM2.5 elemental constituents and eGFR. We found that significant changes in eGFR from -1.69% [95% confidence interval (CI): -3.34%, -0.01%] to -3.27% (95% CI: -5.04%, -1.47%) were associated with interquartile range (IQR) increases in individual PM2.5 exposures at various lag periods (7-12, 13-24, 0-24, 25-48, and 49-72 h). An IQR increase in 72 h moving averages of copper, manganese, and titanium in personal PM2.5 corresponded to -2.34% (95% CI: -3.67%, -0.99%) to -4.56% (95% CI: -7.04%, -2.00%) changes in eGFR. Personal PM2.5 and some of its elemental constituents are inversely associated with eGFR in older individuals.

Primary drug resistance of mycobacterium tuberculosis in Shandong, China, 2004-2018.

BACKGROUND: Primary drug-resistant tuberculosis (DR-TB) has contributed to a significant health and economic burden on a global scale, especially in China. we sought to estimate epidemiological characteristics of primary DR-TB in China from 2004 to 2018. METHODS: Eleven thousand four hundred sixty-seven newly diagnosed and 1981 retreated TB cases with drug susceptibility data were included. Chi-Square test for trends, linear regression, a joinpoint regression model and temporal trend in proportions of the different resistance patterns were carried out. RESULTS: The proportion of primary DR-TB and mono-resistant TB (MR-TB) in China had reduced by more than 12% since 2004, and were 21.38%, 13.35% in 2018 respectively. Among primary DR-TB cases (2173,18.95%), the percentage of multiresistant TB (MDR-TB, from 5.41 to 17.46%), male (from 77.03 to 84.13%), cavity (from 13.51 to 43.92%), rifampicin(RFP)-resistant TB (from 8.11 to 26.98%), streptomycin(SM)-resistant TB (from 50.00 to 71.43%) increased significantly (P < 0.05). On the contrary, the proportion of female, non-cavity, isoniazide(INH)-resistant TB (from 55.41 to 48.15%) and MR-TB (from 82.43 to 62.43%) decreased significant (P < 0.05). The primary drug resistance rate among female, cavity, smoking, drinking, 15 to 44 year-old TB subgroups increased by 0.16, 6.24, 20.95, 158.85, 31.49%, respectively. The percentage of primary DR-TB, RFP-resistant TB dropped significantly during 2004-2007 in Joinpoint regression model. CONCLUSION: The total rate of drug resistance among new TB cases showed a downward trend in Shandong, China, from 2004 to 2018. Primary drug resistance patterns were shifting from female, non-cavity, INH-resistant TB, and MR-TB groups to male, cavity, RFP/SM-resistant TB, and MDR-TB groups. Considering the rising drug resistance rate among some special population, future control of primary DR-TB in China may require an increased focus on female, cavity, smoking, drinking, or 15 to 44 year-old TB subgroups.

Health-risk perception and its mediating effect on protective behavioral adaptation to heat waves.

Ensuring spontaneously adjusting behaviors of the public in their daily life in response to heat waves is an important aspect of successful public health intervention under climate change. However, the current response behavior guidance released by the government is insufficient because of the limited understanding of public perceptions of heat-related risk and the motivating factors for the public's diverse adaptive behaviors. Here, we conducted a survey on the behavioral adaptations of 3065 urban residents in response to heat waves in Jinan, which is a typical city suffering from a hot climate. We provided evidence on the current state of residents' perception of heat waves and the mechanism of how risk perception mediates individual behavioral intentions upon exposure to high ambient temperatures. We found that the mediating effects of risk perception varied significantly with respect to different types of adaptive behaviors. Concern behaviors appeared be motivated completely by the mediating effects of perceived concern (b = 0.45, p < 0.01 for concerns about health guidelines; b = 0.36, p < 0.01 for concerns about the weather forecast) and severity (b = 0.11, p < 0.01 for concerns about health guidelines), while outdoor activity could be consciously adjusted according to temperature changes without those mediating effects (p > 0.05). Indoor cooling behaviors and transportation behaviors are partially mediated by risk perception (b = -0.04, p < 0.01; b = 0.08, p < 0.01; b = 0.08, p < 0.01 for indoor fan usage, use of air-conditioned buses, and use of private cars, respectively). The conclusions could help determine more targeted and detailed interventions to enhance public behavioral adjustments, including participation in adaption to and emergency preparedness for extreme temperature under the ongoing climate changes.

The association of ambient PM2.5 with school absence and symptoms in schoolchildren: a panel study.

BACKGROUND: Children are a susceptible population to exposure of ambient fine particulate air pollution (PM2.5), and the associated symptoms are sensitive prevalent indicators of morbidity. However, few studies to date investigate the association between PM2.5 exposure and school absence and symptoms. METHODS: In a panel study including 20,291 observations in 615 schoolchildren 8-13 years of age, we asked the participants to record their school absence and symptoms on every school day from 17 November to 31 December 2014 in Jinan, China. We used the generalized linear mixed effects models to examine the adverse effects of ambient PM2.5 on school absence and symptoms, adjusting for covariates including meteorological and individual factors. RESULTS: The 3-day moving average of PM2.5 was significantly associated with school absence (1.37; 95% CI: 1.07-1.74) and increases in symptoms of the throat (1.03; 95% CI: 1.00-1.05), nose (1.03; 95% CI: 1.01-1.06), and skin (1.09; 95% CI: 1.06-1.12). High PM2.5 exposure also increased the risks of individual symptoms, especially for cough (1.02; 95% CI: 1.00-1.04), sneezing (1.03; 95% CI: 1.00-1.07), and stuffy nose (1.09; 95% CI: 1.02-1.17). CONCLUSION: High PM2.5 exposure is a risk factor for the health of schoolchildren. Allocation of medical resources for children should take into account the ambient PM2.5 concentrations and be proportioned accordingly.

Pharmacokinetics of pidotimod in broiler chickens by UHPLC-MS/MS after oral and intravenous administration.

Pidotimod is widely used in children as an immune promoter but it has not been fully evaluated in animals. The pharmacokinetics of pidotimod and its oral bioavailability have not been described in broiler chickens. We developed a simple and sensitive UHPLC-MS/MS assay for rapid determination of pidotimod levels in chicken blood. Recoveries were nearly 100% and the coefficients of accuracy and precision were minimal. Healthy broiler chickens were given 10 mg/kg pidotimod either orally or intravenously. The oral pidotimod was rapidly absorbed (time to reach maximum concentration, 1.25 h) and rapidly eliminated (the mean residence time was 3.2 h). A noncompartmental analysis of the intravenous route indicated a mean plasma clearance of 2.2 L (h kg)-1 with an estimated mean volume of distribution at steady state of 12.69 L/kg. The bioavailability of pidotimod after oral dosing was 27%.

Increase in Medical Emergency Calls and Calls for Central Nervous System Symptoms During a Severe Air Pollution Event, January 2013, Jinan City, China.

BACKGROUND: In January 2013, a continuous and severe haze event affected one third of the major cities in China, including Jinan. OBJECTIVES: We investigated whether medical emergency calls (for nonaccidental emergencies) and calls for Central Nervous System (CNS) syndromes increased during this episode compared with the previous winter months (January, February, and December) in 2011 and 2012. METHODS: Daily emergency calls were obtained from Jinan Medical Emergency Center. Sentinel CNS syndromes from nonaccidental emergency calls included seven symptoms: headache, dizziness, syncope, coma, convulsions, paralysis, and epilepsy. Particles with aerodynamic diameter <10 µm (PM10) were used as the indicator of air pollution. A generalized linear model based on quasi-Poisson regression was used to evaluate the effects on nonaccidental emergency calls and calls for CNS syndromes and each symptom, separately, during this episode. RESULTS: Markedly higher mean daily concentration, 332 µg/m of PM10, during this episode versus reference months was found. Obviously increased effects on nonaccidental emergency calls and calls for CNS syndromes were observed during this episode, with relative risk (RR) value 1.3 (95% CI = 1.2, 1.3) and 1.2 (95% CI = 1.1, 1.3). Four of seven CNS symptoms were also increased during this episode: RRs values for dizziness, convulsions, paralysis, and epilepsy were 1.4 (95% CI = 1.2, 1.7), 1.4 (95% CI = 1.1, 1.6), 1.6 (95% CI = 1.2, 2.1), and 1.5 (95% CI = 1.1, 2.0), respectively. CONCLUSIONS: A noticeable increase in medical emergency calls and calls for Central Nervous System syndromes were observed during a severe air pollution episode on January 2013, in a large Chinese city.

Genetic polymorphism of MTHFR C677T with preterm birth and low birth weight susceptibility: a meta-analysis.

PURPOSE: This study aimed at clarifying the association of maternal and neonatal methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms with preterm birth (PTB) and low birth weight (LBW) susceptibility, respectively. MATERIALS AND METHODS: A systematic search of Embase, Medline, China Biological Medicine Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang Database was performed before June, 2016. The frequencies of maternal and neonatal MTHFR C677T genotypes in the cases and controls and other information were extracted by two independent investigators. Odds ratios (ORs) with 95% confidence intervals (CIs) were adopted to estimate the relationships between MTHFR C677T polymorphisms and PTB as well as LBW by random or fixed effect models. RESULTS: Twenty-five studies from 20 articles concerning maternal and neonatal MTHFR C677T gene polymorphism with PTB and LBW were included in this study. Maternal MTHFR C677T polymorphism was associated with PTB risk under allele contrast (T vs. C, OR = 1.36, 95% CI 1.02-1.81), homozygote (TT vs. CC, OR = 1.70, 95% CI 1.07-2.68), and recessive (TT vs. CT + CC, OR = 1.49, 95% CI 1.00-2.22) model, but not dominant or heterozygote model. Maternal MTHFR C677T polymorphism was also associated with LBW risk under allele contrast (OR = 1.69, 95% CI 1.25-2.28), homozygote (OR = 2.26, 95% CI 1.44-3.54), dominant (OR = 1.71, 95% CI 1.19-2.47), recessive (OR = 1.79, 95% CI 1.42-2.26) model, but not heterozygote model. No associations between neonatal MTHFR C677T polymorphism and PTB or LBW were found under all genetic models. CONCLUSIONS: Identification of maternal MTHFR C677T mutation may play a key role for primary prevention of PTB as well as LBW and screening pregnant women of high risk in developing countries.

Wide-humidity, anti-freezing and stretchable multifunctional conductive carboxymethyl cellulose-based hydrogels for flexible wearable strain sensors and arrays.

Hydrogels play an important role in the design and fabrication of wearable sensors with outstanding flexibility, high sensitivity and versatility. Since hydrogels lose and absorb water during changes in humidity and temperature, it is critical and challenging to obtain hydrogels that function properly under different environmental conditions. Herein, a dual network hydrogel based on tannic acid (TA) reinforced polyacrylamide (PAM) and sodium carboxymethylcellulose (CMC) was constructed, while the introduction of the green solvents Solketal and LiCl endowed the hydrogel with greater possibilities for further modification to improve the water content and consistency of the mechanical properties over 30-90 % RH. This composite hydrogel (PTSL) has long-term stability, excellent mechanical strength, and freezing resistance. As strain sensors, they are linear over the entire strain range (R2 = 0.994) and have a high sensitivity (GF = 2.52 over 0-680 % strain range). Furthermore, the hydrogel's exceptional electrical conductivity and freezing resistance are a result of the synergistic effect of Solketal and LiCl, which intensifies the contact between the water molecules and the colloidal phase. This research could address the suitability of hydrogels over a wide range of humidity and temperature, suggesting great applications for smart flexible wearable electronics in harsh environmental conditions.

Acute Effects of Low Temperatures and Cold Waves on Elderly Infectious Pneumonia Mortality - Jinan City, Shandong Province, China, 2014-2022.

What is already known about this topic?: The mortality rate due to pneumonia varies depending on the infectious agents present in a low- temperature environment. What is added by this report?: This study aimed to examine the relationship between low temperatures and cold waves and the risk of mortality from infectious pneumonia in the elderly. The findings indicate a significant increase in the risk of infectious pneumonia, specifically bacterial pneumonia, during periods of low temperatures and cold waves. What are the implications for public health practice?: This study presents compelling evidence that highlights the importance of proactive public responses to infectious pneumonia among the elderly population during periods of cold waves.

The Combined Effects of High Temperatures and Ozone Pollution on Medical Emergency Calls - Jinan City, Shandong Province, China, 2013-2019.

What is already known about this topic?: Studies have extensively documented the separate and independent effects of extreme temperature and ozone on morbidity and mortality associated with respiratory and circulatory diseases. What is added by this report?: The study revealed a significant association between elevated temperature, ozone pollution, and the combined effect of high temperature and ozone pollution with an increased risk of all-cause medical emergency calls (MECs) and MECs specifically related to neurological diseases. What are the implications for public health practice?: Interventional measures should be implemented to mitigate exposure to high temperatures and ozone levels. Specifically, during the warm season, it is crucial for relevant authorities to focus on disseminating scientific information regarding the health impacts of elevated temperatures and ozone pollution. Additionally, timely public health advisories should be issued to alert the public effectively.

Impact of residential solid fuel usage and fuel conversion on children's lung function.

Solid fuel combustion exposure is a leading global health risk factor, yet evidence on its effects, especially on vulnerable children, is sparse. This large-scale, multi-center prospective study aimed to address this gap by involving 9997 schoolchildren across China between 2013 and 2015. Here we show that lung function levels exhibited a marginally significant decline among children exposed to solid fuel usage. Specifically, FVC and FEV1 decreased by 21.2 mL (95% CI: -15.7, 58.1) and 24.1 mL (-8.4, 56.6), respectively. Additionally, PEF, FEF25 and FEF75 decreased by 25.7 mL/s (-46.5, 98.0), 32.7 mL/s (-42.7, 108.2), and 35.4 mL/s (-5.9, 76.7), respectively. Persistent exposure to solid fuel usage in children led to greater lung damage. Children with allergy history were more susceptible to solid fuel exposure. Our study highlights the adverse impact of solid fuel usage on children and the need to promote clean fuel usage for this vulnerable population.

Evaluating the Applicability and Health Benefits of the Graded Heat Health Risk Early Warning Model - Jinan City, Shandong Province, China, 2022.

What is already known about this topic?: The heat health early warning model serves as an effective strategy for reducing health risks related to heatwaves and improving population adaptability. Several high-income countries have taken the lead in conducting research and implementing measures aimed at safeguarding their populations. What is added by this report?: The graded heat health risk early warning model (GHREWM) in Jinan City has demonstrated efficacy in safeguarding males, females, individuals aged above 75 years, and those with cardiopulmonary diseases. During the summer of 2022, the warning stage of GHREWM contributed to the prevention of 10.9 deaths per million individuals, concurrently averting health-related economic losses estimated at approximately 227 million Chinese Yuan (CNY). What are the implications for public health practice?: The GHREWM has the potential to enhance cities' adaptability to climate change. It is crucial to incorporate additional adverse health endpoint data in the development of early warning models, as this will improve their applicability and protective efficacy.

An urgent health problem of indoor air pollution: results from a 15-years carbon monoxide poisoning observed study in Jinan City.

Carbon monoxide (CO) poisoning is a public health concern in developing countries especially in China with a high disease burden. We aimed to focus on non-occupational CO poisoning caused by household coal heating secular trends based on registry data in Jinan, China, and we aim to provide further evidence and suggestions for public health policy. We analyzed the occurrence and development trend and assess the spatial-temporal epidemiological characteristics of non-occupational CO poisoning caused by household coal heating in Jinan between 2007 and 2021. Among total of 6588 CO poisoning, 5616 cases (85.25%) and 180 deaths caused by household coal heating was identified during study period. The cumulative incidence rate was 5.78 per 100,000 person-years and the mortality rate was 0.19 per 100,000 person-years. The incidence in urban areas (6.55 per 100,000 person-years) was higher than rural areas (5.04 per 100,000 person-years), and there was a statistical difference between urban and rural (P < 0.001) (P < 0.001). The poisoning time point mainly occurs in the sleep stage. In Jinan, socioeconomic status, accessibility to health services and rural status are determinants for CO poisoning incidence and mortality. Implementation of urban and rural central heating renovation is an effective way to further reduce the disease burden of CO poisoning in the future.

Maternal apparent temperature during pregnancy on the risk of offspring asthma and wheezing: effect, critical window, and modifiers.

The objective of this study was to explore the impact of maternal AT during pregnancy on childhood asthma and wheezing, as well as the potential effect modifiers in this association. A cross-sectional study was implemented from December 2018 to March 2019 in Jinan to investigate the prevalence of childhood asthma and wheezing among aged 18 months to 3 years. Then, we conducted a case-control study based on population to explore the association between prenatal different AT exposure levels and childhood asthma and wheezing. The association was assessed by generalized additive models and logistic regression models, and stratified analyses were performed to explore potential effect modifiers. A total of 12,384 vaccinated children participated in screening for asthma and wheezing, 236 cases were screened, as well as 1445 controls were randomized. After adjusting for the covariates, childhood asthma and wheezing were significantly associated with cold exposure in the first trimester, with OR 1.731 (95% CI: 1.117-2.628), and cold exposure and heat exposure in the third trimester, with ORs 1.610 (95% CI: 1.030-2.473) and 2.039 (95% CI: 1.343-3.048). In the third trimester, enhanced impacts were found among girls, children whose distance of residence was close to the nearest main traffic road, and children whose parents have asthma. The study indicates that exposure to extreme AT during the first and third trimesters could increase the risk of childhood asthma and wheezing.