Concepts and Terms for Addressing Disparities in Public Health Emergencies: Accounting for the COVID-19 Pandemic and the Social Determinants of Health in the United States.

Public health emergencies, including the coronavirus disease 2019 (COVID-19) pandemic, highlight disproportionate impacts faced by populations with existing disparities. Concepts and terms used to describe populations disproportionately impacted in emergencies vary over time and across disciplines, but United States (US) federal guidance and law require equal access to our nation's emergency resources. At all levels of emergency planning, public health and their partners must be accountable to populations with existing inequities, which requires a conceptual shift toward using the data-driven social determinants of health (SDOH). SDOH are conditions in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. This article reviews the historic use of concepts and terms to describe populations disproportionately impacted by emergencies. It also recommends a shift in emergency activities toward interventions that target the SDOH to adequately address long-standing systemic health disparities and socioeconomic inequities in the United States.

Association between maternal outdoor physical exercise and the risk of preterm birth: a case-control study in Wuhan, China.

BACKGROUND: China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China. METHODS: A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM). RESULTS: Compared to women not involved in any physical activity, those who participated in physical exercise 1-2 times, 3-4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval [95% CI]: 0.68-0.92), 30% (aOR: 0.70, 95% CI: 0.60-0.82), and 32% (aOR: 0.68, 95% CI: 0.59-0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day. CONCLUSION: Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.

Association between ambient air pollution and hyperuricemia in traffic police officers in China: a cohort study.

To evaluate the association between ambient air pollution and hyperuricemia, we prospectively followed 1748 traffic police officers without hyperuricemia at baseline (2009-2014) from 11 districts in Guangzhou, China. We calculated six-year average PM10, SO2 and NO2 concentrations using data collected from air monitoring stations. The hazard ratios for hyperuricemia per 10 µg/m3 increase in air pollutants were 1.46 (95% CI: 1.28-1.68) for PM10, 1.23 (95% CI: 1.00-1.51) for SO2, and 1.43 (95% CI: 1.26-1.61) for NO2. We also identified changes in the ratio of serum uric acid to serum creatinine concentrations (ua/cre) per 10 µg/m3 increase in air pollutants as 11.54% (95% CI: 8.14%-14.93%) higher for PM10, 5.09% (95% CI: 2.76%-7.42%) higher for SO2, and 5.13% (95% CI: 2.35%-7.92%) higher for NO2, respectively. Long-term exposure to ambient air pollution was associated with a higher incidence of hyperuricemia and an increase in ua/cre among traffic police officers.

Investigation of simple, objective, and effective indicators for predicting acute paraquat poisoning outcomes.

Initial symptoms of paraquat (PQ) toxicity are often not obvious, and the lack of advanced testing equipment and medical conditions in the primary hospital make it difficult to provide early diagnosis and timely treatment. To explore simple, objective, and effective indicators of prognosis for primary clinicians, we retrospectively analyzed acute PQ poisoning in 190 patients admitted to our hospital from 2008 to 2017. Based on their condition at the time of discharge, patients were categorized into either the survival group (n = 71) or the mortality group (n = 119). Age, PQ ingested amount, urinary PQ, urinary protein, white blood cell (WBC), and serum creatinine (Cr) were the key factors associated with the prognosis for PQ poisoning. We identified specific diagnostic thresholds for these key indicators of PQ poisoning: PQ ingested amount (36.50 mL), urinary PQ (semiquantitative result "++"), urinary protein (semiquantitative result "±"), WBC (16.50 × 109/L), and serum Cr (102.10 µmol/L). Combining these five indicators to identify poisoning outcomes was considered objective, accurate, and convenient. When the combined score was <1, the predicted probability of patient death was 6%. When the combined score was ≥3, the predicted probability of patient death was 96%. These findings provide metrics to assist primary clinicians in predicting outcomes of acute PQ poisoning at earlier stages, a basis for administering treatment.

How longer can people live by achieving the daily ambient fine particulate pollution standards in the Pearl River Delta region, China?

BACKGROUND: Previous research has reported the effects of long-term fine particulate matter (PM2.5) pollution on years of life lost (YLL), but these effects may not represent the full impact. This study aims to estimate potential benefits in life time from adhering to daily ambient PM2.5 concentration standards/guidelines. METHODS: This study evaluated the relationship between daily ambient PM2.5 level and YLL using a two-stage approach with generalized additive models and meta-analysis. Potential life expectancy gains were then estimated by presuming that daily PM2.5 levels were in compliance with the Chinese and WHO standards. In addition, the attributable fraction of YLL due to excess PM2.5 exposure was also calculated. RESULTS: During 2013-2016, 459,468 non-accidental deaths were recorded in the six cities of Pearl River Delta, China. Each 10 µg/m3 increment in four-day average (lag03) level of PM2.5 was related to an increment of 13.31 [95% confidence interval (CI): 5.74, 20.87] years of life lost. Implementation of the WHO guidelines might avoid 180,980.83 YLLs (95% CI: 78,116.07, 283,845.60), which corresponded to 0.39 (95% CI: 0.17, 0.62) years of increased life time per death. Additionally, an estimated 0.15% (95% CI: 0.06%, 0.23%) or 2.04% (95% CI: 0.88%, 3.20%) of YLLs could be attributed to PM2.5 exposures higher than the Chinese or WHO guidelines, respectively. CONCLUSIONS: This study suggests that people might live longer by controlling daily PM2.5 concentration and highlights the need to adopt stricter standards in China.

Hourly associations between ambient air pollution and emergency ambulance calls in one central Chinese city: Implications for hourly air quality standards.

BACKGROUND: Most studies on the short-term health effects of air pollution have been conducted on a daily time scale, while hourly associations remain unclear. METHODS: We collected the hourly data of emergency ambulance calls (EACs), ambient air pollution, and meteorological variables from 2014 to 2016 in Luoyang, a central Chinese city in Henan Province. We used a generalized additive model to estimate the hourly effects of ambient air pollutants (PM2.5, PM10, SO2, and NO2) on EACs for all natural causes and cardiovascular and respiratory morbidity, with adjustment for potential confounding factors. We further examined the effect modification by temperature, relative humidity, wind speed, and atmospheric pressure using stratified analyses. RESULTS: In the single-pollutant models, PM2.5, PM10, SO2, and NO2 were associated with an immediate increase in all-cause morbidity at 0, 0, 12, 10 h, separately, after exposure to these pollutants (excess risks: 0.19% (95% confidence interval (CI): 0.03%, 0.35%), 0.13% (95% CI: 0.02%, 0.24%), 0.28% (95% CI: 0.01%, 0.54%) and 0.52% (95% CI: 0.06%, 0.99%), respectively). These effects remained generally stable in two-pollutant models. SO2 and NO2 were significantly associated with an immediate increase in risk of cardiovascular morbidity, but the effects on respiratory morbidity were relatively more delayed. The stratified analyses suggested that temperature could modify the association between PM2.5 and EACs, humidity and atmospheric pressure could modify the association between SO2 and EACs. CONCLUSIONS: Our study provides new evidence that higher concentrations of PM2.5, PM10, SO2, and NO2 may have transiently acute effects on all-cause morbidity and subacute effects on respiratory morbidity. SO2 and NO2 may also have immediate effects on cardiovascular morbidity. Findings of this study have important implications for the formation of hourly air quality standards.

Emergency Department Environmental Contamination With Methicillin-Resistant Staphylococcus aureus After Care of Colonized Patients.

STUDY OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) transmission dynamics in the emergency department (ED) are not well defined; environmental surfaces may serve as reservoirs for transmission. This study investigates the effect of patients with a history of MRSA colonization or infection on subsequent MRSA contamination of the ED environment. METHODS: Adult ED patients with evidence of an MRSA-positive surveillance result or clinical microbiologic culture in the year preceding their current ED visit were enrolled. Cultures from 5 anatomic sites were obtained to detect active MRSA colonization. After patients' discharge and before environmental disinfection, up to 16 prespecified surfaces in their ED rooms were cultured. Strain typing was performed by repetitive-sequence polymerase chain reaction on all recovered MRSA isolates to determine concordance with the corresponding patient strain. RESULTS: Of 42 patients enrolled, 25 (60%) remained colonized with MRSA. Nineteen of the 25 ED rooms (76%) occupied by MRSA-colonized patients contained greater than or equal to 1 MRSA-contaminated environmental surface on patient discharge. Surfaces were more likely to be contaminated when rooms were occupied by patients colonized with MRSA at 1 body site (odds ratio 11.7; 95% confidence interval 1.5 to 91.5) and greater than or equal to 2 body sites (odds ratio 16.3; 95% confidence interval 3.1 to 86.8) compared with noncolonized patients. In 16 of the 19 ED rooms (84%) where MRSA was recovered, all environmental strains were concordant with the corresponding patient strain. CONCLUSION: Contamination of the ED environment with MRSA from actively colonized patients is common. Improved environmental surface disinfection may help reduce transmission of MRSA to ED health care professionals and patients during emergency care.